{"ID":78176,"post_author":"9208550","post_date":"2018-12-17 16:21:08","post_date_gmt":"0000-00-00 00:00:00","post_content":"","post_title":"Introduction to Implants: Volume 1","post_excerpt":"","post_status":"draft","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"","to_ping":"","pinged":"","post_modified":"2018-12-17 16:21:08","post_modified_gmt":"2018-12-17 21:21:08","post_content_filtered":"","post_parent":0,"guid":"https:\/\/www.limsforum.com\/?post_type=ebook&p=78176","menu_order":0,"post_type":"ebook","post_mime_type":"","comment_count":"0","filter":"","_ebook_metadata":{"enabled":"on","private":"0","guid":"5DB066D0-4E6E-44B0-8501-274BBB8A3E0E","title":"Introduction to Implants: Volume 1","subtitle":"","cover_theme":"nico_6","cover_image":"https:\/\/www.limsforum.com\/wp-content\/plugins\/rdp-ebook-builder\/pl\/cover.php?cover_style=nico_6&subtitle=&editor=Shawn+Douglas&title=Introduction+to+Implants%3A+Volume+1&title_image=https%3A%2F%2Fs3.limsforum.com%2Fwww.limsforum.com%2Fwp-content%2Fuploads%2FAdjustable_Gastric_Band.png&publisher=LabLynx+Press","editor":"Shawn Douglas","publisher":"LabLynx Press","author_id":"26","image_url":"","items":{"a0517c31013d1b8771b8a1f0bcbe82df_type":"article","a0517c31013d1b8771b8a1f0bcbe82df_title":"Vertebral fixation","a0517c31013d1b8771b8a1f0bcbe82df_url":"https:\/\/www.limswiki.org\/index.php\/Vertebral_fixation","a0517c31013d1b8771b8a1f0bcbe82df_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tVertebral fixation\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs more medical references for verification or relies too heavily on primary sources. Please review the contents of the article and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. (September 2018)\nVertebral fixationSpecialtyorthopedic[edit on Wikidata]\nVertebral fixation (also known as \"spinal fixation\") is a orthopedic surgical procedure in which two or more vertebrae are anchored to each other through a synthetic \"vertebral fixation device\", with the aim of reducing vertebral mobility and thus avoiding possible damage to the spinal cord and\/or spinal roots.\n\nContents \n\n1 Indications \n2 Vertebral fixation devices \n3 See also \n4 References \n\n\nIndications \nA vertebral fixation procedure may be indicated in cases of vertebral fracture, vertebral deformity, or degenerative vertebral disorders (such as spondylolisthesis).\n\nVertebral fixation devices \nThe device used to achieve vertebral fixation is usually a permanent rigid or semi-rigid prosthesis made of titanium; examples include rods, plates, screws, and various combinations thereof. A less common alternative is the use of a resorbable fixation device, composed of a bio-resorbable material.\nThe medical community uses several different techniques for stabilizing the posterior region of the spine. The most radical of these techniques is spinal fusion. In recent years\/decades spinal surgeons have begun to rely more heavily on mechanical implants, which provide increased stability without so severely limiting the recipient\u2019s range of motion. A number of devices have been developed that allow the recipients near natural range of motion while still providing some support. In many cases the support offered by such devices is insufficient, leaving the physician with few other choices than spinal fusion. \nA spinal fixation device stabilizes an area of the posterior spine while allowing for a significant range of motion and limiting the compression of the affected vertebrae. The device consists of two or more arm assemblies (lateral) connected by one or more telescopic assemblies (vertical). Each arm assembly is composed of a central portion, which connects to the telescopic assembly or assemblies. Left and right arms attach to the corresponding side of the central portion of the arm assembly. Each arm section is directly connected to its individual pedicle by means of pedicle fasteners. \nMore information about this specific spinal fixation device can be found in The United States Patent Service\u2019s November 13, 2007 publication of new patents. This patent can currently (September 23, 2008) be found on The U.S. Patent Website.[1]\n\nSee also \nVertebral fusion\nReferences \n\n\n^ The United States Patent Website \n\n\nvteOrthopedic surgery, operations\/surgeries and other procedures on bones and joints (ICD-9-CM V3 76\u201381, ICD-10-PCS 0P\u2013S)BonesFacial\nJaw reduction\nDentofacial osteotomy\nGenioplasty\/Mentoplasty\nChin augmentation\nOrthognathic surgery\nSpine\nCoccygectomy\nLaminotomy\nLaminectomy\nLaminoplasty\nCorpectomy\nFacetectomy\nForaminotomy\nVertebral fixation\nPercutaneous vertebroplasty\nUpper extremity\nAcromioplasty\nLower extremity\nFemoral head ostectomy\nAstragalectomy\nDistraction osteogenesis\nIlizarov apparatus\nPhemister graft\nGeneral\nOstectomy\nBone grafting\nOsteotomy\nEpiphysiodesis\nReduction\nInternal fixation\nExternal fixation\nTension band wiring\nCartilage\nArticular cartilage repair\nMicrofracture surgery\nKnee cartilage replacement therapy\nAutologous chondrocyte implantation\nJointsSpine\nArthrodesis\nSpinal fusion\nIntervertebral discs\nDiscectomy\nAnnuloplasty\nArthroplasty\nUpper extremity\nShoulder surgery\nShoulder replacement\nBankart repair\nWeaver\u2013Dunn procedure\nUlnar collateral ligament reconstruction\nHand surgery\nBrunelli procedure\nLower extremity\nHip resurfacing\nHip replacement\nRotationplasty\nAnterior cruciate ligament reconstruction\nKnee replacement\/Unicompartmental knee arthroplasty\nAnkle replacement\nBrostr\u00f6m procedure\nTriple arthrodesis\nGeneral\nArthrotomy\nArthroplasty\nSynovectomy\nArthroscopy\nReplacement joint\nimaging: Arthrogram\nArthrocentesis\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 1 March 2016, at 19:47.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 323 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","a0517c31013d1b8771b8a1f0bcbe82df_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Vertebral_fixation skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Vertebral fixation<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p><b>Vertebral fixation<\/b> (also known as \"spinal fixation\") is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_surgery\" class=\"mw-redirect\" title=\"Spinal surgery\" rel=\"external_link\" target=\"_blank\">orthopedic surgical<\/a> procedure in which two or more <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertebra\" title=\"Vertebra\" rel=\"external_link\" target=\"_blank\">vertebrae<\/a> are anchored to each other through a synthetic \"<b>vertebral fixation device<\/b>\", with the aim of reducing vertebral mobility and thus avoiding possible damage to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord\" title=\"Spinal cord\" rel=\"external_link\" target=\"_blank\">spinal cord<\/a> and\/or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nerve_root\" title=\"Nerve root\" rel=\"external_link\" target=\"_blank\">spinal roots<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h2>\n<p>A vertebral fixation procedure may be indicated in cases of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertebral_fracture\" class=\"mw-redirect\" title=\"Vertebral fracture\" rel=\"external_link\" target=\"_blank\">vertebral fracture<\/a>, , or degenerative vertebral disorders (such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spondylolisthesis\" title=\"Spondylolisthesis\" rel=\"external_link\" target=\"_blank\">spondylolisthesis<\/a>).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Vertebral_fixation_devices\">Vertebral fixation devices<\/span><\/h2>\n<p>The device used to achieve vertebral fixation is usually a permanent rigid or semi-rigid <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthesis<\/a> made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a>; examples include rods, plates, screws, and various combinations thereof. A less common alternative is the use of a resorbable fixation device, composed of a bio-resorbable material.\n<\/p><p>The medical community uses several different techniques for stabilizing the posterior region of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spine_(anatomy)\" class=\"mw-redirect\" title=\"Spine (anatomy)\" rel=\"external_link\" target=\"_blank\">spine<\/a>. The most radical of these techniques is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_fusion\" title=\"Spinal fusion\" rel=\"external_link\" target=\"_blank\">spinal fusion<\/a>. In recent years\/decades spinal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgeon\" title=\"Surgeon\" rel=\"external_link\" target=\"_blank\">surgeons<\/a> have begun to rely more heavily on mechanical implants, which provide increased stability without so severely limiting the recipient\u2019s range of motion. A number of devices have been developed that allow the recipients near natural range of motion while still providing some support. In many cases the support offered by such devices is insufficient, leaving the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physician\" title=\"Physician\" rel=\"external_link\" target=\"_blank\">physician<\/a> with few other choices than spinal fusion. \n<\/p><p>A spinal fixation device stabilizes an area of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spine_(anatomy)\" class=\"mw-redirect\" title=\"Spine (anatomy)\" rel=\"external_link\" target=\"_blank\">posterior spine<\/a> while allowing for a significant range of motion and limiting the compression of the affected <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertebrae\" class=\"mw-redirect\" title=\"Vertebrae\" rel=\"external_link\" target=\"_blank\">vertebrae<\/a>. The device consists of two or more arm assemblies (lateral) connected by one or more telescopic assemblies (vertical). Each arm assembly is composed of a central portion, which connects to the telescopic assembly or assemblies. Left and right arms attach to the corresponding side of the central portion of the arm assembly. Each arm section is directly connected to its individual pedicle by means of pedicle fasteners. \n<\/p><p>More information about this specific spinal fixation device can be found in <a href=\"https:\/\/en.wikipedia.org\/wiki\/The_United_States_Patent_Association\" title=\"The United States Patent Association\" rel=\"external_link\" target=\"_blank\">The United States Patent Service\u2019s<\/a> November 13, 2007 publication of new patents. This patent can currently (September 23, 2008) be found on <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/patft.uspto.gov\/netacgi\/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=7294129.PN.&OS=PN\/7294129&RS=PN\/7294129\" target=\"_blank\">The U.S. Patent Website<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertebral_fusion\" class=\"mw-redirect\" title=\"Vertebral fusion\" rel=\"external_link\" target=\"_blank\">Vertebral fusion<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">The United States Patent Website<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1250\nCached time: 20181129133400\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.128 seconds\nReal time usage: 0.205 seconds\nPreprocessor visited node count: 481\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 33747\/2097152 bytes\nTemplate argument size: 116\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 319\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.053\/10.000 seconds\nLua memory usage: 1.59 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 157.352 1 -total\n<\/p>\n<pre>40.50% 63.726 1 Template:Infobox_medical_intervention\n40.22% 63.280 1 Template:Medref\n37.07% 58.327 1 Template:Infobox\n27.82% 43.779 1 Template:Ambox\n11.32% 17.818 3 Template:Navbox\n10.71% 16.856 1 Template:Bone,_cartilage,_and_joint_procedures\n 7.43% 11.690 1 Template:Reflist\n 4.35% 6.838 1 Template:PAGENAMEBASE\n 2.20% 3.468 1 Template:Template_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:14318149-1!canonical and timestamp 20181129133400 and revision id 860882620\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Vertebral_fixation\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212252\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.017 seconds\nReal time usage: 0.174 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 164.761 1 - wikipedia:Vertebral_fixation\n100.00% 164.761 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8223-0!*!*!*!*!*!* and timestamp 20181217212252 and revision id 24373\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Vertebral_fixation\">https:\/\/www.limswiki.org\/index.php\/Vertebral_fixation<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","a0517c31013d1b8771b8a1f0bcbe82df_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e3\/Rod_of_Asclepius2.svg\/25px-Rod_of_Asclepius2.svg.png"],"a0517c31013d1b8771b8a1f0bcbe82df_timestamp":1545081772,"4390eac4927db35d6a156aca0b735509_type":"article","4390eac4927db35d6a156aca0b735509_title":"Valve replacement","4390eac4927db35d6a156aca0b735509_url":"https:\/\/www.limswiki.org\/index.php\/Valve_replacement","4390eac4927db35d6a156aca0b735509_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tValve replacement\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (October 2013) (Learn how and when to remove this template message)\nValve replacementICD-9-CMV43.3[edit on Wikidata]\nValve replacement surgery is the replacement of one or more of the heart valves with either an artificial heart valve or a bioprosthesis (homograft from human tissue or xenograft e.g. from pig). It is an alternative to valve repair.\nThere are four procedures\n\nAortic valve replacement\nMitral valve replacement\nTricuspid valve replacement\nPulmonary valve replacement\nCurrent aortic valve replacement approaches include closed heart surgery, Very invasive cardiac surgery (VICS) and Very invasive, Scapulae-based aortic valve replacement.\nCatheter replacement of the aortic valve (called trans-aortic valve replacement or implementation [TAVR or TAVI]) is a minimally invasive option for those suffering from aortic valve stenosis. TAVR is commonly performed by guiding a catheter from the groin to the narrowed valve via the aorta using realtime x-ray technology. A metal stent containing a valve is then deployed using a balloon to press the stent into the valve in effect opening the stenosed (or narrowed) valve and lodging the stent in place. The procedure was first approved in the United States in November 2011 [1] as an alternative for people deemed a poor candidate for open approach replacement; however, TAVR has been successfully implemented into practice in other countries prior to 2011.[1]\n\nMedical uses \nIn those between 50 and 70 years of age bioprosthetic and mechanical aortic valves have similar overall outcomes with respect to stroke and survival.[2]\n\nReferences \n\n\n^ a b \"FDA-approved transcatheter approach offers life-extending valve replacement for inoperable patients\". Stanford School of Medicine. Retrieved 19 July 2013 . \n\n^ Chiang, Yuting P.; Chikwe, Joanna; Moskowitz, Alan J.; Itagaki, Shinobu; Adams, David H.; Egorova, Natalia N. (1 October 2014). \"Survival and Long-term Outcomes Following Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients Aged 50 to 69 Years\". JAMA. 312 (13): 1323\u20139. doi:10.1001\/jama.2014.12679. PMID 25268439. \n\n\nExternal links \nValveReplacement.org An online support forum.\nvteSurgery and other procedures involving the heart (ICD-9-CM V3 35\u201337+89.4+99.6, ICD-10-PCS 02)Surgery and ICHeart valves\r\nand septa\nValve repair\nValvulotomy\nMitral valve repair\nValvuloplasty\naortic\nmitral\nValve replacement\nAortic valve repair\nAortic valve replacement\nRoss procedure\nPercutaneous aortic valve replacement\nMitral valve replacement\nproduction of septal defect in heart \nenlargement of existing septal defect\nAtrial septostomy\nBalloon septostomy<\/dd>\ncreation of septal defect in heart\n\nBlalock\u2013Hanlon procedure<\/dd>\nshunt from heart chamber to blood vessel \natrium to pulmonary artery\nFontan procedure<\/dd>\nleft ventricle to aorta\n\nRastelli procedure<\/dd>\nright ventricle to pulmonary artery\n\nSano shunt<\/dd>\ncompound procedures \nfor transposition of great vessels\nArterial switch operation\nMustard procedure\nSenning procedure<\/dd>\nfor univentricular defect\n\nNorwood procedure\nKawashima procedure<\/dd>\nshunt from blood vessel to blood vessel \nsystemic circulation to pulmonary artery shunt\nBlalock\u2013Taussig shunt<\/dd>\nSVC to the right PA\n\nGlenn procedure<\/dd>\nCardiac vessels\nCHD \nAngioplasty\nBypass\/Coronary artery bypass\nMIDCAB\nOff-pump CAB\nTECAB<\/dd>\nCoronary stent \nBare-metal stent\nDrug-eluting stent\nBentall procedure\nValve-sparing aortic root replacement\nLeCompte maneuver\nOther\nPericardium \nPericardiocentesis\nPericardial window\nPericardiectomy\nMyocardium \nCardiomyoplasty\nDor procedure\nSeptal myectomy\nVentricular reduction\nAlcohol septal ablation\nConduction system \nMaze procedure\nCox maze and minimaze<\/dd>\nCatheter ablation\n\nCryoablation\nRadiofrequency ablation<\/dd>\nPacemaker insertion\nLeft atrial appendage occlusion\nCardiotomy\nHeart transplantation\nDiagnostic\r\ntests and\r\nprocedures\nElectrophysiology \nElectrocardiography\nVectorcardiography<\/dd>\nHolter monitor\nImplantable loop recorder\nCardiac stress test\n\nBruce protocol<\/dd>\nElectrophysiology study\nCardiac imaging \nAngiocardiography\nEchocardiography\nTTE\nTEE<\/dd>\nMyocardial perfusion imaging\nCardiovascular MRI\nVentriculography\n\nRadionuclide ventriculography<\/dd>\nCardiac catheterization\/Coronary catheterization\nCardiac CT\n\nCardiac PET\nsound \nPhonocardiogram\nFunction tests\nImpedance cardiography\nBallistocardiography\nCardiotocography\nPacing\nCardioversion\nTranscutaneous pacing\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Valve_replacement\">https:\/\/www.limswiki.org\/index.php\/Valve_replacement<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical and surgical techniquesHidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","4390eac4927db35d6a156aca0b735509_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Valve_replacement skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Valve replacement<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p><b>Valve replacement<\/b> surgery is the replacement of one or more of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_valve\" title=\"Heart valve\" rel=\"external_link\" target=\"_blank\">heart valves<\/a> with either an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_heart_valve\" title=\"Artificial heart valve\" rel=\"external_link\" target=\"_blank\">artificial heart valve<\/a> or a bioprosthesis (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Homograft\" class=\"mw-redirect\" title=\"Homograft\" rel=\"external_link\" target=\"_blank\">homograft<\/a> from human tissue or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Xenograft\" class=\"mw-redirect\" title=\"Xenograft\" rel=\"external_link\" target=\"_blank\">xenograft<\/a> e.g. from pig). It is an alternative to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Valve_repair\" class=\"mw-redirect\" title=\"Valve repair\" rel=\"external_link\" target=\"_blank\">valve repair<\/a>.\n<\/p><p>There are four procedures\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Aortic_valve_replacement\" title=\"Aortic valve replacement\" rel=\"external_link\" target=\"_blank\">Aortic valve replacement<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mitral_valve_replacement\" title=\"Mitral valve replacement\" rel=\"external_link\" target=\"_blank\">Mitral valve replacement<\/a><\/li>\n<li><\/li>\n<li><\/li><\/ul>\n<p>Current aortic valve replacement approaches include closed heart surgery, Very invasive cardiac surgery (VICS) and Very invasive, Scapulae-based aortic valve replacement.\n<\/p><p>Catheter replacement of the aortic valve (called trans-aortic valve replacement or implementation [TAVR or TAVI]) is a minimally invasive option for those suffering from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aortic_valve_stenosis\" class=\"mw-redirect\" title=\"Aortic valve stenosis\" rel=\"external_link\" target=\"_blank\">aortic valve stenosis<\/a>. TAVR is commonly performed by guiding a catheter from the groin to the narrowed valve via the aorta using realtime x-ray technology. A metal stent containing a valve is then deployed using a balloon to press the stent into the valve in effect opening the stenosed (or narrowed) valve and lodging the stent in place. The procedure was first approved in the United States in November 2011 <sup id=\"rdp-ebb-cite_ref-medicalstaff_1-0\" class=\"reference\"><a href=\"#cite_note-medicalstaff-1\" rel=\"external_link\">[1]<\/a><\/sup> as an alternative for people deemed a poor candidate for open approach replacement; however, TAVR has been successfully implemented into practice in other countries prior to 2011.<sup id=\"rdp-ebb-cite_ref-medicalstaff_1-1\" class=\"reference\"><a href=\"#cite_note-medicalstaff-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<p>In those between 50 and 70 years of age bioprosthetic and mechanical aortic valves have similar overall outcomes with respect to stroke and survival.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-medicalstaff-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-medicalstaff_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-medicalstaff_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/medicalstaff.stanfordhospital.org\/ms\/medstaffupdate\/articles\/201208_FDA_Approved_Transcatheter_Approach.html\" target=\"_blank\">\"FDA-approved transcatheter approach offers life-extending valve replacement for inoperable patients\"<\/a>. Stanford School of Medicine<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 July<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=FDA-approved+transcatheter+approach+offers+life-extending+valve+replacement+for+inoperable+patients&rft.pub=Stanford+School+of+Medicine&rft_id=http%3A%2F%2Fmedicalstaff.stanfordhospital.org%2Fms%2Fmedstaffupdate%2Farticles%2F201208_FDA_Approved_Transcatheter_Approach.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AValve+replacement\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chiang, Yuting P.; Chikwe, Joanna; Moskowitz, Alan J.; Itagaki, Shinobu; Adams, David H.; Egorova, Natalia N. (1 October 2014). \"Survival and Long-term Outcomes Following Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients Aged 50 to 69 Years\". <i>JAMA<\/i>. <b>312<\/b> (13): 1323\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Fjama.2014.12679\" target=\"_blank\">10.1001\/jama.2014.12679<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25268439\" target=\"_blank\">25268439<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JAMA&rft.atitle=Survival+and+Long-term+Outcomes+Following+Bioprosthetic+vs+Mechanical+Aortic+Valve+Replacement+in+Patients+Aged+50+to+69+Years&rft.volume=312&rft.issue=13&rft.pages=1323-9&rft.date=2014-10-01&rft_id=info%3Adoi%2F10.1001%2Fjama.2014.12679&rft_id=info%3Apmid%2F25268439&rft.aulast=Chiang&rft.aufirst=Yuting+P.&rft.au=Chikwe%2C+Joanna&rft.au=Moskowitz%2C+Alan+J.&rft.au=Itagaki%2C+Shinobu&rft.au=Adams%2C+David+H.&rft.au=Egorova%2C+Natalia+N.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AValve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.valvereplacement.com\/forums\/forum.php\" target=\"_blank\">ValveReplacement.org<\/a> An online support forum.<\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1271\nCached time: 20181207025546\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.232 seconds\nReal time usage: 0.327 seconds\nPreprocessor visited node count: 568\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 41805\/2097152 bytes\nTemplate argument size: 557\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 7964\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.124\/10.000 seconds\nLua memory usage: 2.86 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 281.117 1 -total\n<\/p>\n<pre>43.51% 122.304 1 Template:Reflist\n30.89% 86.837 1 Template:Cite_web\n23.98% 67.399 1 Template:Infobox_interventions\n22.06% 62.028 1 Template:Refimprove\n21.40% 60.146 1 Template:Infobox\n14.56% 40.939 1 Template:Ambox\n12.40% 34.848 2 Template:Navbox\n 9.56% 26.879 1 Template:Cardiac_procedures\n 6.28% 17.663 1 Template:Cite_journal\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:5791445-1!canonical and timestamp 20181207025545 and revision id 776335393\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Valve_replacement\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212252\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.135 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 128.843 1 - wikipedia:Valve_replacement\n100.00% 128.843 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8203-0!*!*!*!*!*!* and timestamp 20181217212251 and revision id 24349\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Valve_replacement\">https:\/\/www.limswiki.org\/index.php\/Valve_replacement<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","4390eac4927db35d6a156aca0b735509_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png"],"4390eac4927db35d6a156aca0b735509_timestamp":1545081771,"daf2e890fa4c3eb3b7a572fcacd26359_type":"article","daf2e890fa4c3eb3b7a572fcacd26359_title":"Unicompartmental knee arthroplasty","daf2e890fa4c3eb3b7a572fcacd26359_url":"https:\/\/www.limswiki.org\/index.php\/Unicompartmental_knee_arthroplasty","daf2e890fa4c3eb3b7a572fcacd26359_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tUnicompartmental knee arthroplasty\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\n\nUnicompartmental knee arthroplastyRadiographs of a knee arthroplasty of the medial compartmentICD-9-CM81.54[edit on Wikidata]\nUnicompartmental knee arthroplasty (UKA) is a surgical procedure used to relieve arthritis in one of the knee compartments in which the damaged parts of the knee are replaced. UKA surgery may reduce post-operative pain and have a shorter recovery period than a total knee replacement procedure,[1][2] particularly in people over 75 years of age.[3] Moreover, UKAs may require a smaller incision, less tissue damage, and faster recovery times.[2]\nIn the United States, the procedure constitutes approximately 8% of knee arthroplasties.[4] In comparisons with a more extensive surgical procedure called high tibial osteotomy, UKA has equal or better outcomes.[1][5]\n\nContents \n\n1 Background \n2 Indications and contraindications \n3 History and physical examination \n4 Surgical information \n5 Benefits \n6 Risks \n7 Long-term results \n8 References \n9 External links \n\n\nBackground \nIn the early 1950s, Duncan C. McKeever theorized that osteoarthritis could be isolated to only one compartment of the knee joint,[2] and that replacement of the entire knee might not be necessary if only one knee compartment were affected.[2][6] The UKA concept was designed to cause less trauma or damage than traditional total knee replacement by removing less bone and trying to maintain most of the person\u2019s bone and anatomy.[2] The concept was also designed to use smaller implants and thereby keep most of the person\u2019s bone, helping them return to normal function faster.[3][2]\nInitially, UKAs were not always successful, because the implants were poorly designed, people needing the surgery were not thoroughly screened for suitability, and optimal surgical techniques were not developed.[7] Advancements have been made to improve the design of the implants.[1][7][8] Also, choosing the best-suited people was emphasized to ensure that surgeons followed the indications and contraindications for partial replacement. Proper selection,[9] following the indications\/contraindications, and performing the surgery well are key factors for the success of UKA.[1][2]\n\nIndications and contraindications \nUKA may be suitable for people with moderate joint disease caused by painful osteoarthritis or traumatic injury, a history of unsuccessful surgical procedures or poor bone density that precludes other types of knee surgery.[1] People who may not be eligible for a UKA include those with an active or suspected infection in or about the knee joint, may have a known sensitivity to device materials, have bone infections or disease that result in an inability to support or fixate the new implant to the bone, have inflammatory arthritis, have major deformities that can affect the knee mechanical axis, have neuromuscular disorders that may compromise motor control and\/or stability, have any mental neuromuscular disorder, are obese,[10] have lost a severe amount of bone from the shin (tibia) or have severe tibial deformities, have recurring subluxation of the knee joint, have untreated damage to the knee cap and thigh bone joint (patellofemoral joint), have untreated damage to the opposite compartment or the same side of the knee not being replaced by a device, and\/or have instability of the knee ligaments such that the postoperative stability the UKA would be compromised.[1]\nThe anterior cruciate ligament (ACL) should be intact,[11] although this is debated by clinicians for people who need a medial compartment replacement.[2] For people needing a lateral compartment replacement, the ACL should be intact and is contraindicated for people with ACL-deficient knees because the lateral component has more motion than the medial compartment.[2]\n\nHistory and physical examination \nA physical examination and getting the subject\u2019s history is performed before getting surgery.[2] A person with pain in one area of the knee may be a candidate for UKA.[2] However, a person with pain in multiple areas of the knee may not be a good candidate for UKA.[2] The doctor may take some radiographs (e.g., x-rays) to check for degeneration of the other knee compartments and evaluate the knee.[2] The physical exam may also include special tests designed to test the ligaments of the knee and other anatomical structures.[9] Most likely, the surgeon will decide to do a UKA during surgery where he\/she can directly see the status of the other compartments.[2]\n\nSurgical information \nThe surgeon may choose which type of incision and implant to use for the subject\u2019s knee. During the surgery, the surgeon may align the instruments to determine the amount of bone to remove.[7] The surgeon removes bone from the (tibia) and thigh bone (femur).[1][7] The surgeon may decide to check if the appropriate amount of bone was removed during the surgery.[7] In order to make sure that the proper size implant is used, a surgeon may choose to use a temporary trial. After making sure the proper size implant is selected, the surgeon will put the implant on the ends of the bone and secure it with pegs. Finally, the surgeon will close the wound with sutures.[7][12]\nThe unicompartmental replacement is a minimally invasive option for people whose arthritis is isolated to either the medial or the lateral compartment. The procedure offers several benefits for patients with a moderately active lifestyle, who have arthritis in just one knee compartment, and who are within normal weight ranges. The surgeon uses an incision of just 3-4 inches; a total knee replacement typically requires an incision of 8-12 inches. The partial replacement does not disrupt the knee cap, which makes for a shorter rehabilitation period. A partial replacement also causes minimal blood loss during the procedure, and results in considerably less post-operative pain. The hospitalization time compared with a total knee replacement is also greatly reduced.[1][3][5]\n\nBenefits \nThe potential benefits of UKA include a smaller incision because the UKA implants are smaller than the total knee replacements, and the surgeon may make a smaller incision.[2] This may lead to a smaller scar.[2] Another potential benefit is less post-operative pain because less bone is removed.[1] Also, a quicker operation and shorter recovery period may be a result of less bone being removed during the operation and the soft tissue may sustain less trauma.[1][13] Also, the rehabilitation process may be more progressive.[14] More specific benefits of UKA are that it may improve range of motion, reduce blood loss during surgery, reduce the person\u2019s time spent in the hospital, and decrease costs.[1][10]\nIn 2018, two of the most significant benefits of UKA or partial knee replacements are:\n1. Partial knee replacement subjects report that their replaced knee feels more like their original non-replaced knee as compared to a total knee replacement\n2, Partial knee replacements leave other options open to further advances. By not replacing the rest of the knee with metal and plastic, if other options exist in years to come for arthritis in these areas then a partial knee replacement does not burn that bridge.\n\n<\/p>\nRisks \nBlood clots (also known as deep vein thrombosis) are a common complication after surgery.[15][16] However, a doctor may prescribe certain medications to help prevent blood clots.[15][16] Infection may occur after surgery.[17] However, antibiotics may be prescribed by a doctor to help prevent infections.[16] Individual factors (e.g., anatomy, weight, prior medical history, prior joint surgeries) should be addressed with the surgery subject. The causes of long-term failure of UKAs include polyethylene wear, loosening of the implant, and degeneration of the adjacent knee compartment.[2]\n\nLong-term results \nLong term studies reported excellent outcomes for UKA, partly due to subject screening,[18] minimizing the amount of bone that is removed,[19] and using the proper surgical technique.[18] One study found that at a minimum of 10 years follow up time after the initial surgery, the overall survival rate of the implant was 96%.[18] Also, 92% of the people in this study had excellent or good outcome.[18] Another study, reported that at 15 years follow up time after the initial surgery, the overall rate of the implant was 93% and 91% of these people reported good or excellent outcomes.[19]\n\nReferences \n\n\n^ a b c d e f g h i j k Santoso, M. B; Wu, L (2017). \"Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review\". Journal of Orthopaedic Surgery and Research. 12 (1): 50. doi:10.1186\/s13018-017-0552-9. PMC 5371236 . PMID 28351371. \n\n^ a b c d e f g h i j k l m n o p q Borus T, Thornhill T (January 2008). \"Unicompartmental knee arthroplasty\". J Am Acad Orthop Surg. 16 (1): 9\u201318. PMID 18180388. \n\n^ a b c Siman, H; Kamath, A. F; Carrillo, N; Harmsen, W. S; Pagnano, M. W; Sierra, R. J (2017). \"Unicompartmental Knee Arthroplasty vs Total Knee Arthroplasty for Medial Compartment Arthritis in Patients Older Than 75 Years: Comparable Reoperation, Revision, and Complication Rates\". The Journal of Arthroplasty. 32 (6): 1792\u20131797. doi:10.1016\/j.arth.2017.01.020. PMID 28215968. \n\n^ Riddle DL, Jiranek WA, McGlynn FJ (April 2008). \"Yearly incidence of unicompartmental knee arthroplasty in the United States\". J Arthroplasty. 23 (3): 408\u201312. doi:10.1016\/j.arth.2007.04.012. PMID 18358380. \n\n^ a b Han, S. B; Kyung, H. S; Seo, I. W; Shin, Y. S (2017). \"Better clinical outcomes after unicompartmental knee arthroplasty when comparing with high tibial osteotomy\". Medicine. 96 (50): e9268. doi:10.1097\/MD.0000000000009268. PMC 5815788 . PMID 29390376. \n\n^ Gibbon, Tony. \"Partial Knee Replacement\". North Yorkshire Orthopaedic Specialists. Retrieved 1 February 2013 . \n\n^ a b c d e f Swienckowski JJ, Pennington DW (September 2004). \"Unicompartmental knee arthroplasty in patients sixty years of age or younger\". J Bone Joint Surg Am. 86-A Suppl 1 (Pt 2): 131\u201342. PMID 15466754. \n\n^ Fitzsimmons SE, Vazquez EA, Bronson MJ (April 2010). \"How to Treat the Stiff Total Knee Arthroplasty?: A Systematic Review\". Clin. Orthop. Relat. Res. 468 (4): 1096\u2013106. doi:10.1007\/s11999-010-1230-y. PMC 2835585 . PMID 20087698. CS1 maint: Multiple names: authors list (link) \n\n^ a b Geller JA, Yoon RS, Macaulay W (January 2008). \"Unicompartmental knee arthroplasty: a controversial history and a rationale for contemporary resurgence\". J Knee Surg. 21 (1): 7\u201314. PMID 18300665. \n\n^ a b Bert JM (October 2005). \"Unicompartmental knee replacement\". Orthop. Clin. North Am. 36 (4): 513\u201322. doi:10.1016\/j.ocl.2005.05.001. PMID 16164956. \n\n^ \"Partial Knee Replacement\". Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. 2017. \n\n^ \"Partial Knee Replacement\". North Yorkshire Orthopaedic Specialists. Retrieved 5 February 2013 . \n\n^ Mullaji AB, Sharma A, Marawar S (June 2007). \"Unicompartmental knee arthroplasty: functional recovery and radiographic results with a minimally invasive technique\". J Arthroplasty. 22 (4 Suppl 1): 7\u201311. doi:10.1016\/j.arth.2006.12.109. PMID 17570269. \n\n^ Newman JH (April 2000). \"Unicompartmental knee replacement\". Knee. 7 (2): 63\u201370. doi:10.1016\/S0968-0160(99)00032-0. PMID 10788767. \n\n^ a b Colwell CW (September 2007). \"Rationale for thromboprophylaxis in lower joint arthroplasty\". Am J. Orthop. 36 (9 Suppl): 11\u20133. PMID 17948162. \n\n^ a b c Warwick D, Friedman RJ, Agnelli G, et al. (June 2007). \"Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events: findings from the Global Orthopaedic Registry\". J Bone Joint Surg Br. 89 (6): 799\u2013807. doi:10.1302\/0301-620X.89B6.18844. PMID 17613508. \n\n^ Ritter MA, Olberding EM, Malinzak RA (September 2007). \"Ultraviolet lighting during orthopaedic surgery and the rate of infection\". J Bone Joint Surg Am. 89 (9): 1935\u201340. doi:10.2106\/JBJS.F.01037. PMID 17768189. \n\n^ a b c d Berger RA, Meneghini RM, Jacobs JJ, et al. (May 2005). \"Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up\". J Bone Joint Surg Am. 87 (5): 999\u20131006. doi:10.2106\/JBJS.C.00568. PMID 15866962. \n\n^ a b Price AJ, Waite JC, Svard U (June 2005). \"Long-term clinical results of the medial Oxford unicompartmental knee arthroplasty\". Clin. Orthop. Relat. Res. &na, (435): 171\u201380. doi:10.1097\/00003086-200506000-00024. PMID 15930935. \n\n\nExternal links \nMedline Plus [1]\n\r\n\n\nvteOrthopedic surgery, operations\/surgeries and other procedures on bones and joints (ICD-9-CM V3 76\u201381, ICD-10-PCS 0P\u2013S)BonesFacial\nJaw reduction\nDentofacial osteotomy\nGenioplasty\/Mentoplasty\nChin augmentation\nOrthognathic surgery\nSpine\nCoccygectomy\nLaminotomy\nLaminectomy\nLaminoplasty\nCorpectomy\nFacetectomy\nForaminotomy\nVertebral fixation\nPercutaneous vertebroplasty\nUpper extremity\nAcromioplasty\nLower extremity\nFemoral head ostectomy\nAstragalectomy\nDistraction osteogenesis\nIlizarov apparatus\nPhemister graft\nGeneral\nOstectomy\nBone grafting\nOsteotomy\nEpiphysiodesis\nReduction\nInternal fixation\nExternal fixation\nTension band wiring\nCartilage\nArticular cartilage repair\nMicrofracture surgery\nKnee cartilage replacement therapy\nAutologous chondrocyte implantation\nJointsSpine\nArthrodesis\nSpinal fusion\nIntervertebral discs\nDiscectomy\nAnnuloplasty\nArthroplasty\nUpper extremity\nShoulder surgery\nShoulder replacement\nBankart repair\nWeaver\u2013Dunn procedure\nUlnar collateral ligament reconstruction\nHand surgery\nBrunelli procedure\nLower extremity\nHip resurfacing\nHip replacement\nRotationplasty\nAnterior cruciate ligament reconstruction\nKnee replacement\/Unicompartmental knee arthroplasty\nAnkle replacement\nBrostr\u00f6m procedure\nTriple arthrodesis\nGeneral\nArthrotomy\nArthroplasty\nSynovectomy\nArthroscopy\nReplacement joint\nimaging: Arthrogram\nArthrocentesis\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Unicompartmental_knee_arthroplasty\">https:\/\/www.limswiki.org\/index.php\/Unicompartmental_knee_arthroplasty<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical and surgical techniquesHidden category: Articles 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policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","daf2e890fa4c3eb3b7a572fcacd26359_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Unicompartmental_knee_arthroplasty skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Unicompartmental knee arthroplasty<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p class=\"mw-empty-elt\">\n<\/p>\n\n<p><b>Unicompartmental knee arthroplasty<\/b> (UKA) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_procedure\" class=\"mw-redirect\" title=\"Surgical procedure\" rel=\"external_link\" target=\"_blank\">surgical procedure<\/a> used to relieve <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis\" title=\"Arthritis\" rel=\"external_link\" target=\"_blank\">arthritis<\/a> in one of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee\" title=\"Knee\" rel=\"external_link\" target=\"_blank\">knee<\/a> compartments in which the damaged parts of the knee are replaced. UKA surgery may reduce post-operative pain and have a shorter recovery period than a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Total_knee_replacement\" class=\"mw-redirect\" title=\"Total knee replacement\" rel=\"external_link\" target=\"_blank\">total knee replacement<\/a> procedure,<sup id=\"rdp-ebb-cite_ref-wu_1-0\" class=\"reference\"><a href=\"#cite_note-wu-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid18180388_2-0\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup> particularly in people over 75 years of age.<sup id=\"rdp-ebb-cite_ref-siman_3-0\" class=\"reference\"><a href=\"#cite_note-siman-3\" rel=\"external_link\">[3]<\/a><\/sup> Moreover, UKAs may require a smaller <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_incision\" title=\"Surgical incision\" rel=\"external_link\" target=\"_blank\">incision<\/a>, less tissue damage, and faster recovery times.<sup id=\"rdp-ebb-cite_ref-pmid18180388_2-1\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>In the United States, the procedure constitutes approximately 8% of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee_arthroplasty\" class=\"mw-redirect\" title=\"Knee arthroplasty\" rel=\"external_link\" target=\"_blank\">knee arthroplasties<\/a>.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> In comparisons with a more extensive surgical procedure called <a href=\"https:\/\/en.wikipedia.org\/wiki\/High_tibial_osteotomy\" title=\"High tibial osteotomy\" rel=\"external_link\" target=\"_blank\">high tibial osteotomy<\/a>, UKA has equal or better outcomes.<sup id=\"rdp-ebb-cite_ref-wu_1-1\" class=\"reference\"><a href=\"#cite_note-wu-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-han_5-0\" class=\"reference\"><a href=\"#cite_note-han-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Background\">Background<\/span><\/h2>\n<p>In the early 1950s, Duncan C. McKeever theorized that osteoarthritis could be isolated to only one compartment of the knee joint,<sup id=\"rdp-ebb-cite_ref-pmid18180388_2-2\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup> and that replacement of the entire knee might not be necessary if only one knee compartment were affected.<sup id=\"rdp-ebb-cite_ref-pmid18180388_2-3\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> The UKA concept was designed to cause less trauma or damage than traditional total knee replacement by removing less bone and trying to maintain most of the person\u2019s bone and anatomy.<sup id=\"rdp-ebb-cite_ref-pmid18180388_2-4\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup> The concept was also designed to use smaller implants and thereby keep most of the person\u2019s bone, helping them return to normal function faster.<sup id=\"rdp-ebb-cite_ref-siman_3-1\" class=\"reference\"><a href=\"#cite_note-siman-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid18180388_2-5\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Initially, UKAs were not always successful, because the implants were poorly designed, people needing the surgery were not thoroughly screened for suitability, and optimal surgical techniques were not developed.<sup id=\"rdp-ebb-cite_ref-pmid15466754_7-0\" class=\"reference\"><a href=\"#cite_note-pmid15466754-7\" rel=\"external_link\">[7]<\/a><\/sup> Advancements have been made to improve the design of the implants.<sup id=\"rdp-ebb-cite_ref-wu_1-2\" class=\"reference\"><a href=\"#cite_note-wu-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid15466754_7-1\" class=\"reference\"><a href=\"#cite_note-pmid15466754-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> Also, choosing the best-suited people was emphasized to ensure that surgeons followed the indications and contraindications for partial replacement. Proper selection,<sup id=\"rdp-ebb-cite_ref-pmid18300665_9-0\" class=\"reference\"><a href=\"#cite_note-pmid18300665-9\" rel=\"external_link\">[9]<\/a><\/sup> following the indications\/contraindications, and performing the surgery well are key factors for the success of UKA.<sup id=\"rdp-ebb-cite_ref-wu_1-3\" class=\"reference\"><a href=\"#cite_note-wu-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid18180388_2-6\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Indications_and_contraindications\">Indications and contraindications<\/span><\/h2>\n<p>UKA may be suitable for people with moderate joint disease caused by painful <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\" title=\"Osteoarthritis\" rel=\"external_link\" target=\"_blank\">osteoarthritis<\/a> or traumatic injury, a history of unsuccessful surgical procedures or poor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> density that precludes other types of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee\" title=\"Knee\" rel=\"external_link\" target=\"_blank\">knee<\/a> surgery.<sup id=\"rdp-ebb-cite_ref-wu_1-4\" class=\"reference\"><a href=\"#cite_note-wu-1\" rel=\"external_link\">[1]<\/a><\/sup> People who may not be eligible for a UKA include those with an active or suspected infection in or about the knee joint, may have a known sensitivity to device materials, have bone infections or disease that result in an inability to support or fixate the new implant to the bone, have inflammatory arthritis, have major deformities that can affect the knee mechanical axis, have neuromuscular disorders that may compromise motor control and\/or stability, have any mental neuromuscular disorder, are obese,<sup id=\"rdp-ebb-cite_ref-pmid16164956_10-0\" class=\"reference\"><a href=\"#cite_note-pmid16164956-10\" rel=\"external_link\">[10]<\/a><\/sup> have lost a severe amount of bone from the shin (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Tibia\" title=\"Tibia\" rel=\"external_link\" target=\"_blank\">tibia<\/a>) or have severe tibial deformities, have recurring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subluxation\" title=\"Subluxation\" rel=\"external_link\" target=\"_blank\">subluxation<\/a> of the knee joint, have untreated damage to the knee cap and thigh bone joint (patellofemoral joint), have untreated damage to the opposite compartment or the same side of the knee not being replaced by a device, and\/or have instability of the knee ligaments such that the postoperative stability the UKA would be compromised.<sup id=\"rdp-ebb-cite_ref-wu_1-5\" class=\"reference\"><a href=\"#cite_note-wu-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anterior_cruciate_ligament\" title=\"Anterior cruciate ligament\" rel=\"external_link\" target=\"_blank\">anterior cruciate ligament<\/a> (ACL) should be intact,<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> although this is debated by clinicians for people who need a medial compartment replacement.<sup id=\"rdp-ebb-cite_ref-pmid18180388_2-7\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup> For people needing a lateral compartment replacement, the ACL should be intact and is contraindicated for people with ACL-deficient knees because the lateral component has more motion than the medial compartment.<sup id=\"rdp-ebb-cite_ref-pmid18180388_2-8\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History_and_physical_examination\">History and physical examination<\/span><\/h2>\n<p>A physical examination and getting the subject\u2019s history is performed before getting surgery.<sup id=\"rdp-ebb-cite_ref-pmid18180388_2-9\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup> A person with pain in one area of the knee may be a candidate for UKA.<sup id=\"rdp-ebb-cite_ref-pmid18180388_2-10\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup> However, a person with pain in multiple areas of the knee may not be a good candidate for UKA.<sup id=\"rdp-ebb-cite_ref-pmid18180388_2-11\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup> The doctor may take some radiographs (e.g., x-rays) to check for degeneration of the other knee compartments and evaluate the knee.<sup id=\"rdp-ebb-cite_ref-pmid18180388_2-12\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup> The physical exam may also include special tests designed to test the ligaments of the knee and other anatomical structures.<sup id=\"rdp-ebb-cite_ref-pmid18300665_9-1\" class=\"reference\"><a href=\"#cite_note-pmid18300665-9\" rel=\"external_link\">[9]<\/a><\/sup> Most likely, the surgeon will decide to do a UKA during surgery where he\/she can directly see the status of the other compartments.<sup id=\"rdp-ebb-cite_ref-pmid18180388_2-13\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Surgical_information\">Surgical information<\/span><\/h2>\n<p>The surgeon may choose which type of incision and implant to use for the subject\u2019s knee. During the surgery, the surgeon may align the instruments to determine the amount of bone to remove.<sup id=\"rdp-ebb-cite_ref-pmid15466754_7-2\" class=\"reference\"><a href=\"#cite_note-pmid15466754-7\" rel=\"external_link\">[7]<\/a><\/sup> The surgeon removes bone from the (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Tibia\" title=\"Tibia\" rel=\"external_link\" target=\"_blank\">tibia<\/a>) and thigh bone (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Femur\" title=\"Femur\" rel=\"external_link\" target=\"_blank\">femur<\/a>).<sup id=\"rdp-ebb-cite_ref-wu_1-6\" class=\"reference\"><a href=\"#cite_note-wu-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid15466754_7-3\" class=\"reference\"><a href=\"#cite_note-pmid15466754-7\" rel=\"external_link\">[7]<\/a><\/sup> The surgeon may decide to check if the appropriate amount of bone was removed during the surgery.<sup id=\"rdp-ebb-cite_ref-pmid15466754_7-4\" class=\"reference\"><a href=\"#cite_note-pmid15466754-7\" rel=\"external_link\">[7]<\/a><\/sup> In order to make sure that the proper size implant is used, a surgeon may choose to use a temporary trial. After making sure the proper size implant is selected, the surgeon will put the implant on the ends of the bone and secure it with pegs. Finally, the surgeon will close the wound with sutures.<sup id=\"rdp-ebb-cite_ref-pmid15466754_7-5\" class=\"reference\"><a href=\"#cite_note-pmid15466754-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p>The unicompartmental replacement is a minimally invasive option for people whose arthritis is isolated to either the medial or the lateral compartment. The procedure offers several benefits for patients with a moderately active lifestyle, who have arthritis in just one knee compartment, and who are within normal weight ranges. The surgeon uses an incision of just 3-4 inches; a total knee replacement typically requires an incision of 8-12 inches. The partial replacement does not disrupt the knee cap, which makes for a shorter rehabilitation period. A partial replacement also causes minimal blood loss during the procedure, and results in considerably less post-operative pain. The hospitalization time compared with a total knee replacement is also greatly reduced.<sup id=\"rdp-ebb-cite_ref-wu_1-7\" class=\"reference\"><a href=\"#cite_note-wu-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-siman_3-2\" class=\"reference\"><a href=\"#cite_note-siman-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-han_5-1\" class=\"reference\"><a href=\"#cite_note-han-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Benefits\">Benefits<\/span><\/h2>\n<p>The potential benefits of UKA include a smaller incision because the UKA implants are smaller than the total knee replacements, and the surgeon may make a smaller incision.<sup id=\"rdp-ebb-cite_ref-pmid18180388_2-14\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup> This may lead to a smaller scar.<sup id=\"rdp-ebb-cite_ref-pmid18180388_2-15\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup> Another potential benefit is less post-operative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\" title=\"Pain\" rel=\"external_link\" target=\"_blank\">pain<\/a> because less bone is removed.<sup id=\"rdp-ebb-cite_ref-wu_1-8\" class=\"reference\"><a href=\"#cite_note-wu-1\" rel=\"external_link\">[1]<\/a><\/sup> Also, a quicker operation and shorter recovery period may be a result of less bone being removed during the operation and the soft tissue may sustain less trauma.<sup id=\"rdp-ebb-cite_ref-wu_1-9\" class=\"reference\"><a href=\"#cite_note-wu-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> Also, the rehabilitation process may be more progressive.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> More specific benefits of UKA are that it may improve range of motion, reduce blood loss during surgery, reduce the person\u2019s time spent in the hospital, and decrease costs.<sup id=\"rdp-ebb-cite_ref-wu_1-10\" class=\"reference\"><a href=\"#cite_note-wu-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid16164956_10-1\" class=\"reference\"><a href=\"#cite_note-pmid16164956-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>In 2018, two of the most significant benefits of UKA or partial knee replacements are:\n<p>1. Partial knee replacement subjects report that their replaced knee feels more like their original non-replaced knee as compared to a total knee replacement\n2, Partial knee replacements leave other options open to further advances. By not replacing the rest of the knee with metal and plastic, if other options exist in years to come for arthritis in these areas then a partial knee replacement does not burn that bridge.\n<\/p>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_clots\" class=\"mw-redirect\" title=\"Blood clots\" rel=\"external_link\" target=\"_blank\">Blood clots<\/a> (also known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deep_vein_thrombosis\" title=\"Deep vein thrombosis\" rel=\"external_link\" target=\"_blank\">deep vein thrombosis<\/a>) are a common complication after surgery.<sup id=\"rdp-ebb-cite_ref-pmid17948162_15-0\" class=\"reference\"><a href=\"#cite_note-pmid17948162-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid17613508_16-0\" class=\"reference\"><a href=\"#cite_note-pmid17613508-16\" rel=\"external_link\">[16]<\/a><\/sup> However, a doctor may prescribe certain medications to help prevent blood clots.<sup id=\"rdp-ebb-cite_ref-pmid17948162_15-1\" class=\"reference\"><a href=\"#cite_note-pmid17948162-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid17613508_16-1\" class=\"reference\"><a href=\"#cite_note-pmid17613508-16\" rel=\"external_link\">[16]<\/a><\/sup> Infection may occur after surgery.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> However, antibiotics may be prescribed by a doctor to help prevent infections.<sup id=\"rdp-ebb-cite_ref-pmid17613508_16-2\" class=\"reference\"><a href=\"#cite_note-pmid17613508-16\" rel=\"external_link\">[16]<\/a><\/sup> Individual factors (e.g., anatomy, weight, prior medical history, prior joint surgeries) should be addressed with the surgery subject. The causes of long-term failure of UKAs include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a> wear, loosening of the implant, and degeneration of the adjacent knee compartment.<sup id=\"rdp-ebb-cite_ref-pmid18180388_2-16\" class=\"reference\"><a href=\"#cite_note-pmid18180388-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Long-term_results\">Long-term results<\/span><\/h2>\n<p>Long term studies reported excellent outcomes for UKA, partly due to subject screening,<sup id=\"rdp-ebb-cite_ref-pmid15866962_18-0\" class=\"reference\"><a href=\"#cite_note-pmid15866962-18\" rel=\"external_link\">[18]<\/a><\/sup> minimizing the amount of bone that is removed,<sup id=\"rdp-ebb-cite_ref-pmid15930935_19-0\" class=\"reference\"><a href=\"#cite_note-pmid15930935-19\" rel=\"external_link\">[19]<\/a><\/sup> and using the proper surgical technique.<sup id=\"rdp-ebb-cite_ref-pmid15866962_18-1\" class=\"reference\"><a href=\"#cite_note-pmid15866962-18\" rel=\"external_link\">[18]<\/a><\/sup> One study found that at a minimum of 10 years follow up time after the initial surgery, the overall survival rate of the implant was 96%.<sup id=\"rdp-ebb-cite_ref-pmid15866962_18-2\" class=\"reference\"><a href=\"#cite_note-pmid15866962-18\" rel=\"external_link\">[18]<\/a><\/sup> Also, 92% of the people in this study had excellent or good outcome.<sup id=\"rdp-ebb-cite_ref-pmid15866962_18-3\" class=\"reference\"><a href=\"#cite_note-pmid15866962-18\" rel=\"external_link\">[18]<\/a><\/sup> Another study, reported that at 15 years follow up time after the initial surgery, the overall rate of the implant was 93% and 91% of these people reported good or excellent outcomes.<sup id=\"rdp-ebb-cite_ref-pmid15930935_19-1\" class=\"reference\"><a href=\"#cite_note-pmid15930935-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-wu-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-wu_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wu_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wu_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wu_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wu_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wu_1-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wu_1-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wu_1-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wu_1-8\" rel=\"external_link\"><sup><i><b>i<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wu_1-9\" rel=\"external_link\"><sup><i><b>j<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wu_1-10\" rel=\"external_link\"><sup><i><b>k<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Santoso, M. B; Wu, L (2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5371236\" target=\"_blank\">\"Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review\"<\/a>. <i>Journal of Orthopaedic Surgery and Research<\/i>. <b>12<\/b> (1): 50. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2Fs13018-017-0552-9\" target=\"_blank\">10.1186\/s13018-017-0552-9<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5371236\" target=\"_blank\">5371236<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28351371\" target=\"_blank\">28351371<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Orthopaedic+Surgery+and+Research&rft.atitle=Unicompartmental+knee+arthroplasty%2C+is+it+superior+to+high+tibial+osteotomy+in+treating+unicompartmental+osteoarthritis%3F+A+meta-analysis+and+systemic+review&rft.volume=12&rft.issue=1&rft.pages=50&rft.date=2017&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5371236&rft_id=info%3Apmid%2F28351371&rft_id=info%3Adoi%2F10.1186%2Fs13018-017-0552-9&rft.aulast=Santoso&rft.aufirst=M.+B&rft.au=Wu%2C+L&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5371236&rfr_id=info%3Asid%2Fen.wikipedia.org%3AUnicompartmental+knee+arthroplasty\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-pmid18180388-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-pmid18180388_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid18180388_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid18180388_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid18180388_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid18180388_2-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid18180388_2-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid18180388_2-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid18180388_2-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid18180388_2-8\" rel=\"external_link\"><sup><i><b>i<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid18180388_2-9\" rel=\"external_link\"><sup><i><b>j<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid18180388_2-10\" rel=\"external_link\"><sup><i><b>k<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid18180388_2-11\" rel=\"external_link\"><sup><i><b>l<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid18180388_2-12\" rel=\"external_link\"><sup><i><b>m<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid18180388_2-13\" rel=\"external_link\"><sup><i><b>n<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid18180388_2-14\" rel=\"external_link\"><sup><i><b>o<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid18180388_2-15\" rel=\"external_link\"><sup><i><b>p<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid18180388_2-16\" rel=\"external_link\"><sup><i><b>q<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Borus T, Thornhill T (January 2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jaaos.org\/cgi\/pmidlookup?view=long&pmid=18180388\" target=\"_blank\">\"Unicompartmental knee arthroplasty\"<\/a>. <i>J Am Acad Orthop Surg<\/i>. <b>16<\/b> (1): 9\u201318. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18180388\" target=\"_blank\">18180388<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Am+Acad+Orthop+Surg&rft.atitle=Unicompartmental+knee+arthroplasty&rft.volume=16&rft.issue=1&rft.pages=9-18&rft.date=2008-01&rft_id=info%3Apmid%2F18180388&rft.aulast=Borus&rft.aufirst=T&rft.au=Thornhill%2C+T&rft_id=http%3A%2F%2Fwww.jaaos.org%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D18180388&rfr_id=info%3Asid%2Fen.wikipedia.org%3AUnicompartmental+knee+arthroplasty\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-siman-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-siman_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-siman_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-siman_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Siman, H; Kamath, A. F; Carrillo, N; Harmsen, W. S; Pagnano, M. W; Sierra, R. J (2017). \"Unicompartmental Knee Arthroplasty vs Total Knee Arthroplasty for Medial Compartment Arthritis in Patients Older Than 75 Years: Comparable Reoperation, Revision, and Complication Rates\". <i>The Journal of Arthroplasty<\/i>. <b>32<\/b> (6): 1792\u20131797. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2017.01.020\" target=\"_blank\">10.1016\/j.arth.2017.01.020<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28215968\" target=\"_blank\">28215968<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Arthroplasty&rft.atitle=Unicompartmental+Knee+Arthroplasty+vs+Total+Knee+Arthroplasty+for+Medial+Compartment+Arthritis+in+Patients+Older+Than+75+Years%3A+Comparable+Reoperation%2C+Revision%2C+and+Complication+Rates&rft.volume=32&rft.issue=6&rft.pages=1792-1797&rft.date=2017&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2017.01.020&rft_id=info%3Apmid%2F28215968&rft.aulast=Siman&rft.aufirst=H&rft.au=Kamath%2C+A.+F&rft.au=Carrillo%2C+N&rft.au=Harmsen%2C+W.+S&rft.au=Pagnano%2C+M.+W&rft.au=Sierra%2C+R.+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AUnicompartmental+knee+arthroplasty\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Riddle DL, Jiranek WA, McGlynn FJ (April 2008). \"Yearly incidence of unicompartmental knee arthroplasty in the United States\". <i>J Arthroplasty<\/i>. <b>23<\/b> (3): 408\u201312. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2007.04.012\" target=\"_blank\">10.1016\/j.arth.2007.04.012<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18358380\" target=\"_blank\">18358380<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Arthroplasty&rft.atitle=Yearly+incidence+of+unicompartmental+knee+arthroplasty+in+the+United+States&rft.volume=23&rft.issue=3&rft.pages=408-12&rft.date=2008-04&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2007.04.012&rft_id=info%3Apmid%2F18358380&rft.aulast=Riddle&rft.aufirst=DL&rft.au=Jiranek%2C+WA&rft.au=McGlynn%2C+FJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AUnicompartmental+knee+arthroplasty\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-han-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-han_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-han_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Han, S. 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Retrieved <span class=\"nowrap\">5 February<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Partial+Knee+Replacement&rft.pub=North+Yorkshire+Orthopaedic+Specialists&rft_id=http%3A%2F%2Ftony-gibbon.co.uk%2Ftreatment%2Fknee-treatment%2Ftreatments%2Fpartial-knee-replacement&rfr_id=info%3Asid%2Fen.wikipedia.org%3AUnicompartmental+knee+arthroplasty\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mullaji AB, Sharma A, Marawar S (June 2007). \"Unicompartmental knee arthroplasty: functional recovery and radiographic results with a minimally invasive technique\". <i>J Arthroplasty<\/i>. <b>22<\/b> (4 Suppl 1): 7\u201311. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2006.12.109\" target=\"_blank\">10.1016\/j.arth.2006.12.109<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17570269\" target=\"_blank\">17570269<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Arthroplasty&rft.atitle=Unicompartmental+knee+arthroplasty%3A+functional+recovery+and+radiographic+results+with+a+minimally+invasive+technique&rft.volume=22&rft.issue=4+Suppl+1&rft.pages=7-11&rft.date=2007-06&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2006.12.109&rft_id=info%3Apmid%2F17570269&rft.aulast=Mullaji&rft.aufirst=AB&rft.au=Sharma%2C+A&rft.au=Marawar%2C+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3AUnicompartmental+knee+arthroplasty\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Newman JH (April 2000). \"Unicompartmental knee replacement\". <i>Knee<\/i>. <b>7<\/b> (2): 63\u201370. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0968-0160%2899%2900032-0\" target=\"_blank\">10.1016\/S0968-0160(99)00032-0<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10788767\" target=\"_blank\">10788767<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Knee&rft.atitle=Unicompartmental+knee+replacement&rft.volume=7&rft.issue=2&rft.pages=63-70&rft.date=2000-04&rft_id=info%3Adoi%2F10.1016%2FS0968-0160%2899%2900032-0&rft_id=info%3Apmid%2F10788767&rft.au=Newman+JH&rfr_id=info%3Asid%2Fen.wikipedia.org%3AUnicompartmental+knee+arthroplasty\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid17948162-15\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-pmid17948162_15-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid17948162_15-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Colwell CW (September 2007). \"Rationale for thromboprophylaxis in lower joint arthroplasty\". <i>Am J. Orthop<\/i>. <b>36<\/b> (9 Suppl): 11\u20133. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17948162\" target=\"_blank\">17948162<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Am+J.+Orthop.&rft.atitle=Rationale+for+thromboprophylaxis+in+lower+joint+arthroplasty&rft.volume=36&rft.issue=9+Suppl&rft.pages=11-3&rft.date=2007-09&rft_id=info%3Apmid%2F17948162&rft.au=Colwell+CW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AUnicompartmental+knee+arthroplasty\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid17613508-16\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-pmid17613508_16-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid17613508_16-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid17613508_16-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Warwick D, Friedman RJ, Agnelli G, et al. (June 2007). \"Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events: findings from the Global Orthopaedic Registry\". <i>J Bone Joint Surg Br<\/i>. <b>89<\/b> (6): 799\u2013807. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1302%2F0301-620X.89B6.18844\" target=\"_blank\">10.1302\/0301-620X.89B6.18844<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17613508\" target=\"_blank\">17613508<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Br&rft.atitle=Insufficient+duration+of+venous+thromboembolism+prophylaxis+after+total+hip+or+knee+replacement+when+compared+with+the+time+course+of+thromboembolic+events%3A+findings+from+the+Global+Orthopaedic+Registry&rft.volume=89&rft.issue=6&rft.pages=799-807&rft.date=2007-06&rft_id=info%3Adoi%2F10.1302%2F0301-620X.89B6.18844&rft_id=info%3Apmid%2F17613508&rft.au=Warwick+D&rft.au=Friedman+RJ&rft.au=Agnelli+G&rft.au=Gil-Garay%2C+E.&rft.au=Johnson%2C+K.&rft.au=Fitzgerald%2C+G.&rft.au=Turibio%2C+F.+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AUnicompartmental+knee+arthroplasty\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ritter MA, Olberding EM, Malinzak RA (September 2007). \"Ultraviolet lighting during orthopaedic surgery and the rate of infection\". <i>J Bone Joint Surg Am<\/i>. <b>89<\/b> (9): 1935\u201340. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.F.01037\" target=\"_blank\">10.2106\/JBJS.F.01037<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17768189\" target=\"_blank\">17768189<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Am&rft.atitle=Ultraviolet+lighting+during+orthopaedic+surgery+and+the+rate+of+infection&rft.volume=89&rft.issue=9&rft.pages=1935-40&rft.date=2007-09&rft_id=info%3Adoi%2F10.2106%2FJBJS.F.01037&rft_id=info%3Apmid%2F17768189&rft.aulast=Ritter&rft.aufirst=MA&rft.au=Olberding%2C+EM&rft.au=Malinzak%2C+RA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AUnicompartmental+knee+arthroplasty\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid15866962-18\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-pmid15866962_18-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid15866962_18-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid15866962_18-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid15866962_18-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Berger RA, Meneghini RM, Jacobs JJ, et al. (May 2005). \"Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up\". <i>J Bone Joint Surg Am<\/i>. <b>87<\/b> (5): 999\u20131006. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.C.00568\" target=\"_blank\">10.2106\/JBJS.C.00568<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15866962\" target=\"_blank\">15866962<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Am&rft.atitle=Results+of+unicompartmental+knee+arthroplasty+at+a+minimum+of+ten+years+of+follow-up&rft.volume=87&rft.issue=5&rft.pages=999-1006&rft.date=2005-05&rft_id=info%3Adoi%2F10.2106%2FJBJS.C.00568&rft_id=info%3Apmid%2F15866962&rft.au=Berger+RA&rft.au=Meneghini+RM&rft.au=Jacobs+JJ&rft.au=Sheinkop%2C+MB&rft.au=Della+Valle%2C+CJ&rft.au=Rosenberg%2C+AG&rft.au=Galante%2C+JO&rfr_id=info%3Asid%2Fen.wikipedia.org%3AUnicompartmental+knee+arthroplasty\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid15930935-19\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-pmid15930935_19-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid15930935_19-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Price AJ, Waite JC, Svard U (June 2005). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/meta.wkhealth.com\/pt\/pt-core\/template-journal\/lwwgateway\/media\/landingpage.htm?an=00003086-200506000-00024\" target=\"_blank\">\"Long-term clinical results of the medial Oxford unicompartmental knee arthroplasty\"<\/a>. <i>Clin. Orthop. Relat. Res<\/i>. <b>&na, <\/b> (435): 171\u201380. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00003086-200506000-00024\" target=\"_blank\">10.1097\/00003086-200506000-00024<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15930935\" target=\"_blank\">15930935<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clin.+Orthop.+Relat.+Res.&rft.atitle=Long-term+clinical+results+of+the+medial+Oxford+unicompartmental+knee+arthroplasty&rft.volume=%26na%3B&rft.issue=435&rft.pages=171-80&rft.date=2005-06&rft_id=info%3Adoi%2F10.1097%2F00003086-200506000-00024&rft_id=info%3Apmid%2F15930935&rft.aulast=Price&rft.aufirst=AJ&rft.au=Waite%2C+JC&rft.au=Svard%2C+U&rft_id=http%3A%2F%2Fmeta.wkhealth.com%2Fpt%2Fpt-core%2Ftemplate-journal%2Flwwgateway%2Fmedia%2Flandingpage.htm%3Fan%3D00003086-200506000-00024&rfr_id=info%3Asid%2Fen.wikipedia.org%3AUnicompartmental+knee+arthroplasty\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li>Medline Plus <a rel=\"external_link\" class=\"external autonumber\" href=\"https:\/\/www.nlm.nih.gov\/medlineplus\/ency\/article\/007256.htm\" target=\"_blank\">[1]<\/a><\/li><\/ul>\n<p><br \/>\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1266\nCached time: 20181129051402\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.356 seconds\nReal time usage: 0.435 seconds\nPreprocessor visited node count: 1592\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 70409\/2097152 bytes\nTemplate argument size: 503\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 63834\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.183\/10.000 seconds\nLua memory usage: 4.33 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 363.667 1 -total\n<\/p>\n<pre>59.13% 215.036 1 Template:Reflist\n45.77% 166.441 16 Template:Cite_journal\n16.67% 60.620 1 Template:Infobox_interventions\n15.03% 54.642 1 Template:Infobox\n 8.88% 32.277 1 Template:Use_dmy_dates\n 6.67% 24.258 1 Template:Operations_and_other_procedures_on_the_musculoskeletal_system\n 5.77% 20.983 3 Template:Navbox\n 4.41% 16.040 1 Template:DMCA\n 3.63% 13.194 1 Template:Dated_maintenance_category\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:16991704-1!canonical and timestamp 20181129051402 and revision id 865419874\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Unicompartmental_knee_arthroplasty\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212251\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.151 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 144.406 1 - wikipedia:Unicompartmental_knee_arthroplasty\n100.00% 144.406 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8085-0!*!*!*!*!*!* and timestamp 20181217212251 and revision id 24204\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Unicompartmental_knee_arthroplasty\">https:\/\/www.limswiki.org\/index.php\/Unicompartmental_knee_arthroplasty<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","daf2e890fa4c3eb3b7a572fcacd26359_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/19\/Schlittenprothese.jpg\/560px-Schlittenprothese.jpg"],"daf2e890fa4c3eb3b7a572fcacd26359_timestamp":1545081771,"5f0ff3cb789a58f1c742c239557383e5_type":"article","5f0ff3cb789a58f1c742c239557383e5_title":"Surgery for the dysfunctional sacroiliac joint","5f0ff3cb789a58f1c742c239557383e5_url":"https:\/\/www.limswiki.org\/index.php\/Surgery_for_the_dysfunctional_sacroiliac_joint","5f0ff3cb789a58f1c742c239557383e5_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurgery for the dysfunctional sacroiliac joint\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tSurgery for the dysfunctional sacroiliac jointSpecialtyorthopedic[edit on Wikidata]\nThe sacroiliac joint is a paired joint in the pelvis that lies between the sacrum and an ilium. Due to its location in the lower back, a dysfunctional sacroiliac joint may cause lower back and\/or leg pain. The resulting leg pain can be severe, resembling sciatica or a slipped disc. While nonsurgical treatments are effective for some, others have found that surgery for the dysfunctional sacroiliac joint is the only method to relieve pain.\nSacroiliac joint dysfunction is diagnosed by a physician. Associated surgery should only occur when certain criteria are satisfied.[1] Surgical options, such as the degree of invasiveness, can then be evaluated when deciding on a treatment plan.\nIf complications occur, they are often detected early (during surgery or shortly after) and correlate with the surgical approach.[2][3][4][5] Results and outcomes vary according to the patient, pathology, surgeon, procedure, and methods.[5]\n\nContents \n\n1 History \n2 Diagnosis \n3 Conservative treatment \n4 Surgical options \n5 Complications \n6 Outcomes \n7 Future \n8 See also \n9 References \n\n\nHistory \nSacroiliac joint surgery was first described in 1926 by the Journal of Bone and Joint Surgery.[6] Following its appearance, the original procedure was documented in several publications and practices for nearly a century.[2][3][4][7][8][9][10][11][12][13][14][15][16][17]\nSacroiliac joint surgeries have improved significantly beyond their nascency, which lacked the advent of hardware or instrumentation.[6] The first use of sacroiliac joint surgical materials appeared in 1987 with the use of ceramic blocks to aid in joint fusing.[7] The year 2001 marked the advent of spinal rods and screws to facilitate internal fixation.[8] Continued improvements have been documented as surgeons reduce their incision size while avoiding tissues such as muscle, blood vessels, and nerves.[3][6] Modern sacroiliac joint surgery utilizes instrumentation systems attempts to be as minimally invasive as possible.\nThe first surgical textbook on sacroiliac joint surgery was published in 2014.[5]\n\nDiagnosis \nThe diagnosis for a dysfunctional sacroiliac joint results from a combination of patient history,[1] clinical evaluation,[1][5][18] and one or more injections.[1][5][18][19] The gold standard diagnostic injection utilizes a long-acting anesthetic agent with radiographic dye.[5] A diagnosis can be made following injections into the posterior sacroiliac transverse ligament.[1][3][5]\n\nConservative treatment \nCurrently there is no standard treatment regimen that must precede sacroiliac joint surgery. However, an algorithm has been designed (2010) to guide the treatment process before committing a patient to surgery.[1] This algorithm allows for the use of alternative treatments (prolotherapy, radio frequency neural ablation, cryotherapy, acupuncture, and others) if desired by a clinician or patient.\n\nSurgical options \nWhen preparing to operate on the sacroiliac joint, a surgeon must consider the desired degree of invasiveness, surgical approach (fascial splitting that is posterior midline, posterior lateral, posterior lateral inferior, lateral, anterior), instrumentation, type of bone grafting material (autograft, allograft, and xenograft), and type of bone graft enhancing material (bone morphogenetic proteins).[5] Another consideration is a patient's desired postoperative weight bearing status, as some procedures result in full weight bearing while others only partial.\nCurrent diagnostic criteria (not standard but generally accepted) include at least 6 months of chronic pain, failure of previous treatments, disability from daily activities, and a diagnostic injection.[5] There is no current standard operating procedure,[5] though some surgeons may prefer an approach based on his or her training and exposure (there are exceptions).[5]\nThe most frequently practiced procedure is the lateral minimally invasive approach.[5] One leading explanation for this involves the FDA having made possible a Premarket notification (510(k)) for instrumentation that has a predicate preceding 1976. Several lateral minimally invasive instrumentation systems have acquired this designation.[5][20]\nSome procedures are unique in that they do not rely on a fusion of the joint.[13]\n\nComplications \nOperating on a dysfunctional sacroiliac joint is an elective procedure and should never be an emergency. Preoperative planning and preparation should prevent or lessen the likelihood of most complications. However, aside from the general complications that encompass any reconstructive surgery, specific complications are associated with the sacroiliac joint.\nThe sacroiliac joint is essentially halfway between the ventral and dorsal sides of the body deep within the pelvis, a location in close proximity to several vital structures. Those structures within a few centimeters of the sacroiliac joint include the sacrum, ilium, sciatic nerve, dorsal and ventral sacral nerves, lumbar plexus, superior gluteal artery, iliac vessels, and large intestine.[5] While these structures could be injured during any type of sacroiliac joint procedure, the lateral minimally invasive approach is associated with the greatest number of complications.[4][5]\n\nOutcomes \nSurgical outcome following dysfunctional sacroiliac joint correction has yet to be evaluated by multi-center studies. Multiple peer-reviewed articles have conducted followups, describing an overall success or satisfaction rate in the 70-80% range.[3][4][9][10][11][12][14][15][16][17] However, one article was suggestive of poor outcomes with only 18% of patients being satisfied.[2]\nSurgery has been demonstrated to also be effective for some pathologies that involve sacroiliac joint dysfunction.[5] The one exception is inflammatory arthritis, for which surgery achieves mixed results.[5]\n\nFuture \nSurgeries for the dysfunctional sacroiliac joint are currently in their infancy, despite their many advances. Prospective and multi-center studies are needed to move this surgery into the knowledge base of surgical education and surgical societies.[21] Advancements in surgery are expected to continue as science is applied further to the diagnosis and treatment of sacroiliac joint dysfunction.\n\nSee also \nMyofascial pain\nPiriformis syndrome\nTrochanteric bursitis\nReferences \n \n\n^ a b c d e f Dall BE Eden SV Brumblay HG. Sacroiliac joint dysfunction: an algorithm for diagnosis and treatment. (2010) http:\/\/www.borgess.com\/files\/bbsi\/pdf\/si_joint_white.pdf \n\n^ a b c Shutz U Grob D. Poor outcome following bilateral sacroiliac joint fusion for degenerative sacroiliac joint syndrome. Act Orthop Belg. (2006) 72 (3) 296-308 \n\n^ a b c d e Wise CL Dall BE. Minimally invasive sacroiliac arthrodesis: outcomes of a new technique. J Spinal Disord Tech. (2008) 21 (8) 579-584 \n\n^ a b c d Rudolf L. Sacroiliac joint arthrodesis-MIS technique with titanium implants: report of the first 50 patients and outcomes. Open Orthop J. (2012) 6 495-502 \n\n^ a b c d e f g h i j k l m n o p q Dall BE Editor. Surgical Treatment for the painful dysfunctional sacroiliac joint: a clinical guide. Springer Publishing. (2014) ISBN 3319107259 \n\n^ a b c Smith-Petersen MN Rogers WA. End-result study of arthrodesis of the sacroiliac joint for arthritis-traumatic and non-traumatic. J Bone Joint Surg Am; 1926 (8) 118-136 \n\n^ a b Waisbrod H Krainick JU Gerbershagen HU. Sacroiliac joint arthrodesis for chronic lower back pain. Archives of Orthopedic and Traumatic Surgery: 1987 (4) 106; 238-240 \n\n^ a b Belanger TA Dall BE. Sacroiliac arthrodesis using a posterior midline fascial splitting approach and pedicle screw instrumentation: A new technique. J Spinal Discord: (2001) 14 (2) 118-124 \n\n^ a b Buchowski JM et al. Functional and radiographic outcome of sacroiliac arthrodesis for disorders of the sacroiliac joint. Spine J: (2005) 5 (5) 520-528 Discussion 529 \n\n^ a b Keating JG. Sacroiliac joint fusion in a chronic low back pain population. In Vleeming A, editor. The integrated function of the lumbar spine and sacroiliac joints: second interdisciplinary world congress on low back pain. Rotterdam:ECO; (1995) 361-365 \n\n^ a b Kibsgard TJ et al. Pelvic joint fusions in patients with chronic pelvic girdle pain: a 23-year follow up. Eur Spine J; (2013) 22 (4) 871-877 \n\n^ a b Giannikas KA et al. Sacroiliac joint fusion for chronic pain: a simple technique avoiding he use of metalwork. Euro Spine J. (2004) 13 (3) 253-256 \n\n^ a b Haufe SM Mork AR. Sacroiliac joint debridement: a novel technique for the treatment of sacroiliac joint pain. Photoed Laser Surg. (2005) 23 (6) 596-598 \n\n^ a b Kurana A et al. Percutaneous fusion of the sacroiliac joint with hollow modular anchorage screws: clinical and radiological outcome. J Bone Joint Surg Br. (2009) 91 (5) 627-631 \n\n^ a b Al-hayer A et al. Percutaneous sacroiliac joint arthrodesis: a novel technique. J Spinal Disord Tech; (2008) 21 (5) 359-363 \n\n^ a b Mason LW Chopra I Mohanty K. The percutaneous stabilization of the sacroiliac joint with hollow modular anchorage screws: a prospective outcome study. Euro Spine J. (2013) 22 (10) 2325-2331 \n\n^ a b Sachs D Capobianco R. One year successful outcomes for novel sacroiliac joint arthrodesis system. Ann Surg Innov Res. (2012) 6(1)13 \n\n^ a b Maigne JY Aivaliklis A Pfefer F. Results of the sacroiliac joint double block and value of sacroiliac provocation tests in 54 patients with low back pain. Spine: (1996) 21 1889-1892 \n\n^ Dreyfuss P Dreyer S Cole A Mayo K. Sacroiliac joint pain. J Am Acad Orthop Surg: (2004) 12 255-265 \n\n^ http:\/\/www.accessdata.fda.gov\/cdrh_docs\/pdf12\/K122o74.pdf \n\n^ Dall BE. Someone needs to claim it. 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Due to its location in the lower back, a dysfunctional sacroiliac joint may cause lower back and\/or leg pain. The resulting leg pain can be severe, resembling <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sciatica\" title=\"Sciatica\" rel=\"external_link\" target=\"_blank\">sciatica<\/a> or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lumbar_disc_herniation\" class=\"mw-redirect\" title=\"Lumbar disc herniation\" rel=\"external_link\" target=\"_blank\">slipped disc<\/a>. While nonsurgical treatments are effective for some, others have found that <b>surgery for the dysfunctional sacroiliac joint<\/b> is the only method to relieve pain.\n<\/p><p>Sacroiliac joint dysfunction is diagnosed by a physician. Associated surgery should only occur when certain criteria are satisfied.<sup id=\"rdp-ebb-cite_ref-Algo_1-0\" class=\"reference\"><a href=\"#cite_note-Algo-1\" rel=\"external_link\">[1]<\/a><\/sup> Surgical options, such as the degree of invasiveness, can then be evaluated when deciding on a treatment plan.\n<\/p><p>If complications occur, they are often detected early (during surgery or shortly after) and correlate with the surgical approach.<sup id=\"rdp-ebb-cite_ref-PoorOutcome_2-0\" class=\"reference\"><a href=\"#cite_note-PoorOutcome-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-MinimallyInvasive_3-0\" class=\"reference\"><a href=\"#cite_note-MinimallyInvasive-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-MIS_4-0\" class=\"reference\"><a href=\"#cite_note-MIS-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-DallClinical_5-0\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup> Results and outcomes vary according to the patient, pathology, surgeon, procedure, and methods.<sup id=\"rdp-ebb-cite_ref-DallClinical_5-1\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacroiliac_joint\" title=\"Sacroiliac joint\" rel=\"external_link\" target=\"_blank\">Sacroiliac joint<\/a> surgery was first described in 1926 by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Journal_of_Bone_and_Joint_Surgery\" class=\"mw-redirect\" title=\"Journal of Bone and Joint Surgery\" rel=\"external_link\" target=\"_blank\">Journal of Bone and Joint Surgery<\/a>.<sup id=\"rdp-ebb-cite_ref-End_6-0\" class=\"reference\"><a href=\"#cite_note-End-6\" rel=\"external_link\">[6]<\/a><\/sup> Following its appearance, the original procedure was documented in several publications and practices for nearly a century.<sup id=\"rdp-ebb-cite_ref-PoorOutcome_2-1\" class=\"reference\"><a href=\"#cite_note-PoorOutcome-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-MinimallyInvasive_3-1\" class=\"reference\"><a href=\"#cite_note-MinimallyInvasive-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-MIS_4-1\" class=\"reference\"><a href=\"#cite_note-MIS-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Waisbrod_7-0\" class=\"reference\"><a href=\"#cite_note-Waisbrod-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-VokesNation_8-0\" class=\"reference\"><a href=\"#cite_note-VokesNation-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-BWR_9-0\" class=\"reference\"><a href=\"#cite_note-BWR-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Keat_10-0\" class=\"reference\"><a href=\"#cite_note-Keat-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Kibsgard_11-0\" class=\"reference\"><a href=\"#cite_note-Kibsgard-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Giann_12-0\" class=\"reference\"><a href=\"#cite_note-Giann-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Haufe_13-0\" class=\"reference\"><a href=\"#cite_note-Haufe-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Percutaneous_14-0\" class=\"reference\"><a href=\"#cite_note-Percutaneous-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Arthrodesis_15-0\" class=\"reference\"><a href=\"#cite_note-Arthrodesis-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Stab_16-0\" class=\"reference\"><a href=\"#cite_note-Stab-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-one_17-0\" class=\"reference\"><a href=\"#cite_note-one-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacroiliac_joint\" title=\"Sacroiliac joint\" rel=\"external_link\" target=\"_blank\">Sacroiliac joint<\/a> surgeries have improved significantly beyond their nascency, which lacked the advent of hardware or instrumentation.<sup id=\"rdp-ebb-cite_ref-End_6-1\" class=\"reference\"><a href=\"#cite_note-End-6\" rel=\"external_link\">[6]<\/a><\/sup> The first use of sacroiliac joint surgical materials appeared in 1987 with the use of ceramic blocks to aid in joint fusing.<sup id=\"rdp-ebb-cite_ref-Waisbrod_7-1\" class=\"reference\"><a href=\"#cite_note-Waisbrod-7\" rel=\"external_link\">[7]<\/a><\/sup> The year 2001 marked the advent of spinal rods and screws to facilitate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Internal_fixation\" title=\"Internal fixation\" rel=\"external_link\" target=\"_blank\">internal fixation<\/a>.<sup id=\"rdp-ebb-cite_ref-VokesNation_8-1\" class=\"reference\"><a href=\"#cite_note-VokesNation-8\" rel=\"external_link\">[8]<\/a><\/sup> Continued improvements have been documented as surgeons reduce their incision size while avoiding tissues such as muscle, blood vessels, and nerves.<sup id=\"rdp-ebb-cite_ref-MinimallyInvasive_3-2\" class=\"reference\"><a href=\"#cite_note-MinimallyInvasive-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-End_6-2\" class=\"reference\"><a href=\"#cite_note-End-6\" rel=\"external_link\">[6]<\/a><\/sup> Modern sacroiliac joint surgery utilizes instrumentation systems attempts to be as minimally invasive as possible.\n<\/p><p>The first surgical textbook on sacroiliac joint surgery was published in 2014.<sup id=\"rdp-ebb-cite_ref-DallClinical_5-2\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Diagnosis\">Diagnosis<\/span><\/h2>\n<p>The diagnosis for a dysfunctional sacroiliac joint results from a combination of patient history,<sup id=\"rdp-ebb-cite_ref-Algo_1-1\" class=\"reference\"><a href=\"#cite_note-Algo-1\" rel=\"external_link\">[1]<\/a><\/sup> clinical evaluation,<sup id=\"rdp-ebb-cite_ref-Algo_1-2\" class=\"reference\"><a href=\"#cite_note-Algo-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-DallClinical_5-3\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Maigne_18-0\" class=\"reference\"><a href=\"#cite_note-Maigne-18\" rel=\"external_link\">[18]<\/a><\/sup> and one or more injections.<sup id=\"rdp-ebb-cite_ref-Algo_1-3\" class=\"reference\"><a href=\"#cite_note-Algo-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-DallClinical_5-4\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Maigne_18-1\" class=\"reference\"><a href=\"#cite_note-Maigne-18\" rel=\"external_link\">[18]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> The gold standard diagnostic injection utilizes a long-acting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anesthetic_agent\" class=\"mw-redirect\" title=\"Anesthetic agent\" rel=\"external_link\" target=\"_blank\">anesthetic agent<\/a> with radiographic dye.<sup id=\"rdp-ebb-cite_ref-DallClinical_5-5\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup> A diagnosis can be made following injections into the posterior sacroiliac transverse ligament.<sup id=\"rdp-ebb-cite_ref-Algo_1-4\" class=\"reference\"><a href=\"#cite_note-Algo-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-MinimallyInvasive_3-3\" class=\"reference\"><a href=\"#cite_note-MinimallyInvasive-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-DallClinical_5-6\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Conservative_treatment\">Conservative treatment<\/span><\/h2>\n<p>Currently there is no standard treatment regimen that must precede sacroiliac joint surgery. However, an algorithm has been designed (2010) to guide the treatment process before committing a patient to surgery.<sup id=\"rdp-ebb-cite_ref-Algo_1-5\" class=\"reference\"><a href=\"#cite_note-Algo-1\" rel=\"external_link\">[1]<\/a><\/sup> This algorithm allows for the use of alternative treatments (prolotherapy, radio frequency neural ablation, cryotherapy, acupuncture, and others) if desired by a clinician or patient.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Surgical_options\">Surgical options<\/span><\/h2>\n<p>When preparing to operate on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacroiliac_joint\" title=\"Sacroiliac joint\" rel=\"external_link\" target=\"_blank\">sacroiliac joint<\/a>, a surgeon must consider the desired degree of invasiveness, surgical approach (fascial splitting that is posterior midline, posterior lateral, posterior lateral inferior, lateral, anterior), instrumentation, type of bone grafting material (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Autograft\" class=\"mw-redirect\" title=\"Autograft\" rel=\"external_link\" target=\"_blank\">autograft<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Allograft\" class=\"mw-redirect\" title=\"Allograft\" rel=\"external_link\" target=\"_blank\">allograft<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Xenograft\" class=\"mw-redirect\" title=\"Xenograft\" rel=\"external_link\" target=\"_blank\">xenograft<\/a>), and type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_graft\" class=\"mw-redirect\" title=\"Bone graft\" rel=\"external_link\" target=\"_blank\">bone graft<\/a> enhancing material (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_morphogenetic_proteins\" class=\"mw-redirect\" title=\"Bone morphogenetic proteins\" rel=\"external_link\" target=\"_blank\">bone morphogenetic proteins<\/a>).<sup id=\"rdp-ebb-cite_ref-DallClinical_5-7\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup> Another consideration is a patient's desired postoperative weight bearing status, as some procedures result in full weight bearing while others only partial.\n<\/p><p>Current diagnostic criteria (not standard but generally accepted) include at least 6 months of chronic pain, failure of previous treatments, disability from daily activities, and a diagnostic injection.<sup id=\"rdp-ebb-cite_ref-DallClinical_5-8\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup> There is no current standard operating procedure,<sup id=\"rdp-ebb-cite_ref-DallClinical_5-9\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup> though some surgeons may prefer an approach based on his or her training and exposure (there are exceptions).<sup id=\"rdp-ebb-cite_ref-DallClinical_5-10\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>The most frequently practiced procedure is the lateral minimally invasive approach.<sup id=\"rdp-ebb-cite_ref-DallClinical_5-11\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup> One leading explanation for this involves the <a href=\"https:\/\/en.wikipedia.org\/wiki\/FDA\" class=\"mw-redirect\" title=\"FDA\" rel=\"external_link\" target=\"_blank\">FDA<\/a> having made possible a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Federal_Food,_Drug,_and_Cosmetic_Act#Premarket_notification_(510(k))\" title=\"Federal Food, Drug, and Cosmetic Act\" rel=\"external_link\" target=\"_blank\">Premarket notification (510(k))<\/a> for instrumentation that has a predicate preceding 1976. Several lateral minimally invasive instrumentation systems have acquired this designation.<sup id=\"rdp-ebb-cite_ref-DallClinical_5-12\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><p>Some procedures are unique in that they do not rely on a fusion of the joint.<sup id=\"rdp-ebb-cite_ref-Haufe_13-1\" class=\"reference\"><a href=\"#cite_note-Haufe-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Complications\">Complications<\/span><\/h2>\n<p>Operating on a dysfunctional sacroiliac joint is an elective procedure and should never be an emergency. Preoperative planning and preparation should prevent or lessen the likelihood of most complications. However, aside from the general complications that encompass any <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reconstructive_surgery\" title=\"Reconstructive surgery\" rel=\"external_link\" target=\"_blank\">reconstructive surgery<\/a>, specific complications are associated with the sacroiliac joint.\n<\/p><p>The sacroiliac joint is essentially halfway between the ventral and dorsal sides of the body deep within the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pelvis\" title=\"Pelvis\" rel=\"external_link\" target=\"_blank\">pelvis<\/a>, a location in close proximity to several vital structures. Those structures within a few centimeters of the sacroiliac joint include the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacrum\" title=\"Sacrum\" rel=\"external_link\" target=\"_blank\">sacrum<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ilium_(bone)\" title=\"Ilium (bone)\" rel=\"external_link\" target=\"_blank\">ilium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sciatic_nerve\" title=\"Sciatic nerve\" rel=\"external_link\" target=\"_blank\">sciatic nerve<\/a>, dorsal and ventral <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacral_nerves\" class=\"mw-redirect\" title=\"Sacral nerves\" rel=\"external_link\" target=\"_blank\">sacral nerves<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lumbar_plexus\" title=\"Lumbar plexus\" rel=\"external_link\" target=\"_blank\">lumbar plexus<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superior_gluteal_artery\" title=\"Superior gluteal artery\" rel=\"external_link\" target=\"_blank\">superior gluteal artery<\/a>, iliac vessels, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bowel\" class=\"mw-redirect\" title=\"Bowel\" rel=\"external_link\" target=\"_blank\">large intestine<\/a>.<sup id=\"rdp-ebb-cite_ref-DallClinical_5-13\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup> While these structures could be injured during any type of sacroiliac joint procedure, the lateral minimally invasive approach is associated with the greatest number of complications.<sup id=\"rdp-ebb-cite_ref-MIS_4-2\" class=\"reference\"><a href=\"#cite_note-MIS-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-DallClinical_5-14\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Outcomes\">Outcomes<\/span><\/h2>\n<p>Surgical outcome following dysfunctional sacroiliac joint correction has yet to be evaluated by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Multicenter_trial\" title=\"Multicenter trial\" rel=\"external_link\" target=\"_blank\">multi-center studies<\/a>. Multiple peer-reviewed articles have conducted followups, describing an overall success or satisfaction rate in the 70-80% range.<sup id=\"rdp-ebb-cite_ref-MinimallyInvasive_3-4\" class=\"reference\"><a href=\"#cite_note-MinimallyInvasive-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-MIS_4-3\" class=\"reference\"><a href=\"#cite_note-MIS-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-BWR_9-1\" class=\"reference\"><a href=\"#cite_note-BWR-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Keat_10-1\" class=\"reference\"><a href=\"#cite_note-Keat-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Kibsgard_11-1\" class=\"reference\"><a href=\"#cite_note-Kibsgard-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Giann_12-1\" class=\"reference\"><a href=\"#cite_note-Giann-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Percutaneous_14-1\" class=\"reference\"><a href=\"#cite_note-Percutaneous-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Arthrodesis_15-1\" class=\"reference\"><a href=\"#cite_note-Arthrodesis-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Stab_16-1\" class=\"reference\"><a href=\"#cite_note-Stab-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-one_17-1\" class=\"reference\"><a href=\"#cite_note-one-17\" rel=\"external_link\">[17]<\/a><\/sup> However, one article was suggestive of poor outcomes with only 18% of patients being satisfied.<sup id=\"rdp-ebb-cite_ref-PoorOutcome_2-2\" class=\"reference\"><a href=\"#cite_note-PoorOutcome-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Surgery has been demonstrated to also be effective for some pathologies that involve sacroiliac joint dysfunction.<sup id=\"rdp-ebb-cite_ref-DallClinical_5-15\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup> The one exception is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammatory_arthritis\" title=\"Inflammatory arthritis\" rel=\"external_link\" target=\"_blank\">inflammatory arthritis<\/a>, for which surgery achieves mixed results.<sup id=\"rdp-ebb-cite_ref-DallClinical_5-16\" class=\"reference\"><a href=\"#cite_note-DallClinical-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Future\">Future<\/span><\/h2>\n<p>Surgeries for the dysfunctional sacroiliac joint are currently in their infancy, despite their many advances. Prospective and multi-center studies are needed to move this surgery into the knowledge base of surgical education and surgical societies.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> Advancements in surgery are expected to continue as science is applied further to the diagnosis and treatment of sacroiliac joint dysfunction.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Myofascial_pain\" class=\"mw-redirect\" title=\"Myofascial pain\" rel=\"external_link\" target=\"_blank\">Myofascial pain<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Piriformis_syndrome\" title=\"Piriformis syndrome\" rel=\"external_link\" target=\"_blank\">Piriformis syndrome<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Trochanteric_bursitis\" class=\"mw-redirect\" title=\"Trochanteric bursitis\" rel=\"external_link\" target=\"_blank\">Trochanteric bursitis<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n <div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-Algo-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Algo_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Algo_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Algo_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Algo_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Algo_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Algo_1-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Dall BE Eden SV Brumblay HG. Sacroiliac joint dysfunction: an algorithm for diagnosis and treatment. (2010) <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.borgess.com\/files\/bbsi\/pdf\/si_joint_white.pdf\" target=\"_blank\">http:\/\/www.borgess.com\/files\/bbsi\/pdf\/si_joint_white.pdf<\/a><\/span>\n<\/li>\n<li id=\"cite_note-PoorOutcome-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-PoorOutcome_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-PoorOutcome_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-PoorOutcome_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Shutz U Grob D. Poor outcome following bilateral sacroiliac joint fusion for degenerative sacroiliac joint syndrome. Act Orthop Belg. (2006) 72 (3) 296-308<\/span>\n<\/li>\n<li id=\"cite_note-MinimallyInvasive-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-MinimallyInvasive_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-MinimallyInvasive_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-MinimallyInvasive_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-MinimallyInvasive_3-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-MinimallyInvasive_3-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Wise CL Dall BE. Minimally invasive sacroiliac arthrodesis: outcomes of a new technique. J Spinal Disord Tech. (2008) 21 (8) 579-584<\/span>\n<\/li>\n<li id=\"cite_note-MIS-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-MIS_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-MIS_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-MIS_4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-MIS_4-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Rudolf L. Sacroiliac joint arthrodesis-MIS technique with titanium implants: report of the first 50 patients and outcomes. Open Orthop J. (2012) 6 495-502<\/span>\n<\/li>\n<li id=\"cite_note-DallClinical-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-DallClinical_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DallClinical_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DallClinical_5-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DallClinical_5-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DallClinical_5-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DallClinical_5-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DallClinical_5-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DallClinical_5-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DallClinical_5-8\" rel=\"external_link\"><sup><i><b>i<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DallClinical_5-9\" rel=\"external_link\"><sup><i><b>j<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DallClinical_5-10\" rel=\"external_link\"><sup><i><b>k<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DallClinical_5-11\" rel=\"external_link\"><sup><i><b>l<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DallClinical_5-12\" rel=\"external_link\"><sup><i><b>m<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DallClinical_5-13\" rel=\"external_link\"><sup><i><b>n<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DallClinical_5-14\" rel=\"external_link\"><sup><i><b>o<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DallClinical_5-15\" rel=\"external_link\"><sup><i><b>p<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DallClinical_5-16\" rel=\"external_link\"><sup><i><b>q<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Dall BE Editor. Surgical Treatment for the painful dysfunctional sacroiliac joint: a clinical guide. Springer Publishing. (2014) <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 3319107259<\/span>\n<\/li>\n<li id=\"cite_note-End-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-End_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-End_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-End_6-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Smith-Petersen MN Rogers WA. End-result study of arthrodesis of the sacroiliac joint for arthritis-traumatic and non-traumatic. J Bone Joint Surg Am; 1926 (8) 118-136<\/span>\n<\/li>\n<li id=\"cite_note-Waisbrod-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Waisbrod_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Waisbrod_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Waisbrod H Krainick JU Gerbershagen HU. Sacroiliac joint arthrodesis for chronic lower back pain. Archives of Orthopedic and Traumatic Surgery: 1987 (4) 106; 238-240<\/span>\n<\/li>\n<li id=\"cite_note-VokesNation-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-VokesNation_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-VokesNation_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Belanger TA Dall BE. Sacroiliac arthrodesis using a posterior midline fascial splitting approach and pedicle screw instrumentation: A new technique. J Spinal Discord: (2001) 14 (2) 118-124<\/span>\n<\/li>\n<li id=\"cite_note-BWR-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-BWR_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-BWR_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Buchowski JM et al. Functional and radiographic outcome of sacroiliac arthrodesis for disorders of the sacroiliac joint. Spine J: (2005) 5 (5) 520-528 Discussion 529<\/span>\n<\/li>\n<li id=\"cite_note-Keat-10\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Keat_10-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Keat_10-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Keating JG. Sacroiliac joint fusion in a chronic low back pain population. In Vleeming A, editor. The integrated function of the lumbar spine and sacroiliac joints: second interdisciplinary world congress on low back pain. Rotterdam:ECO; (1995) 361-365<\/span>\n<\/li>\n<li id=\"cite_note-Kibsgard-11\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Kibsgard_11-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kibsgard_11-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Kibsgard TJ et al. Pelvic joint fusions in patients with chronic pelvic girdle pain: a 23-year follow up. Eur Spine J; (2013) 22 (4) 871-877<\/span>\n<\/li>\n<li id=\"cite_note-Giann-12\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Giann_12-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Giann_12-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Giannikas KA et al. Sacroiliac joint fusion for chronic pain: a simple technique avoiding he use of metalwork. Euro Spine J. (2004) 13 (3) 253-256<\/span>\n<\/li>\n<li id=\"cite_note-Haufe-13\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Haufe_13-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Haufe_13-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Haufe SM Mork AR. Sacroiliac joint debridement: a novel technique for the treatment of sacroiliac joint pain. Photoed Laser Surg. (2005) 23 (6) 596-598<\/span>\n<\/li>\n<li id=\"cite_note-Percutaneous-14\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Percutaneous_14-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Percutaneous_14-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Kurana A et al. Percutaneous fusion of the sacroiliac joint with hollow modular anchorage screws: clinical and radiological outcome. J Bone Joint Surg Br. (2009) 91 (5) 627-631<\/span>\n<\/li>\n<li id=\"cite_note-Arthrodesis-15\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Arthrodesis_15-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Arthrodesis_15-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Al-hayer A et al. Percutaneous sacroiliac joint arthrodesis: a novel technique. J Spinal Disord Tech; (2008) 21 (5) 359-363<\/span>\n<\/li>\n<li id=\"cite_note-Stab-16\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Stab_16-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Stab_16-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Mason LW Chopra I Mohanty K. The percutaneous stabilization of the sacroiliac joint with hollow modular anchorage screws: a prospective outcome study. Euro Spine J. (2013) 22 (10) 2325-2331<\/span>\n<\/li>\n<li id=\"cite_note-one-17\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-one_17-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-one_17-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Sachs D Capobianco R. One year successful outcomes for novel sacroiliac joint arthrodesis system. Ann Surg Innov Res. (2012) 6(1)13<\/span>\n<\/li>\n<li id=\"cite_note-Maigne-18\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Maigne_18-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Maigne_18-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Maigne JY Aivaliklis A Pfefer F. Results of the sacroiliac joint double block and value of sacroiliac provocation tests in 54 patients with low back pain. Spine: (1996) 21 1889-1892<\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Dreyfuss P Dreyer S Cole A Mayo K. Sacroiliac joint pain. J Am Acad Orthop Surg: (2004) 12 255-265<\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.accessdata.fda.gov\/cdrh_docs\/pdf12\/K122o74.pdf\" target=\"_blank\">http:\/\/www.accessdata.fda.gov\/cdrh_docs\/pdf12\/K122o74.pdf<\/a><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Dall BE. Someone needs to claim it. Spine J (2009) 2 190-191<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1270\nCached time: 20181217092639\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.168 seconds\nReal time usage: 0.223 seconds\nPreprocessor visited node count: 915\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 2867\/2097152 bytes\nTemplate argument size: 319\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 18398\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.023\/10.000 seconds\nLua memory usage: 1.24 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 179.758 1 -total\n<\/p>\n<pre>47.66% 85.677 1 Template:Reflist\n34.42% 61.865 1 Template:Infobox_medical_intervention\n33.07% 59.452 1 Template:ISBN\n30.20% 54.291 1 Template:Infobox\n21.14% 37.992 1 Template:Catalog_lookup_link\n 3.83% 6.878 1 Template:Error-small\n 3.30% 5.930 1 Template:PAGENAMEBASE\n 3.23% 5.811 3 Template:Yesno-no\n 2.07% 3.724 1 Template:Template_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:47576206-1!canonical and timestamp 20181217092638 and revision id 859805698\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery_for_the_dysfunctional_sacroiliac_joint\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212250\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.052 seconds\nReal time usage: 0.190 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 183.301 1 - wikipedia:Surgery_for_the_dysfunctional_sacroiliac_joint\n100.00% 183.301 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8309-0!*!*!*!*!*!* and timestamp 20181217212250 and revision id 24528\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgery_for_the_dysfunctional_sacroiliac_joint\">https:\/\/www.limswiki.org\/index.php\/Surgery_for_the_dysfunctional_sacroiliac_joint<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","5f0ff3cb789a58f1c742c239557383e5_images":[],"5f0ff3cb789a58f1c742c239557383e5_timestamp":1545081770,"275eff9e4a14509c80b3cb1f7d3ca565_type":"article","275eff9e4a14509c80b3cb1f7d3ca565_title":"Sonomicrometry","275eff9e4a14509c80b3cb1f7d3ca565_url":"https:\/\/www.limswiki.org\/index.php\/Sonomicrometry","275eff9e4a14509c80b3cb1f7d3ca565_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSonomicrometry\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article does not cite any sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (February 2008) (Learn how and when to remove this template message)\nSonomicrometry is a technique of measuring the distance between piezoelectric crystals based on the speed of acoustic signals through the medium they are embedded in. Typically, the crystals will be coated with an epoxy 'lens' and placed into the material facing each other. An electrical signal sent to either crystal will be transformed into sound, which passes through the medium, eventually reaching the other crystal, which converts the sound into electricity, detected by a receiver. From the time taken for sound to move between the crystals and the speed of sound in the medium, the distance between the crystals can be calculated.\n\n Assortment of sonomicrometer crystals\nContents \n\n1 History \n2 Mechanism \n3 Applications \n4 References \n\n\nHistory \nSonomicrometry was originally applied in the study of cardiac function in research animals by Dean Franklin in 1956, and was quickly adopted by biologists working in biomechanics as well as other physiological organ systems and structures (gastro-intestinal, uro-genital and musculo-skeletal). Medical device companies also use sonomicrometry to assess the physical performance, durability and longevity of devices during R&D phase of development. Sonomicrometry is currently the most prevalent method for determining muscle length changes during animal locomotion, feeding, and other biomechanical functions.\nWhen originally developed decades ago, care was taken to orient the crystals correctly to ensure satisfactory signal detection between the crystals, but more modern versions of sonomicrometer hardware (typically dating from 1995 to the present) do not require such attention to crystal orientation.\nSonomicrometer systems are used by scientists, engineers and biologists to measure the material properties of soft solids, gels, and fluids. Even though they are used to measure the mechanics and function of muscle tissue, it should be noted that there is no known medical or therapeutic use for these devices. Sonomicrometer devices are not used to treat or diagnose medical conditions in animals or humans.\n\nMechanism \nThe primary criteria for making sonomicrometer measurements is that the intervening space or material between the crystals must be capable of ultrasonic sound conduction in the frequency range of 100 kHz to at least several MHz. This typically means that the crystals must operate in or on a medium composed of fluids, gels, soft solids and some hard solids, and this includes biological tissues (blood, muscle, fat, etc.). The measurement of distance between crystals becomes problematic or ceases completely if air gaps or solid objects intervene between the crystals.\nSonomicrometer measurements are only accurate when the medium surrounding the crystals or the object the crystals are measuring has a uniform speed of sound. In biological settings, almost all tissues have a speed of sound in the range of 1550 to 1600 meters per second, which is satisfactorily uniform to give accurate measurements to within 3% to 4%, and more typically to within 1%.\nA sonomicrometer device measures distance by performing a timing measurement of the sound transmitted by one crystal and received by one (or more) adjacent crystals. The ability to resolve small differences in this transit-time (or \"time-of-flight\") directly correlates with the ability to resolve small changes in the distances between crystals. The first generation of sonomicrometer devices were analog devices that integrated the time-of-flight as a voltage ramp function. Their resolution was a function of the slope of the ramp and the electrical noise of system components. Those systems output the length measurements as an analog voltage. The second generation of sonomicrometer devices were digital\u2014they measure time-of-flight by incrementing high-speed digital counters. Typically these are 12 to 16-bit counters operating from 32 to 128 MHz. A digital system will output length measurements in form of a digital number (the time-of-flight count value). Because of their digital nature, the resolution can be exactly specified as a function of counter clock frequency. For example, when making measurements in biological tissue at body temperature (velocity = 1,590 m\/s), a digital sonomicrometer operating with a clock speed of 128 MHz will have a spatial resolution of 12 micrometres.\n\nApplications \nSonomicrometry is often used in studies of animal physiology where precise distances at high temporal resolution are needed, particularly when such distances are not externally measurable. Sonomicrometry crystals are most commonly implanted within skeletal or cardiac muscle tissue to track length changes during an activity (heartbeat, flapping a wing, chewing, etc.). However, they can be very useful for tracking movement of entire structures which are not visible but immersed in fluid, such as the bones in the mouth of a fish during feeding.\n\nReferences \nSarazan, R. Dustan; Schweitz, Karl T. R. (2009). \"Standing on the shoulders of giants: Dean Franklin and his remarkable contributions to physiological measurements in animals\". Adv Physiol Educ. 33 (3): 144\u2013156. doi:10.1152\/advan.90208.2008. \n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sonomicrometry\">https:\/\/www.limswiki.org\/index.php\/Sonomicrometry<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesMedical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 12 March 2016, at 03:18.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 321 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","275eff9e4a14509c80b3cb1f7d3ca565_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Sonomicrometry skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Sonomicrometry<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Sonomicrometry<\/b> is a technique of measuring the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Distance\" title=\"Distance\" rel=\"external_link\" target=\"_blank\">distance<\/a> between <a href=\"https:\/\/en.wikipedia.org\/wiki\/Piezoelectric\" class=\"mw-redirect\" title=\"Piezoelectric\" rel=\"external_link\" target=\"_blank\">piezoelectric<\/a> crystals based on the speed of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acoustics\" title=\"Acoustics\" rel=\"external_link\" target=\"_blank\">acoustic signals<\/a> through the medium they are embedded in. Typically, the crystals will be coated with an epoxy 'lens' and placed into the material facing each other. An electrical signal sent to either crystal will be transformed into sound, which passes through the medium, eventually reaching the other crystal, which converts the sound into electricity, detected by a receiver. From the time taken for sound to move between the crystals and the speed of sound in the medium, the distance between the crystals can be calculated.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sonomicrometer_crystals.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8a\/Sonomicrometer_crystals.jpg\/200px-Sonomicrometer_crystals.jpg\" width=\"200\" height=\"125\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sonomicrometer_crystals.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Assortment of sonomicrometer crystals<\/div><\/div><\/div>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Sonomicrometry was originally applied in the study of cardiac function in research animals by in 1956, and was quickly adopted by biologists working in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomechanics\" title=\"Biomechanics\" rel=\"external_link\" target=\"_blank\">biomechanics<\/a> as well as other physiological organ systems and structures (gastro-intestinal, uro-genital and musculo-skeletal). Medical device companies also use sonomicrometry to assess the physical performance, durability and longevity of devices during R&D phase of development. Sonomicrometry is currently the most prevalent method for determining muscle length changes during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Animal_locomotion\" title=\"Animal locomotion\" rel=\"external_link\" target=\"_blank\">animal locomotion<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Feeding\" class=\"mw-redirect\" title=\"Feeding\" rel=\"external_link\" target=\"_blank\">feeding<\/a>, and other biomechanical functions.\n<\/p><p>When originally developed decades ago, care was taken to orient the crystals correctly to ensure satisfactory signal detection between the crystals, but more modern versions of sonomicrometer hardware (typically dating from 1995 to the present) do not require such attention to crystal orientation.\n<\/p><p>Sonomicrometer systems are used by scientists, engineers and biologists to measure the material properties of soft solids, gels, and fluids. Even though they are used to measure the mechanics and function of muscle tissue, it should be noted that there is no known medical or therapeutic use for these devices. Sonomicrometer devices are not used to treat or diagnose medical conditions in animals or humans.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Mechanism\">Mechanism<\/span><\/h2>\n<p>The primary criteria for making sonomicrometer measurements is that the intervening space or material between the crystals must be capable of ultrasonic sound conduction in the frequency range of 100 kHz to at least several MHz. This typically means that the crystals must operate in or on a medium composed of fluids, gels, soft solids and some hard solids, and this includes biological tissues (blood, muscle, fat, etc.). The measurement of distance between crystals becomes problematic or ceases completely if air gaps or solid objects intervene between the crystals.\n<\/p><p>Sonomicrometer measurements are only accurate when the medium surrounding the crystals or the object the crystals are measuring has a uniform speed of sound. In biological settings, almost all tissues have a speed of sound in the range of 1550 to 1600 meters per second, which is satisfactorily uniform to give accurate measurements to within 3% to 4%, and more typically to within 1%.\n<\/p><p>A sonomicrometer device measures distance by performing a timing measurement of the sound transmitted by one crystal and received by one (or more) adjacent crystals. The ability to resolve small differences in this transit-time (or \"time-of-flight\") directly correlates with the ability to resolve small changes in the distances between crystals. The first generation of sonomicrometer devices were analog devices that integrated the time-of-flight as a voltage ramp function. Their resolution was a function of the slope of the ramp and the electrical noise of system components. Those systems output the length measurements as an analog voltage. The second generation of sonomicrometer devices were digital\u2014they measure time-of-flight by incrementing high-speed digital counters. Typically these are 12 to 16-bit counters operating from 32 to 128 MHz. A digital system will output length measurements in form of a digital number (the time-of-flight count value). Because of their digital nature, the resolution can be exactly specified as a function of counter clock frequency. For example, when making measurements in biological tissue at body temperature (velocity = 1,590 m\/s), a digital sonomicrometer operating with a clock speed of 128 MHz will have a spatial resolution of 12 micrometres.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>Sonomicrometry is often used in studies of animal physiology where precise distances at high temporal resolution are needed, particularly when such distances are not externally measurable. Sonomicrometry crystals are most commonly implanted within skeletal or cardiac muscle tissue to track length changes during an activity (heartbeat, flapping a wing, chewing, etc.). However, they can be very useful for tracking movement of entire structures which are not visible but immersed in fluid, such as the bones in the mouth of a fish during feeding.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<ul><li><cite class=\"citation journal\">Sarazan, R. Dustan; Schweitz, Karl T. R. (2009). \"Standing on the shoulders of giants: Dean Franklin and his remarkable contributions to physiological measurements in animals\". <i><\/i>. <b>33<\/b> (3): 144\u2013156. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1152%2Fadvan.90208.2008\" target=\"_blank\">10.1152\/advan.90208.2008<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Adv+Physiol+Educ&rft.atitle=Standing+on+the+shoulders+of+giants%3A+Dean+Franklin+and+his+remarkable+contributions+to+physiological+measurements+in+animals&rft.volume=33&rft.issue=3&rft.pages=144-156&rft.date=2009&rft_id=info%3Adoi%2F10.1152%2Fadvan.90208.2008&rft.aulast=Sarazan&rft.aufirst=R.+Dustan&rft.au=Schweitz%2C+Karl+T.+R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASonomicrometry\" class=\"Z3988\"><\/span><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1331\nCached time: 20181129221802\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.132 seconds\nReal time usage: 0.187 seconds\nPreprocessor visited node count: 119\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 5951\/2097152 bytes\nTemplate argument size: 13\/2097152 bytes\nHighest expansion depth: 6\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 1549\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.096\/10.000 seconds\nLua memory usage: 1.77 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 166.404 1 -total\n<\/p>\n<pre>64.31% 107.013 1 Template:Cite_journal\n35.61% 59.258 1 Template:Unreferenced\n24.51% 40.785 1 Template:Ambox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:14020698-1!canonical and timestamp 20181129221802 and revision id 771430048\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sonomicrometry\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212250\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.018 seconds\nReal time usage: 0.152 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 145.879 1 - wikipedia:Sonomicrometry\n100.00% 145.879 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8432-0!*!*!*!*!*!* and timestamp 20181217212250 and revision id 24674\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sonomicrometry\">https:\/\/www.limswiki.org\/index.php\/Sonomicrometry<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","275eff9e4a14509c80b3cb1f7d3ca565_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8a\/Sonomicrometer_crystals.jpg\/400px-Sonomicrometer_crystals.jpg"],"275eff9e4a14509c80b3cb1f7d3ca565_timestamp":1545081770,"8e03f2269291576004ef47715a87e90d_type":"article","8e03f2269291576004ef47715a87e90d_title":"Sinus lift","8e03f2269291576004ef47715a87e90d_url":"https:\/\/www.limswiki.org\/index.php\/Sinus_lift","8e03f2269291576004ef47715a87e90d_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSinus lift\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article has multiple issues. 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(February 2011) (Learn how and when to remove this template message)\n \n (Learn how and when to remove this template message)\n 1) Edentulous area of two missing teeth is being prepared for future placement of dental implants with a lateral window sinus lift; incisions into the soft tissue are shown here.\r\n 2) The soft tissue is flapped back to expose the underlying lateral wall of the left maxillary sinus.\r\n 3) The bone has been removed with a piezoelectric instrument, exposing the underlying Schneiderian membrane, which is the lining of the maxillary sinus cavity.\r\n 4) Through careful instrumentation, the membrane is carefully peeled from the inner aspect of the sinus cavity.\r\n 5) The membrane has been reflected from the internal aspect of the inferior portion of the sinus cavity; one can now visualize the bony floor of the sinus cavity without its lining membrane (note the triangular ridge of bone within the sinus, known as an Underwood's septum).\r\n 6) The newly formed space within the bony cavity of the sinus yet inferior to the intact membrane is grafted with human cadaver allograft bone. The floor of the sinus will now be roughly 10mm or so more superior than it was before, providing enough room to place dental implants into the edentulous site.\nMaxillary sinus floor augmentation[1] (also termed sinus lift, sinus graft, sinus augmentation or sinus procedure) is a surgical procedure which aims to increase the amount of bone in the posterior maxilla (upper jaw bone), in the area of the premolar and molar teeth, by lifting the lower Schneiderian membrane (sinus membrane) and placing a bone graft.[2]\nWhen a tooth is lost the alveolar process begins to remodel. The vacant tooth socket collapses as it heals leaving an edentulous (toothless) area, termed a ridge. This collapse causes a loss in both height and width of the surrounding bone. In addition, when a maxillary molar or premolar is lost, the floor of the maxillary sinus expands, which further diminishes the thickness of the underlying bone. Overall, this leads to a loss in volume of bone that is available for implantation of dental implants, which rely on osseointegration (bone integration), to replace missing teeth. The goal of the sinus lift is to graft extra bone into the maxillary sinus, so more bone is available to support a dental implant.[3]\n\nContents \n\n1 Indications \n2 Technique \n\n2.1 Traditional Sinus Augmentation or Lateral Window Technique \n2.2 Osteotome Technique \n\n\n3 Complications \n4 Recovery \n5 History \n6 Cost-effectiveness \n7 References \n8 External links \n\n\nIndications \nWhile there may be a number of reasons for wanting a greater volume of bone in the posterior maxilla, the most common reason in contemporary dental treatment planning is to prepare the site for the future placement of dental implants.\nSinus augmentation (sinus lift) is performed when the floor of the sinus is too close to an area where dental implants are to be placed. This procedure is performed to ensure a secure place for the implants while protecting the sinus. Lowering of the sinus can be caused by: Long-term tooth loss without the required treatment, periodontal disease, trauma.[4]\nPatients who have the following may be good candidates for sinus augmentation.[5]\n\nLost more than one tooth in the posterior maxilla.\nLost a significant amount of bone in the posterior maxilla.\nMissing teeth due to genetics or birth defect.\nMinus most of the maxillary teeth and need a strong sinus floor for multiple implants.\nIt is not known if using sinus lift techniques is more successful than using short implants for reducing the number of artificial teeth or dental implant failures up to a year after teeth\/implant placement.[3]\n\nTechnique \nPrior to undergoing sinus augmentation, diagnostics are run to determine the health of the patient's sinuses. Panoramic radiographs are taken to map out the patient's upper jaw and sinuses. In special instances, a computed tomography or CT scan is taken to measure the sinus's height and width, and to rule out any sinus disease or pathology.[6]\nThere are several variations of the sinus lift technique.\n\nTraditional Sinus Augmentation or Lateral Window Technique \nThere are multiple ways to perform sinus augmentation. The procedure is performed from inside the patient's mouth where the surgeon makes an incision into the gum, or gingiva. Once the incision is made, the surgeon then pulls back the gum tissue, exposing the lateral boney wall of the sinus. The surgeon then cuts a \"window\" to the sinus, which is exposing the Schneiderian membrane. The membrane is separated from the bone, and bone graft material is placed into the newly created space. The gums are then sutured close and the graft is left to heal for 4\u201312 months.[7]\nThe graft material used can be either an autograft, an allograft, a xenograft, an alloplast (a growth-factor infused collagen matrix), synthetic variants, or combinations thereof.[8] Studies indicate that the mere lifting of the sinus membrane, creation of a void space and blood clot formation might result in new bone owing to the principles of guided bone regeneration.[9] The long-term prognosis for the technique is estimated to 94%.[10]\n\nOsteotome Technique \nAs an alternative, sinus augmentation can be performed by a less invasive osteotome technique. There are several variations of this technique and all originate from the original technique of Dr. Tatum, first published by Dr.s Boyne and James in 1980.\nDr. Robert B. Summers[11] described a technique that is normally performed when the sinus floor that needs to be lifted is less than 4 mm. This technique is performed by flapping back gum tissue and making a socket in the bone within 1\u20132 mm short of the sinus membrane. The floor of the sinus is then lifted by tapping the sinus floor with the use of osteotomes. The amount of augmentation achieved with the osteotome technique is usually less than what can be achieved with the lateral window technique.\nA dental implant is normally placed in the socket formed at the time of the sinus lift procedure and left to integrate with bone. Bone integration normally lasts 4 to 8 months. The goal of this procedure is to stimulate bone growth and form a thicker sinus floor, in order to support dental implants for teeth replacement.\nSinus dimensions and shape significantly influence new bone formation after transcrestal sinus floor elevation: with this technique, the regeneration of a substantial amount of new bone is a predictable outcome only in narrow sinus cavities. During presurgical planning, bucco- palatal sinus width should be regarded as a crucial parameter when choosing sinus floor elevation with transcrestal approach as a treatment option.[12]\n\n<\/p>Dr. Bruschi and Scipioni[13][14] described a similiar technique (Localized Management of Sinus Floor or L.M.S.F.) that is based on a partial thickness flap procedure. This technique increases the malleability of the crestal bone and uses not the bone directly below the sinus, but rather the bone on the medial wall, and thus can be used in more extreme cases of bone resorption that would normally need to be treated with the lateral wall technique. The healing period is reduced to 1.5 to 3 months. Recently an electrical mallet[15] has been introduced to simplify the application of this and similiar techniques.\n\nComplications \nA major risk of a sinus augmentation is that the sinus membrane could be pierced or ripped. Remedies, should this occur, include stitching the tear or placing a patch over it; in some cases, the surgery is stopped altogether and the tear is given time to heal, usually three to six months. Often, the sinus membrane grows back thicker and stronger, making success more likely on the second operation.[citation needed ] Although rarely reported, such secondary intervention can also be successful when the primary surgery is limited to elevation of the membrane without the insertion of additional material.[16]\nBesides tearing of the sinus membrane, there are other risks involved in sinus augmentation surgery. Most notably, the close relationship of the augmentation site with the sinonasal complex can induce sinusitis, which may chronicize and cause severe symptoms. Sinusitis resulting from maxillary sinus augmentation is considered a Class 1 sinonasal complication according to Felisati classification and should be addressed surgically with a combined endoscopic endonasal and endoral approach.[17] Beside sinusitis, among other procedure related-risks include:\n\nInfection[3]\nInflammation\nPain\nItching\nAllergic reaction\nTissue or nerve damage[3]\nScar formation\nHematoma\nGraft failure\nOro-antral communication \/ oro-antral fistula\nTilting or loosening of implants\nBleeding[3]\nRecovery \nIt takes about three to six months for the sinus augmentation bone to become part of the patient's natural sinus floor bone. Up to six months of healing is sometimes left before implants are attempted. However, some surgeons perform both the augmentation and dental implant simultaneously, to avoid the necessity of two surgeries.[18]\n\nHistory \nThe first maxillary sinus floor augmentation procedure was performed by Oscar Hilt Tatum, Jr. in 1974.\nA sinus-lift procedure was first performed by Dr. Hilt Tatum Jr. in 1974 during his period of preparation to begin sinus grafting. The first sinus graft was done by Tatum in February, 1975 in Lee County Hospital in Opelika, Alabama. This was followed by the placement and successful restoration of two endosteal implants. Between 1975\u20131979, much of the sinus lining elevation was done using inflatable catheters. After this, suitable instruments had been developed to manage the lining elevation from the different anatomical surfaces encountered in sinuses. Tatum first presented the concept at The Alabama Implant Congress in Birmingham, Alabama in 1976 and presented the evolution of technique during multiple podium presentations each year until 1986 when he published an article describing the procedure. Dr. Philip Boyne was introduced to the procedure when he was invited, by Tatum, to be \"The Discusser\" of a presentation on sinus grafting given by Tatum at the annual meeting of The American Academy of Implant Dentistry in 1977 or 1978. Boyne and James authored the first publication on the technique in 1980 when they published case reports of autogenous grafts placed into the sinus and allowed to heal for 6 months, which was followed by the placement of blade implants. This sequence was confirmed by Boyne before the attendees at The Alabama Implant Congress in 1994.\n\nCost-effectiveness \nThe slightly higher effectiveness (implant survival) of the lateral sinus lift technique needs to be considered in relation to the substantially higher costs in comparison with the transalveolar sinus lift technique. From a patient perspective the higher invasiviness of the lateral technique will also be an important decision criterion. However, the transalveolar approach is unlikely to be effective in cases of advanced levels of bone reduction at the implant site.[19]\n\nReferences \n\n\n^ Boyne, PJ. De novo bone induction by recombinant human bone morphogenetic protein-2 (rhBMP-2) in maxillary sinus floor augmentation. J Oral Maxillofac Surg 2005;63:1693-1707 \n\n^ http:\/\/www.colgate.com\/en\/us\/oc\/oral-health\/cosmetic-dentistry\/implants\/article\/sinus-lift \n\n^ a b c d e Esposito, Marco; Felice, Pietro; Worthington, Helen V. (2014-05-13). \"Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus\". The Cochrane Database of Systematic Reviews (5): CD008397. doi:10.1002\/14651858.CD008397.pub2. ISSN 1469-493X. PMID 24825543. \n\n^ Brentwood Periodontists http:\/\/implantperiocenter.com\/patient-education\/sinus-augmentation-sinus-lift \n\n^ https:\/\/www.infusebonegraft.com\/omf_sinus_lift.html \n\n^ \"Sinus Lift\". colgate.com. \n\n^ \"Sinus Lift Surgery | Perio.org\". www.perio.org. Retrieved 2015-11-04 . \n\n^ Kumar, Prasanna; Vinitha, Belliappa; Fathima, Ghousia (2013-06-01). \"Bone grafts in dentistry\". Journal of Pharmacy & Bioallied Sciences. 5 (Suppl 1): S125\u2013S127. doi:10.4103\/0975-7406.113312. ISSN 0976-4879. PMC 3722694 . PMID 23946565. \n\n^ Hurley LA, Stinchfield FE, Bassett AL, Lyon WH (October 1959). \"The role of soft tissues in osteogenesis. An experimental study of canine spine fusions\". J Bone Joint Surg Am. 41-A: 1243\u201354. PMID 13852565. \n\n^ Riben C, Thor A (2016). \"Maxillary Sinus Implants without the Use of Graft Material\". Clin Implant Dent Relat Res. 18 (5): 895\u2013905. doi:10.1111\/cid.12360. PMID 26482214. \n\n^ SUMMERS, ROBERT B. (1998-05). \"Sinus Floor Elevation with Osteotomes\". Journal of Esthetic and Restorative Dentistry. 10 (3): 164\u2013171. doi:10.1111\/j.1708-8240.1998.tb00352.x. ISSN 1496-4155. Check date values in: |date= (help) \n\n^ Stacchi, Claudio; Lombardi, Teresa; Ottonelli, Roberto; Berton, Federico; Perinetti, Giuseppe; Traini, Tonino (2018-03-23). \"New bone formation after transcrestal sinus floor elevation was influenced by sinus cavity dimensions: A prospective histologic and histomorphometric study\". Clinical Oral Implants Research. 29 (5): 465\u2013479. doi:10.1111\/clr.13144. ISSN 1600-0501. \n\n^ Bruschi, G. B.; Scipioni, A.; Calesini, G.; Bruschi, E. (1998-3). \"Localized management of sinus floor with simultaneous implant placement: a clinical report\". The International Journal of Oral & Maxillofacial Implants. 13 (2): 219\u2013226. ISSN 0882-2786. PMID 9581408. Check date values in: |date= (help) \n\n^ Bruschi, Giovanni B.; Crespi, Roberto; Cappar\u00e8, Paolo; Bravi, Fabrizio; Bruschi, Ernesto; Gherlone, Enrico (2013-4). \"Localized management of sinus floor technique for implant placement in fresh molar sockets\". Clinical Implant Dentistry and Related Research. 15 (2): 243\u2013250. doi:10.1111\/j.1708-8208.2011.00348.x. ISSN 1708-8208. PMID 21599829. Check date values in: |date= (help) \n\n^ Crespi, Roberto; Cappar\u00e8, Paolo; Gherlone, Enrico Felice (2013-01-18). \"Electrical mallet provides essential advantages in split-crest and immediate implant placement\". Oral and Maxillofacial Surgery. 18 (1): 59\u201364. doi:10.1007\/s10006-013-0389-2. ISSN 1865-1550. \n\n^ Kharazmi M, Hallberg P. \"Secondary sinus lift: viable technique for when a membrane is raised without a graft, and fails\". Br J Oral Maxillofac Surg. \n\n^ Felisati, Giovanni, Chiapasco, Matteo, Lozza, Paolo, Saibene, Alberto Maria, Pipolo, Carlotta, Zaniboni, Matteo, Biglioli, Federico & Borloni, Roberto, (July 2013). \"Sinonasal complications resulting from dental treatment: outcome-oriented proposal of classification and surgical protocol\". American Journal of Rhinology and Allergy. 27 (4): e101. CS1 maint: Multiple names: authors list (link) \n\n^ \"404 Not Found\". atlantadentist.com. \n\n^ Listl S, Faggion CM (Aug 2010). \"An economic evaluation of different sinus lift techniques\". J Clin Periodontol. 37 (8): 777\u201387. doi:10.1111\/j.1600-051X.2010.01577.x. PMID 20546083. \n\n\nChen, Leon; Cha, Jennifer (2005). \"Journal of Periodontology March 2005,\". Journal of Periodontology. 76 (3): 482\u2013491. doi:10.1902\/jop.2005.76.3.482. \n\nChen, Leon, & Cha, Jennifer, (March 2005). \"An 8-Year Retrospective Study: 1,100 Patients Receiving 1,557 Implants using the Minimally Invasive Hydraulic Sinus Condensing Technique\". Innovations in Periodontics. 76 (3): 490. CS1 maint: Multiple names: authors list (link) \nRaghoebar GM, Timmenga NM, Reintsema H, Stegenga B, Vissink A (June 2001). \"Maxillary bone grafting for insertion of endosseous implants: results after 12-124 months\". Clin Oral Implants Res. 12 (3): 279\u201386. doi:10.1034\/j.1600-0501.2001.012003279.x. PMID 11359486. \n\"Bilateral Sinus Lifts with SynthoGraft Using Floor Transport Technique with Sinus Lift Temporary Abutments, Two Stage Placements, and Restoration with Twelve Maxillary Full Arch Integrated Abutment Crowns\". \nChen, Leon; Cha, Jennifer (2005). \"Journal of Periodontology\". Journal of Periodontology. 76 (3): 482\u2013491. doi:10.1902\/jop.2005.76.3.482. PMID 15857085. \nAbrahams, James J. (2000). Sinus Lift Procedure of the Maxilla in Patients with Inadequate Bone for Dental Implants \"American Journal of Roentgenology\" Check |url= value (help) . 174 (=5): 1289\u20131292. \nBoyne PJ, James RA (1980). \"Grafting of the maxillary sinus floor with autogenous marrow and bone\". J Oral Surg. 38: 613\u2013616. \nTatum H Jr (1986). \"Maxillary and sinus implant reconstructions\". Dent Clin North Am. 30: 207\u2013229. \nLazzara RJ. The sinus elevation procedure in endosseous implant therapy. Curr Opin Periodontol 1996; 3:178-183.\nSummers RB. A new concept in maxillary implant surgery: The osteotome technique. Compendium 1994;15:152, 154-156, 158 passim; quiz 162.\nSummers RB. The osteotome technique: Part 3 \u2013 Less invasive methods of elevating the sinus floor. Compendium 1994;15:698, 700, 702-694 passim; quiz 710.\nZitzmann NU, Scharer P (1998). \"Sinus elevation procedures in the resorbed posterior maxilla. Comparison of the crestal and lateral approaches\". Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 85 (1): 8\u201317. doi:10.1016\/s1079-2104(98)90391-2. PMID 9474608. \nRosen PS; Summers R; Mellado JR; et al. (1999). \"The bone added osteotome sinus floor elevation technique: Multicenter retrospective report of consecutively treated patients\". Int J Oral Maxillofac Implants. 14: 853\u2013858. \nFelisati G; Chiapasco M; Lozza P; et al. (2013). \"Sinonasal complications resulting from dental treatment: outcome-oriented proposal of classification and surgical protocol\". Am J Rhinol Allergy. 27 (4): e101\u2013106. doi:10.2500\/ajra.2013.27.3936. \nExternal links \nEducational Resources\n\nOsseoNews.com A detailed discussion on sinus lift procedures.\nSonosurgery.it Documented cases on sinus lift procedures with sonical instruments.\nvteDentistry involving supporting structures of teeth (Periodontology)Anatomy\nPeriodontium\nAlveolar bone\nBiologic width\nBundle bone\nCementum\nFree gingival margin\nGingiva\nGingival fibers\nGingival sulcus\nJunctional epithelium\nMucogingival junction\nPeriodontal ligament\nSulcular epithelium\nStippling\nDiseaseDiagnoses\nChronic periodontitis\nLocalized aggressive periodontitis\nGeneralized aggressive periodontitis\nPeriodontitis as a manifestation of systemic disease\nPeriodontosis\nNecrotizing periodontal diseases\nAbscesses of the periodontium\nCombined periodontic-endodontic lesions\nInfection\nA. actinomycetemcomitans\nCapnocytophaga sp.\nF. nucleatum\nP. gingivalis\nP. intermedia\nT. forsythia\nT. denticola\nRed complex\nEntamoeba gingivalis\nTrichomonas tenax\nOther\nCalculus\nClinical attachment loss\nEdentulism\nFremitus\nFurcation defect\nGingival enlargement\nGingival pocket\nGingival recession\nGingivitis\nHorizontal bony defect\nLinear gingival erythema\nOcclusal trauma\nPeriodontal pocket\nPeriodontal disease\nPeriodontitis\nPlaque\nVertical bony defect\nTreatment and prevention\nPeriodontal examination\nAnte's law\nBrushing\nBleeding on probing\nChlorhexidine gluconate\nFlossing\nHydrogen peroxide\nMouthwash\nOral hygiene\nTetracycline\nTriclosan\nHost modulatory therapy\nTreatmentConventional therapy\nDebridement\nScaling and root planing\nFull mouth disinfection\nFull mouth ultrasonic debridement\nSurgery\nApically positioned flap\nBone graft\nCoronally positioned flap\nCrown lengthening\nOpen flap debridement\nGingival graft\nGingivectomy\nGuided bone regeneration\nGuided tissue regeneration\nEnamel matrix derivative\nImplant placement\nLateral pedicle graft\nPocket reduction surgery\nSocket preservation\nSinus lift\nSubepithelial connective tissue graft\nTools\nCurette\nMembrane\nProbe\nScaler\nImportant personalities\nTomas Albrektsson\nFrank Beube\nPer-Ingvar Br\u00e5nemark\nRobert Gottsegen\nGary Greenstein\nJan Lindhe\nBrian Mealey\nPreston D. Miller\nWilloughby D. Miller\nCarl E. Misch\nJohn Mankey Riggs\nJay Seibert\nJ\u00f8rgen Slots\nPaul Roscoe Stillman\nDennis P. Tarnow\nHom-Lay Wang\nJames Leon Williams\nW. J. Younger\nOther specialties\nEndodontology\nOrthodontology\nProsthodontology\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sinus_lift\">https:\/\/www.limswiki.org\/index.php\/Sinus_lift<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 22:10.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 418 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","8e03f2269291576004ef47715a87e90d_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Sinus_lift skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Sinus lift<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Lateral_window_sinus_lift.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a3\/Lateral_window_sinus_lift.jpg\/220px-Lateral_window_sinus_lift.jpg\" width=\"220\" height=\"345\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Lateral_window_sinus_lift.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>1) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Edentulous\" class=\"mw-redirect\" title=\"Edentulous\" rel=\"external_link\" target=\"_blank\">Edentulous<\/a> area of two missing teeth is being prepared for future placement of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">dental implants<\/a> with a <b>lateral window sinus lift<\/b>; incisions into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gingiva\" class=\"mw-redirect\" title=\"Gingiva\" rel=\"external_link\" target=\"_blank\">soft tissue<\/a> are shown here.<br \/> 2) The soft tissue is flapped back to expose the underlying lateral wall of the left <a href=\"https:\/\/en.wikipedia.org\/wiki\/Maxillary_sinus\" title=\"Maxillary sinus\" rel=\"external_link\" target=\"_blank\">maxillary sinus<\/a>.<br \/> 3) The bone has been removed with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Piezoelectric\" class=\"mw-redirect\" title=\"Piezoelectric\" rel=\"external_link\" target=\"_blank\">piezoelectric<\/a> instrument, exposing the underlying <a href=\"https:\/\/en.wikipedia.org\/wiki\/Schneiderian_membrane\" title=\"Schneiderian membrane\" rel=\"external_link\" target=\"_blank\">Schneiderian membrane<\/a>, which is the lining of the maxillary sinus cavity.<br \/> 4) Through careful instrumentation, the membrane is carefully peeled from the inner aspect of the sinus cavity.<br \/> 5) The membrane has been reflected from the internal aspect of the inferior portion of the sinus cavity; one can now visualize the bony floor of the sinus cavity without its lining membrane (note the triangular ridge of bone within the sinus, known as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Underwood%27s_septum\" class=\"mw-redirect\" title=\"Underwood's septum\" rel=\"external_link\" target=\"_blank\">Underwood's septum<\/a>).<br \/> 6) The newly formed space within the bony cavity of the sinus yet inferior to the intact membrane is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_graft\" class=\"mw-redirect\" title=\"Bone graft\" rel=\"external_link\" target=\"_blank\">grafted<\/a> with human cadaver allograft bone. The floor of the sinus will now be roughly 10mm or so more superior than it was before, providing enough room to place dental implants into the edentulous site.<\/div><\/div><\/div>\n<p><b>Maxillary sinus floor augmentation<\/b><sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> (also termed <b>sinus lift<\/b>, <b>sinus graft<\/b>, <b>sinus augmentation<\/b> or <b>sinus procedure<\/b>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgical procedure<\/a> which aims to increase the amount of bone in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Commonly_used_terms_of_relationship_and_comparison_in_dentistry\" class=\"mw-redirect\" title=\"Commonly used terms of relationship and comparison in dentistry\" rel=\"external_link\" target=\"_blank\">posterior<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Maxilla\" title=\"Maxilla\" rel=\"external_link\" target=\"_blank\">maxilla<\/a> (upper jaw bone), in the area of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Premolar\" title=\"Premolar\" rel=\"external_link\" target=\"_blank\">premolar<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molar_(tooth)\" title=\"Molar (tooth)\" rel=\"external_link\" target=\"_blank\">molar<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Teeth\" class=\"mw-redirect\" title=\"Teeth\" rel=\"external_link\" target=\"_blank\">teeth<\/a>, by lifting the lower <a href=\"https:\/\/en.wikipedia.org\/wiki\/Schneiderian_membrane\" title=\"Schneiderian membrane\" rel=\"external_link\" target=\"_blank\">Schneiderian membrane<\/a> (sinus membrane) and placing a bone graft.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>When a tooth is lost the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alveolar_process\" title=\"Alveolar process\" rel=\"external_link\" target=\"_blank\">alveolar process<\/a> begins to remodel. The vacant tooth socket collapses as it heals leaving an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Edentulous\" class=\"mw-redirect\" title=\"Edentulous\" rel=\"external_link\" target=\"_blank\">edentulous<\/a> (toothless) area, termed a <i>ridge<\/i>. This collapse causes a loss in both height and width of the surrounding bone. In addition, when a maxillary molar or premolar is lost, the floor of the maxillary sinus expands, which further diminishes the thickness of the underlying bone. Overall, this leads to a loss in volume of bone that is available for implantation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">dental implants<\/a>, which rely on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseointegration\" title=\"Osseointegration\" rel=\"external_link\" target=\"_blank\">osseointegration<\/a> (bone integration), to replace missing teeth. The goal of the sinus lift is to graft extra bone into the maxillary sinus, so more bone is available to support a dental implant.<sup id=\"rdp-ebb-cite_ref-Esposito2016_3-0\" class=\"reference\"><a href=\"#cite_note-Esposito2016-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h2>\n<p>While there may be a number of reasons for wanting a greater volume of bone in the posterior maxilla, the most common reason in contemporary dental treatment planning is to prepare the site for the future placement of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">dental implants<\/a>.\n<\/p><p>Sinus augmentation (sinus lift) is performed when the floor of the sinus is too close to an area where dental implants are to be placed. This procedure is performed to ensure a secure place for the implants while protecting the sinus. Lowering of the sinus can be caused by: Long-term tooth loss without the required treatment, periodontal disease, trauma.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>Patients who have the following may be good candidates for sinus augmentation.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<ul><li>Lost more than one tooth in the posterior maxilla.<\/li>\n<li>Lost a significant amount of bone in the posterior maxilla.<\/li>\n<li>Missing teeth due to genetics or birth defect.<\/li>\n<li>Minus most of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Maxilla\" title=\"Maxilla\" rel=\"external_link\" target=\"_blank\">maxillary<\/a> teeth and need a strong sinus floor for multiple implants.<\/li><\/ul>\n<p>It is not known if using sinus lift techniques is more successful than using short implants for reducing the number of artificial teeth or dental implant failures up to a year after teeth\/implant placement.<sup id=\"rdp-ebb-cite_ref-Esposito2016_3-1\" class=\"reference\"><a href=\"#cite_note-Esposito2016-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technique\">Technique<\/span><\/h2>\n<p>Prior to undergoing sinus augmentation, diagnostics are run to determine the health of the patient's sinuses. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Panoramic_radiograph\" title=\"Panoramic radiograph\" rel=\"external_link\" target=\"_blank\">Panoramic radiographs<\/a> are taken to map out the patient's upper jaw and sinuses. In special instances, a computed tomography or <a href=\"https:\/\/en.wikipedia.org\/wiki\/CT_scan\" title=\"CT scan\" rel=\"external_link\" target=\"_blank\">CT scan<\/a> is taken to measure the sinus's height and width, and to rule out any sinus disease or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pathology\" title=\"Pathology\" rel=\"external_link\" target=\"_blank\">pathology<\/a>.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>There are several variations of the sinus lift technique.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Traditional_Sinus_Augmentation_or_Lateral_Window_Technique\">Traditional Sinus Augmentation or Lateral Window Technique<\/span><\/h3>\n<p>There are multiple ways to perform sinus augmentation. The procedure is performed from inside the patient's mouth where the surgeon makes an incision into the gum, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gingiva\" class=\"mw-redirect\" title=\"Gingiva\" rel=\"external_link\" target=\"_blank\">gingiva<\/a>. Once the incision is made, the surgeon then pulls back the gum tissue, exposing the lateral boney wall of the sinus. The surgeon then cuts a \"window\" to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sinus_(anatomy)\" title=\"Sinus (anatomy)\" rel=\"external_link\" target=\"_blank\">sinus<\/a>, which is exposing the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Schneiderian_membrane\" title=\"Schneiderian membrane\" rel=\"external_link\" target=\"_blank\">Schneiderian membrane<\/a>. The membrane is separated from the bone, and bone graft material is placed into the newly created space. The gums are then sutured close and the graft is left to heal for 4\u201312 months.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>The graft material used can be either an autograft, an allograft, a xenograft, an alloplast (a growth-factor infused collagen matrix), synthetic variants, or combinations thereof.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> Studies indicate that the mere lifting of the sinus membrane, creation of a void space and blood clot formation might result in new bone owing to the principles of guided bone regeneration.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> The long-term prognosis for the technique is estimated to 94%.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Osteotome_Technique\">Osteotome Technique<\/span><\/h3>\n<p>As an alternative, sinus augmentation can be performed by a less invasive osteotome technique. There are several variations of this technique and all originate from the original technique of Dr. Tatum, first published by Dr.s Boyne and James in 1980.\n<\/p><p>Dr. Robert B. Summers<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> described a technique that is normally performed when the sinus floor that needs to be lifted is less than 4 mm. This technique is performed by flapping back gum tissue and making a socket in the bone within 1\u20132 mm short of the sinus membrane. The floor of the sinus is then lifted by tapping the sinus floor with the use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteotome\" title=\"Osteotome\" rel=\"external_link\" target=\"_blank\">osteotomes<\/a>. The amount of augmentation achieved with the osteotome technique is usually less than what can be achieved with the lateral window technique.\n<p>A dental implant is normally placed in the socket formed at the time of the sinus lift procedure and left to integrate with bone. Bone integration normally lasts 4 to 8 months. The goal of this procedure is to stimulate bone growth and form a thicker sinus floor, in order to support dental implants for teeth replacement.\nSinus dimensions and shape significantly influence new bone formation after transcrestal sinus floor elevation: with this technique, the regeneration of a substantial amount of new bone is a predictable outcome only in narrow sinus cavities. During presurgical planning, bucco- palatal sinus width should be regarded as a crucial parameter when choosing sinus floor elevation with transcrestal approach as a treatment option.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<\/p><p>Dr. Bruschi and Scipioni<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> described a similiar technique (Localized Management of Sinus Floor or L.M.S.F.) that is based on a partial thickness flap procedure. This technique increases the malleability of the crestal bone and uses not the bone directly below the sinus, but rather the bone on the medial wall, and thus can be used in more extreme cases of bone resorption that would normally need to be treated with the lateral wall technique. The healing period is reduced to 1.5 to 3 months. Recently an electrical mallet<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> has been introduced to simplify the application of this and similiar techniques.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Complications\">Complications<\/span><\/h2>\n<p>A major risk of a sinus augmentation is that the sinus membrane could be pierced or ripped. Remedies, should this occur, include stitching the tear or placing a patch over it; in some cases, the surgery is stopped altogether and the tear is given time to heal, usually three to six months. Often, the sinus membrane grows back thicker and stronger, making success more likely on the second operation.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2013)\">citation needed<\/span><\/a><\/i>]<\/sup> Although rarely reported, such secondary intervention can also be successful when the primary surgery is limited to elevation of the membrane without the insertion of additional material.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>Besides tearing of the sinus membrane, there are other risks involved in sinus augmentation surgery. Most notably, the close relationship of the augmentation site with the sinonasal complex can induce sinusitis, which may chronicize and cause severe symptoms. Sinusitis resulting from maxillary sinus augmentation is considered a Class 1 sinonasal complication according to Felisati classification and should be addressed surgically with a combined endoscopic endonasal and endoral approach.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> Beside sinusitis, among other procedure related-risks include:\n<\/p>\n<ul><li>Infection<sup id=\"rdp-ebb-cite_ref-Esposito2016_3-2\" class=\"reference\"><a href=\"#cite_note-Esposito2016-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li>\n<li>Inflammation<\/li>\n<li>Pain<\/li>\n<li>Itching<\/li>\n<li>Allergic reaction<\/li>\n<li>Tissue or nerve damage<sup id=\"rdp-ebb-cite_ref-Esposito2016_3-3\" class=\"reference\"><a href=\"#cite_note-Esposito2016-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li>\n<li>Scar formation<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hematoma\" title=\"Hematoma\" rel=\"external_link\" target=\"_blank\">Hematoma<\/a><\/li>\n<li>Graft failure<\/li>\n<li> \/ oro-antral fistula<\/li>\n<li>Tilting or loosening of implants<\/li>\n<li>Bleeding<sup id=\"rdp-ebb-cite_ref-Esposito2016_3-4\" class=\"reference\"><a href=\"#cite_note-Esposito2016-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Recovery\">Recovery<\/span><\/h2>\n<p>It takes about three to six months for the sinus augmentation bone to become part of the patient's natural sinus floor bone. Up to six months of healing is sometimes left before implants are attempted. However, some surgeons perform both the augmentation and dental implant simultaneously, to avoid the necessity of two surgeries.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The first maxillary sinus floor augmentation procedure was performed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hilt_Tatum\" title=\"Hilt Tatum\" rel=\"external_link\" target=\"_blank\">Oscar Hilt Tatum, Jr.<\/a> in 1974.\n<\/p><p>A sinus-lift procedure was first performed by Dr. Hilt Tatum Jr. in 1974 during his period of preparation to begin sinus grafting. The first sinus graft was done by Tatum in February, 1975 in Lee County Hospital in Opelika, Alabama. This was followed by the placement and successful restoration of two endosteal implants. Between 1975\u20131979, much of the sinus lining elevation was done using inflatable catheters. After this, suitable instruments had been developed to manage the lining elevation from the different anatomical surfaces encountered in sinuses. Tatum first presented the concept at The Alabama Implant Congress in Birmingham, Alabama in 1976 and presented the evolution of technique during multiple podium presentations each year until 1986 when he published an article describing the procedure. Dr. Philip Boyne was introduced to the procedure when he was invited, by Tatum, to be \"The Discusser\" of a presentation on sinus grafting given by Tatum at the annual meeting of The American Academy of Implant Dentistry in 1977 or 1978. Boyne and James authored the first publication on the technique in 1980 when they published case reports of autogenous grafts placed into the sinus and allowed to heal for 6 months, which was followed by the placement of blade implants. This sequence was confirmed by Boyne before the attendees at The Alabama Implant Congress in 1994.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Cost-effectiveness\">Cost-effectiveness<\/span><\/h2>\n<p>The slightly higher effectiveness (implant survival) of the lateral sinus lift technique needs to be considered in relation to the substantially higher costs in comparison with the transalveolar sinus lift technique. From a patient perspective the higher invasiviness of the lateral technique will also be an important decision criterion. However, the transalveolar approach is unlikely to be effective in cases of advanced levels of bone reduction at the implant site.<sup id=\"rdp-ebb-cite_ref-PMID20546083_19-0\" class=\"reference\"><a href=\"#cite_note-PMID20546083-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Boyne, PJ. <u>De novo bone induction by recombinant human bone morphogenetic protein-2 (rhBMP-2) in maxillary sinus floor augmentation<\/u>. <i>J Oral Maxillofac Surg<\/i> 2005;63:1693-1707<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.colgate.com\/en\/us\/oc\/oral-health\/cosmetic-dentistry\/implants\/article\/sinus-lift\" target=\"_blank\">http:\/\/www.colgate.com\/en\/us\/oc\/oral-health\/cosmetic-dentistry\/implants\/article\/sinus-lift<\/a><\/span>\n<\/li>\n<li id=\"cite_note-Esposito2016-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Esposito2016_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Esposito2016_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Esposito2016_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Esposito2016_3-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Esposito2016_3-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Esposito, Marco; Felice, Pietro; Worthington, Helen V. (2014-05-13). \"Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus\". <i>The Cochrane Database of Systematic Reviews<\/i> (5): CD008397. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD008397.pub2\" target=\"_blank\">10.1002\/14651858.CD008397.pub2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1469-493X\" target=\"_blank\">1469-493X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24825543\" target=\"_blank\">24825543<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Interventions+for+replacing+missing+teeth%3A+augmentation+procedures+of+the+maxillary+sinus&rft.issue=5&rft.pages=CD008397&rft.date=2014-05-13&rft.issn=1469-493X&rft_id=info%3Apmid%2F24825543&rft_id=info%3Adoi%2F10.1002%2F14651858.CD008397.pub2&rft.aulast=Esposito&rft.aufirst=Marco&rft.au=Felice%2C+Pietro&rft.au=Worthington%2C+Helen+V.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Brentwood Periodontists <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/implantperiocenter.com\/patient-education\/sinus-augmentation-sinus-lift\" target=\"_blank\">http:\/\/implantperiocenter.com\/patient-education\/sinus-augmentation-sinus-lift<\/a><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.infusebonegraft.com\/omf_sinus_lift.html\" target=\"_blank\">https:\/\/www.infusebonegraft.com\/omf_sinus_lift.html<\/a><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.colgate.com\/app\/Colgate\/US\/OC\/Information\/OralHealthBasics\/CheckupsDentProc\/DenturesAndDentalImplants\/SinusLift.cvsp\" target=\"_blank\">\"Sinus Lift\"<\/a>. <i>colgate.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=colgate.com&rft.atitle=Sinus+Lift&rft_id=http%3A%2F%2Fwww.colgate.com%2Fapp%2FColgate%2FUS%2FOC%2FInformation%2FOralHealthBasics%2FCheckupsDentProc%2FDenturesAndDentalImplants%2FSinusLift.cvsp&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.perio.org\/consumer\/sinus-augmentation\" target=\"_blank\">\"Sinus Lift Surgery | Perio.org\"<\/a>. <i>www.perio.org<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-11-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.perio.org&rft.atitle=Sinus+Lift+Surgery+%7C+Perio.org&rft_id=https%3A%2F%2Fwww.perio.org%2Fconsumer%2Fsinus-augmentation&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kumar, Prasanna; Vinitha, Belliappa; Fathima, Ghousia (2013-06-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3722694\" target=\"_blank\">\"Bone grafts in dentistry\"<\/a>. <i>Journal of Pharmacy & Bioallied Sciences<\/i>. <b>5<\/b> (Suppl 1): S125\u2013S127. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4103%2F0975-7406.113312\" target=\"_blank\">10.4103\/0975-7406.113312<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0976-4879\" target=\"_blank\">0976-4879<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3722694\" target=\"_blank\">3722694<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23946565\" target=\"_blank\">23946565<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Pharmacy+%26+Bioallied+Sciences&rft.atitle=Bone+grafts+in+dentistry&rft.volume=5&rft.issue=Suppl+1&rft.pages=S125-S127&rft.date=2013-06-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3722694&rft.issn=0976-4879&rft_id=info%3Apmid%2F23946565&rft_id=info%3Adoi%2F10.4103%2F0975-7406.113312&rft.aulast=Kumar&rft.aufirst=Prasanna&rft.au=Vinitha%2C+Belliappa&rft.au=Fathima%2C+Ghousia&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3722694&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hurley LA, Stinchfield FE, Bassett AL, Lyon WH (October 1959). \"The role of soft tissues in osteogenesis. An experimental study of canine spine fusions\". <i>J Bone Joint Surg Am<\/i>. <b>41-A<\/b>: 1243\u201354. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/13852565\" target=\"_blank\">13852565<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Am&rft.atitle=The+role+of+soft+tissues+in+osteogenesis.+An+experimental+study+of+canine+spine+fusions&rft.volume=41-A&rft.pages=1243-54&rft.date=1959-10&rft_id=info%3Apmid%2F13852565&rft.aulast=Hurley&rft.aufirst=LA&rft.au=Stinchfield%2C+FE&rft.au=Bassett%2C+AL&rft.au=Lyon%2C+WH&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Riben C, Thor A (2016). \"Maxillary Sinus Implants without the Use of Graft Material\". <i>Clin Implant Dent Relat Res<\/i>. <b>18<\/b> (5): 895\u2013905. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fcid.12360\" target=\"_blank\">10.1111\/cid.12360<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26482214\" target=\"_blank\">26482214<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clin+Implant+Dent+Relat+Res&rft.atitle=Maxillary+Sinus+Implants+without+the+Use+of+Graft+Material&rft.volume=18&rft.issue=5&rft.pages=895-905&rft.date=2016&rft_id=info%3Adoi%2F10.1111%2Fcid.12360&rft_id=info%3Apmid%2F26482214&rft.aulast=Riben&rft.aufirst=C&rft.au=Thor%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">SUMMERS, ROBERT B. (1998-05). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/j.1708-8240.1998.tb00352.x\" target=\"_blank\">\"Sinus Floor Elevation with Osteotomes\"<\/a>. <i>Journal of Esthetic and Restorative Dentistry<\/i>. <b>10<\/b> (3): 164\u2013171. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1708-8240.1998.tb00352.x\" target=\"_blank\">10.1111\/j.1708-8240.1998.tb00352.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1496-4155\" target=\"_blank\">1496-4155<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Esthetic+and+Restorative+Dentistry&rft.atitle=Sinus+Floor+Elevation+with+Osteotomes&rft.chron=1998-05&rft.volume=10&rft.issue=3&rft.pages=164-171&rft_id=info%3Adoi%2F10.1111%2Fj.1708-8240.1998.tb00352.x&rft.issn=1496-4155&rft.aulast=SUMMERS&rft.aufirst=ROBERT+B.&rft_id=https%3A%2F%2Fonlinelibrary.wiley.com%2Fdoi%2Fabs%2F10.1111%2Fj.1708-8240.1998.tb00352.x&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span> <span class=\"cs1-visible-error error citation-comment\">Check date values in: <code class=\"cs1-code\">|date=<\/code> (<a href=\"#bad_date\" title=\"Help:CS1 errors\" rel=\"external_link\">help<\/a>)<\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stacchi, Claudio; Lombardi, Teresa; Ottonelli, Roberto; Berton, Federico; Perinetti, Giuseppe; Traini, Tonino (2018-03-23). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/clr.13144\" target=\"_blank\">\"New bone formation after transcrestal sinus floor elevation was influenced by sinus cavity dimensions: A prospective histologic and histomorphometric study\"<\/a>. <i>Clinical Oral Implants Research<\/i>. <b>29<\/b> (5): 465\u2013479. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fclr.13144\" target=\"_blank\">10.1111\/clr.13144<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1600-0501\" target=\"_blank\">1600-0501<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Oral+Implants+Research&rft.atitle=New+bone+formation+after+transcrestal+sinus+floor+elevation+was+influenced+by+sinus+cavity+dimensions%3A+A+prospective+histologic+and+histomorphometric+study.&rft.volume=29&rft.issue=5&rft.pages=465-479&rft.date=2018-03-23&rft_id=info%3Adoi%2F10.1111%2Fclr.13144&rft.issn=1600-0501&rft.aulast=Stacchi&rft.aufirst=Claudio&rft.au=Lombardi%2C+Teresa&rft.au=Ottonelli%2C+Roberto&rft.au=Berton%2C+Federico&rft.au=Perinetti%2C+Giuseppe&rft.au=Traini%2C+Tonino&rft_id=https%3A%2F%2Fonlinelibrary.wiley.com%2Fdoi%2Fabs%2F10.1111%2Fclr.13144&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bruschi, G. B.; Scipioni, A.; Calesini, G.; Bruschi, E. (1998-3). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9581408\" target=\"_blank\">\"Localized management of sinus floor with simultaneous implant placement: a clinical report\"<\/a>. <i>The International Journal of Oral & Maxillofacial Implants<\/i>. <b>13<\/b> (2): 219\u2013226. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0882-2786\" target=\"_blank\">0882-2786<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9581408\" target=\"_blank\">9581408<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+International+Journal+of+Oral+%26+Maxillofacial+Implants&rft.atitle=Localized+management+of+sinus+floor+with+simultaneous+implant+placement%3A+a+clinical+report&rft.chron=1998-3&rft.volume=13&rft.issue=2&rft.pages=219-226&rft_id=info%3Apmid%2F9581408&rft.issn=0882-2786&rft.aulast=Bruschi&rft.aufirst=G.+B.&rft.au=Scipioni%2C+A.&rft.au=Calesini%2C+G.&rft.au=Bruschi%2C+E.&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F9581408&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span> <span class=\"cs1-visible-error error citation-comment\">Check date values in: <code class=\"cs1-code\">|date=<\/code> (<a href=\"#bad_date\" title=\"Help:CS1 errors\" rel=\"external_link\">help<\/a>)<\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bruschi, Giovanni B.; Crespi, Roberto; Cappar\u00e8, Paolo; Bravi, Fabrizio; Bruschi, Ernesto; Gherlone, Enrico (2013-4). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21599829\" target=\"_blank\">\"Localized management of sinus floor technique for implant placement in fresh molar sockets\"<\/a>. <i>Clinical Implant Dentistry and Related Research<\/i>. <b>15<\/b> (2): 243\u2013250. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1708-8208.2011.00348.x\" target=\"_blank\">10.1111\/j.1708-8208.2011.00348.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1708-8208\" target=\"_blank\">1708-8208<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21599829\" target=\"_blank\">21599829<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Implant+Dentistry+and+Related+Research&rft.atitle=Localized+management+of+sinus+floor+technique+for+implant+placement+in+fresh+molar+sockets&rft.chron=2013-4&rft.volume=15&rft.issue=2&rft.pages=243-250&rft.issn=1708-8208&rft_id=info%3Apmid%2F21599829&rft_id=info%3Adoi%2F10.1111%2Fj.1708-8208.2011.00348.x&rft.aulast=Bruschi&rft.aufirst=Giovanni+B.&rft.au=Crespi%2C+Roberto&rft.au=Cappar%C3%A8%2C+Paolo&rft.au=Bravi%2C+Fabrizio&rft.au=Bruschi%2C+Ernesto&rft.au=Gherlone%2C+Enrico&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F21599829&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span> <span class=\"cs1-visible-error error citation-comment\">Check date values in: <code class=\"cs1-code\">|date=<\/code> (<a href=\"#bad_date\" title=\"Help:CS1 errors\" rel=\"external_link\">help<\/a>)<\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Crespi, Roberto; Cappar\u00e8, Paolo; Gherlone, Enrico Felice (2013-01-18). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/link.springer.com\/article\/10.1007%2Fs10006-013-0389-2\" target=\"_blank\">\"Electrical mallet provides essential advantages in split-crest and immediate implant placement\"<\/a>. <i>Oral and Maxillofacial Surgery<\/i>. <b>18<\/b> (1): 59\u201364. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs10006-013-0389-2\" target=\"_blank\">10.1007\/s10006-013-0389-2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1865-1550\" target=\"_blank\">1865-1550<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Oral+and+Maxillofacial+Surgery&rft.atitle=Electrical+mallet+provides+essential+advantages+in+split-crest+and+immediate+implant+placement&rft.volume=18&rft.issue=1&rft.pages=59-64&rft.date=2013-01-18&rft_id=info%3Adoi%2F10.1007%2Fs10006-013-0389-2&rft.issn=1865-1550&rft.aulast=Crespi&rft.aufirst=Roberto&rft.au=Cappar%C3%A8%2C+Paolo&rft.au=Gherlone%2C+Enrico+Felice&rft_id=https%3A%2F%2Flink.springer.com%2Farticle%2F10.1007%252Fs10006-013-0389-2&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kharazmi M, Hallberg P. \"Secondary sinus lift: viable technique for when a membrane is raised without a graft, and fails\". <i>Br J Oral Maxillofac Surg<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Br+J+Oral+Maxillofac+Surg&rft.atitle=Secondary+sinus+lift%3A+viable+technique+for+when+a+membrane+is+raised+without+a+graft%2C+and+fails.&rft.aulast=Kharazmi&rft.aufirst=M&rft.au=Hallberg%2C+P&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Felisati, Giovanni, Chiapasco, Matteo, Lozza, Paolo, Saibene, Alberto Maria, Pipolo, Carlotta, Zaniboni, Matteo, Biglioli, Federico & Borloni, Roberto, (July 2013). \"Sinonasal complications resulting from dental treatment: outcome-oriented proposal of classification and surgical protocol\". <i>American Journal of Rhinology and Allergy<\/i>. <b>27<\/b> (4): e101.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Rhinology+and+Allergy&rft.atitle=Sinonasal+complications+resulting+from+dental+treatment%3A+outcome-oriented+proposal+of+classification+and+surgical+protocol&rft.volume=27&rft.issue=4&rft.pages=e101&rft.date=2013-07&rft.au=Felisati%2C+Giovanni%2C+Chiapasco%2C+Matteo%2C+Lozza%2C+Paolo%2C+Saibene%2C+Alberto+Maria%2C+Pipolo%2C+Carlotta%2C+Zaniboni%2C+Matteo%2C+Biglioli%2C+Federico+%26+Borloni%2C+Roberto%2C&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.atlantadentist.com\/Sinus_Augmentation.html\" target=\"_blank\">\"404 Not Found\"<\/a>. <i>atlantadentist.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=atlantadentist.com&rft.atitle=404+Not+Found&rft_id=http%3A%2F%2Fwww.atlantadentist.com%2FSinus_Augmentation.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-PMID20546083-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-PMID20546083_19-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Listl S, Faggion CM (Aug 2010). \"An economic evaluation of different sinus lift techniques\". <i>J Clin Periodontol<\/i>. <b>37<\/b> (8): 777\u201387. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1600-051X.2010.01577.x\" target=\"_blank\">10.1111\/j.1600-051X.2010.01577.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20546083\" target=\"_blank\">20546083<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Clin+Periodontol&rft.atitle=An+economic+evaluation+of+different+sinus+lift+techniques&rft.volume=37&rft.issue=8&rft.pages=777-87&rft.date=2010-08&rft_id=info%3Adoi%2F10.1111%2Fj.1600-051X.2010.01577.x&rft_id=info%3Apmid%2F20546083&rft.aulast=Listl&rft.aufirst=S&rft.au=Faggion%2C+CM&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<p><cite class=\"citation journal\">Chen, Leon; Cha, Jennifer (2005). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.joponline.org\/doi\/abs\/10.1902\/jop.2005.76.3.482?journalCode=jop\" target=\"_blank\">\"Journal of Periodontology March 2005,\"<\/a>. <i>Journal of Periodontology<\/i>. <b>76<\/b> (3): 482\u2013491. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1902%2Fjop.2005.76.3.482\" target=\"_blank\">10.1902\/jop.2005.76.3.482<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Periodontology&rft.atitle=Journal+of+Periodontology+March+2005%2C&rft.volume=76&rft.issue=3&rft.pages=482-491&rft.date=2005&rft_id=info%3Adoi%2F10.1902%2Fjop.2005.76.3.482&rft.aulast=Chen&rft.aufirst=Leon&rft.au=Cha%2C+Jennifer&rft_id=http%3A%2F%2Fwww.joponline.org%2Fdoi%2Fabs%2F10.1902%2Fjop.2005.76.3.482%3FjournalCode%3Djop&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>\n<\/p>\n<ul><li><cite class=\"citation journal\">Chen, Leon, & Cha, Jennifer, (March 2005). \"An 8-Year Retrospective Study: 1,100 Patients Receiving 1,557 Implants using the Minimally Invasive Hydraulic Sinus Condensing Technique\". <i>Innovations in Periodontics<\/i>. <b>76<\/b> (3): 490.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Innovations+in+Periodontics&rft.atitle=An+8-Year+Retrospective+Study%3A+1%2C100+Patients+Receiving+1%2C557+Implants+using+the+Minimally+Invasive+Hydraulic+Sinus+Condensing+Technique&rft.volume=76&rft.issue=3&rft.pages=490&rft.date=2005-03&rft.au=Chen%2C+Leon%2C+%26+Cha%2C+Jennifer%2C&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Raghoebar GM, Timmenga NM, Reintsema H, Stegenga B, Vissink A (June 2001). \"Maxillary bone grafting for insertion of endosseous implants: results after 12-124 months\". <i>Clin Oral Implants Res<\/i>. <b>12<\/b> (3): 279\u201386. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1034%2Fj.1600-0501.2001.012003279.x\" target=\"_blank\">10.1034\/j.1600-0501.2001.012003279.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11359486\" target=\"_blank\">11359486<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clin+Oral+Implants+Res&rft.atitle=Maxillary+bone+grafting+for+insertion+of+endosseous+implants%3A+results+after+12-124+months&rft.volume=12&rft.issue=3&rft.pages=279-86&rft.date=2001-06&rft_id=info%3Adoi%2F10.1034%2Fj.1600-0501.2001.012003279.x&rft_id=info%3Apmid%2F11359486&rft.aulast=Raghoebar&rft.aufirst=GM&rft.au=Timmenga%2C+NM&rft.au=Reintsema%2C+H&rft.au=Stegenga%2C+B&rft.au=Vissink%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bicon.com\/cases\/GWH.html\" target=\"_blank\">\"Bilateral Sinus Lifts with SynthoGraft Using Floor Transport Technique with Sinus Lift Temporary Abutments, Two Stage Placements, and Restoration with Twelve Maxillary Full Arch Integrated Abutment Crowns\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Bilateral+Sinus+Lifts+with+SynthoGraft+Using+Floor+Transport+Technique+with+Sinus+Lift+Temporary+Abutments%2C+Two+Stage+Placements%2C+and+Restoration+with+Twelve+Maxillary+Full+Arch+Integrated+Abutment+Crowns&rft_id=http%3A%2F%2Fwww.bicon.com%2Fcases%2FGWH.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Chen, Leon; Cha, Jennifer (2005). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.joponline.org\/doi\/abs\/10.1902\/jop.2005.76.3.482?journalCode=jop\" target=\"_blank\">\"Journal of Periodontology\"<\/a>. <i>Journal of Periodontology<\/i>. <b>76<\/b> (3): 482\u2013491. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1902%2Fjop.2005.76.3.482\" target=\"_blank\">10.1902\/jop.2005.76.3.482<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15857085\" target=\"_blank\">15857085<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Periodontology&rft.atitle=Journal+of+Periodontology&rft.volume=76&rft.issue=3&rft.pages=482-491&rft.date=2005&rft_id=info%3Adoi%2F10.1902%2Fjop.2005.76.3.482&rft_id=info%3Apmid%2F15857085&rft.aulast=Chen&rft.aufirst=Leon&rft.au=Cha%2C+Jennifer&rft_id=http%3A%2F%2Fwww.joponline.org%2Fdoi%2Fabs%2F10.1902%2Fjop.2005.76.3.482%3FjournalCode%3Djop&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Abrahams, James J. (2000). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ajronline.org\/cgi\/content\/full\/174\/5\/1289\" target=\"_blank\"><i>Sinus Lift Procedure of the Maxilla in Patients with Inadequate Bone for Dental Implants<\/i> \"American Journal of Roentgenology\"<\/a><span class=\"cs1-visible-error error citation-comment\"> Check <code class=\"cs1-code\">|url=<\/code> value (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Help:CS1_errors#bad_url\" title=\"Help:CS1 errors\" rel=\"external_link\" target=\"_blank\">help<\/a>)<\/span>. <b>174<\/b> (=5): 1289\u20131292.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=American+Journal+of+Roentgenology&rft.volume=174&rft.issue=%3D5&rft.pages=1289-1292&rft.date=2000&rft.au=Abrahams%2C+James+J.&rft_id=http%3A%2F%2Fwww.ajronline.org%2Fcgi%2Fcontent%2Ffull%2F174%2F5%2F1289+%27%27Sinus+Lift+Procedure+of+the+Maxilla+in+Patients+with+Inadequate+Bone+for+Dental+Implants%27%27&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Boyne PJ, James RA (1980). \"Grafting of the maxillary sinus floor with autogenous marrow and bone\". <i>J Oral Surg<\/i>. <b>38<\/b>: 613\u2013616.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Oral+Surg&rft.atitle=Grafting+of+the+maxillary+sinus+floor+with+autogenous+marrow+and+bone&rft.volume=38&rft.pages=613-616&rft.date=1980&rft.aulast=Boyne&rft.aufirst=PJ&rft.au=James%2C+RA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Tatum H Jr (1986). \"Maxillary and sinus implant reconstructions\". <i>Dent Clin North Am<\/i>. <b>30<\/b>: 207\u2013229.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Dent+Clin+North+Am&rft.atitle=Maxillary+and+sinus+implant+reconstructions&rft.volume=30&rft.pages=207-229&rft.date=1986&rft.au=Tatum+H+Jr&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li>Lazzara RJ. The sinus elevation procedure in endosseous implant therapy. Curr Opin Periodontol 1996; 3:178-183.<\/li>\n<li>Summers RB. A new concept in maxillary implant surgery: The osteotome technique. Compendium 1994;15:152, 154-156, 158 passim; quiz 162.<\/li>\n<li>Summers RB. The osteotome technique: Part 3 \u2013 Less invasive methods of elevating the sinus floor. Compendium 1994;15:698, 700, 702-694 passim; quiz 710.<\/li>\n<li><cite class=\"citation journal\">Zitzmann NU, Scharer P (1998). \"Sinus elevation procedures in the resorbed posterior maxilla. Comparison of the crestal and lateral approaches\". <i>Oral Surg Oral Med Oral Pathol Oral Radiol Endod<\/i>. <b>85<\/b> (1): 8\u201317. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fs1079-2104%2898%2990391-2\" target=\"_blank\">10.1016\/s1079-2104(98)90391-2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9474608\" target=\"_blank\">9474608<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Oral+Surg+Oral+Med+Oral+Pathol+Oral+Radiol+Endod&rft.atitle=Sinus+elevation+procedures+in+the+resorbed+posterior+maxilla.+Comparison+of+the+crestal+and+lateral+approaches&rft.volume=85&rft.issue=1&rft.pages=8-17&rft.date=1998&rft_id=info%3Adoi%2F10.1016%2Fs1079-2104%2898%2990391-2&rft_id=info%3Apmid%2F9474608&rft.aulast=Zitzmann&rft.aufirst=NU&rft.au=Scharer%2C+P&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Rosen PS; Summers R; Mellado JR; et al. (1999). \"The bone added osteotome sinus floor elevation technique: Multicenter retrospective report of consecutively treated patients\". <i>Int J Oral Maxillofac Implants<\/i>. <b>14<\/b>: 853\u2013858.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Int+J+Oral+Maxillofac+Implants&rft.atitle=The+bone+added+osteotome+sinus+floor+elevation+technique%3A+Multicenter+retrospective+report+of+consecutively+treated+patients&rft.volume=14&rft.pages=853-858&rft.date=1999&rft.au=Rosen+PS&rft.au=Summers+R&rft.au=Mellado+JR&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Felisati G; Chiapasco M; Lozza P; et al. (2013). \"Sinonasal complications resulting from dental treatment: outcome-oriented proposal of classification and surgical protocol\". <i>Am J Rhinol Allergy<\/i>. <b>27<\/b> (4): e101\u2013106. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2500%2Fajra.2013.27.3936\" target=\"_blank\">10.2500\/ajra.2013.27.3936<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Am+J+Rhinol+Allergy&rft.atitle=Sinonasal+complications+resulting+from+dental+treatment%3A+outcome-oriented+proposal+of+classification+and+surgical+protocol&rft.volume=27&rft.issue=4&rft.pages=e101-106&rft.date=2013&rft_id=info%3Adoi%2F10.2500%2Fajra.2013.27.3936&rft.au=Felisati+G&rft.au=Chiapasco+M&rft.au=Lozza+P&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+lift\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<p><b>Educational Resources<\/b>\n<\/p>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.osseonews.com\/sinus-lift-or-no-lift\/\" target=\"_blank\">OsseoNews.com<\/a> A detailed discussion on sinus lift procedures.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sonosurgery.it\/en\/Clinical-Cases\/sinus-lift.html\" target=\"_blank\">Sonosurgery.it<\/a> Documented cases on sinus lift procedures with sonical instruments.<\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1262\nCached time: 20181216181150\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.504 seconds\nReal time usage: 0.624 seconds\nPreprocessor visited node count: 1974\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 128369\/2097152 bytes\nTemplate argument size: 13879\/2097152 bytes\nHighest expansion depth: 19\/40\nExpensive parser function count: 12\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 63618\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.301\/10.000 seconds\nLua memory usage: 5.62 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 538.354 1 -total\n<\/p>\n<pre>47.55% 255.990 22 Template:Cite_journal\n47.17% 253.954 1 Template:Reflist\n36.46% 196.305 5 Template:Ambox\n29.22% 157.286 1 Template:Multiple_issues\n 9.54% 51.338 1 Template:Cleanup\n 7.14% 38.462 3 Template:Category_handler\n 6.23% 33.548 1 Template:More_citations_needed\n 5.31% 28.566 1 Template:Citation_needed\n 4.68% 25.196 4 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:5051569-1!canonical and timestamp 20181216181149 and revision id 873988804\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sinus_lift\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212249\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.020 seconds\nReal time usage: 0.166 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 158.248 1 - wikipedia:Sinus_lift\n100.00% 158.248 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8323-0!*!*!*!*!*!* and timestamp 20181217212249 and revision id 24548\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sinus_lift\">https:\/\/www.limswiki.org\/index.php\/Sinus_lift<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","8e03f2269291576004ef47715a87e90d_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a3\/Lateral_window_sinus_lift.jpg\/440px-Lateral_window_sinus_lift.jpg"],"8e03f2269291576004ef47715a87e90d_timestamp":1545081769,"d24c960311b9de8ff2d033ef7c1efc54_type":"article","d24c960311b9de8ff2d033ef7c1efc54_title":"Shoulder replacement","d24c960311b9de8ff2d033ef7c1efc54_url":"https:\/\/www.limswiki.org\/index.php\/Shoulder_replacement","d24c960311b9de8ff2d033ef7c1efc54_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tShoulder replacement\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tShoulder replacementX-ray of a shoulder prosthesisICD-9-CM81.80-81.81MedlinePlus007387 [edit on Wikidata]\nShoulder replacement is a surgical procedure in which all or part of the glenohumeral joint is replaced by a prosthetic implant. Such joint replacement surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage.[1]\nShoulder replacement surgery is an option for treatment of severe arthritis of the shoulder joint. Arthritis is a condition that affects the cartilage of the joints. As the cartilage lining wears away, the protective lining between the bones is lost. When this happens, painful bone-on-bone arthritis develops. Severe shoulder arthritis is quite painful, and can cause restriction of motion. While this may be tolerated with some medications and lifestyle adjustments, there may come a time when surgical treatment is necessary.\nThere are a few major approaches to access the shoulder joint. The first is the deltopectoral approach, which saves the deltoid, but requires the subscapularis to be cut.[2] The second is the transdeltoid approach, which provides a straight on approach at the glenoid. However, during this approach the deltoid is put at risk for potential damage.[2]\n\nContents \n\n1 History \n2 Indications \n3 Surgical techniques \n4 Implants \n5 Risks \n6 Anesthesiological considerations \n\n6.1 Post-operative analgesia \n\n6.1.1 Interscalenic analgesia \n6.1.2 Suprascapular with or without Axillary Nerve Blockade Combined with Local Anesthetic Wound Infiltration \n\n\n\n\n7 References \n8 External links \n\n\nHistory \nShoulder replacement, also known as shoulder arthroplasty or glenohumeral arthroplasty, was pioneered by the French surgeon Jules Emile P\u00e9an in 1893.[3] His procedure consisted of physically smoothing the shoulder joint and implanting platinum and rubber materials. The next notable case in the evolution of shoulder replacement procedures was in 1955 when Charles Neer conducted the first hemiarthroplasty, essentially replacing only the humeral head, leaving the natural shoulder socket, or glenoid, intact.[3] This procedure grew exponentially in popularity as time progressed; however, patients often developed cartilage loss on their glenoid surface as well, leading to pain and glenoid erosion. This prompted the development of a procedure to replace not only the humeral component, but the glenoid component as well.[3]\nThroughout the development of the procedures, it became well accepted that the rotator cuff muscles were essential to producing the best outcomes in terms of strength, range of motion, and a decrease in pain. In addition to this finding, physical constraints of the normal ball-and-socket anatomy of the shoulder limited most developments in one way or another. For example, a heavily constrained system limited range of motion. and the inherent anatomy of the glenoid proved difficult to cement prosthetics and fixate components without fracturing it.[3] These challenges and high rates of failure led to the development of the reverse total shoulder arthroplasty to overcome the limitations imposed by the natural shoulder anatomy.\nThe 1970s saw an exponential increase in surgical approaches using this methodology, and the number and variation of surgical techniques are many. However, in 1985 Paul Grammont emerged with a superior technique that is the basis for most reverse shoulder replacement procedures today.[3] However, it is of note that the reverse shoulder replacement is primarily indicated in cases in which a patient has weak or torn rotator cuff muscles. In others, a conventional shoulder replacement may be indicated. Although Grammont continued to develop and refine his new technique to address minor complications that arose, it relied on 4 basic concepts that included the inherent stability and shape of the implant, as well as the placement of the implant relative to the natural glenohumeral joint.[3]\n\nIndications \nThe progression to shoulder replacement usually begins with the development of pain with movement of the shoulder and stiffness which will be conservatively managed with activity modification, physical therapy and nonsteroidal anti-inflammatory (NSAID) drugs.[4][5] Additionally, intra-articular corticosteroid injections (injection into the joint space) are another popular, conservative option.[5] If all non-surgical, conservative treatment options fail and pain is affecting quality of life, then the shoulder replacement will likely be indicated. Various studies on shoulder replacements have confirmed this indication, noting specifically that severe glenohumeral arthritis as the cause.[6][7]\n\nSurgical techniques \nIn traditional total shoulder arthroplasty the approach begins with separating the deltoid muscle from the pectoral muscles, facilitating access to the shoulder (glenohumeral) joint through a relatively nerve free passageway. The shoulder joint is initially covered by the rotator cuff muscles (subscapularis, supraspinatus, infraspinatus & teres minor) and the joint capsule (glenohumeral ligaments). Typically a single rotator cuff muscle is identified and cut to allow direct access to the shoulder joint. As this point, the surgeon can remove the arthritic portions of the joint and then secure the ball and socket prostheses within the joint.[8]\nThe development of safer, more effective techniques have led the to increased use of reverse total shoulder arthroplasty.[2] Reverse total shoulder arthroplasties are typically indicated when the rotator cuff muscles are severely damaged.[9] There are a few major approaches for reverse total shoulder arthroplasties. The first is the deltopectoral approach, which is the approach described above for the traditional total shoulder arthroplasty. This approach saves the deltoid, but requires the supraspinatus to be cut.[2] The second is the transdeltoid approach, which provides a straight on approach at the glenoid. However, during this approach the deltoid is put at risk for potential damage.[2] Both techniques are used, depending on the surgeon's preferences.\n\nImplants \nVarious materials can be used to make prostheses, however the majority consist of a metal ball that rotates within a polyethylene (plastic) socket. The metal ball takes the place of the patient's humeral head and is anchored via a stem, which is inserted down the shaft of the humerus. The plastic socket is placed over the patient's glenoid and is typically secured to the surrounding bone via cement.[8]\nRecent advances in technology have led to the development of stemless as well as cementless replacements being used in the operating room.[10] In addition, the increasing popularity of reverse total shoulder arthroplasty has led to availability of 29 new prostheses in 2016 alone.[11]\n\nRisks \nNon surgery options are preferred treatment for a variety of reasons. Besides not wanting to risk the usual risks of surgery such as infection, shoulder replacement can lead to a variety of complications including rotator cuff tear and glenohumeral instability. However, despite these risks, shoulder replacement shows promise with a low rate of complication which depending on the type of surgery is close to 5%.[12]\n\nAnesthesiological considerations \nRegional and general anesthesia are two methods that can be utilized when performing shoulder replacement. One example of a commonly used regional anesthetic is an interscalene brachial plexus block and it has been used in a number of shoulder procedures including instability repairs, proximal humeral prosthetic replacements, total shoulder arthroplasties, anterior acromioplasties, rotator cuff repairs, and operative treatment of humeral fractures.[13] The benefits of utilizing regional anesthesia over general anesthesia include less intraoperative bleeding, more muscle relaxation, shorter recovery room and hospital stays, decreased use of opioids, and avoiding the side effects of general anesthesia.[13] In addition, regional anesthesia may be more cost-effective because it reduces operating room turnover time and procedure time due to the patients waking up sooner after surgery.\nThe success rate of placing an interscalene brachial plexus block ranges from 84% to 98% according to some case studies.[14][15] Major complications such as seizures, cardiac arrests, Horner's syndrome, hoarseness, and inadvertent spinal\/epidural anesthesia could occur and therefore, patients should be carefully monitored during the insertion of the block until the end of the surgery.[13] Currently, data on combined usage of general anesthesia and interscalene blocks are limited. Some indications for combined anesthesia include difficult airway management and longer surgical procedures.[13]\nA mixture of short and long-acting local anesthetics is used to prolong the duration as well as reduce the onset of the nerve block. Lidocaine is an appropriate short-acting local anesthetic and drugs such as levobupivacaine or ropivacaine are appropriate long-acting local anesthetics.[13] The amount of drugs needed for a patient during shoulder replacement can range from 30 to 50 ml and is calculated based on the patient's characteristics as well as the specific anesthetic technique used.[13]\n\nPost-operative analgesia \nShoulder replacement can cause severe to very severe pain especially during shoulder mobilization and therefore, postoperative pain management is extremely important for recovery. This is because joint tissues are well innervated from nociceptive input and therefore, a surgical procedure in the joint region would produce continuous deep somatic pain as well as muscle spasms.[13]\nThe following anesthetics are methods commonly used to assist with post-operative shoulder replacement pain management:\n\nInterscalenic analgesia \nThree types:\n\nSingle shot\nContinuous infusion\nPatient controlled\nSingle shot interscalenic analgesia is preferably used during minor arthroscopic surgery because of its short duration but overall, it is still a useful alternative when continuous interscalenic analgesia cannot be performed.[13] Interscalenic analgesia is most suited for the continuous infusion approach because shoulder replacement causes severe post-operative pain and the anatomic proximity of the interscalenic catheter to the shoulder joint provides quick relief.[13] The interscalenic catheter can be used from three to five days depending on the type of surgery.\n\nSuprascapular with or without Axillary Nerve Blockade Combined with Local Anesthetic Wound Infiltration \nSince the suprascapular nerve provides sensory information to 70% of the joint capsule, blocking this nerve can help with post-operative shoulder pain. A nerve stimulator, ultrasound device, or a needle insertion that is 1 cm above the midpoint of the scapular spine can quickly block the suprascapular nerve.[13] Furthermore, blocking the axillary nerve together with the suprascapular nerve can further anesthetize the shoulder joint. The benefit of the suprascapular nerve block is that it avoids blocking motor function to parts of the upper limb innervated by the more inferior roots of the brachial plexus (C8-T1), which thus prevents the phrenic nerve from being blocked.[13] Disadvantages to the suprascapular nerve block include using two separate needlings, blocking not all of nerves of the shoulder joint, and short duration of action. Some side effects for the procedure include pneumothorax, intravascular injection, and nerve damage.[13] Although this technique provides more pain control compared to placebo, the technique is still inferior to the interscalene block.\n\nReferences \n\n\n^ American Academy of Orthopaedic Surgeons. \"Shoulder Joint Replacement\" (Web Article) . Retrieved 22 October 2007 . \n\n^ a b c d e Nerot, C.; Ohl, X. (2014). \"Primary shoulder reverse arthroplasty: Surgical technique\". Orthopaedics & Traumatology: Surgery & Research. 100 (1): S181\u2013S190. doi:10.1016\/j.otsr.2013.06.011. \n\n^ a b c d e f Flatow, Evan L.; Harrison, Alicia K. (September 2011). \"A History of Reverse Total Shoulder Arthroplasty\". Clinical Orthopaedics and Related Research. 469 (9): 2432\u20132439. doi:10.1007\/s11999-010-1733-6. ISSN 0009-921X. PMC 3148354 . PMID 21213090. \n\n^ http:\/\/orthoinfo.aaos.org\/topic.cfm?topic=A00094 \n\n^ a b Armstrong, April (July 2014). \"Evaluation and management of adult shoulder pain: a focus on rotator cuff disorders, acromioclavicular joint arthritis, and glenohumeral arthritis\". The Medical Clinics of North America. 98 (4): 755\u2013775, xii. doi:10.1016\/j.mcna.2014.03.004. ISSN 1557-9859. PMID 24994050. \n\n^ Hawi, Nael; Magosch, Petra; Tauber, Mark; Lichtenberg, Sven; Habermeyer, Peter (2017-04-11). \"Nine-year outcome after anatomic stemless shoulder prosthesis: clinical and radiologic results\". Journal of Shoulder and Elbow Surgery. 26: 1609\u20131615. doi:10.1016\/j.jse.2017.02.017. ISSN 1532-6500. PMID 28410956. \n\n^ Bryant, Dianne; Litchfield, Robert; Sandow, Michael; Gartsman, Gary M.; Guyatt, Gordon; Kirkley, Alexandra (September 2005). \"A comparison of pain, strength, range of motion, and functional outcomes after hemiarthroplasty and total shoulder arthroplasty in patients with osteoarthritis of the shoulder. A systematic review and meta-analysis\". The Journal of Bone and Joint Surgery. American Volume. 87 (9): 1947\u20131956. doi:10.2106\/JBJS.D.02854. ISSN 0021-9355. PMID 16140808. \n\n^ a b \"Shoulder Replacement Surgery: Diagnosis, Treatment, and Recovery\". \n\n^ Wand, RJ (November 1, 2012). \"A review of shoulder replacement surgery\". Journal of Perioperative Practice. 22 (11): 354\u2013359. doi:10.1177\/175045891602201102. PMID 23311021. \n\n^ Ballas, Richard; B\u00e9guin, Laurent (2013). \"Results of a stemless reverse shoulder prosthesis at more than 58 months mean without loosening\". Journal of Shoulder and Elbow Surgery. 22 (9): e1. doi:10.1016\/j.jse.2012.12.005. PMID 23419604. \n\n^ Middernacht, Bart; Tongel, Alexander Van; Wilde, Lieven De (2016). \"A Critical Review on Prosthetic Features Available for Reversed Total Shoulder Arthroplasty\". BioMed Research International. 2016: 1\u20139. doi:10.1155\/2016\/3256931. ISSN 2314-6133. PMC 5220426 . PMID 28105417. \n\n^ http:\/\/www.jbjs.org\/article.aspx?Volume=78&page=603 \n\n^ a b c d e f g h i j k l Lanna, M.; Pastore, A.; Policastro, C.; Iacovazzo, C. (2012-04-30). \"Anesthesiological Considerations in Shoulder Surgery\". Translational Medicine @ UniSa. 3: 42\u201348. ISSN 2239-9747. PMC 3728782 . PMID 23905051. \n\n^ Bishop, Julie Y.; Sprague, Mark; Gelber, Jonathan; Krol, Marina; Rosenblatt, Meg A.; Gladstone, James N.; Flatow, Evan L. (September 2006). \"Interscalene regional anesthesia for arthroscopic shoulder surgery: a safe and effective technique\". Journal of Shoulder and Elbow Surgery. 15 (5): 567\u2013570. doi:10.1016\/j.jse.2006.01.009. ISSN 1532-6500. PMID 16979050. \n\n^ Borgeat, A.; Ekatodramis, G.; Kalberer, F.; Benz, C. (October 2001). \"Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study\". Anesthesiology. 95 (4): 875\u2013880. doi:10.1097\/00000542-200110000-00015. ISSN 0003-3022. PMID 11605927. \n\n\nExternal links \nPatient X-ray and Image gallery demonstrating anatomic total shoulder replacement and reverse shoulder replacement surgery\nInformation for Patients - Total Shoulder Replacement Arthroplasty for Shoulder Arthritis\nvteOrthopedic surgery, operations\/surgeries and other procedures on bones and joints (ICD-9-CM V3 76\u201381, ICD-10-PCS 0P\u2013S)BonesFacial\nJaw reduction\nDentofacial osteotomy\nGenioplasty\/Mentoplasty\nChin augmentation\nOrthognathic surgery\nSpine\nCoccygectomy\nLaminotomy\nLaminectomy\nLaminoplasty\nCorpectomy\nFacetectomy\nForaminotomy\nVertebral fixation\nPercutaneous vertebroplasty\nUpper extremity\nAcromioplasty\nLower extremity\nFemoral head ostectomy\nAstragalectomy\nDistraction osteogenesis\nIlizarov apparatus\nPhemister graft\nGeneral\nOstectomy\nBone grafting\nOsteotomy\nEpiphysiodesis\nReduction\nInternal fixation\nExternal fixation\nTension band wiring\nCartilage\nArticular cartilage repair\nMicrofracture surgery\nKnee cartilage replacement therapy\nAutologous chondrocyte implantation\nJointsSpine\nArthrodesis\nSpinal fusion\nIntervertebral discs\nDiscectomy\nAnnuloplasty\nArthroplasty\nUpper extremity\nShoulder surgery\nShoulder replacement\nBankart repair\nWeaver\u2013Dunn procedure\nUlnar collateral ligament reconstruction\nHand surgery\nBrunelli procedure\nLower extremity\nHip resurfacing\nHip replacement\nRotationplasty\nAnterior cruciate ligament reconstruction\nKnee replacement\/Unicompartmental knee arthroplasty\nAnkle replacement\nBrostr\u00f6m procedure\nTriple arthrodesis\nGeneral\nArthrotomy\nArthroplasty\nSynovectomy\nArthroscopy\nReplacement joint\nimaging: Arthrogram\nArthrocentesis\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 29 February 2016, at 23:07.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 486 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","d24c960311b9de8ff2d033ef7c1efc54_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Shoulder_replacement skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Shoulder replacement<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Shoulder replacement<\/b> is a surgical procedure in which all or part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glenohumeral_joint\" class=\"mw-redirect\" title=\"Glenohumeral joint\" rel=\"external_link\" target=\"_blank\">glenohumeral joint<\/a> is replaced by a prosthetic implant. Such <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement\" title=\"Joint replacement\" rel=\"external_link\" target=\"_blank\">joint replacement<\/a> surgery generally is conducted to relieve <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis\" title=\"Arthritis\" rel=\"external_link\" target=\"_blank\">arthritis<\/a> pain or fix severe physical joint damage.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Shoulder replacement surgery is an option for treatment of severe arthritis of the shoulder joint. Arthritis is a condition that affects the cartilage of the joints. As the cartilage lining wears away, the protective lining between the bones is lost. When this happens, painful bone-on-bone arthritis develops. Severe shoulder arthritis is quite painful, and can cause restriction of motion. While this may be tolerated with some medications and lifestyle adjustments, there may come a time when surgical treatment is necessary.\n<\/p><p>There are a few major approaches to access the shoulder joint. The first is the deltopectoral approach, which saves the deltoid, but requires the subscapularis to be cut.<sup id=\"rdp-ebb-cite_ref-Nerot_2014_S181\u2013S190_2-0\" class=\"reference\"><a href=\"#cite_note-Nerot_2014_S181\u2013S190-2\" rel=\"external_link\">[2]<\/a><\/sup> The second is the transdeltoid approach, which provides a straight on approach at the glenoid. However, during this approach the deltoid is put at risk for potential damage.<sup id=\"rdp-ebb-cite_ref-Nerot_2014_S181\u2013S190_2-1\" class=\"reference\"><a href=\"#cite_note-Nerot_2014_S181\u2013S190-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Shoulder replacement, also known as shoulder arthroplasty or glenohumeral arthroplasty, was pioneered by the French surgeon Jules Emile P\u00e9an in 1893.<sup id=\"rdp-ebb-cite_ref-:0_3-0\" class=\"reference\"><a href=\"#cite_note-:0-3\" rel=\"external_link\">[3]<\/a><\/sup> His procedure consisted of physically smoothing the shoulder joint and implanting platinum and rubber materials. The next notable case in the evolution of shoulder replacement procedures was in 1955 when Charles Neer conducted the first hemiarthroplasty, essentially replacing only the humeral head, leaving the natural shoulder socket, or glenoid, intact.<sup id=\"rdp-ebb-cite_ref-:0_3-1\" class=\"reference\"><a href=\"#cite_note-:0-3\" rel=\"external_link\">[3]<\/a><\/sup> This procedure grew exponentially in popularity as time progressed; however, patients often developed cartilage loss on their glenoid surface as well, leading to pain and glenoid erosion. This prompted the development of a procedure to replace not only the humeral component, but the glenoid component as well.<sup id=\"rdp-ebb-cite_ref-:0_3-2\" class=\"reference\"><a href=\"#cite_note-:0-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>Throughout the development of the procedures, it became well accepted that the rotator cuff muscles were essential to producing the best outcomes in terms of strength, range of motion, and a decrease in pain. In addition to this finding, physical constraints of the normal ball-and-socket anatomy of the shoulder limited most developments in one way or another. For example, a heavily constrained system limited range of motion. and the inherent anatomy of the glenoid proved difficult to cement prosthetics and fixate components without fracturing it.<sup id=\"rdp-ebb-cite_ref-:0_3-3\" class=\"reference\"><a href=\"#cite_note-:0-3\" rel=\"external_link\">[3]<\/a><\/sup> These challenges and high rates of failure led to the development of the reverse total shoulder arthroplasty to overcome the limitations imposed by the natural shoulder anatomy.\n<\/p><p>The 1970s saw an exponential increase in surgical approaches using this methodology, and the number and variation of surgical techniques are many. However, in 1985 Paul Grammont emerged with a superior technique that is the basis for most <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reverse_shoulder_replacement\" title=\"Reverse shoulder replacement\" rel=\"external_link\" target=\"_blank\">reverse shoulder replacement<\/a> procedures today.<sup id=\"rdp-ebb-cite_ref-:0_3-4\" class=\"reference\"><a href=\"#cite_note-:0-3\" rel=\"external_link\">[3]<\/a><\/sup> However, it is of note that the reverse shoulder replacement is primarily indicated in cases in which a patient has weak or torn rotator cuff muscles. In others, a conventional shoulder replacement may be indicated. Although Grammont continued to develop and refine his new technique to address minor complications that arose, it relied on 4 basic concepts that included the inherent stability and shape of the implant, as well as the placement of the implant relative to the natural glenohumeral joint.<sup id=\"rdp-ebb-cite_ref-:0_3-5\" class=\"reference\"><a href=\"#cite_note-:0-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h2>\n<p>The progression to shoulder replacement usually begins with the development of pain with movement of the shoulder and stiffness which will be conservatively managed with activity modification, physical therapy and nonsteroidal anti-inflammatory (NSAID) drugs.<sup id=\"rdp-ebb-cite_ref-:1_4-0\" class=\"reference\"><a href=\"#cite_note-:1-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-:2_5-0\" class=\"reference\"><a href=\"#cite_note-:2-5\" rel=\"external_link\">[5]<\/a><\/sup> Additionally, intra-articular corticosteroid injections (injection into the joint space) are another popular, conservative option.<sup id=\"rdp-ebb-cite_ref-:2_5-1\" class=\"reference\"><a href=\"#cite_note-:2-5\" rel=\"external_link\">[5]<\/a><\/sup> If all non-surgical, conservative treatment options fail and pain is affecting quality of life, then the shoulder replacement will likely be indicated. Various studies on shoulder replacements have confirmed this indication, noting specifically that severe glenohumeral arthritis as the cause.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Surgical_techniques\">Surgical techniques<\/span><\/h2>\n<p>In traditional total shoulder arthroplasty the approach begins with separating the deltoid muscle from the pectoral muscles, facilitating access to the shoulder (glenohumeral) joint through a relatively nerve free passageway. The shoulder joint is initially covered by the rotator cuff muscles (subscapularis, supraspinatus, infraspinatus & teres minor) and the joint capsule (glenohumeral ligaments). Typically a single rotator cuff muscle is identified and cut to allow direct access to the shoulder joint. As this point, the surgeon can remove the arthritic portions of the joint and then secure the ball and socket prostheses within the joint.<sup id=\"rdp-ebb-cite_ref-:4_8-0\" class=\"reference\"><a href=\"#cite_note-:4-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>The development of safer, more effective techniques have led the to increased use of reverse total shoulder arthroplasty.<sup id=\"rdp-ebb-cite_ref-Nerot_2014_S181\u2013S190_2-2\" class=\"reference\"><a href=\"#cite_note-Nerot_2014_S181\u2013S190-2\" rel=\"external_link\">[2]<\/a><\/sup> Reverse total shoulder arthroplasties are typically indicated when the rotator cuff muscles are severely damaged.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> There are a few major approaches for reverse total shoulder arthroplasties. The first is the deltopectoral approach, which is the approach described above for the traditional total shoulder arthroplasty. This approach saves the deltoid, but requires the supraspinatus to be cut.<sup id=\"rdp-ebb-cite_ref-Nerot_2014_S181\u2013S190_2-3\" class=\"reference\"><a href=\"#cite_note-Nerot_2014_S181\u2013S190-2\" rel=\"external_link\">[2]<\/a><\/sup> The second is the transdeltoid approach, which provides a straight on approach at the glenoid. However, during this approach the deltoid is put at risk for potential damage.<sup id=\"rdp-ebb-cite_ref-Nerot_2014_S181\u2013S190_2-4\" class=\"reference\"><a href=\"#cite_note-Nerot_2014_S181\u2013S190-2\" rel=\"external_link\">[2]<\/a><\/sup> Both techniques are used, depending on the surgeon's preferences.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Implants\">Implants<\/span><\/h2>\n<p>Various materials can be used to make prostheses, however the majority consist of a metal ball that rotates within a polyethylene (plastic) socket. The metal ball takes the place of the patient's humeral head and is anchored via a stem, which is inserted down the shaft of the humerus. The plastic socket is placed over the patient's glenoid and is typically secured to the surrounding bone via cement.<sup id=\"rdp-ebb-cite_ref-:4_8-1\" class=\"reference\"><a href=\"#cite_note-:4-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>Recent advances in technology have led to the development of stemless as well as cementless replacements being used in the operating room.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> In addition, the increasing popularity of reverse total shoulder arthroplasty has led to availability of 29 new prostheses in 2016 alone.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h2>\n<p>Non surgery options are preferred treatment for a variety of reasons. Besides not wanting to risk the usual risks of surgery such as infection, shoulder replacement can lead to a variety of complications including rotator cuff tear and glenohumeral instability. However, despite these risks, shoulder replacement shows promise with a low rate of complication which depending on the type of surgery is close to 5%.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Anesthesiological_considerations\">Anesthesiological considerations<\/span><\/h2>\n<p>Regional and general anesthesia are two methods that can be utilized when performing shoulder replacement. One example of a commonly used regional anesthetic is an interscalene brachial plexus block and it has been used in a number of shoulder procedures including instability repairs, proximal humeral prosthetic replacements, total shoulder arthroplasties, anterior acromioplasties, rotator cuff repairs, and operative treatment of humeral fractures.<sup id=\"rdp-ebb-cite_ref-:3_13-0\" class=\"reference\"><a href=\"#cite_note-:3-13\" rel=\"external_link\">[13]<\/a><\/sup> The benefits of utilizing regional anesthesia over general anesthesia include less intraoperative bleeding, more muscle relaxation, shorter recovery room and hospital stays, decreased use of opioids, and avoiding the side effects of general anesthesia.<sup id=\"rdp-ebb-cite_ref-:3_13-1\" class=\"reference\"><a href=\"#cite_note-:3-13\" rel=\"external_link\">[13]<\/a><\/sup> In addition, regional anesthesia may be more cost-effective because it reduces operating room turnover time and procedure time due to the patients waking up sooner after surgery.\n<\/p><p>The success rate of placing an interscalene brachial plexus block ranges from 84% to 98% according to some case studies.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> Major complications such as seizures, cardiac arrests, Horner's syndrome, hoarseness, and inadvertent spinal\/epidural anesthesia could occur and therefore, patients should be carefully monitored during the insertion of the block until the end of the surgery.<sup id=\"rdp-ebb-cite_ref-:3_13-2\" class=\"reference\"><a href=\"#cite_note-:3-13\" rel=\"external_link\">[13]<\/a><\/sup> Currently, data on combined usage of general anesthesia and interscalene blocks are limited. Some indications for combined anesthesia include difficult airway management and longer surgical procedures.<sup id=\"rdp-ebb-cite_ref-:3_13-3\" class=\"reference\"><a href=\"#cite_note-:3-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p><p>A mixture of short and long-acting local anesthetics is used to prolong the duration as well as reduce the onset of the nerve block. Lidocaine is an appropriate short-acting local anesthetic and drugs such as levobupivacaine or ropivacaine are appropriate long-acting local anesthetics.<sup id=\"rdp-ebb-cite_ref-:3_13-4\" class=\"reference\"><a href=\"#cite_note-:3-13\" rel=\"external_link\">[13]<\/a><\/sup> The amount of drugs needed for a patient during shoulder replacement can range from 30 to 50 ml and is calculated based on the patient's characteristics as well as the specific anesthetic technique used.<sup id=\"rdp-ebb-cite_ref-:3_13-5\" class=\"reference\"><a href=\"#cite_note-:3-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Post-operative_analgesia\">Post-operative analgesia<\/span><\/h3>\n<p>Shoulder replacement can cause severe to very severe pain especially during shoulder mobilization and therefore, postoperative pain management is extremely important for recovery. This is because joint tissues are well innervated from nociceptive input and therefore, a surgical procedure in the joint region would produce continuous deep somatic pain as well as muscle spasms.<sup id=\"rdp-ebb-cite_ref-:3_13-6\" class=\"reference\"><a href=\"#cite_note-:3-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p><p>The following anesthetics are methods commonly used to assist with post-operative shoulder replacement pain management:\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Interscalenic_analgesia\">Interscalenic analgesia<\/span><\/h4>\n<p>Three types:\n<\/p>\n<ol><li>Single shot<\/li>\n<li>Continuous infusion<\/li>\n<li>Patient controlled<\/li><\/ol>\n<p>Single shot interscalenic analgesia is preferably used during minor arthroscopic surgery because of its short duration but overall, it is still a useful alternative when continuous interscalenic analgesia cannot be performed.<sup id=\"rdp-ebb-cite_ref-:3_13-7\" class=\"reference\"><a href=\"#cite_note-:3-13\" rel=\"external_link\">[13]<\/a><\/sup> Interscalenic analgesia is most suited for the continuous infusion approach because shoulder replacement causes severe post-operative pain and the anatomic proximity of the interscalenic catheter to the shoulder joint provides quick relief.<sup id=\"rdp-ebb-cite_ref-:3_13-8\" class=\"reference\"><a href=\"#cite_note-:3-13\" rel=\"external_link\">[13]<\/a><\/sup> The interscalenic catheter can be used from three to five days depending on the type of surgery.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Suprascapular_with_or_without_Axillary_Nerve_Blockade_Combined_with_Local_Anesthetic_Wound_Infiltration\">Suprascapular with or without Axillary Nerve Blockade Combined with Local Anesthetic Wound Infiltration<\/span><\/h4>\n<p>Since the suprascapular nerve provides sensory information to 70% of the joint capsule, blocking this nerve can help with post-operative shoulder pain. A nerve stimulator, ultrasound device, or a needle insertion that is 1 cm above the midpoint of the scapular spine can quickly block the suprascapular nerve.<sup id=\"rdp-ebb-cite_ref-:3_13-9\" class=\"reference\"><a href=\"#cite_note-:3-13\" rel=\"external_link\">[13]<\/a><\/sup> Furthermore, blocking the axillary nerve together with the suprascapular nerve can further anesthetize the shoulder joint. The benefit of the suprascapular nerve block is that it avoids blocking motor function to parts of the upper limb innervated by the more inferior roots of the brachial plexus (C8-T1), which thus prevents the phrenic nerve from being blocked.<sup id=\"rdp-ebb-cite_ref-:3_13-10\" class=\"reference\"><a href=\"#cite_note-:3-13\" rel=\"external_link\">[13]<\/a><\/sup> Disadvantages to the suprascapular nerve block include using two separate needlings, blocking not all of nerves of the shoulder joint, and short duration of action. Some side effects for the procedure include pneumothorax, intravascular injection, and nerve damage.<sup id=\"rdp-ebb-cite_ref-:3_13-11\" class=\"reference\"><a href=\"#cite_note-:3-13\" rel=\"external_link\">[13]<\/a><\/sup> Although this technique provides more pain control compared to placebo, the technique is still inferior to the interscalene block.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">American Academy of Orthopaedic Surgeons. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/orthoinfo.aaos.org\/topic.cfm?topic=A00094\" target=\"_blank\">\"Shoulder Joint Replacement\"<\/a> <span class=\"cs1-format\">(Web Article)<\/span><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">22 October<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Shoulder+Joint+Replacement&rft.au=American+Academy+of+Orthopaedic+Surgeons&rft_id=http%3A%2F%2Forthoinfo.aaos.org%2Ftopic.cfm%3Ftopic%3DA00094&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShoulder+replacement\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Nerot_2014_S181\u2013S190-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Nerot_2014_S181\u2013S190_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Nerot_2014_S181\u2013S190_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Nerot_2014_S181\u2013S190_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Nerot_2014_S181\u2013S190_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Nerot_2014_S181\u2013S190_2-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Nerot, C.; Ohl, X. (2014). \"Primary shoulder reverse arthroplasty: Surgical technique\". <i>Orthopaedics & Traumatology: Surgery & Research<\/i>. <b>100<\/b> (1): S181\u2013S190. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.otsr.2013.06.011\" target=\"_blank\">10.1016\/j.otsr.2013.06.011<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Orthopaedics+%26+Traumatology%3A+Surgery+%26+Research&rft.atitle=Primary+shoulder+reverse+arthroplasty%3A+Surgical+technique&rft.volume=100&rft.issue=1&rft.pages=S181-S190&rft.date=2014&rft_id=info%3Adoi%2F10.1016%2Fj.otsr.2013.06.011&rft.aulast=Nerot&rft.aufirst=C.&rft.au=Ohl%2C+X.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShoulder+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:0-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_3-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_3-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_3-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Flatow, Evan L.; Harrison, Alicia K. (September 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3148354\" target=\"_blank\">\"A History of Reverse Total Shoulder Arthroplasty\"<\/a>. <i>Clinical Orthopaedics and Related Research<\/i>. <b>469<\/b> (9): 2432\u20132439. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11999-010-1733-6\" target=\"_blank\">10.1007\/s11999-010-1733-6<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0009-921X\" target=\"_blank\">0009-921X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3148354\" target=\"_blank\">3148354<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21213090\" target=\"_blank\">21213090<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Orthopaedics+and+Related+Research&rft.atitle=A+History+of+Reverse+Total+Shoulder+Arthroplasty&rft.volume=469&rft.issue=9&rft.pages=2432-2439&rft.date=2011-09&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3148354&rft.issn=0009-921X&rft_id=info%3Apmid%2F21213090&rft_id=info%3Adoi%2F10.1007%2Fs11999-010-1733-6&rft.aulast=Flatow&rft.aufirst=Evan+L.&rft.au=Harrison%2C+Alicia+K.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3148354&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShoulder+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:1-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-:1_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/orthoinfo.aaos.org\/topic.cfm?topic=A00094\" target=\"_blank\">http:\/\/orthoinfo.aaos.org\/topic.cfm?topic=A00094<\/a><\/span>\n<\/li>\n<li id=\"cite_note-:2-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:2_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:2_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Armstrong, April (July 2014). \"Evaluation and management of adult shoulder pain: a focus on rotator cuff disorders, acromioclavicular joint arthritis, and glenohumeral arthritis\". <i>The Medical Clinics of North America<\/i>. <b>98<\/b> (4): 755\u2013775, xii. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.mcna.2014.03.004\" target=\"_blank\">10.1016\/j.mcna.2014.03.004<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1557-9859\" target=\"_blank\">1557-9859<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24994050\" target=\"_blank\">24994050<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Medical+Clinics+of+North+America&rft.atitle=Evaluation+and+management+of+adult+shoulder+pain%3A+a+focus+on+rotator+cuff+disorders%2C+acromioclavicular+joint+arthritis%2C+and+glenohumeral+arthritis&rft.volume=98&rft.issue=4&rft.pages=755-775%2C+xii&rft.date=2014-07&rft.issn=1557-9859&rft_id=info%3Apmid%2F24994050&rft_id=info%3Adoi%2F10.1016%2Fj.mcna.2014.03.004&rft.aulast=Armstrong&rft.aufirst=April&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShoulder+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hawi, Nael; Magosch, Petra; Tauber, Mark; Lichtenberg, Sven; Habermeyer, Peter (2017-04-11). \"Nine-year outcome after anatomic stemless shoulder prosthesis: clinical and radiologic results\". <i>Journal of Shoulder and Elbow Surgery<\/i>. <b>26<\/b>: 1609\u20131615. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jse.2017.02.017\" target=\"_blank\">10.1016\/j.jse.2017.02.017<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1532-6500\" target=\"_blank\">1532-6500<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28410956\" target=\"_blank\">28410956<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Shoulder+and+Elbow+Surgery&rft.atitle=Nine-year+outcome+after+anatomic+stemless+shoulder+prosthesis%3A+clinical+and+radiologic+results&rft.volume=26&rft.pages=1609-1615&rft.date=2017-04-11&rft.issn=1532-6500&rft_id=info%3Apmid%2F28410956&rft_id=info%3Adoi%2F10.1016%2Fj.jse.2017.02.017&rft.aulast=Hawi&rft.aufirst=Nael&rft.au=Magosch%2C+Petra&rft.au=Tauber%2C+Mark&rft.au=Lichtenberg%2C+Sven&rft.au=Habermeyer%2C+Peter&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShoulder+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bryant, Dianne; Litchfield, Robert; Sandow, Michael; Gartsman, Gary M.; Guyatt, Gordon; Kirkley, Alexandra (September 2005). \"A comparison of pain, strength, range of motion, and functional outcomes after hemiarthroplasty and total shoulder arthroplasty in patients with osteoarthritis of the shoulder. 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American Volume<\/i>. <b>87<\/b> (9): 1947\u20131956. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.D.02854\" target=\"_blank\">10.2106\/JBJS.D.02854<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0021-9355\" target=\"_blank\">0021-9355<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16140808\" target=\"_blank\">16140808<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Bone+and+Joint+Surgery.+American+Volume&rft.atitle=A+comparison+of+pain%2C+strength%2C+range+of+motion%2C+and+functional+outcomes+after+hemiarthroplasty+and+total+shoulder+arthroplasty+in+patients+with+osteoarthritis+of+the+shoulder.+A+systematic+review+and+meta-analysis&rft.volume=87&rft.issue=9&rft.pages=1947-1956&rft.date=2005-09&rft.issn=0021-9355&rft_id=info%3Apmid%2F16140808&rft_id=info%3Adoi%2F10.2106%2FJBJS.D.02854&rft.aulast=Bryant&rft.aufirst=Dianne&rft.au=Litchfield%2C+Robert&rft.au=Sandow%2C+Michael&rft.au=Gartsman%2C+Gary+M.&rft.au=Guyatt%2C+Gordon&rft.au=Kirkley%2C+Alexandra&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShoulder+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:4-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:4_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:4_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.hss.edu\/conditions_Shoulder-Replacement-Surgery-Diagnosis-Treatment-Recovery.asp\" target=\"_blank\">\"Shoulder Replacement Surgery: Diagnosis, Treatment, and Recovery\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Shoulder+Replacement+Surgery%3A+Diagnosis%2C+Treatment%2C+and+Recovery&rft_id=https%3A%2F%2Fwww.hss.edu%2Fconditions_Shoulder-Replacement-Surgery-Diagnosis-Treatment-Recovery.asp&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShoulder+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wand, RJ (November 1, 2012). \"A review of shoulder replacement surgery\". <i>Journal of Perioperative Practice<\/i>. <b>22<\/b> (11): 354\u2013359. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F175045891602201102\" target=\"_blank\">10.1177\/175045891602201102<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23311021\" target=\"_blank\">23311021<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Perioperative+Practice&rft.atitle=A+review+of+shoulder+replacement+surgery&rft.volume=22&rft.issue=11&rft.pages=354-359&rft.date=2012-11-01&rft_id=info%3Adoi%2F10.1177%2F175045891602201102&rft_id=info%3Apmid%2F23311021&rft.aulast=Wand&rft.aufirst=RJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShoulder+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ballas, Richard; B\u00e9guin, Laurent (2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.researchgate.net\/publication\/235658245_Results_of_a_stemless_reverse_shoulder_prosthesis_at_more_than_58_months_mean_without_loosening\" target=\"_blank\">\"Results of a stemless reverse shoulder prosthesis at more than 58 months mean without loosening\"<\/a>. <i>Journal of Shoulder and Elbow Surgery<\/i>. <b>22<\/b> (9): e1. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jse.2012.12.005\" target=\"_blank\">10.1016\/j.jse.2012.12.005<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23419604\" target=\"_blank\">23419604<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Shoulder+and+Elbow+Surgery&rft.atitle=Results+of+a+stemless+reverse+shoulder+prosthesis+at+more+than+58+months+mean+without+loosening&rft.volume=22&rft.issue=9&rft.pages=e1&rft.date=2013&rft_id=info%3Adoi%2F10.1016%2Fj.jse.2012.12.005&rft_id=info%3Apmid%2F23419604&rft.aulast=Ballas&rft.aufirst=Richard&rft.au=B%C3%A9guin%2C+Laurent&rft_id=https%3A%2F%2Fwww.researchgate.net%2Fpublication%2F235658245_Results_of_a_stemless_reverse_shoulder_prosthesis_at_more_than_58_months_mean_without_loosening&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShoulder+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Middernacht, Bart; Tongel, Alexander Van; Wilde, Lieven De (2016). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.hindawi.com\/journals\/bmri\/2016\/3256931\/\" target=\"_blank\">\"A Critical Review on Prosthetic Features Available for Reversed Total Shoulder Arthroplasty\"<\/a>. <i>BioMed Research International<\/i>. <b>2016<\/b>: 1\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1155%2F2016%2F3256931\" target=\"_blank\">10.1155\/2016\/3256931<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2314-6133\" target=\"_blank\">2314-6133<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5220426\" target=\"_blank\">5220426<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28105417\" target=\"_blank\">28105417<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BioMed+Research+International&rft.atitle=A+Critical+Review+on+Prosthetic+Features+Available+for+Reversed+Total+Shoulder+Arthroplasty&rft.volume=2016&rft.pages=1-9&rft.date=2016&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5220426&rft.issn=2314-6133&rft_id=info%3Apmid%2F28105417&rft_id=info%3Adoi%2F10.1155%2F2016%2F3256931&rft.aulast=Middernacht&rft.aufirst=Bart&rft.au=Tongel%2C+Alexander+Van&rft.au=Wilde%2C+Lieven+De&rft_id=https%3A%2F%2Fwww.hindawi.com%2Fjournals%2Fbmri%2F2016%2F3256931%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShoulder+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.jbjs.org\/article.aspx?Volume=78&page=603\" target=\"_blank\">http:\/\/www.jbjs.org\/article.aspx?Volume=78&page=603<\/a><\/span>\n<\/li>\n<li id=\"cite_note-:3-13\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:3_13-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_13-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_13-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_13-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_13-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_13-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_13-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_13-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_13-8\" rel=\"external_link\"><sup><i><b>i<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_13-9\" rel=\"external_link\"><sup><i><b>j<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_13-10\" rel=\"external_link\"><sup><i><b>k<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_13-11\" rel=\"external_link\"><sup><i><b>l<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lanna, M.; Pastore, A.; Policastro, C.; Iacovazzo, C. (2012-04-30). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3728782\" target=\"_blank\">\"Anesthesiological Considerations in Shoulder Surgery\"<\/a>. <i>Translational Medicine @ UniSa<\/i>. <b>3<\/b>: 42\u201348. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2239-9747\" target=\"_blank\">2239-9747<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3728782\" target=\"_blank\">3728782<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23905051\" target=\"_blank\">23905051<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Translational+Medicine+%40+UniSa&rft.atitle=Anesthesiological+Considerations+in+Shoulder+Surgery&rft.volume=3&rft.pages=42-48&rft.date=2012-04-30&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3728782&rft.issn=2239-9747&rft_id=info%3Apmid%2F23905051&rft.aulast=Lanna&rft.aufirst=M.&rft.au=Pastore%2C+A.&rft.au=Policastro%2C+C.&rft.au=Iacovazzo%2C+C.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3728782&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShoulder+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bishop, Julie Y.; Sprague, Mark; Gelber, Jonathan; Krol, Marina; Rosenblatt, Meg A.; Gladstone, James N.; Flatow, Evan L. (September 2006). \"Interscalene regional anesthesia for arthroscopic shoulder surgery: a safe and effective technique\". <i>Journal of Shoulder and Elbow Surgery<\/i>. <b>15<\/b> (5): 567\u2013570. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jse.2006.01.009\" target=\"_blank\">10.1016\/j.jse.2006.01.009<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1532-6500\" target=\"_blank\">1532-6500<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16979050\" target=\"_blank\">16979050<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Shoulder+and+Elbow+Surgery&rft.atitle=Interscalene+regional+anesthesia+for+arthroscopic+shoulder+surgery%3A+a+safe+and+effective+technique&rft.volume=15&rft.issue=5&rft.pages=567-570&rft.date=2006-09&rft.issn=1532-6500&rft_id=info%3Apmid%2F16979050&rft_id=info%3Adoi%2F10.1016%2Fj.jse.2006.01.009&rft.aulast=Bishop&rft.aufirst=Julie+Y.&rft.au=Sprague%2C+Mark&rft.au=Gelber%2C+Jonathan&rft.au=Krol%2C+Marina&rft.au=Rosenblatt%2C+Meg+A.&rft.au=Gladstone%2C+James+N.&rft.au=Flatow%2C+Evan+L.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShoulder+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Borgeat, A.; Ekatodramis, G.; Kalberer, F.; Benz, C. (October 2001). \"Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study\". <i>Anesthesiology<\/i>. <b>95<\/b> (4): 875\u2013880. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00000542-200110000-00015\" target=\"_blank\">10.1097\/00000542-200110000-00015<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0003-3022\" target=\"_blank\">0003-3022<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11605927\" target=\"_blank\">11605927<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesiology&rft.atitle=Acute+and+nonacute+complications+associated+with+interscalene+block+and+shoulder+surgery%3A+a+prospective+study&rft.volume=95&rft.issue=4&rft.pages=875-880&rft.date=2001-10&rft.issn=0003-3022&rft_id=info%3Apmid%2F11605927&rft_id=info%3Adoi%2F10.1097%2F00000542-200110000-00015&rft.aulast=Borgeat&rft.aufirst=A.&rft.au=Ekatodramis%2C+G.&rft.au=Kalberer%2C+F.&rft.au=Benz%2C+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AShoulder+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sydneyshoulder.com.au\/shoulder-replacement-image-gallery\" target=\"_blank\">Patient X-ray and Image gallery demonstrating anatomic total shoulder replacement and reverse shoulder replacement surgery<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.orthop.washington.edu\/?q=patient-care\/articles\/shoulder\/total-shoulder-replacement-arthroplasty-for-shoulder-arthritis.html\" target=\"_blank\">Information for Patients - Total Shoulder Replacement Arthroplasty for Shoulder Arthritis<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1245\nCached time: 20181126221830\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.396 seconds\nReal time usage: 0.483 seconds\nPreprocessor visited node count: 1226\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 61452\/2097152 bytes\nTemplate argument size: 403\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 44877\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.220\/10.000 seconds\nLua memory usage: 4.56 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 406.093 1 -total\n<\/p>\n<pre>62.53% 253.917 1 Template:Reflist\n28.02% 113.795 11 Template:Cite_journal\n25.22% 102.437 2 Template:Cite_web\n23.32% 94.690 1 Template:Infobox_interventions\n21.62% 87.805 1 Template:Infobox\n 5.82% 23.634 1 Template:Operations_and_other_procedures_on_the_musculoskeletal_system\n 5.31% 21.571 3 Template:Navbox\n 1.10% 4.474 2 Template:ICD9proc\n 0.90% 3.665 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:13843567-1!canonical and timestamp 20181126221830 and revision id 870722832\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Shoulder_replacement\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212249\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.056 seconds\nReal time usage: 0.202 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 194.262 1 - wikipedia:Shoulder_replacement\n100.00% 194.262 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8201-0!*!*!*!*!*!* and timestamp 20181217212248 and revision id 24347\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Shoulder_replacement\">https:\/\/www.limswiki.org\/index.php\/Shoulder_replacement<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","d24c960311b9de8ff2d033ef7c1efc54_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/88\/Shoulderprotesis.jpg\/560px-Shoulderprotesis.jpg"],"d24c960311b9de8ff2d033ef7c1efc54_timestamp":1545081768,"8019f4a793549b80b4608f1a1bf4d570_type":"article","8019f4a793549b80b4608f1a1bf4d570_title":"Optogenetics","8019f4a793549b80b4608f1a1bf4d570_url":"https:\/\/www.limswiki.org\/index.php\/Optogenetics","8019f4a793549b80b4608f1a1bf4d570_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tOptogenetics\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tOptogenetics (from Greek, Modern  optik\u00f3s, meaning 'seen, visible') is a biological technique that involves the use of light to control cells in living tissue, typically neurons, that have been genetically modified to express light-sensitive ion channels. It is a neuromodulation method that uses a combination of techniques from optics and genetics to control and monitor the activities of individual neurons in living tissue\u2014even within freely-moving animals\u2014and to precisely measure these manipulation effects in real-time.[1] The key reagents used in optogenetics are light-sensitive proteins. Neuronal control is achieved using optogenetic actuators like channelrhodopsin, halorhodopsin, and archaerhodopsin, while optical recording of neuronal activities can be made with the help of optogenetic sensors for calcium (GCaMP), vesicular release (synapto-pHluorin), neurotransmitter (GluSnFRs), or membrane voltage (arc lightning, ASAP1).[2][3] Control (or recording) of activity is restricted to genetically defined neurons and performed in a spatiotemporal-specific manner by light.\nIn 2010, optogenetics was chosen as the \"Method of the Year\" across all fields of science and engineering by the interdisciplinary research journal Nature Methods.[4] At the same time, optogenetics was highlighted in the article on \"Breakthroughs of the Decade\" in the academic research journal Science.[5] These journals also referenced recent public-access general-interest video Method of the year video and textual SciAm summaries of optogenetics.\n\nContents \n\n1 History \n2 Description \n3 Technique \n4 Issues \n\n4.1 Selective expression \n4.2 Kinetics and synchronization \n4.3 Excitation spectrum \n\n\n5 Applications \n\n5.1 Identification of particular neurons and networks \n\n5.1.1 Amygdala \n5.1.2 Olfactory bulb \n5.1.3 Nucleus accumbens \n5.1.4 Prefrontal cortex \n5.1.5 Heart \n5.1.6 Spiral ganglion \n5.1.7 Brainstem \n\n\n5.2 Precise temporal control of interventions \n\n5.2.1 Hippocampus \n\n\n5.3 Cellular biology\/cell signaling pathways \n\n5.3.1 Photosensitive proteins utilized in various cell signaling pathways \n5.3.2 Optogenetic temporal control of signals \n\n\n\n\n6 References \n7 Further reading \n8 External links \n\n\nHistory \nThe \"far-fetched\" possibility of using light for selectively controlling precise neural activity (action potential) patterns within subtypes of cells in the brain was thought of by Francis Crick in his Kuffler Lectures at the University of California in San Diego in 1999.[6] An earlier use of light to activate neurons was carried out by Richard Fork,[7] who demonstrated laser activation of neurons within intact tissue, although not in a genetically-targeted manner. The earliest genetically targeted method that used light to control rhodopsin-sensitized neurons was reported in January 2002, by Boris Zemelman and Gero Miesenb\u00f6ck, who employed Drosophila rhodopsin cultured mammalian neurons.[8] In 2003, Zemelman and Miesenb\u00f6ck developed a second method for light-dependent activation of neurons in which single inotropic channels TRPV1, TRPM8 and P2X2 were gated by photocaged ligands in response to light.[9] Beginning in 2004, the Kramer and Isacoff groups developed organic photoswitches or \"reversibly caged\" compounds in collaboration with the Trauner group that could interact with genetically introduced ion channels.[10][11] TRPV1 methodology, albeit without the illumination trigger, was subsequently used by several laboratories to alter feeding, locomotion and behavioral resilience in laboratory animals.[12][13][14] However, light-based approaches for altering neuronal activity were not applied outside the original laboratories, likely because the easier to employ channelrhodopsin was cloned soon thereafter.[15]\nPeter Hegemann, studying the light response of green algae at the University of Regensburg, had discovered photocurrents that were too fast to be explained by the classic g-protein-coupled animal rhodopsins.[16] Teaming up with the electrophysiologist Georg Nagel at the Max Planck Institute in Frankfurt, they could demonstrate that a single gene from the alga Chlamydomonas produced large photocurents when expressed in the oocyte of a frog.[17] To identify expressing cells, they replaced the cytoplasmic tail of the algal protein with the fluorescent protein YFP, generating the first generally applicable optogenetic tool.[15] \nZhuo-Hua Pan of Wayne State University, researching on restore sight to blindness, thought about using channelrhodopsin when it came out in late 2003. By February 2004, he was trying channelrhodopsin out in ganglion cells\u2014the neurons in our eyes that connect directly to the brain\u2014that he had cultured in a dish. Indeed, the transfected neurons became electrically active in response to light. In 2005, Zhuo-Hua Pan reported successful in-vivo transfection of channelrhodopsin in retinal ganglion cells of mice, and electrical responses to photostimulation in retinal slice culture[18] \nIn April 2005, Susana Lima and Miesenb\u00f6ck reported the first use of genetically-targeted P2X2 photostimulation to control the behaviour of an animal.[19] They showed that photostimulation of genetically circumscribed groups of neurons, such as those of the dopaminergic system, elicited characteristic behavioural changes in fruit flies. \nIn August 2005, Karl Deisseroth's laboratory in the Bioengineering Department at Stanford including graduate students Ed Boyden and Feng Zhang published the first demonstration of a single-component optogenetic system in cultured mammalian neurons,[20][21] using the channelrhodopsin-2(H134R)-eYFP construct from Nagel and Hegemann.[15] \nThe groups of Gottschalk and Nagel were first to use channelrhodopsin-2 for controlling neuronal activity in an intact animal, showing that motor patterns in the roundworm Caenorhabditis elegans could be evoked by light stimulation of genetically selected neural circuits (published in December 2005).[22] In mice, controlled expression of optogenetic tools is often achieved with cell-type-specific Cre\/loxP methods developed for neuroscience by Joe Z. Tsien back in the 1990s[23] to activate or inhibit specific brain regions and cell-types in vivo.[24]\nThe primary tools for optogenetic recordings have been genetically encoded calcium indicators (GECIs). The first GECI to be used to image activity in an animal was cameleon, designed by Atsushi Miyawaki, Roger Tsien and coworkers.[25] Cameleon was first used successfully in an animal by Rex Kerr, William Schafer and coworkers to record from neurons and muscle cells of the nematode C. elegans.[26] Cameleon was subsequently used to record neural activity in flies[27] and zebrafish.[28] In mammals, the first GECI to be used in vivo was GCaMP,[29] first developed by Nakai and coworkers.[30] GCaMP has undergone numerous improvements, and GCaMP6[31] in particular has become widely used throughout neuroscience.\nIn 2010, Karl Deisseroth at Stanford University was awarded the inaugural HFSP Nakasone Award \"for his pioneering work on the development of optogenetic methods for studying the function of neuronal networks underlying behavior\". In 2012, Gero Miesenb\u00f6ck was awarded the InBev-Baillet Latour International Health Prize for \"pioneering optogenetic approaches to manipulate neuronal activity and to control animal behaviour.\" In 2013, Ernst Bamberg, Ed Boyden, Karl Deisseroth, Peter Hegemann, Gero Miesenb\u00f6ck and Georg Nagel were awarded The Brain Prize for \"their invention and refinement of optogenetics.\"[32][33] Karl Deisseroth was awarded the Else Kr\u00f6ner Fresenius Research Prize 2017 (4 million euro) for his \"contributions to the understanding of the biological basis of psychiatric disorders\".\n\nDescription \n Fig 1. Channelrhodopsin-2 (ChR2) induces temporally precise blue light-driven activity in rat prelimbic prefrontal cortical neurons. a) In vitro schematic (left) showing blue light delivery and whole-cell patch-clamp recording of light-evoked activity from a fluorescent CaMKll\u03b1::ChR2-EYFP expressing pyramidal neuron (right) in an acute brain slice. b) In vivo schematic (left) showing blue light (473 nm) delivery and single-unit recording. (bottom left) Coronal brain slice showing expression of CaMKll\u03b1::ChR2-EYFP in the prelimbic region. Light blue arrow shows tip of the optical fiber; black arrow shows tip of the recording electrode (left). White bar, 100 \u00b5m. (bottom right) In vivo light recording of prefrontal cortical neuron in a transduced CaMKll\u03b1::ChR2-EYFP rat showing light-evoked spiking to 20 Hz delivery of blue light pulses (right). Inset, representative light-evoked single-unit response.[34]\n Fig 2. Halorhodopsin (NpHR) rapidly and reversibly silences spontaneous activity in vivo in rat prelimbic prefrontal cortex. (Top left) Schematic showing in vivo green (532 nm) light delivery and single- unit recording of a spontaneously active CaMKll\u03b1::eNpHR3.0- EYFP expressing pyramidal neuron. (Right) Example trace showing that continuous 532 nm illumination inhibits single-unit activity in vivo. Inset, representative single unit event; Green bar, 10 seconds.[34]\nPlay media A nematode expressing the light-sensitive ion channel Mac. Mac is a proton pump originally isolated in the fungus Leptosphaeria maculans and now expressed in the muscle cells of C. elegans that opens in response to green light and causes hyperpolarizing inhibition. Of note is the extension in body length that the worm undergoes each time it is exposed to green light, which is presumably caused by Mac's muscle-relaxant effects.[35]\nPlay media A nematode expressing ChR2 in its gubernacular-oblique muscle group responding to stimulation by blue light. Blue light stimulation causes the gubernacular-oblique muscles to repeatedly contract, causing repetitive thrusts of the spicule, as would be seen naturally during copulation.[36]\nOptogenetics provides millisecond-scale temporal precision which allows the experimenter to keep pace with fast biological information processing (for example, in probing the causal role of specific action potential patterns in defined neurons). Indeed, to probe the neural code, optogenetics by definition must operate on the millisecond timescale to allow addition or deletion of precise activity patterns within specific cells in the brains of intact animals, including mammals (see Figure 1). By comparison, the temporal precision of traditional genetic manipulations (employed to probe the causal role of specific genes within cells, via \"loss-of-function\" or \"gain of function\" changes in these genes) is rather slow, from hours or days to months. It is important to also have fast readouts in optogenetics that can keep pace with the optical control. This can be done with electrical recordings (\"optrodes\") or with reporter proteins that are biosensors, where scientists have fused fluorescent proteins to detector proteins. An example of this is voltage-sensitive fluorescent protein (VSFP2).[37] Additionally, beyond its scientific impact optogenetics represents an important case study in the value of both ecological conservation (as many of the key tools of optogenetics arise from microbial organisms occupying specialized environmental niches), and in the importance of pure basic science as these opsins were studied over decades for their own sake by biophysicists and microbiologists, without involving consideration of their potential value in delivering insights into neuroscience and neuropsychiatric disease.[38]\nLight-activated proteins: channels, pumps and enzymes\nThe hallmark of optogenetics therefore is introduction of fast light-activated channels, pumps, and enzymes that allow temporally precise manipulation of electrical and biochemical events while maintaining cell-type resolution through the use of specific targeting mechanisms. Among the microbial opsins which can be used to investigate the function of neural systems are the channelrhodopsins (ChR2, ChR1, VChR1, and SFOs) to excite neurons and anion-conducting channelrhodopsins for light-induced inhibition. Indirectly light-controlled potassium channels have recently been engineered to prevent action potential generation in neurons during blue light illumination.[39][40] Light-driven ion pumps are also used to inhibit neuronal activity, e.g. halorhodopsin (NpHR),[41] enhanced halorhodopsins (eNpHR2.0 and eNpHR3.0, see Figure 2),[42] archaerhodopsin (Arch), fungal opsins (Mac) and enhanced bacteriorhodopsin (eBR).[43]\nOptogenetic control of well-defined biochemical events within behaving mammals is now also possible. Building on prior work fusing vertebrate opsins to specific G-protein coupled receptors[44] a family of chimeric single-component optogenetic tools was created that allowed researchers to manipulate within behaving mammals the concentration of defined intracellular messengers such as cAMP and IP3 in targeted cells.[45] Other biochemical approaches to optogenetics (crucially, with tools that displayed low activity in the dark) followed soon thereafter, when optical control over small GTPases and adenylyl cyclases was achieved in cultured cells using novel strategies from several different laboratories.[46][47][48][49][50] This emerging repertoire of optogenetic probes now allows cell-type-specific and temporally precise control of multiple axes of cellular function within intact animals.[51]\nHardware for light application\nAnother necessary factor is hardware (e.g. integrated fiberoptic and solid-state light sources) to allow specific cell types, even deep within the brain, to be controlled in freely behaving animals. Most commonly, the latter is now achieved using the fiberoptic-coupled diode technology introduced in 2007,[52][53][54] though to avoid use of implanted electrodes, researchers have engineered ways to inscribe a \"window\" made of zirconia that has been modified to be transparent and implanted in mice skulls, to allow optical waves to penetrate more deeply to stimulate or inhibit individual neurons.[55] To stimulate superficial brain areas such as the cerebral cortex, optical fibers or LEDs can be directly mounted to the skull of the animal. More deeply implanted optical fibers have been used to deliver light to deeper brain areas. Complementary to fiber-tethered approaches, completely wireless techniques have been developed utilizing wirelessly delivered power to headborne LEDs for unhindered study of complex behaviors in freely behaving organisms.[56]\nExpression of optogenetic actuators\nOptogenetics also necessarily includes the development of genetic targeting strategies such as cell-specific promoters or other customized conditionally-active viruses, to deliver the light-sensitive probes to specific populations of neurons in the brain of living animals (e.g. worms, fruit flies, mice, rats, and monkeys). In invertebrates such as worms and fruit flies some amount of all-trans-retinal (ATR) is supplemented with food. A key advantage of microbial opsins as noted above is that they are fully functional without the addition of exogenous co-factors in vertebrates.[54]\n\nTechnique \n Three primary components in the application of optogenetics are as follows (A) Identification or synthesis of a light-sensitive protein (opsin) such as channelrhodopsin-2 (ChR2), halorhodopsin (NpHR), etc... (B) The design of a system to introduce the genetic material containing the opsin into cells for protein expression such as application of Cre recombinase or an adeno-associated-virus (C) application of light emitting instruments.[57]\nThe technique of using optogenetics is flexible and adaptable to the experimenter's needs. For starters, experimenters genetically engineer a microbial opsin based on the gating properties (rate of excitability, refractory period, etc..) required for the experiment.\nThere is a challenge in introducing the microbial opsin, an optogenetic actuator, into a specific region of the organism in question. A rudimentary approach is to introduce an engineered viral vector that contains the optogenetic actuator gene attached to a recognizable promoter such as CAMKII\u03b1. This allows for some level of specificity as cells that already contain and can translate the given promoter will be infected with the viral vector and hopefully express the optogenetic actuator gene.\nAnother approach is the creation of transgenic mice where the optogenetic actuator gene is introduced into mice zygotes with a given promoter, most commonly Thy1. Introduction of the optogenetic actuator at an early stage allows for a larger genetic code to be incorporated and as a result, increases the specificity of cells to be infected.\nA third and rather novel approach that has been developed is creating transgenic mice with Cre recombinase, an enzyme that catalyzes recombination between two lox-P sites. Then by introducing an engineered viral vector containing the optogenetic actuator gene in between two lox-P sites, only the cells containing the Cre recombinase will express the microbial opsin. This last technique has allowed for multiple modified optogenetic actuators to be used without the need to create a whole line of transgenic animals every time a new microbial opsin is needed.\nAfter the introduction and expression of the microbial opsin, depending on the type of analysis being performed, application of light can be placed at the terminal ends or the main region where the infected cells are situated. Light stimulation can be performed with a vast array of instruments from light emitting diodes (LEDs) or diode-pumped solid state (DPSS). These light sources are most commonly connected to a computer through a fiber optic cable. Recent advances include the advent of wireless head-mounted devices that also apply LED to targeted areas and as a result give the animal more freedom of mobility to reproduce in vivo results.[58][59]\n\nIssues \nAlthough already a powerful scientific tool, optogenetics, according to Doug Tischer & Orion D. Weiner of the University of California San Francisco, should be regarded as a \"first-generation GFP\" because of its immense potential for both utilization and optimization.[60] With that being said, the current approach to optogenetics is limited primarily by its versatility. Even within the field of Neuroscience where it is most potent, the technique is less robust on a subcellular level.[61]\n\nSelective expression \nOne of the main problems of optogenetics is that not all the cells in question may express the microbial opsin gene at the same level. Thus, even illumination with a defined light intensity will have variable effects on individual cells. Optogenetic stimulation of neurons in the brain is even less controlled as the light intensity drops exponentially from the light source (e.g. implanted optical fiber).\nMoreover, mathematical modelling shows that selective expression of opsin in specific cell types can dramatically alter the dynamical behavior of the neural circuitry. In particular, optogenetic stimulation that preferentially targets inhibitory cells can transform the excitability of the neural tissue from Type 1 \u2014 where neurons operate as integrators \u2014 to Type 2 where neurons operate as resonators.[62]\nType 1 excitable media sustain propagating waves of activity whereas Type 2 excitable media do not. The transformation from one to the other explains how constant optical stimulation of primate motor cortex elicits gamma-band (40\u201380 Hz) oscillations in the manner of a Type 2 excitable medium. Yet those same oscillations propagate far into the surrounding tissue in the manner of a Type 1 excitable medium.[63]\n\n<\/p>Nonetheless, it remains difficult to target opsin to defined subcellular compartments, e.g. the plasma membrane, synaptic vesicles, or mitochondria.[61][64] Restricting the opsin to specific regions of the plasma membrane such as dendrites, somata or axon terminals would provide a more robust understanding of neuronal circuitry.[61]\n\nKinetics and synchronization \nAn issue with channelrhodopsin-2 is that its gating properties don't mimic in vivo cation channels of cortical neurons. A solution to this issue with a protein's kinetic property is introduction of variants of channelrhodopsin-2 with more favorable kinetics.[55][56]\nAnother one of the technique's limitations is that light stimulation produces a synchronous activation of infected cells and this removes any individual cell properties of activation among the population affected. Therefore, it is difficult to understand how the cells in the population affected communicate with one another or how their phasic properties of activation may relate to the circuitry being observed.\nOptogenetic activation has been combined with functional magnetic resonance imaging (ofMRI) to elucidate the connectome, a thorough map of the brain\u2019s neural connections. The results, however, are limited by the general properties of fMRI.[61][65] The readouts from this neuroimaging procedure lack the spatial and temporal resolution appropriate for studying the densely packed and rapid-firing neuronal circuits.[65]\n\nExcitation spectrum \nThe opsin proteins currently in use have absorption peaks across the visual spectrum, but remain considerable sensitivity to blue light.[61] This spectral overlap makes it very difficult to combine opsin activation with genenetically encoded indictors (GEVIs, GECIs, GluSnFR, synapto-pHluorin), most of which need blue light excitation. Opsins with infrared activation would, at a standard irradiance value, increase light penetration and augment resolution through reduction of light scattering.\n\nApplications \nThe field of optogenetics has furthered the fundamental scientific understanding of how specific cell types contribute to the function of biological tissues such as neural circuits in vivo (see references from the scientific literature below). Moreover, on the clinical side, optogenetics-driven research has led to insights into Parkinson's disease[66][67] and other neurological and psychiatric disorders. Indeed, optogenetics papers in 2009 have also provided insight into neural codes relevant to autism, Schizophrenia, drug abuse, anxiety, and depression.[43][68][69][70]\n\nIdentification of particular neurons and networks \nAmygdala \nOptogenetic approaches have been used to map neural circuits in the amygdala that contribute to fear conditioning.[71][72][73][74] One such example of a neural circuit is the connection made from the basolateral amygdala to the dorsal-medial prefrontal cortex where neuronal oscillations of 4 Hz have been observed in correlation to fear induced freezing behaviors in mice. Transgenic mice were introduced with channelrhodoposin-2 attached with a parvalbumin-Cre promoter that selectively infected interneurons located both in the basolateral amygdala and the dorsal-medial prefrontal cortex responsible for the 4 Hz oscillations. The interneurons were optically stimulated generating a freezing behavior and as a result provided evidence that these 4 Hz oscillations may be responsible for the basic fear response produced by the neuronal populations along the dorsal-medial prefrontal cortex and basolateral amygdala.[75]\n\nOlfactory bulb \nOptogenetic activation of olfactory sensory neurons was critical for demonstrating timing in odor processing[76] and for mechanism of neuromodulatory mediated olfactory guided behaviors (e.g. aggression, mating)[77] In addition, with the aid of optogenetics, evidence has been reproduced to show that the \"afterimage\" of odors is concentrated more centrally around the olfactory bulb rather than on the periphery where the olfactory receptor neurons would be located. Transgenic mice infected with channel-rhodopsin Thy1-ChR2, were stimulated with a 473 nm laser transcranially positioned over the dorsal section of the olfactory bulb. Longer photostimulation of mitral cells in the olfactory bulb led to observations of longer lasting neuronal activity in the region after the photostimulation had ceased, meaning the olfactory sensory system is able to undergo long term changes and recognize differences between old and new odors.[78]\n\nNucleus accumbens \nOptogenetics, freely moving mammalian behavior, in vivo electrophysiology, and slice physiology have been integrated to probe the cholinergic interneurons of the nucleus accumbens by direct excitation or inhibition. Despite representing less than 1% of the total population of accumbal neurons, these cholinergic cells are able to control the activity of the dopaminergic terminals that innervate medium spiny neurons (MSNs) in the nucleus accumbens.[79] These accumbal MSNs are known to be involved in the neural pathway through which cocaine exerts its effects, because decreasing cocaine-induced changes in the activity of these neurons has been shown to inhibit cocaine conditioning. The few cholinergic neurons present in the nucleus accumbens may prove viable targets for pharmacotherapy in the treatment of cocaine dependence[43] Cages for rat equipped of optogenetics leds commutators which permit in vivo to study animal behavior during optogenetics' stimulations.\nPrefrontal cortex \nIn vivo and in vitro recordings (by the Cooper laboratory) of individual CAMKII AAV-ChR2 expressing pyramidal neurons within the prefrontal cortex demonstrated high fidelity action potential output with short pulses of blue light at 20 Hz (Figure 1).[34] The same group recorded complete green light-induced silencing of spontaneous activity in the same prefrontal cortical neuronal population expressing an AAV-NpHR vector (Figure 2).[34]\n\nHeart \nOptogenetics was applied on atrial cardiomyocytes to end spiral wave arrhythmias, found to occur in atrial fibrillation, with light.[80] This method is still in the development stage. A recent study explored the possibilities of optogenetics as a method to correct for arrythmias and resynchronize cardiac pacing. The study introduced channelrhodopsin-2 into cardiomyocytes in ventricular areas of hearts of transgenic mice and performed in vitro studies of photostimulation on both open-cavity and closed-cavity mice. Photostimulation led to increased activation of cells and thus increased ventricular contractions resulting in increasing heart rates. In addition, this approach has been applied in cardiac resynchronization therapy (CRT) as a new biological pacemaker as a substitute for electrode based-CRT.[81] Lately, optogenetics has been used in the heart to defibrillate ventricular arrhythmias with local epicardial illumination,[82] a generalized whole heart illumination[83] or with customized stimulation patterns based on arrhythmogenic mechanisms in order to lower defibrillation energy.[84]\n\nSpiral ganglion \nOptogenetic stimulation of the spiral ganglion in deaf mice restored auditory activity.[85][86] Optogenetic application onto the cochlear region allows for the stimulation or inhibition of the spiral ganglion cells (SGN). In addition, due to the characteristics of the resting potentials of SGN's, different variants of the protein channelrhodopsin-2 have been employed such as Chronos and CatCh. Chronos and CatCh variants are particularly useful in that they have less time spent in their deactivated states, which allow for more activity with less bursts of blue light emitted. The result being that the LED producing the light would require less energy and the idea of cochlear prosthetics in association with photo-stimulation, would be more feasible.[87]\n\nBrainstem \nOptogenetic stimulation of a modified red-light excitable channelrhodopsin (ReaChR) expressed in the facial motor nucleus enabled minimally invasive activation of motoneurons effective in driving whisker movements in mice.[88] One novel study employed optogenetics on the Dorsal Ralphe Nucleus to both activate and inhibit dopaminergic release onto the ventral tegmental area. To produce activation transgenic mice were infected with channelrhodopsin-2 with a TH-Cre promoter and to produce inhibition the hyperpolarizing opsin NpHR was added onto the TH-Cre promoter. Results showed that optically activating dopaminergic neurons led to an increase in social interactions, and their inhibition decreased the need to socialize only after a period of isolation.[89]\n\nPrecise temporal control of interventions \nThe currently available optogenetic actuators allow for the accurate temporal control of the required intervention (i.e. inhibition or excitation of the target neurons) with precision routinely going down to the millisecond level. Therefore, experiments can now be devised where the light used for the intervention is triggered by a particular element of behavior (to inhibit the behavior), a particular unconditioned stimulus (to associate something to that stimulus) or a particular oscillatory event in the brain (to inhibit the event). This kind of approach has already been used in several brain regions:\n\nHippocampus \nSharp waves and ripple complexes (SWRs) are distinct high frequency oscillatory events in the hippocampus thought to play a role in memory formation and consolidation. These events can be readily detected by following the oscillatory cycles of the on-line recorded local field potential. In this way the onset of the event can be used as a trigger signal for a light flash that is guided back into the hippocampus to inhibit neurons specifically during the SWRs and also to optogenetically inhibit the oscillation itself[90] These kinds of \"closed-loop\" experiments are useful to study SWR complexes and their role in memory.\n\n Cellular biology\/cell signaling pathways \n Optogenetic control of cellular forces and induction of mechanotransduction. Pictured cells receive an hour of imaging concurrent with blue light that pulses every 60 seconds. This is also indicated when the blue point flashes onto the image. The cell relaxes for an hour without light activation and then this cycle repeats again. The square inset magnifies the cell's nucleus.\nThe optogenetic toolkit has proven pivotal for the field of neuroscience as it allows precise manipulation of neuronal excitability. Moreover, this technique has been shown to extend outside neurons to an increasing number of proteins and cellular functions.[60] Cellular scale modifications including manipulation of contractile forces relevant to cell migration, cell division and wound healing have been optogenetically manipulated.[91] The field has not developed to the point where processes crucial to cellular and developmental biology and cell signaling including protein localization, post-translational modification and GTP loading can be consistently controlled via optogenetics.[60]\n\nPhotosensitive proteins utilized in various cell signaling pathways \nWhile this extension of optogenetics remains to be further investigated, there are various conceptual methodologies that may prove to immediately robust. There is a considerable body of literature outlining photosensitive proteins that have been utilized in cell signaling pathways.[60] CRY2, LOV, DRONPA and PHYB are photosynthetic proteins involved in inducible protein association whereby activation via light can induce\/turn off a signaling cascade via recruitment of a signaling domain to its respective substrate.[92][93][94][95] LOV and PHYB are photosensitive proteins that engage in homodimerization and\/or heterodimerization to recruit some DNA-modifying protein, translocate to the site of DNA and alter gene expression levels.[96][97][98] CRY2, a protein that inherently clusters when active, has been fused with signaling domains and subsequently photoactivated allowing for clustering-based activation.[99] Proteins LOV and Dronpa have also been adapted to cell signaling manipulation; exposure to light induces conformational changes in the photosensitive protein which can subsequently reveal a previously obscured signaling domain and\/or activate a protein that was otherwise allosterically inhibited.[100][101] LOV has been fused to caspase 3 to produce a construct capable of inducing apoptosis upon light stimulation.[102]\n\nOptogenetic temporal control of signals \nA different set of signaling cascades respond to stimulus timing duration and dynamics.[103] Adaptive signaling pathways, for instance, adjust in accordance to the current level of the projected stimulus and display activity only when these levels change as opposed to responding to absolute levels of the input.[104] Stimulus dynamics also can trigger activity; treating PC12 cells with epidermal growth factor (inducing a transient profile of ERK activity) leads to cellular proliferation whereas introduction of nerve growth factor (inducing a sustained profile of ERK activity) is associated with a different cellular decision whereby the PC12 cells differentiate into neuron-like cells.[105] This discovery was guided pharmacologically but the finding was replicated utilizing optogenetic inputs instead.[106] This ability to optogenetically control signals for various time durations is being explored to elucidate various cell signaling pathways where there is not a strong enough understanding to utilize either drug\/genetic manipulation.[60]\n\nReferences \n\n\n^ Deisseroth, K.; Feng, G.; Majewska, A. 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Y.; Zhong, L.; Xu, Y.; Johnson, T.; Zhang, F.; Deisseroth, K.; Tracey, W. D. (2007-12-18). \"Nociceptive neurons protect Drosophila larvae from parasitoid wasps\". Current Biology. 17 (24): 2105\u201316. doi:10.1016\/j.cub.2007.11.029. PMC 2225350 . PMID 18060782. \nKuhlman, S. J.; Huang, Z. J.; Huang (2008). Wong, Rachel O. L., ed. \"High-resolution labeling and functional manipulation of specific neuron types in mouse brain by Cre-activated viral gene expression\". PLoS ONE. 3 (4): e2005. Bibcode:2008PLoSO...3.2005K. doi:10.1371\/journal.pone.0002005. PMC 2289876 . PMID 18414675. CS1 maint: Multiple names: authors list (link) \nLagali, P. S.; Balya, D.; Awatramani, G. B.; M\u00fcnch, Thomas A; et al. (June 2008). \"Light-activated channels targeted to ON bipolar cells restore visual function in retinal degeneration\". Nat. Neurosci. 11 (6): 667\u201375. doi:10.1038\/nn.2117. PMID 18432197. \nLee, J. H.; Durand, R.; Gradinaru, V.; Zhang, F.; Goshen, I.; Kim, D. S.; Fenno, L. E.; Ramakrishnan, C.; Deisseroth, K. (2010-06-10). \"Global and local fMRI signals driven by neurons defined optogenetically by type and wiring\". Nature. 465 (7299): 788\u201392. Bibcode:2010Natur.465..788L. doi:10.1038\/nature09108. PMC 3177305 . PMID 20473285. \nLi, H. H.; Roy, M.; Kuscuoglu, U.; Spencer, C. M.; Halm, B.; Harrison, K. C.; Bayle, J. H.; Splendore, A.; Ding, F.; Meltzer, L. A.; Wright, E.; Paylor, R.; Deisseroth, K.; Francke, U. (April 2009). \"Induced chromosome deletions cause hypersociability and other features of Williams-Beuren syndrome in mice\". EMBO Molecular Medicine. 1 (1): 50\u201365. doi:10.1002\/emmm.200900003. PMC 3378107 . PMID 20049703. \nLiewald, J. F.; Brauner, M.; Stephens, G. J.; Bouhours, Magali; et al. (October 2008). \"Optogenetic analysis of synaptic function\". Nat. Methods. 5 (10): 895\u2013902. doi:10.1038\/nmeth.1252. PMID 18794862. \nLima, S. Q.; Hrom\u00e1dka, T.; Znamenskiy, P.; Zador, A. M.; Hrom\u00e1dka; Znamenskiy; Zador (2009). Nitabach, Michael N., ed. \"PINP: a new method of tagging neuronal populations for identification during in vivo electrophysiological recording\". PLoS ONE. 4 (7): e6099. Bibcode:2009PLoSO...4.6099L. doi:10.1371\/journal.pone.0006099. PMC 2702752 . PMID 19584920. CS1 maint: Multiple names: authors list (link) \nLin, J. Y.; Lin, M. Z.; Steinbach, P.; Tsien, R. Y.; Lin; Steinbach; Tsien (March 2009). \"Characterization of engineered channelrhodopsin variants with improved properties and kinetics\". Biophys. J. 96 (5): 1803\u201314. Bibcode:2009BpJ....96.1803L. doi:10.1016\/j.bpj.2008.11.034. PMC 2717302 . PMID 19254539. CS1 maint: Multiple names: authors list (link) \nLiu, Q.; Hollopeter, G.; Jorgensen, E. M.; Hollopeter; Jorgensen (June 2009). \"Graded synaptic transmission at the Caenorhabditis elegans neuromuscular junction\". Proc. Natl. Acad. Sci. U.S.A. 106 (26): 10823\u20138. Bibcode:2009PNAS..10610823L. doi:10.1073\/pnas.0903570106. PMC 2705609 . PMID 19528650. CS1 maint: Multiple names: authors list (link) \nLlewellyn, M. E.; Thompson, K. R.; Deisseroth, K.; Delp, S. L. (October 2010). \"Orderly recruitment of motor units under optical control in vivo\". Nature Medicine. 16 (10): 1161\u20135. doi:10.1038\/nm.2228. PMID 20871612. \nLobo, M. K.; Covington, H. E., 3rd; Chaudhury, D.; Friedman, A. K.; Sun, H.; Damez-Werno, D.; Dietz, D. M.; Zaman, S.; Koo, J. W.; Kennedy, P. J.; Mouzon, E.; Mogri, M.; Neve, R. L.; Deisseroth, K.; Han, M. H.; Nestler, E. J. (2010-10-15). \"Cell type-specific loss of BDNF signaling mimics optogenetic control of cocaine reward\". Science. 330 (6002): 385\u201390. Bibcode:2010Sci...330..385L. doi:10.1126\/science.1188472. PMC 3011229 . PMID 20947769. CS1 maint: Multiple names: authors list (link) \nMiesenb\u00f6ck, G. (October 2008). \"Lighting up the brain\". Sci. Am. 299 (4): 52\u20139. Bibcode:2008SciAm.299d..52M. doi:10.1038\/scientificamerican1008-52. PMID 18847085. \nMiesenb\u00f6ck, G. (October 2009). \"The optogenetic catechism\". Science. 326 (5951): 395\u20139. Bibcode:2009Sci...326..395M. doi:10.1126\/science.1174520. PMID 19833960. \nMiller, G. (December 2006). \"Optogenetics. Shining new light on neural circuits\". Science. 314 (5806): 1674\u20136. doi:10.1126\/science.314.5806.1674. PMID 17170269. \nSchneider, M. B.; Gradinaru, V.; Zhang, F.; Deisseroth, K. (May 2008). \"Controlling neuronal activity\". The American Journal of Psychiatry. 165 (5): 562. doi:10.1176\/appi.ajp.2008.08030444. PMID 18450936. \nSchr\u00f6der-Lang, S.; Schw\u00e4rzel, M.; Seifert, R.; Str\u00fcnker, Timo; et al. (January 2007). \"Fast manipulation of cellular cAMP level by light in vivo\". Nature Methods. 4 (1): 39\u201342. doi:10.1038\/nmeth975. PMID 17128267. \nSzobota, S.; Gorostiza, P.; Del Bene, F.; Wyart, Claire; et al. (May 2007). \"Remote control of neuronal activity with a light-gated glutamate receptor\". Neuron. 54 (4): 535\u201345. doi:10.1016\/j.neuron.2007.05.010. PMID 17521567. \nToni, N.; Laplagne, D. A.; Zhao, C.; Lombardi, Gabriela; et al. (August 2008). \"Neurons born in the adult dentate gyrus form functional synapses with target cells\". Nat. Neurosci. 11 (8): 901\u20137. doi:10.1038\/nn.2156. PMC 2572641 . PMID 18622400. \nT\u00f8nnesen, J.; S\u00f8rensen, A. T.; Deisseroth, K.; Lundberg, C.; Kokaia, M. (2009-07-21). \"Optogenetic control of epileptiform activity\". Proceedings of the National Academy of Sciences of the United States of America. 106 (29): 12162\u20137. Bibcode:2009PNAS..10612162T. doi:10.1073\/pnas.0901915106. PMC 2715517 . PMID 19581573. \nWang, S.; Szobota, S.; Wang, Y.; Volgraf, Matthew; et al. (December 2007). \"All optical interface for parallel, remote, and spatiotemporal control of neuronal activity\". Nano Lett. 7 (12): 3859\u201363. Bibcode:2007NanoL...7.3859W. doi:10.1021\/nl072783t. PMID 18034506. \nWang, H.; Peca, J.; Matsuzaki, M.; Matsuzaki, K.; et al. (May 2007). \"High-speed mapping of synaptic connectivity using photostimulation in Channelrhodopsin-2 transgenic mice\". Proc. Natl. Acad. Sci. U.S.A. 104 (19): 8143\u20138. Bibcode:2007PNAS..104.8143W. doi:10.1073\/pnas.0700384104. PMC 1876585 . PMID 17483470. \nWang, Y.; Dye, C. A.; Sohal, V.; Long, J. E.; Estrada, R. C.; Roztocil, T.; Lufkin, T.; Deisseroth, K.; Baraban, S. C.; Rubenstein, J. L. (2010-04-14). \"Dlx5 and Dlx6 regulate the development of parvalbumin-expressing cortical interneurons\". Journal of Neuroscience. 30 (15): 5334\u201345. doi:10.1523\/JNEUROSCI.5963-09.2010. PMC 2919857 . PMID 20392955. \nWeick, J. P.; Johnson, M. A.; Skroch, S. P.; Williams, J. C.; Deisseroth, K.; Zhang, S. C. (November 2010). \"Functional control of transplantable human ESC-derived neurons via optogenetic targeting\". Stem Cells. 28 (11): 2008\u201316. doi:10.1002\/stem.514. PMC 2988875 . PMID 20827747. \nZhang, F.; Wang, L. P.; Boyden, E. S.; Deisseroth, K. (October 2006). \"Channelrhodopsin-2 and optical control of excitable cells\". Nat. Methods. 3 (10): 785\u201392. doi:10.1038\/nmeth936. PMID 16990810. \nZhang, F.; Wang, L. P.; Brauner, M.; Liewald, Jana F.; et al. (April 2007). \"Multimodal fast optical interrogation of neural circuitry\". Nature. 446 (7136): 633\u20139. Bibcode:2007Natur.446..633Z. doi:10.1038\/nature05744. PMID 17410168. \nZhang, F.; Aravanis, A. M.; Adamantidis, A.; de Lecea, L.; Deisseroth, K. (August 2007). \"Circuit-breakers: optical technologies for probing neural signals and systems\". Nature Reviews Neuroscience. 8 (8): 577\u201381. doi:10.1038\/nrn2192. PMID 17643087. \nZhang, Y. P.; Holbro, N.; Oertner, T. G.; Holbro; Oertner (August 2008). \"Optical induction of plasticity at single synapses reveals input-specific accumulation of alphaCaMKII\". Proc. Natl. Acad. Sci. U.S.A. 105 (33): 12039\u201344. Bibcode:2008PNAS..10512039Z. doi:10.1073\/pnas.0802940105. PMC 2575337 . PMID 18697934. CS1 maint: Multiple names: authors list (link) \nZhang, F.; Prigge, M.; Beyri\u00e8re, F.; Tsunoda, Satoshi P; et al. (June 2008). \"Red-shifted optogenetic excitation: a tool for fast neural control derived from Volvox carteri\". Nat. Neurosci. 11 (6): 631\u20133. doi:10.1038\/nn.2120. PMC 2692303 . PMID 18432196. \nZhang, F.; Gradinaru, V.; Adamantidis, A. R.; Durand, R.; Airan, R. D.; de Lecea, L.; Deisseroth, K. (2010). \"Optogenetic interrogation of neural circuits: technology for probing mammalian brain structures\". Nature Protocols. 5 (3): 439\u201356. doi:10.1038\/nprot.2009.226. PMC 4503465 . PMID 20203662. \nZhang, J.; Laiwalla, F.; Kim, J. A.; Urabe, H.; Van Wagenen, R.; Song, Y. K.; Connors, B. W.; Zhang, F.; Deisseroth, K.; Nurmikko, A. V. (October 2009). \"Integrated device for optical stimulation and spatiotemporal electrical recording of neural activity in light-sensitized brain tissue\". Journal of neural engineering. 6 (5): 055007. Bibcode:2009JNEng...6e5007Z. doi:10.1088\/1741-2560\/6\/5\/055007. PMC 2921864 . PMID 19721185. \nZhu, P.; Narita, Y.; Bundschuh, S. T.; Fajardo, O.; Sch\u00e4rer, Y. P.; Chattopadhyaya, B.; Bouldoires, E. A.; Stepien, A. E.; Deisseroth, K.; Arber, S.; Sprengel, R.; Rijli, F. M.; Friedrich, R. W. (2009-12-11). \"Optogenetic Dissection of Neuronal Circuits in Zebrafish using Viral Gene Transfer and the Tet System\". Frontiers in Neural Circuits. 3: 21. doi:10.3389\/neuro.04.021.2009. PMC 2805431 . PMID 20126518. \nZimmermann, G.; Wang, L. P.; Vaughan, A. G.; Manoli, D. S.; Zhang, F.; Deisseroth, K.; Baker, B. S.; Scott, M. P. (2009). Nitabach, Michael N., ed. \"Manipulation of an innate escape response in Drosophila: photoexcitation of acj6 neurons induces the escape response\". PLoS ONE. 4 (4): e5100. Bibcode:2009PLoSO...4.5100Z. doi:10.1371\/journal.pone.0005100. PMC 2660433 . PMID 19340304. \nExternal links \nThis article's use of external links may not follow Wikipedia's policies or guidelines. Please improve this article by removing excessive or inappropriate external links, and converting useful links where appropriate into footnote references. (October 2013) (Learn how and when to remove this template message)\nOptogenetics Resource Center, maintained by the Deisseroth lab.\nSynthetic Neurobiology Group, MIT, the portal of the Boyden lab.\nOpenOptogenetics.org, an optogenetics wiki, and its companion blog.\nMolecular Neurogenetics and Optophysiology Laboratory,\"Optogenetic activation and silencing recordings of individual prefrontal cortical neurons in vivo and in vitro.\nSohal lab portal\nNurmikko lab portal\nLab of Dr. Zhuo-Hua Pan\nOptophysiology at the Tyler lab\nVideo: Ed Boyden on Optogenetics -- selective brain stimulation with light (SPIE Newsroom, April 2011)\nvteBrain\u2013computer interfaceTechnologies\nBiomechatronics\nBrain implant\nBrainGate\nBrainport\nCyberware\nExocortex\nIntelligence amplification\nIsolated brain\nNeuroprosthetics\nNeurotechnology\nOptogenetics\nSensory substitution\nSynthetic telepathy\nScientific phenomena\nElectrocorticography (ECoG)\nNeural ensemble\nNeuroplasticity\nDisciplines\nCognitive science\nCognitive neuroscience\nComputational neuroscience\nNBIC\nNeural engineering\nNeuroscience\nSpeculative\nBrain transplant\nCyborg\nMind uploading\nPeople\nCharles Stross\nDouglas Engelbart\nHugh Herr\nJ. C. R. 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It is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromodulation_(medicine)\" title=\"Neuromodulation (medicine)\" rel=\"external_link\" target=\"_blank\">neuromodulation<\/a> method that uses a combination of techniques from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optics\" title=\"Optics\" rel=\"external_link\" target=\"_blank\">optics<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Genetics\" title=\"Genetics\" rel=\"external_link\" target=\"_blank\">genetics<\/a> to control and monitor the activities of individual <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuron\" title=\"Neuron\" rel=\"external_link\" target=\"_blank\">neurons<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/In_vivo\" title=\"In vivo\" rel=\"external_link\" target=\"_blank\">living tissue<\/a>\u2014even within freely-moving animals\u2014and to precisely measure these manipulation effects in real-time.<sup id=\"rdp-ebb-cite_ref-Deisseroth_2006_1-0\" class=\"reference\"><a href=\"#cite_note-Deisseroth_2006-1\" rel=\"external_link\">[1]<\/a><\/sup> The key reagents used in optogenetics are light-sensitive proteins. Neuronal control is achieved using <b>optogenetic actuators<\/b> like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Channelrhodopsin\" title=\"Channelrhodopsin\" rel=\"external_link\" target=\"_blank\">channelrhodopsin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Halorhodopsin\" title=\"Halorhodopsin\" rel=\"external_link\" target=\"_blank\">halorhodopsin<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microbial_rhodopsin\" title=\"Microbial rhodopsin\" rel=\"external_link\" target=\"_blank\">archaerhodopsin<\/a>, while optical recording of neuronal activities can be made with the help of <b>optogenetic sensors<\/b> for calcium (<a href=\"https:\/\/en.wikipedia.org\/wiki\/GCaMP\" title=\"GCaMP\" rel=\"external_link\" target=\"_blank\">GCaMP<\/a>), vesicular release (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Synapto-pHluorin\" title=\"Synapto-pHluorin\" rel=\"external_link\" target=\"_blank\">synapto-pHluorin<\/a>), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurotransmitter\" title=\"Neurotransmitter\" rel=\"external_link\" target=\"_blank\">neurotransmitter<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Glutamate-sensitive_fluorescent_reporter\" title=\"Glutamate-sensitive fluorescent reporter\" rel=\"external_link\" target=\"_blank\">GluSnFRs<\/a>), or membrane voltage (arc lightning, ASAP1).<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> Control (or recording) of activity is restricted to genetically defined neurons and performed in a spatiotemporal-specific manner by light.\n<\/p><p>In 2010, optogenetics was chosen as the \"Method of the Year\" across all fields of science and engineering by the interdisciplinary research journal <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nature_Methods\" title=\"Nature Methods\" rel=\"external_link\" target=\"_blank\">Nature Methods<\/a><\/i>.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> At the same time, optogenetics was highlighted in the article on \"Breakthroughs of the Decade\" in the academic research journal <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Science_(journal)\" title=\"Science (journal)\" rel=\"external_link\" target=\"_blank\">Science<\/a><\/i>.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> These journals also referenced recent public-access general-interest video <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=I64X7vHSHOE\" target=\"_blank\">Method of the year video<\/a> and textual <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.scientificamerican.com\/article.cfm?id=optogenetics-controlling\" target=\"_blank\">SciAm<\/a> summaries of optogenetics.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The \"far-fetched\" possibility of using light for selectively controlling precise neural activity (action potential) patterns within subtypes of cells in the brain was thought of by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Francis_Crick\" title=\"Francis Crick\" rel=\"external_link\" target=\"_blank\">Francis Crick<\/a> in his Kuffler Lectures at the University of California in San Diego in 1999.<sup id=\"rdp-ebb-cite_ref-Crick_6-0\" class=\"reference\"><a href=\"#cite_note-Crick-6\" rel=\"external_link\">[6]<\/a><\/sup> An earlier use of light to activate neurons was carried out by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Richard_Fork\" title=\"Richard Fork\" rel=\"external_link\" target=\"_blank\">Richard Fork<\/a>,<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> who demonstrated laser activation of neurons within intact tissue, although not in a genetically-targeted manner. The earliest genetically targeted method that used light to control rhodopsin-sensitized neurons was reported in January 2002, by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boris_Valery_Zemelman\" class=\"mw-redirect\" title=\"Boris Valery Zemelman\" rel=\"external_link\" target=\"_blank\">Boris Zemelman<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gero_Miesenb%C3%B6ck\" title=\"Gero Miesenb\u00f6ck\" rel=\"external_link\" target=\"_blank\">Gero Miesenb\u00f6ck<\/a>, who employed <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Drosophila\" title=\"Drosophila\" rel=\"external_link\" target=\"_blank\">Drosophila<\/a><\/i> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rhodopsin\" title=\"Rhodopsin\" rel=\"external_link\" target=\"_blank\">rhodopsin<\/a> cultured mammalian neurons.<sup id=\"rdp-ebb-cite_ref-Zemelman_2002_8-0\" class=\"reference\"><a href=\"#cite_note-Zemelman_2002-8\" rel=\"external_link\">[8]<\/a><\/sup> In 2003, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boris_Valery_Zemelman\" class=\"mw-redirect\" title=\"Boris Valery Zemelman\" rel=\"external_link\" target=\"_blank\">Zemelman<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gero_Miesenb%C3%B6ck\" title=\"Gero Miesenb\u00f6ck\" rel=\"external_link\" target=\"_blank\">Miesenb\u00f6ck<\/a> developed a second method for light-dependent activation of neurons in which single inotropic channels TRPV1, TRPM8 and P2X2 were gated by photocaged ligands in response to light.<sup id=\"rdp-ebb-cite_ref-ReferenceA_9-0\" class=\"reference\"><a href=\"#cite_note-ReferenceA-9\" rel=\"external_link\">[9]<\/a><\/sup> Beginning in 2004, the Kramer and Isacoff groups developed organic photoswitches or \"reversibly caged\" compounds in collaboration with the Trauner group that could interact with genetically introduced ion channels.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> TRPV1 methodology, albeit without the illumination trigger, was subsequently used by several laboratories to alter feeding, locomotion and behavioral resilience in laboratory animals.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> However, light-based approaches for altering neuronal activity were not applied outside the original laboratories, likely because the easier to employ channelrhodopsin was cloned soon thereafter.<sup id=\"rdp-ebb-cite_ref-Nagel_2003_15-0\" class=\"reference\"><a href=\"#cite_note-Nagel_2003-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Peter_Hegemann\" title=\"Peter Hegemann\" rel=\"external_link\" target=\"_blank\">Peter Hegemann<\/a>, studying the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phototaxis\" title=\"Phototaxis\" rel=\"external_link\" target=\"_blank\">light response<\/a> of green algae at the University of Regensburg, had discovered photocurrents that were too fast to be explained by the classic g-protein-coupled <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rhodopsin\" title=\"Rhodopsin\" rel=\"external_link\" target=\"_blank\">animal rhodopsins<\/a>.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> Teaming up with the electrophysiologist Georg Nagel at the Max Planck Institute in Frankfurt, they could demonstrate that a single gene from the alga <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Chlamydomonas_reinhardtii\" title=\"Chlamydomonas reinhardtii\" rel=\"external_link\" target=\"_blank\">Chlamydomonas<\/a><\/i> produced large photocurents when expressed in the oocyte of a frog.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> To identify expressing cells, they replaced the cytoplasmic tail of the algal protein with the fluorescent protein <a href=\"https:\/\/en.wikipedia.org\/wiki\/YFP\" class=\"mw-redirect\" title=\"YFP\" rel=\"external_link\" target=\"_blank\">YFP<\/a>, generating the first generally applicable optogenetic tool.<sup id=\"rdp-ebb-cite_ref-Nagel_2003_15-1\" class=\"reference\"><a href=\"#cite_note-Nagel_2003-15\" rel=\"external_link\">[15]<\/a><\/sup> \n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Zhuo-Hua_Pan\" title=\"Zhuo-Hua Pan\" rel=\"external_link\" target=\"_blank\">Zhuo-Hua Pan<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayne_State_University\" title=\"Wayne State University\" rel=\"external_link\" target=\"_blank\">Wayne State University<\/a>, researching on restore sight to blindness, thought about using channelrhodopsin when it came out in late 2003. By February 2004, he was trying channelrhodopsin out in ganglion cells\u2014the neurons in our eyes that connect directly to the brain\u2014that he had cultured in a dish. Indeed, the transfected neurons became electrically active in response to light. In 2005, Zhuo-Hua Pan reported successful in-vivo transfection of channelrhodopsin in retinal ganglion cells of mice, and electrical responses to photostimulation in retinal slice culture<sup id=\"rdp-ebb-cite_ref-BiCui2006_18-0\" class=\"reference\"><a href=\"#cite_note-BiCui2006-18\" rel=\"external_link\">[18]<\/a><\/sup> \n<\/p><p>In April 2005, Susana Lima and Miesenb\u00f6ck reported the first use of genetically-targeted P2X2 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photostimulation\" title=\"Photostimulation\" rel=\"external_link\" target=\"_blank\">photostimulation<\/a> to control the behaviour of an animal.<sup id=\"rdp-ebb-cite_ref-Lima_2005_19-0\" class=\"reference\"><a href=\"#cite_note-Lima_2005-19\" rel=\"external_link\">[19]<\/a><\/sup> They showed that photostimulation of genetically circumscribed groups of neurons, such as those of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dopaminergic\" title=\"Dopaminergic\" rel=\"external_link\" target=\"_blank\">dopaminergic<\/a> system, elicited characteristic behavioural changes in fruit flies. \n<\/p><p>In August 2005, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Karl_Deisseroth\" title=\"Karl Deisseroth\" rel=\"external_link\" target=\"_blank\">Karl Deisseroth<\/a>'s laboratory in the Bioengineering Department at Stanford including graduate students <a href=\"https:\/\/en.wikipedia.org\/wiki\/Edward_Boyden\" title=\"Edward Boyden\" rel=\"external_link\" target=\"_blank\">Ed Boyden<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Feng_Zhang\" title=\"Feng Zhang\" rel=\"external_link\" target=\"_blank\">Feng Zhang<\/a> published the first demonstration of a single-component optogenetic system in cultured mammalian neurons,<sup id=\"rdp-ebb-cite_ref-Boyden_2005_20-0\" class=\"reference\"><a href=\"#cite_note-Boyden_2005-20\" rel=\"external_link\">[20]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Li_2005_21-0\" class=\"reference\"><a href=\"#cite_note-Li_2005-21\" rel=\"external_link\">[21]<\/a><\/sup> using the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Channelrhodopsin-2\" class=\"mw-redirect\" title=\"Channelrhodopsin-2\" rel=\"external_link\" target=\"_blank\">channelrhodopsin-2<\/a>(H134R)-eYFP construct from Nagel and Hegemann.<sup id=\"rdp-ebb-cite_ref-Nagel_2003_15-2\" class=\"reference\"><a href=\"#cite_note-Nagel_2003-15\" rel=\"external_link\">[15]<\/a><\/sup> \n<\/p><p>The groups of Gottschalk and Nagel were first to use channelrhodopsin-2 for controlling neuronal activity in an intact animal, showing that motor patterns in the roundworm <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Caenorhabditis_elegans\" title=\"Caenorhabditis elegans\" rel=\"external_link\" target=\"_blank\">Caenorhabditis elegans<\/a><\/i> could be evoked by light stimulation of genetically selected neural circuits (published in December 2005).<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> In mice, controlled expression of optogenetic tools is often achieved with cell-type-specific Cre\/loxP methods developed for neuroscience by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joe_Z._Tsien\" title=\"Joe Z. Tsien\" rel=\"external_link\" target=\"_blank\">Joe Z. Tsien<\/a> back in the 1990s<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> to activate or inhibit specific brain regions and cell-types in vivo.<sup id=\"rdp-ebb-cite_ref-pmid26925095_24-0\" class=\"reference\"><a href=\"#cite_note-pmid26925095-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p><p>The primary tools for optogenetic recordings have been genetically encoded calcium indicators (GECIs). The first GECI to be used to image activity in an animal was <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cameleon_(protein)\" title=\"Cameleon (protein)\" rel=\"external_link\" target=\"_blank\">cameleon<\/a>, designed by Atsushi Miyawaki, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Roger_Y._Tsien\" title=\"Roger Y. Tsien\" rel=\"external_link\" target=\"_blank\">Roger Tsien<\/a> and coworkers.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> Cameleon was first used successfully in an animal by Rex Kerr, William Schafer and coworkers to record from neurons and muscle cells of the nematode <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Caenorhabditis_elegans\" title=\"Caenorhabditis elegans\" rel=\"external_link\" target=\"_blank\">C. elegans<\/a><\/i>.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> Cameleon was subsequently used to record neural activity in flies<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> and zebrafish.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> In mammals, the first GECI to be used in vivo was <a href=\"https:\/\/en.wikipedia.org\/wiki\/GCaMP\" title=\"GCaMP\" rel=\"external_link\" target=\"_blank\">GCaMP<\/a>,<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> first developed by Nakai and coworkers.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup> GCaMP has undergone numerous improvements, and GCaMP6<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> in particular has become widely used throughout neuroscience.\n<\/p><p>In 2010, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Karl_Deisseroth\" title=\"Karl Deisseroth\" rel=\"external_link\" target=\"_blank\">Karl Deisseroth<\/a> at Stanford University was awarded the inaugural <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hfsp.org\/awardees\/hfsp-nakasone-award\/2010-award\" target=\"_blank\">HFSP Nakasone Award<\/a> \"for his pioneering work on the development of optogenetic methods for studying the function of neuronal networks underlying behavior\". In 2012, Gero Miesenb\u00f6ck was awarded the <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.inbevbailletlatour.com\/index.cfm?ee=3%7C336\" target=\"_blank\">InBev-Baillet Latour International Health Prize<\/a> for \"pioneering optogenetic approaches to manipulate neuronal activity and to control animal behaviour.\" In 2013, Ernst Bamberg, Ed Boyden, Karl Deisseroth, Peter Hegemann, Gero Miesenb\u00f6ck and Georg Nagel were awarded <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grete_Lundbeck_European_Brain_Research_Prize\" class=\"mw-redirect\" title=\"Grete Lundbeck European Brain Research Prize\" rel=\"external_link\" target=\"_blank\">The Brain Prize<\/a> for \"their invention and refinement of optogenetics.\"<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup> Karl Deisseroth was awarded the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Else_Kr%C3%B6ner-Fresenius_Foundation\" title=\"Else Kr\u00f6ner-Fresenius Foundation\" rel=\"external_link\" target=\"_blank\">Else Kr\u00f6ner Fresenius<\/a> Research Prize 2017 (4 million euro) for his \"contributions to the understanding of the biological basis of psychiatric disorders\".\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Description\">Description<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:402px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Example_of_optogenetic_activation_of_prefrontal_cortex.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/15\/Example_of_optogenetic_activation_of_prefrontal_cortex.jpg\/400px-Example_of_optogenetic_activation_of_prefrontal_cortex.jpg\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Example_of_optogenetic_activation_of_prefrontal_cortex.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><b>Fig 1.<\/b> Channelrhodopsin-2 (ChR2) induces temporally precise blue light-driven activity in rat prelimbic prefrontal cortical neurons. a) <i>In vitro<\/i> schematic (left) showing blue light delivery and whole-cell patch-clamp recording of light-evoked activity from a fluorescent CaMKll\u03b1::ChR2-EYFP expressing pyramidal neuron (right) in an acute brain slice. b) In vivo schematic (left) showing blue light (473 nm) delivery and single-unit recording. (bottom left) Coronal brain slice showing expression of CaMKll\u03b1::ChR2-EYFP in the prelimbic region. Light blue arrow shows tip of the optical fiber; black arrow shows tip of the recording electrode (left). White bar, 100 <a href=\"https:\/\/en.wikipedia.org\/wiki\/%CE%9Cm\" class=\"mw-redirect\" title=\"\u039cm\" rel=\"external_link\" target=\"_blank\">\u00b5m<\/a>. (bottom right) <i>In vivo<\/i> light recording of prefrontal cortical neuron in a transduced CaMKll\u03b1::ChR2-EYFP rat showing light-evoked spiking to 20 Hz delivery of blue light pulses (right). Inset, representative light-evoked single-unit response.<sup id=\"rdp-ebb-cite_ref-Baratta_34-0\" class=\"reference\"><a href=\"#cite_note-Baratta-34\" rel=\"external_link\">[34]<\/a><\/sup><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:402px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cooper_laboratory_recording_of_optogenetic_silencing_of_prefrontal_cortical_neuron.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/64\/Cooper_laboratory_recording_of_optogenetic_silencing_of_prefrontal_cortical_neuron.jpg\/400px-Cooper_laboratory_recording_of_optogenetic_silencing_of_prefrontal_cortical_neuron.jpg\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cooper_laboratory_recording_of_optogenetic_silencing_of_prefrontal_cortical_neuron.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><b>Fig 2<\/b>. Halorhodopsin (NpHR) rapidly and reversibly silences spontaneous activity <i>in vivo<\/i> in rat prelimbic prefrontal cortex. (Top left) Schematic showing in vivo green (532 nm) light delivery and single- unit recording of a spontaneously active CaMKll\u03b1::eNpHR3.0- EYFP expressing pyramidal neuron. (Right) Example trace showing that continuous 532 nm illumination inhibits single-unit activity <i>in vivo<\/i>. Inset, representative single unit event; Green bar, 10 seconds.<sup id=\"rdp-ebb-cite_ref-Baratta_34-1\" class=\"reference\"><a href=\"#cite_note-Baratta-34\" rel=\"external_link\">[34]<\/a><\/sup><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><div id=\"rdp-ebb-mwe_player_0\" class=\"PopUpMediaTransform\" style=\"width:220px;\" videopayload=\"<div class="mediaContainer" style="width:320px"><video id="mwe_player_1" poster="\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a1\/Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv\/320px--Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv.jpg" controls="" preload="none" autoplay="" style="width:320px;height:240px" class="kskin" data-durationhint="44.022" data-startoffset="0" data-mwtitle="Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv" data-mwprovider="wikimediacommons"><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/a\/a1\/Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv\/Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv.240p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Small VP9 (240P)" data-shorttitle="VP9 240P" data-transcodekey="240p.vp9.webm" data-width="320" data-height="240" data-bandwidth="33232" data-framerate="15.151515151515"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/a\/a1\/Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv" type="video\/ogg; codecs=&quot;theora&quot;" data-title="Original Ogg file, 320 \u00d7 240 (77 kbps)" data-shorttitle="Ogg source" data-width="320" data-height="240" data-bandwidth="76824" data-framerate="15.151515151515"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/a\/a1\/Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv\/Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv.240p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Small WebM (240P)" data-shorttitle="WebM 240P" data-transcodekey="240p.webm" data-width="320" data-height="240" data-bandwidth="190104" data-framerate="15.151515151515"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/a\/a1\/Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv\/Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv.120p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Lowest bandwidth VP9 (120P)" data-shorttitle="VP9 120P" data-transcodekey="120p.vp9.webm" data-width="160" data-height="120" data-bandwidth="13688" data-framerate="15.151515151515"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/a\/a1\/Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv\/Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv.160p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Low bandwidth WebM (160P)" data-shorttitle="WebM 160P" data-transcodekey="160p.webm" data-width="214" data-height="160" data-bandwidth="111736" data-framerate="15.151515151515"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/a\/a1\/Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv\/Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv.180p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Low bandwidth VP9 (180P)" data-shorttitle="VP9 180P" data-transcodekey="180p.vp9.webm" data-width="240" data-height="180" data-bandwidth="21952" data-framerate="15.151515151515"\/><\/video><\/div>\"><img alt=\"File:Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv\" style=\"width:220px;height:165px\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a1\/Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv\/220px--Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv.jpg\" \/><a href=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/a\/a1\/Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv\" title=\"Play media\" target=\"_blank\" rel=\"external_link\"><span class=\"play-btn-large\"><span class=\"mw-tmh-playtext\">Play media<\/span><\/span><\/a><\/div> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Microbial-Light-Activatable-Proton-Pumps-as-Neuronal-Inhibitors-to-Functionally-Dissect-Neuronal-pone.0040937.s007.ogv\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A nematode expressing the light-sensitive ion channel Mac. Mac is a proton pump originally isolated in the fungus <i>Leptosphaeria maculans<\/i> and now expressed in the muscle cells of <i>C. elegans<\/i> that opens in response to green light and causes hyperpolarizing inhibition. Of note is the extension in body length that the worm undergoes each time it is exposed to green light, which is presumably caused by Mac's muscle-relaxant effects.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><div id=\"rdp-ebb-mwe_player_2\" class=\"PopUpMediaTransform\" style=\"width:220px;\" videopayload=\"<div class="mediaContainer" style="width:852px"><video id="mwe_player_3" poster="\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/31\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv\/852px--A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv.jpg" controls="" preload="none" autoplay="" style="width:852px;height:480px" class="kskin" data-durationhint="34.613666666667" data-startoffset="0" data-mwtitle="A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv" data-mwprovider="wikimediacommons"><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/3\/31\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv.480p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="SD VP9 (480P)" data-shorttitle="VP9 480P" data-transcodekey="480p.vp9.webm" data-width="852" data-height="480" data-bandwidth="261392" data-framerate="29.97000002997"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/3\/31\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv" type="video\/ogg; codecs=&quot;theora, vorbis&quot;" data-title="Original Ogg file, 852 \u00d7 480 (522 kbps)" data-shorttitle="Ogg source" data-width="852" data-height="480" data-bandwidth="522279" data-framerate="29.97000002997"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/3\/31\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv.480p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="SD WebM (480P)" data-shorttitle="WebM 480P" data-transcodekey="480p.webm" data-width="852" data-height="480" data-bandwidth="940320" data-framerate="29.97000002997"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/3\/31\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv.120p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Lowest bandwidth VP9 (120P)" data-shorttitle="VP9 120P" data-transcodekey="120p.vp9.webm" data-width="214" data-height="120" data-bandwidth="34120" data-framerate="29.97000002997"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/3\/31\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv.160p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Low bandwidth WebM (160P)" data-shorttitle="WebM 160P" data-transcodekey="160p.webm" data-width="284" data-height="160" data-bandwidth="120744" data-framerate="29.97000002997"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/3\/31\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv.180p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Low bandwidth VP9 (180P)" data-shorttitle="VP9 180P" data-transcodekey="180p.vp9.webm" data-width="320" data-height="180" data-bandwidth="55160" data-framerate="29.97000002997"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/3\/31\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv.240p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Small VP9 (240P)" data-shorttitle="VP9 240P" data-transcodekey="240p.vp9.webm" data-width="426" data-height="240" data-bandwidth="75984" data-framerate="29.97000002997"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/3\/31\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv.240p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Small WebM (240P)" data-shorttitle="WebM 240P" data-transcodekey="240p.webm" data-width="426" data-height="240" data-bandwidth="237336" data-framerate="29.97000002997"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/3\/31\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv.360p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="VP9 (360P)" data-shorttitle="VP9 360P" data-transcodekey="360p.vp9.webm" data-width="640" data-height="360" data-bandwidth="134944" data-framerate="29.97000002997"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/3\/31\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv.360p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="WebM (360P)" data-shorttitle="WebM 360P" data-transcodekey="360p.webm" data-width="640" data-height="360" data-bandwidth="465272" data-framerate="29.97000002997"\/><\/video><\/div>\"><img alt=\"File:A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv\" style=\"width:220px;height:124px\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/31\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv\/220px--A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv.jpg\" \/><a href=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/3\/31\/A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv\" title=\"Play media\" target=\"_blank\" rel=\"external_link\"><span class=\"play-btn-large\"><span class=\"mw-tmh-playtext\">Play media<\/span><\/span><\/a><\/div> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:A-Cholinergic-Regulated-Circuit-Coordinates-the-Maintenance-and-Bi-Stable-States-of-a-Sensory-Motor-pgen.1001326.s010.ogv\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A nematode expressing ChR2 in its gubernacular-oblique muscle group responding to stimulation by blue light. Blue light stimulation causes the gubernacular-oblique muscles to repeatedly contract, causing repetitive thrusts of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spicule_(nematode)\" class=\"mw-redirect\" title=\"Spicule (nematode)\" rel=\"external_link\" target=\"_blank\">spicule<\/a>, as would be seen naturally during copulation.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup><\/div><\/div><\/div>\n<p>Optogenetics provides millisecond-scale temporal precision which allows the experimenter to keep pace with fast biological information processing (for example, in probing the causal role of specific <a href=\"https:\/\/en.wikipedia.org\/wiki\/Action_potential\" title=\"Action potential\" rel=\"external_link\" target=\"_blank\">action potential<\/a> patterns in defined neurons). Indeed, to probe the neural code, optogenetics by definition must operate on the millisecond timescale to allow addition or deletion of precise activity patterns within specific cells in the brains of intact animals, including mammals (see <b>Figure 1)<\/b>. By comparison, the temporal precision of traditional genetic manipulations (employed to probe the causal role of specific genes within cells, via \"loss-of-function\" or \"gain of function\" changes in these genes) is rather slow, from hours or days to months. It is important to also have fast readouts in optogenetics that can keep pace with the optical control. This can be done with electrical recordings (\"optrodes\") or with reporter proteins that are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biosensor\" title=\"Biosensor\" rel=\"external_link\" target=\"_blank\">biosensors<\/a>, where scientists have fused fluorescent proteins to detector proteins. An example of this is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Genetically_encoded_voltage_indicator\" title=\"Genetically encoded voltage indicator\" rel=\"external_link\" target=\"_blank\">voltage-sensitive fluorescent protein<\/a> (VSFP2).<sup id=\"rdp-ebb-cite_ref-pmid22815406_37-0\" class=\"reference\"><a href=\"#cite_note-pmid22815406-37\" rel=\"external_link\">[37]<\/a><\/sup> Additionally, beyond its scientific impact optogenetics represents an important case study in the value of both ecological conservation (as many of the key tools of optogenetics arise from microbial organisms occupying specialized environmental niches), and in the importance of pure basic science as these opsins were studied over decades for their own sake by biophysicists and microbiologists, without involving consideration of their potential value in delivering insights into neuroscience and neuropsychiatric disease.<b><sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup><\/b>\n<\/p><p><b>Light-activated proteins: channels, pumps and enzymes<\/b>\n<\/p><p>The hallmark of optogenetics therefore is introduction of fast light-activated channels, pumps, and enzymes that allow temporally precise manipulation of electrical and biochemical events while maintaining cell-type resolution through the use of specific targeting mechanisms. Among the microbial opsins which can be used to investigate the function of neural systems are the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Channelrhodopsin\" title=\"Channelrhodopsin\" rel=\"external_link\" target=\"_blank\">channelrhodopsins<\/a> (ChR2, ChR1, VChR1, and SFOs) to excite neurons and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anion-conducting_channelrhodopsin\" title=\"Anion-conducting channelrhodopsin\" rel=\"external_link\" target=\"_blank\">anion-conducting channelrhodopsins<\/a> for light-induced inhibition. Indirectly light-controlled <a href=\"https:\/\/en.wikipedia.org\/wiki\/Potassium_channel\" title=\"Potassium channel\" rel=\"external_link\" target=\"_blank\">potassium channels<\/a> have recently been engineered to prevent action potential generation in neurons during blue light illumination.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup> Light-driven ion pumps are also used to inhibit neuronal activity, e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Halorhodopsin\" title=\"Halorhodopsin\" rel=\"external_link\" target=\"_blank\">halorhodopsin<\/a> (NpHR),<sup id=\"rdp-ebb-cite_ref-Zhao_2008_41-0\" class=\"reference\"><a href=\"#cite_note-Zhao_2008-41\" rel=\"external_link\">[41]<\/a><\/sup> enhanced halorhodopsins (eNpHR2.0 and eNpHR3.0, see Figure 2),<sup id=\"rdp-ebb-cite_ref-Gradinaru_2008_42-0\" class=\"reference\"><a href=\"#cite_note-Gradinaru_2008-42\" rel=\"external_link\">[42]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Archaerhodopsin\" title=\"Archaerhodopsin\" rel=\"external_link\" target=\"_blank\">archaerhodopsin<\/a> (Arch), fungal opsins (Mac) and enhanced bacteriorhodopsin (eBR).<sup id=\"rdp-ebb-cite_ref-Witten_2010_43-0\" class=\"reference\"><a href=\"#cite_note-Witten_2010-43\" rel=\"external_link\">[43]<\/a><\/sup>\n<\/p><p>Optogenetic control of well-defined biochemical events within behaving mammals is now also possible. Building on prior work fusing vertebrate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Opsins\" class=\"mw-redirect\" title=\"Opsins\" rel=\"external_link\" target=\"_blank\">opsins<\/a> to specific <a href=\"https:\/\/en.wikipedia.org\/wiki\/G-protein_coupled_receptors\" class=\"mw-redirect\" title=\"G-protein coupled receptors\" rel=\"external_link\" target=\"_blank\">G-protein coupled receptors<\/a><sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup> a family of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chimera_(genetics)\" title=\"Chimera (genetics)\" rel=\"external_link\" target=\"_blank\">chimeric<\/a> single-component optogenetic tools was created that allowed researchers to manipulate within behaving mammals the concentration of defined intracellular messengers such as cAMP and IP3 in targeted cells.<sup id=\"rdp-ebb-cite_ref-Airan_2009_45-0\" class=\"reference\"><a href=\"#cite_note-Airan_2009-45\" rel=\"external_link\">[45]<\/a><\/sup> Other biochemical approaches to optogenetics (crucially, with tools that displayed low activity in the dark) followed soon thereafter, when optical control over small GTPases and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adenylyl_cyclase\" title=\"Adenylyl cyclase\" rel=\"external_link\" target=\"_blank\">adenylyl cyclases<\/a> was achieved in cultured cells using novel strategies from several different laboratories.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup> This emerging repertoire of optogenetic probes now allows cell-type-specific and temporally precise control of multiple axes of cellular function within intact animals.<b><sup id=\"rdp-ebb-cite_ref-pmid26967281_51-0\" class=\"reference\"><a href=\"#cite_note-pmid26967281-51\" rel=\"external_link\">[51]<\/a><\/sup><\/b>\n<\/p><p><b>Hardware for light application<\/b>\n<\/p><p>Another necessary factor is hardware (e.g. integrated fiberoptic and solid-state light sources) to allow specific cell types, even deep within the brain, to be controlled in freely behaving animals. Most commonly, the latter is now achieved using the fiberoptic-coupled diode technology introduced in 2007,<sup id=\"rdp-ebb-cite_ref-Aravanis_2007_52-0\" class=\"reference\"><a href=\"#cite_note-Aravanis_2007-52\" rel=\"external_link\">[52]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Adamantidis_2007_53-0\" class=\"reference\"><a href=\"#cite_note-Adamantidis_2007-53\" rel=\"external_link\">[53]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Gradinaru_2007_54-0\" class=\"reference\"><a href=\"#cite_note-Gradinaru_2007-54\" rel=\"external_link\">[54]<\/a><\/sup> though to avoid use of implanted electrodes, researchers have engineered ways to inscribe a \"window\" made of zirconia that has been modified to be transparent and implanted in mice skulls, to allow optical waves to penetrate more deeply to stimulate or inhibit individual neurons.<sup id=\"rdp-ebb-cite_ref-Nanomedicine201308_55-0\" class=\"reference\"><a href=\"#cite_note-Nanomedicine201308-55\" rel=\"external_link\">[55]<\/a><\/sup> To stimulate superficial brain areas such as the cerebral cortex, optical fibers or <a href=\"https:\/\/en.wikipedia.org\/wiki\/LED\" class=\"mw-redirect\" title=\"LED\" rel=\"external_link\" target=\"_blank\">LEDs<\/a> can be directly mounted to the skull of the animal. More deeply implanted optical fibers have been used to deliver light to deeper brain areas. Complementary to fiber-tethered approaches, completely wireless techniques have been developed utilizing wirelessly delivered power to headborne LEDs for unhindered study of complex behaviors in freely behaving organisms.<b><sup id=\"rdp-ebb-cite_ref-Wentz_2011_56-0\" class=\"reference\"><a href=\"#cite_note-Wentz_2011-56\" rel=\"external_link\">[56]<\/a><\/sup><\/b>\n<\/p><p><b>Expression of optogenetic actuators<\/b>\n<\/p><p>Optogenetics also necessarily includes the development of genetic targeting strategies such as cell-specific promoters or other customized conditionally-active viruses, to deliver the light-sensitive probes to specific populations of neurons in the brain of living animals (e.g. worms, fruit flies, mice, rats, and monkeys). In invertebrates such as worms and fruit flies some amount of <a href=\"https:\/\/en.wikipedia.org\/wiki\/All-trans-retinal\" class=\"mw-redirect\" title=\"All-trans-retinal\" rel=\"external_link\" target=\"_blank\">all-trans-retinal<\/a> (ATR) is supplemented with food. A key advantage of microbial opsins as noted above is that they are fully functional without the addition of exogenous co-factors in vertebrates.<b><sup id=\"rdp-ebb-cite_ref-Gradinaru_2007_54-1\" class=\"reference\"><a href=\"#cite_note-Gradinaru_2007-54\" rel=\"external_link\">[54]<\/a><\/sup><\/b>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technique\">Technique<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:523px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Optogenetic_stimulation_consists_of_several_steps.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/28\/Optogenetic_stimulation_consists_of_several_steps.png\/521px-Optogenetic_stimulation_consists_of_several_steps.png\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Optogenetic_stimulation_consists_of_several_steps.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Three primary components in the application of optogenetics are as follows <b>(A)<\/b> Identification or synthesis of a light-sensitive protein (opsin) such as channelrhodopsin-2 (ChR2), halorhodopsin (NpHR), etc... <b>(B)<\/b> The design of a system to introduce the genetic material containing the opsin into cells for protein expression such as application of Cre recombinase or an adeno-associated-virus <b>(C)<\/b> application of light emitting instruments.<sup id=\"rdp-ebb-cite_ref-57\" class=\"reference\"><a href=\"#cite_note-57\" rel=\"external_link\">[57]<\/a><\/sup><\/div><\/div><\/div>\n<p>The technique of using optogenetics is flexible and adaptable to the experimenter's needs. For starters, experimenters genetically engineer a microbial opsin based on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gating_(electrophysiology)\" title=\"Gating (electrophysiology)\" rel=\"external_link\" target=\"_blank\">gating<\/a> properties (rate of excitability, refractory period, etc..) required for the experiment.\n<\/p><p>There is a challenge in introducing the microbial opsin, an optogenetic actuator, into a specific region of the organism in question. A rudimentary approach is to introduce an engineered viral vector that contains the optogenetic actuator gene attached to a recognizable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Promoter_(genetics)\" title=\"Promoter (genetics)\" rel=\"external_link\" target=\"_blank\">promoter<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/CAMK2A\" title=\"CAMK2A\" rel=\"external_link\" target=\"_blank\">CAMKII\u03b1<\/a>. This allows for some level of specificity as cells that already contain and can translate the given promoter will be infected with the viral vector and hopefully express the optogenetic actuator gene.\n<\/p><p>Another approach is the creation of transgenic mice where the optogenetic actuator gene is introduced into mice zygotes with a given promoter, most commonly <a href=\"https:\/\/en.wikipedia.org\/wiki\/CD90\" title=\"CD90\" rel=\"external_link\" target=\"_blank\">Thy1<\/a>. Introduction of the optogenetic actuator at an early stage allows for a larger genetic code to be incorporated and as a result, increases the specificity of cells to be infected.\n<\/p><p>A third and rather novel approach that has been developed is creating transgenic mice with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cre_recombinase\" title=\"Cre recombinase\" rel=\"external_link\" target=\"_blank\">Cre recombinase<\/a>, an enzyme that catalyzes recombination between two lox-P sites. Then by introducing an engineered viral vector containing the optogenetic actuator gene in between two lox-P sites, only the cells containing the Cre recombinase will express the microbial opsin. This last technique has allowed for multiple modified optogenetic actuators to be used without the need to create a whole line of transgenic animals every time a new microbial opsin is needed.\n<\/p><p>After the introduction and expression of the microbial opsin, depending on the type of analysis being performed, application of light can be placed at the terminal ends or the main region where the infected cells are situated. Light stimulation can be performed with a vast array of instruments from light emitting diodes (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Light-emitting_diode\" title=\"Light-emitting diode\" rel=\"external_link\" target=\"_blank\">LEDs<\/a>) or diode-pumped solid state (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Diode-pumped_solid-state_laser\" title=\"Diode-pumped solid-state laser\" rel=\"external_link\" target=\"_blank\">DPSS<\/a>). These light sources are most commonly connected to a computer through a fiber optic cable. Recent advances include the advent of wireless head-mounted devices that also apply LED to targeted areas and as a result give the animal more freedom of mobility to reproduce <i>in vivo<\/i> results.<b><sup id=\"rdp-ebb-cite_ref-58\" class=\"reference\"><a href=\"#cite_note-58\" rel=\"external_link\">[58]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-:0_59-0\" class=\"reference\"><a href=\"#cite_note-:0-59\" rel=\"external_link\">[59]<\/a><\/sup><\/b>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Issues\">Issues<\/span><\/h2>\n<p>Although already a powerful scientific tool, optogenetics, according to Doug Tischer & Orion D. Weiner of the University of California San Francisco, should be regarded as a \"first-generation <a href=\"https:\/\/en.wikipedia.org\/wiki\/Green_fluorescent_protein\" title=\"Green fluorescent protein\" rel=\"external_link\" target=\"_blank\">GFP<\/a>\" because of its immense potential for both utilization and optimization.<sup id=\"rdp-ebb-cite_ref-:1_60-0\" class=\"reference\"><a href=\"#cite_note-:1-60\" rel=\"external_link\">[60]<\/a><\/sup> With that being said, the current approach to optogenetics is limited primarily by its versatility. Even within the field of Neuroscience where it is most potent, the technique is less robust on a subcellular level.<sup id=\"rdp-ebb-cite_ref-:2_61-0\" class=\"reference\"><a href=\"#cite_note-:2-61\" rel=\"external_link\">[61]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Selective_expression\">Selective expression<\/span><\/h3>\n<p>One of the main problems of optogenetics is that not all the cells in question may express the microbial opsin gene at the same level. Thus, even illumination with a defined light intensity will have variable effects on individual cells. Optogenetic stimulation of neurons in the brain is even less controlled as the light intensity drops exponentially from the light source (e.g. implanted optical fiber).\n<\/p><p>Moreover, mathematical modelling shows that selective expression of opsin in specific cell types can dramatically alter the dynamical behavior of the neural circuitry. In particular, optogenetic stimulation that preferentially targets inhibitory cells can transform the excitability of the neural tissue from Type 1 \u2014 where neurons operate as integrators \u2014 to Type 2 where neurons operate as resonators.<sup id=\"rdp-ebb-cite_ref-62\" class=\"reference\"><a href=\"#cite_note-62\" rel=\"external_link\">[62]<\/a><\/sup>\n<p>Type 1 excitable media sustain propagating waves of activity whereas Type 2 excitable media do not. The transformation from one to the other explains how constant optical stimulation of primate motor cortex elicits gamma-band (40\u201380 Hz) oscillations in the manner of a Type 2 excitable medium. Yet those same oscillations propagate far into the surrounding tissue in the manner of a Type 1 excitable medium.<sup id=\"rdp-ebb-cite_ref-63\" class=\"reference\"><a href=\"#cite_note-63\" rel=\"external_link\">[63]<\/a><\/sup>\n<\/p>\n<\/p><p>Nonetheless, it remains difficult to target opsin to defined subcellular compartments, e.g. the plasma membrane, synaptic vesicles, or mitochondria.<sup id=\"rdp-ebb-cite_ref-:2_61-1\" class=\"reference\"><a href=\"#cite_note-:2-61\" rel=\"external_link\">[61]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-64\" class=\"reference\"><a href=\"#cite_note-64\" rel=\"external_link\">[64]<\/a><\/sup> Restricting the opsin to specific regions of the plasma membrane such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dendrite\" title=\"Dendrite\" rel=\"external_link\" target=\"_blank\">dendrites<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soma_(biology)\" title=\"Soma (biology)\" rel=\"external_link\" target=\"_blank\">somata<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Axon_terminal\" title=\"Axon terminal\" rel=\"external_link\" target=\"_blank\">axon terminals<\/a> would provide a more robust understanding of neuronal circuitry.<sup id=\"rdp-ebb-cite_ref-:2_61-2\" class=\"reference\"><a href=\"#cite_note-:2-61\" rel=\"external_link\">[61]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Kinetics_and_synchronization\">Kinetics and synchronization<\/span><\/h3>\n<p>An issue with channelrhodopsin-2 is that its gating properties don't mimic <i>in vivo<\/i> cation channels of cortical neurons. A solution to this issue with a protein's kinetic property is introduction of variants of channelrhodopsin-2 with more favorable kinetics.<sup><a href=\"https:\/\/en.wikipedia.org\/wiki\/Optogenetics#cite_note-:0-55\" title=\"Optogenetics\" rel=\"external_link\" target=\"_blank\">[55]<\/a>[56]<\/sup>\n<\/p><p>Another one of the technique's limitations is that light stimulation produces a synchronous activation of infected cells and this removes any individual cell properties of activation among the population affected. Therefore, it is difficult to understand how the cells in the population affected communicate with one another or how their phasic properties of activation may relate to the circuitry being observed.\n<\/p><p>Optogenetic activation has been combined with functional magnetic resonance imaging (ofMRI) to elucidate the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Connectome\" title=\"Connectome\" rel=\"external_link\" target=\"_blank\">connectome<\/a>, a thorough map of the brain\u2019s neural connections. The results, however, are limited by the general properties of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Functional_magnetic_resonance_imaging\" title=\"Functional magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">fMRI<\/a>.<sup id=\"rdp-ebb-cite_ref-:2_61-3\" class=\"reference\"><a href=\"#cite_note-:2-61\" rel=\"external_link\">[61]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-:3_65-0\" class=\"reference\"><a href=\"#cite_note-:3-65\" rel=\"external_link\">[65]<\/a><\/sup> The readouts from this neuroimaging procedure lack the spatial and temporal resolution appropriate for studying the densely packed and rapid-firing neuronal circuits.<sup id=\"rdp-ebb-cite_ref-:3_65-1\" class=\"reference\"><a href=\"#cite_note-:3-65\" rel=\"external_link\">[65]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Excitation_spectrum\">Excitation spectrum<\/span><\/h3>\n<p>The opsin proteins currently in use have absorption peaks across the visual spectrum, but remain considerable sensitivity to blue light.<sup id=\"rdp-ebb-cite_ref-:2_61-4\" class=\"reference\"><a href=\"#cite_note-:2-61\" rel=\"external_link\">[61]<\/a><\/sup> This spectral overlap makes it very difficult to combine opsin activation with genenetically encoded indictors (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Genetically_encoded_voltage_indicator\" title=\"Genetically encoded voltage indicator\" rel=\"external_link\" target=\"_blank\">GEVIs<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Genetically_encoded_calcium_sensor\" class=\"mw-redirect\" title=\"Genetically encoded calcium sensor\" rel=\"external_link\" target=\"_blank\">GECIs<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glutamate-sensitive_fluorescent_reporter\" title=\"Glutamate-sensitive fluorescent reporter\" rel=\"external_link\" target=\"_blank\">GluSnFR<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Synapto-pHluorin\" title=\"Synapto-pHluorin\" rel=\"external_link\" target=\"_blank\">synapto-pHluorin<\/a>), most of which need blue light excitation. Opsins with infrared activation would, at a standard irradiance value, increase light penetration and augment resolution through reduction of light scattering.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>The field of optogenetics has furthered the fundamental scientific understanding of how specific cell types contribute to the function of biological tissues such as neural circuits <i>in vivo<\/i> (see references from the scientific literature below). Moreover, on the clinical side, optogenetics-driven research has led to insights into <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parkinson%27s_disease\" title=\"Parkinson's disease\" rel=\"external_link\" target=\"_blank\">Parkinson's disease<\/a><sup id=\"rdp-ebb-cite_ref-Kravitz_2010_66-0\" class=\"reference\"><a href=\"#cite_note-Kravitz_2010-66\" rel=\"external_link\">[66]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Gradinaru_2009_67-0\" class=\"reference\"><a href=\"#cite_note-Gradinaru_2009-67\" rel=\"external_link\">[67]<\/a><\/sup> and other neurological and psychiatric disorders. Indeed, optogenetics papers in 2009 have also provided insight into neural codes relevant to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autism\" title=\"Autism\" rel=\"external_link\" target=\"_blank\">autism<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Schizophrenia\" title=\"Schizophrenia\" rel=\"external_link\" target=\"_blank\">Schizophrenia<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug_abuse\" class=\"mw-redirect\" title=\"Drug abuse\" rel=\"external_link\" target=\"_blank\">drug abuse<\/a>, anxiety, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Major_depressive_disorder\" title=\"Major depressive disorder\" rel=\"external_link\" target=\"_blank\">depression<\/a>.<b><sup id=\"rdp-ebb-cite_ref-Witten_2010_43-1\" class=\"reference\"><a href=\"#cite_note-Witten_2010-43\" rel=\"external_link\">[43]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Cardin_2009_68-0\" class=\"reference\"><a href=\"#cite_note-Cardin_2009-68\" rel=\"external_link\">[68]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Sohal_2009_69-0\" class=\"reference\"><a href=\"#cite_note-Sohal_2009-69\" rel=\"external_link\">[69]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Tsai_2009_70-0\" class=\"reference\"><a href=\"#cite_note-Tsai_2009-70\" rel=\"external_link\">[70]<\/a><\/sup><\/b>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Identification_of_particular_neurons_and_networks\">Identification of particular neurons and networks<\/span><\/h3>\n<h4><span class=\"mw-headline\" id=\"Amygdala\">Amygdala<\/span><\/h4>\n<p>Optogenetic approaches have been used to map neural circuits in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amygdala\" title=\"Amygdala\" rel=\"external_link\" target=\"_blank\">amygdala<\/a> that contribute to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fear_conditioning\" title=\"Fear conditioning\" rel=\"external_link\" target=\"_blank\">fear conditioning<\/a>.<sup id=\"rdp-ebb-cite_ref-Haubensak_2010_71-0\" class=\"reference\"><a href=\"#cite_note-Haubensak_2010-71\" rel=\"external_link\">[71]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Johansen_2010_72-0\" class=\"reference\"><a href=\"#cite_note-Johansen_2010-72\" rel=\"external_link\">[72]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Jasnow2013_73-0\" class=\"reference\"><a href=\"#cite_note-Jasnow2013-73\" rel=\"external_link\">[73]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Dias_2013_74-0\" class=\"reference\"><a href=\"#cite_note-Dias_2013-74\" rel=\"external_link\">[74]<\/a><\/sup> One such example of a neural circuit is the connection made from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Basolateral_amygdala\" title=\"Basolateral amygdala\" rel=\"external_link\" target=\"_blank\">basolateral amygdala<\/a> to the dorsal-medial prefrontal cortex where <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neural_oscillation\" title=\"Neural oscillation\" rel=\"external_link\" target=\"_blank\">neuronal oscillations<\/a> of 4 Hz have been observed in correlation to fear induced freezing behaviors in mice. Transgenic mice were introduced with channelrhodoposin-2 attached with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parvalbumin\" title=\"Parvalbumin\" rel=\"external_link\" target=\"_blank\">parvalbumin<\/a>-Cre promoter that selectively infected interneurons located both in the basolateral amygdala and the dorsal-medial prefrontal cortex responsible for the 4 Hz oscillations. The interneurons were optically stimulated generating a freezing behavior and as a result provided evidence that these 4 Hz oscillations may be responsible for the basic fear response produced by the neuronal populations along the dorsal-medial prefrontal cortex and basolateral amygdala.<b><sup id=\"rdp-ebb-cite_ref-75\" class=\"reference\"><a href=\"#cite_note-75\" rel=\"external_link\">[75]<\/a><\/sup><\/b>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Olfactory_bulb\">Olfactory bulb<\/span><\/h4>\n<p>Optogenetic activation of olfactory sensory neurons was critical for demonstrating timing in odor processing<sup id=\"rdp-ebb-cite_ref-76\" class=\"reference\"><a href=\"#cite_note-76\" rel=\"external_link\">[76]<\/a><\/sup> and for mechanism of neuromodulatory mediated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Olfaction\" title=\"Olfaction\" rel=\"external_link\" target=\"_blank\">olfactory<\/a> guided behaviors (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aggression\" title=\"Aggression\" rel=\"external_link\" target=\"_blank\">aggression<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mating\" title=\"Mating\" rel=\"external_link\" target=\"_blank\">mating<\/a>)<sup id=\"rdp-ebb-cite_ref-77\" class=\"reference\"><a href=\"#cite_note-77\" rel=\"external_link\">[77]<\/a><\/sup> In addition, with the aid of optogenetics, evidence has been reproduced to show that the \"afterimage\" of odors is concentrated more centrally around the olfactory bulb rather than on the periphery where the olfactory receptor neurons would be located. Transgenic mice infected with channel-rhodopsin Thy1-ChR2, were stimulated with a 473 nm laser transcranially positioned over the dorsal section of the olfactory bulb. Longer photostimulation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Olfactory_bulb_mitral_cell\" title=\"Olfactory bulb mitral cell\" rel=\"external_link\" target=\"_blank\">mitral<\/a> cells in the olfactory bulb led to observations of longer lasting neuronal activity in the region after the photostimulation had ceased, meaning the olfactory sensory system is able to undergo long term changes and recognize differences between old and new odors.<b><sup id=\"rdp-ebb-cite_ref-78\" class=\"reference\"><a href=\"#cite_note-78\" rel=\"external_link\">[78]<\/a><\/sup><\/b>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Nucleus_accumbens\">Nucleus accumbens<\/span><\/h4><p>\nOptogenetics, freely moving mammalian behavior, <i>in vivo<\/i> electrophysiology, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Slice_preparation\" title=\"Slice preparation\" rel=\"external_link\" target=\"_blank\">slice physiology<\/a> have been integrated to probe the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetylcholine\" title=\"Acetylcholine\" rel=\"external_link\" target=\"_blank\">cholinergic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interneuron\" title=\"Interneuron\" rel=\"external_link\" target=\"_blank\">interneurons<\/a> of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nucleus_accumbens\" title=\"Nucleus accumbens\" rel=\"external_link\" target=\"_blank\">nucleus accumbens<\/a> by direct excitation or inhibition. Despite representing less than 1% of the total population of accumbal neurons, these cholinergic cells are able to control the activity of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dopamine\" title=\"Dopamine\" rel=\"external_link\" target=\"_blank\">dopaminergic<\/a> terminals that innervate medium spiny neurons (MSNs) in the nucleus accumbens.<sup id=\"rdp-ebb-cite_ref-Tecuapetla_2010_79-0\" class=\"reference\"><a href=\"#cite_note-Tecuapetla_2010-79\" rel=\"external_link\">[79]<\/a><\/sup> These accumbal MSNs are known to be involved in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mesolimbic_pathway\" title=\"Mesolimbic pathway\" rel=\"external_link\" target=\"_blank\">neural pathway<\/a> through which <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cocaine\" title=\"Cocaine\" rel=\"external_link\" target=\"_blank\">cocaine<\/a> exerts its effects, because decreasing cocaine-induced changes in the activity of these neurons has been shown to inhibit cocaine <a href=\"https:\/\/en.wikipedia.org\/wiki\/Classical_conditioning\" title=\"Classical conditioning\" rel=\"external_link\" target=\"_blank\">conditioning<\/a>. The few cholinergic neurons present in the nucleus accumbens may prove viable targets for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacotherapy\" title=\"Pharmacotherapy\" rel=\"external_link\" target=\"_blank\">pharmacotherapy<\/a> in the treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cocaine_dependence\" title=\"Cocaine dependence\" rel=\"external_link\" target=\"_blank\">cocaine dependence<\/a><b><sup id=\"rdp-ebb-cite_ref-Witten_2010_43-2\" class=\"reference\"><a href=\"#cite_note-Witten_2010-43\" rel=\"external_link\">[43]<\/a><\/sup><\/b><\/p><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Optogenetics_imetronic.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/75\/Optogenetics_imetronic.JPG\/220px-Optogenetics_imetronic.JPG\" width=\"220\" height=\"146\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Optogenetics_imetronic.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Cages for rat equipped of optogenetics leds commutators which permit in vivo to study animal behavior during optogenetics' stimulations.<\/div><\/div><\/div>\n<h4><span class=\"mw-headline\" id=\"Prefrontal_cortex\">Prefrontal cortex<\/span><\/h4>\n<p><i>In vivo<\/i> and <i>in vitro<\/i> recordings (by the <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/neurocloud.org\" target=\"_blank\">Cooper laboratory<\/a>) of individual CAMKII AAV-ChR2 expressing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyramidal_neuron\" class=\"mw-redirect\" title=\"Pyramidal neuron\" rel=\"external_link\" target=\"_blank\">pyramidal neurons<\/a> within the prefrontal cortex demonstrated high fidelity action potential output with short pulses of blue light at 20 Hz (<b>Figure 1<\/b>).<sup id=\"rdp-ebb-cite_ref-Baratta_34-2\" class=\"reference\"><a href=\"#cite_note-Baratta-34\" rel=\"external_link\">[34]<\/a><\/sup> The same group recorded complete green light-induced silencing of spontaneous activity in the same prefrontal cortical neuronal population expressing an AAV-NpHR vector (<b>Figure 2<\/b>).<sup id=\"rdp-ebb-cite_ref-Baratta_34-3\" class=\"reference\"><a href=\"#cite_note-Baratta-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Heart\">Heart<\/span><\/h4>\n<p>Optogenetics was applied on atrial <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiomyocytes\" class=\"mw-redirect\" title=\"Cardiomyocytes\" rel=\"external_link\" target=\"_blank\">cardiomyocytes<\/a> to end spiral wave <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arrhythmias\" class=\"mw-redirect\" title=\"Arrhythmias\" rel=\"external_link\" target=\"_blank\">arrhythmias<\/a>, found to occur in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrial_fibrillation\" title=\"Atrial fibrillation\" rel=\"external_link\" target=\"_blank\">atrial fibrillation<\/a>, with light.<sup id=\"rdp-ebb-cite_ref-pmid25082848_80-0\" class=\"reference\"><a href=\"#cite_note-pmid25082848-80\" rel=\"external_link\">[80]<\/a><\/sup> This method is still in the development stage. A recent study explored the possibilities of optogenetics as a method to correct for arrythmias and resynchronize cardiac pacing. The study introduced channelrhodopsin-2 into cardiomyocytes in ventricular areas of hearts of transgenic mice and performed <i>in vitro<\/i> studies of photostimulation on both open-cavity and closed-cavity mice. Photostimulation led to increased activation of cells and thus increased ventricular contractions resulting in increasing heart rates. In addition, this approach has been applied in cardiac resynchronization therapy (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_resynchronization_therapy\" title=\"Cardiac resynchronization therapy\" rel=\"external_link\" target=\"_blank\">CRT<\/a>) as a new biological pacemaker as a substitute for electrode based-CRT.<b><sup id=\"rdp-ebb-cite_ref-81\" class=\"reference\"><a href=\"#cite_note-81\" rel=\"external_link\">[81]<\/a><\/sup><\/b> Lately, optogenetics has been used in the heart to defibrillate ventricular arrhythmias with local epicardial illumination,<sup id=\"rdp-ebb-cite_ref-82\" class=\"reference\"><a href=\"#cite_note-82\" rel=\"external_link\">[82]<\/a><\/sup> a generalized whole heart illumination<sup id=\"rdp-ebb-cite_ref-83\" class=\"reference\"><a href=\"#cite_note-83\" rel=\"external_link\">[83]<\/a><\/sup> or with customized stimulation patterns based on arrhythmogenic mechanisms in order to lower defibrillation energy.<b><sup id=\"rdp-ebb-cite_ref-84\" class=\"reference\"><a href=\"#cite_note-84\" rel=\"external_link\">[84]<\/a><\/sup><\/b>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Spiral_ganglion\">Spiral ganglion<\/span><\/h4>\n<p>Optogenetic stimulation of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spiral_ganglion\" title=\"Spiral ganglion\" rel=\"external_link\" target=\"_blank\">spiral ganglion<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deaf\" class=\"mw-redirect\" title=\"Deaf\" rel=\"external_link\" target=\"_blank\">deaf<\/a> mice restored auditory activity.<sup id=\"rdp-ebb-cite_ref-85\" class=\"reference\"><a href=\"#cite_note-85\" rel=\"external_link\">[85]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Mager_2018_86-0\" class=\"reference\"><a href=\"#cite_note-Mager_2018-86\" rel=\"external_link\">[86]<\/a><\/sup> Optogenetic application onto the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlea\" title=\"Cochlea\" rel=\"external_link\" target=\"_blank\">cochlear<\/a> region allows for the stimulation or inhibition of the spiral ganglion cells (SGN). In addition, due to the characteristics of the resting potentials of SGN's, different variants of the protein channelrhodopsin-2 have been employed such as Chronos and CatCh. Chronos and CatCh variants are particularly useful in that they have less time spent in their deactivated states, which allow for more activity with less bursts of blue light emitted. The result being that the LED producing the light would require less energy and the idea of cochlear prosthetics in association with photo-stimulation, would be more feasible.<b><sup id=\"rdp-ebb-cite_ref-87\" class=\"reference\"><a href=\"#cite_note-87\" rel=\"external_link\">[87]<\/a><\/sup><\/b>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Brainstem\">Brainstem<\/span><\/h4>\n<p>Optogenetic stimulation of a modified red-light excitable channelrhodopsin (ReaChR) expressed in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Facial_motor_nucleus\" title=\"Facial motor nucleus\" rel=\"external_link\" target=\"_blank\">facial motor nucleus<\/a> enabled minimally invasive activation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Motoneurons\" class=\"mw-redirect\" title=\"Motoneurons\" rel=\"external_link\" target=\"_blank\">motoneurons<\/a> effective in driving whisker movements in mice.<sup id=\"rdp-ebb-cite_ref-Lin001_88-0\" class=\"reference\"><a href=\"#cite_note-Lin001-88\" rel=\"external_link\">[88]<\/a><\/sup> One novel study employed optogenetics on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dorsal_raphe_nucleus\" title=\"Dorsal raphe nucleus\" rel=\"external_link\" target=\"_blank\">Dorsal Ralphe Nucleus<\/a> to both activate and inhibit dopaminergic release onto the ventral tegmental area. To produce activation transgenic mice were infected with channelrhodopsin-2 with a TH-Cre promoter and to produce inhibition the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperpolarization_(biology)\" title=\"Hyperpolarization (biology)\" rel=\"external_link\" target=\"_blank\">hyperpolarizing<\/a> opsin NpHR was added onto the TH-Cre promoter. Results showed that optically activating dopaminergic neurons led to an increase in social interactions, and their inhibition decreased the need to socialize only after a period of isolation.<b><sup id=\"rdp-ebb-cite_ref-89\" class=\"reference\"><a href=\"#cite_note-89\" rel=\"external_link\">[89]<\/a><\/sup><\/b>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Precise_temporal_control_of_interventions\">Precise temporal control of interventions<\/span><\/h3>\n<p>The currently available optogenetic actuators allow for the accurate temporal control of the required intervention (i.e. inhibition or excitation of the target neurons) with precision routinely going down to the millisecond level. Therefore, experiments can now be devised where the light used for the intervention is triggered by a particular <b>element of behavior<\/b> (to inhibit the behavior), a particular <b>unconditioned stimulus<\/b> (to associate something to that stimulus) or a particular <b>oscillatory event<\/b> in the brain (to inhibit the event). This kind of approach has already been used in several brain regions:\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Hippocampus\">Hippocampus<\/span><\/h4>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sharp_waves_and_ripples\" title=\"Sharp waves and ripples\" rel=\"external_link\" target=\"_blank\">Sharp waves and ripple complexes<\/a> (SWRs) are distinct high frequency oscillatory events in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hippocampus\" title=\"Hippocampus\" rel=\"external_link\" target=\"_blank\">hippocampus<\/a> thought to play a role in memory formation and consolidation. These events can be readily detected by following the oscillatory cycles of the on-line recorded <a href=\"https:\/\/en.wikipedia.org\/wiki\/Local_field_potential\" title=\"Local field potential\" rel=\"external_link\" target=\"_blank\">local field potential<\/a>. In this way the onset of the event can be used as a trigger signal for a light flash that is guided back into the hippocampus to inhibit neurons specifically during the SWRs and also to optogenetically inhibit the oscillation itself<sup id=\"rdp-ebb-cite_ref-pmid27760158_90-0\" class=\"reference\"><a href=\"#cite_note-pmid27760158-90\" rel=\"external_link\">[90]<\/a><\/sup> These kinds of \"closed-loop\" experiments are useful to study SWR complexes and their role in memory.\n<\/p>\n<h3><span id=\"rdp-ebb-Cellular_biology.2Fcell_signaling_pathways\"><\/span><span class=\"mw-headline\" id=\"Cellular_biology\/cell_signaling_pathways\">Cellular biology\/cell signaling pathways<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:982px;\"><div class=\"mediaContainer\" style=\"width:980px\"><video id=\"rdp-ebb-mwe_player_4\" poster=\"\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv\/980px--Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv.jpg\" controls=\"\" preload=\"none\" style=\"width:980px;height:420px\" class=\"kskin\" data-durationhint=\"9.6\" data-startoffset=\"0\" data-mwtitle=\"Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv\" data-mwprovider=\"wikimediacommons\"><source src=\"\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/7\/71\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv.480p.webm\" type=\"video\/webm; codecs="vp8, vorbis"\" data-title=\"SD WebM (480P)\" data-shorttitle=\"WebM 480P\" data-transcodekey=\"480p.webm\" data-width=\"854\" data-height=\"366\" data-bandwidth=\"1020648\" data-framerate=\"25\" \/><source src=\"\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/7\/71\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv.480p.vp9.webm\" type=\"video\/webm; codecs="vp9, opus"\" data-title=\"SD VP9 (480P)\" data-shorttitle=\"VP9 480P\" data-transcodekey=\"480p.vp9.webm\" data-width=\"854\" data-height=\"366\" data-bandwidth=\"1286688\" data-framerate=\"25\" \/><source src=\"\/\/upload.wikimedia.org\/wikipedia\/commons\/7\/71\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv\" type=\"video\/ogg; codecs="theora"\" data-title=\"Original Ogg file, 980 \u00d7 420 (8.32 Mbps)\" data-shorttitle=\"Ogg source\" data-width=\"980\" data-height=\"420\" data-bandwidth=\"8321454\" data-framerate=\"25\" \/><source src=\"\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/7\/71\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv.120p.vp9.webm\" type=\"video\/webm; codecs="vp9, opus"\" data-title=\"Lowest bandwidth VP9 (120P)\" data-shorttitle=\"VP9 120P\" data-transcodekey=\"120p.vp9.webm\" data-width=\"214\" data-height=\"92\" data-bandwidth=\"81624\" data-framerate=\"25\" \/><source src=\"\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/7\/71\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv.160p.webm\" type=\"video\/webm; codecs="vp8, vorbis"\" data-title=\"Low bandwidth WebM (160P)\" data-shorttitle=\"WebM 160P\" data-transcodekey=\"160p.webm\" data-width=\"288\" data-height=\"124\" data-bandwidth=\"129688\" data-framerate=\"25\" \/><source src=\"\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/7\/71\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv.180p.vp9.webm\" type=\"video\/webm; codecs="vp9, opus"\" data-title=\"Low bandwidth VP9 (180P)\" data-shorttitle=\"VP9 180P\" data-transcodekey=\"180p.vp9.webm\" data-width=\"320\" data-height=\"138\" data-bandwidth=\"195080\" data-framerate=\"25\" \/><source src=\"\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/7\/71\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv.240p.webm\" type=\"video\/webm; codecs="vp8, vorbis"\" data-title=\"Small WebM (240P)\" data-shorttitle=\"WebM 240P\" data-transcodekey=\"240p.webm\" data-width=\"426\" data-height=\"182\" data-bandwidth=\"254776\" data-framerate=\"25\" \/><source src=\"\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/7\/71\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv.240p.vp9.webm\" type=\"video\/webm; codecs="vp9, opus"\" data-title=\"Small VP9 (240P)\" data-shorttitle=\"VP9 240P\" data-transcodekey=\"240p.vp9.webm\" data-width=\"426\" data-height=\"182\" data-bandwidth=\"322104\" data-framerate=\"25\" \/><source src=\"\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/7\/71\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv.360p.webm\" type=\"video\/webm; codecs="vp8, vorbis"\" data-title=\"WebM (360P)\" data-shorttitle=\"WebM 360P\" data-transcodekey=\"360p.webm\" data-width=\"640\" data-height=\"274\" data-bandwidth=\"511216\" data-framerate=\"25\" \/><source src=\"\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/7\/71\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv\/Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv.360p.vp9.webm\" type=\"video\/webm; codecs="vp9, opus"\" data-title=\"VP9 (360P)\" data-shorttitle=\"VP9 360P\" data-transcodekey=\"360p.vp9.webm\" data-width=\"640\" data-height=\"274\" data-bandwidth=\"645184\" data-framerate=\"25\" \/><\/video><\/div> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Optogenetic-control-of-cellular-forces-and-mechanotransduction-ncomms14396-s12.ogv\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Optogenetic control of cellular forces and induction of mechanotransduction. Pictured cells receive an hour of imaging concurrent with blue light that pulses every 60 seconds. This is also indicated when the blue point flashes onto the image. The cell relaxes for an hour without light activation and then this cycle repeats again. The square inset magnifies the cell's nucleus.<\/div><\/div><\/div>\n<p>The optogenetic toolkit has proven pivotal for the field of neuroscience as it allows precise manipulation of neuronal excitability. Moreover, this technique has been shown to extend outside neurons to an increasing number of proteins and cellular functions.<sup id=\"rdp-ebb-cite_ref-:1_60-1\" class=\"reference\"><a href=\"#cite_note-:1-60\" rel=\"external_link\">[60]<\/a><\/sup> Cellular scale modifications including manipulation of contractile forces relevant to cell migration, cell division and wound healing have been optogenetically manipulated.<sup id=\"rdp-ebb-cite_ref-91\" class=\"reference\"><a href=\"#cite_note-91\" rel=\"external_link\">[91]<\/a><\/sup> The field has not developed to the point where processes crucial to cellular and developmental biology and cell signaling including protein localization, post-translational modification and GTP loading can be consistently controlled via optogenetics.<sup id=\"rdp-ebb-cite_ref-:1_60-2\" class=\"reference\"><a href=\"#cite_note-:1-60\" rel=\"external_link\">[60]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Photosensitive_proteins_utilized_in_various_cell_signaling_pathways\">Photosensitive proteins utilized in various cell signaling pathways<\/span><\/h4>\n<p>While this extension of optogenetics remains to be further investigated, there are various conceptual methodologies that may prove to immediately robust. There is a considerable body of literature outlining photosensitive proteins that have been utilized in cell signaling pathways.<sup id=\"rdp-ebb-cite_ref-:1_60-3\" class=\"reference\"><a href=\"#cite_note-:1-60\" rel=\"external_link\">[60]<\/a><\/sup> CRY2, LOV, DRONPA and PHYB are photosynthetic proteins involved in inducible protein association whereby activation via light can induce\/turn off a signaling cascade via recruitment of a signaling domain to its respective substrate.<sup id=\"rdp-ebb-cite_ref-92\" class=\"reference\"><a href=\"#cite_note-92\" rel=\"external_link\">[92]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-93\" class=\"reference\"><a href=\"#cite_note-93\" rel=\"external_link\">[93]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-94\" class=\"reference\"><a href=\"#cite_note-94\" rel=\"external_link\">[94]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-95\" class=\"reference\"><a href=\"#cite_note-95\" rel=\"external_link\">[95]<\/a><\/sup> LOV and PHYB are photosensitive proteins that engage in homodimerization and\/or heterodimerization to recruit some DNA-modifying protein, translocate to the site of DNA and alter gene expression levels.<sup id=\"rdp-ebb-cite_ref-96\" class=\"reference\"><a href=\"#cite_note-96\" rel=\"external_link\">[96]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-97\" class=\"reference\"><a href=\"#cite_note-97\" rel=\"external_link\">[97]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-98\" class=\"reference\"><a href=\"#cite_note-98\" rel=\"external_link\">[98]<\/a><\/sup> CRY2, a protein that inherently clusters when active, has been fused with signaling domains and subsequently photoactivated allowing for clustering-based activation.<sup id=\"rdp-ebb-cite_ref-99\" class=\"reference\"><a href=\"#cite_note-99\" rel=\"external_link\">[99]<\/a><\/sup> Proteins LOV and Dronpa have also been adapted to cell signaling manipulation; exposure to light induces conformational changes in the photosensitive protein which can subsequently reveal a previously obscured signaling domain and\/or activate a protein that was otherwise allosterically inhibited.<sup id=\"rdp-ebb-cite_ref-100\" class=\"reference\"><a href=\"#cite_note-100\" rel=\"external_link\">[100]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-101\" class=\"reference\"><a href=\"#cite_note-101\" rel=\"external_link\">[101]<\/a><\/sup> LOV has been fused to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Caspase_3\" title=\"Caspase 3\" rel=\"external_link\" target=\"_blank\">caspase 3<\/a> to produce a construct capable of inducing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apoptosis\" title=\"Apoptosis\" rel=\"external_link\" target=\"_blank\">apoptosis<\/a> upon light stimulation.<sup id=\"rdp-ebb-cite_ref-102\" class=\"reference\"><a href=\"#cite_note-102\" rel=\"external_link\">[102]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Optogenetic_temporal_control_of_signals\">Optogenetic temporal control of signals<\/span><\/h4>\n<p>A different set of signaling cascades respond to stimulus timing duration and dynamics.<sup id=\"rdp-ebb-cite_ref-103\" class=\"reference\"><a href=\"#cite_note-103\" rel=\"external_link\">[103]<\/a><\/sup> Adaptive signaling pathways, for instance, adjust in accordance to the current level of the projected stimulus and display activity only when these levels change as opposed to responding to absolute levels of the input.<sup id=\"rdp-ebb-cite_ref-104\" class=\"reference\"><a href=\"#cite_note-104\" rel=\"external_link\">[104]<\/a><\/sup> Stimulus dynamics also can trigger activity; treating PC12 cells with epidermal growth factor (inducing a transient profile of ERK activity) leads to cellular proliferation whereas introduction of nerve growth factor (inducing a sustained profile of ERK activity) is associated with a different cellular decision whereby the PC12 cells differentiate into neuron-like cells.<sup id=\"rdp-ebb-cite_ref-105\" class=\"reference\"><a href=\"#cite_note-105\" rel=\"external_link\">[105]<\/a><\/sup> This discovery was guided pharmacologically but the finding was replicated utilizing optogenetic inputs instead.<sup id=\"rdp-ebb-cite_ref-106\" class=\"reference\"><a href=\"#cite_note-106\" rel=\"external_link\">[106]<\/a><\/sup> This ability to optogenetically control signals for various time durations is being explored to elucidate various cell signaling pathways where there is not a strong enough understanding to utilize either drug\/genetic manipulation.<sup id=\"rdp-ebb-cite_ref-:1_60-4\" class=\"reference\"><a href=\"#cite_note-:1-60\" rel=\"external_link\">[60]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; 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target=\"_blank\">\"Single-molecule fluorimetry and gating currents inspire an improved optical voltage indicator\"<\/a>. <i>eLife<\/i>. <b>4<\/b>: e10482. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.7554%2FeLife.10482\" target=\"_blank\">10.7554\/eLife.10482<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4658195\" target=\"_blank\">4658195<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Methods&rft.atitle=Optogenetics%3A+Controlling+cell+function+with+light&rft.volume=8&rft.issue=1&rft.pages=24-25&rft.date=2010&rft_id=info%3Adoi%2F10.1038%2Fnmeth.f.323&rft.aulast=Pastrana&rft.aufirst=Erika&rft_id=http%3A%2F%2Fwww.nature.com%2Fnmeth%2Fjournal%2Fv8%2Fn1%2Ffull%2Fnmeth.f.323.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><br \/> Editorial: <cite class=\"citation journal\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nature.com\/nmeth\/journal\/v8\/n1\/full\/nmeth.f.321.html\" target=\"_blank\">\"Method of the Year 2010\"<\/a>. <i>Nature Methods<\/i>. <b>8<\/b> (1): 1. 2010. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" 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Introduction\". <i>Science<\/i>. <b>330<\/b> (6011): 1612\u20133. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2010Sci...330.1612.\" target=\"_blank\">2010Sci...330.1612.<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1126%2Fscience.330.6011.1612\" target=\"_blank\">10.1126\/science.330.6011.1612<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21163985\" target=\"_blank\">21163985<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Science&rft.atitle=Insights+of+the+decade.+Stepping+away+from+the+trees+for+a+look+at+the+forest.+Introduction&rft.volume=330&rft.issue=6011&rft.pages=1612-3&rft.date=2010&rft_id=info%3Apmid%2F21163985&rft_id=info%3Adoi%2F10.1126%2Fscience.330.6011.1612&rft_id=info%3Abibcode%2F2010Sci...330.1612.&rft.aulast=News&rft.aufirst=Staff&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Crick-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Crick_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Crick, F. 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Post, Ryan J; Ho, Yi-Yun; Warden, Melissa R (2015-07-25). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4756725\" target=\"_blank\">\"Making Sense of Optogenetics\"<\/a>. <i>International Journal of Neuropsychopharmacology<\/i>. <b>18<\/b> (11): pyv079. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1093%2Fijnp%2Fpyv079\" target=\"_blank\">10.1093\/ijnp\/pyv079<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1461-1457\" target=\"_blank\">1461-1457<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4756725\" target=\"_blank\">4756725<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26209858\" target=\"_blank\">26209858<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Neuropsychopharmacology&rft.atitle=Making+Sense+of+Optogenetics&rft.volume=18&rft.issue=11&rft.pages=pyv079&rft.date=2015-07-25&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4756725&rft.issn=1461-1457&rft_id=info%3Apmid%2F26209858&rft_id=info%3Adoi%2F10.1093%2Fijnp%2Fpyv079&rft.aulast=Guru&rft.aufirst=Akash&rft.au=Post%2C+Ryan+J&rft.au=Ho%2C+Yi-Yun&rft.au=Warden%2C+Melissa+R&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4756725&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:1-60\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:1_60-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_60-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_60-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_60-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_60-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tischer, Doug; 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(2016). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4461886\" target=\"_blank\">\"Optogenetically induced spatiotemporal gamma oscillations and neuronal spiking activity in primate motor cortex\"<\/a>. <i>Journal of Neurophysiology<\/i>. <b>113<\/b> (10): 3574\u20133587. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1152%2Fjn.00792.2014\" target=\"_blank\">10.1152\/jn.00792.2014<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1522-1598\" target=\"_blank\">1522-1598<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4461886\" target=\"_blank\">4461886<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Neurophysiology&rft.atitle=Optogenetically+induced+spatiotemporal+gamma+oscillations+and+neuronal+spiking+activity+in+primate+motor+cortex&rft.volume=113&rft.issue=10&rft.pages=3574-3587&rft.date=2016&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4461886&rft.issn=1522-1598&rft_id=info%3Adoi%2F10.1152%2Fjn.00792.2014&rft.aulast=Lu&rft.aufirst=Yao&rft.au=Truccolo%2C+Wilson&rft.au=Wagner%2C+Fabien+B.&rft.au=Vargas-Irwin%2C+Carlos+E.&rft.au=Ozden%2C+Ilker&rft.au=Zimmermann%2C+Jonas+B.&rft.au=May%2C+Travis&rft.au=Agha%2C+Naubahar+S.&rft.au=Wang%2C+Jing&rft.au=Nurmikko%2C+Arto+V.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4461886&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-64\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-64\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gradinaru, Viviana; Thompson, Kimberly R.; Deisseroth, Karl (2008-08-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2588488\" target=\"_blank\">\"eNpHR: a Natronomonas halorhodopsin enhanced for optogenetic applications\"<\/a>. <i>Brain Cell Biology<\/i>. <b>36<\/b> (1\u20134): 129\u2013139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11068-008-9027-6\" target=\"_blank\">10.1007\/s11068-008-9027-6<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1559-7113\" target=\"_blank\">1559-7113<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2588488\" target=\"_blank\">2588488<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18677566\" target=\"_blank\">18677566<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Brain+Cell+Biology&rft.atitle=eNpHR%3A+a+Natronomonas+halorhodopsin+enhanced+for+optogenetic+applications&rft.volume=36&rft.issue=1%E2%80%934&rft.pages=129-139&rft.date=2008-08-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2588488&rft.issn=1559-7113&rft_id=info%3Apmid%2F18677566&rft_id=info%3Adoi%2F10.1007%2Fs11068-008-9027-6&rft.aulast=Gradinaru&rft.aufirst=Viviana&rft.au=Thompson%2C+Kimberly+R.&rft.au=Deisseroth%2C+Karl&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2588488&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:3-65\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:3_65-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_65-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Leergaard, Trygve B.; 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class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fncomms14396\" target=\"_blank\">10.1038\/ncomms14396<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2041-1723\" target=\"_blank\">2041-1723<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5309899\" target=\"_blank\">5309899<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28186127\" target=\"_blank\">28186127<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Communications&rft.atitle=Optogenetic+control+of+cellular+forces+and+mechanotransduction&rft.volume=8&rft.pages=14396&rft.date=2017-02-10&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5309899&rft_id=info%3Abibcode%2F2017NatCo...814396V&rft_id=info%3Apmid%2F28186127&rft_id=info%3Adoi%2F10.1038%2Fncomms14396&rft.issn=2041-1723&rft.aulast=Valon&rft.aufirst=L%C3%A9o&rft.au=Mar%C3%ADn-Llaurad%C3%B3%2C+Ariadna&rft.au=Wyatt%2C+Thomas&rft.au=Charras%2C+Guillaume&rft.au=Trepat%2C+Xavier&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5309899&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-92\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-92\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Strickland, Devin; Lin, Yuan; Wagner, Elizabeth; Hope, C. Matthew; Zayner, Josiah; Antoniou, Chloe; Sosnick, Tobin R.; Weiss, Eric L.; Glotzer, Michael (2012-03-04). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3444151\" target=\"_blank\">\"TULIPs: tunable, light-controlled interacting protein tags for cell biology\"<\/a>. <i>Nature Methods<\/i>. <b>9<\/b> (4): 379\u2013384. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnmeth.1904\" target=\"_blank\">10.1038\/nmeth.1904<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1548-7105\" target=\"_blank\">1548-7105<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3444151\" target=\"_blank\">3444151<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22388287\" target=\"_blank\">22388287<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Methods&rft.atitle=TULIPs%3A+tunable%2C+light-controlled+interacting+protein+tags+for+cell+biology&rft.volume=9&rft.issue=4&rft.pages=379-384&rft.date=2012-03-04&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3444151&rft.issn=1548-7105&rft_id=info%3Apmid%2F22388287&rft_id=info%3Adoi%2F10.1038%2Fnmeth.1904&rft.aulast=Strickland&rft.aufirst=Devin&rft.au=Lin%2C+Yuan&rft.au=Wagner%2C+Elizabeth&rft.au=Hope%2C+C.+Matthew&rft.au=Zayner%2C+Josiah&rft.au=Antoniou%2C+Chloe&rft.au=Sosnick%2C+Tobin+R.&rft.au=Weiss%2C+Eric+L.&rft.au=Glotzer%2C+Michael&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3444151&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-93\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-93\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Idevall-Hagren, Olof; Dickson, Eamonn J.; Hille, Bertil; Toomre, Derek K.; De Camilli, Pietro (2012-08-28). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3435206\" target=\"_blank\">\"Optogenetic control of phosphoinositide metabolism\"<\/a>. <i>Proceedings of the National Academy of Sciences of the United States of America<\/i>. <b>109<\/b> (35): E2316\u20132323. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2012PNAS..109E2316I\" target=\"_blank\">2012PNAS..109E2316I<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1073%2Fpnas.1211305109\" target=\"_blank\">10.1073\/pnas.1211305109<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1091-6490\" target=\"_blank\">1091-6490<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3435206\" target=\"_blank\">3435206<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22847441\" target=\"_blank\">22847441<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+the+National+Academy+of+Sciences+of+the+United+States+of+America&rft.atitle=Optogenetic+control+of+phosphoinositide+metabolism&rft.volume=109&rft.issue=35&rft.pages=E2316-2323&rft.date=2012-08-28&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3435206&rft_id=info%3Abibcode%2F2012PNAS..109E2316I&rft_id=info%3Apmid%2F22847441&rft_id=info%3Adoi%2F10.1073%2Fpnas.1211305109&rft.issn=1091-6490&rft.aulast=Idevall-Hagren&rft.aufirst=Olof&rft.au=Dickson%2C+Eamonn+J.&rft.au=Hille%2C+Bertil&rft.au=Toomre%2C+Derek+K.&rft.au=De+Camilli%2C+Pietro&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3435206&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-94\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-94\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Leung, Daisy W.; Otomo, Chinatsu; Chory, Joanne; Rosen, Michael K. (2008-09-02). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2525560\" target=\"_blank\">\"Genetically encoded photoswitching of actin assembly through the Cdc42-WASP-Arp2\/3 complex pathway\"<\/a>. <i>Proceedings of the National Academy of Sciences of the United States of America<\/i>. <b>105<\/b> (35): 12797\u201312802. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2008PNAS..10512797L\" target=\"_blank\">2008PNAS..10512797L<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1073%2Fpnas.0801232105\" target=\"_blank\">10.1073\/pnas.0801232105<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1091-6490\" target=\"_blank\">1091-6490<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2525560\" target=\"_blank\">2525560<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18728185\" target=\"_blank\">18728185<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+the+National+Academy+of+Sciences+of+the+United+States+of+America&rft.atitle=Genetically+encoded+photoswitching+of+actin+assembly+through+the+Cdc42-WASP-Arp2%2F3+complex+pathway&rft.volume=105&rft.issue=35&rft.pages=12797-12802&rft.date=2008-09-02&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2525560&rft_id=info%3Abibcode%2F2008PNAS..10512797L&rft_id=info%3Apmid%2F18728185&rft_id=info%3Adoi%2F10.1073%2Fpnas.0801232105&rft.issn=1091-6490&rft.aulast=Leung&rft.aufirst=Daisy+W.&rft.au=Otomo%2C+Chinatsu&rft.au=Chory%2C+Joanne&rft.au=Rosen%2C+Michael+K.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2525560&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-95\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-95\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Toettcher, Jared E.; Gong, Delquin; Lim, Wendell A.; Weiner, Orion D. (2011-09-11). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3184382\" target=\"_blank\">\"Light-based feedback for controlling intracellular signaling dynamics\"<\/a>. <i>Nature Methods<\/i>. <b>8<\/b> (10): 837\u2013839. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnmeth.1700\" target=\"_blank\">10.1038\/nmeth.1700<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1548-7105\" target=\"_blank\">1548-7105<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3184382\" target=\"_blank\">3184382<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21909100\" target=\"_blank\">21909100<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Methods&rft.atitle=Light-based+feedback+for+controlling+intracellular+signaling+dynamics&rft.volume=8&rft.issue=10&rft.pages=837-839&rft.date=2011-09-11&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3184382&rft.issn=1548-7105&rft_id=info%3Apmid%2F21909100&rft_id=info%3Adoi%2F10.1038%2Fnmeth.1700&rft.aulast=Toettcher&rft.aufirst=Jared+E.&rft.au=Gong%2C+Delquin&rft.au=Lim%2C+Wendell+A.&rft.au=Weiner%2C+Orion+D.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3184382&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-96\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-96\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lungu, Oana I.; Hallett, Ryan A.; Choi, Eun Jung; Aiken, Mary J.; Hahn, Klaus M.; Kuhlman, Brian (2012-04-20). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3334866\" target=\"_blank\">\"Designing photoswitchable peptides using the AsLOV2 domain\"<\/a>. <i>Chemistry & Biology<\/i>. <b>19<\/b> (4): 507\u2013517. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.chembiol.2012.02.006\" target=\"_blank\">10.1016\/j.chembiol.2012.02.006<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1879-1301\" target=\"_blank\">1879-1301<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3334866\" target=\"_blank\">3334866<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22520757\" target=\"_blank\">22520757<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Chemistry+%26+Biology&rft.atitle=Designing+photoswitchable+peptides+using+the+AsLOV2+domain&rft.volume=19&rft.issue=4&rft.pages=507-517&rft.date=2012-04-20&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3334866&rft.issn=1879-1301&rft_id=info%3Apmid%2F22520757&rft_id=info%3Adoi%2F10.1016%2Fj.chembiol.2012.02.006&rft.aulast=Lungu&rft.aufirst=Oana+I.&rft.au=Hallett%2C+Ryan+A.&rft.au=Choi%2C+Eun+Jung&rft.au=Aiken%2C+Mary+J.&rft.au=Hahn%2C+Klaus+M.&rft.au=Kuhlman%2C+Brian&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3334866&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-97\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-97\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Konermann, Silvana; Brigham, Mark D.; Trevino, Alexandro E.; Hsu, Patrick D.; Heidenreich, Matthias; Cong, Le; Platt, Randall J.; Scott, David A.; Church, George M. (2013-08-22). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3856241\" target=\"_blank\">\"Optical control of mammalian endogenous transcription and epigenetic states\"<\/a>. <i>Nature<\/i>. <b>500<\/b> (7463): 472\u2013476. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2013Natur.500..472K\" target=\"_blank\">2013Natur.500..472K<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnature12466\" target=\"_blank\">10.1038\/nature12466<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1476-4687\" target=\"_blank\">1476-4687<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3856241\" target=\"_blank\">3856241<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23877069\" target=\"_blank\">23877069<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature&rft.atitle=Optical+control+of+mammalian+endogenous+transcription+and+epigenetic+states&rft.volume=500&rft.issue=7463&rft.pages=472-476&rft.date=2013-08-22&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3856241&rft_id=info%3Abibcode%2F2013Natur.500..472K&rft_id=info%3Apmid%2F23877069&rft_id=info%3Adoi%2F10.1038%2Fnature12466&rft.issn=1476-4687&rft.aulast=Konermann&rft.aufirst=Silvana&rft.au=Brigham%2C+Mark+D.&rft.au=Trevino%2C+Alexandro+E.&rft.au=Hsu%2C+Patrick+D.&rft.au=Heidenreich%2C+Matthias&rft.au=Cong%2C+Le&rft.au=Platt%2C+Randall+J.&rft.au=Scott%2C+David+A.&rft.au=Church%2C+George+M.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3856241&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-98\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-98\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Shimizu-Sato, Sae; Huq, Enamul; Tepperman, James M.; Quail, Peter H. 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(2012-11-09). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3702057\" target=\"_blank\">\"Optical control of protein activity by fluorescent protein domains\"<\/a>. <i>Science<\/i>. <b>338<\/b> (6108): 810\u2013814. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2012Sci...338..810Z\" target=\"_blank\">2012Sci...338..810Z<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1126%2Fscience.1226854\" target=\"_blank\">10.1126\/science.1226854<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1095-9203\" target=\"_blank\">1095-9203<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3702057\" target=\"_blank\">3702057<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23139335\" target=\"_blank\">23139335<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Science&rft.atitle=Optical+control+of+protein+activity+by+fluorescent+protein+domains&rft.volume=338&rft.issue=6108&rft.pages=810-814&rft.date=2012-11-09&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3702057&rft_id=info%3Abibcode%2F2012Sci...338..810Z&rft_id=info%3Apmid%2F23139335&rft_id=info%3Adoi%2F10.1126%2Fscience.1226854&rft.issn=1095-9203&rft.aulast=Zhou&rft.aufirst=Xin+X.&rft.au=Chung%2C+Hokyung+K.&rft.au=Lam%2C+Amy+J.&rft.au=Lin%2C+Michael+Z.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3702057&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-101\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-101\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wu, Yi I.; Frey, Daniel; Lungu, Oana I.; Jaehrig, Angelika; Schlichting, Ilme; Kuhlman, Brian; Hahn, Klaus M. (2009-09-03). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2766670\" target=\"_blank\">\"A genetically encoded photoactivatable Rac controls the motility of living cells\"<\/a>. <i>Nature<\/i>. <b>461<\/b> (7260): 104\u2013108. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2009Natur.461..104W\" target=\"_blank\">2009Natur.461..104W<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnature08241\" target=\"_blank\">10.1038\/nature08241<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1476-4687\" target=\"_blank\">1476-4687<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2766670\" target=\"_blank\">2766670<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19693014\" target=\"_blank\">19693014<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature&rft.atitle=A+genetically+encoded+photoactivatable+Rac+controls+the+motility+of+living+cells&rft.volume=461&rft.issue=7260&rft.pages=104-108&rft.date=2009-09-03&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2766670&rft_id=info%3Abibcode%2F2009Natur.461..104W&rft_id=info%3Apmid%2F19693014&rft_id=info%3Adoi%2F10.1038%2Fnature08241&rft.issn=1476-4687&rft.aulast=Wu&rft.aufirst=Yi+I.&rft.au=Frey%2C+Daniel&rft.au=Lungu%2C+Oana+I.&rft.au=Jaehrig%2C+Angelika&rft.au=Schlichting%2C+Ilme&rft.au=Kuhlman%2C+Brian&rft.au=Hahn%2C+Klaus+M.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2766670&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-102\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-102\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Smart, Ashley D.; Pache, Roland A.; Thomsen, Nathan D.; Kortemme, Tanja; Davis, Graeme W.; Wells, James A. (2017-09-11). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5625904\" target=\"_blank\">\"Engineering a light-activated caspase-3 for precise ablation of neurons in vivo\"<\/a>. <i>Proceedings of the National Academy of Sciences of the United States of America<\/i>. <b>114<\/b> (39): E8174\u2013E8183. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1073%2Fpnas.1705064114\" target=\"_blank\">10.1073\/pnas.1705064114<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1091-6490\" target=\"_blank\">1091-6490<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5625904\" target=\"_blank\">5625904<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28893998\" target=\"_blank\">28893998<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+the+National+Academy+of+Sciences+of+the+United+States+of+America&rft.atitle=Engineering+a+light-activated+caspase-3+for+precise+ablation+of+neurons+in+vivo&rft.volume=114&rft.issue=39&rft.pages=E8174-E8183&rft.date=2017-09-11&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5625904&rft.issn=1091-6490&rft_id=info%3Apmid%2F28893998&rft_id=info%3Adoi%2F10.1073%2Fpnas.1705064114&rft.aulast=Smart&rft.aufirst=Ashley+D.&rft.au=Pache%2C+Roland+A.&rft.au=Thomsen%2C+Nathan+D.&rft.au=Kortemme%2C+Tanja&rft.au=Davis%2C+Graeme+W.&rft.au=Wells%2C+James+A.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5625904&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-103\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-103\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Purvis, Jeremy E.; Lahav, Galit (2013-02-28). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3707615\" target=\"_blank\">\"Encoding and decoding cellular information through signaling dynamics\"<\/a>. <i>Cell<\/i>. <b>152<\/b> (5): 945\u2013956. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.cell.2013.02.005\" target=\"_blank\">10.1016\/j.cell.2013.02.005<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1097-4172\" target=\"_blank\">1097-4172<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3707615\" target=\"_blank\">3707615<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23452846\" target=\"_blank\">23452846<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cell&rft.atitle=Encoding+and+decoding+cellular+information+through+signaling+dynamics&rft.volume=152&rft.issue=5&rft.pages=945-956&rft.date=2013-02-28&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3707615&rft.issn=1097-4172&rft_id=info%3Apmid%2F23452846&rft_id=info%3Adoi%2F10.1016%2Fj.cell.2013.02.005&rft.aulast=Purvis&rft.aufirst=Jeremy+E.&rft.au=Lahav%2C+Galit&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3707615&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-104\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-104\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Shimizu, Thomas S.; Tu, Yuhai; Berg, Howard C. (2010-06-22). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2913400\" target=\"_blank\">\"A modular gradient-sensing network for chemotaxis in Escherichia coli revealed by responses to time-varying stimuli\"<\/a>. <i>Molecular Systems Biology<\/i>. <b>6<\/b>: 382. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fmsb.2010.37\" target=\"_blank\">10.1038\/msb.2010.37<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1744-4292\" target=\"_blank\">1744-4292<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2913400\" target=\"_blank\">2913400<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20571531\" target=\"_blank\">20571531<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Molecular+Systems+Biology&rft.atitle=A+modular+gradient-sensing+network+for+chemotaxis+in+Escherichia+coli+revealed+by+responses+to+time-varying+stimuli&rft.volume=6&rft.pages=382&rft.date=2010-06-22&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2913400&rft.issn=1744-4292&rft_id=info%3Apmid%2F20571531&rft_id=info%3Adoi%2F10.1038%2Fmsb.2010.37&rft.aulast=Shimizu&rft.aufirst=Thomas+S.&rft.au=Tu%2C+Yuhai&rft.au=Berg%2C+Howard+C.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2913400&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-105\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-105\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Santos, Silvia D. M.; Verveer, Peter J.; Bastiaens, Philippe I. H. (2007-03-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nature.com\/ncb\/journal\/v9\/n3\/full\/ncb1543.html\" target=\"_blank\">\"Growth factor-induced MAPK network topology shapes Erk response determining PC-12 cell fate\"<\/a>. <i>Nature Cell Biology<\/i>. <b>9<\/b> (3): 324\u2013330. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fncb1543\" target=\"_blank\">10.1038\/ncb1543<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1465-7392\" target=\"_blank\">1465-7392<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Cell+Biology&rft.atitle=Growth+factor-induced+MAPK+network+topology+shapes+Erk+response+determining+PC-12+cell+fate&rft.volume=9&rft.issue=3&rft.pages=324-330&rft.date=2007-03-01&rft_id=info%3Adoi%2F10.1038%2Fncb1543&rft.issn=1465-7392&rft.aulast=Santos&rft.aufirst=Silvia+D.+M.&rft.au=Verveer%2C+Peter+J.&rft.au=Bastiaens%2C+Philippe+I.+H.&rft_id=https%3A%2F%2Fwww.nature.com%2Fncb%2Fjournal%2Fv9%2Fn3%2Ffull%2Fncb1543.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-106\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-106\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Toettcher, Jared E.; Weiner, Orion D.; Lim, Wendell A. (2013-12-05). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3925772\" target=\"_blank\">\"Using optogenetics to interrogate the dynamic control of signal transmission by the Ras\/Erk module\"<\/a>. <i>Cell<\/i>. <b>155<\/b> (6): 1422\u20131434. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.cell.2013.11.004\" target=\"_blank\">10.1016\/j.cell.2013.11.004<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1097-4172\" target=\"_blank\">1097-4172<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3925772\" target=\"_blank\">3925772<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24315106\" target=\"_blank\">24315106<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cell&rft.atitle=Using+optogenetics+to+interrogate+the+dynamic+control+of+signal+transmission+by+the+Ras%2FErk+module&rft.volume=155&rft.issue=6&rft.pages=1422-1434&rft.date=2013-12-05&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3925772&rft.issn=1097-4172&rft_id=info%3Apmid%2F24315106&rft_id=info%3Adoi%2F10.1016%2Fj.cell.2013.11.004&rft.aulast=Toettcher&rft.aufirst=Jared+E.&rft.au=Weiner%2C+Orion+D.&rft.au=Lim%2C+Wendell+A.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3925772&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n\n<ul><li><cite id=\"rdp-ebb-refAiran2007\" class=\"citation journal\">Airan, R. D.; Hu, E. S.; Vijaykumar, R.; Roy, M.; Meltzer, L. A.; Deisseroth, K. (October 2007). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0959-4388(07)00121-3\" target=\"_blank\">\"Integration of light-controlled neuronal firing and fast circuit imaging\"<\/a>. <i>Current Opinion in Neurobiology<\/i>. <b>17<\/b> (5): 587\u201392. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.conb.2007.11.003\" target=\"_blank\">10.1016\/j.conb.2007.11.003<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18093822\" target=\"_blank\">18093822<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Current+Opinion+in+Neurobiology&rft.atitle=Integration+of+light-controlled+neuronal+firing+and+fast+circuit+imaging&rft.volume=17&rft.issue=5&rft.pages=587-92&rft.date=2007-10&rft_id=info%3Adoi%2F10.1016%2Fj.conb.2007.11.003&rft_id=info%3Apmid%2F18093822&rft.au=Airan%2C+R.+D.&rft.au=Hu%2C+E.+S.&rft.au=Vijaykumar%2C+R.&rft.au=Roy%2C+M.&rft.au=Meltzer%2C+L.+A.&rft.au=Deisseroth%2C+K.&rft_id=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0959-4388%2807%2900121-3&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite id=\"rdp-ebb-refAlilain2008\" class=\"citation journal\">Alilain, W. J.; Li, X.; Horn, K. P.; Dhingra, R.; et al. (November 2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2615537\" target=\"_blank\">\"Light-induced rescue of breathing after spinal cord injury\"<\/a>. <i>J. Neurosci<\/i>. <b>28<\/b> (46): 11862\u201370. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1523%2FJNEUROSCI.3378-08.2008\" target=\"_blank\">10.1523\/JNEUROSCI.3378-08.2008<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2615537\" target=\"_blank\">2615537<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19005051\" target=\"_blank\">19005051<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J.+Neurosci.&rft.atitle=Light-induced+rescue+of+breathing+after+spinal+cord+injury&rft.volume=28&rft.issue=46&rft.pages=11862-70&rft.date=2008-11&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2615537&rft_id=info%3Apmid%2F19005051&rft_id=info%3Adoi%2F10.1523%2FJNEUROSCI.3378-08.2008&rft.au=Alilain%2C+W.+J.&rft.au=Li%2C+X.&rft.au=Horn%2C+K.+P.&rft.au=Dhingra%2C+R.&rft.au=Dick%2C+T.+E.&rft.au=Herlitze%2C+S.&rft.au=Silver%2C+J.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2615537&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite id=\"rdp-ebb-refArenkiel2007\" class=\"citation journal\">Arenkiel, B. R.; Peca, J.; Davison, I. G.; Feliciano, Catia; et al. 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T.; Fajardo, O.; Sch\u00e4rer, Y. P.; Chattopadhyaya, B.; Bouldoires, E. A.; Stepien, A. E.; Deisseroth, K.; Arber, S.; Sprengel, R.; Rijli, F. M.; Friedrich, R. W. (2009-12-11). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2805431\" target=\"_blank\">\"Optogenetic Dissection of Neuronal Circuits in Zebrafish using Viral Gene Transfer and the Tet System\"<\/a>. <i>Frontiers in Neural Circuits<\/i>. <b>3<\/b>: 21. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3389%2Fneuro.04.021.2009\" target=\"_blank\">10.3389\/neuro.04.021.2009<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2805431\" target=\"_blank\">2805431<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20126518\" target=\"_blank\">20126518<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Frontiers+in+Neural+Circuits&rft.atitle=Optogenetic+Dissection+of+Neuronal+Circuits+in+Zebrafish+using+Viral+Gene+Transfer+and+the+Tet+System&rft.volume=3&rft.pages=21&rft.date=2009-12-11&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2805431&rft_id=info%3Apmid%2F20126518&rft_id=info%3Adoi%2F10.3389%2Fneuro.04.021.2009&rft.aulast=Zhu&rft.aufirst=P.&rft.au=Narita%2C+Y.&rft.au=Bundschuh%2C+S.+T.&rft.au=Fajardo%2C+O.&rft.au=Sch%C3%A4rer%2C+Y.+P.&rft.au=Chattopadhyaya%2C+B.&rft.au=Bouldoires%2C+E.+A.&rft.au=Stepien%2C+A.+E.&rft.au=Deisseroth%2C+K.&rft.au=Arber%2C+S.&rft.au=Sprengel%2C+R.&rft.au=Rijli%2C+F.+M.&rft.au=Friedrich%2C+R.+W.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2805431&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Zimmermann, G.; Wang, L. P.; Vaughan, A. G.; Manoli, D. S.; Zhang, F.; Deisseroth, K.; Baker, B. S.; Scott, M. P. (2009). Nitabach, Michael N., ed. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2660433\" target=\"_blank\">\"Manipulation of an innate escape response in Drosophila: photoexcitation of acj6 neurons induces the escape response\"<\/a>. <i>PLoS ONE<\/i>. <b>4<\/b> (4): e5100. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2009PLoSO...4.5100Z\" target=\"_blank\">2009PLoSO...4.5100Z<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1371%2Fjournal.pone.0005100\" target=\"_blank\">10.1371\/journal.pone.0005100<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2660433\" target=\"_blank\">2660433<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19340304\" target=\"_blank\">19340304<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=PLoS+ONE&rft.atitle=Manipulation+of+an+innate+escape+response+in+Drosophila%3A+photoexcitation+of+acj6+neurons+induces+the+escape+response&rft.volume=4&rft.issue=4&rft.pages=e5100&rft.date=2009&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2660433&rft_id=info%3Apmid%2F19340304&rft_id=info%3Adoi%2F10.1371%2Fjournal.pone.0005100&rft_id=info%3Abibcode%2F2009PLoSO...4.5100Z&rft.aulast=Zimmermann&rft.aufirst=G.&rft.au=Wang%2C+L.+P.&rft.au=Vaughan%2C+A.+G.&rft.au=Manoli%2C+D.+S.&rft.au=Zhang%2C+F.&rft.au=Deisseroth%2C+K.&rft.au=Baker%2C+B.+S.&rft.au=Scott%2C+M.+P.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2660433&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOptogenetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> <span style=\"position:relative; top: -2px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Open_access\" title=\"open access publication \u2013 free to read\" rel=\"external_link\" target=\"_blank\"><img alt=\"open access publication \u2013 free to read\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/77\/Open_Access_logo_PLoS_transparent.svg\/9px-Open_Access_logo_PLoS_transparent.svg.png\" width=\"9\" height=\"14\" \/><\/a><\/span><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.stanford.edu\/group\/dlab\/optogenetics\" target=\"_blank\">Optogenetics Resource Center<\/a>, maintained by the Deisseroth lab.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/syntheticneurobiology.org\" target=\"_blank\">Synthetic Neurobiology Group, MIT<\/a>, the portal of the Boyden lab.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.openoptogenetics.org\/\" target=\"_blank\">OpenOptogenetics.org<\/a>, an optogenetics wiki, and its <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.openoptogeneticsblog.org\/\" target=\"_blank\">companion blog<\/a>.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.neurocloud.org\" target=\"_blank\">Molecular Neurogenetics and Optophysiology Laboratory<\/a>,\"Optogenetic activation and silencing recordings of individual prefrontal cortical neurons <i>in vivo<\/i> and <i>in vitro<\/i>.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/keck.ucsf.edu\/neurograd\/faculty\/sohal.html\" target=\"_blank\">Sohal lab portal<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/nurmikko.engin.brown.edu\/\" target=\"_blank\">Nurmikko lab portal<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.med.wayne.edu\/anatomy\/department\/pan.htm\" target=\"_blank\">Lab of Dr. Zhuo-Hua Pan<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.tylerlab.com\/approaches\/optophysiology\" target=\"_blank\">Optophysiology at the Tyler lab<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/spie.org\/x48167.xml\" target=\"_blank\">Video: Ed Boyden on Optogenetics -- selective brain stimulation with light (SPIE Newsroom, April 2011)<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1266\nCached time: 20181217110840\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 1.932 seconds\nReal time usage: 2.064 seconds\nPreprocessor visited node count: 10032\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 468798\/2097152 bytes\nTemplate argument size: 216\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 7\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 454007\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 1.261\/10.000 seconds\nLua memory usage: 5.71 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1683.754 1 -total\n<\/p>\n<pre>75.33% 1268.288 159 Template:Cite_journal\n62.10% 1045.585 1 Template:Reflist\n 2.51% 42.186 1 Template:Further_reading_cleanup\n 2.49% 41.917 1 Template:BCI\n 2.39% 40.260 1 Template:Ety\n 2.27% 38.288 2 Template:Ambox\n 2.07% 34.898 1 Template:Navbox\n 1.95% 32.883 1 Template:Etymology\/lang\n 0.99% 16.697 2 Template:Icon\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:14958673-1!canonical and timestamp 20181217110838 and revision id 874114794\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Optogenetics\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212248\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.039 seconds\nReal time usage: 0.239 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 221.604 1 - wikipedia:Optogenetics\n100.00% 221.604 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8314-0!*!*!*!*!*!* and timestamp 20181217212247 and revision id 24539\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Optogenetics\">https:\/\/www.limswiki.org\/index.php\/Optogenetics<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","8019f4a793549b80b4608f1a1bf4d570_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/1\/15\/Example_of_optogenetic_activation_of_prefrontal_cortex.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/64\/Cooper_laboratory_recording_of_optogenetic_silencing_of_prefrontal_cortical_neuron.jpg\/800px-Cooper_laboratory_recording_of_optogenetic_silencing_of_prefrontal_cortical_neuron.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/28\/Optogenetic_stimulation_consists_of_several_steps.png\/1042px-Optogenetic_stimulation_consists_of_several_steps.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/75\/Optogenetics_imetronic.JPG\/440px-Optogenetics_imetronic.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fd\/BrainGate.jpg\/200px-BrainGate.jpg"],"8019f4a793549b80b4608f1a1bf4d570_timestamp":1545081767,"4a6ab168e20da76c1b1773788dbfd71f_type":"article","4a6ab168e20da76c1b1773788dbfd71f_title":"Occipital nerve stimulation","4a6ab168e20da76c1b1773788dbfd71f_url":"https:\/\/www.limswiki.org\/index.php\/Occipital_nerve_stimulation","4a6ab168e20da76c1b1773788dbfd71f_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tOccipital nerve stimulation\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tOccipital nerve stimulation (ONS), also called peripheral nerve stimulation (PNS) of the occipital nerves, is used to treat chronic migraine patients who have failed to respond to pharmaceutical treatments.\nThe treatment involves the use of mild electrical impulses to stimulate the greater occipital nerve and lesser occipital nerve[1] which are part of the peripheral nervous system and are located at the back of the head just above the neck area.\nThe electrical impulses are generated by a small device called a neurostimulator \u2013 similar to an artificial cardiac pacemaker \u2013 which is implanted in the buttock, chest, low abdomen, beneath the shoulder blade or below the clavicle.[1] The electricity is delivered to the greater occipital nerve and lesser occipital nerve by small metal electrodes which are arranged on thin leads and implanted just under the skin.[2] The intensity of the electrical impulses can be adjusted using a small remote control device.[1]\n\nContents \n\n1 History \n2 Candidates for the therapy \n3 Procedure \n\n3.1 Pre-operation \n3.2 Implantation \n\n\n4 Clinical evidence \n5 References \n\n\nHistory \nThe history of PNS is thoroughly reported by Slavin, 2011.[3] The use of PNS for chronic pain was first reported in 1967 by Wall and Sweet although the first implantations were performed in 1962 by Shelden. They demonstrated that electrical stimulation of peripheral nerves suppresses the perception of pain. A period of semi-experimental PNS usage continued for 15 \u2013 20 years. During the latter half of the 1980s, PNS became an established surgical procedure. In the late 1990s, Weiner and Reed reported the percutaneous technique of inserting electrodes in the vicinity of the occipital nerves to treat occipital neuralgia. Weiner showed that placing a PNS electrode close to a nerve is effective for pain relief and a technically simple procedure. This pioneering work heralded the start of the modern era of PNS. It was 2003 before Popeney and Al\u00f3 proposed using PNS for the treatment of chronic migraine. Subsequently, prospective randomized controlled trials were launched to gather additional clinical evidence.\nThis is further detailed in an article published by Cephalagia titled \"Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: Results from a randomized, multicenter, double-blinded, controlled study.\"[4]\nIn September 2011, St Jude Medical Inc. became the first company to receive European approval for the use of PNS in treating chronic migraine.[5]\n\nCandidates for the therapy \nAppropriate candidates for PNS of the occipital nerves for the treatment of chronic migraine must be diagnosed with chronic migraine which is classified as intractable.\nChronic migraine is defined by the International Headache Society (IHS) guidelines:[6]\n\n15 or more migraine (without aura) headache days per month for more than 3 months with headaches lasting at least 4\u201372 hours in duration\nAt least 2 of the following: unilateral location, pulsating quality, moderate or severe pain intensity, aggravated by or causing avoidance of, routine physical activity (walking or climbing stairs)\nDuring the headache, at least one of the following: nausea and\/or vomiting, photophobia and phonophobia\nNot attributed to another disorder\nAbsence of medication overuse\nIntractable chronic migraine is generally defined as chronic migraine with failure of three or more preventive drugs and at least moderate disability determined using a validated migraine disability instrument (e.g. MIDAS or HIT-6).[7]\n\nProcedure \nPre-operation \nPrior to the implantation, patients usually undergo a psychological assessment to assess their well-being and mental health.[1] The risks of the procedure will be discussed and the patient will be asked for their informed consent.[1] Risks that may be highlighted include no guarantee of effectiveness, infection, nerve damage, painful direct muscle stimulation, lead movement with loss of stimulation, lead fracture, battery failure, eventual need for battery replacement, hematoma and seroma formation.[1]\n\nImplantation \nIn most cases, a trial (test) lead placement is performed in order to assess whether the stimulation will work as expected.[8] Local anesthetic is applied to the back of the neck and a Tuohy needle is advanced towards the location of the greater occipital nerve and lesser occipital nerve under fluoroscopic guidance.[8][9][10] When the location is confirmed, a temporary lead is placed through the needle before the needle is carefully removed.[8][9] Electrical impulses are sent through the lead and its position is adjusted until the patient reports a \"pins-and-needles\" sensation, called paresthesia, across the areas of the nerves.[8][9] If paresthesia is successfully achieved in the right place, permanent leads are usually implanted at a later date.[9] In some cases, the trial leads are left in for up to one week to see whether there is any relief of symptoms.[8]\nPermanent lead placement may be carried out under general anesthetic[10] or local anesthetic with sedation.[8] First, a small incision is made at the base of the skull, then a Tuohy needle is advanced under fluoroscopic guidance towards the location of the greater occipital nerve and lesser occipital nerve on one side of the head.[8][9][10] When the lead is adequately positioned through the needle under fluoroscopic guidance, the needle is carefully removed and the lead is fixed in place.[8][9][10] Since most patients require two leads, a second lead is usually inserted and fixed in place on the other side of the head in the same way.[8][10] The lead(s) are then tunneled to a neurostimulator device which is usually implanted the buttock, chest, low abdomen, beneath the shoulder blade or below the clavicle.[1]\n\nClinical evidence \nThis section needs more medical references for verification or relies too heavily on primary sources, specifically: Section presently consists of primary sources only which are not generally acceptable for medical claims. Please review the contents of the section and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. (March 2015)\nResults from three randomized controlled trials have been published. One randomized controlled trial of 157 patients with chronic migraine was published in October 2012.[11] Participants were implanted with the device and then randomized to have the device turned on (the treatment group) or off (the control group) for 12 weeks. After week 12, participants received active treatment until week 52. All participants had trial stimulation to ensure correct position of electrodes. A total of 153 participants completed 12 weeks in the trial. There was a statistically significant difference (p<0.05) between the number of patients in the treatment group]and control group at the 30% reduction in pain level using the Visual Analogue Scale (VAS). In addition the study showed that, on average, the treatment group (device on) had 6.1 fewer days of headache days per month which was more than double the average reduction for the control group (device off), which is statistically significant (p<0.001). The clinical study investigators reported that the overall rate of serious device and procedure related adverse events was 1% and that these included one infection and one case of post-operative pain which required additional hospitalization.\nIn February 2011, the ONSTIM clinical study investigators reported three-month results from a randomized controlled trial of patients with chronic migraine.[12] Participants were first given occipital nerve block. Those who responded were randomized into three groups. The first group was a treatment group (33 participants) and received adjustable stimulation. The other two groups were control groups and received sham stimulation for one minute per day or standard medical management (17 participants each). Patients who achieved a 50% or greater reduction in their number of headache days per month or a three-point or greater reduction in average overall pain intensity compared with baseline were defined as responders to the therapy. 39% of patients in the adjustable stimulation group were responders, 6% in the sham stimulation group and 0% in the medical management group. The differences between the responder rates in the treatment group and control groups were statistically significant. Other outcome measures, such as number of headache days, were not statistically significantly different between the groups. However, the percentage reduction in headache days was 27% for the treatment group and less than 9% for each control group, showing a numerical advantage for the treatment group. No unanticipated device adverse events were reported. Movement of the lead occurred in 24% of subjects.\nIn December 2009, the PRISM study investigators reported three-month results in abstract form from a randomized controlled trial of 125 patients with chronic migraine.[13][14][15] Patients were randomized into two groups. One group was a treatment group and received active stimulation. The other was a control group and received sham stimulation. Patients in the treatment group reduced their number of migraine days per month by 5.5 from a baseline of 20.2 days per month. Patients in the control group reduced their number of migraine days per month by 3.9 from a baseline of 19.2 days per month. The difference between the two groups was not statistically significant. \n\nReferences \n\n^ a b c d e f g Trentman, Terrence L; Zimmerman RS; Dodick DW (2011). \"Occipital Nerve Stimulation: Technical and Surgical Aspects of Implantation\". Prog Neurol Surg. Progress in Neurological Surgery. 24: 96\u2013108. doi:10.1159\/000323043. ISBN 978-3-8055-9489-9. PMID 21422780. \n\n^ Slavin, Konstantin V. (2011). \"Technical Aspects of Peripheral Nerve Stimulation: Hardware and Complications\". Prog Neurol Surg. Progress in Neurological Surgery. 24: 189\u2013202. doi:10.1159\/000323275. ISBN 978-3-8055-9489-9. PMID 21422789. \n\n^ Slavin, Konstantin V. (2011). \"History of peripheral nerve stimulation\". Prog Neurol Surg. Progress in Neurological Surgery. 24: 1\u201315. doi:10.1159\/000323002. ISBN 978-3-8055-9489-9. PMID 21422772. \n\n^ \"Reed Migraine Article on Safety and efficacy of peripheral nerve stimulation of the occipital nerves\" (PDF) . Cephalagia. Retrieved 12 November 2012 . \n\n^ \"St Jude Press release\". St. Jude Medical Inc. Archived from the original on 5 January 2013. Retrieved 8 August 2012 . \n\n^ \"The International Classification of Headache Disorders, 2nd Edition, 1st revision (May, 2005)\". \n\n^ Silberstein, Stephen D.; Dodick DW; Pearlman S (2010). \"Defining the pharmacologically intractable headache for clinical trials and clinical practice\". Headache. 50 (9): 1499\u2013506. doi:10.1111\/j.1526-4610.2010.01764.x. PMID 20958296. \n\n^ a b c d e f g h i AI\u00f3, Kenneth M.; Abramova MV; Richter EO (2011). \"Percutaneous Peripheral Nerve Stimulation\". Prog Neurol Surg. Progress in Neurological Surgery. 24: 41\u2013S7. doi:10.1159\/000323023. ISBN 978-3-8055-9489-9. PMID 21422775. \n\n^ a b c d e f Ellens, Damien J.; Levy RM (2011). \"Peripheral Neuromodulation for Migraine Headache\". Prog Neurol Surg. Progress in Neurological Surgery. 24: 109\u2013117. doi:10.1159\/000323890. ISBN 978-3-8055-9489-9. PMID 21422781. \n\n^ a b c d e Trentman, Terrence L.; Slavin KV; Freeman JA; Zimmerman RS (2010). \"Occipital Nerve Stimulator Placement via a Retromastoid to Infraclavicular Approach: A Technical Report\". Stereotact Funct Neurosurg. 88 (2): 121\u2013125. doi:10.1159\/000289356. PMID 20197713. \n\n^ Silberstein SD, Dodick DW, Saper J, Huh B, Slavin KV, Sharan A, Reed K, Narouze S, Mogilner A, Goldstein J, Trentman T, Vaisman J, Vaisma J, Ordia J, Weber P, Deer T, Levy R, Diaz RL, Washburn SN, Mekhail N (Dec 2012). \"Safety and Efficacy of Peripheral Nerve Stimulation of the Occipital Nerves for the Management of Chronic Migraine: Results from a Randomized, Multicenter, Double-blinded, Controlled Study\". Cephalalgia. 32 (16): 1165\u20131179]. doi:10.1177\/0333102412462642. PMID 23034698. \n\n^ Saper, Joel R.; Dodick DW; Silberstein SD; McCarville S; Sun M; Goadsby PJ (2011). \"Occipital nerve stimulation for the treatment of intractable chronic migraine headache: ONSTIM feasibility study\". Cephalalgia. 31 (3): 271\u201385. doi:10.1177\/0333102410381142. PMC 3057439 . PMID 20861241. \n\n^ Lipton, Richard B.; Goadsby PJ; Cady RK; Aurora SK; Grosberg BM; Freitag FG; Silberstein SD; Whiten DM; Jaax KN (2010). \"PRISM study: Occipital nerve stimulation for treatment-refractory migraine\". Headache. 50 (3): 509\u2013519. doi:10.1111\/j.1526-4610.2010.01615.x. PMID 20456145. \n\n^ \"Abstracts for the 14th Congress of the International Headache Conference, Philadelphia, USA, 10 - 13 September 2009\". \n\n^ Diener, Hans-Christoph; Dodick DW; Goadsby PJ; Lipton RB; Olesen J (2012). \"Chronic migraine\u2014classification, characteristics and treatment\". Nature Reviews Neurology. 8: 162\u2013171. doi:10.1038\/nrneurol.2012.13. PMID 22331030. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Occipital_nerve_stimulation\">https:\/\/www.limswiki.org\/index.php\/Occipital_nerve_stimulation<\/a>\n\t\t\t\t\tCategories: Medical and surgical techniquesNeurostimulationHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 17:28.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 328 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","4a6ab168e20da76c1b1773788dbfd71f_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Occipital_nerve_stimulation skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Occipital nerve stimulation<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Occipital nerve stimulation<\/b> (<b>ONS<\/b>), also called <b>peripheral nerve stimulation<\/b> (<b>PNS<\/b>) <b>of the occipital nerves<\/b>, is used to treat chronic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Migraine\" title=\"Migraine\" rel=\"external_link\" target=\"_blank\">migraine<\/a> patients who have failed to respond to pharmaceutical treatments.\n<\/p><p>The treatment involves the use of mild <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electricity\" title=\"Electricity\" rel=\"external_link\" target=\"_blank\">electrical<\/a> impulses to stimulate the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greater_occipital_nerve\" title=\"Greater occipital nerve\" rel=\"external_link\" target=\"_blank\">greater occipital nerve<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lesser_occipital_nerve\" title=\"Lesser occipital nerve\" rel=\"external_link\" target=\"_blank\">lesser occipital nerve<\/a><sup id=\"rdp-ebb-cite_ref-Trentman1_1-0\" class=\"reference\"><a href=\"#cite_note-Trentman1-1\" rel=\"external_link\">[1]<\/a><\/sup> which are part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peripheral_nervous_system\" title=\"Peripheral nervous system\" rel=\"external_link\" target=\"_blank\">peripheral nervous system<\/a> and are located at the back of the head just above the neck area.\n<\/p><p>The electrical impulses are generated by a small device called a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurostimulator\" class=\"mw-redirect\" title=\"Neurostimulator\" rel=\"external_link\" target=\"_blank\">neurostimulator<\/a> \u2013 similar to an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_cardiac_pacemaker\" title=\"Artificial cardiac pacemaker\" rel=\"external_link\" target=\"_blank\">artificial cardiac pacemaker<\/a> \u2013 which is implanted in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Buttock\" class=\"mw-redirect\" title=\"Buttock\" rel=\"external_link\" target=\"_blank\">buttock<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest\" class=\"mw-redirect\" title=\"Chest\" rel=\"external_link\" target=\"_blank\">chest<\/a>, low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdomen\" title=\"Abdomen\" rel=\"external_link\" target=\"_blank\">abdomen<\/a>, beneath the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scapula\" title=\"Scapula\" rel=\"external_link\" target=\"_blank\">shoulder blade<\/a> or below the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clavicle\" title=\"Clavicle\" rel=\"external_link\" target=\"_blank\">clavicle<\/a>.<sup id=\"rdp-ebb-cite_ref-Trentman1_1-1\" class=\"reference\"><a href=\"#cite_note-Trentman1-1\" rel=\"external_link\">[1]<\/a><\/sup> The electricity is delivered to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greater_occipital_nerve\" title=\"Greater occipital nerve\" rel=\"external_link\" target=\"_blank\">greater occipital nerve<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lesser_occipital_nerve\" title=\"Lesser occipital nerve\" rel=\"external_link\" target=\"_blank\">lesser occipital nerve<\/a> by small metal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrode\" title=\"Electrode\" rel=\"external_link\" target=\"_blank\">electrodes<\/a> which are arranged on thin leads and implanted just under the skin.<sup id=\"rdp-ebb-cite_ref-Slavin2_2-0\" class=\"reference\"><a href=\"#cite_note-Slavin2-2\" rel=\"external_link\">[2]<\/a><\/sup> The intensity of the electrical impulses can be adjusted using a small remote control device.<sup id=\"rdp-ebb-cite_ref-Trentman1_1-2\" class=\"reference\"><a href=\"#cite_note-Trentman1-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The history of PNS is thoroughly reported by Slavin, 2011.<sup id=\"rdp-ebb-cite_ref-Slavin3_3-0\" class=\"reference\"><a href=\"#cite_note-Slavin3-3\" rel=\"external_link\">[3]<\/a><\/sup> The use of PNS for chronic pain was first reported in 1967 by Wall and Sweet although the first implantations were performed in 1962 by Shelden. They demonstrated that electrical stimulation of peripheral nerves suppresses the perception of pain. A period of semi-experimental PNS usage continued for 15 \u2013 20 years. During the latter half of the 1980s, PNS became an established surgical procedure. In the late 1990s, Weiner and Reed reported the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous\" title=\"Percutaneous\" rel=\"external_link\" target=\"_blank\">percutaneous<\/a> technique of inserting electrodes in the vicinity of the occipital nerves to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Occipital_neuralgia\" title=\"Occipital neuralgia\" rel=\"external_link\" target=\"_blank\">occipital neuralgia<\/a>. Weiner showed that placing a PNS electrode close to a nerve is effective for pain relief and a technically simple procedure. This pioneering work heralded the start of the modern era of PNS. It was 2003 before Popeney and Al\u00f3 proposed using PNS for the treatment of chronic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Migraine\" title=\"Migraine\" rel=\"external_link\" target=\"_blank\">migraine<\/a>. Subsequently, prospective <a href=\"https:\/\/en.wikipedia.org\/wiki\/Randomized_controlled_trial\" title=\"Randomized controlled trial\" rel=\"external_link\" target=\"_blank\">randomized controlled trials<\/a> were launched to gather additional clinical evidence.\n<\/p><p>This is further detailed in an article published by Cephalagia titled \"Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: Results from a randomized, multicenter, double-blinded, controlled study.\"<sup id=\"rdp-ebb-cite_ref-Reed_Migraine_4-0\" class=\"reference\"><a href=\"#cite_note-Reed_Migraine-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>In September 2011, St Jude Medical Inc. became the first company to receive European approval for the use of PNS in treating chronic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Migraine\" title=\"Migraine\" rel=\"external_link\" target=\"_blank\">migraine<\/a>.<sup id=\"rdp-ebb-cite_ref-St_Jude_Medical_Inc._Press_release4_5-0\" class=\"reference\"><a href=\"#cite_note-St_Jude_Medical_Inc._Press_release4-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Candidates_for_the_therapy\">Candidates for the therapy<\/span><\/h2>\n<p>Appropriate candidates for PNS of the occipital nerves for the treatment of chronic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Migraine\" title=\"Migraine\" rel=\"external_link\" target=\"_blank\">migraine<\/a> must be diagnosed with chronic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Migraine\" title=\"Migraine\" rel=\"external_link\" target=\"_blank\">migraine<\/a> which is classified as intractable.\n<\/p><p>Chronic migraine is defined by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ICHD_classification_and_diagnosis_of_migraine\" title=\"ICHD classification and diagnosis of migraine\" rel=\"external_link\" target=\"_blank\">International Headache Society (IHS) guidelines<\/a>:<sup id=\"rdp-ebb-cite_ref-ICHD5_6-0\" class=\"reference\"><a href=\"#cite_note-ICHD5-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<ul><li>15 or more <a href=\"https:\/\/en.wikipedia.org\/wiki\/Migraine\" title=\"Migraine\" rel=\"external_link\" target=\"_blank\">migraine<\/a> (without <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aura_(symptom)\" title=\"Aura (symptom)\" rel=\"external_link\" target=\"_blank\">aura<\/a>) headache days per month for more than 3 months with headaches lasting at least 4\u201372 hours in duration<\/li>\n<li>At least 2 of the following: unilateral location, pulsating quality, moderate or severe pain intensity, aggravated by or causing avoidance of, routine physical activity (walking or climbing stairs)\n<ul><li>During the headache, at least one of the following: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nausea\" title=\"Nausea\" rel=\"external_link\" target=\"_blank\">nausea<\/a> and\/or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vomiting\" title=\"Vomiting\" rel=\"external_link\" target=\"_blank\">vomiting<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photophobia\" title=\"Photophobia\" rel=\"external_link\" target=\"_blank\">photophobia<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phonophobia\" title=\"Phonophobia\" rel=\"external_link\" target=\"_blank\">phonophobia<\/a><\/li><\/ul><\/li>\n<li>Not attributed to another disorder<\/li>\n<li>Absence of medication overuse<\/li><\/ul>\n<p>Intractable chronic migraine is generally defined as chronic migraine with failure of three or more preventive drugs and at least moderate disability determined using a validated migraine disability instrument (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Migraine_Disability_Assessment_Test\" title=\"Migraine Disability Assessment Test\" rel=\"external_link\" target=\"_blank\">MIDAS<\/a> or HIT-6).<sup id=\"rdp-ebb-cite_ref-Silberstein6_7-0\" class=\"reference\"><a href=\"#cite_note-Silberstein6-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Procedure\">Procedure<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Pre-operation\">Pre-operation<\/span><\/h3>\n<p>Prior to the implantation, patients usually undergo a psychological assessment to assess their well-being and mental health.<sup id=\"rdp-ebb-cite_ref-Trentman1_1-3\" class=\"reference\"><a href=\"#cite_note-Trentman1-1\" rel=\"external_link\">[1]<\/a><\/sup> The risks of the procedure will be discussed and the patient will be asked for their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Informed_consent\" title=\"Informed consent\" rel=\"external_link\" target=\"_blank\">informed consent<\/a>.<sup id=\"rdp-ebb-cite_ref-Trentman1_1-4\" class=\"reference\"><a href=\"#cite_note-Trentman1-1\" rel=\"external_link\">[1]<\/a><\/sup> Risks that may be highlighted include no guarantee of effectiveness, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a>, nerve damage, painful direct muscle stimulation, lead movement with loss of stimulation, lead fracture, battery failure, eventual need for battery replacement, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hematoma\" title=\"Hematoma\" rel=\"external_link\" target=\"_blank\">hematoma<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Seroma\" title=\"Seroma\" rel=\"external_link\" target=\"_blank\">seroma<\/a> formation.<sup id=\"rdp-ebb-cite_ref-Trentman1_1-5\" class=\"reference\"><a href=\"#cite_note-Trentman1-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Implantation\">Implantation<\/span><\/h3>\n<p>In most cases, a trial (test) lead placement is performed in order to assess whether the stimulation will work as expected.<sup id=\"rdp-ebb-cite_ref-Alo7_8-0\" class=\"reference\"><a href=\"#cite_note-Alo7-8\" rel=\"external_link\">[8]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Local_anesthetic\" title=\"Local anesthetic\" rel=\"external_link\" target=\"_blank\">Local anesthetic<\/a> is applied to the back of the neck and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tuohy_needle\" title=\"Tuohy needle\" rel=\"external_link\" target=\"_blank\">Tuohy needle<\/a> is advanced towards the location of the greater occipital nerve and lesser occipital nerve under <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroscopy\" title=\"Fluoroscopy\" rel=\"external_link\" target=\"_blank\">fluoroscopic guidance<\/a>.<sup id=\"rdp-ebb-cite_ref-Alo7_8-1\" class=\"reference\"><a href=\"#cite_note-Alo7-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Ellens8_9-0\" class=\"reference\"><a href=\"#cite_note-Ellens8-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Trentman9_10-0\" class=\"reference\"><a href=\"#cite_note-Trentman9-10\" rel=\"external_link\">[10]<\/a><\/sup> When the location is confirmed, a temporary lead is placed through the needle before the needle is carefully removed.<sup id=\"rdp-ebb-cite_ref-Alo7_8-2\" class=\"reference\"><a href=\"#cite_note-Alo7-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Ellens8_9-1\" class=\"reference\"><a href=\"#cite_note-Ellens8-9\" rel=\"external_link\">[9]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electricity\" title=\"Electricity\" rel=\"external_link\" target=\"_blank\">Electrical<\/a> impulses are sent through the lead and its position is adjusted until the patient reports a \"pins-and-needles\" sensation, called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paresthesia\" title=\"Paresthesia\" rel=\"external_link\" target=\"_blank\">paresthesia<\/a>, across the areas of the nerves.<sup id=\"rdp-ebb-cite_ref-Alo7_8-3\" class=\"reference\"><a href=\"#cite_note-Alo7-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Ellens8_9-2\" class=\"reference\"><a href=\"#cite_note-Ellens8-9\" rel=\"external_link\">[9]<\/a><\/sup> If paresthesia is successfully achieved in the right place, permanent leads are usually implanted at a later date.<sup id=\"rdp-ebb-cite_ref-Ellens8_9-3\" class=\"reference\"><a href=\"#cite_note-Ellens8-9\" rel=\"external_link\">[9]<\/a><\/sup> In some cases, the trial leads are left in for up to one week to see whether there is any relief of symptoms.<sup id=\"rdp-ebb-cite_ref-Alo7_8-4\" class=\"reference\"><a href=\"#cite_note-Alo7-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>Permanent lead placement may be carried out under <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_anesthetic\" class=\"mw-redirect\" title=\"General anesthetic\" rel=\"external_link\" target=\"_blank\">general anesthetic<\/a><sup id=\"rdp-ebb-cite_ref-Trentman9_10-1\" class=\"reference\"><a href=\"#cite_note-Trentman9-10\" rel=\"external_link\">[10]<\/a><\/sup> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Local_anesthetic\" title=\"Local anesthetic\" rel=\"external_link\" target=\"_blank\">local anesthetic<\/a> with sedation.<sup id=\"rdp-ebb-cite_ref-Alo7_8-5\" class=\"reference\"><a href=\"#cite_note-Alo7-8\" rel=\"external_link\">[8]<\/a><\/sup> First, a small incision is made at the base of the skull, then a Tuohy needle is advanced under fluoroscopic guidance towards the location of the greater occipital nerve and lesser occipital nerve on one side of the head.<sup id=\"rdp-ebb-cite_ref-Alo7_8-6\" class=\"reference\"><a href=\"#cite_note-Alo7-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Ellens8_9-4\" class=\"reference\"><a href=\"#cite_note-Ellens8-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Trentman9_10-2\" class=\"reference\"><a href=\"#cite_note-Trentman9-10\" rel=\"external_link\">[10]<\/a><\/sup> When the lead is adequately positioned through the needle under fluoroscopic guidance, the needle is carefully removed and the lead is fixed in place.<sup id=\"rdp-ebb-cite_ref-Alo7_8-7\" class=\"reference\"><a href=\"#cite_note-Alo7-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Ellens8_9-5\" class=\"reference\"><a href=\"#cite_note-Ellens8-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Trentman9_10-3\" class=\"reference\"><a href=\"#cite_note-Trentman9-10\" rel=\"external_link\">[10]<\/a><\/sup> Since most patients require two leads, a second lead is usually inserted and fixed in place on the other side of the head in the same way.<sup id=\"rdp-ebb-cite_ref-Alo7_8-8\" class=\"reference\"><a href=\"#cite_note-Alo7-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Trentman9_10-4\" class=\"reference\"><a href=\"#cite_note-Trentman9-10\" rel=\"external_link\">[10]<\/a><\/sup> The lead(s) are then tunneled to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurostimulator\" class=\"mw-redirect\" title=\"Neurostimulator\" rel=\"external_link\" target=\"_blank\">neurostimulator<\/a> device which is usually implanted the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Buttock\" class=\"mw-redirect\" title=\"Buttock\" rel=\"external_link\" target=\"_blank\">buttock<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest\" class=\"mw-redirect\" title=\"Chest\" rel=\"external_link\" target=\"_blank\">chest<\/a>, low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdomen\" title=\"Abdomen\" rel=\"external_link\" target=\"_blank\">abdomen<\/a>, beneath the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scapula\" title=\"Scapula\" rel=\"external_link\" target=\"_blank\">shoulder blade<\/a> or below the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clavicle\" title=\"Clavicle\" rel=\"external_link\" target=\"_blank\">clavicle<\/a>.<sup id=\"rdp-ebb-cite_ref-Trentman1_1-6\" class=\"reference\"><a href=\"#cite_note-Trentman1-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Clinical_evidence\">Clinical evidence<\/span><\/h2>\n\n<p>Results from three <a href=\"https:\/\/en.wikipedia.org\/wiki\/Randomized_controlled_trial\" title=\"Randomized controlled trial\" rel=\"external_link\" target=\"_blank\">randomized controlled trials<\/a> have been published. One randomized controlled trial of 157 patients with chronic migraine was published in October 2012.<sup id=\"rdp-ebb-cite_ref-Silberstein13_11-0\" class=\"reference\"><a href=\"#cite_note-Silberstein13-11\" rel=\"external_link\">[11]<\/a><\/sup> Participants were implanted with the device and then randomized to have the device turned on (the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Treatment_group\" class=\"mw-redirect\" title=\"Treatment group\" rel=\"external_link\" target=\"_blank\">treatment group<\/a>) or off (the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Control_group\" class=\"mw-redirect\" title=\"Control group\" rel=\"external_link\" target=\"_blank\">control group<\/a>) for 12 weeks. After week 12, participants received active treatment until week 52. All participants had trial stimulation to ensure correct position of electrodes. A total of 153 participants completed 12 weeks in the trial. There was a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Statistically_significant\" class=\"mw-redirect\" title=\"Statistically significant\" rel=\"external_link\" target=\"_blank\">statistically significant<\/a> difference (<a href=\"https:\/\/en.wikipedia.org\/wiki\/P-value\" title=\"P-value\" rel=\"external_link\" target=\"_blank\">p<0.05<\/a>) between the number of patients in the treatment group]and control group at the 30% reduction in pain level using the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_analogue_scale\" title=\"Visual analogue scale\" rel=\"external_link\" target=\"_blank\">Visual Analogue Scale<\/a> (VAS). In addition the study showed that, on average, the treatment group (device on) had 6.1 fewer days of headache days per month which was more than double the average reduction for the control group (device off), which is statistically significant (p<0.001). The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_investigator\" title=\"Clinical investigator\" rel=\"external_link\" target=\"_blank\">clinical study investigators<\/a> reported that the overall rate of serious device and procedure related <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adverse_event\" title=\"Adverse event\" rel=\"external_link\" target=\"_blank\">adverse events<\/a> was 1% and that these included one <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a> and one case of post-operative pain which required additional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospitalization\" class=\"mw-redirect\" title=\"Hospitalization\" rel=\"external_link\" target=\"_blank\">hospitalization<\/a>.\n<\/p><p>In February 2011, the ONSTIM clinical study investigators reported three-month results from a randomized controlled trial of patients with chronic migraine.<sup id=\"rdp-ebb-cite_ref-Saper14_12-0\" class=\"reference\"><a href=\"#cite_note-Saper14-12\" rel=\"external_link\">[12]<\/a><\/sup> Participants were first given <a href=\"https:\/\/en.wikipedia.org\/wiki\/Occipital_nerve_block\" title=\"Occipital nerve block\" rel=\"external_link\" target=\"_blank\">occipital nerve block<\/a>. Those who responded were randomized into three groups. The first group was a treatment group (33 participants) and received adjustable stimulation. The other two groups were control groups and received sham stimulation for one minute per day or standard medical management (17 participants each). Patients who achieved a 50% or greater reduction in their number of headache days per month or a three-point or greater reduction in average overall pain intensity compared with baseline were defined as responders to the therapy. 39% of patients in the adjustable stimulation group were responders, 6% in the sham stimulation group and 0% in the medical management group. The differences between the responder rates in the treatment group and control groups were statistically significant. Other outcome measures, such as number of headache days, were not statistically significantly different between the groups. However, the percentage reduction in headache days was 27% for the treatment group and less than 9% for each control group, showing a numerical advantage for the treatment group. No unanticipated device adverse events were reported. Movement of the lead occurred in 24% of subjects.\n<\/p><p>In December 2009, the PRISM study investigators reported three-month results in abstract form from a randomized controlled trial of 125 patients with chronic migraine.<sup id=\"rdp-ebb-cite_ref-Lipton15_13-0\" class=\"reference\"><a href=\"#cite_note-Lipton15-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-IHC-Abstracts_14-0\" class=\"reference\"><a href=\"#cite_note-IHC-Abstracts-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Diener_15-0\" class=\"reference\"><a href=\"#cite_note-Diener-15\" rel=\"external_link\">[15]<\/a><\/sup> Patients were randomized into two groups. One group was a treatment group and received active stimulation. The other was a control group and received sham stimulation. Patients in the treatment group reduced their number of migraine days per month by 5.5 from a baseline of 20.2 days per month. Patients in the control group reduced their number of migraine days per month by 3.9 from a baseline of 19.2 days per month. The difference between the two groups was not statistically significant. \n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-Trentman1-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Trentman1_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Trentman1_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Trentman1_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Trentman1_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Trentman1_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Trentman1_1-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Trentman1_1-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Trentman, Terrence L; Zimmerman RS; Dodick DW (2011). \"Occipital Nerve Stimulation: Technical and Surgical Aspects of Implantation\". <i>Prog Neurol Surg<\/i>. Progress in Neurological Surgery. <b>24<\/b>: 96\u2013108. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000323043\" target=\"_blank\">10.1159\/000323043<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-8055-9489-9. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21422780\" target=\"_blank\">21422780<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Prog+Neurol+Surg&rft.atitle=Occipital+Nerve+Stimulation%3A+Technical+and+Surgical+Aspects+of+Implantation&rft.volume=24&rft.pages=96-108&rft.date=2011&rft_id=info%3Apmid%2F21422780&rft_id=info%3Adoi%2F10.1159%2F000323043&rft.isbn=978-3-8055-9489-9&rft.aulast=Trentman&rft.aufirst=Terrence+L&rft.au=Zimmerman+RS&rft.au=Dodick+DW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOccipital+nerve+stimulation\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Slavin2-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Slavin2_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Slavin, Konstantin V. (2011). \"Technical Aspects of Peripheral Nerve Stimulation: Hardware and Complications\". <i>Prog Neurol Surg<\/i>. Progress in Neurological Surgery. <b>24<\/b>: 189\u2013202. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000323275\" target=\"_blank\">10.1159\/000323275<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-8055-9489-9. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21422789\" target=\"_blank\">21422789<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Prog+Neurol+Surg.&rft.atitle=Technical+Aspects+of+Peripheral+Nerve+Stimulation%3A+Hardware+and+Complications&rft.volume=24&rft.pages=189-202&rft.date=2011&rft_id=info%3Apmid%2F21422789&rft_id=info%3Adoi%2F10.1159%2F000323275&rft.isbn=978-3-8055-9489-9&rft.aulast=Slavin&rft.aufirst=Konstantin+V.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOccipital+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Slavin3-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Slavin3_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Slavin, Konstantin V. (2011). \"History of peripheral nerve stimulation\". <i>Prog Neurol Surg<\/i>. Progress in Neurological Surgery. <b>24<\/b>: 1\u201315. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000323002\" target=\"_blank\">10.1159\/000323002<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-8055-9489-9. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21422772\" target=\"_blank\">21422772<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Prog+Neurol+Surg.&rft.atitle=History+of+peripheral+nerve+stimulation&rft.volume=24&rft.pages=1-15&rft.date=2011&rft_id=info%3Apmid%2F21422772&rft_id=info%3Adoi%2F10.1159%2F000323002&rft.isbn=978-3-8055-9489-9&rft.aulast=Slavin&rft.aufirst=Konstantin+V.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOccipital+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Reed_Migraine-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Reed_Migraine_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/reedmigraine.com\/sites\/default\/files\/Cephalalgia%20Online%2010.3.12%20copy.pdf\" target=\"_blank\">\"Reed Migraine Article on Safety and efficacy of peripheral nerve stimulation of the occipital nerves\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Cephalagia<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">12 November<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Reed+Migraine+Article+on+Safety+and+efficacy+of+peripheral+nerve+stimulation+of+the+occipital+nerves&rft.pub=Cephalagia&rft_id=http%3A%2F%2Freedmigraine.com%2Fsites%2Fdefault%2Ffiles%2FCephalalgia%2520Online%252010.3.12%2520copy.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOccipital+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-St_Jude_Medical_Inc._Press_release4-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-St_Jude_Medical_Inc._Press_release4_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/archive.is\/20130105104114\/http:\/\/investors.sjm.com\/phoenix.zhtml?c=73836&p=irol-newsArticle&ID=1604154&highlight\" target=\"_blank\">\"St Jude Press release\"<\/a>. St. Jude Medical Inc. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/investors.sjm.com\/phoenix.zhtml?c=73836&p=irol-newsArticle&ID=1604154&highlight\" target=\"_blank\">the original<\/a> on 5 January 2013<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">8 August<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=St+Jude+Press+release&rft.pub=St.+Jude+Medical+Inc.&rft_id=http%3A%2F%2Finvestors.sjm.com%2Fphoenix.zhtml%3Fc%3D73836%26p%3Dirol-newsArticle%26ID%3D1604154%26highlight&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOccipital+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ICHD5-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ICHD5_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ihs-classification.org\/en\/02_klassifikation\/02_teil1\/01.01.00_migraine.html\" target=\"_blank\">\"The International Classification of Headache Disorders, 2nd Edition, 1st revision (May, 2005)\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=The+International+Classification+of+Headache+Disorders%2C+2nd+Edition%2C+1st+revision+%28May%2C+2005%29&rft_id=http%3A%2F%2Fihs-classification.org%2Fen%2F02_klassifikation%2F02_teil1%2F01.01.00_migraine.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOccipital+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Silberstein6-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Silberstein6_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Silberstein, Stephen D.; Dodick DW; Pearlman S (2010). \"Defining the pharmacologically intractable headache for clinical trials and clinical practice\". <i>Headache<\/i>. <b>50<\/b> (9): 1499\u2013506. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1526-4610.2010.01764.x\" target=\"_blank\">10.1111\/j.1526-4610.2010.01764.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20958296\" target=\"_blank\">20958296<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Headache&rft.atitle=Defining+the+pharmacologically+intractable+headache+for+clinical+trials+and+clinical+practice&rft.volume=50&rft.issue=9&rft.pages=1499-506&rft.date=2010&rft_id=info%3Adoi%2F10.1111%2Fj.1526-4610.2010.01764.x&rft_id=info%3Apmid%2F20958296&rft.aulast=Silberstein&rft.aufirst=Stephen+D.&rft.au=Dodick+DW&rft.au=Pearlman+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOccipital+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Alo7-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Alo7_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Alo7_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Alo7_8-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Alo7_8-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Alo7_8-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Alo7_8-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Alo7_8-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Alo7_8-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Alo7_8-8\" rel=\"external_link\"><sup><i><b>i<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">AI\u00f3, Kenneth M.; Abramova MV; Richter EO (2011). \"Percutaneous Peripheral Nerve Stimulation\". <i>Prog Neurol Surg<\/i>. Progress in Neurological Surgery. <b>24<\/b>: 41\u2013S7. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000323023\" target=\"_blank\">10.1159\/000323023<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-8055-9489-9. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21422775\" target=\"_blank\">21422775<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Prog+Neurol+Surg.&rft.atitle=Percutaneous+Peripheral+Nerve+Stimulation&rft.volume=24&rft.pages=41-S7&rft.date=2011&rft_id=info%3Apmid%2F21422775&rft_id=info%3Adoi%2F10.1159%2F000323023&rft.isbn=978-3-8055-9489-9&rft.aulast=AI%C3%B3&rft.aufirst=Kenneth+M.&rft.au=Abramova+MV&rft.au=Richter+EO&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOccipital+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Ellens8-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Ellens8_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ellens8_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ellens8_9-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ellens8_9-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ellens8_9-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ellens8_9-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ellens, Damien J.; Levy RM (2011). \"Peripheral Neuromodulation for Migraine Headache\". <i>Prog Neurol Surg<\/i>. Progress in Neurological Surgery. <b>24<\/b>: 109\u2013117. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000323890\" target=\"_blank\">10.1159\/000323890<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-8055-9489-9. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21422781\" target=\"_blank\">21422781<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Prog+Neurol+Surg&rft.atitle=Peripheral+Neuromodulation+for+Migraine+Headache&rft.volume=24&rft.pages=109-117&rft.date=2011&rft_id=info%3Apmid%2F21422781&rft_id=info%3Adoi%2F10.1159%2F000323890&rft.isbn=978-3-8055-9489-9&rft.aulast=Ellens&rft.aufirst=Damien+J.&rft.au=Levy+RM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOccipital+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Trentman9-10\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Trentman9_10-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Trentman9_10-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Trentman9_10-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Trentman9_10-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Trentman9_10-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Trentman, Terrence L.; Slavin KV; Freeman JA; Zimmerman RS (2010). \"Occipital Nerve Stimulator Placement via a Retromastoid to Infraclavicular Approach: A Technical Report\". <i>Stereotact Funct Neurosurg<\/i>. <b>88<\/b> (2): 121\u2013125. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000289356\" target=\"_blank\">10.1159\/000289356<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20197713\" target=\"_blank\">20197713<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Stereotact+Funct+Neurosurg&rft.atitle=Occipital+Nerve+Stimulator+Placement+via+a+Retromastoid+to+Infraclavicular+Approach%3A+A+Technical+Report&rft.volume=88&rft.issue=2&rft.pages=121-125&rft.date=2010&rft_id=info%3Adoi%2F10.1159%2F000289356&rft_id=info%3Apmid%2F20197713&rft.aulast=Trentman&rft.aufirst=Terrence+L.&rft.au=Slavin+KV&rft.au=Freeman+JA&rft.au=Zimmerman+RS&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOccipital+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Silberstein13-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Silberstein13_11-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Silberstein SD, Dodick DW, Saper J, Huh B, Slavin KV, Sharan A, Reed K, Narouze S, Mogilner A, Goldstein J, Trentman T, Vaisman J, Vaisma J, Ordia J, Weber P, Deer T, Levy R, Diaz RL, Washburn SN, Mekhail N (Dec 2012). \"Safety and Efficacy of Peripheral Nerve Stimulation of the Occipital Nerves for the Management of Chronic Migraine: Results from a Randomized, Multicenter, Double-blinded, Controlled Study\". <i>Cephalalgia<\/i>. <b>32<\/b> (16): 1165\u20131179]. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F0333102412462642\" target=\"_blank\">10.1177\/0333102412462642<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23034698\" target=\"_blank\">23034698<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cephalalgia&rft.atitle=Safety+and+Efficacy+of+Peripheral+Nerve+Stimulation+of+the+Occipital+Nerves+for+the+Management+of+Chronic+Migraine%3A+Results+from+a+Randomized%2C+Multicenter%2C+Double-blinded%2C+Controlled+Study&rft.volume=32&rft.issue=16&rft.pages=1165-1179&rft.date=2012-12&rft_id=info%3Adoi%2F10.1177%2F0333102412462642&rft_id=info%3Apmid%2F23034698&rft.aulast=Silberstein&rft.aufirst=SD&rft.au=Dodick%2C+DW&rft.au=Saper%2C+J&rft.au=Huh%2C+B&rft.au=Slavin%2C+KV&rft.au=Sharan%2C+A&rft.au=Reed%2C+K&rft.au=Narouze%2C+S&rft.au=Mogilner%2C+A&rft.au=Goldstein%2C+J&rft.au=Trentman%2C+T&rft.au=Vaisman%2C+J&rft.au=Vaisma%2C+J&rft.au=Ordia%2C+J&rft.au=Weber%2C+P&rft.au=Deer%2C+T&rft.au=Levy%2C+R&rft.au=Diaz%2C+RL&rft.au=Washburn%2C+SN&rft.au=Mekhail%2C+N&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOccipital+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Saper14-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Saper14_12-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Saper, Joel R.; Dodick DW; Silberstein SD; McCarville S; Sun M; Goadsby PJ (2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3057439\" target=\"_blank\">\"Occipital nerve stimulation for the treatment of intractable chronic migraine headache: ONSTIM feasibility study\"<\/a>. <i>Cephalalgia<\/i>. <b>31<\/b> (3): 271\u201385. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F0333102410381142\" target=\"_blank\">10.1177\/0333102410381142<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3057439\" target=\"_blank\">3057439<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20861241\" target=\"_blank\">20861241<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cephalalgia&rft.atitle=Occipital+nerve+stimulation+for+the+treatment+of+intractable+chronic+migraine+headache%3A+ONSTIM+feasibility+study&rft.volume=31&rft.issue=3&rft.pages=271-85&rft.date=2011&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3057439&rft_id=info%3Apmid%2F20861241&rft_id=info%3Adoi%2F10.1177%2F0333102410381142&rft.aulast=Saper&rft.aufirst=Joel+R.&rft.au=Dodick+DW&rft.au=Silberstein+SD&rft.au=McCarville+S&rft.au=Sun+M&rft.au=Goadsby+PJ&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3057439&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOccipital+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Lipton15-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Lipton15_13-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lipton, Richard B.; Goadsby PJ; Cady RK; Aurora SK; Grosberg BM; Freitag FG; Silberstein SD; Whiten DM; Jaax KN (2010). \"PRISM study: Occipital nerve stimulation for treatment-refractory migraine\". <i>Headache<\/i>. <b>50<\/b> (3): 509\u2013519. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1526-4610.2010.01615.x\" target=\"_blank\">10.1111\/j.1526-4610.2010.01615.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20456145\" target=\"_blank\">20456145<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Headache&rft.atitle=PRISM+study%3A+Occipital+nerve+stimulation+for+treatment-refractory+migraine&rft.volume=50&rft.issue=3&rft.pages=509-519&rft.date=2010&rft_id=info%3Adoi%2F10.1111%2Fj.1526-4610.2010.01615.x&rft_id=info%3Apmid%2F20456145&rft.aulast=Lipton&rft.aufirst=Richard+B.&rft.au=Goadsby+PJ&rft.au=Cady+RK&rft.au=Aurora+SK&rft.au=Grosberg+BM&rft.au=Freitag+FG&rft.au=Silberstein+SD&rft.au=Whiten+DM&rft.au=Jaax+KN&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOccipital+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-IHC-Abstracts-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-IHC-Abstracts_14-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.scribd.com\/doc\/20113408\/Abstracts-for-IHC-Website\" target=\"_blank\">\"Abstracts for the 14th Congress of the International Headache Conference, Philadelphia, USA, 10 - 13 September 2009\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Abstracts+for+the+14th+Congress+of+the+International+Headache+Conference%2C+Philadelphia%2C+USA%2C+10+-+13+September+2009&rft_id=https%3A%2F%2Fwww.scribd.com%2Fdoc%2F20113408%2FAbstracts-for-IHC-Website&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOccipital+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Diener-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Diener_15-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Diener, Hans-Christoph; Dodick DW; Goadsby PJ; Lipton RB; Olesen J (2012). \"Chronic migraine\u2014classification, characteristics and treatment\". <i>Nature Reviews Neurology<\/i>. <b>8<\/b>: 162\u2013171. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnrneurol.2012.13\" target=\"_blank\">10.1038\/nrneurol.2012.13<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22331030\" target=\"_blank\">22331030<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Reviews+Neurology&rft.atitle=Chronic+migraine%E2%80%94classification%2C+characteristics+and+treatment&rft.volume=8&rft.pages=162-171&rft.date=2012&rft_id=info%3Adoi%2F10.1038%2Fnrneurol.2012.13&rft_id=info%3Apmid%2F22331030&rft.aulast=Diener&rft.aufirst=Hans-Christoph&rft.au=Dodick+DW&rft.au=Goadsby+PJ&rft.au=Lipton+RB&rft.au=Olesen+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOccipital+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1269\nCached time: 20181130011759\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.284 seconds\nReal time usage: 0.337 seconds\nPreprocessor visited node count: 923\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 35993\/2097152 bytes\nTemplate argument size: 232\/2097152 bytes\nHighest expansion depth: 6\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 49032\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.169\/10.000 seconds\nLua memory usage: 3.9 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 252.360 1 -total\n<\/p>\n<pre>64.12% 161.813 11 Template:Cite_journal\n24.50% 61.832 1 Template:Medref\n15.58% 39.306 1 Template:Ambox\n 7.15% 18.055 4 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:36666029-1!canonical and timestamp 20181130011759 and revision id 841737712\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Occipital_nerve_stimulation\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212247\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.157 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 149.956 1 - wikipedia:Occipital_nerve_stimulation\n100.00% 149.956 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8307-0!*!*!*!*!*!* and timestamp 20181217212247 and revision id 24521\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Occipital_nerve_stimulation\">https:\/\/www.limswiki.org\/index.php\/Occipital_nerve_stimulation<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","4a6ab168e20da76c1b1773788dbfd71f_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e3\/Rod_of_Asclepius2.svg\/25px-Rod_of_Asclepius2.svg.png"],"4a6ab168e20da76c1b1773788dbfd71f_timestamp":1545081767,"4d5921e9284f26136fff92699d045ff1_type":"article","4d5921e9284f26136fff92699d045ff1_title":"Percutaneous aortic valve replacement","4d5921e9284f26136fff92699d045ff1_url":"https:\/\/www.limswiki.org\/index.php\/Percutaneous_aortic_valve_replacement","4d5921e9284f26136fff92699d045ff1_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPercutaneous aortic valve replacement\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tPercutaneous aortic valve replacementICD-9-CM35.05[edit on Wikidata]\nPercutaneous aortic valve replacement (PAVR), also known as transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR), is the replacement of the aortic valve of the heart through the blood vessels (as opposed to valve replacement by open heart surgery). The replacement valve is delivered via one of several access methods: transfemoral (in the upper leg), transapical (through the wall of the heart), subclavian (beneath the collar bone), direct aortic (through a minimally invasive surgical incision into the aorta), and transcaval (from a temporary hole in the aorta near the belly button through a vein in the upper leg), among others.\nSevere symptomatic aortic stenosis carries a poor prognosis. Until recently, surgical aortic valve replacement was the standard of care in adults with severe symptomatic aortic stenosis. However, the risks associated with surgical aortic valve replacement are increased in elderly patients and those with concomitant severe systolic heart failure or coronary artery disease, as well as in people with comorbidities such as cerebrovascular and peripheral arterial disease, chronic kidney disease, and chronic respiratory dysfunction.\n\nContents \n\n1 Medical uses \n2 History \n3 Devices \n4 Implantation \n5 References \n6 Further reading \n\n\nMedical uses \nPatients with symptomatic severe aortic stenosis have a mortality rate of approximately 50% at 2 years without intervention[1]. In patients who are deemed too high risk for open heart surgery, TAVR significantly reduces the rates of death and cardiac symptoms[2]. At present, TAVR is not routinely recommended for low risk patients in favor of surgical aortic valve replacement, however it is increasingly being offered to intermediate risk patients, based on recent studies showing it to be non-inferior to surgical aortic valve replacement[3].\nTransapical TAVR is reserved for patients for whom other approaches are not feasible: an evidence-based BMJ Rapid Recommendation[4] made a strong recommendation against transapical TAVR in people who are also candidates for either transfemoral TAVR or surgery.[5] People who have the option of either transfemoral TAVR or surgical replacement are likely to choose surgery if they are younger than 75 and transfemoral TAVR if they are older than 75.[5] The rationale for age-based recommendations is that surgical aortic valve replacements are known to be durable long-term (average of durability of 20 years) so people with longer life expectancy would be at higher risk if TAVR durability is worse than surgery.[6]\n\nHistory \nThe catheter procedure was invented and developed in Aarhus University Hospital Denmark in 1989 by Dr. Henning Rud Andersen,[7] who performed the first animal implantations the same year.[8] The first implantation in a patient was performed in 2002 on April 16 by Prof Alain Cribier in Hopital Charles Nicolle, at the University of Rouen.[9] Technology experts Stan Rowe and Stan Rabinowitz partnered with physicians Alain Cribier, Mehmet Oz, Marty Leon and others to create Percutaneous Valve Technologies (PVT) in 2002. The company was purchased by Edwards Life Sciences in 2004 and became the Sapien valve, the first aortic valve device to receive FDA approval.[10][11] It received FDA approval in November 2011 for use in inoperable patients and in October 2012 for use in patients at high surgical risk.[12] The device is effective in improving functioning in the patients with severe aortic stenosis. It is now approved in more than 50 countries.\n\nDevices \nMedtronic\u2019s CoreValve Transcatheter Aortic Valve is constructed of a self-expanding Nitinol frame and delivered through the femoral artery. This device received FDA approval in January 2014.[13][14][15]\nBoston Scientific's Lotus Valve system was awarded CE approval in October 2013. It allows the final position to be assessed and evaluated before release and has been designed to minimise regurgitation.[15]\nSt Jude Medical's Portico Transcatheter aortic valve received European CE mark approval in December 2013. The valve is repositionable before release to ensure accurate placement helping to improve patient outcomes.[15]\nEdwards' Sapien aortic valve is made from bovine pericardial tissue and is implanted via a catheter-based delivery system. It is approved by the FDA for use in the US.[13][14][15]\n\nImplantation \nThe devices are implanted without open heart surgery. The valve delivery system is inserted in the body, the valve is positioned and then implanted inside the diseased aortic valve, and then the delivery system is removed. The catheter based delivery system can be inserted into the body from one of several sites.This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2015) (Learn how and when to remove this template message)\nThe transfemoral approach requires the catheter and valve to be inserted via the femoral artery. Similar to coronary artery stenting procedures, this is accessed via a small incision in the groin, through which the delivery system is slowly fed along the artery to the correct position at the aortic valve. A larger incision in the groin may be required in some circumstancesThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2015) (Learn how and when to remove this template message)\nThe transapical approach sees the catheter and valve inserted through the tip of the heart and into the left ventricle. Under general anesthesia, a small surgical incision is made between the ribs, followed by a small puncture of the heart. The delivery system is then fed slowly to the correct position at the aortic valve. The puncture in the heart is then sutured shut.This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2015) (Learn how and when to remove this template message)\nThe transaortic approach sees the catheter and valve inserted through the top of the right chest. Under general anesthesia, a small surgical incision is made alongside the right upper breastbone, followed by a small puncture of the aorta. The delivery system is then fed slowly to the correct position at the aortic valve. The hole in the aorta is then sutured shut.This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2015) (Learn how and when to remove this template message)\nThe transcaval approach has been applied to a smaller number of patients who are not eligible for transfemoral, transapical, or transaortic approaches. In the transcaval approach a tube is inserted via the femoral vein instead of the femoral artery, and a small wire is used to cross from the inferior vena cava into the adjacent abdominal aorta. Once the wire is across, a large tube is used to place the transcatheter heart valve through the femoral vein and inferior vena cava into the aorta and from there the heart. This otherwise resembles the transfemoral approach. Afterwards, the hole in the aorta is closed with a self-collapsing nitinol device designed to close holes in the heart.[16][17]\nIn the subclavian approach, an incision is made under the collar bone under general anesthesia, and the delivery system is advanced into the correct position in the aortic valve. The delivery system is then removed and the incision is sutured closed.\n\nReferences \n\n\n^ Circulation. 1968 Jul;38(1 Suppl):61-7. Aortic stenosis. Ross J Jr, Braunwald E. \n\n^ N Engl J Med. 2010 Oct 21;363(17):1597-607. doi: 10.1056\/NEJMoa1008232. Epub 2010 Sep 22. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. Leon MB1, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S; PARTNER Trial Investigators. \n\n^ N Engl J Med. 2017 Apr 6;376(14):1321-1331. doi: 10.1056\/NEJMoa1700456. Epub 2017 Mar 17.\nSurgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients.\nReardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, S\u00f8ndergaard L, Mumtaz M, Adams DH, Deeb GM, Maini B, Gada H, Chetcuti S, Gleason T, Heiser J, Lange R, Merhi W, Oh JK, Olsen PS, Piazza N, Williams M, Windecker S, Yakubov SJ, Grube E, Makkar R, Lee JS, Conte J, Vang E, Nguyen H, Chang Y, Mugglin AS, Serruys PW, Kappetein AP; SURTAVI Investigators. \n\n^ Siemieniuk RA, Agoritsas T, Macdonald H, Guyatt GH, Brandt L, Vandvik PO (2016). \"TIntroduction to BMJ Rapid Recommendations\". BMJ. 354: i5191. doi:10.1136\/bmj.i5191. PMID 27680768. \n\n^ a b Vandvik PO, Otto CM, Siemieniuk RA, Bagur R, Guyatt GH, Lytvyn L, Whitlock R, Vartdal T, Brieger D, Aertgeerts B, Price S, Foroutan F, Shapiro M, Mertz R, Spencer FA (2016). \"Transcatheter or surgical aortic valve replacement for patients with severe, symptomatic, aortic stenosis at low to intermediate surgical risk: a clinical practice guideline\". BMJ. 354: i5085. doi:10.1136\/bmj.i5085. PMID 27680583. \n\n^ Foroutan F, Guyatt GH, O'Brien K, et al. (2016). \"Prognosis after surgical replacement with a bioprosthetic aortic valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies\". BMJ. 354: i5065. doi:10.1136\/bmj.i5065. PMC 5040922 . PMID 27683072. \n\n^ Grigorios T, Stefanos D, Athanasios M, Ioanna K, Stylianos A, Periklis D, George H (January 2018). \"Transcatheter versus surgical aortic valve replacement in severe, symptomatic aortic stenosis\". J Geriatr Cardiol. 15 (1): 76\u201385. doi:10.11909\/j.issn.1671-5411.2018.01.002. PMC 5803541 . PMID 29434629. \n\n^ Andersen HR, Knudsen LL, Hasenkam JM (May 1992). \"Transluminal implantation of artificial heart valves. Description of a new expandable aortic valve and initial results with implantation by catheter technique in closed chest pigs\". Eur. Heart J. 13 (5): 704\u20138. PMID 1618213. \n\n^ Cribier, A; Eltchaninoff H; Bash A; Borenstein N; Tron C; Bauer F; Derumeaux G; Anselme F; Laborde F; Leon MB (10 December 2002). \"Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis. First human case description\". Circulation. 106 (24): 3006\u20133008. doi:10.1161\/01.cir.0000047200.36165.b8. PMID 12473543. \n\n^ TAVR: Still the Next Big Thing in Cardiology? \n\n^ Sapien Transcatheter Aortic Heart Valve Gains FDA Approval \n\n^ http:\/\/www.fda.gov\/NewsEvents\/Newsroom\/PressAnnouncements\/ucm278348.htm \n\n^ a b Medscape. \"Transcatheter Aortic Valve Replacement Devices\". Retrieved December 2013. \n\n^ a b Agarwal S, et al. (Feb 2015). \"Transcatheter aortic valve replacement: current perspectives and future implications\". Heart. 101 (3): 169\u201377. doi:10.1136\/heartjnl-2014-306254. PMID 25410500. \n\n^ a b c d Abdel-Wahab M, et al. (Feb 2015). \"Update on transcatheter aortic valve replacement\". Trends Cardiovasc. Med. 25 (2): 154\u2013161. doi:10.1016\/j.tcm.2014.10.001. PMID 25453986. \n\n^ Steinberger, JD; McWilliams JP; Moriarty JM (10 April 2015). \"Alternative Aortic Access: Translumbar, Transapical, Subclavian, Conduit, and Transvenous Access to the Aorta\". Tech Vasc Interv Radiol. 18 (2): 93\u201399. doi:10.1053\/j.tvir.2015.04.007. PMID 26070621. \n\n^ Greenbaum, AB; ONeill WW; Paone G; Guerrero M; Wyman JF; Cooper RL; Lederman RJ (1 July 2014). \"Caval-aortic access to allow transcatheter aortic valve replacement in otherwise ineligible patients. Initial human experience\". J Am Coll Cardiol. 63 (25 Pt A): 2795\u20132804. doi:10.1016\/j.jacc.2014.04.015. PMC 4105161 . PMID 24814495. \n\n\nFurther reading \nOtto, Catherine M.; Kumbhani, Dharam J.; Alexander, Karen P.; Calhoon, John H.; Desai, Milind Y.; Kaul, Sanjay; Lee, James C.; Ruiz, Carlos E.; Vassileva, Christina M. (January 2017). \"2017 ACC Expert Consensus Decision Pathway for Transcatheter Aortic Valve Replacement in the Management of Adults with Aortic Stenosis\". Journal of the American College of Cardiology. 69: 1313\u20131346. doi:10.1016\/j.jacc.2016.12.006. \nvan Herwerden L, Serruys P (2002). \"Percutaneous valve implantation: back to the future?\". Eur Heart J. 23 (18): 1415\u20136. doi:10.1053\/euhj.2002.3305. PMID 12208220. \nvteSurgery and other procedures involving the heart (ICD-9-CM V3 35\u201337+89.4+99.6, ICD-10-PCS 02)Surgery and ICHeart valves\r\nand septa\nValve repair\nValvulotomy\nMitral valve repair\nValvuloplasty\naortic\nmitral\nValve replacement\nAortic valve repair\nAortic valve replacement\nRoss procedure\nPercutaneous aortic valve replacement\nMitral valve replacement\nproduction of septal defect in heart \nenlargement of existing septal defect\nAtrial septostomy\nBalloon septostomy<\/dd>\ncreation of septal defect in heart\n\nBlalock\u2013Hanlon procedure<\/dd>\nshunt from heart chamber to blood vessel \natrium to pulmonary artery\nFontan procedure<\/dd>\nleft ventricle to aorta\n\nRastelli procedure<\/dd>\nright ventricle to pulmonary artery\n\nSano shunt<\/dd>\ncompound procedures \nfor transposition of great vessels\nArterial switch operation\nMustard procedure\nSenning procedure<\/dd>\nfor univentricular defect\n\nNorwood procedure\nKawashima procedure<\/dd>\nshunt from blood vessel to blood vessel \nsystemic circulation to pulmonary artery shunt\nBlalock\u2013Taussig shunt<\/dd>\nSVC to the right PA\n\nGlenn procedure<\/dd>\nCardiac vessels\nCHD \nAngioplasty\nBypass\/Coronary artery bypass\nMIDCAB\nOff-pump CAB\nTECAB<\/dd>\nCoronary stent \nBare-metal stent\nDrug-eluting stent\nBentall procedure\nValve-sparing aortic root replacement\nLeCompte maneuver\nOther\nPericardium \nPericardiocentesis\nPericardial window\nPericardiectomy\nMyocardium \nCardiomyoplasty\nDor procedure\nSeptal myectomy\nVentricular reduction\nAlcohol septal ablation\nConduction system \nMaze procedure\nCox maze and minimaze<\/dd>\nCatheter ablation\n\nCryoablation\nRadiofrequency ablation<\/dd>\nPacemaker insertion\nLeft atrial appendage occlusion\nCardiotomy\nHeart transplantation\nDiagnostic\r\ntests and\r\nprocedures\nElectrophysiology \nElectrocardiography\nVectorcardiography<\/dd>\nHolter monitor\nImplantable loop recorder\nCardiac stress test\n\nBruce protocol<\/dd>\nElectrophysiology study\nCardiac imaging \nAngiocardiography\nEchocardiography\nTTE\nTEE<\/dd>\nMyocardial perfusion imaging\nCardiovascular MRI\nVentriculography\n\nRadionuclide ventriculography<\/dd>\nCardiac catheterization\/Coronary catheterization\nCardiac CT\n\nCardiac PET\nsound \nPhonocardiogram\nFunction tests\nImpedance cardiography\nBallistocardiography\nCardiotocography\nPacing\nCardioversion\nTranscutaneous pacing\n\n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Percutaneous_aortic_valve_replacement\">https:\/\/www.limswiki.org\/index.php\/Percutaneous_aortic_valve_replacement<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesMedical and surgical techniquesHidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","4d5921e9284f26136fff92699d045ff1_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Percutaneous_aortic_valve_replacement skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Percutaneous aortic valve replacement<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Percutaneous aortic valve replacement<\/b> (<b>PAVR<\/b>), also known as <b>transcatheter aortic valve implantation<\/b> (<b>TAVI<\/b>) or <b>transcatheter aortic valve replacement<\/b> (<b>TAVR<\/b>), is the replacement of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aortic_valve\" title=\"Aortic valve\" rel=\"external_link\" target=\"_blank\">aortic valve<\/a> of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart\" title=\"Heart\" rel=\"external_link\" target=\"_blank\">heart<\/a> through the blood vessels (as opposed to valve replacement by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_surgery#Open_heart_surgery\" title=\"Cardiac surgery\" rel=\"external_link\" target=\"_blank\">open heart surgery<\/a>). The replacement valve is delivered via one of several access methods: transfemoral (in the upper leg), transapical (through the wall of the heart), subclavian (beneath the collar bone), direct aortic (through a minimally invasive surgical incision into the aorta), and transcaval (from a temporary hole in the aorta near the belly button through a vein in the upper leg), among others.\n<\/p><p>Severe symptomatic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aortic_stenosis\" title=\"Aortic stenosis\" rel=\"external_link\" target=\"_blank\">aortic stenosis<\/a> carries a poor prognosis. Until recently, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aortic_valve_replacement\" title=\"Aortic valve replacement\" rel=\"external_link\" target=\"_blank\">surgical aortic valve replacement<\/a> was the standard of care in adults with severe symptomatic aortic stenosis. However, the risks associated with surgical aortic valve replacement are increased in elderly patients and those with concomitant severe systolic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_failure\" title=\"Heart failure\" rel=\"external_link\" target=\"_blank\">heart failure<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery_disease\" title=\"Coronary artery disease\" rel=\"external_link\" target=\"_blank\">coronary artery disease<\/a>, as well as in people with comorbidities such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebrovascular_disease\" title=\"Cerebrovascular disease\" rel=\"external_link\" target=\"_blank\">cerebrovascular<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peripheral_arterial_disease\" class=\"mw-redirect\" title=\"Peripheral arterial disease\" rel=\"external_link\" target=\"_blank\">peripheral arterial disease<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_kidney_disease\" title=\"Chronic kidney disease\" rel=\"external_link\" target=\"_blank\">chronic kidney disease<\/a>, and chronic respiratory dysfunction.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<p>Patients with symptomatic severe aortic stenosis have a mortality rate of approximately 50% at 2 years without intervention<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>. In patients who are deemed too high risk for open heart surgery, TAVR significantly reduces the rates of death and cardiac symptoms<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>. At present, TAVR is not routinely recommended for low risk patients in favor of surgical aortic valve replacement, however it is increasingly being offered to intermediate risk patients, based on recent studies showing it to be non-inferior to surgical aortic valve replacement<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>.\n<\/p><p>Transapical TAVR is reserved for patients for whom other approaches are not feasible: an evidence-based BMJ Rapid Recommendation<sup id=\"rdp-ebb-cite_ref-siemieniuk1_4-0\" class=\"reference\"><a href=\"#cite_note-siemieniuk1-4\" rel=\"external_link\">[4]<\/a><\/sup> made a strong recommendation against <i>transapical<\/i> TAVR in people who are also candidates for either <i>transfemoral<\/i> TAVR or surgery.<sup id=\"rdp-ebb-cite_ref-vandvik_5-0\" class=\"reference\"><a href=\"#cite_note-vandvik-5\" rel=\"external_link\">[5]<\/a><\/sup> People who have the option of either transfemoral TAVR or surgical replacement are likely to choose surgery if they are younger than 75 and transfemoral TAVR if they are older than 75.<sup id=\"rdp-ebb-cite_ref-vandvik_5-1\" class=\"reference\"><a href=\"#cite_note-vandvik-5\" rel=\"external_link\">[5]<\/a><\/sup> The rationale for age-based recommendations is that surgical aortic valve replacements are known to be durable long-term (average of durability of 20 years) so people with longer life expectancy would be at higher risk if TAVR durability is worse than surgery.<sup id=\"rdp-ebb-cite_ref-foroutan_6-0\" class=\"reference\"><a href=\"#cite_note-foroutan-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The catheter procedure was invented and developed in Aarhus University Hospital Denmark in 1989 by Dr. Henning Rud Andersen,<sup id=\"rdp-ebb-cite_ref-pmid29434629_7-0\" class=\"reference\"><a href=\"#cite_note-pmid29434629-7\" rel=\"external_link\">[7]<\/a><\/sup> who performed the first animal implantations the same year.<sup id=\"rdp-ebb-cite_ref-pmid1618213_8-0\" class=\"reference\"><a href=\"#cite_note-pmid1618213-8\" rel=\"external_link\">[8]<\/a><\/sup> The first implantation in a patient was performed in 2002 on April 16 by Prof <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alain_Cribier\" title=\"Alain Cribier\" rel=\"external_link\" target=\"_blank\">Alain Cribier<\/a> in Hopital Charles Nicolle, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Rouen\" title=\"University of Rouen\" rel=\"external_link\" target=\"_blank\">University of Rouen<\/a>.<sup id=\"rdp-ebb-cite_ref-cribier_pti_9-0\" class=\"reference\"><a href=\"#cite_note-cribier_pti-9\" rel=\"external_link\">[9]<\/a><\/sup> Technology experts Stan Rowe and Stan Rabinowitz partnered with physicians <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alain_Cribier\" title=\"Alain Cribier\" rel=\"external_link\" target=\"_blank\">Alain Cribier<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mehmet_Oz\" title=\"Mehmet Oz\" rel=\"external_link\" target=\"_blank\">Mehmet Oz<\/a>, Marty Leon and others to create Percutaneous Valve Technologies (PVT) in 2002. The company was purchased by Edwards Life Sciences in 2004 and became the Sapien valve, the first aortic valve device to receive FDA approval.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> It received FDA approval in November 2011 for use in inoperable patients and in October 2012 for use in patients at high surgical risk.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> The device is effective in improving functioning in the patients with severe aortic stenosis. It is now approved in more than 50 countries.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Devices\">Devices<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medtronic\" title=\"Medtronic\" rel=\"external_link\" target=\"_blank\">Medtronic<\/a>\u2019s CoreValve Transcatheter Aortic Valve is constructed of a self-expanding Nitinol frame and delivered through the femoral artery. This device received FDA approval in January 2014.<sup id=\"rdp-ebb-cite_ref-medscape_13-0\" class=\"reference\"><a href=\"#cite_note-medscape-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Agarwal2015_14-0\" class=\"reference\"><a href=\"#cite_note-Agarwal2015-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Abdel2015_15-0\" class=\"reference\"><a href=\"#cite_note-Abdel2015-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Boston_Scientific\" title=\"Boston Scientific\" rel=\"external_link\" target=\"_blank\">Boston Scientific<\/a>'s Lotus Valve system was awarded CE approval in October 2013. It allows the final position to be assessed and evaluated before release and has been designed to minimise regurgitation.<sup id=\"rdp-ebb-cite_ref-Abdel2015_15-1\" class=\"reference\"><a href=\"#cite_note-Abdel2015-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/St_Jude_Medical\" class=\"mw-redirect\" title=\"St Jude Medical\" rel=\"external_link\" target=\"_blank\">St Jude Medical<\/a>'s Portico Transcatheter aortic valve received European CE mark approval in December 2013. The valve is repositionable before release to ensure accurate placement helping to improve patient outcomes.<sup id=\"rdp-ebb-cite_ref-Abdel2015_15-2\" class=\"reference\"><a href=\"#cite_note-Abdel2015-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Edwards_Lifesciences\" title=\"Edwards Lifesciences\" rel=\"external_link\" target=\"_blank\">Edwards<\/a>' Sapien aortic valve is made from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bovinae\" title=\"Bovinae\" rel=\"external_link\" target=\"_blank\">bovine<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pericardial_heart_valves\" title=\"Pericardial heart valves\" rel=\"external_link\" target=\"_blank\">pericardial tissue<\/a> and is implanted via a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheter<\/a>-based delivery system. It is approved by the FDA for use in the US.<sup id=\"rdp-ebb-cite_ref-medscape_13-1\" class=\"reference\"><a href=\"#cite_note-medscape-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Agarwal2015_14-1\" class=\"reference\"><a href=\"#cite_note-Agarwal2015-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Abdel2015_15-3\" class=\"reference\"><a href=\"#cite_note-Abdel2015-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Implantation\">Implantation<\/span><\/h2><p>\nThe devices are implanted without open heart surgery. The valve delivery system is inserted in the body, the valve is positioned and then implanted inside the diseased aortic valve, and then the delivery system is removed. The catheter based delivery system can be inserted into the body from one of several sites.<\/p><p>\nThe transfemoral approach requires the catheter and valve to be inserted via the femoral artery. Similar to coronary artery stenting procedures, this is accessed via a small incision in the groin, through which the delivery system is slowly fed along the artery to the correct position at the aortic valve. A larger incision in the groin may be required in some circumstances<\/p><p>\nThe transapical approach sees the catheter and valve inserted through the tip of the heart and into the left ventricle. Under general anesthesia, a small surgical incision is made between the ribs, followed by a small puncture of the heart. The delivery system is then fed slowly to the correct position at the aortic valve. The puncture in the heart is then sutured shut.<\/p><p>\nThe transaortic approach sees the catheter and valve inserted through the top of the right chest. Under general anesthesia, a small surgical incision is made alongside the right upper breastbone, followed by a small puncture of the aorta. The delivery system is then fed slowly to the correct position at the aortic valve. The hole in the aorta is then sutured shut.<\/p>\n<p>The transcaval approach has been applied to a smaller number of patients who are not eligible for transfemoral, transapical, or transaortic approaches. In the transcaval approach a tube is inserted via the femoral vein instead of the femoral artery, and a small wire is used to cross from the inferior vena cava into the adjacent abdominal aorta. Once the wire is across, a large tube is used to place the transcatheter heart valve through the femoral vein and inferior vena cava into the aorta and from there the heart. This otherwise resembles the transfemoral approach. Afterwards, the hole in the aorta is closed with a self-collapsing nitinol device designed to close holes in the heart.<sup id=\"rdp-ebb-cite_ref-steinberger_tc_16-0\" class=\"reference\"><a href=\"#cite_note-steinberger_tc-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-greenbaum_tc_17-0\" class=\"reference\"><a href=\"#cite_note-greenbaum_tc-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p><p>In the subclavian approach, an incision is made under the collar bone under general anesthesia, and the delivery system is advanced into the correct position in the aortic valve. The delivery system is then removed and the incision is sutured closed.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Circulation. 1968 Jul;38(1 Suppl):61-7. Aortic stenosis. Ross J Jr, Braunwald E.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">N Engl J Med. 2010 Oct 21;363(17):1597-607. doi: 10.1056\/NEJMoa1008232. Epub 2010 Sep 22. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. Leon MB1, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S; PARTNER Trial Investigators.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">N Engl J Med. 2017 Apr 6;376(14):1321-1331. doi: 10.1056\/NEJMoa1700456. 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(Feb 2015). \"Transcatheter aortic valve replacement: current perspectives and future implications\". <i>Heart<\/i>. <b>101<\/b> (3): 169\u201377. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fheartjnl-2014-306254\" target=\"_blank\">10.1136\/heartjnl-2014-306254<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25410500\" target=\"_blank\">25410500<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Heart&rft.atitle=Transcatheter+aortic+valve+replacement%3A+current+perspectives+and+future+implications&rft.volume=101&rft.issue=3&rft.pages=169-77&rft.date=2015-02&rft_id=info%3Adoi%2F10.1136%2Fheartjnl-2014-306254&rft_id=info%3Apmid%2F25410500&rft.aulast=Agarwal&rft.aufirst=S&rfr_id=info%3Asid%2Fen.wikipedia.org%3APercutaneous+aortic+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Abdel2015-15\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Abdel2015_15-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Abdel2015_15-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Abdel2015_15-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Abdel2015_15-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Abdel-Wahab M, et al. (Feb 2015). \"Update on transcatheter aortic valve replacement\". <i>Trends Cardiovasc. Med<\/i>. <b>25<\/b> (2): 154\u2013161. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.tcm.2014.10.001\" target=\"_blank\">10.1016\/j.tcm.2014.10.001<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25453986\" target=\"_blank\">25453986<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Trends+Cardiovasc.+Med.&rft.atitle=Update+on+transcatheter+aortic+valve+replacement&rft.volume=25&rft.issue=2&rft.pages=154-161&rft.date=2015-02&rft_id=info%3Adoi%2F10.1016%2Fj.tcm.2014.10.001&rft_id=info%3Apmid%2F25453986&rft.aulast=Abdel-Wahab&rft.aufirst=M&rfr_id=info%3Asid%2Fen.wikipedia.org%3APercutaneous+aortic+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-steinberger_tc-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-steinberger_tc_16-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Steinberger, JD; McWilliams JP; Moriarty JM (10 April 2015). \"Alternative Aortic Access: Translumbar, Transapical, Subclavian, Conduit, and Transvenous Access to the Aorta\". <i>Tech Vasc Interv Radiol<\/i>. <b>18<\/b> (2): 93\u201399. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1053%2Fj.tvir.2015.04.007\" target=\"_blank\">10.1053\/j.tvir.2015.04.007<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26070621\" target=\"_blank\">26070621<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Tech+Vasc+Interv+Radiol&rft.atitle=Alternative+Aortic+Access%3A+Translumbar%2C+Transapical%2C+Subclavian%2C+Conduit%2C+and+Transvenous+Access+to+the+Aorta.&rft.volume=18&rft.issue=2&rft.pages=93-99&rft.date=2015-04-10&rft_id=info%3Adoi%2F10.1053%2Fj.tvir.2015.04.007&rft_id=info%3Apmid%2F26070621&rft.aulast=Steinberger&rft.aufirst=JD&rft.au=McWilliams+JP&rft.au=Moriarty+JM&rfr_id=info%3Asid%2Fen.wikipedia.org%3APercutaneous+aortic+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-greenbaum_tc-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-greenbaum_tc_17-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Greenbaum, AB; ONeill WW; Paone G; Guerrero M; Wyman JF; Cooper RL; Lederman RJ (1 July 2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4105161\" target=\"_blank\">\"Caval-aortic access to allow transcatheter aortic valve replacement in otherwise ineligible patients. Initial human experience\"<\/a>. <i>J Am Coll Cardiol<\/i>. <b>63<\/b> (25 Pt A): 2795\u20132804. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jacc.2014.04.015\" target=\"_blank\">10.1016\/j.jacc.2014.04.015<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4105161\" target=\"_blank\">4105161<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24814495\" target=\"_blank\">24814495<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Am+Coll+Cardiol&rft.atitle=Caval-aortic+access+to+allow+transcatheter+aortic+valve+replacement+in+otherwise+ineligible+patients.+Initial+human+experience.&rft.volume=63&rft.issue=25+Pt+A&rft.pages=2795-2804&rft.date=2014-07-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4105161&rft_id=info%3Apmid%2F24814495&rft_id=info%3Adoi%2F10.1016%2Fj.jacc.2014.04.015&rft.aulast=Greenbaum&rft.aufirst=AB&rft.au=ONeill+WW&rft.au=Paone+G&rft.au=Guerrero+M&rft.au=Wyman+JF&rft.au=Cooper+RL&rft.au=Lederman+RJ&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4105161&rfr_id=info%3Asid%2Fen.wikipedia.org%3APercutaneous+aortic+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation journal\">Otto, Catherine M.; Kumbhani, Dharam J.; Alexander, Karen P.; Calhoon, John H.; Desai, Milind Y.; Kaul, Sanjay; Lee, James C.; Ruiz, Carlos E.; Vassileva, Christina M. (January 2017). \"2017 ACC Expert Consensus Decision Pathway for Transcatheter Aortic Valve Replacement in the Management of Adults with Aortic Stenosis\". <i>Journal of the American College of Cardiology<\/i>. <b>69<\/b>: 1313\u20131346. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jacc.2016.12.006\" target=\"_blank\">10.1016\/j.jacc.2016.12.006<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+American+College+of+Cardiology&rft.atitle=2017+ACC+Expert+Consensus+Decision+Pathway+for+Transcatheter+Aortic+Valve+Replacement+in+the+Management+of+Adults+with+Aortic+Stenosis&rft.volume=69&rft.pages=1313-1346&rft.date=2017-01&rft_id=info%3Adoi%2F10.1016%2Fj.jacc.2016.12.006&rft.aulast=Otto&rft.aufirst=Catherine+M.&rft.au=Kumbhani%2C+Dharam+J.&rft.au=Alexander%2C+Karen+P.&rft.au=Calhoon%2C+John+H.&rft.au=Desai%2C+Milind+Y.&rft.au=Kaul%2C+Sanjay&rft.au=Lee%2C+James+C.&rft.au=Ruiz%2C+Carlos+E.&rft.au=Vassileva%2C+Christina+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APercutaneous+aortic+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">van Herwerden L, Serruys P (2002). \"Percutaneous valve implantation: back to the future?\". <i>Eur Heart J<\/i>. <b>23<\/b> (18): 1415\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1053%2Feuhj.2002.3305\" target=\"_blank\">10.1053\/euhj.2002.3305<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12208220\" target=\"_blank\">12208220<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Eur+Heart+J&rft.atitle=Percutaneous+valve+implantation%3A+back+to+the+future%3F&rft.volume=23&rft.issue=18&rft.pages=1415-6&rft.date=2002&rft_id=info%3Adoi%2F10.1053%2Feuhj.2002.3305&rft_id=info%3Apmid%2F12208220&rft.aulast=van+Herwerden&rft.aufirst=L&rft.au=Serruys%2C+P&rfr_id=info%3Asid%2Fen.wikipedia.org%3APercutaneous+aortic+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n\n<p class=\"mw-empty-elt\">\n<\/p>\n<p><!-- \nNewPP limit report\nParsed by mw1251\nCached time: 20181212041421\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.356 seconds\nReal time usage: 0.461 seconds\nPreprocessor visited node count: 1388\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 79394\/2097152 bytes\nTemplate argument size: 724\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 41797\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.188\/10.000 seconds\nLua memory usage: 5.19 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 379.169 1 -total\n<\/p>\n<pre>45.27% 171.657 1 Template:Reflist\n41.71% 158.145 12 Template:Cite_journal\n21.11% 80.047 1 Template:Infobox_interventions\n19.24% 72.957 1 Template:Infobox\n14.96% 56.706 4 Template:Mcn\n11.80% 44.758 4 Template:Ambox\n 7.37% 27.949 2 Template:Navbox\n 6.64% 25.171 1 Template:Interventional_cardiology\n 4.58% 17.350 1 Template:Use_dmy_dates\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:7499144-1!canonical and timestamp 20181212041420 and revision id 873250730\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous_aortic_valve_replacement\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212246\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.142 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 134.823 1 - wikipedia:Percutaneous_aortic_valve_replacement\n100.00% 134.823 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8050-0!*!*!*!*!*!* and timestamp 20181217212246 and revision id 24160\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Percutaneous_aortic_valve_replacement\">https:\/\/www.limswiki.org\/index.php\/Percutaneous_aortic_valve_replacement<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","4d5921e9284f26136fff92699d045ff1_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png"],"4d5921e9284f26136fff92699d045ff1_timestamp":1545081766,"e95f72b03a3d9938fff8dc8ffead5981_type":"article","e95f72b03a3d9938fff8dc8ffead5981_title":"Neurostimulation","e95f72b03a3d9938fff8dc8ffead5981_url":"https:\/\/www.limswiki.org\/index.php\/Neurostimulation","e95f72b03a3d9938fff8dc8ffead5981_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tNeurostimulation\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tNeurostimulationOPS-301 code8-631[edit on Wikidata]\nNeurostimulation is the purposeful modulation of the nervous system's activity using invasive (e.g. microelectrodes) or non-invasive means (e.g. transcranial magnetic stimulation or transcranial electric stimulation, tES, such as tDCS or transcranial alternating current stimulation, tACS). Neurostimulation usually refers to the electromagnetic approaches to neuromodulation.\nNeurostimulation technology can improve the life quality of those who are severely paralyzed or suffering from profound losses to various sense organs, as well as for permanent reduction of severe, chronic pain which would otherwise require constant (around-the-clock), high-dose opioid therapy (such as neuropathic pain and spinal-cord injury). It serves as the key part of neural prosthetics for hearing aids, artificial vision, artificial limbs, and brain-machine interfaces. In the case of neural stimulation, mostly an electrical stimulation is utilized and charge-balanced biphasic constant current waveforms or capacitively coupled charge injection approaches are adopted. Alternatively, transcranial magnetic stimulation and transcranial electric stimulation have been proposed as non-invasive methods in which either a magnetic field or transcranially applied electric currents cause neurostimulation.[1][2]\n\nContents \n\n1 Brain stimulation \n2 Deep brain stimulation \n3 Non-invasive brain stimulation \n\n3.1 Transcranial magnetic stimulation \n3.2 Transcranial electrical stimulation \n\n\n4 Spinal cord stimulation \n5 Transcutaneous supraorbital nerve stimulation \n6 Cochlear implants \n7 Visual prosthesis \n8 Cardiac electrostimulation devices \n9 Stimulation microelectrode technologies \n10 History \n11 Research \n12 See also \n13 References \n\n\nBrain stimulation \nBrain stimulation has potentials to treat some disorders such as epilepsy. In this method, scheduled stimulation is applied to specific cortical or subcortical targets. There are available commercial devices[3] that can deliver an electrical pulse at scheduled time intervals. Scheduled stimulation is hypothesized to alter the intrinsic neurophysiologic properties of epileptic networks. The most explored targets for scheduled stimulation are the anterior nucleus of the thalamus and the hippocampus. The anterior nucleus of the thalamus has been studied, which has shown a significant seizure reduction with the stimulator on versus off during several months after stimulator implantation.[4] Moreover, the cluster headache (CH) can be treated by using a temporary stimulating electrode at sphenopalatine ganglion (SPG). Pain relief is reported within several minutes of stimulation in this method.[5] To avoid use of implanted electrodes, researchers have engineered ways to inscribe a \"window\" made of zirconia that has been modified to be transparent and implanted in mice skulls, to allow optical waves to penetrate more deeply, as in optogenetics, to stimulate or inhibit individual neurons.[6]\n\nDeep brain stimulation \nDeep brain stimulation (DBS) has shown benefits for movement disorders such as Parkinson's disease, tremor and dystonia and affective disorders such as depression, obsessive-compulsive disorder, Tourette syndrome, chronic pain and cluster headache. Since DBS can directly change the brain activity in a controlled manner, it is used to map fundamental mechanisms of brain functions along with neuroimaging methods. A simple DBS system consists of two different parts. First, tiny microelectrodes are implanted in the brain to deliver stimulation pulses to the tissue. Second, an electrical pulse generator (PG) generates stimulation pulses, which is connected to the electrodes via microwires.\nPhysiological properties of the brain tissue, which may change with disease state, stimulation parameters, which include amplitude and temporal characteristics, and the geometric configuration of the electrode and the surrounding tissue are all parameters on which DBS of both the normal and the diseased brain depend on. In spite of a huge amount of studies on DBS, its mechanism of action is still not well understood.\nDeveloping DBS microelectrodes is still challenging.[7]\n\nNon-invasive brain stimulation \n rTMS in a rodent. From Oscar Arias-Carri\u00f3n, 2008\nTranscranial magnetic stimulation \nMain article: Transcranial magnetic stimulation\nCompared to electrical stimulation that utilizes brief, high-voltage electric shock to activate neurons, which can potentially activate pain fibers, transcranial magnetic stimulation (TMS) was developed by Baker in 1985. TMS uses a magnetic wire above the scalp, which carries a sharp and high current pulse. A time variant magnetic field is induced perpendicular to the coil due to the applied pulse which consequently generates an electric field based on Maxwell's law. The electric field provides the necessary current for a non-invasive and much less painful stimulation. There are two TMS devices called single pulse TMS and repetitive pulse TMS (rTMS) while the latter has greater effect but potential to cause seizure. TMS can be used for therapy particularly in psychiatry, as a tool to measure central motor conduction and a research tool to study different aspects of human brain physiology such as motor function, vision, and language. The rTMS method has been used to treat epilepsy with rates of 8\u201325 Hz for 10 seconds. The other therapeutic uses of rTMS include parkinson diseases, dystonia and mood diseases. Also, TMS can be used to determine the contribution of cortical networks to specific cognitive functions by disrupting activity in the focal brain region.[1] Early, inconclusive, results have been obtained in recovery from coma (persistent vegetative state) by Pape et al. (2009).[8]\n\n Transcranial electrical stimulation techniques. While tDCS uses constant current intensity, tRNS and tACS use oscillating current. The vertical axis represents the current intensity in milliamp (mA), while the horizontal axis illustrates the time-course.\nTranscranial electrical stimulation \nThis section needs expansion. You can help by adding to it. (April 2017)\nTranscranial direct current stimulation (tDCS)\nTranscranial alternating current stimulation (tACS)\nTranscranial pulsed current stimulation (tPCS)\nTranscranial random noise stimulation (tRNS)\nSpinal cord stimulation \nSpinal cord stimulation (SCS) is an effective therapy for the treatment of chronic and intractable pain including diabetic neuropathy, failed back surgery syndrome, complex regional pain syndrome, phantom limb pain, ischemic limb pain, refractory unilateral limb pain syndrome, postherpetic neuralgia and acute herpes zoster pain. Another pain condition that is a potential candidate for SCS treatment is Charcot-Marie-Tooth (CMT) disease, which is associated with moderate to severe chronic extremity pain.[9] SCS therapy consists of the electrical stimulation of the spinal cord to 'mask' pain. The gate theory proposed in 1965 by Melzack and Wall[10] provided a theoretical construct to attempt SCS as a clinical treatment for chronic pain. This theory postulates that activation of large diameter, myelinated primary afferent fibers suppresses the response of dorsal horn neurons to input from small, unmyelinated primary afferents.\nA simple SCS system consists of three different parts. First, microelectrodes are implanted in the epidural space to deliver stimulation pulses to the tissue. Second, an electrical pulse generator implanted in the lower abdominal area or gluteal region while is connected to the electrodes via wires, and third a remote control to adjust the stimulus parameters such as pulse width and pulse rate in the PG. Improvements have been made in both the clinical aspects of SCS such as transition from subdural placement of contacts to epidural placement, which reduces the risk and morbidity of SCS implantation, and also technical aspects of SCS such as improving percutaneous leads, and fully implantable multi-channel stimulators. However, there are many parameters that need to be optimized including number of implanted contacts, contact size and spacing, and electrical sources for stimulation. The stimulus pulse width and pulse rate are important parameters that need to be adjusted in SCS, which are typically 400 us and 8\u2013200 Hz respectively.[11]\n\nTranscutaneous supraorbital nerve stimulation \nTentative evidence supports transcutaneous supraorbital nerve stimulation.[12] Side effects are few.[13]\n\nCochlear implants \n Cochlear implant\nCochlear implants have provided partial hearing to more than 120,000 persons worldwide as of 2008. The electrical stimulation is used in a cochlear implant to provide functional hearing in totally deafened persons. Cochlear implants include several subsystem components from the external speech processor and radio frequency (RF) transmission link to the internal receiver, stimulator, and electrode arrays. Modern cochlear implant research started in the 1960s and 1970s. In 1961, a crude single electrode device was implanted in two deaf patients and useful hearing with electric stimulation was reported. The first FDA approved complete single channel device was released in 1984.[14]\nIn cochlear implants, the sound is picked up by a microphone and transmitted to the behind-the-ear external processor to be converted to the digital data. The digitized data is then modulated on a radio frequency signal and transmitted to an antenna inside a headpiece. The data and power carrier are transmitted through a pair of coupled coils to the hermetically sealed internal unit. By extracting the power and demodulating the data, electric current commands are sent to the cochlea to stimulate the auditory nerve through microelectrodes.[15] The key point is that the internal unit does not have a battery and it should be able to extract the required energy. Also to reduce the infection, data is transmitted wirelessly along with power. Inductively coupled coils are the best candidate for power and data telemetry. Parameters needed by the internal unit include the pulse amplitude, pulse duration, pulse gap, active electrode, and return electrode that are used to define a biphasic pulse and the stimulation mode. An example of the commercial devices include Nucleus 22 device that utilized a carrier frequency of 2.5 MHz and later in the newer revision called Nucleus 24 device, the carrier frequency was increased to 5 MHz.[16] The internal unit in the cochlear implants is an ASIC (application-specific integrated circuit) chip that is responsible to ensure safe and reliable electric stimulation. Inside the ASIC chip, there is a forward pathway, a backward pathway, and control units. The forward pathway recovers digital information from the RF signal which includes stimulation parameters and some handshaking bits to reduce the communication error. The backward pathway usually includes a back telemetry voltage\nsampler that reads the voltage over a period of time on the recording electrode. The stimulator block is responsible to deliver predetermined current by external unit to the microelectrodes. This block includes a reference current and a digital to analog converter to transform digital commands to an analog current.[17]\n\nVisual prosthesis \n The Visual Cortical Implant\nTheoretical and experimental clinical evidences suggest that direct electrical stimulation of the retina might be able to provide some vision to subjects who have lost the photoreceptive elements of their retina.[18] Therefore, visual prostheses are developed to restore vision for the blind by using the stimulation. Depending upon which visual pathway location is targeted for neural stimulation, different approaches have been considered. Visual pathway consists mainly of the eye, optic nerve, lateral geniculate nucleus (LGN), and visual cortex. Therefore, retinal, optic nerve and visual cortex stimulation are the three different methods used in visual prostheses.[19]\nRetinal degenerative diseases, such as retinitis pigmentosa (RP) and age-related macular degeneration (AMD), are two likely candidate diseases in which retinal stimulation may be helpful. Three approaches called intraocular epiretinal, subretinal and extraocular transretinal stimulation are pursued in retinal devices that stimulate remaining retinal neural cells to bypass lost photoreceptors and allow the visual signal to reach the brain via the normal visual pathway. In epiretinal approach, electrodes are placed on the top side of the retina near ganglion cells,[20] whereas the electrodes are placed under the retina in subretinal approaches.[21] Finally, the posterior scleral surface of the eye is the place in which extraocular approach electrodes are positioned. Second Sight and the Humayun group at USC are the most active groups in the design of intraocular retinal prostheses. The ArgusTM 16 retinal implant is an intraocular retinal prosthesis utilizing video processing technologies.\nRegarding to the visual cortex stimulation, Brindley, and Dobelle were the first ones who did the experiments and demonstrated that by stimulating the top side of the visual cortex most of the electrodes can produce visual percept.[11] More recently Sawan built a complete implant for intracortical stimulation and validated the operation in rats[22]\n\n A pacemaker, scale in centimeters\nLGN, which is located in the midbrain to relay signals from the retina to the visual cortex, is another potential area that can be used for stimulation. But this area has limited access due to surgical difficulty. The recent success of deep brain stimulation techniques targeting the midbrain has encouraged research to pursue the approach of LGN stimulation for a visual prosthesis.[23]\n\nCardiac electrostimulation devices \nFurther information: Artificial cardiac pacemaker\nImplantable pacemakers were proposed for the first time in 1959 and became more sophisticated since then. The therapeutic application of pacemakers consists of numerous rhythm disturbances including some forms of tachycardia (too fast a heart beat), heart failure, and even stroke. Early implantable pacemakers worked only a short time and needed periodic recharging by an inductive link. These implantable pacemakers needed a pulse generator to stimulate heart muscles with a certain rate in addition to electrodes.[24] Today, modern pulse generators are programmed non-invasively by sophisticated computerized machines using RF, obtaining information about the patient's and device's status by telemetry. Also they use a single hermetically sealed lithium iodide (LiI) cell as the battery. The pacemaker circuitry includes sense amplifiers to detect the heart's intrinsic electrical signals, which are used to track heart activity, rate adaptive circuitry, which determine the need for increased or reduced pacing rate, a microprocessor, memory to store the parameters, telemetry control for communication protocol and power supplies to provide regulated voltage.[25]\n\nStimulation microelectrode technologies \n Utah microelectrode array\nMicroelectrodes are one of the key components of the neurostimulation, which deliver the current to neurons. Typical microelectrodes have three main components: a substrate (the carrier), a conductive metal layer, and an insulation material. In cochlear implants, microelectrodes are formed from platinum-iridium alloy. State-of-the-art electrodes include deeper insertion to better match the tonotopic place of stimulation to the frequency band assigned to each electrode channel, improving efficiency of stimulation, and reducing insertion related trauma. These cochlear implant electrodes are either straight or spiral such as Med El Combi 40+ and Advanced Bionics Helix microelectrodes respectively.\nIn visual implants, there are two types of electrode arrays called planar type or three dimensional needle or pillar type, where needle type array such as Utah array is mostly used for cortical and optic nerve stimulations and rarely used in retinal implants due to the possible damage of retina. However, a pillar-shaped gold electrode array on thin-film polyimide has been used in an extraocular implant. On the other hand, planar electrode arrays are formed from flexible polymers, such as silicone, polyimide, and parylene as candidates for retinal implants.\nRegarding to DBS microelectrodes an array, which can be controlled independently, distributed throughout the target nucleus would permit precise control of the spatial distribution of the stimulation, and thus, allow better personalized DBS. There are several requirements for DBS microelectrodes that include long lifetime without injury to the tissue or degradation of the electrodes, customized for different brain sites, long-term biocompatibility of the material, mechanically durable in order to reach the target without being damaged during handling by the implant surgeon, and finally uniformity of performance across the microelectrodes in a particular array. Tungsten microwire, iridium microwires, and sputtered or electrodeposited[26] Platinum-iridium alloy microelectrodes are the examples of microelectrode used in DBS.[11] Silicon carbide is a potential interesting material for realizing biocompatible semiconductor devices.[27]\n\nHistory \nThe primary findings about neurostimulation originated from the idea to stimulate nerves for therapeutic purposes. The 1st recorded use of electrical stimulation for pain relief goes back to 46 AD, when Scribonius Largus used torpedo fish (electric ray) for relieving headaches.[28] In the late 18th century, Luigi Galvani discovered that the muscles of dead frog legs twitched when struck by direct current on the nervous system.[29] The modulation of the brain activity by electrical stimulation of the motor cortex in dogs was shown in 1870 that resulted in limb movement.[30] From the late 18th century to today many milestones have been developed. Nowadays, sensory prosthetic devices, such as visual implants, cochlear implants, auditory midbrain implants, and spinal cord stimulators and also motor prosthetic devices, such as deep brain stimulators, Bion microstimulators, the brain control and sensing interface, and cardiac electro-stimulation devices are widely used.[11]\nIn 2013 the British pharmaceutical company GlaxoSmithKline (GSK) coined the term \"electroceutical\" to broadly encompass medical devices that use electrical, mechanical, or light stimulation to affect electrical signaling in relevant tissue types.[31][32] Clinical neural implants such as cochlear implants to restore hearing, retinal implants to restore sight, spinal cord stimulators for pain relief or cardiac pacemakers and implantable defibrillators are proposed examples of electroceuticals.[31] GSK formed a venture fund and said it would host a conference in 2013 to lay out a research agenda for the field.[33] A 2016 review of research on interactions between the nervous and immune systems in autoimmune disorders and mentioned \"electroceuticals\" in passing and quotation marks, referring to neurostimulation devices in development for conditions like arthritis.[34]\n\nResearch \nIn addition to the enormous usage of neurostimulation for clinical applications, it is also used widely in laboratories started dates back to 1920s by people link Delgado who used stimulation as an experimental manipulation to study basics of how the brain works. The primary works were on the reward center of the brain in which stimulation of those structures led to pleasure that requested more stimulation. Another most recent example is the electrical stimulation of the MT area of primary visual cortex to bias perception. In particular, the directionality of motion is represented in a regular way in the MT area. They presented monkeys with moving images on screen and monkey throughput was to determine what the direction is. They found that by systematically introducing some errors to the monkey's responses, by stimulating the MT area which is responsible for perceiving the motion in another direction, the monkey responded to somewhere in between the actual motion and the stimulated one. This was an elegant use of stimulation to show that MT area is essential in the actual perception of motion. Within the memory field, stimulation is used very frequently to test the strength of the connection between one bundle of cells to another by applying a small current in one cell which results in the release of neurotransmitters and measuring the postsynaptic potential.\nGenerally, a short but high-frequency current in the range of 100 Hz helps strengthening the connection known as long-term potentiation. However, longer but low-frequency current tends to weaken the connections known as long-term depression.[35] tends to weaken the connections known as long-term depression.[35]\n\nSee also \nNon-invasive cerebellar stimulation\nReferences \n\n\n^ a b Hallett M (July 2000). \"Transcranial magnetic stimulation and the human brain\". Nature. 406 (6792): 147\u201350. doi:10.1038\/35018000. PMID 10910346. \n\n^ Nitsche, Michael A.; Cohen, Leonardo G.; Wassermann, Eric M.; Priori, Alberto; Lang, Nicolas; Antal, Andrea; Paulus, Walter; Hummel, Friedhelm; Boggio, Paulo S.; Fregni, Felipe; Pascual-Leone, Alvaro (2008). \"Transcranial direct current stimulation: State of the art 2008\". Brain Stimulation 1 (3): 206\u201323. \n\n^ Medtronic, Minneapolis, MN, U.S.A. \n\n^ Jobst BC, Darcey TM, Thadani VM, Roberts DW (July 2010). \"Brain stimulation for the treatment of epilepsy\". Epilepsia. 51 (Suppl 3): 88\u201392. doi:10.1111\/j.1528-1167.2010.02618.x. PMID 20618409. \n\n^ Ansarinia M, Rezai A, Tepper SJ, et al. (July 2010). \"Electrical stimulation of sphenopalatine ganglion for acute treatment of cluster headaches\". Headache. 50 (7): 1164\u201374. doi:10.1111\/j.1526-4610.2010.01661.x. PMID 20438584. \n\n^ Damestani, Yasaman (2013). \"Transparent nanocrystalline yttria-stabilized-zirconia calvarium prosthesis\". Nanomedicine. Elsevier Inc. 9 (8): 1135\u20138. doi:10.1016\/j.nano.2013.08.002. PMID 23969102. Retrieved September 11, 2013 . \u2022 Explained by Mohan, Geoffrey (September 4, 2013). \"A window to the brain? It's here, says UC Riverside team\". Los Angeles Times. \n\n^ Kringelbach ML, Jenkinson N, Owen SL, Aziz TZ (August 2007). \"Translational principles of deep brain stimulation\". Nat. Rev. Neurosci. 8 (8): 623\u201335. doi:10.1038\/nrn2196. PMID 17637800. \n\n^ Pape T, Rosenow J, Lewis G, Ahmed G, Walker M, Guernon A, Roth H, Patil V. (2009). Repetitive transcranial magnetic stimulation-associated neurobehavioral gains during coma recovery, Brain Stimul, 2(1):22-35. Epub 2008 Oct 23. \n\n^ Skaribas I.M.; Washburn S.N. (January 2010). \"Successful treatment of charcot-marie-tooth chronic pain with spinal cord stimulation: A case study\". Neuromodulation. 13 (3): 224\u20138. doi:10.1111\/j.1525-1403.2009.00272.x. \n\n^ Melzack R, Wall PD (November 1965). \"Pain mechanisms: a new theory\". Science. 150 (3699): 971\u20139. Bibcode:1965Sci...150..971M. doi:10.1126\/science.150.3699.971. PMID 5320816. \n\n^ a b c d Greenbaum, Elias S.; David Zhou (2009). Implantable Neural Prostheses 1: Devices and Applications. Biological and Medical Physics, Biomedical Engineering. Berlin: Springer. ISBN 0-387-77260-X. \n\n^ J\u00fcrgens, TP; Leone, M (Jun 2013). \"Pearls and pitfalls: neurostimulation in headache\". Cephalalgia: An International Journal of Headache. 33 (8): 512\u201325. doi:10.1177\/0333102413483933. PMID 23671249. \n\n^ Schoenen, J; Roberta, B; Magis, D; Coppola, G (29 March 2016). \"Noninvasive neurostimulation methods for migraine therapy: The available evidence\". Cephalalgia: An International Journal of Headache. 36: 1170\u20131180. doi:10.1177\/0333102416636022. PMID 27026674. \n\n^ House WF, Urban J (1973). \"Long term results of electrode implantation and electronic stimulation of the cochlea in man\". Ann. Otol. Rhinol. Laryngol. 82 (4): 504\u201317. doi:10.1177\/000348947308200408. PMID 4721186. \n\n^ An SK, Park SI, Jun SB, et al. (June 2007). \"Design for a simplified cochlear implant system\". IEEE Trans Biomed Eng. 54 (6 Pt 1): 973\u201382. doi:10.1109\/TBME.2007.895372. PMID 17554817. \n\n^ P. Crosby, C. Daly, D. Money, and et al., Aug. 1985, \" Cochlear implant system for an auditory prosthesis,\" United States Patent 4532930. \n\n^ Ghovanloo M.; Najafi K. (December 2004). \"A modular 32-site wireless neural stimulation microsystem\". IEEE J. Solid State Cir. 39: 2457\u201366. doi:10.1109\/jssc.2004.837026. \n\n^ Clausen J (1955). \"Visual sensations (phosphenes) produced by AC sine wave stimulation\". Acta Psychiatr Neurol Scand Suppl. 94: 1\u2013101. PMID 13258326. \n\n^ Weiland J.D.; Humayun M.S. (July 2008). \"Visual prosthesis\". Proceedings of the IEEE. 96 (7): 1076\u201384. doi:10.1109\/JPROC.2008.922589. \n\n^ Humayun MS, de Juan E, Dagnelie G, Greenberg RJ, Propst RH, Phillips DH (January 1996). \"Visual perception elicited by electrical stimulation of retina in blind humans\". Arch. Ophthalmol. 114 (1): 40\u20136. doi:10.1001\/archopht.1996.01100130038006. PMID 8540849. [permanent dead link ] \n\n^ Chow AY, Chow VY (March 1997). \"Subretinal electrical stimulation of the rabbit retina\". Neurosci. Lett. 225 (1): 13\u20136. doi:10.1016\/S0304-3940(97)00185-7. PMID 9143006. \n\n^ Sawan, Mohamad. [mohamadsawan.org mohamadsawan.org] Check |url= value (help) . Missing or empty |title= (help) \n\n^ Pezaris JS, Reid RC (May 2007). \"Demonstration of artificial visual percepts generated through thalamic microstimulation\". Proc. Natl. Acad. Sci. U.S.A. 104 (18): 7670\u20135. Bibcode:2007PNAS..104.7670P. doi:10.1073\/pnas.0608563104. PMC 1863473 . PMID 17452646. \n\n^ Elmvquist R.; Senning A. (1960). \"Implantable pacemaker for the heart\". In Smyth CN. Medical electronics. Paris: Iliffe & Sons. \n\n^ Warren J., Nelson J. (2000). \"Pacemakers and ICD pulse generator circuitry\". In Ellenbogen KA, Kay GN, Wilkoff BL. Clinical cardiac pacing and defibrillation (2nd ed.). Philadelphia: WB Saunders. pp. 194\u2013216. \n\n^ http:\/\/www.platinumgroupcoatings.com\/#!technology\/c1l1j \n\n^ Saddow SE (2011). Silicon Carbide Biotechnology: A Biocompatible Semiconductor for Advanced Biomedical Devices and Applications. Elsevier LTD. ISBN 0-12385-906-9. \n\n^ Jensen JE, Conn RR, Hazelrigg G, Hewett JE (1985). \"The use of transcutaneous neural stimulation and isokinetic testing in arthroscopic knee surgery\". Am J Sports Med. 13 (1): 27\u201333. doi:10.1177\/036354658501300105. PMID 3872082. \n\n^ Weisstein, Eric W. (2002). \"Galvani, Luigi (1737\u20131798)\". Eric Weisstein's World of Scientific Biography. Wolfram Research. \n\n^ Fritsch G.; Hitzig E. (1870). \"Uber die elektrische Erregbarkeit des Grosshirns\". Arch. Anat. Physiol. 37: 300\u2013332. \n\n^ a b Moore, Samuel (29 May 2015). \"The Vagus Nerve: A Back Door for Brain Hacking\". IEEE Spectrum. Retrieved 4 June 2015 . \n\n^ Famm, Kristoffer; Litt, Brian; Tracey, Kevin J.; Boyden, Edward S.; Slaoui, Moncef (10 April 2013). \"Drug discovery: A jump-start for electroceuticals\". Nature. 496 (7444): 159\u2013161. Bibcode:2013Natur.496..159F. doi:10.1038\/496159a. PMC 4179459 . PMID 23579662. \n\n^ Solon, Olivia (28 May 2013). \"Electroceuticals: swapping drugs for devices\". Wired UK. \n\n^ Reardon, Colin (October 2016). \"Neuro-immune interactions in the cholinergic anti-inflammatory reflex\". Immunology Letters. 178: 92\u201396. doi:10.1016\/j.imlet.2016.08.006. PMID 27542331. \n\n^ a b Interview with Dr. J. Manns, Emory University, Oct. 2010 \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Neurostimulation\">https:\/\/www.limswiki.org\/index.php\/Neurostimulation<\/a>\n\t\t\t\t\tCategories: Medical and surgical techniquesNeurostimulationHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 17:30.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 841 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","e95f72b03a3d9938fff8dc8ffead5981_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Neurostimulation skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Neurostimulation<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Neurostimulation<\/b> is the purposeful modulation of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nervous_system\" title=\"Nervous system\" rel=\"external_link\" target=\"_blank\">nervous system<\/a>'s activity using invasive (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microelectrodes\" class=\"mw-redirect\" title=\"Microelectrodes\" rel=\"external_link\" target=\"_blank\">microelectrodes<\/a>) or non-invasive means (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcranial_magnetic_stimulation\" title=\"Transcranial magnetic stimulation\" rel=\"external_link\" target=\"_blank\">transcranial magnetic stimulation<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcranial_electric_stimulation\" class=\"mw-redirect\" title=\"Transcranial electric stimulation\" rel=\"external_link\" target=\"_blank\">transcranial electric stimulation<\/a>, tES, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcranial_direct-current_stimulation\" title=\"Transcranial direct-current stimulation\" rel=\"external_link\" target=\"_blank\">tDCS<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcranial_alternating_current_stimulation\" class=\"mw-redirect\" title=\"Transcranial alternating current stimulation\" rel=\"external_link\" target=\"_blank\">transcranial alternating current stimulation<\/a>, tACS). Neurostimulation usually refers to the electromagnetic approaches to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromodulation_(medicine)\" title=\"Neuromodulation (medicine)\" rel=\"external_link\" target=\"_blank\">neuromodulation<\/a>.\n<\/p><p>Neurostimulation technology can improve the life quality of those who are severely paralyzed or suffering from profound losses to various sense organs, as well as for permanent reduction of severe, chronic pain which would otherwise require constant (around-the-clock), high-dose opioid therapy (such as neuropathic pain and spinal-cord injury). It serves as the key part of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neural_prosthetics\" class=\"mw-redirect\" title=\"Neural prosthetics\" rel=\"external_link\" target=\"_blank\">neural prosthetics<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hearing_aids\" class=\"mw-redirect\" title=\"Hearing aids\" rel=\"external_link\" target=\"_blank\">hearing aids<\/a>, artificial vision, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_limb\" class=\"mw-redirect\" title=\"Artificial limb\" rel=\"external_link\" target=\"_blank\">artificial limbs<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain-machine_interfaces\" class=\"mw-redirect\" title=\"Brain-machine interfaces\" rel=\"external_link\" target=\"_blank\">brain-machine interfaces<\/a>. In the case of neural <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stimulation\" title=\"Stimulation\" rel=\"external_link\" target=\"_blank\">stimulation<\/a>, mostly an electrical stimulation is utilized and charge-balanced biphasic constant current waveforms or capacitively coupled charge injection approaches are adopted. Alternatively, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcranial_magnetic_stimulation\" title=\"Transcranial magnetic stimulation\" rel=\"external_link\" target=\"_blank\">transcranial magnetic stimulation<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcranial_electric_stimulation\" class=\"mw-redirect\" title=\"Transcranial electric stimulation\" rel=\"external_link\" target=\"_blank\">transcranial electric stimulation<\/a> have been proposed as non-invasive methods in which either a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_field\" title=\"Magnetic field\" rel=\"external_link\" target=\"_blank\">magnetic field<\/a> or transcranially applied electric currents cause neurostimulation.<sup id=\"rdp-ebb-cite_ref-hal_1-0\" class=\"reference\"><a href=\"#cite_note-hal-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Brain_stimulation\">Brain stimulation<\/span><\/h2>\n<p>Brain stimulation has potentials to treat some disorders such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epilepsy\" title=\"Epilepsy\" rel=\"external_link\" target=\"_blank\">epilepsy<\/a>. In this method, scheduled stimulation is applied to specific cortical or subcortical targets. There are available commercial devices<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> that can deliver an electrical pulse at scheduled time intervals. Scheduled stimulation is hypothesized to alter the intrinsic neurophysiologic properties of epileptic networks. The most explored targets for scheduled stimulation are the anterior nucleus of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thalamus\" title=\"Thalamus\" rel=\"external_link\" target=\"_blank\">thalamus<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hippocampus\" title=\"Hippocampus\" rel=\"external_link\" target=\"_blank\">hippocampus<\/a>. The anterior nucleus of the thalamus has been studied, which has shown a significant seizure reduction with the stimulator <i>on<\/i> versus <i>off<\/i> during several months after stimulator implantation.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Moreover, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cluster_headache\" title=\"Cluster headache\" rel=\"external_link\" target=\"_blank\">cluster headache<\/a> (CH) can be treated by using a temporary stimulating electrode at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sphenopalatine_ganglion\" class=\"mw-redirect\" title=\"Sphenopalatine ganglion\" rel=\"external_link\" target=\"_blank\">sphenopalatine ganglion<\/a> (SPG). Pain relief is reported within several minutes of stimulation in this method.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> To avoid use of implanted electrodes, researchers have engineered ways to inscribe a \"window\" made of zirconia that has been modified to be transparent and implanted in mice skulls, to allow optical waves to penetrate more deeply, as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optogenetics\" title=\"Optogenetics\" rel=\"external_link\" target=\"_blank\">optogenetics<\/a>, to stimulate or inhibit individual neurons.<sup id=\"rdp-ebb-cite_ref-Nanomedicine201308_6-0\" class=\"reference\"><a href=\"#cite_note-Nanomedicine201308-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Deep_brain_stimulation\">Deep brain stimulation<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Deep_brain_stimulation\" title=\"Deep brain stimulation\" rel=\"external_link\" target=\"_blank\">Deep brain stimulation<\/a> (DBS) has shown benefits for movement disorders such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parkinson%27s_disease\" title=\"Parkinson's disease\" rel=\"external_link\" target=\"_blank\">Parkinson's disease<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tremor\" title=\"Tremor\" rel=\"external_link\" target=\"_blank\">tremor<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dystonia\" title=\"Dystonia\" rel=\"external_link\" target=\"_blank\">dystonia<\/a> and affective disorders such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Major_depressive_disorder\" title=\"Major depressive disorder\" rel=\"external_link\" target=\"_blank\">depression<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Obsessive-compulsive_disorder\" class=\"mw-redirect\" title=\"Obsessive-compulsive disorder\" rel=\"external_link\" target=\"_blank\">obsessive-compulsive disorder<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tourette_syndrome\" title=\"Tourette syndrome\" rel=\"external_link\" target=\"_blank\">Tourette syndrome<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_pain\" title=\"Chronic pain\" rel=\"external_link\" target=\"_blank\">chronic pain<\/a> and cluster headache. Since DBS can directly change the brain activity in a controlled manner, it is used to map fundamental mechanisms of brain functions along with neuroimaging methods. A simple DBS system consists of two different parts. First, tiny microelectrodes are implanted in the brain to deliver stimulation pulses to the tissue. Second, an electrical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse_generator\" title=\"Pulse generator\" rel=\"external_link\" target=\"_blank\">pulse generator<\/a> (PG) generates stimulation pulses, which is connected to the electrodes via microwires.\nPhysiological properties of the brain tissue, which may change with disease state, stimulation parameters, which include amplitude and temporal characteristics, and the geometric configuration of the electrode and the surrounding tissue are all parameters on which DBS of both the normal and the diseased brain depend on. In spite of a huge amount of studies on DBS, its mechanism of action is still not well understood.\nDeveloping DBS microelectrodes is still challenging.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Non-invasive_brain_stimulation\">Non-invasive brain stimulation<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Repetitive_transcranial_magnetic_stimulation_(rTMS)_is_a_technique_for_noninvasive_stimulation_of_the_adult_brain.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/16\/Repetitive_transcranial_magnetic_stimulation_%28rTMS%29_is_a_technique_for_noninvasive_stimulation_of_the_adult_brain.jpg\/220px-Repetitive_transcranial_magnetic_stimulation_%28rTMS%29_is_a_technique_for_noninvasive_stimulation_of_the_adult_brain.jpg\" width=\"220\" height=\"205\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Repetitive_transcranial_magnetic_stimulation_(rTMS)_is_a_technique_for_noninvasive_stimulation_of_the_adult_brain.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>rTMS in a rodent. From Oscar Arias-Carri\u00f3n, 2008<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Transcranial_magnetic_stimulation\">Transcranial magnetic stimulation<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcranial_magnetic_stimulation\" title=\"Transcranial magnetic stimulation\" rel=\"external_link\" target=\"_blank\">Transcranial magnetic stimulation<\/a><\/div>\n<p>Compared to electrical stimulation that utilizes brief, high-voltage electric shock to activate neurons, which can potentially activate pain fibers, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcranial_magnetic_stimulation\" title=\"Transcranial magnetic stimulation\" rel=\"external_link\" target=\"_blank\">transcranial magnetic stimulation (TMS)<\/a> was developed by Baker in 1985. TMS uses a magnetic wire above the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scalp\" title=\"Scalp\" rel=\"external_link\" target=\"_blank\">scalp<\/a>, which carries a sharp and high current pulse. A time variant magnetic field is induced perpendicular to the coil due to the applied pulse which consequently generates an electric field based on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Maxwell%27s_equations\" title=\"Maxwell's equations\" rel=\"external_link\" target=\"_blank\">Maxwell<\/a>'s law. The electric field provides the necessary current for a non-invasive and much less painful stimulation. There are two TMS devices called single pulse TMS and repetitive pulse TMS (rTMS) while the latter has greater effect but potential to cause seizure. TMS can be used for therapy particularly in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Psychiatry\" title=\"Psychiatry\" rel=\"external_link\" target=\"_blank\">psychiatry<\/a>, as a tool to measure central motor conduction and a research tool to study different aspects of human brain physiology such as motor function, vision, and language. The rTMS method has been used to treat epilepsy with rates of 8\u201325 Hz for 10 seconds. The other therapeutic uses of rTMS include parkinson diseases, dystonia and mood diseases. Also, TMS can be used to determine the contribution of cortical networks to specific cognitive functions by disrupting activity in the focal brain region.<sup id=\"rdp-ebb-cite_ref-hal_1-1\" class=\"reference\"><a href=\"#cite_note-hal-1\" rel=\"external_link\">[1]<\/a><\/sup> Early, inconclusive, results have been obtained in recovery from coma (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Persistent_vegetative_state\" title=\"Persistent vegetative state\" rel=\"external_link\" target=\"_blank\">persistent vegetative state<\/a>) by Pape et al. (2009).<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Fnhum-07-00435-g001.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8e\/Fnhum-07-00435-g001.jpg\/220px-Fnhum-07-00435-g001.jpg\" width=\"220\" height=\"213\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Fnhum-07-00435-g001.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Transcranial electrical stimulation techniques. While tDCS uses constant current intensity, tRNS and tACS use oscillating current. The vertical axis represents the current intensity in milliamp (mA), while the horizontal axis illustrates the time-course.<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Transcranial_electrical_stimulation\">Transcranial electrical stimulation<\/span><\/h3>\n\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcranial_direct_current_stimulation\" class=\"mw-redirect\" title=\"Transcranial direct current stimulation\" rel=\"external_link\" target=\"_blank\">Transcranial direct current stimulation<\/a> (tDCS)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcranial_alternating_current_stimulation\" class=\"mw-redirect\" title=\"Transcranial alternating current stimulation\" rel=\"external_link\" target=\"_blank\">Transcranial alternating current stimulation<\/a> (tACS)<\/li>\n<li> (tPCS)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcranial_random_noise_stimulation\" title=\"Transcranial random noise stimulation\" rel=\"external_link\" target=\"_blank\">Transcranial random noise stimulation<\/a> (tRNS)<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Spinal_cord_stimulation\">Spinal cord stimulation<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_stimulation\" class=\"mw-redirect\" title=\"Spinal cord stimulation\" rel=\"external_link\" target=\"_blank\">Spinal cord stimulation<\/a> (SCS) is an effective therapy for the treatment of chronic and intractable pain including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetic_neuropathy\" title=\"Diabetic neuropathy\" rel=\"external_link\" target=\"_blank\">diabetic neuropathy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Failed_back_syndrome\" title=\"Failed back syndrome\" rel=\"external_link\" target=\"_blank\">failed back surgery syndrome<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Complex_regional_pain_syndrome\" title=\"Complex regional pain syndrome\" rel=\"external_link\" target=\"_blank\">complex regional pain syndrome<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phantom_limb\" title=\"Phantom limb\" rel=\"external_link\" target=\"_blank\">phantom limb<\/a> pain, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Critical_limb_ischemia\" title=\"Critical limb ischemia\" rel=\"external_link\" target=\"_blank\">ischemic limb<\/a> pain, refractory unilateral limb pain syndrome, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Postherpetic_neuralgia\" title=\"Postherpetic neuralgia\" rel=\"external_link\" target=\"_blank\">postherpetic neuralgia<\/a> and acute <a href=\"https:\/\/en.wikipedia.org\/wiki\/Herpes_zoster\" class=\"mw-redirect\" title=\"Herpes zoster\" rel=\"external_link\" target=\"_blank\">herpes zoster<\/a> pain. Another pain condition that is a potential candidate for SCS treatment is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Charcot-Marie-Tooth\" class=\"mw-redirect\" title=\"Charcot-Marie-Tooth\" rel=\"external_link\" target=\"_blank\">Charcot-Marie-Tooth<\/a> (CMT) disease, which is associated with moderate to severe chronic extremity pain.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> SCS therapy consists of the electrical stimulation of the spinal cord to 'mask' pain. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gate_theory\" class=\"mw-redirect\" title=\"Gate theory\" rel=\"external_link\" target=\"_blank\">gate theory<\/a> proposed in 1965 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Melzack\" class=\"mw-redirect\" title=\"Melzack\" rel=\"external_link\" target=\"_blank\">Melzack<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wall\" title=\"Wall\" rel=\"external_link\" target=\"_blank\">Wall<\/a><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> provided a theoretical construct to attempt SCS as a clinical treatment for chronic pain. This theory postulates that activation of large diameter, myelinated primary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Afferent_fibers\" class=\"mw-redirect\" title=\"Afferent fibers\" rel=\"external_link\" target=\"_blank\">afferent fibers<\/a> suppresses the response of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Posterior_horn_of_spinal_cord\" class=\"mw-redirect\" title=\"Posterior horn of spinal cord\" rel=\"external_link\" target=\"_blank\">dorsal horn<\/a> neurons to input from small, unmyelinated primary afferents.\nA simple SCS system consists of three different parts. First, microelectrodes are implanted in the epidural space to deliver stimulation pulses to the tissue. Second, an electrical pulse generator implanted in the lower abdominal area or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteal_region\" class=\"mw-redirect\" title=\"Gluteal region\" rel=\"external_link\" target=\"_blank\">gluteal region<\/a> while is connected to the electrodes via wires, and third a remote control to adjust the stimulus parameters such as pulse width and pulse rate in the PG. Improvements have been made in both the clinical aspects of SCS such as transition from subdural placement of contacts to epidural placement, which reduces the risk and morbidity of SCS implantation, and also technical aspects of SCS such as improving percutaneous leads, and fully implantable multi-channel stimulators. However, there are many parameters that need to be optimized including number of implanted contacts, contact size and spacing, and electrical sources for stimulation. The stimulus pulse width and pulse rate are important parameters that need to be adjusted in SCS, which are typically 400 us and 8\u2013200 Hz respectively.<sup id=\"rdp-ebb-cite_ref-zho_11-0\" class=\"reference\"><a href=\"#cite_note-zho-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Transcutaneous_supraorbital_nerve_stimulation\">Transcutaneous supraorbital nerve stimulation<\/span><\/h2>\n<p>Tentative evidence supports transcutaneous supraorbital nerve stimulation.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> Side effects are few.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Cochlear_implants\">Cochlear implants<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cochlear_implant.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cb\/Cochlear_implant.jpg\/250px-Cochlear_implant.jpg\" width=\"250\" height=\"263\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cochlear_implant.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Cochlear implant<\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implants\" class=\"mw-redirect\" title=\"Cochlear implants\" rel=\"external_link\" target=\"_blank\">Cochlear implants<\/a> have provided partial hearing to more than 120,000 persons worldwide as of 2008. The electrical stimulation is used in a cochlear implant to provide functional hearing in totally deafened persons. Cochlear implants include several subsystem components from the external speech processor and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radio_frequency\" title=\"Radio frequency\" rel=\"external_link\" target=\"_blank\">radio frequency<\/a> (RF) transmission link to the internal receiver, stimulator, and electrode arrays. Modern cochlear implant research started in the 1960s and 1970s. In 1961, a crude single electrode device was implanted in two deaf patients and useful hearing with electric stimulation was reported. The first FDA approved complete single channel device was released in 1984.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\nIn cochlear implants, the sound is picked up by a microphone and transmitted to the behind-the-ear external processor to be converted to the digital data. The digitized data is then modulated on a radio frequency signal and transmitted to an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antenna_(radio)\" title=\"Antenna (radio)\" rel=\"external_link\" target=\"_blank\">antenna<\/a> inside a headpiece. The data and power carrier are transmitted through a pair of coupled coils to the hermetically sealed internal unit. By extracting the power and demodulating the data, electric current commands are sent to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlea\" title=\"Cochlea\" rel=\"external_link\" target=\"_blank\">cochlea<\/a> to stimulate the auditory nerve through microelectrodes.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> The key point is that the internal unit does not have a battery and it should be able to extract the required energy. Also to reduce the infection, data is transmitted wirelessly along with power. Inductively coupled coils are the best candidate for power and data telemetry. Parameters needed by the internal unit include the pulse amplitude, pulse duration, pulse gap, active electrode, and return electrode that are used to define a biphasic pulse and the stimulation mode. An example of the commercial devices include Nucleus 22 device that utilized a carrier frequency of 2.5 MHz and later in the newer revision called Nucleus 24 device, the carrier frequency was increased to 5 MHz.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> The internal unit in the cochlear implants is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/ASIC\" class=\"mw-redirect\" title=\"ASIC\" rel=\"external_link\" target=\"_blank\">ASIC<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Application-specific_integrated_circuit\" title=\"Application-specific integrated circuit\" rel=\"external_link\" target=\"_blank\">application-specific integrated circuit<\/a>) chip that is responsible to ensure safe and reliable electric stimulation. Inside the ASIC chip, there is a forward pathway, a backward pathway, and control units. The forward pathway recovers digital information from the RF signal which includes stimulation parameters and some handshaking bits to reduce the communication error. The backward pathway usually includes a back telemetry voltage\nsampler that reads the voltage over a period of time on the recording electrode. The stimulator block is responsible to deliver predetermined current by external unit to the microelectrodes. This block includes a reference current and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_to_analog_converter\" class=\"mw-redirect\" title=\"Digital to analog converter\" rel=\"external_link\" target=\"_blank\">digital to analog converter<\/a> to transform digital commands to an analog current.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Visual_prosthesis\">Visual prosthesis<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ImplantSawan.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Visual cortical implant designed by Mohamad Sawan\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/66\/ImplantSawan.JPG\/220px-ImplantSawan.JPG\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ImplantSawan.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The Visual Cortical Implant<\/div><\/div><\/div>\n<p>Theoretical and experimental clinical evidences suggest that direct electrical stimulation of the retina might be able to provide some vision to subjects who have lost the photoreceptive elements of their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retina\" title=\"Retina\" rel=\"external_link\" target=\"_blank\">retina<\/a>.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> Therefore, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_prosthesis\" title=\"Visual prosthesis\" rel=\"external_link\" target=\"_blank\">visual prostheses<\/a> are developed to restore vision for the blind by using the stimulation. Depending upon which <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_pathway\" class=\"mw-redirect\" title=\"Visual pathway\" rel=\"external_link\" target=\"_blank\">visual pathway<\/a> location is targeted for neural stimulation, different approaches have been considered. Visual pathway consists mainly of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_eye\" title=\"Human eye\" rel=\"external_link\" target=\"_blank\">eye<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optic_nerve\" title=\"Optic nerve\" rel=\"external_link\" target=\"_blank\">optic nerve<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lateral_geniculate_nucleus\" title=\"Lateral geniculate nucleus\" rel=\"external_link\" target=\"_blank\">lateral geniculate nucleus<\/a> (LGN), and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_cortex\" title=\"Visual cortex\" rel=\"external_link\" target=\"_blank\">visual cortex<\/a>. Therefore, retinal, optic nerve and visual cortex stimulation are the three different methods used in visual prostheses.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\nRetinal degenerative diseases, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinitis_pigmentosa\" title=\"Retinitis pigmentosa\" rel=\"external_link\" target=\"_blank\">retinitis pigmentosa<\/a> (RP) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Age-related_macular_degeneration\" class=\"mw-redirect\" title=\"Age-related macular degeneration\" rel=\"external_link\" target=\"_blank\">age-related macular degeneration<\/a> (AMD), are two likely candidate diseases in which retinal stimulation may be helpful. Three approaches called intraocular epiretinal, subretinal and extraocular transretinal stimulation are pursued in retinal devices that stimulate remaining retinal neural cells to bypass lost photoreceptors and allow the visual signal to reach the brain via the normal visual pathway. In epiretinal approach, electrodes are placed on the top side of the retina near <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinal_ganglion_cell\" title=\"Retinal ganglion cell\" rel=\"external_link\" target=\"_blank\">ganglion cells<\/a>,<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> whereas the electrodes are placed under the retina in subretinal approaches.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> Finally, the posterior scleral surface of the eye is the place in which extraocular approach electrodes are positioned. Second Sight and the Humayun group at USC are the most active groups in the design of intraocular retinal prostheses. The ArgusTM 16 retinal implant is an intraocular retinal prosthesis utilizing video processing technologies.\nRegarding to the visual cortex stimulation, Brindley, and Dobelle were the first ones who did the experiments and demonstrated that by stimulating the top side of the visual cortex most of the electrodes can produce visual percept.<sup id=\"rdp-ebb-cite_ref-zho_11-1\" class=\"reference\"><a href=\"#cite_note-zho-11\" rel=\"external_link\">[11]<\/a><\/sup> More recently Sawan built a complete implant for intracortical stimulation and validated the operation in rats<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pacemaker_GuidantMeridianSR.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b1\/Pacemaker_GuidantMeridianSR.jpg\/220px-Pacemaker_GuidantMeridianSR.jpg\" width=\"220\" height=\"240\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pacemaker_GuidantMeridianSR.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A pacemaker, scale in centimeters<\/div><\/div><\/div>\n<p>LGN, which is located in the midbrain to relay signals from the retina to the visual cortex, is another potential area that can be used for stimulation. But this area has limited access due to surgical difficulty. The recent success of deep brain stimulation techniques targeting the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Midbrain\" title=\"Midbrain\" rel=\"external_link\" target=\"_blank\">midbrain<\/a> has encouraged research to pursue the approach of LGN stimulation for a visual prosthesis.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Cardiac_electrostimulation_devices\">Cardiac electrostimulation devices<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_cardiac_pacemaker\" title=\"Artificial cardiac pacemaker\" rel=\"external_link\" target=\"_blank\">Artificial cardiac pacemaker<\/a><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_cardiac_pacemaker\" title=\"Artificial cardiac pacemaker\" rel=\"external_link\" target=\"_blank\">Implantable pacemakers<\/a> were proposed for the first time in 1959 and became more sophisticated since then. The therapeutic application of pacemakers consists of numerous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_arrythmia\" class=\"mw-redirect\" title=\"Heart arrythmia\" rel=\"external_link\" target=\"_blank\">rhythm disturbances<\/a> including some forms of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tachycardia\" title=\"Tachycardia\" rel=\"external_link\" target=\"_blank\">tachycardia<\/a> (too fast a heart beat), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_failure\" title=\"Heart failure\" rel=\"external_link\" target=\"_blank\">heart failure<\/a>, and even <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a>. Early implantable pacemakers worked only a short time and needed periodic recharging by an inductive link. These implantable pacemakers needed a pulse generator to stimulate heart <a href=\"https:\/\/en.wikipedia.org\/wiki\/Muscles\" class=\"mw-redirect\" title=\"Muscles\" rel=\"external_link\" target=\"_blank\">muscles<\/a> with a certain rate in addition to electrodes.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> Today, modern pulse generators are programmed non-invasively by sophisticated computerized machines using RF, obtaining information about the patient's and device's status by telemetry. Also they use a single hermetically sealed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithium_iodide\" title=\"Lithium iodide\" rel=\"external_link\" target=\"_blank\">lithium iodide<\/a> (LiI) cell as the battery. The pacemaker circuitry includes sense amplifiers to detect the heart's intrinsic electrical signals, which are used to track heart activity, rate adaptive circuitry, which determine the need for increased or reduced pacing rate, a microprocessor, memory to store the parameters, telemetry control for communication protocol and power supplies to provide regulated voltage.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Stimulation_microelectrode_technologies\">Stimulation microelectrode technologies<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:302px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Utah_array_pat5215088.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/Utah_array_pat5215088.jpg\/300px-Utah_array_pat5215088.jpg\" width=\"300\" height=\"202\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Utah_array_pat5215088.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Utah microelectrode array<\/div><\/div><\/div>\n<p>Microelectrodes are one of the key components of the neurostimulation, which deliver the current to neurons. Typical microelectrodes have three main components: a substrate (the <i>carrier<\/i>), a conductive metal layer, and an insulation material. In cochlear implants, microelectrodes are formed from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Platinum-iridium_alloy\" title=\"Platinum-iridium alloy\" rel=\"external_link\" target=\"_blank\">platinum-iridium alloy<\/a>. State-of-the-art electrodes include deeper insertion to better match the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tonotopic\" class=\"mw-redirect\" title=\"Tonotopic\" rel=\"external_link\" target=\"_blank\">tonotopic<\/a> place of stimulation to the frequency band assigned to each electrode channel, improving efficiency of stimulation, and reducing insertion related trauma. These cochlear implant electrodes are either straight or spiral such as Med El Combi 40+ and Advanced Bionics Helix microelectrodes respectively.\nIn visual implants, there are two types of electrode arrays called planar type or three dimensional needle or pillar type, where needle type array such as Utah array is mostly used for cortical and optic nerve stimulations and rarely used in retinal implants due to the possible damage of retina. However, a pillar-shaped gold electrode array on thin-film <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyimide\" title=\"Polyimide\" rel=\"external_link\" target=\"_blank\">polyimide<\/a> has been used in an extraocular implant. On the other hand, planar electrode arrays are formed from flexible polymers, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a>, polyimide, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parylene\" title=\"Parylene\" rel=\"external_link\" target=\"_blank\">parylene<\/a> as candidates for retinal implants.\nRegarding to DBS microelectrodes an array, which can be controlled independently, distributed throughout the target nucleus would permit precise control of the spatial distribution of the stimulation, and thus, allow better personalized DBS. There are several requirements for DBS microelectrodes that include long lifetime without injury to the tissue or degradation of the electrodes, customized for different brain sites, long-term <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatibility<\/a> of the material, mechanically durable in order to reach the target without being damaged during handling by the implant surgeon, and finally uniformity of performance across the microelectrodes in a particular array. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tungsten\" title=\"Tungsten\" rel=\"external_link\" target=\"_blank\">Tungsten<\/a> microwire, iridium microwires, and sputtered or electrodeposited<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Platinum-iridium_alloy\" title=\"Platinum-iridium alloy\" rel=\"external_link\" target=\"_blank\">Platinum-iridium alloy<\/a> microelectrodes are the examples of microelectrode used in DBS.<sup id=\"rdp-ebb-cite_ref-zho_11-2\" class=\"reference\"><a href=\"#cite_note-zho-11\" rel=\"external_link\">[11]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_carbide\" title=\"Silicon carbide\" rel=\"external_link\" target=\"_blank\">Silicon carbide<\/a> is a potential interesting material for realizing biocompatible semiconductor devices.<sup id=\"rdp-ebb-cite_ref-saddow_27-0\" class=\"reference\"><a href=\"#cite_note-saddow-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The primary findings about neurostimulation originated from the idea to stimulate nerves for therapeutic purposes. The 1st recorded use of electrical stimulation for pain relief goes back to 46 AD, when <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scribonius_Largus\" title=\"Scribonius Largus\" rel=\"external_link\" target=\"_blank\">Scribonius Largus<\/a> used torpedo fish (electric ray) for relieving headaches.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> In the late 18th century, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Luigi_Galvani\" title=\"Luigi Galvani\" rel=\"external_link\" target=\"_blank\">Luigi Galvani<\/a> discovered that the muscles of dead frog legs twitched when struck by direct current on the nervous system.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> The modulation of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain\" title=\"Brain\" rel=\"external_link\" target=\"_blank\">brain<\/a> activity by electrical stimulation of the motor cortex in dogs was shown in 1870 that resulted in limb movement.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup> From the late 18th century to today many milestones have been developed. Nowadays, sensory prosthetic devices, such as visual implants, cochlear implants, auditory midbrain implants, and spinal cord stimulators and also motor prosthetic devices, such as deep brain stimulators, Bion microstimulators, the brain control and sensing interface, and cardiac electro-stimulation devices are widely used.<sup id=\"rdp-ebb-cite_ref-zho_11-3\" class=\"reference\"><a href=\"#cite_note-zho-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>In 2013 the British pharmaceutical company <a href=\"https:\/\/en.wikipedia.org\/wiki\/GlaxoSmithKline\" title=\"GlaxoSmithKline\" rel=\"external_link\" target=\"_blank\">GlaxoSmithKline<\/a> (GSK) coined the term \"electroceutical\" to broadly encompass <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_devices\" class=\"mw-redirect\" title=\"Medical devices\" rel=\"external_link\" target=\"_blank\">medical devices<\/a> that use electrical, mechanical, or light stimulation to affect <a href=\"https:\/\/en.wikipedia.org\/wiki\/Action_potential\" title=\"Action potential\" rel=\"external_link\" target=\"_blank\">electrical signaling<\/a> in relevant tissue types.<sup id=\"rdp-ebb-cite_ref-IEEE_31-0\" class=\"reference\"><a href=\"#cite_note-IEEE-31\" rel=\"external_link\">[31]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> Clinical neural implants such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implant\" title=\"Cochlear implant\" rel=\"external_link\" target=\"_blank\">cochlear implants<\/a> to restore hearing, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinal_implant\" title=\"Retinal implant\" rel=\"external_link\" target=\"_blank\">retinal implants<\/a> to restore sight, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_stimulator\" title=\"Spinal cord stimulator\" rel=\"external_link\" target=\"_blank\">spinal cord stimulators<\/a> for pain relief or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_cardiac_pacemaker\" title=\"Artificial cardiac pacemaker\" rel=\"external_link\" target=\"_blank\">cardiac pacemakers<\/a> and implantable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Defibrillator\" class=\"mw-redirect\" title=\"Defibrillator\" rel=\"external_link\" target=\"_blank\">defibrillators<\/a> are proposed examples of electroceuticals.<sup id=\"rdp-ebb-cite_ref-IEEE_31-1\" class=\"reference\"><a href=\"#cite_note-IEEE-31\" rel=\"external_link\">[31]<\/a><\/sup> GSK formed a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Venture_fund\" class=\"mw-redirect\" title=\"Venture fund\" rel=\"external_link\" target=\"_blank\">venture fund<\/a> and said it would host a conference in 2013 to lay out a research agenda for the field.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup> A 2016 review of research on interactions between the nervous and immune systems in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autoimmune_disorders\" class=\"mw-redirect\" title=\"Autoimmune disorders\" rel=\"external_link\" target=\"_blank\">autoimmune disorders<\/a> and mentioned \"electroceuticals\" in passing and quotation marks, referring to neurostimulation devices in development for conditions like arthritis.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Research\">Research<\/span><\/h2>\n<p>In addition to the enormous usage of neurostimulation for clinical applications, it is also used widely in laboratories started dates back to 1920s by people link Delgado who used stimulation as an experimental manipulation to study basics of how the brain works. The primary works were on the reward center of the brain in which stimulation of those structures led to pleasure that requested more stimulation. Another most recent example is the electrical stimulation of the MT area of primary visual cortex to bias perception. In particular, the directionality of motion is represented in a regular way in the MT area. They presented monkeys with moving images on screen and monkey throughput was to determine what the direction is. They found that by systematically introducing some errors to the monkey's responses, by stimulating the MT area which is responsible for perceiving the motion in another direction, the monkey responded to somewhere in between the actual motion and the stimulated one. This was an elegant use of stimulation to show that MT area is essential in the actual perception of motion. Within the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Memory\" title=\"Memory\" rel=\"external_link\" target=\"_blank\">memory<\/a> field, stimulation is used very frequently to test the strength of the connection between one bundle of cells to another by applying a small current in one cell which results in the release of neurotransmitters and measuring the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Postsynaptic_potential\" title=\"Postsynaptic potential\" rel=\"external_link\" target=\"_blank\">postsynaptic potential<\/a>.\n<\/p><p>Generally, a short but high-frequency current in the range of 100 Hz helps strengthening the connection known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Long-term_potentiation\" title=\"Long-term potentiation\" rel=\"external_link\" target=\"_blank\">long-term potentiation<\/a>. However, longer but low-frequency current tends to weaken the connections known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Long-term_depression\" title=\"Long-term depression\" rel=\"external_link\" target=\"_blank\">long-term depression<\/a>.<sup id=\"rdp-ebb-cite_ref-ReferenceA_35-0\" class=\"reference\"><a href=\"#cite_note-ReferenceA-35\" rel=\"external_link\">[35]<\/a><\/sup> tends to weaken the connections known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Long-term_depression\" title=\"Long-term depression\" rel=\"external_link\" target=\"_blank\">long-term depression<\/a>.<sup id=\"rdp-ebb-cite_ref-ReferenceA_35-1\" class=\"reference\"><a href=\"#cite_note-ReferenceA-35\" rel=\"external_link\">[35]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Non-invasive_cerebellar_stimulation\" title=\"Non-invasive cerebellar stimulation\" rel=\"external_link\" target=\"_blank\">Non-invasive cerebellar stimulation<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-hal-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-hal_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-hal_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hallett M (July 2000). \"Transcranial magnetic stimulation and the human brain\". <i>Nature<\/i>. <b>406<\/b> (6792): 147\u201350. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2F35018000\" target=\"_blank\">10.1038\/35018000<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10910346\" target=\"_blank\">10910346<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature&rft.atitle=Transcranial+magnetic+stimulation+and+the+human+brain&rft.volume=406&rft.issue=6792&rft.pages=147-50&rft.date=2000-07&rft_id=info%3Adoi%2F10.1038%2F35018000&rft_id=info%3Apmid%2F10910346&rft.au=Hallett+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeurostimulation\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Nitsche, Michael A.; Cohen, Leonardo G.; Wassermann, Eric M.; Priori, Alberto; Lang, Nicolas; Antal, Andrea; Paulus, Walter; Hummel, Friedhelm; Boggio, Paulo S.; Fregni, Felipe; Pascual-Leone, Alvaro (2008). \"Transcranial direct current stimulation: State of the art 2008\". Brain Stimulation 1 (3): 206\u201323.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Medtronic, Minneapolis, MN, U.S.A.<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jobst BC, Darcey TM, Thadani VM, Roberts DW (July 2010). \"Brain stimulation for the treatment of epilepsy\". <i>Epilepsia<\/i>. <b>51<\/b> (Suppl 3): 88\u201392. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1528-1167.2010.02618.x\" target=\"_blank\">10.1111\/j.1528-1167.2010.02618.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20618409\" target=\"_blank\">20618409<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Epilepsia&rft.atitle=Brain+stimulation+for+the+treatment+of+epilepsy&rft.volume=51&rft.issue=Suppl+3&rft.pages=88-92&rft.date=2010-07&rft_id=info%3Adoi%2F10.1111%2Fj.1528-1167.2010.02618.x&rft_id=info%3Apmid%2F20618409&rft.aulast=Jobst&rft.aufirst=BC&rft.au=Darcey%2C+TM&rft.au=Thadani%2C+VM&rft.au=Roberts%2C+DW&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeurostimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ansarinia M, Rezai A, Tepper SJ, et al. (July 2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/onlinelibrary.wiley.com\/resolve\/openurl?genre=article&sid=nlm:pubmed&issn=0017-8748&date=2010&volume=50&issue=7&spage=1164\" target=\"_blank\">\"Electrical stimulation of sphenopalatine ganglion for acute treatment of cluster headaches\"<\/a>. <i>Headache<\/i>. <b>50<\/b> (7): 1164\u201374. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1526-4610.2010.01661.x\" target=\"_blank\">10.1111\/j.1526-4610.2010.01661.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20438584\" target=\"_blank\">20438584<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Headache&rft.atitle=Electrical+stimulation+of+sphenopalatine+ganglion+for+acute+treatment+of+cluster+headaches&rft.volume=50&rft.issue=7&rft.pages=1164-74&rft.date=2010-07&rft_id=info%3Adoi%2F10.1111%2Fj.1526-4610.2010.01661.x&rft_id=info%3Apmid%2F20438584&rft.aulast=Ansarinia&rft.aufirst=M&rft.au=Rezai%2C+A&rft.au=Tepper%2C+SJ&rft_id=http%3A%2F%2Fonlinelibrary.wiley.com%2Fresolve%2Fopenurl%3Fgenre%3Darticle%26sid%3Dnlm%3Apubmed%26issn%3D0017-8748%26date%3D2010%26volume%3D50%26issue%3D7%26spage%3D1164&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeurostimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Nanomedicine201308-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Nanomedicine201308_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Damestani, Yasaman (2013). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nanomedjournal.com\/article\/S1549-9634(13)00361-4\/abstract\" target=\"_blank\">\"Transparent nanocrystalline yttria-stabilized-zirconia calvarium prosthesis\"<\/a>. <i>Nanomedicine<\/i>. 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class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4179459\" target=\"_blank\">4179459<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23579662\" target=\"_blank\">23579662<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature&rft.atitle=Drug+discovery%3A+A+jump-start+for+electroceuticals&rft.volume=496&rft.issue=7444&rft.pages=159-161&rft.date=2013-04-10&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4179459&rft_id=info%3Apmid%2F23579662&rft_id=info%3Adoi%2F10.1038%2F496159a&rft_id=info%3Abibcode%2F2013Natur.496..159F&rft.aulast=Famm&rft.aufirst=Kristoffer&rft.au=Litt%2C+Brian&rft.au=Tracey%2C+Kevin+J.&rft.au=Boyden%2C+Edward+S.&rft.au=Slaoui%2C+Moncef&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4179459&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeurostimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Solon, Olivia (28 May 2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.wired.co.uk\/news\/archive\/2013-05\/28\/electroceuticals\" target=\"_blank\">\"Electroceuticals: swapping drugs for devices\"<\/a>. <i>Wired UK<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Wired+UK&rft.atitle=Electroceuticals%3A+swapping+drugs+for+devices&rft.date=2013-05-28&rft.aulast=Solon&rft.aufirst=Olivia&rft_id=https%3A%2F%2Fwww.wired.co.uk%2Fnews%2Farchive%2F2013-05%2F28%2Felectroceuticals&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeurostimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Reardon, Colin (October 2016). \"Neuro-immune interactions in the cholinergic anti-inflammatory reflex\". <i>Immunology Letters<\/i>. <b>178<\/b>: 92\u201396. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.imlet.2016.08.006\" target=\"_blank\">10.1016\/j.imlet.2016.08.006<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27542331\" target=\"_blank\">27542331<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Immunology+Letters&rft.atitle=Neuro-immune+interactions+in+the+cholinergic+anti-inflammatory+reflex&rft.volume=178&rft.pages=92-96&rft.date=2016-10&rft_id=info%3Adoi%2F10.1016%2Fj.imlet.2016.08.006&rft_id=info%3Apmid%2F27542331&rft.aulast=Reardon&rft.aufirst=Colin&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeurostimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ReferenceA-35\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ReferenceA_35-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ReferenceA_35-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Interview with Dr. J. Manns, Emory University, Oct. 2010<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1240\nCached time: 20181208062637\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.568 seconds\nReal time usage: 0.683 seconds\nPreprocessor visited node count: 1842\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 60742\/2097152 bytes\nTemplate argument size: 749\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 87521\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.310\/10.000 seconds\nLua memory usage: 5.33 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 551.303 1 -total\n<\/p>\n<pre>66.50% 366.637 1 Template:Reflist\n44.34% 244.474 21 Template:Cite_journal\n14.56% 80.263 1 Template:Infobox_medical_intervention\n13.72% 75.616 1 Template:Infobox\n 8.57% 47.222 1 Template:Expand_section\n 7.23% 39.877 1 Template:Ambox\n 4.62% 25.461 4 Template:Cite_book\n 3.79% 20.913 4 Template:Cite_web\n 3.11% 17.173 1 Template:Main\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:29803004-1!canonical and timestamp 20181208062636 and revision id 872610511\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Neurostimulation\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212246\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.055 seconds\nReal time usage: 0.187 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 179.359 1 - wikipedia:Neurostimulation\n100.00% 179.359 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8306-0!*!*!*!*!*!* and timestamp 20181217212245 and revision id 24525\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Neurostimulation\">https:\/\/www.limswiki.org\/index.php\/Neurostimulation<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","e95f72b03a3d9938fff8dc8ffead5981_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/16\/Repetitive_transcranial_magnetic_stimulation_%28rTMS%29_is_a_technique_for_noninvasive_stimulation_of_the_adult_brain.jpg\/440px-Repetitive_transcranial_magnetic_stimulation_%28rTMS%29_is_a_technique_for_noninvasive_stimulation_of_the_adult_brain.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/8\/8e\/Fnhum-07-00435-g001.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1c\/Wiki_letter_w_cropped.svg\/40px-Wiki_letter_w_cropped.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/c\/cb\/Cochlear_implant.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/66\/ImplantSawan.JPG\/440px-ImplantSawan.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b1\/Pacemaker_GuidantMeridianSR.jpg\/440px-Pacemaker_GuidantMeridianSR.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/Utah_array_pat5215088.jpg\/600px-Utah_array_pat5215088.jpg"],"e95f72b03a3d9938fff8dc8ffead5981_timestamp":1545081765,"36d1bad27e438d4551403b2329d681f7_type":"article","36d1bad27e438d4551403b2329d681f7_title":"Neuromodulation (medicine)","36d1bad27e438d4551403b2329d681f7_url":"https:\/\/www.limswiki.org\/index.php\/Neuromodulation_(medicine)","36d1bad27e438d4551403b2329d681f7_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tNeuromodulation (medicine)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is about the therapeutic electromagnetic or chemical stimulation of nerve cells. For the natural physiological process in the nervous system, see Neuromodulation (biology).\nNeuromodulation[edit on Wikidata]\nNeuromodulation is \"the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body\". It is carried out to normalize \u2013 or modulate \u2013 nervous tissue function. Neuromodulation is an evolving therapy that can involve a range of electromagnetic stimuli such as a magnetic field (rTMS), an electric current, or a drug instilled directly in the subdural space (intrathecal drug delivery). Emerging applications involve targeted introduction of genes or gene regulators and light (optogenetics), and by 2014, these had been at minimum demonstrated in mammalian models, or first-in-human data had been acquired.[1] The most clinical experience has been with electrical stimulation.\nNeuromodulation, whether electrical or magnetic, employs the body's natural biological response by stimulating nerve cell activity that can influence populations of nerves by releasing transmitters, such as dopamine, or other chemical messengers such as the peptide Substance P, that can modulate the excitability and firing patterns of neural circuits. There may also be more direct electrophysiological effects on neural membranes as the mechanism of action of electrical interaction with neural elements. The end effect is a \"normalization\" of a neural network function from its perturbed state. Presumed mechanisms of action for neurostimulation include depolarizing blockade, stochastic normalization of neural firing, axonal blockade, reduction of neural firing keratosis, and suppression of neural network oscillations.[2] Although the exact mechanisms of neurostimulation are not known, the empirical effectiveness has led to considerable application clinically.\nExisting and emerging neuromodulation treatments also include application in medication-resistant epilepsy,[3] chronic head pain conditions, and functional therapy ranging from bladder and bowel or respiratory control to improvement of sensory deficits, such as hearing (cochlear implants and auditory brainstem implants) and vision (retinal implants).[4] Technical improvements include a trend toward minimally invasive (or noninvasive) systems; as well as smaller, more sophisticated devices that may have automated feedback control,[5] and conditional compatibility with magnetic resonance imaging.[6][7]\nNeuromodulation therapy has been investigated for other chronic conditions, such as Alzheimer's disease,[8][9] depression, chronic pain,[10][11] and as an adjunctive treatment in recovery from stroke.[12][13]\n\nContents \n\n1 Invasive electrical neuromodulation methods \n\n1.1 Spinal cord stimulation \n1.2 Deep brain stimulation \n1.3 Other invasive electrical methods \n\n\n2 Non-invasive electrical methods \n3 Non-invasive magnetic methods \n4 Invasive chemical methods \n5 History \n6 Relationship to electroceuticals \n7 See also \n8 References \n9 Further reading \n10 External links \n\n\nInvasive electrical neuromodulation methods \nElectrical stimulation using implantable devices came into modern usage in the 1980s and its techniques and applications have continued to develop and expand.[14] \nThese are methods where an operation is required to position an electrode. The stimulator, with the battery, similar to a pacemaker, may also be implanted, or may remain outside the body.\nIn general, neuromodulation systems deliver electrical currents and typically consist of the following components: An epidural, subdural or parenchymal electrode placed via minimally invasive needle techniques (so-called percutaneous leads) or an open surgical exposure to the target (surgical \"paddle\" or \"grid\" electrodes), or stereotactic implants for the central nervous system, and an implanted pulse generator (IPG). Depending on the distance from the electrode access point an extension cable may also be added into the system. The IPG can have either a non-rechargeable battery needing replacement every 2\u20135 years (depending on stimulation parameters) or a rechargeable battery that is replenished via an external inductive charging system.\nAlthough most systems operate via delivery of a constant train of stimulation, there is now the advent of so-called \"feed-forward\" stimulation where the device's activation is contingent on a physiological event, such as an epileptic seizure. In this circumstance, the device is activated and delivers a desynchronizing pulse to the cortical area that is undergoing an epileptic seizure. This concept of feed-forward stimulation will likely become more prevalent as physiological markers of targeted diseases and neural disorders are discovered and verified.[15] The on-demand stimulation may contribute to longer battery life, if sensing and signal-processing demands of the system are sufficiently power-efficient. New electrode designs could yield more efficient and precise stimulation, requiring less current and minimizing unwanted side-stimulation. In addition, to overcome the challenge of preventing lead migration in areas of the body that are subject to motion such as turning and bending, researchers are exploring developing small stimulation systems that are recharged wirelessly rather than through an electrical lead.[16]\n\nSpinal cord stimulation \nMain article: Spinal cord stimulation\nSpinal cord stimulation is a form of invasive neuromodulation therapy in common use since the 1980s. Its principal use is as a reversible, non-pharmacological therapy for chronic pain management that delivers mild electrical pulses to the spinal cord.[17] In patients who experience pain reduction of 50 percent or more during a temporary trial, a permanent implant may be offered in which, as with a cardiac pacemaker, an implantable pulse generator about the size of a stopwatch is placed under the skin on the trunk. It delivers mild impulses along slender electrical leads leading to small electrical contacts, about the size of a grain of rice, at the area of the spine to be stimulated.[18]\nStimulation is typically in the 20\u2013200 Hz range, though a novel class of stimulation parameters are now emerging that employ a 10 kHz stimulation train as well as 500 Hz \"burst stimulation\". Kilohertz stimulation trains have been applied to both the spinal cord proper as well as the dorsal root ganglion in humans. All forms of spinal cord stimulation have been shown to have varying degrees of efficacy to address a variety of pharmacoresistant neuropathic or mixed (neuropathic and noiciceptive) pain syndromes such as post-laminectomy syndrome, low back pain, complex regional pain syndrome, peripheral neuropathy, peripheral vascular disease and angina.[19]\nThe general process for spinal cord stimulation involves a temporary trailing of appropriate patients with an external pulse generator attached to epidural electrodes located in the lower thoracic spinal cord. The electrodes are placed either via a minimally invasive needle technique (so-called percutaneous leads) or an open surgical exposure (surgical \"paddle\" electrodes).\nPatient selection is key, and candidates should pass rigorous psychological screening as well as a medical workup to assure that their pain syndrome is truly medication-resistant.[19] After recuperating from the implant procedure, the patient will return to have the system turned on and programmed. Depending on the system, the program may elicit a tingling sensation that covers most of the painful area, replacing some of the painful sensations with more of a gentle massaging sensation, although other more recent systems do not create a tingling sensation. The patient is sent home with a handheld remote controller to turn the system off or on or switch between pre-set stimulation parameters, and can follow up to adjust the parameters.\n\nDeep brain stimulation \nMain article: Deep brain stimulation\nAnother invasive neuromodulation treatment developed in the 1980s is deep brain stimulation, which may be used to help limit symptoms of movement disorder in Parkinson's disease, dystonia, or essential tremor.[20] Deep brain stimulation was approved by the U.S. Food and Drug Administration in 1997 for essential tremor, in 2002 for Parkinson's disease, and received a humanitarian device exemption from the FDA in 2003 for motor symptoms of dystonia.[21] It was approved in 2010 in Europe for the treatment of certain types of severe epilepsy.[22] DBS also has shown promise, although still in research, for medically intractable psychiatric syndromes of depression, obsessive compulsive disorders, intractable rage, dementia, and morbid obesity. It has also shown promise for Tourette syndrome, torticollis, and tardive dyskinesia. DBS therapy, unlike spinal cord stimulation, has a variety of central nervous system targets, depending on the target pathology. For Parkinson's disease central nervous system targets include the subthalamic nucleus, globus pallidus interna, and the ventral intermidus nucleus of the thalamus. Dystonias are often treated by implants targeting globus pallidus interna, or less often, parts of the ventral thalamic group. The anterior thalamus is the target for epilepsy.[23][24][21]\nDBS research targets include, but are not limited to the following areas: Cg25 for depression, the anterior limb of the internal capsule for depression as well as obsessive compulsive disorder (OCD), centromedian\/parafasicularis, centromedian thalamic nuclei and the subthalamic nucleus for OCD, anorexia and Tourette syndrome, the nucleus accumbens and ventral striatum have also been assayed for depression and pain.[24][21]\n\nOther invasive electrical methods \nAuditory brainstem implant, which provides a sense of sound to a person who cannot use a cochlear implant due to a damaged or missing cochlea or auditory nerve\nFunctional electrical stimulation (FES)\nVagus nerve stimulation (VNS)[25]\nHypoglossal nerve stimulation, an option for some patients who have obstructive sleep apnea[26]\nPercutaneous tibial nerve stimulation (PTNS) for the treatment of incontinence.\nPeripheral nerve stimulation (PNS, which refers to simulation of nerves beyond the spine or brain, and may be considered to include occipital or sacral nerve stimulation)\nOccipital nerve stimulation (ONS)\nSacral nerve stimulation (SNS) \/ sacral neuromodulation (SNM)\nNon-invasive electrical methods \nThese methods use external electrodes to apply a current to the body in order to change the functioning of the nervous system.\nMethods include:\n\nTranscranial direct current stimulation (tDCS)[13]\nTranscutaneous electrical nerve stimulation (TENS)\nElectroconvulsive therapy (ECT)\nNon-invasive magnetic methods \nMagnetic methods of neuromodulation are normally non-invasive: no surgery is required to allow a magnetic field to enter the body because the magnetic permeability of tissue is similar to that of air. In other words: magnetic field penetrate the body very easily.\nThe two main techniques are highly related in that both use changes in magnetic field strength to induce electric fields and ionic currents in the body. There are however differences in approach and hardware. In rTMS the stimulation has a high amplitude (0.5\u20133 tesla), a low complexity and anatomical specificity is reached through a highly focal magnetic field. In tPEMF the stimulation has a low amplitude (0.01\u2013500 millitesla), a high complexity and anatomical specificity is reached through the specific frequency content of the signal.[27]\n\nRepetitive transcranial magnetic stimulation (rTMS)\nTranscranial pulsed electromagnetic fields (tPEMF)\nInvasive chemical methods \nChemical neuromodulation is always invasive, because a drug is delivered in a highly specific location of the body. The non-invasive variant is traditional pharmacotherapy, e.g. swallowing a tablet.\n\nIntrathecal drug delivery systems (ITDS, which may deliver micro-doses of painkiller (for instance, ziconotide) or anti-spasm medicine (such as baclofen) directly to the site of action)\nHistory \nElectrical stimulation of the nervous system has a long and complex history. Earlier practitioners of deep brain stimulation in the latter half of the 20th century (Delgado, Heath, Hosbuchi. See Hariz et al. for historical review[28]) were limited by the technology available. Heath, in the 1950s, stimulated subcortical areas and made detailed observations of behavioral changes. A new understanding of pain perception was ushered in in 1965, with the Gate Theory of Wall and Melzack.[29] Although now considered oversimplified, the theory held that pain transmissions from small nerve fibers can be overridden, or the gate \"closed\", by competing transmissions along the wider touch nerve fibers. Building on that concept, in 1967, the first dorsal column stimulator for pain control was demonstrated by Dr. Norm Shealy at Western Reserve Medical School, using a design adapted by Tom Mortimer, a graduate student at Case Institute of Technology, from cardiac nerve stimulators by Medtronic, Inc., where he had a professional acquaintance who shared the circuit diagram. In 1973, Hosbuchi reported alleviating the denervation facial pain of anesthesia dolorosa through ongoing electrical stimulation of the somatosensory thalamus, marking the start of the age of deep brain stimulation.[14]:13\u201316 [30][31]\nDespite the limited clinical experience in these decades, that era is remarkable for the demonstration of the role technology has in neuromodulation, and there are some case reports of deep brain stimulation for a variety of problems; real or perceived. Delgado hinted at the power of neuromodulation with his implants in the bovine septal region and the ability of electrical stimulation to blunt or alter behavior. Further attempts at this \"behavioral modification\" in humans were difficult and seldom reliable, and contributed to the overall lack progress in central nervous system neuromodulation from that era. Attempts at intractable pain syndromes were met with more success, but again hampered by the quality of technology. In particular, the so-called DBS \"zero\" electrode, (consisting of a contact loop on its end) had an unacceptable failure rate and revisions were fraught with more risk than benefit. Overall, attempts at using electrical stimulation for \"behavioral modification\" were difficult and seldom reliable, slowing development of DBS. Attempts at addressing intractable pain syndromes with DBS were met with more success, but again hampered by the quality of technology. A number of physicians who hoped to address hitherto intractable problems sought development of more specialized equipment; for instance, in the 1960s, Wall's colleague Bill Sweet recruited engineer Roger Avery to make an implantable peripheral nerve stimulator. Avery started the Avery Company, which made a number of implantable stimulators. Shortly before his retirement in 1983, he submitted data requested by the FDA, which had begun to regulate medical devices following a 1977 meeting on the topic, regarding DBS for chronic pain. Medtronic and Neuromed also made deep brain stimulators at the time, but reportedly felt a complex safety and efficacy clinical trial in patients who were difficult to evaluate would be too costly for the size of the potential patient base, so did not submit clinical data on DBS for chronic pain to the FDA, and that indication was de-approved.[14]:13\u201316 [30][31]\nHowever, near this time in France and elsewhere, DBS was investigated as a substitute for lesioning of brain nuclei to control motor symptoms of movement disorders such as Parkinson's disease, and by the mid-1990s, this reversible, non-destructive stimulation therapy had become the primary application of DBS in appropriate patients, to slow progression of movement impairment from the disease and reduce side effects from long-term, escalating medication use.[32]\nIn parallel to the development of neuromodulation systems to address motor impairment, cochlear implants were the first neuromodulation system to reach a broad commercial stage to address a functional deficit; they provide sound perception in users who are hearing-impaired due to missing or damaged sensory cells (cilia) in the inner ear. The approach to electrical stimulation used in cochlear implants was soon modified by one manufacturer, Boston Scientific Corporation, for design of electrical leads to be used in spinal cord stimulation treatment of chronic pain conditions.[14]:13\u201316 \n\nRelationship to electroceuticals \nIn 2012, the global pharmaceutical company GlaxoSmithKline announced an initiative in bioelectric medicine in which the autonomic nervous system's impact on the immune system and inflammatory disease might be treated through electrical stimulation rather than pharmaceutical agents. The company's first investment in 2013 involved a small startup company, SetPoint Medical, which was developing neurostimulators to address inflammatory autoimmune disorders such as rheumatoid arthritis.[33][34][35]\nUltimately, the electroceuticals quest aims to find the electro-neural signature of disease and at a cellular level, in real time, play back the more normal electro-signature to help maintain the neural signature in the normal state. Unlike preceding neuromodulation therapy methods, the approach would not involve electrical leads stimulating large nerves or spinal cords or brain centers. It might involve methods that are emerging within the neuromodulation family of therapies, such as optogenetics or some new nanotechnology. Disease states and conditions that have been discussed as targets for future electroceutical therapy include diabetes, infertility, obesity, rheumatoid arthritis, and autoimmune disorders.[36]\n\nSee also \nAlim-Louis Benabid\nBrain computer interfacing (BCI)\nBrainGate\nInternational Neuromodulation Society\nInterventional pain management\nNorth American Neuromodulation Society\nNeuromodulation (journal)\nNeuroprosthetics\nNeurotechnology\nNeurostimulation\nOptogenetics\nVisual prosthesis\nReferences \n\n\n^ \"International Neuromodulation Society home page\". Retrieved 1 October 2013 . \n\n^ Karas, Patrick J.; Mikell, Charles B.; Christian, Eisha; Liker, Mark A.; Sheth, Sameer A. (2013). \"Deep brain stimulation: a mechanistic and clinical update\". Neurosurgical Focus. 35 (5): E1. doi:10.3171\/2013.9.focus13383. \n\n^ Al-Otaibi, FA.; Hamani, C.; Lozano, AM. (Oct 2011). \"Neuromodulation in epilepsy\". 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PMID 23620795. \n\n^ Shupak NM, Prato FS, Thomas AW (June 2004). \"Human exposure to a specific pulsed magnetic field: effects on thermal sensory and pain thresholds\". Neurosci. Lett. 363 (2): 157\u201362. doi:10.1016\/j.neulet.2004.03.069. PMID 15172106. \n\n^ Matsumura Y, Hirayama T, Yamamoto T (2013). \"Comparison between pharmacologic evaluation and repetitive transcranial magnetic stimulation-induced analgesia in poststroke pain patients\". Neuromodulation. 16 (4): 349\u201354, discussion 354. doi:10.1111\/ner.12019. PMID 23311356. \n\n^ a b Feng WW, Bowden MG, Kautz S (2013). \"Review of transcranial direct current stimulation in poststroke recovery\". Top Stroke Rehabil. 20 (1): 68\u201377. doi:10.1310\/tsr2001-68. PMID 23340073. \n\n^ a b c d Krames, Elliot S.; Peckham, P. Hunter; Rezai, Ali R., eds. (2009). Neuromodulation, Vol. 1-2. Academic Press. pp. 1\u20131200. ISBN 9780123742483. \n\n^ Sun FT, Morrell MJ, Wharen RE (January 2008). \"Responsive cortical stimulation for the treatment of epilepsy\". Neurotherapeutics. 5 (1): 68\u201374. doi:10.1016\/j.nurt.2007.10.069. PMC 5084128 . PMID 18164485. \n\n^ Deer, T.R.; Krames, E.; Mekhail, N.; Pope, J.; Leong, M.; Stanton-Hicks, M.; Golovac, S.; Kaprual, L.; Alo, K.; Anderson, J.; Foreman, R.D.; Caraway, D.; Narouze, S.; Linderoth, B.; Buvanendran, A.; Feler, C.; Poree, L.; Lynch, P.; McJunkin, T.; Swing, T.; Staats, P.; Liem, L.; Williams, K. (Jan 2008). \"The Appropriate Use of Neurostimulation: New and Evolving Neurostimulation Therapies and Applicable Treatment for Chronic Pain and Selected Disease States\". Neuromodulation. 17: 599\u2013615. doi:10.1111\/ner.12204. \n\n^ Mekhail NA, Cheng J, Narouze S, Kapural L, Mekhail MN, Deer T (2010). \"Clinical applications of neurostimulation: forty years later\". Pain Pract. 10 (2): 103\u2013112. doi:10.1111\/j.1533-2500.2009.00341.x. \n\n^ Bailey, Madeleine. \"A remote control turns off my spine\", London, UK. The Express. May 14, 2013. \n\n^ a b Deer TR, Mekhail N, Provenzano D, Pope J, Krames E, Leong M, et al. (August 2014). \"The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the Neuromodulation Appropriateness Consensus Committee\". Neuromodulation. 17 (6): 515\u201350, discussion 550. doi:10.1111\/ner.12208. PMID 25112889. \n\n^ Bronstein, JM.; Tagliati, M.; Alterman, RL.; Lozano, AM.; Volkmann, J.; Stefani, A.; Horak, FB.; Okun, MS.; et al. (Feb 2011). \"Deep brain stimulation for Parkinson disease: an expert consensus and review of key issues\". Arch. Neurol. 68 (2): 165. doi:10.1001\/archneurol.2010.260. PMC 4523130 . PMID 20937936. \n\n^ a b c Williams, Noaln R.; Okun, Michael S. (6 February 2013). \"Deep brain stimulation (DBS) at the interface of neurology and psychiatry\". J. Clin. Invest. 123 (11): 4546\u20134556. doi:10.1172\/JCI68341. PMC 3809784 . PMID 24177464. \n\n^ \"Medtronic Receives European CE Mark Approval for Deep Brain Stimulation Therapy for Refractory Epilepsy Further Clinical Study Required for Application to U.S. Food and Drug Administration\" (Press release). 16 September 2010. Retrieved 2014-10-12 . \n\n^ Wilner, Andrew (22 April 2010). \"Thalamic Stimulation: New Approach to Treatment of Epilepsy\". Medscape Neurology. Retrieved Oct 13, 2014 . \n\n^ a b Lozano, Andres M.; Lipsman, Nir (6 February 2013). \"Probing and Regulating Dysfunctional Circuits Using Deep Brain Stimulation\". Neuron. 77 (3): 406\u2013424. doi:10.1016\/j.neuron.2013.01.020. PMID 23395370. \n\n^ George, MS.; Nahas, Z.; Borckardt, JJ.; Anderson, B.; Burns, C.; Kose, S.; Short, EB. (Jan 2007). \"Vagus nerve stimulation for the treatment of depression and other neuropsychiatric disorders\". Expert Rev. Neurother. 7 (1): 63\u201374. doi:10.1586\/14737175.7.1.63. PMID 17187498. \n\n^ http:\/\/www.accessdata.fda.gov\/scripts\/cdrh\/cfdocs\/cfPMA\/pma.cfm?id=18437. FDA \"Premarket Approval (PMA) Inspire II Upper Airway Stimulation System\" U.S. Food and Drug Administration. April 30, 2014. \n\n^ Whissell PD, Persinger MA (2007). \"Emerging synergisms between drugs and physiologically-patterned weak magnetic fields: implications for neuropharmacology and the human population in the twenty-first century\". Curr. Neuropharmacol. 4 (5): 278\u2013288. doi:10.2174\/157015907782793603. PMC 2644491 . PMID 19305744. \n\n^ Hariz, Marwan I.; Blomstedt, Patric; Zrinzo, Ludvic. Neurosurg Focus 29 (2):E1 2010. \n\n^ Wall PD & Melzack R. The challenge of pain. 2nd ed. New York: Penguin Books; 1996. ISBN 0-14-025670-9. p. 61\u201369. \n\n^ a b Textbook of Stereotactic and Functional Neurosurgery, Volume 1 edited by Andres M. Lozano, Philip L. Gildenberg, Ronald R. Tasker. (2009) pp. 16 \u2013 20. \n\n^ a b Bittar RG, Kar-Purkayastha I, Owen SL, et al. (2005). \"Deep brain stimulation for pain relief: A meta-analysis\". J. Clin. Neurosci. 12: 515\u20139. \n\n^ Benabid, AL.; Chabardes, S.; Torres, N.; Piallat, B.; Krack, P.; Fraix, V.; Pollak, P. (2009). \"Functional neurosurgery for movement disorders: a historial perspective\". Prog. Brain Res. 175: 379\u2013391. doi:10.1016\/S0079-6123(09)17525-8. \n\n^ Cookson, Clive (31 July 2012). \"Healthcare: Into the cortex Scientific advances on the brain promise to transform the pharmaceutical industry\". Financial Times. London. Retrieved 11 October 2014 . \n\n^ Famm, Kristoffer; Litt, Brian; Tracey, Kevin J.; Boyden, Edward S.; Siaoui, Moncef (11 April 2013). \"Drug discovery: A jump-start for electroceuticals\". Nature. 496: 159\u2013161. doi:10.1038\/496159a. PMC 4179459 . PMID 23579662. Retrieved 12 October 2014 . \n\n^ John Carroll (10 April 2013). \"GlaxoSmithKline stakes a pioneering effort to launch 'electroceutical' R&D\". Fierce Biotech. Retrieved 11 October 2014 . \n\n^ Birmingham, Karen; Gradinaru, Viviana; Anikeeva, Polina; Grill, Warren M.; McLaughlin, Bryan; Pansricha, Pankaj; Weber, Douglas; Ludwig, Kip; Kristoffer, Famm; Pikov, Victor (2014). \"Bioelectronic medicines: A research roadmap\". Nature Reviews Drug Discovery (published 30 May 2014). 13: 399\u2013400. doi:10.1038\/nrd4351. PMID 24875080. \n\n\nFurther reading \n\nAl\u00f3, KM.; Holsheimer, J. (Apr 2002). \"New trends in neuromodulation for the management of neuropathic pain\". Neurosurgery. 50 (4): 690\u2013703, discussion 703-4. doi:10.1097\/00006123-200204000-00003. PMID 11904018. \nAlthaus J: A Treatise on Medical Electricity, Theoretical and Practical; and Its Use in the Treatment of Paralysis, Neuralgia, and Other Diseases Philadelphia, Lindsay & Blakiston, 1860;163-170.\nAndrews, RJ. (Jun 2010). \"Neuromodulation: advances in the next five years\". Ann. N. Y. Acad. Sci. 1199: 204\u201311. doi:10.1111\/j.1749-6632.2009.05379.x. PMID 20633126. \nAttal, N.; Cruccu, G.; Haanp\u00e4\u00e4, M.; Hansson, P.; Jensen, TS.; Nurmikko, T.; Sampaio, C.; Sindrup, S.; Wiffen, P. (Nov 2006). \"EFNS guidelines on pharmacological treatment of neuropathic pain\". Eur. J. Neurol. 13 (11): 1153\u201369. doi:10.1111\/j.1468-1331.2006.01511.x. PMID 17038030. \nBen-Menachem, E. (Sep 2001). \"Vagus nerve stimulation, side effects, and long-term safety\". J. Clin. Neurophysiol. 18 (5): 415\u20138. doi:10.1097\/00004691-200109000-00005. PMID 11709646. \nBeric, A.; Kelly, PJ.; Rezai, A.; Sterio, D.; Mogilner, A.; Zonenshayn, M.; Kopell, B. (2001). \"Complications of deep brain stimulation surgery\". Stereotact. Funct. Neurosurg. 77 (1\u20134): 73\u20138. doi:10.1159\/000064600. PMID 12378060. \nDeer T. R.; Prager J.; Levy R.; Rathmell J.; Buchser E.; Burton A.; Caraway D.; Cousins M.; De Andr\u00e9s J.; Diwan S.; Erdek M.; Grigsby E.; Huntoon M.; Jacobs M. S.; Kim P.; Kumar K.; Leong M.; Liem L.; McDowell II; Panchal S.; Rauck R.; Saulino M.; Sitzman B. T.; Staats P.; Stanton-Hicks M.; Stearns L.; Wallace M.; Willis K. D.; Witt W.; Yaksh T.; Mekhail N. (2012). \"Polyanalgesic Consensus Conference 2012: Recommendations for the Management of Pain by Intrathecal (Intraspinal) Drug Delivery: Report of an Interdisciplinary Expert Panel\". Neuromodulation. 15: 436\u2013466. doi:10.1111\/j.1525-1403.2012.00476.x. \nDe Vos C, Meier K, Zaalberg PB, Nijhuis HJ, Duyvendak W, Vesper J, Enggaard TP, Lenders MW (2014). \"Spinal cord stimulation in patients with painful diabetic neuropathy: A multicentre randomized clinical trial\". Pain. 155: 2426\u20132431. doi:10.1016\/j.pain.2014.08.031. PMID 25180016. \nDormandy JA, Rutherford RB (2000). \"Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC)\". J. Vasc. Surg. 31 (1): S1\u2013S296. \nFrancisco GE, Hu MM, Boake C, Ivanhoe CB (May 2005). \"Efficacy of early use of intrathecal baclofen therapy for treating spastic hypertonia due to acquired brain injury\". Brain Inj. 19 (5): 359\u201364. doi:10.1080\/02699050400003999. \nFrancisco GE, Saulino MF, Yablon SA, Turner M (Sep 2009). \"Intrathecal baclofen therapy: an update\". PM&R. 1 (9): 852\u20138. doi:10.1016\/j.pmrj.2009.07.015. \nGaylor JM, Raman G, Chung M, Lee J, Rao M, Lau J, Poe DS (2013). \"Cochlear Implantation in Adults. A Systematic Review and Meta-analysis\". JAMA Otolaryngol. Head Neck Surg. 139 (3): 265\u2013272. doi:10.1001\/jamaoto.2013.1744. \nGildenberg PL (2006). \"History of electrical neuromodulation for chronic pain\". Pain Med. 7: S7\u2013S13. doi:10.1111\/j.1526-4637.2006.00118.x. \nGracies JM, Nance P, Elovic E, McGuire J, Simpson DM (1997). \"Traditional pharmacological treatments for spacticity part I: local treatments\". Muscle Nerve. 6: S1\u2013S92. doi:10.1002\/(SICI)1097-4598(1997)6+<61::AID-MUS6>3.0.CO;2-H. \nGreenberg BD, Gabriels LA, Malone DA Jr, Rezai AR, Friehs GM, Okun MS, Shapira NA, Foote KD, Cosyns PR, Kubu CS, Malloy PF, Salloway SP, Giftakis JE, Rise MT, Machado AG, Baker KB, Stypulkowski PH, Goodman WK, Rasmussen SA, Nuttin BJ (Jan 2010). \"Deep brain stimulation of the ventral internal capsule\/ventral striatum for obsessive-compulsive disorder: worldwide experience\". Mol. Psychiatry. 15 (1): 64\u201379. doi:10.1038\/mp.2008.55. PMC 3790898 . PMID 18490925. \nHealth C for D and R. \"Recently-Approved Devices - VNS Therapy System - P970003s050. Available at: http:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/DeviceApprovalsandClearances\/Recently-ApprovedDevices\/ucm078532.htm. Accessed October 3, 2012.\nJobst, BC. (Sep 2010). \"Electrical stimulation in epilepsy: vagus nerve and brain stimulation\". Curr. Treat. Options Neurol. 12 (5): 443\u201353. doi:10.1007\/s11940-010-0087-4. PMID 20842599. \nKellaway P (1946). \"The part played by electric fish in the early history of bioelectricity and electrotherapy\". Bull. Hist. Med. 20: 112\u2013137. \nKemler MA, de Vet HC, Barendse GA, et al. (2006). \"Spinal cord stimulation for chronic reflex sympathetic dystrophy--five-year follow-up\". N. Engl. J. Med. 354 (22): 2394\u20132396. doi:10.1056\/nejmc055504. \nKrames E, et al. (2011). \"Using the SAFE principles when evaluating electrical stimulation therapies for the pain of failed back surgery syndrome\". Neuromodulation. 14: 299\u2013311. doi:10.1111\/j.1525-1403.2011.00373.x. \nKumar K, Taylor RS (2008). \"The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation\". Neurosurgery. 63 (4): 762\u201370. doi:10.1227\/01.NEU.0000325731.46702.D9. PMID 18981888. \nMallet L, Polosan M, Jaafari N, Baup N, Welter ML, Fontaine D, Montcel ST, Yelnik J, Ch\u00e9reau I, Arbus C, Raoul S, Aouizerate B, Damier P, Chabard\u00e8s S, Czernecki V, Ardouin C, Krebs MO, Bardinet E, Chaynes P, Burbaud P, Cornu P, Derost P, Bougerol T, Bataille B, Mattei V, Dormont D, Devaux B, V\u00e9rin M, Houeto JL, Pollak P, Benabid AL, Agid Y, Krack P, Millet B, Pelissolo A (Nov 2008). \"Subthalamic nucleus stimulation in severe obsessive-compulsive disorder\". N. Engl. J. 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(Jan 2008). \"Responsive cortical stimulation for the treatment of epilepsy\". Neurotherapeutics. 5 (1): 68\u201374. doi:10.1016\/j.nurt.2007.10.069. PMID 18164485. \nUbbink DT, Vermeulen H (2006). \"Spinal Cord Stimulation for Critical Leg Ischemia: A Review of Effectiveness and Optimal Patient Selection\". Journal of Pain and Symptom Management. 31 (4): S30\u2013S35. doi:10.1016\/j.jpainsymman.2005.12.013. \nUbbink DT, Vermeulen H (2013). \"Spinal cord stimulation for non-reconstructable chronic critical leg ischaemia\". Cochrane Database Syst. Rev. 2: CD004001. doi:10.1002\/14651858.CD004001.pub3. PMID 23450547. .\nYampolsky C, Hem S, Bendersky D (2012). \"Dorsal column stimulator applications\". Surg. Neurol. Int. 3 (Suppl 4): S275\u201389. doi:10.4103\/2152-7806.103019. \nYelnik, AP.; Simon, O.; Parratte, B.; Gracies, JM. (Oct 2010). \"How to clinically assess and treat muscle overactivity in spastic paresis\". J. Rehabil. Med. 42 (9): 801\u20137. doi:10.2340\/16501977-0613. PMID 20878038. \nZafonte R, Lombard L, Elovic E (2004). \"Antispasticity medications: uses and limitations of enteral therapy\". Am. J. Phys. Med. Rehabil. 83: S50\u2013S58. doi:10.1097\/01.phm.0000141132.48673.fa. \nExternal links \nNeuromodulation: Technology at the Neural Interface\nNeuromodulation Appropriateness Consensus Committee (news release)\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Neuromodulation_(medicine)\">https:\/\/www.limswiki.org\/index.php\/Neuromodulation_(medicine)<\/a>\n\t\t\t\t\tCategories: Medical and surgical techniquesNeurostimulationHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 17:29.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 798 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","36d1bad27e438d4551403b2329d681f7_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Neuromodulation_medicine skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Neuromodulation (medicine)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">This article is about the therapeutic electromagnetic or chemical stimulation of nerve cells. For the natural physiological process in the nervous system, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromodulation_(biology)\" class=\"mw-redirect\" title=\"Neuromodulation (biology)\" rel=\"external_link\" target=\"_blank\">Neuromodulation (biology)<\/a>.<\/div>\n\n<p><b>Neuromodulation<\/b> is \"the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body\". It is carried out to normalize \u2013 or modulate \u2013 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nervous_tissue\" title=\"Nervous tissue\" rel=\"external_link\" target=\"_blank\">nervous tissue<\/a> function. Neuromodulation is an evolving therapy that can involve a range of electromagnetic stimuli such as a magnetic field (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcranial_magnetic_stimulation\" title=\"Transcranial magnetic stimulation\" rel=\"external_link\" target=\"_blank\">rTMS<\/a>), an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electric_current\" title=\"Electric current\" rel=\"external_link\" target=\"_blank\">electric current<\/a>, or a drug instilled directly in the subdural space (intrathecal drug delivery). Emerging applications involve targeted introduction of genes or gene regulators and light (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Optogenetics\" title=\"Optogenetics\" rel=\"external_link\" target=\"_blank\">optogenetics<\/a>), and by 2014, these had been at minimum demonstrated in mammalian models, or first-in-human data had been acquired.<sup id=\"rdp-ebb-cite_ref-INS_1-0\" class=\"reference\"><a href=\"#cite_note-INS-1\" rel=\"external_link\">[1]<\/a><\/sup> The most clinical experience has been with electrical stimulation.\n<\/p><p>Neuromodulation, whether electrical or magnetic, employs the body's natural biological response by stimulating nerve cell activity that can influence populations of nerves by releasing transmitters, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dopamine\" title=\"Dopamine\" rel=\"external_link\" target=\"_blank\">dopamine<\/a>, or other chemical messengers such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peptide\" title=\"Peptide\" rel=\"external_link\" target=\"_blank\">peptide<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Substance_P\" title=\"Substance P\" rel=\"external_link\" target=\"_blank\">Substance P<\/a>, that can modulate the excitability and firing patterns of neural circuits. There may also be more direct electrophysiological effects on neural membranes as the mechanism of action of electrical interaction with neural elements. The end effect is a \"normalization\" of a neural network function from its perturbed state. Presumed mechanisms of action for neurostimulation include depolarizing blockade, stochastic normalization of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neural_firing\" class=\"mw-redirect\" title=\"Neural firing\" rel=\"external_link\" target=\"_blank\">neural firing<\/a>, , reduction of neural firing keratosis, and suppression of neural network oscillations.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> Although the exact mechanisms of neurostimulation are not known, the empirical effectiveness has led to considerable application clinically.\n<\/p><p>Existing and emerging neuromodulation treatments also include application in medication-resistant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epilepsy\" title=\"Epilepsy\" rel=\"external_link\" target=\"_blank\">epilepsy<\/a>,<sup id=\"rdp-ebb-cite_ref-Al-Otaibi_2011_3-0\" class=\"reference\"><a href=\"#cite_note-Al-Otaibi_2011-3\" rel=\"external_link\">[3]<\/a><\/sup> chronic head pain conditions, and functional therapy ranging from bladder and bowel or respiratory control to improvement of sensory deficits, such as hearing (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implants\" class=\"mw-redirect\" title=\"Cochlear implants\" rel=\"external_link\" target=\"_blank\">cochlear implants<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Auditory_brainstem_implant\" title=\"Auditory brainstem implant\" rel=\"external_link\" target=\"_blank\">auditory brainstem implants<\/a>) and vision (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinal_implant\" title=\"Retinal implant\" rel=\"external_link\" target=\"_blank\">retinal implants<\/a>).<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Technical improvements include a trend toward minimally invasive (or noninvasive) systems; as well as smaller, more sophisticated devices that may have automated feedback control,<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> and conditional compatibility with magnetic resonance imaging.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>Neuromodulation therapy has been investigated for other chronic conditions, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alzheimer%27s_disease\" title=\"Alzheimer's disease\" rel=\"external_link\" target=\"_blank\">Alzheimer's disease<\/a>,<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Major_depressive_disorder\" title=\"Major depressive disorder\" rel=\"external_link\" target=\"_blank\">depression<\/a>, chronic pain,<sup id=\"rdp-ebb-cite_ref-pmid23620795_10-0\" class=\"reference\"><a href=\"#cite_note-pmid23620795-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid15172106_11-0\" class=\"reference\"><a href=\"#cite_note-pmid15172106-11\" rel=\"external_link\">[11]<\/a><\/sup> and as an adjunctive treatment in recovery from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a>.<sup id=\"rdp-ebb-cite_ref-Matsumura_2013_12-0\" class=\"reference\"><a href=\"#cite_note-Matsumura_2013-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Feng_2013_13-0\" class=\"reference\"><a href=\"#cite_note-Feng_2013-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Invasive_electrical_neuromodulation_methods\">Invasive electrical neuromodulation methods<\/span><\/h2>\n<p>Electrical stimulation using implantable devices came into modern usage in the 1980s and its techniques and applications have continued to develop and expand.<sup id=\"rdp-ebb-cite_ref-krames_14-0\" class=\"reference\"><a href=\"#cite_note-krames-14\" rel=\"external_link\">[14]<\/a><\/sup> \nThese are methods where an operation is required to position an electrode. The stimulator, with the battery, similar to a pacemaker, may also be implanted, or may remain outside the body.\n<\/p><p>In general, neuromodulation systems deliver electrical currents and typically consist of the following components: An epidural, subdural or parenchymal electrode placed via minimally invasive needle techniques (so-called percutaneous leads) or an open surgical exposure to the target (surgical \"paddle\" or \"grid\" electrodes), or stereotactic implants for the central nervous system, and an implanted pulse generator (IPG). Depending on the distance from the electrode access point an extension cable may also be added into the system. The IPG can have either a non-rechargeable battery needing replacement every 2\u20135 years (depending on stimulation parameters) or a rechargeable battery that is replenished via an external inductive charging system.\n<\/p><p>Although most systems operate via delivery of a constant train of stimulation, there is now the advent of so-called \"feed-forward\" stimulation where the device's activation is contingent on a physiological event, such as an epileptic seizure. In this circumstance, the device is activated and delivers a desynchronizing pulse to the cortical area that is undergoing an epileptic seizure. This concept of feed-forward stimulation will likely become more prevalent as physiological markers of targeted diseases and neural disorders are discovered and verified.<sup id=\"rdp-ebb-cite_ref-pmid18164485_15-0\" class=\"reference\"><a href=\"#cite_note-pmid18164485-15\" rel=\"external_link\">[15]<\/a><\/sup> The on-demand stimulation may contribute to longer battery life, if sensing and signal-processing demands of the system are sufficiently power-efficient. New electrode designs could yield more efficient and precise stimulation, requiring less current and minimizing unwanted side-stimulation. In addition, to overcome the challenge of preventing lead migration in areas of the body that are subject to motion such as turning and bending, researchers are exploring developing small stimulation systems that are recharged wirelessly rather than through an electrical lead.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Spinal_cord_stimulation\">Spinal cord stimulation<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_stimulation\" class=\"mw-redirect\" title=\"Spinal cord stimulation\" rel=\"external_link\" target=\"_blank\">Spinal cord stimulation<\/a><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_stimulation\" class=\"mw-redirect\" title=\"Spinal cord stimulation\" rel=\"external_link\" target=\"_blank\">Spinal cord stimulation<\/a> is a form of invasive neuromodulation therapy in common use since the 1980s. Its principal use is as a reversible, non-pharmacological therapy for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_pain\" title=\"Chronic pain\" rel=\"external_link\" target=\"_blank\">chronic pain<\/a> management that delivers mild electrical pulses to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord\" title=\"Spinal cord\" rel=\"external_link\" target=\"_blank\">spinal cord<\/a>.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> In patients who experience pain reduction of 50 percent or more during a temporary trial, a permanent implant may be offered in which, as with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_pacemaker\" title=\"Cardiac pacemaker\" rel=\"external_link\" target=\"_blank\">cardiac pacemaker<\/a>, an implantable pulse generator about the size of a stopwatch is placed under the skin on the trunk. It delivers mild impulses along slender electrical leads leading to small electrical contacts, about the size of a grain of rice, at the area of the spine to be stimulated.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p><p>Stimulation is typically in the 20\u2013200 Hz range, though a novel class of stimulation parameters are now emerging that employ a 10 kHz stimulation train as well as 500 Hz \"burst stimulation\". Kilohertz stimulation trains have been applied to both the spinal cord proper as well as the dorsal root ganglion in humans. All forms of spinal cord stimulation have been shown to have varying degrees of efficacy to address a variety of pharmacoresistant neuropathic or mixed (neuropathic and noiciceptive) pain syndromes such as post-laminectomy syndrome, low back pain, complex regional pain syndrome, peripheral neuropathy, peripheral vascular disease and angina.<sup id=\"rdp-ebb-cite_ref-NACC_19-0\" class=\"reference\"><a href=\"#cite_note-NACC-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p><p>The general process for spinal cord stimulation involves a temporary trailing of appropriate patients with an external pulse generator attached to epidural electrodes located in the lower thoracic spinal cord. The electrodes are placed either via a minimally invasive needle technique (so-called percutaneous leads) or an open surgical exposure (surgical \"paddle\" electrodes).\n<\/p><p>Patient selection is key, and candidates should pass rigorous psychological screening as well as a medical workup to assure that their pain syndrome is truly medication-resistant.<sup id=\"rdp-ebb-cite_ref-NACC_19-1\" class=\"reference\"><a href=\"#cite_note-NACC-19\" rel=\"external_link\">[19]<\/a><\/sup> After recuperating from the implant procedure, the patient will return to have the system turned on and programmed. Depending on the system, the program may elicit a tingling sensation that covers most of the painful area, replacing some of the painful sensations with more of a gentle massaging sensation, although other more recent systems do not create a tingling sensation. The patient is sent home with a handheld remote controller to turn the system off or on or switch between pre-set stimulation parameters, and can follow up to adjust the parameters.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Deep_brain_stimulation\">Deep brain stimulation<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deep_brain_stimulation\" title=\"Deep brain stimulation\" rel=\"external_link\" target=\"_blank\">Deep brain stimulation<\/a><\/div>\n<p>Another invasive neuromodulation treatment developed in the 1980s is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deep_brain_stimulation\" title=\"Deep brain stimulation\" rel=\"external_link\" target=\"_blank\">deep brain stimulation<\/a>, which may be used to help limit symptoms of movement disorder in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parkinson%27s_disease\" title=\"Parkinson's disease\" rel=\"external_link\" target=\"_blank\">Parkinson's disease<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dystonia\" title=\"Dystonia\" rel=\"external_link\" target=\"_blank\">dystonia<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Essential_tremor\" title=\"Essential tremor\" rel=\"external_link\" target=\"_blank\">essential tremor<\/a>.<sup id=\"rdp-ebb-cite_ref-Bronstein_2011_20-0\" class=\"reference\"><a href=\"#cite_note-Bronstein_2011-20\" rel=\"external_link\">[20]<\/a><\/sup> Deep brain stimulation was approved by the U.S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> in 1997 for essential tremor, in 2002 for Parkinson's disease, and received a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Humanitarian_device_exemption\" class=\"mw-redirect\" title=\"Humanitarian device exemption\" rel=\"external_link\" target=\"_blank\">humanitarian device exemption<\/a> from the FDA in 2003 for motor symptoms of dystonia.<sup id=\"rdp-ebb-cite_ref-williams-okun-psych-2013_21-0\" class=\"reference\"><a href=\"#cite_note-williams-okun-psych-2013-21\" rel=\"external_link\">[21]<\/a><\/sup> It was approved in 2010 in Europe for the treatment of certain types of severe epilepsy.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> DBS also has shown promise, although still in research, for medically intractable psychiatric syndromes of depression, obsessive compulsive disorders, intractable rage, dementia, and morbid obesity. It has also shown promise for Tourette syndrome, torticollis, and tardive dyskinesia. DBS therapy, unlike spinal cord stimulation, has a variety of central nervous system targets, depending on the target pathology. For Parkinson's disease central nervous system targets include the subthalamic nucleus, globus pallidus interna, and the ventral intermidus nucleus of the thalamus. Dystonias are often treated by implants targeting globus pallidus interna, or less often, parts of the ventral thalamic group. The anterior thalamus is the target for epilepsy.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-lozano-neuron-2013_24-0\" class=\"reference\"><a href=\"#cite_note-lozano-neuron-2013-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-williams-okun-psych-2013_21-1\" class=\"reference\"><a href=\"#cite_note-williams-okun-psych-2013-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p><p>DBS research targets include, but are not limited to the following areas: Cg25 for depression, the anterior limb of the internal capsule for depression as well as obsessive compulsive disorder (OCD), centromedian\/parafasicularis, centromedian thalamic nuclei and the subthalamic nucleus for OCD, anorexia and Tourette syndrome, the nucleus accumbens and ventral striatum have also been assayed for depression and pain.<sup id=\"rdp-ebb-cite_ref-lozano-neuron-2013_24-1\" class=\"reference\"><a href=\"#cite_note-lozano-neuron-2013-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-williams-okun-psych-2013_21-2\" class=\"reference\"><a href=\"#cite_note-williams-okun-psych-2013-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Other_invasive_electrical_methods\">Other invasive electrical methods<\/span><\/h3>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Auditory_brainstem_implant\" title=\"Auditory brainstem implant\" rel=\"external_link\" target=\"_blank\">Auditory brainstem implant<\/a>, which provides a sense of sound to a person who cannot use a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implant\" title=\"Cochlear implant\" rel=\"external_link\" target=\"_blank\">cochlear implant<\/a> due to a damaged or missing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlea\" title=\"Cochlea\" rel=\"external_link\" target=\"_blank\">cochlea<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Auditory_nerve\" class=\"mw-redirect\" title=\"Auditory nerve\" rel=\"external_link\" target=\"_blank\">auditory nerve<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Functional_electrical_stimulation\" title=\"Functional electrical stimulation\" rel=\"external_link\" target=\"_blank\">Functional electrical stimulation (FES)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vagus_nerve_stimulation\" title=\"Vagus nerve stimulation\" rel=\"external_link\" target=\"_blank\">Vagus nerve stimulation (VNS)<\/a><sup id=\"rdp-ebb-cite_ref-George_2007_25-0\" class=\"reference\"><a href=\"#cite_note-George_2007-25\" rel=\"external_link\">[25]<\/a><\/sup><\/li>\n<li>Hypoglossal nerve stimulation, an option for some patients who have <a href=\"https:\/\/en.wikipedia.org\/wiki\/Obstructive_sleep_apnea\" title=\"Obstructive sleep apnea\" rel=\"external_link\" target=\"_blank\">obstructive sleep apnea<\/a><sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous_tibial_nerve_stimulation\" title=\"Percutaneous tibial nerve stimulation\" rel=\"external_link\" target=\"_blank\">Percutaneous tibial nerve stimulation (PTNS)<\/a> for the treatment of incontinence.<\/li>\n<li>Peripheral nerve stimulation (PNS, which refers to simulation of nerves beyond the spine or brain, and may be considered to include occipital or sacral nerve stimulation)<\/li>\n<li>Occipital nerve stimulation (ONS)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacral_nerve_stimulation\" title=\"Sacral nerve stimulation\" rel=\"external_link\" target=\"_blank\">Sacral nerve stimulation (SNS) \/ sacral neuromodulation (SNM)<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Non-invasive_electrical_methods\">Non-invasive electrical methods<\/span><\/h2>\n<p>These methods use external electrodes to apply a current to the body in order to change the functioning of the nervous system.\n<\/p><p>Methods include:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcranial_direct-current_stimulation\" title=\"Transcranial direct-current stimulation\" rel=\"external_link\" target=\"_blank\">Transcranial direct current stimulation (tDCS)<\/a><sup id=\"rdp-ebb-cite_ref-Feng_2013_13-1\" class=\"reference\"><a href=\"#cite_note-Feng_2013-13\" rel=\"external_link\">[13]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcutaneous_electrical_nerve_stimulation\" title=\"Transcutaneous electrical nerve stimulation\" rel=\"external_link\" target=\"_blank\">Transcutaneous electrical nerve stimulation (TENS)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electroconvulsive_therapy\" title=\"Electroconvulsive therapy\" rel=\"external_link\" target=\"_blank\">Electroconvulsive therapy (ECT)<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Non-invasive_magnetic_methods\">Non-invasive magnetic methods<\/span><\/h2>\n<p>Magnetic methods of neuromodulation are normally non-invasive: no surgery is required to allow a magnetic field to enter the body because the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Permeability_(electromagnetism)\" title=\"Permeability (electromagnetism)\" rel=\"external_link\" target=\"_blank\">magnetic permeability<\/a> of tissue is similar to that of air. In other words: magnetic field penetrate the body very easily.\n<\/p><p>The two main techniques are highly related in that both use changes in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_flux\" title=\"Magnetic flux\" rel=\"external_link\" target=\"_blank\">magnetic field strength<\/a> to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electromagnetic_induction\" title=\"Electromagnetic induction\" rel=\"external_link\" target=\"_blank\">induce<\/a> electric fields and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ion\" title=\"Ion\" rel=\"external_link\" target=\"_blank\">ionic<\/a> currents in the body. There are however differences in approach and hardware. In rTMS the stimulation has a high amplitude (0.5\u20133 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tesla_(unit)\" title=\"Tesla (unit)\" rel=\"external_link\" target=\"_blank\">tesla<\/a>), a low complexity and anatomical specificity is reached through a highly focal magnetic field. In tPEMF the stimulation has a low amplitude (0.01\u2013500 millitesla), a high complexity and anatomical specificity is reached through the specific frequency content of the signal.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcranial_magnetic_stimulation\" title=\"Transcranial magnetic stimulation\" rel=\"external_link\" target=\"_blank\">Repetitive transcranial magnetic stimulation (rTMS)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulsed_electromagnetic_field_therapy\" title=\"Pulsed electromagnetic field therapy\" rel=\"external_link\" target=\"_blank\">Transcranial pulsed electromagnetic fields (tPEMF)<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Invasive_chemical_methods\">Invasive chemical methods<\/span><\/h2>\n<p>Chemical neuromodulation is always invasive, because a drug is delivered in a highly specific location of the body. The non-invasive variant is traditional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacotherapy\" title=\"Pharmacotherapy\" rel=\"external_link\" target=\"_blank\">pharmacotherapy<\/a>, e.g. swallowing a tablet.\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Intrathecal\" class=\"mw-redirect\" title=\"Intrathecal\" rel=\"external_link\" target=\"_blank\">Intrathecal<\/a> drug delivery systems (ITDS, which may deliver micro-doses of painkiller (for instance, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ziconotide\" title=\"Ziconotide\" rel=\"external_link\" target=\"_blank\">ziconotide<\/a>) or anti-spasm medicine (such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Baclofen\" title=\"Baclofen\" rel=\"external_link\" target=\"_blank\">baclofen<\/a>) directly to the site of action)<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Electrical stimulation of the nervous system has a long and complex history. Earlier practitioners of deep brain stimulation in the latter half of the 20th century (Delgado, Heath, Hosbuchi. See Hariz <i>et al.<\/i> for historical review<sup id=\"rdp-ebb-cite_ref-hariz_28-0\" class=\"reference\"><a href=\"#cite_note-hariz-28\" rel=\"external_link\">[28]<\/a><\/sup>) were limited by the technology available. Heath, in the 1950s, stimulated subcortical areas and made detailed observations of behavioral changes. A new understanding of pain perception was ushered in in 1965, with the Gate Theory of Wall and Melzack.<sup id=\"rdp-ebb-cite_ref-Melzack&Wall61\u201369_29-0\" class=\"reference\"><a href=\"#cite_note-Melzack&Wall61\u201369-29\" rel=\"external_link\">[29]<\/a><\/sup> Although now considered oversimplified, the theory held that pain transmissions from small nerve fibers can be overridden, or the gate \"closed\", by competing transmissions along the wider touch nerve fibers. Building on that concept, in 1967, the first dorsal column stimulator for pain control was demonstrated by Dr. Norm Shealy at Western Reserve Medical School, using a design adapted by Tom Mortimer, a graduate student at Case Institute of Technology, from cardiac nerve stimulators by Medtronic, Inc., where he had a professional acquaintance who shared the circuit diagram. In 1973, Hosbuchi reported alleviating the denervation facial pain of anesthesia dolorosa through ongoing electrical stimulation of the somatosensory thalamus, marking the start of the age of deep brain stimulation.<sup id=\"rdp-ebb-cite_ref-krames_14-1\" class=\"reference\"><a href=\"#cite_note-krames-14\" rel=\"external_link\">[14]<\/a><\/sup><sup class=\"reference\" style=\"white-space:nowrap;\">:<span>13\u201316<\/span><\/sup><sup id=\"rdp-ebb-cite_ref-lozano-textbook-2009_30-0\" class=\"reference\"><a href=\"#cite_note-lozano-textbook-2009-30\" rel=\"external_link\">[30]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-bittar-meta-analysis_31-0\" class=\"reference\"><a href=\"#cite_note-bittar-meta-analysis-31\" rel=\"external_link\">[31]<\/a><\/sup>\n<\/p><p>Despite the limited clinical experience in these decades, that era is remarkable for the demonstration of the role technology has in neuromodulation, and there are some case reports of deep brain stimulation for a variety of problems; real or perceived. Delgado hinted at the power of neuromodulation with his implants in the bovine septal region and the ability of electrical stimulation to blunt or alter behavior. Further attempts at this \"behavioral modification\" in humans were difficult and seldom reliable, and contributed to the overall lack progress in central nervous system neuromodulation from that era. Attempts at intractable pain syndromes were met with more success, but again hampered by the quality of technology. In particular, the so-called DBS \"zero\" electrode, (consisting of a contact loop on its end) had an unacceptable failure rate and revisions were fraught with more risk than benefit. Overall, attempts at using electrical stimulation for \"behavioral modification\" were difficult and seldom reliable, slowing development of DBS. Attempts at addressing intractable pain syndromes with DBS were met with more success, but again hampered by the quality of technology. A number of physicians who hoped to address hitherto intractable problems sought development of more specialized equipment; for instance, in the 1960s, Wall's colleague Bill Sweet recruited engineer Roger Avery to make an implantable peripheral nerve stimulator. Avery started the Avery Company, which made a number of implantable stimulators. Shortly before his retirement in 1983, he submitted data requested by the FDA, which had begun to regulate medical devices following a 1977 meeting on the topic, regarding DBS for chronic pain. Medtronic and Neuromed also made deep brain stimulators at the time, but reportedly felt a complex safety and efficacy clinical trial in patients who were difficult to evaluate would be too costly for the size of the potential patient base, so did not submit clinical data on DBS for chronic pain to the FDA, and that indication was de-approved.<sup id=\"rdp-ebb-cite_ref-krames_14-2\" class=\"reference\"><a href=\"#cite_note-krames-14\" rel=\"external_link\">[14]<\/a><\/sup><sup class=\"reference\" style=\"white-space:nowrap;\">:<span>13\u201316<\/span><\/sup><sup id=\"rdp-ebb-cite_ref-lozano-textbook-2009_30-1\" class=\"reference\"><a href=\"#cite_note-lozano-textbook-2009-30\" rel=\"external_link\">[30]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-bittar-meta-analysis_31-1\" class=\"reference\"><a href=\"#cite_note-bittar-meta-analysis-31\" rel=\"external_link\">[31]<\/a><\/sup>\n<\/p><p>However, near this time in France and elsewhere, DBS was investigated as a substitute for lesioning of brain nuclei to control motor symptoms of movement disorders such as Parkinson's disease, and by the mid-1990s, this reversible, non-destructive stimulation therapy had become the primary application of DBS in appropriate patients, to slow progression of movement impairment from the disease and reduce side effects from long-term, escalating medication use.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup>\n<\/p><p>In parallel to the development of neuromodulation systems to address motor impairment, cochlear implants were the first neuromodulation system to reach a broad commercial stage to address a functional deficit; they provide sound perception in users who are hearing-impaired due to missing or damaged sensory cells (cilia) in the inner ear. The approach to electrical stimulation used in cochlear implants was soon modified by one manufacturer, Boston Scientific Corporation, for design of electrical leads to be used in spinal cord stimulation treatment of chronic pain conditions.<sup id=\"rdp-ebb-cite_ref-krames_14-3\" class=\"reference\"><a href=\"#cite_note-krames-14\" rel=\"external_link\">[14]<\/a><\/sup><sup class=\"reference\" style=\"white-space:nowrap;\">:<span>13\u201316<\/span><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Relationship_to_electroceuticals\">Relationship to electroceuticals<\/span><\/h2>\n<p>In 2012, the global pharmaceutical company GlaxoSmithKline announced an initiative in bioelectric medicine in which the autonomic nervous system's impact on the immune system and inflammatory disease might be treated through electrical stimulation rather than pharmaceutical agents. The company's first investment in 2013 involved a small startup company, SetPoint Medical, which was developing neurostimulators to address inflammatory autoimmune disorders such as rheumatoid arthritis.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup>\n<\/p><p>Ultimately, the electroceuticals quest aims to find the electro-neural signature of disease and at a cellular level, in real time, play back the more normal electro-signature to help maintain the neural signature in the normal state. Unlike preceding neuromodulation therapy methods, the approach would not involve electrical leads stimulating large nerves or spinal cords or brain centers. It might involve methods that are emerging within the neuromodulation family of therapies, such as optogenetics or some new nanotechnology. Disease states and conditions that have been discussed as targets for future electroceutical therapy include diabetes, infertility, obesity, rheumatoid arthritis, and autoimmune disorders.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Alim-Louis_Benabid\" class=\"mw-redirect\" title=\"Alim-Louis Benabid\" rel=\"external_link\" target=\"_blank\">Alim-Louis Benabid<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain_computer_interface\" class=\"mw-redirect\" title=\"Brain computer interface\" rel=\"external_link\" target=\"_blank\">Brain computer interfacing (BCI)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/BrainGate\" title=\"BrainGate\" rel=\"external_link\" target=\"_blank\">BrainGate<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Neuromodulation_Society\" title=\"International Neuromodulation Society\" rel=\"external_link\" target=\"_blank\">International Neuromodulation Society<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_pain_management\" title=\"Interventional pain management\" rel=\"external_link\" target=\"_blank\">Interventional pain management<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/North_American_Neuromodulation_Society\" title=\"North American Neuromodulation Society\" rel=\"external_link\" target=\"_blank\">North American Neuromodulation Society<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromodulation_(journal)\" title=\"Neuromodulation (journal)\" rel=\"external_link\" target=\"_blank\"><i>Neuromodulation<\/i> (journal)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroprosthetics\" title=\"Neuroprosthetics\" rel=\"external_link\" target=\"_blank\">Neuroprosthetics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurotechnology\" title=\"Neurotechnology\" rel=\"external_link\" target=\"_blank\">Neurotechnology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurostimulation\" title=\"Neurostimulation\" rel=\"external_link\" target=\"_blank\">Neurostimulation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Optogenetics\" title=\"Optogenetics\" rel=\"external_link\" target=\"_blank\">Optogenetics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_prosthesis\" title=\"Visual prosthesis\" rel=\"external_link\" target=\"_blank\">Visual prosthesis<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-INS-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-INS_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.neuromodulation.com\/\" target=\"_blank\">\"International Neuromodulation Society home page\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">1 October<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=International+Neuromodulation+Society+home+page&rft_id=http%3A%2F%2Fwww.neuromodulation.com%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Karas, Patrick J.; Mikell, Charles B.; Christian, Eisha; Liker, Mark A.; Sheth, Sameer A. (2013). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/thejns.org\/doi\/abs\/10.3171\/2013.9.FOCUS13383\" target=\"_blank\">\"Deep brain stimulation: a mechanistic and clinical update\"<\/a>. <i>Neurosurgical Focus<\/i>. <b>35<\/b> (5): E1. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3171%2F2013.9.focus13383\" target=\"_blank\">10.3171\/2013.9.focus13383<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurosurgical+Focus&rft.atitle=Deep+brain+stimulation%3A+a+mechanistic+and+clinical+update.&rft.volume=35&rft.issue=5&rft.pages=E1&rft.date=2013&rft_id=info%3Adoi%2F10.3171%2F2013.9.focus13383&rft.aulast=Karas&rft.aufirst=Patrick+J.&rft.au=Mikell%2C+Charles+B.&rft.au=Christian%2C+Eisha&rft.au=Liker%2C+Mark+A.&rft.au=Sheth%2C+Sameer+A.&rft_id=http%3A%2F%2Fthejns.org%2Fdoi%2Fabs%2F10.3171%2F2013.9.FOCUS13383&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Al-Otaibi_2011-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Al-Otaibi_2011_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Al-Otaibi, FA.; Hamani, C.; Lozano, AM. (Oct 2011). \"Neuromodulation in epilepsy\". <i>Neurosurgery<\/i>. <b>69<\/b> (4): 957\u201379, discussion 979. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1227%2FNEU.0b013e31822b30cd\" target=\"_blank\">10.1227\/NEU.0b013e31822b30cd<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21716154\" target=\"_blank\">21716154<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurosurgery&rft.atitle=Neuromodulation+in+epilepsy.&rft.volume=69&rft.issue=4&rft.pages=957-79%2C+discussion+979&rft.date=2011-10&rft_id=info%3Adoi%2F10.1227%2FNEU.0b013e31822b30cd&rft_id=info%3Apmid%2F21716154&rft.aulast=Al-Otaibi&rft.aufirst=FA.&rft.au=Hamani%2C+C.&rft.au=Lozano%2C+AM.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Krames, Elliot S.; Peckham, P. Hunter; Rezai, Ali R., eds. (2009). Neuromodulation, Vol. 1-2. Academic Press. p. 274. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780123742483.<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wu C.; Sharan A. D. (2013). \"Neurostimulation for the Treatment of Epilepsy: A Review of Current Surgical Interventions\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromodulation_(journal)\" title=\"Neuromodulation (journal)\" rel=\"external_link\" target=\"_blank\">Neuromodulation<\/a><\/i>. <b>16<\/b>: 10\u201324. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1525-1403.2012.00501.x\" target=\"_blank\">10.1111\/j.1525-1403.2012.00501.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22947069\" target=\"_blank\">22947069<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuromodulation&rft.atitle=Neurostimulation+for+the+Treatment+of+Epilepsy%3A+A+Review+of+Current+Surgical+Interventions&rft.volume=16&rft.pages=10-24&rft.date=2013&rft_id=info%3Adoi%2F10.1111%2Fj.1525-1403.2012.00501.x&rft_id=info%3Apmid%2F22947069&rft.au=Wu+C.&rft.au=Sharan+A.+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Boston Scientific Corporation, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bostonscientific.mediaroom.com\/index.php?s=24889&item=132247\" target=\"_blank\">\"Precision\u2122 Plus Spinal Cord Stimulator System Receives CE Mark Approval as MRI Conditional\"<\/a>, Paris, France. 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Neuropharmacol<\/i>. <b>4<\/b> (5): 278\u2013288. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2174%2F157015907782793603\" target=\"_blank\">10.2174\/157015907782793603<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2644491\" target=\"_blank\">2644491<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19305744\" target=\"_blank\">19305744<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Curr.+Neuropharmacol.&rft.atitle=Emerging+synergisms+between+drugs+and+physiologically-patterned+weak+magnetic+fields%3A+implications+for+neuropharmacology+and+the+human+population+in+the+twenty-first+century.&rft.volume=4&rft.issue=5&rft.pages=278-288&rft.date=2007&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2644491&rft_id=info%3Apmid%2F19305744&rft_id=info%3Adoi%2F10.2174%2F157015907782793603&rft.au=Whissell+PD%2C+Persinger+MA&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2644491&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-hariz-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-hariz_28-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Hariz, Marwan I.; Blomstedt, Patric; Zrinzo, Ludvic. <i>Neurosurg Focus<\/i> 29 (2):E1 2010.<\/span>\n<\/li>\n<li id=\"cite_note-Melzack&Wall61\u201369-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Melzack&Wall61\u201369_29-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><span class=\"citation\">Wall PD & Melzack R. <i>The challenge of pain<\/i>. 2nd ed. New York: Penguin Books; 1996. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-14-025670-9. p. 61\u201369.<\/span><\/span>\n<\/li>\n<li id=\"cite_note-lozano-textbook-2009-30\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-lozano-textbook-2009_30-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-lozano-textbook-2009_30-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Textbook of Stereotactic and Functional Neurosurgery, Volume 1 edited by Andres M. Lozano, Philip L. Gildenberg, Ronald R. Tasker. 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Retrieved <span class=\"nowrap\">11 October<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Financial+Times&rft.atitle=Healthcare%3A+Into+the+cortex+Scientific+advances+on+the+brain+promise+to+transform+the+pharmaceutical+industry&rft.date=2012-07-31&rft.aulast=Cookson&rft.aufirst=Clive&rft_id=http%3A%2F%2Fwww.ft.com%2Fcms%2Fs%2F0%2F487fb69e-db1f-11e1-8074-00144feab49a.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Famm, Kristoffer; Litt, Brian; Tracey, Kevin J.; Boyden, Edward S.; Siaoui, Moncef (11 April 2013). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nature.com\/nature\/journal\/v496\/n7444\/full\/496159a.html?WT.ec_id=NATURE-20130411\" target=\"_blank\">\"Drug discovery: A jump-start for electroceuticals\"<\/a>. <i>Nature<\/i>. <b>496<\/b>: 159\u2013161. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2F496159a\" target=\"_blank\">10.1038\/496159a<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4179459\" target=\"_blank\">4179459<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23579662\" target=\"_blank\">23579662<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">12 October<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature&rft.atitle=Drug+discovery%3A+A+jump-start+for+electroceuticals&rft.volume=496&rft.pages=159-161&rft.date=2013-04-11&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4179459&rft_id=info%3Apmid%2F23579662&rft_id=info%3Adoi%2F10.1038%2F496159a&rft.aulast=Famm&rft.aufirst=Kristoffer&rft.au=Litt%2C+Brian&rft.au=Tracey%2C+Kevin+J.&rft.au=Boyden%2C+Edward+S.&rft.au=Siaoui%2C+Moncef&rft_id=http%3A%2F%2Fwww.nature.com%2Fnature%2Fjournal%2Fv496%2Fn7444%2Ffull%2F496159a.html%3FWT.ec_id%3DNATURE-20130411&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">John Carroll (10 April 2013). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fiercebiotech.com\/story\/glaxosmithkline-stakes-pioneering-effort-launch-electroceutical-rd\/2013-04-10\" target=\"_blank\">\"GlaxoSmithKline stakes a pioneering effort to launch 'electroceutical' R&D\"<\/a>. <i>Fierce Biotech<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 October<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Fierce+Biotech&rft.atitle=GlaxoSmithKline+stakes+a+pioneering+effort+to+launch+%27electroceutical%27+R%26D&rft.date=2013-04-10&rft.au=John+Carroll&rft_id=http%3A%2F%2Fwww.fiercebiotech.com%2Fstory%2Fglaxosmithkline-stakes-pioneering-effort-launch-electroceutical-rd%2F2013-04-10&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Birmingham, Karen; Gradinaru, Viviana; Anikeeva, Polina; Grill, Warren M.; McLaughlin, Bryan; Pansricha, Pankaj; Weber, Douglas; Ludwig, Kip; Kristoffer, Famm; Pikov, Victor (2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nature.com\/nrd\/journal\/v13\/n6\/full\/nrd4351.html\" target=\"_blank\">\"Bioelectronic medicines: A research roadmap\"<\/a>. <i>Nature Reviews Drug Discovery<\/i> (published 30 May 2014). <b>13<\/b>: 399\u2013400. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnrd4351\" target=\"_blank\">10.1038\/nrd4351<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24875080\" target=\"_blank\">24875080<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Reviews+Drug+Discovery&rft.atitle=Bioelectronic+medicines%3A+A+research+roadmap&rft.volume=13&rft.pages=399-400&rft.date=2014&rft_id=info%3Adoi%2F10.1038%2Fnrd4351&rft_id=info%3Apmid%2F24875080&rft.aulast=Birmingham&rft.aufirst=Karen&rft.au=Gradinaru%2C+Viviana&rft.au=Anikeeva%2C+Polina&rft.au=Grill%2C+Warren+M.&rft.au=McLaughlin%2C+Bryan&rft.au=Pansricha%2C+Pankaj&rft.au=Weber%2C+Douglas&rft.au=Ludwig%2C+Kip&rft.au=Kristoffer%2C+Famm&rft.au=Pikov%2C+Victor&rft_id=http%3A%2F%2Fwww.nature.com%2Fnrd%2Fjournal%2Fv13%2Fn6%2Ffull%2Fnrd4351.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><cite class=\"citation journal\">Al\u00f3, KM.; Holsheimer, J. (Apr 2002). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/journals.lww.com\/neurosurgery\/pages\/articleviewer.aspx?year=2002&issue=04000&article=00003&type=abstract\" target=\"_blank\">\"New trends in neuromodulation for the management of neuropathic pain\"<\/a>. <i>Neurosurgery<\/i>. <b>50<\/b> (4): 690\u2013703, discussion 703-4. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00006123-200204000-00003\" target=\"_blank\">10.1097\/00006123-200204000-00003<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11904018\" target=\"_blank\">11904018<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurosurgery&rft.atitle=New+trends+in+neuromodulation+for+the+management+of+neuropathic+pain.&rft.volume=50&rft.issue=4&rft.pages=690-703%2C+discussion+703-4&rft.date=2002-04&rft_id=info%3Adoi%2F10.1097%2F00006123-200204000-00003&rft_id=info%3Apmid%2F11904018&rft.aulast=Al%C3%B3&rft.aufirst=KM.&rft.au=Holsheimer%2C+J.&rft_id=http%3A%2F%2Fjournals.lww.com%2Fneurosurgery%2Fpages%2Farticleviewer.aspx%3Fyear%3D2002%26issue%3D04000%26article%3D00003%26type%3Dabstract&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li>Althaus J: A Treatise on Medical Electricity, Theoretical and Practical; and Its Use in the Treatment of Paralysis, Neuralgia, and Other Diseases Philadelphia, Lindsay & Blakiston, 1860;163-170.<\/li>\n<li><cite class=\"citation journal\">Andrews, RJ. (Jun 2010). \"Neuromodulation: advances in the next five years\". <i>Ann. N. Y. Acad. Sci<\/i>. <b>1199<\/b>: 204\u201311. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1749-6632.2009.05379.x\" target=\"_blank\">10.1111\/j.1749-6632.2009.05379.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20633126\" target=\"_blank\">20633126<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ann.+N.+Y.+Acad.+Sci.&rft.atitle=Neuromodulation%3A+advances+in+the+next+five+years.&rft.volume=1199&rft.pages=204-11&rft.date=2010-06&rft_id=info%3Adoi%2F10.1111%2Fj.1749-6632.2009.05379.x&rft_id=info%3Apmid%2F20633126&rft.aulast=Andrews&rft.aufirst=RJ.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Attal, N.; Cruccu, G.; Haanp\u00e4\u00e4, M.; Hansson, P.; Jensen, TS.; Nurmikko, T.; Sampaio, C.; Sindrup, S.; Wiffen, P. 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Basel, Karger, 2011, vol 24, 224 p.<\/li>\n<li><cite class=\"citation journal\">Slangen R, Schaper NC, Faber CG, Joosten EA, Dirksen CD, van Dongen RT, Kessels AG, van Kleef M (2014). \"Spinal Cord Stimulation and Pain Relief in Painful Diabetic Peripheral Neuropathy: A Prospective Two-Center Randomized Controlled Trial\". <i>Diabetes Care<\/i>. <b>37<\/b> (11): 3016\u20133024. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2337%2Fdc14-0684\" target=\"_blank\">10.2337\/dc14-0684<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25216508\" target=\"_blank\">25216508<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Diabetes+Care&rft.atitle=Spinal+Cord+Stimulation+and+Pain+Relief+in+Painful+Diabetic+Peripheral+Neuropathy%3A+A+Prospective+Two-Center+Randomized+Controlled+Trial&rft.volume=37&rft.issue=11&rft.pages=3016-3024&rft.date=2014&rft_id=info%3Adoi%2F10.2337%2Fdc14-0684&rft_id=info%3Apmid%2F25216508&rft.aulast=Slangen&rft.aufirst=R&rft.au=Schaper%2C+NC&rft.au=Faber%2C+CG&rft.au=Joosten%2C+EA&rft.au=Dirksen%2C+CD&rft.au=van+Dongen%2C+RT&rft.au=Kessels%2C+AG&rft.au=van+Kleef%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Stanton-Hicks M, Salamon J (1997). \"Stimulation of the central and peripheral nervous system for the control of pain\". <i>J. Clin. Neurophysiol<\/i>. <b>14<\/b>: 46\u201362. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00004691-199701000-00004\" target=\"_blank\">10.1097\/00004691-199701000-00004<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J.+Clin.+Neurophysiol.&rft.atitle=Stimulation+of+the+central+and+peripheral+nervous+system+for+the+control+of+pain&rft.volume=14&rft.pages=46-62&rft.date=1997&rft_id=info%3Adoi%2F10.1097%2F00004691-199701000-00004&rft.aulast=Stanton-Hicks&rft.aufirst=M&rft.au=Salamon%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Sun, FT.; Morrell, MJ.; Wharen, RE. (Jan 2008). \"Responsive cortical stimulation for the treatment of epilepsy\". <i>Neurotherapeutics<\/i>. <b>5<\/b> (1): 68\u201374. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.nurt.2007.10.069\" target=\"_blank\">10.1016\/j.nurt.2007.10.069<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18164485\" target=\"_blank\">18164485<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurotherapeutics&rft.atitle=Responsive+cortical+stimulation+for+the+treatment+of+epilepsy.&rft.volume=5&rft.issue=1&rft.pages=68-74&rft.date=2008-01&rft_id=info%3Adoi%2F10.1016%2Fj.nurt.2007.10.069&rft_id=info%3Apmid%2F18164485&rft.aulast=Sun&rft.aufirst=FT.&rft.au=Morrell%2C+MJ.&rft.au=Wharen%2C+RE.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Ubbink DT, Vermeulen H (2006). \"Spinal Cord Stimulation for Critical Leg Ischemia: A Review of Effectiveness and Optimal Patient Selection\". <i>Journal of Pain and Symptom Management<\/i>. <b>31<\/b> (4): S30\u2013S35. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jpainsymman.2005.12.013\" target=\"_blank\">10.1016\/j.jpainsymman.2005.12.013<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Pain+and+Symptom+Management&rft.atitle=Spinal+Cord+Stimulation+for+Critical+Leg+Ischemia%3A+A+Review+of+Effectiveness+and+Optimal+Patient+Selection&rft.volume=31&rft.issue=4&rft.pages=S30-S35&rft.date=2006&rft_id=info%3Adoi%2F10.1016%2Fj.jpainsymman.2005.12.013&rft.aulast=Ubbink&rft.aufirst=DT&rft.au=Vermeulen%2C+H&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Ubbink DT, Vermeulen H (2013). \"Spinal cord stimulation for non-reconstructable chronic critical leg ischaemia\". <i>Cochrane Database Syst. Rev<\/i>. <b>2<\/b>: CD004001. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD004001.pub3\" target=\"_blank\">10.1002\/14651858.CD004001.pub3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23450547\" target=\"_blank\">23450547<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cochrane+Database+Syst.+Rev.&rft.atitle=Spinal+cord+stimulation+for+non-reconstructable+chronic+critical+leg+ischaemia.&rft.volume=2&rft.pages=CD004001&rft.date=2013&rft_id=info%3Adoi%2F10.1002%2F14651858.CD004001.pub3&rft_id=info%3Apmid%2F23450547&rft.au=Ubbink+DT%2C+Vermeulen+H&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>.<\/li>\n<li><cite class=\"citation journal\">Yampolsky C, Hem S, Bendersky D (2012). \"Dorsal column stimulator applications\". <i>Surg. Neurol. Int<\/i>. <b>3<\/b> (Suppl 4): S275\u201389. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4103%2F2152-7806.103019\" target=\"_blank\">10.4103\/2152-7806.103019<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Surg.+Neurol.+Int.&rft.atitle=Dorsal+column+stimulator+applications&rft.volume=3&rft.issue=Suppl+4&rft.pages=S275-89&rft.date=2012&rft_id=info%3Adoi%2F10.4103%2F2152-7806.103019&rft.aulast=Yampolsky&rft.aufirst=C&rft.au=Hem%2C+S&rft.au=Bendersky%2C+D&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Yelnik, AP.; Simon, O.; Parratte, B.; Gracies, JM. (Oct 2010). \"How to clinically assess and treat muscle overactivity in spastic paresis\". <i>J. Rehabil. Med<\/i>. <b>42<\/b> (9): 801\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2340%2F16501977-0613\" target=\"_blank\">10.2340\/16501977-0613<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20878038\" target=\"_blank\">20878038<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J.+Rehabil.+Med.&rft.atitle=How+to+clinically+assess+and+treat+muscle+overactivity+in+spastic+paresis.&rft.volume=42&rft.issue=9&rft.pages=801-7&rft.date=2010-10&rft_id=info%3Adoi%2F10.2340%2F16501977-0613&rft_id=info%3Apmid%2F20878038&rft.aulast=Yelnik&rft.aufirst=AP.&rft.au=Simon%2C+O.&rft.au=Parratte%2C+B.&rft.au=Gracies%2C+JM.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Zafonte R, Lombard L, Elovic E (2004). \"Antispasticity medications: uses and limitations of enteral therapy\". <i>Am. J. Phys. Med. Rehabil<\/i>. <b>83<\/b>: S50\u2013S58. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.phm.0000141132.48673.fa\" target=\"_blank\">10.1097\/01.phm.0000141132.48673.fa<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Am.+J.+Phys.+Med.+Rehabil.&rft.atitle=Antispasticity+medications%3A+uses+and+limitations+of+enteral+therapy&rft.volume=83&rft.pages=S50-S58&rft.date=2004&rft_id=info%3Adoi%2F10.1097%2F01.phm.0000141132.48673.fa&rft.aulast=Zafonte&rft.aufirst=R&rft.au=Lombard%2C+L&rft.au=Elovic%2C+E&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuromodulation+%28medicine%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/onlinelibrary.wiley.com\/journal\/10.1111\/(ISSN)1525-1403\" target=\"_blank\">Neuromodulation: Technology at the Neural Interface<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.newswise.com\/articles\/1st-global-guidance-announced-on-neurostimulation-for-pain\" target=\"_blank\">Neuromodulation Appropriateness Consensus Committee (news release)<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1270\nCached time: 20181217110839\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.828 seconds\nReal time usage: 0.937 seconds\nPreprocessor visited node count: 3771\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 262240\/2097152 bytes\nTemplate argument size: 133998\/2097152 bytes\nHighest expansion depth: 15\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 138006\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.524\/10.000 seconds\nLua memory usage: 5.8 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 806.437 1 -total\n<\/p>\n<pre>52.14% 420.496 1 Template:Reflist\n51.62% 416.258 51 Template:Cite_journal\n27.87% 224.727 1 Template:Columns-list\n 8.87% 71.525 1 Template:Infobox_medical_intervention\n 8.85% 71.377 1 Template:Cite_web\n 8.32% 67.116 1 Template:Infobox\n 7.17% 57.808 3 Template:ISBN\n 6.05% 48.827 1 Template:About\n 2.59% 20.885 3 Template:Catalog_lookup_link\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:40651435-1!canonical and timestamp 20181217110838 and revision id 872609558\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromodulation_%28medicine%29\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212245\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.020 seconds\nReal time usage: 0.172 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 162.943 1 - wikipedia:Neuromodulation_(medicine)\n100.00% 162.943 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8305-0!*!*!*!*!*!* and timestamp 20181217212245 and revision id 24524\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Neuromodulation_(medicine)\">https:\/\/www.limswiki.org\/index.php\/Neuromodulation_(medicine)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","36d1bad27e438d4551403b2329d681f7_images":[],"36d1bad27e438d4551403b2329d681f7_timestamp":1545081765,"17f99801ff5f468fb33355f5b215a3f6_type":"article","17f99801ff5f468fb33355f5b215a3f6_title":"Nanno-scaffolding","17f99801ff5f468fb33355f5b215a3f6_url":"https:\/\/www.limswiki.org\/index.php\/Nano-scaffold","17f99801ff5f468fb33355f5b215a3f6_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tNano-scaffold\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs more medical references for verification or relies too heavily on primary sources. Please review the contents of the article and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. (December 2012)\nNano-scaffolding (or nanoscaffolding) is a medical process used to regrow tissue and bone, including limbs and organs. The nano-scaffold is a three-dimensional structure composed of polymer fibers very small that are scaled from a Nanometer (10\u22129 m) scale.[1] Developed by the American military, the medical technology uses a microscopic apparatus made of fine polymer fibers called a scaffold.[2] Damaged cells grip to the scaffold and begin to rebuild missing bone and tissue through tiny holes in the scaffold. As tissue grows, the scaffold is absorbed into the body and disappears completely.\nNano-scaffolding has also been used to regrow burned skin. The process cannot grow complex organs like hearts.[3]\nHistorically, research on nano-scaffolds dates back to at least the late 1980s when Simon showed that electrospinning could be used to produced nano- and submicron-scale polymeric fibrous scaffolds specifically intended for use as in vitro cell and tissue substrates. This early use of electrospun fibrous lattices for cell culture and tissue engineering showed that various cell types would adhere to and proliferate upon polycarbonate fibers. It was noted that as opposed to the flattened morphology typically seen in 2D culture, cells grown on the electrospun fibers exhibited a more rounded 3-dimensional morphology generally observed of tissues in vivo.[4]\n\nContents \n\n1 How it works \n2 Mechanical Properties \n\n2.1 Bone Scaffolds \n2.2 Heart Muscle Scaffolds \n2.3 Spinal Cord Engineering \n\n\n3 References \n\n\nHow it works \nNano-scaffolding is very small, 100 times smaller than the human hair and is built out of biodegradable fibers. The use of this scaffolding allows more effective use of stem cells and quicker regeneration. Electrospun nanofibers are prepared using microscopic tubes that range between 100 and 200 nanometers in diameter. These entangle with each other in the form of a web as they're produced. Electrospinning allows the construction of these webs to be controlled in the sense of the tube's diameter, thickness, and the material being used.[5] Nano-scaffolding is placed into the body at the site where the regeneration process will occur. Once injected, stem cells are added to the scaffolding. Stem cells that are attached to a scaffold are shown to be more successful in adapting to their environment and performing the task of regeneration. The nerve ends in the body will attach to the scaffolding by weaving in-between the openings. This will cause them to act as a bridge to connect severed sections. Over time the scaffolding will dissolve and safely exit the body leaving healthy nerves in its place.\nThis technology is the combination of stem cell research and nanotechnology. The ability to be able to repair damaged nerves is the greatest challenge and prize for many researchers as well as a huge step for the medical field.[6] This would allow doctors to repair nerves damaged in an extreme accident, like third degree burns. The technology however, is still in its infancy and is still not capable of regenerating complex organs like a heart, although it can already be used to create skin, bone and nails.[7] Nano scaffolding has been shown to be four to seven times more effective in keeping the stem cells alive in the body, which would allow them to perform their job more effectively. This technology can be used to save limbs that would otherwise need amputation.[8] Nanoscaffolding provides a large surface area for the material being produced, along with changeable chemical and physical properties. This allows them to be applicable in many different types of technological fields.[5]\n\nMechanical Properties \nMechanical properties are one of the most important considerations when designing scaffolds for medical use. If the mechanical properties, in particular the elastic modulus, of the scaffold do not align with those of the host tissue, the scaffold is more likely to inhibit regeneration or mechanically fail.\n\nBone Scaffolds \nAs with natural bone, the primary issue with bone scaffolds is brittle failure. They typically follow linear elastic behavior, and under compressive forces experiences a plateau and recovery reminiscent of cellular solids as well as trabecular bone.[9] The elastic modulus of natural bone ranges from 10 to 20 GPa; it requires a high stiffness to withstand constant mechanical load.[10] Bone scaffolds must therefore be as stiff as natural bone, or the scaffold will fail through crack nucleation and propagation before the host tissue can regenerate. However, if the scaffold is significantly stiffer than the surrounding tissue, the elastic mismatch and continuity at the scaffold boundary with cause strain in the natural bone and could create unwanted defects.\n\nHeart Muscle Scaffolds \nCardiac muscle, on the other hand, has an elastic modulus of only around 10 MPa, 3 orders of magnitude smaller than bone. However, it experiences constant cyclic loading as the heart pumps.[11] This means that the scaffold must be both tough and elastic, a property achieved using polymeric materials.\n\nSpinal Cord Engineering \nThe spinal cord presents yet another challenge in the engineering of mechanical properties for tissue engineering. Discs in the spine are stiff like bone, and must withstand high mechanical loading; this part of the spine must be engineered with a high elastic modulus. The discs are filled with white and grey matter, which are gel-like and much less stiff. In repairing a defect in the grey matter, the modulus must be matched precisely so that the shock-absorbing properties are not affected. A mismatch in elastic modulus will also hinder contact between the regenerative material and the host grey matter as well as the exterior bone layer.[12]\n\nReferences \n\n\n^ http:\/\/nanoscaffoldtech.com\/ May 17, 2013 \n\n^ [1][dead link ] \n\n^ \"Nanoscaffolding regrows limbs, organs\". TechCrunch. 19 November 2008. \n\n^ Simon, Eric M. (1988). \"NIH PHASE I FINAL REPORT: FIBROUS SUBSTRATES FOR CELL CULTURE (R3RR03544A) (PDF Download Available)\". ResearchGate. Retrieved 2017-05-22 . \n\n^ a b http:\/\/nanoscaffoldtech.com\/nanoscaffold.php May 21, 2013 \n\n^ https:\/\/www.sciencedaily.com\/releases\/2008\/02\/080225085147.htm \n\n^ \"Nanoscaffolding regrows limbs, organs\". TechCrunch. AOL. 19 November 2008. \n\n^ \"Avoiding amputations - development of nano-scaffold significantly increases effectiveness of angiogenesis treatment\". nanowerk.com. \n\n^ Woodard Joseph R. \"The mechanical properties and osteoconductivity of hydroxyapatite bone scaffolds with multi-scale porosity\". Biomaterials. 28 (1): 45\u201354. doi:10.1016\/j.biomaterials.2006.08.021. Retrieved 2017-06-01 . \n\n^ Rho, J. Y.; Ashman, R. B.; Turner, C. H. (February 1993). \"Young's modulus of trabecular and cortical bone material: ultrasonic and microtensile measurements\". Journal of Biomechanics. 26 (2): 111\u2013119. doi:10.1016\/0021-9290(93)90042-d. ISSN 0021-9290. PMID 8429054. \n\n^ Hunter, P. J.; McCulloch, A. D.; ter Keurs, H. E. D. J. (March 1998). \"Modelling the mechanical properties of cardiac muscle\". Progress in Biophysics and Molecular Biology. 69 (2\u20133): 289\u2013331. doi:10.1016\/S0079-6107(98)00013-3. \n\n^ Sparrey, Carolyn J.; Manley, Geoffrey T.; Keaveny, Tony M. (April 2009). \"Effects of White, Grey, and Pia Mater Properties on Tissue Level Stresses and Strains in the Compressed Spinal Cord\". Journal of Neurotrauma. 26 (4): 585\u2013595. doi:10.1089\/neu.2008.0654. ISSN 0897-7151. PMC 2877118 . PMID 19292657. \n\n\n[1]\n^ \"Scaffolding UAE\". Archived from the original on 2018-07-06. Retrieved 7 July 2018 . \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Nano-scaffold\">https:\/\/www.limswiki.org\/index.php\/Nano-scaffold<\/a>\n\t\t\t\t\tCategories: BiomaterialsImplants (medicine)Medical and surgical techniquesMedical devicesNanotechnologyHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 2 March 2016, at 19:58.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 713 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","17f99801ff5f468fb33355f5b215a3f6_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Nano-scaffold skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Nano-scaffold<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Nano-scaffolding<\/b> (or nanoscaffolding) is a medical process used to regrow tissue and bone, including limbs and organs. The nano-scaffold is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Three-dimensional\" class=\"mw-redirect\" title=\"Three-dimensional\" rel=\"external_link\" target=\"_blank\">three-dimensional<\/a> structure composed of polymer fibers very small that are scaled from a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nanometer\" class=\"mw-redirect\" title=\"Nanometer\" rel=\"external_link\" target=\"_blank\">Nanometer<\/a> (10<sup>\u22129<\/sup> m) scale.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> Developed by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_military\" class=\"mw-redirect\" title=\"American military\" rel=\"external_link\" target=\"_blank\">American military<\/a>, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_technology\" class=\"mw-redirect\" title=\"Medical technology\" rel=\"external_link\" target=\"_blank\">medical technology<\/a> uses a microscopic apparatus made of fine <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiber#Polymer_fibers\" title=\"Fiber\" rel=\"external_link\" target=\"_blank\">polymer fibers<\/a> called a scaffold.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> Damaged cells grip to the scaffold and begin to rebuild missing bone and tissue through tiny holes in the scaffold. As tissue grows, the scaffold is absorbed into the body and disappears completely.\n<\/p><p>Nano-scaffolding has also been used to regrow burned skin. The process cannot grow complex organs like hearts.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>Historically, research on nano-scaffolds dates back to at least the late 1980s when Simon showed that electrospinning could be used to produced nano- and submicron-scale polymeric fibrous scaffolds specifically intended for use as <i>in vitro<\/i> cell and tissue substrates. This early use of electrospun fibrous lattices for cell culture and tissue engineering showed that various cell types would adhere to and proliferate upon polycarbonate fibers. It was noted that as opposed to the flattened morphology typically seen in 2D culture, cells grown on the electrospun fibers exhibited a more rounded 3-dimensional morphology generally observed of tissues <i>in vivo<\/i>.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"How_it_works\">How it works<\/span><\/h2>\n<p>Nano-scaffolding is very small, 100 times smaller than the human hair and is built out of biodegradable fibers. The use of this scaffolding allows more effective use of stem cells and quicker regeneration. Electrospun <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nanofibers\" class=\"mw-redirect\" title=\"Nanofibers\" rel=\"external_link\" target=\"_blank\">nanofibers<\/a> are prepared using microscopic tubes that range between 100 and 200 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nanometers\" class=\"mw-redirect\" title=\"Nanometers\" rel=\"external_link\" target=\"_blank\">nanometers<\/a> in diameter. These entangle with each other in the form of a web as they're produced. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrospinning\" title=\"Electrospinning\" rel=\"external_link\" target=\"_blank\">Electrospinning<\/a> allows the construction of these webs to be controlled in the sense of the tube's diameter, thickness, and the material being used.<sup id=\"rdp-ebb-cite_ref-nst_5-0\" class=\"reference\"><a href=\"#cite_note-nst-5\" rel=\"external_link\">[5]<\/a><\/sup> Nano-scaffolding is placed into the body at the site where the regeneration process will occur. Once injected, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stem_cells\" class=\"mw-redirect\" title=\"Stem cells\" rel=\"external_link\" target=\"_blank\">stem cells<\/a> are added to the scaffolding. Stem cells that are attached to a scaffold are shown to be more successful in adapting to their environment and performing the task of regeneration. The nerve ends in the body will attach to the scaffolding by weaving in-between the openings. This will cause them to act as a bridge to connect severed sections. Over time the scaffolding will dissolve and safely exit the body leaving healthy nerves in its place.\n<\/p><p>This technology is the combination of stem cell research and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nanotechnology\" title=\"Nanotechnology\" rel=\"external_link\" target=\"_blank\">nanotechnology<\/a>. The ability to be able to repair damaged nerves is the greatest challenge and prize for many researchers as well as a huge step for the medical field.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> This would allow doctors to repair nerves damaged in an extreme accident, like third degree burns. The technology however, is still in its infancy and is still not capable of regenerating complex organs like a heart, although it can already be used to create skin, bone and nails.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> Nano scaffolding has been shown to be four to seven times more effective in keeping the stem cells alive in the body, which would allow them to perform their job more effectively. This technology can be used to save limbs that would otherwise need amputation.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> Nanoscaffolding provides a large <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surface_area\" title=\"Surface area\" rel=\"external_link\" target=\"_blank\">surface area<\/a> for the material being produced, along with changeable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical\" class=\"mw-redirect\" title=\"Chemical\" rel=\"external_link\" target=\"_blank\">chemical<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_property\" title=\"Physical property\" rel=\"external_link\" target=\"_blank\">physical properties<\/a>. This allows them to be applicable in many different types of technological fields.<sup id=\"rdp-ebb-cite_ref-nst_5-1\" class=\"reference\"><a href=\"#cite_note-nst-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Mechanical_Properties\">Mechanical Properties<\/span><\/h2>\n<p>Mechanical properties are one of the most important considerations when designing scaffolds for medical use. If the mechanical properties, in particular the elastic modulus, of the scaffold do not align with those of the host tissue, the scaffold is more likely to inhibit regeneration or mechanically fail.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Bone_Scaffolds\">Bone Scaffolds<\/span><\/h3>\n<p>As with natural bone, the primary issue with bone scaffolds is brittle failure. They typically follow linear elastic behavior, and under compressive forces experiences a plateau and recovery reminiscent of cellular solids as well as trabecular bone.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> The elastic modulus of natural bone ranges from 10 to 20 GPa; it requires a high stiffness to withstand constant mechanical load.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> Bone scaffolds must therefore be as stiff as natural bone, or the scaffold will fail through crack nucleation and propagation before the host tissue can regenerate. However, if the scaffold is significantly stiffer than the surrounding tissue, the elastic mismatch and continuity at the scaffold boundary with cause strain in the natural bone and could create unwanted defects.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Heart_Muscle_Scaffolds\">Heart Muscle Scaffolds<\/span><\/h3>\n<p>Cardiac muscle, on the other hand, has an elastic modulus of only around 10 MPa, 3 orders of magnitude smaller than bone. However, it experiences constant cyclic loading as the heart pumps.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> This means that the scaffold must be both tough and elastic, a property achieved using polymeric materials.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Spinal_Cord_Engineering\">Spinal Cord Engineering<\/span><\/h3>\n<p>The spinal cord presents yet another challenge in the engineering of mechanical properties for tissue engineering. Discs in the spine are stiff like bone, and must withstand high mechanical loading; this part of the spine must be engineered with a high elastic modulus. The discs are filled with white and grey matter, which are gel-like and much less stiff. In repairing a defect in the grey matter, the modulus must be matched precisely so that the shock-absorbing properties are not affected. A mismatch in elastic modulus will also hinder contact between the regenerative material and the host grey matter as well as the exterior bone layer.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/nanoscaffoldtech.com\/\" target=\"_blank\">http:\/\/nanoscaffoldtech.com\/<\/a> May 17, 2013<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"https:\/\/nationalpost.com\/news\/story.html?id=941552\" target=\"_blank\">[1]<\/a><sup class=\"noprint Inline-Template\"><span style=\"white-space: nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Link_rot\" title=\"Wikipedia:Link rot\" rel=\"external_link\" target=\"_blank\"><span title=\" Dead link since September 2016\">dead link<\/span><\/a><\/i>]<\/span><\/sup><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.crunchgear.com\/2008\/11\/19\/nanoscaffolding-regrows-limbs-organs\/\" target=\"_blank\">\"Nanoscaffolding regrows limbs, organs\"<\/a>. <i>TechCrunch<\/i>. 19 November 2008.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=TechCrunch&rft.atitle=Nanoscaffolding+regrows+limbs%2C+organs&rft.date=2008-11-19&rft_id=http%3A%2F%2Fwww.crunchgear.com%2F2008%2F11%2F19%2Fnanoscaffolding-regrows-limbs-organs%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANano-scaffold\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Simon, Eric M. (1988). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.researchgate.net\/publication\/317053872_NIH_PHASE_I_FINAL_REPORT_FIBROUS_SUBSTRATES_FOR_CELL_CULTURE_R3RR03544A\" target=\"_blank\">\"NIH PHASE I FINAL REPORT: FIBROUS SUBSTRATES FOR CELL CULTURE (R3RR03544A) (PDF Download Available)\"<\/a>. <i>ResearchGate<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-05-22<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=ResearchGate&rft.atitle=NIH+PHASE+I+FINAL+REPORT%3A+FIBROUS+SUBSTRATES+FOR+CELL+CULTURE+%28R3RR03544A%29+%28PDF+Download+Available%29&rft.date=1988&rft.aulast=Simon&rft.aufirst=Eric+M.&rft_id=https%3A%2F%2Fwww.researchgate.net%2Fpublication%2F317053872_NIH_PHASE_I_FINAL_REPORT_FIBROUS_SUBSTRATES_FOR_CELL_CULTURE_R3RR03544A&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANano-scaffold\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-nst-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-nst_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-nst_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/nanoscaffoldtech.com\/nanoscaffold.php\" target=\"_blank\">http:\/\/nanoscaffoldtech.com\/nanoscaffold.php<\/a> May 21, 2013<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.sciencedaily.com\/releases\/2008\/02\/080225085147.htm\" target=\"_blank\">https:\/\/www.sciencedaily.com\/releases\/2008\/02\/080225085147.htm<\/a><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/techcrunch.com\/2008\/11\/19\/nanoscaffolding-regrows-limbs-organs\/\" target=\"_blank\">\"Nanoscaffolding regrows limbs, organs\"<\/a>. <i>TechCrunch<\/i>. AOL. 19 November 2008.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=TechCrunch&rft.atitle=Nanoscaffolding+regrows+limbs%2C+organs&rft.date=2008-11-19&rft_id=https%3A%2F%2Ftechcrunch.com%2F2008%2F11%2F19%2Fnanoscaffolding-regrows-limbs-organs%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANano-scaffold\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nanowerk.com\/news\/newsid=25107.php\" target=\"_blank\">\"Avoiding amputations - development of nano-scaffold significantly increases effectiveness of angiogenesis treatment\"<\/a>. nanowerk.com.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Avoiding+amputations+-+development+of+nano-scaffold+significantly+increases+effectiveness+of+angiogenesis+treatment&rft.pub=nanowerk.com&rft_id=http%3A%2F%2Fwww.nanowerk.com%2Fnews%2Fnewsid%3D25107.php&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANano-scaffold\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Woodard Joseph R. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S014296120600723X\" target=\"_blank\">\"The mechanical properties and osteoconductivity of hydroxyapatite bone scaffolds with multi-scale porosity\"<\/a>. <i>Biomaterials<\/i>. <b>28<\/b> (1): 45\u201354. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.biomaterials.2006.08.021\" target=\"_blank\">10.1016\/j.biomaterials.2006.08.021<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-06-01<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biomaterials&rft.atitle=The+mechanical+properties+and+osteoconductivity+of+hydroxyapatite+bone+scaffolds+with+multi-scale+porosity&rft.volume=28&rft.issue=1&rft.pages=45-54&rft_id=info%3Adoi%2F10.1016%2Fj.biomaterials.2006.08.021&rft.au=Woodard+Joseph+R&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS014296120600723X&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANano-scaffold\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rho, J. Y.; Ashman, R. B.; Turner, C. H. (February 1993). \"Young's modulus of trabecular and cortical bone material: ultrasonic and microtensile measurements\". <i>Journal of Biomechanics<\/i>. <b>26<\/b> (2): 111\u2013119. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0021-9290%2893%2990042-d\" target=\"_blank\">10.1016\/0021-9290(93)90042-d<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0021-9290\" target=\"_blank\">0021-9290<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8429054\" target=\"_blank\">8429054<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Biomechanics&rft.atitle=Young%27s+modulus+of+trabecular+and+cortical+bone+material%3A+ultrasonic+and+microtensile+measurements&rft.volume=26&rft.issue=2&rft.pages=111-119&rft.date=1993-02&rft.issn=0021-9290&rft_id=info%3Apmid%2F8429054&rft_id=info%3Adoi%2F10.1016%2F0021-9290%2893%2990042-d&rft.aulast=Rho&rft.aufirst=J.+Y.&rft.au=Ashman%2C+R.+B.&rft.au=Turner%2C+C.+H.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANano-scaffold\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hunter, P. J.; McCulloch, A. D.; ter Keurs, H. E. D. J. (March 1998). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0079610798000133\" target=\"_blank\">\"Modelling the mechanical properties of cardiac muscle\"<\/a>. <i>Progress in Biophysics and Molecular Biology<\/i>. <b>69<\/b> (2\u20133): 289\u2013331. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0079-6107%2898%2900013-3\" target=\"_blank\">10.1016\/S0079-6107(98)00013-3<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Progress+in+Biophysics+and+Molecular+Biology&rft.atitle=Modelling+the+mechanical+properties+of+cardiac+muscle&rft.volume=69&rft.issue=2%E2%80%933&rft.pages=289-331&rft.date=1998-03&rft_id=info%3Adoi%2F10.1016%2FS0079-6107%2898%2900013-3&rft.aulast=Hunter&rft.aufirst=P.+J.&rft.au=McCulloch%2C+A.+D.&rft.au=ter+Keurs%2C+H.+E.+D.+J.&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS0079610798000133&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANano-scaffold\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sparrey, Carolyn J.; Manley, Geoffrey T.; Keaveny, Tony M. (April 2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2877118\" target=\"_blank\">\"Effects of White, Grey, and Pia Mater Properties on Tissue Level Stresses and Strains in the Compressed Spinal Cord\"<\/a>. <i>Journal of Neurotrauma<\/i>. <b>26<\/b> (4): 585\u2013595. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1089%2Fneu.2008.0654\" target=\"_blank\">10.1089\/neu.2008.0654<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0897-7151\" target=\"_blank\">0897-7151<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2877118\" target=\"_blank\">2877118<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19292657\" target=\"_blank\">19292657<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Neurotrauma&rft.atitle=Effects+of+White%2C+Grey%2C+and+Pia+Mater+Properties+on+Tissue+Level+Stresses+and+Strains+in+the+Compressed+Spinal+Cord&rft.volume=26&rft.issue=4&rft.pages=585-595&rft.date=2009-04&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2877118&rft.issn=0897-7151&rft_id=info%3Apmid%2F19292657&rft_id=info%3Adoi%2F10.1089%2Fneu.2008.0654&rft.aulast=Sparrey&rft.aufirst=Carolyn+J.&rft.au=Manley%2C+Geoffrey+T.&rft.au=Keaveny%2C+Tony+M.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2877118&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANano-scaffold\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[1]<\/a><\/sup><\/p><div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20180706104638\/http:\/\/360degreeglobal.ae\/\" target=\"_blank\">\"Scaffolding UAE\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/360degreeglobal.ae\/\" target=\"_blank\">the original<\/a> on 2018-07-06<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">7 July<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Scaffolding+UAE&rft_id=http%3A%2F%2F360degreeglobal.ae%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANano-scaffold\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1330\nCached time: 20181129151636\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.260 seconds\nReal time usage: 0.360 seconds\nPreprocessor visited node count: 690\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 22718\/2097152 bytes\nTemplate argument size: 662\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 26244\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.158\/10.000 seconds\nLua memory usage: 3.99 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 333.926 1 -total\n<\/p>\n<pre>68.56% 228.955 1 Template:Reflist\n36.84% 123.030 5 Template:Cite_web\n23.26% 77.684 1 Template:Medical_citations_needed\n18.75% 62.610 4 Template:Cite_journal\n16.62% 55.492 1 Template:Ambox\n 6.74% 22.516 1 Template:Dead_link\n 5.37% 17.925 1 Template:Fix\n 4.20% 14.021 2 Template:Category_handler\n 1.52% 5.073 1 Template:Fix\/category\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:21880823-1!canonical and timestamp 20181129151635 and revision id 870390770\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nano-scaffold\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212244\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.018 seconds\nReal time usage: 0.146 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 139.392 1 - wikipedia:Nano-scaffold\n100.00% 139.392 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8045-0!*!*!*!*!*!* and timestamp 20181217212244 and revision id 24391\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Nano-scaffold\">https:\/\/www.limswiki.org\/index.php\/Nano-scaffold<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","17f99801ff5f468fb33355f5b215a3f6_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e3\/Rod_of_Asclepius2.svg\/25px-Rod_of_Asclepius2.svg.png"],"17f99801ff5f468fb33355f5b215a3f6_timestamp":1545081764,"48414124df76605567b3e70f0a83d886_type":"article","48414124df76605567b3e70f0a83d886_title":"Mitral valve replacement","48414124df76605567b3e70f0a83d886_url":"https:\/\/www.limswiki.org\/index.php\/Mitral_valve_replacement","48414124df76605567b3e70f0a83d886_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMitral valve replacement\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tMitral valve replacementStarr-Edwards mitral valveICD-9-CM35.23-35.24[edit on Wikidata]\nMitral valve replacement is a cardiac surgical procedure in which a patient\u2019s diseased mitral valve is replaced by either a mechanical or bioprosthetic valve. Mitral valve replacement is performed when the valve becomes too tight (mitral valve stenosis) for blood to flow into the left ventricle, or too loose (mitral valve regurgitation) in which case blood can leak back into the left atrium and thereby back into the lung.[1][2] Mitral valve disease can occur from infection, calcification,[3][4] inherited collagen disease, or other causes.[5] Since a mitral valve replacement is an open heart surgical procedure, it requires placing the patient on cardiopulmonary bypass.[1]\n\nContents \n\n1 Effectiveness \n2 Risks \n\n2.1 Postoperative complications \n\n\n3 Options \n\n3.1 Non-surgical options \n\n\n4 Procedure \n\n4.1 Types \n\n\n5 Recovery \n6 See also \n7 References \n8 External links \n\n\nEffectiveness \nIn a study of 99 patients who had mitral valve surgery for regurgitation from January 1990 to June 1996, overall mortality was 4%, which included 3 operative deaths and 4 late deaths. Overall 5-year survival rate was 92%.[6]\n\nRisks \nWith mitral valve replacement surgery, there are risks such as bleeding, infection or reaction to anesthesia.[2] Risks depend on a patient\u2019s age, general condition, specific medical conditions, and heart function.[1] Neuropsychological and psychopathologic changes following mitral valve replacement surgery have been recognized from the very beginning of modern heart surgery.\nVariables correlated with nonpsychotic mental disorder after cardiac surgery must be divided into pre-, intra- and postoperative. The incidence, phenomenology, and duration of symptoms diverge from patient to patient, and are difficult to define. One wonders whether any of the patients in either group in this analysis underwent any mechanical cardiac valve replacement. If so, one has to consider Skumin syndrome, described by Victor Skumin in 1978 as a \u201ccardioprosthetic psychopathological syndrome\u201d[7][8] associated with mechanical heart valve implant and manifested by irrational fear, anxiety, depression and sleep disorder.[9]\n\nPostoperative complications \nA common postoperative complication with mitral valve surgery in a study involving 99 patients who had surgery for mitral regurgitation from January 1990 to June 1996 is atrial fibrillation. This occurred in 32% of patients. A common pulmonary complication is congestion necessitating prolonged use of oxygen. Other patients required prolonged ventilation of longer than 24 hours for conditions like pulmonary edema, ARDS, and pulmonary thromboemboli [6] Nine patients had renal failure with six of them dying within 30 days after their operation. Five patients had permanent strokes, and nine patients were readmitted to the hospital within 30 days of their discharge.[6]\n\nOptions \nMany mitral valves can be repaired instead of replaced, especially for minimally damaged valves.[1] Advantages to valve repair instead of replacement include lower surgical mortality (1-2% for repair versus 6-8% for replacement), lower risk of stroke, lower rate of endocardial infection, and improved long-term survival. Patients who receive a valve repair stay on the same survival curve as the normal population. After mitral valve repair, blood thinners are not required; however, lifelong maintenance on blood thinners is required after mechanical mitral valve replacement.[10] Mitral valve surgery can now also be performed robotically although the procedure may take longer.[11]\n\nNon-surgical options \nMost patients can endure surgery without complications; however, there are some whose heart functions are too weak to withstand surgery. Non-surgical approaches to treat heart valve disease without surgery are divided into three categories: Clinical Practice treatment (this is used in every day clinical practice), Investigational treatment (current clinical studies that are underway), Early Development treatment (early stages of investigation).[12]\n\nProcedure \nPeople having mitral valve surgery receive general anesthesia.[2] Incision can be made somewhat horizontally under the left breast, or vertically through the sternum. After the heart is exposed, canulae are placed to reroute blood to a heart-lung machine for cardiopulmonary bypass.[2] An incision is made in the left atrium to expose the mitral valve. The valve is then replaced with either a biological or mechanical valve. The left artium is then closed, and the patient weaned from cardiopulmonary bypass. After surgery patients are typically taken to an intensive care unit (ICU).[2]\n\nTypes \nThere are two primary types of artificial mitral valves: mechanical valves and bioprosthetic tissue (biological) valves.[10] The mechanical valves are made from metal and pyrolytic carbon, and can last a lifetime.[1] Patients with mechanical valves must take blood-thinning medications to prevent clotting. Bioprosthetic valves are made from animal tissues.[1] Use of these biological valves allows patients to avoid blood thinners. However, the bioprosthetic valves may only last 10 to 15 years.[10] The choice of which valve type to use depends upon the patient's age, medical condition, preferences with medication, and lifestyle.[1]\nNew Developments (2014 -2017): Transcatheter mitral valve replacement or TMVR[13] involves human heart mitral valve replacement without recourse to open-heart surgery. TMVR treats mitral valve stenosis and\/or mitral valve regurgitation leading to mitral insufficiency. TMVR, initially developed by the company Tendyne (a subsidiary of Jean Boulle Medtech Ltd) for open-heart high risk patients is expected to replace traditional mitral valve replacement surgery in the longer term.[14] The Tendyne mitral valve is placed inside a beating heart via a transcatheter at the bottom of the heart through a tube inserted in a small incision in the patient\u2019s chest. The physician uses the tube to deploy the valve and positions it so that it rests over the heart's existing mitral valve. It is then anchored securely in place by an adjustable tether. The valve is fully retrievable, totally repositionable and is sewn onto a Nitinol frame. Nitinol is a superelastic nickel and titanium \"shape memory alloy\" whose flexibility eases implantation, but regains its original shape when it returns to a patient\u2019s normal body temperature.\nThe transition of TMVR from concept to reality occurred during the period 2014 -2017.[15]\n\r\n\n\nRecovery \nAfter the surgery the person is taken to a post-operative intensive care unit for monitoring. A respirator may be required for the first few hours or days after surgery. After a day, the patient should be able to sit up in bed. After two days, the patient may be taken out of the intensive care unit. Patients are usually discharged after about seven to ten days.[2] If the mitral valve replacement is successful, patients can expect to return to their regular condition or even better.\nPatients who have biological valve are prescribed blood thinners (anticoagulants) with warfarin for 6 weeks to 3 months postoperative, while patients with mechanical valves are prescribed blood thinners for the rest of their lives. These blood thinners are taken to prevent blood clots that can move to other parts of the body and cause serious medical problems, such as a heart attack. Blood thinners will not dissolve a blood clot but they prevent other clots from forming or prevent clots from becoming larger.[16]\nOnce the person\u2019s wounds are healed they should have few, if any, restrictions from daily activities.[1] People are advised to walk or undertake other physical activities gradually to regain strength. Patients who have physically demanding jobs will have to wait a little longer than those who don\u2019t. Patients are also restricted from driving a car for six weeks after the surgery.[2]\nOnce a person has a mitral valve procedure, they are required to have prophylactic antibiotics as a preventative measure against infection whenever they have dental work done.[1] Some scarring occurs after surgery. For median sternotomy (access through the sternum, or breastbone), the patient will have a vertical scar on the anterior chest above the sternum. If the heart is accessed from under the left breast there will be a smaller scar in this location.[2]\n\nSee also \nMitral regurgitation\nMitral stenosis\nArtificial heart valve\nCardiac surgery\nHeart-lung machine\nReferences \n\n\n^ a b c d e f g h i Sundt, Thoralf M. \"Mitral Valve Repair\". The Society of Thoracic Surgeons. Retrieved 18 February 2012 . \n\n^ a b c d e f g h \"Mitral Valve Repair\/Replacement\". Baylor College of Medicine. Retrieved 18 February 2012 . \n\n^ Bertazzo, S.; et al. (2013). \"Nano-analytical electron microscopy reveals fundamental insights into human cardiovascular tissue calcification\". Nature Materials. 12: 576\u2013583. doi:10.1038\/nmat3627. CS1 maint: Explicit use of et al. (link) \n\n^ Miller, J. D. (2013). \"Cardiovascular calcification: Orbicular origins\". Nature Materials. 12: 476\u2013478. doi:10.1038\/nmat3663. \n\n^ \"Valvular Heart Disease\". Lahey Clinic Foundation. Retrieved 18 February 2012 . \n\n^ a b c Knott, Hurley W. (Jan 1999). \"Clinical study of mitral valve repair: short-term and long-term outcomes\". Southern Medical Journal. 92 (1): 33\u201340. doi:10.1097\/00007611-199901000-00006. PMID 9932824. Retrieved 18 February 2012 . \n\n^ Bendet, Ya. A.; Morozov, S. M.; Skumin, V. A. (1980). \"Psychological aspects of the rehabilitation of patients after the surgical treatment of heart defects\" Psikhologicheskie aspekty reabilitatsii bol'nykh posle khirurgicheskogo lecheniia porokov serdtsa [Psychological aspects of the rehabilitation of patients after the surgical treatment of heart defects]. Kardiologiia. 20 (6): 45\u201351. OCLC 114137678. PMID 7392405. Archived from the original on 2018-01-02. \n\n^ Skumin, V. A. (1982). Nepsikhoticheskie narusheniia psikhiki u bol'nykh s priobretennymi porokami serdtsa do i posle operatsii (obzor) [Nonpsychotic mental disorders in patients with acquired heart defects before and after surgery (review)]. Zhurnal nevropatologii i psikhiatrii imeni S.S. Korsakova. 82: 130\u20135. OCLC 112979417. PMID 6758444. Archived from the original on 2018-01-02. \n\n^ Ruzza, Andrea. \u2033Nonpsychotic mental disorder after open heart surgery\u2033 Asian Cardiovascular and Thoracic Annals (2013) \n\n^ a b c \"Mitral Valve Repair and Replacement\". Maryland Heart Center. Retrieved 18 February 2012 . \n\n^ Folliguet, T; Vanhuyse F; Constantino X; Realli M; Laborde F (Mar 2006). \"Mitral valve repair robotic versus sternotomy\". Eur J Cardiothorac Surg. 29 (3): 362\u20136. doi:10.1016\/j.ejcts.2005.12.004. PMID 16423535. \n\n^ \"Heart Valve Disease - Percutaneous Interventions\". Cleveland Clinic. Retrieved 18 February 2012 . \n\n^ Alkhouli, M; Alqahtani, F; Aljohani, S (2017). \"Transcatheter mitral valve replacement: an evolution of a revolution\". Journal of Thoracic Disease. 9: S668\u2013S672. doi:10.21037\/jtd.2017.05.60. PMC 5505942 . PMID 28740722. \n\n^ \"Transcatheter Mitral Valve Replacement \u2013 TMVR Explained\". My Heart. Retrieved 24 Feb 2018 . \n\n^ \"Transcatheter mitral valve replacement: A frontier in cardiac intervention\". Cleveland Clinic Journal of Medicine 2017 November; 83(suppl 2):S10-S17. Retrieved 24 Feb 2018 . \n\n^ \"Warfarin and Other Blood Thinners for Heart Disease\". WebMD. Retrieved 18 February 2012 . \n\n\nExternal links \nMitral Valve Replacement vs. Repair\nBCM: The Michael E DeBakey Department of Surgery. Mitral Valve Repair\/ Replacement. n.d. 29 Apr. 2007\n\"FDA approves second clinical trial for robotic heart surgery.\" Health Sciences News. 9 Nov. 2000. ECU Division of Health Sciences. 2 May 2007\n\"Heart Disease: Warfarin and Other Blood Thinners.\" WebMD. The Cleveland Clinic. 10 May 2007 \nHeart and Vascular Institute. Heart Valve Disease - Percutaneous Interventions: Non-surgical approaches. 2007. 7 May 2007 \n\"Mitral Valve Replacement.\" University of Maryland Medical Center: 1-2. 26 Apr. 2007 \nMotulsky, Harvey. Intuitive Biostatistics. Oxford University Press Inc, 1995. 2 May 2007 \nvteSurgery and other procedures involving the heart (ICD-9-CM V3 35\u201337+89.4+99.6, ICD-10-PCS 02)Surgery and ICHeart valves\r\nand septa\nValve repair\nValvulotomy\nMitral valve repair\nValvuloplasty\naortic\nmitral\nValve replacement\nAortic valve repair\nAortic valve replacement\nRoss procedure\nPercutaneous aortic valve replacement\nMitral valve replacement\nproduction of septal defect in heart \nenlargement of existing septal defect\nAtrial septostomy\nBalloon septostomy<\/dd>\ncreation of septal defect in heart\n\nBlalock\u2013Hanlon procedure<\/dd>\nshunt from heart chamber to blood vessel \natrium to pulmonary artery\nFontan procedure<\/dd>\nleft ventricle to aorta\n\nRastelli procedure<\/dd>\nright ventricle to pulmonary artery\n\nSano shunt<\/dd>\ncompound procedures \nfor transposition of great vessels\nArterial switch operation\nMustard procedure\nSenning procedure<\/dd>\nfor univentricular defect\n\nNorwood procedure\nKawashima procedure<\/dd>\nshunt from blood vessel to blood vessel \nsystemic circulation to pulmonary artery shunt\nBlalock\u2013Taussig shunt<\/dd>\nSVC to the right PA\n\nGlenn procedure<\/dd>\nCardiac vessels\nCHD \nAngioplasty\nBypass\/Coronary artery bypass\nMIDCAB\nOff-pump CAB\nTECAB<\/dd>\nCoronary stent \nBare-metal stent\nDrug-eluting stent\nBentall procedure\nValve-sparing aortic root replacement\nLeCompte maneuver\nOther\nPericardium \nPericardiocentesis\nPericardial window\nPericardiectomy\nMyocardium \nCardiomyoplasty\nDor procedure\nSeptal myectomy\nVentricular reduction\nAlcohol septal ablation\nConduction system \nMaze procedure\nCox maze and minimaze<\/dd>\nCatheter ablation\n\nCryoablation\nRadiofrequency ablation<\/dd>\nPacemaker insertion\nLeft atrial appendage occlusion\nCardiotomy\nHeart transplantation\nDiagnostic\r\ntests and\r\nprocedures\nElectrophysiology \nElectrocardiography\nVectorcardiography<\/dd>\nHolter monitor\nImplantable loop recorder\nCardiac stress test\n\nBruce protocol<\/dd>\nElectrophysiology study\nCardiac imaging \nAngiocardiography\nEchocardiography\nTTE\nTEE<\/dd>\nMyocardial perfusion imaging\nCardiovascular MRI\nVentriculography\n\nRadionuclide ventriculography<\/dd>\nCardiac catheterization\/Coronary catheterization\nCardiac CT\n\nCardiac PET\nsound \nPhonocardiogram\nFunction tests\nImpedance cardiography\nBallistocardiography\nCardiotocography\nPacing\nCardioversion\nTranscutaneous pacing\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Mitral_valve_replacement\">https:\/\/www.limswiki.org\/index.php\/Mitral_valve_replacement<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical and surgical techniquesHidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","48414124df76605567b3e70f0a83d886_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Mitral_valve_replacement skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Mitral valve replacement<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Mitral valve replacement<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_surgery\" title=\"Cardiac surgery\" rel=\"external_link\" target=\"_blank\">cardiac surgical<\/a> procedure in which a patient\u2019s diseased <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mitral_valve\" title=\"Mitral valve\" rel=\"external_link\" target=\"_blank\">mitral valve<\/a> is replaced by either a mechanical or bioprosthetic valve. Mitral valve replacement is performed when the valve becomes too tight (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Mitral_valve_stenosis\" title=\"Mitral valve stenosis\" rel=\"external_link\" target=\"_blank\">mitral valve stenosis<\/a>) for blood to flow into the left <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricle_(heart)\" title=\"Ventricle (heart)\" rel=\"external_link\" target=\"_blank\">ventricle<\/a>, or too loose (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Mitral_valve_regurgitation\" class=\"mw-redirect\" title=\"Mitral valve regurgitation\" rel=\"external_link\" target=\"_blank\">mitral valve regurgitation<\/a>) in which case blood can leak back into the left <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrium_(heart)\" title=\"Atrium (heart)\" rel=\"external_link\" target=\"_blank\">atrium<\/a> and thereby back into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lung\" title=\"Lung\" rel=\"external_link\" target=\"_blank\">lung<\/a>.<sup id=\"rdp-ebb-cite_ref-Sundt_1-0\" class=\"reference\"><a href=\"#cite_note-Sundt-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-BCM_2-0\" class=\"reference\"><a href=\"#cite_note-BCM-2\" rel=\"external_link\">[2]<\/a><\/sup> Mitral valve disease can occur from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcification\" title=\"Calcification\" rel=\"external_link\" target=\"_blank\">calcification<\/a>,<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> inherited <a href=\"https:\/\/en.wikipedia.org\/wiki\/Collagen_disease\" title=\"Collagen disease\" rel=\"external_link\" target=\"_blank\">collagen disease<\/a>, or other causes.<sup id=\"rdp-ebb-cite_ref-Lahey_5-0\" class=\"reference\"><a href=\"#cite_note-Lahey-5\" rel=\"external_link\">[5]<\/a><\/sup> Since a mitral valve replacement is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_surgery\" title=\"Cardiac surgery\" rel=\"external_link\" target=\"_blank\">open heart<\/a> surgical procedure, it requires placing the patient on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiopulmonary_bypass\" title=\"Cardiopulmonary bypass\" rel=\"external_link\" target=\"_blank\">cardiopulmonary bypass<\/a>.<sup id=\"rdp-ebb-cite_ref-Sundt_1-1\" class=\"reference\"><a href=\"#cite_note-Sundt-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Effectiveness\">Effectiveness<\/span><\/h2>\n<p>In a study of 99 patients who had mitral valve surgery for regurgitation from January 1990 to June 1996, overall mortality was 4%, which included 3 operative deaths and 4 late deaths. Overall 5-year survival rate was 92%.<sup id=\"rdp-ebb-cite_ref-Knott_6-0\" class=\"reference\"><a href=\"#cite_note-Knott-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h2>\n<p>With mitral valve replacement surgery, there are risks such as bleeding, infection or reaction to anesthesia.<sup id=\"rdp-ebb-cite_ref-BCM_2-1\" class=\"reference\"><a href=\"#cite_note-BCM-2\" rel=\"external_link\">[2]<\/a><\/sup> Risks depend on a patient\u2019s age, general condition, specific medical conditions, and heart function.<sup id=\"rdp-ebb-cite_ref-Sundt_1-2\" class=\"reference\"><a href=\"#cite_note-Sundt-1\" rel=\"external_link\">[1]<\/a><\/sup> Neuropsychological and psychopathologic changes following mitral valve replacement surgery have been recognized from the very beginning of modern heart surgery.\n<\/p><p>Variables correlated with nonpsychotic mental disorder after cardiac surgery must be divided into pre-, intra- and postoperative. The incidence, phenomenology, and duration of symptoms diverge from patient to patient, and are difficult to define. One wonders whether any of the patients in either group in this analysis underwent any mechanical cardiac valve replacement. If so, one has to consider <a href=\"https:\/\/fr.wikipedia.org\/wiki\/Syndrome_de_Skumin\" class=\"extiw\" title=\"fr:Syndrome de Skumin\" rel=\"external_link\" target=\"_blank\">Skumin syndrome<\/a>, described by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Victor_Skumin\" title=\"Victor Skumin\" rel=\"external_link\" target=\"_blank\">Victor Skumin<\/a> in 1978 as a \u201ccardioprosthetic psychopathological syndrome\u201d<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> associated with mechanical heart valve implant and manifested by irrational fear, anxiety, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Depression_(mood)\" title=\"Depression (mood)\" rel=\"external_link\" target=\"_blank\">depression<\/a> and sleep disorder.<sup id=\"rdp-ebb-cite_ref-ruzza2013_9-0\" class=\"reference\"><a href=\"#cite_note-ruzza2013-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Postoperative_complications\">Postoperative complications<\/span><\/h3>\n<p>A common postoperative complication with mitral valve surgery in a study involving 99 patients who had surgery for mitral regurgitation from January 1990 to June 1996 is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrial_fibrillation\" title=\"Atrial fibrillation\" rel=\"external_link\" target=\"_blank\">atrial fibrillation<\/a>. This occurred in 32% of patients. A common pulmonary complication is congestion necessitating prolonged use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen\" title=\"Oxygen\" rel=\"external_link\" target=\"_blank\">oxygen<\/a>. Other patients required prolonged ventilation of longer than 24 hours for conditions like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulmonary_edema\" title=\"Pulmonary edema\" rel=\"external_link\" target=\"_blank\">pulmonary edema<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/ARDS\" class=\"mw-redirect\" title=\"ARDS\" rel=\"external_link\" target=\"_blank\">ARDS<\/a>, and pulmonary thromboemboli <sup id=\"rdp-ebb-cite_ref-Knott_6-1\" class=\"reference\"><a href=\"#cite_note-Knott-6\" rel=\"external_link\">[6]<\/a><\/sup> Nine patients had <a href=\"https:\/\/en.wikipedia.org\/wiki\/Renal_failure\" class=\"mw-redirect\" title=\"Renal failure\" rel=\"external_link\" target=\"_blank\">renal failure<\/a> with six of them dying within 30 days after their operation. Five patients had permanent strokes, and nine patients were readmitted to the hospital within 30 days of their discharge.<sup id=\"rdp-ebb-cite_ref-Knott_6-2\" class=\"reference\"><a href=\"#cite_note-Knott-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Options\">Options<\/span><\/h2>\n<p>Many mitral valves can be repaired instead of replaced, especially for minimally damaged valves.<sup id=\"rdp-ebb-cite_ref-Sundt_1-3\" class=\"reference\"><a href=\"#cite_note-Sundt-1\" rel=\"external_link\">[1]<\/a><\/sup> Advantages to valve repair instead of replacement include lower surgical mortality (1-2% for repair versus 6-8% for replacement), lower risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a>, lower rate of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endocardium\" title=\"Endocardium\" rel=\"external_link\" target=\"_blank\">endocardial<\/a> infection, and improved long-term survival. Patients who receive a valve repair stay on the same <a href=\"https:\/\/en.wikipedia.org\/wiki\/Survival_curve\" class=\"mw-redirect\" title=\"Survival curve\" rel=\"external_link\" target=\"_blank\">survival curve<\/a> as the normal population. After mitral valve repair, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_thinner\" class=\"mw-redirect\" title=\"Blood thinner\" rel=\"external_link\" target=\"_blank\">blood thinners<\/a> are not required; however, lifelong maintenance on blood thinners is required after mechanical mitral valve replacement.<sup id=\"rdp-ebb-cite_ref-UMMC_10-0\" class=\"reference\"><a href=\"#cite_note-UMMC-10\" rel=\"external_link\">[10]<\/a><\/sup> Mitral valve surgery can now also be performed robotically although the procedure may take longer.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Non-surgical_options\">Non-surgical options<\/span><\/h3>\n<p>Most patients can endure surgery without complications; however, there are some whose heart functions are too weak to withstand surgery. Non-surgical approaches to treat heart valve disease without surgery are divided into three categories: Clinical Practice treatment (this is used in every day clinical practice), Investigational treatment (current clinical studies that are underway), Early Development treatment (early stages of investigation).<sup id=\"rdp-ebb-cite_ref-Cleveland_12-0\" class=\"reference\"><a href=\"#cite_note-Cleveland-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Procedure\">Procedure<\/span><\/h2>\n<p>People having mitral valve surgery receive <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_anesthesia\" class=\"mw-redirect\" title=\"General anesthesia\" rel=\"external_link\" target=\"_blank\">general anesthesia<\/a>.<sup id=\"rdp-ebb-cite_ref-BCM_2-2\" class=\"reference\"><a href=\"#cite_note-BCM-2\" rel=\"external_link\">[2]<\/a><\/sup> Incision can be made somewhat horizontally under the left <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast\" title=\"Breast\" rel=\"external_link\" target=\"_blank\">breast<\/a>, or vertically through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_breastbone\" class=\"mw-redirect\" title=\"Human breastbone\" rel=\"external_link\" target=\"_blank\">sternum<\/a>. After the heart is exposed, canulae are placed to reroute blood to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart-lung_machine\" class=\"mw-redirect\" title=\"Heart-lung machine\" rel=\"external_link\" target=\"_blank\">heart-lung machine<\/a> for cardiopulmonary bypass.<sup id=\"rdp-ebb-cite_ref-BCM_2-3\" class=\"reference\"><a href=\"#cite_note-BCM-2\" rel=\"external_link\">[2]<\/a><\/sup> An incision is made in the left atrium to expose the mitral valve. The valve is then replaced with either a biological or mechanical valve. The left artium is then closed, and the patient weaned from cardiopulmonary bypass. After surgery patients are typically taken to an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intensive_care_unit\" title=\"Intensive care unit\" rel=\"external_link\" target=\"_blank\">intensive care unit<\/a> (ICU).<sup id=\"rdp-ebb-cite_ref-BCM_2-4\" class=\"reference\"><a href=\"#cite_note-BCM-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h3>\n<p>There are two primary types of artificial mitral valves: mechanical valves and bioprosthetic tissue (biological) valves.<sup id=\"rdp-ebb-cite_ref-UMMC_10-1\" class=\"reference\"><a href=\"#cite_note-UMMC-10\" rel=\"external_link\">[10]<\/a><\/sup> The mechanical valves are made from metal and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyrolytic_carbon\" title=\"Pyrolytic carbon\" rel=\"external_link\" target=\"_blank\">pyrolytic carbon<\/a>, and can last a lifetime.<sup id=\"rdp-ebb-cite_ref-Sundt_1-4\" class=\"reference\"><a href=\"#cite_note-Sundt-1\" rel=\"external_link\">[1]<\/a><\/sup> Patients with mechanical valves must take blood-thinning medications to prevent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thrombus\" title=\"Thrombus\" rel=\"external_link\" target=\"_blank\">clotting<\/a>. Bioprosthetic valves are made from animal tissues.<sup id=\"rdp-ebb-cite_ref-Sundt_1-5\" class=\"reference\"><a href=\"#cite_note-Sundt-1\" rel=\"external_link\">[1]<\/a><\/sup> Use of these biological valves allows patients to avoid blood thinners. However, the bioprosthetic valves may only last 10 to 15 years.<sup id=\"rdp-ebb-cite_ref-UMMC_10-2\" class=\"reference\"><a href=\"#cite_note-UMMC-10\" rel=\"external_link\">[10]<\/a><\/sup> The choice of which valve type to use depends upon the patient's age, medical condition, preferences with medication, and lifestyle.<sup id=\"rdp-ebb-cite_ref-Sundt_1-6\" class=\"reference\"><a href=\"#cite_note-Sundt-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>New Developments (2014 -2017): Transcatheter mitral valve replacement or <a href=\"https:\/\/en.wikipedia.org\/wiki\/TMVR\" class=\"mw-redirect\" title=\"TMVR\" rel=\"external_link\" target=\"_blank\">TMVR<\/a><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> involves human heart mitral valve replacement without recourse to open-heart surgery. TMVR treats mitral valve stenosis and\/or mitral valve regurgitation leading to mitral insufficiency. TMVR, initially developed by the company Tendyne (a subsidiary of Jean Boulle Medtech Ltd) for open-heart high risk patients is expected to replace traditional mitral valve replacement surgery in the longer term.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> The Tendyne mitral valve is placed inside a beating heart via a transcatheter at the bottom of the heart through a tube inserted in a small incision in the patient\u2019s chest. The physician uses the tube to deploy the valve and positions it so that it rests over the heart's existing mitral valve. It is then anchored securely in place by an adjustable tether. The valve is fully retrievable, totally repositionable and is sewn onto a Nitinol frame. Nitinol is a superelastic nickel and titanium \"shape memory alloy\" whose flexibility eases implantation, but regains its original shape when it returns to a patient\u2019s normal body temperature.\n<\/p><p>The transition of TMVR from concept to reality occurred during the period 2014 -2017.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p><br \/>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Recovery\">Recovery<\/span><\/h2>\n<p>After the surgery the person is taken to a post-operative intensive care unit for monitoring. A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_ventilator\" title=\"Medical ventilator\" rel=\"external_link\" target=\"_blank\">respirator<\/a> may be required for the first few hours or days after surgery. After a day, the patient should be able to sit up in bed. After two days, the patient may be taken out of the intensive care unit. Patients are usually discharged after about seven to ten days.<sup id=\"rdp-ebb-cite_ref-BCM_2-5\" class=\"reference\"><a href=\"#cite_note-BCM-2\" rel=\"external_link\">[2]<\/a><\/sup> If the mitral valve replacement is successful, patients can expect to return to their regular condition or even better.\n<\/p><p>Patients who have biological valve are prescribed blood thinners (anticoagulants) with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Warfarin\" title=\"Warfarin\" rel=\"external_link\" target=\"_blank\">warfarin<\/a> for 6 weeks to 3 months postoperative, while patients with mechanical valves are prescribed blood thinners for the rest of their lives. These blood thinners are taken to prevent blood clots that can move to other parts of the body and cause serious medical problems, such as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_attack\" class=\"mw-redirect\" title=\"Heart attack\" rel=\"external_link\" target=\"_blank\">heart attack<\/a>. Blood thinners will not dissolve a blood clot but they prevent other clots from forming or prevent clots from becoming larger.<sup id=\"rdp-ebb-cite_ref-Warfarin_16-0\" class=\"reference\"><a href=\"#cite_note-Warfarin-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>Once the person\u2019s wounds are healed they should have few, if any, restrictions from daily activities.<sup id=\"rdp-ebb-cite_ref-Sundt_1-7\" class=\"reference\"><a href=\"#cite_note-Sundt-1\" rel=\"external_link\">[1]<\/a><\/sup> People are advised to walk or undertake other physical activities gradually to regain strength. Patients who have physically demanding jobs will have to wait a little longer than those who don\u2019t. Patients are also restricted from driving a car for six weeks after the surgery.<sup id=\"rdp-ebb-cite_ref-BCM_2-6\" class=\"reference\"><a href=\"#cite_note-BCM-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Once a person has a mitral valve procedure, they are required to have prophylactic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antibiotics\" class=\"mw-redirect\" title=\"Antibiotics\" rel=\"external_link\" target=\"_blank\">antibiotics<\/a> as a preventative measure against infection whenever they have dental work done.<sup id=\"rdp-ebb-cite_ref-Sundt_1-8\" class=\"reference\"><a href=\"#cite_note-Sundt-1\" rel=\"external_link\">[1]<\/a><\/sup> Some scarring occurs after surgery. For median sternotomy (access through the sternum, or breastbone), the patient will have a vertical scar on the anterior chest above the sternum. If the heart is accessed from under the left breast there will be a smaller scar in this location.<sup id=\"rdp-ebb-cite_ref-BCM_2-7\" class=\"reference\"><a href=\"#cite_note-BCM-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mitral_regurgitation\" class=\"mw-redirect\" title=\"Mitral regurgitation\" rel=\"external_link\" target=\"_blank\">Mitral regurgitation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mitral_stenosis\" class=\"mw-redirect\" title=\"Mitral stenosis\" rel=\"external_link\" target=\"_blank\">Mitral stenosis<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_heart_valve\" title=\"Artificial heart valve\" rel=\"external_link\" target=\"_blank\">Artificial heart valve<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_surgery\" title=\"Cardiac surgery\" rel=\"external_link\" target=\"_blank\">Cardiac surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart-lung_machine\" class=\"mw-redirect\" title=\"Heart-lung machine\" rel=\"external_link\" target=\"_blank\">Heart-lung machine<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-Sundt-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Sundt_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Sundt_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Sundt_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Sundt_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Sundt_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Sundt_1-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Sundt_1-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Sundt_1-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Sundt_1-8\" rel=\"external_link\"><sup><i><b>i<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Sundt, Thoralf M. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sts.org\/patient-information\/valve-repair\/replacement-surgery\/mitral-valve-repair\" target=\"_blank\">\"Mitral Valve Repair\"<\/a>. The Society of Thoracic Surgeons<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">18 February<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Mitral+Valve+Repair&rft.pub=The+Society+of+Thoracic+Surgeons&rft.aulast=Sundt&rft.aufirst=Thoralf+M.&rft_id=http%3A%2F%2Fwww.sts.org%2Fpatient-information%2Fvalve-repair%2Freplacement-surgery%2Fmitral-valve-repair&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+replacement\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-BCM-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-BCM_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-BCM_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-BCM_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-BCM_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-BCM_2-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-BCM_2-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-BCM_2-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-BCM_2-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.debakeydepartmentofsurgery.org\/home\/content.cfm?proc_name=mitral+valve+repair+replacement&content_id=274\" target=\"_blank\">\"Mitral Valve Repair\/Replacement\"<\/a>. Baylor College of Medicine<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">18 February<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Mitral+Valve+Repair%2FReplacement&rft.pub=Baylor+College+of+Medicine&rft_id=http%3A%2F%2Fwww.debakeydepartmentofsurgery.org%2Fhome%2Fcontent.cfm%3Fproc_name%3Dmitral%2Bvalve%2Brepair%2Breplacement%26content_id%3D274&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bertazzo, S.; et al. (2013). \"Nano-analytical electron microscopy reveals fundamental insights into human cardiovascular tissue calcification\". <i>Nature Materials<\/i>. <b>12<\/b>: 576\u2013583. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnmat3627\" target=\"_blank\">10.1038\/nmat3627<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Materials&rft.atitle=Nano-analytical+electron+microscopy+reveals+fundamental+insights+into+human+cardiovascular+tissue+calcification&rft.volume=12&rft.pages=576-583&rft.date=2013&rft_id=info%3Adoi%2F10.1038%2Fnmat3627&rft.aulast=Bertazzo&rft.aufirst=S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+replacement\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Explicit use of et al. (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Explicit_use_of_et_al.\" title=\"Category:CS1 maint: Explicit use of et al.\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Miller, J. D. (2013). \"Cardiovascular calcification: Orbicular origins\". <i>Nature Materials<\/i>. <b>12<\/b>: 476\u2013478. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnmat3663\" target=\"_blank\">10.1038\/nmat3663<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Materials&rft.atitle=Cardiovascular+calcification%3A+Orbicular+origins&rft.volume=12&rft.pages=476-478&rft.date=2013&rft_id=info%3Adoi%2F10.1038%2Fnmat3663&rft.aulast=Miller&rft.aufirst=J.+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Lahey-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Lahey_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.lahey.org\/Departments_and_Locations\/Departments\/Heart_and_Vascular_Center\/Valvular_Heart_Disease.aspx?_vsignck&_vsrefdom=vascular2\" target=\"_blank\">\"Valvular Heart Disease\"<\/a>. Lahey Clinic Foundation<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">18 February<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Valvular+Heart+Disease&rft.pub=Lahey+Clinic+Foundation&rft_id=http%3A%2F%2Fwww.lahey.org%2FDepartments_and_Locations%2FDepartments%2FHeart_and_Vascular_Center%2FValvular_Heart_Disease.aspx%3F_vsignck%26_vsrefdom%3Dvascular2&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Knott-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Knott_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Knott_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Knott_6-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Knott, Hurley W. (Jan 1999). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=9932824\" target=\"_blank\">\"Clinical study of mitral valve repair: short-term and long-term outcomes\"<\/a>. <i>Southern Medical Journal<\/i>. <b>92<\/b> (1): 33\u201340. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00007611-199901000-00006\" target=\"_blank\">10.1097\/00007611-199901000-00006<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9932824\" target=\"_blank\">9932824<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">18 February<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Southern+Medical+Journal&rft.atitle=Clinical+study+of+mitral+valve+repair%3A+short-term+and+long-term+outcomes.&rft.volume=92&rft.issue=1&rft.pages=33-40&rft.date=1999-01&rft_id=info%3Adoi%2F10.1097%2F00007611-199901000-00006&rft_id=info%3Apmid%2F9932824&rft.aulast=Knott&rft.aufirst=Hurley+W.&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%3Fterm%3D9932824&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bendet, Ya. A.; Morozov, S. M.; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Victor_Skumin\" title=\"Victor Skumin\" rel=\"external_link\" target=\"_blank\">Skumin<\/a>, V. A. (1980). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.webcitation.org\/6wAuZ2Ar5?url=http:\/\/biblmdkz.ru\/articles\/kardiologiia.html\" target=\"_blank\">\"Psychological aspects of the rehabilitation of patients after the surgical treatment of heart defects\" <bdi lang=\"ru\">Psikhologicheskie aspekty reabilitatsii bol'nykh posle khirurgicheskogo lecheniia porokov serdtsa<\/bdi><\/a> [Psychological aspects of the rehabilitation of patients after the surgical treatment of heart defects]. <i>Kardiologiia<\/i>. <b>20<\/b> (6): 45\u201351. <a href=\"https:\/\/en.wikipedia.org\/wiki\/OCLC\" title=\"OCLC\" rel=\"external_link\" target=\"_blank\">OCLC<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/oclc\/114137678\" target=\"_blank\">114137678<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7392405\" target=\"_blank\">7392405<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/biblmdkz.ru\/articles\/kardiologiia.html\" target=\"_blank\">the original<\/a> on 2018-01-02.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Kardiologiia&rft.atitle=Psychological+aspects+of+the+rehabilitation+of+patients+after+the+surgical+treatment+of+heart+defects+Psikhologicheskie+aspekty+reabilitatsii+bol%27nykh+posle+khirurgicheskogo+lecheniia+porokov+serdtsa&rft.volume=20&rft.issue=6&rft.pages=45-51&rft.date=1980&rft_id=info%3Aoclcnum%2F114137678&rft_id=info%3Apmid%2F7392405&rft.aulast=Bendet&rft.aufirst=Ya.+A.&rft.au=Morozov%2C+S.+M.&rft.au=Skumin%2C+V.+A.&rft_id=http%3A%2F%2Fbiblmdkz.ru%2Farticles%2Fkardiologiia.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Victor_Skumin\" title=\"Victor Skumin\" rel=\"external_link\" target=\"_blank\">Skumin<\/a>, V. A. (1982). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.webcitation.org\/6wAYHGzbC?url=http:\/\/biblmdkz.ru\/articles\/nmd.html\" target=\"_blank\"><bdi lang=\"ru\">Nepsikhoticheskie narusheniia psikhiki u bol'nykh s priobretennymi porokami serdtsa do i posle operatsii (obzor)<\/bdi><\/a> [Nonpsychotic mental disorders in patients with acquired heart defects before and after surgery (review)]. <i><a href=\"https:\/\/ru.wikipedia.org\/wiki\/%D0%96%D1%83%D1%80%D0%BD%D0%B0%D0%BB_%D0%BD%D0%B5%D0%B2%D1%80%D0%BE%D0%BB%D0%BE%D0%B3%D0%B8%D0%B8_%D0%B8_%D0%BF%D1%81%D0%B8%D1%85%D0%B8%D0%B0%D1%82%D1%80%D0%B8%D0%B8_%D0%B8%D0%BC%D0%B5%D0%BD%D0%B8_%D0%A1._%D0%A1._%D0%9A%D0%BE%D1%80%D1%81%D0%B0%D0%BA%D0%BE%D0%B2%D0%B0\" class=\"extiw\" title=\"ru:\u0416\u0443\u0440\u043d\u0430\u043b \u043d\u0435\u0432\u0440\u043e\u043b\u043e\u0433\u0438\u0438 \u0438 \u043f\u0441\u0438\u0445\u0438\u0430\u0442\u0440\u0438\u0438 \u0438\u043c\u0435\u043d\u0438 \u0421. \u0421. \u041a\u043e\u0440\u0441\u0430\u043a\u043e\u0432\u0430\" rel=\"external_link\" target=\"_blank\">Zhurnal nevropatologii i psikhiatrii imeni S.S. Korsakova<\/a><\/i>. <b>82<\/b>: 130\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/OCLC\" title=\"OCLC\" rel=\"external_link\" target=\"_blank\">OCLC<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/oclc\/112979417\" target=\"_blank\">112979417<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6758444\" target=\"_blank\">6758444<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/biblmdkz.ru\/articles\/nmd.html\" target=\"_blank\">the original<\/a> on 2018-01-02.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Zhurnal+nevropatologii+i+psikhiatrii+imeni+S.S.+Korsakova&rft.atitle=Nepsikhoticheskie+narusheniia+psikhiki+u+bol%27nykh+s+priobretennymi+porokami+serdtsa+do+i+posle+operatsii+%28obzor%29&rft.volume=82&rft.pages=130-5&rft.date=1982&rft_id=info%3Aoclcnum%2F112979417&rft_id=info%3Apmid%2F6758444&rft.aulast=Skumin&rft.aufirst=V.+A.&rft_id=http%3A%2F%2Fbiblmdkz.ru%2Farticles%2Fnmd.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ruzza2013-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ruzza2013_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Ruzza, Andrea. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/aan.sagepub.com\/content\/early\/2013\/10\/16\/0218492313493427\" target=\"_blank\">\u2033Nonpsychotic mental disorder after open heart surgery\u2033<\/a> <i>Asian Cardiovascular and Thoracic Annals<\/i> (2013)<\/span>\n<\/li>\n<li id=\"cite_note-UMMC-10\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-UMMC_10-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-UMMC_10-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-UMMC_10-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.umm.edu\/heart\/mitral_repla.htm\" target=\"_blank\">\"Mitral Valve Repair and Replacement\"<\/a>. Maryland Heart Center<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">18 February<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Mitral+Valve+Repair+and+Replacement&rft.pub=Maryland+Heart+Center&rft_id=http%3A%2F%2Fwww.umm.edu%2Fheart%2Fmitral_repla.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Folliguet, T; Vanhuyse F; Constantino X; Realli M; Laborde F (Mar 2006). \"Mitral valve repair robotic versus sternotomy\". <i>Eur J Cardiothorac Surg<\/i>. <b>29<\/b> (3): 362\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ejcts.2005.12.004\" target=\"_blank\">10.1016\/j.ejcts.2005.12.004<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16423535\" target=\"_blank\">16423535<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Eur+J+Cardiothorac+Surg&rft.atitle=Mitral+valve+repair+robotic+versus+sternotomy&rft.volume=29&rft.issue=3&rft.pages=362-6&rft.date=2006-03&rft_id=info%3Adoi%2F10.1016%2Fj.ejcts.2005.12.004&rft_id=info%3Apmid%2F16423535&rft.aulast=Folliguet&rft.aufirst=T&rft.au=Vanhuyse+F&rft.au=Constantino+X&rft.au=Realli+M&rft.au=Laborde+F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Cleveland-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Cleveland_12-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"#investigational\">\"Heart Valve Disease - Percutaneous Interventions\"<\/a>. Cleveland Clinic<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">18 February<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Heart+Valve+Disease+-+Percutaneous+Interventions&rft.pub=Cleveland+Clinic&rft_id=http%3A%2F%2Fmy.clevelandclinic.org%2Fheart%2Fpercutaneous%2Fpercutaneousvalve.aspx%23investigational%23investigational&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Alkhouli, M; Alqahtani, F; Aljohani, S (2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5505942\" target=\"_blank\">\"Transcatheter mitral valve replacement: an evolution of a revolution\"<\/a>. <i>Journal of Thoracic Disease<\/i>. <b>9<\/b>: S668\u2013S672. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.21037%2Fjtd.2017.05.60\" target=\"_blank\">10.21037\/jtd.2017.05.60<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5505942\" target=\"_blank\">5505942<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28740722\" target=\"_blank\">28740722<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Thoracic+Disease&rft.atitle=Transcatheter+mitral+valve+replacement%3A+an+evolution+of+a+revolution&rft.volume=9&rft.pages=S668-S672&rft.date=2017&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5505942&rft_id=info%3Apmid%2F28740722&rft_id=info%3Adoi%2F10.21037%2Fjtd.2017.05.60&rft.aulast=Alkhouli&rft.aufirst=M&rft.au=Alqahtani%2C+F&rft.au=Aljohani%2C+S&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5505942&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/myheart.net\/articles\/tmvr-transcatheter-mitral-valve-replacement\/\" target=\"_blank\">\"Transcatheter Mitral Valve Replacement \u2013 TMVR Explained\"<\/a>. My Heart<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">24 Feb<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Transcatheter+Mitral+Valve+Replacement+%E2%80%93+TMVR+Explained&rft.pub=My+Heart&rft_id=https%3A%2F%2Fmyheart.net%2Farticles%2Ftmvr-transcatheter-mitral-valve-replacement%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.mdedge.com\/ccjm\/article\/120398\/cardiology\/transcatheter-mitral-valve-replacement-frontier-cardiac-intervention\" target=\"_blank\">\"Transcatheter mitral valve replacement: A frontier in cardiac intervention\"<\/a>. Cleveland Clinic Journal of Medicine 2017 November; 83(suppl 2):S10-S17<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">24 Feb<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Transcatheter+mitral+valve+replacement%3A+A+frontier+in+cardiac+intervention&rft.pub=Cleveland+Clinic+Journal+of+Medicine+2017+November%3B+83%28suppl+2%29%3AS10-S17&rft_id=https%3A%2F%2Fwww.mdedge.com%2Fccjm%2Farticle%2F120398%2Fcardiology%2Ftranscatheter-mitral-valve-replacement-frontier-cardiac-intervention&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Warfarin-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Warfarin_16-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.webmd.com\/heart-disease\/warfarin-other-blood-thinners?page=1\" target=\"_blank\">\"Warfarin and Other Blood Thinners for Heart Disease\"<\/a>. WebMD<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">18 February<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Warfarin+and+Other+Blood+Thinners+for+Heart+Disease&rft.pub=WebMD&rft_id=http%3A%2F%2Fwww.webmd.com%2Fheart-disease%2Fwarfarin-other-blood-thinners%3Fpage%3D1&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mitralvalverepair.org\/content\/view\/77\/\" target=\"_blank\">Mitral Valve Replacement vs. Repair<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.debakeydepartmentofsurgery.org\/home\/content.cfm?proc_name=mitral+valve+repair+replacement&content_id=274\" target=\"_blank\">BCM: The Michael E DeBakey Department of Surgery. Mitral Valve Repair\/ Replacement. n.d. 29 Apr. 2007<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ecu.edu\/cs-admin\/news\/newsstory.cfm?ID=307\" target=\"_blank\">\"FDA approves second clinical trial for robotic heart surgery.\" Health Sciences News. 9 Nov. 2000. ECU Division of Health Sciences. 2 May 2007<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.webmd.com\/heart-disease\/warfarin-other-blood-thinners?page=1\" target=\"_blank\">\"Heart Disease: Warfarin and Other Blood Thinners.\" WebMD. The Cleveland Clinic. 10 May 2007 <\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.clevelandclinic.org\/heartcenter\/pub\/guide\/percutaneous\/percutaneousValve.htm#investigational#investigational\" target=\"_blank\">Heart and Vascular Institute. <i>Heart Valve Disease - Percutaneous Interventions: Non-surgical approaches.<\/i> 2007. 7 May 2007 <\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.umm.edu\/heart\/mitral_repla.html\" target=\"_blank\">\"Mitral Valve Replacement.\" University of Maryland Medical Center: 1-2. 26 Apr. 2007 <\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.graphpad.com\/www\/book\/survive.htm\" target=\"_blank\">Motulsky, Harvey. <i>Intuitive Biostatistics<\/i>. Oxford University Press Inc, 1995. 2 May 2007 <\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1328\nCached time: 20181205233130\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.312 seconds\nReal time usage: 0.370 seconds\nPreprocessor visited node count: 1205\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 63093\/2097152 bytes\nTemplate argument size: 736\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 47854\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.158\/10.000 seconds\nLua memory usage: 4.46 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 302.416 1 -total\n<\/p>\n<pre>58.90% 178.126 1 Template:Reflist\n28.49% 86.159 8 Template:Cite_web\n24.49% 74.051 1 Template:Infobox_medical_intervention\n23.02% 69.624 1 Template:Infobox\n21.69% 65.586 7 Template:Cite_journal\n10.52% 31.816 2 Template:Navbox\n 9.68% 29.273 1 Template:Cardiac_surgery\n 2.05% 6.213 12 Template:Nobold\n 0.85% 2.559 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:7638170-1!canonical and timestamp 20181205233130 and revision id 863201628\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Mitral_valve_replacement\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212244\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.159 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 150.993 1 - wikipedia:Mitral_valve_replacement\n100.00% 150.993 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8202-0!*!*!*!*!*!* and timestamp 20181217212244 and revision id 24348\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Mitral_valve_replacement\">https:\/\/www.limswiki.org\/index.php\/Mitral_valve_replacement<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","48414124df76605567b3e70f0a83d886_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d5\/Starr-Edwards-Mitral-Valve.jpg\/560px-Starr-Edwards-Mitral-Valve.jpg"],"48414124df76605567b3e70f0a83d886_timestamp":1545081764,"7f167309f5601a436158b97bafa6f365_type":"article","7f167309f5601a436158b97bafa6f365_title":"Knee replacement","7f167309f5601a436158b97bafa6f365_url":"https:\/\/www.limswiki.org\/index.php\/Knee_replacement","7f167309f5601a436158b97bafa6f365_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tKnee replacement\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\n\nKnee replacementKnee replacementICD-10-PCS0SRD0JZICD-9-CM81.54MeSHD019645 MedlinePlus002974 eMedicine1250275 [edit on Wikidata]\nKnee replacement, also known as knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability. It is most commonly performed for osteoarthritis,[1] and also for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. In patients with severe deformity from advanced rheumatoid arthritis, trauma, or long-standing osteoarthritis, the surgery may be more complicated and carry higher risk. Osteoporosis does not typically cause knee pain, deformity, or inflammation and is not a reason to perform knee replacement\nOther major causes of debilitating pain include meniscus tears, cartilage defects, and ligament tears. Debilitating pain from osteoarthritis is much more common in the elderly.\nKnee replacement surgery can be performed as a partial or a total knee replacement.[2] In general, the surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee.\nThe operation typically involves substantial postoperative pain, and includes vigorous physical rehabilitation. The recovery period may be 6 weeks or longer and may involve the use of mobility aids (e.g. walking frames, canes, crutches) to enable the patient's return to preoperative mobility.[3]\n\nContents \n\n1 Medical uses \n2 Risks \n\n2.1 Deep vein thrombosis \n2.2 Fractures \n2.3 Loss of motion \n2.4 Instability \n2.5 Infection \n\n\n3 Pre-operative preparation \n4 Technique \n\n4.1 Femoral replacement \n4.2 Post-operative pain control \n\n\n5 Variations \n\n5.1 Partial knee replacement \n\n\n6 Post-operative evaluation \n7 Post-operative rehabilitation \n8 Epidemiology \n9 See also \n10 References \n11 External links \n\n\nMedical uses \n X-ray of total knee replacement, anterior-posterior (front to back) view.\n X-ray of total knee replacement, lateral (side) view.\n The incision for knee replacement surgery\nKnee replacement surgery is most commonly performed in people with advanced osteoarthritis and should be considered when conservative treatments have been exhausted.[4] Total knee replacement is also an option to correct significant knee joint or bone trauma in young patients. Similarly, total knee replacement can be performed to correct mild valgus or varus deformity. Serious valgus or varus deformity should be corrected by osteotomy. Physical therapy has been shown to improve function and may delay or prevent the need for knee replacement. Pain is often noted when performing physical activities requiring a wide range of motion in the knee joint.[5]\n\nRisks \nRisks and complications in knee replacement[6] are similar to those associated with all joint replacements. The most serious complication is infection of the joint, which occurs in <1% of patients. Risk factors for infection are related to both patient and surgical factors.[7] Deep vein thrombosis occurs in up to 15% of patients, and is symptomatic in 2\u20133%. Nerve injuries occur in 1\u20132% of patients. Persistent pain or stiffness occurs in 8\u201323% of patients. Prosthesis failure occurs in approximately 2% of patients at 5 years.[3]\nThere is increased risk of complications for obese people going through total knee replacement.[8] The morbidly obese should be advised to lose weight before surgery and, if medically eligible, would probably benefit from bariatric surgery.[9]\nFracturing or chipping of the polyethylene platform between the femoral and tibial components may be of concern. These fragments may become lodged in the knee and create pain or may move to other parts of the body. Advancements in implant design have greatly reduced these issues but the potential for concern is still present over the lifespan of the knee replacement.\n\nDeep vein thrombosis \nAccording to the American Academy of Orthopedic Surgeons (AAOS), deep vein thrombosis in the leg is \"the most common complication of knee replacement surgery... prevention... may include periodic elevation of patient's legs, lower leg exercises to increase circulation, support stockings and medication to thin your blood.\"[2]\n\nFractures \nPeriprosthetic fractures are becoming more frequent with the aging patient population and can occur intraoperatively or postoperatively. Depending on the location of the fracture and the stability of the prosthesis, these can be treated surgically with open reduction and internal fixation or revision of the prosthesis.[citation needed ]\n\nLoss of motion \nThe knee at times may not recover its normal range of motion (0\u2013135 degrees usually) after total knee replacement. Much of this is dependent on pre-operative function. Most patients can achieve 0\u2013110 degrees, but stiffness of the joint can occur. In some situations, manipulation of the knee under anesthetic is used to reduce post operative stiffness. There are also many implants from manufacturers that are designed to be \"high-flex\" knees, offering a greater range of motion.\n\nInstability \nIn some patients, the kneecap is unrevertable post-surgery and dislocates to the outer side of the knee. This is painful and usually needs to be treated by surgery to realign the kneecap. However this is quite rare.\nIn the past, there was a considerable risk of the implant components loosening over time as a result of wear. As medical technology has improved however, this risk has fallen considerably.\n\nInfection \nThe current classification of AAOS divides prosthetic infections into four types.[10]\n\nType 1 (positive intraoperative culture): Two positive intraoperative cultures\nType 2 (early postoperative infection): Infection occurring within first month after surgery\nType 3 (acute hematogenous infection): Hematogenous seeding of site of previously well-functioning prosthesis\nType 4 (late chronic infection): Chronic indolent clinical course; infection present for more than a month\nWhile it is relatively rare, periprosthetic infection remains one of the most challenging complications of joint arthroplasty.\nA detailed clinical history and physical remain the most reliable tool to recognize a potential periprosthetic infection. In some cases the classic signs of fever, chills, painful joint, and a draining sinus may be present, and diagnostic studies are simply done to confirm the diagnosis. In reality though, most patients do not present with those clinical signs, and in fact the clinical presentation may overlap with other complications such as aseptic loosening and pain. In those cases diagnostic tests can be useful in confirming or excluding infection.\n\n FDG-PET CT showing septic loosening of knee prothesis; the FDG-enrichment shows entensive inflammatory foci: demonstrative: the PET-image ist unlike the CT reconstruction not disturbed by the high radiation attenuation of the prothesis.\nModern diagnosis of infection around a total knee replacement is based on the Musculoskeletal Infection Society (MSIS) criteria.[11] They are:\n1.There is a sinus tract communicating with the prosthesis; or\n2. A pathogen is isolated by culture from at least two separate tissue or fluid samples obtained from the affected prosthetic joint; \nor\n\n<\/p>Four of the following six criteria exist:\n1.Elevated serum erythrocyte sedimentation rate (ESR>30mm\/hr) and serum C-reactive protein (CRP>10 mg\/L) concentration,\n2.Elevated synovial leukocyte count,\n3.Elevated synovial neutrophil percentage (PMN%),\n4.Presence of purulence in the affected joint,\n5.Isolation of a microorganism in one culture of periprosthetic tissue or fluid, or\n6.Greater than five neutrophils per high-power field in five high-power fields observed from histologic analysis of periprosthetic tissue at \u00d7400 magnification.\nNone of the above laboratory tests has 100% sensitivity or specificity for diagnosing infection. Specificity improves when the tests are performed in patients in whom clinical suspicion exists. ESR and CRP remain good 1st line tests for screening (high sensitivity, low specificity). Aspiration of the joint remains the test with the highest specificity for confirming infection.\nThe choice of treatment depends on the type of prosthetic infection.[12]\n\nPositive intraoperative cultures: Antibiotic therapy alone\nEarly post-operative infections: debridement, antibiotics, and retention of prosthesis.\nAcute hematogenous infections: debridement, antibiotic therapy, retention of prosthesis.\nLate chronic: delayed exchange arthroplasty. Surgical d\u00e9bridement and parenteral antibiotics alone in this group has limited success, and standard of care involves exchange arthroplasty.[13]\nAppropriate antibiotic doses can be found at the following instructional course lecture by AAOS [10]\n\nPre-operative preparation \n\n\n\n\n\nAngles commonly measured before knee replacement surgery:\nHip-knee-shaft angle (HKS)[14]\nHip-knee-ankle angle (HKA)[15]\n\nTo indicate knee replacement in case of osteoarthritis, its radiographic classification and severity of symptoms should both be substantial. Such radiography should consist of weightbearing X-rays of both knees- AP, Lateral, and 30 degrees of flexion. AP and lateral views may not show joint space narrowing, but the 30 degree flexion view is most sensitive for narrowing. Full length projections are also used in order to adjust the prosthesis to provide a neutral angle for the distal lower extremity. Two angles used for this purpose are:\n\nHip-knee-shaft angle (HKS),[14] an angle formed between a line through the longitudinal axis of the femoral shaft and its mechanical axis, which is a line from the center of the femoral head to the intercondylar notch of the distal femur.[16]\nHip-knee-ankle angle (HKA),[15] which is an angle between the femoral mechanical axis and the center of the ankle joint.[16]\nThe patient is to perform range of motion exercises and hip, knee and ankle strengthening as directed daily. Before the surgery is performed, pre-operative tests are done: usually a complete blood count, electrolytes, APTT and PT to measure blood clotting, chest X-rays, ECG, and blood cross-matching for possible transfusion. About a month before the surgery, the patient may be prescribed supplemental iron to boost the hemoglobin in their blood system. Accurate X-rays of the affected knee are needed to measure the size of components which will be needed. Medications such as warfarin and aspirin will be stopped some days before surgery to reduce the amount of bleeding. Patients may be admitted on the day of surgery if the pre-op work-up is done in the pre-anesthetic clinic or may come into hospital one or more days before surgery. Currently there is insufficient quality evidence to support the use of pre-operative physiotherapy in older adults undergoing total knee arthroplasty.[17]\nPreoperative education is currently an important part of patient care. There is some evidence that it may slightly reduce anxiety before knee replacement surgery, with low risk of detrimental effects.[18]\nWeight loss surgery before a knee replacement does not appear to change outcomes.[19]\n\nTechnique \n Model of total knee replacement\nThe surgery involves exposure of the front of the knee, with detachment of part of the quadriceps muscle (vastus medialis) from the patella. The patella is displaced to one side of the joint, allowing exposure of the distal end of the femur and the proximal end of the tibia. The ends of these bones are then accurately cut to shape using cutting guides oriented to the long axis of the bones. The cartilages and the anterior cruciate ligament are removed; the posterior cruciate ligament may also be removed[20] but the tibial and fibular collateral ligaments are preserved. Whether the posterior cruciate ligament is removed or preserved depends on the type of implant used, although there appears to be no clear difference in knee function or range of motion favouring either approach.[21] Metal components are then impacted onto the bone or fixed using polymethylmethacrylate (PMMA) cement. Alternative techniques exist that affix the implant without cement. These cement-less techniques may involve osseointegration, including porous metal prostheses.\n\nFemoral replacement \n Main components of a knee prosthesis.\nA round ended implant is used for the femur, mimicking the natural shape of the joint. On the tibia the component is flat, although it sometimes has a stem which goes down inside the bone for further stability. A flattened or slightly dished high density polyethylene surface is then inserted onto the tibial component so that the weight is transferred metal to plastic not metal to metal. During the operation any deformities must be corrected, and the ligaments balanced so that the knee has a good range of movement and is stable and aligned. In some cases the articular surface of the patella is also removed and replaced by a polyethylene button cemented to the posterior surface of the patella. In other cases, the patella is replaced unaltered.\n\nPost-operative pain control \nThe regional analgesia techniques (neuraxial anesthesia or continuous femoral nerve block[22] or adductor canal block) are used most commonly.[23] Local anesthesia infiltration in the pericapsular area using liposomal bupivacaine provides good analgesia in the post-operative period without increasing the risk for instability or nerve injury.[24] A combined approach of local infiltration analagesia and femoral nerve block to achieve multimodal analagesia is common.\n\nVariations \nDifferent implant manufacturers require slightly different instrumentation and technique. No consensus has emerged over which one is the best. Clinical studies are very difficult to perform, requiring large numbers of cases followed over many years. The most significant variations are between cemented and uncemented components and between resurfacing the patella or not. Among those who do not resurface the patella, there is also variation between denervating the patella using electrocautery or not. In theory, this technique could disrupt the superficial pain receptors near the patella in hopes of relieving anterior knee pain, a common post-operative complaint. No consensus exists, but a recent randomized controlled trial indicates that while both methods provide relief, patellar denervation results in a modest benefit compared to no denervation in the short-term. The patient satisfaction was higher with more number of patients rating the procedure as excellent in the denervation group (74.6% vs 50.8%). The benefit does not, however, persist mid- to long-term post-operatively. Anterior knee pain component within the patellar score and Visual Analogue Scale for anterior knee pain were significantly better in the denervation group at 3 months (4.5 vs 5.1) but not at 12 months (4.4 vs 4.9) and 24 months (2.1 vs. 2.2).[25]\nSome also study patient satisfaction data associated with pain. Retaining the posterior cruciate ligament (PCL) has been shown to be beneficial for patients. Removal of the PCL has been shown to reduce the maximal force that the individual can place on that knee.[26] Typically individuals who have the PCL removed will lean forward while climbing in order to maximize the force of the quadriceps. A variation in the total knee replacement procedure is to permit movement in the prostheses using a polyethylene insert, an approach called a mobile bearing total knee arthroplasty.[27] There is no strong evidence that this approach improves a persons knee function, mortality, number of adverse effects, or amount of pain compared to a fixed bearing approach for total knee replacement that retains the posterior cruciate ligament.[27]\nMinimally invasive procedures have been developed in total knee replacement (TKR) that do not cut the quadriceps tendon. There are different definitions of minimally invasive knee surgery, which may include a shorter incision length, retraction of the patella (kneecap) without eversion (rotating out), and specialized instruments. There are few randomized trials, but studies have found less postoperative pain, shorter hospital stays, and shorter recovery. However, no studies have shown long-term benefits.[3]\nIn 2015 The OGAAP team from Sydney Australia led by Dr Al Muderis presented a revolutionary technology for the first time enabling the use of knee replacement in combination with percutaneous bone anchoring device enabling amputees with short residual tibia and or knee joint arthritis to mobilise with ease. This technology provided a solution for individuals with amputation who are unable to wear a traditional socket prosthesis.[28]\nAnother variation in the total knee replacement procedure is to permit movement in the prostheses using a polyethylene insert, an approach called a mobile bearing total knee arthroplasty. There is no strong evidence that this approach improves a persons function compared to the fixed bearing approach for total knee replacement that retains the cruciate ligament.\nThe mobile (meniscal or ro-\ntating ) bearing TKA with a polyeth ylene insert has some freedom\nof mo vement and is an example of such a new devel opment. The\nmain goal of the mobile bearing inser t is to de crease contact stresses\nat the implant inter face (\nM atsu da 199 8 ; S zivek 1996). Contradic-\ntory views e xist as to whe ther th e mobile bearing prosthesis will\nimpro ve function ality as compar ed with the fix ed bearing pros-\nthesis for cr uciate retainin g TKA.\n\nPartial knee replacement \nMain article: Unicompartmental knee arthroplasty\nUnicompartmental arthroplasty (UKA), also called partial knee replacement, is an option for some patients. The knee is generally divided into three \"compartments\": medial (the inside part of the knee), lateral (the outside), and patellofemoral (the joint between the kneecap and the thighbone). Most patients with arthritis severe enough to consider knee replacement have significant wear in two or more of the above compartments and are best treated with total knee replacement.[29] A minority of patients (the exact percentage is hotly debated but is probably between 10 and 30 percent) have wear confined primarily to one compartment, usually the medial, and may be candidates for unicompartmental knee replacement. Advantages of UKA compared to TKA include smaller incision, easier post-op rehabilitation, better post-operative range of motion, shorter hospital stay, less blood loss, lower risk of infection, stiffness, and blood clots, but a harder revision if necessary. While most recent data suggests that UKA in properly selected patients has survival rates comparable to TKA, most surgeons believe that TKA is the more reliable long term procedure. Persons with infectious or inflammatory arthritis (Rheumatoid, Lupus, Psoriatic), or marked deformity are not candidates for this procedure.\n\nPost-operative evaluation \n X-ray with angles used to evaluate knee replacement:[30]\r\nHKA: Hip-knee-ankle angle\r\nFFC: frontal femoral component angle\r\nFTC: frontal tibial component angle\r\nLFC: lateral femoral component angle\r\nLTC: lateral tibial component angle\nKnee replacement is routinely evaluated by X-ray, including the following measures:\n\nHKA: Hip-knee-ankle angle, which is ideally between 3\u00b0 varum to 3\u00b0 valgum from a right angle.[30]\nFFC: frontal femoral component angle. It is typically regarded as optimal when being 2\u20137\u00b0 in valgus.[31]\nFTC: frontal tibial component angle, which is regarded as optimal when being at a right angle. A varus position of more than 3\u00b0 has generally been found to increase the failure rate of the prosthesis.[31]\nLFC: lateral (or sagittal) femoral component angle[30]\nLTC: lateral (or sagittal) tibial component angle, which is ideally positioned so that the tibia is 0\u20137\u00b0 flexed compared to at a right angle with the tibial plate.[31]\nPost-operative rehabilitation \nThe length of post-operative hospitalization is 5 days on average depending on the health status of the patient and the amount of support available outside the hospital setting.[32] Protected weight bearing on crutches or a walker is required until specified by the surgeon [33] because of weakness in the quadriceps muscle[34]\nTo increase the likelihood of a good outcome after surgery, multiple weeks of physical therapy is necessary. In these weeks, the therapist will help the patient return to normal activities, as well as prevent blood clots, improve circulation, increase range of motion, and eventually strengthen the surrounding muscles through specific exercises. Whether techniques such as neuromuscular electrical stimulation are effective at promoting gains in knee muscle strength after surgery are unclear.[35]\nOften range of motion (to the limits of the prosthesis) is recovered over the first two weeks (the earlier the better). Over time, patients are able to increase the amount of weight bearing on the operated leg, and eventually are able to tolerate full weight bearing with the guidance of the physical therapist.[33] After about ten months, the patient should be able to return to normal daily activities, although the operated leg may be significantly weaker than the non-operated leg.[34]\n\n<\/p>For post-operative knee replacement patients, immobility is a factor precipitated by pain and other complications. Mobility is known as an important aspect of human biology that has many beneficial effects on the body system.[36] It is well documented in literature that physical immobility affects every body system and contributes to functional complications of prolonged illness.[37] In most medical-surgical hospital units that perform knee replacements, ambulation is a key aspect of nursing care that is promoted to patients. Early ambulation can decrease the risk of complications associated with immobilization such as pressure ulcers, deep vein thrombosis (DVT), impaired pulmonary function, and loss of functional mobility.[38] Nurses\u2019 promotion and execution of early ambulation on patients has found that it greatly reduces the complications listed above, as well as decreases length of stay and costs associated with further hospitalization.[38] Nurses may also work with teams such as physical therapy and occupational therapy to accomplish ambulation goals and reduce complications.[39]\nContinuous passive motion (CPM) is a postoperative therapy approach that uses a machine to move the knee continuously through a specific range of motion, with the goal of preventing joint stiffness and improving recovery.[40][41] There is no evidence that CPM therapy leads to a clinically significant improvement in range of motion, pain, knee function, or quality of life.[41] CPM is inexpensive, convenient, and assists patients in therapeutic compliance. However, CPM should be used in conjunction with traditional physical therapy.[40] In unusual cases where the person has a problem which prevents standard mobilization treatment, then CPM may be useful.[40]\nCryotherapy, also known as 'cold therapy' is sometimes recommended after surgery for pain relief and to limit swelling of the knee. Cryotherapy involves the application of ice bags or cooled water to the skin of the knee joint. However, the evidence that cryotherapy reduces pain and swelling is very weak and the benefits after total knee replacement surgery have been shown to be very small.[42]\nSome physicians and patients may consider having ultrasonography for deep venous thrombosis after knee replacement.[43] However, this kind of screening should be done only when indicated because to perform it routinely would be unnecessary health care.[43] If a medical condition exists that could cause deep vein thrombosis, a physician can choose to treat patients with cryotherapy and intermittent pneumatic compression as a preventive measure.[citation needed ]\nNeither gabapentin nor pregabalin have been found to be useful for pain following a knee replacement.[44]\n\nEpidemiology \nWith 718,000 hospitalizations, knee arthroplasty accounted for 4.6% of all United States operating room procedures in 2011\u2014making it one of the most common procedures performed during hospital stays.[45][46] The number of knee arthroplasty procedures performed in U.S. hospitals increased 93% between 2001 and 2011.[47] A study of United States community hospitals showed that in 2012, among hospitalizations that involved an OR procedure, knee arthroplasty was the OR procedure performed most frequently during hospital stays paid by Medicare (10.8 percent of stays) and by private insurance (9.1 percent). Knee arthroplasty was not among the top five most frequently performed OR procedures for stays paid by Medicaid or for uninsured stays.[48]\nBy 2030, the demand for primary total knee arthroplasty is projected to increase to 3.48 million surgeries performed annually in the U.S.[49]\n\nSee also \nAutologous chondrocyte implantation\nMicrofracture surgery\nKnee osteoarthritis\nOsseointegration\nMeniscus transplant\nReferences \n\n\n^ Simon H Palmer (27 June 2012). \"Total Knee Arthroplasty\". Medscape Reference. \n\n^ a b \n\"Total Knee Replacement\". American Academy of Orthopedic Surgeons. December 2011. \n\n^ a b c Leopold SS (April 2009). \"Minimally invasive total knee arthroplasty for osteoarthritis\". N. Engl. J. Med. 360 (17): 1749\u201358. doi:10.1056\/NEJMct0806027. PMID 19387017. \n\n^ Van Manen, MD; Nace, J; Mont, MA (November 2012). \"Management of primary knee osteoarthritis and indications for total knee arthroplasty for general practitioners\". The Journal of the American Osteopathic Association. 112 (11): 709\u2013715. PMID 23139341. \n\n^ Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC (February 2000). \"Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial\". Ann. Intern. Med. 132 (3): 173\u201381. doi:10.7326\/0003-4819-132-3-200002010-00002. PMID 10651597. \n\n^ http:\/\/www.vims.ac.in\/healthcare\/joint-replace-recovery-process.html \n\n^ Tayton, E. R.; Frampton, C.; Hooper, G. J.; Young, S. W. (1 March 2016). \"The impact of patient and surgical factors on the rate of infection after primary total knee arthroplasty\". Bone Joint J. 98-B (3): 334\u2013340. doi:10.1302\/0301-620X.98B3.36775. ISSN 2049-4394. PMID 26920958. \n\n^ Kerkhoffs, GM; Servien, E; Dunn, W; Dahm, D; Bramer, JA; Haverkamp, D (17 October 2012). \"The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review\". The Journal of Bone and Joint Surgery. American Volume. 94 (20): 1839\u201344. doi:10.2106\/JBJS.K.00820. PMC 3489068 . PMID 23079875. \n\n^ \nSamson AJ, Mercer GE, Campbell DG (September 2010). \"Total knee replacement in the morbidly obese: a literature review\". ANZ J Surg. 80 (9): 595\u20139. doi:10.1111\/j.1445-2197.2010.05396.x. PMID 20840400. \n\n^ a b Leone JM, Hanssen AD (2006). \"Management of infection at the site of a total knee arthroplasty\". Instr Course Lect. 55: 449\u201361. PMID 16958480. \n\n^ Parvizi, Javad; Zmistowski, Benjamin; Berbari, Elie F.; Bauer, Thomas W.; Springer, Bryan D.; Della Valle, Craig J.; Garvin, Kevin L.; Mont, Michael A.; Wongworawat, Montri D.; Zalavras, Charalampos G. (22 September 2011). \"New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society\". Clinical Orthopaedics and Related Research. 469 (11): 2992\u20132994. doi:10.1007\/s11999-011-2102-9. PMC 3183178 . \n\n^ Segawa H, Tsukayama DT, Kyle RF, Becker DA, Gustilo RB (1999). \"Infection after total knee arthroplasty. A retrospective study of the treatment of eighty-one infections\". J Bone Joint Surg Am. 81 (10): 1434\u201345. PMID 10535593. \n\n^ Chiu FY, Chen CM (2007). \"Surgical d\u00e9bridement and parenteral antibiotics in infected revision total knee arthroplasty\". Clin. Orthop. Relat. Res. 461: 130\u20135. doi:10.1097\/BLO.0b013e318063e7f3. PMID 17438469. \n\n^ a b Cooke TD, Sled EA, Scudamore RA (2007). \"Frontal plane knee alignment: a call for standardized measurement\". J Rheumatol. 34 (9): 1796\u2013801. PMID 17787049. CS1 maint: Multiple names: authors list (link) \n\n^ a b W-Dahl, Annette; Toksvig-Larsen, S\u00f6ren; Roos, Ewa M (2009). \"Association between knee alignment and knee pain in patients surgically treated for medial knee osteoarthritis by high tibial osteotomy. A one year follow-up study\". BMC Musculoskeletal Disorders. 10 (1). doi:10.1186\/1471-2474-10-154. ISSN 1471-2474. \n\n^ a b Cherian, Jeffrey J.; Kapadia, Bhaveen H.; Banerjee, Samik; Jauregui, Julio J.; Issa, Kimona; Mont, Michael A. (2014). \"Mechanical, Anatomical, and Kinematic Axis in TKA: Concepts and Practical Applications\". Current Reviews in Musculoskeletal Medicine. 7 (2): 89\u201395. doi:10.1007\/s12178-014-9218-y. ISSN 1935-973X. PMC 4092202 . PMID 24671469. \n\n^ Chesham, Ross Alexander; Shanmugam, Sivaramkumar (13 October 2016). \"Does preoperative physiotherapy improve postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty? A systematic review\". Physiotherapy Theory and Practice. 33 (1): 1\u201322. doi:10.1080\/09593985.2016.1230660. PMID 27736286. \n\n^ McDonald, S; Page, MJ; Beringer, K; Wasiak, J; Sprowson, A (13 May 2014). \"Preoperative education for hip or knee replacement\". The Cochrane Database of Systematic Reviews (5): CD003526. doi:10.1002\/14651858.CD003526.pub3. PMID 24820247. \n\n^ Smith, TO; Aboelmagd, T; Hing, CB; MacGregor, A (September 2016). \"Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients? Systematic review and meta-analysis\". The Bone & Joint Journal. 98-B (9): 1160\u20136. doi:10.1302\/0301-620x.98b9.38024. PMID 27587514. \n\n^ Jacobs, WC; Clement, DJ; Wymenga, AB (19 October 2005). \"Retention versus sacrifice of the posterior cruciate ligament in total knee replacement for treatment of osteoarthritis and rheumatoid arthritis\". The Cochrane Database of Systematic Reviews (4): CD004803. doi:10.1002\/14651858.CD004803.pub2. PMID 16235383. \n\n^ Verra, WC; van den Boom, LG; Jacobs, W; Clement, DJ; Wymenga, AA; Nelissen, RG (11 October 2013). \"Retention versus sacrifice of the posterior cruciate ligament in total knee arthroplasty for treating osteoarthritis\". The Cochrane Database of Systematic Reviews (10): CD004803. doi:10.1002\/14651858.CD004803.pub3. PMID 24114343. \n\n^ Toftdahl, K; Nikolajsen, L; Haraldsted, V; Madsen, F; T\u00f8nnesen, EK; S\u00f8balle, K (April 2007). \"Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial\". Acta orthopaedica. 78 (2): 172\u20139. doi:10.1080\/17453670710013645. PMID 17464603. \n\n^ \"Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management\". Anesthesiology: 248\u2013273. February 2012. doi:10.1097\/ALN.0b013e31823c1030. PMID 22227789. \n\n^ Essving, P; Axelsson, K; \u00c5berg, E; Sp\u00e4nnar, H; Gupta, A; Lundin, A (October 2011). \"Local infiltration analgesia versus intrathecal morphine for postoperative pain management after total knee arthroplasty: a randomized controlled trial\". Anesthesia & Analgesia. 113 (4): 926\u201333. doi:10.1213\/ANE.0b013e3182288deb. PMID 21821506. \n\n^ Pulavarti RS1, Raut VV, McLauchlan GJ. (May 2014). \"Patella Denervation in Primary Total Knee Arthroplasty - A Randomized Controlled Trial with 2Years of Follow-Up\". J Arthroplasty. 29 (5): 977\u201381. doi:10.1016\/j.arth.2013.10.017. PMID 24291230. CS1 maint: Multiple names: authors list (link) \n\n^ Mahoney OM, Noble PC, Rhoads DD, Alexander JW, Tullos HS (December 1994). \"Posterior cruciate function following total knee arthroplasty. A biomechanical study\". J Arthroplasty. 9 (6): 569\u201378. doi:10.1016\/0883-5403(94)90110-4. PMID 7699369. \n\n^ a b Hofstede, Stefanie N.; Nouta, Klaas Auke; Jacobs, Wilco; van Hooff, Miranda L.; Wymenga, Ate B.; Pijls, Bart G.; Nelissen, Rob G. H. H.; Marang-van de Mheen, Perla J. (2015). \"Mobile bearing vs fixed bearing prostheses for posterior cruciate retaining total knee arthroplasty for postoperative functional status in patients with osteoarthritis and rheumatoid arthritis\". The Cochrane Database of Systematic Reviews (2): CD003130. doi:10.1002\/14651858.CD003130.pub3. ISSN 1469-493X. PMID 25650566. \n\n^ Khemka A, Frossard L, Lord SJ, Bosley B, Al Muderis M (2015). \"Osseointegrated total knee replacement connected to a lower limb prosthesis: 4 cases\". Acta Orthop. 86 (6): 740\u20134. doi:10.3109\/17453674.2015.1068635. PMC 4750776 . PMID 26145721. \n\n^ Unicompartmental vs. Total Knee Replacement By Dr. Gregory Markarian. Retrieved 29 January 2015. \n\n^ a b c Inui, Hiroshi; Taketomi, Shuji; Nakamura, Kensuke; Takei, Seira; Takeda, Hideki; Tanaka, Sakae; Nakagawa, Takumi (2013). \"Influence of navigation system updates on total knee arthroplasty\". Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology. 5 (1). doi:10.1186\/2052-1847-5-10. ISSN 1758-2555. (CC-BY-2.0) \n\n^ a b c Gromov, Kirill; Korchi, Mounim; Thomsen, Morten G; Husted, Henrik; Troelsen, Anders (2014). \"What is the optimal alignment of the tibial and femoral components in knee arthroplasty?\". Acta Orthopaedica. 85 (5): 480\u2013487. doi:10.3109\/17453674.2014.940573. ISSN 1745-3674. \n\n^ Carter, Evelene M; Potts, Henry WW (2014). \"Predicting length of stay from an electronic patient record system: a primary total knee replacement example\". BMC Medical Informatics and Decision Making. 14 (1): 26. doi:10.1186\/1472-6947-14-26. ISSN 1472-6947. \n\n^ a b \"Rehabilitation\" (PDF) . massgeneral.org. \n\n^ a b Valtonen, Anu; P\u00f6yh\u00f6nen, Tapani; Heinonen, Ari; Sipil\u00e4, Sarianna (1 October 2009). \"Muscle Deficits Persist After Unilateral Knee Replacement and Have Implications for Rehabilitation\". Physical Therapy. 89 (10): 1072\u20131079. doi:10.2522\/ptj.20070295. ISSN 0031-9023. PMID 19713269. Archived from the original on 11 August 2016. \n\n^ Monaghan, B; Caulfield, B; O'Math\u00fana, DP (20 January 2010). \"Surface neuromuscular electrical stimulation for quadriceps strengthening pre and post total knee replacement\" (PDF) . The Cochrane Database of Systematic Reviews (1): CD007177. doi:10.1002\/14651858.CD007177.pub2. PMID 20091621. \n\n^ Leah, 2013[full citation needed ] \n\n^ &Na; Dickinson, S (2013). \"Foreword\". Critical Care Nursing Quarterly. 36 (1): 1\u20132. doi:10.1097\/cnq.0b013e3182750631. PMID 23221435. \n\n^ a b Teodoro, 2016[full citation needed ] \n\n^ Ong & Pua, 2011[full citation needed ] \n\n^ a b c American Physical Therapy Association (15 September 2014), \"Five Things Physicians and Patients Should Question\", Choosing Wisely: an initiative of the ABIM Foundation, American Physical Therapy Association, retrieved 15 September 2014 \n\n^ a b Harvey, Lisa A.; Brosseau, Lucie; Herbert, Robert D. (2014-02-06). \"Continuous passive motion following total knee arthroplasty in people with arthritis\". The Cochrane Database of Systematic Reviews (2): CD004260. doi:10.1002\/14651858.CD004260.pub3. ISSN 1469-493X. PMID 24500904. \n\n^ Adie, S; Kwan, A; Naylor, JM; Harris, IA; Mittal, R (12 September 2012). \"Cryotherapy following total knee replacement\". The Cochrane Database of Systematic Reviews (9): CD007911. doi:10.1002\/14651858.CD007911.pub2. PMID 22972114. \n\n^ a b American Academy of Orthopaedic Surgeons (February 2013), \"Five Things Physicians and Patients Should Question\", Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Orthopaedic Surgeons, retrieved 19 May 2013 , which cites\nMembers of 2007 and 2011 AAOS Guideline Development Work Groups on PE\/VTED Prophylaxis; Mont, M; Jacobs, J; Lieberman, J; Parvizi, J; Lachiewicz, P; Johanson, N; Watters, W (18 April 2012). \"Preventing venous thromboembolic disease in patients undergoing elective total hip and knee arthroplasty\". The Journal of Bone and Joint Surgery. American Volume. 94 (8): 673\u20134. doi:10.2106\/JBJS.9408edit. PMC 3326687 . PMID 22517384. \n \n^ Hamilton, TW; Strickland, LH; Pandit, HG (17 August 2016). \"A Meta-Analysis on the Use of Gabapentinoids for the Treatment of Acute Postoperative Pain Following Total Knee Arthroplasty\". The Journal of Bone and Joint Surgery. American Volume. 98 (16): 1340\u201350. doi:10.2106\/jbjs.15.01202. PMID 27535436. \n\n^ Pfuntner A., Wier L.M., Stocks C. Most Frequent Procedures Performed in U.S. Hospitals, 2011. HCUP Statistical Brief #165. October 2013. Agency for Healthcare Research and Quality, Rockville, MD. [1]. \n\n^ Weiss AJ, Elixhauser A, Andrews RM (February 2014). \"Characteristics of Operating Room Procedures in U.S. Hospitals, 2011\". HCUP Statistical Brief #170. Rockville, MD: Agency for Healthcare Research and Quality. \n\n^ Weiss AJ, Elixhauser A (March 2014). \"Trends in Operating Room Procedures in U.S. Hospitals, 2001\u20142011\". HCUP Statistical Brief #171. Rockville, MD: Agency for Healthcare Research and Quality. \n\n^ Fingar KR, Stocks C, Weiss AJ, Steiner CA (December 2014). \"Most Frequent Operating Room Procedures Performed in U.S. Hospitals, 2003-2012\". HCUP Statistical Brief #186. Rockville, MD: Agency for Healthcare Research and Quality. \n\n^ Dreyer HC, Strycker LA, Senesac HA, Hocker AD, Smolkowski K, Shah SN, Jewett BA (2013). \"Essential amino acid supplementation in patients following total knee arthroplasty\". J Clin Invest. 123 (11): 4654\u20134666. doi:10.1172\/JCI70160. PMC 3809795 . PMID 24135139. CS1 maint: Multiple names: authors list (link) \n\n\nExternal links \nA New Set of Knees Comes at a Price: A Whole Lot of Pain By Jane E. Brody, The New York Times, 8 February 2005\nWhen It Comes to Severe Pain, Doctors Still Have Much to Learn By Jane E. Brody, The New York Times, 15 February 2005\nA Year With My New Knees: Much Pain but Much Gain By Jane E. Brody, The New York Times, 20 December 2005\n3 Years Later, Knees Made for Dancing, By Jane E. Brody, The New York Times, 3 June 2008\nRelief for Joints Besieged by Arthritis, By Jane E. Brody, The New York Times, 9 July 2012\nvteOrthopedic surgery, operations\/surgeries and other procedures on bones and joints (ICD-9-CM V3 76\u201381, ICD-10-PCS 0P\u2013S)BonesFacial\nJaw reduction\nDentofacial osteotomy\nGenioplasty\/Mentoplasty\nChin augmentation\nOrthognathic surgery\nSpine\nCoccygectomy\nLaminotomy\nLaminectomy\nLaminoplasty\nCorpectomy\nFacetectomy\nForaminotomy\nVertebral fixation\nPercutaneous vertebroplasty\nUpper extremity\nAcromioplasty\nLower extremity\nFemoral head ostectomy\nAstragalectomy\nDistraction osteogenesis\nIlizarov apparatus\nPhemister graft\nGeneral\nOstectomy\nBone grafting\nOsteotomy\nEpiphysiodesis\nReduction\nInternal fixation\nExternal fixation\nTension band wiring\nCartilage\nArticular cartilage repair\nMicrofracture surgery\nKnee cartilage replacement therapy\nAutologous chondrocyte implantation\nJointsSpine\nArthrodesis\nSpinal fusion\nIntervertebral discs\nDiscectomy\nAnnuloplasty\nArthroplasty\nUpper extremity\nShoulder surgery\nShoulder replacement\nBankart repair\nWeaver\u2013Dunn procedure\nUlnar collateral ligament reconstruction\nHand surgery\nBrunelli procedure\nLower extremity\nHip resurfacing\nHip replacement\nRotationplasty\nAnterior cruciate ligament reconstruction\nKnee replacement\/Unicompartmental knee arthroplasty\nAnkle replacement\nBrostr\u00f6m procedure\nTriple arthrodesis\nGeneral\nArthrotomy\nArthroplasty\nSynovectomy\nArthroscopy\nReplacement joint\nimaging: Arthrogram\nArthrocentesis\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Knee_replacement\">https:\/\/www.limswiki.org\/index.php\/Knee_replacement<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical and surgical techniquesHidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","7f167309f5601a436158b97bafa6f365_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Knee_replacement skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Knee replacement<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p class=\"mw-empty-elt\">\n<\/p>\n\n<p><b>Knee replacement<\/b>, also known as <b>knee <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroplasty\" title=\"Arthroplasty\" rel=\"external_link\" target=\"_blank\">arthroplasty<\/a><\/b>, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability. It is most commonly performed for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\" title=\"Osteoarthritis\" rel=\"external_link\" target=\"_blank\">osteoarthritis<\/a>,<sup id=\"rdp-ebb-cite_ref-Palmer_1-0\" class=\"reference\"><a href=\"#cite_note-Palmer-1\" rel=\"external_link\">[1]<\/a><\/sup> and also for other knee diseases such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\" title=\"Rheumatoid arthritis\" rel=\"external_link\" target=\"_blank\">rheumatoid arthritis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Psoriatic_arthritis\" title=\"Psoriatic arthritis\" rel=\"external_link\" target=\"_blank\">psoriatic arthritis<\/a>. In patients with severe deformity from advanced rheumatoid <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis\" title=\"Arthritis\" rel=\"external_link\" target=\"_blank\">arthritis<\/a>, trauma, or long-standing osteoarthritis, the surgery may be more complicated and carry higher risk. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoporosis\" title=\"Osteoporosis\" rel=\"external_link\" target=\"_blank\">Osteoporosis<\/a> does not typically cause knee pain, deformity, or inflammation and is not a reason to perform knee replacement\n<\/p><p>Other major causes of debilitating pain include meniscus tears, cartilage defects, and ligament tears. Debilitating pain from osteoarthritis is much more common in the elderly.\n<\/p><p>Knee replacement surgery can be performed as a partial or a total knee replacement.<sup id=\"rdp-ebb-cite_ref-AAOS_2-0\" class=\"reference\"><a href=\"#cite_note-AAOS-2\" rel=\"external_link\">[2]<\/a><\/sup> In general, the surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee.\n<\/p><p>The operation typically involves substantial postoperative pain, and includes vigorous physical rehabilitation. The recovery period may be 6 weeks or longer and may involve the use of mobility aids (e.g. walking frames, canes, crutches) to enable the patient's return to preoperative mobility.<sup id=\"rdp-ebb-cite_ref-Leopold09_3-0\" class=\"reference\"><a href=\"#cite_note-Leopold09-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PTG_F.jpeg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0e\/PTG_F.jpeg\/220px-PTG_F.jpeg\" width=\"220\" height=\"375\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PTG_F.jpeg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>X-ray of total knee replacement, anterior-posterior (front to back) view.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PTG_P.jpeg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b1\/PTG_P.jpeg\/220px-PTG_P.jpeg\" width=\"220\" height=\"381\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PTG_P.jpeg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>X-ray of total knee replacement, lateral (side) view.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Knee_Replacement.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b5\/Knee_Replacement.jpg\/220px-Knee_Replacement.jpg\" width=\"220\" height=\"293\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Knee_Replacement.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The incision for knee replacement surgery<\/div><\/div><\/div>\n<p>Knee replacement surgery is most commonly performed in people with advanced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\" title=\"Osteoarthritis\" rel=\"external_link\" target=\"_blank\">osteoarthritis<\/a> and should be considered when conservative treatments have been exhausted.<sup id=\"rdp-ebb-cite_ref-Management_4-0\" class=\"reference\"><a href=\"#cite_note-Management-4\" rel=\"external_link\">[4]<\/a><\/sup> Total knee replacement is also an option to correct significant knee joint or bone trauma in young patients. Similarly, total knee replacement can be performed to correct mild <a href=\"https:\/\/en.wikipedia.org\/wiki\/Valgus_deformity\" title=\"Valgus deformity\" rel=\"external_link\" target=\"_blank\">valgus<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Varus_deformity\" title=\"Varus deformity\" rel=\"external_link\" target=\"_blank\">varus deformity<\/a>. Serious valgus or varus deformity should be corrected by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteotomy\" title=\"Osteotomy\" rel=\"external_link\" target=\"_blank\">osteotomy<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_therapy\" title=\"Physical therapy\" rel=\"external_link\" target=\"_blank\">Physical therapy<\/a> has been shown to improve function and may delay or prevent the need for knee replacement. Pain is often noted when performing physical activities requiring a wide range of motion in the knee joint.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h2>\n<p>Risks and complications in knee replacement<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> are similar to those associated with all <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement#Risks_and_complications\" title=\"Joint replacement\" rel=\"external_link\" target=\"_blank\">joint replacements<\/a>. The most serious complication is infection of the joint, which occurs in <1% of patients. Risk factors for infection are related to both patient and surgical factors.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deep_vein_thrombosis\" title=\"Deep vein thrombosis\" rel=\"external_link\" target=\"_blank\">Deep vein thrombosis<\/a> occurs in up to 15% of patients, and is symptomatic in 2\u20133%. Nerve injuries occur in 1\u20132% of patients. Persistent pain or stiffness occurs in 8\u201323% of patients. Prosthesis failure occurs in approximately 2% of patients at 5 years.<sup id=\"rdp-ebb-cite_ref-Leopold09_3-1\" class=\"reference\"><a href=\"#cite_note-Leopold09-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>There is increased risk of complications for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Obese\" class=\"mw-redirect\" title=\"Obese\" rel=\"external_link\" target=\"_blank\">obese<\/a> people going through total knee replacement.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> The morbidly obese should be advised to lose weight before surgery and, if medically eligible, would probably benefit from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bariatric_surgery\" title=\"Bariatric surgery\" rel=\"external_link\" target=\"_blank\">bariatric surgery<\/a>.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>Fracturing or chipping of the polyethylene platform between the femoral and tibial components may be of concern. These fragments may become lodged in the knee and create pain or may move to other parts of the body. Advancements in implant design have greatly reduced these issues but the potential for concern is still present over the lifespan of the knee replacement.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Deep_vein_thrombosis\">Deep vein thrombosis<\/span><\/h3>\n<p>According to the American Academy of Orthopedic Surgeons (AAOS), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deep_vein_thrombosis\" title=\"Deep vein thrombosis\" rel=\"external_link\" target=\"_blank\">deep vein thrombosis<\/a> in the leg is \"the most common complication of knee replacement surgery... prevention... may include periodic elevation of patient's legs, lower leg exercises to increase circulation, support stockings and medication to thin your blood.\"<sup id=\"rdp-ebb-cite_ref-AAOS_2-1\" class=\"reference\"><a href=\"#cite_note-AAOS-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Fractures\">Fractures<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Periprosthetic\" title=\"Periprosthetic\" rel=\"external_link\" target=\"_blank\">Periprosthetic<\/a> fractures are becoming more frequent with the aging patient population and can occur intraoperatively or postoperatively. Depending on the location of the fracture and the stability of the prosthesis, these can be treated surgically with open reduction and internal fixation or revision of the prosthesis.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (July 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Loss_of_motion\">Loss of motion<\/span><\/h3>\n<p>The knee at times may not recover its normal range of motion (0\u2013135 degrees usually) after total knee replacement. Much of this is dependent on pre-operative function. Most patients can achieve 0\u2013110 degrees, but stiffness of the joint can occur. In some situations, manipulation of the knee under anesthetic is used to reduce post operative stiffness. There are also many implants from manufacturers that are designed to be \"high-flex\" knees, offering a greater range of motion.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Instability\">Instability<\/span><\/h3>\n<p>In some patients, the kneecap is unrevertable post-surgery and dislocates to the outer side of the knee. This is painful and usually needs to be treated by surgery to realign the kneecap. However this is quite rare.\n<\/p><p>In the past, there was a considerable risk of the implant components loosening over time as a result of wear. As medical technology has improved however, this risk has fallen considerably.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Infection\">Infection<\/span><\/h3>\n<p>The current classification of AAOS divides prosthetic infections into four types.<sup id=\"rdp-ebb-cite_ref-pmid16958480_10-0\" class=\"reference\"><a href=\"#cite_note-pmid16958480-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<ul><li>Type 1 (positive intraoperative culture): Two positive intraoperative cultures<\/li>\n<li>Type 2 (early postoperative infection): Infection occurring within first month after surgery<\/li>\n<li>Type 3 (acute hematogenous infection): Hematogenous seeding of site of previously well-functioning prosthesis<\/li>\n<li>Type 4 (late chronic infection): Chronic indolent clinical course; infection present for more than a month<\/li><\/ul>\n<p>While it is relatively rare, periprosthetic infection remains one of the most challenging complications of joint arthroplasty.\nA detailed clinical history and physical remain the most reliable tool to recognize a potential periprosthetic infection. In some cases the classic signs of fever, chills, painful joint, and a draining sinus may be present, and diagnostic studies are simply done to confirm the diagnosis. In reality though, most patients do not present with those clinical signs, and in fact the clinical presentation may overlap with other complications such as aseptic loosening and pain. In those cases diagnostic tests can be useful in confirming or excluding infection.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ProthesenlockerungPET-CT.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e7\/ProthesenlockerungPET-CT.jpg\/220px-ProthesenlockerungPET-CT.jpg\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ProthesenlockerungPET-CT.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>FDG-PET CT showing septic loosening of knee prothesis; the FDG-enrichment shows entensive inflammatory foci: demonstrative: the PET-image ist unlike the CT reconstruction not disturbed by the high radiation attenuation of the prothesis.<\/div><\/div><\/div>\n<p>Modern diagnosis of infection around a total knee replacement is based on the Musculoskeletal Infection Society (MSIS) criteria.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> They are:\n<\/p><p>1.There is a sinus tract communicating with the prosthesis; or\n<p>2. A pathogen is isolated by culture from at least two separate tissue or fluid samples obtained from the affected prosthetic joint; \nor\n<\/p>\n<\/p><p>Four of the following six criteria exist:\n<\/p><p>1.Elevated serum erythrocyte sedimentation rate (ESR>30mm\/hr) and serum C-reactive protein (CRP>10 mg\/L) concentration,\n<\/p><p>2.Elevated synovial leukocyte count,\n<\/p><p>3.Elevated synovial neutrophil percentage (PMN%),\n<\/p><p>4.Presence of purulence in the affected joint,\n<\/p><p>5.Isolation of a microorganism in one culture of periprosthetic tissue or fluid, or\n<\/p><p>6.Greater than five neutrophils per high-power field in five high-power fields observed from histologic analysis of periprosthetic tissue at \u00d7400 magnification.\n<\/p><p>None of the above laboratory tests has 100% sensitivity or specificity for diagnosing infection. Specificity improves when the tests are performed in patients in whom clinical suspicion exists. ESR and CRP remain good 1st line tests for screening (high sensitivity, low specificity). Aspiration of the joint remains the test with the highest specificity for confirming infection.\n<\/p><p>The choice of treatment depends on the type of prosthetic infection.<sup id=\"rdp-ebb-cite_ref-pmid10535593_12-0\" class=\"reference\"><a href=\"#cite_note-pmid10535593-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<ol><li>Positive intraoperative cultures: Antibiotic therapy alone<\/li>\n<li>Early post-operative infections: debridement, antibiotics, and retention of prosthesis.<\/li>\n<li>Acute hematogenous infections: debridement, antibiotic therapy, retention of prosthesis.<\/li>\n<li>Late chronic: delayed exchange arthroplasty. Surgical d\u00e9bridement and parenteral antibiotics alone in this group has limited success, and standard of care involves exchange arthroplasty.<sup id=\"rdp-ebb-cite_ref-pmid17438469_13-0\" class=\"reference\"><a href=\"#cite_note-pmid17438469-13\" rel=\"external_link\">[13]<\/a><\/sup><\/li><\/ol>\n<p>Appropriate antibiotic doses can be found at the following instructional course lecture by AAOS <sup id=\"rdp-ebb-cite_ref-pmid16958480_10-1\" class=\"reference\"><a href=\"#cite_note-pmid16958480-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Pre-operative_preparation\">Pre-operative preparation<\/span><\/h2>\n<table class=\"wikitable\" align=\"right\" style=\"\">\n\n<tbody><tr style=\"vertical-align: top;\">\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HKA_and_HKS_angles.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"HKA and HKS angles.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/ce\/HKA_and_HKS_angles.jpg\/70px-HKA_and_HKS_angles.jpg\" width=\"70\" height=\"341\" \/><\/a>\n<\/td>\n<td>Angles commonly measured before knee replacement surgery:\n<ul><li>Hip-knee-shaft angle (HKS)<sup id=\"rdp-ebb-cite_ref-cooke2007_14-0\" class=\"reference\"><a href=\"#cite_note-cooke2007-14\" rel=\"external_link\">[14]<\/a><\/sup><\/li>\n<li>Hip-knee-ankle angle (HKA)<sup id=\"rdp-ebb-cite_ref-dahl2009_15-0\" class=\"reference\"><a href=\"#cite_note-dahl2009-15\" rel=\"external_link\">[15]<\/a><\/sup><\/li><\/ul>\n<\/td><\/tr><\/tbody><\/table>\n<p>To indicate knee replacement in case of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\" title=\"Osteoarthritis\" rel=\"external_link\" target=\"_blank\">osteoarthritis<\/a>, its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiographic_classification_of_osteoarthritis\" title=\"Radiographic classification of osteoarthritis\" rel=\"external_link\" target=\"_blank\">radiographic classification<\/a> and severity of symptoms should both be substantial. Such radiography should consist of weightbearing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Projectional_radiography\" title=\"Projectional radiography\" rel=\"external_link\" target=\"_blank\">X-rays<\/a> of both knees- AP, Lateral, and 30 degrees of flexion. AP and lateral views may not show joint space narrowing, but the 30 degree flexion view is most sensitive for narrowing. Full length projections are also used in order to adjust the prosthesis to provide a neutral angle for the distal lower extremity. Two angles used for this purpose are:\n<\/p>\n<ul><li>Hip-knee-shaft angle (HKS),<sup id=\"rdp-ebb-cite_ref-cooke2007_14-1\" class=\"reference\"><a href=\"#cite_note-cooke2007-14\" rel=\"external_link\">[14]<\/a><\/sup> an angle formed between a line through the longitudinal axis of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femur\" title=\"Femur\" rel=\"external_link\" target=\"_blank\">femoral<\/a> shaft and its mechanical axis, which is a line from the center of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femoral_head\" title=\"Femoral head\" rel=\"external_link\" target=\"_blank\">femoral head<\/a> to the intercondylar notch of the distal femur.<sup id=\"rdp-ebb-cite_ref-CherianKapadia2014_16-0\" class=\"reference\"><a href=\"#cite_note-CherianKapadia2014-16\" rel=\"external_link\">[16]<\/a><\/sup><\/li>\n<li>Hip-knee-ankle angle (HKA),<sup id=\"rdp-ebb-cite_ref-dahl2009_15-1\" class=\"reference\"><a href=\"#cite_note-dahl2009-15\" rel=\"external_link\">[15]<\/a><\/sup> which is an angle between the femoral mechanical axis and the center of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ankle_joint\" class=\"mw-redirect\" title=\"Ankle joint\" rel=\"external_link\" target=\"_blank\">ankle joint<\/a>.<sup id=\"rdp-ebb-cite_ref-CherianKapadia2014_16-1\" class=\"reference\"><a href=\"#cite_note-CherianKapadia2014-16\" rel=\"external_link\">[16]<\/a><\/sup><\/li><\/ul>\n<p>The patient is to perform range of motion exercises and hip, knee and ankle strengthening as directed daily. Before the surgery is performed, pre-operative tests are done: usually a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Complete_blood_count\" title=\"Complete blood count\" rel=\"external_link\" target=\"_blank\">complete blood count<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrolytes\" class=\"mw-redirect\" title=\"Electrolytes\" rel=\"external_link\" target=\"_blank\">electrolytes<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/APTT\" class=\"mw-redirect\" title=\"APTT\" rel=\"external_link\" target=\"_blank\">APTT<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prothrombin_time\" title=\"Prothrombin time\" rel=\"external_link\" target=\"_blank\">PT<\/a> to measure <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coagulation\" title=\"Coagulation\" rel=\"external_link\" target=\"_blank\">blood clotting<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest_X-ray\" class=\"mw-redirect\" title=\"Chest X-ray\" rel=\"external_link\" target=\"_blank\">chest X-rays<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/ECG\" class=\"mw-redirect\" title=\"ECG\" rel=\"external_link\" target=\"_blank\">ECG<\/a>, and blood <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cross-matching\" title=\"Cross-matching\" rel=\"external_link\" target=\"_blank\">cross-matching<\/a> for possible <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_transfusion\" title=\"Blood transfusion\" rel=\"external_link\" target=\"_blank\">transfusion<\/a>. About a month before the surgery, the patient may be prescribed supplemental iron to boost the hemoglobin in their blood system. Accurate X-rays of the affected knee are needed to measure the size of components which will be needed. Medications such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Warfarin\" title=\"Warfarin\" rel=\"external_link\" target=\"_blank\">warfarin<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aspirin\" title=\"Aspirin\" rel=\"external_link\" target=\"_blank\">aspirin<\/a> will be stopped some days before surgery to reduce the amount of bleeding. Patients may be admitted on the day of surgery if the pre-op work-up is done in the pre-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Anesthetic\" title=\"Anesthetic\" rel=\"external_link\" target=\"_blank\">anesthetic<\/a> clinic or may come into <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital\" title=\"Hospital\" rel=\"external_link\" target=\"_blank\">hospital<\/a> one or more days before surgery. Currently there is insufficient quality evidence to support the use of pre-operative physiotherapy in older adults undergoing total knee arthroplasty.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p><p>Preoperative education is currently an important part of patient care. There is some evidence that it may slightly reduce anxiety before knee replacement surgery, with low risk of detrimental effects.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bariatric_surgery\" title=\"Bariatric surgery\" rel=\"external_link\" target=\"_blank\">Weight loss surgery<\/a> before a knee replacement does not appear to change outcomes.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technique\">Technique<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:152px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Prothese-genou-IMG_0033.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/dc\/Prothese-genou-IMG_0033.jpg\/150px-Prothese-genou-IMG_0033.jpg\" width=\"150\" height=\"225\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Prothese-genou-IMG_0033.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Model of total knee replacement<\/div><\/div><\/div>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a> involves exposure of the front of the knee, with detachment of part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quadriceps_muscle\" class=\"mw-redirect\" title=\"Quadriceps muscle\" rel=\"external_link\" target=\"_blank\">quadriceps muscle<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Vastus_medialis\" title=\"Vastus medialis\" rel=\"external_link\" target=\"_blank\">vastus medialis<\/a>) from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patella\" title=\"Patella\" rel=\"external_link\" target=\"_blank\">patella<\/a>. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patella\" title=\"Patella\" rel=\"external_link\" target=\"_blank\">patella<\/a> is displaced to one side of the joint, allowing exposure of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatomical_terms_of_location\" title=\"Anatomical terms of location\" rel=\"external_link\" target=\"_blank\">distal<\/a> end of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femur\" title=\"Femur\" rel=\"external_link\" target=\"_blank\">femur<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatomical_terms_of_location\" title=\"Anatomical terms of location\" rel=\"external_link\" target=\"_blank\">proximal<\/a> end of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tibia\" title=\"Tibia\" rel=\"external_link\" target=\"_blank\">tibia<\/a>. The ends of these bones are then accurately cut to shape using cutting guides oriented to the long axis of the bones. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cartilage\" title=\"Cartilage\" rel=\"external_link\" target=\"_blank\">cartilages<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anterior_cruciate_ligament\" title=\"Anterior cruciate ligament\" rel=\"external_link\" target=\"_blank\">anterior cruciate ligament<\/a> are removed; the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Posterior_cruciate_ligament\" title=\"Posterior cruciate ligament\" rel=\"external_link\" target=\"_blank\">posterior cruciate ligament<\/a> may also be removed<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> but the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medial_collateral_ligament\" title=\"Medial collateral ligament\" rel=\"external_link\" target=\"_blank\">tibial<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibular_collateral_ligament\" title=\"Fibular collateral ligament\" rel=\"external_link\" target=\"_blank\">fibular<\/a> collateral ligaments are preserved. Whether the posterior cruciate ligament is removed or preserved depends on the type of implant used, although there appears to be no clear difference in knee function or range of motion favouring either approach.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> Metal components are then impacted onto the bone or fixed using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymethylmethacrylate\" class=\"mw-redirect\" title=\"Polymethylmethacrylate\" rel=\"external_link\" target=\"_blank\">polymethylmethacrylate<\/a> (PMMA) cement. Alternative techniques exist that affix the implant without cement. These cement-less techniques may involve <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseointegration\" title=\"Osseointegration\" rel=\"external_link\" target=\"_blank\">osseointegration<\/a>, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal_foam\" title=\"Metal foam\" rel=\"external_link\" target=\"_blank\">porous metal<\/a> prostheses.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Femoral_replacement\">Femoral replacement<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Knee_prosthesis_components.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a1\/Knee_prosthesis_components.jpg\/200px-Knee_prosthesis_components.jpg\" width=\"200\" height=\"125\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Knee_prosthesis_components.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Main components of a knee prosthesis.<\/div><\/div><\/div>\n<p>A round ended implant is used for the femur, mimicking the natural shape of the joint. On the tibia the component is flat, although it sometimes has a stem which goes down inside the bone for further stability. A flattened or slightly dished high density <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a> surface is then inserted onto the tibial component so that the weight is transferred metal to plastic not metal to metal. During the operation any deformities must be corrected, and the ligaments balanced so that the knee has a good range of movement and is stable and aligned. In some cases the articular surface of the patella is also removed and replaced by a polyethylene button cemented to the posterior surface of the patella. In other cases, the patella is replaced unaltered.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Post-operative_pain_control\">Post-operative pain control<\/span><\/h3>\n<p>The regional analgesia techniques (neuraxial anesthesia or continuous femoral nerve block<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> or adductor canal block) are used most commonly.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> Local anesthesia infiltration in the pericapsular area using liposomal bupivacaine provides good analgesia in the post-operative period without increasing the risk for instability or nerve injury.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> A combined approach of local infiltration analagesia and femoral nerve block to achieve multimodal analagesia is common.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Variations\">Variations<\/span><\/h2>\n<p>Different implant manufacturers require slightly different instrumentation and technique. No consensus has emerged over which one is the best. Clinical studies are very difficult to perform, requiring large numbers of cases followed over many years. The most significant variations are between cemented and uncemented components and between resurfacing the patella or not. Among those who do not resurface the patella, there is also variation between denervating the patella using electrocautery or not. In theory, this technique could disrupt the superficial pain receptors near the patella in hopes of relieving anterior knee pain, a common post-operative complaint. No consensus exists, but a recent randomized controlled trial indicates that while both methods provide relief, patellar denervation results in a modest benefit compared to no denervation in the short-term. The patient satisfaction was higher with more number of patients rating the procedure as excellent in the denervation group (74.6% vs 50.8%). The benefit does not, however, persist mid- to long-term post-operatively. Anterior knee pain component within the patellar score and Visual Analogue Scale for anterior knee pain were significantly better in the denervation group at 3 months (4.5 vs 5.1) but not at 12 months (4.4 vs 4.9) and 24 months (2.1 vs. 2.2).<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p><p>Some also study patient satisfaction data associated with pain. Retaining the posterior cruciate ligament (PCL) has been shown to be beneficial for patients. Removal of the PCL has been shown to reduce the maximal force that the individual can place on that knee.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> Typically individuals who have the PCL removed will lean forward while climbing in order to maximize the force of the quadriceps. A variation in the total knee replacement procedure is to permit movement in the prostheses using a polyethylene insert, an approach called a mobile bearing total knee arthroplasty.<sup id=\"rdp-ebb-cite_ref-:2_27-0\" class=\"reference\"><a href=\"#cite_note-:2-27\" rel=\"external_link\">[27]<\/a><\/sup> There is no strong evidence that this approach improves a persons knee function, mortality, number of adverse effects, or amount of pain compared to a fixed bearing approach for total knee replacement that retains the posterior cruciate ligament.<sup id=\"rdp-ebb-cite_ref-:2_27-1\" class=\"reference\"><a href=\"#cite_note-:2-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive_procedure\" class=\"mw-redirect\" title=\"Minimally invasive procedure\" rel=\"external_link\" target=\"_blank\">Minimally invasive procedures<\/a> have been developed in total knee replacement (TKR) that do not cut the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quadriceps_tendon\" title=\"Quadriceps tendon\" rel=\"external_link\" target=\"_blank\">quadriceps tendon<\/a>. There are different definitions of minimally invasive knee surgery, which may include a shorter incision length, retraction of the patella (kneecap) without eversion (rotating out), and specialized instruments. There are few randomized trials, but studies have found less postoperative pain, shorter hospital stays, and shorter recovery. However, no studies have shown long-term benefits.<sup id=\"rdp-ebb-cite_ref-Leopold09_3-2\" class=\"reference\"><a href=\"#cite_note-Leopold09-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>In 2015 The OGAAP team from Sydney Australia led by presented a revolutionary technology for the first time enabling the use of knee replacement in combination with percutaneous bone anchoring device enabling amputees with short residual tibia and or knee joint arthritis to mobilise with ease. This technology provided a solution for individuals with amputation who are unable to wear a traditional socket prosthesis.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/p><p>Another variation in the total knee replacement procedure is to permit movement in the prostheses using a polyethylene insert, an approach called a mobile bearing total knee arthroplasty. There is no strong evidence that this approach improves a persons function compared to the fixed bearing approach for total knee replacement that retains the cruciate ligament.\n<\/p><p>The mobile (meniscal or ro-\n<\/p><p>tating<span class=\"_ _5 current-selection\"><\/span>) bearing TKA with a polyeth<span class=\"_ _1 current-selection\"><\/span>ylene insert has some freedom\n<\/p><p>of mo<span class=\"_ _5 current-selection\"><\/span>vement and is an example of such a new devel<span class=\"_ _1 current-selection\"><\/span>opment. The\n<\/p><p>main goal of the mobile bearing inser<span class=\"_ _1 current-selection\"><\/span>t is to de crease contact stresses\n<\/p><p>at the implant inter<span class=\"_ _1 current-selection\"><\/span>face (\n<\/p><p>M<span class=\"_ _5 current-selection\"><\/span>atsu<span class=\"_ _5 current-selection\"><\/span>da 199<span class=\"_ _5 current-selection\"><\/span>8<span class=\"_ _1 current-selection\"><\/span>; S<span class=\"_ _1 current-selection\"><\/span>zivek 1996). Contradic-\n<\/p><p>tory views e<span class=\"_ _1 current-selection\"><\/span>xist as to whe<span class=\"_ _1 current-selection\"><\/span>ther th<span class=\"_ _1 current-selection\"><\/span>e mobile bearing prosthesis will\n<\/p><p>impro<span class=\"_ _5 current-selection\"><\/span>ve function<span class=\"_ _5 current-selection\"><\/span>ality as compar<span class=\"_ _5 current-selection\"><\/span>ed with the fix<span class=\"_ _13 current-selection\"><\/span>ed bearing pros-\n<\/p><p>thesis for cr<span class=\"_ _1 current-selection\"><\/span>uciate retainin<span class=\"_ _5 current-selection\"><\/span>g TKA.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Partial_knee_replacement\">Partial knee replacement<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Unicompartmental_knee_arthroplasty\" title=\"Unicompartmental knee arthroplasty\" rel=\"external_link\" target=\"_blank\">Unicompartmental knee arthroplasty<\/a><\/div>\n<p>Unicompartmental arthroplasty (UKA), also called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Partial_knee_replacement\" class=\"mw-redirect\" title=\"Partial knee replacement\" rel=\"external_link\" target=\"_blank\">partial knee replacement<\/a>, is an option for some patients. The knee is generally divided into three \"compartments\": medial (the inside part of the knee), lateral (the outside), and patellofemoral (the joint between the kneecap and the thighbone). Most patients with arthritis severe enough to consider knee replacement have significant wear in two or more of the above compartments and are best treated with total knee replacement.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> A minority of patients (the exact percentage is hotly debated but is probably between 10 and 30 percent) have wear confined primarily to one compartment, usually the medial, and may be candidates for unicompartmental knee replacement. Advantages of UKA compared to TKA include smaller incision, easier post-op rehabilitation, better post-operative range of motion, shorter hospital stay, less blood loss, lower risk of infection, stiffness, and blood clots, but a harder revision if necessary. While most recent data suggests that UKA in properly selected patients has survival rates comparable to TKA, most surgeons believe that TKA is the more reliable long term procedure. Persons with infectious or inflammatory arthritis (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid\" class=\"mw-redirect\" title=\"Rheumatoid\" rel=\"external_link\" target=\"_blank\">Rheumatoid<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lupus_erythematosus\" title=\"Lupus erythematosus\" rel=\"external_link\" target=\"_blank\">Lupus<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Psoriatic\" class=\"mw-redirect\" title=\"Psoriatic\" rel=\"external_link\" target=\"_blank\">Psoriatic<\/a>), or marked deformity are not candidates for this procedure.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Post-operative_evaluation\">Post-operative evaluation<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Radiograph_with_knee_angles.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b3\/Radiograph_with_knee_angles.jpg\/220px-Radiograph_with_knee_angles.jpg\" width=\"220\" height=\"331\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Radiograph_with_knee_angles.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Projectional_radiograph\" class=\"mw-redirect\" title=\"Projectional radiograph\" rel=\"external_link\" target=\"_blank\">X-ray<\/a> with angles used to evaluate knee replacement:<sup id=\"rdp-ebb-cite_ref-Inui2013_30-0\" class=\"reference\"><a href=\"#cite_note-Inui2013-30\" rel=\"external_link\">[30]<\/a><\/sup><br \/>HKA: Hip-knee-ankle angle<br \/>FFC: frontal femoral component angle<br \/>FTC: frontal tibial component angle<br \/>LFC: lateral femoral component angle<br \/>LTC: lateral tibial component angle<\/div><\/div><\/div>\n<p>Knee replacement is routinely evaluated by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Projectional_radiograph\" class=\"mw-redirect\" title=\"Projectional radiograph\" rel=\"external_link\" target=\"_blank\">X-ray<\/a>, including the following measures:\n<\/p>\n<ul><li>HKA: Hip-knee-ankle angle, which is ideally between 3\u00b0 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Genu_varum\" title=\"Genu varum\" rel=\"external_link\" target=\"_blank\">varum<\/a> to 3\u00b0 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Genu_valgum\" title=\"Genu valgum\" rel=\"external_link\" target=\"_blank\">valgum<\/a> from a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Right_angle\" title=\"Right angle\" rel=\"external_link\" target=\"_blank\">right angle<\/a>.<sup id=\"rdp-ebb-cite_ref-Inui2013_30-1\" class=\"reference\"><a href=\"#cite_note-Inui2013-30\" rel=\"external_link\">[30]<\/a><\/sup><\/li>\n<li>FFC: frontal femoral component angle. It is typically regarded as optimal when being 2\u20137\u00b0 in valgus.<sup id=\"rdp-ebb-cite_ref-GromovKorchi2014_31-0\" class=\"reference\"><a href=\"#cite_note-GromovKorchi2014-31\" rel=\"external_link\">[31]<\/a><\/sup><\/li>\n<li>FTC: frontal tibial component angle, which is regarded as optimal when being at a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Right_angle\" title=\"Right angle\" rel=\"external_link\" target=\"_blank\">right angle<\/a>. A varus position of more than 3\u00b0 has generally been found to increase the failure rate of the prosthesis.<sup id=\"rdp-ebb-cite_ref-GromovKorchi2014_31-1\" class=\"reference\"><a href=\"#cite_note-GromovKorchi2014-31\" rel=\"external_link\">[31]<\/a><\/sup><\/li>\n<li>LFC: lateral (or sagittal) femoral component angle<sup id=\"rdp-ebb-cite_ref-Inui2013_30-2\" class=\"reference\"><a href=\"#cite_note-Inui2013-30\" rel=\"external_link\">[30]<\/a><\/sup><\/li>\n<li>LTC: lateral (or sagittal) tibial component angle, which is ideally positioned so that the tibia is 0\u20137\u00b0 flexed compared to at a right angle with the tibial plate.<sup id=\"rdp-ebb-cite_ref-GromovKorchi2014_31-2\" class=\"reference\"><a href=\"#cite_note-GromovKorchi2014-31\" rel=\"external_link\">[31]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Post-operative_rehabilitation\">Post-operative rehabilitation<\/span><\/h2>\n<p>The length of post-operative hospitalization is 5 days on average depending on the health status of the patient and the amount of support available outside the hospital setting.<sup id=\"rdp-ebb-cite_ref-CarterPotts2014_32-0\" class=\"reference\"><a href=\"#cite_note-CarterPotts2014-32\" rel=\"external_link\">[32]<\/a><\/sup> Protected <a href=\"https:\/\/en.wikipedia.org\/wiki\/Weight_bearing\" class=\"mw-redirect\" title=\"Weight bearing\" rel=\"external_link\" target=\"_blank\">weight bearing<\/a> on crutches or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Walker_(tool)\" class=\"mw-redirect\" title=\"Walker (tool)\" rel=\"external_link\" target=\"_blank\">walker<\/a> is required until specified by the surgeon <sup id=\"rdp-ebb-cite_ref-:0_33-0\" class=\"reference\"><a href=\"#cite_note-:0-33\" rel=\"external_link\">[33]<\/a><\/sup> because of weakness in the quadriceps muscle<sup id=\"rdp-ebb-cite_ref-:1_34-0\" class=\"reference\"><a href=\"#cite_note-:1-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p><p>To increase the likelihood of a good outcome after surgery, multiple weeks of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_therapy\" title=\"Physical therapy\" rel=\"external_link\" target=\"_blank\">physical therapy<\/a> is necessary. In these weeks, the therapist will help the patient return to normal activities, as well as prevent blood clots, improve circulation, increase range of motion, and eventually strengthen the surrounding muscles through specific exercises. Whether techniques such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromuscular_electrical_stimulation\" class=\"mw-redirect\" title=\"Neuromuscular electrical stimulation\" rel=\"external_link\" target=\"_blank\">neuromuscular electrical stimulation<\/a> are effective at promoting gains in knee muscle strength after surgery are unclear.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup>\n<p>Often range of motion (to the limits of the prosthesis) is recovered over the first two weeks (the earlier the better). Over time, patients are able to increase the amount of weight bearing on the operated leg, and eventually are able to tolerate full weight bearing with the guidance of the physical therapist.<sup id=\"rdp-ebb-cite_ref-:0_33-1\" class=\"reference\"><a href=\"#cite_note-:0-33\" rel=\"external_link\">[33]<\/a><\/sup> After about ten months, the patient should be able to return to normal daily activities, although the operated leg may be significantly weaker than the non-operated leg.<sup id=\"rdp-ebb-cite_ref-:1_34-1\" class=\"reference\"><a href=\"#cite_note-:1-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p>\n<\/p><p>For post-operative knee replacement patients, immobility is a factor precipitated by pain and other complications. Mobility is known as an important aspect of human biology that has many beneficial effects on the body system.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup> It is well documented in literature that physical immobility affects every body system and contributes to functional complications of prolonged illness.<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup> In most medical-surgical hospital units that perform knee replacements, ambulation is a key aspect of nursing care that is promoted to patients. Early ambulation can decrease the risk of complications associated with immobilization such as pressure ulcers, deep vein thrombosis (DVT), impaired pulmonary function, and loss of functional mobility.<sup id=\"rdp-ebb-cite_ref-Teodoro,_2016_38-0\" class=\"reference\"><a href=\"#cite_note-Teodoro,_2016-38\" rel=\"external_link\">[38]<\/a><\/sup> Nurses\u2019 promotion and execution of early ambulation on patients has found that it greatly reduces the complications listed above, as well as decreases length of stay and costs associated with further hospitalization.<sup id=\"rdp-ebb-cite_ref-Teodoro,_2016_38-1\" class=\"reference\"><a href=\"#cite_note-Teodoro,_2016-38\" rel=\"external_link\">[38]<\/a><\/sup> Nurses may also work with teams such as physical therapy and occupational therapy to accomplish ambulation goals and reduce complications.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Continuous_passive_motion\" title=\"Continuous passive motion\" rel=\"external_link\" target=\"_blank\">Continuous passive motion<\/a> (CPM) is a postoperative therapy approach that uses a machine to move the knee continuously through a specific range of motion, with the goal of preventing joint stiffness and improving recovery.<sup id=\"rdp-ebb-cite_ref-APTAfive_40-0\" class=\"reference\"><a href=\"#cite_note-APTAfive-40\" rel=\"external_link\">[40]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Harvey2014_41-0\" class=\"reference\"><a href=\"#cite_note-Harvey2014-41\" rel=\"external_link\">[41]<\/a><\/sup> There is no evidence that CPM therapy leads to a clinically significant improvement in range of motion, pain, knee function, or quality of life.<sup id=\"rdp-ebb-cite_ref-Harvey2014_41-1\" class=\"reference\"><a href=\"#cite_note-Harvey2014-41\" rel=\"external_link\">[41]<\/a><\/sup> CPM is inexpensive, convenient, and assists patients in therapeutic compliance. However, CPM should be used in conjunction with traditional physical therapy.<sup id=\"rdp-ebb-cite_ref-APTAfive_40-1\" class=\"reference\"><a href=\"#cite_note-APTAfive-40\" rel=\"external_link\">[40]<\/a><\/sup> In unusual cases where the person has a problem which prevents standard mobilization treatment, then CPM may be useful.<sup id=\"rdp-ebb-cite_ref-APTAfive_40-2\" class=\"reference\"><a href=\"#cite_note-APTAfive-40\" rel=\"external_link\">[40]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cryotherapy\" title=\"Cryotherapy\" rel=\"external_link\" target=\"_blank\">Cryotherapy<\/a>, also known as 'cold therapy' is sometimes recommended after surgery for pain relief and to limit swelling of the knee. Cryotherapy involves the application of ice bags or cooled water to the skin of the knee joint. However, the evidence that cryotherapy reduces pain and swelling is very weak and the benefits after total knee replacement surgery have been shown to be very small.<sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup>\n<\/p><p>Some physicians and patients may consider having <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasonography_for_deep_venous_thrombosis\" class=\"mw-redirect\" title=\"Ultrasonography for deep venous thrombosis\" rel=\"external_link\" target=\"_blank\">ultrasonography for deep venous thrombosis<\/a> after knee replacement.<sup id=\"rdp-ebb-cite_ref-AAOSfive_43-0\" class=\"reference\"><a href=\"#cite_note-AAOSfive-43\" rel=\"external_link\">[43]<\/a><\/sup> However, this kind of screening should be done only when indicated because to perform it routinely would be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Unnecessary_health_care\" title=\"Unnecessary health care\" rel=\"external_link\" target=\"_blank\">unnecessary health care<\/a>.<sup id=\"rdp-ebb-cite_ref-AAOSfive_43-1\" class=\"reference\"><a href=\"#cite_note-AAOSfive-43\" rel=\"external_link\">[43]<\/a><\/sup> If a medical condition exists that could cause deep vein thrombosis, a physician can choose to treat patients with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cryotherapy\" title=\"Cryotherapy\" rel=\"external_link\" target=\"_blank\">cryotherapy<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intermittent_pneumatic_compression\" title=\"Intermittent pneumatic compression\" rel=\"external_link\" target=\"_blank\">intermittent pneumatic compression<\/a> as a preventive measure.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Neither <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gabapentin\" title=\"Gabapentin\" rel=\"external_link\" target=\"_blank\">gabapentin<\/a> nor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pregabalin\" title=\"Pregabalin\" rel=\"external_link\" target=\"_blank\">pregabalin<\/a> have been found to be useful for pain following a knee replacement.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Epidemiology\">Epidemiology<\/span><\/h2>\n<p>With 718,000 hospitalizations, knee arthroplasty accounted for 4.6% of all United States operating room procedures in 2011\u2014making it one of the most common procedures performed during hospital stays.<sup id=\"rdp-ebb-cite_ref-hcup-us.ahrq.gov_45-0\" class=\"reference\"><a href=\"#cite_note-hcup-us.ahrq.gov-45\" rel=\"external_link\">[45]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup> The number of knee arthroplasty procedures performed in U.S. hospitals increased 93% between 2001 and 2011.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup> A study of United States community hospitals showed that in 2012, among hospitalizations that involved an OR procedure, knee arthroplasty was the OR procedure performed most frequently during hospital stays paid by Medicare (10.8 percent of stays) and by private insurance (9.1 percent). Knee arthroplasty was not among the top five most frequently performed OR procedures for stays paid by Medicaid or for uninsured stays.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup>\n<\/p><p>By 2030, the demand for primary total knee arthroplasty is projected to increase to 3.48 million surgeries performed annually in the U.S.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Autologous_chondrocyte_implantation\" title=\"Autologous chondrocyte implantation\" rel=\"external_link\" target=\"_blank\">Autologous chondrocyte implantation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Microfracture_surgery\" title=\"Microfracture surgery\" rel=\"external_link\" target=\"_blank\">Microfracture surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee_osteoarthritis\" class=\"mw-redirect\" title=\"Knee osteoarthritis\" rel=\"external_link\" target=\"_blank\">Knee osteoarthritis<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseointegration\" title=\"Osseointegration\" rel=\"external_link\" target=\"_blank\">Osseointegration<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Meniscus_transplant\" title=\"Meniscus transplant\" rel=\"external_link\" target=\"_blank\">Meniscus transplant<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-Palmer-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Palmer_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Simon H Palmer (27 June 2012). <a rel=\"external_link\" class=\"external text\" href=\"#showall\">\"Total Knee Arthroplasty\"<\/a>. <i>Medscape Reference<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Medscape+Reference&rft.atitle=Total+Knee+Arthroplasty&rft.date=2012-06-27&rft.au=Simon+H+Palmer&rft_id=http%3A%2F%2Femedicine.medscape.com%2Farticle%2F1250275-overview%23showall&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-AAOS-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-AAOS_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-AAOS_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">\n<cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/orthoinfo.aaos.org\/topic.cfm?topic=A00389\" target=\"_blank\">\"Total Knee Replacement\"<\/a>. American Academy of Orthopedic Surgeons. December 2011.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Total+Knee+Replacement&rft.pub=American+Academy+of+Orthopedic+Surgeons&rft.date=2011-12&rft_id=http%3A%2F%2Forthoinfo.aaos.org%2Ftopic.cfm%3Ftopic%3DA00389&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Leopold09-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Leopold09_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Leopold09_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Leopold09_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Leopold SS (April 2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/360\/17\/1749\" target=\"_blank\">\"Minimally invasive total knee arthroplasty for osteoarthritis\"<\/a>. <i>N. Engl. J. Med<\/i>. <b>360<\/b> (17): 1749\u201358. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2FNEJMct0806027\" target=\"_blank\">10.1056\/NEJMct0806027<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19387017\" target=\"_blank\">19387017<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=N.+Engl.+J.+Med.&rft.atitle=Minimally+invasive+total+knee+arthroplasty+for+osteoarthritis&rft.volume=360&rft.issue=17&rft.pages=1749-58&rft.date=2009-04&rft_id=info%3Adoi%2F10.1056%2FNEJMct0806027&rft_id=info%3Apmid%2F19387017&rft.au=Leopold+SS&rft_id=http%3A%2F%2Fcontent.nejm.org%2Fcgi%2Fcontent%2Ffull%2F360%2F17%2F1749&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Management-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Management_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Van Manen, MD; Nace, J; Mont, MA (November 2012). \"Management of primary knee osteoarthritis and indications for total knee arthroplasty for general practitioners\". <i>The Journal of the American Osteopathic Association<\/i>. <b>112<\/b> (11): 709\u2013715. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23139341\" target=\"_blank\">23139341<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+the+American+Osteopathic+Association&rft.atitle=Management+of+primary+knee+osteoarthritis+and+indications+for+total+knee+arthroplasty+for+general+practitioners.&rft.volume=112&rft.issue=11&rft.pages=709-715&rft.date=2012-11&rft_id=info%3Apmid%2F23139341&rft.aulast=Van+Manen&rft.aufirst=MD&rft.au=Nace%2C+J&rft.au=Mont%2C+MA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC (February 2000). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.annals.org\/article.aspx?volume=132&page=173\" target=\"_blank\">\"Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial\"<\/a>. <i>Ann. Intern. Med<\/i>. <b>132<\/b> (3): 173\u201381. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.7326%2F0003-4819-132-3-200002010-00002\" target=\"_blank\">10.7326\/0003-4819-132-3-200002010-00002<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10651597\" target=\"_blank\">10651597<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ann.+Intern.+Med.&rft.atitle=Effectiveness+of+manual+physical+therapy+and+exercise+in+osteoarthritis+of+the+knee.+A+randomized%2C+controlled+trial&rft.volume=132&rft.issue=3&rft.pages=173-81&rft.date=2000-02&rft_id=info%3Adoi%2F10.7326%2F0003-4819-132-3-200002010-00002&rft_id=info%3Apmid%2F10651597&rft.aulast=Deyle&rft.aufirst=GD&rft.au=Henderson%2C+NE&rft.au=Matekel%2C+RL&rft.au=Ryder%2C+MG&rft.au=Garber%2C+MB&rft.au=Allison%2C+SC&rft_id=http%3A%2F%2Fwww.annals.org%2Farticle.aspx%3Fvolume%3D132%26page%3D173&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.vims.ac.in\/healthcare\/joint-replace-recovery-process.html\" target=\"_blank\">http:\/\/www.vims.ac.in\/healthcare\/joint-replace-recovery-process.html<\/a><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tayton, E. R.; Frampton, C.; Hooper, G. J.; Young, S. W. (1 March 2016). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bjj.boneandjoint.org.uk\/content\/98-B\/3\/334\" target=\"_blank\">\"The impact of patient and surgical factors on the rate of infection after primary total knee arthroplasty\"<\/a>. <i>Bone Joint J<\/i>. <b>98-B<\/b> (3): 334\u2013340. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1302%2F0301-620X.98B3.36775\" target=\"_blank\">10.1302\/0301-620X.98B3.36775<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2049-4394\" target=\"_blank\">2049-4394<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26920958\" target=\"_blank\">26920958<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Bone+Joint+J&rft.atitle=The+impact+of+patient+and+surgical+factors+on+the+rate+of+infection+after+primary+total+knee+arthroplasty&rft.volume=98-B&rft.issue=3&rft.pages=334-340&rft.date=2016-03-01&rft.issn=2049-4394&rft_id=info%3Apmid%2F26920958&rft_id=info%3Adoi%2F10.1302%2F0301-620X.98B3.36775&rft.aulast=Tayton&rft.aufirst=E.+R.&rft.au=Frampton%2C+C.&rft.au=Hooper%2C+G.+J.&rft.au=Young%2C+S.+W.&rft_id=http%3A%2F%2Fwww.bjj.boneandjoint.org.uk%2Fcontent%2F98-B%2F3%2F334&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kerkhoffs, GM; Servien, E; Dunn, W; Dahm, D; Bramer, JA; Haverkamp, D (17 October 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3489068\" target=\"_blank\">\"The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review\"<\/a>. <i>The Journal of Bone and Joint Surgery. American Volume<\/i>. <b>94<\/b> (20): 1839\u201344. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.K.00820\" target=\"_blank\">10.2106\/JBJS.K.00820<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3489068\" target=\"_blank\">3489068<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23079875\" target=\"_blank\">23079875<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Bone+and+Joint+Surgery.+American+Volume&rft.atitle=The+influence+of+obesity+on+the+complication+rate+and+outcome+of+total+knee+arthroplasty%3A+a+meta-analysis+and+systematic+literature+review.&rft.volume=94&rft.issue=20&rft.pages=1839-44&rft.date=2012-10-17&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3489068&rft_id=info%3Apmid%2F23079875&rft_id=info%3Adoi%2F10.2106%2FJBJS.K.00820&rft.aulast=Kerkhoffs&rft.aufirst=GM&rft.au=Servien%2C+E&rft.au=Dunn%2C+W&rft.au=Dahm%2C+D&rft.au=Bramer%2C+JA&rft.au=Haverkamp%2C+D&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3489068&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\n<cite class=\"citation journal\">Samson AJ, Mercer GE, Campbell DG (September 2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/onlinelibrary.wiley.com\/resolve\/openurl?genre=article&sid=nlm:pubmed&issn=1445-1433&date=2010&volume=80&issue=9&spage=595\" target=\"_blank\">\"Total knee replacement in the morbidly obese: a literature review\"<\/a>. <i>ANZ J Surg<\/i>. <b>80<\/b> (9): 595\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1445-2197.2010.05396.x\" target=\"_blank\">10.1111\/j.1445-2197.2010.05396.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20840400\" target=\"_blank\">20840400<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=ANZ+J+Surg&rft.atitle=Total+knee+replacement+in+the+morbidly+obese%3A+a+literature+review&rft.volume=80&rft.issue=9&rft.pages=595-9&rft.date=2010-09&rft_id=info%3Adoi%2F10.1111%2Fj.1445-2197.2010.05396.x&rft_id=info%3Apmid%2F20840400&rft.aulast=Samson&rft.aufirst=AJ&rft.au=Mercer%2C+GE&rft.au=Campbell%2C+DG&rft_id=http%3A%2F%2Fonlinelibrary.wiley.com%2Fresolve%2Fopenurl%3Fgenre%3Darticle%26sid%3Dnlm%3Apubmed%26issn%3D1445-1433%26date%3D2010%26volume%3D80%26issue%3D9%26spage%3D595&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Instr+Course+Lect&rft.atitle=Management+of+infection+at+the+site+of+a+total+knee+arthroplasty&rft.volume=55&rft.pages=449-61&rft.date=2006&rft_id=info%3Apmid%2F16958480&rft.aulast=Leone&rft.aufirst=JM&rft.au=Hanssen%2C+AD&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Parvizi, Javad; Zmistowski, Benjamin; Berbari, Elie F.; Bauer, Thomas W.; Springer, Bryan D.; Della Valle, Craig J.; Garvin, Kevin L.; Mont, Michael A.; Wongworawat, Montri D.; Zalavras, Charalampos G. 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Clement, DJ; Wymenga, AB (19 October 2005). \"Retention versus sacrifice of the posterior cruciate ligament in total knee replacement for treatment of osteoarthritis and rheumatoid arthritis\". <i>The Cochrane Database of Systematic Reviews<\/i> (4): CD004803. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD004803.pub2\" target=\"_blank\">10.1002\/14651858.CD004803.pub2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16235383\" target=\"_blank\">16235383<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Retention+versus+sacrifice+of+the+posterior+cruciate+ligament+in+total+knee+replacement+for+treatment+of+osteoarthritis+and+rheumatoid+arthritis.&rft.issue=4&rft.pages=CD004803&rft.date=2005-10-19&rft_id=info%3Adoi%2F10.1002%2F14651858.CD004803.pub2&rft_id=info%3Apmid%2F16235383&rft.aulast=Jacobs&rft.aufirst=WC&rft.au=Clement%2C+DJ&rft.au=Wymenga%2C+AB&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Verra, WC; van den Boom, LG; Jacobs, W; Clement, DJ; Wymenga, AA; Nelissen, RG (11 October 2013). \"Retention versus sacrifice of the posterior cruciate ligament in total knee arthroplasty for treating osteoarthritis\". <i>The Cochrane Database of Systematic Reviews<\/i> (10): CD004803. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD004803.pub3\" target=\"_blank\">10.1002\/14651858.CD004803.pub3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24114343\" target=\"_blank\">24114343<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Retention+versus+sacrifice+of+the+posterior+cruciate+ligament+in+total+knee+arthroplasty+for+treating+osteoarthritis.&rft.issue=10&rft.pages=CD004803&rft.date=2013-10-11&rft_id=info%3Adoi%2F10.1002%2F14651858.CD004803.pub3&rft_id=info%3Apmid%2F24114343&rft.aulast=Verra&rft.aufirst=WC&rft.au=van+den+Boom%2C+LG&rft.au=Jacobs%2C+W&rft.au=Clement%2C+DJ&rft.au=Wymenga%2C+AA&rft.au=Nelissen%2C+RG&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Toftdahl, K; 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February 2012. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FALN.0b013e31823c1030\" target=\"_blank\">10.1097\/ALN.0b013e31823c1030<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22227789\" target=\"_blank\">22227789<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesiology&rft.atitle=Practice+guidelines+for+acute+pain+management+in+the+perioperative+setting%3A+an+updated+report+by+the+American+Society+of+Anesthesiologists+Task+Force+on+Acute+Pain+Management&rft.pages=248-273&rft.date=2012-02&rft_id=info%3Adoi%2F10.1097%2FALN.0b013e31823c1030&rft_id=info%3Apmid%2F22227789&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Essving, P; Axelsson, K; \u00c5berg, E; Sp\u00e4nnar, H; Gupta, A; Lundin, A (October 2011). \"Local infiltration analgesia versus intrathecal morphine for postoperative pain management after total knee arthroplasty: a randomized controlled trial\". <i>Anesthesia & Analgesia<\/i>. <b>113<\/b> (4): 926\u201333. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1213%2FANE.0b013e3182288deb\" target=\"_blank\">10.1213\/ANE.0b013e3182288deb<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21821506\" target=\"_blank\">21821506<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesia+%26+Analgesia&rft.atitle=Local+infiltration+analgesia+versus+intrathecal+morphine+for+postoperative+pain+management+after+total+knee+arthroplasty%3A+a+randomized+controlled+trial.&rft.volume=113&rft.issue=4&rft.pages=926-33&rft.date=2011-10&rft_id=info%3Adoi%2F10.1213%2FANE.0b013e3182288deb&rft_id=info%3Apmid%2F21821506&rft.aulast=Essving&rft.aufirst=P&rft.au=Axelsson%2C+K&rft.au=%C3%85berg%2C+E&rft.au=Sp%C3%A4nnar%2C+H&rft.au=Gupta%2C+A&rft.au=Lundin%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pulavarti RS1, Raut VV, McLauchlan GJ. 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(2015). \"Mobile bearing vs fixed bearing prostheses for posterior cruciate retaining total knee arthroplasty for postoperative functional status in patients with osteoarthritis and rheumatoid arthritis\". <i>The Cochrane Database of Systematic Reviews<\/i> (2): CD003130. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD003130.pub3\" target=\"_blank\">10.1002\/14651858.CD003130.pub3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1469-493X\" target=\"_blank\">1469-493X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25650566\" target=\"_blank\">25650566<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Mobile+bearing+vs+fixed+bearing+prostheses+for+posterior+cruciate+retaining+total+knee+arthroplasty+for+postoperative+functional+status+in+patients+with+osteoarthritis+and+rheumatoid+arthritis&rft.issue=2&rft.pages=CD003130&rft.date=2015&rft.issn=1469-493X&rft_id=info%3Apmid%2F25650566&rft_id=info%3Adoi%2F10.1002%2F14651858.CD003130.pub3&rft.aulast=Hofstede&rft.aufirst=Stefanie+N.&rft.au=Nouta%2C+Klaas+Auke&rft.au=Jacobs%2C+Wilco&rft.au=van+Hooff%2C+Miranda+L.&rft.au=Wymenga%2C+Ate+B.&rft.au=Pijls%2C+Bart+G.&rft.au=Nelissen%2C+Rob+G.+H.+H.&rft.au=Marang-van+de+Mheen%2C+Perla+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Khemka A, Frossard L, Lord SJ, Bosley B, Al Muderis M (2015). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4750776\" target=\"_blank\">\"Osseointegrated total knee replacement connected to a lower limb prosthesis: 4 cases\"<\/a>. <i>Acta Orthop<\/i>. <b>86<\/b> (6): 740\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3109%2F17453674.2015.1068635\" target=\"_blank\">10.3109\/17453674.2015.1068635<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4750776\" target=\"_blank\">4750776<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26145721\" target=\"_blank\">26145721<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Orthop&rft.atitle=Osseointegrated+total+knee+replacement+connected+to+a+lower+limb+prosthesis%3A+4+cases&rft.volume=86&rft.issue=6&rft.pages=740-4&rft.date=2015&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4750776&rft_id=info%3Apmid%2F26145721&rft_id=info%3Adoi%2F10.3109%2F17453674.2015.1068635&rft.aulast=Khemka&rft.aufirst=A&rft.au=Frossard%2C+L&rft.au=Lord%2C+SJ&rft.au=Bosley%2C+B&rft.au=Al+Muderis%2C+M&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4750776&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.oansportsmed.com\/news\/total-knee-replacement-vs-unicompartmental-knee-replacement\" target=\"_blank\">Unicompartmental vs. Total Knee Replacement<\/a> By Dr. Gregory Markarian. Retrieved 29 January 2015.<\/span>\n<\/li>\n<li id=\"cite_note-Inui2013-30\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Inui2013_30-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Inui2013_30-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Inui2013_30-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Inui, Hiroshi; Taketomi, Shuji; Nakamura, Kensuke; Takei, Seira; Takeda, Hideki; Tanaka, Sakae; Nakagawa, Takumi (2013). \"Influence of navigation system updates on total knee arthroplasty\". <i>Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology<\/i>. <b>5<\/b> (1). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2F2052-1847-5-10\" target=\"_blank\">10.1186\/2052-1847-5-10<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1758-2555\" target=\"_blank\">1758-2555<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Sports+Medicine%2C+Arthroscopy%2C+Rehabilitation%2C+Therapy+%26+Technology&rft.atitle=Influence+of+navigation+system+updates+on+total+knee+arthroplasty&rft.volume=5&rft.issue=1&rft.date=2013&rft_id=info%3Adoi%2F10.1186%2F2052-1847-5-10&rft.issn=1758-2555&rft.aulast=Inui&rft.aufirst=Hiroshi&rft.au=Taketomi%2C+Shuji&rft.au=Nakamura%2C+Kensuke&rft.au=Takei%2C+Seira&rft.au=Takeda%2C+Hideki&rft.au=Tanaka%2C+Sakae&rft.au=Nakagawa%2C+Takumi&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\" target=\"_blank\">(CC-BY-2.0)<\/a><\/span>\n<\/li>\n<li id=\"cite_note-GromovKorchi2014-31\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-GromovKorchi2014_31-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-GromovKorchi2014_31-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-GromovKorchi2014_31-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gromov, Kirill; Korchi, Mounim; Thomsen, Morten G; Husted, Henrik; Troelsen, Anders (2014). \"What is the optimal alignment of the tibial and femoral components in knee arthroplasty?\". <i>Acta Orthopaedica<\/i>. <b>85<\/b> (5): 480\u2013487. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3109%2F17453674.2014.940573\" target=\"_blank\">10.3109\/17453674.2014.940573<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1745-3674\" target=\"_blank\">1745-3674<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Orthopaedica&rft.atitle=What+is+the+optimal+alignment+of+the+tibial+and+femoral+components+in+knee+arthroplasty%3F&rft.volume=85&rft.issue=5&rft.pages=480-487&rft.date=2014&rft_id=info%3Adoi%2F10.3109%2F17453674.2014.940573&rft.issn=1745-3674&rft.aulast=Gromov&rft.aufirst=Kirill&rft.au=Korchi%2C+Mounim&rft.au=Thomsen%2C+Morten+G&rft.au=Husted%2C+Henrik&rft.au=Troelsen%2C+Anders&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-CarterPotts2014-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-CarterPotts2014_32-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Carter, Evelene M; Potts, Henry WW (2014). \"Predicting length of stay from an electronic patient record system: a primary total knee replacement example\". <i>BMC Medical Informatics and Decision Making<\/i>. <b>14<\/b> (1): 26. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2F1472-6947-14-26\" target=\"_blank\">10.1186\/1472-6947-14-26<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1472-6947\" target=\"_blank\">1472-6947<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMC+Medical+Informatics+and+Decision+Making&rft.atitle=Predicting+length+of+stay+from+an+electronic+patient+record+system%3A+a+primary+total+knee+replacement+example&rft.volume=14&rft.issue=1&rft.pages=26&rft.date=2014&rft_id=info%3Adoi%2F10.1186%2F1472-6947-14-26&rft.issn=1472-6947&rft.aulast=Carter&rft.aufirst=Evelene+M&rft.au=Potts%2C+Henry+WW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:0-33\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_33-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_33-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.massgeneral.org\/ortho-hip-knee\/patient-education\/pt-ed-kneerehab.pdf\" target=\"_blank\">\"Rehabilitation\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>massgeneral.org<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=massgeneral.org&rft.atitle=Rehabilitation&rft_id=http%3A%2F%2Fwww.massgeneral.org%2Fortho-hip-knee%2Fpatient-education%2Fpt-ed-kneerehab.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:1-34\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:1_34-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_34-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Valtonen, Anu; 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Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ptjournal.apta.org\/content\/89\/10\/1072\" target=\"_blank\">the original<\/a> on 11 August 2016.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Physical+Therapy&rft.atitle=Muscle+Deficits+Persist+After+Unilateral+Knee+Replacement+and+Have+Implications+for+Rehabilitation&rft.volume=89&rft.issue=10&rft.pages=1072-1079&rft.date=2009-10-01&rft.issn=0031-9023&rft_id=info%3Apmid%2F19713269&rft_id=info%3Adoi%2F10.2522%2Fptj.20070295&rft.aulast=Valtonen&rft.aufirst=Anu&rft.au=P%C3%B6yh%C3%B6nen%2C+Tapani&rft.au=Heinonen%2C+Ari&rft.au=Sipil%C3%A4%2C+Sarianna&rft_id=http%3A%2F%2Fptjournal.apta.org%2Fcontent%2F89%2F10%2F1072&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Monaghan, B; Caulfield, B; O'Math\u00fana, DP (20 January 2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/doras.dcu.ie\/19651\/1\/dpom4.pdf\" target=\"_blank\">\"Surface neuromuscular electrical stimulation for quadriceps strengthening pre and post total knee replacement\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>The Cochrane Database of Systematic Reviews<\/i> (1): CD007177. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD007177.pub2\" target=\"_blank\">10.1002\/14651858.CD007177.pub2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20091621\" target=\"_blank\">20091621<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Surface+neuromuscular+electrical+stimulation+for+quadriceps+strengthening+pre+and+post+total+knee+replacement.&rft.issue=1&rft.pages=CD007177&rft.date=2010-01-20&rft_id=info%3Adoi%2F10.1002%2F14651858.CD007177.pub2&rft_id=info%3Apmid%2F20091621&rft.aulast=Monaghan&rft.aufirst=B&rft.au=Caulfield%2C+B&rft.au=O%27Math%C3%BAna%2C+DP&rft_id=http%3A%2F%2Fdoras.dcu.ie%2F19651%2F1%2Fdpom4.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Leah, 2013<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"#What_information_to_include\" title=\"Wikipedia:Citing sources\" rel=\"external_link\"><span title=\"A complete citation is needed (April 2018)\">full citation needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">&Na; Dickinson, S (2013). \"Foreword\". <i>Critical Care Nursing Quarterly<\/i>. <b>36<\/b> (1): 1\u20132. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2Fcnq.0b013e3182750631\" target=\"_blank\">10.1097\/cnq.0b013e3182750631<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23221435\" target=\"_blank\">23221435<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Critical+Care+Nursing+Quarterly&rft.atitle=Foreword&rft.volume=36&rft.issue=1&rft.pages=1-2&rft.date=2013&rft_id=info%3Adoi%2F10.1097%2Fcnq.0b013e3182750631&rft_id=info%3Apmid%2F23221435&rft.au=%26Na&rft.au=Dickinson%2C+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Teodoro,_2016-38\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Teodoro,_2016_38-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Teodoro,_2016_38-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Teodoro, 2016<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"#What_information_to_include\" title=\"Wikipedia:Citing sources\" rel=\"external_link\"><span title=\"A complete citation is needed (April 2018)\">full citation needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-39\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-39\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Ong & Pua, 2011<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"#What_information_to_include\" title=\"Wikipedia:Citing sources\" rel=\"external_link\"><span title=\"A complete citation is needed (April 2018)\">full citation needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-APTAfive-40\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-APTAfive_40-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-APTAfive_40-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-APTAfive_40-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFAmerican_Physical_Therapy_Association2014\" class=\"citation\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Physical_Therapy_Association\" title=\"American Physical Therapy Association\" rel=\"external_link\" target=\"_blank\">American Physical Therapy Association<\/a> (15 September 2014), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.choosingwisely.org\/doctor-patient-lists\/american-physical-therapy-association\/\" target=\"_blank\">\"Five Things Physicians and Patients Should Question\"<\/a>, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Choosing_Wisely\" title=\"Choosing Wisely\" rel=\"external_link\" target=\"_blank\">Choosing Wisely<\/a>: an initiative of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ABIM_Foundation\" class=\"mw-redirect\" title=\"ABIM Foundation\" rel=\"external_link\" target=\"_blank\">ABIM Foundation<\/a><\/i>, American Physical Therapy Association<span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">15 September<\/span> 2014<\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Choosing+Wisely%3A+an+initiative+of+the+ABIM+Foundation&rft.atitle=Five+Things+Physicians+and+Patients+Should+Question&rft.date=2014-09-15&rft.au=American+Physical+Therapy+Association&rft_id=http%3A%2F%2Fwww.choosingwisely.org%2Fdoctor-patient-lists%2Famerican-physical-therapy-association%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> <\/span>\n<\/li>\n<li id=\"cite_note-Harvey2014-41\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Harvey2014_41-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Harvey2014_41-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Harvey, Lisa A.; 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(2014-02-06). \"Continuous passive motion following total knee arthroplasty in people with arthritis\". <i>The Cochrane Database of Systematic Reviews<\/i> (2): CD004260. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD004260.pub3\" target=\"_blank\">10.1002\/14651858.CD004260.pub3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1469-493X\" target=\"_blank\">1469-493X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24500904\" target=\"_blank\">24500904<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Continuous+passive+motion+following+total+knee+arthroplasty+in+people+with+arthritis&rft.issue=2&rft.pages=CD004260&rft.date=2014-02-06&rft.issn=1469-493X&rft_id=info%3Apmid%2F24500904&rft_id=info%3Adoi%2F10.1002%2F14651858.CD004260.pub3&rft.aulast=Harvey&rft.aufirst=Lisa+A.&rft.au=Brosseau%2C+Lucie&rft.au=Herbert%2C+Robert+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-42\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-42\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Adie, S; Kwan, A; Naylor, JM; Harris, IA; Mittal, R (12 September 2012). \"Cryotherapy following total knee replacement\". <i>The Cochrane Database of Systematic Reviews<\/i> (9): CD007911. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD007911.pub2\" target=\"_blank\">10.1002\/14651858.CD007911.pub2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22972114\" target=\"_blank\">22972114<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Cryotherapy+following+total+knee+replacement.&rft.issue=9&rft.pages=CD007911&rft.date=2012-09-12&rft_id=info%3Adoi%2F10.1002%2F14651858.CD007911.pub2&rft_id=info%3Apmid%2F22972114&rft.aulast=Adie&rft.aufirst=S&rft.au=Kwan%2C+A&rft.au=Naylor%2C+JM&rft.au=Harris%2C+IA&rft.au=Mittal%2C+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-AAOSfive-43\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-AAOSfive_43-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-AAOSfive_43-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFAmerican_Academy_of_Orthopaedic_Surgeons2013\" class=\"citation\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Academy_of_Orthopaedic_Surgeons\" title=\"American Academy of Orthopaedic Surgeons\" rel=\"external_link\" target=\"_blank\">American Academy of Orthopaedic Surgeons<\/a> (February 2013), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.choosingwisely.org\/doctor-patient-lists\/american-academy-of-orthopaedic-surgeons\/\" target=\"_blank\">\"Five Things Physicians and Patients Should Question\"<\/a>, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Choosing_Wisely\" title=\"Choosing Wisely\" rel=\"external_link\" target=\"_blank\">Choosing Wisely<\/a>: an initiative of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ABIM_Foundation\" class=\"mw-redirect\" title=\"ABIM Foundation\" rel=\"external_link\" target=\"_blank\">ABIM Foundation<\/a><\/i>, American Academy of Orthopaedic Surgeons<span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">19 May<\/span> 2013<\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Choosing+Wisely%3A+an+initiative+of+the+ABIM+Foundation&rft.atitle=Five+Things+Physicians+and+Patients+Should+Question&rft.date=2013-02&rft.au=American+Academy+of+Orthopaedic+Surgeons&rft_id=http%3A%2F%2Fwww.choosingwisely.org%2Fdoctor-patient-lists%2Famerican-academy-of-orthopaedic-surgeons%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>, which cites\n<ul><li><cite class=\"citation journal\">Members of 2007 and 2011 AAOS Guideline Development Work Groups on PE\/VTED Prophylaxis; Mont, M; Jacobs, J; Lieberman, J; Parvizi, J; Lachiewicz, P; Johanson, N; Watters, W (18 April 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3326687\" target=\"_blank\">\"Preventing venous thromboembolic disease in patients undergoing elective total hip and knee arthroplasty\"<\/a>. <i>The Journal of Bone and Joint Surgery. American Volume<\/i>. <b>94<\/b> (8): 673\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.9408edit\" target=\"_blank\">10.2106\/JBJS.9408edit<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3326687\" target=\"_blank\">3326687<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22517384\" target=\"_blank\">22517384<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Bone+and+Joint+Surgery.+American+Volume&rft.atitle=Preventing+venous+thromboembolic+disease+in+patients+undergoing+elective+total+hip+and+knee+arthroplasty.&rft.volume=94&rft.issue=8&rft.pages=673-4&rft.date=2012-04-18&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3326687&rft_id=info%3Apmid%2F22517384&rft_id=info%3Adoi%2F10.2106%2FJBJS.9408edit&rft.au=Members+of+2007+and+2011+AAOS+Guideline+Development+Work+Groups+on+PE%2FVTED+Prophylaxis&rft.au=Mont%2C+M&rft.au=Jacobs%2C+J&rft.au=Lieberman%2C+J&rft.au=Parvizi%2C+J&rft.au=Lachiewicz%2C+P&rft.au=Johanson%2C+N&rft.au=Watters%2C+W&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3326687&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<\/span><\/li>\n<li id=\"cite_note-44\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-44\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hamilton, TW; Strickland, LH; Pandit, HG (17 August 2016). \"A Meta-Analysis on the Use of Gabapentinoids for the Treatment of Acute Postoperative Pain Following Total Knee Arthroplasty\". <i>The Journal of Bone and Joint Surgery. 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Most Frequent Procedures Performed in U.S. Hospitals, 2011. HCUP Statistical Brief #165. October 2013. Agency for Healthcare Research and Quality, Rockville, MD. <a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.hcup-us.ahrq.gov\/reports\/statbriefs\/sb165.jsp\" target=\"_blank\">[1]<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-46\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-46\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Weiss AJ, Elixhauser A, Andrews RM (February 2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/hcup-us.ahrq.gov\/reports\/statbriefs\/sb170-Operating-Room-Procedures-United-States-2011.jsp\" target=\"_blank\">\"Characteristics of Operating Room Procedures in U.S. Hospitals, 2011\"<\/a>. <i>HCUP Statistical Brief #170<\/i>. Rockville, MD: Agency for Healthcare Research and Quality.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=HCUP+Statistical+Brief+%23170&rft.atitle=Characteristics+of+Operating+Room+Procedures+in+U.S.+Hospitals%2C+2011.&rft.date=2014-02&rft.aulast=Weiss&rft.aufirst=AJ&rft.au=Elixhauser%2C+A&rft.au=Andrews%2C+RM&rft_id=http%3A%2F%2Fhcup-us.ahrq.gov%2Freports%2Fstatbriefs%2Fsb170-Operating-Room-Procedures-United-States-2011.jsp&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-47\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-47\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Weiss AJ, Elixhauser A (March 2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/hcup-us.ahrq.gov\/reports\/statbriefs\/sb171-Operating-Room-Procedure-Trends.jsp\" target=\"_blank\">\"Trends in Operating Room Procedures in U.S. Hospitals, 2001\u20142011\"<\/a>. <i>HCUP Statistical Brief #171<\/i>. Rockville, MD: Agency for Healthcare Research and Quality.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=HCUP+Statistical+Brief+%23171&rft.atitle=Trends+in+Operating+Room+Procedures+in+U.S.+Hospitals%2C+2001%E2%80%942011.&rft.date=2014-03&rft.aulast=Weiss&rft.aufirst=AJ&rft.au=Elixhauser%2C+A&rft_id=http%3A%2F%2Fhcup-us.ahrq.gov%2Freports%2Fstatbriefs%2Fsb171-Operating-Room-Procedure-Trends.jsp&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-48\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-48\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Fingar KR, Stocks C, Weiss AJ, Steiner CA (December 2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.hcup-us.ahrq.gov\/reports\/statbriefs\/sb186-Operating-Room-Procedures-United-States-2012.jsp\" target=\"_blank\">\"Most Frequent Operating Room Procedures Performed in U.S. Hospitals, 2003-2012\"<\/a>. <i>HCUP Statistical Brief #186<\/i>. Rockville, MD: Agency for Healthcare Research and Quality.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=HCUP+Statistical+Brief+%23186&rft.atitle=Most+Frequent+Operating+Room+Procedures+Performed+in+U.S.+Hospitals%2C+2003-2012&rft.date=2014-12&rft.aulast=Fingar&rft.aufirst=KR&rft.au=Stocks%2C+C&rft.au=Weiss%2C+AJ&rft.au=Steiner%2C+CA&rft_id=https%3A%2F%2Fwww.hcup-us.ahrq.gov%2Freports%2Fstatbriefs%2Fsb186-Operating-Room-Procedures-United-States-2012.jsp&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-49\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-49\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Dreyer HC, Strycker LA, Senesac HA, Hocker AD, Smolkowski K, Shah SN, Jewett BA (2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3809795\" target=\"_blank\">\"Essential amino acid supplementation in patients following total knee arthroplasty\"<\/a>. <i>J Clin Invest<\/i>. <b>123<\/b> (11): 4654\u20134666. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1172%2FJCI70160\" target=\"_blank\">10.1172\/JCI70160<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3809795\" target=\"_blank\">3809795<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24135139\" target=\"_blank\">24135139<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Clin+Invest&rft.atitle=Essential+amino+acid+supplementation+in+patients+following+total+knee+arthroplasty&rft.volume=123&rft.issue=11&rft.pages=4654-4666&rft.date=2013&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3809795&rft_id=info%3Apmid%2F24135139&rft_id=info%3Adoi%2F10.1172%2FJCI70160&rft.au=Dreyer+HC%2C+Strycker+LA%2C+Senesac+HA%2C+Hocker+AD%2C+Smolkowski+K%2C+Shah+SN%2C+Jewett+BA&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3809795&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKnee+replacement\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2005\/02\/08\/health\/08brod.html\" target=\"_blank\">A New Set of Knees Comes at a Price: A Whole Lot of Pain<\/a> By Jane E. Brody, The New York Times, 8 February 2005<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2005\/02\/15\/health\/15brod.html\" target=\"_blank\">When It Comes to Severe Pain, Doctors Still Have Much to Learn<\/a> By Jane E. Brody, The New York Times, 15 February 2005<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2005\/12\/20\/health\/20brod.html\" target=\"_blank\">A Year With My New Knees: Much Pain but Much Gain<\/a> By Jane E. Brody, The New York Times, 20 December 2005<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2008\/06\/03\/health\/03brod.html\" target=\"_blank\">3 Years Later, Knees Made for Dancing<\/a>, By Jane E. Brody, The New York Times, 3 June 2008<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/well.blogs.nytimes.com\/2012\/07\/09\/relief-for-joints-besieged-by-arthritis\/\" target=\"_blank\">Relief for Joints Besieged by Arthritis<\/a>, By Jane E. Brody, The New York Times, 9 July 2012<\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1267\nCached time: 20181212022831\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.720 seconds\nReal time usage: 0.844 seconds\nPreprocessor visited node count: 3565\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 145536\/2097152 bytes\nTemplate argument size: 3054\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 7\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 141337\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.422\/10.000 seconds\nLua memory usage: 5.91 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 709.773 1 -total\n<\/p>\n<pre>67.73% 480.726 1 Template:Reflist\n48.31% 342.872 37 Template:Cite_journal\n10.86% 77.047 5 Template:Fix\n 8.96% 63.604 2 Template:Citation_needed\n 8.29% 58.863 1 Template:Infobox_medical_intervention\n 7.29% 51.736 1 Template:Infobox\n 5.92% 42.036 7 Template:Category_handler\n 4.24% 30.061 1 Template:Use_dmy_dates\n 4.17% 29.620 5 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2830398-1!canonical and timestamp 20181212022830 and revision id 873252327\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Knee_replacement\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212243\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.023 seconds\nReal time usage: 0.165 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 154.521 1 - wikipedia:Knee_replacement\n100.00% 154.521 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8198-0!*!*!*!*!*!* and timestamp 20181217212243 and revision id 24344\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Knee_replacement\">https:\/\/www.limswiki.org\/index.php\/Knee_replacement<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","7f167309f5601a436158b97bafa6f365_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/Knee_Replacement.png\/560px-Knee_Replacement.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0e\/PTG_F.jpeg\/440px-PTG_F.jpe","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b1\/PTG_P.jpeg\/440px-PTG_P.jpe","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b5\/Knee_Replacement.jpg\/440px-Knee_Replacement.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e7\/ProthesenlockerungPET-CT.jpg\/440px-ProthesenlockerungPET-CT.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/ce\/HKA_and_HKS_angles.jpg\/140px-HKA_and_HKS_angles.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/dc\/Prothese-genou-IMG_0033.jpg\/300px-Prothese-genou-IMG_0033.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a1\/Knee_prosthesis_components.jpg\/400px-Knee_prosthesis_components.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b3\/Radiograph_with_knee_angles.jpg\/440px-Radiograph_with_knee_angles.jpg"],"7f167309f5601a436158b97bafa6f365_timestamp":1545081763,"03702616ce6f6edc52550ce2503f857d_type":"article","03702616ce6f6edc52550ce2503f857d_title":"Joint replacement","03702616ce6f6edc52550ce2503f857d_url":"https:\/\/www.limswiki.org\/index.php\/Joint_replacement","03702616ce6f6edc52550ce2503f857d_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tJoint replacement\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tJoint replacementHip joint replacementICD-10-PCS0?R?0JZICD-9-CM81.5, 81.8MeSHD019643 [edit on Wikidata]\nReplacement arthroplasty (from Greek arthron, joint, limb, articulate, + plassein, to form, mould, forge, feign, make an image of), or joint replacement surgery, is a procedure of orthopedic surgery in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pain or dysfunction is not alleviated by less-invasive therapies. It is a form of arthroplasty, and is often indicated from various joint diseases, including osteoarthritis and rheumatoid arthritis.\nJoint replacement surgery is becoming more common with knees and hips replaced most often. About 773,000 Americans had a hip or knee replaced in 2009.[1]\n\nContents \n\n1 Background \n2 Joints \n\n2.1 Shoulder \n2.2 Hip \n2.3 Knee \n2.4 Ankle \n2.5 Finger \n\n\n3 Procedural timeline \n4 Materials \n5 Risks and complications \n\n5.1 Medical risks \n5.2 Intra-operative risks \n5.3 Immediate risks \n5.4 Medium-term risks \n5.5 Long-term risks \n\n\n6 Prosthesis replacement \n7 See also \n\n7.1 Related treatments \n\n\n8 References \n9 External links \n\n\nBackground \nStephen S. Hudack, a surgeon based in New York City, began animal testing with artificial joints in 1939.[2] By 1948,\nhe was at the New York Orthopedic Hospital (part of the Columbia Presbyterian Medical Center) and with funding from the Office of Naval Research, was replacing hip joints in humans.[2]\nTwo previously[when? ] popular forms of arthroplasty were: (1) interpositional arthroplasty', with interposition of some other tissue like skin, muscle or tendon to keep inflammatory surfaces apart and (2) excisional arthroplasty in which the joint surface and bone were removed leaving scar tissue to fill in the gap. Other forms of arthroplasty include resection(al) arthroplasty, resurfacing arthroplasty, mold arthroplasty, cup arthroplasty, and silicone replacement arthroplasty. Osteotomy to restore or modify joint congruity is also a form of arthroplasty.\nIn recent decades, the most successful and common form of arthroplasty is the surgical replacement of a joint or joint surface with a prosthesis. For example, a hip joint that is affected by osteoarthritis may be replaced entirely (total hip arthroplasty) with a prosthetic hip. This procedure involves replacing both the acetabulum (hip socket) and the head and neck of the femur. The purpose of doing this surgery is to relieve pain, to restore range of motion and to improve walking ability, leading to the improvement of muscle strength.\n\nJoints \nShoulder \nMain article: Shoulder replacement\nFor shoulder replacement, there are a few major approaches to access the shoulder joint. The first is the deltopectoral approach, which saves the deltoid, but requires the supraspinatus to be cut.[3] The second is the transdeltoid approach, which provides a straight on approach at the glenoid. However, during this approach the deltoid is put at risk for potential damage.[3] Both techniques are used, depending on the surgeon's preferences.\n\nHip \nMain article: Hip replacement\nHip replacement can be performed as a total replacement or a hemi (half) replacement. A total hip replacement consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is currently the most common orthopaedic operation, though patient satisfaction short- and long-term varies widely.\n\nKnee \n Knee replacement.\nMain article: Knee replacement\nKnee replacement involves exposure of the front of the knee, with detachment of part of the quadriceps muscle (vastus medialis) from the patella. The patella is displaced to one side of the joint, allowing exposure of the distal end of the femur and the proximal end of the tibia. The ends of these bones are then accurately cut to shape using cutting guides oriented to the long axis of the bones. The cartilages and the anterior cruciate ligament are removed; the posterior cruciate ligament may also be removed[4] but the tibial and fibular collateral ligaments are preserved. Metal components are then impacted onto the bone or fixed using polymethylmethacrylate (PMMA) cement. Alternative techniques exist that affix the implant without cement. These cement-less techniques may involve osseointegration, including porous metal prostheses.\nThe operation typically involves substantial postoperative pain, and includes vigorous physical rehabilitation. The recovery period may be 6 weeks or longer and may involve the use of mobility aids (e.g. walking frames, canes, crutches) to enable the patient's return to preoperative mobility.[5]\n\nAnkle \nMain article: Ankle replacement\nAnkle replacement is becoming the treatment of choice for patients requiring arthroplasty, replacing the conventional use of arthrodesis, i.e. fusion of the bones. The restoration of range of motion is the key feature in favor of ankle replacement with respect to arthrodesis. However, clinical evidence of the superiority of the former has only been demonstrated for particular isolated implant designs.[6]\n\nFinger \n Finger joint replacement.\nFinger joint replacement is a relatively quick procedure of about 30 minutes, but requires several months of subsequent therapy.[7]\n\nProcedural timeline \nBefore major surgery is performed, a complete pre-anaesthetic work-up is required. In elderly patients this usually would include ECG, urine tests, hematology and blood tests. Cross match of blood is routine also, as a high percentage of patients receive a blood transfusion.\nPre-operative planning requires accurate Xrays of the affected joint, implant design selecting and size-matching to the xray images (a process known as templating).\nA few days' hospitalization is followed by several weeks of protected function, healing and rehabilitation. This may then be followed by several months of slow improvement in strength and endurance.\nEarly mobilisation of the patient is thought to be the key to reducing the chances of complications[1] such as venous thromboembolism and Pneumonia. Modern practice is to mobilize patients as soon as possible and ambulate with walking aids when tolerated. Depending on the joint involved and the pre-op status of the patient, the time of hospitalization varies from 1 day to 2 weeks, with the average being 4\u20137 days in most regions.\nPhysiotherapy is used extensively to help patients recover function after joint replacement surgery. A graded exercise programme is needed initially, as the patients' muscles take time to heal after the surgery; exercises for range of motion of the joints and ambulation should not be strenuous. Later when the muscles have healed, the aim of exercise expands to include strengthening and recovery of function.\n\nMaterials \nSome ceramic materials commonly used in joint replacement are alumina (Al2O3), zirconia (ZrO2), silica (SiO2), hydroxyapatite (Ca10(PO4)6(OH)2), titanium nitride (TiN), silicon nitride (Si3N4). A combination of titanium and titanium carbide is a very hard ceramic material often used in components of arthroplasties due to the impressive degree of strength and toughness it presents, as well as its compatibility with medical imaging.\nTitanium carbide has proved to be possible to use combined with sintered polycrystalline diamond surface (PCD), a superhard ceramic which promises to provide an improved, strong, long-wearing material for artificial joints. PCD is formed from polycrystalline diamond compact (PDC) through a process involving high pressures and temperatures. When compared with other ceramic materials such as cubic boron nitride, silicon nitride, and aluminum oxide, PCD shows many better characteristics, including a high level of hardness and a relatively low coefficient of friction. For the application of artificial joints it will likely be combined with certain metals and metal alloys like cobalt, chrome, titanium, vanadium, stainless steel, aluminum, nickel, hafnium, silicon, cobalt-chrome, tungsten, zirconium, etc.[8] This means that people with nickel allergy or sensitivities to other metals are at risk for complications due to the chemicals in the device.[9]\nIn knee replacements there are two parts that are ceramic and they can be made of either the same ceramic or a different one. If they are made of the same ceramic, however, they have different weight ratios. These ceramic parts are configured so that should shards break off of the implant, the particles are benign and not sharp. They are also made so that if a shard were to break off of one of the two ceramic components, they would be noticeable through x-rays during a check-up or inspection of the implant. With implants such as hip implants, the ball of the implant could be made of ceramic, and between the ceramic layer and where it attaches to the rest of the implant, there is usually a membrane to help hold the ceramic. The membrane can help prevent cracks, but if cracks should occur at two points which create a separate piece, the membrane can hold the shard in place so that it doesn't leave the implant and cause further injury. Because these cracks and separations can occur, the material of the membrane is a bio-compatible polymer that has a high fracture toughness and a high shear toughness.[10]\n\nRisks and complications \nMedical risks \nThe Stress of the operation may result in medical problems of varying incidence and severity.\n\nHeart Attack\nStroke\nVenous Thromboembolism\nPneumonia\nIncreased confusion\nUrinary Tract Infection (UTI)\nIntra-operative risks \nMal-positioning of the components\nShortening;\nInstability\/dislocation;\nLoss of range of motion;\nFracture of the adjacent bone;\nNerve damage;\nDamage to blood vessels.\nImmediate risks \nInfection, either Superficial or Deep\nDislocation\nMedium-term risks \nDislocation\nPersistent pain;\nLoss of range of motion;\nWeakness;\nIndolent infection.\nLong-term risks \nLoosening of the components: the bond between the bone and the components or the cement may break down or fatigue. As a result, the component moves inside the bone, causing pain. Fragments of wear debris may cause an inflammatory reaction with bone absorption which can cause loosening. This phenomenon is known as osteolysis.\nPolyethylene synovitis - Wear of the weight-bearing surfaces: polyethylene is thought to wear in weight-bearing joints such as the hip at a rate of 0.3mm per year[citation needed ]. This may be a problem in itself since the bearing surfaces are often less than 10 mm thick and may deform as they get thinner. The wear may also cause problems, as inflammation can be caused by increased quantities of polyethylene wear particles in the synovial fluid.\nThere are many controversies. Much of the research effort of the orthopedic-community is directed to studying and improving joint replacement. The main controversies are\n\nthe best or most appropriate bearing surface - metal\/polyethylene, metal-metal, ceramic-ceramic;\ncemented vs uncemented fixation of the components;\nMinimally invasive surgery.\n \n\nProsthesis replacement \nThe prosthesis may need to be replaced due to complications such as infection or prosthetic fracture. Replacement may be done in one single surgical session. Alternatively, an initial surgery may be performed to remove previous prosthetic material, and the new prosthesis is then inserted in a separate surgery at a later time. In such cases, especially when complicated by infection, a spacer may be used, which is a sturdy mass to provide some basic joint stability and mobility until a more permanent prosthesis is inserted. It can contain antibiotics to help treating any infection.[11]\n\nSee also \nRheumasurgery\nArthroplasty\nOrthopedic surgery\nJoint replacement registry\nRelated treatments \nAutologous chondrocyte implantation\nMicrofracture surgery\nReferences \n\n\n^ a b Joint Replacement Surgery and You. (April, 2009) In Arthritis, Musculoskeletal and Skin Disease online. Retrieved from http:\/\/www.niams.nih.gov\/#. \n\n^ a b \"Joints of Steel and Plastic\". Life. April 12, 1948: 127\u2013130. ISSN 0024-3019. Retrieved 2011-03-19 . \n\n^ a b Nerot, C.; Ohl, X. (2014). \"Primary shoulder reverse arthroplasty: Surgical technique\". Orthopaedics & Traumatology: Surgery & Research. 100 (1): S181\u2013S190. doi:10.1016\/j.otsr.2013.06.011. \n\n^ Jacobs, WC; Clement, DJ; Wymenga, AB (Oct 19, 2005). \"Retention versus sacrifice of the posterior cruciate ligament in total knee replacement for treatment of osteoarthritis and rheumatoid arthritis\". The Cochrane Database of Systematic Reviews (4): CD004803. doi:10.1002\/14651858.CD004803.pub2. PMID 16235383. \n\n^ Leopold SS (April 2009). \"Minimally invasive total knee arthroplasty for osteoarthritis\". N. Engl. J. Med. 360 (17): 1749\u201358. doi:10.1056\/NEJMct0806027. PMID 19387017. \n\n^ Saltzman, C.L.; Mann, R.A.; Ahrens, J.E.; Amendola, A.; Anderson, R.B.; Berlet, G.C.; Brodky, J.W.; Chou, L.B.; Clanton, T.O.; Deland, J.T.; Deorio, J.K.; Horton, G.A.; Lee, T.H.; Mann, J.A.; Nunley, J.A.; Thordarson, D.B.; Walling, A.K.; Wapner, K.L.; Coughlin, M.J. (2009). \"Prospective Controlled Trial of STAR Total Ankle Replacement Versus Ankle Fusion: Initial Results\". Foot & Ankle International. 30 (7): 579\u2013596. doi:10.3113\/FAI.2009.0579. PMID 19589303. \n\n^ Page 50 in: Leslie Galliker (2014). Joint Replacements. ABDO. ISBN 9781617839030. \n\n^ Pope, Bill et al. (2011) International Patent No. 127321A. Orem, UT: US http:\/\/worldwide.espacenet.com \n\n^ Thomas, Peter (2014-01-01). \"Clinical and diagnostic challenges of metal implant allergy using the example of orthopaedic surgical implants: Part 15 of the Series Molecular Allergology\". Allergo Journal International. 23 (6): 179\u2013185. doi:10.1007\/s40629-014-0023-3. ISSN 2197-0378. PMC 4479460 . PMID 26120529. \n\n^ Monaghan, Matthew, David Miller. (2013). US Patent No. 0282134A1. Warsaw, IN: US http:\/\/worldwide.espacenet.com\/ \n\n^ Mazzucchelli, Luca; Rosso, Federica; Marmotti, Antongiulio; Bonasia, Davide Edoardo; Bruzzone, Matteo; Rossi, Roberto (2015). \"The use of spacers (static and mobile) in infection knee arthroplasty\". Current Reviews in Musculoskeletal Medicine. 8 (4): 373\u2013382. doi:10.1007\/s12178-015-9293-8. ISSN 1935-973X. PMC 4630232 . \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Arthroplasty.\nPatient Information from the American Academy of Orthopedic Surgeons\nPatient Information from the FDA\nP. Benum; A. Aamodt; and K. Haugan Uncementeed Custom Femoral Components In Hip Arthroplasty\nFinkelstein, JA; Anderson, GI; Richards, RR; Waddell, JP (1991). \"Polyethylene synovitis following canine total hip arthroplasty. Histomorphometric analysis\". The Journal of arthroplasty. 6 Suppl: S91\u20136. doi:10.1016\/s0883-5403(08)80062-9. PMID 1774577. \nvteOrthopedic surgery, operations\/surgeries and other procedures on bones and joints (ICD-9-CM V3 76\u201381, ICD-10-PCS 0P\u2013S)BonesFacial\nJaw reduction\nDentofacial osteotomy\nGenioplasty\/Mentoplasty\nChin augmentation\nOrthognathic surgery\nSpine\nCoccygectomy\nLaminotomy\nLaminectomy\nLaminoplasty\nCorpectomy\nFacetectomy\nForaminotomy\nVertebral fixation\nPercutaneous vertebroplasty\nUpper extremity\nAcromioplasty\nLower extremity\nFemoral head ostectomy\nAstragalectomy\nDistraction osteogenesis\nIlizarov apparatus\nPhemister graft\nGeneral\nOstectomy\nBone grafting\nOsteotomy\nEpiphysiodesis\nReduction\nInternal fixation\nExternal fixation\nTension band wiring\nCartilage\nArticular cartilage repair\nMicrofracture surgery\nKnee cartilage replacement therapy\nAutologous chondrocyte implantation\nJointsSpine\nArthrodesis\nSpinal fusion\nIntervertebral discs\nDiscectomy\nAnnuloplasty\nArthroplasty\nUpper extremity\nShoulder surgery\nShoulder replacement\nBankart repair\nWeaver\u2013Dunn procedure\nUlnar collateral ligament reconstruction\nHand surgery\nBrunelli procedure\nLower extremity\nHip resurfacing\nHip replacement\nRotationplasty\nAnterior cruciate ligament reconstruction\nKnee replacement\/Unicompartmental knee arthroplasty\nAnkle replacement\nBrostr\u00f6m procedure\nTriple arthrodesis\nGeneral\nArthrotomy\nArthroplasty\nSynovectomy\nArthroscopy\nReplacement joint\nimaging: Arthrogram\nArthrocentesis\n\nAuthority control \nNDL: 00575402 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Joint_replacement\">https:\/\/www.limswiki.org\/index.php\/Joint_replacement<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical and surgical techniquesHidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","03702616ce6f6edc52550ce2503f857d_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Joint_replacement skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Joint replacement<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Replacement arthroplasty<\/b> (from Greek <i>arthron<\/i>, joint, limb, articulate, + <i>plassein<\/i>, to form, mould, forge, feign, make an image of), or <b>joint replacement surgery<\/b>, is a procedure of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedic_surgery\" title=\"Orthopedic surgery\" rel=\"external_link\" target=\"_blank\">orthopedic surgery<\/a> in which an arthritic or dysfunctional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint\" title=\"Joint\" rel=\"external_link\" target=\"_blank\">joint<\/a> surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pain or dysfunction is not alleviated by less-invasive therapies. It is a form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroplasty\" title=\"Arthroplasty\" rel=\"external_link\" target=\"_blank\">arthroplasty<\/a>, and is often indicated from various <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthropathy\" title=\"Arthropathy\" rel=\"external_link\" target=\"_blank\">joint diseases<\/a>, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\" title=\"Osteoarthritis\" rel=\"external_link\" target=\"_blank\">osteoarthritis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\" title=\"Rheumatoid arthritis\" rel=\"external_link\" target=\"_blank\">rheumatoid arthritis<\/a>.\n<\/p><p>Joint replacement surgery is becoming more common with knees and hips replaced most often. About 773,000 Americans had a hip or knee replaced in 2009.<sup id=\"rdp-ebb-cite_ref-NIAMS_1-0\" class=\"reference\"><a href=\"#cite_note-NIAMS-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Background\">Background<\/span><\/h2>\n<p>Stephen S. Hudack, a surgeon based in New York City, began <a href=\"https:\/\/en.wikipedia.org\/wiki\/Animal_testing\" title=\"Animal testing\" rel=\"external_link\" target=\"_blank\">animal testing<\/a> with artificial joints in 1939.<sup id=\"rdp-ebb-cite_ref-life48_2-0\" class=\"reference\"><a href=\"#cite_note-life48-2\" rel=\"external_link\">[2]<\/a><\/sup> By 1948,\nhe was at the (part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Columbia_Presbyterian_Medical_Center\" class=\"mw-redirect\" title=\"Columbia Presbyterian Medical Center\" rel=\"external_link\" target=\"_blank\">Columbia Presbyterian Medical Center<\/a>) and with funding from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Office_of_Naval_Research\" title=\"Office of Naval Research\" rel=\"external_link\" target=\"_blank\">Office of Naval Research<\/a>, was replacing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_joint\" class=\"mw-redirect\" title=\"Hip joint\" rel=\"external_link\" target=\"_blank\">hip joints<\/a> in humans.<sup id=\"rdp-ebb-cite_ref-life48_2-1\" class=\"reference\"><a href=\"#cite_note-life48-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Two previously<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Dates_and_numbers#Chronological_items\" title=\"Wikipedia:Manual of Style\/Dates and numbers\" rel=\"external_link\" target=\"_blank\"><span title=\"The time period mentioned near this tag is ambiguous. (March 2011)\">when?<\/span><\/a><\/i>]<\/sup> popular forms of arthroplasty were: (1) <i>interpositional arthroplasty'<\/i>, with interposition of some other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_tissue\" class=\"mw-redirect\" title=\"Biological tissue\" rel=\"external_link\" target=\"_blank\">tissue<\/a> like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin\" title=\"Skin\" rel=\"external_link\" target=\"_blank\">skin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Muscle\" title=\"Muscle\" rel=\"external_link\" target=\"_blank\">muscle<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tendon\" title=\"Tendon\" rel=\"external_link\" target=\"_blank\">tendon<\/a> to keep <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\" title=\"Inflammation\" rel=\"external_link\" target=\"_blank\">inflammatory<\/a> surfaces apart and (2) <i>excisional arthroplasty<\/i> in which the joint surface and bone were removed leaving <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scar\" title=\"Scar\" rel=\"external_link\" target=\"_blank\">scar<\/a> tissue to fill in the gap. Other forms of arthroplasty include <i>resection(al) arthroplasty<\/i>, <i>resurfacing arthroplasty<\/i>, <i>mold arthroplasty<\/i>, <i>cup arthroplasty<\/i>, and <i>silicone replacement arthroplasty<\/i>. Osteotomy to restore or modify joint congruity is also a form of arthroplasty.\n<\/p><p>In recent decades, the most successful and common form of arthroplasty is the surgical replacement of a joint or joint surface with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthesis<\/a>. For example, a hip joint that is affected by osteoarthritis may be replaced entirely (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">total hip arthroplasty<\/a>) with a prosthetic hip. This procedure involves replacing both the acetabulum (hip socket) and the head and neck of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femur\" title=\"Femur\" rel=\"external_link\" target=\"_blank\">femur<\/a>. The purpose of doing this surgery is to relieve pain, to restore range of motion and to improve walking ability, leading to the improvement of muscle strength.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Joints\">Joints<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Shoulder\">Shoulder<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shoulder_replacement\" title=\"Shoulder replacement\" rel=\"external_link\" target=\"_blank\">Shoulder replacement<\/a><\/div>\n<p>For <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shoulder_replacement\" title=\"Shoulder replacement\" rel=\"external_link\" target=\"_blank\">shoulder replacement<\/a>, there are a few major approaches to access the shoulder joint. The first is the deltopectoral approach, which saves the deltoid, but requires the supraspinatus to be cut.<sup id=\"rdp-ebb-cite_ref-Nerot_2014_S181\u2013S190_3-0\" class=\"reference\"><a href=\"#cite_note-Nerot_2014_S181\u2013S190-3\" rel=\"external_link\">[3]<\/a><\/sup> The second is the transdeltoid approach, which provides a straight on approach at the glenoid. However, during this approach the deltoid is put at risk for potential damage.<sup id=\"rdp-ebb-cite_ref-Nerot_2014_S181\u2013S190_3-1\" class=\"reference\"><a href=\"#cite_note-Nerot_2014_S181\u2013S190-3\" rel=\"external_link\">[3]<\/a><\/sup> Both techniques are used, depending on the surgeon's preferences.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hip\">Hip<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">Hip replacement<\/a><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">Hip replacement<\/a> can be performed as a total replacement or a hemi (half) replacement. A total hip replacement consists of replacing both the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetabulum\" title=\"Acetabulum\" rel=\"external_link\" target=\"_blank\">acetabulum<\/a> and the femoral head while <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemiarthroplasty\" class=\"mw-redirect\" title=\"Hemiarthroplasty\" rel=\"external_link\" target=\"_blank\">hemiarthroplasty<\/a> generally only replaces the femoral head. Hip replacement is currently the most common orthopaedic operation, though patient satisfaction short- and long-term varies widely.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Knee\">Knee<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Knee_Replacement.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/Knee_Replacement.png\/220px-Knee_Replacement.png\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Knee_Replacement.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Knee replacement.<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee_replacement\" title=\"Knee replacement\" rel=\"external_link\" target=\"_blank\">Knee replacement<\/a><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee_replacement\" title=\"Knee replacement\" rel=\"external_link\" target=\"_blank\">Knee replacement<\/a> involves exposure of the front of the knee, with detachment of part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quadriceps_muscle\" class=\"mw-redirect\" title=\"Quadriceps muscle\" rel=\"external_link\" target=\"_blank\">quadriceps muscle<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Vastus_medialis\" title=\"Vastus medialis\" rel=\"external_link\" target=\"_blank\">vastus medialis<\/a>) from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patella\" title=\"Patella\" rel=\"external_link\" target=\"_blank\">patella<\/a>. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patella\" title=\"Patella\" rel=\"external_link\" target=\"_blank\">patella<\/a> is displaced to one side of the joint, allowing exposure of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatomical_terms_of_location\" title=\"Anatomical terms of location\" rel=\"external_link\" target=\"_blank\">distal<\/a> end of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femur\" title=\"Femur\" rel=\"external_link\" target=\"_blank\">femur<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatomical_terms_of_location\" title=\"Anatomical terms of location\" rel=\"external_link\" target=\"_blank\">proximal<\/a> end of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tibia\" title=\"Tibia\" rel=\"external_link\" target=\"_blank\">tibia<\/a>. The ends of these bones are then accurately cut to shape using cutting guides oriented to the long axis of the bones. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cartilage\" title=\"Cartilage\" rel=\"external_link\" target=\"_blank\">cartilages<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anterior_cruciate_ligament\" title=\"Anterior cruciate ligament\" rel=\"external_link\" target=\"_blank\">anterior cruciate ligament<\/a> are removed; the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Posterior_cruciate_ligament\" title=\"Posterior cruciate ligament\" rel=\"external_link\" target=\"_blank\">posterior cruciate ligament<\/a> may also be removed<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> but the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medial_collateral_ligament\" title=\"Medial collateral ligament\" rel=\"external_link\" target=\"_blank\">tibial<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibular_collateral_ligament\" title=\"Fibular collateral ligament\" rel=\"external_link\" target=\"_blank\">fibular<\/a> collateral ligaments are preserved. Metal components are then impacted onto the bone or fixed using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymethylmethacrylate\" class=\"mw-redirect\" title=\"Polymethylmethacrylate\" rel=\"external_link\" target=\"_blank\">polymethylmethacrylate<\/a> (PMMA) cement. Alternative techniques exist that affix the implant without cement. These cement-less techniques may involve <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseointegration\" title=\"Osseointegration\" rel=\"external_link\" target=\"_blank\">osseointegration<\/a>, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal_foam\" title=\"Metal foam\" rel=\"external_link\" target=\"_blank\">porous metal<\/a> prostheses.\n<\/p><p>The operation typically involves substantial postoperative pain, and includes vigorous physical rehabilitation. The recovery period may be 6 weeks or longer and may involve the use of mobility aids (e.g. walking frames, canes, crutches) to enable the patient's return to preoperative mobility.<sup id=\"rdp-ebb-cite_ref-Leopold09_5-0\" class=\"reference\"><a href=\"#cite_note-Leopold09-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Ankle\">Ankle<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ankle_replacement\" title=\"Ankle replacement\" rel=\"external_link\" target=\"_blank\">Ankle replacement<\/a><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ankle_replacement\" title=\"Ankle replacement\" rel=\"external_link\" target=\"_blank\">Ankle replacement<\/a> is becoming the treatment of choice for patients requiring arthroplasty, replacing the conventional use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthrodesis\" title=\"Arthrodesis\" rel=\"external_link\" target=\"_blank\">arthrodesis<\/a>, i.e. fusion of the bones. The restoration of range of motion is the key feature in favor of ankle replacement with respect to arthrodesis. However, clinical evidence of the superiority of the former has only been demonstrated for particular isolated implant designs.<sup id=\"rdp-ebb-cite_ref-pmid19589303_6-0\" class=\"reference\"><a href=\"#cite_note-pmid19589303-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Finger\">Finger<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Finger_joint_replacement_prosthesis.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/53\/Finger_joint_replacement_prosthesis.png\/220px-Finger_joint_replacement_prosthesis.png\" width=\"220\" height=\"172\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Finger_joint_replacement_prosthesis.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Finger joint replacement.<\/div><\/div><\/div>\n<p>Finger joint replacement is a relatively quick procedure of about 30 minutes, but requires several months of subsequent therapy.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Procedural_timeline\">Procedural timeline<\/span><\/h2>\n<p>Before major surgery is performed, a complete pre-anaesthetic work-up is required. In elderly patients this usually would include ECG, urine tests, hematology and blood tests. Cross match of blood is routine also, as a high percentage of patients receive a blood transfusion.\nPre-operative planning requires accurate Xrays of the affected joint, implant design selecting and size-matching to the xray images (a process known as templating).\n<\/p><p>A few days' hospitalization is followed by several weeks of protected function, healing and rehabilitation. This may then be followed by several months of slow improvement in strength and endurance.\n<\/p><p>Early mobilisation of the patient is thought to be the key to reducing the chances of complications<sup id=\"rdp-ebb-cite_ref-NIAMS_1-1\" class=\"reference\"><a href=\"#cite_note-NIAMS-1\" rel=\"external_link\">[1]<\/a><\/sup> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thrombosis\" title=\"Thrombosis\" rel=\"external_link\" target=\"_blank\">venous thromboembolism<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pneumonia\" title=\"Pneumonia\" rel=\"external_link\" target=\"_blank\">Pneumonia<\/a>. Modern practice is to mobilize patients as soon as possible and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Walking\" title=\"Walking\" rel=\"external_link\" target=\"_blank\">ambulate<\/a> with walking aids when tolerated. Depending on the joint involved and the pre-op status of the patient, the time of hospitalization varies from 1 day to 2 weeks, with the average being 4\u20137 days in most regions.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Physiotherapy\" class=\"mw-redirect\" title=\"Physiotherapy\" rel=\"external_link\" target=\"_blank\">Physiotherapy<\/a> is used extensively to help patients recover function after joint replacement surgery. A graded exercise programme is needed initially, as the patients' muscles take time to heal after the surgery; exercises for range of motion of the joints and ambulation should not be strenuous. Later when the muscles have healed, the aim of exercise expands to include strengthening and recovery of function.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Materials\">Materials<\/span><\/h2>\n<p>Some ceramic materials commonly used in joint replacement are alumina (Al<sub>2<\/sub>O<sub>3<\/sub>), zirconia (ZrO<sub>2<\/sub>), silica (SiO<sub>2<\/sub>), hydroxyapatite (Ca<sub>10<\/sub>(PO<sub>4<\/sub>)<sub>6<\/sub>(OH)<sub>2<\/sub>), titanium nitride (TiN), silicon nitride (Si<sub>3<\/sub>N<sub>4<\/sub>). A combination of titanium and titanium carbide is a very hard ceramic material often used in components of arthroplasties due to the impressive degree of strength and toughness it presents, as well as its compatibility with medical imaging.\n<\/p><p>Titanium carbide has proved to be possible to use combined with sintered polycrystalline diamond surface (PCD), a superhard ceramic which promises to provide an improved, strong, long-wearing material for artificial joints. PCD is formed from polycrystalline diamond compact (PDC) through a process involving high pressures and temperatures. When compared with other ceramic materials such as cubic boron nitride, silicon nitride, and aluminum oxide, PCD shows many better characteristics, including a high level of hardness and a relatively low coefficient of friction. For the application of artificial joints it will likely be combined with certain metals and metal alloys like cobalt, chrome, titanium, vanadium, stainless steel, aluminum, nickel, hafnium, silicon, cobalt-chrome, tungsten, zirconium, etc.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> This means that people with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nickel_allergy\" title=\"Nickel allergy\" rel=\"external_link\" target=\"_blank\">nickel allergy<\/a> or sensitivities to other metals are at risk for complications due to the chemicals in the device.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee_replacement\" title=\"Knee replacement\" rel=\"external_link\" target=\"_blank\">knee replacements<\/a> there are two parts that are ceramic and they can be made of either the same ceramic or a different one. If they are made of the same ceramic, however, they have different weight ratios. These ceramic parts are configured so that should shards break off of the implant, the particles are benign and not sharp. They are also made so that if a shard were to break off of one of the two ceramic components, they would be noticeable through x-rays during a check-up or inspection of the implant. With implants such as hip implants, the ball of the implant could be made of ceramic, and between the ceramic layer and where it attaches to the rest of the implant, there is usually a membrane to help hold the ceramic. The membrane can help prevent cracks, but if cracks should occur at two points which create a separate piece, the membrane can hold the shard in place so that it doesn't leave the implant and cause further injury. Because these cracks and separations can occur, the material of the membrane is a bio-compatible polymer that has a high fracture toughness and a high shear toughness.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Risks_and_complications\">Risks and complications<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Medical_risks\">Medical risks<\/span><\/h3>\n<p>The Stress of the operation may result in medical problems of varying incidence and severity.\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Myocardial_infarction\" title=\"Myocardial infarction\" rel=\"external_link\" target=\"_blank\">Heart Attack<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebrovascular_Accident\" class=\"mw-redirect\" title=\"Cerebrovascular Accident\" rel=\"external_link\" target=\"_blank\">Stroke<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Thrombosis\" title=\"Thrombosis\" rel=\"external_link\" target=\"_blank\">Venous Thromboembolism<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pneumonia\" title=\"Pneumonia\" rel=\"external_link\" target=\"_blank\">Pneumonia<\/a><\/li>\n<li>Increased <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mental_confusion\" class=\"mw-redirect\" title=\"Mental confusion\" rel=\"external_link\" target=\"_blank\">confusion<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinary_tract_infection\" title=\"Urinary tract infection\" rel=\"external_link\" target=\"_blank\">Urinary Tract Infection<\/a> (UTI)<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Intra-operative_risks\">Intra-operative risks<\/span><\/h3>\n<ul><li>Mal-positioning of the components\n<ul><li>Shortening;<\/li>\n<li>Instability\/dislocation;<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_stiffness\" title=\"Joint stiffness\" rel=\"external_link\" target=\"_blank\">Loss of range of motion<\/a>;<\/li><\/ul><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_fracture\" title=\"Bone fracture\" rel=\"external_link\" target=\"_blank\">Fracture<\/a> of the adjacent bone;<\/li>\n<li>Nerve damage;<\/li>\n<li>Damage to blood vessels.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Immediate_risks\">Immediate risks<\/span><\/h3>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">Infection<\/a>, either Superficial or Deep<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_dislocation\" title=\"Joint dislocation\" rel=\"external_link\" target=\"_blank\">Dislocation<\/a><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Medium-term_risks\">Medium-term risks<\/span><\/h3>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_dislocation\" title=\"Joint dislocation\" rel=\"external_link\" target=\"_blank\">Dislocation<\/a><\/li>\n<li>Persistent pain;<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_stiffness\" title=\"Joint stiffness\" rel=\"external_link\" target=\"_blank\">Loss of range of motion<\/a>;<\/li>\n<li>Weakness;<\/li>\n<li>Indolent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a>.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Long-term_risks\">Long-term risks<\/span><\/h3>\n<ul><li>Loosening of the components: the bond between the bone and the components or the cement may break down or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fatigue_(material)\" title=\"Fatigue (material)\" rel=\"external_link\" target=\"_blank\">fatigue<\/a>. As a result, the component moves inside the bone, causing pain. Fragments of wear debris may cause an inflammatory reaction with bone absorption which can cause loosening. This phenomenon is known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteolysis\" title=\"Osteolysis\" rel=\"external_link\" target=\"_blank\">osteolysis<\/a>.<\/li>\n<li><b>Polyethylene synovitis<\/b> - Wear of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Weight_bearing\" class=\"mw-redirect\" title=\"Weight bearing\" rel=\"external_link\" target=\"_blank\">weight-bearing<\/a> surfaces: polyethylene is thought to wear in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Weight_bearing\" class=\"mw-redirect\" title=\"Weight bearing\" rel=\"external_link\" target=\"_blank\">weight-bearing<\/a> joints such as the hip at a rate of 0.3mm per year<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (May 2010)\">citation needed<\/span><\/a><\/i>]<\/sup>. This may be a problem in itself since the bearing surfaces are often less than 10 mm thick and may deform as they get thinner. The wear may also cause problems, as inflammation can be caused by increased quantities of polyethylene wear particles in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Synovial_fluid\" title=\"Synovial fluid\" rel=\"external_link\" target=\"_blank\">synovial fluid<\/a>.<\/li><\/ul>\n<p>There are many controversies. Much of the research effort of the orthopedic-community is directed to studying and improving joint replacement. The main controversies are\n<\/p>\n<ul><li>the best or most appropriate bearing surface - metal\/polyethylene, metal-metal, ceramic-ceramic;<\/li>\n<li>cemented vs uncemented fixation of the components;<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopic_surgery\" class=\"mw-redirect\" title=\"Laparoscopic surgery\" rel=\"external_link\" target=\"_blank\">Minimally invasive<\/a> surgery.<\/li><\/ul>\n<p><span id=\"rdp-ebb-spacer\"><\/span>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Prosthesis_replacement\">Prosthesis replacement<\/span><\/h2>\n<p>The prosthesis may need to be replaced due to complications such as infection or prosthetic fracture. Replacement may be done in one single surgical session. Alternatively, an initial surgery may be performed to remove previous prosthetic material, and the new prosthesis is then inserted in a separate surgery at a later time. In such cases, especially when complicated by infection, a <i>spacer<\/i> may be used, which is a sturdy mass to provide some basic joint stability and mobility until a more permanent prosthesis is inserted. It can contain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antibiotic\" title=\"Antibiotic\" rel=\"external_link\" target=\"_blank\">antibiotics<\/a> to help treating any infection.<sup id=\"rdp-ebb-cite_ref-MazzucchelliRosso2015_11-0\" class=\"reference\"><a href=\"#cite_note-MazzucchelliRosso2015-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumasurgery\" class=\"mw-redirect\" title=\"Rheumasurgery\" rel=\"external_link\" target=\"_blank\">Rheumasurgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroplasty\" title=\"Arthroplasty\" rel=\"external_link\" target=\"_blank\">Arthroplasty<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedic_surgery\" title=\"Orthopedic surgery\" rel=\"external_link\" target=\"_blank\">Orthopedic surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement_registry\" title=\"Joint replacement registry\" rel=\"external_link\" target=\"_blank\">Joint replacement registry<\/a><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Related_treatments\">Related treatments<\/span><\/h3>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Autologous_chondrocyte_implantation\" title=\"Autologous chondrocyte implantation\" rel=\"external_link\" target=\"_blank\">Autologous chondrocyte implantation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Microfracture_surgery\" title=\"Microfracture surgery\" rel=\"external_link\" target=\"_blank\">Microfracture surgery<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-NIAMS-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-NIAMS_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-NIAMS_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Joint Replacement Surgery and You. (April, 2009) In <i>Arthritis, Musculoskeletal and Skin Disease online<\/i>. Retrieved from <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.niams.nih.gov\/\" target=\"_blank\">http:\/\/www.niams.nih.gov\/#<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-life48-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-life48_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-life48_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=ZUEEAAAAMBAJ&pg=PA127&lpg=PA111\" target=\"_blank\">\"Joints of Steel and Plastic\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Life_(magazine)\" title=\"Life (magazine)\" rel=\"external_link\" target=\"_blank\">Life<\/a>. April 12, 1948: 127\u2013130. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0024-3019\" target=\"_blank\">0024-3019<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2011-03-19<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Joints+of+Steel+and+Plastic&rft.pages=127-130&rft.date=1948-04-12&rft.issn=0024-3019&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DZUEEAAAAMBAJ%26pg%3DPA127%26lpg%3DPA111&rfr_id=info%3Asid%2Fen.wikipedia.org%3AJoint+replacement\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Nerot_2014_S181\u2013S190-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Nerot_2014_S181\u2013S190_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Nerot_2014_S181\u2013S190_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Nerot, C.; Ohl, X. (2014). \"Primary shoulder reverse arthroplasty: Surgical technique\". <i>Orthopaedics & Traumatology: Surgery & Research<\/i>. <b>100<\/b> (1): S181\u2013S190. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.otsr.2013.06.011\" target=\"_blank\">10.1016\/j.otsr.2013.06.011<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Orthopaedics+%26+Traumatology%3A+Surgery+%26+Research&rft.atitle=Primary+shoulder+reverse+arthroplasty%3A+Surgical+technique&rft.volume=100&rft.issue=1&rft.pages=S181-S190&rft.date=2014&rft_id=info%3Adoi%2F10.1016%2Fj.otsr.2013.06.011&rft.aulast=Nerot&rft.aufirst=C.&rft.au=Ohl%2C+X.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AJoint+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jacobs, WC; Clement, DJ; Wymenga, AB (Oct 19, 2005). \"Retention versus sacrifice of the posterior cruciate ligament in total knee replacement for treatment of osteoarthritis and rheumatoid arthritis\". <i>The Cochrane Database of Systematic Reviews<\/i> (4): CD004803. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD004803.pub2\" target=\"_blank\">10.1002\/14651858.CD004803.pub2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16235383\" target=\"_blank\">16235383<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Retention+versus+sacrifice+of+the+posterior+cruciate+ligament+in+total+knee+replacement+for+treatment+of+osteoarthritis+and+rheumatoid+arthritis.&rft.issue=4&rft.pages=CD004803&rft.date=2005-10-19&rft_id=info%3Adoi%2F10.1002%2F14651858.CD004803.pub2&rft_id=info%3Apmid%2F16235383&rft.aulast=Jacobs&rft.aufirst=WC&rft.au=Clement%2C+DJ&rft.au=Wymenga%2C+AB&rfr_id=info%3Asid%2Fen.wikipedia.org%3AJoint+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Leopold09-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Leopold09_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Leopold SS (April 2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/360\/17\/1749\" target=\"_blank\">\"Minimally invasive total knee arthroplasty for osteoarthritis\"<\/a>. <i>N. Engl. J. Med<\/i>. <b>360<\/b> (17): 1749\u201358. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2FNEJMct0806027\" target=\"_blank\">10.1056\/NEJMct0806027<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19387017\" target=\"_blank\">19387017<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=N.+Engl.+J.+Med.&rft.atitle=Minimally+invasive+total+knee+arthroplasty+for+osteoarthritis&rft.volume=360&rft.issue=17&rft.pages=1749-58&rft.date=2009-04&rft_id=info%3Adoi%2F10.1056%2FNEJMct0806027&rft_id=info%3Apmid%2F19387017&rft.au=Leopold+SS&rft_id=http%3A%2F%2Fcontent.nejm.org%2Fcgi%2Fcontent%2Ffull%2F360%2F17%2F1749&rfr_id=info%3Asid%2Fen.wikipedia.org%3AJoint+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid19589303-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid19589303_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Saltzman, C.L.; Mann, R.A.; Ahrens, J.E.; Amendola, A.; Anderson, R.B.; Berlet, G.C.; Brodky, J.W.; Chou, L.B.; Clanton, T.O.; Deland, J.T.; Deorio, J.K.; Horton, G.A.; Lee, T.H.; Mann, J.A.; Nunley, J.A.; Thordarson, D.B.; Walling, A.K.; Wapner, K.L.; Coughlin, M.J. (2009). \"Prospective Controlled Trial of STAR Total Ankle Replacement Versus Ankle Fusion: Initial Results\". <i><\/i>. <b>30<\/b> (7): 579\u2013596. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3113%2FFAI.2009.0579\" target=\"_blank\">10.3113\/FAI.2009.0579<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19589303\" target=\"_blank\">19589303<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Foot+%26+Ankle+International&rft.atitle=Prospective+Controlled+Trial+of+STAR+Total+Ankle+Replacement+Versus+Ankle+Fusion%3A+Initial+Results&rft.volume=30&rft.issue=7&rft.pages=579-596&rft.date=2009&rft_id=info%3Adoi%2F10.3113%2FFAI.2009.0579&rft_id=info%3Apmid%2F19589303&rft.aulast=Saltzman&rft.aufirst=C.L.&rft.au=Mann%2C+R.A.&rft.au=Ahrens%2C+J.E.&rft.au=Amendola%2C+A.&rft.au=Anderson%2C+R.B.&rft.au=Berlet%2C+G.C.&rft.au=Brodky%2C+J.W.&rft.au=Chou%2C+L.B.&rft.au=Clanton%2C+T.O.&rft.au=Deland%2C+J.T.&rft.au=Deorio%2C+J.K.&rft.au=Horton%2C+G.A.&rft.au=Lee%2C+T.H.&rft.au=Mann%2C+J.A.&rft.au=Nunley%2C+J.A.&rft.au=Thordarson%2C+D.B.&rft.au=Walling%2C+A.K.&rft.au=Wapner%2C+K.L.&rft.au=Coughlin%2C+M.J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AJoint+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.se\/books?id=NZ6WAAAAQBAJ&pg=PA50\" target=\"_blank\">Page 50<\/a> in: <cite class=\"citation book\">Leslie Galliker (2014). <i>Joint Replacements<\/i>. ABDO. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781617839030.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Joint+Replacements&rft.pub=ABDO&rft.date=2014&rft.isbn=9781617839030&rft.au=Leslie+Galliker&rfr_id=info%3Asid%2Fen.wikipedia.org%3AJoint+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Pope, Bill et al. (2011) International Patent No. 127321A. Orem, UT: US <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/worldwide.espacenet.com\/publicationDetails\/originalDocument?CC=WO&NR=2011127321A2&KC=A2&FT=D&ND=3&date=20111013&DB=EPODOC&locale=en_EP\" target=\"_blank\">http:\/\/worldwide.espacenet.com<\/a><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Thomas, Peter (2014-01-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4479460\" target=\"_blank\">\"Clinical and diagnostic challenges of metal implant allergy using the example of orthopaedic surgical implants: Part 15 of the Series Molecular Allergology\"<\/a>. <i>Allergo Journal International<\/i>. <b>23<\/b> (6): 179\u2013185. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs40629-014-0023-3\" target=\"_blank\">10.1007\/s40629-014-0023-3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2197-0378\" target=\"_blank\">2197-0378<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4479460\" target=\"_blank\">4479460<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26120529\" target=\"_blank\">26120529<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Allergo+Journal+International&rft.atitle=Clinical+and+diagnostic+challenges+of+metal+implant+allergy+using+the+example+of+orthopaedic+surgical+implants%3A+Part+15+of+the+Series+Molecular+Allergology&rft.volume=23&rft.issue=6&rft.pages=179-185&rft.date=2014-01-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4479460&rft.issn=2197-0378&rft_id=info%3Apmid%2F26120529&rft_id=info%3Adoi%2F10.1007%2Fs40629-014-0023-3&rft.aulast=Thomas&rft.aufirst=Peter&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4479460&rfr_id=info%3Asid%2Fen.wikipedia.org%3AJoint+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Monaghan, Matthew, David Miller. (2013). US Patent No. 0282134A1. Warsaw, IN: US <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/worldwide.espacenet.com\/publicationDetails\/originalDocument?CC=US&NR=2013282134A1&KC=A1&FT=D&ND=3&date=20131024&DB=EPODOC&locale=en_EP\" target=\"_blank\">http:\/\/worldwide.espacenet.com\/<\/a><\/span>\n<\/li>\n<li id=\"cite_note-MazzucchelliRosso2015-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MazzucchelliRosso2015_11-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mazzucchelli, Luca; Rosso, Federica; Marmotti, Antongiulio; Bonasia, Davide Edoardo; Bruzzone, Matteo; Rossi, Roberto (2015). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4630232\" target=\"_blank\">\"The use of spacers (static and mobile) in infection knee arthroplasty\"<\/a>. <i>Current Reviews in Musculoskeletal Medicine<\/i>. <b>8<\/b> (4): 373\u2013382. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs12178-015-9293-8\" target=\"_blank\">10.1007\/s12178-015-9293-8<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1935-973X\" target=\"_blank\">1935-973X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4630232\" target=\"_blank\">4630232<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Current+Reviews+in+Musculoskeletal+Medicine&rft.atitle=The+use+of+spacers+%28static+and+mobile%29+in+infection+knee+arthroplasty&rft.volume=8&rft.issue=4&rft.pages=373-382&rft.date=2015&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4630232&rft.issn=1935-973X&rft_id=info%3Adoi%2F10.1007%2Fs12178-015-9293-8&rft.aulast=Mazzucchelli&rft.aufirst=Luca&rft.au=Rosso%2C+Federica&rft.au=Marmotti%2C+Antongiulio&rft.au=Bonasia%2C+Davide+Edoardo&rft.au=Bruzzone%2C+Matteo&rft.au=Rossi%2C+Roberto&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4630232&rfr_id=info%3Asid%2Fen.wikipedia.org%3AJoint+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/orthoinfo.aaos.org\/\" target=\"_blank\">Patient Information from the American Academy of Orthopedic Surgeons<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/fdac\/features\/2004\/204_joints.html\" target=\"_blank\">Patient Information from the FDA<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20091212203938\/http:\/\/proceedings.jbjs.org.uk\/cgi\/content\/abstract\/86-B\/SUPP_III\/353-b\" target=\"_blank\">P. Benum; A. Aamodt; and K. Haugan <i>Uncementeed Custom Femoral Components In Hip Arthroplasty<\/i><\/a><\/li>\n<li><cite class=\"citation journal\">Finkelstein, JA; Anderson, GI; Richards, RR; Waddell, JP (1991). \"Polyethylene synovitis following canine total hip arthroplasty. Histomorphometric analysis\". <i>The Journal of arthroplasty<\/i>. 6 Suppl: S91\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fs0883-5403%2808%2980062-9\" target=\"_blank\">10.1016\/s0883-5403(08)80062-9<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1774577\" target=\"_blank\">1774577<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+arthroplasty&rft.atitle=Polyethylene+synovitis+following+canine+total+hip+arthroplasty.+Histomorphometric+analysis&rft.volume=6+Suppl&rft.pages=S91-6&rft.date=1991&rft_id=info%3Adoi%2F10.1016%2Fs0883-5403%2808%2980062-9&rft_id=info%3Apmid%2F1774577&rft.aulast=Finkelstein&rft.aufirst=JA&rft.au=Anderson%2C+GI&rft.au=Richards%2C+RR&rft.au=Waddell%2C+JP&rfr_id=info%3Asid%2Fen.wikipedia.org%3AJoint+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1272\nCached time: 20181211192904\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.380 seconds\nReal time usage: 0.532 seconds\nPreprocessor visited node count: 1446\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 61062\/2097152 bytes\nTemplate argument size: 1512\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 6\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 28513\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.202\/10.000 seconds\nLua memory usage: 5.83 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 446.137 1 -total\n<\/p>\n<pre>36.13% 161.170 1 Template:Reflist\n30.22% 134.817 8 Template:Cite_journal\n14.26% 63.614 1 Template:Infobox_medical_intervention\n13.71% 61.144 2 Template:Fix\n13.31% 59.403 1 Template:Infobox\n12.82% 57.217 1 Template:Commonscat\n11.53% 51.429 1 Template:When\n 9.65% 43.065 4 Template:Category_handler\n 5.85% 26.120 1 Template:Authority_control\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2867638-1!canonical and timestamp 20181211192903 and revision id 863700896\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212242\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.051 seconds\nReal time usage: 0.203 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 195.743 1 - wikipedia:Joint_replacement\n100.00% 195.743 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8197-0!*!*!*!*!*!* and timestamp 20181217212242 and revision id 24343\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Joint_replacement\">https:\/\/www.limswiki.org\/index.php\/Joint_replacement<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","03702616ce6f6edc52550ce2503f857d_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2f\/Hip_replacement_Image_3684-PH.jpg\/560px-Hip_replacement_Image_3684-PH.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/Knee_Replacement.png\/440px-Knee_Replacement.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/5\/53\/Finger_joint_replacement_prosthesis.png"],"03702616ce6f6edc52550ce2503f857d_timestamp":1545081762,"47c965e79a708dea53faa0f26d9634a4_type":"article","47c965e79a708dea53faa0f26d9634a4_title":"In vivo bioreactor","47c965e79a708dea53faa0f26d9634a4_url":"https:\/\/www.limswiki.org\/index.php\/In_vivo_bioreactor","47c965e79a708dea53faa0f26d9634a4_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tIn vivo bioreactor\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and when to remove these template messages)\n\n This article includes a list of references, but its sources remain unclear because it has insufficient inline citations. Please help to improve this article by introducing more precise citations. (March 2014) (Learn how and when to remove this template message)This article may be too technical for most readers to understand. Please help improve it to make it understandable to non-experts, without removing the technical details. (March 2014) (Learn how and when to remove this template message)\nThis article is an orphan, as no other articles link to it. Please introduce links to this page from related articles ; try the Find link tool for suggestions. (March 2014)\n \n (Learn how and when to remove this template message)\nThe in vivo bioreactor (IVB) is a regenerative medicine paradigm where bone is grown in vivo. The IVB has basic elements:\n\nCreation of a confined environment in vivo that is adjacent to a tissue locality rich in pluripotent cells,\nInjection of a Hydrogel Biomaterial with the appropriate physicochemical and biophysical characteristics in this confined environment so as to predictably alter the signaling environment or trigger a process within this confined environment leading to recapitulation of developmental processes and de novo formation of a functional tissue mass, and\nThe harvest of the tissue from the confined site and transplantation of this tissue into another site within the patient, leading to a complete autologous tissue engineering strategy.\nAn example of the implementation of the IVB approach was in the engineering of autologous bone by injecting calcium alginate in a sub-periosteal location.[1][2] The periosteum is a membrane that covers the long bones, jawbone, ribs and the skull. This membrane contains an endogenous population of pluripotent cells called the periosteal cells, which are a type of mesenchymal stem cells (MSC), which reside in the cambium layer, i.e., the side facing the bone. A key step in the procedure is the elevation of the periosteum without damaging the cambium surface and to ensure this a new technique called hydraulic elevation was developed.[3]\nThe choice of the sub-periosteum site is used because stimulation of the cambium layer using transforming growth factor\u2013beta resulted in enhanced chondrogenesis, i.e., formation of cartilage. In development the formation of bone can either occur via a Cartilage template initially formed by the MSCs that then gets ossified through a process called endochondral ossification or directly from MSC differentiation to bone via a process termed intra-membranous ossification. Upon exposure of the periosteal cells to calcium from the alginate gel, these cells become bone cells and start producing bone matrix through the intra-membranous ossification process, recapitulating all steps of bone matrix deposition. The extension of the IVB paradigm to engineering autologous hyaline cartilage was also recently demonstrated.[4] In this case, agarose is injected and this triggers local hypoxia, which then results in the differentiation of the periosteal MSCs into articular chondrocytes, i.e. cells similar to those found in the joint cartilage. Since this processes occurs in a relative short period of less than two weeks and cartilage can remodel into bone, this approach might provide some advantages in treatment of both cartilage and bone loss. The IVB concept needs to be however realized in humans and this is currently being undertaken.\n\nSee also \nru:\u0412\u044b\u0440\u0430\u0449\u0438\u0432\u0430\u043d\u0438\u0435 \u043e\u0440\u0433\u0430\u043d\u043e\u0432\n\nFurther reading \nChantarawaratit P., Sangvanich P., Banlunara W., Soontornvipart K., Thunyakitpisal P. (2014). \"Acemannan sponges stimulate alveolar bone, cementum and periodontal ligament regeneration in a canine class II furcation defect model\". J. Periodont Res. 49 (2): 164\u2013178. doi:10.1111\/jre.12090. CS1 maint: Uses authors parameter (link) \nBai M., Zhang T., Ling T., Zhou Z., Xie H., Zhang W., Wu H. (2013). \"Guided bone regeneration using acellular bovine pericardium in a rabbit mandibular model: in\u2010vitro and in\u2010vivo studies\". J. Periodont Res. 49: 499\u2013507. doi:10.1111\/jre.12129. CS1 maint: Uses authors parameter (link) \nAberle T, Franke K, Rist E, Benz K, Schlosshauer B (2014). \"Cell-Type Specific Four-Component Hydrogel\". PLoS ONE. 9 (1): e86740. doi:10.1371\/journal.pone.0086740. PMC 3903574 . PMID 24475174. CS1 maint: Uses authors parameter (link) \nKhanlari A., Suekama T. C., Detamore M. S., Gehrke S. H. (2014). \"Mimicking the Extracellular Matrix: Tuning the Mechanical Properties of Chondroitin Sulfate Hydrogels by Copolymerization with Oligo (ethylene glycol) Diacrylates\". MRS Proceedings. 1622: 13. doi:10.1557\/opl.2013.1207. CS1 maint: Uses authors parameter (link) \nReferences \n\n\n^ Stevens, Molly M.; Marini, Robert P.; Schaefer, Dirk; Aronson, Joshua; Langer, Robert; Shastri, V. Prasad (June 8, 2005). \"In vivo engineering of organs: The bone bioreactor\". Proceedings of the National Academy of Sciences, USA. 102 (32): 11450\u201311455. doi:10.1073\/pnas.0504705102. PMC 1183576 . Retrieved 19 February 2014 . \n\n^ Service, Robert F. (29 July 2005). \"Technique Uses Body as 'Bioreactor' to Grow New Bone\". Science. 309 (5735): 683. doi:10.1126\/science.309.5735.683a. PMID 16051759. Retrieved 19 February 2014 . \n\n^ Marini, Robert P.; Stevens, Molly M.; Langer, Robert; Shastri, V. Prasad (2004). \"Hydraulic Elevation of the Periosteum: A Novel Technique for Periosteal Harvest\". Journal of Investigative Surgery. 17 (4): 229\u2013233. doi:10.1080\/08941930490472073. Retrieved 19 February 2014 . \n\n^ Emans, Pieter J.; Lodewijk W. van Rhijn; Welting, Tim J. M.; Cremers, Andy; Wijnands, Nina; Spaapen, Frank; J. Voncken, Willem; Shastri, V. Prasad (January 7, 2010). \"Autologous engineering of cartilage\". Proceedings of the National Academy of Sciences, USA. 107 (8): 3418\u20133423. doi:10.1073\/pnas.0907774107. PMC 2840469 . Retrieved 19 February 2014 . \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/In_vivo_bioreactor\">https:\/\/www.limswiki.org\/index.php\/In_vivo_bioreactor<\/a>\n\t\t\t\t\tCategories: BiomaterialsMedical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:01.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 348 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","47c965e79a708dea53faa0f26d9634a4_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-In_vivo_bioreactor skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">In vivo bioreactor<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>The <b>in vivo bioreactor (IVB)<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Regenerative_medicine\" title=\"Regenerative medicine\" rel=\"external_link\" target=\"_blank\">regenerative medicine<\/a> paradigm where bone is grown in vivo. The IVB has basic elements:\n<\/p>\n<ol><li>Creation of a confined environment in vivo that is adjacent to a tissue locality rich in pluripotent cells,<\/li>\n<li>Injection of a Hydrogel Biomaterial with the appropriate physicochemical and biophysical characteristics in this confined environment so as to predictably alter the signaling environment or trigger a process within this confined environment leading to recapitulation of developmental processes and de novo formation of a functional tissue mass, and<\/li>\n<li>The harvest of the tissue from the confined site and transplantation of this tissue into another site within the patient, leading to a complete autologous tissue engineering strategy.<\/li><\/ol>\n<p>An example of the implementation of the IVB approach was in the engineering of autologous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> by injecting calcium <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alginate\" class=\"mw-redirect\" title=\"Alginate\" rel=\"external_link\" target=\"_blank\">alginate<\/a> in a sub-periosteal location.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Periosteum\" title=\"Periosteum\" rel=\"external_link\" target=\"_blank\">periosteum<\/a> is a membrane that covers the long bones, jawbone, ribs and the skull. This membrane contains an endogenous population of pluripotent cells called the periosteal cells, which are a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mesenchymal_stem_cells\" class=\"mw-redirect\" title=\"Mesenchymal stem cells\" rel=\"external_link\" target=\"_blank\">mesenchymal stem cells<\/a> (MSC), which reside in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cambium\" title=\"Cambium\" rel=\"external_link\" target=\"_blank\">cambium<\/a> layer, i.e., the side facing the bone. A key step in the procedure is the elevation of the periosteum without damaging the cambium surface and to ensure this a new technique called hydraulic elevation was developed.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>The choice of the sub-periosteum site is used because stimulation of the cambium layer using transforming growth factor\u2013beta resulted in enhanced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chondrogenesis\" title=\"Chondrogenesis\" rel=\"external_link\" target=\"_blank\">chondrogenesis<\/a>, i.e., formation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cartilage\" title=\"Cartilage\" rel=\"external_link\" target=\"_blank\">cartilage<\/a>. In development the formation of bone can either occur via a Cartilage template initially formed by the MSCs that then gets ossified through a process called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endochondral_ossification\" title=\"Endochondral ossification\" rel=\"external_link\" target=\"_blank\">endochondral ossification<\/a> or directly from MSC <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cellular_differentiation\" title=\"Cellular differentiation\" rel=\"external_link\" target=\"_blank\">differentiation<\/a> to bone via a process termed <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Intramembranous_ossification\" title=\"Intramembranous ossification\" rel=\"external_link\" target=\"_blank\">intra-membranous ossification<\/a><\/i>. Upon exposure of the periosteal cells to calcium from the alginate gel, these cells become bone cells and start producing bone matrix through the intra-membranous ossification process, recapitulating all steps of bone matrix deposition. The extension of the IVB paradigm to engineering autologous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyaline\" title=\"Hyaline\" rel=\"external_link\" target=\"_blank\">hyaline<\/a> cartilage was also recently demonstrated.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> In this case, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Agarose\" title=\"Agarose\" rel=\"external_link\" target=\"_blank\">agarose<\/a> is injected and this triggers local <a href=\"https:\/\/en.wikipedia.org\/wiki\/Agarose\" title=\"Agarose\" rel=\"external_link\" target=\"_blank\">hypoxia<\/a>, which then results in the differentiation of the periosteal MSCs into articular chondrocytes, i.e. cells similar to those found in the joint cartilage. Since this processes occurs in a relative short period of less than two weeks and cartilage can remodel into bone, this approach might provide some advantages in treatment of both cartilage and bone loss. The IVB concept needs to be however realized in humans and this is currently being undertaken.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<p><a href=\"https:\/\/ru.wikipedia.org\/wiki\/%D0%92%D1%8B%D1%80%D0%B0%D1%89%D0%B8%D0%B2%D0%B0%D0%BD%D0%B8%D0%B5_%D0%BE%D1%80%D0%B3%D0%B0%D0%BD%D0%BE%D0%B2\" class=\"extiw\" title=\"ru:\u0412\u044b\u0440\u0430\u0449\u0438\u0432\u0430\u043d\u0438\u0435 \u043e\u0440\u0433\u0430\u043d\u043e\u0432\" rel=\"external_link\" target=\"_blank\">ru:\u0412\u044b\u0440\u0430\u0449\u0438\u0432\u0430\u043d\u0438\u0435 \u043e\u0440\u0433\u0430\u043d\u043e\u0432<\/a>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation journal\">Chantarawaratit P., Sangvanich P., Banlunara W., Soontornvipart K., Thunyakitpisal P. (2014). \"Acemannan sponges stimulate alveolar bone, cementum and periodontal ligament regeneration in a canine class II furcation defect model\". <i>J. Periodont Res<\/i>. <b>49<\/b> (2): 164\u2013178. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fjre.12090\" target=\"_blank\">10.1111\/jre.12090<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J.+Periodont+Res.&rft.atitle=Acemannan+sponges+stimulate+alveolar+bone%2C+cementum+and+periodontal+ligament+regeneration+in+a+canine+class+II+furcation+defect+model&rft.volume=49&rft.issue=2&rft.pages=164-178&rft.date=2014&rft_id=info%3Adoi%2F10.1111%2Fjre.12090&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIn+vivo+bioreactor\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Uses authors parameter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Uses_authors_parameter\" title=\"Category:CS1 maint: Uses authors parameter\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><\/li>\n<li><cite class=\"citation journal\">Bai M., Zhang T., Ling T., Zhou Z., Xie H., Zhang W., Wu H. (2013). \"Guided bone regeneration using acellular bovine pericardium in a rabbit mandibular model: in\u2010vitro and in\u2010vivo studies\". <i>J. Periodont Res<\/i>. <b>49<\/b>: 499\u2013507. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fjre.12129\" target=\"_blank\">10.1111\/jre.12129<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J.+Periodont+Res.&rft.atitle=Guided+bone+regeneration+using+acellular+bovine+pericardium+in+a+rabbit+mandibular+model%3A+in%E2%80%90vitro+and+in%E2%80%90vivo+studies&rft.volume=49&rft.pages=499-507&rft.date=2013&rft_id=info%3Adoi%2F10.1111%2Fjre.12129&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIn+vivo+bioreactor\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Uses authors parameter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Uses_authors_parameter\" title=\"Category:CS1 maint: Uses authors parameter\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Aberle T, Franke K, Rist E, Benz K, Schlosshauer B (2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3903574\" target=\"_blank\">\"Cell-Type Specific Four-Component Hydrogel\"<\/a>. <i>PLoS ONE<\/i>. <b>9<\/b> (1): e86740. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1371%2Fjournal.pone.0086740\" target=\"_blank\">10.1371\/journal.pone.0086740<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3903574\" target=\"_blank\">3903574<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24475174\" target=\"_blank\">24475174<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=PLoS+ONE&rft.atitle=Cell-Type+Specific+Four-Component+Hydrogel&rft.volume=9&rft.issue=1&rft.pages=e86740&rft.date=2014&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3903574&rft_id=info%3Apmid%2F24475174&rft_id=info%3Adoi%2F10.1371%2Fjournal.pone.0086740&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3903574&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIn+vivo+bioreactor\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Uses authors parameter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Uses_authors_parameter\" title=\"Category:CS1 maint: Uses authors parameter\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Khanlari A., Suekama T. C., Detamore M. S., Gehrke S. H. (2014). \"Mimicking the Extracellular Matrix: Tuning the Mechanical Properties of Chondroitin Sulfate Hydrogels by Copolymerization with Oligo (ethylene glycol) Diacrylates\". <i>MRS Proceedings<\/i>. <b>1622<\/b>: 13. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1557%2Fopl.2013.1207\" target=\"_blank\">10.1557\/opl.2013.1207<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=MRS+Proceedings&rft.atitle=Mimicking+the+Extracellular+Matrix%3A+Tuning+the+Mechanical+Properties+of+Chondroitin+Sulfate+Hydrogels+by+Copolymerization+with+Oligo+%28ethylene+glycol%29+Diacrylates&rft.volume=1622&rft.pages=13&rft.date=2014&rft_id=info%3Adoi%2F10.1557%2Fopl.2013.1207&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIn+vivo+bioreactor\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Uses authors parameter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Uses_authors_parameter\" title=\"Category:CS1 maint: Uses authors parameter\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stevens, Molly M.; Marini, Robert P.; Schaefer, Dirk; Aronson, Joshua; Langer, Robert; Shastri, V. Prasad (June 8, 2005). <a rel=\"external_link\" class=\"external text\" href=\"#xref-ref-1-1\">\"In vivo engineering of organs: The bone bioreactor\"<\/a>. <i>Proceedings of the National Academy of Sciences, USA<\/i>. <b>102<\/b> (32): 11450\u201311455. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1073%2Fpnas.0504705102\" target=\"_blank\">10.1073\/pnas.0504705102<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1183576\" target=\"_blank\">1183576<\/a><\/span><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 February<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+the+National+Academy+of+Sciences%2C+USA&rft.atitle=In+vivo+engineering+of+organs%3A+The+bone+bioreactor&rft.volume=102&rft.issue=32&rft.pages=11450-11455&rft.date=2005-06-08&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1183576&rft_id=info%3Adoi%2F10.1073%2Fpnas.0504705102&rft.aulast=Stevens&rft.aufirst=Molly+M.&rft.au=Marini%2C+Robert+P.&rft.au=Schaefer%2C+Dirk&rft.au=Aronson%2C+Joshua&rft.au=Langer%2C+Robert&rft.au=Shastri%2C+V.+Prasad&rft_id=http%3A%2F%2Fwww.pnas.org%2Fcontent%2F102%2F32%2F11450.full%23xref-ref-1-1&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIn+vivo+bioreactor\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Service, Robert F. (29 July 2005). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencemag.org\/content\/309\/5735\/683.1.full\" target=\"_blank\">\"Technique Uses Body as 'Bioreactor' to Grow New Bone\"<\/a>. <i>Science<\/i>. <b>309<\/b> (5735): 683. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1126%2Fscience.309.5735.683a\" target=\"_blank\">10.1126\/science.309.5735.683a<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16051759\" target=\"_blank\">16051759<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 February<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Science&rft.atitle=Technique+Uses+Body+as+%27Bioreactor%27+to+Grow+New+Bone&rft.volume=309&rft.issue=5735&rft.pages=683&rft.date=2005-07-29&rft_id=info%3Adoi%2F10.1126%2Fscience.309.5735.683a&rft_id=info%3Apmid%2F16051759&rft.aulast=Service&rft.aufirst=Robert+F.&rft_id=http%3A%2F%2Fwww.sciencemag.org%2Fcontent%2F309%2F5735%2F683.1.full&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIn+vivo+bioreactor\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Marini, Robert P.; Stevens, Molly M.; Langer, Robert; Shastri, V. Prasad (2004). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/informahealthcare.com\/doi\/abs\/10.1080\/08941930490472073\" target=\"_blank\">\"Hydraulic Elevation of the Periosteum: A Novel Technique for Periosteal Harvest\"<\/a>. <i>Journal of Investigative Surgery<\/i>. <b>17<\/b> (4): 229\u2013233. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1080%2F08941930490472073\" target=\"_blank\">10.1080\/08941930490472073<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 February<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Investigative+Surgery&rft.atitle=Hydraulic+Elevation+of+the+Periosteum%3A+A+Novel+Technique+for+Periosteal+Harvest&rft.volume=17&rft.issue=4&rft.pages=229-233&rft.date=2004&rft_id=info%3Adoi%2F10.1080%2F08941930490472073&rft.aulast=Marini&rft.aufirst=Robert+P.&rft.au=Stevens%2C+Molly+M.&rft.au=Langer%2C+Robert&rft.au=Shastri%2C+V.+Prasad&rft_id=http%3A%2F%2Finformahealthcare.com%2Fdoi%2Fabs%2F10.1080%2F08941930490472073&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIn+vivo+bioreactor\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Emans, Pieter J.; Lodewijk W. van Rhijn; Welting, Tim J. M.; Cremers, Andy; Wijnands, Nina; Spaapen, Frank; J. Voncken, Willem; Shastri, V. Prasad (January 7, 2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.pnas.org\/content\/107\/8\/3418.abstract\" target=\"_blank\">\"Autologous engineering of cartilage\"<\/a>. <i>Proceedings of the National Academy of Sciences, USA<\/i>. <b>107<\/b> (8): 3418\u20133423. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1073%2Fpnas.0907774107\" target=\"_blank\">10.1073\/pnas.0907774107<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2840469\" target=\"_blank\">2840469<\/a><\/span><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 February<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+the+National+Academy+of+Sciences%2C+USA&rft.atitle=Autologous+engineering+of+cartilage&rft.volume=107&rft.issue=8&rft.pages=3418-3423&rft.date=2010-01-07&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2840469&rft_id=info%3Adoi%2F10.1073%2Fpnas.0907774107&rft.aulast=Emans&rft.aufirst=Pieter+J.&rft.au=Lodewijk+W.+van+Rhijn&rft.au=Welting%2C+Tim+J.+M.&rft.au=Cremers%2C+Andy&rft.au=Wijnands%2C+Nina&rft.au=Spaapen%2C+Frank&rft.au=J.+Voncken%2C+Willem&rft.au=Shastri%2C+V.+Prasad&rft_id=http%3A%2F%2Fwww.pnas.org%2Fcontent%2F107%2F8%2F3418.abstract&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIn+vivo+bioreactor\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1270\nCached time: 20181217101423\nCache expiry: 86400\nDynamic content: true\nCPU time usage: 0.232 seconds\nReal time usage: 0.310 seconds\nPreprocessor visited node count: 834\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 52291\/2097152 bytes\nTemplate argument size: 9953\/2097152 bytes\nHighest expansion depth: 16\/40\nExpensive parser function count: 6\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 19387\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.150\/10.000 seconds\nLua memory usage: 4.12 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 279.790 1 -total\n<\/p>\n<pre>57.66% 161.339 4 Template:Ambox\n52.58% 147.106 8 Template:Cite_journal\n42.08% 117.723 1 Template:Multiple_issues\n16.64% 46.544 1 Template:More_footnotes\n15.52% 43.430 1 Template:Reflist\n 7.06% 19.743 1 Template:Orphan\n 5.60% 15.682 1 Template:Draft_other\n 2.88% 8.064 1 Template:Technical\n 1.83% 5.123 2 Template:Yesno-no\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:41989305-1!canonical and timestamp 20181217101423 and revision id 842556382\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/In_vivo_bioreactor\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212242\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.148 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 142.569 1 - wikipedia:In_vivo_bioreactor\n100.00% 142.569 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8029-0!*!*!*!*!*!* and timestamp 20181217212242 and revision id 24140\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/In_vivo_bioreactor\">https:\/\/www.limswiki.org\/index.php\/In_vivo_bioreactor<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","47c965e79a708dea53faa0f26d9634a4_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/6c\/Wiki_letter_w.svg\/80px-Wiki_letter_w.svg.png"],"47c965e79a708dea53faa0f26d9634a4_timestamp":1545081762,"18026209e7901858227ab2cae8f033cf_type":"article","18026209e7901858227ab2cae8f033cf_title":"Hip replacement","18026209e7901858227ab2cae8f033cf_url":"https:\/\/www.limswiki.org\/index.php\/Hip_replacement","18026209e7901858227ab2cae8f033cf_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tHip replacement\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is about human hip replacement. For hip replacement in animals, see Hip replacement (animal).\nHip replacementAn X-ray showing a right hip (left of image) has been replaced, with the ball of this ball-and-socket joint replaced by a metal head that is set in the femur and the socket replaced by a white plastic cup (clear in this X-ray).ICD-9-CM81.51\u201381.53MeSHD019644 MedlinePlus002975 [edit on Wikidata]\nHip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures. A total hip replacement (total hip arthroplasty) consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is currently one of the most common orthopaedic operations, though patient satisfaction short- and long-term varies widely. The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.[1]\n\nContents \n\n1 Medical uses \n2 Modern process \n3 Techniques \n\n3.1 Posterior approach \n3.2 Lateral approach \n3.3 Antero-lateral approach \n3.4 Anterior approach \n3.5 Minimally invasive approaches \n\n\n4 Implants \n\n4.1 Acetabular cup \n4.2 Femoral component \n4.3 Articular interface \n\n\n5 Configuration \n6 Risks \n\n6.1 Infection \n6.2 Dislocation \n6.3 Limb Length Inequality \n6.4 Fracture \n6.5 Vein thrombosis \n6.6 Osteolysis \n6.7 Loosening \n6.8 Metal sensitivity \n6.9 Metal toxicity \n6.10 Nerve palsy \n6.11 Chronic pain \n6.12 Death \n6.13 Metal-on-metal hip implant failure \n\n\n7 Alternatives and variations \n\n7.1 Conservative management \n7.2 Preoperative care \n7.3 Hemiarthroplasty \n7.4 Hip resurfacing \n7.5 Viscosupplementation \n\n\n8 Prevalence and cost \n9 History \n10 See also \n11 References \n12 External links \n\n\nMedical uses \nTotal hip replacement is most commonly used to treat joint failure caused by osteoarthritis. Other indications include rheumatoid arthritis, avascular necrosis, traumatic arthritis, protrusio acetabuli, certain hip fractures, benign and malignant bone tumors, arthritis associated with Paget's disease, ankylosing spondylitis and juvenile rheumatoid arthritis. The aims of the procedure are pain relief and improvement in hip function. Hip replacement is usually considered only after other therapies, such as physical therapy and pain medications, have failed.\n\nModern process \n Main components of a hip prosthesis[2]\n A titanium hip prosthesis, with a ceramic head and polyethylene acetabular cup\nThe modern artificial joint owes much to the 1962 work of Sir John Charnley at Wrightington Hospital. His work in the field of tribology resulted in a design that almost completely replaced the other designs by the 1970s. Charnley's design consisted of three parts:\n\nstainless steel one-piece femoral stem and head\npolyethylene (originally Teflon), acetabular component, both of which were fixed to the bone using\nPMMA (acrylic) bone cement\nThe replacement joint, which was known as the Low Friction Arthroplasty, was lubricated with synovial fluid. The small femoral head (7⁄8  in (22.2 mm)) was chosen for Charnley's belief that it would have lower friction against the acetabular component and thus wear out the acetabulum more slowly. Unfortunately, the smaller head dislocated more easily. Alternative designs with larger heads such as the Mueller prosthesis were proposed. Stability was improved, but acetabular wear and subsequent failure rates were increased with these designs. The Teflon acetabular components of Charnley's early designs failed within a year or two of implantation. This prompted a search for a more suitable material. A German salesman showed a polyethylene gear sample to Charnley's machinist, sparking the idea to use this material for the acetabular component. The ultra high molecular weight polyethylene or UHMWPE acetabular component was introduced in 1962. Charnley's other major contribution was to use polymethylmethacrylate (PMMA) bone cement to attach the two components to the bone. For over two decades, the Charnley Low Friction Arthroplasty, and derivative designs were the most used systems in the world. It formed the basis for all modern hip implants.\nThe Exeter hip stem was developed in the United Kingdom during the same time as the Charnley device. Its development occurred following a collaboration between Orthopaedic Surgeon Robin Ling and University of Exeter engineer Clive Lee and it was first implanted at the Princess Elizabeth Orthopaedic Hospital in Exeter in 1970.[3] The Exeter Hip is a cemented device, but with a slightly different stem geometry. Both designs have shown excellent long-term durability when properly placed and are still widely used in slightly modified versions.\nEarly implant designs had the potential to loosen from their attachment to the bones, typically becoming painful ten to twelve years after placement. In addition, erosion of the bone around the implant was seen on x-rays. Initially, surgeons believed this was caused by an abnormal reaction to the cement holding the implant in place. That belief prompted a search for an alternative method to attach the implants. The Austin Moore device had a small hole in the stem into which bone graft was placed before implanting the stem. It was hoped bone would then grow through the window over time and hold the stem in position. Success was unpredictable and the fixation not very robust. In the early 1980s, surgeons in the United States applied a coating of small beads to the Austin Moore device and implanted it without cement. The beads were constructed so that gaps between beads matched the size of the pores in native bone. Over time, bone cells from the patient would grow into these spaces and fix the stem in position. The stem was modified slightly to fit more tightly into the femoral canal, resulting in the Anatomic Medullary Locking (AML) stem design. With time, other forms of stem surface treatment and stem geometry have been developed and improved.\nInitial hip designs were made of a one-piece femoral component and a one-piece acetabular component. Current designs have a femoral stem and separate head piece. Using an independent head allows the surgeon to adjust leg length (some heads seat more or less onto the stem) and to select from various materials from which the head is formed. A modern acetabulum component is also made up of two parts: a metal shell with a coating for bone attachment and a separate liner. First the shell is placed. Its position can be adjusted, unlike the original cemented cup design which are fixed in place once the cement sets. When proper positioning of the metal shell is obtained, the surgeon may select a liner made from various materials.\nTo combat loosening caused by polyethylene wear debris, hip manufacturers developed improved and novel materials for the acetabular liners. Ceramic heads mated with regular polyethylene liners or a ceramic liner were the first significant alternative. Metal liners to mate with a metal head were also developed. At the same time these designs were being developed, the problems that caused polyethylene wear were determined and manufacturing of this material improved. Highly crosslinked UHMWPE was introduced in the late 1990s. The most recent data comparing the various bearing surfaces has shown no clinically significant differences in their performance. Potential early problems with each material are discussed below. Performance data after 20 or 30 years may be needed to demonstrate significant differences in the devices. All newer materials allow use of larger diameter femoral heads. Use of larger heads significantly decreases the chance of the hip dislocating, which remains the greatest complication of the surgery.\nWhen currently available implants are used, cemented stems tend to have a better longevity than uncemented stems. No significant difference is observed in the clinical performance of the various methods of surface treatment of uncemented devices. Uncemented stems are selected for patients with good quality bone that can resist the forces needed to drive the stem in tightly. Cemented devices are typically selected for patients with poor quality bone who are at risk of fracture during stem insertion. Cemented stems are less expensive due to lower manufacturing cost, but require good surgical technique to place them correctly. Uncemented stems can cause pain with activity in up to 20% of patients during the first year after placement as the bone adapts to the device. This is rarely seen with cemented stems.\nOnce an uncommon operation reserved for frail patients with a limited life expectancy, hip replacement is now common, even among active athletes including race car drivers Bobby Labonte and Dale Jarrett, and the 8-time Major-winning American golfer Tom Watson, who shot a 67 in the opening round of the Masters Tournament in the year following his operation.\n\nTechniques \nThere are several incisions, defined by their relation to the gluteus medius. The approaches are posterior (Moore), lateral (Hardinge or Liverpool),[4] antero-lateral (Watson-Jones),[5] anterior (Smith-Petersen)[6] and greater trochanter osteotomy. There is no compelling evidence in the literature for any particular approach, but consensus of professional opinion favours either modified anterolateral (Watson-Jones) or posterior approach.[citation needed ]\n\nPosterior approach \nThe posterior (Moore or Southern) approach accesses the joint and capsule through the back, taking piriformis muscle and the short external rotators of the femur. This approach gives excellent access to the acetabulum and femur and preserves the hip abductors and thus minimizes the risk of abductor dysfunction post operatively. It has the advantage of becoming a more extensile approach if needed. Critics cite a higher dislocation rate, although repair of the capsule, piriformis and the short external rotators along with use of modern large diameter head balls reduces this risk.\n\nLateral approach \nThe lateral approach is also commonly used for hip replacement. The approach requires elevation of the hip abductors (gluteus medius and gluteus minimus) to access the joint. The abductors may be lifted up by osteotomy of the greater trochanter and reapplying it afterwards using wires (as per Charnley),[citation needed ] or may be divided at their tendinous portion, or through the functional tendon (as per Hardinge) and repaired using sutures. Although this approach has a lower dislocation risk than the posterior approach, critics note that occasionally the abductor muscles do not heal back on, leading to pain and weakness which is often very difficult to treat.\n\nAntero-lateral approach \nThe anterolateral approach develops the interval between the tensor fasciae latae and the gluteus medius. The Gluteus medius, gluteus minimus and hip capsule are detached from the anterior (front) for the greater trochanter and femoral neck and then repaired with heavy suture after the replacement of the joint.\n\nAnterior approach \nThe anterior approach uses an interval between the sartorius muscle and tensor fasciae latae. Dr. Joel Matta and Dr. Bert Thomas have adapted this approach, which was commonly used for pelvic fracture repair surgery, for use when performing hip replacement. When used with older hip implant systems that had a small diameter head, dislocation rates were reduced compared to surgery performed through a posterior approach. With modern implant designs, dislocation rates are similar between the anterior and posterior approaches.[7] The anterior approach has been shown in studies to variably improve early functional recovery, with possible complications of femoral component loosening and early revision compared to other approaches[8][9][10][11][12][13]\n\nMinimally invasive approaches \nThe dual incision approach and other minimally invasive surgery seeks to reduce soft tissue damage through reducing the size of the incision. However, component positioning accuracy and visualization of the bone structures can be significantly impaired as the approaches get smaller. This can result in unintended fractures and soft tissue injury. The majority of current orthopedic surgeons use a \"minimally invasive\" approach compared to traditional approaches which were quite large comparatively.\nComputer-assisted surgery and robotic surgery techniques are also available to guide the surgeon to provide enhanced accuracy. Several commercial CAS and robotic systems are available for use worldwide. Improved patient outcomes and reduced complications have not been demonstrated when these systems are used when compared to standard techniques.[14][15]\n\nImplants \n Metal on metal prosthetic hip\n Cement-free implant sixteen days after surgery. Femoral component is cobalt chromium combined with titanium which induces bone growth into the implant. Ceramic head. Acetabular cup coated with bone growth-inducing material and held temporarily in place with a single screw.\nThe prosthetic implant used in hip replacement consists of three parts: the acetabular cup, the femoral component, and the articular interface. Options exist for different people and indications. The evidence for a number of newer devices is not very good, including: ceramic-on-ceramic bearings, modular femoral necks, and uncemented monoblock cups.[16] Correct selection of the prosthesis is important.\n\nAcetabular cup \nThe acetabular cup is the component which is placed into the acetabulum (hip socket). Cartilage and bone are removed from the acetabulum and the acetabular cup is attached using friction or cement. Some acetabular cups are one piece, while others are modular. One-piece (monobloc) shells are either UHMWPE (ultra-high-molecular-weight polyethylene) or metal, they have their articular surface machined on the inside surface of the cup and do not rely on a locking mechanism to hold a liner in place. A monobloc polyethylene cup is cemented in place while a metal cup is held in place by a metal coating on the outside of the cup. Modular cups consist of two pieces, a shell and liner. The shell is made of metal; the outside has a porous coating while the inside contains a locking mechanism designed to accept a liner. Two types of porous coating used to form a friction fit are sintered beads and a foam metal design to mimic the trabeculae of cancellous bone and initial stability is influenced by under-reaming and insertion force.[17] Permanent fixation is achieved as bone grows onto or into the porous coating. Screws can be used to lag the shell to the bone providing even more fixation. Polyethylene liners are placed into the shell and connected by a rim locking mechanism; ceramic and metal liners are attached with a Morse taper.[citation needed ]\n\nFemoral component \nThis section possibly contains original research. Please improve it by verifying the claims made and adding inline citations. Statements consisting only of original research should be removed. (April 2016) (Learn how and when to remove this template message)The femoral component is the component that fits in the femur (thigh bone). Bone is removed and the femur is shaped to accept the femoral stem with attached prosthetic femoral head (ball). There are two types of fixation: cemented and uncemented. Cemented stems use acrylic bone cement to form a mantle between the stem and to the bone. Uncemented stems use friction, shape and surface coatings to stimulate bone to remodel and bond to the implant. Stems are made of multiple materials (titanium, cobalt chromium, stainless steel, and polymer composites) and they can be monolithic or modular. Modular components consist of different head dimensions and\/or modular neck orientations; these attach via a taper similar to a Morse taper. These options allow for variability in leg length, offset and version. Femoral heads are made of metal or ceramic material. Metal heads, made of cobalt chromium for hardness, are machined to size and then polished to reduce wear of the socket liner. Ceramic heads are more smooth than polished metal heads, have a lower coefficient of friction than a cobalt chrome head, and in theory will wear down the socket liner more slowly. As of early 2011, follow-up studies in patients have not demonstrated significant reductions in wear rates between the various types of femoral heads on the market. Ceramic implants are more brittle and may break after being implanted.\nArticular interface \nThis section possibly contains original research. Please improve it by verifying the claims made and adding inline citations. Statements consisting only of original research should be removed. (April 2016) (Learn how and when to remove this template message)The articular interface is not part of either implant, rather it is the area between the acetabular cup and femoral component. The articular interface of the hip is a simple ball and socket joint. Size, material properties and machining tolerances at the articular interface can be selected based on patient demand to optimise implant function and longevity whilst mitigating associated risks. The interface size is measured by the outside diameter of the head or the inside diameter of the socket. Common sizes of femoral heads are 28 mm (1.1 in), 32 mm (1.3 in) and 36 mm (1.4 in). While 22.25 mm (7⁄8  in) was common in the first modern prostheses, now even larger sizes are available from 38 to over 54 mm. Larger-diameter heads lead to increased stability and range of motion whilst lowering the risk of dislocation. At the same time they are also subject to higher stresses such as friction and inertia. Different combinations of materials have different physical properties which can be coupled to reduce the amount of wear debris generated by friction. Typical pairings of materials include metal on polyethylene (MOP), metal on crosslinked polyethylene (MOXP), ceramic on ceramic (COC), ceramic on crosslinked polyethylene (COXP) and metal on metal (MOM). Each combination has different advantages and disadvantages.\nConfiguration \nPost-operative projectional radiography is routinely performed to ensure proper configuration of hip prostheses.\nThe direction of the acetabular cup influences the range of motion of the leg, and also affects the risk of dislocation.[18] For this purpose, the acetabular inclination and the acetabular anteversion are measurements of cup angulation in the coronal plane and the sagittal plane, respectively.\n\n\n\t\t\n\t\t\t\n\t\t\t\nAcetabular inclination.[19] This parameter is calculated on an anteroposterior radiograph as the angle between a line through the lateral and medial margins of the acetabular cup and the transischial line which is tangential to the inferior margins of the ischium bones.[19]\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nAcetabular inclination is normally between 30 and 50\u00b0.[19] A larger angle increases the risk of dislocation.[18]\n\n\t\t\t\n\t\t\n\n\n\t\t\n\t\t\t\n\t\t\t\nAcetabular anteversion.[20] This parameter is calculated on a lateral radiograph as the angle between the transverse plane and a line going through the (anterior and posterior) margins of the acetabular cup.[20]\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nAcetabular anteversion is normally between 5 and 25\u00b0.[18] An anteversion below or above this range increases the risk of dislocation.[18] There is an intra-individual variability in this method because the pelvis may be tilted in various degrees in relation to the transverse plane.[18]\n\n\t\t\t\n\t\t\n\n\n\t\t\n\t\t\t\n\t\t\t\nLeg length discrepancy after hip replacement is calculated as the vertical distance between the middle of the minor trochanters, using the acetabular tear drops[19] or the transischial line[18] as references for the horizontal plane. A discrepancy of up to 1 cm is generally tolerated.[19][18]\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nCenter of rotation: The horizontal center of rotation is calculated as the distance between the acetabular teardrop and the center of the head (or caput) of the prosthesis and\/or the native femoral head on the contralateral side.[19] The vertical center of rotation instead uses the transischial line for reference.[19] The parameter should be equal on both sides.[19]\n\n\t\t\t\n\t\t\n\nRisks \nRisks and complications in hip replacement are similar to those associated with all joint replacements. They can include infection, dislocation, limb length inequality, loosening, impingement, osteolysis, metal sensitivity, nerve palsy, chronic pain and death. Weight loss surgery before a hip replacement does not appear to change outcomes.[21]\n\nInfection \nInfection is one of the most common causes for revision of a total hip replacement, along with loosening and dislocation. The incidence of infection in primary hip replacement is around 1% or less in the United States.[22] Risk factors for infection include obesity, diabetes, smoking, immunosuppressive medications or diseases, and history of infection.\nModern diagnosis of infection around a total knee replacement is based on the Musculoskeletal Infection Society (MSIS) criteria.[23] They are:\n1.There is a sinus tract communicating with the prosthesis; or\n2. A pathogen is isolated by culture from at least two separate tissue or fluid samples obtained from the affected prosthetic joint; \nor\n\n<\/p>Four of the following six criteria exist:\n1.Elevated serum erythrocyte sedimentation rate (ESR>30mm\/hr) and serum C-reactive protein (CRP>10 mg\/L) concentration,\n2.Elevated synovial leukocyte count,\n3.Elevated synovial neutrophil percentage (PMN%),\n4.Presence of purulence in the affected joint,\n5.Isolation of a microorganism in one culture of periprosthetic tissue or fluid, or\n6.Greater than five neutrophils per high-power field in five high-power fields observed from histologic analysis of periprosthetic tissue at \u00d7400 magnification.\nNone of the above laboratory tests has 100% sensitivity or specificity for diagnosing infection. Specificity improves when the tests are performed in patients in whom clinical suspicion exists. ESR and CRP remain good 1st line tests for screening (high sensitivity, low specificity). Aspiration of the joint remains the test with the highest specificity for confirming infection.\n\nDislocation \n Dislocated artificial hip\n Liner wear, particularly when over 2 mm, increases the risk of dislocation.[24] Liner creep, on the other hand, is normal remoulding.[18]\nDislocation is the most common complication of hip replacement surgery. The most common causes vary by the duration since the surgery.\nHip prosthesis dislocation mostly occurs in the first 3 months after insertion, mainly because of incomplete scar formation and relaxed soft tissues.[24] It takes eight to twelve weeks for the soft tissues injured or cut during surgery to heal. During this period, the hip ball can come out of the socket. The chance of this is diminished if less tissue is cut, if the tissue cut is repaired and if large diameter head balls are used.\nDislocations occurring between 3 months and 5 years after insertion usually occur due to malposition of the components, or dysfunction of nearby muscles.[24]\nRisk factors of late dislocation (after 5 years) mainly include:[24]\n\nFemale gender\nYounger age at primary hip arthroplasty\nPrevious subluxation without complete dislocation\nPrevious trauma\nSubstantial weight loss\nRecent onset or progression of dementia or a neurological disorder\nMalposition of the cup\nWear of the liner, particularly when it causes movement of the head of more than 2 mm within the cup compared to its original position\nProsthesis loosening with migration\nSurgeons who perform more of the operations each year tend to have fewer patients dislocate. Doing the surgery from an anterior approach seems to lower dislocation rates when small diameter heads are used, but the benefit has not been shown when compared to modern posterior incisions with the use of larger diameter heads. The use of larger diameter head size does in it self decrease the risk of dislocation, even though this correlation is only found in head sizes up to 28 mm, thereafter no additional decrease in dislocation rate is found.[25] Patients can decrease the risk further by keeping the leg out of certain positions during the first few months after surgery.\n\nLimb Length Inequality \nMost adults prior to a hip replacement have a limb length inequality of 0\u20132 cm which they were born with and which causes no clinical deficits.[26] It is common for patients to feel a limb length inequality after total hip replacement.[27] Sometimes the leg seems long immediately after surgery when in fact both are equal length. An arthritic hip can develop contractures that make the leg behave as if it is short. When these are relieved with replacement surgery and normal motion and function are restored, the body feels that the limb is now longer than it was. This feeling usually subsides by 6 months after surgery as the body adjusts to the new hip joint. The cause of this feeling is variable, and usually related to abductor muscle weakness, pelvic obliquity, and minor lengthening of the hip during surgery (<1 cm) to achieve stability and restore the joint to pre-arthritic mechanics. If the limb length difference remains bothersome to the patient more than 6 months after surgery, a shoe lift can be used. Only in extreme cases is surgery required for correction.\n\nFracture \nBones with internal fixation devices in situ are at risk of periprosthetic fractures at the end of the implant, an area of relative mechanical stress. Post-operative femoral fractures are graded by the Vancouver classification.\n\nVein thrombosis \nVenous thrombosis such as deep vein thrombosis and pulmonary embolism are relatively common following hip replacement surgery. Standard treatment with anticoagulants is for 7\u201310 days; however treatment for more than 21 days may be superior.[28] Research from 2013 has on the other hand suggested that anticoagulants in otherwise healthy patients undergoing a so-called fast track protocol with hospital stays under five days, might only be necessary while in the hospital.[29]\nSome physicians and patients may consider having an ultrasonography for deep vein thrombosis after hip replacement.[30] However, this kind of screening should only be done when indicated because to perform it routinely would be unnecessary health care.[30]\n\nOsteolysis \nMany long-term problems with hip replacements are the result of osteolysis. This is the loss of bone caused by the body's reaction to polyethylene wear debris, fine bits of plastic that come off the cup liner over time. An inflammatory process causes bone resorption that may lead to subsequent loosening of the hip implants and even fractures in the bone around the implants. In an attempt to eliminate the generation of wear particles, ceramic bearing surfaces are being used in the hope that they will have less wear and less osteolysis with better long-term results. Metal cup liners joined with metal heads (metal-on-metal hip arthroplasty) were also developed for similar reasons. In the lab these show excellent wear characteristics and benefit from a different mode of lubrication. At the same time that these two bearing surfaces were being developed, highly cross linked polyethylene plastic liners were also developed. The greater cross linking significantly reduces the amount of plastic wear debris given off over time. The newer ceramic and metal prostheses do not always have the long-term track record of established metal on poly bearings. Ceramic pieces can break leading to catastrophic failure. This occurs in about 2% of the implants placed. They may also cause an audible, high pitched squeaking noise with activity. Metal-on-metal arthroplasty releases metal debris into the body raising concerns about the potential dangers of these accumulating over time. Highly cross linked polyethylene is not as strong as regular polyethylene. These plastic liners can crack or break free of the metal shell that holds them.\n\nLoosening \n Hip prosthesis displaying aseptic loosening (arrows)\n Hip prosthesis zones according to DeLee and Charnley,[31] and Gruen.[32] These are used to describe the location of for example areas of loosening.\nOn radiography, it is normal to see thin radiolucent areas of less than 2 mm around hip prosthesis components, or between a cement mantle and bone. However, these may still indicate loosening of the prosthesis if they are new or changing, and areas greater than 2 mm may be harmless if they are stable.[33] The most important prognostic factors of cemented cups are absence of radiolucent lines in DeLee and Charnley zone I, as well as adequate cement mantle thickness.[34] In the first year after insertion of uncemented femoral stems, it is normal to have mild subsidence (less than 10 mm).[33] The direct anterior approach has been shown to itself be a risk factor for early femoral component loosening.[9][35][8]\n\nMetal sensitivity \nConcerns are being raised about the metal sensitivity and potential dangers of metal particulate debris. New publications[36][37] have demonstrated development of pseudotumors, soft tissue masses containing necrotic tissue, around the hip joint. It appears these masses are more common in women and these patients show a higher level of iron in the blood. The cause is unknown and is probably multifactorial. There may be a toxic reaction to an excess of particulate metal wear debris or a hypersensitivity reaction to a normal amount of metal debris.\nMetal hypersensitivity is a well-established phenomenon and is common, affecting about 10\u201315% of the population.[38] Contact with metals can cause immune reactions such as skin hives, eczema, redness and itching. Although little is known about the short- and long-term pharmacodynamics and bioavailability of circulating metal degradation products in vivo, there have been many reports of immunologic type responses temporally associated with implantation of metal components. Individual case reports link hypersensitivity immune reactions with adverse performance of metallic clinical cardiovascular, orthopedic and plastic surgical and dental implants.[38]\n\nMetal toxicity \nMain article: Metallosis\nMost hip replacements consist of cobalt and chromium alloys, or titanium. Stainless steel is no longer used. All implants release their constituent ions into the blood. Typically these are excreted in the urine, but in certain individuals the ions can accumulate in the body. In implants which involve metal-on-metal contact, microscopic fragments of cobalt and chromium can be absorbed into the patient's bloodstream. There are reports of cobalt toxicity with hip replacement patients.[39][40]\n\nNerve palsy \nPost operative sciatic nerve palsy is another possible complication. The incidence of this complication is low. Femoral nerve palsy is another but much more rare complication. Both of these will typically resolve over time, but the healing process is slow. Patients with pre-existing nerve injury are at greater risk of experiencing this complication and are also slower to recover.\n\nChronic pain \nA few patients who have had a hip replacement suffer chronic pain after the surgery. Groin pain can develop if the muscle that raises the hip (iliopsoas) rubs against the edge of the acetabular cup. Bursitis can develop at the trochanter where a surgical scar crosses the bone, or if the femoral component used pushes the leg out to the side too far. Also some patients can experience pain in cold or damp weather.[citation needed ] Incision made in the front of the hip (anterior approach) can cut a nerve running down the thigh leading to numbness in the thigh and occasionally chronic pain at the point where the nerve was cut (a neuroma).\n\nDeath \nThe rate of death for elective hip replacements is significantly less than 1%.[41][42]\n\nMetal-on-metal hip implant failure \nSee also: Implant failure\nBy 2010, reports in the orthopaedic literature increasingly cited the problem of early failure of metal on metal prostheses in a small percentage of patients.[43] Failures may relate to release of minute metallic particles or metal ions from wear of the implants, causing pain and disability severe enough to require revision surgery in 1\u20133% of patients.[44] Design deficits of some prothesis models, especially with heat-treated alloys and a lack of special surgical experience accounting for most of the failures. In 2010, surgeons at medical centers such as the Mayo Clinic reported reducing their use of metal-on-metal implants by 80 percent over the previous year in favor of those made from other materials, like combinations of metal and plastic.[45] The cause of these failures remain controversial, and may include both design factors, technique factors, and factors related to patient immune responses (allergy type reactions). In the United Kingdom the Medicines and Healthcare Products Regulatory Agency commenced an annual monitoring regime for metal-on-metal hip replacement patients from May 2010.[46] Data which are shown in The Australian Orthopaedic Association's 2008 National Joint replacement registry, a record of nearly every hip implanted in that country over the previous 10 years, tracked 6,773 BHR (Birmingham Hip Resurfacing) Hips and found that less than one-third of one percent may have been revised due to the patient's reaction to the metal component.[47] Other similar metal-on-metal designs have not fared as well, where some reports show 76% to 100% of the people with these metal-on-metal implants and have aseptic implant failures requiring revision also have evidence of histological inflammation accompanied by extensive lymphocyte infiltrates, characteristic of delayed type hypersensitivity responses.[48] It is not clear to what extent this phenomenon negatively affects orthopedic patients. However, for patients presenting with signs of an allergic reactions, evaluation for sensitivity should be conducted. Removal of the device that is not needed should be considered, since removal may alleviate the symptoms. Patients who have allergic reactions to cheap jewelry are more likely to have reactions to orthopedic implants. There is increasing awareness of the phenomenon of metal sensitivity and many surgeons now take this into account when planning which implant is optimal for each patient.\nOn March 12, 2012, The Lancet published a study, based on data from the National Joint Registry of England and Wales, finding that metal-on-metal hip implants failed at much greater rates than other types of hip implants and calling for a ban on all metal-on-metal hips.[49] The analysis of 402,051 hip replacements showed that 6.2% of metal-on-metal hip implants had failed within five years, compared to 1.7% of metal-on-plastic and 2.3% of ceramic-on-ceramic hip implants. Each 1 mm (0.039 in) increase in head size of metal-on-metal hip implants was associated with a 2% increase of failure.[50] Surgeons of the British Hip Society are recommending that large head metal-on-metal implants should no longer be performed.[51][52]\nOn February 10, 2011, the U.S. FDA issued an advisory on metal-metal hip implants, stating it was continuing to gather and review all available information about metal-on-metal hip systems.[53] On June 27\u201328, 2012, an advisory panel met to decide whether to impose new standards, taking into account findings of the study in The Lancet.[40][54][55] No new standards, such as routine checking of blood metal ion levels, were set, but guidance was updated.[56] Currently, FDA has not required hip implants to be tested in clinical trials before they can be sold in the U.S.[57] Instead, companies making new hip implants only need to prove that they are \"substantially equivalent\" to other hip implants already on the market. The exception is metal-on-metal implants, which were not tested in clinical trials but because of the high revision rate of metal-on-metal hips, in the future the FDA has stated that clinical trials will be required for approval and that post-market studies will be required to keep metal on metal hip implants on the market.[58]\n\nAlternatives and variations \nConservative management \nThe first line approach as an alternative to hip replacement is conservative management which involves a multimodal approach of oral medication, injections, activity modification and physical therapy.[59] Conservative management can prevent or delay the need for hip replacement.\n\nPreoperative care \nPreoperative education is currently an important part of patient care. There is some evidence that it may slightly reduce anxiety before hip or knee replacement, with low risk of negative effects.[60]\n\nHemiarthroplasty \nHemiarthroplasty is a surgical procedure which replaces one half of the joint with an artificial surface and leaves the other part in its natural (pre-operative) state. This class of procedure is most commonly performed on the hip after a subcapital (just below the head) fracture of the neck of the femur (a hip fracture). The procedure is performed by removing the head of the femur and replacing it with a metal or composite prosthesis. The most commonly used prosthesis designs are the Austin Moore prosthesis and the Thompson Prosthesis. More recently a composite of metal and HDPE which forms two interphases (bipolar prosthesis) has also been used. The monopolar prosthesis has not been shown to have any advantage over bipolar designs. The procedure is recommended only for elderly and frail patients, due to their lower life expectancy and activity level. This is because with the passage of time the prosthesis tends to loosen or to erode the acetabulum.[61]\n\n\n\t\t\n\t\t\t\n\t\t\t\nHip prosthesis for hemiarthroplasty. This example is bipolar, meaning that the head has 2 separate articulations.\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nX-ray of the hips, with a right-sided hemiarthroplasty.\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nFemoral (neck) offset is defined as the perpendicular distance between the intramedullary or longitudinal axis of the femur and the center of rotation of the native or prosthetic femoral head. An unnatural offset is associated with hip dislocation.[62]\n\n\t\t\t\n\t\t\n\nHip resurfacing \nHip resurfacing is an alternative to hip replacement surgery. It has been used in Europe for over seventeen years and become a common procedure. Health-related quality of life measures are markedly improved and patient satisfaction is favorable after hip resurfacing arthroplasty.[63]\nThe minimally invasive hip resurfacing procedure is a further refinement to hip resurfacing.\n\nViscosupplementation \nCurrent alternatives also include viscosupplementation, or the injection of artificial lubricants into the joint.[64] Use of these medications in the hip is off label. The cost of treatment is typically not covered by health insurance organizations.\nSome believe that the future of osteoarthritis treatment is bioengineering, targeting the growth and\/or repair of the damaged, arthritic joint. Centeno et al. have reported on the partial regeneration of an arthritic human hip joint using mesenchymal stem cells in one patient.[65] It is yet to be shown that this result will apply to a larger group of patients and result in significant benefits. The FDA has stated that this procedure is being practiced without conforming to regulations, but Centeno claims that it is exempt from FDA regulation. It has not been shown in controlled clinical trials to be effective[citation needed ], and costs over $7,000.\n\nPrevalence and cost \nTotal hip replacement incidence varies in developed countries between 30 (Romania) and 290 (Germany) procedures per 100,000 population per year.[66] Approximately 0.8% of Americans have undergone the procedure.[67]\nAccording to the International Federation of Healthcare Plans, the average cost of a total hip replacement in 2012 was $40,364 in the United States, $11,889 in the United Kingdom, $10,987 in France, $9,574 in Switzerland, and $7,731 in Spain.[1] In the United States, the average cost of a total hip replacement varies widely by geographic region, ranging from $11,327 (Birmingham, Alabama) to $73,927 (Boston, Massachusetts).[68]\n\nHistory \nThe earliest recorded attempts at hip replacement were carried out in Germany in 1891 by Themistocles Gluck (1853\u20131942),[69][70] who used ivory to replace the femoral head (the ball on the femur), attaching it with nickel-plated screws, Plaster of Paris, and glue.[71]\nOn September 28, 1940 at Columbia Hospital in Columbia, South Carolina, American surgeon Dr. Austin T. Moore (1899\u20131963)[72] performed the first metallic hip replacement surgery. The original prosthesis he designed was a proximal femoral replacement, with a large fixed head made of the cobalt-chrome alloy Vitallium. It was about a foot in length and bolted to the resected end of the femoral shaft (hemiarthroplasty). A later version, the so-called Austin Moore Prosthesis which was introduced in 1952, is still in use today, although rarely. Like modern hip implants, it is inserted into the medullary canal of the femur, and depends on bone growth through a hole in the stem for long-term attachment.\n\nSee also \nAbductor wedge\nFemoral Acetabular Impingement\nGruen zone\nHip examination\n2010 DePuy Hip Recall\nReferences \n\n\n^ a b \"2012 comparative price report\" (PDF) . International Federation of Health Plans. Retrieved 4 October 2015 . \n\n^ Andrew Still (2002-11-02). \"Total Hip Replacement\". University of Southern California. Retrieved 2017-01-05 . \n\n^ Timperley, A John (20 October 2017). \"Robin Ling obituary\". The Guardian. Retrieved 22 October 2017 . \n\n^ Pai VS (1997). \"A comparison of three lateral approaches in primary total hip replacement\". Int Orthop. 21 (6): 393\u2013398. doi:10.1007\/s002640050193. PMC 3619565 . PMID 9498150. Archived from the original on 2002-01-08. \n\n^ \"Anterolateral Approach to Hip Joint: (Watson Jones) \u2013 Wheeless' Textbook of Orthopaedics\". Retrieved 2007-11-26 . \n\n^ \"Anterior Approach to the Hip (Smith Petersen) \u2013 Wheeless' Textbook of Orthopaedics\". Retrieved 2007-11-26 . \n\n^ Maratt, Joseph D.; Gagnier, Joel J.; Butler, Paul D.; Hallstrom, Brian R.; Urquhart, Andrew G.; Roberts, Karl C. (September 2016). \"No Difference in Dislocation Seen in Anterior Vs Posterior Approach Total Hip Arthroplasty\". The Journal of Arthroplasty. 31 (9): 127\u2013130. doi:10.1016\/j.arth.2016.02.071. \n\n^ a b Meneghini, R. Michael; Elston, Addison S.; Chen, Antonia F.; Kheir, Michael M.; Fehring, Thomas K.; Springer, Bryan D. (January 2017). \"Direct Anterior Approach\". The Journal of Bone and Joint Surgery. 99 (2): 99\u2013105. doi:10.2106\/JBJS.16.00060. PMID 28099299. \n\n^ a b Eto, Shuichi; Hwang, Katherine; Huddleston, James I.; Amanatullah, Derek F.; Maloney, William J.; Goodman, Stuart B. (March 2017). \"The Direct Anterior Approach is Associated With Early Revision Total Hip Arthroplasty\". The Journal of Arthroplasty. 32 (3): 1001\u20131005. doi:10.1016\/j.arth.2016.09.012. PMID 27843039. \n\n^ Christensen, Christian P.; Jacobs, Cale A. (September 2015). \"Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study\". The Journal of Arthroplasty. 30 (9): 94\u201397. doi:10.1016\/j.arth.2014.12.038. \n\n^ Higgins, Brendan T.; Barlow, Daniel R.; Heagerty, Nathan E.; Lin, Tim J. (March 2015). \"Anterior vs. Posterior Approach for Total Hip Arthroplasty, a Systematic Review and Meta-analysis\". The Journal of Arthroplasty. 30 (3): 419\u2013434. doi:10.1016\/j.arth.2014.10.020. \n\n^ Meermans, G.; Konan, S.; Das, R.; Volpin, A.; Haddad, F. S. (June 2017). \"The direct anterior approach in total hip arthroplasty\". The Bone & Joint Journal. 99-B (6): 732\u2013740. doi:10.1302\/0301-620X.99B6.38053. \n\n^ Graves, Sara C.; Dropkin, Benjamin M.; Keeney, Benjamin J.; Lurie, Jon D.; Tomek, Ivan M. (30 November 2015). \"Does Surgical Approach Affect Patient-reported Function After Primary THA?\". Clinical Orthopaedics and Related Research. 474 (4): 971\u2013981. doi:10.1007\/s11999-015-4639-5. PMC 4773324 . \n\n^ Parsley, Brian S. (February 2018). \"Robotics in Orthopedics: A Brave New World\". The Journal of Arthroplasty. doi:10.1016\/j.arth.2018.02.032. \n\n^ Jacofsky, David J.; Allen, Mark (October 2016). \"Robotics in Arthroplasty: A Comprehensive Review\". The Journal of Arthroplasty. 31 (10): 2353\u20132363. doi:10.1016\/j.arth.2016.05.026. \n\n^ Nieuwenhuijse, M. J.; Nelissen, R. G. H. H.; Schoones, J. W.; Sedrakyan, A. (9 September 2014). \"Appraisal of evidence base for introduction of new implants in hip and knee replacement: a systematic review of five widely used device technologies\". BMJ. 349 (sep09 1): g5133\u2013g5133. doi:10.1136\/bmj.g5133. \n\n^ Amirouche, Farid (2014). \"Factors influencing initial cup stability in total hip arthroplasty\". Clinical Biomechanics. 29 (10): 1177\u201385. doi:10.1016\/j.clinbiomech.2014.09.006. PMID 25266242. \n\n^ a b c d e f g h Iain Watt, Susanne Boldrik, Evert van Langelaan and Robin Smithuis. \"Hip - Arthroplasty -Normal and abnormal imaging findings\". Radiology Assistant. Retrieved 2017-05-21 . CS1 maint: Multiple names: authors list (link) \n\n^ a b c d e f g h Vanrusselt, Jan; Vansevenant, Milan; Vanderschueren, Geert; Vanhoenacker, Filip (2015). \"Postoperative radiograph of the hip arthroplasty: what the radiologist should know\". Insights into Imaging. 6 (6): 591\u2013600. doi:10.1007\/s13244-015-0438-5. ISSN 1869-4101. PMID 26487647. \n\n^ a b Shin, W. C.; Lee, S. M.; Lee, K. W.; Cho, H. J.; Lee, J. S.; Suh, K. T. (2015). \"The reliability and accuracy of measuring anteversion of the acetabular component on plain anteroposterior and lateral radiographs after total hip arthroplasty\". The Bone & Joint Journal. 97-B (5): 611\u2013616. doi:10.1302\/0301-620X.97B5.34735. ISSN 2049-4394. \n\n^ Smith, TO; Aboelmagd, T; Hing, CB; MacGregor, A (September 2016). \"Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients? Systematic review and meta-analysis\". The Bone & Joint Journal. 98-B (9): 1160\u20131166. doi:10.1302\/0301-620x.98b9.38024. PMID 27587514. \n\n^ Bozic, Kevin J; Kurtz, Steven M; Lau, Edmund; Ong, Kevin; Vail, Thomas P; Berry, Daniel J (January 2009). \"The Epidemiology of Revision Total Hip Arthroplasty in the United States\". The Journal of Bone and Joint Surgery. American Volume. 91 (1): 128\u2013133. doi:10.2106\/JBJS.H.00155. \n\n^ Parvizi, Javad; Zmistowski, Benjamin; Berbari, Elie F.; Bauer, Thomas W.; Springer, Bryan D.; Della Valle, Craig J.; Garvin, Kevin L.; Mont, Michael A.; Wongworawat, Montri D.; Zalavras, Charalampos G. (22 September 2011). \"New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society\". Clinical Orthopaedics and Related Research. 469 (11): 2992\u20132994. doi:10.1007\/s11999-011-2102-9. PMC 3183178 . \n\n^ a b c d Daniel J. Berry, Jay Lieberman (2012). Surgery of the Hip. Elsevier Health Sciences. p. 1035. ISBN 9781455727056. \n\n^ Hailer, Nils P.; Weiss, R\u00fcdiger J.; Stark, Andr\u00e9; K\u00e4rrholm, Johan (October 2012). \"The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. An analysis of 78,098 operations in the Swedish Hip Arthroplasty Register\". Acta Orthopaedica. 83 (5): 442\u2013448. doi:10.3109\/17453674.2012.733919. ISSN 1745-3682. PMC 3488169 . PMID 23039167. \n\n^ Knutson, Gary A (2005). \"Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance\". Chiropractic & Osteopathy. 13 (1): 11. doi:10.1186\/1746-1340-13-11. PMC 1232860 . \n\n^ Maloney, William J; Keeney, James A (June 2004). \"Leg length discrepancy after total hip arthroplasty\". The Journal of Arthroplasty. 19 (4): 108\u2013110. doi:10.1016\/j.arth.2004.02.018. \n\n^ Sobieraj, DM; Lee, S; Coleman, CI; Tongbram, V; Chen, W; Colby, J; Kluger, J; Makanji, S; Ashaye, AO; White, CM (May 15, 2012). \"Prolonged versus standard-duration venous thromboprophylaxis in major orthopedic surgery: a systematic review\". Annals of Internal Medicine. 156 (10): 720\u20137. doi:10.7326\/0003-4819-156-10-201205150-00423. PMID 22412039. \n\n^ J\u00f8rgensen, Christoffer C.; Jacobsen, Michael K.; Soeballe, Kjeld; Hansen, Torben B.; Husted, Henrik; Kj\u00e6rsgaard-Andersen, Per; Hansen, Lars T.; Laursen, Mogens B.; Kehlet, Henrik (2013). \"Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study\". BMJ Open. 3 (12): e003965. doi:10.1136\/bmjopen-2013-003965. ISSN 2044-6055. PMC 3863129 . PMID 24334158. \n\n^ a b American Academy of Orthopaedic Surgeons (February 2013), \"Five Things Physicians and Patients Should Question\", Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Orthopaedic Surgeons, retrieved 19 May 2013 , which cites\nMembers of 2007 and 2011 AAOS Guideline Development Work Groups on PE\/VTED Prophylaxis; Mont, M; Jacobs, J; Lieberman, J; Parvizi, J; Lachiewicz, P; Johanson, N; Watters, W (Apr 18, 2012). \"Preventing venous thromboembolic disease in patients undergoing elective total hip and knee arthroplasty\". The Journal of Bone and Joint Surgery. American Volume. 94 (8): 673\u20134. doi:10.2106\/JBJS.9408edit. PMC 3326687 . PMID 22517384. \n \n^ John J. Callaghan, Aaron G. Rosenberg, Harry E. Rubash (2007). The Adult Hip, Volume 1. Lippincott Williams & Wilkins. p. 958. ISBN 978-0-7817-5092-9. CS1 maint: Multiple names: authors list (link) \n\n^ Neumann, Daniel R.P.; Thaler, Christoph; Hitzl, Wolfgang; Huber, Monika; Hofst\u00e4dter, Thomas; Dorn, Ulrich (2010). \"Long-Term Results of a Contemporary Metal-on-Metal Total Hip Arthroplasty\". The Journal of Arthroplasty. 25 (5): 700\u2013708. doi:10.1016\/j.arth.2009.05.018. ISSN 0883-5403. \n\n^ a b Roth, Trenton D.; Maertz, Nathan A.; Parr, J. Andrew; Buckwalter, Kenneth A.; Choplin, Robert H. (2012). \"CT of the Hip Prosthesis: Appearance of Components, Fixation, and Complications\". RadioGraphics. 32 (4): 1089\u20131107. doi:10.1148\/rg.324115183. ISSN 0271-5333. \n\n^ Steffen Breusch, Henrik Malchau (2005). The Well-Cemented Total Hip Arthroplasty: Theory and Practice. Springer Science & Business Media. p. 336. ISBN 978-3-540-24197-3. \n\n^ Angerame, Marc R.; Fehring, Thomas K.; Masonis, John L.; Mason, J. Bohannon; Odum, Susan M.; Springer, Bryan D. (February 2018). \"Early Failure of Primary Total Hip Arthroplasty: Is Surgical Approach a Risk Factor?\". The Journal of Arthroplasty. doi:10.1016\/j.arth.2018.01.014. \n\n^ Pandit H, Glyn-Jones S, McLardy-Smith P, et al. (July 2008). \"Pseudotumours associated with metal-on-metal hip resurfacings\". J Bone Joint Surg Br. 90 (7): 847\u201351. doi:10.1302\/0301-620X.90B7.20213. PMID 18591590. \n\n^ Boardman DR, Middleton FR, Kavanagh TG (March 2006). \"A benign psoas mass following metal-on-metal resurfacing of the hip\". J Bone Joint Surg Br. 88 (3): 402\u20134. doi:10.1302\/0301-620X.88B3.16748. PMID 16498023. \r\nKorovessis P, Petsinis G, Repanti M, Repantis T (June 2006). \"Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow-up\". J Bone Joint Surg Am. 88 (6): 1183\u201391. doi:10.2106\/JBJS.D.02916. PMID 16757749. \n\n^ a b Hallab N, Merritt K, Jacobs JJ (March 2001). \"Metal sensitivity in patients with orthopaedic implants\". J Bone Joint Surg Am. 83-A (3): 428\u201336. PMID 11263649. \n\n^ http:\/\/www.epi.hss.state.ak.us\/bulletins\/docs\/b2010_14.pdf \n\n^ a b \"FDA seeks more advice on metal hip implants\". Reuters. 29 March 2012. Retrieved 20 May 2012 . \n\n^ Cot\u00e9, John (July 22, 2007). \"Hip replacement is not viewed as high-risk surgery; Death is rare, but underlying medical condition a factor\". San Francisco Chronicle. \n\n^ Medscape Conference Coverage, American Academy of Orthopaedic Surgeons (AAOS) 2009 Annual Meeting, AAOS 2009: Certain Factors Increase Risk for Death After Total Hip Arthroplasty, Barbara Boughton, March 3, 2009. \n\n^ Mikael, Mark M.; Hanssen, Arlen D.; Sierra, Rafael J. (2009). \"Failure of Metal-on-Metal Total Hip Arthroplasty Mimicking Hip Infection\". The Journal of Bone and Joint Surgery. American Volume. 2009 (91): 443\u2013446. doi:10.2106\/JBJS.H.00603. PMID 19181991. Retrieved 2010-05-07 . \n\n^ Meier, Barry (March 3, 2010). \"As Use of Metal-on-Metal Hip Implants Grows, Studies Raise Concerns\". The New York Times. \n\n^ Meier, Barry (March 3, 2010). \"Concerns Over 'Metal on Metal' Hip Implants\". The New York Times. \n\n^ \"Medical Device Alert: All metal-on-metal (MoM) hip replacements\". Medicines and Healthcare products Regulatory Agency. 22 April 2010. MDA\/2010\/033. Archived from the original on 25 April 2010. Retrieved 2010-05-07 . \n\n^ Table HT 46. Australian Orthopaedic Association National Joint Replacement Registry Annual Report. Adelaide: AOA; 2008 \n\n^ Milosev I, Trebse R, Kovac S, C\u00f6r A, Pisot V (June 2006). \"Survivorship and retrieval analysis of Sikomet metal-on-metal total hip replacements at a mean of seven years\". J Bone Joint Surg Am. 88 (6): 1173\u201382. doi:10.2106\/JBJS.E.00604. PMID 16757748. \n\n^ Smith AJ, Dieppe P, Vernon K, Porter M, Blom AW (March 2012). \"Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales\". Lancet. 379 (9822): 1199\u2013204. doi:10.1016\/S0140-6736(12)60353-5. PMID 22417410. \n\n^ Gallagher, James (13 March 2012). \"Metal-on-metal hip replacements 'high failure rate' \". BBC. Retrieved 20 May 2012 . \n\n^ Pijls, B. G.; Meessen, J. M. T. A.; Schoones, J. W.; Fiocco, M.; Heide, H. J. L. van der; Sedrakyan, A.; Nelissen, R. G. H. H. (2016). \"Increased Mortality in Metal-on-Metal versus Non-Metal-on-Metal Primary Total Hip Arthroplasty at 10 Years and Longer Follow-Up: A Systematic Review and Meta-Analysis\". PLOS One. 11 (6): e0156051. doi:10.1371\/journal.pone.0156051. ISSN 1932-6203. PMC 4905643 . PMID 27295038. \n\n^ Roberts, Michelle (5 March 2012). \"Surgeons call for end to metal hip replacements\". BBC. Retrieved 20 May 2012 . \n\n^ \"Metal-on-Metal Hip Implants\". Food and Drug Administration. February 10, 2011. Retrieved January 4, 2012 . \n\n^ \"Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee Meeting Announcement\". Food and Drug Administration. 27 March 2012. FDA-2012-N-0293. Retrieved 20 May 2012 . \n\n^ FDA Executive Summary Memorandum \u2013 Metal-on-Metal Hip Implant System (PDF) (Report). Food and Drug Administration. 27 June 2012. Retrieved 15 March 2013 . \n\n^ \"Concerns about Metal-on-Metal Hip Implants\". Food and Drug Administration. 17 January 2013. Retrieved 15 March 2013 . \n\n^ \"Study Suggests Women Have Higher Risk of Hip Implant Failure - For The Media - JAMA Network\". media.jamanetwork.com. \n\n^ Rising, Joshua P.; Reynolds, Ian S.; Sedrakyan, Art (2012). \"Delays and Difficulties in Assessing Metal-on-Metal Hip Implants\". New England Journal of Medicine. 367 (1): e1. doi:10.1056\/NEJMp1206794. PMID 22716934. \n\n^ Cibulka MT, White DM, Woehrle J, et al. (April 2009). \"Hip pain and mobility deficits\u2014hip osteoarthritis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopaedic section of the American Physical Therapy Association\". J Orthop Sports Phys Ther. 39 (4): A1\u201325. doi:10.2519\/jospt.2009.0301. PMC 3963282 . PMID 19352008. \n\n^ McDonald, S; Page, MJ; Beringer, K; Wasiak, J; Sprowson, A (2014). \"Preoperative education for hip or knee replacement\". The Cochrane Database of Systematic Reviews (published 13 May 2014) (5): CD003526. doi:10.1002\/14651858.CD003526.pub3. PMID 24820247. \n\n^ van der Meulen, M.C.H.; Allen, W.A.; Giddings, V.L.; Athanasiou, K.A.; Poser, R.D.; Goodman, S.B.; Smith, R.L.; Beaupr\u00e9, G.S. \"Effect of hemiarthroplasty on acetabular cartilage\". 1996 Project Reports. VA Palo Alto Health Care System's Bone and Joint Rehabilitation Research and Development Center. \n\n^ Jones, Carl; Briffa, Nikolai; Jacob, Joshua; Hargrove, Richard (2017). \"The Dislocated Hip Hemiarthroplasty: Current Concepts of Etiological factors and Management\". The Open Orthopaedics Journal. 11 (Suppl-7, M4): 1200\u20131212. doi:10.2174\/1874325001711011200. ISSN 1874-3250. \n\n^ Koutras C, Antoniou SA, Talias MA, Heep H (19 May 2015). \"Impact of Total Hip Resurfacing Arthroplasty on Health-Related Quality of Life Measures: A Systematic Review and Meta-Analysis\". J Arthroplasty. 30 (11): 1938\u201352. doi:10.1016\/j.arth.2015.05.014. PMID 26067708. \n\n^ van den Bekerom MP, Lamme B, Sermon A, Mulier M (August 2008). \"What is the evidence for viscosupplementation in the treatment of patients with hip osteoarthritis? Systematic review of the literature\". Arch Orthop Trauma Surg. 128 (8): 815\u2013823. doi:10.1007\/s00402-007-0447-z. PMID 17874246. \n\n^ Centeno CJ, Kisiday J, Freeman M, Schultz JR (July 2006). \"Partial regeneration of the human hip via autologous bone marrow nucleated cell transfer: A case study\". Pain Physician. 9 (3): 253\u20136. PMID 16886034. Archived from the original on 2009-02-12. \n\n^ Kurtz SM, Ong KL, Lau E, Widmer M, Maravic M, G\u00f3mez-Barrena E, de Pina Mde F, Manno V, Torre M, Walter WL, de Steiger R, Geesink RG, Peltola M, R\u00f6der C (2011). \"International survey of primary and revision total knee replacement\". Int Orthop. 35 (12): 1783\u20139. doi:10.1007\/s00264-011-1235-5. PMC 3224613 . PMID 21404023. \n\n^ Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, Jiranek WA, Berry DJ (2015). \"Prevalence of Total Hip and Knee Replacement in the United States\". J Bone Joint Surg Am. 97 (17): 1386\u201397. doi:10.2106\/JBJS.N.01141. PMC 4551172 . PMID 26333733. \n\n^ \"A study of cost variations for knee and hip replacement surgeries in the U.S.\" (PDF) . Blue Cross Blue Shield Association. 21 January 2015. Archived from the original (PDF) on 22 October 2015. Retrieved 4 October 2015 . \n\n^ \"History of Artificial Joints - ppt video online download\". slideplayer.com. \n\n^ Brand, RA; Mont, MA; Manring, M (2011). \"Biographical sketch: Themistocles Gluck (1853\u20131942)\". Clin. Orthop. Relat. Res. 469 (6): 1525\u20131527. doi:10.1007\/s11999-011-1836-8. PMC 3094624 . PMID 21403990. \n\n^ Gomez PF; Morcuende JA (2005). \"Early attempts at hip arthroplasty\u20141700s to 1950s\". Iowa Orthop J. 25: 25\u20139. PMC 1888777 . PMID 16089067. \n\n^ \"What You Need to Know About Joint Replacement Surgery\". about.com. \n\n\nExternal links \nEdheads Virtual Hip Surgery + Surgery Photos\nAAOS Hip Replacement\nvteOrthopedic surgery, operations\/surgeries and other procedures on bones and joints (ICD-9-CM V3 76\u201381, ICD-10-PCS 0P\u2013S)BonesFacial\nJaw reduction\nDentofacial osteotomy\nGenioplasty\/Mentoplasty\nChin augmentation\nOrthognathic surgery\nSpine\nCoccygectomy\nLaminotomy\nLaminectomy\nLaminoplasty\nCorpectomy\nFacetectomy\nForaminotomy\nVertebral fixation\nPercutaneous vertebroplasty\nUpper extremity\nAcromioplasty\nLower extremity\nFemoral head ostectomy\nAstragalectomy\nDistraction osteogenesis\nIlizarov apparatus\nPhemister graft\nGeneral\nOstectomy\nBone grafting\nOsteotomy\nEpiphysiodesis\nReduction\nInternal fixation\nExternal fixation\nTension band wiring\nCartilage\nArticular cartilage repair\nMicrofracture surgery\nKnee cartilage replacement therapy\nAutologous chondrocyte implantation\nJointsSpine\nArthrodesis\nSpinal fusion\nIntervertebral discs\nDiscectomy\nAnnuloplasty\nArthroplasty\nUpper extremity\nShoulder surgery\nShoulder replacement\nBankart repair\nWeaver\u2013Dunn procedure\nUlnar collateral ligament reconstruction\nHand surgery\nBrunelli procedure\nLower extremity\nHip resurfacing\nHip replacement\nRotationplasty\nAnterior cruciate ligament reconstruction\nKnee replacement\/Unicompartmental knee arthroplasty\nAnkle replacement\nBrostr\u00f6m procedure\nTriple arthrodesis\nGeneral\nArthrotomy\nArthroplasty\nSynovectomy\nArthroscopy\nReplacement joint\nimaging: Arthrogram\nArthrocentesis\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Hip_replacement\">https:\/\/www.limswiki.org\/index.php\/Hip_replacement<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 29 February 2016, at 23:07.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 583 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","18026209e7901858227ab2cae8f033cf_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Hip_replacement skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Hip replacement<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">This article is about human hip replacement. For hip replacement in animals, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement_(animal)\" title=\"Hip replacement (animal)\" rel=\"external_link\" target=\"_blank\">Hip replacement (animal)<\/a>.<\/div>\n\n<p><b>Hip replacement<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgical<\/a> procedure in which the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip\" title=\"Hip\" rel=\"external_link\" target=\"_blank\">hip<\/a> joint is replaced by a prosthetic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implant<\/a>, that is, a <b>hip prosthesis<\/b>. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement\" title=\"Joint replacement\" rel=\"external_link\" target=\"_blank\">joint replacement<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopaedic_surgery\" class=\"mw-redirect\" title=\"Orthopaedic surgery\" rel=\"external_link\" target=\"_blank\">orthopaedic surgery<\/a> is generally conducted to relieve <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis\" title=\"Arthritis\" rel=\"external_link\" target=\"_blank\">arthritis<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\" title=\"Pain\" rel=\"external_link\" target=\"_blank\">pain<\/a> or in some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_fracture\" title=\"Hip fracture\" rel=\"external_link\" target=\"_blank\">hip fractures<\/a>. A total hip replacement (total hip arthroplasty) consists of replacing both the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetabulum\" title=\"Acetabulum\" rel=\"external_link\" target=\"_blank\">acetabulum<\/a> and the femoral head while <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemiarthroplasty\" class=\"mw-redirect\" title=\"Hemiarthroplasty\" rel=\"external_link\" target=\"_blank\">hemiarthroplasty<\/a> generally only replaces the femoral head. Hip replacement is currently one of the most common orthopaedic operations, though patient satisfaction short- and long-term varies widely. The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.<sup id=\"rdp-ebb-cite_ref-ifhp_1-0\" class=\"reference\"><a href=\"#cite_note-ifhp-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<p>Total hip replacement is most commonly used to treat joint failure caused by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\" title=\"Osteoarthritis\" rel=\"external_link\" target=\"_blank\">osteoarthritis<\/a>. Other indications include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\" title=\"Rheumatoid arthritis\" rel=\"external_link\" target=\"_blank\">rheumatoid arthritis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Avascular_necrosis\" title=\"Avascular necrosis\" rel=\"external_link\" target=\"_blank\">avascular necrosis<\/a>, , <a href=\"https:\/\/en.wikipedia.org\/wiki\/Protrusio_acetabuli\" title=\"Protrusio acetabuli\" rel=\"external_link\" target=\"_blank\">protrusio acetabuli<\/a>, certain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_fracture\" title=\"Hip fracture\" rel=\"external_link\" target=\"_blank\">hip fractures<\/a>, benign and malignant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_tumor\" title=\"Bone tumor\" rel=\"external_link\" target=\"_blank\">bone tumors<\/a>, arthritis associated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paget%27s_disease_of_bone\" title=\"Paget's disease of bone\" rel=\"external_link\" target=\"_blank\">Paget's disease<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ankylosing_spondylitis\" title=\"Ankylosing spondylitis\" rel=\"external_link\" target=\"_blank\">ankylosing spondylitis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Juvenile_rheumatoid_arthritis\" class=\"mw-redirect\" title=\"Juvenile rheumatoid arthritis\" rel=\"external_link\" target=\"_blank\">juvenile rheumatoid arthritis<\/a>. The aims of the procedure are pain relief and improvement in hip function. Hip replacement is usually considered only after other therapies, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_therapy\" title=\"Physical therapy\" rel=\"external_link\" target=\"_blank\">physical therapy<\/a> and pain medications, have failed.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Modern_process\">Modern process<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:162px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_components.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/da\/Hip_prosthesis_components.jpg\/160px-Hip_prosthesis_components.jpg\" width=\"160\" height=\"197\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_components.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Main components of a hip prosthesis<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0a\/Hip_prosthesis.jpg\/220px-Hip_prosthesis.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a> hip prosthesis, with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic\" title=\"Ceramic\" rel=\"external_link\" target=\"_blank\">ceramic<\/a> head and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a> acetabular cup<\/div><\/div><\/div>\n<p>The modern artificial joint owes much to the 1962 work of Sir <a href=\"https:\/\/en.wikipedia.org\/wiki\/John_Charnley\" title=\"John Charnley\" rel=\"external_link\" target=\"_blank\">John Charnley<\/a> at Wrightington Hospital. His work in the field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tribology\" title=\"Tribology\" rel=\"external_link\" target=\"_blank\">tribology<\/a> resulted in a design that almost completely replaced the other designs by the 1970s. Charnley's design consisted of three parts:\n<\/p>\n<ol><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_Steel\" class=\"mw-redirect\" title=\"Stainless Steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a> one-piece femoral stem and head<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a> (originally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Teflon\" class=\"mw-redirect\" title=\"Teflon\" rel=\"external_link\" target=\"_blank\">Teflon<\/a>), acetabular component, both of which were fixed to the bone using<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Poly(methyl_methacrylate)\" title=\"Poly(methyl methacrylate)\" rel=\"external_link\" target=\"_blank\">PMMA<\/a> (acrylic) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_cement\" title=\"Bone cement\" rel=\"external_link\" target=\"_blank\">bone cement<\/a><\/li><\/ol>\n<p>The replacement joint, which was known as the Low Friction <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroplasty\" title=\"Arthroplasty\" rel=\"external_link\" target=\"_blank\">Arthroplasty<\/a>, was lubricated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Synovial_fluid\" title=\"Synovial fluid\" rel=\"external_link\" target=\"_blank\">synovial fluid<\/a>. The small femoral head (<span class=\"frac nowrap\"><sup>7<\/sup>⁄<sub>8<\/sub><\/span> in (22.2 mm)) was chosen for Charnley's belief that it would have lower friction against the acetabular component and thus wear out the acetabulum more slowly. Unfortunately, the smaller head dislocated more easily. Alternative designs with larger heads such as the Mueller prosthesis were proposed. Stability was improved, but acetabular wear and subsequent failure rates were increased with these designs. The Teflon acetabular components of Charnley's early designs failed within a year or two of implantation. This prompted a search for a more suitable material. A German salesman showed a polyethylene gear sample to Charnley's machinist, sparking the idea to use this material for the acetabular component. The ultra high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_weight\" class=\"mw-redirect\" title=\"Molecular weight\" rel=\"external_link\" target=\"_blank\">molecular weight<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/UHMWPE\" class=\"mw-redirect\" title=\"UHMWPE\" rel=\"external_link\" target=\"_blank\">UHMWPE<\/a> acetabular component was introduced in 1962. Charnley's other major contribution was to use polymethylmethacrylate (PMMA) bone cement to attach the two components to the bone. For over two decades, the Charnley Low Friction Arthroplasty, and derivative designs were the most used systems in the world. It formed the basis for all modern hip implants.\n<\/p><p>The Exeter hip stem was developed in the United Kingdom during the same time as the Charnley device. Its development occurred following a collaboration between Orthopaedic Surgeon <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robin_Ling\" title=\"Robin Ling\" rel=\"external_link\" target=\"_blank\">Robin Ling<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Exeter\" title=\"University of Exeter\" rel=\"external_link\" target=\"_blank\">University of Exeter<\/a> engineer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clive_Lee\" title=\"Clive Lee\" rel=\"external_link\" target=\"_blank\">Clive Lee<\/a> and it was first implanted at the Princess Elizabeth Orthopaedic Hospital in Exeter in 1970.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> The Exeter Hip is a cemented device, but with a slightly different stem geometry. Both designs have shown excellent long-term durability when properly placed and are still widely used in slightly modified versions.\n<\/p><p>Early implant designs had the potential to loosen from their attachment to the bones, typically becoming painful ten to twelve years after placement. In addition, erosion of the bone around the implant was seen on x-rays. Initially, surgeons believed this was caused by an abnormal reaction to the cement holding the implant in place. That belief prompted a search for an alternative method to attach the implants. The Austin Moore device had a small hole in the stem into which bone graft was placed before implanting the stem. It was hoped bone would then grow through the window over time and hold the stem in position. Success was unpredictable and the fixation not very robust. In the early 1980s, surgeons in the United States applied a coating of small beads to the Austin Moore device and implanted it without cement. The beads were constructed so that gaps between beads matched the size of the pores in native bone. Over time, bone cells from the patient would grow into these spaces and fix the stem in position. The stem was modified slightly to fit more tightly into the femoral canal, resulting in the Anatomic Medullary Locking (AML) stem design. With time, other forms of stem surface treatment and stem geometry have been developed and improved.\n<\/p><p>Initial hip designs were made of a one-piece femoral component and a one-piece acetabular component. Current designs have a femoral stem and separate head piece. Using an independent head allows the surgeon to adjust leg length (some heads seat more or less onto the stem) and to select from various materials from which the head is formed. A modern acetabulum component is also made up of two parts: a metal shell with a coating for bone attachment and a separate liner. First the shell is placed. Its position can be adjusted, unlike the original cemented cup design which are fixed in place once the cement sets. When proper positioning of the metal shell is obtained, the surgeon may select a liner made from various materials.\n<\/p><p>To combat loosening caused by polyethylene wear debris, hip manufacturers developed improved and novel materials for the acetabular liners. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic\" title=\"Ceramic\" rel=\"external_link\" target=\"_blank\">Ceramic<\/a> heads mated with regular polyethylene liners or a ceramic liner were the first significant alternative. Metal liners to mate with a metal head were also developed. At the same time these designs were being developed, the problems that caused polyethylene wear were determined and manufacturing of this material improved. Highly crosslinked UHMWPE was introduced in the late 1990s. The most recent data comparing the various bearing surfaces has shown no clinically significant differences in their performance. Potential early problems with each material are discussed below. Performance data after 20 or 30 years may be needed to demonstrate significant differences in the devices. All newer materials allow use of larger diameter femoral heads. Use of larger heads significantly decreases the chance of the hip dislocating, which remains the greatest complication of the surgery.\n<\/p><p>When currently available implants are used, cemented stems tend to have a better longevity than uncemented stems. No significant difference is observed in the clinical performance of the various methods of surface treatment of uncemented devices. Uncemented stems are selected for patients with good quality bone that can resist the forces needed to drive the stem in tightly. Cemented devices are typically selected for patients with poor quality bone who are at risk of fracture during stem insertion. Cemented stems are less expensive due to lower manufacturing cost, but require good surgical technique to place them correctly. Uncemented stems can cause pain with activity in up to 20% of patients during the first year after placement as the bone adapts to the device. This is rarely seen with cemented stems.\n<\/p><p>Once an uncommon operation reserved for frail patients with a limited life expectancy, hip replacement is now common, even among active <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sportsperson\" class=\"mw-redirect\" title=\"Sportsperson\" rel=\"external_link\" target=\"_blank\">athletes<\/a> including race car drivers <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bobby_Labonte\" title=\"Bobby Labonte\" rel=\"external_link\" target=\"_blank\">Bobby Labonte<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dale_Jarrett\" title=\"Dale Jarrett\" rel=\"external_link\" target=\"_blank\">Dale Jarrett<\/a>, and the 8-time Major-winning American golfer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tom_Watson_(golfer)\" title=\"Tom Watson (golfer)\" rel=\"external_link\" target=\"_blank\">Tom Watson<\/a>, who shot a 67 in the opening round of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Masters_Tournament\" title=\"Masters Tournament\" rel=\"external_link\" target=\"_blank\">Masters Tournament<\/a> in the year following his operation.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Techniques\">Techniques<\/span><\/h2>\n<p>There are several incisions, defined by their relation to the gluteus medius. The approaches are posterior (Moore), lateral (Hardinge or Liverpool),<sup id=\"rdp-ebb-cite_ref-pmid9498150_4-0\" class=\"reference\"><a href=\"#cite_note-pmid9498150-4\" rel=\"external_link\">[4]<\/a><\/sup> antero-lateral (Watson-Jones),<sup id=\"rdp-ebb-cite_ref-titleAnterolateral_Approach_to_Hip_Joint:_(Watson_Jones)_-_Wheeless'_Textbook_of_Orthopaedics_5-0\" class=\"reference\"><a href=\"#39;_Textbook_of_Orthopaedics-5\" rel=\"external_link\">[5]<\/a><\/sup> anterior (Smith-Petersen)<sup id=\"rdp-ebb-cite_ref-titleAnterior_Approach_to_the_Hip_(Smith_Petersen)_-_Wheeless'_Textbook_of_Orthopaedics_6-0\" class=\"reference\"><a href=\"#39;_Textbook_of_Orthopaedics-6\" rel=\"external_link\">[6]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greater_trochanter\" title=\"Greater trochanter\" rel=\"external_link\" target=\"_blank\">greater trochanter<\/a> osteotomy. There is no compelling evidence in the literature for any particular approach, but consensus of professional opinion favours either modified anterolateral (Watson-Jones) or posterior approach.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2007)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Posterior_approach\">Posterior approach<\/span><\/h3>\n<p>The <i>posterior (Moore or Southern) approach<\/i> accesses the joint and capsule through the back, taking <a href=\"https:\/\/en.wikipedia.org\/wiki\/Piriformis_muscle\" title=\"Piriformis muscle\" rel=\"external_link\" target=\"_blank\">piriformis muscle<\/a> and the short external rotators of the femur. This approach gives excellent access to the acetabulum and femur and preserves the hip <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abduction_(kinesiology)\" class=\"mw-redirect\" title=\"Abduction (kinesiology)\" rel=\"external_link\" target=\"_blank\">abductors<\/a> and thus minimizes the risk of abductor dysfunction post operatively. It has the advantage of becoming a more extensile approach if needed. Critics cite a higher dislocation rate, although repair of the capsule, piriformis and the short external rotators along with use of modern large diameter head balls reduces this risk.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Lateral_approach\">Lateral approach<\/span><\/h3>\n<p>The <i>lateral approach<\/i> is also commonly used for hip replacement. The approach requires elevation of the hip abductors (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteus_medius\" title=\"Gluteus medius\" rel=\"external_link\" target=\"_blank\">gluteus medius<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteus_minimus\" title=\"Gluteus minimus\" rel=\"external_link\" target=\"_blank\">gluteus minimus<\/a>) to access the joint. The abductors may be lifted up by osteotomy of the greater trochanter and reapplying it afterwards using wires (as per Charnley),<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2007)\">citation needed<\/span><\/a><\/i>]<\/sup> or may be divided at their tendinous portion, or through the functional tendon (as per Hardinge) and repaired using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" title=\"Surgical suture\" rel=\"external_link\" target=\"_blank\">sutures<\/a>. Although this approach has a lower dislocation risk than the posterior approach, critics note that occasionally the abductor muscles do not heal back on, leading to pain and weakness which is often very difficult to treat.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Antero-lateral_approach\">Antero-lateral approach<\/span><\/h3>\n<p>The <i>anterolateral approach<\/i> develops the interval between the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tensor_fasciae_latae\" class=\"mw-redirect\" title=\"Tensor fasciae latae\" rel=\"external_link\" target=\"_blank\">tensor fasciae latae<\/a> and the gluteus medius. The Gluteus medius, gluteus minimus and hip capsule are detached from the anterior (front) for the greater trochanter and femoral neck and then repaired with heavy suture after the replacement of the joint.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Anterior_approach\">Anterior approach<\/span><\/h3>\n<p>The <i>anterior approach<\/i> uses an interval between the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sartorius_muscle\" title=\"Sartorius muscle\" rel=\"external_link\" target=\"_blank\">sartorius muscle<\/a> and tensor fasciae latae. Dr. Joel Matta and Dr. Bert Thomas have adapted this approach, which was commonly used for pelvic fracture repair surgery, for use when performing hip replacement. When used with older hip implant systems that had a small diameter head, dislocation rates were reduced compared to surgery performed through a posterior approach. With modern implant designs, dislocation rates are similar between the anterior and posterior approaches.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> The anterior approach has been shown in studies to variably improve early functional recovery, with possible complications of femoral component loosening and early revision compared to other approaches<sup id=\"rdp-ebb-cite_ref-Direct_Anterior_Approach_8-0\" class=\"reference\"><a href=\"#cite_note-Direct_Anterior_Approach-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-James_I_2016_9-0\" class=\"reference\"><a href=\"#cite_note-James_I_2016-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Minimally_invasive_approaches\">Minimally invasive approaches<\/span><\/h3>\n<p>The dual incision approach and other minimally invasive surgery seeks to reduce soft tissue damage through reducing the size of the incision. However, component positioning accuracy and visualization of the bone structures can be significantly impaired as the approaches get smaller. This can result in unintended fractures and soft tissue injury. The majority of current orthopedic surgeons use a \"minimally invasive\" approach compared to traditional approaches which were quite large comparatively.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-assisted_surgery\" title=\"Computer-assisted surgery\" rel=\"external_link\" target=\"_blank\">Computer-assisted surgery<\/a> and robotic surgery techniques are also available to guide the surgeon to provide enhanced accuracy. Several commercial CAS and robotic systems are available for use worldwide. Improved patient outcomes and reduced complications have not been demonstrated when these systems are used when compared to standard techniques.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Implants\">Implants<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MetalonmetalhipreplaceMark.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/33\/MetalonmetalhipreplaceMark.png\/220px-MetalonmetalhipreplaceMark.png\" width=\"220\" height=\"183\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MetalonmetalhipreplaceMark.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Metal on metal prosthetic hip<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip-replacement.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Hip-replacement.jpg\/170px-Hip-replacement.jpg\" width=\"170\" height=\"294\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip-replacement.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Cement-free implant sixteen days after surgery. Femoral component is cobalt chromium combined with titanium which induces bone growth into the implant. Ceramic head. Acetabular cup coated with bone growth-inducing material and held temporarily in place with a single screw.<\/div><\/div><\/div>\n<p>The prosthetic implant used in hip replacement consists of three parts: the acetabular cup, the femoral component, and the articular interface. Options exist for different people and indications. The evidence for a number of newer devices is not very good, including: ceramic-on-ceramic bearings, modular femoral necks, and uncemented monoblock cups.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> Correct selection of the prosthesis is important.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Acetabular_cup\">Acetabular cup<\/span><\/h3>\n<p>The acetabular cup is the component which is placed into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetabulum\" title=\"Acetabulum\" rel=\"external_link\" target=\"_blank\">acetabulum<\/a> (hip socket). Cartilage and bone are removed from the acetabulum and the acetabular cup is attached using friction or cement. Some acetabular cups are one piece, while others are modular. One-piece (monobloc) shells are either UHMWPE (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultra-high-molecular-weight_polyethylene\" title=\"Ultra-high-molecular-weight polyethylene\" rel=\"external_link\" target=\"_blank\">ultra-high-molecular-weight polyethylene<\/a>) or metal, they have their articular surface machined on the inside surface of the cup and do not rely on a locking mechanism to hold a liner in place. A monobloc polyethylene cup is cemented in place while a metal cup is held in place by a metal coating on the outside of the cup. Modular cups consist of two pieces, a shell and liner. The shell is made of metal; the outside has a porous coating while the inside contains a locking mechanism designed to accept a liner. Two types of porous coating used to form a friction fit are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sintering\" title=\"Sintering\" rel=\"external_link\" target=\"_blank\">sintered<\/a> beads and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foam_metal\" class=\"mw-redirect\" title=\"Foam metal\" rel=\"external_link\" target=\"_blank\">foam metal<\/a> design to mimic the trabeculae of cancellous bone and initial stability is influenced by under-reaming and insertion force.<sup id=\"rdp-ebb-cite_ref-Amirouche_17-0\" class=\"reference\"><a href=\"#cite_note-Amirouche-17\" rel=\"external_link\">[17]<\/a><\/sup> Permanent fixation is achieved as bone grows onto or into the porous coating. Screws can be used to lag the shell to the bone providing even more fixation. Polyethylene liners are placed into the shell and connected by a rim locking mechanism; ceramic and metal liners are attached with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Morse_taper\" class=\"mw-redirect\" title=\"Morse taper\" rel=\"external_link\" target=\"_blank\">Morse taper<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (July 2012)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Femoral_component\">Femoral component<\/span><\/h3>\n<p>The femoral component is the component that fits in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femur\" title=\"Femur\" rel=\"external_link\" target=\"_blank\">femur<\/a> (thigh bone). Bone is removed and the femur is shaped to accept the femoral stem with attached prosthetic femoral head (ball). There are two types of fixation: cemented and uncemented. Cemented stems use acrylic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_cement\" title=\"Bone cement\" rel=\"external_link\" target=\"_blank\">bone cement<\/a> to form a mantle between the stem and to the bone. Uncemented stems use friction, shape and surface coatings to stimulate bone to remodel and bond to the implant. Stems are made of multiple materials (titanium, cobalt chromium, stainless steel, and polymer composites) and they can be monolithic or modular. Modular components consist of different head dimensions and\/or modular neck orientations; these attach via a taper similar to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Morse_taper\" class=\"mw-redirect\" title=\"Morse taper\" rel=\"external_link\" target=\"_blank\">Morse taper<\/a>. These options allow for variability in leg length, offset and version. Femoral heads are made of metal or ceramic material. Metal heads, made of cobalt chromium for hardness, are machined to size and then polished to reduce wear of the socket liner. Ceramic heads are more smooth than polished metal heads, have a lower coefficient of friction than a cobalt chrome head, and in theory will wear down the socket liner more slowly. As of early 2011, follow-up studies in patients have not demonstrated significant reductions in wear rates between the various types of femoral heads on the market. Ceramic implants are more brittle and may break after being implanted.\n<\/p><h3><span class=\"mw-headline\" id=\"Articular_interface\">Articular interface<\/span><\/h3>\n<p>The articular interface is not part of either implant, rather it is the area between the acetabular cup and femoral component. The articular interface of the hip is a simple ball and socket joint. Size, material properties and machining <a href=\"https:\/\/en.wikipedia.org\/wiki\/Engineering_tolerance\" title=\"Engineering tolerance\" rel=\"external_link\" target=\"_blank\">tolerances<\/a> at the articular interface can be selected based on patient demand to optimise implant function and longevity whilst mitigating associated risks. The interface size is measured by the outside diameter of the head or the inside diameter of the socket. Common sizes of femoral heads are 28 mm (1.1 in), 32 mm (1.3 in) and 36 mm (1.4 in). While 22.25 mm (<span class=\"frac nowrap\"><sup>7<\/sup>⁄<sub>8<\/sub><\/span> in) was common in the first modern prostheses, now even larger sizes are available from 38 to over 54 mm. Larger-diameter heads lead to increased stability and range of motion whilst lowering the risk of dislocation. At the same time they are also subject to higher stresses such as friction and inertia. Different combinations of materials have different physical properties which can be coupled to reduce the amount of wear debris generated by friction. Typical pairings of materials include metal on polyethylene (MOP), metal on crosslinked polyethylene (MOXP), ceramic on ceramic (COC), ceramic on crosslinked polyethylene (COXP) and metal on metal (MOM). Each combination has different advantages and disadvantages.\n<\/p><h2><span class=\"mw-headline\" id=\"Configuration\">Configuration<\/span><\/h2>\n<p>Post-operative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Projectional_radiography\" title=\"Projectional radiography\" rel=\"external_link\" target=\"_blank\">projectional radiography<\/a> is routinely performed to ensure proper configuration of hip prostheses.\n<\/p><p>The direction of the acetabular cup influences the range of motion of the leg, and also affects the risk of dislocation.<sup id=\"rdp-ebb-cite_ref-Watt_18-0\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup> For this purpose, the <i>acetabular inclination<\/i> and the <i>acetabular anteversion<\/i> are measurements of cup angulation in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronal_plane\" title=\"Coronal plane\" rel=\"external_link\" target=\"_blank\">coronal plane<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sagittal_plane\" title=\"Sagittal plane\" rel=\"external_link\" target=\"_blank\">sagittal plane<\/a>, respectively.\n<\/p>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Acetabular_inclination_of_hip_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/92\/Acetabular_inclination_of_hip_prosthesis.jpg\/230px-Acetabular_inclination_of_hip_prosthesis.jpg\" width=\"230\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Acetabular inclination.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-0\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup> This parameter is calculated on an anteroposterior radiograph as the angle between a line through the lateral and medial margins of the acetabular cup and the <i>transischial line<\/i> which is tangential to the inferior margins of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ischium\" title=\"Ischium\" rel=\"external_link\" target=\"_blank\">ischium<\/a> bones.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-1\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:23.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Range_of_acetabular_inclination.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/91\/Range_of_acetabular_inclination.png\/230px-Range_of_acetabular_inclination.png\" width=\"230\" height=\"103\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Acetabular inclination is normally between 30 and 50\u00b0.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-2\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup> A larger angle increases the risk of dislocation.<sup id=\"rdp-ebb-cite_ref-Watt_18-1\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Acetabular_anteversion_of_hip_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/28\/Acetabular_anteversion_of_hip_prosthesis.jpg\/104px-Acetabular_anteversion_of_hip_prosthesis.jpg\" width=\"104\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Acetabular anteversion.<sup id=\"rdp-ebb-cite_ref-ShinLee2015_20-0\" class=\"reference\"><a href=\"#cite_note-ShinLee2015-20\" rel=\"external_link\">[20]<\/a><\/sup> This parameter is calculated on a lateral radiograph as the angle between the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transverse_plane\" title=\"Transverse plane\" rel=\"external_link\" target=\"_blank\">transverse plane<\/a> and a line going through the (anterior and posterior) margins of the acetabular cup.<sup id=\"rdp-ebb-cite_ref-ShinLee2015_20-1\" class=\"reference\"><a href=\"#cite_note-ShinLee2015-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:22px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Range_of_acetabular_anteversion.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/Range_of_acetabular_anteversion.png\/230px-Range_of_acetabular_anteversion.png\" width=\"230\" height=\"106\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Acetabular anteversion is normally between 5 and 25\u00b0.<sup id=\"rdp-ebb-cite_ref-Watt_18-2\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup> An anteversion below or above this range increases the risk of dislocation.<sup id=\"rdp-ebb-cite_ref-Watt_18-3\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup> There is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intra-individual_variability\" class=\"mw-redirect\" title=\"Intra-individual variability\" rel=\"external_link\" target=\"_blank\">intra-individual variability<\/a> in this method because the pelvis may be tilted in various degrees in relation to the transverse plane.<sup id=\"rdp-ebb-cite_ref-Watt_18-4\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:24px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Leg_length_discrepancy_after_hip_replacement.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d7\/Leg_length_discrepancy_after_hip_replacement.jpg\/230px-Leg_length_discrepancy_after_hip_replacement.jpg\" width=\"230\" height=\"102\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p><i>Leg length discrepancy<\/i> after hip replacement is calculated as the vertical distance between the middle of the minor trochanters, using the acetabular tear drops<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-3\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup> or the transischial line<sup id=\"rdp-ebb-cite_ref-Watt_18-5\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup> as references for the horizontal plane. A discrepancy of up to 1 cm is generally tolerated.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-4\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Watt_18-6\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:22px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Center_of_rotation_of_hip_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Center_of_rotation_of_hip_prosthesis.jpg\/230px-Center_of_rotation_of_hip_prosthesis.jpg\" width=\"230\" height=\"106\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p><i>Center of rotation<\/i>: The horizontal center of rotation is calculated as the distance between the acetabular teardrop and the center of the head (or caput) of the prosthesis and\/or the native femoral head on the contralateral side.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-5\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup> The vertical center of rotation instead uses the transischial line for reference.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-6\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup> The parameter should be equal on both sides.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-7\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h2><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h2>\n<p>Risks and complications in hip replacement are similar to those associated with all <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement#Risks_and_complications\" title=\"Joint replacement\" rel=\"external_link\" target=\"_blank\">joint replacements<\/a>. They can include infection, dislocation, limb length inequality, loosening, impingement, osteolysis, metal sensitivity, nerve palsy, chronic pain and death. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bariatric_surgery\" title=\"Bariatric surgery\" rel=\"external_link\" target=\"_blank\">Weight loss surgery<\/a> before a hip replacement does not appear to change outcomes.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Infection\">Infection<\/span><\/h3>\n<p>Infection is one of the most common causes for revision of a total hip replacement, along with loosening and dislocation. The incidence of infection in primary hip replacement is around 1% or less in the United States.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> Risk factors for infection include obesity, diabetes, smoking, immunosuppressive medications or diseases, and history of infection.\n<\/p><p>Modern diagnosis of infection around a total knee replacement is based on the Musculoskeletal Infection Society (MSIS) criteria.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> They are:\n<\/p><p>1.There is a sinus tract communicating with the prosthesis; or\n<p>2. A pathogen is isolated by culture from at least two separate tissue or fluid samples obtained from the affected prosthetic joint; \nor\n<\/p>\n<\/p><p>Four of the following six criteria exist:\n<\/p><p>1.Elevated serum erythrocyte sedimentation rate (ESR>30mm\/hr) and serum C-reactive protein (CRP>10 mg\/L) concentration,\n<\/p><p>2.Elevated synovial leukocyte count,\n<\/p><p>3.Elevated synovial neutrophil percentage (PMN%),\n<\/p><p>4.Presence of purulence in the affected joint,\n<\/p><p>5.Isolation of a microorganism in one culture of periprosthetic tissue or fluid, or\n<\/p><p>6.Greater than five neutrophils per high-power field in five high-power fields observed from histologic analysis of periprosthetic tissue at \u00d7400 magnification.\n<\/p><p>None of the above laboratory tests has 100% sensitivity or specificity for diagnosing infection. Specificity improves when the tests are performed in patients in whom clinical suspicion exists. ESR and CRP remain good 1st line tests for screening (high sensitivity, low specificity). Aspiration of the joint remains the test with the highest specificity for confirming infection.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Dislocation\">Dislocation<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dislocated_hip_replacement.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/76\/Dislocated_hip_replacement.jpg\/170px-Dislocated_hip_replacement.jpg\" width=\"170\" height=\"226\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dislocated_hip_replacement.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Dislocated artificial hip<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:162px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_liner_creep_and_wear.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d9\/Hip_prosthesis_liner_creep_and_wear.png\/160px-Hip_prosthesis_liner_creep_and_wear.png\" width=\"160\" height=\"153\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_liner_creep_and_wear.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Liner wear, particularly when over 2 mm, increases the risk of dislocation.<sup id=\"rdp-ebb-cite_ref-berry2012_24-0\" class=\"reference\"><a href=\"#cite_note-berry2012-24\" rel=\"external_link\">[24]<\/a><\/sup> Liner creep, on the other hand, is normal remoulding.<sup id=\"rdp-ebb-cite_ref-Watt_18-7\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup><\/div><\/div><\/div>\n<p>Dislocation is the most common complication of hip replacement surgery. The most common causes vary by the duration since the surgery.\n<\/p><p>Hip prosthesis <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_dislocation\" title=\"Joint dislocation\" rel=\"external_link\" target=\"_blank\">dislocation<\/a> mostly occurs in the first 3 months after insertion, mainly because of incomplete scar formation and relaxed soft tissues.<sup id=\"rdp-ebb-cite_ref-berry2012_24-1\" class=\"reference\"><a href=\"#cite_note-berry2012-24\" rel=\"external_link\">[24]<\/a><\/sup> It takes eight to twelve weeks for the soft tissues injured or cut during surgery to heal. During this period, the hip ball can come out of the socket. The chance of this is diminished if less tissue is cut, if the tissue cut is repaired and if large diameter head balls are used.\n<\/p><p>Dislocations occurring between 3 months and 5 years after insertion usually occur due to malposition of the components, or dysfunction of nearby muscles.<sup id=\"rdp-ebb-cite_ref-berry2012_24-2\" class=\"reference\"><a href=\"#cite_note-berry2012-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p><p>Risk factors of late dislocation (after 5 years) mainly include:<sup id=\"rdp-ebb-cite_ref-berry2012_24-3\" class=\"reference\"><a href=\"#cite_note-berry2012-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p>\n<ul><li>Female gender<\/li>\n<li>Younger age at primary hip arthroplasty<\/li>\n<li>Previous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subluxation\" title=\"Subluxation\" rel=\"external_link\" target=\"_blank\">subluxation<\/a> without complete dislocation<\/li>\n<li>Previous trauma<\/li>\n<li>Substantial weight loss<\/li>\n<li>Recent onset or progression of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dementia\" title=\"Dementia\" rel=\"external_link\" target=\"_blank\">dementia<\/a> or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurological_disorder\" title=\"Neurological disorder\" rel=\"external_link\" target=\"_blank\">neurological disorder<\/a><\/li>\n<li>Malposition of the cup<\/li>\n<li>Wear of the liner, particularly when it causes movement of the head of more than 2 mm within the cup compared to its original position<\/li>\n<li>Prosthesis loosening with migration<\/li><\/ul>\n<p>Surgeons who perform more of the operations each year tend to have fewer patients dislocate. Doing the surgery from an anterior approach seems to lower dislocation rates when small diameter heads are used, but the benefit has not been shown when compared to modern posterior incisions with the use of larger diameter heads. The use of larger diameter head size does in it self decrease the risk of dislocation, even though this correlation is only found in head sizes up to 28 mm, thereafter no additional decrease in dislocation rate is found.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> Patients can decrease the risk further by keeping the leg out of certain positions during the first few months after surgery.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Limb_Length_Inequality\">Limb Length Inequality<\/span><\/h3>\n<p>Most adults prior to a hip replacement have a limb length inequality of 0\u20132 cm which they were born with and which causes no clinical deficits.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> It is common for patients to feel a limb length inequality after total hip replacement.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> Sometimes the leg seems long immediately after surgery when in fact both are equal length. An arthritic hip can develop contractures that make the leg behave as if it is short. When these are relieved with replacement surgery and normal motion and function are restored, the body feels that the limb is now longer than it was. This feeling usually subsides by 6 months after surgery as the body adjusts to the new hip joint. The cause of this feeling is variable, and usually related to abductor muscle weakness, pelvic obliquity, and minor lengthening of the hip during surgery (<1 cm) to achieve stability and restore the joint to pre-arthritic mechanics. If the limb length difference remains bothersome to the patient more than 6 months after surgery, a shoe lift can be used. Only in extreme cases is surgery required for correction.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Fracture\">Fracture<\/span><\/h3>\n<p>Bones with internal fixation devices in situ are at risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Periprosthetic\" title=\"Periprosthetic\" rel=\"external_link\" target=\"_blank\">periprosthetic<\/a> fractures at the end of the implant, an area of relative mechanical stress. Post-operative femoral fractures are graded by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vancouver_classification\" title=\"Vancouver classification\" rel=\"external_link\" target=\"_blank\">Vancouver classification<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Vein_thrombosis\">Vein thrombosis<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Venous_thrombosis\" title=\"Venous thrombosis\" rel=\"external_link\" target=\"_blank\">Venous thrombosis<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deep_vein_thrombosis\" title=\"Deep vein thrombosis\" rel=\"external_link\" target=\"_blank\">deep vein thrombosis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulmonary_embolism\" title=\"Pulmonary embolism\" rel=\"external_link\" target=\"_blank\">pulmonary embolism<\/a> are relatively common following hip replacement surgery. Standard treatment with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anticoagulant\" title=\"Anticoagulant\" rel=\"external_link\" target=\"_blank\">anticoagulants<\/a> is for 7\u201310 days; however treatment for more than 21 days may be superior.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> Research from 2013 has on the other hand suggested that anticoagulants in otherwise healthy patients undergoing a so-called fast track protocol with hospital stays under five days, might only be necessary while in the hospital.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p><p>Some physicians and patients may consider having an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasonography_for_deep_vein_thrombosis\" class=\"mw-redirect\" title=\"Ultrasonography for deep vein thrombosis\" rel=\"external_link\" target=\"_blank\">ultrasonography for deep vein thrombosis<\/a> after hip replacement.<sup id=\"rdp-ebb-cite_ref-AAOSfive_30-0\" class=\"reference\"><a href=\"#cite_note-AAOSfive-30\" rel=\"external_link\">[30]<\/a><\/sup> However, this kind of screening should only be done when indicated because to perform it routinely would be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Unnecessary_health_care\" title=\"Unnecessary health care\" rel=\"external_link\" target=\"_blank\">unnecessary health care<\/a>.<sup id=\"rdp-ebb-cite_ref-AAOSfive_30-1\" class=\"reference\"><a href=\"#cite_note-AAOSfive-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Osteolysis\">Osteolysis<\/span><\/h3>\n<p>Many long-term problems with hip replacements are the result of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteolysis\" title=\"Osteolysis\" rel=\"external_link\" target=\"_blank\">osteolysis<\/a>. This is the loss of bone caused by the body's reaction to polyethylene wear debris, fine bits of plastic that come off the cup liner over time. An <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\" title=\"Inflammation\" rel=\"external_link\" target=\"_blank\">inflammatory<\/a> process causes bone resorption that may lead to subsequent loosening of the hip implants and even fractures in the bone around the implants. In an attempt to eliminate the generation of wear particles, ceramic bearing surfaces are being used in the hope that they will have less wear and less osteolysis with better long-term results. Metal cup liners joined with metal heads (metal-on-metal hip arthroplasty) were also developed for similar reasons. In the lab these show excellent wear characteristics and benefit from a different mode of lubrication. At the same time that these two bearing surfaces were being developed, highly cross linked polyethylene plastic liners were also developed. The greater cross linking significantly reduces the amount of plastic wear debris given off over time. The newer ceramic and metal prostheses do not always have the long-term track record of established metal on poly bearings. Ceramic pieces can break leading to catastrophic failure. This occurs in about 2% of the implants placed. They may also cause an audible, high pitched squeaking noise with activity. Metal-on-metal arthroplasty releases metal debris into the body raising concerns about the potential dangers of these accumulating over time. Highly cross linked polyethylene is not as strong as regular polyethylene. These plastic liners can crack or break free of the metal shell that holds them.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Loosening\">Loosening<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_joint_aseptic_loosening_ar1938-1.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b7\/Hip_joint_aseptic_loosening_ar1938-1.png\/170px-Hip_joint_aseptic_loosening_ar1938-1.png\" width=\"170\" height=\"254\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_joint_aseptic_loosening_ar1938-1.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Hip prosthesis displaying aseptic loosening (arrows)<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:212px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_zones_by_DeLee_and_Charnley_system,_and_Gruen_system.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/00\/Hip_prosthesis_zones_by_DeLee_and_Charnley_system%2C_and_Gruen_system.jpg\/210px-Hip_prosthesis_zones_by_DeLee_and_Charnley_system%2C_and_Gruen_system.jpg\" width=\"210\" height=\"215\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_zones_by_DeLee_and_Charnley_system,_and_Gruen_system.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_prosthesis_zones\" title=\"Hip prosthesis zones\" rel=\"external_link\" target=\"_blank\">Hip prosthesis zones<\/a> according to DeLee and Charnley,<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> and Gruen.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> These are used to describe the location of for example areas of loosening.<\/div><\/div><\/div>\n<p>On radiography, it is normal to see thin radiolucent areas of less than 2 mm around hip prosthesis components, or between a cement mantle and bone. However, these may still indicate loosening of the prosthesis if they are new or changing, and areas greater than 2 mm may be harmless if they are stable.<sup id=\"rdp-ebb-cite_ref-RothMaertz2012_33-0\" class=\"reference\"><a href=\"#cite_note-RothMaertz2012-33\" rel=\"external_link\">[33]<\/a><\/sup> The most important prognostic factors of cemented cups are absence of radiolucent lines in DeLee and Charnley zone I, as well as adequate cement mantle thickness.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup> In the first year after insertion of uncemented femoral stems, it is normal to have mild subsidence (less than 10 mm).<sup id=\"rdp-ebb-cite_ref-RothMaertz2012_33-1\" class=\"reference\"><a href=\"#cite_note-RothMaertz2012-33\" rel=\"external_link\">[33]<\/a><\/sup> The direct anterior approach has been shown to itself be a risk factor for early femoral component loosening.<sup id=\"rdp-ebb-cite_ref-James_I_2016_9-1\" class=\"reference\"><a href=\"#cite_note-James_I_2016-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Direct_Anterior_Approach_8-1\" class=\"reference\"><a href=\"#cite_note-Direct_Anterior_Approach-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Metal_sensitivity\">Metal sensitivity<\/span><\/h3>\n<p>Concerns are being raised about the metal sensitivity and potential dangers of metal particulate debris. New publications<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup> have demonstrated development of <i>pseudotumors<\/i>, soft tissue masses containing necrotic tissue, around the hip joint. It appears these masses are more common in women and these patients show a higher level of iron in the blood. The cause is unknown and is probably multifactorial. There may be a toxic reaction to an excess of particulate metal wear debris or a hypersensitivity reaction to a normal amount of metal debris.\n<\/p><p>Metal hypersensitivity is a well-established phenomenon and is common, affecting about 10\u201315% of the population.<sup id=\"rdp-ebb-cite_ref-Hallab01_38-0\" class=\"reference\"><a href=\"#cite_note-Hallab01-38\" rel=\"external_link\">[38]<\/a><\/sup> Contact with metals can cause immune reactions such as skin hives, eczema, redness and itching. Although little is known about the short- and long-term pharmacodynamics and bioavailability of circulating metal degradation products in vivo, there have been many reports of immunologic type responses temporally associated with implantation of metal components. Individual case reports link hypersensitivity immune reactions with adverse performance of metallic clinical cardiovascular, orthopedic and plastic surgical and dental implants.<sup id=\"rdp-ebb-cite_ref-Hallab01_38-1\" class=\"reference\"><a href=\"#cite_note-Hallab01-38\" rel=\"external_link\">[38]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Metal_toxicity\">Metal toxicity<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metallosis\" title=\"Metallosis\" rel=\"external_link\" target=\"_blank\">Metallosis<\/a><\/div>\n<p>Most hip replacements consist of cobalt and chromium alloys, or titanium. Stainless steel is no longer used. All implants release their constituent ions into the blood. Typically these are excreted in the urine, but in certain individuals the ions can accumulate in the body. In implants which involve metal-on-metal contact, microscopic fragments of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cobalt\" title=\"Cobalt\" rel=\"external_link\" target=\"_blank\">cobalt<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium\" title=\"Chromium\" rel=\"external_link\" target=\"_blank\">chromium<\/a> can be absorbed into the patient's bloodstream. There are reports of cobalt toxicity with hip replacement patients.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-reuters-20120329_40-0\" class=\"reference\"><a href=\"#cite_note-reuters-20120329-40\" rel=\"external_link\">[40]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Nerve_palsy\">Nerve palsy<\/span><\/h3>\n<p>Post operative sciatic nerve palsy is another possible complication. The incidence of this complication is low. Femoral nerve palsy is another but much more rare complication. Both of these will typically resolve over time, but the healing process is slow. Patients with pre-existing nerve injury are at greater risk of experiencing this complication and are also slower to recover.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Chronic_pain\">Chronic pain<\/span><\/h3>\n<p>A few patients who have had a hip replacement suffer chronic pain after the surgery. Groin pain can develop if the muscle that raises the hip (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Iliopsoas\" title=\"Iliopsoas\" rel=\"external_link\" target=\"_blank\">iliopsoas<\/a>) rubs against the edge of the acetabular cup. Bursitis can develop at the trochanter where a surgical scar crosses the bone, or if the femoral component used pushes the leg out to the side too far. Also some patients can experience pain in cold or damp weather.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2012)\">citation needed<\/span><\/a><\/i>]<\/sup> Incision made in the front of the hip (anterior approach) can cut a nerve running down the thigh leading to numbness in the thigh and occasionally chronic pain at the point where the nerve was cut (a neuroma).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Death\">Death<\/span><\/h3>\n<p>The rate of death for elective hip replacements is significantly less than 1%.<sup id=\"rdp-ebb-cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\" rel=\"external_link\">[41]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Metal-on-metal_hip_implant_failure\">Metal-on-metal hip implant failure<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_failure\" title=\"Implant failure\" rel=\"external_link\" target=\"_blank\">Implant failure<\/a><\/div>\n<p>By 2010, reports in the orthopaedic literature increasingly cited the problem of early failure of metal on metal prostheses in a small percentage of patients.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup> Failures may relate to release of minute metallic particles or metal ions from wear of the implants, causing pain and disability severe enough to require revision surgery in 1\u20133% of patients.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup> Design deficits of some prothesis models, especially with heat-treated alloys and a lack of special surgical experience accounting for most of the failures. In 2010, surgeons at medical centers such as the Mayo Clinic reported reducing their use of metal-on-metal implants by 80 percent over the previous year in favor of those made from other materials, like combinations of metal and plastic.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup> The cause of these failures remain controversial, and may include both design factors, technique factors, and factors related to patient immune responses (allergy type reactions). In the United Kingdom the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicines_and_Healthcare_Products_Regulatory_Agency\" class=\"mw-redirect\" title=\"Medicines and Healthcare Products Regulatory Agency\" rel=\"external_link\" target=\"_blank\">Medicines and Healthcare Products Regulatory Agency<\/a> commenced an annual monitoring regime for metal-on-metal hip replacement patients from May 2010.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup> Data which are shown in The Australian Orthopaedic Association's 2008 National <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement_registry\" title=\"Joint replacement registry\" rel=\"external_link\" target=\"_blank\">Joint replacement registry<\/a>, a record of nearly every hip implanted in that country over the previous 10 years, tracked 6,773 BHR (Birmingham Hip Resurfacing) Hips and found that less than one-third of one percent may have been revised due to the patient's reaction to the metal component.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup> Other similar metal-on-metal designs have not fared as well, where some reports show 76% to 100% of the people with these metal-on-metal implants and have aseptic implant failures requiring revision also have evidence of histological inflammation accompanied by extensive lymphocyte infiltrates, characteristic of delayed type hypersensitivity responses.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup> It is not clear to what extent this phenomenon negatively affects orthopedic patients. However, for patients presenting with signs of an allergic reactions, evaluation for sensitivity should be conducted. Removal of the device that is not needed should be considered, since removal may alleviate the symptoms. Patients who have allergic reactions to cheap jewelry are more likely to have reactions to orthopedic implants. There is increasing awareness of the phenomenon of metal sensitivity and many surgeons now take this into account when planning which implant is optimal for each patient.\n<\/p><p>On March 12, 2012, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Lancet\" title=\"The Lancet\" rel=\"external_link\" target=\"_blank\">The Lancet<\/a><\/i> published a study, based on data from the National Joint Registry of England and Wales, finding that metal-on-metal hip implants failed at much greater rates than other types of hip implants and calling for a ban on all metal-on-metal hips.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup> The analysis of 402,051 hip replacements showed that 6.2% of metal-on-metal hip implants had failed within five years, compared to 1.7% of metal-on-plastic and 2.3% of ceramic-on-ceramic hip implants. Each 1 mm (0.039 in) increase in head size of metal-on-metal hip implants was associated with a 2% increase of failure.<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup> Surgeons of the British Hip Society are recommending that large head metal-on-metal implants should no longer be performed.<sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup>\n<\/p><p>On February 10, 2011, the U.S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">FDA<\/a> issued an advisory on metal-metal hip implants, stating it was continuing to gather and review all available information about metal-on-metal hip systems.<sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup> On June 27\u201328, 2012, an advisory panel met to decide whether to impose new standards, taking into account findings of the study in <i>The Lancet<\/i>.<sup id=\"rdp-ebb-cite_ref-reuters-20120329_40-1\" class=\"reference\"><a href=\"#cite_note-reuters-20120329-40\" rel=\"external_link\">[40]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\" rel=\"external_link\">[54]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FDA-summary-memo_55-0\" class=\"reference\"><a href=\"#cite_note-FDA-summary-memo-55\" rel=\"external_link\">[55]<\/a><\/sup> No new standards, such as routine checking of blood metal ion levels, were set, but guidance was updated.<sup id=\"rdp-ebb-cite_ref-56\" class=\"reference\"><a href=\"#cite_note-56\" rel=\"external_link\">[56]<\/a><\/sup> Currently, FDA has not required hip implants to be tested in clinical trials before they can be sold in the U.S.<sup id=\"rdp-ebb-cite_ref-57\" class=\"reference\"><a href=\"#cite_note-57\" rel=\"external_link\">[57]<\/a><\/sup> Instead, companies making new hip implants only need to prove that they are \"substantially equivalent\" to other hip implants already on the market. The exception is metal-on-metal implants, which were not tested in clinical trials but because of the high revision rate of metal-on-metal hips, in the future the FDA has stated that clinical trials will be required for approval and that post-market studies will be required to keep metal on metal hip implants on the market.<sup id=\"rdp-ebb-cite_ref-58\" class=\"reference\"><a href=\"#cite_note-58\" rel=\"external_link\">[58]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Alternatives_and_variations\">Alternatives and variations<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Conservative_management\">Conservative management<\/span><\/h3>\n<p>The first line approach as an alternative to hip replacement is conservative management which involves a multimodal approach of oral medication, injections, activity modification and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_therapy\" title=\"Physical therapy\" rel=\"external_link\" target=\"_blank\">physical therapy<\/a>.<sup id=\"rdp-ebb-cite_ref-59\" class=\"reference\"><a href=\"#cite_note-59\" rel=\"external_link\">[59]<\/a><\/sup> Conservative management can prevent or delay the need for hip replacement.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Preoperative_care\">Preoperative care<\/span><\/h3>\n<p>Preoperative education is currently an important part of patient care. There is some evidence that it may slightly reduce anxiety before hip or knee replacement, with low risk of negative effects.<sup id=\"rdp-ebb-cite_ref-60\" class=\"reference\"><a href=\"#cite_note-60\" rel=\"external_link\">[60]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hemiarthroplasty\">Hemiarthroplasty<\/span><\/h3>\n<p><b>Hemiarthroplasty<\/b> is a surgical procedure which replaces one half of the joint with an artificial surface and leaves the other part in its natural (pre-operative) state. This class of procedure is most commonly performed on the hip after a subcapital (just below the head) fracture of the neck of the femur (a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_fracture\" title=\"Hip fracture\" rel=\"external_link\" target=\"_blank\">hip fracture<\/a>). The procedure is performed by removing the head of the femur and replacing it with a metal or composite <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthesis<\/a>. The most commonly used prosthesis designs are the Austin Moore prosthesis and the Thompson Prosthesis. More recently a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Composite_material\" title=\"Composite material\" rel=\"external_link\" target=\"_blank\">composite<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal\" title=\"Metal\" rel=\"external_link\" target=\"_blank\">metal<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/HDPE\" class=\"mw-redirect\" title=\"HDPE\" rel=\"external_link\" target=\"_blank\">HDPE<\/a> which forms two interphases (bipolar prosthesis) has also been used. The monopolar prosthesis has not been shown to have any advantage over bipolar designs. The procedure is recommended only for elderly and frail patients, due to their lower life expectancy and activity level. This is because with the passage of time the prosthesis tends to loosen or to erode the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetabulum\" title=\"Acetabulum\" rel=\"external_link\" target=\"_blank\">acetabulum<\/a>.<sup id=\"rdp-ebb-cite_ref-61\" class=\"reference\"><a href=\"#cite_note-61\" rel=\"external_link\">[61]<\/a><\/sup>\n<\/p>\n<ul class=\"gallery mw-gallery-packed\">\n\t\t<li class=\"gallerybox\" style=\"width: 242.66666666667px\"><div style=\"width: 242.66666666667px\">\n\t\t\t<div class=\"thumb\" style=\"width: 240.66666666667px;\"><div style=\"margin:0px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bipolar_hip_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/47\/Bipolar_hip_prosthesis.jpg\/361px-Bipolar_hip_prosthesis.jpg\" width=\"241\" height=\"160\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Hip prosthesis for hemiarthroplasty. This example is bipolar, meaning that the head has 2 separate articulations.\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 215.33333333333px\"><div style=\"width: 215.33333333333px\">\n\t\t\t<div class=\"thumb\" style=\"width: 213.33333333333px;\"><div style=\"margin:0px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:X-ray_of_hips_with_a_hemiarthroplasty.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/X-ray_of_hips_with_a_hemiarthroplasty.jpg\/320px-X-ray_of_hips_with_a_hemiarthroplasty.jpg\" width=\"214\" height=\"160\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Projectional_radiography\" title=\"Projectional radiography\" rel=\"external_link\" target=\"_blank\">X-ray<\/a> of the hips, with a right-sided hemiarthroplasty.\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 265.33333333333px\"><div style=\"width: 265.33333333333px\">\n\t\t\t<div class=\"thumb\" style=\"width: 263.33333333333px;\"><div style=\"margin:0px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Femoral_offset_in_hemiarthroplasty.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/Femoral_offset_in_hemiarthroplasty.jpg\/395px-Femoral_offset_in_hemiarthroplasty.jpg\" width=\"264\" height=\"160\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Femoral (neck) offset is defined as the perpendicular distance between the intramedullary or longitudinal axis of the femur and the center of rotation of the native or prosthetic femoral head. An unnatural offset is associated with hip dislocation.<sup id=\"rdp-ebb-cite_ref-JonesBriffa2017_62-0\" class=\"reference\"><a href=\"#cite_note-JonesBriffa2017-62\" rel=\"external_link\">[62]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h3><span class=\"mw-headline\" id=\"Hip_resurfacing\">Hip resurfacing<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_resurfacing\" title=\"Hip resurfacing\" rel=\"external_link\" target=\"_blank\">Hip resurfacing<\/a> is an alternative to hip replacement surgery. It has been used in Europe for over seventeen years and become a common procedure. Health-related quality of life measures are markedly improved and patient satisfaction is favorable after hip resurfacing arthroplasty.<sup id=\"rdp-ebb-cite_ref-63\" class=\"reference\"><a href=\"#cite_note-63\" rel=\"external_link\">[63]<\/a><\/sup>\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive_hip_resurfacing\" title=\"Minimally invasive hip resurfacing\" rel=\"external_link\" target=\"_blank\">minimally invasive hip resurfacing<\/a> procedure is a further refinement to hip resurfacing.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Viscosupplementation\">Viscosupplementation<\/span><\/h3>\n<p>Current alternatives also include viscosupplementation, or the injection of artificial lubricants into the joint.<sup id=\"rdp-ebb-cite_ref-pmid17874246_64-0\" class=\"reference\"><a href=\"#cite_note-pmid17874246-64\" rel=\"external_link\">[64]<\/a><\/sup> Use of these medications in the hip is off label. The cost of treatment is typically not covered by health insurance organizations.\n<\/p><p>Some believe that the future of osteoarthritis treatment is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioengineering\" class=\"mw-redirect\" title=\"Bioengineering\" rel=\"external_link\" target=\"_blank\">bioengineering<\/a>, targeting the growth and\/or repair of the damaged, arthritic joint. Centeno et al. have reported on the partial regeneration of an arthritic human hip joint using mesenchymal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stem_cell\" title=\"Stem cell\" rel=\"external_link\" target=\"_blank\">stem cells<\/a> in one patient.<sup id=\"rdp-ebb-cite_ref-pmid16886034_65-0\" class=\"reference\"><a href=\"#cite_note-pmid16886034-65\" rel=\"external_link\">[65]<\/a><\/sup> It is yet to be shown that this result will apply to a larger group of patients and result in significant benefits. The FDA has stated that this procedure is being practiced without conforming to regulations, but Centeno claims that it is exempt from FDA regulation. It has not been shown in controlled clinical trials to be effective<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (May 2014)\">citation needed<\/span><\/a><\/i>]<\/sup>, and costs over $7,000.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Prevalence_and_cost\">Prevalence and cost<\/span><\/h2>\n<p>Total hip replacement incidence varies in developed countries between 30 (Romania) and 290 (Germany) procedures per 100,000 population per year.<sup id=\"rdp-ebb-cite_ref-66\" class=\"reference\"><a href=\"#cite_note-66\" rel=\"external_link\">[66]<\/a><\/sup> Approximately 0.8% of Americans have undergone the procedure.<sup id=\"rdp-ebb-cite_ref-67\" class=\"reference\"><a href=\"#cite_note-67\" rel=\"external_link\">[67]<\/a><\/sup>\n<\/p><p>According to the International Federation of Healthcare Plans, the average cost of a total hip replacement in 2012 was $40,364 in the United States, $11,889 in the United Kingdom, $10,987 in France, $9,574 in Switzerland, and $7,731 in Spain.<sup id=\"rdp-ebb-cite_ref-ifhp_1-1\" class=\"reference\"><a href=\"#cite_note-ifhp-1\" rel=\"external_link\">[1]<\/a><\/sup> In the United States, the average cost of a total hip replacement varies widely by geographic region, ranging from $11,327 (Birmingham, Alabama) to $73,927 (Boston, Massachusetts).<sup id=\"rdp-ebb-cite_ref-68\" class=\"reference\"><a href=\"#cite_note-68\" rel=\"external_link\">[68]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The earliest recorded attempts at hip replacement were carried out in Germany in 1891 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Themistocles_Gluck\" title=\"Themistocles Gluck\" rel=\"external_link\" target=\"_blank\">Themistocles Gluck<\/a> (1853\u20131942),<sup id=\"rdp-ebb-cite_ref-69\" class=\"reference\"><a href=\"#cite_note-69\" rel=\"external_link\">[69]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-70\" class=\"reference\"><a href=\"#cite_note-70\" rel=\"external_link\">[70]<\/a><\/sup> who used ivory to replace the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femoral_head\" title=\"Femoral head\" rel=\"external_link\" target=\"_blank\">femoral head<\/a> (the ball on the femur), attaching it with nickel-plated screws, Plaster of Paris, and glue.<sup id=\"rdp-ebb-cite_ref-pmid16089067_71-0\" class=\"reference\"><a href=\"#cite_note-pmid16089067-71\" rel=\"external_link\">[71]<\/a><\/sup>\n<\/p><p>On September 28, 1940 at Columbia Hospital in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Columbia,_South_Carolina\" title=\"Columbia, South Carolina\" rel=\"external_link\" target=\"_blank\">Columbia, South Carolina<\/a>, American surgeon Dr. Austin T. Moore (1899\u20131963)<sup id=\"rdp-ebb-cite_ref-72\" class=\"reference\"><a href=\"#cite_note-72\" rel=\"external_link\">[72]<\/a><\/sup> performed the first metallic hip replacement surgery. The original prosthesis he designed was a proximal femoral replacement, with a large fixed head made of the cobalt-chrome alloy <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vitallium\" title=\"Vitallium\" rel=\"external_link\" target=\"_blank\">Vitallium<\/a>. It was about a foot in length and bolted to the resected end of the femoral shaft (hemiarthroplasty). A later version, the so-called Austin Moore Prosthesis which was introduced in 1952, is still in use today, although rarely. Like modern hip implants, it is inserted into the medullary canal of the femur, and depends on bone growth through a hole in the stem for long-term attachment.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Abductor_wedge\" title=\"Abductor wedge\" rel=\"external_link\" target=\"_blank\">Abductor wedge<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Femoral_Acetabular_Impingement\" class=\"mw-redirect\" title=\"Femoral Acetabular Impingement\" rel=\"external_link\" target=\"_blank\">Femoral Acetabular Impingement<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gruen_zone\" class=\"mw-redirect\" title=\"Gruen zone\" rel=\"external_link\" target=\"_blank\">Gruen zone<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_examination\" title=\"Hip examination\" rel=\"external_link\" target=\"_blank\">Hip examination<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/2010_DePuy_Hip_Recall\" title=\"2010 DePuy Hip Recall\" rel=\"external_link\" target=\"_blank\">2010 DePuy Hip Recall<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-ifhp-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ifhp_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ifhp_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/hushp.harvard.edu\/sites\/default\/files\/downloadable_files\/IFHP%202012%20Comparative%20Price%20Report.pdf\" target=\"_blank\">\"2012 comparative price report\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. International Federation of Health Plans<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">4 October<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=2012+comparative+price+report&rft.pub=International+Federation+of+Health+Plans&rft_id=http%3A%2F%2Fhushp.harvard.edu%2Fsites%2Fdefault%2Ffiles%2Fdownloadable_files%2FIFHP%25202012%2520Comparative%2520Price%2520Report.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Andrew Still (2002-11-02). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/illumin.usc.edu\/61\/total-hip-replacement\/\" target=\"_blank\">\"Total Hip Replacement\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Southern_California\" title=\"University of Southern California\" rel=\"external_link\" target=\"_blank\">University of Southern California<\/a><\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-01-05<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=University+of+Southern+California&rft.atitle=Total+Hip+Replacement&rft.date=2002-11-02&rft.au=Andrew+Still&rft_id=http%3A%2F%2Fillumin.usc.edu%2F61%2Ftotal-hip-replacement%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Timperley, A John (20 October 2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.theguardian.com\/science\/2017\/oct\/20\/robin-ling-obituary\" target=\"_blank\">\"Robin Ling obituary\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Guardian\" title=\"The Guardian\" rel=\"external_link\" target=\"_blank\">The Guardian<\/a><\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">22 October<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Guardian&rft.atitle=Robin+Ling+obituary&rft.date=2017-10-20&rft.aulast=Timperley&rft.aufirst=A+John&rft_id=https%3A%2F%2Fwww.theguardian.com%2Fscience%2F2017%2Foct%2F20%2Frobin-ling-obituary&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid9498150-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid9498150_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pai VS (1997). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20020108155635\/http:\/\/www.link.springer.de\/link\/service\/journals\/00264\/bibs\/8021006\/80210393.htm\" target=\"_blank\">\"A comparison of three lateral approaches in primary total hip replacement\"<\/a>. <i>Int Orthop<\/i>. <b>21<\/b> (6): 393\u2013398. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs002640050193\" target=\"_blank\">10.1007\/s002640050193<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3619565\" target=\"_blank\">3619565<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9498150\" target=\"_blank\">9498150<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/link.springer.de\/link\/service\/journals\/00264\/bibs\/8021006\/80210393.htm\" target=\"_blank\">the original<\/a> on 2002-01-08.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Int+Orthop&rft.atitle=A+comparison+of+three+lateral+approaches+in+primary+total+hip+replacement&rft.volume=21&rft.issue=6&rft.pages=393-398&rft.date=1997&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3619565&rft_id=info%3Apmid%2F9498150&rft_id=info%3Adoi%2F10.1007%2Fs002640050193&rft.au=Pai+VS&rft_id=http%3A%2F%2Flink.springer.de%2Flink%2Fservice%2Fjournals%2F00264%2Fbibs%2F8021006%2F80210393.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-titleAnterolateral_Approach_to_Hip_Joint:_(Watson_Jones)_-_Wheeless'_Textbook_of_Orthopaedics-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#39;_Textbook_of_Orthopaedics_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.wheelessonline.com\/ortho\/anterolateral_approach_to_hip_joint_watson_jones\" target=\"_blank\">\"Anterolateral Approach to Hip Joint: (Watson Jones) \u2013 Wheeless' Textbook of Orthopaedics\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2007-11-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Anterolateral+Approach+to+Hip+Joint%3A+%28Watson+Jones%29+%E2%80%93+Wheeless%27+Textbook+of+Orthopaedics&rft_id=http%3A%2F%2Fwww.wheelessonline.com%2Fortho%2Fanterolateral_approach_to_hip_joint_watson_jones&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-titleAnterior_Approach_to_the_Hip_(Smith_Petersen)_-_Wheeless'_Textbook_of_Orthopaedics-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#39;_Textbook_of_Orthopaedics_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.wheelessonline.com\/ortho\/anterior_approach_to_the_hip_smith_peterson\" target=\"_blank\">\"Anterior Approach to the Hip (Smith Petersen) \u2013 Wheeless' Textbook of Orthopaedics\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2007-11-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Anterior+Approach+to+the+Hip+%28Smith+Petersen%29+%E2%80%93+Wheeless%27+Textbook+of+Orthopaedics&rft_id=http%3A%2F%2Fwww.wheelessonline.com%2Fortho%2Fanterior_approach_to_the_hip_smith_peterson&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Maratt, Joseph D.; Gagnier, Joel J.; Butler, Paul D.; Hallstrom, Brian R.; Urquhart, Andrew G.; Roberts, Karl C. (September 2016). \"No Difference in Dislocation Seen in Anterior Vs Posterior Approach Total Hip Arthroplasty\". <i>The Journal of Arthroplasty<\/i>. <b>31<\/b> (9): 127\u2013130. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2016.02.071\" target=\"_blank\">10.1016\/j.arth.2016.02.071<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Arthroplasty&rft.atitle=No+Difference+in+Dislocation+Seen+in+Anterior+Vs+Posterior+Approach+Total+Hip+Arthroplasty&rft.volume=31&rft.issue=9&rft.pages=127-130&rft.date=2016-09&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2016.02.071&rft.aulast=Maratt&rft.aufirst=Joseph+D.&rft.au=Gagnier%2C+Joel+J.&rft.au=Butler%2C+Paul+D.&rft.au=Hallstrom%2C+Brian+R.&rft.au=Urquhart%2C+Andrew+G.&rft.au=Roberts%2C+Karl+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Direct_Anterior_Approach-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Direct_Anterior_Approach_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Direct_Anterior_Approach_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Meneghini, R. Michael; Elston, Addison S.; Chen, Antonia F.; Kheir, Michael M.; Fehring, Thomas K.; Springer, Bryan D. (January 2017). \"Direct Anterior Approach\". <i>The Journal of Bone and Joint Surgery<\/i>. <b>99<\/b> (2): 99\u2013105. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.16.00060\" target=\"_blank\">10.2106\/JBJS.16.00060<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28099299\" target=\"_blank\">28099299<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Bone+and+Joint+Surgery&rft.atitle=Direct+Anterior+Approach&rft.volume=99&rft.issue=2&rft.pages=99-105&rft.date=2017-01&rft_id=info%3Adoi%2F10.2106%2FJBJS.16.00060&rft_id=info%3Apmid%2F28099299&rft.aulast=Meneghini&rft.aufirst=R.+Michael&rft.au=Elston%2C+Addison+S.&rft.au=Chen%2C+Antonia+F.&rft.au=Kheir%2C+Michael+M.&rft.au=Fehring%2C+Thomas+K.&rft.au=Springer%2C+Bryan+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-James_I_2016-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-James_I_2016_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-James_I_2016_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Eto, Shuichi; Hwang, Katherine; Huddleston, James I.; Amanatullah, Derek F.; Maloney, William J.; Goodman, Stuart B. (March 2017). \"The Direct Anterior Approach is Associated With Early Revision Total Hip Arthroplasty\". <i>The Journal of Arthroplasty<\/i>. <b>32<\/b> (3): 1001\u20131005. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2016.09.012\" target=\"_blank\">10.1016\/j.arth.2016.09.012<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27843039\" target=\"_blank\">27843039<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Arthroplasty&rft.atitle=The+Direct+Anterior+Approach+is+Associated+With+Early+Revision+Total+Hip+Arthroplasty&rft.volume=32&rft.issue=3&rft.pages=1001-1005&rft.date=2017-03&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2016.09.012&rft_id=info%3Apmid%2F27843039&rft.aulast=Eto&rft.aufirst=Shuichi&rft.au=Hwang%2C+Katherine&rft.au=Huddleston%2C+James+I.&rft.au=Amanatullah%2C+Derek+F.&rft.au=Maloney%2C+William+J.&rft.au=Goodman%2C+Stuart+B.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Christensen, Christian P.; Jacobs, Cale A. (September 2015). \"Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study\". <i>The Journal of Arthroplasty<\/i>. <b>30<\/b> (9): 94\u201397. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2014.12.038\" target=\"_blank\">10.1016\/j.arth.2014.12.038<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Arthroplasty&rft.atitle=Comparison+of+Patient+Function+during+the+First+Six+Weeks+after+Direct+Anterior+or+Posterior+Total+Hip+Arthroplasty+%28THA%29%3A+A+Randomized+Study&rft.volume=30&rft.issue=9&rft.pages=94-97&rft.date=2015-09&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2014.12.038&rft.aulast=Christensen&rft.aufirst=Christian+P.&rft.au=Jacobs%2C+Cale+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Higgins, Brendan T.; Barlow, Daniel R.; Heagerty, Nathan E.; Lin, Tim J. (March 2015). \"Anterior vs. Posterior Approach for Total Hip Arthroplasty, a Systematic Review and Meta-analysis\". <i>The Journal of Arthroplasty<\/i>. <b>30<\/b> (3): 419\u2013434. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2014.10.020\" target=\"_blank\">10.1016\/j.arth.2014.10.020<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Arthroplasty&rft.atitle=Anterior+vs.+Posterior+Approach+for+Total+Hip+Arthroplasty%2C+a+Systematic+Review+and+Meta-analysis&rft.volume=30&rft.issue=3&rft.pages=419-434&rft.date=2015-03&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2014.10.020&rft.aulast=Higgins&rft.aufirst=Brendan+T.&rft.au=Barlow%2C+Daniel+R.&rft.au=Heagerty%2C+Nathan+E.&rft.au=Lin%2C+Tim+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Meermans, G.; Konan, S.; Das, R.; Volpin, A.; Haddad, F. 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(June 2017). \"The direct anterior approach in total hip arthroplasty\". <i>The Bone & Joint Journal<\/i>. <b>99-B<\/b> (6): 732\u2013740. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1302%2F0301-620X.99B6.38053\" target=\"_blank\">10.1302\/0301-620X.99B6.38053<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Bone+%26+Joint+Journal&rft.atitle=The+direct+anterior+approach+in+total+hip+arthroplasty&rft.volume=99-B&rft.issue=6&rft.pages=732-740&rft.date=2017-06&rft_id=info%3Adoi%2F10.1302%2F0301-620X.99B6.38053&rft.aulast=Meermans&rft.aufirst=G.&rft.au=Konan%2C+S.&rft.au=Das%2C+R.&rft.au=Volpin%2C+A.&rft.au=Haddad%2C+F.+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Graves, Sara C.; Dropkin, Benjamin M.; Keeney, Benjamin J.; Lurie, Jon D.; Tomek, Ivan M. 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(22 September 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3183178\" target=\"_blank\">\"New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society\"<\/a>. <i>Clinical Orthopaedics and Related Research<\/i>. <b>469<\/b> (11): 2992\u20132994. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11999-011-2102-9\" target=\"_blank\">10.1007\/s11999-011-2102-9<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3183178\" target=\"_blank\">3183178<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Orthopaedics+and+Related+Research&rft.atitle=New+Definition+for+Periprosthetic+Joint+Infection%3A+From+the+Workgroup+of+the+Musculoskeletal+Infection+Society&rft.volume=469&rft.issue=11&rft.pages=2992-2994&rft.date=2011-09-22&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3183178&rft_id=info%3Adoi%2F10.1007%2Fs11999-011-2102-9&rft.aulast=Parvizi&rft.aufirst=Javad&rft.au=Zmistowski%2C+Benjamin&rft.au=Berbari%2C+Elie+F.&rft.au=Bauer%2C+Thomas+W.&rft.au=Springer%2C+Bryan+D.&rft.au=Della+Valle%2C+Craig+J.&rft.au=Garvin%2C+Kevin+L.&rft.au=Mont%2C+Michael+A.&rft.au=Wongworawat%2C+Montri+D.&rft.au=Zalavras%2C+Charalampos+G.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3183178&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-berry2012-24\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-berry2012_24-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-berry2012_24-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-berry2012_24-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-berry2012_24-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Daniel J. Berry, Jay Lieberman (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.se\/books?id=Kc-AhYLnIF4C&pg=PA1035\" target=\"_blank\"><i>Surgery of the Hip<\/i><\/a>. Elsevier Health Sciences. p. 1035. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781455727056.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Surgery+of+the+Hip&rft.pages=1035&rft.pub=Elsevier+Health+Sciences&rft.date=2012&rft.isbn=9781455727056&rft.au=Daniel+J.+Berry%2C+Jay+Lieberman&rft_id=https%3A%2F%2Fbooks.google.se%2Fbooks%3Fid%3DKc-AhYLnIF4C%26pg%3DPA1035&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hailer, Nils P.; Weiss, R\u00fcdiger J.; Stark, Andr\u00e9; K\u00e4rrholm, Johan (October 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3488169\" target=\"_blank\">\"The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. An analysis of 78,098 operations in the Swedish Hip Arthroplasty Register\"<\/a>. <i>Acta Orthopaedica<\/i>. <b>83<\/b> (5): 442\u2013448. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3109%2F17453674.2012.733919\" target=\"_blank\">10.3109\/17453674.2012.733919<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1745-3682\" target=\"_blank\">1745-3682<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3488169\" target=\"_blank\">3488169<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23039167\" target=\"_blank\">23039167<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Orthopaedica&rft.atitle=The+risk+of+revision+due+to+dislocation+after+total+hip+arthroplasty+depends+on+surgical+approach%2C+femoral+head+size%2C+sex%2C+and+primary+diagnosis.+An+analysis+of+78%2C098+operations+in+the+Swedish+Hip+Arthroplasty+Register&rft.volume=83&rft.issue=5&rft.pages=442-448&rft.date=2012-10&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3488169&rft.issn=1745-3682&rft_id=info%3Apmid%2F23039167&rft_id=info%3Adoi%2F10.3109%2F17453674.2012.733919&rft.aulast=Hailer&rft.aufirst=Nils+P.&rft.au=Weiss%2C+R%C3%BCdiger+J.&rft.au=Stark%2C+Andr%C3%A9&rft.au=K%C3%A4rrholm%2C+Johan&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3488169&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Knutson, Gary A (2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1232860\" target=\"_blank\">\"Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance\"<\/a>. <i>Chiropractic & Osteopathy<\/i>. <b>13<\/b> (1): 11. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2F1746-1340-13-11\" target=\"_blank\">10.1186\/1746-1340-13-11<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1232860\" target=\"_blank\">1232860<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Chiropractic+%26+Osteopathy&rft.atitle=Anatomic+and+functional+leg-length+inequality%3A+A+review+and+recommendation+for+clinical+decision-making.+Part+I%2C+anatomic+leg-length+inequality%3A+prevalence%2C+magnitude%2C+effects+and+clinical+significance&rft.volume=13&rft.issue=1&rft.pages=11&rft.date=2005&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1232860&rft_id=info%3Adoi%2F10.1186%2F1746-1340-13-11&rft.aulast=Knutson&rft.aufirst=Gary+A&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1232860&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Maloney, William J; Keeney, James A (June 2004). \"Leg length discrepancy after total hip arthroplasty\". <i>The Journal of Arthroplasty<\/i>. <b>19<\/b> (4): 108\u2013110. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2004.02.018\" target=\"_blank\">10.1016\/j.arth.2004.02.018<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Arthroplasty&rft.atitle=Leg+length+discrepancy+after+total+hip+arthroplasty&rft.volume=19&rft.issue=4&rft.pages=108-110&rft.date=2004-06&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2004.02.018&rft.aulast=Maloney&rft.aufirst=William+J&rft.au=Keeney%2C+James+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sobieraj, DM; Lee, S; Coleman, CI; Tongbram, V; Chen, W; Colby, J; Kluger, J; Makanji, S; Ashaye, AO; White, CM (May 15, 2012). \"Prolonged versus standard-duration venous thromboprophylaxis in major orthopedic surgery: a systematic review\". <i>Annals of Internal Medicine<\/i>. <b>156<\/b> (10): 720\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.7326%2F0003-4819-156-10-201205150-00423\" target=\"_blank\">10.7326\/0003-4819-156-10-201205150-00423<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22412039\" target=\"_blank\">22412039<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+Internal+Medicine&rft.atitle=Prolonged+versus+standard-duration+venous+thromboprophylaxis+in+major+orthopedic+surgery%3A+a+systematic+review&rft.volume=156&rft.issue=10&rft.pages=720-7&rft.date=2012-05-15&rft_id=info%3Adoi%2F10.7326%2F0003-4819-156-10-201205150-00423&rft_id=info%3Apmid%2F22412039&rft.aulast=Sobieraj&rft.aufirst=DM&rft.au=Lee%2C+S&rft.au=Coleman%2C+CI&rft.au=Tongbram%2C+V&rft.au=Chen%2C+W&rft.au=Colby%2C+J&rft.au=Kluger%2C+J&rft.au=Makanji%2C+S&rft.au=Ashaye%2C+AO&rft.au=White%2C+CM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">J\u00f8rgensen, Christoffer C.; Jacobsen, Michael K.; Soeballe, Kjeld; Hansen, Torben B.; Husted, Henrik; Kj\u00e6rsgaard-Andersen, Per; Hansen, Lars T.; Laursen, Mogens B.; Kehlet, Henrik (2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3863129\" target=\"_blank\">\"Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study\"<\/a>. <i>BMJ Open<\/i>. <b>3<\/b> (12): e003965. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmjopen-2013-003965\" target=\"_blank\">10.1136\/bmjopen-2013-003965<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2044-6055\" target=\"_blank\">2044-6055<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3863129\" target=\"_blank\">3863129<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24334158\" target=\"_blank\">24334158<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMJ+Open&rft.atitle=Thromboprophylaxis+only+during+hospitalisation+in+fast-track+hip+and+knee+arthroplasty%2C+a+prospective+cohort+study&rft.volume=3&rft.issue=12&rft.pages=e003965&rft.date=2013&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3863129&rft.issn=2044-6055&rft_id=info%3Apmid%2F24334158&rft_id=info%3Adoi%2F10.1136%2Fbmjopen-2013-003965&rft.aulast=J%C3%B8rgensen&rft.aufirst=Christoffer+C.&rft.au=Jacobsen%2C+Michael+K.&rft.au=Soeballe%2C+Kjeld&rft.au=Hansen%2C+Torben+B.&rft.au=Husted%2C+Henrik&rft.au=Kj%C3%A6rsgaard-Andersen%2C+Per&rft.au=Hansen%2C+Lars+T.&rft.au=Laursen%2C+Mogens+B.&rft.au=Kehlet%2C+Henrik&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3863129&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-AAOSfive-30\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-AAOSfive_30-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-AAOSfive_30-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFAmerican_Academy_of_Orthopaedic_Surgeons2013\" class=\"citation\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Academy_of_Orthopaedic_Surgeons\" title=\"American Academy of Orthopaedic Surgeons\" rel=\"external_link\" target=\"_blank\">American Academy of Orthopaedic Surgeons<\/a> (February 2013), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.choosingwisely.org\/doctor-patient-lists\/american-academy-of-orthopaedic-surgeons\/\" target=\"_blank\">\"Five Things Physicians and Patients Should Question\"<\/a>, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Choosing_Wisely\" title=\"Choosing Wisely\" rel=\"external_link\" target=\"_blank\">Choosing Wisely<\/a>: an initiative of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ABIM_Foundation\" class=\"mw-redirect\" title=\"ABIM Foundation\" rel=\"external_link\" target=\"_blank\">ABIM Foundation<\/a><\/i>, American Academy of Orthopaedic Surgeons<span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">19 May<\/span> 2013<\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Choosing+Wisely%3A+an+initiative+of+the+ABIM+Foundation&rft.atitle=Five+Things+Physicians+and+Patients+Should+Question&rft.date=2013-02&rft.au=American+Academy+of+Orthopaedic+Surgeons&rft_id=http%3A%2F%2Fwww.choosingwisely.org%2Fdoctor-patient-lists%2Famerican-academy-of-orthopaedic-surgeons%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>, which cites\n<ul><li><cite class=\"citation journal\">Members of 2007 and 2011 AAOS Guideline Development Work Groups on PE\/VTED Prophylaxis; Mont, M; Jacobs, J; Lieberman, J; Parvizi, J; Lachiewicz, P; Johanson, N; Watters, W (Apr 18, 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3326687\" target=\"_blank\">\"Preventing venous thromboembolic disease in patients undergoing elective total hip and knee arthroplasty\"<\/a>. <i>The Journal of Bone and Joint Surgery. American Volume<\/i>. <b>94<\/b> (8): 673\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.9408edit\" target=\"_blank\">10.2106\/JBJS.9408edit<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3326687\" target=\"_blank\">3326687<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22517384\" target=\"_blank\">22517384<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Bone+and+Joint+Surgery.+American+Volume&rft.atitle=Preventing+venous+thromboembolic+disease+in+patients+undergoing+elective+total+hip+and+knee+arthroplasty.&rft.volume=94&rft.issue=8&rft.pages=673-4&rft.date=2012-04-18&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3326687&rft_id=info%3Apmid%2F22517384&rft_id=info%3Adoi%2F10.2106%2FJBJS.9408edit&rft.au=Members+of+2007+and+2011+AAOS+Guideline+Development+Work+Groups+on+PE%2FVTED+Prophylaxis&rft.au=Mont%2C+M&rft.au=Jacobs%2C+J&rft.au=Lieberman%2C+J&rft.au=Parvizi%2C+J&rft.au=Lachiewicz%2C+P&rft.au=Johanson%2C+N&rft.au=Watters%2C+W&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3326687&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<\/span><\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">John J. Callaghan, Aaron G. Rosenberg, Harry E. Rubash (2007). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=-fwULYB1gJIC&pg=PA958\" target=\"_blank\"><i>The Adult Hip, Volume 1<\/i><\/a>. Lippincott Williams & Wilkins. p. 958. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-7817-5092-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Adult+Hip%2C+Volume+1&rft.pages=958&rft.pub=Lippincott+Williams+%26+Wilkins&rft.date=2007&rft.isbn=978-0-7817-5092-9&rft.au=John+J.+Callaghan%2C+Aaron+G.+Rosenberg%2C+Harry+E.+Rubash&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D-fwULYB1gJIC%26pg%3DPA958&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Neumann, Daniel R.P.; Thaler, Christoph; Hitzl, Wolfgang; Huber, Monika; Hofst\u00e4dter, Thomas; Dorn, Ulrich (2010). \"Long-Term Results of a Contemporary Metal-on-Metal Total Hip Arthroplasty\". <i>The Journal of Arthroplasty<\/i>. <b>25<\/b> (5): 700\u2013708. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2009.05.018\" target=\"_blank\">10.1016\/j.arth.2009.05.018<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0883-5403\" target=\"_blank\">0883-5403<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Arthroplasty&rft.atitle=Long-Term+Results+of+a+Contemporary+Metal-on-Metal+Total+Hip+Arthroplasty&rft.volume=25&rft.issue=5&rft.pages=700-708&rft.date=2010&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2009.05.018&rft.issn=0883-5403&rft.aulast=Neumann&rft.aufirst=Daniel+R.P.&rft.au=Thaler%2C+Christoph&rft.au=Hitzl%2C+Wolfgang&rft.au=Huber%2C+Monika&rft.au=Hofst%C3%A4dter%2C+Thomas&rft.au=Dorn%2C+Ulrich&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-RothMaertz2012-33\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-RothMaertz2012_33-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-RothMaertz2012_33-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Roth, Trenton D.; Maertz, Nathan A.; Parr, J. Andrew; Buckwalter, Kenneth A.; Choplin, Robert H. (2012). \"CT of the Hip Prosthesis: Appearance of Components, Fixation, and Complications\". <i>RadioGraphics<\/i>. <b>32<\/b> (4): 1089\u20131107. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1148%2Frg.324115183\" target=\"_blank\">10.1148\/rg.324115183<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0271-5333\" target=\"_blank\">0271-5333<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=RadioGraphics&rft.atitle=CT+of+the+Hip+Prosthesis%3A+Appearance+of+Components%2C+Fixation%2C+and+Complications&rft.volume=32&rft.issue=4&rft.pages=1089-1107&rft.date=2012&rft_id=info%3Adoi%2F10.1148%2Frg.324115183&rft.issn=0271-5333&rft.aulast=Roth&rft.aufirst=Trenton+D.&rft.au=Maertz%2C+Nathan+A.&rft.au=Parr%2C+J.+Andrew&rft.au=Buckwalter%2C+Kenneth+A.&rft.au=Choplin%2C+Robert+H.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Steffen Breusch, Henrik Malchau (2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.se\/books?id=PQ6NZAeJUXcC&pg=PA337&lpg=PA336\" target=\"_blank\"><i>The Well-Cemented Total Hip Arthroplasty: Theory and Practice<\/i><\/a>. Springer Science & Business Media. p. 336. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-540-24197-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Well-Cemented+Total+Hip+Arthroplasty%3A+Theory+and+Practice&rft.pages=336&rft.pub=Springer+Science+%26+Business+Media&rft.date=2005&rft.isbn=978-3-540-24197-3&rft.au=Steffen+Breusch%2C+Henrik+Malchau&rft_id=https%3A%2F%2Fbooks.google.se%2Fbooks%3Fid%3DPQ6NZAeJUXcC%26pg%3DPA337%26lpg%3DPA336&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Angerame, Marc R.; Fehring, Thomas K.; Masonis, John L.; Mason, J. Bohannon; Odum, Susan M.; Springer, Bryan D. (February 2018). \"Early Failure of Primary Total Hip Arthroplasty: Is Surgical Approach a Risk Factor?\". <i>The Journal of Arthroplasty<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2018.01.014\" target=\"_blank\">10.1016\/j.arth.2018.01.014<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Arthroplasty&rft.atitle=Early+Failure+of+Primary+Total+Hip+Arthroplasty%3A+Is+Surgical+Approach+a+Risk+Factor%3F&rft.date=2018-02&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2018.01.014&rft.aulast=Angerame&rft.aufirst=Marc+R.&rft.au=Fehring%2C+Thomas+K.&rft.au=Masonis%2C+John+L.&rft.au=Mason%2C+J.+Bohannon&rft.au=Odum%2C+Susan+M.&rft.au=Springer%2C+Bryan+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pandit H, Glyn-Jones S, McLardy-Smith P, et al. (July 2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bjj.boneandjoint.org.uk\/cgi\/pmidlookup?view=long&pmid=18591590\" target=\"_blank\">\"Pseudotumours associated with metal-on-metal hip resurfacings\"<\/a>. <i>J Bone Joint Surg Br<\/i>. <b>90<\/b> (7): 847\u201351. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1302%2F0301-620X.90B7.20213\" target=\"_blank\">10.1302\/0301-620X.90B7.20213<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18591590\" target=\"_blank\">18591590<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Br&rft.atitle=Pseudotumours+associated+with+metal-on-metal+hip+resurfacings&rft.volume=90&rft.issue=7&rft.pages=847-51&rft.date=2008-07&rft_id=info%3Adoi%2F10.1302%2F0301-620X.90B7.20213&rft_id=info%3Apmid%2F18591590&rft.aulast=Pandit&rft.aufirst=H&rft.au=Glyn-Jones%2C+S&rft.au=McLardy-Smith%2C+P&rft_id=http%3A%2F%2Fbjj.boneandjoint.org.uk%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D18591590&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Boardman DR, Middleton FR, Kavanagh TG (March 2006). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bjj.boneandjoint.org.uk\/cgi\/pmidlookup?view=long&pmid=16498023\" target=\"_blank\">\"A benign psoas mass following metal-on-metal resurfacing of the hip\"<\/a>. <i>J Bone Joint Surg Br<\/i>. <b>88<\/b> (3): 402\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1302%2F0301-620X.88B3.16748\" target=\"_blank\">10.1302\/0301-620X.88B3.16748<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16498023\" target=\"_blank\">16498023<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Br&rft.atitle=A+benign+psoas+mass+following+metal-on-metal+resurfacing+of+the+hip&rft.volume=88&rft.issue=3&rft.pages=402-4&rft.date=2006-03&rft_id=info%3Adoi%2F10.1302%2F0301-620X.88B3.16748&rft_id=info%3Apmid%2F16498023&rft.aulast=Boardman&rft.aufirst=DR&rft.au=Middleton%2C+FR&rft.au=Kavanagh%2C+TG&rft_id=http%3A%2F%2Fbjj.boneandjoint.org.uk%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D16498023&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><br \/><cite class=\"citation journal\">Korovessis P, Petsinis G, Repanti M, Repantis T (June 2006). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jbjs.org\/article.aspx?volume=88&page=1183\" target=\"_blank\">\"Metallosis after contemporary metal-on-metal total hip arthroplasty. 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Int+Orthop&rft.atitle=International+survey+of+primary+and+revision+total+knee+replacement&rft.volume=35&rft.issue=12&rft.pages=1783-9&rft.date=2011&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3224613&rft_id=info%3Apmid%2F21404023&rft_id=info%3Adoi%2F10.1007%2Fs00264-011-1235-5&rft.aulast=Kurtz&rft.aufirst=SM&rft.au=Ong%2C+KL&rft.au=Lau%2C+E&rft.au=Widmer%2C+M&rft.au=Maravic%2C+M&rft.au=G%C3%B3mez-Barrena%2C+E&rft.au=de+Pina+Mde%2C+F&rft.au=Manno%2C+V&rft.au=Torre%2C+M&rft.au=Walter%2C+WL&rft.au=de+Steiger%2C+R&rft.au=Geesink%2C+RG&rft.au=Peltola%2C+M&rft.au=R%C3%B6der%2C+C&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3224613&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-67\"><span 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class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4551172\" target=\"_blank\">4551172<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26333733\" target=\"_blank\">26333733<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Am&rft.atitle=Prevalence+of+Total+Hip+and+Knee+Replacement+in+the+United+States&rft.volume=97&rft.issue=17&rft.pages=1386-97&rft.date=2015&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4551172&rft_id=info%3Apmid%2F26333733&rft_id=info%3Adoi%2F10.2106%2FJBJS.N.01141&rft.aulast=Maradit+Kremers&rft.aufirst=H&rft.au=Larson%2C+DR&rft.au=Crowson%2C+CS&rft.au=Kremers%2C+WK&rft.au=Washington%2C+RE&rft.au=Steiner%2C+CA&rft.au=Jiranek%2C+WA&rft.au=Berry%2C+DJ&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4551172&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-68\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-68\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20151022105614\/http:\/\/www.bcbs.com\/healthofamerica\/BCBS_BHI_Report-Jan-_21_Final.pdf\" target=\"_blank\">\"A study of cost variations for knee and hip replacement surgeries in the U.S.\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Blue Cross Blue Shield Association. 21 January 2015. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bcbs.com\/healthofamerica\/BCBS_BHI_Report-Jan-_21_Final.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 22 October 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">4 October<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=A+study+of+cost+variations+for+knee+and+hip+replacement+surgeries+in+the+U.S.&rft.pub=Blue+Cross+Blue+Shield+Association&rft.date=2015-01-21&rft_id=http%3A%2F%2Fwww.bcbs.com%2Fhealthofamerica%2FBCBS_BHI_Report-Jan-_21_Final.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-69\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-69\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/slideplayer.com\/slide\/1659480\/\" target=\"_blank\">\"History of Artificial Joints - ppt video online download\"<\/a>. <i>slideplayer.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=slideplayer.com&rft.atitle=History+of+Artificial+Joints+-++ppt+video+online+download&rft_id=http%3A%2F%2Fslideplayer.com%2Fslide%2F1659480%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-70\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-70\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brand, RA; Mont, MA; Manring, M (2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3094624\" target=\"_blank\">\"Biographical sketch: Themistocles Gluck (1853\u20131942)\"<\/a>. <i>Clin. Orthop. Relat. Res<\/i>. <b>469<\/b> (6): 1525\u20131527. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11999-011-1836-8\" target=\"_blank\">10.1007\/s11999-011-1836-8<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3094624\" target=\"_blank\">3094624<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21403990\" target=\"_blank\">21403990<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clin.+Orthop.+Relat.+Res.&rft.atitle=Biographical+sketch%3A+Themistocles+Gluck+%281853%E2%80%931942%29&rft.volume=469&rft.issue=6&rft.pages=1525-1527&rft.date=2011&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3094624&rft_id=info%3Apmid%2F21403990&rft_id=info%3Adoi%2F10.1007%2Fs11999-011-1836-8&rft.aulast=Brand&rft.aufirst=RA&rft.au=Mont%2C+MA&rft.au=Manring%2C+M&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3094624&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid16089067-71\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid16089067_71-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gomez PF; Morcuende JA (2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1888777\" target=\"_blank\">\"Early attempts at hip arthroplasty\u20141700s to 1950s\"<\/a>. <i>Iowa Orthop J<\/i>. <b>25<\/b>: 25\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1888777\" target=\"_blank\">1888777<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16089067\" target=\"_blank\">16089067<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Iowa+Orthop+J&rft.atitle=Early+attempts+at+hip+arthroplasty%E2%80%941700s+to+1950s&rft.volume=25&rft.pages=25-9&rft.date=2005&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1888777&rft_id=info%3Apmid%2F16089067&rft.au=Gomez+PF&rft.au=Morcuende+JA&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1888777&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-72\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-72\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/orthopedics.about.com\/cs\/jointreplacement1\/p\/austinmoore.htm\" target=\"_blank\">\"What You Need to Know About Joint Replacement Surgery\"<\/a>. <i>about.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=about.com&rft.atitle=What+You+Need+to+Know+About+Joint+Replacement+Surgery&rft_id=http%3A%2F%2Forthopedics.about.com%2Fcs%2Fjointreplacement1%2Fp%2Faustinmoore.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060619082711\/http:\/\/www.edheads.org\/activities\/hip\/\" target=\"_blank\">Edheads Virtual Hip Surgery + Surgery Photos<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/orthoinfo.aaos.org\/fact\/thr_report.cfm?Thread_ID=271&topcategory=Hip\" target=\"_blank\">AAOS Hip Replacement<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1332\nCached time: 20181129125012\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 1.024 seconds\nReal time usage: 1.180 seconds\nPreprocessor visited node count: 4852\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 203601\/2097152 bytes\nTemplate argument size: 3090\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 9\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 228472\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.610\/10.000 seconds\nLua memory usage: 9.31 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 988.562 1 -total\n<\/p>\n<pre>63.81% 630.782 1 Template:Reflist\n37.69% 372.617 46 Template:Cite_journal\n11.15% 110.266 13 Template:Cite_web\n 8.60% 85.032 5 Template:Citation_needed\n 7.46% 73.733 5 Template:Fix\n 6.70% 66.232 1 Template:Infobox_medical_intervention\n 6.00% 59.309 1 Template:Infobox\n 5.27% 52.104 1 Template:About\n 4.16% 41.111 6 Template:Convert\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1125423-1!canonical and timestamp 20181129125010 and revision id 870719990\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212241\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.030 seconds\nReal time usage: 0.192 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 177.740 1 - wikipedia:Hip_replacement\n100.00% 177.740 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8200-0!*!*!*!*!*!* and timestamp 20181217212241 and revision id 24346\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Hip_replacement\">https:\/\/www.limswiki.org\/index.php\/Hip_replacement<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","18026209e7901858227ab2cae8f033cf_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2f\/Hip_replacement_Image_3684-PH.jpg\/560px-Hip_replacement_Image_3684-PH.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/da\/Hip_prosthesis_components.jpg\/320px-Hip_prosthesis_components.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0a\/Hip_prosthesis.jpg\/440px-Hip_prosthesis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/33\/MetalonmetalhipreplaceMark.png\/440px-MetalonmetalhipreplaceMark.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Hip-replacement.jpg\/340px-Hip-replacement.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/92\/Acetabular_inclination_of_hip_prosthesis.jpg\/460px-Acetabular_inclination_of_hip_prosthesis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/91\/Range_of_acetabular_inclination.png\/460px-Range_of_acetabular_inclination.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/28\/Acetabular_anteversion_of_hip_prosthesis.jpg\/208px-Acetabular_anteversion_of_hip_prosthesis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/Range_of_acetabular_anteversion.png\/460px-Range_of_acetabular_anteversion.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d7\/Leg_length_discrepancy_after_hip_replacement.jpg\/460px-Leg_length_discrepancy_after_hip_replacement.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Center_of_rotation_of_hip_prosthesis.jpg\/460px-Center_of_rotation_of_hip_prosthesis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/76\/Dislocated_hip_replacement.jpg\/340px-Dislocated_hip_replacement.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d9\/Hip_prosthesis_liner_creep_and_wear.png\/320px-Hip_prosthesis_liner_creep_and_wear.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b7\/Hip_joint_aseptic_loosening_ar1938-1.png\/340px-Hip_joint_aseptic_loosening_ar1938-1.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/00\/Hip_prosthesis_zones_by_DeLee_and_Charnley_system%2C_and_Gruen_system.jpg\/420px-Hip_prosthesis_zones_by_DeLee_and_Charnley_system%2C_and_Gruen_system.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/4\/47\/Bipolar_hip_prosthesis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/X-ray_of_hips_with_a_hemiarthroplasty.jpg\/639px-X-ray_of_hips_with_a_hemiarthroplasty.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/Femoral_offset_in_hemiarthroplasty.jpg\/790px-Femoral_offset_in_hemiarthroplasty.jpg"],"18026209e7901858227ab2cae8f033cf_timestamp":1545081761,"3ad07f4d1fb8e8f005b2bb513840596a_type":"article","3ad07f4d1fb8e8f005b2bb513840596a_title":"Grafting","3ad07f4d1fb8e8f005b2bb513840596a_url":"https:\/\/www.limswiki.org\/index.php\/Graft_(surgery)","3ad07f4d1fb8e8f005b2bb513840596a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tGraft (surgery)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (May 2015) (Learn how and when to remove this template message)\nGraft (surgery)MeSHD019737 [edit on Wikidata]\nGrafting refers to a surgical procedure to move tissue from one site to another on the body, or from another creature, without bringing its own blood supply with it. Instead, a new blood supply grows in after it is placed. A similar technique where tissue is transferred with the blood supply intact is called a flap. In some instances a graft can be an artificially manufactured device. Examples of this are a tube to carry blood flow across a defect or from an artery to a vein for use in hemodialysis.\n\nContents \n\n1 Classification \n2 Types of grafting \n3 Indications \n4 Reasons for failure \n5 References \n\n\nClassification \nAutografts and isografts are usually not considered as foreign and, therefore, do not elicit rejection. Allografts and xenografts are recognized as foreign by the recipient and are rejected.[1] \n\nAutograft: graft taken from one part of the body of an individual and transplanted onto another site in the same individual, e.g., skin graft.\nIsograft: graft taken from one individual and placed on another individual of the same genetic constitution, e.g., grafts between identical twins.\nAllograft: graft taken from one individual placed on genetically non-identical member of the same species.\nXenograft: graft taken from one individual placed on an individual belonging to another species, e.g., animal to man.\nTypes of grafting \nThe term grafting is most commonly applied to skin grafting, however many tissues can be grafted: skin, bone, nerves, tendons, neurons, blood vessels, fat, and cornea are tissues commonly grafted today. The grafting process places fresh skin over a wound with damaged skin.\nSpecific types include:\n\nSkin grafting is often used to treat skin loss due to a wound, burn, infection, or surgery. In the case of damaged skin, it is removed, and new skin is grafted in its place. Skin grafting can reduce the course of treatment and hospitalization needed, and can also improve function and appearance. There are two types of skin grafts:\nSplit-thickness skin grafts [epidermis + part of the dermis]\nFull-thickness skin grafts [epidermis + entire thickness of the dermis]\nBone grafting[2] is used in dental implants, as well as other instances. The bone may be autologous, typically harvested from the iliac crest of the pelvis, or banked bone.\nVascular grafting is the use of transplanted or prosthetic blood vessels in surgical procedures.\nLigament repair, as with anterior cruciate ligament reconstruction or ulnar collateral ligament reconstruction.\nIndications \nLarge amount of skin loss due to infections\nBurns\nSkin cancer surgery[3]\nReasons for failure \nHematoma (a collection of blood) development when the graft is placed over an active bleed\nInfection\nSeroma (a collection of fluid) development\nShear force disrupting growth of new blood supply\nInappropriate bed for new blood supply to grow from, such as cartilage, tendons, or bone\nReferences \n\n\n^ Textbook of Microbiology, R. Vasanthakumari, p166, 2007, New Delhi, ISBN 978-81-7225-234-2 \n\n^ \"What Is a Bone Graft?\". Retrieved 18 May 2015 . \n\n^ \"Skin graft\". NIH. Retrieved 18 May 2015 . \n\n\n\r\nvteOrgan transplantationTypes\nAllotransplantation\nABOi\nAutotransplantation\nXenotransplantation\nOrgans and tissues\nBone\nBone marrow\nBrain\nCorneal\nFace\nHand\nHead\nHeart\nHeart\u2013lung\nIntestine\nKidney\nLiver\nLiving donor\nLung\nPancreas\nIslet cell\nPenis\nSkin\nSpleen\nTesticle\nThymus\nUterus\nVagina\nMedical grafting\nBone grafting\nSkin grafting\nVascular grafting\nOrgan donation\nNon-heart-beating donation\nOrgan harvesting\nOrgan trade\nComplications\nGraft-versus-host disease\nPost-transplant lymphoproliferative disorder\nTransplant rejection\nTransplant networks\r\nand government departments\nBalttransplant\nBC Transplant Society\nEurotransplant\nGift of Life Marrow Registry\nHuman Tissue Authority\nLifeSharers\nNational Marrow Donor Program\nNOD-Lb\nNational Transplant Organization\nNHS Blood and Transplant\nScandiatransplant\nTrillium Gift of Life Network\nUnited Network for Organ Sharing\nAdvocacy organizations\nAnthony Nolan\nBloodwise\nDKMS\nDonate Life America\nHalachic Organ Donor Society\nKidney Foundation of Canada\nNational Kidney Foundation\nORGANIZE\nJoint societies\nAmerican Society of Nephrology\nAmerican Society of Transplantation\nCanadian Society of Transplantation\nCountries\nOrgan transplantation in different countries\nOrgan transplantation in China\nOrgan transplantation in Israel\nOrgan transplantation in Japan\nOrgan theft in Kosovo\nGurgaon kidney scandal\nPeopleHeart\nChristiaan Barnard\n James D. Hardy\nAdrian Kantrowitz\nRichard Lower\nNorman Shumway\nKidney\nJ. Hartwell Harrison\nJohn P. Merrill\nJoseph Murray\nMichael Woodruff\nLiver\nFikri Alican\n James D. Hardy\nThomas Starzl\nLung\nFikri Alican\nJoel D. Cooper\nVladimir Demikhov\n James D. Hardy\nPancreas\nRichard C. Lillehei\nPenis\nAndr\u00e9 van der Merwe\nOther\nAlexis Carrel\nJean-Michel Dubernard\nDonna Mansell\nBruce Reitz\n\nList of organ transplant donors and recipients\nRelated topics\nBiomedical tissue\nEdmonton protocol\nEye bank\nImmunosuppressive drugs\nLung allocation score\nMachine perfusion\nTotal body irradiation\nFrankenstein's monster\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Graft_(surgery)\">https:\/\/www.limswiki.org\/index.php\/Graft_(surgery)<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 22:49.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 379 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","3ad07f4d1fb8e8f005b2bb513840596a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Graft_surgery skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Graft (surgery)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p><b>Grafting<\/b> refers to a surgical procedure to move tissue from one site to another on the body, or from another creature, without bringing its own blood supply with it. Instead, a new blood supply grows in after it is placed. A similar technique where tissue is transferred with the blood supply intact is called a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flap_(surgery)\" title=\"Flap (surgery)\" rel=\"external_link\" target=\"_blank\">flap<\/a>. In some instances a graft can be an artificially manufactured device. Examples of this are a tube to carry blood flow across a defect or from an artery to a vein for use in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Classification\">Classification<\/span><\/h2>\n<p>Autografts and isografts are usually not considered as foreign and, therefore, do not elicit rejection. Allografts and xenografts are recognized as foreign by the recipient and are rejected.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> \n<\/p>\n<ul><li>Autograft: graft taken from one part of the body of an individual and transplanted onto another site in the same individual, e.g., skin graft.<\/li>\n<li>Isograft: graft taken from one individual and placed on another individual of the same genetic constitution, e.g., grafts between identical twins.<\/li>\n<li>Allograft: graft taken from one individual placed on genetically non-identical member of the same species.<\/li>\n<li>Xenograft: graft taken from one individual placed on an individual belonging to another species, e.g., animal to man.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Types_of_grafting\">Types of grafting<\/span><\/h2><p>\nThe term grafting is most commonly applied to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin_graft\" class=\"mw-redirect\" title=\"Skin graft\" rel=\"external_link\" target=\"_blank\">skin grafting<\/a>, however many tissues can be grafted: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin\" title=\"Skin\" rel=\"external_link\" target=\"_blank\">skin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nerve\" title=\"Nerve\" rel=\"external_link\" target=\"_blank\">nerves<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tendon\" title=\"Tendon\" rel=\"external_link\" target=\"_blank\">tendons<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurons\" class=\"mw-redirect\" title=\"Neurons\" rel=\"external_link\" target=\"_blank\">neurons<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_vessels\" class=\"mw-redirect\" title=\"Blood vessels\" rel=\"external_link\" target=\"_blank\">blood vessels<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adipose_tissue\" title=\"Adipose tissue\" rel=\"external_link\" target=\"_blank\">fat<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornea\" title=\"Cornea\" rel=\"external_link\" target=\"_blank\">cornea<\/a> are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_tissue\" class=\"mw-redirect\" title=\"Biological tissue\" rel=\"external_link\" target=\"_blank\">tissues<\/a> commonly grafted today.<\/p><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:251px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Skin_Grafting.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/24\/Skin_Grafting.jpg\/249px-Skin_Grafting.jpg\" width=\"249\" height=\"140\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Skin_Grafting.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The grafting process places fresh skin over a wound with damaged skin.<\/div><\/div><\/div>\n<p>Specific types include:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin_grafting\" title=\"Skin grafting\" rel=\"external_link\" target=\"_blank\">Skin grafting<\/a> is often used to treat skin loss due to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wound\" title=\"Wound\" rel=\"external_link\" target=\"_blank\">wound<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Burn_(injury)\" class=\"mw-redirect\" title=\"Burn (injury)\" rel=\"external_link\" target=\"_blank\">burn<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a>. In the case of damaged skin, it is removed, and new skin is grafted in its place. Skin grafting can reduce the course of treatment and hospitalization needed, and can also improve function and appearance. There are two types of skin grafts:<\/li><\/ul>\n<ol><li>Split-thickness skin grafts [epidermis + part of the dermis]<\/li>\n<li>Full-thickness skin grafts [epidermis + entire thickness of the dermis]<\/li><\/ol>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_grafting\" title=\"Bone grafting\" rel=\"external_link\" target=\"_blank\">Bone grafting<\/a><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implants\" class=\"mw-redirect\" title=\"Dental implants\" rel=\"external_link\" target=\"_blank\">dental implants<\/a>, as well as other instances. The bone may be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autologous\" class=\"mw-redirect\" title=\"Autologous\" rel=\"external_link\" target=\"_blank\">autologous<\/a>, typically harvested from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iliac_crest\" title=\"Iliac crest\" rel=\"external_link\" target=\"_blank\">iliac crest<\/a> of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pelvis\" title=\"Pelvis\" rel=\"external_link\" target=\"_blank\">pelvis<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Allotransplantation\" title=\"Allotransplantation\" rel=\"external_link\" target=\"_blank\">banked bone<\/a>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular_grafting\" class=\"mw-redirect\" title=\"Vascular grafting\" rel=\"external_link\" target=\"_blank\">Vascular grafting<\/a> is the use of transplanted or prosthetic blood vessels in surgical procedures.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ligament\" title=\"Ligament\" rel=\"external_link\" target=\"_blank\">Ligament<\/a> repair, as with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anterior_cruciate_ligament_reconstruction\" title=\"Anterior cruciate ligament reconstruction\" rel=\"external_link\" target=\"_blank\">anterior cruciate ligament reconstruction<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tommy_John_surgery\" class=\"mw-redirect\" title=\"Tommy John surgery\" rel=\"external_link\" target=\"_blank\">ulnar collateral ligament reconstruction<\/a>.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h2>\n<ul><li>Large amount of skin loss due to infections<\/li>\n<li>Burns<\/li>\n<li>Skin cancer surgery<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Reasons_for_failure\">Reasons for failure<\/span><\/h2>\n<ul><li>Hematoma (a collection of blood) development when the graft is placed over an active bleed<\/li>\n<li>Infection<\/li>\n<li>Seroma (a collection of fluid) development<\/li>\n<li>Shear force disrupting growth of new blood supply<\/li>\n<li>Inappropriate bed for new blood supply to grow from, such as cartilage, tendons, or bone<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Textbook of Microbiology, R. Vasanthakumari, p166, 2007, New Delhi, <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-81-7225-234-2<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"#Overview1\">\"What Is a Bone Graft?\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">18 May<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=What+Is+a+Bone+Graft%3F&rft_id=http%3A%2F%2Fwww.healthline.com%2Fhealth%2Fbone-graft%23Overview1&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGraft+%28surgery%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nlm.nih.gov\/medlineplus\/ency\/article\/002982.htm\" target=\"_blank\">\"Skin graft\"<\/a>. NIH<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">18 May<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Skin+graft&rft.pub=NIH&rft_id=https%3A%2F%2Fwww.nlm.nih.gov%2Fmedlineplus%2Fency%2Farticle%2F002982.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGraft+%28surgery%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><br \/><\/p>\n<p><!-- \nNewPP limit report\nParsed by mw1327\nCached time: 20181217110834\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.232 seconds\nReal time usage: 0.348 seconds\nPreprocessor visited node count: 735\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 41750\/2097152 bytes\nTemplate argument size: 347\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 6869\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.087\/10.000 seconds\nLua memory usage: 3.01 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 295.303 1 -total\n<\/p>\n<pre>45.19% 133.460 1 Template:Reflist\n25.07% 74.038 1 Template:Refimprove\n23.59% 69.659 1 Template:ISBN\n20.80% 61.414 1 Template:Infobox_medical_intervention\n19.25% 56.860 1 Template:Infobox\n17.41% 51.399 2 Template:Cite_web\n14.93% 44.099 1 Template:Catalog_lookup_link\n14.43% 42.621 1 Template:Ambox\n 8.47% 25.018 2 Template:Navbox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:740468-1!canonical and timestamp 20181217110833 and revision id 869926546\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Graft_%28surgery%29\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212241\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.139 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 133.241 1 - wikipedia:Graft_(surgery)\n100.00% 133.241 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8017-0!*!*!*!*!*!* and timestamp 20181217212240 and revision id 24128\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Graft_(surgery)\">https:\/\/www.limswiki.org\/index.php\/Graft_(surgery)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","3ad07f4d1fb8e8f005b2bb513840596a_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/24\/Skin_Grafting.jpg\/498px-Skin_Grafting.jpg"],"3ad07f4d1fb8e8f005b2bb513840596a_timestamp":1545081760,"4caaef5bad05e716bce0c64e52cb4953_type":"article","4caaef5bad05e716bce0c64e52cb4953_title":"Functional electrical stimulation","4caaef5bad05e716bce0c64e52cb4953_url":"https:\/\/www.limswiki.org\/index.php\/Functional_electrical_stimulation","4caaef5bad05e716bce0c64e52cb4953_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tFunctional electrical stimulation\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Functional Electrical Stimulation - Schematic Representation: Illustration of motor neuron stimulation. (a) The cell nucleus is responsible for synthesizing input from dendrites and deciding whether or not to generate signals. Following a stroke or spinal cord injury, muscles are impaired because motor neurons no longer receive sufficient input from the central nervous system. (b) A functional electrical stimulation system injects electrical current into the cell. (c) The intact but dormant axon receives the stimulus and propagates an action potential to (d) the neuromuscular junction. (e) The corresponding muscle fibers contract and generate (f) muscle force. (g) A train of negative pulses is produced. (h) Depolarization occurs where negative current enters the axon at the \"active\" electrode indicated.\nFunctional electrical stimulation (FES) is a technique that uses low energy electrical pulses to artificially generate body movements in individuals who have been paralyzed due to injury to the central nervous system. More specifically, FES can be used to generate muscle contraction in otherwise paralyzed limbs to produce functions such as grasping, walking, bladder voiding and standing. This technology was originally used to develop neuroprostheses that were implemented to permanently substitute impaired functions in individuals with spinal cord injury (SCI), head injury, stroke and other neurological disorders. In other words, a consumer would use the device each time he\/she wanted to generate a desired function.[1] FES is sometimes also referred to as neuromuscular electrical stimulation ^(NMES).[2]\nIn recent years FES technology has been used to deliver therapies to retrain voluntary motor functions such as grasping, reaching and walking. In this embodiment, FES is used as a short-term therapy, the objective of which is restoration of voluntary function and not lifelong dependence on the FES device, hence the name functional electrical stimulation therapy, FES therapy (FET or FEST). In other words, the FEST is used as a short-term intervention to help the central nervous system of the consumer to re-learn how to execute impaired functions, instead of making the consumer dependent on neuroprostheses for the rest of her\/his life.[3]\n\nContents \n\n1 Principles \n2 History \n3 Common applications \n\n3.1 Spinal cord injury \n\n3.1.1 Walking in spinal cord injury \n\n\n3.2 Stroke and upper limb recovery \n3.3 Drop foot \n3.4 Stroke \n3.5 Multiple sclerosis \n3.6 Cerebral palsy \n3.7 National Institute for Health and Care Excellence Guidelines (NICE) (UK) \n\n\n4 In popular culture \n5 See also \n6 References \n7 Further reading \n8 External links \n\n\nPrinciples \nThis section needs more medical references for verification or relies too heavily on primary sources. Please review the contents of the section and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. (December 2014)\nNeurons are electrically active cells.[4] In neurons, information is coded and transmitted as a series of electrical impulses called action potentials, which represent a brief change in cell electric potential of approximately 80\u201390 mV. Nerve signals are frequency modulated; i.e. the number of action potentials that occur in a unit of time is proportional to the intensity of the transmitted signal. Typical action potential frequency is between 4 and 12 Hz. An electrical stimulation can artificially elicit this action potential by changing the electric potential across a nerve cell membrane (this also includes the nerve axon) by inducing electrical charge in the immediate vicinity of the outer membrane of the cell.[5]\nFES devices take advantage of this property to electrically activate nerve cells, which then may go on to activate muscles or other nerves.[6] However, special care must be taken in designing safe FES devices, as passing electric current through tissue can lead to adverse effects such as decrease in excitability or cell death. This may be due to thermal damage, electroporation of the cell membrane, toxic products from electrochemical reactions at the electrode surface, or overexcitation of the targeted neutrons or muscles. Typically FES is concerned with stimulation of neurons and nerves. In some applications, FES can be used to directly stimulate muscles, if their peripheral nerves have been severed or damaged (i.e., denervated muscles).[7] However, the majority of the FES systems used today stimulate the nerves or the points where the junction occurs between the nerve and the muscle. The stimulated nerve bundle includes motor nerves (efferent nerves\u2014descending nerves from the central nervous system to muscles) and sensory nerves (afferent nerves\u2014ascending nerves from sensory organs to the central nervous system).\nThe electrical charge can stimulate both motor and sensory nerves. In some applications, the nerves are stimulated to generate localized muscle activity, i.e., the stimulation is aimed at generating direct muscle contraction. In other applications, stimulation is used to activate simple or complex reflexes. In other words, the afferent nerves are stimulated to evoke a reflex, which is typically expressed as a coordinated contraction of one or more muscles in response to the sensory nerve stimulation.\nWhen a nerve is stimulated, i.e., when sufficient electrical charge is provided to a nerve cell, a localized depolarization of the cell wall occurs resulting in an action potential that propagates toward both ends of the axon. Typically, one \"wave\" of action potentials will propagate along the axon towards the muscle (orthodromic propagation) and concurrently, the other \"wave\" of action potentials will propagate towards the cell body in the central nervous system (antidromic propagation). While the direction of propagation in case of the antidromic stimulation and the sensory nerve stimulation is the same, i.e., towards the central nervous system, their end effects are very different. The antidromic stimulus has been considered an irrelevant side effect of FES. However, in recent years a hypothesis has been presented suggesting the potential role of the antidromic stimulation in neurorehabilitation.[8] Typically, FES is concerned with orthodromic stimulation and uses it to generate coordinated muscle contractions.\nIn the case where sensory nerves are stimulated, the reflex arcs are triggered by the stimulation on sensory nerve axons at specific peripheral sites. One example of such a reflex is the flexor withdrawal reflex. The flexor withdrawal reflex occurs naturally when a sudden, painful sensation is applied to the sole of the foot. It results in flexion of the hip, knee and ankle of the affected leg, and extension of the contralateral leg in order to get the foot away from the painful stimulus as quickly as possible. The sensory nerve stimulation can be used to generate desired motor tasks, such as evoking flexor withdrawal reflex to facilitate walking in individuals following stroke, or they can be used to alter reflexes or the function of the central nervous system. In the later case, the electrical stimulation is commonly described by the term neuromodulation.\nNerves can be stimulated using either surface (transcutaneous) or subcutaneous (percutaneous or implanted) electrodes. The surface electrodes are placed on the skin surface above the nerve or muscle that needs to be \"activated\". They are noninvasive, easy to apply, and generally inexpensive. Until recently the common belief in the FES field has been that due to the electrode-skin contact impedance, skin and tissue impedance, and current dispersion during stimulation, much higher-intensity pulses are required to stimulate nerves using surface stimulation electrodes as compared to the subcutaneous electrodes.\n(This statement is correct for all commercially available stimulators except MyndMove stimulator, which has implemented a new stimulation pulse that allows the stimulator to generate muscle contractions without causing discomfort during stimulation, which is a common problem with commercially available transcutaneous electrical stimulation systems.)\nA major limitation of the transcutaneous electrical stimulation is that some nerves, for example those innervating the hip flexors, are too profound to be stimulated using surface electrodes. This limitation can be partly addressed by using arrays of electrodes, which can use several electrical contacts to increase selectivity.[9][10][11]\nSubcutaneous electrodes can be divided into percutaneous and implanted electrodes. The percutaneous electrodes consist of thin wires inserted through the skin and into muscular tissue close to the targeted nerve. These electrodes typically remain in place for a short period of time and are only considered for short-term FES interventions. However, it is worth mentioning that some groups, such as Cleveland FES Center, have been able to safely use percutaneous electrodes with individual patients for months and years at a time. One of the drawbacks of using the percutaneous electrodes is that they are prone to infection and special care has to be taken to prevent such events.\nThe other class of subcutaneous electrodes is implanted electrodes. These are permanently implanted in the consumer's body and remain in the body for the remainder of the consumer's life. Compared to surface stimulation electrodes, implanted and percutaneous electrodes potentially have higher stimulation selectivity, which is a desired characteristics of FES systems. To achieve higher selectivity while applying lower stimulation amplitudes, it is recommended that both cathode and anode are in the vicinity of the nerve that is stimulated. The drawbacks of the implanted electrodes are they require an invasive surgical procedure to install, and, as is the case with every surgical intervention, there exists a possibility of infection following implantation.\nTypical stimulation protocols used in clinical FES involves trains of electric pulses. Biphasic, charged balanced pulses are employed as they improve the safety of electrical stimulation and minimize some of the adverse effects. Pulse duration, pulse amplitude and pulse frequency are the key parameters that are regulated by the FES devices. The FES devices can be current or voltage regulated. Current regulated FES systems always deliver the same charge to the tissue regardless of the skin\/tissue resistance. Because of that, the current regulated FES systems do not require frequent adjustments of the stimulation intensity. The voltage regulated devices may require more frequent adjustments of the stimulation intensity as the charge that they deliver changes as the skin\/tissue resistance changes. The properties of the stimulation pulse trains and how many channels are used during stimulation define how complex and sophisticated FES-induced function is. The system can be as simple such as FES systems for muscle strengthening or they can be complex such as FES systems used to deliver simultaneous reaching and grasping,[12] or bipedal locomotion.[13][14][15]\nNote: This paragraph was developed in part using material from.[1] For more information on FES please consult that and other references provided in the paragraph.\n\nHistory \nFES was initially referred to as Functional Electrotherapy by Liberson,[16] and it was not until 1967 that the term Functional Electrical Stimulation was coined by Moe and Post,[17] and used in a patent entitled, \"Electrical stimulation of muscle deprived of nervous control with a view of providing muscular contraction and producing a functionally useful moment\".[18] Offner's patent described a system used to treat foot drop.\nThe first commercially available FES devices treated foot drop by stimulating the peroneal nerve during gait. In this case, a switch, located in the heel end of a user's shoe, would activate a stimulator worn by the user.\n\nCommon applications \nSpinal cord injury \nInjuries to the spinal cord interfere with electrical signals between the brain and the muscles, resulting in paralysis below the level of injury. Restoration of limb function as well as regulation of organ function are the main application of FES, although FES is also used for treatment of pain, pressure, sore prevention, etc. Some examples of FES applications involve the use of Neuroprostheses that allow the people with paraplegia to walk, stand, restore hand grasp function in people with quadriplegia, or restore bowel and bladder function.[19] High intensity FES of the quadriceps muscles allows patients with complete lower motor neuron lesion to increase their muscle mass, muscle fiber diameter, improve ultrastructural organization of contractile material, increase of force output during electrical stimulation and perform FES assisted stand-up exercises.[20]\n\nWalking in spinal cord injury \nKralj and his colleagues described a technique for paraplegic gait using surface stimulation, which remains the most popular method in use today.[21] Electrodes are placed over the quadriceps muscles and peroneal nerves bilaterally. The user controls the neuroprosthesis with two pushbuttons attached to the left and right handles of a walking frame, or on canes or crutches. When the neuroprosthesis is turned on, both quadriceps muscles are stimulated to provide a standing posture. Electrodes are placed over the quadriceps muscles and peroneal nerves bilaterally. The user controls the neuroprosthesis with two pushbuttons attached to the left and right handles of a walking frame, or on canes or crutches. When the neuroprosthesis is turned on, both quadriceps muscles are stimulated to provide a standing posture.[22] \nKralj\u2019s approach was extended by Graupe et al. [23] into a digital FES system that employs the power of digital signal processing to result in the Parastep FES system, based on US Patents 5,014,705 (1991), 5,016,636 (1991), 5,070,873 (1991), 5,081,989 (1992), 5,092,329 (1992) and related foreign patents. The Parastep system became the first FES system for standing and walking to receive the US FDA approval (FDA, PMA P900038, 1994) and become commercially available.\nThe Parastep\u2019s digital design allows a considerable reduction in rate of patient-fatigue by drastically reducing of stimulation pulse-width (100-140 microseconds) and pulse-rate (12-24 per sec.), to result, in walking times of 20-60 minutes and average walking distances of 450 meters per walk, for adequately trained thoracic-level complete paraplegics patients who complete training that includes daily treadmill sessions [24], with some patients exceeding one mile per walk ( https:\/\/www.youtube.com\/watch?v=7AKlSzEwhsg). Also, Parestep-based walking was reported to result in several medical and psychological benefits, including restoration of near-normal blood flow to lower extremities and holding of bone density decline [25] [26] [27]\nWalking performance with the Parastep system greatly depends on rigorous upper body conditioning-training and on a completing 3-5 months of a daily one\/two hours training program which includes 30 of more minutes of treadmill training [28].\n\r\n\nAn alternative approach to the above techniques is the FES system for walking developed using the Compex Motion neuroprosthesis.[29][30] Compex Motion neuroprosthesis for walking is an eight to sixteen channel surface FES system used to restore voluntary walking in stroke and spinal cord injury individuals.[31] This system does not apply peroneal nerve stimulation to enable locomotion. Instead, it activates all relevant lower limb muscles in a sequence similar to the one that brain uses to enable locomotion. The hybrid assistive systems (HAS)[32] and the RGO[33] walking neuroprostheses are devices that also apply active and passive braces, respectively. The braces were introduced to provide additional stability during standing and walking. A major limitation of neuroprostheses for walking that are based on surface stimulation is that the hip flexors cannot be stimulated directly. Therefore, hip flexion during walking must come from voluntary effort, which is often absent in paraplegia, or from the flexor withdrawal reflex. Implanted systems have the advantage of being able to stimulate the hip flexors, and therefore, to provide better muscle selectivity and potentially better gait patterns.[34] Hybrid systems with exoskeleton have been also proposed to solve this problem.[35] These technologies have been found to be successful and promising, but at the present time these FES systems are mostly used for exercise purposes and seldom as an alternative to wheelchair mobility.\n\n<\/p>\nStroke and upper limb recovery \nIn the acute stage of stroke recovery, the use of cyclic electrical stimulation has been seen to increase the isometric strength of wrist extensors. In order to increase strength of wrist extensors, there must be a degree of motor function at the wrist spared following the stroke and have significant hemiplegia. Patients who will elicit benefits of cyclic electrical stimulation of the wrist extensors must be highly motivated to follow through with treatment, After 8 weeks of electrical stimulation, an increase in grip strength can be apparent. Many scales, which assess the level of disability of the upper extremities following a stroke, use grip strength as a common item. Therefore, increasing strength of wrist extensors will decrease the level of upper extremity disability.\nPatients with hemiplegia following a stroke commonly experience shoulder pain and subluxation; both of which will interfere with the rehabilitation process. Functional electrical stimulation has been found to be effective for the management of pain and reduction of shoulder subluxation, as well as accelerating the degree and rate of motor recovery. Furthermore, the benefits of FES are maintained over time; research has demonstrated that the benefits are maintained for at least 24 months.[36]\n\nDrop foot \nDrop foot is a common symptom in hemiplegia, characterized by a lack of dorsiflexion during the swing phase of gait, resulting in short, shuffling strides. It has been shown that FES can be used to effectively compensate for the drop foot during the swing phase of the gait. At the moment just before the heel off phase of gait occurs, the stimulator delivers a stimulus to the common peroneal nerve, which results in contraction of the muscles responsible for dorsiflexion. There are currently a number of drop foot stimulators that use surface and implanted FES technologies.[37][38][39][40][41] Drop foot stimulators have been used successfully with various patient populations, such as stroke, spinal cord injury and multiple sclerosis.\n\nThe term \"orthotic effect\" can be used to describe the immediate improvement in function observed when the individual switches on their FES device compared to unassisted walking. This improvement disappears as soon as the person switches off their FES device. In contrast, a \"training\" or \"therapeutic effect\" is used to describe a long term improvement or restoration of function following a period of using the device which is still present even when the device is switched off. A further complication to measuring an orthotic effect and any long term training or therapeutic effects is the presence of a so-called \"temporary carry over effect\". Liberson et al., 1961[16] was the first to observe that some stroke patients appeared to benefit from a temporary improvement in function and were able to dorsiflex their foot for up to an hour after the electrical stimulation had been turned off. It has been hypothesised that this temporary improvement in function may be linked to a long term training or therapeutic effect. This image describes Functional Electrical Stimulation Therapy for walking. The therapy was used to help retrain incomplete spinal cord injured individuals to walk [30,31]. The\nStroke \nHemiparetic stroke patients, who are impacted by the denervation, muscular atrophy, and spasticity, typically experience an abnormal gait pattern due to muscular weakness and the incapacity to voluntary contract certain ankle and hip muscles at the appropriate walking phase. Liberson et al., (1961) were the first to pioneer FES in stroke patients.[16] More recently, there have been a number of studies that have been conducted in this area. A systematic review conducted in 2012 on the use of FES in chronic stroke included seven randomized controlled trials with a total of 231 participants. The review found a small treatment effect for using FES for the 6 minute walking test.[42]\n\nMultiple sclerosis \nFES has also been found to be useful for treating foot drop in people with multiple sclerosis. The first use was reported in 1977 by Carnstam et al., who found that it was possible to generate strength increases through using peroneal stimulation.[43][44] A more recent study examined the use of FES compared to an exercise group and found that although there was an orthotic effect for the FES group, no training effect in walking speed was found.[45] Further qualitative analysis including all participants from the same study found improvements in activities of daily living and a reduced number of falls for those using FES compared with exercise.[46] A further small scale (n=32) longitudinal observational study has found evidence for a significant training effect through using FES.[47]\nWith NMES treatment there were measurable gains in ambulatory function.[48]\nHowever, a further large observational study (n=187) was supportive of previous findings and found a significant improvement in orthotic effect for walking speed.[49]\n\nCerebral palsy \nFES has been found to be useful for treating the symptoms of cerebral palsy. A recent randomised controlled trial (n=32) found significant orthotic and training effects for children with unilateral spastic cerebral palsy. Improvements were found in gastrocnemius spasticity, community mobility and balance skills.[50] A recent comprehensive literature review of the area of using electrical stimulation and FES to treat children with disabilities mostly included studies on children with cerebral palsy.[51] The reviewers summarised the evidence as the treatment having the potential to improve a number of different areas including muscle mass and strength, spasticity, passive range of motion, upper extremity function, walking speed, positioning of the foot and ankle kinematics. The review further concludes that adverse events were rare and the technology is safe and well tolerated by this population.\n\n National Institute for Health and Care Excellence Guidelines (NICE) (UK) \nNICE have issued full guidelines on the treatment of drop foot of central neurological origin[52] (IPG278). NICE have stated that \"current evidence on the safety and efficacy (in terms of improving gait) of functional electrical stimulation (FES) for drop foot of central neurological origin appears adequate to support the use of this procedure provided that normal arrangements are in place for clinical governance, consent and audit\".\n\nIn popular culture \nMark Coggins' novel No Hard Feelings (2015) features a female protagonist with a spinal cord injury who regains mobility via advanced FES technology developed by a fictional biomedical startup.[53]\nSee also \nElectrotherapy\nCleveland FES Center\nShannon Criteria\nReferences \nThis article includes a list of references, but its sources remain unclear because it has insufficient inline citations. Please help to improve this article by introducing more precise citations. (February 2009) (Learn how and when to remove this template message)\n\n\n^ a b M.R. Popovic, K. Masani and S. Micera, \"Chapter 9 \u2013 Functional Electrical Stimulation Therapy: Recovery of function following spinal cord injury and stroke,\" In press, Neurorehabilitation Technology \u2013 Second Edition, Z. Rymer, T. Nef and V. Dietz, Ed. Springer Science Publishers in November 2015. \n\n^ M. Claudia et al., (2000), Artificial Grasping System for the Paralyzed Hand, International Society for Artificial Organs, Vol 24 No.3 \n\n^ M.K. Nagai, C. Marquez-Chin, and M.R. Popovic, \"Why is functional electrical stimulation therapy capable of restoring motor function following severe injury to the central nervous system?\" Translational Neuroscience, Mark Tuszynski, Ed. Springer Science and Business Media LLC, pp: 479-498, 2016. \n\n^ Guyton and Hall Textbook of Medical Physiology, John Hall, 13th edition, Elsevier Health Sciences, May 31, 2015 \n\n^ M.R. Popovic and T.A. Thrasher, \"Neuroprostheses,\" in Encyclopedia of Biomaterials and Biomedical Engineering, G.E. Wnek and G.L. Bowlin, Eds.: Marcel Dekker, Inc., vol. 2, pp. 1056-1065, 2004. \n\n^ Control of Movement for the Physically Disabled: Control for Rehabilitation Technology, Dejan Popovic and Thomas Sinkjaer, Springer Science & Business Media, December 6, 2012. \n\n^ Reichel M, Breyer T, Mayr W, and Rattay F. Simulation of the three-dimensional electrical field in the course of functional electrical stimulation. Artificial Organs 26: 252\u2013255, 2002. \n\n^ Rushton D. Functional electrical stimulation and rehabilitation\u2014an hypothesis. Med Eng Phys 25: 75\u201378, 2003. \n\n^ Kuhn A, Keller T, Micera S, Morari (2009). \"a simulation study\". Medical engineering & physics. 31: 945\u2013951. doi:10.1016\/j.medengphy.2009.05.006. CS1 maint: Multiple names: authors list (link) \n\n^ Micera S, Keller T, Lawrence M, Morari M, Popovi\u0107 DB (2010). \"Wearable neural prostheses. Restoration of sensory-motor function by transcutaneous electrical stimulation\". IEEE engineering in medicine and biology magazine. 29: 64\u201369. doi:10.1109\/memb.2010.936547. CS1 maint: Multiple names: authors list (link) \n\n^ Popovi\u0107 DB, Popovi\u0107 MB (2009). \"Automatic determination of the optimal shape of a surface electrode: selective stimulation\". Journal of Neuroscience Methods. 178: 174\u2013181. doi:10.1016\/j.jneumeth.2008.12.003. \n\n^ Popovic MR, Thrasher TA, Zivanovic P, Takaki M, and Hajek P. Neuroprosthesis for Retraining Reaching and Grasping Functions in Severe Hemiplegic Patients. Neuromodulation 8: 58\u201372, 2005. \n\n^ Bajd T, Kralj A, Stefancic M, and Lavrac N. Use of functional electrical stimulation in the lower extremities of incomplete spinal cord injured patients. Artificial Organs 23: 403\u2013409, 1999. \n\n^ Kapadia N, Masani K, Craven BC, Giangregorio LM, Hitzig SL, Richards K, Popovic (2014). \"Effects on walking competency\". The Journal of Spinal Cord Medicine. 37 (5): 511\u2013524. doi:10.1179\/2045772314y.0000000263. PMC 4166186 . CS1 maint: Multiple names: authors list (link) \n\n^ Bailey SN, Hardin EC, Kobetic R, Boggs LM, Pinault G, and Triolo RJ. Neurotherapeutic and neuroprosthetic effects of implanted functional electrical stimulation for ambulation after incomplete spinal cord injury Journal of rehabilitation research and development 2010; 47: 7\u201316 \n\n^ a b c Liberson, W. T.; Holmquest, H. J.; Scot, D.; Dow, M. (1961). \"Functional electrotherapy: Stimulation of the peroneal nerve synchronized with the swing phase of the gait of hemiplegic patients\". Archives of Physical Medicine and Rehabilitation. 42: 101\u2013105. PMID 13761879. \n\n^ Moe J. H., Post H. W. (1962). \"Functional electrical stimulation for ambulation in hemiplegia\". The Journal-lancet. 82: 285\u2013288. PMID 14474974. \n\n^ Offner et al. (1965), Patent 3,344,792 \n\n^ Pow\u2013ell, Joanna; David Pandyan; Malcolm Granat; Margart Cameron; David Stott (1999). \"Electrical Stimulation of Wrist Extensors in Poststroke Hemiplegia\". Stroke. 30 (7): 1384\u20131389. Retrieved 11 May 2011 . \n\n^ Kern H, Carraro U, Adami N, Biral D, Hofer C, Forstner C, M\u00f6dlin M, Vogelauer M, Pond A, Boncompagni S, Paolini C, Mayr W, Protasi F, Zampieri S (2010). \"Home-based functional electrical stimulation rescues permanently denervated muscles in paraplegic patients with complete lower motor neuron lesion\". Neurorehabil Neural Repair. 24 (8): 709\u2013721. doi:10.1177\/1545968310366129. PMID 20460493. \n\n^ Kralj A, Bajd T, and Turk R. \"Enhancement of gait restoration in spinal injured patients by functional electrical stimulation. Clin Orthop Relat Res 1988; 34-43 \n\n^ Graupe D, Davis R, Kordylewski H, Kohn K (1998). \"Ambulation by traumatic T4-12 paraplegics using functional neuromuscular stimulation\". Crit Rev Neurosurg. 8: 221\u2013231. doi:10.1007\/s003290050081. CS1 maint: Multiple names: authors list (link) \n\n^ Graupe D, Davis R, Kordylewski H, Kohn K (1998). \"Ambulation by traumatic T4-12 paraplegics using functional neuromuscular stimulation\". Crit Rev Neurosurg. 8: 221\u2013231. doi:10.1007\/s003290050081. CS1 maint: Multiple names: authors list (link) \n\n^ Graupe D, Davis R, Kordylewski H, Kohn K (1998). \"Ambulation by traumatic T4-12 paraplegics using functional neuromuscular stimulation\". Crit Rev Neurosurg. 8: 221\u2013231. doi:10.1007\/s003290050081. CS1 maint: Multiple names: authors list (link) \n\n^ [{cite journal = | author = Nash N S, Jacobs P L, Montalvo B M, Klose K J, Guest B, Needham-Shroshire M | year = 1997 | title = Evaluation of a training program for persons with SCI paraplegia using the Parastep\u00ae1 ambulation system: Part 5. Lower extremity blood flow and hyperemic responses to occlusion are augmented by ambulation training | url = | journal = Archives of Physical Medicine and Rehabilitation | volume = 78 | issue = 8 | pages = 808-814 | doi.org\/10.1016\/S0003-9993(97)90192-1}] \n\n^ [{cite journal | author = Gater D R, Dolbow D, Tsui B, Gorgey A S | year = 2011 | title = Functional electrical stimulation therapies after spinal cord injury | url = | journal = Neuro Rehabilitation | volume = 28 | issue = | pages = 231-248 | doi=10.3233\/nre-2011-0652}] \n\n^ Graupe D, Davis R, Kordylewski H, Kohn K (1998). \"Ambulation by traumatic T4-12 paraplegics using functional neuromuscular stimulation\". Crit Rev Neurosurg. 8: 221\u2013231. doi:10.1007\/s003290050081. CS1 maint: Multiple names: authors list (link) \n\n^ Graupe D, Davis R, Kordylewski H, Kohn K (1998). \"Ambulation by traumatic T4-12 paraplegics using functional neuromuscular stimulation\". Crit Rev Neurosurg. 8: 221\u2013231. doi:10.1007\/s003290050081. CS1 maint: Multiple names: authors list (link) \n\n^ Popovic MR, Keller T (2005). \"Modular transcutaneous functional electrical stimulation system\". Medical engineering & physics. 27: 81\u201392. doi:10.1016\/j.medengphy.2004.08.016. \n\n^ Thrasher TA, Flett HM, Popovic MR (2006). \"Gait training regimen for incomplete spinal cord injury using functional electrical stimulation\". Spinal Cord. 44: 357\u2013361. doi:10.1038\/sj.sc.3101864. CS1 maint: Multiple names: authors list (link) \n\n^ Kapadia N., Masani K., Craven B.C., Giangregorio L.M., Hitzig S.L., Richards K., Popovic M.R. (2014). \"A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: Effects on walking competency\". The Journal of Spinal Cord Medicine. 37 (5): 511\u2013524. doi:10.1179\/2045772314y.0000000263. PMC 4166186 . CS1 maint: Multiple names: authors list (link) \n\n^ Popovic D, Tomovi\u0107 R, Schwirtlich L (1989). \"Hybrid assistive system--the motor neuroprosthesis\". IEEE Transactions on Bio-medical Engineering. 36: 729\u2013737. doi:10.1109\/10.32105. CS1 maint: Multiple names: authors list (link) \n\n^ Solomonow M, Baratta R, Hirokawa S, Rightor N, Walker W, Beaudette P, Shoji H, D'Ambrosia R (1989). \"The RGO Generation II: muscle stimulation powered orthosis as a practical walking system for thoracic paraplegics\". Orthopedics. 12: 1309\u20131315. CS1 maint: Multiple names: authors list (link) \n\n^ Triolo RJ, Bieri C, Uhlir J, Kobetic R, Scheiner A, Marsolais EB (1996). \"Implanted Functional Neuromuscular Stimulation systems for individuals with cervical spinal cord injuries: clinical case reports\". Archives of Physical Medicine and Rehabilitation. 77: 1119\u20131128. doi:10.1016\/s0003-9993(96)90133-1. CS1 maint: Multiple names: authors list (link) \n\n^ Kobetic R, To CS, Schnellenberger JR, Audu ML, Bulea TC, Gaudio R, Pinault G, Tashman S, Triolo RJ (2009). \"Development of hybrid orthosis for standing, walking, and stair climbing after spinal cord injury\". Journal of rehabilitation research and development. 46: 447\u2013462. CS1 maint: Multiple names: authors list (link) \n\n^ Chantraine, Alex; Baribeault, Alain; Uebelhart, Daniel; Gremion, Gerald (1999). \"Shoulder Pain and Dysfunction in Hemiplegia: Effects of Functional Electrical Stimulation\". Archives of Physical Medicine and Rehabilitation. 80: 328\u2013331. doi:10.1016\/s0003-9993(99)90146-6. \n\n^ Taylor PN, Burridge JH, Dunkerley AL, Wood DE, Norton JA, Singleton C, Swain ID (1999). \"Clinical use of the Odstock dropped foot stimulator: its effect on the speed and effort of walking\". Archives of Physical Medicine and Rehabilitation. 80 (12): 1577\u20131583. doi:10.1016\/s0003-9993(99)90333-7. CS1 maint: Multiple names: authors list (link) \n\n^ Stein RB, Everaert DG, Thompson AK, Chong SL, Whittaker M, Robertson J, Kuether G (2010) Long-term therapeutic and orthotic effects of a foot drop stimulator on walking performance in progressive and nonprogressive neurological disorders. Neurorehabilitation and neural repair 24 (2):152-167. \n\n^ Hausdorff JM, Ring H (2008) Effects of a new radio frequency-controlled neuroprosthesis on gait symmetry and rhythmicity in patients with chronic hemiparesis. American journal of physical medicine & rehabilitation \/ Association of Academic Physiatrists 87 (1):4-13. \n\n^ Burridge JH, Haugland M, Larsen B, Svaneborg N, Iversen HK, Christensen PB, Pickering RM, Sinkjaer T (2008) Patients' perceptions of the benefits and problems of using the ActiGait implanted drop-foot stimulator. J Rehabil Med 40 (10):873-875. \n\n^ Kenney L, Bultstra G, Buschman R, Taylor P, Mann G, Hermens H, Holsheimer J, Nene A, Tenniglo M, van der Aa H, Hobby J (2002) An implantable two channel drop foot stimulator: initial clinical results. Artificial Organs 26 (3):267-270 \n\n^ Pereira, Shelialah; Mehta, Swati; McIntyre, Amanda; Lobo, Liane; Teasell, Robert W. (2012-12-01). \"Functional electrical stimulation for improving gait in persons with chronic stroke\". Topics in Stroke Rehabilitation. 19 (6): 491\u2013498. doi:10.1310\/tsr1906-491. ISSN 1074-9357. PMID 23192714. \n\n^ Cook AW (1976). \"Electrical stimulation in multiple sclerosis\". Hosp Pract. 11: 51\u20138. doi:10.1080\/21548331.1976.11706516. PMID 1088368. \n\n^ Carnstam, B.; Larsson, L. E.; Prevec, T. S. (1977-01-01). \"Improvement of gait following functional electrical stimulation. I. Investigations on changes in voluntary strength and proprioceptive reflexes\". Scandinavian Journal of Rehabilitation Medicine. 9 (1): 7\u201313. ISSN 0036-5505. PMID 302481. \n\n^ Barrett, C. L.; Mann, G. E.; Taylor, P. N.; Strike, P. (2009-04-01). \"A randomized trial to investigate the effects of functional electrical stimulation and therapeutic exercise on walking performance for people with multiple sclerosis\". Multiple Sclerosis (Houndmills, Basingstoke, England). 15 (4): 493\u2013504. doi:10.1177\/1352458508101320. ISSN 1352-4585. PMID 19282417. \n\n^ Esnouf, J. E.; Taylor, P. N.; Mann, G. E.; Barrett, C. L. (2010-09-01). \"Impact on activities of daily living using a functional electrical stimulation device to improve dropped foot in people with multiple sclerosis, measured by the Canadian Occupational Performance Measure\". Multiple Sclerosis (Houndmills, Basingstoke, England). 16 (9): 1141\u20131147. doi:10.1177\/1352458510366013. ISSN 1477-0970. PMID 20601398. \n\n^ Stein, Richard B.; Everaert, Dirk G.; Thompson, Aiko K.; Chong, Su Ling; Whittaker, Maura; Robertson, Jenny; Kuether, Gerald (2010-02-01). \"Long-term therapeutic and orthotic effects of a foot drop stimulator on walking performance in progressive and nonprogressive neurological disorders\". Neurorehabilitation and Neural Repair. 24 (2): 152\u2013167. doi:10.1177\/1545968309347681. ISSN 1552-6844. PMID 19846759. \n\n^ Wahls TL, Reese D, Kaplan D, Darling WG (2010). \"Rehabilitation with neuromuscular electrical stimulation leads to functional gains in ambulation in patients with secondary progressive and primary progressive multiple sclerosis: a case series report\". J Altern Complement Med. 16: 1343\u20139. doi:10.1089\/acm.2010.0080. PMID 21138391. CS1 maint: Multiple names: authors list (link) \n\n^ Street, Tamsyn; Taylor, Paul; Swain, Ian (2015-04-01). \"Effectiveness of functional electrical stimulation on walking speed, functional walking category, and clinically meaningful changes for people with multiple sclerosis\". Archives of Physical Medicine and Rehabilitation. 96 (4): 667\u2013672. doi:10.1016\/j.apmr.2014.11.017. ISSN 1532-821X. PMID 25499688. \n\n^ Pool, Dayna; Valentine, Jane; Bear, Natasha; Donnelly, Cyril J.; Elliott, Catherine; Stannage, Katherine (2015-01-01). \"The orthotic and therapeutic effects following daily community applied functional electrical stimulation in children with unilateral spastic cerebral palsy: a randomised controlled trial\". BMC Pediatrics. 15: 154. doi:10.1186\/s12887-015-0472-y. ISSN 1471-2431. PMC 4603297 . PMID 26459358. \n\n^ Bosques, Glendaliz; Martin, Rebecca; McGee, Leah; Sadowsky, Cristina (2016-05-31). \"Does therapeutic electrical stimulation improve function in children with disabilities? A comprehensive literature review\". Journal of Pediatric Rehabilitation Medicine. 9 (2): 83\u201399. doi:10.3233\/PRM-160375. ISSN 1875-8894. PMID 27285801. \n\n^ \"Functional electrical stimulation for drop foot of central neurological origin | Guidance and guidelines | NICE\". www.nice.org.uk. Retrieved 2016-06-14 . \n\n^ \"The Rap Sheet, \"The Story Behind the Story: No Hard Feelings by Mark Coggins\" \". Retrieved February 10, 2016 . \n\n\nFurther reading \nChudler, Eric H. \"Neuroscience For Kids - Cells of the Nervous System.\" UW Faculty Web Server. Eric H. Chudler, 1 June 2011. Web. 7 June 2011.<http:\/\/faculty.washington.edu\/chudler\/cells.html>.\nCooper E.B., Scherder E.J.A., Cooper J.B (2005) \"Electrical treatment of reduced consciousness: experience with coma and Alzheimer's disease,\" Neuropsyh Rehab (UK).Vol. 15,389-405.\nCooper E.B,& Cooper J.B. (2003) \"Electrical treatment of coma via the median nerve,\" Acta Neurochirurg Supp, Vol. 87, 7-10.\n\"FEScenter.org \u00bb Cleveland FES Center.\" FEScenter.org \u00bb Home. Cleveland VA Medical Center, Case Western Reserve University, MetroHealth Medical Center, 3 June 2011. Web. 8 June 2011. <http:\/\/fescenter.org\/index.php?option=com_content>\nGraupe D (2002). \"An overview of the state of the art of noninvasive FES for independent ambulation by thoracic level paraplegics\". Neurological Research. 24: 431\u2013442. doi:10.1179\/016164102101200302. \nGraupe D, Cerrel-Bazo H, Kern H, Carraro U (2008). \"Walking Performance, Medical Outcomes and Patient Training in FES of Innervated Muscles for Ambulation by Thoracic-Level Complete Paraplegics\". Neurol. Res. 31: 123\u2013130. \nJohnston, Laurance. \"FES.\" Human Spinal Chord Injury: New & Emerging Therapies. Institute of Spinal Cord Injury, Iceland. Web. 7 June 2011. <http:\/\/www.sci-therapies.info\/FES.htm>.\nLichy A., Libin A., Ljunberg I., Groach L., (2007) \" Preserving bone health after acute spinal cord injury: Differential responses to a neuromuscular electrical stimulation intervention\", Proc. 12th Annual Conf. of the International FES Soc., Philadelphia, PA, Session 2, Paper 205.\nLiu Yi-Liang, Ling Qi-Dan, Kang En-Tang, Neoh Koon-Gee, Liaw Der-Jang, Wang Kun-Li, Liou Wun-Tai, Zhu Chun-Xiang, Siu-Hung Chan Daniel (2009). \"Volatile Electrical Switching in a Functional Polyimide Containing Electron-donor and -acceptor Moieties\". Journal of Applied Physics. 105: 1\u20139. doi:10.1063\/1.3077286. CS1 maint: Multiple names: authors list (link) \nNolte, John, and John Sundsten. The Human Brain: an Introduction to Its Functional Anatomy. 5th ed. St. Louis: Mosby, 2002.\nRosenzweig, Mark R., Arnold L. Leiman, and S. Marc. Breedlove. Biological Psychology. Sunderland: Sinauer Associates, 2003.\nWilkenfeld Ari J., Audu Musa L., Triolo Ronald J. (2006). \"Feasibility of Functional Electrical Stimulation for Control of Seated Posture after Spinal Cord Injury: A Simulation Study\". The Journal of Rehabilitation Research and Development. 43 (2): 139\u201343. doi:10.1682\/jrrd.2005.06.0101. CS1 maint: Multiple names: authors list (link) \nYuan Wang, Ming Zhang, Rana Netra, Hai Liu, Chen-wang Jin, Shao-hui Ma (2010). \"A Functional Magnetic Resonance Imaging Study of Human Brain in Pain-related Areas Induced by Electrical Stimulation with Different Intensities\". Neurology India. 58 (6): 922\u201327. CS1 maint: Multiple names: authors list (link) \nExternal links \nHistory of Functional Electrical Stimulation, 1998\nBack From the Dead, Wired Magazine\nFunctional electrical stimulation (FES) factsheet\n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Functional_electrical_stimulation\">https:\/\/www.limswiki.org\/index.php\/Functional_electrical_stimulation<\/a>\n\t\t\t\t\tCategories: Medical and surgical techniquesNeurostimulationHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 17:29.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 788 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","4caaef5bad05e716bce0c64e52cb4953_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Functional_electrical_stimulation skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Functional electrical stimulation<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Functional_Electrical_Stimulation_.tif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/63\/Functional_Electrical_Stimulation_.tif\/lossy-page1-220px-Functional_Electrical_Stimulation_.tif.jpg\" width=\"220\" height=\"170\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Functional_Electrical_Stimulation_.tif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Functional Electrical Stimulation - Schematic Representation: Illustration of motor neuron stimulation. (a) The cell nucleus is responsible for synthesizing input from dendrites and deciding whether or not to generate signals. Following a stroke or spinal cord injury, muscles are impaired because motor neurons no longer receive sufficient input from the central nervous system. (b) A functional electrical stimulation system injects electrical current into the cell. (c) The intact but dormant axon receives the stimulus and propagates an action potential to (d) the neuromuscular junction. (e) The corresponding muscle fibers contract and generate (f) muscle force. (g) A train of negative pulses is produced. (h) Depolarization occurs where negative current enters the axon at the \"active\" electrode indicated.<\/div><\/div><\/div>\n<p><b>Functional electrical stimulation<\/b> (<b>FES<\/b>) is a technique that uses low energy electrical pulses to artificially generate body movements in individuals who have been paralyzed due to injury to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Central_nervous_system\" title=\"Central nervous system\" rel=\"external_link\" target=\"_blank\">central nervous system<\/a>. More specifically, FES can be used to generate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Muscle\" title=\"Muscle\" rel=\"external_link\" target=\"_blank\">muscle<\/a> contraction in otherwise paralyzed limbs to produce functions such as grasping, walking, bladder voiding and standing. This technology was originally used to develop neuroprostheses that were implemented to permanently substitute impaired functions in individuals with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_injury\" title=\"Spinal cord injury\" rel=\"external_link\" target=\"_blank\">spinal cord injury<\/a> (SCI), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Head_injury\" title=\"Head injury\" rel=\"external_link\" target=\"_blank\">head injury<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a> and other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurological_disorder\" title=\"Neurological disorder\" rel=\"external_link\" target=\"_blank\">neurological disorders<\/a>. In other words, a consumer would use the device each time he\/she wanted to generate a desired function.<sup id=\"rdp-ebb-cite_ref-:0_1-0\" class=\"reference\"><a href=\"#cite_note-:0-1\" rel=\"external_link\">[1]<\/a><\/sup> FES is sometimes also referred to as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromuscular_electrical_stimulation\" class=\"mw-redirect\" title=\"Neuromuscular electrical stimulation\" rel=\"external_link\" target=\"_blank\">neuromuscular electrical stimulation<\/a> ^(<a href=\"https:\/\/en.wikipedia.org\/wiki\/NMES\" class=\"mw-redirect\" title=\"NMES\" rel=\"external_link\" target=\"_blank\">NMES<\/a>).<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>In recent years FES technology has been used to deliver therapies to retrain voluntary motor functions such as grasping, reaching and walking. In this embodiment, FES is used as a short-term therapy, the objective of which is restoration of voluntary function and not lifelong dependence on the FES device, hence the name <b>functional electrical stimulation therapy<\/b>, <b>FES therapy<\/b> (<b>FET<\/b> or <b>FEST<\/b>). In other words, the FEST is used as a short-term intervention to help the central nervous system of the consumer to re-learn how to execute impaired functions, instead of making the consumer dependent on neuroprostheses for the rest of her\/his life.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Principles\">Principles<\/span><\/h2>\n\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuron\" title=\"Neuron\" rel=\"external_link\" target=\"_blank\">Neurons<\/a> are electrically active <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cell_(biology)\" title=\"Cell (biology)\" rel=\"external_link\" target=\"_blank\">cells<\/a>.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> In neurons, information is coded and transmitted as a series of electrical impulses called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Action_potential\" title=\"Action potential\" rel=\"external_link\" target=\"_blank\">action potentials<\/a>, which represent a brief change in cell electric potential of approximately 80\u201390 mV. Nerve signals are frequency modulated; i.e. the number of action potentials that occur in a unit of time is proportional to the intensity of the transmitted signal. Typical action potential frequency is between 4 and 12 Hz. An electrical stimulation can artificially elicit this action potential by changing the electric potential across a nerve cell membrane (this also includes the nerve axon) by inducing electrical charge in the immediate vicinity of the outer membrane of the cell.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>FES devices take advantage of this property to electrically activate nerve cells, which then may go on to activate muscles or other nerves.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> However, special care must be taken in designing safe FES devices, as passing electric current through tissue can lead to adverse effects such as decrease in excitability or cell death. This may be due to thermal damage, electroporation of the cell membrane, toxic products from electrochemical reactions at the electrode surface, or overexcitation of the targeted neutrons or muscles. Typically FES is concerned with stimulation of neurons and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nerve\" title=\"Nerve\" rel=\"external_link\" target=\"_blank\">nerves<\/a>. In some applications, FES can be used to directly stimulate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Muscle\" title=\"Muscle\" rel=\"external_link\" target=\"_blank\">muscles<\/a>, if their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peripheral_nervous_system\" title=\"Peripheral nervous system\" rel=\"external_link\" target=\"_blank\">peripheral nerves<\/a> have been severed or damaged (i.e., denervated muscles).<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> However, the majority of the FES systems used today stimulate the nerves or the points where the junction occurs between the nerve and the muscle. The stimulated nerve bundle includes motor nerves (efferent nerves\u2014descending nerves from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Central_nervous_system\" title=\"Central nervous system\" rel=\"external_link\" target=\"_blank\">central nervous system<\/a> to muscles) and sensory nerves (afferent nerves\u2014ascending nerves from sensory organs to the central nervous system).\n<\/p><p>The electrical charge can stimulate both motor and sensory nerves. In some applications, the nerves are stimulated to generate localized muscle activity, i.e., the stimulation is aimed at generating direct muscle contraction. In other applications, stimulation is used to activate simple or complex <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reflex\" title=\"Reflex\" rel=\"external_link\" target=\"_blank\">reflexes<\/a>. In other words, the afferent nerves are stimulated to evoke a reflex, which is typically expressed as a coordinated contraction of one or more muscles in response to the sensory nerve stimulation.\n<\/p><p>When a nerve is stimulated, i.e., when sufficient electrical charge is provided to a nerve cell, a localized depolarization of the cell wall occurs resulting in an action potential that propagates toward both ends of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Axon\" title=\"Axon\" rel=\"external_link\" target=\"_blank\">axon<\/a>. Typically, one \"wave\" of action potentials will propagate along the axon towards the muscle (orthodromic propagation) and concurrently, the other \"wave\" of action potentials will propagate towards the cell body in the central nervous system (antidromic propagation). While the direction of propagation in case of the antidromic stimulation and the sensory nerve stimulation is the same, i.e., towards the central nervous system, their end effects are very different. The antidromic stimulus has been considered an irrelevant side effect of FES. However, in recent years a hypothesis has been presented suggesting the potential role of the antidromic stimulation in neurorehabilitation.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> Typically, FES is concerned with orthodromic stimulation and uses it to generate coordinated muscle contractions.\n<\/p><p>In the case where sensory nerves are stimulated, the reflex arcs are triggered by the stimulation on sensory nerve axons at specific peripheral sites. One example of such a reflex is the flexor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Withdrawal_reflex\" title=\"Withdrawal reflex\" rel=\"external_link\" target=\"_blank\">withdrawal reflex<\/a>. The flexor withdrawal reflex occurs naturally when a sudden, painful sensation is applied to the sole of the foot. It results in flexion of the hip, knee and ankle of the affected leg, and extension of the contralateral leg in order to get the foot away from the painful stimulus as quickly as possible. The sensory nerve stimulation can be used to generate desired motor tasks, such as evoking flexor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Withdrawal_reflex\" title=\"Withdrawal reflex\" rel=\"external_link\" target=\"_blank\">withdrawal reflex<\/a> to facilitate walking in individuals following <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a>, or they can be used to alter reflexes or the function of the central nervous system. In the later case, the electrical stimulation is commonly described by the term <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromodulation\" title=\"Neuromodulation\" rel=\"external_link\" target=\"_blank\">neuromodulation<\/a><\/i>.\n<\/p><p>Nerves can be stimulated using either surface (transcutaneous) or subcutaneous (percutaneous or implanted) electrodes. The surface electrodes are placed on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin\" title=\"Skin\" rel=\"external_link\" target=\"_blank\">skin<\/a> surface above the nerve or muscle that needs to be \"activated\". They are noninvasive, easy to apply, and generally inexpensive. Until recently the common belief in the FES field has been that due to the electrode-skin contact impedance, skin and tissue impedance, and current dispersion during stimulation, much higher-intensity pulses are required to stimulate nerves using surface stimulation electrodes as compared to the subcutaneous electrodes.\n<\/p><p>(This statement is correct for all commercially available stimulators except MyndMove stimulator, which has implemented a new stimulation pulse that allows the stimulator to generate muscle contractions without causing discomfort during stimulation, which is a common problem with commercially available transcutaneous electrical stimulation systems.)\n<\/p><p>A major limitation of the transcutaneous electrical stimulation is that some nerves, for example those innervating the hip flexors, are too profound to be stimulated using surface electrodes. This limitation can be partly addressed by using arrays of electrodes, which can use several electrical contacts to increase selectivity.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>Subcutaneous electrodes can be divided into <a href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous\" title=\"Percutaneous\" rel=\"external_link\" target=\"_blank\">percutaneous<\/a> and implanted electrodes. The percutaneous electrodes consist of thin wires inserted through the skin and into muscular tissue close to the targeted nerve. These electrodes typically remain in place for a short period of time and are only considered for short-term FES interventions. However, it is worth mentioning that some groups, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cleveland_FES_Center\" title=\"Cleveland FES Center\" rel=\"external_link\" target=\"_blank\">Cleveland FES Center<\/a>, have been able to safely use percutaneous electrodes with individual patients for months and years at a time. One of the drawbacks of using the percutaneous electrodes is that they are prone to infection and special care has to be taken to prevent such events.\n<\/p><p>The other class of subcutaneous electrodes is implanted electrodes. These are permanently implanted in the consumer's body and remain in the body for the remainder of the consumer's life. Compared to surface stimulation electrodes, implanted and percutaneous electrodes potentially have higher stimulation selectivity, which is a desired characteristics of FES systems. To achieve higher selectivity while applying lower stimulation amplitudes, it is recommended that both cathode and anode are in the vicinity of the nerve that is stimulated. The drawbacks of the implanted electrodes are they require an invasive surgical procedure to install, and, as is the case with every surgical intervention, there exists a possibility of infection following implantation.\n<\/p><p>Typical stimulation protocols used in clinical FES involves trains of electric pulses. Biphasic, charged balanced pulses are employed as they improve the safety of electrical stimulation and minimize some of the adverse effects. Pulse duration, pulse amplitude and pulse frequency are the key parameters that are regulated by the FES devices. The FES devices can be current or voltage regulated. Current regulated FES systems always deliver the same charge to the tissue regardless of the skin\/tissue resistance. Because of that, the current regulated FES systems do not require frequent adjustments of the stimulation intensity. The voltage regulated devices may require more frequent adjustments of the stimulation intensity as the charge that they deliver changes as the skin\/tissue resistance changes. The properties of the stimulation pulse trains and how many channels are used during stimulation define how complex and sophisticated FES-induced function is. The system can be as simple such as FES systems for muscle strengthening or they can be complex such as FES systems used to deliver simultaneous reaching and grasping,<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> or bipedal locomotion.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p><i>Note: This paragraph was developed in part using material from.<sup id=\"rdp-ebb-cite_ref-:0_1-1\" class=\"reference\"><a href=\"#cite_note-:0-1\" rel=\"external_link\">[1]<\/a><\/sup> For more information on FES please consult that and other references provided in the paragraph.<\/i>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>FES was initially referred to as Functional Electrotherapy by Liberson,<sup id=\"rdp-ebb-cite_ref-Liberson1961_16-0\" class=\"reference\"><a href=\"#cite_note-Liberson1961-16\" rel=\"external_link\">[16]<\/a><\/sup> and it was not until 1967 that the term Functional Electrical Stimulation was coined by Moe and Post,<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> and used in a patent entitled, \"Electrical stimulation of muscle deprived of nervous control with a view of providing muscular contraction and producing a functionally useful moment\".<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> Offner's patent described a system used to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foot_drop\" title=\"Foot drop\" rel=\"external_link\" target=\"_blank\">foot drop<\/a>.\n<\/p><p>The first commercially available FES devices treated foot drop by stimulating the peroneal nerve during gait. In this case, a switch, located in the heel end of a user's shoe, would activate a stimulator worn by the user.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Common_applications\">Common applications<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Spinal_cord_injury\">Spinal cord injury<\/span><\/h3>\n<p>Injuries to the spinal cord interfere with electrical signals between the brain and the muscles, resulting in paralysis below the level of injury. Restoration of limb function as well as regulation of organ function are the main application of FES, although FES is also used for treatment of pain, pressure, sore prevention, etc. Some examples of FES applications involve the use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroprostheses\" class=\"mw-redirect\" title=\"Neuroprostheses\" rel=\"external_link\" target=\"_blank\">Neuroprostheses<\/a> that allow the people with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paraplegia\" title=\"Paraplegia\" rel=\"external_link\" target=\"_blank\">paraplegia<\/a> to walk, stand, restore hand grasp function in people with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quadriplegia\" class=\"mw-redirect\" title=\"Quadriplegia\" rel=\"external_link\" target=\"_blank\">quadriplegia<\/a>, or restore bowel and bladder function.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> High intensity FES of the quadriceps muscles allows patients with complete lower motor neuron lesion to increase their muscle mass, muscle fiber diameter, improve ultrastructural organization of contractile material, increase of force output during electrical stimulation and perform FES assisted stand-up exercises.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Walking_in_spinal_cord_injury\">Walking in spinal cord injury<\/span><\/h4>\n<p>Kralj and his colleagues described a technique for paraplegic gait using surface stimulation, which remains the most popular method in use today.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> Electrodes are placed over the quadriceps muscles and peroneal nerves bilaterally. The user controls the neuroprosthesis with two pushbuttons attached to the left and right handles of a walking frame, or on canes or crutches. When the neuroprosthesis is turned on, both quadriceps muscles are stimulated to provide a standing posture. Electrodes are placed over the quadriceps muscles and peroneal nerves bilaterally. The user controls the neuroprosthesis with two pushbuttons attached to the left and right handles of a walking frame, or on canes or crutches. When the neuroprosthesis is turned on, both quadriceps muscles are stimulated to provide a standing posture.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> \n<\/p><p>Kralj\u2019s approach was extended by Graupe et al. <sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> into a digital FES system that employs the power of digital signal processing to result in the Parastep FES system, based on US Patents 5,014,705 (1991), 5,016,636 (1991), 5,070,873 (1991), 5,081,989 (1992), 5,092,329 (1992) and related foreign patents. The Parastep system became the first FES system for standing and walking to receive the US FDA approval (FDA, PMA P900038, 1994) and become commercially available.\n<\/p><p>The Parastep\u2019s digital design allows a considerable reduction in rate of patient-fatigue by drastically reducing of stimulation pulse-width (100-140 microseconds) and pulse-rate (12-24 per sec.), to result, in walking times of 20-60 minutes and average walking distances of 450 meters per walk, for adequately trained thoracic-level complete paraplegics patients who complete training that includes daily treadmill sessions <sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup>, with some patients exceeding one mile per walk ( <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.youtube.com\/watch?v=7AKlSzEwhsg\" target=\"_blank\">https:\/\/www.youtube.com\/watch?v=7AKlSzEwhsg<\/a>). Also, Parestep-based walking was reported to result in several medical and psychological benefits, including restoration of near-normal blood flow to lower extremities and holding of bone density decline <sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> <sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> <sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p><p>Walking performance with the Parastep system greatly depends on rigorous upper body conditioning-training and on a completing 3-5 months of a daily one\/two hours training program which includes 30 of more minutes of treadmill training <sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup>.\n<\/p><p><br \/>\n<p>An alternative approach to the above techniques is the FES system for walking developed using the Compex Motion neuroprosthesis.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup> Compex Motion neuroprosthesis for walking is an eight to sixteen channel surface FES system used to restore voluntary walking in stroke and spinal cord injury individuals.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> This system does not apply peroneal nerve stimulation to enable locomotion. Instead, it activates all relevant lower limb muscles in a sequence similar to the one that brain uses to enable locomotion. The hybrid assistive systems (HAS)<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> and the RGO<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup> walking neuroprostheses are devices that also apply active and passive braces, respectively. The braces were introduced to provide additional stability during standing and walking. A major limitation of neuroprostheses for walking that are based on surface stimulation is that the hip flexors cannot be stimulated directly. Therefore, hip flexion during walking must come from voluntary effort, which is often absent in paraplegia, or from the flexor withdrawal reflex. Implanted systems have the advantage of being able to stimulate the hip flexors, and therefore, to provide better muscle selectivity and potentially better gait patterns.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup> Hybrid systems with exoskeleton have been also proposed to solve this problem.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup> These technologies have been found to be successful and promising, but at the present time these FES systems are mostly used for exercise purposes and seldom as an alternative to wheelchair mobility.\n<\/p>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Stroke_and_upper_limb_recovery\">Stroke and upper limb recovery<\/span><\/h3>\n<p>In the acute stage of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a> recovery, the use of cyclic electrical stimulation has been seen to increase the isometric strength of wrist extensors. In order to increase strength of wrist extensors, there must be a degree of motor function at the wrist spared following the stroke and have significant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemiplegia\" class=\"mw-redirect\" title=\"Hemiplegia\" rel=\"external_link\" target=\"_blank\">hemiplegia<\/a>. Patients who will elicit benefits of cyclic electrical stimulation of the wrist extensors must be highly motivated to follow through with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Therapy\" title=\"Therapy\" rel=\"external_link\" target=\"_blank\">treatment<\/a>, After 8 weeks of electrical stimulation, an increase in grip strength can be apparent. Many scales, which assess the level of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disability\" title=\"Disability\" rel=\"external_link\" target=\"_blank\">disability<\/a> of the upper extremities following a stroke, use grip strength as a common item. Therefore, increasing strength of wrist extensors will decrease the level of upper extremity disability.\n<\/p><p>Patients with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemiplegia\" class=\"mw-redirect\" title=\"Hemiplegia\" rel=\"external_link\" target=\"_blank\">hemiplegia<\/a> following a stroke commonly experience shoulder pain and subluxation; both of which will interfere with the rehabilitation process. Functional electrical stimulation has been found to be effective for the management of pain and reduction of shoulder subluxation, as well as accelerating the degree and rate of motor recovery. Furthermore, the benefits of FES are maintained over time; research has demonstrated that the benefits are maintained for at least 24 months.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Drop_foot\">Drop foot<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Foot_drop\" title=\"Foot drop\" rel=\"external_link\" target=\"_blank\">Drop foot<\/a> is a common symptom in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemiparesis\" title=\"Hemiparesis\" rel=\"external_link\" target=\"_blank\">hemiplegia<\/a>, characterized by a lack of dorsiflexion during the swing phase of gait, resulting in short, shuffling strides. It has been shown that FES can be used to effectively compensate for the drop foot during the swing phase of the gait. At the moment just before the heel off phase of gait occurs, the stimulator delivers a stimulus to the common peroneal nerve, which results in contraction of the muscles responsible for dorsiflexion. There are currently a number of drop foot stimulators that use surface and implanted FES technologies.<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\" rel=\"external_link\">[41]<\/a><\/sup> Drop foot stimulators have been used successfully with various patient populations, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_injury\" title=\"Spinal cord injury\" rel=\"external_link\" target=\"_blank\">spinal cord injury<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Multiple_sclerosis\" title=\"Multiple sclerosis\" rel=\"external_link\" target=\"_blank\">multiple sclerosis<\/a>.\n<\/p><p>\nThe term \"orthotic effect\" can be used to describe the immediate improvement in function observed when the individual switches on their FES device compared to unassisted walking. This improvement disappears as soon as the person switches off their FES device. In contrast, a \"training\" or \"therapeutic effect\" is used to describe a long term improvement or restoration of function following a period of using the device which is still present even when the device is switched off. A further complication to measuring an orthotic effect and any long term training or therapeutic effects is the presence of a so-called \"temporary carry over effect\". Liberson et al., 1961<sup id=\"rdp-ebb-cite_ref-Liberson1961_16-1\" class=\"reference\"><a href=\"#cite_note-Liberson1961-16\" rel=\"external_link\">[16]<\/a><\/sup> was the first to observe that some stroke patients appeared to benefit from a temporary improvement in function and were able to dorsiflex their foot for up to an hour after the electrical stimulation had been turned off. It has been hypothesised that this temporary improvement in function may be linked to a long term training or therapeutic effect. <\/p><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Functional_Electrical_Stimulation_Therapy_for_improving_walking_in_incomplete_spinal_cord_injured_individuals_-30,31-.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/55\/Functional_Electrical_Stimulation_Therapy_for_improving_walking_in_incomplete_spinal_cord_injured_individuals_-30%2C31-.jpg\/220px-Functional_Electrical_Stimulation_Therapy_for_improving_walking_in_incomplete_spinal_cord_injured_individuals_-30%2C31-.jpg\" width=\"220\" height=\"208\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Functional_Electrical_Stimulation_Therapy_for_improving_walking_in_incomplete_spinal_cord_injured_individuals_-30,31-.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>This image describes Functional Electrical Stimulation Therapy for walking. The therapy was used to help retrain incomplete spinal cord injured individuals to walk [30,31]. The<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Stroke\">Stroke<\/span><\/h3>\n<p>Hemiparetic stroke patients, who are impacted by the denervation, muscular atrophy, and spasticity, typically experience an abnormal gait pattern due to muscular weakness and the incapacity to voluntary contract certain ankle and hip muscles at the appropriate walking phase. Liberson et al., (1961) were the first to pioneer FES in stroke patients.<sup id=\"rdp-ebb-cite_ref-Liberson1961_16-2\" class=\"reference\"><a href=\"#cite_note-Liberson1961-16\" rel=\"external_link\">[16]<\/a><\/sup> More recently, there have been a number of studies that have been conducted in this area. A systematic review conducted in 2012 on the use of FES in chronic stroke included seven randomized controlled trials with a total of 231 participants. The review found a small treatment effect for using FES for the 6 minute walking test.<sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Multiple_sclerosis\">Multiple sclerosis<\/span><\/h3>\n<p>FES has also been found to be useful for treating foot drop in people with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Multiple_sclerosis\" title=\"Multiple sclerosis\" rel=\"external_link\" target=\"_blank\">multiple sclerosis<\/a>. The first use was reported in 1977 by Carnstam et al., who found that it was possible to generate strength increases through using peroneal stimulation.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup> A more recent study examined the use of FES compared to an exercise group and found that although there was an orthotic effect for the FES group, no training effect in walking speed was found.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup> Further <a href=\"https:\/\/en.wikipedia.org\/wiki\/Qualitative_research\" title=\"Qualitative research\" rel=\"external_link\" target=\"_blank\">qualitative analysis<\/a> including all participants from the same study found improvements in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Activities_of_daily_living\" title=\"Activities of daily living\" rel=\"external_link\" target=\"_blank\">activities of daily living<\/a> and a reduced number of falls for those using FES compared with exercise.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup> A further small scale (n=32) longitudinal observational study has found evidence for a significant training effect through using FES.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup>\nWith NMES treatment there were measurable gains in ambulatory function.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup>\n<\/p><p>However, a further large observational study (n=187) was supportive of previous findings and found a significant improvement in orthotic effect for walking speed.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Cerebral_palsy\">Cerebral palsy<\/span><\/h3>\n<p>FES has been found to be useful for treating the symptoms of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_palsy\" title=\"Cerebral palsy\" rel=\"external_link\" target=\"_blank\">cerebral palsy<\/a>. A recent randomised controlled trial (n=32) found significant orthotic and training effects for children with unilateral spastic cerebral palsy. Improvements were found in gastrocnemius spasticity, community mobility and balance skills.<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup> A recent comprehensive literature review of the area of using electrical stimulation and FES to treat children with disabilities mostly included studies on children with cerebral palsy.<sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup> The reviewers summarised the evidence as the treatment having the potential to improve a number of different areas including muscle mass and strength, spasticity, passive range of motion, upper extremity function, walking speed, positioning of the foot and ankle kinematics. The review further concludes that adverse events were rare and the technology is safe and well tolerated by this population.\n<\/p>\n<h3><span id=\"rdp-ebb-National_Institute_for_Health_and_Care_Excellence_Guidelines_.28NICE.29_.28UK.29\"><\/span><span class=\"mw-headline\" id=\"National_Institute_for_Health_and_Care_Excellence_Guidelines_(NICE)_(UK)\">National Institute for Health and Care Excellence Guidelines (NICE) (UK)<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Institute_for_Health_and_Care_Excellence\" title=\"National Institute for Health and Care Excellence\" rel=\"external_link\" target=\"_blank\">NICE<\/a> have issued full guidelines on the treatment of drop foot of central neurological origin<sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup> (IPG278). NICE have stated that \"current evidence on the safety and efficacy (in terms of improving gait) of functional electrical stimulation (FES) for drop foot of central neurological origin appears adequate to support the use of this procedure provided that normal arrangements are in place for clinical governance, consent and audit\".\n<\/p>\n<h2><span class=\"mw-headline\" id=\"In_popular_culture\">In popular culture<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mark_Coggins\" title=\"Mark Coggins\" rel=\"external_link\" target=\"_blank\">Mark Coggins<\/a>' novel <i>No Hard Feelings<\/i> (2015) features a female protagonist with a spinal cord injury who regains mobility via advanced FES technology developed by a fictional biomedical startup.<sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrotherapy\" title=\"Electrotherapy\" rel=\"external_link\" target=\"_blank\">Electrotherapy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cleveland_FES_Center\" title=\"Cleveland FES Center\" rel=\"external_link\" target=\"_blank\">Cleveland FES Center<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Shannon_Criteria\" title=\"Shannon Criteria\" rel=\"external_link\" target=\"_blank\">Shannon Criteria<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-:0-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">M.R. Popovic, K. Masani and S. Micera, \"Chapter 9 \u2013 Functional Electrical Stimulation Therapy: Recovery of function following spinal cord injury and stroke,\" In press, Neurorehabilitation Technology \u2013 Second Edition, Z. Rymer, T. Nef and V. Dietz, Ed. Springer Science Publishers in November 2015.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">M. Claudia et al., (2000), Artificial Grasping System for the Paralyzed Hand, International Society for Artificial Organs, Vol 24 No.3<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">M.K. Nagai, C. Marquez-Chin, and M.R. Popovic, \"Why is functional electrical stimulation therapy capable of restoring motor function following severe injury to the central nervous system?\" Translational Neuroscience, Mark Tuszynski, Ed. Springer Science and Business Media LLC, pp: 479-498, 2016.<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Guyton and Hall Textbook of Medical Physiology, John Hall, 13th edition, Elsevier Health Sciences, May 31, 2015<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">M.R. Popovic and T.A. Thrasher, \"Neuroprostheses,\" in Encyclopedia of Biomaterials and Biomedical Engineering, G.E. Wnek and G.L. Bowlin, Eds.: Marcel Dekker, Inc., vol. 2, pp. 1056-1065, 2004.<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Control of Movement for the Physically Disabled: Control for Rehabilitation Technology, Dejan Popovic and Thomas Sinkjaer, Springer Science & Business Media, December 6, 2012.<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Reichel M, Breyer T, Mayr W, and Rattay F. Simulation of the three-dimensional electrical field in the course of functional electrical stimulation. Artificial Organs 26: 252\u2013255, 2002.<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Rushton D. Functional electrical stimulation and rehabilitation\u2014an hypothesis. Med Eng Phys 25: 75\u201378, 2003.<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kuhn A, Keller T, Micera S, Morari (2009). \"a simulation study\". <i>Medical engineering & physics<\/i>. <b>31<\/b>: 945\u2013951. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.medengphy.2009.05.006\" target=\"_blank\">10.1016\/j.medengphy.2009.05.006<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Medical+engineering+%26+physics&rft.atitle=a+simulation+study&rft.volume=31&rft.pages=945-951&rft.date=2009&rft_id=info%3Adoi%2F10.1016%2Fj.medengphy.2009.05.006&rft.au=Kuhn+A%2C+Keller+T%2C+Micera+S%2C+Morari&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Micera S, Keller T, Lawrence M, Morari M, Popovi\u0107 DB (2010). \"Wearable neural prostheses. Restoration of sensory-motor function by transcutaneous electrical stimulation\". <i>IEEE engineering in medicine and biology magazine<\/i>. <b>29<\/b>: 64\u201369. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2Fmemb.2010.936547\" target=\"_blank\">10.1109\/memb.2010.936547<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=IEEE+engineering+in+medicine+and+biology+magazine&rft.atitle=Wearable+neural+prostheses.+Restoration+of+sensory-motor+function+by+transcutaneous+electrical+stimulation&rft.volume=29&rft.pages=64-69&rft.date=2010&rft_id=info%3Adoi%2F10.1109%2Fmemb.2010.936547&rft.au=Micera+S%2C+Keller+T%2C+Lawrence+M%2C+Morari+M%2C+Popovi%C4%87+DB&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Popovi\u0107 DB, Popovi\u0107 MB (2009). \"Automatic determination of the optimal shape of a surface electrode: selective stimulation\". <i>Journal of Neuroscience Methods<\/i>. <b>178<\/b>: 174\u2013181. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jneumeth.2008.12.003\" target=\"_blank\">10.1016\/j.jneumeth.2008.12.003<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Neuroscience+Methods&rft.atitle=Automatic+determination+of+the+optimal+shape+of+a+surface+electrode%3A+selective+stimulation&rft.volume=178&rft.pages=174-181&rft.date=2009&rft_id=info%3Adoi%2F10.1016%2Fj.jneumeth.2008.12.003&rft.au=Popovi%C4%87+DB%2C+Popovi%C4%87+MB&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Popovic MR, Thrasher TA, Zivanovic P, Takaki M, and Hajek P. Neuroprosthesis for Retraining Reaching and Grasping Functions in Severe Hemiplegic Patients. Neuromodulation 8: 58\u201372, 2005.<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Bajd T, Kralj A, Stefancic M, and Lavrac N. Use of functional electrical stimulation in the lower extremities of incomplete spinal cord injured patients. Artificial Organs 23: 403\u2013409, 1999.<\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kapadia N, Masani K, Craven BC, Giangregorio LM, Hitzig SL, Richards K, Popovic (2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4166186\" target=\"_blank\">\"Effects on walking competency\"<\/a>. <i>The Journal of Spinal Cord Medicine<\/i>. <b>37<\/b> (5): 511\u2013524. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1179%2F2045772314y.0000000263\" target=\"_blank\">10.1179\/2045772314y.0000000263<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4166186\" target=\"_blank\">4166186<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Spinal+Cord+Medicine&rft.atitle=Effects+on+walking+competency&rft.volume=37&rft.issue=5&rft.pages=511-524&rft.date=2014&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4166186&rft_id=info%3Adoi%2F10.1179%2F2045772314y.0000000263&rft.au=Kapadia+N%2C+Masani+K%2C+Craven+BC%2C+Giangregorio+LM%2C+Hitzig+SL%2C+Richards+K%2C+Popovic&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4166186&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Bailey SN, Hardin EC, Kobetic R, Boggs LM, Pinault G, and Triolo RJ. 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J Rehabil Med 40 (10):873-875.<\/span>\n<\/li>\n<li id=\"cite_note-41\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-41\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Kenney L, Bultstra G, Buschman R, Taylor P, Mann G, Hermens H, Holsheimer J, Nene A, Tenniglo M, van der Aa H, Hobby J (2002) An implantable two channel drop foot stimulator: initial clinical results. Artificial Organs 26 (3):267-270<\/span>\n<\/li>\n<li id=\"cite_note-42\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-42\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pereira, Shelialah; Mehta, Swati; McIntyre, Amanda; Lobo, Liane; Teasell, Robert W. 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(2009-04-01). \"A randomized trial to investigate the effects of functional electrical stimulation and therapeutic exercise on walking performance for people with multiple sclerosis\". <i>Multiple Sclerosis (Houndmills, Basingstoke, England)<\/i>. <b>15<\/b> (4): 493\u2013504. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F1352458508101320\" target=\"_blank\">10.1177\/1352458508101320<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1352-4585\" target=\"_blank\">1352-4585<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19282417\" target=\"_blank\">19282417<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Multiple+Sclerosis+%28Houndmills%2C+Basingstoke%2C+England%29&rft.atitle=A+randomized+trial+to+investigate+the+effects+of+functional+electrical+stimulation+and+therapeutic+exercise+on+walking+performance+for+people+with+multiple+sclerosis&rft.volume=15&rft.issue=4&rft.pages=493-504&rft.date=2009-04-01&rft.issn=1352-4585&rft_id=info%3Apmid%2F19282417&rft_id=info%3Adoi%2F10.1177%2F1352458508101320&rft.aulast=Barrett&rft.aufirst=C.+L.&rft.au=Mann%2C+G.+E.&rft.au=Taylor%2C+P.+N.&rft.au=Strike%2C+P.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-46\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-46\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Esnouf, J. E.; Taylor, P. N.; Mann, G. E.; Barrett, C. L. (2010-09-01). \"Impact on activities of daily living using a functional electrical stimulation device to improve dropped foot in people with multiple sclerosis, measured by the Canadian Occupational Performance Measure\". <i>Multiple Sclerosis (Houndmills, Basingstoke, England)<\/i>. <b>16<\/b> (9): 1141\u20131147. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F1352458510366013\" target=\"_blank\">10.1177\/1352458510366013<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1477-0970\" target=\"_blank\">1477-0970<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20601398\" target=\"_blank\">20601398<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Multiple+Sclerosis+%28Houndmills%2C+Basingstoke%2C+England%29&rft.atitle=Impact+on+activities+of+daily+living+using+a+functional+electrical+stimulation+device+to+improve+dropped+foot+in+people+with+multiple+sclerosis%2C+measured+by+the+Canadian+Occupational+Performance+Measure&rft.volume=16&rft.issue=9&rft.pages=1141-1147&rft.date=2010-09-01&rft.issn=1477-0970&rft_id=info%3Apmid%2F20601398&rft_id=info%3Adoi%2F10.1177%2F1352458510366013&rft.aulast=Esnouf&rft.aufirst=J.+E.&rft.au=Taylor%2C+P.+N.&rft.au=Mann%2C+G.+E.&rft.au=Barrett%2C+C.+L.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-47\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-47\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stein, Richard B.; Everaert, Dirk G.; Thompson, Aiko K.; Chong, Su Ling; Whittaker, Maura; Robertson, Jenny; Kuether, Gerald (2010-02-01). \"Long-term therapeutic and orthotic effects of a foot drop stimulator on walking performance in progressive and nonprogressive neurological disorders\". <i>Neurorehabilitation and Neural Repair<\/i>. <b>24<\/b> (2): 152\u2013167. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F1545968309347681\" target=\"_blank\">10.1177\/1545968309347681<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1552-6844\" target=\"_blank\">1552-6844<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19846759\" target=\"_blank\">19846759<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurorehabilitation+and+Neural+Repair&rft.atitle=Long-term+therapeutic+and+orthotic+effects+of+a+foot+drop+stimulator+on+walking+performance+in+progressive+and+nonprogressive+neurological+disorders&rft.volume=24&rft.issue=2&rft.pages=152-167&rft.date=2010-02-01&rft.issn=1552-6844&rft_id=info%3Apmid%2F19846759&rft_id=info%3Adoi%2F10.1177%2F1545968309347681&rft.aulast=Stein&rft.aufirst=Richard+B.&rft.au=Everaert%2C+Dirk+G.&rft.au=Thompson%2C+Aiko+K.&rft.au=Chong%2C+Su+Ling&rft.au=Whittaker%2C+Maura&rft.au=Robertson%2C+Jenny&rft.au=Kuether%2C+Gerald&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-48\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-48\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wahls TL, Reese D, Kaplan D, Darling WG (2010). \"Rehabilitation with neuromuscular electrical stimulation leads to functional gains in ambulation in patients with secondary progressive and primary progressive multiple sclerosis: a case series report\". <i>J Altern Complement Med<\/i>. <b>16<\/b>: 1343\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1089%2Facm.2010.0080\" target=\"_blank\">10.1089\/acm.2010.0080<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21138391\" target=\"_blank\">21138391<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Altern+Complement+Med&rft.atitle=Rehabilitation+with+neuromuscular+electrical+stimulation+leads+to+functional+gains+in+ambulation+in+patients+with+secondary+progressive+and+primary+progressive+multiple+sclerosis%3A+a+case+series+report&rft.volume=16&rft.pages=1343-9&rft.date=2010&rft_id=info%3Adoi%2F10.1089%2Facm.2010.0080&rft_id=info%3Apmid%2F21138391&rft.au=Wahls+TL%2C+Reese+D%2C+Kaplan+D%2C+Darling+WG&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-49\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-49\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Street, Tamsyn; Taylor, Paul; Swain, Ian (2015-04-01). \"Effectiveness of functional electrical stimulation on walking speed, functional walking category, and clinically meaningful changes for people with multiple sclerosis\". <i>Archives of Physical Medicine and Rehabilitation<\/i>. <b>96<\/b> (4): 667\u2013672. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.apmr.2014.11.017\" target=\"_blank\">10.1016\/j.apmr.2014.11.017<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1532-821X\" target=\"_blank\">1532-821X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25499688\" target=\"_blank\">25499688<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+of+Physical+Medicine+and+Rehabilitation&rft.atitle=Effectiveness+of+functional+electrical+stimulation+on+walking+speed%2C+functional+walking+category%2C+and+clinically+meaningful+changes+for+people+with+multiple+sclerosis&rft.volume=96&rft.issue=4&rft.pages=667-672&rft.date=2015-04-01&rft.issn=1532-821X&rft_id=info%3Apmid%2F25499688&rft_id=info%3Adoi%2F10.1016%2Fj.apmr.2014.11.017&rft.aulast=Street&rft.aufirst=Tamsyn&rft.au=Taylor%2C+Paul&rft.au=Swain%2C+Ian&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-50\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-50\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pool, Dayna; Valentine, Jane; Bear, Natasha; Donnelly, Cyril J.; Elliott, Catherine; Stannage, Katherine (2015-01-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4603297\" target=\"_blank\">\"The orthotic and therapeutic effects following daily community applied functional electrical stimulation in children with unilateral spastic cerebral palsy: a randomised controlled trial\"<\/a>. <i>BMC Pediatrics<\/i>. <b>15<\/b>: 154. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2Fs12887-015-0472-y\" target=\"_blank\">10.1186\/s12887-015-0472-y<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1471-2431\" target=\"_blank\">1471-2431<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4603297\" target=\"_blank\">4603297<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26459358\" target=\"_blank\">26459358<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMC+Pediatrics&rft.atitle=The+orthotic+and+therapeutic+effects+following+daily+community+applied+functional+electrical+stimulation+in+children+with+unilateral+spastic+cerebral+palsy%3A+a+randomised+controlled+trial&rft.volume=15&rft.pages=154&rft.date=2015-01-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4603297&rft.issn=1471-2431&rft_id=info%3Apmid%2F26459358&rft_id=info%3Adoi%2F10.1186%2Fs12887-015-0472-y&rft.aulast=Pool&rft.aufirst=Dayna&rft.au=Valentine%2C+Jane&rft.au=Bear%2C+Natasha&rft.au=Donnelly%2C+Cyril+J.&rft.au=Elliott%2C+Catherine&rft.au=Stannage%2C+Katherine&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4603297&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-51\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-51\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bosques, Glendaliz; Martin, Rebecca; McGee, Leah; Sadowsky, Cristina (2016-05-31). \"Does therapeutic electrical stimulation improve function in children with disabilities? A comprehensive literature review\". <i>Journal of Pediatric Rehabilitation Medicine<\/i>. <b>9<\/b> (2): 83\u201399. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3233%2FPRM-160375\" target=\"_blank\">10.3233\/PRM-160375<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1875-8894\" target=\"_blank\">1875-8894<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27285801\" target=\"_blank\">27285801<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Pediatric+Rehabilitation+Medicine&rft.atitle=Does+therapeutic+electrical+stimulation+improve+function+in+children+with+disabilities%3F+A+comprehensive+literature+review&rft.volume=9&rft.issue=2&rft.pages=83-99&rft.date=2016-05-31&rft.issn=1875-8894&rft_id=info%3Apmid%2F27285801&rft_id=info%3Adoi%2F10.3233%2FPRM-160375&rft.aulast=Bosques&rft.aufirst=Glendaliz&rft.au=Martin%2C+Rebecca&rft.au=McGee%2C+Leah&rft.au=Sadowsky%2C+Cristina&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-52\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-52\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nice.org.uk\/guidance\/ipg278\" target=\"_blank\">\"Functional electrical stimulation for drop foot of central neurological origin | Guidance and guidelines | NICE\"<\/a>. <i>www.nice.org.uk<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-06-14<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.nice.org.uk&rft.atitle=Functional+electrical+stimulation+for+drop+foot+of+central+neurological+origin+%7C+Guidance+and+guidelines+%7C+NICE&rft_id=https%3A%2F%2Fwww.nice.org.uk%2Fguidance%2Fipg278&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-53\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-53\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/therapsheet.blogspot.com\/2015\/08\/the-story-behind-story-no-hard-feelings.html\" target=\"_blank\">\"The Rap Sheet, \"The Story Behind the Story: No Hard Feelings by Mark Coggins<span class=\"cs1-kern-right\">\"<\/span>\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">February 10,<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=The+Rap+Sheet%2C+%22The+Story+Behind+the+Story%3A+No+Hard+Feelings+by+Mark+Coggins%22&rft_id=http%3A%2F%2Ftherapsheet.blogspot.com%2F2015%2F08%2Fthe-story-behind-story-no-hard-feelings.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li>Chudler, Eric H. \"Neuroscience For Kids - Cells of the Nervous System.\" UW Faculty Web Server. Eric H. Chudler, 1 June 2011. Web. 7 June 2011.<<a rel=\"external_link\" class=\"external free\" href=\"http:\/\/faculty.washington.edu\/chudler\/cells.html\" target=\"_blank\">http:\/\/faculty.washington.edu\/chudler\/cells.html<\/a>>.<\/li>\n<li>Cooper E.B., Scherder E.J.A., Cooper J.B (2005) \"Electrical treatment of reduced consciousness: experience with coma and Alzheimer's disease,\" Neuropsyh Rehab (UK).Vol. 15,389-405.<\/li>\n<li>Cooper E.B,& Cooper J.B. (2003) \"Electrical treatment of coma via the median nerve,\" Acta Neurochirurg Supp, Vol. 87, 7-10.<\/li>\n<li>\"FEScenter.org \u00bb Cleveland FES Center.\" FEScenter.org \u00bb Home. Cleveland VA Medical Center, Case Western Reserve University, MetroHealth Medical Center, 3 June 2011. Web. 8 June 2011. <<a rel=\"external_link\" class=\"external free\" href=\"http:\/\/fescenter.org\/index.php?option=com_content\" target=\"_blank\">http:\/\/fescenter.org\/index.php?option=com_content<\/a>><\/li>\n<li><cite class=\"citation journal\">Graupe D (2002). \"An overview of the state of the art of noninvasive FES for independent ambulation by thoracic level paraplegics\". <i>Neurological Research<\/i>. <b>24<\/b>: 431\u2013442. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1179%2F016164102101200302\" target=\"_blank\">10.1179\/016164102101200302<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurological+Research&rft.atitle=An+overview+of+the+state+of+the+art+of+noninvasive+FES+for+independent+ambulation+by+thoracic+level+paraplegics&rft.volume=24&rft.pages=431-442&rft.date=2002&rft_id=info%3Adoi%2F10.1179%2F016164102101200302&rft.au=Graupe+D&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Graupe D, Cerrel-Bazo H, Kern H, Carraro U (2008). \"Walking Performance, Medical Outcomes and Patient Training in FES of Innervated Muscles for Ambulation by Thoracic-Level Complete Paraplegics\". <i>Neurol. Res<\/i>. <b>31<\/b>: 123\u2013130.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurol.+Res.&rft.atitle=Walking+Performance%2C+Medical+Outcomes+and+Patient+Training+in+FES+of+Innervated+Muscles+for+Ambulation+by+Thoracic-Level+Complete+Paraplegics&rft.volume=31&rft.pages=123-130&rft.date=2008&rft.aulast=Graupe&rft.aufirst=D&rft.au=Cerrel-Bazo%2C+H&rft.au=Kern%2C+H&rft.au=Carraro%2C+U&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li>Johnston, Laurance. \"FES.\" Human Spinal Chord Injury: New & Emerging Therapies. Institute of Spinal Cord Injury, Iceland. Web. 7 June 2011. <<a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.sci-therapies.info\/FES.htm\" target=\"_blank\">http:\/\/www.sci-therapies.info\/FES.htm<\/a>>.<\/li>\n<li>Lichy A., Libin A., Ljunberg I., Groach L., (2007) \" Preserving bone health after acute spinal cord injury: Differential responses to a neuromuscular electrical stimulation intervention\", Proc. 12th Annual Conf. of the International FES Soc., Philadelphia, PA, Session 2, Paper 205.<\/li>\n<li><cite class=\"citation journal\">Liu Yi-Liang, Ling Qi-Dan, Kang En-Tang, Neoh Koon-Gee, Liaw Der-Jang, Wang Kun-Li, Liou Wun-Tai, Zhu Chun-Xiang, Siu-Hung Chan Daniel (2009). \"Volatile Electrical Switching in a Functional Polyimide Containing Electron-donor and -acceptor Moieties\". <i>Journal of Applied Physics<\/i>. <b>105<\/b>: 1\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1063%2F1.3077286\" target=\"_blank\">10.1063\/1.3077286<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Applied+Physics&rft.atitle=Volatile+Electrical+Switching+in+a+Functional+Polyimide+Containing+Electron-donor+and+-acceptor+Moieties&rft.volume=105&rft.pages=1-9&rft.date=2009&rft_id=info%3Adoi%2F10.1063%2F1.3077286&rft.au=Liu+Yi-Liang%2C+Ling+Qi-Dan%2C+Kang+En-Tang%2C+Neoh+Koon-Gee%2C+Liaw+Der-Jang%2C+Wang+Kun-Li%2C+Liou+Wun-Tai%2C+Zhu+Chun-Xiang%2C+Siu-Hung+Chan+Daniel&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li>Nolte, John, and John Sundsten. The Human Brain: an Introduction to Its Functional Anatomy. 5th ed. St. Louis: Mosby, 2002.<\/li>\n<li>Rosenzweig, Mark R., Arnold L. Leiman, and S. Marc. Breedlove. Biological Psychology. Sunderland: Sinauer Associates, 2003.<\/li>\n<li><cite class=\"citation journal\">Wilkenfeld Ari J., Audu Musa L., Triolo Ronald J. (2006). \"Feasibility of Functional Electrical Stimulation for Control of Seated Posture after Spinal Cord Injury: A Simulation Study\". <i>The Journal of Rehabilitation Research and Development<\/i>. <b>43<\/b> (2): 139\u201343. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1682%2Fjrrd.2005.06.0101\" target=\"_blank\">10.1682\/jrrd.2005.06.0101<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Rehabilitation+Research+and+Development&rft.atitle=Feasibility+of+Functional+Electrical+Stimulation+for+Control+of+Seated+Posture+after+Spinal+Cord+Injury%3A+A+Simulation+Study&rft.volume=43&rft.issue=2&rft.pages=139-43&rft.date=2006&rft_id=info%3Adoi%2F10.1682%2Fjrrd.2005.06.0101&rft.au=Wilkenfeld+Ari+J.%2C+Audu+Musa+L.%2C+Triolo+Ronald+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Yuan Wang, Ming Zhang, Rana Netra, Hai Liu, Chen-wang Jin, Shao-hui Ma (2010). \"A Functional Magnetic Resonance Imaging Study of Human Brain in Pain-related Areas Induced by Electrical Stimulation with Different Intensities\". <i>Neurology India<\/i>. <b>58<\/b> (6): 922\u201327.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurology+India&rft.atitle=A+Functional+Magnetic+Resonance+Imaging+Study+of+Human+Brain+in+Pain-related+Areas+Induced+by+Electrical+Stimulation+with+Different+Intensities&rft.volume=58&rft.issue=6&rft.pages=922-27&rft.date=2010&rft.au=Yuan+Wang%2C+Ming+Zhang%2C+Rana+Netra%2C+Hai+Liu%2C+Chen-wang+Jin%2C+Shao-hui+Ma&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFunctional+electrical+stimulation\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ifess.org\/ifess98\/presentations\/IFESS%20history%20-%20PPT95_files\/frame.htm\" target=\"_blank\">History of Functional Electrical Stimulation, 1998<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.wired.com\/wired\/archive\/14.09\/brainshock.html\" target=\"_blank\">Back From the Dead, Wired Magazine<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mstrust.org.uk\/information\/publications\/factsheets\/fes.jsp\" target=\"_blank\">Functional electrical stimulation (FES) factsheet<\/a><\/li><\/ul>\n<p class=\"mw-empty-elt\">\n<\/p>\n<p><!-- \nNewPP limit report\nParsed by mw1322\nCached time: 20181129131138\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.508 seconds\nReal time usage: 0.596 seconds\nPreprocessor visited node count: 2323\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 99535\/2097152 bytes\nTemplate argument size: 383\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 6\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 118721\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.305\/10.000 seconds\nLua memory usage: 4.64 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 514.253 1 -total\n<\/p>\n<pre>66.88% 343.956 1 Template:Reflist\n59.36% 305.263 37 Template:Cite_journal\n11.99% 61.653 1 Template:Medical_citations_needed\n10.49% 53.922 2 Template:Ambox\n 4.49% 23.075 1 Template:More_footnotes\n 3.39% 17.417 1 Template:Use_dmy_dates\n 2.65% 13.648 1 Template:DMCA\n 2.62% 13.456 2 Template:Cite_web\n 2.20% 11.306 1 Template:Dated_maintenance_category\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:842532-1!canonical and timestamp 20181129131137 and revision id 864966375\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Functional_electrical_stimulation\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212240\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.021 seconds\nReal time usage: 0.174 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 165.725 1 - wikipedia:Functional_electrical_stimulation\n100.00% 165.725 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8303-0!*!*!*!*!*!* and timestamp 20181217212240 and revision id 24523\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Functional_electrical_stimulation\">https:\/\/www.limswiki.org\/index.php\/Functional_electrical_stimulation<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","4caaef5bad05e716bce0c64e52cb4953_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/63\/Functional_Electrical_Stimulation_.tif\/lossy-page1-440px-Functional_Electrical_Stimulation_.tif.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e3\/Rod_of_Asclepius2.svg\/25px-Rod_of_Asclepius2.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/55\/Functional_Electrical_Stimulation_Therapy_for_improving_walking_in_incomplete_spinal_cord_injured_individuals_-30%2C31-.jpg\/440px-Functional_Electrical_Stimulation_Therapy_for_improving_walking_in_incomplete_spinal_cord_injured_individuals_-30%2C31-.jpg"],"4caaef5bad05e716bce0c64e52cb4953_timestamp":1545081760,"978acd329b72bc0b79fc5758b2e4084e_type":"article","978acd329b72bc0b79fc5758b2e4084e_title":"Diaphragm pacing","978acd329b72bc0b79fc5758b2e4084e_url":"https:\/\/www.limswiki.org\/index.php\/Diaphragm_pacing","978acd329b72bc0b79fc5758b2e4084e_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tDiaphragm pacing\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tDiaphragm pacingElectrical stimulation of the phrenic nerve has been known to stimulate respiration for centuries.Synonymsphrenic nerve pacing[edit on Wikidata]\nDiaphragm pacing, (and even earlier as electrophrenic respiration[1][2]), is the rhythmic application of electrical impulses to the diaphragm to provide ventilatory support for respiratory failure or sleep apnea.[3][4] Historically, this has been accomplished through the electrical stimulation of a phrenic nerve by an implanted receiver\/electrode,[5] though today an alternative option of attaching percutaneous wires to the diaphragm exists.[6]\n\nContents \n\n1 History \n2 Methodology and devices \n3 Surgical procedure \n4 References \n5 Further reading \n\n\nHistory \nThe idea of stimulating the diaphragm through the phrenic nerve was first firmly postulated by German physician Christoph Wilhelm Hufeland, who in 1783 proposed that such a technique could be applied as a treatment for asphyxia.[7][8]:545\u2013549 French neurologist Duchenne de Boulogne made a similar proposal in 1855, though neither of them tested it.[9] It wasn't until a year later that Hugo Wilhelm von Ziemssen demonstrated diaphragm pacing on a 27-year-old woman asphyxiated on charcoal fumes by rhythmically faradizing her phrenic nerves, saving her life.[8][10]:49 Duchenne would later in 1872 declare the technique the \"best means of imitating natural respiration\".[11] However, advances in mechanical ventilation by the likes of George Poe in the early twentieth century[12] ended up being initially favored over phrenic nerve stimulation.\nHarvard researchers Sarnoff et al. revisited diaphragm pacing via the phrenic nerve in 1948, publishing their experimental results on dogs.[1] In a separate publication a few days before, the same group also revealed they had an opportunity to use the technique \"on a five-year-old boy with complete respiratory paralysis following rupture of a cerebral aneurysm\". Referring to the process as \"electrophrenic respiration\", Sarnoff was able to artificially respirate the young boy for 52 hours.[13] The technology behind diaphragm pacing was advanced further in 1968 with the publication of doctors John P. Judson and William W. L. Glenn's research on the use of radio-frequency transmission to at whim \"adjust the amplitude of stimulation, and to control the rate of stimulation externally\".[14] Teaming up with Avery Laboratories, Glenn brought his prototype device to commercial market in the early 1970s.[15]\nBy the early 1990s, long-term evaluations of the technology were being published, with some researchers such as Bach and O'Connor stating that phrenic nerve pacing is a valid option \"for the properly screened patient but that expense, failure rate, morbidity and mortality remain excessive and that alternative methods of ventilatory support should be explored\".[16] Others such as Brouillette and Marzocchi suggested that advances in encapsulation and electrode technologies could improve system longevity and reduce damage to diaphragm muscle.[17] Additionally, new surgical techniques such as a thoracoscopic approach began to appear in the late 1990s.[18]\nIn the mid-2000s, U.S. company Synapse Biomedical began researching a new diaphragm pacing system that wouldn't have to attach to the phrenic nerve but instead depended on \"four electrodes implanted in the muscle of the diaphragm to electronically stimulate contraction\". The marketed NeuRx device received several FDA approvals under a Humanitarian Device Exemption (HDE), one in 2008 and another in 2011.[19]\n\nMethodology and devices \nThe basic principle behind a diaphragm pacing device (the U.S. Food and Drug Administration identifies the device as a \"diaphragmatic\/phrenic nerve stimulator\"[20]) involves passing an electric current through electrodes that are attached internally. The diaphragm contracts, expanding the chest cavity, causing air to be sucked into the lungs (inspiration). When not stimulated, the diaphragm relaxes and air moves out of the lungs (expiration).\nAccording to the United States Medicare system, phrenic nerve stimulators are indicated for \"selected patients with partial or complete respiratory insufficiency\" and \"can be effective only if the patient has an intact phrenic nerve and diaphragm\".[21] Common patient diagnoses for phrenic nerve pacing include patients with spinal cord injury, central sleep apnea (i.e., Ondine's curse), and diaphragm paralysis.[19][21]\nThere are currently three commercially distributed diaphragm pacing devices: Synapse Biomedical, Inc.'s NeuRx (US), Avery Biomedical Devices, Inc.'s Mark IV Breathing Pacemaker (US),[19] and Atrotech OY's Atrostim PNS (Finland).[22] The Synapse and Avery devices are distributed worldwide and approved for use in the United States.[19] The Atrotech device is not available in the U.S.\n\nSurgical procedure \nIn the case of the Atrostim and Mark IV devices, several surgical techniques may be used. Surgery is typically performed by placing an electrode around the phrenic nerve, either in the neck (i.e., cervically; an older technique), or in the chest (i.e., thoracically; more modern). This electrode is connected to a radiofrequency receiver which is implanted just under the skin. An external transmitter sends radio signals to the device by an antenna which is worn over the receiver.[23] For the cervical surgical technique, the phrenic nerve is approached via a small (~5 cm) incision slightly above, and midline to, the clavic. The phrenic nerve is then isolated under the scalenus anticus muscle. For the thoracic surgical technique, a small (~5 cm) incisions over the 2nd or 3rd intercostal space. The electrodes are placed around the phrenic nerves alongside the pericardium. Use of a thorascope allows for this technique to be performed in a minimally-invasive manner.[23]\nIn the case of the NeuRx device, a series of four incisions are made in the abdominal skin. Several tools such as a laparoscope and probe are used to find the best four locations on the diaphragm to attach four electrodes, which have connections outside the body. A fifth electrode is placed just under the skin in the same area. All these connect to the device.[24]\n\nReferences \n\n\n^ a b Sarnoff, S.J.; Whittenberger, J.L.; Hardenbergh, E. (1948). \"Electrophrenic respiration. Mechanism of the inhibition of spontaneous respiration\". American Journal of Physiology. 155 (2): 203\u2013207. PMID 18107083. \n\n^ Marshall, L.B., ed. (1951). \"Electrophrenic Respiration\". United States Navy Medical News Letter. 18 (4): 10\u201312. \n\n^ Bhimji, S. (16 December 2015). Mosenifar, Z., ed. \"Overview - Indications and Contraindications\". Medscape - Diaphragm Pacing. WebMD LLC. Retrieved 19 February 2016 . \n\n^ Khanna, V.K. (2015). \"Chapter 19: Diaphragmatic\/Phrenic Nerve Stimulation\". Implantable Medical Electronics: Prosthetics, Drug Delivery, and Health Monitoring. Springer International Publishing AG Switzerland. p. 453. ISBN 9783319254487. Retrieved 19 February 2016 . \n\n^ Chen, M.L; Tablizo, M.A.; Kun, S.; Keens, T.G. (2005). \"Diaphragm pacers as a treatment for congenital central hypoventilation syndrome\". Expert Review of Medical Devices. 2 (5): 577\u2013585. doi:10.1586\/17434440.2.5.577. PMID 16293069. \n\n^ \"Use and Care of the NeuRx Diaphragm Pacing System\" (PDF) . Synapse Biomedical, Inc. Retrieved 19 February 2016 . \n\n^ Hufeland, C.W. (1783). Usum uis electriciae in asphyxia experimentis illustratum. Dissertatio inauguralis medica sistens. \n\n^ a b Althaus, Julius (1870). A Treatise on Medical Electricity, Theoretical and Practical: And Its Use in the Treatment of Paralysis, Neuralgia and Other Diseases (2nd ed.). London: Longmans, Green, and Co. p. 676. Retrieved 19 February 2016 . \n\n^ Duchenne, G.B.A. (1855). De l'electrisation localis\u00e9e et de son application a la physiologie, a la pathologie et a la th\u00e9rapeutique. Paris: Bailli\u00e8re. Retrieved 19 February 2016 . \n\n^ von Ziemssen, H.W. (1857). Die Electricit\u00e4t in der Medicin Studien. Berlin: Hirschwald. p. 106. Retrieved 19 February 2016 . \n\n^ Duchenne, G.B.A. (1872). De l'\u00e9lectrisation localis\u00e9e et de son application \u00e0 la pathologie et \u00e0 la th\u00e9rapeutique par courants induits et par courants galvaniques interrompus et continus. Paris: Bailli\u00e8re. Retrieved 19 February 2016 . \n\n^ \"Smother Small Dog To See it Revived\". The New York Times. 29 May 1908. Retrieved 19 February 2016 – via WikiMedia Commons. \n\n^ Sarnoff, S.J.; Hardenbergh, E.; Whittenberger, J.L. (1948). \"Electrophrenic Respiration\". Science. 108 (2809): 482. doi:10.1126\/science.108.2809.482. \n\n^ Judson, J.P.; Glenn, W.W.L. (1968). \"Radio-Frequency electrophrenic respiration: Long-term application to a patient with primary hypoventilation\". JAMA. 203 (12): 1033\u20131037. doi:10.1001\/jama.1968.03140120031007. PMID 5694362. \n\n^ \"History of Pacing\". Avery Biomedical Devices, Inc. Retrieved 19 February 2016 . \n\n^ Bach, J.R.; O'Connor, K. (1991). \"Electrophrenic ventilation: A different perspective\". The Journal of the American Paraplegia Society. 14 (1): 9\u201317. doi:10.1080\/01952307.1991.11735829. PMID 2022962. \n\n^ Brouillette, R.T.; Marzocchi, M. (1994). \"Diaphragm pacing: clinical and experimental results\". Biology of the Neonate. 65 (3\u20134): 265\u2013271. doi:10.1159\/000244063. PMID 8038293. \n\n^ Shaul, D.B.; Danielson, P.D.; McComb, J.G.; Keens, T.G. (2002). \"Thoracoscopic placement of phrenic nerve electrodes for diaphragmatic pacing in children\". Journal of Pediatric Surgery. 37 (7): 974\u2013978. doi:10.1053\/jpsu.2002.33821. PMID 12077752. \n\n^ a b c d \"Diaphragmatic\/Phrenic Nerve Stimulation and Diaphragm Pacing Systems\". Policy # MED.00100. Anthem Insurance Companies, Inc. 5 February 2015. Retrieved 19 February 2016 . \n\n^ \"PART 882 -- NEUROLOGICAL DEVICES\". CFR - Code of Federal Regulations Title 21. U.S. Food and Drug Administration. 21 August 2015. Retrieved 19 February 2016 . \n\n^ a b \"Chapter 1, Part 2, Section 160.19: Phrenic Nerve Stimulator\". Medicare National Coverage Determinations Manual (PDF) . Centers for Medicare and Medicaid Services. 27 March 2015. Retrieved 19 February 2016 . \n\n^ \"Phrenic Nerve Stimulation\". Atrotech OY. Retrieved 19 February 2016 . \n\n^ a b Bhimji, S. (16 December 2015). Mosenifar, Z., ed. \"Technique - Insertion of Pacemaker\". Medscape - Diaphragm Pacing. WebMD LLC. Retrieved 19 February 2016 . \n\n^ \"Surgery: What to Expect\". NeuRx Diaphragm Pacing System Patient\/Caregiver Information and Instruction Manual (PDF) . Synapse Biomedical, Inc. 2011. p. 18. Retrieved 19 February 2016 . \n\n\nFurther reading \nBhimji, S. (16 December 2015). Mosenifar, Z., ed. \"Diaphragm Pacing\". Medscape. WebMD LLC. \nKhanna, V.K. (2015). \"Chapter 19: Diaphragmatic\/Phrenic Nerve Stimulation\". Implantable Medical Electronics: Prosthetics, Drug Delivery, and Health Monitoring. Springer International Publishing AG Switzerland. p. 453. ISBN 9783319254487. \n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Diaphragm_pacing\">https:\/\/www.limswiki.org\/index.php\/Diaphragm_pacing<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesMedical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 22:40.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 828 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","978acd329b72bc0b79fc5758b2e4084e_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Diaphragm_pacing skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Diaphragm pacing<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Diaphragm pacing<\/b>, (and even earlier as <b>electrophrenic respiration<\/b><sup id=\"rdp-ebb-cite_ref-SarnoffElectro48_1-0\" class=\"reference\"><a href=\"#cite_note-SarnoffElectro48-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-MNL18_4_2-0\" class=\"reference\"><a href=\"#cite_note-MNL18_4-2\" rel=\"external_link\">[2]<\/a><\/sup>), is the rhythmic application of electrical impulses to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thoracic_diaphragm\" title=\"Thoracic diaphragm\" rel=\"external_link\" target=\"_blank\">diaphragm<\/a> to provide <a href=\"https:\/\/en.wikipedia.org\/wiki\/Respiratory_system\" title=\"Respiratory system\" rel=\"external_link\" target=\"_blank\">ventilatory<\/a> support for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Respiratory_failure\" title=\"Respiratory failure\" rel=\"external_link\" target=\"_blank\">respiratory failure<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sleep_apnea\" title=\"Sleep apnea\" rel=\"external_link\" target=\"_blank\">sleep apnea<\/a>.<sup id=\"rdp-ebb-cite_ref-BhimjiDia15_3-0\" class=\"reference\"><a href=\"#cite_note-BhimjiDia15-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-KhannaImp15_4-0\" class=\"reference\"><a href=\"#cite_note-KhannaImp15-4\" rel=\"external_link\">[4]<\/a><\/sup> Historically, this has been accomplished through the electrical stimulation of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phrenic_nerve\" title=\"Phrenic nerve\" rel=\"external_link\" target=\"_blank\">phrenic nerve<\/a> by an implanted receiver\/electrode,<sup id=\"rdp-ebb-cite_ref-ChenDia05_5-0\" class=\"reference\"><a href=\"#cite_note-ChenDia05-5\" rel=\"external_link\">[5]<\/a><\/sup> though today an alternative option of attaching <a href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous\" title=\"Percutaneous\" rel=\"external_link\" target=\"_blank\">percutaneous<\/a> wires to the diaphragm exists.<sup id=\"rdp-ebb-cite_ref-SynapseUse_6-0\" class=\"reference\"><a href=\"#cite_note-SynapseUse-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The idea of stimulating the diaphragm through the phrenic nerve was first firmly postulated by German physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/Christoph_Wilhelm_Hufeland\" title=\"Christoph Wilhelm Hufeland\" rel=\"external_link\" target=\"_blank\">Christoph Wilhelm Hufeland<\/a>, who in 1783 proposed that such a technique could be applied as a treatment for asphyxia.<sup id=\"rdp-ebb-cite_ref-HufelandUsum1783_7-0\" class=\"reference\"><a href=\"#cite_note-HufelandUsum1783-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-AlthausTreat1870_8-0\" class=\"reference\"><a href=\"#cite_note-AlthausTreat1870-8\" rel=\"external_link\">[8]<\/a><\/sup><sup class=\"reference\" style=\"white-space:nowrap;\">:<span>545\u2013549<\/span><\/sup> French neurologist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Duchenne_de_Boulogne\" title=\"Duchenne de Boulogne\" rel=\"external_link\" target=\"_blank\">Duchenne de Boulogne<\/a> made a similar proposal in 1855, though neither of them tested it.<sup id=\"rdp-ebb-cite_ref-DuchenneDel'elec1855_9-0\" class=\"reference\"><a href=\"#39;elec1855-9\" rel=\"external_link\">[9]<\/a><\/sup> It wasn't until a year later that <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hugo_Wilhelm_von_Ziemssen\" title=\"Hugo Wilhelm von Ziemssen\" rel=\"external_link\" target=\"_blank\">Hugo Wilhelm von Ziemssen<\/a> demonstrated diaphragm pacing on a 27-year-old woman asphyxiated on charcoal fumes by rhythmically faradizing her phrenic nerves, saving her life.<sup id=\"rdp-ebb-cite_ref-AlthausTreat1870_8-1\" class=\"reference\"><a href=\"#cite_note-AlthausTreat1870-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-ZiemssenDie1857_10-0\" class=\"reference\"><a href=\"#cite_note-ZiemssenDie1857-10\" rel=\"external_link\">[10]<\/a><\/sup><sup class=\"reference\" style=\"white-space:nowrap;\">:<span>49<\/span><\/sup> Duchenne would later in 1872 declare the technique the \"best means of imitating natural respiration\".<sup id=\"rdp-ebb-cite_ref-DuchenneDel'elec1872_11-0\" class=\"reference\"><a href=\"#39;elec1872-11\" rel=\"external_link\">[11]<\/a><\/sup> However, advances in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mechanical_ventilation\" title=\"Mechanical ventilation\" rel=\"external_link\" target=\"_blank\">mechanical ventilation<\/a> by the likes of <a href=\"https:\/\/en.wikipedia.org\/wiki\/George_Poe\" title=\"George Poe\" rel=\"external_link\" target=\"_blank\">George Poe<\/a> in the early twentieth century<sup id=\"rdp-ebb-cite_ref-NYTSmother1908_12-0\" class=\"reference\"><a href=\"#cite_note-NYTSmother1908-12\" rel=\"external_link\">[12]<\/a><\/sup> ended up being initially favored over phrenic nerve stimulation.\n<\/p><p>Harvard researchers Sarnoff et al. revisited diaphragm pacing via the phrenic nerve in 1948, publishing their experimental results on dogs.<sup id=\"rdp-ebb-cite_ref-SarnoffElectro48_1-1\" class=\"reference\"><a href=\"#cite_note-SarnoffElectro48-1\" rel=\"external_link\">[1]<\/a><\/sup> In a separate publication a few days before, the same group also revealed they had an opportunity to use the technique \"on a five-year-old boy with complete respiratory paralysis following rupture of a cerebral aneurysm\". Referring to the process as \"electrophrenic respiration\", Sarnoff was able to artificially respirate the young boy for 52 hours.<sup id=\"rdp-ebb-cite_ref-SarnoffElectroScience48_13-0\" class=\"reference\"><a href=\"#cite_note-SarnoffElectroScience48-13\" rel=\"external_link\">[13]<\/a><\/sup> The technology behind diaphragm pacing was advanced further in 1968 with the publication of doctors John P. Judson and <a href=\"https:\/\/en.wikipedia.org\/wiki\/William_Glenn\" title=\"William Glenn\" rel=\"external_link\" target=\"_blank\">William W. L. Glenn<\/a>'s research on the use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radio-frequency_engineering\" title=\"Radio-frequency engineering\" rel=\"external_link\" target=\"_blank\">radio-frequency transmission<\/a> to at whim \"adjust the amplitude of stimulation, and to control the rate of stimulation externally\".<sup id=\"rdp-ebb-cite_ref-JudsonRadio68_14-0\" class=\"reference\"><a href=\"#cite_note-JudsonRadio68-14\" rel=\"external_link\">[14]<\/a><\/sup> Teaming up with Avery Laboratories, Glenn brought his prototype device to commercial market in the early 1970s.<sup id=\"rdp-ebb-cite_ref-AveryHist_15-0\" class=\"reference\"><a href=\"#cite_note-AveryHist-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p>By the early 1990s, long-term evaluations of the technology were being published, with some researchers such as Bach and O'Connor stating that phrenic nerve pacing is a valid option \"for the properly screened patient but that expense, failure rate, morbidity and mortality remain excessive and that alternative methods of ventilatory support should be explored\".<sup id=\"rdp-ebb-cite_ref-BachElectro91_16-0\" class=\"reference\"><a href=\"#cite_note-BachElectro91-16\" rel=\"external_link\">[16]<\/a><\/sup> Others such as Brouillette and Marzocchi suggested that advances in encapsulation and electrode technologies could improve system longevity and reduce damage to diaphragm muscle.<sup id=\"rdp-ebb-cite_ref-BrouilletteDia94_17-0\" class=\"reference\"><a href=\"#cite_note-BrouilletteDia94-17\" rel=\"external_link\">[17]<\/a><\/sup> Additionally, new surgical techniques such as a thoracoscopic approach began to appear in the late 1990s.<sup id=\"rdp-ebb-cite_ref-ShaulThor02_18-0\" class=\"reference\"><a href=\"#cite_note-ShaulThor02-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p><p>In the mid-2000s, U.S. company Synapse Biomedical began researching a new diaphragm pacing system that wouldn't have to attach to the phrenic nerve but instead depended on \"four electrodes implanted in the muscle of the diaphragm to electronically stimulate contraction\". The marketed NeuRx device received several <a href=\"https:\/\/en.wikipedia.org\/wiki\/FDA\" class=\"mw-redirect\" title=\"FDA\" rel=\"external_link\" target=\"_blank\">FDA<\/a> approvals under a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Humanitarian_Device_Exemption\" title=\"Humanitarian Device Exemption\" rel=\"external_link\" target=\"_blank\">Humanitarian Device Exemption<\/a> (HDE), one in 2008 and another in 2011.<sup id=\"rdp-ebb-cite_ref-AnthemMED.00100_19-0\" class=\"reference\"><a href=\"#cite_note-AnthemMED.00100-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Methodology_and_devices\">Methodology and devices<\/span><\/h2>\n<p>The basic principle behind a diaphragm pacing device (the U.S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> identifies the device as a \"diaphragmatic\/phrenic nerve stimulator\"<sup id=\"rdp-ebb-cite_ref-FDADPNS_20-0\" class=\"reference\"><a href=\"#cite_note-FDADPNS-20\" rel=\"external_link\">[20]<\/a><\/sup>) involves passing an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electric_current\" title=\"Electric current\" rel=\"external_link\" target=\"_blank\">electric current<\/a> through electrodes that are attached internally. The diaphragm contracts, expanding the chest cavity, causing air to be sucked into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lung\" title=\"Lung\" rel=\"external_link\" target=\"_blank\">lungs<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Inhalation\" title=\"Inhalation\" rel=\"external_link\" target=\"_blank\">inspiration<\/a>). When not stimulated, the diaphragm relaxes and air moves out of the lungs (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Exhalation\" title=\"Exhalation\" rel=\"external_link\" target=\"_blank\">expiration<\/a>).\n<\/p><p>According to the United States <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicare_(United_States)\" title=\"Medicare (United States)\" rel=\"external_link\" target=\"_blank\">Medicare<\/a> system, phrenic nerve stimulators are indicated for \"selected patients with partial or complete respiratory insufficiency\" and \"can be effective only if the patient has an intact phrenic nerve and diaphragm\".<sup id=\"rdp-ebb-cite_ref-CMSNatCovMan_21-0\" class=\"reference\"><a href=\"#cite_note-CMSNatCovMan-21\" rel=\"external_link\">[21]<\/a><\/sup> Common patient diagnoses for phrenic nerve pacing include patients with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_injury\" title=\"Spinal cord injury\" rel=\"external_link\" target=\"_blank\">spinal cord injury<\/a>, central <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sleep_apnea\" title=\"Sleep apnea\" rel=\"external_link\" target=\"_blank\">sleep apnea<\/a> (i.e., <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ondine%27s_curse\" class=\"mw-redirect\" title=\"Ondine's curse\" rel=\"external_link\" target=\"_blank\">Ondine's curse<\/a>), and diaphragm paralysis.<sup id=\"rdp-ebb-cite_ref-AnthemMED.00100_19-1\" class=\"reference\"><a href=\"#cite_note-AnthemMED.00100-19\" rel=\"external_link\">[19]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-CMSNatCovMan_21-1\" class=\"reference\"><a href=\"#cite_note-CMSNatCovMan-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p><p>There are currently three commercially distributed diaphragm pacing devices: Synapse Biomedical, Inc.'s NeuRx (US), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Avery_Biomedical_Devices\" title=\"Avery Biomedical Devices\" rel=\"external_link\" target=\"_blank\">Avery Biomedical Devices<\/a>, Inc.'s Mark IV Breathing Pacemaker (US),<sup id=\"rdp-ebb-cite_ref-AnthemMED.00100_19-2\" class=\"reference\"><a href=\"#cite_note-AnthemMED.00100-19\" rel=\"external_link\">[19]<\/a><\/sup> and Atrotech OY's Atrostim PNS (Finland).<sup id=\"rdp-ebb-cite_ref-Atrostim_22-0\" class=\"reference\"><a href=\"#cite_note-Atrostim-22\" rel=\"external_link\">[22]<\/a><\/sup> The Synapse and Avery devices are distributed worldwide and approved for use in the United States.<sup id=\"rdp-ebb-cite_ref-AnthemMED.00100_19-3\" class=\"reference\"><a href=\"#cite_note-AnthemMED.00100-19\" rel=\"external_link\">[19]<\/a><\/sup> The Atrotech device is not available in the U.S.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Surgical_procedure\">Surgical procedure<\/span><\/h2>\n<p>In the case of the Atrostim and Mark IV devices, several surgical techniques may be used. Surgery is typically performed by placing an electrode around the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phrenic_nerve\" title=\"Phrenic nerve\" rel=\"external_link\" target=\"_blank\">phrenic nerve<\/a>, either in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neck\" title=\"Neck\" rel=\"external_link\" target=\"_blank\">neck<\/a> (i.e., cervically; an older technique), or in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest\" class=\"mw-redirect\" title=\"Chest\" rel=\"external_link\" target=\"_blank\">chest<\/a> (i.e., thoracically; more modern). This electrode is connected to a radiofrequency receiver which is implanted just under the skin. An external transmitter sends radio signals to the device by an antenna which is worn over the receiver.<sup id=\"rdp-ebb-cite_ref-BhimjiDia15-Insertion_23-0\" class=\"reference\"><a href=\"#cite_note-BhimjiDia15-Insertion-23\" rel=\"external_link\">[23]<\/a><\/sup> For the cervical surgical technique, the phrenic nerve is approached via a small (~5 cm) incision slightly above, and midline to, the clavic. The phrenic nerve is then isolated under the scalenus anticus muscle. For the thoracic surgical technique, a small (~5 cm) incisions over the 2nd or 3rd intercostal space. The electrodes are placed around the phrenic nerves alongside the pericardium. Use of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopy\" title=\"Endoscopy\" rel=\"external_link\" target=\"_blank\">thorascope<\/a> allows for this technique to be performed in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive_procedure\" class=\"mw-redirect\" title=\"Minimally invasive procedure\" rel=\"external_link\" target=\"_blank\">minimally-invasive<\/a> manner.<sup id=\"rdp-ebb-cite_ref-BhimjiDia15-Insertion_23-1\" class=\"reference\"><a href=\"#cite_note-BhimjiDia15-Insertion-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p><p>In the case of the NeuRx device, a series of four incisions are made in the abdominal skin. Several tools such as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscope\" class=\"mw-redirect\" title=\"Laparoscope\" rel=\"external_link\" target=\"_blank\">laparoscope<\/a> and probe are used to find the best four locations on the diaphragm to attach four electrodes, which have connections outside the body. A fifth electrode is placed just under the skin in the same area. All these connect to the device.<sup id=\"rdp-ebb-cite_ref-SynapseNeuRx11_24-0\" class=\"reference\"><a href=\"#cite_note-SynapseNeuRx11-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 33em; -webkit-column-width: 33em; column-width: 33em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-SarnoffElectro48-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-SarnoffElectro48_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-SarnoffElectro48_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sarnoff, S.J.; Whittenberger, J.L.; Hardenbergh, E. (1948). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ajplegacy.physiology.org\/content\/155\/2\/203\" target=\"_blank\">\"Electrophrenic respiration. Mechanism of the inhibition of spontaneous respiration\"<\/a>. <i>American Journal of Physiology<\/i>. <b>155<\/b> (2): 203\u2013207. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18107083\" target=\"_blank\">18107083<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Physiology&rft.atitle=Electrophrenic+respiration.+Mechanism+of+the+inhibition+of+spontaneous+respiration&rft.volume=155&rft.issue=2&rft.pages=203-207&rft.date=1948&rft_id=info%3Apmid%2F18107083&rft.au=Sarnoff%2C+S.J.&rft.au=Whittenberger%2C+J.L.&rft.au=Hardenbergh%2C+E.&rft_id=http%3A%2F%2Fajplegacy.physiology.org%2Fcontent%2F155%2F2%2F203&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiaphragm+pacing\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-MNL18_4-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MNL18_4_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Marshall, L.B., ed. (1951). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/archive.org\/details\/MedicalNewsLetter19510824\" target=\"_blank\">\"Electrophrenic Respiration\"<\/a>. <i>United States Navy Medical News Letter<\/i>. <b>18<\/b> (4): 10\u201312.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=United+States+Navy+Medical+News+Letter&rft.atitle=Electrophrenic+Respiration&rft.volume=18&rft.issue=4&rft.pages=10-12&rft.date=1951&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2FMedicalNewsLetter19510824&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiaphragm+pacing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-BhimjiDia15-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-BhimjiDia15_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Bhimji, S. 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Retrieved <span class=\"nowrap\">19 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Medscape+-+Diaphragm+Pacing&rft.atitle=Overview+-+Indications+and+Contraindications&rft.date=2015-12-16&rft.au=Bhimji%2C+S.&rft_id=http%3A%2F%2Femedicine.medscape.com%2Farticle%2F1970348-overview%23a4&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiaphragm+pacing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-KhannaImp15-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-KhannaImp15_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Khanna, V.K. (2015). \"Chapter 19: Diaphragmatic\/Phrenic Nerve Stimulation\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=lLEvCwAAQBAJ&pg=PA359\" target=\"_blank\"><i>Implantable Medical Electronics: Prosthetics, Drug Delivery, and Health Monitoring<\/i><\/a>. Springer International Publishing AG Switzerland. p. 453. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9783319254487<span class=\"reference-accessdate\">. 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(1968). \"Radio-Frequency electrophrenic respiration: Long-term application to a patient with primary hypoventilation\". <i>JAMA<\/i>. <b>203<\/b> (12): 1033\u20131037. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Fjama.1968.03140120031007\" target=\"_blank\">10.1001\/jama.1968.03140120031007<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/5694362\" target=\"_blank\">5694362<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JAMA&rft.atitle=Radio-Frequency+electrophrenic+respiration%3A+Long-term+application+to+a+patient+with+primary+hypoventilation&rft.volume=203&rft.issue=12&rft.pages=1033-1037&rft.date=1968&rft_id=info%3Adoi%2F10.1001%2Fjama.1968.03140120031007&rft_id=info%3Apmid%2F5694362&rft.au=Judson%2C+J.P.&rft.au=Glenn%2C+W.W.L.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiaphragm+pacing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-AveryHist-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-AveryHist_15-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.averybiomedical.com\/company-information\/history-of-pacing\/\" target=\"_blank\">\"History of Pacing\"<\/a>. 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(1991). \"Electrophrenic ventilation: A different perspective\". <i>The Journal of the American Paraplegia Society<\/i>. <b>14<\/b> (1): 9\u201317. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1080%2F01952307.1991.11735829\" target=\"_blank\">10.1080\/01952307.1991.11735829<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2022962\" target=\"_blank\">2022962<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+the+American+Paraplegia+Society&rft.atitle=Electrophrenic+ventilation%3A+A+different+perspective&rft.volume=14&rft.issue=1&rft.pages=9-17&rft.date=1991&rft_id=info%3Adoi%2F10.1080%2F01952307.1991.11735829&rft_id=info%3Apmid%2F2022962&rft.au=Bach%2C+J.R.&rft.au=O%27Connor%2C+K.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiaphragm+pacing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-BrouilletteDia94-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-BrouilletteDia94_17-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brouillette, R.T.; Marzocchi, M. (1994). \"Diaphragm pacing: clinical and experimental results\". <i>Biology of the Neonate<\/i>. <b>65<\/b> (3\u20134): 265\u2013271. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000244063\" target=\"_blank\">10.1159\/000244063<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8038293\" target=\"_blank\">8038293<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biology+of+the+Neonate&rft.atitle=Diaphragm+pacing%3A+clinical+and+experimental+results&rft.volume=65&rft.issue=3%E2%80%934&rft.pages=265-271&rft.date=1994&rft_id=info%3Adoi%2F10.1159%2F000244063&rft_id=info%3Apmid%2F8038293&rft.au=Brouillette%2C+R.T.&rft.au=Marzocchi%2C+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiaphragm+pacing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ShaulThor02-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ShaulThor02_18-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Shaul, D.B.; Danielson, P.D.; McComb, J.G.; Keens, T.G. (2002). \"Thoracoscopic placement of phrenic nerve electrodes for diaphragmatic pacing in children\". <i>Journal of Pediatric Surgery<\/i>. <b>37<\/b> (7): 974\u2013978. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1053%2Fjpsu.2002.33821\" target=\"_blank\">10.1053\/jpsu.2002.33821<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12077752\" target=\"_blank\">12077752<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Pediatric+Surgery&rft.atitle=Thoracoscopic+placement+of+phrenic+nerve+electrodes+for+diaphragmatic+pacing+in+children&rft.volume=37&rft.issue=7&rft.pages=974-978&rft.date=2002&rft_id=info%3Adoi%2F10.1053%2Fjpsu.2002.33821&rft_id=info%3Apmid%2F12077752&rft.au=Shaul%2C+D.B.&rft.au=Danielson%2C+P.D.&rft.au=McComb%2C+J.G.&rft.au=Keens%2C+T.G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiaphragm+pacing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-AnthemMED.00100-19\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-AnthemMED.00100_19-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-AnthemMED.00100_19-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-AnthemMED.00100_19-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-AnthemMED.00100_19-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.anthem.com\/medicalpolicies\/policies\/mp_pw_b099011.htm\" target=\"_blank\">\"Diaphragmatic\/Phrenic Nerve Stimulation and Diaphragm Pacing Systems\"<\/a>. <i>Policy # MED.00100<\/i>. Anthem Insurance Companies, Inc. 5 February 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Policy+%23+MED.00100&rft.atitle=Diaphragmatic%2FPhrenic+Nerve+Stimulation+and+Diaphragm+Pacing+Systems&rft.date=2015-02-05&rft_id=https%3A%2F%2Fwww.anthem.com%2Fmedicalpolicies%2Fpolicies%2Fmp_pw_b099011.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiaphragm+pacing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FDADPNS-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FDADPNS_20-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.accessdata.fda.gov\/scripts\/cdrh\/cfdocs\/cfCFR\/CFRSearch.cfm?FR=882.5830\" target=\"_blank\">\"PART 882 -- NEUROLOGICAL DEVICES\"<\/a>. <i>CFR - Code of Federal Regulations Title 21<\/i>. U.S. Food and Drug Administration. 21 August 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=CFR+-+Code+of+Federal+Regulations+Title+21&rft.atitle=PART+882+--+NEUROLOGICAL+DEVICES&rft.date=2015-08-21&rft_id=http%3A%2F%2Fwww.accessdata.fda.gov%2Fscripts%2Fcdrh%2Fcfdocs%2FcfCFR%2FCFRSearch.cfm%3FFR%3D882.5830&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiaphragm+pacing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-CMSNatCovMan-21\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-CMSNatCovMan_21-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CMSNatCovMan_21-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">\"Chapter 1, Part 2, Section 160.19: Phrenic Nerve Stimulator\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cms.gov\/Regulations-and-Guidance\/Guidance\/Manuals\/Downloads\/ncd103c1_Part2.pdf\" target=\"_blank\"><i>Medicare National Coverage Determinations Manual<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. Centers for Medicare and Medicaid Services. 27 March 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+1%2C+Part+2%2C+Section+160.19%3A+Phrenic+Nerve+Stimulator&rft.btitle=Medicare+National+Coverage+Determinations+Manual&rft.pub=Centers+for+Medicare+and+Medicaid+Services&rft.date=2015-03-27&rft_id=https%3A%2F%2Fwww.cms.gov%2FRegulations-and-Guidance%2FGuidance%2FManuals%2FDownloads%2Fncd103c1_Part2.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiaphragm+pacing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Atrostim-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Atrostim_22-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.atrotech.com\/pns\/pns\" target=\"_blank\">\"Phrenic Nerve Stimulation\"<\/a>. Atrotech OY<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Phrenic+Nerve+Stimulation&rft.pub=Atrotech+OY&rft_id=http%3A%2F%2Fwww.atrotech.com%2Fpns%2Fpns&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiaphragm+pacing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-BhimjiDia15-Insertion-23\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-BhimjiDia15-Insertion_23-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-BhimjiDia15-Insertion_23-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Bhimji, S. (16 December 2015). Mosenifar, Z., ed. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/emedicine.medscape.com\/article\/1970348-technique\" target=\"_blank\">\"Technique - Insertion of Pacemaker\"<\/a>. <i>Medscape - Diaphragm Pacing<\/i>. WebMD LLC<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Medscape+-+Diaphragm+Pacing&rft.atitle=Technique+-+Insertion+of+Pacemaker&rft.date=2015-12-16&rft.au=Bhimji%2C+S.&rft_id=http%3A%2F%2Femedicine.medscape.com%2Farticle%2F1970348-technique&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiaphragm+pacing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-SynapseNeuRx11-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SynapseNeuRx11_24-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">\"Surgery: What to Expect\". <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.synapsebiomedical.com\/support\/PDFs\/006_%2077-0055_A%20Patient%20Caregiver%20Manual-ALS.pdf\" target=\"_blank\"><i>NeuRx Diaphragm Pacing System Patient\/Caregiver Information and Instruction Manual<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. Synapse Biomedical, Inc. 2011. p. 18<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Surgery%3A+What+to+Expect&rft.btitle=NeuRx+Diaphragm+Pacing+System+Patient%2FCaregiver+Information+and+Instruction+Manual&rft.pages=18&rft.pub=Synapse+Biomedical%2C+Inc&rft.date=2011&rft_id=http%3A%2F%2Fwww.synapsebiomedical.com%2Fsupport%2FPDFs%2F006_%252077-0055_A%2520Patient%2520Caregiver%2520Manual-ALS.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiaphragm+pacing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation web\">Bhimji, S. (16 December 2015). Mosenifar, Z., ed. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/emedicine.medscape.com\/article\/1970348-overview#a4\" target=\"_blank\">\"Diaphragm Pacing\"<\/a>. <i>Medscape<\/i>. WebMD LLC.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Medscape&rft.atitle=Diaphragm+Pacing&rft.date=2015-12-16&rft.au=Bhimji%2C+S.&rft_id=http%3A%2F%2Femedicine.medscape.com%2Farticle%2F1970348-overview%23a4&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiaphragm+pacing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Khanna, V.K. (2015). \"Chapter 19: Diaphragmatic\/Phrenic Nerve Stimulation\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=lLEvCwAAQBAJ&pg=PA359\" target=\"_blank\"><i>Implantable Medical Electronics: Prosthetics, Drug Delivery, and Health Monitoring<\/i><\/a>. Springer International Publishing AG Switzerland. p. 453. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9783319254487.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+19%3A+Diaphragmatic%2FPhrenic+Nerve+Stimulation&rft.btitle=Implantable+Medical+Electronics%3A+Prosthetics%2C+Drug+Delivery%2C+and+Health+Monitoring&rft.pages=453&rft.pub=Springer+International+Publishing+AG+Switzerland&rft.date=2015&rft.isbn=9783319254487&rft.au=Khanna%2C+V.K.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DlLEvCwAAQBAJ%26pg%3DPA359&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADiaphragm+pacing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1330\nCached time: 20181129231344\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.352 seconds\nReal time usage: 0.409 seconds\nPreprocessor visited node count: 1364\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 46920\/2097152 bytes\nTemplate argument size: 257\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 71026\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.198\/10.000 seconds\nLua memory usage: 4.44 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 355.588 1 -total\n<\/p>\n<pre>71.57% 254.490 1 Template:Reflist\n35.30% 125.528 8 Template:Cite_journal\n19.33% 68.740 1 Template:Infobox_medical_intervention\n18.07% 64.267 1 Template:Infobox\n13.40% 47.635 9 Template:Cite_book\n10.22% 36.356 8 Template:Cite_web\n 2.32% 8.236 1 Template:Cite_news\n 2.14% 7.599 1 Template:PAGENAMEBASE\n 0.99% 3.504 2 Template:Rp\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:19275701-1!canonical and timestamp 20181129231344 and revision id 862590415\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Diaphragm_pacing\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212239\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.149 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 141.895 1 - wikipedia:Diaphragm_pacing\n100.00% 141.895 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8008-0!*!*!*!*!*!* and timestamp 20181217212239 and revision id 24119\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Diaphragm_pacing\">https:\/\/www.limswiki.org\/index.php\/Diaphragm_pacing<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","978acd329b72bc0b79fc5758b2e4084e_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/3\/3c\/Gray806.png"],"978acd329b72bc0b79fc5758b2e4084e_timestamp":1545081759,"30fc8ee25ea342bda9af77a35b2a6f1f_type":"article","30fc8ee25ea342bda9af77a35b2a6f1f_title":"Deep brain stimulation","30fc8ee25ea342bda9af77a35b2a6f1f_url":"https:\/\/www.limswiki.org\/index.php\/Deep_brain_stimulation","30fc8ee25ea342bda9af77a35b2a6f1f_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tDeep brain stimulation\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tDeep brain stimulationDBS-probes shown in X-ray of the skull (white areas around maxilla and mandible represent metal dentures and are unrelated to DBS devices)MeSHD046690 MedlinePlus007453 [edit on Wikidata]\nDeep brain stimulation (DBS) is a neurosurgical procedure involving the implantation of a medical device called a neurostimulator (sometimes referred to as a 'brain pacemaker'), which sends electrical impulses, through implanted electrodes, to specific targets in the brain (brain nuclei) for the treatment of movement disorders, including Parkinson's disease, essential tremor, and dystonia.[1] While DBS has proven to be effective for some people, the potential for serious complications and side effects exists. DBS directly changes brain activity in a controlled manner, but its underlying principles and mechanisms are not clear.[2][3]\nThe Food and Drug Administration approved DBS as a treatment for essential tremor and Parkinson's disease (PD) in 1997,[4] dystonia in 2003,[5] and obsessive\u2013compulsive disorder (OCD) in 2009.[6][7] DBS has been studied in clinical trials as a potential treatment for chronic pain for various affective disorders, including major depression; it is one of only a few neurosurgical methods that allow blinded studies.[1]\n\r\n\n\nContents \n\n1 Medical use \n2 Adverse effects \n3 Mechanisms \n4 Components and placement \n5 Research \n\n5.1 Chronic pain \n5.2 Major depression and obsessive-compulsive disorder \n5.3 Tourette syndrome \n5.4 Other clinical applications \n\n\n6 See also \n7 References \n8 Further reading \n9 External links \n\n\nMedical use \n Drawing of DBS electrodes deep in the brain (side view)\n Insertion of electrode during surgery using a stereotactic frame\nDBS is used to manage some of the symptoms of Parkinson's Disease that cannot be adequately controlled with medications.[8][9]\n\nAdverse effects \nDBS carries the risks of major surgery, with a complication rate related to the experience of the surgical team. The major complications include hemorrhage (1\u20132%) and infection (3\u20135%).[10]\nWhile DBS is helpful for some people, the potential also exists for neuropsychiatric side effects, including apathy, hallucinations, hypersexuality, cognitive dysfunction, depression, and euphoria. However, these may be temporary and related to correct placement of electrodes and calibration of the stimulator, so these side effects are potentially reversible.[11]\nBecause the brain can shift slightly during surgery, the electrodes can become displaced or dislodged from the specific location. This may cause more profound complications such as personality changes, but electrode misplacement is relatively easy to identify using CT. Also, complications of surgery may occur, such as bleeding within the brain. After surgery, swelling of the brain tissue, mild disorientation, and sleepiness are normal. After 2\u20134 weeks, a follow-up visit is used to remove sutures, turn on the neurostimulator, and program it.[citation needed ]\n\nAs with all surgery, a risk exists of infection and bleeding during and after a surgery. The foreign object placed may be rejected by the body or calcification of the implant might take place.This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (March 2015) (Learn how and when to remove this template message)\nMechanisms \nThe exact mechanism of action of DBS is not known.[12] A variety of hypotheses try to explain the mechanisms of DBS:[13][14]\n\nDepolarization blockade: Electrical currents block the neuronal output at or near the electrode site.\nSynaptic inhibition: This causes an indirect regulation of the neuronal output by activating axon terminals with synaptic connections to neurons near the stimulating electrode.\nDesynchronization of abnormal oscillatory activity of neurons\nAntidromic activation either activating\/blockading distant neurons or blockading slow axons[3]\nDBS represents an advance on previous treatments which involved pallidotomy (i.e., surgical ablation of the globus pallidus) or thalamotomy (i.e., surgical ablation of the thalamus).[15] Instead, a thin lead with multiple electrodes is implanted in the globus pallidus, nucleus ventralis intermedius thalami, or subthalamic nucleus, and electric pulses are used therapeutically. The lead from the implant is extended to the neurostimulator under the skin in the chest area.[citation needed ]\nIts direct effect on the physiology of brain cells and neurotransmitters is currently debated, but by sending high-frequency electrical impulses into specific areas of the brain, it can mitigate symptoms[16] and directly diminish the side effects induced by PD medications,[17] allowing a decrease in medications, or making a medication regimen more tolerable.[citation needed ]\n\nComponents and placement \nThe DBS system consists of three components: the implanted pulse generator (IPG), the lead, and an extension. The IPG is a battery-powered neurostimulator encased in a titanium housing, which sends electrical pulses to the brain that interfere with neural activity at the target site. The lead is a coiled wire insulated in polyurethane with four platinum-iridium electrodes and is placed in one or two different nuclei of the brain. The lead is connected to the IPG by an extension, an insulated wire that runs below the skin, from the head, down the side of the neck, behind the ear, to the IPG, which is placed subcutaneously below the clavicle, or in some cases, the abdomen.[8] The IPG can be calibrated by a neurologist, nurse, or trained technician to optimize symptom suppression and control side effects.[18]\nDBS leads are placed in the brain according to the type of symptoms to be addressed. For non-Parkinsonian essential tremor, the lead is placed in either the ventrointermediate nucleus of the thalamus or the zona incerta;[19] for dystonia and symptoms associated with PD (rigidity, bradykinesia\/akinesia, and tremor), the lead may be placed in either the globus pallidus internus or the subthalamic nucleus; for OCD and depression to the nucleus accumbens; for incessant pain to the posterior thalamic region or periaqueductal gray; and for epilepsy treatment to the anterior thalamic nucleus.[20]\nAll three components are surgically implanted inside the body. Lead implantation may take place under local anesthesia or under general anesthesia (\"asleep DBS\") such as for dystonia. A hole about 14 mm in diameter is drilled in the skull and the probe electrode is inserted stereotactically. During the awake procedure with local anesthesia, feedback from the person is used to determine the optimal placement of the permanent electrode. During the asleep procedure, intraoperative MRI guidance is used for direct visualization of brain tissue and device.[21] The installation of the IPG and extension leads occurs under general anesthesia.[22] The right side of the brain is stimulated to address symptoms on the left side of the body and vice versa.[citation needed ]\n\nResearch \nChronic pain \nStimulation of the periaqueductal gray and periventricular gray for nociceptive pain, and the internal capsule, ventral posterolateral nucleus, and ventral posteromedial nucleus for neuropathic pain has produced impressive results with some people, but results vary. One study[23] of 17 people with intractable cancer pain found that 13 were virtually pain free and only four required opioid analgesics on release from hospital after the intervention. Most ultimately did resort to opioids, usually in the last few weeks of life.[24] DBS has also been applied for phantom limb pain.[25]\n\nMajor depression and obsessive-compulsive disorder \nDBS has been used in a small number of clinical trials to treat people with severe treatment-resistant depression (TRD).[26] A number of neuroanatomical targets have been used for DBS for TRD including the subgenual cingulate gyrus, posterior gyrus rectus,[27] nucleus accumbens,[28] ventral capsule\/ventral striatum, inferior thalamic peduncle, and the lateral habenula.[26] A recently proposed target of DBS intervention in depression is the superolateral branch of the medial forebrain bundle; its stimulation lead to surprisingly rapid antidepressant effects.[29]\nThe small numbers in the early trials of DBS for TRD currently limit the selection of an optimal neuroanatomical target.[26] Evidence is insufficient to support DBS as a therapeutic modality for depression; however, the procedure may be an effective treatment modality in the future.[30] In fact, beneficial results have been documented in the neurosurgical literature, including a few instances in which people who were deeply depressed were provided with portable stimulators for self treatment.[31][32][33]\nA systematic review of DBS for TRD and OCD identified 23 cases, nine for OCD, seven for TRD, and one for both. \"[A]bout half the patients did show dramatic improvement\" and adverse events were \"generally trivial\" given the younger age of the psychiatric population relative to the age of people with movement disorders.[34] The first randomized, controlled study of DBS for the treatment of TRD targeting the ventral capsule\/ventral striatum area did not demonstrate a significant difference in response rates between the active and sham groups at the end of a 16-week study.[35] However, a second randomized controlled study of ventral capsule DBS for TRD did demonstrate a significant difference in response rates between active DBS (44% responders) and sham DBS (0% responders).[36] Efficacy of DBS is established for OCD, with on average 60% responders in severely ill and treatment-resistant patients.[37] Based on these results the FDA has approved DBS for treatment-resistant OCD under a Humanitarian Device Exemption (HDE), requiring that the procedure be performed only in a hospital with specialist qualifications to do so.\nDBS for TRD can be as effective as antidepressants, with good response and remission rates, but adverse effects and safety must be more fully evaluated. Common side effects include \"wound infection, perioperative headache, and worsening\/irritable mood [and] increased suicidality\".[38]\n\nTourette syndrome \nFurther information: Treatment of Tourette syndrome\nDBS has been used experimentally in treating adults with severe Tourette syndrome that does not respond to conventional treatment. Despite widely publicized early successes, DBS remains a highly experimental procedure for the treatment of Tourette's, and more study is needed to determine whether long-term benefits outweigh the risks.[39][40][41][42] The procedure is well tolerated, but complications include \"short battery life, abrupt symptom worsening upon cessation of stimulation, hypomanic or manic conversion, and the significant time and effort involved in optimizing stimulation parameters\".[43] As of 2006, five people with TS had been reported on; all experienced reduction in tics and the disappearance of obsessive-compulsive behaviors.[43]\nThe procedure is invasive and expensive, and requires long-term expert care. Benefits for severe Tourette's are not conclusive, considering less robust effects of this surgery seen in the Netherlands. Tourette's is more common in pediatric populations, tending to remit in adulthood, so in general this would not be a recommended procedure for use on children. Because diagnosis of Tourette's is made based on a history of symptoms rather than analysis of neurological activity, it may not always be clear how to apply DBS for a particular person. Due to concern over the use of DBS in Tourette syndrome treatment, the Tourette Association of America convened a group of experts to develop recommendations guiding the use and potential clinical trials of DBS for TS.[44]\nRobertson reported that DBS had been used on 55 adults by 2011, remained an experimental treatment at that time, and recommended that the procedure \"should only be conducted by experienced functional neurosurgeons operating in centres which also have a dedicated Tourette syndrome clinic\".[40] According to Malone et al (2006), \"Only patients with severe, debilitating, and treatment-refractory illness should be considered; while those with severe personality disorders and substance-abuse problems should be excluded.\"[43] Du et al (2010) say, \"As an invasive therapy, DBS is currently only advisable for severely affected, treatment-refractory TS adults\".[41] Singer (2011) says, \"pending determination of patient selection criteria and the outcome of carefully controlled clinical trials, a cautious approach is recommended\".[39] Viswanathan et al (2012) say DBS should be used for people with \"severe functional impairment that cannot be managed medically\".[45]\n\nOther clinical applications \nResults of DBS in people with dystonia, where positive effects often appear gradually over a period of weeks to months, indicate a role of functional reorganization in at least some cases.[46] The procedure has been tested for effectiveness in people with epilepsy that is resistant to medication.[47] DBS may reduce or eliminate epileptic seizures with programmed or responsive stimulation.[citation needed ]\nDBS of the septal areas of persons with schizophrenia have resulted in enhanced alertness, cooperation, and euphoria.[48] Persons with narcolepsy and complex-partial seizures also reported euphoria and sexual thoughts from self-elicited DBS of the septal nuclei.[32]\nOrgasmic ecstasy was reported with the electrical stimulation of the brain with depth electrodes in the left hippocampus at 3mA, and the right hippocampus at 1 mA.[49]\nIn 2015, a group of Brazilian researchers led by neurosurgeon Dr. Erich Fonoff [pt] described a new technique that allows for simultaneous implants of electrodes called bilateral stereotactic procedure for DBS. The main benefits are less time spent on the procedure and greater accuracy.[50]\nForniceal DBS was found to improve learning and memory in a mouse model of Rett syndrome.[51] More recent work showed, that DBS upregulates genes involved in synaptic function, cell survival, and neurogenesis,[52] making some first steps at explaining the restoration of hippocampal circuit function.\n\nSee also \n\nBrain implant\nElectroconvulsive therapy\nElectroencephalography\nNeuromodulation (medicine)\nNeuroprosthetics\nOrganization for Human Brain Mapping\nResponsive neurostimulation device\nRobert G. Heath\nStimulation c\u00e9r\u00e9brale profonde [fr] \n\nReferences \n\n\n^ a b Kringelbach ML, Jenkinson N, Owen SL, Aziz TZ (August 2007). \"Translational principles of deep brain stimulation\". Nature Reviews. Neuroscience. 8 (8): 623\u201335. doi:10.1038\/nrn2196. PMID 17637800. \n\n^ Hammond C, Ammari R, Bioulac B, Garcia L (November 2008). \"Latest view on the mechanism of action of deep brain stimulation\". Movement Disorders. 23 (15): 2111\u201321. doi:10.1002\/mds.22120. PMID 18785230. \n\n^ a b Garc\u00eda MR, Pearlmutter BA, Wellstead PE, Middleton RH (2013). \"A slow axon antidromic blockade hypothesis for tremor reduction via deep brain stimulation\". PLOS One. 8 (9): e73456. doi:10.1371\/journal.pone.0073456. PMC 3774723 . PMID 24066049. \n\n^ \"Press Announcements - FDA approves brain implant to help reduce Parkinson's disease and essential tremor symptoms\". FDA. Retrieved May 23, 2016 . The first device, Medtronic\u2019s Activa Deep Brain Stimulation Therapy System, was approved in 1997 for tremor associated with essential tremor and Parkinson\u2019s disease. \n\n^ 'Brain pacemaker' treats dystonia. KNBC TV, April 22, 2003. Retrieved October 18, 2006. \n\n^ \"FDA Approves Humanitarian Device Exemption for Deep Brain Stimulator for Severe Obsessive-Compulsive Disorder\". FDA. \n\n^ Gildenberg PL (2005). \"Evolution of neuromodulation\". Stereotactic and Functional Neurosurgery. 83 (2\u20133): 71\u20139. doi:10.1159\/000086865. PMID 16006778. \n\n^ a b National Institute of Neurological Disorders and Stroke. Deep brain stimulation for Parkinson's disease information page Retrieved November 23, 2006. \n\n^ U.S. Department of Health and Human Services. FDA approves implanted brain stimulator to control tremors. Retrieved February 10, 2015. \n\n^ Doshi PK (April 2011). \"Long-term surgical and hardware-related complications of deep brain stimulation\". Stereotactic and Functional Neurosurgery. 89 (2): 89\u201395. doi:10.1159\/000323372. PMID 21293168. \n\n^ Burn DJ, Tr\u00f6ster AI (September 2004). \"Neuropsychiatric complications of medical and surgical therapies for Parkinson's disease\". Journal of Geriatric Psychiatry and Neurology. 17 (3): 172\u201380. doi:10.1177\/0891988704267466. PMID 15312281. \n\n^ Mogilner A.Y.; Benabid A.L.; Rezai A.R. (2004). \"Chronic Therapeutic Brain Stimulation: History, Current Clinical Indications, and Future Prospects\". In Markov, Marko; Paul J. Rosch. Bioelectromagnetic medicine. New York, N.Y: Marcel Dekker. pp. 133\u201351. ISBN 0-8247-4700-3. \n\n^ McIntyre CC, Thakor NV (2002). \"Uncovering the mechanisms of deep brain stimulation for Parkinson's disease through functional imaging, neural recording, and neural modeling\". Critical Reviews in Biomedical Engineering. 30 (4\u20136): 249\u201381. doi:10.1615\/critrevbiomedeng.v30.i456.20. PMID 12739751. \n\n^ Herrington TM, Cheng JJ, Eskandar EN (January 2016). \"Mechanisms of deep brain stimulation\". Journal of Neurophysiology. 115 (1): 19\u201338. doi:10.1152\/jn.00281.2015. PMC 4760496 . PMID 26510756. \n\n^ Machado A, Rezai AR, Kopell BH, Gross RE, Sharan AD, Benabid AL (June 2006). \"Deep brain stimulation for Parkinson's disease: surgical technique and perioperative management\". Movement Disorders. 21 Suppl 14 (Suppl 14): S247\u201358. doi:10.1002\/mds.20959. PMID 16810722. \n\n^ Moro E, Lang AE (November 2006). \"Criteria for deep-brain stimulation in Parkinson's disease: review and analysis\". Expert Review of Neurotherapeutics. 6 (11): 1695\u2013705. doi:10.1586\/14737175.6.11.1695. PMID 17144783. \n\n^ Apetauerova D, Ryan RK, Ro SI, Arle J, Shils J, Papavassiliou E, Tarsy D (August 2006). \"End of day dyskinesia in advanced Parkinson's disease can be eliminated by bilateral subthalamic nucleus or globus pallidus deep brain stimulation\". Movement Disorders. 21 (8): 1277\u20139. doi:10.1002\/mds.20896. PMID 16637040. \n\n^ Volkmann J, Herzog J, Kopper F, Deuschl G (2002). \"Introduction to the programming of deep brain stimulators\". Movement Disorders. 17 Suppl 3: S181\u20137. doi:10.1002\/mds.10162. PMID 11948775. \n\n^ Lee JY, Deogaonkar M, Rezai A (July 2007). \"Deep brain stimulation of globus pallidus internus for dystonia\". Parkinsonism & Related Disorders. 13 (5): 261\u20135. doi:10.1016\/j.parkreldis.2006.07.020. PMID 17081796. \n\n^ Deep brain stimulation. Surgery Encyclopedia. Retrieved January 25, 2007. \n\n^ Starr PA, Martin AJ, Ostrem JL, Talke P, Levesque N, Larson PS (March 2010). \"Subthalamic nucleus deep brain stimulator placement using high-field interventional magnetic resonance imaging and a skull-mounted aiming device: technique and application accuracy\". Journal of Neurosurgery. 112 (3): 479\u201390. doi:10.3171\/2009.6.JNS081161. PMC 2866526 . PMID 19681683. \n\n^ Deep Brain Stimulation, Department of Neurological Surgery, University of Pittsburgh. Retrieved May 13, 2008. \n\n^  Electrical stimulation of the brain for relief of intractable pain due to cancer. Cancer. 1986;57:1266\u201372. doi:10.1002\/1097-0142(19860315)57:6<1266::aid-cncr2820570634>3.0.co;2-q. PMID 3484665. \n\n^ Johnson MI, Oxberry SG & Robb K. Stimulation-induced analgesia. In: Sykes N, Bennett MI & Yuan C-S. Clinical pain management: Cancer pain. 2nd ed. London: Hodder Arnold; 2008. ISBN 978-0-340-94007-5. p. 235\u2013250. \n\n^ Kringelbach ML, Jenkinson N, Green AL, Owen SL, Hansen PC, Cornelissen PL, Holliday IE, Stein J, Aziz TZ (February 2007). \"Deep brain stimulation for chronic pain investigated with magnetoencephalography\". NeuroReport. 18 (3): 223\u20138. doi:10.1097\/wnr.0b013e328010dc3d. PMID 17314661. \n\n^ a b c Anderson RJ, Frye MA, Abulseoud OA, Lee KH, McGillivray JA, Berk M, Tye SJ (September 2012). \"Deep brain stimulation for treatment-resistant depression: efficacy, safety and mechanisms of action\". Neuroscience and Biobehavioral Reviews. 36 (8): 1920\u201333. doi:10.1016\/j.neubiorev.2012.06.001. PMID 22721950. \n\n^ Accolla EA, Aust S, Merkl A, Schneider GH, K\u00fchn AA, Bajbouj M, Draganski B (April 2016). \"Deep brain stimulation of the posterior gyrus rectus region for treatment resistant depression\". Journal of Affective Disorders. 194: 33\u20137. doi:10.1016\/j.jad.2016.01.022. PMID 26802505. \n\n^ Schlaepfer TE, Cohen MX, Frick C, Kosel M, Brodesser D, Axmacher N, Joe AY, Kreft M, Lenartz D, Sturm V (January 2008). \"Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression\". Neuropsychopharmacology. 33 (2): 368\u201377. doi:10.1038\/sj.npp.1301408. PMID 17429407. \n\n^ Schlaepfer TE, Bewernick BH, Kayser S, M\u00e4dler B, Coenen VA (June 2013). \"Rapid effects of deep brain stimulation for treatment-resistant major depression\". Biological Psychiatry. 73 (12): 1204\u201312. doi:10.1016\/j.biopsych.2013.01.034. PMID 23562618. \n\n^ Curr Opin Psychiatry. 2009 May;22(3):306\u201311 \n\n^ Delgado, Jose (1986). Physical Control of the Mind: Toward a Psychocivilized Society. New York: Harper and Row. \n\n^ a b Faria MA (2013). \"Violence, mental illness, and the brain - A brief history of psychosurgery: Part 3 - From deep brain stimulation to amygdalotomy for violent behavior, seizures, and pathological aggression in humans\". Surgical Neurology International. 4 (1): 91. doi:10.4103\/2152-7806.115162. PMC 3740620 . PMID 23956934. \n\n^ Robison RA, Taghva A, Liu CY, Apuzzo ML (2012). \"Surgery of the mind, mood, and conscious state: an idea in evolution\". World Neurosurgery. 77 (5\u20136): 662\u201386. doi:10.1016\/j.wneu.2012.03.005. PMID 22446082. \n\n^ Lakhan SE, Callaway E (March 2010). \"Deep brain stimulation for obsessive-compulsive disorder and treatment-resistant depression: systematic review\". BMC Research Notes. 3 (1): 60. doi:10.1186\/1756-0500-3-60. PMC 2838907 . PMID 20202203. \n\n^ Dougherty DD, Rezai AR, Carpenter LL, Howland RH, Bhati MT, O'Reardon JP, Eskandar EN, Baltuch GH, Machado AD, Kondziolka D, Cusin C, Evans KC, Price LH, Jacobs K, Pandya M, Denko T, Tyrka AR, Brelje T, Deckersbach T, Kubu C, Malone DA (August 2015). \"A Randomized Sham-Controlled Trial of Deep Brain Stimulation of the Ventral Capsule\/Ventral Striatum for Chronic Treatment-Resistant Depression\". Biological Psychiatry. 78 (4): 240\u20138. doi:10.1016\/j.biopsych.2014.11.023. PMID 25726497. \n\n^ Bergfeld IO, Mantione M, Hoogendoorn ML, Ruh\u00e9 HG, Notten P, van Laarhoven J, et al. (May 2016). \"Deep Brain Stimulation of the Ventral Anterior Limb of the Internal Capsule for Treatment-Resistant Depression: A Randomized Clinical Trial\". JAMA Psychiatry. 73 (5): 456\u201364. doi:10.1001\/jamapsychiatry.2016.0152. PMID 27049915. \n\n^ Alonso P, Cuadras D, Gabri\u00ebls L, Denys D, Goodman W, Greenberg BD, et al. (2015-07-24). \"Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response\". PLOS One. 10 (7): e0133591. doi:10.1371\/journal.pone.0133591. PMC 4514753 . PMID 26208305. \n\n^ Moreines JL, McClintock SM, Holtzheimer PE (January 2011). \"Neuropsychologic effects of neuromodulation techniques for treatment-resistant depression: a review\". Brain Stimulation. 4 (1): 17\u201327. doi:10.1016\/j.brs.2010.01.005. PMC 3023999 . PMID 21255751. \n\n^ a b Singer HS (March 2005). \"Tourette syndrome and other tic disorders\". Handbook of Clinical Neurology. 100: 641\u201357. doi:10.1016\/B978-0-444-52014-2.00046-X. PMID 21496613. Also see Singer HS (March 2005). \"Tourette's syndrome: from behaviour to biology\". The Lancet. Neurology. 4 (3): 149\u201359. doi:10.1016\/S1474-4422(05)01012-4. PMID 15721825. \n\n^ a b Robertson MM (February 2011). \"Gilles de la Tourette syndrome: the complexities of phenotype and treatment\". British Journal of Hospital Medicine. 72 (2): 100\u20137. doi:10.12968\/hmed.2011.72.2.100. PMID 21378617. \n\n^ a b Du JC, Chiu TF, Lee KM, Wu HL, Yang YC, Hsu SY, Sun CS, Hwang B, Leckman JF (October 2010). \"Tourette syndrome in children: an updated review\". Pediatrics and Neonatology. 51 (5): 255\u201364. doi:10.1016\/S1875-9572(10)60050-2. PMID 20951354. \n\n^ Tourette Syndrome Association. Statement: Deep Brain Stimulation and Tourette Syndrome. Retrieved November 22, 2005. \n\n^ a b c Malone DA, Pandya MM (2006). \"Behavioral neurosurgery\". Advances in Neurology. 99: 241\u20137. PMID 16536372. \n\n^ Mink JW, Walkup J, Frey KA, Como P, Cath D, Delong MR, Erenberg G, Jankovic J, Juncos J, Leckman JF, Swerdlow N, Visser-Vandewalle V, Vitek JL (November 2006). \"Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome\". Movement Disorders. 21 (11): 1831\u20138. doi:10.1002\/mds.21039. PMID 16991144. \n\n^ Viswanathan A, Jimenez-Shahed J, Baizabal Carvallo JF, Jankovic J (2012). \"Deep brain stimulation for Tourette syndrome: target selection\". Stereotactic and Functional Neurosurgery. 90 (4): 213\u201324. doi:10.1159\/000337776. PMID 22699684. \n\n^ Krauss JK (2002). \"Deep brain stimulation for dystonia in adults. Overview and developments\". Stereotactic and Functional Neurosurgery. 78 (3\u20134): 168\u201382. doi:10.1159\/000068963. PMID 12652041. \n\n^ Wu C, Sharan AD (Jan\u2013Feb 2013). \"Neurostimulation for the treatment of epilepsy: a review of current surgical interventions\". Neuromodulation. 16 (1): 10\u201324, discussion 24. doi:10.1111\/j.1525-1403.2012.00501.x. PMID 22947069. \n\n^ Heath RG (January 1972). \"Pleasure and brain activity in man. Deep and surface electroencephalograms during orgasm\". The Journal of Nervous and Mental Disease. 154 (1): 3\u201318. doi:10.1097\/00005053-197201000-00002. PMID 5007439. \n\n^ Surbeck W, Bouthillier A, Nguyen DK. \"Bilateral cortical representation of orgasmic ecstasy localized by depth electrodes\". Epilepsy & Behavior Case Reports. 1: 62\u20135. doi:10.1016\/j.ebcr.2013.03.002. PMC 4150648 . PMID 25667829. \n\n^ Fonoff ET, Azevedo A, Angelos JS, Martinez RC, Navarro J, Reis PR, Sepulveda ME, Cury RG, Ghilardi MG, Teixeira MJ, Lopez WO (July 2016). \"Simultaneous bilateral stereotactic procedure for deep brain stimulation implants: a significant step for reducing operation time\". Journal of Neurosurgery. 125 (1): 85\u20139. doi:10.3171\/2015.7.JNS151026. PMID 26684776. \n\n^ Lu H, Ash RT, He L, Kee SE, Wang W, Yu D, Hao S, Meng X, Ure K, Ito-Ishida A, Tang B, Sun Y, Ji D, Tang J, Arenkiel BR, Smirnakis SM, Zoghbi HY (August 2016). \"Loss and Gain of MeCP2 Cause Similar Hippocampal Circuit Dysfunction that Is Rescued by Deep Brain Stimulation in a Rett Syndrome Mouse Model\". Neuron. 91 (4): 739\u2013747. doi:10.1016\/j.neuron.2016.07.018. PMID 27499081. \n\n^ Pohodich AE, Yalamanchili H, Raman AT, Wan YW, Gundry M, Hao S, Jin H, Tang J, Liu Z, Zoghbi HY (March 2018). \"Forniceal deep brain stimulation induces gene expression and splicing changes that promote neurogenesis and plasticity\". eLife. 7. doi:10.7554\/elife.34031. PMID 29570050. \n\n\nFurther reading \n\nAppleby BS, Duggan PS, Regenberg A, Rabins PV (September 2007). \"Psychiatric and neuropsychiatric adverse events associated with deep brain stimulation: A meta-analysis of ten years' experience\". Movement Disorders. 22 (12): 1722\u20138. doi:10.1002\/mds.21551. PMID 17721929. \nSchlaepfer TE, Bewernick BH, Kayser S, Hurlemann R, Coenen VA (May 2014). \"Deep brain stimulation of the human reward system for major depression--rationale, outcomes and outlook\". Neuropsychopharmacology. 39 (6): 1303\u201314. doi:10.1038\/npp.2014.28. PMC 3988559 . PMID 24513970. \nDiamond A, Shahed J, Azher S, Dat-Vuong K, Jankovic J (May 2006). \"Globus pallidus deep brain stimulation in dystonia\". Movement Disorders. 21 (5): 692\u20135. doi:10.1002\/mds.20767. PMID 16342255. \nRichter EO, Lozano AM (2004). \"Deep Brain Stimulation for Parkinson's Disease in Movement Disorders\". In Markov M, Rosch PJ. Bioelectromagnetic medicine. New York, N.Y: Marcel Dekker. pp. 265\u201376. ISBN 0-8247-4700-3. \n\nExternal links \n\n\n\nWikimedia Commons has media related to Deep brain stimulation.\nVideo: Deep brain stimulation to treat Parkinson's disease\nVideo: Deep brain stimulation therapy for Parkinson's disease\nThe Perils of Deep Brain Stimulation for Depression. Author Danielle Egan. September 24, 2015.\nTreatment center for Deep Brain Stimulation of movement disorders, OCD, Tourette or depression.\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Deep_brain_stimulation\">https:\/\/www.limswiki.org\/index.php\/Deep_brain_stimulation<\/a>\n\t\t\t\t\tCategories: Medical and surgical techniquesNeurostimulationHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 17:29.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 702 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","30fc8ee25ea342bda9af77a35b2a6f1f_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Deep_brain_stimulation skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Deep brain stimulation<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Deep brain stimulation<\/b> (<b>DBS<\/b>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurosurgery\" title=\"Neurosurgery\" rel=\"external_link\" target=\"_blank\">neurosurgical<\/a> procedure involving the implantation of a medical device called a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurostimulator\" class=\"mw-redirect\" title=\"Neurostimulator\" rel=\"external_link\" target=\"_blank\">neurostimulator<\/a> (sometimes referred to as a 'brain pacemaker'), which sends electrical impulses, through implanted <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrode\" title=\"Electrode\" rel=\"external_link\" target=\"_blank\">electrodes<\/a>, to specific targets in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain\" title=\"Brain\" rel=\"external_link\" target=\"_blank\">brain<\/a> (brain nuclei) for the treatment of movement disorders, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parkinson%27s_disease\" title=\"Parkinson's disease\" rel=\"external_link\" target=\"_blank\">Parkinson's disease<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Essential_tremor\" title=\"Essential tremor\" rel=\"external_link\" target=\"_blank\">essential tremor<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dystonia\" title=\"Dystonia\" rel=\"external_link\" target=\"_blank\">dystonia<\/a>.<sup id=\"rdp-ebb-cite_ref-Kringelbach_1-0\" class=\"reference\"><a href=\"#cite_note-Kringelbach-1\" rel=\"external_link\">[1]<\/a><\/sup> While DBS has proven to be effective for some people, the potential for serious complications and side effects exists. DBS directly changes brain activity in a controlled manner, but its underlying principles and mechanisms are not clear.<sup id=\"rdp-ebb-cite_ref-Hammond_2-0\" class=\"reference\"><a href=\"#cite_note-Hammond-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-garcia_3-0\" class=\"reference\"><a href=\"#cite_note-garcia-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> approved DBS as a treatment for essential tremor and Parkinson's disease (PD) in 1997,<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> dystonia in 2003,<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> and obsessive\u2013compulsive disorder (OCD) in 2009.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-gildenberg_7-0\" class=\"reference\"><a href=\"#cite_note-gildenberg-7\" rel=\"external_link\">[7]<\/a><\/sup> DBS has been studied in clinical trials as a potential treatment for chronic pain for various affective disorders, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Major_depressive_disorder\" title=\"Major depressive disorder\" rel=\"external_link\" target=\"_blank\">major depression<\/a>; it is one of only a few neurosurgical methods that allow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blind_experiment\" class=\"mw-redirect\" title=\"Blind experiment\" rel=\"external_link\" target=\"_blank\">blinded studies<\/a>.<sup id=\"rdp-ebb-cite_ref-Kringelbach_1-1\" class=\"reference\"><a href=\"#cite_note-Kringelbach-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p><br \/>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_use\">Medical use<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Deep_Brain_Stimulation_(DBS)_of_Nucleus_Basalis_of_Meynert.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/05\/Deep_Brain_Stimulation_%28DBS%29_of_Nucleus_Basalis_of_Meynert.jpg\/250px-Deep_Brain_Stimulation_%28DBS%29_of_Nucleus_Basalis_of_Meynert.jpg\" width=\"250\" height=\"182\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Deep_Brain_Stimulation_(DBS)_of_Nucleus_Basalis_of_Meynert.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Drawing of DBS electrodes deep in the brain (side view)<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Parkinson_surgery.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/91\/Parkinson_surgery.jpg\/250px-Parkinson_surgery.jpg\" width=\"250\" height=\"373\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Parkinson_surgery.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Insertion of electrode during surgery using a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stereotactic_surgery\" title=\"Stereotactic surgery\" rel=\"external_link\" target=\"_blank\">stereotactic frame<\/a><\/div><\/div><\/div>\n<p>DBS is used to manage some of the symptoms of Parkinson's Disease that cannot be adequately controlled with medications.<sup id=\"rdp-ebb-cite_ref-NINDS_8-0\" class=\"reference\"><a href=\"#cite_note-NINDS-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-USDHHS_9-0\" class=\"reference\"><a href=\"#cite_note-USDHHS-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Adverse_effects\">Adverse effects<\/span><\/h2>\n<p>DBS carries the risks of major surgery, with a complication rate related to the experience of the surgical team. The major complications include hemorrhage (1\u20132%) and infection (3\u20135%).<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>While DBS is helpful for some people, the potential also exists for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuropsychiatry\" title=\"Neuropsychiatry\" rel=\"external_link\" target=\"_blank\">neuropsychiatric<\/a> side effects, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apathy\" title=\"Apathy\" rel=\"external_link\" target=\"_blank\">apathy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hallucinations\" class=\"mw-redirect\" title=\"Hallucinations\" rel=\"external_link\" target=\"_blank\">hallucinations<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypersexuality\" title=\"Hypersexuality\" rel=\"external_link\" target=\"_blank\">hypersexuality<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cognitive_dysfunction\" class=\"mw-redirect\" title=\"Cognitive dysfunction\" rel=\"external_link\" target=\"_blank\">cognitive dysfunction<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_depression\" class=\"mw-redirect\" title=\"Clinical depression\" rel=\"external_link\" target=\"_blank\">depression<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Euphoria\" title=\"Euphoria\" rel=\"external_link\" target=\"_blank\">euphoria<\/a>. However, these may be temporary and related to correct placement of electrodes and calibration of the stimulator, so these side effects are potentially reversible.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>Because the brain can shift slightly during surgery, the electrodes can become displaced or dislodged from the specific location. This may cause more profound complications such as personality changes, but electrode misplacement is relatively easy to identify using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography\" class=\"mw-redirect\" title=\"Computed tomography\" rel=\"external_link\" target=\"_blank\">CT<\/a>. Also, complications of surgery may occur, such as bleeding within the brain. After surgery, swelling of the brain tissue, mild disorientation, and sleepiness are normal. After 2\u20134 weeks, a follow-up visit is used to remove <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" title=\"Surgical suture\" rel=\"external_link\" target=\"_blank\">sutures<\/a>, turn on the neurostimulator, and program it.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>\nAs with all surgery, a risk exists of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a> and bleeding during and after a surgery. The foreign object placed may be rejected by the body or calcification of the implant might take place.<\/p>\n<h2><span class=\"mw-headline\" id=\"Mechanisms\">Mechanisms<\/span><\/h2>\n<p>The exact mechanism of action of DBS is not known.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> A variety of hypotheses try to explain the mechanisms of DBS:<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<ol><li>Depolarization blockade: Electrical currents block the neuronal output at or near the electrode site.<\/li>\n<li>Synaptic inhibition: This causes an indirect regulation of the neuronal output by activating axon terminals with synaptic connections to neurons near the stimulating electrode.<\/li>\n<li>Desynchronization of abnormal oscillatory activity of neurons<\/li>\n<li>Antidromic activation either activating\/blockading distant neurons or blockading slow axons<sup id=\"rdp-ebb-cite_ref-garcia_3-1\" class=\"reference\"><a href=\"#cite_note-garcia-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li><\/ol>\n<p>DBS represents an advance on previous treatments which involved <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pallidotomy\" title=\"Pallidotomy\" rel=\"external_link\" target=\"_blank\">pallidotomy<\/a> (i.e., surgical ablation of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Globus_pallidus\" title=\"Globus pallidus\" rel=\"external_link\" target=\"_blank\">globus pallidus<\/a>) or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thalamotomy\" title=\"Thalamotomy\" rel=\"external_link\" target=\"_blank\">thalamotomy<\/a> (i.e., surgical ablation of the thalamus).<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> Instead, a thin lead with multiple electrodes is implanted in the globus pallidus, , or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subthalamic_nucleus\" title=\"Subthalamic nucleus\" rel=\"external_link\" target=\"_blank\">subthalamic nucleus<\/a>, and electric pulses are used therapeutically. The lead from the implant is extended to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implanted_pulse_generator\" class=\"mw-redirect\" title=\"Implanted pulse generator\" rel=\"external_link\" target=\"_blank\">neurostimulator<\/a> under the skin in the chest area.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (January 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Its direct effect on the physiology of brain cells and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurotransmitters\" class=\"mw-redirect\" title=\"Neurotransmitters\" rel=\"external_link\" target=\"_blank\">neurotransmitters<\/a> is currently debated, but by sending high-frequency electrical impulses into specific areas of the brain, it can mitigate symptoms<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> and directly diminish the side effects induced by PD medications,<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> allowing a decrease in medications, or making a medication regimen more tolerable.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (January 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Components_and_placement\">Components and placement<\/span><\/h2>\n<p>The DBS system consists of three components: the implanted pulse generator (IPG), the lead, and an extension. The IPG is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Battery_(electricity)\" class=\"mw-redirect\" title=\"Battery (electricity)\" rel=\"external_link\" target=\"_blank\">battery<\/a>-powered neurostimulator encased in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a> housing, which sends electrical pulses to the brain that interfere with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neural\" class=\"mw-redirect\" title=\"Neural\" rel=\"external_link\" target=\"_blank\">neural<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Action_potential\" title=\"Action potential\" rel=\"external_link\" target=\"_blank\">activity<\/a> at the target site. The lead is a coiled wire insulated in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyurethane\" title=\"Polyurethane\" rel=\"external_link\" target=\"_blank\">polyurethane<\/a> with four <a href=\"https:\/\/en.wikipedia.org\/wiki\/Platinum-iridium_alloy\" title=\"Platinum-iridium alloy\" rel=\"external_link\" target=\"_blank\">platinum-iridium<\/a> electrodes and is placed in one or two different nuclei of the brain. The lead is connected to the IPG by an extension, an insulated wire that runs below the skin, from the head, down the side of the neck, behind the ear, to the IPG, which is placed subcutaneously below the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clavicle\" title=\"Clavicle\" rel=\"external_link\" target=\"_blank\">clavicle<\/a>, or in some cases, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_abdomen\" class=\"mw-redirect\" title=\"Human abdomen\" rel=\"external_link\" target=\"_blank\">abdomen<\/a>.<sup id=\"rdp-ebb-cite_ref-NINDS_8-1\" class=\"reference\"><a href=\"#cite_note-NINDS-8\" rel=\"external_link\">[8]<\/a><\/sup> The IPG can be calibrated by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurology\" title=\"Neurology\" rel=\"external_link\" target=\"_blank\">neurologist<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nurse\" class=\"mw-redirect\" title=\"Nurse\" rel=\"external_link\" target=\"_blank\">nurse<\/a>, or trained <a href=\"https:\/\/en.wikipedia.org\/wiki\/Technician\" title=\"Technician\" rel=\"external_link\" target=\"_blank\">technician<\/a> to optimize symptom suppression and control side effects.<sup id=\"rdp-ebb-cite_ref-Volkmann_18-0\" class=\"reference\"><a href=\"#cite_note-Volkmann-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p><p>DBS leads are placed in the brain according to the type of symptoms to be addressed. For non-Parkinsonian essential tremor, the lead is placed in either the ventrointermediate nucleus of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_thalamus\" class=\"mw-redirect\" title=\"Human thalamus\" rel=\"external_link\" target=\"_blank\">thalamus<\/a> or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zona_incerta\" title=\"Zona incerta\" rel=\"external_link\" target=\"_blank\">zona incerta<\/a>;<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> for dystonia and symptoms associated with PD (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Rigidity_(neurology)\" class=\"mw-redirect\" title=\"Rigidity (neurology)\" rel=\"external_link\" target=\"_blank\">rigidity<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bradykinesia\" class=\"mw-redirect\" title=\"Bradykinesia\" rel=\"external_link\" target=\"_blank\">bradykinesia<\/a>\/<a href=\"https:\/\/en.wikipedia.org\/wiki\/Akinesia\" class=\"mw-redirect\" title=\"Akinesia\" rel=\"external_link\" target=\"_blank\">akinesia<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tremor\" title=\"Tremor\" rel=\"external_link\" target=\"_blank\">tremor<\/a>), the lead may be placed in either the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Globus_pallidus_internus\" class=\"mw-redirect\" title=\"Globus pallidus internus\" rel=\"external_link\" target=\"_blank\">globus pallidus internus<\/a> or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subthalamic_nucleus\" title=\"Subthalamic nucleus\" rel=\"external_link\" target=\"_blank\">subthalamic nucleus<\/a>; for OCD and depression to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nucleus_accumbens\" title=\"Nucleus accumbens\" rel=\"external_link\" target=\"_blank\">nucleus accumbens<\/a>; for incessant pain to the posterior thalamic region or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Periaqueductal_gray\" title=\"Periaqueductal gray\" rel=\"external_link\" target=\"_blank\">periaqueductal gray<\/a>; and for epilepsy treatment to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anterior_nuclei_of_thalamus\" title=\"Anterior nuclei of thalamus\" rel=\"external_link\" target=\"_blank\">anterior thalamic nucleus<\/a>.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><p>All three components are surgically implanted inside the body. Lead implantation may take place under local anesthesia or under general anesthesia (\"asleep DBS\") such as for dystonia. A hole about 14 mm in diameter is drilled in the skull and the probe electrode is inserted <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stereotactic_surgery\" title=\"Stereotactic surgery\" rel=\"external_link\" target=\"_blank\">stereotactically<\/a>. During the awake procedure with local anesthesia, feedback from the person is used to determine the optimal placement of the permanent electrode. During the asleep procedure, intraoperative MRI guidance is used for direct visualization of brain tissue and device.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> The installation of the IPG and extension leads occurs under general anesthesia.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> The right side of the brain is stimulated to address symptoms on the left side of the body and vice versa.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (January 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Research\">Research<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Chronic_pain\">Chronic pain<\/span><\/h3>\n<p>Stimulation of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Periaqueductal_gray\" title=\"Periaqueductal gray\" rel=\"external_link\" target=\"_blank\">periaqueductal gray<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Periventricular_nucleus\" title=\"Periventricular nucleus\" rel=\"external_link\" target=\"_blank\">periventricular gray<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain#Nociceptive\" title=\"Pain\" rel=\"external_link\" target=\"_blank\">nociceptive pain<\/a>, and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Internal_capsule\" title=\"Internal capsule\" rel=\"external_link\" target=\"_blank\">internal capsule<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventral_posterolateral_nucleus\" title=\"Ventral posterolateral nucleus\" rel=\"external_link\" target=\"_blank\">ventral posterolateral nucleus<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventral_posteromedial_nucleus\" title=\"Ventral posteromedial nucleus\" rel=\"external_link\" target=\"_blank\">ventral posteromedial nucleus<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain#Nociceptive\" title=\"Pain\" rel=\"external_link\" target=\"_blank\">neuropathic pain<\/a> has produced impressive results with some people, but results vary. One study<sup id=\"rdp-ebb-cite_ref-Young_23-0\" class=\"reference\"><a href=\"#cite_note-Young-23\" rel=\"external_link\">[23]<\/a><\/sup> of 17 people with intractable cancer pain found that 13 were virtually pain free and only four required opioid analgesics on release from hospital after the intervention. Most ultimately did resort to opioids, usually in the last few weeks of life.<sup id=\"rdp-ebb-cite_ref-Johnson_24-0\" class=\"reference\"><a href=\"#cite_note-Johnson-24\" rel=\"external_link\">[24]<\/a><\/sup> DBS has also been applied for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phantom_limb_pain\" class=\"mw-redirect\" title=\"Phantom limb pain\" rel=\"external_link\" target=\"_blank\">phantom limb pain<\/a>.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Major_depression_and_obsessive-compulsive_disorder\">Major depression and obsessive-compulsive disorder<\/span><\/h3>\n<p>DBS has been used in a small number of clinical trials to treat people with severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Treatment-resistant_depression\" title=\"Treatment-resistant depression\" rel=\"external_link\" target=\"_blank\">treatment-resistant depression<\/a> (TRD).<sup id=\"rdp-ebb-cite_ref-Anderson_26-0\" class=\"reference\"><a href=\"#cite_note-Anderson-26\" rel=\"external_link\">[26]<\/a><\/sup> A number of neuroanatomical targets have been used for DBS for TRD including the subgenual cingulate gyrus, posterior gyrus rectus,<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nucleus_accumbens\" title=\"Nucleus accumbens\" rel=\"external_link\" target=\"_blank\">nucleus accumbens<\/a>,<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> ventral capsule\/ventral striatum, inferior thalamic peduncle, and the lateral habenula.<sup id=\"rdp-ebb-cite_ref-Anderson_26-1\" class=\"reference\"><a href=\"#cite_note-Anderson-26\" rel=\"external_link\">[26]<\/a><\/sup> A recently proposed target of DBS intervention in depression is the superolateral branch of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medial_forebrain_bundle\" title=\"Medial forebrain bundle\" rel=\"external_link\" target=\"_blank\">medial forebrain bundle<\/a>; its stimulation lead to surprisingly rapid antidepressant effects.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p><p>The small numbers in the early trials of DBS for TRD currently limit the selection of an optimal neuroanatomical target.<sup id=\"rdp-ebb-cite_ref-Anderson_26-2\" class=\"reference\"><a href=\"#cite_note-Anderson-26\" rel=\"external_link\">[26]<\/a><\/sup> Evidence is insufficient to support DBS as a therapeutic modality for depression; however, the procedure may be an effective <a href=\"https:\/\/en.wikipedia.org\/wiki\/Treatment_modality\" class=\"mw-redirect\" title=\"Treatment modality\" rel=\"external_link\" target=\"_blank\">treatment modality<\/a> in the future.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup> In fact, beneficial results have been documented in the neurosurgical literature, including a few instances in which people who were deeply depressed were provided with portable stimulators for self treatment.<sup id=\"rdp-ebb-cite_ref-Delgado_1986_31-0\" class=\"reference\"><a href=\"#cite_note-Delgado_1986-31\" rel=\"external_link\">[31]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Faria_3_32-0\" class=\"reference\"><a href=\"#cite_note-Faria_3-32\" rel=\"external_link\">[32]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p><p>A systematic review of DBS for TRD and OCD identified 23 cases, nine for OCD, seven for TRD, and one for both. \"[A]bout half the patients did show dramatic improvement\" and adverse events were \"generally trivial\" given the younger age of the psychiatric population relative to the age of people with movement disorders.<sup id=\"rdp-ebb-cite_ref-Lakhan_34-0\" class=\"reference\"><a href=\"#cite_note-Lakhan-34\" rel=\"external_link\">[34]<\/a><\/sup> The first randomized, controlled study of DBS for the treatment of TRD targeting the ventral capsule\/ventral striatum area did not demonstrate a significant difference in response rates between the active and sham groups at the end of a 16-week study.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup> However, a second randomized controlled study of ventral capsule DBS for TRD did demonstrate a significant difference in response rates between active DBS (44% responders) and sham DBS (0% responders).<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup> Efficacy of DBS is established for OCD, with on average 60% responders in severely ill and treatment-resistant patients.<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup> Based on these results the FDA has approved DBS for treatment-resistant OCD under a Humanitarian Device Exemption (HDE), requiring that the procedure be performed only in a hospital with specialist qualifications to do so.\n<\/p><p>DBS for TRD can be as effective as antidepressants, with good response and remission rates, but adverse effects and safety must be more fully evaluated. Common side effects include \"wound infection, perioperative headache, and worsening\/irritable mood [and] increased suicidality\".<sup id=\"rdp-ebb-cite_ref-Moreines_38-0\" class=\"reference\"><a href=\"#cite_note-Moreines-38\" rel=\"external_link\">[38]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Tourette_syndrome\">Tourette syndrome<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Treatment_of_Tourette_syndrome\" title=\"Treatment of Tourette syndrome\" rel=\"external_link\" target=\"_blank\">Treatment of Tourette syndrome<\/a><\/div>\n<p>DBS has been used experimentally in treating adults with severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tourette_syndrome\" title=\"Tourette syndrome\" rel=\"external_link\" target=\"_blank\">Tourette syndrome<\/a> that does not respond to conventional treatment. Despite widely publicized early successes, DBS remains a highly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical_research\" class=\"mw-redirect\" title=\"Biomedical research\" rel=\"external_link\" target=\"_blank\">experimental<\/a> procedure for the treatment of Tourette's, and more study is needed to determine whether long-term benefits outweigh the risks.<sup id=\"rdp-ebb-cite_ref-Singer2011_39-0\" class=\"reference\"><a href=\"#cite_note-Singer2011-39\" rel=\"external_link\">[39]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Robertson2011_40-0\" class=\"reference\"><a href=\"#cite_note-Robertson2011-40\" rel=\"external_link\">[40]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Du2010_41-0\" class=\"reference\"><a href=\"#cite_note-Du2010-41\" rel=\"external_link\">[41]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup> The procedure is well tolerated, but complications include \"short battery life, abrupt symptom worsening upon cessation of stimulation, hypomanic or manic conversion, and the significant time and effort involved in optimizing stimulation parameters\".<sup id=\"rdp-ebb-cite_ref-Malone_43-0\" class=\"reference\"><a href=\"#cite_note-Malone-43\" rel=\"external_link\">[43]<\/a><\/sup> As of 2006, five people with TS had been reported on; all experienced reduction in tics and the disappearance of obsessive-compulsive behaviors.<sup id=\"rdp-ebb-cite_ref-Malone_43-1\" class=\"reference\"><a href=\"#cite_note-Malone-43\" rel=\"external_link\">[43]<\/a><\/sup>\n<\/p><p>The procedure is invasive and expensive, and requires long-term expert care. Benefits for severe Tourette's are not conclusive, considering less robust effects of this surgery seen in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Netherlands\" title=\"Netherlands\" rel=\"external_link\" target=\"_blank\">Netherlands<\/a>. Tourette's is more common in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pediatric\" class=\"mw-redirect\" title=\"Pediatric\" rel=\"external_link\" target=\"_blank\">pediatric<\/a> populations, tending to remit in adulthood, so in general this would not be a recommended procedure for use on children. Because diagnosis of Tourette's is made based on a history of symptoms rather than analysis of neurological activity, it may not always be clear how to apply DBS for a particular person. Due to concern over the use of DBS in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Treatment_of_Tourette_syndrome\" title=\"Treatment of Tourette syndrome\" rel=\"external_link\" target=\"_blank\">Tourette syndrome treatment<\/a>, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tourette_Association_of_America\" title=\"Tourette Association of America\" rel=\"external_link\" target=\"_blank\">Tourette Association of America<\/a> convened a group of experts to develop recommendations guiding the use and potential <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_trials\" class=\"mw-redirect\" title=\"Clinical trials\" rel=\"external_link\" target=\"_blank\">clinical trials<\/a> of DBS for TS.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup>\n<\/p><p>Robertson reported that DBS had been used on 55 adults by 2011, remained an experimental treatment at that time, and recommended that the procedure \"should only be conducted by experienced functional neurosurgeons operating in centres which also have a dedicated Tourette syndrome clinic\".<sup id=\"rdp-ebb-cite_ref-Robertson2011_40-1\" class=\"reference\"><a href=\"#cite_note-Robertson2011-40\" rel=\"external_link\">[40]<\/a><\/sup> According to Malone <i>et al<\/i> (2006), \"Only patients with severe, debilitating, and treatment-refractory illness should be considered; while those with severe personality disorders and substance-abuse problems should be excluded.\"<sup id=\"rdp-ebb-cite_ref-Malone_43-2\" class=\"reference\"><a href=\"#cite_note-Malone-43\" rel=\"external_link\">[43]<\/a><\/sup> Du <i>et al<\/i> (2010) say, \"As an invasive therapy, DBS is currently only advisable for severely affected, treatment-refractory TS adults\".<sup id=\"rdp-ebb-cite_ref-Du2010_41-1\" class=\"reference\"><a href=\"#cite_note-Du2010-41\" rel=\"external_link\">[41]<\/a><\/sup> Singer (2011) says, \"pending determination of patient selection criteria and the outcome of carefully controlled clinical trials, a cautious approach is recommended\".<sup id=\"rdp-ebb-cite_ref-Singer2011_39-1\" class=\"reference\"><a href=\"#cite_note-Singer2011-39\" rel=\"external_link\">[39]<\/a><\/sup> Viswanathan <i>et al<\/i> (2012) say DBS should be used for people with \"severe functional impairment that cannot be managed medically\".<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Other_clinical_applications\">Other clinical applications<\/span><\/h3>\n<p>Results of DBS in people with dystonia, where positive effects often appear gradually over a period of weeks to months, indicate a role of functional reorganization in at least some cases.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup> The procedure has been tested for effectiveness in people with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epilepsy\" title=\"Epilepsy\" rel=\"external_link\" target=\"_blank\">epilepsy<\/a> that is resistant to medication.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup> DBS may reduce or eliminate epileptic seizures with programmed or responsive stimulation.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (January 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>DBS of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Septal_nuclei\" title=\"Septal nuclei\" rel=\"external_link\" target=\"_blank\">septal areas<\/a> of persons with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Schizophrenia\" title=\"Schizophrenia\" rel=\"external_link\" target=\"_blank\">schizophrenia<\/a> have resulted in enhanced alertness, cooperation, and euphoria.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup> Persons with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Narcolepsy\" title=\"Narcolepsy\" rel=\"external_link\" target=\"_blank\">narcolepsy<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Complex-partial_seizures\" class=\"mw-redirect\" title=\"Complex-partial seizures\" rel=\"external_link\" target=\"_blank\">complex-partial seizures<\/a> also reported euphoria and sexual thoughts from self-elicited DBS of the septal nuclei.<sup id=\"rdp-ebb-cite_ref-Faria_3_32-1\" class=\"reference\"><a href=\"#cite_note-Faria_3-32\" rel=\"external_link\">[32]<\/a><\/sup>\n<\/p><p>Orgasmic ecstasy was reported with the electrical stimulation of the brain with depth electrodes in the left <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hippocampus\" title=\"Hippocampus\" rel=\"external_link\" target=\"_blank\">hippocampus<\/a> at 3mA, and the right <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hippocampus\" title=\"Hippocampus\" rel=\"external_link\" target=\"_blank\">hippocampus<\/a> at 1 mA.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/p><p>In 2015, a group of Brazilian researchers led by neurosurgeon Dr. <span class=\"noprint\" style=\"font-size:85%; font-style: normal;\"> [<a href=\"https:\/\/pt.wikipedia.org\/wiki\/Erich_Fonoff\" class=\"extiw\" title=\"pt:Erich Fonoff\" rel=\"external_link\" target=\"_blank\">pt<\/a>]<\/span> described a new technique that allows for simultaneous implants of electrodes called bilateral stereotactic procedure for DBS. The main benefits are less time spent on the procedure and greater accuracy.<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup>\n<\/p><p>Forniceal DBS was found to improve learning and memory in a mouse model of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rett_syndrome\" title=\"Rett syndrome\" rel=\"external_link\" target=\"_blank\">Rett<\/a> syndrome.<sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup> More recent work showed, that DBS upregulates genes involved in synaptic function, cell survival, and neurogenesis,<sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup> making some first steps at explaining the restoration of hippocampal circuit function.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain_implant\" title=\"Brain implant\" rel=\"external_link\" target=\"_blank\">Brain implant<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electroconvulsive_therapy\" title=\"Electroconvulsive therapy\" rel=\"external_link\" target=\"_blank\">Electroconvulsive therapy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electroencephalography\" title=\"Electroencephalography\" rel=\"external_link\" target=\"_blank\">Electroencephalography<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromodulation_(medicine)\" title=\"Neuromodulation (medicine)\" rel=\"external_link\" target=\"_blank\">Neuromodulation (medicine)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroprosthetics\" title=\"Neuroprosthetics\" rel=\"external_link\" target=\"_blank\">Neuroprosthetics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Organization_for_Human_Brain_Mapping\" title=\"Organization for Human Brain Mapping\" rel=\"external_link\" target=\"_blank\">Organization for Human Brain Mapping<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Responsive_neurostimulation_device\" title=\"Responsive neurostimulation device\" rel=\"external_link\" target=\"_blank\">Responsive neurostimulation device<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_Galbraith_Heath\" title=\"Robert Galbraith Heath\" rel=\"external_link\" target=\"_blank\">Robert G. Heath<\/a><\/li>\n<li><span class=\"noprint\" style=\"font-size:85%; font-style: normal;\"> [<a href=\"https:\/\/fr.wikipedia.org\/wiki\/Stimulation_c%C3%A9r%C3%A9brale_profonde\" class=\"extiw\" title=\"fr:Stimulation c\u00e9r\u00e9brale profonde\" rel=\"external_link\" target=\"_blank\">fr<\/a>]<\/span><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 32em; -webkit-column-width: 32em; column-width: 32em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-Kringelbach-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Kringelbach_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kringelbach_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kringelbach ML, Jenkinson N, Owen SL, Aziz TZ (August 2007). \"Translational principles of deep brain stimulation\". <i>Nature Reviews. Neuroscience<\/i>. <b>8<\/b> (8): 623\u201335. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnrn2196\" target=\"_blank\">10.1038\/nrn2196<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17637800\" target=\"_blank\">17637800<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Reviews.+Neuroscience&rft.atitle=Translational+principles+of+deep+brain+stimulation&rft.volume=8&rft.issue=8&rft.pages=623-35&rft.date=2007-08&rft_id=info%3Adoi%2F10.1038%2Fnrn2196&rft_id=info%3Apmid%2F17637800&rft.aulast=Kringelbach&rft.aufirst=ML&rft.au=Jenkinson%2C+N&rft.au=Owen%2C+SL&rft.au=Aziz%2C+TZ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Hammond-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Hammond_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hammond C, Ammari R, Bioulac B, Garcia L (November 2008). \"Latest view on the mechanism of action of deep brain stimulation\". <i>Movement Disorders<\/i>. <b>23<\/b> (15): 2111\u201321. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fmds.22120\" target=\"_blank\">10.1002\/mds.22120<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18785230\" target=\"_blank\">18785230<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Movement+Disorders&rft.atitle=Latest+view+on+the+mechanism+of+action+of+deep+brain+stimulation&rft.volume=23&rft.issue=15&rft.pages=2111-21&rft.date=2008-11&rft_id=info%3Adoi%2F10.1002%2Fmds.22120&rft_id=info%3Apmid%2F18785230&rft.aulast=Hammond&rft.aufirst=C&rft.au=Ammari%2C+R&rft.au=Bioulac%2C+B&rft.au=Garcia%2C+L&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-garcia-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-garcia_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-garcia_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Garc\u00eda MR, Pearlmutter BA, Wellstead PE, Middleton RH (2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3774723\" target=\"_blank\">\"A slow axon antidromic blockade hypothesis for tremor reduction via deep brain stimulation\"<\/a>. <i>PLOS One<\/i>. <b>8<\/b> (9): e73456. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1371%2Fjournal.pone.0073456\" target=\"_blank\">10.1371\/journal.pone.0073456<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3774723\" target=\"_blank\">3774723<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24066049\" target=\"_blank\">24066049<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=PLOS+One&rft.atitle=A+slow+axon+antidromic+blockade+hypothesis+for+tremor+reduction+via+deep+brain+stimulation&rft.volume=8&rft.issue=9&rft.pages=e73456&rft.date=2013&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3774723&rft_id=info%3Apmid%2F24066049&rft_id=info%3Adoi%2F10.1371%2Fjournal.pone.0073456&rft.aulast=Garc%C3%ADa&rft.aufirst=MR&rft.au=Pearlmutter%2C+BA&rft.au=Wellstead%2C+PE&rft.au=Middleton%2C+RH&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3774723&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/NewsEvents\/Newsroom\/PressAnnouncements\/ucm451152.htm\" target=\"_blank\">\"Press Announcements - FDA approves brain implant to help reduce Parkinson's disease and essential tremor symptoms\"<\/a>. <i>FDA<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">May 23,<\/span> 2016<\/span>. <q>The first device, Medtronic\u2019s Activa Deep Brain Stimulation Therapy System, was approved in 1997 for tremor associated with essential tremor and Parkinson\u2019s disease.<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=FDA&rft.atitle=Press+Announcements+-+FDA+approves+brain+implant+to+help+reduce+Parkinson%E2%80%99s+disease+and+essential+tremor+symptoms&rft_id=http%3A%2F%2Fwww.fda.gov%2FNewsEvents%2FNewsroom%2FPressAnnouncements%2Fucm451152.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/knbc-tvhealth.ip2m.com\/index.cfm?pt=itemDetail&item_id=97349&site_cat_id=470\" target=\"_blank\">'Brain pacemaker' treats dystonia.<\/a> KNBC TV, April 22, 2003. Retrieved October 18, 2006.<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/NewsEvents\/Newsroom\/PressAnnouncements\/ucm149529.htm\" target=\"_blank\">\"FDA Approves Humanitarian Device Exemption for Deep Brain Stimulator for Severe Obsessive-Compulsive Disorder\"<\/a>. <i>FDA<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=FDA&rft.atitle=FDA+Approves+Humanitarian+Device+Exemption+for+Deep+Brain+Stimulator+for+Severe+Obsessive-Compulsive+Disorder&rft_id=http%3A%2F%2Fwww.fda.gov%2FNewsEvents%2FNewsroom%2FPressAnnouncements%2Fucm149529.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-gildenberg-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-gildenberg_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gildenberg PL (2005). \"Evolution of neuromodulation\". <i>Stereotactic and Functional Neurosurgery<\/i>. <b>83<\/b> (2\u20133): 71\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000086865\" target=\"_blank\">10.1159\/000086865<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16006778\" target=\"_blank\">16006778<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Stereotactic+and+Functional+Neurosurgery&rft.atitle=Evolution+of+neuromodulation&rft.volume=83&rft.issue=2%E2%80%933&rft.pages=71-9&rft.date=2005&rft_id=info%3Adoi%2F10.1159%2F000086865&rft_id=info%3Apmid%2F16006778&rft.aulast=Gildenberg&rft.aufirst=PL&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-NINDS-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-NINDS_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-NINDS_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Institute_of_Neurological_Disorders_and_Stroke\" title=\"National Institute of Neurological Disorders and Stroke\" rel=\"external_link\" target=\"_blank\">National Institute of Neurological Disorders and Stroke<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ninds.nih.gov\/disorders\/deep_brain_stimulation\/deep_brain_stimulation.htm\" target=\"_blank\">Deep brain stimulation for Parkinson's disease information page<\/a> Retrieved November 23, 2006.<\/span>\n<\/li>\n<li id=\"cite_note-USDHHS-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-USDHHS_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">U.S. Department of Health and Human Services. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/DeviceApprovalsandClearances\/Recently-ApprovedDevices\/ucm083894.htm\" target=\"_blank\">FDA approves implanted brain stimulator to control tremors.<\/a> Retrieved February 10, 2015.<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Doshi PK (April 2011). \"Long-term surgical and hardware-related complications of deep brain stimulation\". <i>Stereotactic and Functional Neurosurgery<\/i>. <b>89<\/b> (2): 89\u201395. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000323372\" target=\"_blank\">10.1159\/000323372<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21293168\" target=\"_blank\">21293168<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Stereotactic+and+Functional+Neurosurgery&rft.atitle=Long-term+surgical+and+hardware-related+complications+of+deep+brain+stimulation&rft.volume=89&rft.issue=2&rft.pages=89-95&rft.date=2011-04&rft_id=info%3Adoi%2F10.1159%2F000323372&rft_id=info%3Apmid%2F21293168&rft.aulast=Doshi&rft.aufirst=PK&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Burn DJ, Tr\u00f6ster AI (September 2004). \"Neuropsychiatric complications of medical and surgical therapies for Parkinson's disease\". <i>Journal of Geriatric Psychiatry and Neurology<\/i>. <b>17<\/b> (3): 172\u201380. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F0891988704267466\" target=\"_blank\">10.1177\/0891988704267466<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15312281\" target=\"_blank\">15312281<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Geriatric+Psychiatry+and+Neurology&rft.atitle=Neuropsychiatric+complications+of+medical+and+surgical+therapies+for+Parkinson%27s+disease&rft.volume=17&rft.issue=3&rft.pages=172-80&rft.date=2004-09&rft_id=info%3Adoi%2F10.1177%2F0891988704267466&rft_id=info%3Apmid%2F15312281&rft.aulast=Burn&rft.aufirst=DJ&rft.au=Tr%C3%B6ster%2C+AI&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Mogilner A.Y.; Benabid A.L.; Rezai A.R. (2004). \"Chronic Therapeutic Brain Stimulation: History, Current Clinical Indications, and Future Prospects\". In Markov, Marko; Paul J. Rosch. <i>Bioelectromagnetic medicine<\/i>. New York, N.Y: Marcel Dekker. pp. 133\u201351. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-8247-4700-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chronic+Therapeutic+Brain+Stimulation%3A+History%2C+Current+Clinical+Indications%2C+and+Future+Prospects&rft.btitle=Bioelectromagnetic+medicine&rft.place=New+York%2C+N.Y&rft.pages=133-51&rft.pub=Marcel+Dekker&rft.date=2004&rft.isbn=0-8247-4700-3&rft.au=Mogilner+A.Y.&rft.au=Benabid+A.L.&rft.au=Rezai+A.R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Critical+Reviews+in+Biomedical+Engineering&rft.atitle=Uncovering+the+mechanisms+of+deep+brain+stimulation+for+Parkinson%27s+disease+through+functional+imaging%2C+neural+recording%2C+and+neural+modeling&rft.volume=30&rft.issue=4%E2%80%936&rft.pages=249-81&rft.date=2002&rft_id=info%3Adoi%2F10.1615%2Fcritrevbiomedeng.v30.i456.20&rft_id=info%3Apmid%2F12739751&rft.aulast=McIntyre&rft.aufirst=CC&rft.au=Thakor%2C+NV&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Herrington TM, Cheng JJ, Eskandar EN (January 2016). <a rel=\"external_link\" class=\"external 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target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26510756\" target=\"_blank\">26510756<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Neurophysiology&rft.atitle=Mechanisms+of+deep+brain+stimulation&rft.volume=115&rft.issue=1&rft.pages=19-38&rft.date=2016-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4760496&rft_id=info%3Apmid%2F26510756&rft_id=info%3Adoi%2F10.1152%2Fjn.00281.2015&rft.aulast=Herrington&rft.aufirst=TM&rft.au=Cheng%2C+JJ&rft.au=Eskandar%2C+EN&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4760496&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Machado A, Rezai AR, Kopell BH, Gross RE, Sharan AD, Benabid AL (June 2006). \"Deep brain stimulation for Parkinson's disease: surgical technique and perioperative management\". <i>Movement Disorders<\/i>. 21 Suppl 14 (Suppl 14): S247\u201358. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fmds.20959\" target=\"_blank\">10.1002\/mds.20959<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16810722\" target=\"_blank\">16810722<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Movement+Disorders&rft.atitle=Deep+brain+stimulation+for+Parkinson%27s+disease%3A+surgical+technique+and+perioperative+management&rft.volume=21+Suppl+14&rft.issue=Suppl+14&rft.pages=S247-58&rft.date=2006-06&rft_id=info%3Adoi%2F10.1002%2Fmds.20959&rft_id=info%3Apmid%2F16810722&rft.aulast=Machado&rft.aufirst=A&rft.au=Rezai%2C+AR&rft.au=Kopell%2C+BH&rft.au=Gross%2C+RE&rft.au=Sharan%2C+AD&rft.au=Benabid%2C+AL&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Moro E, Lang AE (November 2006). \"Criteria for deep-brain stimulation in Parkinson's disease: review and analysis\". <i>Expert Review of Neurotherapeutics<\/i>. <b>6<\/b> (11): 1695\u2013705. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1586%2F14737175.6.11.1695\" target=\"_blank\">10.1586\/14737175.6.11.1695<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17144783\" target=\"_blank\">17144783<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Expert+Review+of+Neurotherapeutics&rft.atitle=Criteria+for+deep-brain+stimulation+in+Parkinson%27s+disease%3A+review+and+analysis&rft.volume=6&rft.issue=11&rft.pages=1695-705&rft.date=2006-11&rft_id=info%3Adoi%2F10.1586%2F14737175.6.11.1695&rft_id=info%3Apmid%2F17144783&rft.aulast=Moro&rft.aufirst=E&rft.au=Lang%2C+AE&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Apetauerova D, Ryan RK, Ro SI, Arle J, Shils J, Papavassiliou E, Tarsy D (August 2006). \"End of day dyskinesia in advanced Parkinson's disease can be eliminated by bilateral subthalamic 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href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Robison RA, Taghva A, Liu CY, Apuzzo ML (2012). \"Surgery of the mind, mood, and conscious state: an idea in evolution\". <i>World Neurosurgery<\/i>. <b>77<\/b> (5\u20136): 662\u201386. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.wneu.2012.03.005\" target=\"_blank\">10.1016\/j.wneu.2012.03.005<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22446082\" target=\"_blank\">22446082<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=World+Neurosurgery&rft.atitle=Surgery+of+the+mind%2C+mood%2C+and+conscious+state%3A+an+idea+in+evolution&rft.volume=77&rft.issue=5%E2%80%936&rft.pages=662-86&rft.date=2012&rft_id=info%3Adoi%2F10.1016%2Fj.wneu.2012.03.005&rft_id=info%3Apmid%2F22446082&rft.aulast=Robison&rft.aufirst=RA&rft.au=Taghva%2C+A&rft.au=Liu%2C+CY&rft.au=Apuzzo%2C+ML&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Lakhan-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Lakhan_34-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lakhan SE, Callaway E (March 2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2838907\" target=\"_blank\">\"Deep brain stimulation for obsessive-compulsive disorder and treatment-resistant depression: systematic review\"<\/a>. <i>BMC Research Notes<\/i>. <b>3<\/b> (1): 60. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2F1756-0500-3-60\" target=\"_blank\">10.1186\/1756-0500-3-60<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2838907\" target=\"_blank\">2838907<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20202203\" target=\"_blank\">20202203<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMC+Research+Notes&rft.atitle=Deep+brain+stimulation+for+obsessive-compulsive+disorder+and+treatment-resistant+depression%3A+systematic+review&rft.volume=3&rft.issue=1&rft.pages=60&rft.date=2010-03&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2838907&rft_id=info%3Apmid%2F20202203&rft_id=info%3Adoi%2F10.1186%2F1756-0500-3-60&rft.aulast=Lakhan&rft.aufirst=SE&rft.au=Callaway%2C+E&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2838907&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Dougherty DD, Rezai AR, Carpenter LL, Howland RH, Bhati MT, O'Reardon JP, Eskandar EN, Baltuch GH, Machado AD, Kondziolka D, Cusin C, Evans KC, Price LH, Jacobs K, Pandya M, Denko T, Tyrka AR, Brelje T, Deckersbach T, Kubu C, Malone DA (August 2015). \"A Randomized Sham-Controlled Trial of Deep Brain Stimulation of the Ventral Capsule\/Ventral Striatum for Chronic Treatment-Resistant Depression\". <i>Biological Psychiatry<\/i>. <b>78<\/b> (4): 240\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.biopsych.2014.11.023\" target=\"_blank\">10.1016\/j.biopsych.2014.11.023<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25726497\" target=\"_blank\">25726497<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biological+Psychiatry&rft.atitle=A+Randomized+Sham-Controlled+Trial+of+Deep+Brain+Stimulation+of+the+Ventral+Capsule%2FVentral+Striatum+for+Chronic+Treatment-Resistant+Depression&rft.volume=78&rft.issue=4&rft.pages=240-8&rft.date=2015-08&rft_id=info%3Adoi%2F10.1016%2Fj.biopsych.2014.11.023&rft_id=info%3Apmid%2F25726497&rft.aulast=Dougherty&rft.aufirst=DD&rft.au=Rezai%2C+AR&rft.au=Carpenter%2C+LL&rft.au=Howland%2C+RH&rft.au=Bhati%2C+MT&rft.au=O%27Reardon%2C+JP&rft.au=Eskandar%2C+EN&rft.au=Baltuch%2C+GH&rft.au=Machado%2C+AD&rft.au=Kondziolka%2C+D&rft.au=Cusin%2C+C&rft.au=Evans%2C+KC&rft.au=Price%2C+LH&rft.au=Jacobs%2C+K&rft.au=Pandya%2C+M&rft.au=Denko%2C+T&rft.au=Tyrka%2C+AR&rft.au=Brelje%2C+T&rft.au=Deckersbach%2C+T&rft.au=Kubu%2C+C&rft.au=Malone%2C+DA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bergfeld IO, Mantione M, Hoogendoorn ML, Ruh\u00e9 HG, Notten P, van Laarhoven J, et al. (May 2016). \"Deep Brain Stimulation of the Ventral Anterior Limb of the Internal Capsule for Treatment-Resistant Depression: A Randomized Clinical Trial\". <i>JAMA Psychiatry<\/i>. <b>73<\/b> (5): 456\u201364. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Fjamapsychiatry.2016.0152\" target=\"_blank\">10.1001\/jamapsychiatry.2016.0152<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27049915\" target=\"_blank\">27049915<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JAMA+Psychiatry&rft.atitle=Deep+Brain+Stimulation+of+the+Ventral+Anterior+Limb+of+the+Internal+Capsule+for+Treatment-Resistant+Depression%3A+A+Randomized+Clinical+Trial&rft.volume=73&rft.issue=5&rft.pages=456-64&rft.date=2016-05&rft_id=info%3Adoi%2F10.1001%2Fjamapsychiatry.2016.0152&rft_id=info%3Apmid%2F27049915&rft.aulast=Bergfeld&rft.aufirst=IO&rft.au=Mantione%2C+M&rft.au=Hoogendoorn%2C+ML&rft.au=Ruh%C3%A9%2C+HG&rft.au=Notten%2C+P&rft.au=van+Laarhoven%2C+J&rft.au=Visser%2C+I&rft.au=Figee%2C+M&rft.au=de+Kwaasteniet%2C+BP&rft.au=Horst%2C+F&rft.au=Schene%2C+AH&rft.au=van+den+Munckhof%2C+P&rft.au=Beute%2C+G&rft.au=Schuurman%2C+R&rft.au=Denys%2C+D&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Alonso P, Cuadras D, Gabri\u00ebls L, Denys D, Goodman W, Greenberg BD, et al. (2015-07-24). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4514753\" target=\"_blank\">\"Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response\"<\/a>. <i>PLOS One<\/i>. <b>10<\/b> (7): e0133591. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1371%2Fjournal.pone.0133591\" target=\"_blank\">10.1371\/journal.pone.0133591<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4514753\" target=\"_blank\">4514753<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26208305\" target=\"_blank\">26208305<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=PLOS+One&rft.atitle=Deep+Brain+Stimulation+for+Obsessive-Compulsive+Disorder%3A+A+Meta-Analysis+of+Treatment+Outcome+and+Predictors+of+Response&rft.volume=10&rft.issue=7&rft.pages=e0133591&rft.date=2015-07-24&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4514753&rft_id=info%3Apmid%2F26208305&rft_id=info%3Adoi%2F10.1371%2Fjournal.pone.0133591&rft.aulast=Alonso&rft.aufirst=P&rft.au=Cuadras%2C+D&rft.au=Gabri%C3%ABls%2C+L&rft.au=Denys%2C+D&rft.au=Goodman%2C+W&rft.au=Greenberg%2C+BD&rft.au=Jimenez-Ponce%2C+F&rft.au=Kuhn%2C+J&rft.au=Lenartz%2C+D&rft.au=Mallet%2C+L&rft.au=Nuttin%2C+B&rft.au=Real%2C+E&rft.au=Segalas%2C+C&rft.au=Schuurman%2C+R&rft.au=du+Montcel%2C+ST&rft.au=Menchon%2C+JM&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4514753&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Moreines-38\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Moreines_38-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Moreines JL, McClintock SM, Holtzheimer PE (January 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3023999\" target=\"_blank\">\"Neuropsychologic effects of neuromodulation techniques for treatment-resistant depression: a review\"<\/a>. <i>Brain Stimulation<\/i>. <b>4<\/b> (1): 17\u201327. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.brs.2010.01.005\" target=\"_blank\">10.1016\/j.brs.2010.01.005<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3023999\" target=\"_blank\">3023999<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21255751\" target=\"_blank\">21255751<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Brain+Stimulation&rft.atitle=Neuropsychologic+effects+of+neuromodulation+techniques+for+treatment-resistant+depression%3A+a+review&rft.volume=4&rft.issue=1&rft.pages=17-27&rft.date=2011-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3023999&rft_id=info%3Apmid%2F21255751&rft_id=info%3Adoi%2F10.1016%2Fj.brs.2010.01.005&rft.aulast=Moreines&rft.aufirst=JL&rft.au=McClintock%2C+SM&rft.au=Holtzheimer%2C+PE&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3023999&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Singer2011-39\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Singer2011_39-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Singer2011_39-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Singer HS (March 2005). \"Tourette syndrome and other tic disorders\". <i>Handbook of Clinical Neurology<\/i>. <b>100<\/b>: 641\u201357. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FB978-0-444-52014-2.00046-X\" target=\"_blank\">10.1016\/B978-0-444-52014-2.00046-X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21496613\" target=\"_blank\">21496613<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Handbook+of+Clinical+Neurology&rft.atitle=Tourette+syndrome+and+other+tic+disorders&rft.volume=100&rft.pages=641-57&rft.date=2005-03&rft_id=info%3Adoi%2F10.1016%2FB978-0-444-52014-2.00046-X&rft_id=info%3Apmid%2F21496613&rft.aulast=Singer&rft.aufirst=HS&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> Also see <cite class=\"citation journal\">Singer HS (March 2005). \"Tourette's syndrome: from behaviour to biology\". <i>The Lancet. Neurology<\/i>. <b>4<\/b> (3): 149\u201359. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS1474-4422%2805%2901012-4\" target=\"_blank\">10.1016\/S1474-4422(05)01012-4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15721825\" target=\"_blank\">15721825<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Lancet.+Neurology&rft.atitle=Tourette%27s+syndrome%3A+from+behaviour+to+biology&rft.volume=4&rft.issue=3&rft.pages=149-59&rft.date=2005-03&rft_id=info%3Adoi%2F10.1016%2FS1474-4422%2805%2901012-4&rft_id=info%3Apmid%2F15721825&rft.aulast=Singer&rft.aufirst=HS&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Robertson2011-40\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Robertson2011_40-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Robertson2011_40-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Robertson MM (February 2011). \"Gilles de la Tourette syndrome: the complexities of phenotype and treatment\". <i>British Journal of Hospital Medicine<\/i>. <b>72<\/b> (2): 100\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.12968%2Fhmed.2011.72.2.100\" target=\"_blank\">10.12968\/hmed.2011.72.2.100<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21378617\" target=\"_blank\">21378617<\/a>.<\/cite><span 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rel=\"external_link\" target=\"_blank\">Tourette Syndrome Association<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20051122154536\/http:\/\/tsa-usa.org\/news\/DBS-Statement.htm\" target=\"_blank\">Statement: Deep Brain Stimulation and Tourette Syndrome.<\/a> Retrieved November 22, 2005.<\/span>\n<\/li>\n<li id=\"cite_note-Malone-43\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Malone_43-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Malone_43-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Malone_43-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Malone DA, Pandya MM (2006). \"Behavioral neurosurgery\". <i>Advances in Neurology<\/i>. <b>99<\/b>: 241\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" 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target=\"_blank\">26684776<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Neurosurgery&rft.atitle=Simultaneous+bilateral+stereotactic+procedure+for+deep+brain+stimulation+implants%3A+a+significant+step+for+reducing+operation+time&rft.volume=125&rft.issue=1&rft.pages=85-9&rft.date=2016-07&rft_id=info%3Adoi%2F10.3171%2F2015.7.JNS151026&rft_id=info%3Apmid%2F26684776&rft.aulast=Fonoff&rft.aufirst=ET&rft.au=Azevedo%2C+A&rft.au=Angelos%2C+JS&rft.au=Martinez%2C+RC&rft.au=Navarro%2C+J&rft.au=Reis%2C+PR&rft.au=Sepulveda%2C+ME&rft.au=Cury%2C+RG&rft.au=Ghilardi%2C+MG&rft.au=Teixeira%2C+MJ&rft.au=Lopez%2C+WO&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-51\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-51\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lu H, Ash RT, He L, Kee SE, Wang W, Yu D, Hao S, Meng X, Ure K, Ito-Ishida A, Tang B, Sun Y, Ji D, Tang J, Arenkiel BR, Smirnakis SM, Zoghbi HY (August 2016). \"Loss and Gain of MeCP2 Cause Similar Hippocampal Circuit Dysfunction that Is Rescued by Deep Brain Stimulation in a Rett Syndrome Mouse Model\". <i>Neuron<\/i>. <b>91<\/b> (4): 739\u2013747. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.neuron.2016.07.018\" target=\"_blank\">10.1016\/j.neuron.2016.07.018<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27499081\" target=\"_blank\">27499081<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuron&rft.atitle=Loss+and+Gain+of+MeCP2+Cause+Similar+Hippocampal+Circuit+Dysfunction+that+Is+Rescued+by+Deep+Brain+Stimulation+in+a+Rett+Syndrome+Mouse+Model&rft.volume=91&rft.issue=4&rft.pages=739-747&rft.date=2016-08&rft_id=info%3Adoi%2F10.1016%2Fj.neuron.2016.07.018&rft_id=info%3Apmid%2F27499081&rft.aulast=Lu&rft.aufirst=H&rft.au=Ash%2C+RT&rft.au=He%2C+L&rft.au=Kee%2C+SE&rft.au=Wang%2C+W&rft.au=Yu%2C+D&rft.au=Hao%2C+S&rft.au=Meng%2C+X&rft.au=Ure%2C+K&rft.au=Ito-Ishida%2C+A&rft.au=Tang%2C+B&rft.au=Sun%2C+Y&rft.au=Ji%2C+D&rft.au=Tang%2C+J&rft.au=Arenkiel%2C+BR&rft.au=Smirnakis%2C+SM&rft.au=Zoghbi%2C+HY&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-52\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-52\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pohodich AE, Yalamanchili H, Raman AT, Wan YW, Gundry M, Hao S, Jin H, Tang J, Liu Z, Zoghbi HY (March 2018). \"Forniceal deep brain stimulation induces gene expression and splicing changes that promote neurogenesis and plasticity\". <i>eLife<\/i>. <b>7<\/b>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.7554%2Felife.34031\" target=\"_blank\">10.7554\/elife.34031<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29570050\" target=\"_blank\">29570050<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=eLife&rft.atitle=Forniceal+deep+brain+stimulation+induces+gene+expression+and+splicing+changes+that+promote+neurogenesis+and+plasticity&rft.volume=7&rft.date=2018-03&rft_id=info%3Adoi%2F10.7554%2Felife.34031&rft_id=info%3Apmid%2F29570050&rft.aulast=Pohodich&rft.aufirst=AE&rft.au=Yalamanchili%2C+H&rft.au=Raman%2C+AT&rft.au=Wan%2C+YW&rft.au=Gundry%2C+M&rft.au=Hao%2C+S&rft.au=Jin%2C+H&rft.au=Tang%2C+J&rft.au=Liu%2C+Z&rft.au=Zoghbi%2C+HY&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<div class=\"refbegin\" style=\"\">\n<ul><li><cite class=\"citation journal\">Appleby BS, Duggan PS, Regenberg A, Rabins PV (September 2007). \"Psychiatric and neuropsychiatric adverse events associated with deep brain stimulation: A meta-analysis of ten years' experience\". <i>Movement Disorders<\/i>. <b>22<\/b> (12): 1722\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fmds.21551\" target=\"_blank\">10.1002\/mds.21551<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17721929\" target=\"_blank\">17721929<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Movement+Disorders&rft.atitle=Psychiatric+and+neuropsychiatric+adverse+events+associated+with+deep+brain+stimulation%3A+A+meta-analysis+of+ten+years%27+experience&rft.volume=22&rft.issue=12&rft.pages=1722-8&rft.date=2007-09&rft_id=info%3Adoi%2F10.1002%2Fmds.21551&rft_id=info%3Apmid%2F17721929&rft.aulast=Appleby&rft.aufirst=BS&rft.au=Duggan%2C+PS&rft.au=Regenberg%2C+A&rft.au=Rabins%2C+PV&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Schlaepfer TE, Bewernick BH, Kayser S, Hurlemann R, Coenen VA (May 2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3988559\" target=\"_blank\">\"Deep brain stimulation of the human reward system for major depression--rationale, outcomes and outlook\"<\/a>. <i>Neuropsychopharmacology<\/i>. <b>39<\/b> (6): 1303\u201314. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnpp.2014.28\" target=\"_blank\">10.1038\/npp.2014.28<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3988559\" target=\"_blank\">3988559<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24513970\" target=\"_blank\">24513970<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuropsychopharmacology&rft.atitle=Deep+brain+stimulation+of+the+human+reward+system+for+major+depression--rationale%2C+outcomes+and+outlook&rft.volume=39&rft.issue=6&rft.pages=1303-14&rft.date=2014-05&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3988559&rft_id=info%3Apmid%2F24513970&rft_id=info%3Adoi%2F10.1038%2Fnpp.2014.28&rft.aulast=Schlaepfer&rft.aufirst=TE&rft.au=Bewernick%2C+BH&rft.au=Kayser%2C+S&rft.au=Hurlemann%2C+R&rft.au=Coenen%2C+VA&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3988559&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Diamond A, Shahed J, Azher S, Dat-Vuong K, Jankovic J (May 2006). \"Globus pallidus deep brain stimulation in dystonia\". <i>Movement Disorders<\/i>. <b>21<\/b> (5): 692\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fmds.20767\" target=\"_blank\">10.1002\/mds.20767<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16342255\" target=\"_blank\">16342255<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Movement+Disorders&rft.atitle=Globus+pallidus+deep+brain+stimulation+in+dystonia&rft.volume=21&rft.issue=5&rft.pages=692-5&rft.date=2006-05&rft_id=info%3Adoi%2F10.1002%2Fmds.20767&rft_id=info%3Apmid%2F16342255&rft.aulast=Diamond&rft.aufirst=A&rft.au=Shahed%2C+J&rft.au=Azher%2C+S&rft.au=Dat-Vuong%2C+K&rft.au=Jankovic%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Richter EO, Lozano AM (2004). \"Deep Brain Stimulation for Parkinson's Disease in Movement Disorders\". In Markov M, Rosch PJ. <i>Bioelectromagnetic medicine<\/i>. New York, N.Y: Marcel Dekker. pp. 265\u201376. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-8247-4700-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Deep+Brain+Stimulation+for+Parkinson%27s+Disease+in+Movement+Disorders&rft.btitle=Bioelectromagnetic+medicine&rft.place=New+York%2C+N.Y&rft.pages=265-76&rft.pub=Marcel+Dekker&rft.date=2004&rft.isbn=0-8247-4700-3&rft.aulast=Richter&rft.aufirst=EO&rft.au=Lozano%2C+AM&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADeep+brain+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><b>Video:<\/b> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=KDjWdtDyz5I\" target=\"_blank\">Deep brain stimulation to treat Parkinson's disease<\/a><\/li>\n<li><b>Video:<\/b> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=9phXvB077Dw\" target=\"_blank\">Deep brain stimulation therapy for Parkinson's disease<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.madinamerica.com\/2015\/09\/adverse-effects-perils-deep-brain-stimulation-depression\/\" target=\"_blank\">The Perils of Deep Brain Stimulation for Depression. Author Danielle Egan. September 24, 2015.<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.mountsinai.org\/locations\/center-neuromodulation\/what-is\/dbs\/info\" target=\"_blank\">Treatment center for Deep Brain Stimulation of movement disorders, OCD, Tourette or depression.<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1275\nCached time: 20181217092935\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.872 seconds\nReal time usage: 1.032 seconds\nPreprocessor visited node count: 4024\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 133228\/2097152 bytes\nTemplate argument size: 4932\/2097152 bytes\nHighest expansion depth: 15\/40\nExpensive parser function count: 7\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 150612\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.521\/10.000 seconds\nLua memory usage: 6.47 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 924.555 1 -total\n<\/p>\n<pre>57.89% 535.246 1 Template:Reflist\n44.49% 411.313 43 Template:Cite_journal\n10.46% 96.753 5 Template:Citation_needed\n 9.22% 85.226 5 Template:Fix\n 8.04% 74.303 1 Template:Infobox_medical_intervention\n 7.55% 69.814 1 Template:Infobox\n 7.10% 65.629 1 Template:Commons_category\n 5.28% 48.773 10 Template:Category_handler\n 3.89% 35.921 1 Template:Vcite_journal\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:370268-1!canonical and timestamp 20181217092934 and revision id 872290703\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Deep_brain_stimulation\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212239\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.020 seconds\nReal time usage: 0.166 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 156.919 1 - wikipedia:Deep_brain_stimulation\n100.00% 156.919 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8302-0!*!*!*!*!*!* and timestamp 20181217212239 and revision id 24522\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Deep_brain_stimulation\">https:\/\/www.limswiki.org\/index.php\/Deep_brain_stimulation<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","30fc8ee25ea342bda9af77a35b2a6f1f_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/73\/Tiefe_Hirnstimulation_-_Sonden_RoeSchaedel_ap.jpg\/560px-Tiefe_Hirnstimulation_-_Sonden_RoeSchaedel_ap.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/0\/05\/Deep_Brain_Stimulation_%28DBS%29_of_Nucleus_Basalis_of_Meynert.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/91\/Parkinson_surgery.jpg\/500px-Parkinson_surgery.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png"],"30fc8ee25ea342bda9af77a35b2a6f1f_timestamp":1545081759,"495e37383e893b9dd49f3dee45eb7791_type":"article","495e37383e893b9dd49f3dee45eb7791_title":"Cotrel\u2013Dubousset instrumentation","495e37383e893b9dd49f3dee45eb7791_url":"https:\/\/www.limswiki.org\/index.php\/Cotrel%E2%80%93Dubousset_instrumentation","495e37383e893b9dd49f3dee45eb7791_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCotrel\u2013Dubousset instrumentation\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tCotrel\u2013Dubousset instrumentationSpecialtyorthopedic[edit on Wikidata]\nIntroduced in 1983, Cotrel\u2013Dubousset Instrumentation is a treatment approach to scoliosis. Unlike Harrington rods, this treatment is more than just an osteodistraction mechanism and allows correction of some of the features of scolioisis untreatable by Harrington rods, such as rib hump.[1][2]\n\nReferences \n\n\n^ P.J. Cundy (1990). \"Cotrel\u2013Dubousset instrumentation and vertebral rotation in adolescent idiopathic scoliosis\" (PDF) . J Bone Joint Surg [Br]. 72-B (4): 670\u20134. \n\n^ Norbert Boos; Lori A. Dolan; Stuart L. Weinstein (2007). \"Long-Term Clinical and Radiographic Results of Cotreldubousset Instrumentation of Right Thoracic Adolescent Idiopathic Scoliosis\". Iowa Orthopaedic Journal. 27: 40\u201346. PMC 2150653 . PMID 17907428. \n\n\n\r\n\n\nThis medical treatment\u2013related article is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Cotrel%E2%80%93Dubousset_instrumentation\">https:\/\/www.limswiki.org\/index.php\/Cotrel%E2%80%93Dubousset_instrumentation<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesMedical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 22:36.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 389 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","495e37383e893b9dd49f3dee45eb7791_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Cotrel\u2013Dubousset_instrumentation skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Cotrel\u2013Dubousset instrumentation<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>Introduced in 1983, <b>Cotrel\u2013Dubousset Instrumentation<\/b> is a treatment approach to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scoliosis\" title=\"Scoliosis\" rel=\"external_link\" target=\"_blank\">scoliosis<\/a>. Unlike <a href=\"https:\/\/en.wikipedia.org\/wiki\/Harrington_implant\" class=\"mw-redirect\" title=\"Harrington implant\" rel=\"external_link\" target=\"_blank\">Harrington rods<\/a>, this treatment is more than just an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteodistraction\" class=\"mw-redirect\" title=\"Osteodistraction\" rel=\"external_link\" target=\"_blank\">osteodistraction<\/a> mechanism and allows correction of some of the features of scolioisis untreatable by Harrington rods, such as rib hump.<sup id=\"rdp-ebb-cite_ref-Cundy_1-0\" class=\"reference\"><a href=\"#cite_note-Cundy-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Boos_2-0\" class=\"reference\"><a href=\"#cite_note-Boos-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-Cundy-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Cundy_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">P.J. Cundy (1990). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jbjs.org.uk\/cgi\/reprint\/72-B\/4\/670.pdf\" target=\"_blank\">\"Cotrel\u2013Dubousset instrumentation and vertebral rotation in adolescent idiopathic scoliosis\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>J Bone Joint Surg [Br]<\/i>. <b>72-B<\/b> (4): 670\u20134.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+%5BBr%5D&rft.atitle=Cotrel%E2%80%93Dubousset+instrumentation+and+vertebral+rotation+in+adolescent+idiopathic+scoliosis&rft.volume=72-B&rft.issue=4&rft.pages=670-4&rft.date=1990&rft.au=P.J.+Cundy&rft_id=http%3A%2F%2Fwww.jbjs.org.uk%2Fcgi%2Freprint%2F72-B%2F4%2F670.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACotrel%E2%80%93Dubousset+instrumentation\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Boos-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Boos_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Norbert Boos; Lori A. Dolan; Stuart L. Weinstein (2007). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2150653\" target=\"_blank\">\"Long-Term Clinical and Radiographic Results of Cotreldubousset Instrumentation of Right Thoracic Adolescent Idiopathic Scoliosis\"<\/a>. <i>Iowa Orthopaedic Journal<\/i>. <b>27<\/b>: 40\u201346. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2150653\" target=\"_blank\">2150653<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17907428\" target=\"_blank\">17907428<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Iowa+Orthopaedic+Journal&rft.atitle=Long-Term+Clinical+and+Radiographic+Results+of+Cotreldubousset+Instrumentation+of+Right+Thoracic+Adolescent+Idiopathic+Scoliosis&rft.volume=27&rft.pages=40-46&rft.date=2007&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2150653&rft_id=info%3Apmid%2F17907428&rft.au=Norbert+Boos&rft.au=Lori+A.+Dolan&rft.au=Stuart+L.+Weinstein&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2150653&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACotrel%E2%80%93Dubousset+instrumentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><br \/>\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1272\nCached time: 20181201180925\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.172 seconds\nReal time usage: 0.239 seconds\nPreprocessor visited node count: 356\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 8784\/2097152 bytes\nTemplate argument size: 118\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 6031\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.116\/10.000 seconds\nLua memory usage: 2.55 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 219.166 1 -total\n<\/p>\n<pre>57.49% 125.989 1 Template:Reflist\n51.69% 113.286 2 Template:Cite_journal\n32.42% 71.057 1 Template:Infobox_medical_intervention\n30.29% 66.395 1 Template:Infobox\n 9.23% 20.227 1 Template:Treatment-stub\n 8.22% 18.010 1 Template:Asbox\n 3.41% 7.481 1 Template:PAGENAMEBASE\n 1.32% 2.899 1 Template:Main_other\n 1.12% 2.459 1 Template:Template_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:20874241-1!canonical and timestamp 20181201180925 and revision id 860260260\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cotrel%E2%80%93Dubousset_instrumentation\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212238\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.017 seconds\nReal time usage: 0.148 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 142.884 1 - wikipedia:Cotrel\u2013Dubousset_instrumentation\n100.00% 142.884 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8005-0!*!*!*!*!*!* and timestamp 20181217212238 and revision id 24116\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Cotrel%E2%80%93Dubousset_instrumentation\">https:\/\/www.limswiki.org\/index.php\/Cotrel%E2%80%93Dubousset_instrumentation<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","495e37383e893b9dd49f3dee45eb7791_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5c\/AdhesiveBandage.png\/80px-AdhesiveBandage.png"],"495e37383e893b9dd49f3dee45eb7791_timestamp":1545081758,"91a4b9dfbfbb2211c807eb202cfe561d_type":"article","91a4b9dfbfbb2211c807eb202cfe561d_title":"Chin augmentation","91a4b9dfbfbb2211c807eb202cfe561d_url":"https:\/\/www.limswiki.org\/index.php\/Chin_augmentation","91a4b9dfbfbb2211c807eb202cfe561d_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tChin augmentation\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tChin augmentationSpecialtyplastic surgery ICD-9-CM76.68MedlinePlus002986 [edit on Wikidata]\nChin augmentation using surgical implants can alter the underlying structure of the face, providing better balance to the facial features. The specific medical terms mentoplasty and genioplasty are used to refer to the reduction and addition of material to a patient's chin. This can take the form of chin height reduction or chin rounding by osteotomy, or chin augmentation using implants.\nThis operation is often, but not always, performed at the time of rhinoplasty to help balance the facial proportions. Chin augmentation may be achieved by manipulation of the jaw bone (mandible) and augmentation utilizing this technique usually provides a more dramatic correction than with the use of prosthetic implants.\nChin implants are used to build a better profile.[1]\nPatients' own bone is donated from ribs and from part of the pelvis (the ilium). Use of donated bone implants in chin augmentation, even the patient\u2019s own, appears to be associated with a higher rate of infection, even after the implant has been in place for decades.\n\n<\/p>Chin augmentation is still popular because it is a relatively easy operation for the patient while producing noticeable changes in the silhouette of the face. This type of surgery is usually performed by an oral and maxillofacial surgeon, otolaryngologist, or plastic surgeon.\n\nContents \n\n1 T-osteotomy method \n2 Potential risks and side effects \n3 Types of implants \n4 Types of procedures \n5 See also \n6 References \n7 External links \n\n\nT-osteotomy method \nT-osteotomy method (or mini V-line)[2] is used to narrow and lengthen the chin using an osteotomy technique formulated by Korean surgeons. The surgery is performed under general anesthesia (orotracheal intubation) using an intraoral approach.[3] Using a double-bladed reciprocating saw,[4] a horizontal osteotomy is performed, leaving a small portion of bone in the middle. Then two vertical osteotomies are performed in an upside-down trapezoidal shape which is excised. The bones remaining from the horizontal osteotomy are then attached and adjusted to lengthen the chin, and advanced forward for an additional frontal chin projection if required.[3] Pre-bent titanium plates and screws are used to fixate the bone to its new position.[4] The chin can be lengthened 2 to 3 mm on average.[5] \nThe mentalis muscles controls the elevation functions of the lower lip and chin, so extra caution should be taken to carefully attach the mentalis muscle back after the surgery.[6][7]\n\nPotential risks and side effects \nThe usual complications are relatively minor and include swelling, hematoma (blood pooling), weakness or numbness of the lower lip, which usually does not last long. Other, less common risks include infection, bony changes and displacement of the implant.[8] Seeking an experienced surgeon can help reduce your risks of complications.[9]\nChewing should be kept at a minimum immediately after this procedure, and patients are recommended to eat only soft food and drink for a time after the surgery.\n\nTypes of implants \nSilicone - Silicone chin Implants are one of the most commonly used implants for chin augmentation. They are soft, smooth, flexible and come in different shapes and sizes. They do not incorporate (stick) to the surrounding tissues, so the pocket must be made precisely. They usually stay in place, but may move, buckle and cause bone resorption where they contact the mandible in some cases. Since they are smooth, they can also be removed easily.\nPolyethylene - Polyethylene chin implants, brand name Medpor, are hard, porous, slightly flexible and come in various shapes and sizes. The do incorporate, as the surrounding tissues can grow into the pores of the material. This fixes the polyethylene chin implants in place, and provides a blood supply to help prevent infection. It also makes these implants much more difficult to remove.\nPolytetrafluoroethylene - Polytetrafluoroethylene, brand name Gore-Tex, is used in plastic surgery and other operations is known by an abbreviation of its chemical name, ePTFE (expanded polytetrafluoroethylene) or Gore S.A.M. (subcutaneous augmentation material).[10] Because ePTFE is flexible and soft but very strong, it is inserted during operations in trimmed sheets and carved blocks and held to the bone by titanium screws. But because the material is porous, the force that really holds the implant in place is soft tissue and bone growing through and into the implant.\nThe above artificial materials are used in medicine because they are biocompatible and have a low incidence of causing problems inside the human body. They are abundant, FDA cleared and can be used \"off-the-shelf\", without a donor site injury to the recipient.\nAcellular dermal matrix - ADMs are another chin augmentation implant material. Commercially known as AlloDerm and known to physicians as acellular human cadaveric dermis, AlloDerm comes from tissue donors Just after death, technicians remove a layer of skin, remove the epidermis, and treat the remaining dermis with antibiotics and other substances to remove the donor's cells and DNA that would cause rejection. The graft that emerges is often used to cover chin implants.\nOther implant materials include Supramid, a braided nonabsorbale synthetic suture material in polymer shell and Mersiline, a mesh-like material that provides a scaffold on the bone.[11]\n\nTypes of procedures \nSurgical chin augmentation - The most common type of surgical chin augmentation uses a chin implant. There are many types of chin implants, and many are described in the previous section. Chin augmentation with a chin implant is usually a cosmetic procedure. An incision is made either under the chin or inside the lower lip, a pocket is made and the implant placed into the pocket. Some chin implants are fixed to the mandible, while others are held in place by the pocket itself.\nAnother surgical chin augmentation uses the lower prominence of the mandible as the \"implant.\" Known as a sliding genioplasty, the procedure involves cutting a horseshoe-shaped piece of bone from the lower border of the mandible known as an osteotomy. For chin augmentation, the piece of bone is advanced forward to increase to projection of the chin. The piece can also be recessed backward for a chin reduction. The new position is held in place with a titanium step plate using titanium screws. The bone segment can also be fixated with 26 or 27 gauge wires and IMF (wiring the jaw shut) for 3-4weeks. This type of surgery is usually performed by an oral and maxillofacial surgeon or a plastic surgeon.\nMore involved Orthognathic Surgery may be required in cases where the chin is small and a significant overbite co-exist. While the procedures above may improve the cosmetic appearance of the chin, they will not improve dental occlusion. Mandibular advancement surgery can be used to correct the alignment of the teeth and improve the projection of the chin.\nNon-surgical chin augmentation - Another method of chin augmentation uses an injectable filler. Most fillers are temporary, with results lasting months to years. Common temporary fillers include hyaluronic acid and calcium hydroxyapatite preparations. Permanent fillers, like \"free\" silicone, have fallen out of favor due to the risk of migration, chronic inflammation and infection, which can permanently disfigure the chin.\n\nSee also \nChin sling\nJaw reduction\nOrthognathic surgery\nMaxillofacial surgery\nPlastic surgery\nOtolaryngology\nReferences \n\n\n^ Aufricht, G: combined plastic surgery of the nose and chin; resume of twenty seven years' experiences. Am J Surg 1958 Feb;95(2): 231-6 \n\n^ Lee, Tae Sung; Kim, Hye Young; Kim, Takho; Lee, Ji Hyuck; Park, Sanghoon (October 2014). \"Importance of the Chin in Achieving a Feminine Lower Face\". The Journal of Craniofacial Surgery: 1. doi:10.1097\/scs.0000000000001096. ISSN 1049-2275. \n\n^ a b Lee, Tae Sung; Kim, Hye Young; Kim, Tak Ho; Lee, Ji Hyuck; Park, Sanghoon (March 2014). \"Contouring of the Lower Face by a Novel Method of Narrowing and Lengthening Genioplasty\". Plastic and Reconstructive Surgery. 133 (3): 274e\u2013282e. doi:10.1097\/01.prs.0000438054.21634.4a. ISSN 0032-1052. \n\n^ a b Lee, Tae Sung (December 2015). \"Standardization of surgical techniques used in facial bone contouring\". Journal of Plastic, Reconstructive & Aesthetic Surgery. 68 (12): 1694\u20131700. doi:10.1016\/j.bjps.2015.08.010. ISSN 1748-6815. \n\n^ Park, Sanghoon (2017-06-14), \"The Osseous Genioplasty\", Facial Bone Contouring Surgery, Springer Singapore, pp. 63\u201377, doi:10.1007\/978-981-10-2726-0_8, ISBN 9789811027253, retrieved 2018-08-08 \n\n^ Lim, Jongwoo (2017-06-14), \"Essential Surgical Anatomy for Facial Bone Contouring Surgery\", Facial Bone Contouring Surgery, Springer Singapore, pp. 7\u201313, doi:10.1007\/978-981-10-2726-0_2, ISBN 9789811027253, retrieved 2018-08-08 \n\n^ Lee, Tae Sung (2017-06-14), \"Surgical Approaches for Facial Bone Surgery\", Facial Bone Contouring Surgery, Springer Singapore, pp. 15\u201322, doi:10.1007\/978-981-10-2726-0_3, ISBN 9789811027253, retrieved 2018-08-08 \n\n^ Costantino PD. FriedmanCD: Soft-tissue augmentation and replacement in the head and neck. General considerations, Ontolaryngol Clin North Am 1994 Feb;27(1): 1-12 \n\n^ White JB, Dufresne CR. Management and avoidance of complications in chin augmentation. Aesthet Surg J. 2011 Aug 1;31(6):634-42. \n\n^ Gore Medical Products Maas CS, Merwin GE, Wilson J, et al.: Comparison of biomaterials for facial augmentation. Arch Otolaryngol Head Neck Surg 1990 May; 116(5): 551-6. \n\n^ Guyuron B, Raszewski RL: A critical comparison of osteoplasic and alloplastic augmentation genioplasty. Aesthetic Plast Surg 1990 Summer, 14(3): 199-206 \n\n\nExternal links \nCombining Chin-Jowl Implants with Local Anesthesia Facial Rejuvenation\nMini V-line Surgery\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Chin_augmentation\">https:\/\/www.limswiki.org\/index.php\/Chin_augmentation<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesMedical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 22:33.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 453 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","91a4b9dfbfbb2211c807eb202cfe561d_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Chin_augmentation skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Chin augmentation<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Chin augmentation<\/b> using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">surgical implants<\/a> can alter the underlying structure of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Face\" title=\"Face\" rel=\"external_link\" target=\"_blank\">face<\/a>, providing better balance to the facial features. The specific medical terms <b>mentoplasty<\/b> and <b>genioplasty<\/b> are used to refer to the reduction and addition of material to a patient's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chin\" title=\"Chin\" rel=\"external_link\" target=\"_blank\">chin<\/a>. This can take the form of chin height reduction or chin rounding by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteotomy\" title=\"Osteotomy\" rel=\"external_link\" target=\"_blank\">osteotomy<\/a>, or chin augmentation using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">implants<\/a>.\n<\/p><p>This operation is often, but not always, performed at the time of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rhinoplasty\" title=\"Rhinoplasty\" rel=\"external_link\" target=\"_blank\">rhinoplasty<\/a> to help balance the facial proportions. Chin augmentation may be achieved by manipulation of the jaw bone (mandible) and augmentation utilizing this technique usually provides a more dramatic correction than with the use of prosthetic implants.\n<\/p><p>Chin implants are used to build a better profile.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<p>Patients' own bone is donated from ribs and from part of the pelvis (the ilium). Use of donated bone implants in chin augmentation, even the patient\u2019s own, appears to be associated with a higher rate of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a>, even after the implant has been in place for decades.\n<\/p>\n<\/p><p>Chin augmentation is still popular because it is a relatively easy operation for the patient while producing noticeable changes in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silhouette\" title=\"Silhouette\" rel=\"external_link\" target=\"_blank\">silhouette<\/a> of the face. This type of surgery is usually performed by an oral and maxillofacial surgeon, otolaryngologist, or plastic surgeon.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"T-osteotomy_method\">T-osteotomy method<\/span><\/h2>\n<p>T-osteotomy method (or mini V-line)<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> is used to narrow and lengthen the chin using an osteotomy technique formulated by Korean surgeons. The surgery is performed under general anesthesia (orotracheal intubation) using an intraoral approach.<sup id=\"rdp-ebb-cite_ref-:0_3-0\" class=\"reference\"><a href=\"#cite_note-:0-3\" rel=\"external_link\">[3]<\/a><\/sup> Using a double-bladed reciprocating saw,<sup id=\"rdp-ebb-cite_ref-:1_4-0\" class=\"reference\"><a href=\"#cite_note-:1-4\" rel=\"external_link\">[4]<\/a><\/sup> a horizontal osteotomy is performed, leaving a small portion of bone in the middle. Then two vertical osteotomies are performed in an upside-down trapezoidal shape which is excised. The bones remaining from the horizontal osteotomy are then attached and adjusted to lengthen the chin, and advanced forward for an additional frontal chin projection if required.<sup id=\"rdp-ebb-cite_ref-:0_3-1\" class=\"reference\"><a href=\"#cite_note-:0-3\" rel=\"external_link\">[3]<\/a><\/sup> Pre-bent titanium plates and screws are used to fixate the bone to its new position.<sup id=\"rdp-ebb-cite_ref-:1_4-1\" class=\"reference\"><a href=\"#cite_note-:1-4\" rel=\"external_link\">[4]<\/a><\/sup> The chin can be lengthened 2 to 3 mm on average.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> \n<\/p><p>The mentalis muscles controls the elevation functions of the lower lip and chin, so extra caution should be taken to carefully attach the mentalis muscle back after the surgery.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Potential_risks_and_side_effects\">Potential risks and side effects<\/span><\/h2>\n<p>The usual complications are relatively minor and include swelling, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hematoma\" title=\"Hematoma\" rel=\"external_link\" target=\"_blank\">hematoma<\/a> (blood pooling), weakness or numbness of the lower lip, which usually does not last long. Other, less common risks include infection, bony changes and displacement of the implant.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> Seeking an experienced surgeon can help reduce your risks of complications.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>Chewing should be kept at a minimum immediately after this procedure, and patients are recommended to eat only soft food and drink for a time after the surgery.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types_of_implants\">Types of implants<\/span><\/h2>\n<p><b>Silicone<\/b> - <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">Silicone<\/a> chin Implants are one of the most commonly used implants for chin augmentation. They are soft, smooth, flexible and come in different shapes and sizes. They do not incorporate (stick) to the surrounding tissues, so the pocket must be made precisely. They usually stay in place, but may move, buckle and cause bone resorption where they contact the mandible in some cases. Since they are smooth, they can also be removed easily.\n<\/p><p><b>Polyethylene<\/b> - <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">Polyethylene<\/a> chin implants, brand name Medpor, are hard, porous, slightly flexible and come in various shapes and sizes. The do incorporate, as the surrounding tissues can grow into the pores of the material. This fixes the polyethylene chin implants in place, and provides a blood supply to help prevent infection. It also makes these implants much more difficult to remove.\n<\/p><p><b>Polytetrafluoroethylene<\/b> - Polytetrafluoroethylene, brand name <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gore-Tex\" title=\"Gore-Tex\" rel=\"external_link\" target=\"_blank\">Gore-Tex<\/a>, is used in plastic surgery and other operations is known by an abbreviation of its chemical name, <a href=\"https:\/\/en.wikipedia.org\/wiki\/EPTFE\" class=\"mw-redirect\" title=\"EPTFE\" rel=\"external_link\" target=\"_blank\">ePTFE<\/a> (expanded <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polytetrafluoroethylene\" title=\"Polytetrafluoroethylene\" rel=\"external_link\" target=\"_blank\">polytetrafluoroethylene<\/a>) or Gore S.A.M. (subcutaneous augmentation material).<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> Because ePTFE is flexible and soft but very strong, it is inserted during operations in trimmed sheets and carved blocks and held to the bone by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a> screws. But because the material is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Porous\" class=\"mw-redirect\" title=\"Porous\" rel=\"external_link\" target=\"_blank\">porous<\/a>, the force that really holds the implant in place is soft tissue and bone growing through and into the implant.\n<\/p><p>The above artificial materials are used in medicine because they are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatible\" class=\"mw-redirect\" title=\"Biocompatible\" rel=\"external_link\" target=\"_blank\">biocompatible<\/a> and have a low incidence of causing problems inside the human body. They are abundant, FDA cleared and can be used \"off-the-shelf\", without a donor site injury to the recipient.\n<\/p><p><b>Acellular dermal matrix<\/b> - ADMs are another chin augmentation implant material. Commercially known as AlloDerm and known to physicians as acellular human cadaveric dermis, AlloDerm comes from tissue donors Just after death, technicians remove a layer of skin, remove the epidermis, and treat the remaining dermis with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antibiotics\" class=\"mw-redirect\" title=\"Antibiotics\" rel=\"external_link\" target=\"_blank\">antibiotics<\/a> and other substances to remove the donor's cells and <a href=\"https:\/\/en.wikipedia.org\/wiki\/DNA\" title=\"DNA\" rel=\"external_link\" target=\"_blank\">DNA<\/a> that would cause rejection. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin_grafting\" title=\"Skin grafting\" rel=\"external_link\" target=\"_blank\">graft<\/a> that emerges is often used to cover chin implants.\n<\/p><p>Other implant materials include Supramid, a braided nonabsorbale synthetic suture material in polymer shell and Mersiline, a mesh-like material that provides a scaffold on the bone.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types_of_procedures\">Types of procedures<\/span><\/h2>\n<p><b>Surgical chin augmentation<\/b> - The most common type of surgical chin augmentation uses a chin implant. There are many types of chin implants, and many are described in the previous section. Chin augmentation with a chin implant is usually a cosmetic procedure. An incision is made either under the chin or inside the lower lip, a pocket is made and the implant placed into the pocket. Some chin implants are fixed to the mandible, while others are held in place by the pocket itself.\n<\/p><p>Another surgical chin augmentation uses the lower prominence of the mandible as the \"implant.\" Known as a sliding genioplasty, the procedure involves cutting a horseshoe-shaped piece of bone from the lower border of the mandible known as an osteotomy. For chin augmentation, the piece of bone is advanced forward to increase to projection of the chin. The piece can also be recessed backward for a chin reduction. The new position is held in place with a titanium step plate using titanium screws. The bone segment can also be fixated with 26 or 27 gauge wires and IMF (wiring the jaw shut) for 3-4weeks. This type of surgery is usually performed by an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oral_and_maxillofacial_surgeon\" class=\"mw-redirect\" title=\"Oral and maxillofacial surgeon\" rel=\"external_link\" target=\"_blank\">oral and maxillofacial surgeon<\/a> or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgeon\" class=\"mw-redirect\" title=\"Plastic surgeon\" rel=\"external_link\" target=\"_blank\">plastic surgeon<\/a>.\n<\/p><p>More involved Orthognathic Surgery may be required in cases where the chin is small and a significant overbite co-exist. While the procedures above may improve the cosmetic appearance of the chin, they will not improve dental occlusion. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mandibular_advancement_surgery\" class=\"mw-redirect\" title=\"Mandibular advancement surgery\" rel=\"external_link\" target=\"_blank\">Mandibular advancement surgery<\/a> can be used to correct the alignment of the teeth and improve the projection of the chin.\n<\/p><p><b>Non-surgical chin augmentation<\/b> - Another method of chin augmentation uses an injectable filler. Most fillers are temporary, with results lasting months to years. Common temporary fillers include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyaluronic_acid\" title=\"Hyaluronic acid\" rel=\"external_link\" target=\"_blank\">hyaluronic acid<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_hydroxyapatite\" class=\"mw-redirect\" title=\"Calcium hydroxyapatite\" rel=\"external_link\" target=\"_blank\">calcium hydroxyapatite<\/a> preparations. Permanent fillers, like \"free\" <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a>, have fallen out of favor due to the risk of migration, chronic inflammation and infection, which can permanently disfigure the chin.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Chin_sling\" class=\"mw-redirect\" title=\"Chin sling\" rel=\"external_link\" target=\"_blank\">Chin sling<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Jaw_reduction\" title=\"Jaw reduction\" rel=\"external_link\" target=\"_blank\">Jaw reduction<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthognathic_surgery\" title=\"Orthognathic surgery\" rel=\"external_link\" target=\"_blank\">Orthognathic surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Maxillofacial_surgery\" class=\"mw-redirect\" title=\"Maxillofacial surgery\" rel=\"external_link\" target=\"_blank\">Maxillofacial surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">Plastic surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Otolaryngology\" class=\"mw-redirect\" title=\"Otolaryngology\" rel=\"external_link\" target=\"_blank\">Otolaryngology<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Aufricht, G: combined plastic surgery of the nose and chin; resume of twenty seven years' experiences. Am J Surg 1958 Feb;95(2): 231-6<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lee, Tae Sung; Kim, Hye Young; Kim, Takho; Lee, Ji Hyuck; Park, Sanghoon (October 2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/content.wkhealth.com\/linkback\/openurl?sid=WKPTLP:landingpage&an=00001665-900000000-98482\" target=\"_blank\">\"Importance of the Chin in Achieving a Feminine Lower Face\"<\/a>. <i>The Journal of Craniofacial Surgery<\/i>: 1. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2Fscs.0000000000001096\" target=\"_blank\">10.1097\/scs.0000000000001096<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1049-2275\" target=\"_blank\">1049-2275<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Craniofacial+Surgery&rft.atitle=Importance+of+the+Chin+in+Achieving+a+Feminine+Lower+Face&rft.pages=1&rft.date=2014-10&rft_id=info%3Adoi%2F10.1097%2Fscs.0000000000001096&rft.issn=1049-2275&rft.aulast=Lee&rft.aufirst=Tae+Sung&rft.au=Kim%2C+Hye+Young&rft.au=Kim%2C+Takho&rft.au=Lee%2C+Ji+Hyuck&rft.au=Park%2C+Sanghoon&rft_id=http%3A%2F%2Fcontent.wkhealth.com%2Flinkback%2Fopenurl%3Fsid%3DWKPTLP%3Alandingpage%26an%3D00001665-900000000-98482&rfr_id=info%3Asid%2Fen.wikipedia.org%3AChin+augmentation\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-:0-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lee, Tae Sung; Kim, Hye Young; Kim, Tak Ho; Lee, Ji Hyuck; Park, Sanghoon (March 2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/insights.ovid.com\/crossref?an=00006534-201403000-00013\" target=\"_blank\">\"Contouring of the Lower Face by a Novel Method of Narrowing and Lengthening Genioplasty\"<\/a>. <i>Plastic and Reconstructive Surgery<\/i>. <b>133<\/b> (3): 274e\u2013282e. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.prs.0000438054.21634.4a\" target=\"_blank\">10.1097\/01.prs.0000438054.21634.4a<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0032-1052\" target=\"_blank\">0032-1052<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Contouring+of+the+Lower+Face+by+a+Novel+Method+of+Narrowing+and+Lengthening+Genioplasty&rft.volume=133&rft.issue=3&rft.pages=274e-282e&rft.date=2014-03&rft_id=info%3Adoi%2F10.1097%2F01.prs.0000438054.21634.4a&rft.issn=0032-1052&rft.aulast=Lee&rft.aufirst=Tae+Sung&rft.au=Kim%2C+Hye+Young&rft.au=Kim%2C+Tak+Ho&rft.au=Lee%2C+Ji+Hyuck&rft.au=Park%2C+Sanghoon&rft_id=https%3A%2F%2Finsights.ovid.com%2Fcrossref%3Fan%3D00006534-201403000-00013&rfr_id=info%3Asid%2Fen.wikipedia.org%3AChin+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:1-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:1_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lee, Tae Sung (December 2015). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016\/j.bjps.2015.08.010\" target=\"_blank\">\"Standardization of surgical techniques used in facial bone contouring\"<\/a>. <i>Journal of Plastic, Reconstructive & Aesthetic Surgery<\/i>. <b>68<\/b> (12): 1694\u20131700. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.bjps.2015.08.010\" target=\"_blank\">10.1016\/j.bjps.2015.08.010<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1748-6815\" target=\"_blank\">1748-6815<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Plastic%2C+Reconstructive+%26+Aesthetic+Surgery&rft.atitle=Standardization+of+surgical+techniques+used+in+facial+bone+contouring&rft.volume=68&rft.issue=12&rft.pages=1694-1700&rft.date=2015-12&rft_id=info%3Adoi%2F10.1016%2Fj.bjps.2015.08.010&rft.issn=1748-6815&rft.aulast=Lee&rft.aufirst=Tae+Sung&rft_id=https%3A%2F%2Fdoi.org%2F10.1016%2Fj.bjps.2015.08.010&rfr_id=info%3Asid%2Fen.wikipedia.org%3AChin+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFPark2017\" class=\"citation\">Park, Sanghoon (2017-06-14), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/link.springer.com\/10.1007\/978-981-10-2726-0_8\" target=\"_blank\">\"The Osseous Genioplasty\"<\/a>, <i>Facial Bone Contouring Surgery<\/i>, Springer Singapore, pp. 63\u201377, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2F978-981-10-2726-0_8\" target=\"_blank\">10.1007\/978-981-10-2726-0_8<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9789811027253<span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">2018-08-08<\/span><\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Facial+Bone+Contouring+Surgery&rft.atitle=The+Osseous+Genioplasty&rft.pages=63-77&rft.date=2017-06-14&rft_id=info%3Adoi%2F10.1007%2F978-981-10-2726-0_8&rft.isbn=9789811027253&rft.aulast=Park&rft.aufirst=Sanghoon&rft_id=http%3A%2F%2Flink.springer.com%2F10.1007%2F978-981-10-2726-0_8&rfr_id=info%3Asid%2Fen.wikipedia.org%3AChin+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFLim2017\" class=\"citation\">Lim, Jongwoo (2017-06-14), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/link.springer.com\/10.1007\/978-981-10-2726-0_2\" target=\"_blank\">\"Essential Surgical Anatomy for Facial Bone Contouring Surgery\"<\/a>, <i>Facial Bone Contouring Surgery<\/i>, Springer Singapore, pp. 7\u201313, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2F978-981-10-2726-0_2\" target=\"_blank\">10.1007\/978-981-10-2726-0_2<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9789811027253<span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">2018-08-08<\/span><\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Facial+Bone+Contouring+Surgery&rft.atitle=Essential+Surgical+Anatomy+for+Facial+Bone+Contouring+Surgery&rft.pages=7-13&rft.date=2017-06-14&rft_id=info%3Adoi%2F10.1007%2F978-981-10-2726-0_2&rft.isbn=9789811027253&rft.aulast=Lim&rft.aufirst=Jongwoo&rft_id=http%3A%2F%2Flink.springer.com%2F10.1007%2F978-981-10-2726-0_2&rfr_id=info%3Asid%2Fen.wikipedia.org%3AChin+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFLee2017\" class=\"citation\">Lee, Tae Sung (2017-06-14), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/link.springer.com\/10.1007\/978-981-10-2726-0_3\" target=\"_blank\">\"Surgical Approaches for Facial Bone Surgery\"<\/a>, <i>Facial Bone Contouring Surgery<\/i>, Springer Singapore, pp. 15\u201322, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2F978-981-10-2726-0_3\" target=\"_blank\">10.1007\/978-981-10-2726-0_3<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9789811027253<span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">2018-08-08<\/span><\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Facial+Bone+Contouring+Surgery&rft.atitle=Surgical+Approaches+for+Facial+Bone+Surgery&rft.pages=15-22&rft.date=2017-06-14&rft_id=info%3Adoi%2F10.1007%2F978-981-10-2726-0_3&rft.isbn=9789811027253&rft.aulast=Lee&rft.aufirst=Tae+Sung&rft_id=http%3A%2F%2Flink.springer.com%2F10.1007%2F978-981-10-2726-0_3&rfr_id=info%3Asid%2Fen.wikipedia.org%3AChin+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Costantino PD. FriedmanCD: Soft-tissue augmentation and replacement in the head and neck. General considerations, Ontolaryngol Clin North Am 1994 Feb;27(1): 1-12<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">White JB, Dufresne CR. Management and avoidance of complications in chin augmentation. Aesthet Surg J. 2011 Aug 1;31(6):634-42.<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Gore Medical Products Maas CS, Merwin GE, Wilson J, et al.: Comparison of biomaterials for facial augmentation. Arch Otolaryngol Head Neck Surg 1990 May; 116(5): 551-6.<\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Guyuron B, Raszewski RL: A critical comparison of osteoplasic and alloplastic augmentation genioplasty. Aesthetic Plast Surg 1990 Summer, 14(3): 199-206<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.medscape.com\/viewarticle\/519835_print\" target=\"_blank\">Combining Chin-Jowl Implants with Local Anesthesia Facial Rejuvenation<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/eng.idhospital.com\/facial-contouring\/mini-v-line-surgery\/\" target=\"_blank\">Mini V-line Surgery<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1253\nCached time: 20181204135340\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.244 seconds\nReal time usage: 0.297 seconds\nPreprocessor visited node count: 683\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 20121\/2097152 bytes\nTemplate argument size: 231\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 20828\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.121\/10.000 seconds\nLua memory usage: 3.5 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 256.602 1 -total\n<\/p>\n<pre>60.17% 154.385 1 Template:Reflist\n41.38% 106.185 3 Template:Cite_journal\n35.38% 90.785 1 Template:Infobox_interventions\n32.64% 83.744 1 Template:Infobox\n 9.11% 23.371 3 Template:Citation\n 1.21% 3.105 1 Template:Template_other\n 1.03% 2.653 1 Template:Main_other\n 0.97% 2.500 1 Template:ICD9proc\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1505801-1!canonical and timestamp 20181204135339 and revision id 871871229\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Chin_augmentation\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212238\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.146 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 139.983 1 - wikipedia:Chin_augmentation\n100.00% 139.983 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8003-0!*!*!*!*!*!* and timestamp 20181217212238 and revision id 24114\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Chin_augmentation\">https:\/\/www.limswiki.org\/index.php\/Chin_augmentation<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","91a4b9dfbfbb2211c807eb202cfe561d_images":[],"91a4b9dfbfbb2211c807eb202cfe561d_timestamp":1545081757,"8860581448f752dc9f79c5be048380a2_type":"article","8860581448f752dc9f79c5be048380a2_title":"Cheek augmentation","8860581448f752dc9f79c5be048380a2_url":"https:\/\/www.limswiki.org\/index.php\/Cheek_augmentation","8860581448f752dc9f79c5be048380a2_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCheek augmentation\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tCheek augmentation is a cosmetic surgical procedure that is intended to emphasize the cheeks on a person's face. To augment the cheeks, a plastic surgeon may place a solid implant over the cheekbone. Injections with the patients' own fat or a soft tissue filler, like Restylane, are also popular. Rarely, various cuts to the zygomatic bone (cheekbone) may be performed. Cheek augmentation is commonly combined with other procedures, such as a face lift or chin augmentation.[1]\n\nContents \n\n1 Implants \n\n1.1 Materials \n1.2 Shapes \n1.3 Incisions \n1.4 Risks \n\n\n2 Fillers or injections \n3 Zygomatic osteotomy \n4 References \n\n\nImplants \nMaterials \nCheek implants can be made of a variety of materials. The most common material is solid silicone. In addition, two popular options are high-density porous polyethylene, marketed as Medpor, and ePTFE (expanded polytetrafluoroethylene), better known as Gore-Tex. Both Medpor and ePTFE are inert substances, providing better integration with the underlying tissue and bone than solid silicone. However, in the case of Medpor, the implants' integration and ingrowth with the underlying tissue causes difficulty removing the implant if revisions are needed.[1][2]\n\nShapes \nThere are three general shapes to cheek implants: malar, submalar, or combined. Malar implants, the most common shape, are placed directly on the cheekbones. The result is more projection to the cheekbones, providing a \"higher\" contour to the side of the face. In contrast, submalar implants are not placed on the cheekbones. They are intended to augment the midface, especially if the person has a gaunt or \"sunken\" appearance to this area. Combined implants or malar\/submalar combination, are an extended implant intended to augment both the midface and the cheekbones.[3]\n\nIncisions \nA surgeon will usually make an incision in the upper mouth near the top of the gum line and slide the implants into place. Another method is to make an external incision near the eye, but most patients do not choose this method since it can create a visible scar. However, the intraoral (inside the mouth) approach carries a higher risk of infection since the mouth contains more bacteria. Cheek implant surgery is usually performed under sedation or general anesthesia and take about one to two hours. Recovery from this surgery usually takes about ten days.[4]\n\nRisks \nAs with any surgery there is a risk of infection, postoperative bleeding, formation of a blood clot, and severe swelling. Asymmetry is a risk with all forms of cheek augmentation. This can occur due to uneven resorption, implant displacement, or shifting. This shift can happen due to swelling, trauma or scarring. Although a temporary loss of sensation is common, an extended loss of sensation can occur with any surgery, especially cosmetic plastic surgery.[3]\n\nFillers or injections \nInjections to the cheekbones to provide a less invasive and less expensive approach to cheek augmentation. A hyaluronic acid, such as Restylane or Juvederm, can be injected to the cheek area. Autologous fat is considered a \"more permanent\" option, but all are eventually completely resorbed.[5]\n\nZygomatic osteotomy \nA zygomatic \"sandwich\" osteotomy is far less common. The procedure is often indicated during reconstructive surgery for birth defects or traumatic injury. During this procedure, the zygoma, or cheekbone, is separated by bone cuts near the orbital rim and maxilla. The bone is then moved outward and a solid material, such as hydroxylapatite, is wedged in place to hold the new position of the zygoma.[6]\n\nReferences \n\n\n^ a b Augmentation options Archived June 28, 2009, at the Wayback Machine.All About Cheek Augmentation: A Patient Education and Support Network. Last accessed 6 July 2009. \n\n^ High-density porous polyethylene implantseMedicine.com from WebMed. Medscape Last accessed 7 July 2009. \n\n^ a b Malar and Submalar Implants: OvervieweMedicine.com from WebMed. Medscape. Last accessed 7 July 2009. \n\n^ Hinderer, UT; Hinderer, Ulrich T. (1975). \"Malar implants for improvement of the facial appearance\". Plast Reconstr Surg. 56 (2): 157\u2013165. doi:10.1097\/00006534-197508000-00007. PMID 1096196. \n\n^ Injectable Fillers University of Michigan Dept. of Surgery website. Last accessed 7 July 2009. \n\n^ Milrolo, Michael et al. Peterson's Principles of Oral and Maxillofacial Surgery. 1200-1201. Google Books preview \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Cheek_augmentation\">https:\/\/www.limswiki.org\/index.php\/Cheek_augmentation<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 17:07.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 408 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","8860581448f752dc9f79c5be048380a2_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Cheek_augmentation skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Cheek augmentation<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Cheek augmentation<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cosmetic_surgery#Cosmetic_surgery\" class=\"mw-redirect\" title=\"Cosmetic surgery\" rel=\"external_link\" target=\"_blank\">cosmetic surgical procedure<\/a> that is intended to emphasize the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cheek\" title=\"Cheek\" rel=\"external_link\" target=\"_blank\">cheeks<\/a> on a person's face. To augment the cheeks, a plastic surgeon may place a solid implant over the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zygomatic_bone\" title=\"Zygomatic bone\" rel=\"external_link\" target=\"_blank\">cheekbone<\/a>. Injections with the patients' own fat or a soft tissue filler, like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Restylane\" title=\"Restylane\" rel=\"external_link\" target=\"_blank\">Restylane<\/a>, are also popular. Rarely, various <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteotomy\" title=\"Osteotomy\" rel=\"external_link\" target=\"_blank\">cuts<\/a> to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zygomatic_bone\" title=\"Zygomatic bone\" rel=\"external_link\" target=\"_blank\">zygomatic bone<\/a> (cheekbone) may be performed. Cheek augmentation is commonly combined with other procedures, such as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Face_lift\" class=\"mw-redirect\" title=\"Face lift\" rel=\"external_link\" target=\"_blank\">face lift<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chin_augmentation\" title=\"Chin augmentation\" rel=\"external_link\" target=\"_blank\">chin augmentation<\/a>.<sup id=\"rdp-ebb-cite_ref-allabout_1-0\" class=\"reference\"><a href=\"#cite_note-allabout-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Implants\">Implants<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Materials\">Materials<\/span><\/h3>\n<p>Cheek implants can be made of a variety of materials. The most common material is solid <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a>. In addition, two popular options are high-density porous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a>, marketed as <i><\/i>, and ePTFE (expanded <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polytetrafluoroethylene\" title=\"Polytetrafluoroethylene\" rel=\"external_link\" target=\"_blank\">polytetrafluoroethylene<\/a>), better known as <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gore-Tex\" title=\"Gore-Tex\" rel=\"external_link\" target=\"_blank\">Gore-Tex<\/a><\/i>. Both Medpor and ePTFE are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemically_inert\" title=\"Chemically inert\" rel=\"external_link\" target=\"_blank\">inert<\/a> substances, providing better integration with the underlying tissue and bone than solid silicone. However, in the case of Medpor, the implants' integration and ingrowth with the underlying tissue causes difficulty removing the implant if revisions are needed.<sup id=\"rdp-ebb-cite_ref-allabout_1-1\" class=\"reference\"><a href=\"#cite_note-allabout-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Shapes\">Shapes<\/span><\/h3>\n<p>There are three general shapes to cheek implants: <i>malar<\/i>, <i>submalar<\/i>, or <i>combined<\/i>. Malar implants, the most common shape, are placed directly on the cheekbones. The result is more projection to the cheekbones, providing a \"higher\" contour to the side of the face. In contrast, submalar implants are not placed on the cheekbones. They are intended to augment the midface, especially if the person has a gaunt or \"sunken\" appearance to this area. Combined implants or <i>malar\/submalar combination<\/i>, are an extended implant intended to augment both the midface and the cheekbones.<sup id=\"rdp-ebb-cite_ref-emed_3-0\" class=\"reference\"><a href=\"#cite_note-emed-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Incisions\">Incisions<\/span><\/h3>\n<p>A surgeon will usually make an incision in the upper mouth near the top of the gum line and slide the implants into place. Another method is to make an external incision near the eye, but most patients do not choose this method since it can create a visible scar. However, the intraoral (inside the mouth) approach carries a higher risk of infection since the mouth contains more <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bacteria\" title=\"Bacteria\" rel=\"external_link\" target=\"_blank\">bacteria<\/a>. Cheek implant surgery is usually performed under sedation or <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_anesthesia\" class=\"mw-redirect\" title=\"General anesthesia\" rel=\"external_link\" target=\"_blank\">general anesthesia<\/a> and take about one to two hours. Recovery from this surgery usually takes about ten days.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h3>\n<p>As with any surgery there is a risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a>, postoperative bleeding, formation of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_clot\" class=\"mw-redirect\" title=\"Blood clot\" rel=\"external_link\" target=\"_blank\">blood clot<\/a>, and severe swelling. Asymmetry is a risk with all forms of cheek augmentation. This can occur due to uneven resorption, implant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Displacement_(vector)\" title=\"Displacement (vector)\" rel=\"external_link\" target=\"_blank\">displacement<\/a>, or shifting. This shift can happen due to swelling, trauma or scarring. Although a temporary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paresis\" title=\"Paresis\" rel=\"external_link\" target=\"_blank\">loss of sensation<\/a> is common, an extended loss of sensation can occur with any surgery, especially cosmetic plastic surgery.<sup id=\"rdp-ebb-cite_ref-emed_3-1\" class=\"reference\"><a href=\"#cite_note-emed-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Fillers_or_injections\">Fillers or injections<\/span><\/h2>\n<p>Injections to the cheekbones to provide a less invasive and less expensive approach to cheek augmentation. A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyaluronic_acid\" title=\"Hyaluronic acid\" rel=\"external_link\" target=\"_blank\">hyaluronic acid<\/a>, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Restylane\" title=\"Restylane\" rel=\"external_link\" target=\"_blank\">Restylane<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Juvederm\" class=\"mw-redirect\" title=\"Juvederm\" rel=\"external_link\" target=\"_blank\">Juvederm<\/a>, can be injected to the cheek area. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autologous\" class=\"mw-redirect\" title=\"Autologous\" rel=\"external_link\" target=\"_blank\">Autologous<\/a> fat is considered a \"more permanent\" option, but all are eventually completely resorbed.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Zygomatic_osteotomy\">Zygomatic osteotomy<\/span><\/h2>\n<p>A zygomatic \"sandwich\" osteotomy is far less common. The procedure is often indicated during reconstructive surgery for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Birth_defect\" title=\"Birth defect\" rel=\"external_link\" target=\"_blank\">birth defects<\/a> or traumatic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Injury\" title=\"Injury\" rel=\"external_link\" target=\"_blank\">injury<\/a>. During this procedure, the zygoma, or cheekbone, is separated by bone cuts near the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orbit_(anatomy)\" title=\"Orbit (anatomy)\" rel=\"external_link\" target=\"_blank\">orbital rim<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Maxilla\" title=\"Maxilla\" rel=\"external_link\" target=\"_blank\">maxilla<\/a>. The bone is then moved outward and a solid material, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxylapatite\" class=\"mw-redirect\" title=\"Hydroxylapatite\" rel=\"external_link\" target=\"_blank\">hydroxylapatite<\/a>, is wedged in place to hold the new position of the zygoma.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-allabout-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-allabout_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-allabout_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/cheekaugmentation.com\/augmentation_options.htm\" target=\"_blank\">Augmentation options<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090628195758\/http:\/\/cheekaugmentation.com\/augmentation_options.htm\" target=\"_blank\">Archived<\/a> June 28, 2009, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<i>All About Cheek Augmentation: A Patient Education and Support Network.<\/i> Last accessed 6 July 2009.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/emedicine.medscape.com\/article\/882205-overview\" target=\"_blank\">High-density porous polyethylene implants<\/a><i>eMedicine.com from <\/i>. Medscape Last accessed 7 July 2009.<\/span>\n<\/li>\n<li id=\"cite_note-emed-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-emed_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-emed_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/emedicine.medscape.com\/article\/843020-overview\" target=\"_blank\">Malar and Submalar Implants: Overview<\/a><i>eMedicine.com from <\/i>. Medscape. Last accessed 7 July 2009.<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hinderer, UT; Hinderer, Ulrich T. (1975). \"Malar implants for improvement of the facial appearance\". <i>Plast Reconstr Surg<\/i>. <b>56<\/b> (2): 157\u2013165. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00006534-197508000-00007\" target=\"_blank\">10.1097\/00006534-197508000-00007<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1096196\" target=\"_blank\">1096196<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plast+Reconstr+Surg&rft.atitle=Malar+implants+for+improvement+of+the+facial+appearance&rft.volume=56&rft.issue=2&rft.pages=157-165&rft.date=1975&rft_id=info%3Adoi%2F10.1097%2F00006534-197508000-00007&rft_id=info%3Apmid%2F1096196&rft.aulast=Hinderer&rft.aufirst=UT&rft.au=Hinderer%2C+Ulrich+T.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACheek+augmentation\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/surgery.med.umich.edu\/plastic\/clinical\/cosmetic\/fillers\" target=\"_blank\">Injectable Fillers<\/a> University of Michigan Dept. of Surgery website. Last accessed 7 July 2009.<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Milrolo, Michael et al. <i>Peterson's Principles of Oral and Maxillofacial Surgery.<\/i> 1200-1201. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=uzZhODdfn8gC&lpg=PP1&pg=PP1\" target=\"_blank\">Google Books preview<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1251\nCached time: 20181207133859\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.124 seconds\nReal time usage: 0.165 seconds\nPreprocessor visited node count: 236\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 2564\/2097152 bytes\nTemplate argument size: 82\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 5731\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.071\/10.000 seconds\nLua memory usage: 1.7 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 138.847 1 Template:Reflist\n100.00% 138.847 1 -total\n<\/p>\n<pre>68.95% 95.736 1 Template:Cite_journal\n17.94% 24.908 1 Template:Webarchive\n 2.31% 3.210 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:4241765-1!canonical and timestamp 20181207133859 and revision id 814479010\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cheek_augmentation\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212237\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.018 seconds\nReal time usage: 0.144 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 137.520 1 - wikipedia:Cheek_augmentation\n100.00% 137.520 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8300-0!*!*!*!*!*!* and timestamp 20181217212237 and revision id 24513\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Cheek_augmentation\">https:\/\/www.limswiki.org\/index.php\/Cheek_augmentation<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","8860581448f752dc9f79c5be048380a2_images":[],"8860581448f752dc9f79c5be048380a2_timestamp":1545081757,"428a36600e8c3d3691be72a6b610df2e_type":"article","428a36600e8c3d3691be72a6b610df2e_title":"Buttock augmentation","428a36600e8c3d3691be72a6b610df2e_url":"https:\/\/www.limswiki.org\/index.php\/Buttock_augmentation","428a36600e8c3d3691be72a6b610df2e_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tButtock augmentation\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article has multiple issues. 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(May 2017) (Learn how and when to remove this template message)\n \n (Learn how and when to remove this template message)\nButtock augmentationGluteoplasty: the relative anatomic locations of the buttocks muscles, considered for buttocks augmentation.Specialtyplastic surgeon[edit on Wikidata]\nGluteoplasty (Greek glout\u03ccs, rump + plassein, to shape) denotes the plastic surgery and the liposuction procedures for the correction of the congenital, traumatic, and acquired defects and deformities of the buttocks and the anatomy of the gluteal region; and for the aesthetic enhancement (by augmentation or by reduction) of the contour of the buttocks.\nThe corrective procedures for buttcock augmentation and buttcock repair include the surgical emplacement of a gluteal implant (buttock prosthesis); liposculpture (fat transfer and liposuction); and body contouring (surgery and liposculpture) to resolve the patient\u2019s particular defect or deformity of the gluteal region. Moreover, in the praxis of sexual reassignment surgery, the prosthetic and liposculpture augmentation of the buttocks can be performed on transsexual and transgender women to enhance the anatomic curvature of the gluteal region in order to establish the markedly feminine buttocks and hips that project more (to the rear and to the side) than do masculine hips.[citation needed ]\n\nContents \n\n1 Background \n2 Surgical anatomy of the buttocks \n\n2.1 Innervation \n2.2 Vascularization \n\n\n3 Surgical procedures \n\n3.1 Medical therapy \n3.2 Surgical therapy \n3.3 Buttocks augmentation treatments \n\n3.3.1 Gluteal implants \n3.3.2 Lipoinjection \n3.3.3 Body contouring \n\n\n3.4 Buttocks reduction treatments \n\n3.4.1 Ultrasonic lipectomy \n3.4.2 Superficial liposculpture \n\n\n\n\n4 Surgical technique \n\n4.1 Surgical contouring of the gluteal region \n\n4.1.1 Pre-operative matters \n4.1.2 Intra-operative matters \n4.1.3 Operative matters \n4.1.4 Post-operative matters \n4.1.5 Follow-up and convalescence \n4.1.6 Complications \n\n\n4.2 Dangers \n\n4.2.1 Unmet expectations \n4.2.2 Contour problems \n4.2.3 Drug complications (anaesthetic and tumescent) \n4.2.4 Numbness (paresthesia) \n\n\n4.3 Outcome \n\n\n5 References \n\n\nBackground \nThe functional purpose of the buttocks musculature is to establish a stable gait (balanced walk) for the man or the woman who requires the surgical correction of either a defect or a deformity of the gluteal region; therefore, the restoration of anatomic functionality is the therapeutic consideration that determines which gluteoplasty procedure will effectively correct the damaged muscles of the buttocks. The applicable techniques for surgical and correction include the surgical emplacement of gluteal implants; autologous tissue-flaps; the excision (cutting and removal) of damaged tissues; lipoinjection augmentation; and liposuction reduction \u2014 to resolve the defect or deformity caused by a traumatic injury (blunt, penetrating, blast) to the buttocks muscles (gluteus maximus, gluteus medius, gluteus minimus), and any deformation of the anatomic contour of the buttocks. Likewise, the corrective techniques apply to resolving the sagging skin of the body, and the muscle and bone deformities presented by the formerly obese patient, after a massive weight loss (MWL) bariatric surgery procedure; and for resolving congenital defects and congenital deformities of the gluteal region.[1]\n\nSurgical anatomy of the buttocks \nMuscular origins and insertions\n Gluteoplasty: The surgical anatomy of the gluteus maximus muscle, as considered for a buttock-lift surgery.\nAnatomically, the mass of each buttock principally comprises two (2) muscles \u2014 the gluteus maximus muscle and the gluteus medius muscle \u2014 which are covered by a layer of adipose body fat. The upper aspects of the buttocks end at the iliac crest (the upper edges of the wings of the ilium, and the upper lateral margins of the greater pelvis), and the lower aspects of the buttocks end at the horizontal gluteal crease, where the buttocks anatomy joins the rear, upper portion of the thighs. The gluteus maximus muscle has two (2) points of insertion: (i) the one-third (1\/3) superior portion of the (coarse line) linea aspera of the thigh bone (femur), and (ii) the superior portion of the iliotibial tract (a long, fibrous reinforcement of the deep fascia lata of the thigh). The left and the right gluteus maximus muscles (the butt cheeks) are vertically divided by the intergluteal cleft (the butt-crack) which contains the anus.[1]\nThe gluteus maximus muscle is a large and very thick muscle (6\u20137 cm) located on the sacrum, which is the large, triangular bone located at the base of the vertebral column, and at the upper- and back-part of the pelvic cavity, where it is inserted (like a wedge) between the two hip bones. The upper part of the sacrum is connected to the final lumbar vertebra (L5), and to the bottom of the coccyx (tailbone). At its origin, the gluteus maximus muscle extends to include parts of the iliac bone, the sacrum, the coccyx, the sacrosciatic ligament, and the tuberosity of the ischium.[citation needed ]\nLike every pelvic-area muscle, the gluteus maximus muscle originates from the pelvis; nonetheless, it is the sole pelvic muscle not inserted to the trochanter (head of the femur), and is approximately aligned to the femur and the fascia lata (the deep fascia of the thigh); the tissues of the gluteus maximus muscle cover only the rear, lateral face of the trochanter, and there form a bursa (purse) that faces the interior of the thigh.[2]\n\nInnervation \nThe motor innervation of the gluteus maximus muscle is performed by the inferior gluteal nerve (a branch nerve of the sacral plexus) and extends from the pelvis to the gluteal region, then traverses the greater sciatic foramen (opening) from behind and to the middle to then join the sciatic nerve. The inferior gluteal nerve divides into three (3) collateral branches: (i) the gluteus branch, (ii) the perineal branch, and (iii) the femoral branch. The first ramification \u2014 the gluteus branch \u2014 is a branch nerve that is very close to the emergence of the inferior gluteal nerve to the area, next to the inferior border of the pyramidalis muscle.[3] As it arises, the inferior gluteal nerve then divides into four (4) or more fillets (bands of nerve fibres) that travel (in a crow\u2019s-foot configuration) between the gluteus maximus muscle and its (front) anterior fascia; the thickest nerve-bands are the superior-most and the inferior-most fillets. The superior-most fillet runs almost vertically, near the sacrum, and innervates the superior portion of the gluteus muscle; the inferior-most fillet, which has the greatest calibre, travels very close and parallel to the sacrotuberous ligament; the inferior-most fillet provides fine-gauge branch-nerve ramifications that innervate the gluteus muscle through its anterior (front) face.[citation needed ]\nIn surgical and body contouring praxis, the plastic surgeon creates the implant-pocket \u2014 either for the gluteal prosthesis or for the injections of autologous fat \u2014 by undermining the gluteus maximus muscle with a dissection technique that avoids the sacrum, the sacrotuberous ligament, and the tuberosity of the ischium; which, if accidentally cut, might isolate the posterior (back) portion of the muscle and lead to denervation, the loss of nerve function and of innervation.[2]\n\nVascularization \nThe superior gluteal artery, the inferior gluteal artery, the superior gluteal veins, and the inferior gluteal veins irrigate the gluteus maximus muscle with arterial and venous blood. The vascularization, the entrance of the blood vessels to the muscle tissues, occurs at the anterior (front) face of the muscle, very close to the sacrum. As the arteries and the veins enter the mass of the gluteal muscle, they divide into narrower blood-vessel ramifications (configured like the horizontal branches of a tree), most of which travel parallel to the muscle fibres.[citation needed ]\nIn surgical and body contouring praxis, the plastic surgeon effects the implant-pocket undermining of the gluteus maximus muscle by carefully separating the muscle fibres to avoid severing the pertinent blood vessels, which would interfere with the blood irrigation of the muscle tissue. Therefore, to create an implant-pocket, either for a gluteal prosthesis or for lipoinjection, a low-angle muscle-dissection is performed in order to avoid the risk of severing any major branch \u2014 superior or inferior \u2014 of the gluteal artery, which travels very close to the sacrum and to the sacrotuberous ligament.[2]\n\nSurgical procedures \nMedical therapy \nThe resolution of the defects and deformities of the muscles of the gluteal region (the buttocks and the thighs) of the human body cannot be realized with medical therapy; thus, for example, a treatment with cellulite-diminishing cream is ineffective for correcting the corresponding physical faults respectively presented by the man and by the woman patient.[4]\n\nSurgical therapy \nWhile the resolution of the defects and deformities of the gluteal region can be realized surgically, the assessment of the degree of severity of the injury organizes treatment therapies into three types: (i) buttocks augmentation, (ii) buttocks reduction, and (iii) contour irregularity treatments that combine surgery and liposculpture (liposuction and fat-injection).[1]\n\nButtocks augmentation treatments \nGluteal implants \nThe augmentation of the buttocks is realized with a gluteal implant, which is emplaced under each gluteus maximus muscle; the insertion of the buttock prosthesis is through a midline incision (5\u20138-cm-wide) over the tailbone (coccyx). Augmentation with a gluteal implant is the method most effective for enlarging the buttocks of the man or of the woman whose body possesses few stores of excess adipose fat in the lower portion of the trunk, the buttocks and thighs, the anatomic regions where the human body usually stores excess body fat. Post-operatively, because of the cutting (incising) into the flesh of the tailbone muscles, the full healing of the augmented tissues can be approximately 6\u20138 months, in the course of which the gluteal-muscle tissues relax, and the settled buttocks prostheses are integrated to the gluteal region.[5] The implantation procedure can be performed upon a patient who is either sedated or anaesthetized, either under general anaesthesia or under local anaesthesia. The usual operating-room time for a buttocks augmentation procedure is approximately 2 hours. The procedure can be managed either as an overnight in-patient treatment or as a hospital outpatient treatment. Given the nature of the surgical incisions to the gluteus maximus muscles, the therapeutic management of post-surgical pain (at the surgical-wound sites) and normal tissue-healing usually require a 4-6-week convalescence, after which the patient resumes his or her normal-life activities.[1]\n\nLipoinjection \nThe augmentation and contouring of the buttocks with autologous-fat transfer (lipoinjection) therapy is realized with the excess adipose-fat tissue harvested from the abdomen, flanks, and thighs of the patient. In 1987 Dr. Eduardo Krulig, a Venezuelan Plastic Surgeon describes the technique, using the name \"Lipoinjection\" for the first time, mentioning the regions of the body where the technique is useful.[6] The gentle liposuction applied to harvest the autologous fat minimally disturbs the local tissues, especially the connective-tissue layer between the skin and the immediate subcutaneous muscle tissues. Then, the harvested fat is injected to the pertinent body area of the gluteal region, through a fine-gauge cannula inserted through a small incision, which produces a short and narrow scar. Lipoinjection contouring and augmentation with the patient\u2019s own body fat avoids the possibility of tissue rejection, and is physically less invasive than buttocks-implant surgery. Therefore, depending upon the health of the patient, the convalescence period allows him or her to resume daily, normal-life activities at 2-days post-operative, and the full spectrum of physical activity at 2-weeks post-operative. Furthermore, the liposuction harvesting of the patient\u2019s excess body fat improves the aesthetic appearance of the body fat donor-sites.[7] Nonetheless, physiologically, the human body\u2019s normal, health-management chemistry does resorb (break down and eliminate) some of the injected adipose-fat tissue, and so might diminish the augmentation. According to the degree of diminishment of the volume and contour caused by the fat-resorption, the patient might require additional sessions of fat-transfer therapy to achieve the desired size, shape, and contour of the buttocks.[1]\n\nBody contouring \nThe augmentation of the buttocks, by rearranging and enhancing the pertinent muscle and fat tissues of the gluteal region, is realized with a combined gluteoplasty procedure of surgery (subcutaneous dermal-fat flaps) and liposculpture (fat-suction, fat-injection). Therapeutically, such a combined correction-and-enhancement procedure is a realistic and feasible lower-body-lift treatment for the man and for the woman patient who has undergone massive weight loss (MWL) in the course of resolving obesity with bariatric surgery.[8][9][10] In the case of the man or woman who presents under-projected, flat buttocks (gluteal hypoplasia), and a degree of gluteal-muscle ptosis (prolapsation, falling forward), wherein neither gluteal-implant surgery nor lipoinjection would be adequate to restoring the natural anatomic contour of the gluteal region, the application of a combined treatment of autologous dermal-fat flap surgery and lipoinjection can achieve the required functional correction and aesthetic contour.[1]\n\nButtocks reduction treatments \nThe methods for reducing the size of the buttocks include the varieties of liposuction, such as lipectomy (with and without ultrasonic enhancement) to reduce excess body fat, and superficial liposculpture, to reshape, refine, and re-establish the natural contour of the body. The usual buttocks-reduction treatment is lipectomy with applied tumescence and anaesthesia, wherein the body fat is harvested by aspiration (suction) through a small-gauge cannula (2\u20134 mm) that is inserted through a small incision, either to the intergluteal sulcus (the butt-crack), or to the upper area of the gluteus maximus muscle proper.[1]\n\nUltrasonic lipectomy \nUltrasonically-assisted liposuction can quickly remove a large volume of body fat for the correction of a notable occurrence of lipodystrophy, a deposit of adipose fat to the buttocks and related anatomic areas. The ultrasonic liposuction machine liquefies the excess fat tissue, and so more readily facilitates its removal with conventional suction-lipectomy. The quick fat-harvesting allowed by the ultrasonic lipectomy technique has eliminated the larger (long and wide) surgical incisions that once were required for removing a large volume of adipose tissue. Nonetheless, because of the sensitivity of the gluteal-region tissues, the skin of the pertinent donor-site is cooled in order to prevent ultrasonic heat damage caused by the liquefying and removal of the excess adipose fat.[1]\n\nSuperficial liposculpture \nReshaping the buttocks with liposculpture is performed with a small cannula (2 mm) specifically for contouring superficial body fat, the configuration of which (number of open ports) is determined by the type and the degree of gluteal correction to be realized. To sculpt rounded contours to square-shaped buttocks muscles, superficial liposculpture allows the plastic surgeon to control the injection-rate of the fat-volume. Moreover, superficial liposuction can be combined with other treatment methods for contouring the gluteal region to achieve the required functional, anatomic correction, and the aesthetic enhancement sought by the patient, such as reshaping the lateral area of the buttocks into an athletic form.[11][12] The study Contouring the Gluteal Region with Tumescent Liposculpture (2011) indicated that effective, gluteal-region contouring is best achieved by tailoring the liposuction-reduction and the lipoinjection-augmentation techniques to the anatomic topography of the body areas to be corrected.[13] Furthermore, the study Contouring of the Gluteal Region in Women: Enhancement and Augmentation (2011) indicated that natural contours of the buttocks and the thighs are effectively achieved with a combined gluteoplasty of selective liposuction and lipoinjection, which reduces the need for aggressive surgical procedures, decreases the risk of medical complications, abbreviates wound-recovery-time, and lessens post-operative scarring. Combined with any buttocks-correction method, superficial liposculpture facilitates the treatment of contour irregularities, the surgical revision of scars, and the correction of gluteal-region contour depressions.[14]\n\nSurgical technique \nSurgical contouring of the gluteal region \nPre-operative matters \nTo meet the functional requirements and the aesthetic expectations (body image) of the patient, the plastic surgeon establishes a realistic and feasible surgery plan by which to correct the anatomic contour deficiencies of the gluteal region. The surgeon and the patient determine the location of the surgical-wound scars, and determine the best operative position, to allow the proper exposure of the pertinent anatomy to be corrected. Because the surgical procedure requires the tumescence and anaesthesia of the gluteal-region area to be corrected, the physician and the anaesthesiologist determine the volumes of the anaesthetic and tumescent fluids to be administered to the patient during the procedure, and so avoid the risks of drugs overdose and toxicity.[1]\n\nIntra-operative matters \nOnce the patient is atop the operating table, the surgeon positions him or her to best expose the pertinent gluteal-region area that is to be corrected or contoured, or both; the usual operative position is the prone (face down) position, but the patient can also be positioned laterally (on his or her side). The surgical correction plan can be delineated and marked to the patient\u2019s body when he or she is awake (before sedation or anaesthesia) or it can be delineated when the patient is on the operating table (already sedated or anaesthetized). In operative praxis, the second option allows the plastic surgeon greater freedom to properly manipulate the patient into the position best suited for performing the body-contouring surgery.[citation needed ]\n\nOperative matters \nOnce the patient is in the operative position, the surgeon begins the liposuction correction by making incisions to the marks of the surgical-correction plan, and then infiltrates (injects) a solution of anaesthesia- and tumescence-inducing drugs, usually a combination of lidocaine and epinephrine. The volume of the anaesthetic-tumescent solution is gradually infiltrated to the pertinent gluteal area, in order to avoid the nerves and the deeper anatomic structures of the gluteus maximus muscle. The particular anatomic features to be contoured determine the types of cannula (gauge, size, grade) used to effect and control the harvesting of excess adipose fat from the patient\u2019s body.[citation needed ]\nFor a lipoinjection augmentation, the surgeon first dissects and prepares the augmentation-pocket to which will be injected the autologous fat-tissue. The surgical creation (muscle dissection) of the augmentation-pocket avoids the gluteal innervation (superior gluteal nerve and inferior gluteal nerve) and the vascular system (venous and arterial) of the gluteus maximus muscle. Afterwards, the surgeon sutures the dissection-incision and secures it with adhesive tape to ensure that the augmentation-pocket remains open, as dissected, ready to receive the injections of adipose fat. For the revision of scars, with surgery and injections of autologous fat, or with allopathic synthetic fillers, the surgeon applies subcuticular closures to the incision wounds, which then are bandaged.[1]\n\nPost-operative matters \nAfter completing the surgical corrections and the lipoinjection contouring of the pertinent area(s) of the gluteal region, the surgeon thoroughly examines the patient to ensure his or her general recovery from the operation; and examines each surgical incision to ascertain that it is correctly sutured and taped, in order to facilitate the uneventful healing of the gluteus-muscle tissues, without medical complications. The patient is advised to avoid exercise and strenuous physical activity until 3-weeks post-operative; how to properly care for surgical-incision wounds; and how to wear a compression garment that will keep in place the surgically corrected tissues, and so ensure their healing as a whole anatomic unit of the gluteal region.[1]\n\nFollow-up and convalescence \nThe physician advises the patient who has undergone a surgical contouring of the buttocks with gluteal implants, that, although immediate results can be observed, the final, corrected body contour usually is observed at 6-months post-operative, and at 1-year post-operative, depending upon the tissue-healing capabilities of the patient\u2019s body. The liposculpture patient usually requires approximately 6 months, and occasionally 1 year before producing the final, corrected body contour. For both procedures, at approximately 1-month post-operative, marked aesthetic improvement is noticeable in the corrected body areas, as is the elimination of the initial, post-operative weight gain caused by the body\u2019s retention of the infiltrated, anaesthetic and tumescent, fluids. The patient is advised to wear a compression garment to contain swelling and to immobilize the corrected tissues, so that they heal as one anatomic unit of the gluteal region. Moreover, throughout the convalescence, to facilitate shrinking the skin to the new, corrected body contour, and to resolve unevenness, wrinkles to the skin, and localized swelling, the continual application of massage and (occasional) ultrasound treatments can facilitate the diminishment of the post-operative conditions.[1]\n\nComplications \nThe surgical and liposculpture contouring of the human body presents possible medical complications such as: the psychological \u2014 unmet body image expectations of aesthetic improvement; the physical \u2014 uneven contour, local and general; the physiologic \u2014 toxic reactions to the anaesthesic and the tumescent drugs; and the nervous \u2014 paresthesia, localized areas of perduring numbness in the corrected portion(s) of the gluteal region.[1] The medical complications possible to a surgical buttocks augmentation procedure, the submuscular emplacement of a gluteal implant, include infection, surgical-wound dehiscence that exposes the implant, revision surgery, rupture of the implant, seroma (a pocket of clear serous fluid), capsular contracture, asymmetry of the corrected area, shifting of the implant, surgical over-correction, injury to the sciatic nerve, and paresthesia (tingling skin). The medical complications possible to a liposclupture buttocks augmentation include the bodily resorption of some of the injected adipose fat, asymmetric contour of the corrected body area, an irregular contour to the body, seroma, abscess (pus enclosed by inflamed tissue), cellulitis (subcutaneous connective-tissue inflammation), and paresthesia.[1]\n\nDangers \nLike most medical procedures, buttock augmentation come with risks some of which can be life threatening. A total of 413 Mexican plastic surgeons reported 64 deaths related to liposuction, with 13 deaths caused by gluteal lipoinjection. In Colombia, nine deaths were documented. Of the 13 deaths in Mexico, eight (61.6 percent) occurred during lipoinjection, whereas the remaining five (38.4 percent) occurred within the first 24 hours. In Colombia, six deaths (77.7 percent) occurred during surgery and three occurred (22.2 percent) immediately after surgery.[1] Secondary lymphoedema of the lower extremities has been reported as an unusual side effect of liquid silicone injection on the hips and buttock while thromboembolism, implant displacement and explosion has also been listed as some of the dangers.[2][3] The surgical and liposculpture contouring of the human body presents possible medical complications such as: the psychological \u2014 unmet body image expectations of aesthetic improvement; the physical \u2014 uneven contour, local and general; the physiologic \u2014 toxic reactions to the anaesthesic and the tumescent drugs; and the nervous \u2014 paresthesia, localized areas of perduring numbness in the corrected portion(s) of the gluteal region.[1] The medical complications possible to a surgical buttocks augmentation procedure, the submuscular emplacement of a gluteal implant, include infection, surgical-wound dehiscence that exposes the implant, revision surgery, rupture of the implant, seroma (a pocket of clear serous fluid), capsular contracture, asymmetry of the corrected area, shifting of the implant, surgical over-correction, injury to the sciatic nerve, and paresthesia (tingling skin). The medical complications possible to a liposclupture buttocks augmentation include the bodily resorption of some of the injected adipose fat, asymmetric contour of the corrected body area, an irregular contour to the body, seroma, abscess (pus enclosed by inflamed tissue), cellulitis (subcutaneous connective-tissue inflammation), and paresthesia.[1]\n\nUnmet expectations \nIn the surgical praxis of body contouring therapy, the patient\u2019s body-image expectations can be different from the contoured body that is the outcome of the performed surgical operation. Such unmet aesthetic expectations can be avoided at the pre-operative consultation stage, whereby, with informed consent, the physician and the patient jointly establish a realistic and feasible surgery plan to achieve a mutually satisfactory corrective outcome (functional and aesthetic) of the operation to the gluteal region, the buttock- and thigh-areas.[1]\n\nContour problems \nContour problems of the corrected gluteal region can be prevented with the operational use of small-gauge cannulas (ca. 2.0 mm) specifically for superficial liposuction; and with the application of cross-pattern harvesting of the excess body fat, to avoid removing too much adipose fat tissue, which might disfigure the contour of the patient\u2019s fat-donor area. The possible contour problems that might arise from ultrasonic liposuction are skin burns and hypertrophic scarring, which might occur if the fat-donor area skin is not cooled and protected during the fat harvest. To that end, the infusion of a tumescence-inducing solution to the fat-donor area(s) assists in cooling the patient\u2019s skin during the ultrasonic lipo-harvesting; likewise, the application of moist towels, a skin protector, and the constant cooling-fluid infiltration of the cannula in an integrated sheath.[1]\n\n Drug complications (anaesthetic and tumescent) \nThe infiltration of a solution of anaesthesia- and tumescence-inducing drugs can present medical complications such as a fluid overload of the tissues, the inadequate replacement of the infiltrated solution, and the partitioning (separation) of a single infiltration into several pools, which then are removed by suction lipectomy. Moreover, during anaesthesia, maintaining the patient\u2019s stable blood pressure can be difficult, which increases the possibility of bleeding, and the possibility that anaesthetic toxicity can occur if excessive doses are administered by infiltration; the symptoms are manifested as central nervous system (CNS) occurrences of drug-induced anxiety, apprehension, restlessness, nervousness, disorientation, confusion, dizziness, blurred vision, tremors, nausea, vomiting, shivering, and seizures; likewise, as manifestations of drowsiness, unconsciousness, respiratory depression, and respiratory arrest. Furthermore, the toxicity symptoms of a tumescence-inducing drug (e.g. epinephrine) might cause such CNS symptoms, for which reason the operative application of a tumescent drug is limited throughout the operation.[1]\n\n Numbness (paresthesia) \nPost-operatively, local areas of numbness (paresthesia) might occur in the contoured portion(s) of the gluteal region, and might perdure for a long time after the surgery. Hence, the patient is advised to facilitate the re-sensitizing of the numb area(s) with applications of gentle massage, to prevent the development of a neuroma complication, and to alleviate pain. Nonetheless, depending upon the tissue-healing capabilities of the patient, he or she can recover in full at 2-years post-operative.[1]\n\nOutcome \nThe outcome of a buttocks-contouring procedure depends upon the specific defect or deformity that can be effectively corrected with liposculpture, ultrasonic or not. Nonetheless, depressed scars and deep morphological defects are difficult to correct because of the curvature of the buttocks as an anatomic unit, and because of the scar-contracting elements of the tissues across the gluteal curvature. In such a case, although the injection of (autologous or artificial) tissue fillers to correct the defect or the deformity might be impermanent \u2014 it usually will remedy the functional and aesthetic shortcoming(s) required by the patient, which is the therapeutic purpose of gluteoplasty.[1]\n\nReferences \n\n\n^ a b c d e f g h i j k l m n o p q r s t u Buttocks Contouring at eMedicine \n\n^ a b c Gonzalez, Raul (2004). \"Augmentation Gluteoplasty: The XYZ Method\". Aesthetic Plastic Surgery. 28 (6): 417\u201325. doi:10.1007\/s00266-004-3130-6. PMID 15633021. \n\n^ Reid, R. W. (1920). \"Motor Points in Relation to the Surface of the Body\". Journal of Anatomy. 54 (Pt 4): 271\u20135. PMC 1262878 . PMID 17103903. \n\n^ \"Brazilian Butt Lift\". Dr. Mark Bosbous. Retrieved 23 November 2016 . \n\n^ Flores-Lima, Gerardo; Eppley, Barry L. (2009). \"Body Contouring with Solid Silicone Implants\". Aesthetic Plastic Surgery. 33 (2): 140\u20136. doi:10.1007\/s00266-008-9292-x. PMID 19123020. \n\n^ Krulig, Eduardo (April 1987). \"Lipo-injection\". American Journal of Cosmetic Surgery. 4 (2): 123\u20139. \n\n^ Rosique, Rodrigo G.; Rosique, Marina J. F.; De Moraes, Carlos Gustavo (2015). \"Gluteoplasty with Autologous Fat Tissue\". Plastic and Reconstructive Surgery. 135 (5): 1381\u20139. doi:10.1097\/PRS.0000000000001167. PMID 25919253. \n\n^ Sozer, S; Agullo, F; Palladino, H (2008). \"Autologous augmentation gluteoplasty with a dermal fat flap\". Aesthetic Surgery Journal. 28 (1): 70\u20136. doi:10.1016\/j.asj.2007.10.003. PMID 19083509. \n\n^ Le Louarn, Claude; Pascal, Jean Fran\u00e7ois (2008). \"Autologous Gluteal Augmentation after Massive Weight Loss\". Plastic and Reconstructive Surgery. 121 (4): 1515\u20136, author reply 1516\u20137. doi:10.1097\/01.prs.0000305369.21408.92. PMID 18349690. \n\n^ \"Butt Augmentation Surgery NYC | Butt Lift Westchester NY\". www.drberan.com. Retrieved 2018-09-06 . \n\n^ Centeno, Robert F.; Young, V. Leroy (2006). \"Clinical Anatomy in Aesthetic Gluteal Body Contouring Surgery\". Clinics in Plastic Surgery. 33 (3): 347\u201358. doi:10.1016\/j.cps.2006.05.005. PMID 16818093. \n\n^ Cuenca-Guerra, Ramon; Lugo-Beltran, Ignacio (2006). \"Beautiful Buttocks: Characteristics and Surgical Techniques\". Clinics in Plastic Surgery. 33 (3): 321\u201332. doi:10.1016\/j.cps.2006.04.002. PMID 16818091. \n\n^ Avendano-Valenzuela, G.; Guerrerosantos, J. (2011). \"Contouring the Gluteal Region With Tumescent Liposculpture\". Aesthetic Surgery Journal. 31 (2): 200\u201313. doi:10.1177\/1090820X10394815. PMID 21317118. \n\n^ Ali, Ahmed (2011). \"Contouring of the Gluteal Region in Women\". Annals of Plastic Surgery. 67 (3): 209\u201314. doi:10.1097\/SAP.0b013e318206595b. 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 2 March 2016, at 20:36.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,094 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","428a36600e8c3d3691be72a6b610df2e_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Buttock_augmentation skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Buttock augmentation<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p><b>Gluteoplasty<\/b> (Greek <i>glout\u03ccs<\/i>, <b>rump<\/b> + <i>plassein<\/i>, <b>to shape<\/b>) denotes the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">plastic surgery<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liposuction\" title=\"Liposuction\" rel=\"external_link\" target=\"_blank\">liposuction<\/a> procedures for the correction of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital_defect\" class=\"mw-redirect\" title=\"Congenital defect\" rel=\"external_link\" target=\"_blank\">congenital<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trauma_(medicine)\" class=\"mw-redirect\" title=\"Trauma (medicine)\" rel=\"external_link\" target=\"_blank\">traumatic<\/a>, and acquired defects and deformities of the buttocks and the anatomy of the gluteal region; and for the aesthetic enhancement (by augmentation or by reduction) of the contour of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Buttocks\" title=\"Buttocks\" rel=\"external_link\" target=\"_blank\">buttocks<\/a>.\n<\/p><p>The corrective procedures for buttcock augmentation and buttcock repair include the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgical<\/a> emplacement of a <b>gluteal implant<\/b> (buttock prosthesis); <b>liposculpture<\/b> (fat transfer and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liposuction\" title=\"Liposuction\" rel=\"external_link\" target=\"_blank\">liposuction<\/a>); and <b>body contouring<\/b> (surgery and liposculpture) to resolve the patient\u2019s particular defect or deformity of the gluteal region. Moreover, in the praxis of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sexual_reassignment_surgery_male-to-female\" class=\"mw-redirect\" title=\"Sexual reassignment surgery male-to-female\" rel=\"external_link\" target=\"_blank\">sexual reassignment surgery<\/a>, the prosthetic and liposculpture augmentation of the buttocks can be performed on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transsexualism\" class=\"mw-redirect\" title=\"Transsexualism\" rel=\"external_link\" target=\"_blank\">transsexual<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transgender\" title=\"Transgender\" rel=\"external_link\" target=\"_blank\">transgender<\/a> women to enhance the anatomic curvature of the gluteal region in order to establish the markedly feminine buttocks and hips that project more (to the rear and to the side) than do masculine hips.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2015)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Background\">Background<\/span><\/h2>\n<p>The functional purpose of the <b>buttocks musculature<\/b> is to establish a stable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gait\" title=\"Gait\" rel=\"external_link\" target=\"_blank\">gait<\/a> (balanced walk) for the man or the woman who requires the surgical correction of either a defect or a deformity of the gluteal region; therefore, the restoration of anatomic functionality is the therapeutic consideration that determines which <b>gluteoplasty<\/b> procedure will effectively correct the damaged muscles of the buttocks. The applicable techniques for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">surgical<\/a> and correction include the surgical emplacement of gluteal implants; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flap_(surgery)\" title=\"Flap (surgery)\" rel=\"external_link\" target=\"_blank\">autologous tissue-flaps<\/a>; the excision (cutting and removal) of damaged tissues; lipoinjection augmentation; and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liposuction\" title=\"Liposuction\" rel=\"external_link\" target=\"_blank\">liposuction<\/a> reduction \u2014 to resolve the defect or deformity caused by a traumatic injury (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Blunt_trauma\" title=\"Blunt trauma\" rel=\"external_link\" target=\"_blank\">blunt<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Penetrating_trauma\" title=\"Penetrating trauma\" rel=\"external_link\" target=\"_blank\">penetrating<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blast_injury\" title=\"Blast injury\" rel=\"external_link\" target=\"_blank\">blast<\/a>) to the buttocks muscles (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteus_maximus_muscle\" class=\"mw-redirect\" title=\"Gluteus maximus muscle\" rel=\"external_link\" target=\"_blank\">gluteus maximus<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteus_medius_muscle\" class=\"mw-redirect\" title=\"Gluteus medius muscle\" rel=\"external_link\" target=\"_blank\">gluteus medius<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteus_minimus_muscle\" class=\"mw-redirect\" title=\"Gluteus minimus muscle\" rel=\"external_link\" target=\"_blank\">gluteus minimus<\/a>), and any deformation of the anatomic contour of the buttocks. Likewise, the corrective techniques apply to resolving the sagging skin of the body, and the muscle and bone deformities presented by the formerly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Obesity\" title=\"Obesity\" rel=\"external_link\" target=\"_blank\">obese<\/a> patient, after a massive weight loss (MWL) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bariatric_surgery\" title=\"Bariatric surgery\" rel=\"external_link\" target=\"_blank\">bariatric surgery<\/a> procedure; and for resolving <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital_defects\" class=\"mw-redirect\" title=\"Congenital defects\" rel=\"external_link\" target=\"_blank\">congenital defects<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital_deformity\" class=\"mw-redirect\" title=\"Congenital deformity\" rel=\"external_link\" target=\"_blank\">congenital deformities<\/a> of the gluteal region.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-0\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Surgical_anatomy_of_the_buttocks\">Surgical anatomy of the buttocks<\/span><\/h2>\n<dl><dt>Muscular origins and insertions<\/dt><\/dl>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:187px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gluteus_maximus_muscle.PNG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c6\/Gluteus_maximus_muscle.PNG\/185px-Gluteus_maximus_muscle.PNG\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gluteus_maximus_muscle.PNG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><b>Gluteoplasty:<\/b> The surgical anatomy of the gluteus maximus muscle, as considered for a buttock-lift surgery.<\/div><\/div><\/div>\n<p>Anatomically, the mass of each <a href=\"https:\/\/en.wikipedia.org\/wiki\/Buttocks\" title=\"Buttocks\" rel=\"external_link\" target=\"_blank\">buttock<\/a> principally comprises two (2) muscles \u2014 the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteus_maximus_muscle\" class=\"mw-redirect\" title=\"Gluteus maximus muscle\" rel=\"external_link\" target=\"_blank\">gluteus maximus muscle<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteus_medius_muscle\" class=\"mw-redirect\" title=\"Gluteus medius muscle\" rel=\"external_link\" target=\"_blank\">gluteus medius muscle<\/a> \u2014 which are covered by a layer of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adipose_tissue\" title=\"Adipose tissue\" rel=\"external_link\" target=\"_blank\">adipose body fat<\/a>. The upper aspects of the buttocks end at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iliac_crest\" title=\"Iliac crest\" rel=\"external_link\" target=\"_blank\">iliac crest<\/a> (the upper edges of the wings of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ilium_(bone)\" title=\"Ilium (bone)\" rel=\"external_link\" target=\"_blank\">ilium<\/a>, and the upper lateral margins of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greater_pelvis\" class=\"mw-redirect\" title=\"Greater pelvis\" rel=\"external_link\" target=\"_blank\">greater pelvis<\/a>), and the lower aspects of the buttocks end at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteal_sulcus\" title=\"Gluteal sulcus\" rel=\"external_link\" target=\"_blank\">horizontal gluteal crease<\/a>, where the buttocks anatomy joins the rear, upper portion of the thighs. The gluteus maximus muscle has two (2) points of insertion: (i) the one-third (1\/3) superior portion of the (coarse line) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Linea_aspera\" title=\"Linea aspera\" rel=\"external_link\" target=\"_blank\">linea aspera<\/a> of the thigh bone (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Femur\" title=\"Femur\" rel=\"external_link\" target=\"_blank\">femur<\/a>), and (ii) the superior portion of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iliotibial_tract\" title=\"Iliotibial tract\" rel=\"external_link\" target=\"_blank\">iliotibial tract<\/a> (a long, fibrous reinforcement of the deep <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fascia_lata\" title=\"Fascia lata\" rel=\"external_link\" target=\"_blank\">fascia lata<\/a> of the thigh). The left and the right gluteus maximus muscles (the butt cheeks) are vertically divided by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intergluteal_cleft\" title=\"Intergluteal cleft\" rel=\"external_link\" target=\"_blank\">intergluteal cleft<\/a> (the butt-crack) which contains the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_anus\" title=\"Human anus\" rel=\"external_link\" target=\"_blank\">anus<\/a>.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-1\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteus_maximus_muscle\" class=\"mw-redirect\" title=\"Gluteus maximus muscle\" rel=\"external_link\" target=\"_blank\">gluteus maximus muscle<\/a> is a large and very thick muscle (6\u20137 cm) located on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacrum\" title=\"Sacrum\" rel=\"external_link\" target=\"_blank\">sacrum<\/a>, which is the large, triangular bone located at the base of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertebral_column\" title=\"Vertebral column\" rel=\"external_link\" target=\"_blank\">vertebral column<\/a>, and at the upper- and back-part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pelvic_cavity\" title=\"Pelvic cavity\" rel=\"external_link\" target=\"_blank\">pelvic cavity<\/a>, where it is inserted (like a wedge) between the two <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_bone\" title=\"Hip bone\" rel=\"external_link\" target=\"_blank\">hip bones<\/a>. The upper part of the sacrum is connected to the final <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lumbar_vertebrae\" title=\"Lumbar vertebrae\" rel=\"external_link\" target=\"_blank\">lumbar vertebra<\/a> (L5), and to the bottom of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coccyx\" title=\"Coccyx\" rel=\"external_link\" target=\"_blank\">coccyx<\/a> (tailbone). At its origin, the gluteus maximus muscle extends to include parts of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ilium_(bone)\" title=\"Ilium (bone)\" rel=\"external_link\" target=\"_blank\">iliac bone<\/a>, the sacrum, the coccyx, the sacrosciatic ligament, and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tuberosity_of_the_ischium\" class=\"mw-redirect\" title=\"Tuberosity of the ischium\" rel=\"external_link\" target=\"_blank\">tuberosity of the ischium<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2015)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Like every pelvic-area muscle, the gluteus maximus muscle originates from the pelvis; nonetheless, it is the sole pelvic muscle not inserted to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_trochanter\" class=\"mw-redirect\" title=\"Human trochanter\" rel=\"external_link\" target=\"_blank\">trochanter<\/a> (head of the femur), and is approximately aligned to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femur\" title=\"Femur\" rel=\"external_link\" target=\"_blank\">femur<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fascia_lata\" title=\"Fascia lata\" rel=\"external_link\" target=\"_blank\">fascia lata<\/a> (the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deep_fascia\" title=\"Deep fascia\" rel=\"external_link\" target=\"_blank\">deep fascia<\/a> of the thigh); the tissues of the gluteus maximus muscle cover only the rear, lateral face of the trochanter, and there form a bursa (purse) that faces the interior of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thigh\" title=\"Thigh\" rel=\"external_link\" target=\"_blank\">thigh<\/a>.<sup id=\"rdp-ebb-cite_ref-Gluteoplasty_2-0\" class=\"reference\"><a href=\"#cite_note-Gluteoplasty-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Innervation\">Innervation<\/span><\/h3>\n<p>The motor innervation of the gluteus maximus muscle is performed by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inferior_gluteal_nerve\" title=\"Inferior gluteal nerve\" rel=\"external_link\" target=\"_blank\">inferior gluteal nerve<\/a> (a branch nerve of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacral_plexus\" title=\"Sacral plexus\" rel=\"external_link\" target=\"_blank\">sacral plexus<\/a>) and extends from the pelvis to the gluteal region, then traverses the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greater_sciatic_foramen\" title=\"Greater sciatic foramen\" rel=\"external_link\" target=\"_blank\">greater sciatic foramen<\/a> (opening) from behind and to the middle to then join the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sciatic_nerve\" title=\"Sciatic nerve\" rel=\"external_link\" target=\"_blank\">sciatic nerve<\/a>. The inferior gluteal nerve divides into three (3) collateral branches: (i) the <b>gluteus branch<\/b>, (ii) the <b>perineal branch<\/b>, and (iii) the <b>femoral branch<\/b>. The first ramification \u2014 the gluteus branch \u2014 is a branch nerve that is very close to the emergence of the inferior gluteal nerve to the area, next to the inferior border of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyramidalis_muscle\" title=\"Pyramidalis muscle\" rel=\"external_link\" target=\"_blank\">pyramidalis muscle<\/a>.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> As it arises, the inferior gluteal nerve then divides into four (4) or more <b>fillets<\/b> (bands of nerve fibres) that travel (in a crow\u2019s-foot configuration) between the gluteus maximus muscle and its (front) anterior fascia; the thickest nerve-bands are the superior-most and the inferior-most fillets. The superior-most fillet runs almost vertically, near the sacrum, and innervates the superior portion of the gluteus muscle; the inferior-most fillet, which has the greatest calibre, travels very close and parallel to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacrotuberous_ligament\" title=\"Sacrotuberous ligament\" rel=\"external_link\" target=\"_blank\">sacrotuberous ligament<\/a>; the inferior-most fillet provides fine-gauge branch-nerve ramifications that innervate the gluteus muscle through its anterior (front) face.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2015)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>In surgical and body contouring praxis, the plastic surgeon creates the <b>implant-pocket<\/b> \u2014 either for the gluteal prosthesis or for the injections of autologous fat \u2014 by undermining the gluteus maximus muscle with a dissection technique that avoids the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacrum\" title=\"Sacrum\" rel=\"external_link\" target=\"_blank\">sacrum<\/a>, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacrotuberous_ligament\" title=\"Sacrotuberous ligament\" rel=\"external_link\" target=\"_blank\">sacrotuberous ligament<\/a>, and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tuberosity_of_the_ischium\" class=\"mw-redirect\" title=\"Tuberosity of the ischium\" rel=\"external_link\" target=\"_blank\">tuberosity of the ischium<\/a>; which, if accidentally cut, might isolate the posterior (back) portion of the muscle and lead to denervation, the loss of nerve function and of innervation.<sup id=\"rdp-ebb-cite_ref-Gluteoplasty_2-1\" class=\"reference\"><a href=\"#cite_note-Gluteoplasty-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Vascularization\">Vascularization<\/span><\/h3>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superior_gluteal_artery\" title=\"Superior gluteal artery\" rel=\"external_link\" target=\"_blank\">superior gluteal artery<\/a>, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inferior_gluteal_artery\" title=\"Inferior gluteal artery\" rel=\"external_link\" target=\"_blank\">inferior gluteal artery<\/a>, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superior_gluteal_veins\" title=\"Superior gluteal veins\" rel=\"external_link\" target=\"_blank\">superior gluteal veins<\/a>, and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inferior_gluteal_veins\" title=\"Inferior gluteal veins\" rel=\"external_link\" target=\"_blank\">inferior gluteal veins<\/a> irrigate the gluteus maximus muscle with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arterial_blood\" title=\"Arterial blood\" rel=\"external_link\" target=\"_blank\">arterial<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Venous_blood\" title=\"Venous blood\" rel=\"external_link\" target=\"_blank\">venous<\/a> blood. The vascularization, the entrance of the blood vessels to the muscle tissues, occurs at the anterior (front) face of the muscle, very close to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacrum\" title=\"Sacrum\" rel=\"external_link\" target=\"_blank\">sacrum<\/a>. As the arteries and the veins enter the mass of the gluteal muscle, they divide into narrower blood-vessel ramifications (configured like the horizontal branches of a tree), most of which travel parallel to the muscle fibres.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2015)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>In surgical and body contouring praxis, the plastic surgeon effects the implant-pocket undermining of the gluteus maximus muscle by carefully separating the muscle fibres to avoid severing the pertinent blood vessels, which would interfere with the blood irrigation of the muscle tissue. Therefore, to create an implant-pocket, either for a gluteal prosthesis or for lipoinjection, a low-angle muscle-dissection is performed in order to avoid the risk of severing any major branch \u2014 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superior_gluteal_artery\" title=\"Superior gluteal artery\" rel=\"external_link\" target=\"_blank\">superior<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inferior_gluteal_artery\" title=\"Inferior gluteal artery\" rel=\"external_link\" target=\"_blank\">inferior<\/a> \u2014 of the gluteal artery, which travels very close to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacrum\" title=\"Sacrum\" rel=\"external_link\" target=\"_blank\">sacrum<\/a> and to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacrotuberous_ligament\" title=\"Sacrotuberous ligament\" rel=\"external_link\" target=\"_blank\">sacrotuberous ligament<\/a>.<sup id=\"rdp-ebb-cite_ref-Gluteoplasty_2-2\" class=\"reference\"><a href=\"#cite_note-Gluteoplasty-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Surgical_procedures\">Surgical procedures<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Medical_therapy\">Medical therapy<\/span><\/h3>\n<p>The resolution of the defects and deformities of the muscles of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteal_region\" class=\"mw-redirect\" title=\"Gluteal region\" rel=\"external_link\" target=\"_blank\">gluteal region<\/a> (the buttocks and the thighs) of the human body cannot be realized with medical therapy; thus, for example, a treatment with cellulite-diminishing cream is ineffective for correcting the corresponding physical faults respectively presented by the man and by the woman patient.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Surgical_therapy\">Surgical therapy<\/span><\/h3>\n<p>While the resolution of the defects and deformities of the <b>gluteal region<\/b> can be realized surgically, the assessment of the degree of severity of the injury organizes treatment therapies into three types: (i) buttocks augmentation, (ii) buttocks reduction, and (iii) contour irregularity treatments that combine surgery and liposculpture (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Liposuction\" title=\"Liposuction\" rel=\"external_link\" target=\"_blank\">liposuction<\/a> and fat-injection).<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-2\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Buttocks_augmentation_treatments\">Buttocks augmentation treatments<\/span><\/h3>\n<h4><span class=\"mw-headline\" id=\"Gluteal_implants\">Gluteal implants<\/span><\/h4>\n<p>The augmentation of the buttocks is realized with a <b>gluteal implant<\/b>, which is emplaced under each <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteus_maximus_muscle\" class=\"mw-redirect\" title=\"Gluteus maximus muscle\" rel=\"external_link\" target=\"_blank\">gluteus maximus muscle<\/a>; the insertion of the buttock prosthesis is through a midline incision (5\u20138-cm-wide) over the tailbone (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Coccyx\" title=\"Coccyx\" rel=\"external_link\" target=\"_blank\">coccyx<\/a>). Augmentation with a gluteal implant is the method most effective for enlarging the buttocks of the man or of the woman whose body possesses few stores of excess <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adipose_fat\" class=\"mw-redirect\" title=\"Adipose fat\" rel=\"external_link\" target=\"_blank\">adipose fat<\/a> in the lower portion of the trunk, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Buttocks\" title=\"Buttocks\" rel=\"external_link\" target=\"_blank\">buttocks<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thigh\" title=\"Thigh\" rel=\"external_link\" target=\"_blank\">thighs<\/a>, the anatomic regions where the human body usually stores excess body fat. Post-operatively, because of the cutting (incising) into the flesh of the tailbone muscles, the full healing of the augmented tissues can be approximately 6\u20138 months, in the course of which the gluteal-muscle tissues relax, and the settled buttocks prostheses are integrated to the gluteal region.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> The implantation procedure can be performed upon a patient who is either <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sedation\" title=\"Sedation\" rel=\"external_link\" target=\"_blank\">sedated<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anaesthesia\" class=\"mw-redirect\" title=\"Anaesthesia\" rel=\"external_link\" target=\"_blank\">anaesthetized<\/a>, either under <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_anaesthesia\" title=\"General anaesthesia\" rel=\"external_link\" target=\"_blank\">general anaesthesia<\/a> or under <a href=\"https:\/\/en.wikipedia.org\/wiki\/Local_anaesthesia\" class=\"mw-redirect\" title=\"Local anaesthesia\" rel=\"external_link\" target=\"_blank\">local anaesthesia<\/a>. The usual operating-room time for a buttocks augmentation procedure is approximately 2 hours. The procedure can be managed either as an overnight in-patient treatment or as a hospital outpatient treatment. Given the nature of the surgical incisions to the gluteus maximus muscles, the therapeutic management of post-surgical pain (at the surgical-wound sites) and normal tissue-healing usually require a 4-6-week convalescence, after which the patient resumes his or her normal-life activities.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-3\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Lipoinjection\">Lipoinjection<\/span><\/h4>\n<p>The augmentation and contouring of the buttocks with (lipoinjection) therapy is realized with the excess <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adipose_fat\" class=\"mw-redirect\" title=\"Adipose fat\" rel=\"external_link\" target=\"_blank\">adipose-fat tissue<\/a> harvested from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdomen\" title=\"Abdomen\" rel=\"external_link\" target=\"_blank\">abdomen<\/a>, flanks, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thigh\" title=\"Thigh\" rel=\"external_link\" target=\"_blank\">thighs<\/a> of the patient. In 1987 Dr. Eduardo Krulig, a Venezuelan Plastic Surgeon describes the technique, using the name \"Lipoinjection\" for the first time, mentioning the regions of the body where the technique is useful.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> The gentle liposuction applied to harvest the autologous fat minimally disturbs the local tissues, especially the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Connective_tissue\" title=\"Connective tissue\" rel=\"external_link\" target=\"_blank\">connective-tissue layer<\/a> between the skin and the immediate subcutaneous muscle tissues. Then, the harvested fat is injected to the pertinent body area of the gluteal region, through a fine-gauge cannula inserted through a small incision, which produces a short and narrow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scar\" title=\"Scar\" rel=\"external_link\" target=\"_blank\">scar<\/a>. Lipoinjection contouring and augmentation with the patient\u2019s own body fat avoids the possibility of tissue rejection, and is physically less invasive than buttocks-implant surgery. Therefore, depending upon the health of the patient, the convalescence period allows him or her to resume daily, normal-life activities at 2-days post-operative, and the full spectrum of physical activity at 2-weeks post-operative. Furthermore, the liposuction harvesting of the patient\u2019s excess body fat improves the aesthetic appearance of the body fat donor-sites.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> Nonetheless, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physiology\" title=\"Physiology\" rel=\"external_link\" target=\"_blank\">physiologically<\/a>, the human body\u2019s normal, health-management chemistry does resorb (break down and eliminate) some of the injected adipose-fat tissue, and so might diminish the augmentation. According to the degree of diminishment of the volume and contour caused by the fat-resorption, the patient might require additional sessions of fat-transfer therapy to achieve the desired size, shape, and contour of the buttocks.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-4\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Body_contouring\">Body contouring<\/span><\/h4>\n<p>The augmentation of the buttocks, by rearranging and enhancing the pertinent muscle and fat tissues of the gluteal region, is realized with a combined gluteoplasty procedure of <b>surgery<\/b> (subcutaneous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flap_(surgery)\" title=\"Flap (surgery)\" rel=\"external_link\" target=\"_blank\">dermal-fat flaps<\/a>) and <b>liposculpture<\/b> (fat-suction, fat-injection). Therapeutically, such a combined correction-and-enhancement procedure is a realistic and feasible lower-body-lift treatment for the man and for the woman patient who has undergone massive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Weight_loss\" title=\"Weight loss\" rel=\"external_link\" target=\"_blank\">weight loss<\/a> (MWL) in the course of resolving <a href=\"https:\/\/en.wikipedia.org\/wiki\/Obesity\" title=\"Obesity\" rel=\"external_link\" target=\"_blank\">obesity<\/a> with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bariatric_surgery\" title=\"Bariatric surgery\" rel=\"external_link\" target=\"_blank\">bariatric surgery<\/a>.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> In the case of the man or woman who presents under-projected, flat buttocks (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypoplasia\" title=\"Hypoplasia\" rel=\"external_link\" target=\"_blank\">gluteal hypoplasia<\/a>), and a degree of gluteal-muscle ptosis (prolapsation, falling forward), wherein neither gluteal-implant surgery nor lipoinjection would be adequate to restoring the natural anatomic contour of the gluteal region, the application of a combined treatment of autologous dermal-fat flap surgery and lipoinjection can achieve the required functional correction and aesthetic contour.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-5\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Buttocks_reduction_treatments\">Buttocks reduction treatments<\/span><\/h3>\n<p>The methods for reducing the size of the buttocks include the varieties of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liposuction\" title=\"Liposuction\" rel=\"external_link\" target=\"_blank\">liposuction<\/a>, such as <b>lipectomy<\/b> (with and without <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_ultrasonography\" class=\"mw-redirect\" title=\"Medical ultrasonography\" rel=\"external_link\" target=\"_blank\">ultrasonic<\/a> enhancement) to reduce excess body fat, and <b>superficial liposculpture<\/b>, to reshape, refine, and re-establish the natural contour of the body. The usual buttocks-reduction treatment is lipectomy with applied <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumescence\" title=\"Tumescence\" rel=\"external_link\" target=\"_blank\">tumescence<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anaesthesia\" class=\"mw-redirect\" title=\"Anaesthesia\" rel=\"external_link\" target=\"_blank\">anaesthesia<\/a>, wherein the body fat is harvested by aspiration (suction) through a small-gauge cannula (2\u20134 mm) that is inserted through a small incision, either to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intergluteal_cleft\" title=\"Intergluteal cleft\" rel=\"external_link\" target=\"_blank\">intergluteal sulcus<\/a> (the butt-crack), or to the upper area of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteus_maximus_muscle\" class=\"mw-redirect\" title=\"Gluteus maximus muscle\" rel=\"external_link\" target=\"_blank\">gluteus maximus muscle<\/a> proper.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-6\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Ultrasonic_lipectomy\">Ultrasonic lipectomy<\/span><\/h4>\n<p>Ultrasonically-assisted liposuction can quickly remove a large volume of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adipose_fat\" class=\"mw-redirect\" title=\"Adipose fat\" rel=\"external_link\" target=\"_blank\">body fat<\/a> for the correction of a notable occurrence of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lipodystrophy\" title=\"Lipodystrophy\" rel=\"external_link\" target=\"_blank\">lipodystrophy<\/a>, a deposit of adipose fat to the buttocks and related anatomic areas. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_ultrasonography\" class=\"mw-redirect\" title=\"Medical ultrasonography\" rel=\"external_link\" target=\"_blank\">ultrasonic<\/a> liposuction machine liquefies the excess fat tissue, and so more readily facilitates its removal with conventional suction-lipectomy. The quick fat-harvesting allowed by the ultrasonic lipectomy technique has eliminated the larger (long and wide) surgical incisions that once were required for removing a large volume of adipose tissue. Nonetheless, because of the sensitivity of the gluteal-region tissues, the skin of the pertinent donor-site is cooled in order to prevent ultrasonic heat damage caused by the liquefying and removal of the excess adipose fat.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-7\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Superficial_liposculpture\">Superficial liposculpture<\/span><\/h4>\n<p>Reshaping the buttocks with liposculpture is performed with a small cannula (2 mm) specifically for contouring superficial body fat, the configuration of which (number of open ports) is determined by the type and the degree of gluteal correction to be realized. To sculpt rounded contours to square-shaped buttocks muscles, superficial liposculpture allows the plastic surgeon to control the injection-rate of the fat-volume. Moreover, superficial <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liposuction\" title=\"Liposuction\" rel=\"external_link\" target=\"_blank\">liposuction<\/a> can be combined with other treatment methods for contouring the gluteal region to achieve the required functional, anatomic correction, and the aesthetic enhancement sought by the patient, such as reshaping the lateral area of the buttocks into an athletic form.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> The study <i>Contouring the Gluteal Region with Tumescent Liposculpture<\/i> (2011) indicated that effective, gluteal-region contouring is best achieved by tailoring the liposuction-reduction and the lipoinjection-augmentation techniques to the anatomic topography of the body areas to be corrected.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> Furthermore, the study <i>Contouring of the Gluteal Region in Women: Enhancement and Augmentation<\/i> (2011) indicated that natural contours of the buttocks and the thighs are effectively achieved with a combined gluteoplasty of selective liposuction and lipoinjection, which reduces the need for aggressive surgical procedures, decreases the risk of medical complications, abbreviates wound-recovery-time, and lessens post-operative scarring. Combined with any buttocks-correction method, superficial liposculpture facilitates the treatment of contour irregularities, the surgical revision of scars, and the correction of gluteal-region contour depressions.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Surgical_technique\">Surgical technique<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Surgical_contouring_of_the_gluteal_region\">Surgical contouring of the gluteal region<\/span><\/h3>\n<h4><span class=\"mw-headline\" id=\"Pre-operative_matters\">Pre-operative matters<\/span><\/h4>\n<p>To meet the functional requirements and the aesthetic expectations (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_image\" title=\"Body image\" rel=\"external_link\" target=\"_blank\">body image<\/a>) of the patient, the plastic surgeon establishes a realistic and feasible surgery plan by which to correct the anatomic contour deficiencies of the gluteal region. The surgeon and the patient determine the location of the surgical-wound <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scar\" title=\"Scar\" rel=\"external_link\" target=\"_blank\">scars<\/a>, and determine the best operative position, to allow the proper exposure of the pertinent anatomy to be corrected. Because the surgical procedure requires the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumescence\" title=\"Tumescence\" rel=\"external_link\" target=\"_blank\">tumescence<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anaesthesia\" class=\"mw-redirect\" title=\"Anaesthesia\" rel=\"external_link\" target=\"_blank\">anaesthesia<\/a> of the gluteal-region area to be corrected, the physician and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anaesthesiologist\" class=\"mw-redirect\" title=\"Anaesthesiologist\" rel=\"external_link\" target=\"_blank\">anaesthesiologist<\/a> determine the volumes of the anaesthetic and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumescent\" class=\"mw-redirect\" title=\"Tumescent\" rel=\"external_link\" target=\"_blank\">tumescent<\/a> fluids to be administered to the patient during the procedure, and so avoid the risks of drugs overdose and toxicity.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-8\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Intra-operative_matters\">Intra-operative matters<\/span><\/h4>\n<p>Once the patient is atop the operating table, the surgeon positions him or her to best expose the pertinent gluteal-region area that is to be corrected or contoured, or both; the usual operative position is the prone (face down) position, but the patient can also be positioned laterally (on his or her side). The surgical correction plan can be delineated and marked to the patient\u2019s body when he or she is awake (before sedation or anaesthesia) or it can be delineated when the patient is on the operating table (already <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sedation\" title=\"Sedation\" rel=\"external_link\" target=\"_blank\">sedated<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anaesthesia\" class=\"mw-redirect\" title=\"Anaesthesia\" rel=\"external_link\" target=\"_blank\">anaesthetized<\/a>). In operative praxis, the second option allows the plastic surgeon greater freedom to properly manipulate the patient into the position best suited for performing the body-contouring surgery.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2015)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Operative_matters\">Operative matters<\/span><\/h4>\n<p>Once the patient is in the operative position, the surgeon begins the liposuction correction by making incisions to the marks of the surgical-correction plan, and then infiltrates (injects) a solution of anaesthesia- and tumescence-inducing drugs, usually a combination of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lidocaine\" title=\"Lidocaine\" rel=\"external_link\" target=\"_blank\">lidocaine<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epinephrine\" class=\"mw-redirect\" title=\"Epinephrine\" rel=\"external_link\" target=\"_blank\">epinephrine<\/a>. The volume of the anaesthetic-tumescent solution is gradually infiltrated to the pertinent gluteal area, in order to avoid the nerves and the deeper anatomic structures of the gluteus maximus muscle. The particular anatomic features to be contoured determine the types of cannula (gauge, size, grade) used to effect and control the harvesting of excess adipose fat from the patient\u2019s body.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2015)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>For a lipoinjection augmentation, the surgeon first dissects and prepares the augmentation-pocket to which will be injected the autologous fat-tissue. The surgical creation (muscle dissection) of the augmentation-pocket avoids the gluteal innervation (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Superior_gluteal_nerve\" title=\"Superior gluteal nerve\" rel=\"external_link\" target=\"_blank\">superior gluteal nerve<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inferior_gluteal_nerve\" title=\"Inferior gluteal nerve\" rel=\"external_link\" target=\"_blank\">inferior gluteal nerve<\/a>) and the vascular system (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Venous_blood\" title=\"Venous blood\" rel=\"external_link\" target=\"_blank\">venous<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arterial_blood\" title=\"Arterial blood\" rel=\"external_link\" target=\"_blank\">arterial<\/a>) of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteus_maximus_muscle\" class=\"mw-redirect\" title=\"Gluteus maximus muscle\" rel=\"external_link\" target=\"_blank\">gluteus maximus muscle<\/a>. Afterwards, the surgeon <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" title=\"Surgical suture\" rel=\"external_link\" target=\"_blank\">sutures<\/a> the dissection-incision and secures it with adhesive tape to ensure that the augmentation-pocket remains open, as dissected, ready to receive the injections of adipose fat. For the revision of scars, with surgery and injections of autologous fat, or with allopathic synthetic fillers, the surgeon applies subcuticular closures to the incision wounds, which then are bandaged.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-9\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Post-operative_matters\">Post-operative matters<\/span><\/h4>\n<p>After completing the surgical corrections and the lipoinjection contouring of the pertinent area(s) of the gluteal region, the surgeon thoroughly examines the patient to ensure his or her general recovery from the operation; and examines each surgical incision to ascertain that it is correctly sutured and taped, in order to facilitate the uneventful healing of the gluteus-muscle tissues, without medical complications. The patient is advised to avoid exercise and strenuous physical activity until 3-weeks post-operative; how to properly care for surgical-incision wounds; and how to wear a compression garment that will keep in place the surgically corrected tissues, and so ensure their healing as a whole anatomic unit of the gluteal region.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-10\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Follow-up_and_convalescence\">Follow-up and convalescence<\/span><\/h4>\n<p>The physician advises the patient who has undergone a <b>surgical contouring<\/b> of the buttocks with gluteal implants, that, although immediate results can be observed, the final, corrected body contour usually is observed at 6-months post-operative, and at 1-year post-operative, depending upon the tissue-healing capabilities of the patient\u2019s body. The <b>liposculpture<\/b> patient usually requires approximately 6 months, and occasionally 1 year before producing the final, corrected body contour. For both procedures, at approximately 1-month post-operative, marked aesthetic improvement is noticeable in the corrected body areas, as is the elimination of the initial, post-operative weight gain caused by the body\u2019s retention of the infiltrated, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anaesthesia\" class=\"mw-redirect\" title=\"Anaesthesia\" rel=\"external_link\" target=\"_blank\">anaesthetic<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumescence\" title=\"Tumescence\" rel=\"external_link\" target=\"_blank\">tumescent<\/a>, fluids. The patient is advised to wear a compression garment to contain swelling and to immobilize the corrected tissues, so that they heal as one anatomic unit of the gluteal region. Moreover, throughout the convalescence, to facilitate shrinking the skin to the new, corrected body contour, and to resolve unevenness, wrinkles to the skin, and localized swelling, the continual application of massage and (occasional) ultrasound treatments can facilitate the diminishment of the post-operative conditions.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-11\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Complications\">Complications<\/span><\/h4>\n<p>The surgical and liposculpture contouring of the human body presents possible medical complications such as: the psychological \u2014 unmet <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_image\" title=\"Body image\" rel=\"external_link\" target=\"_blank\">body image<\/a> expectations of aesthetic improvement; the physical \u2014 uneven contour, local and general; the physiologic \u2014 toxic reactions to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Allergic_reactions_to_anaesthesia\" title=\"Allergic reactions to anaesthesia\" rel=\"external_link\" target=\"_blank\">anaesthesic<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumescence\" title=\"Tumescence\" rel=\"external_link\" target=\"_blank\">tumescent<\/a> drugs; and the nervous \u2014 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paresthesia\" title=\"Paresthesia\" rel=\"external_link\" target=\"_blank\">paresthesia<\/a>, localized areas of perduring numbness in the corrected portion(s) of the gluteal region.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-12\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup> The medical complications possible to a <b>surgical buttocks augmentation<\/b> procedure, the submuscular emplacement of a gluteal implant, include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wound_dehiscence\" title=\"Wound dehiscence\" rel=\"external_link\" target=\"_blank\">surgical-wound dehiscence<\/a> that exposes the implant, revision surgery, rupture of the implant, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Seroma\" title=\"Seroma\" rel=\"external_link\" target=\"_blank\">seroma<\/a> (a pocket of clear serous fluid), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capsular_contracture\" title=\"Capsular contracture\" rel=\"external_link\" target=\"_blank\">capsular contracture<\/a>, asymmetry of the corrected area, shifting of the implant, surgical over-correction, injury to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sciatic_nerve\" title=\"Sciatic nerve\" rel=\"external_link\" target=\"_blank\">sciatic nerve<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paresthesia\" title=\"Paresthesia\" rel=\"external_link\" target=\"_blank\">paresthesia<\/a> (tingling skin). The medical complications possible to a <b>liposclupture buttocks augmentation<\/b> include the bodily resorption of some of the injected adipose fat, asymmetric contour of the corrected body area, an irregular contour to the body, seroma, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abscess\" title=\"Abscess\" rel=\"external_link\" target=\"_blank\">abscess<\/a> (pus enclosed by inflamed tissue), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cellulitis\" title=\"Cellulitis\" rel=\"external_link\" target=\"_blank\">cellulitis<\/a> (subcutaneous connective-tissue inflammation), and paresthesia.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-13\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Dangers\">Dangers<\/span><\/h3>\n<p>Like most medical procedures, buttock augmentation come with risks some of which can be life threatening. A total of 413 Mexican plastic surgeons reported 64 deaths related to liposuction, with 13 deaths caused by gluteal lipoinjection. In Colombia, nine deaths were documented. Of the 13 deaths in Mexico, eight (61.6 percent) occurred during lipoinjection, whereas the remaining five (38.4 percent) occurred within the first 24 hours. In Colombia, six deaths (77.7 percent) occurred during surgery and three occurred (22.2 percent) immediately after surgery.<a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/journals.lww.com\/plasreconsurg\/Abstract\/2015\/07000\/Deaths_Caused_by_Gluteal_Lipoinjection___What_Are.11.aspx\" target=\"_blank\">[1]<\/a> Secondary lymphoedema of the lower extremities has been reported as an unusual side effect of liquid silicone injection on the hips and buttock while thromboembolism, implant displacement and explosion has also been listed as some of the dangers.<a rel=\"external_link\" class=\"external autonumber\" href=\"https:\/\/www.karger.com\/Article\/Abstract\/77845\" target=\"_blank\">[2]<\/a><a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.publichealth.com.ng\/six-dangerous-side-effects-of-buttocks-augmentation-and-implants\" target=\"_blank\">[3]<\/a> The surgical and liposculpture contouring of the human body presents possible medical complications such as: the psychological \u2014 unmet <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_image\" title=\"Body image\" rel=\"external_link\" target=\"_blank\">body image<\/a> expectations of aesthetic improvement; the physical \u2014 uneven contour, local and general; the physiologic \u2014 toxic reactions to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Allergic_reactions_to_anaesthesia\" title=\"Allergic reactions to anaesthesia\" rel=\"external_link\" target=\"_blank\">anaesthesic<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumescence\" title=\"Tumescence\" rel=\"external_link\" target=\"_blank\">tumescent<\/a> drugs; and the nervous \u2014 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paresthesia\" title=\"Paresthesia\" rel=\"external_link\" target=\"_blank\">paresthesia<\/a>, localized areas of perduring numbness in the corrected portion(s) of the gluteal region.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-14\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup> The medical complications possible to a <b>surgical buttocks augmentation<\/b> procedure, the submuscular emplacement of a gluteal implant, include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wound_dehiscence\" title=\"Wound dehiscence\" rel=\"external_link\" target=\"_blank\">surgical-wound dehiscence<\/a> that exposes the implant, revision surgery, rupture of the implant, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Seroma\" title=\"Seroma\" rel=\"external_link\" target=\"_blank\">seroma<\/a> (a pocket of clear serous fluid), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capsular_contracture\" title=\"Capsular contracture\" rel=\"external_link\" target=\"_blank\">capsular contracture<\/a>, asymmetry of the corrected area, shifting of the implant, surgical over-correction, injury to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sciatic_nerve\" title=\"Sciatic nerve\" rel=\"external_link\" target=\"_blank\">sciatic nerve<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paresthesia\" title=\"Paresthesia\" rel=\"external_link\" target=\"_blank\">paresthesia<\/a> (tingling skin). The medical complications possible to a <b>liposclupture buttocks augmentation<\/b> include the bodily resorption of some of the injected adipose fat, asymmetric contour of the corrected body area, an irregular contour to the body, seroma, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abscess\" title=\"Abscess\" rel=\"external_link\" target=\"_blank\">abscess<\/a> (pus enclosed by inflamed tissue), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cellulitis\" title=\"Cellulitis\" rel=\"external_link\" target=\"_blank\">cellulitis<\/a> (subcutaneous connective-tissue inflammation), and paresthesia.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-15\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h5><span class=\"mw-headline\" id=\"Unmet_expectations\">Unmet expectations<\/span><\/h5>\n<p>In the surgical praxis of body contouring therapy, the patient\u2019s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_image\" title=\"Body image\" rel=\"external_link\" target=\"_blank\">body-image<\/a> expectations can be different from the contoured body that is the outcome of the performed surgical operation. Such unmet aesthetic expectations can be avoided at the pre-operative consultation stage, whereby, with informed consent, the physician and the patient jointly establish a realistic and feasible surgery plan to achieve a mutually satisfactory corrective outcome (functional and aesthetic) of the operation to the gluteal region, the buttock- and thigh-areas.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-16\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h5><span class=\"mw-headline\" id=\"Contour_problems\">Contour problems<\/span><\/h5>\n<p>Contour problems of the corrected gluteal region can be prevented with the operational use of small-gauge cannulas (ca. 2.0 mm) specifically for superficial liposuction; and with the application of cross-pattern harvesting of the excess body fat, to avoid removing too much <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adipose_fat\" class=\"mw-redirect\" title=\"Adipose fat\" rel=\"external_link\" target=\"_blank\">adipose fat<\/a> tissue, which might disfigure the contour of the patient\u2019s fat-donor area. The possible contour problems that might arise from ultrasonic liposuction are skin burns and hypertrophic scarring, which might occur if the fat-donor area skin is not cooled and protected during the fat harvest. To that end, the infusion of a tumescence-inducing solution to the fat-donor area(s) assists in cooling the patient\u2019s skin during the ultrasonic lipo-harvesting; likewise, the application of moist towels, a skin protector, and the constant cooling-fluid infiltration of the cannula in an integrated sheath.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-17\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h5><span id=\"rdp-ebb-Drug_complications_.28anaesthetic_and_tumescent.29\"><\/span><span class=\"mw-headline\" id=\"Drug_complications_(anaesthetic_and_tumescent)\">Drug complications (anaesthetic and tumescent)<\/span><\/h5>\n<p>The infiltration of a solution of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anaesthesia\" class=\"mw-redirect\" title=\"Anaesthesia\" rel=\"external_link\" target=\"_blank\">anaesthesia<\/a>- and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumescence\" title=\"Tumescence\" rel=\"external_link\" target=\"_blank\">tumescence<\/a>-inducing drugs can present medical complications such as a fluid overload of the tissues, the inadequate replacement of the infiltrated solution, and the partitioning (separation) of a single infiltration into several pools, which then are removed by suction lipectomy. Moreover, during anaesthesia, maintaining the patient\u2019s stable blood pressure can be difficult, which increases the possibility of bleeding, and the possibility that <a href=\"https:\/\/en.wikipedia.org\/wiki\/Allergic_reactions_to_anaesthesia\" title=\"Allergic reactions to anaesthesia\" rel=\"external_link\" target=\"_blank\">anaesthetic toxicity<\/a> can occur if excessive doses are administered by infiltration; the symptoms are manifested as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Central_nervous_system\" title=\"Central nervous system\" rel=\"external_link\" target=\"_blank\">central nervous system<\/a> (CNS) occurrences of drug-induced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anxiety\" title=\"Anxiety\" rel=\"external_link\" target=\"_blank\">anxiety<\/a>, apprehension, restlessness, nervousness, disorientation, confusion, dizziness, blurred vision, tremors, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nausea\" title=\"Nausea\" rel=\"external_link\" target=\"_blank\">nausea<\/a>, vomiting, shivering, and seizures; likewise, as manifestations of drowsiness, unconsciousness, respiratory depression, and respiratory arrest. Furthermore, the toxicity symptoms of a tumescence-inducing drug (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epinephrine\" class=\"mw-redirect\" title=\"Epinephrine\" rel=\"external_link\" target=\"_blank\">epinephrine<\/a>) might cause such CNS symptoms, for which reason the operative application of a tumescent drug is limited throughout the operation.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-18\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h5><span id=\"rdp-ebb-Numbness_.28paresthesia.29\"><\/span><span class=\"mw-headline\" id=\"Numbness_(paresthesia)\">Numbness (paresthesia)<\/span><\/h5>\n<p>Post-operatively, local areas of numbness (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Paresthesia\" title=\"Paresthesia\" rel=\"external_link\" target=\"_blank\">paresthesia<\/a>) might occur in the contoured portion(s) of the gluteal region, and might perdure for a long time after the surgery. Hence, the patient is advised to facilitate the re-sensitizing of the numb area(s) with applications of gentle massage, to prevent the development of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroma\" title=\"Neuroma\" rel=\"external_link\" target=\"_blank\">neuroma<\/a> complication, and to alleviate pain. Nonetheless, depending upon the tissue-healing capabilities of the patient, he or she can recover in full at 2-years post-operative.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-19\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Outcome\">Outcome<\/span><\/h3>\n<p>The outcome of a buttocks-contouring procedure depends upon the specific defect or deformity that can be effectively corrected with liposculpture, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_ultrasonography\" class=\"mw-redirect\" title=\"Medical ultrasonography\" rel=\"external_link\" target=\"_blank\">ultrasonic<\/a> or not. Nonetheless, depressed scars and deep <a href=\"https:\/\/en.wikipedia.org\/wiki\/Morphology_(biology)\" title=\"Morphology (biology)\" rel=\"external_link\" target=\"_blank\">morphological<\/a> defects are difficult to correct because of the curvature of the buttocks as an anatomic unit, and because of the scar-contracting elements of the tissues across the gluteal curvature. In such a case, although the injection of (autologous or artificial) tissue fillers to correct the defect or the deformity might be impermanent \u2014 it usually will remedy the functional and aesthetic shortcoming(s) required by the patient, which is the therapeutic purpose of gluteoplasty.<sup id=\"rdp-ebb-cite_ref-EMedicine1271806_1-20\" class=\"reference\"><a href=\"#cite_note-EMedicine1271806-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-EMedicine1271806-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-EMedicine1271806_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-8\" rel=\"external_link\"><sup><i><b>i<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-9\" rel=\"external_link\"><sup><i><b>j<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-10\" rel=\"external_link\"><sup><i><b>k<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-11\" rel=\"external_link\"><sup><i><b>l<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-12\" rel=\"external_link\"><sup><i><b>m<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-13\" rel=\"external_link\"><sup><i><b>n<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-14\" rel=\"external_link\"><sup><i><b>o<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-15\" rel=\"external_link\"><sup><i><b>p<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-16\" rel=\"external_link\"><sup><i><b>q<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-17\" rel=\"external_link\"><sup><i><b>r<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-18\" rel=\"external_link\"><sup><i><b>s<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-19\" rel=\"external_link\"><sup><i><b>t<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EMedicine1271806_1-20\" rel=\"external_link\"><sup><i><b>u<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><i><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/emedicine.medscape.com\/article\/1271806-overview\" target=\"_blank\">Buttocks Contouring<\/a><\/i> at <a href=\"https:\/\/en.wikipedia.org\/wiki\/EMedicine\" title=\"EMedicine\" rel=\"external_link\" target=\"_blank\">eMedicine<\/a><\/span>\n<\/li>\n<li id=\"cite_note-Gluteoplasty-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Gluteoplasty_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gluteoplasty_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gluteoplasty_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gonzalez, Raul (2004). \"Augmentation Gluteoplasty: The XYZ Method\". <i>Aesthetic Plastic Surgery<\/i>. <b>28<\/b> (6): 417\u201325. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00266-004-3130-6\" target=\"_blank\">10.1007\/s00266-004-3130-6<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15633021\" target=\"_blank\">15633021<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Aesthetic+Plastic+Surgery&rft.atitle=Augmentation+Gluteoplasty%3A+The+XYZ+Method&rft.volume=28&rft.issue=6&rft.pages=417-25&rft.date=2004&rft_id=info%3Adoi%2F10.1007%2Fs00266-004-3130-6&rft_id=info%3Apmid%2F15633021&rft.aulast=Gonzalez&rft.aufirst=Raul&rfr_id=info%3Asid%2Fen.wikipedia.org%3AButtock+augmentation\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Reid, R. W. (1920). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1262878\" target=\"_blank\">\"Motor Points in Relation to the Surface of the Body\"<\/a>. <i>Journal of Anatomy<\/i>. <b>54<\/b> (Pt 4): 271\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1262878\" target=\"_blank\">1262878<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17103903\" target=\"_blank\">17103903<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Anatomy&rft.atitle=Motor+Points+in+Relation+to+the+Surface+of+the+Body&rft.volume=54&rft.issue=Pt+4&rft.pages=271-5&rft.date=1920&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1262878&rft_id=info%3Apmid%2F17103903&rft.aulast=Reid&rft.aufirst=R.+W.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1262878&rfr_id=info%3Asid%2Fen.wikipedia.org%3AButtock+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/milwaukeeplasticsurgery.com\/body-procedures\/butt-lift-augmentation\/\" target=\"_blank\">\"Brazilian Butt Lift\"<\/a>. Dr. Mark Bosbous<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">23 November<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Brazilian+Butt+Lift&rft.pub=Dr.+Mark+Bosbous&rft_id=http%3A%2F%2Fmilwaukeeplasticsurgery.com%2Fbody-procedures%2Fbutt-lift-augmentation%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AButtock+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Flores-Lima, Gerardo; Eppley, Barry L. (2009). \"Body Contouring with Solid Silicone Implants\". <i>Aesthetic Plastic Surgery<\/i>. <b>33<\/b> (2): 140\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00266-008-9292-x\" target=\"_blank\">10.1007\/s00266-008-9292-x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19123020\" target=\"_blank\">19123020<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Aesthetic+Plastic+Surgery&rft.atitle=Body+Contouring+with+Solid+Silicone+Implants&rft.volume=33&rft.issue=2&rft.pages=140-6&rft.date=2009&rft_id=info%3Adoi%2F10.1007%2Fs00266-008-9292-x&rft_id=info%3Apmid%2F19123020&rft.aulast=Flores-Lima&rft.aufirst=Gerardo&rft.au=Eppley%2C+Barry+L.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AButtock+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Krulig, Eduardo (April 1987). \"Lipo-injection\". <i>American Journal of Cosmetic Surgery<\/i>. <b>4<\/b> (2): 123\u20139.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Cosmetic+Surgery&rft.atitle=Lipo-injection&rft.volume=4&rft.issue=2&rft.pages=123-9&rft.date=1987-04&rft.aulast=Krulig&rft.aufirst=Eduardo&rfr_id=info%3Asid%2Fen.wikipedia.org%3AButtock+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rosique, Rodrigo G.; Rosique, Marina J. F.; De Moraes, Carlos Gustavo (2015). \"Gluteoplasty with Autologous Fat Tissue\". <i>Plastic and Reconstructive Surgery<\/i>. <b>135<\/b> (5): 1381\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FPRS.0000000000001167\" target=\"_blank\">10.1097\/PRS.0000000000001167<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25919253\" target=\"_blank\">25919253<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Gluteoplasty+with+Autologous+Fat+Tissue&rft.volume=135&rft.issue=5&rft.pages=1381-9&rft.date=2015&rft_id=info%3Adoi%2F10.1097%2FPRS.0000000000001167&rft_id=info%3Apmid%2F25919253&rft.aulast=Rosique&rft.aufirst=Rodrigo+G.&rft.au=Rosique%2C+Marina+J.+F.&rft.au=De+Moraes%2C+Carlos+Gustavo&rfr_id=info%3Asid%2Fen.wikipedia.org%3AButtock+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sozer, S; Agullo, F; Palladino, H (2008). \"Autologous augmentation gluteoplasty with a dermal fat flap\". <i>Aesthetic Surgery Journal<\/i>. <b>28<\/b> (1): 70\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.asj.2007.10.003\" target=\"_blank\">10.1016\/j.asj.2007.10.003<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19083509\" target=\"_blank\">19083509<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Aesthetic+Surgery+Journal&rft.atitle=Autologous+augmentation+gluteoplasty+with+a+dermal+fat+flap&rft.volume=28&rft.issue=1&rft.pages=70-6&rft.date=2008&rft_id=info%3Adoi%2F10.1016%2Fj.asj.2007.10.003&rft_id=info%3Apmid%2F19083509&rft.aulast=Sozer&rft.aufirst=S&rft.au=Agullo%2C+F&rft.au=Palladino%2C+H&rfr_id=info%3Asid%2Fen.wikipedia.org%3AButtock+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Le Louarn, Claude; Pascal, Jean Fran\u00e7ois (2008). \"Autologous Gluteal Augmentation after Massive Weight Loss\". <i>Plastic and Reconstructive Surgery<\/i>. <b>121<\/b> (4): 1515\u20136, author reply 1516\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.prs.0000305369.21408.92\" target=\"_blank\">10.1097\/01.prs.0000305369.21408.92<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18349690\" target=\"_blank\">18349690<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Plastic+and+Reconstructive+Surgery&rft.atitle=Autologous+Gluteal+Augmentation+after+Massive+Weight+Loss&rft.volume=121&rft.issue=4&rft.pages=1515-6%2C+author+reply+1516-7&rft.date=2008&rft_id=info%3Adoi%2F10.1097%2F01.prs.0000305369.21408.92&rft_id=info%3Apmid%2F18349690&rft.aulast=Le+Louarn&rft.aufirst=Claude&rft.au=Pascal%2C+Jean+Fran%C3%A7ois&rfr_id=info%3Asid%2Fen.wikipedia.org%3AButtock+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.drberan.com\/procedures\/body\/butt-augmentation-in-new-york\/\" target=\"_blank\">\"Butt Augmentation Surgery NYC | Butt Lift Westchester NY\"<\/a>. <i>www.drberan.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-09-06<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.drberan.com&rft.atitle=Butt+Augmentation+Surgery+NYC+%7C+Butt+Lift+Westchester+NY&rft_id=https%3A%2F%2Fwww.drberan.com%2Fprocedures%2Fbody%2Fbutt-augmentation-in-new-york%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AButtock+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Centeno, Robert F.; Young, V. Leroy (2006). \"Clinical Anatomy in Aesthetic Gluteal Body Contouring Surgery\". <i>Clinics in Plastic Surgery<\/i>. <b>33<\/b> (3): 347\u201358. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.cps.2006.05.005\" target=\"_blank\">10.1016\/j.cps.2006.05.005<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16818093\" target=\"_blank\">16818093<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinics+in+Plastic+Surgery&rft.atitle=Clinical+Anatomy+in+Aesthetic+Gluteal+Body+Contouring+Surgery&rft.volume=33&rft.issue=3&rft.pages=347-58&rft.date=2006&rft_id=info%3Adoi%2F10.1016%2Fj.cps.2006.05.005&rft_id=info%3Apmid%2F16818093&rft.aulast=Centeno&rft.aufirst=Robert+F.&rft.au=Young%2C+V.+Leroy&rfr_id=info%3Asid%2Fen.wikipedia.org%3AButtock+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cuenca-Guerra, Ramon; Lugo-Beltran, Ignacio (2006). \"Beautiful Buttocks: Characteristics and Surgical Techniques\". <i>Clinics in Plastic Surgery<\/i>. <b>33<\/b> (3): 321\u201332. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.cps.2006.04.002\" target=\"_blank\">10.1016\/j.cps.2006.04.002<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16818091\" target=\"_blank\">16818091<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinics+in+Plastic+Surgery&rft.atitle=Beautiful+Buttocks%3A+Characteristics+and+Surgical+Techniques&rft.volume=33&rft.issue=3&rft.pages=321-32&rft.date=2006&rft_id=info%3Adoi%2F10.1016%2Fj.cps.2006.04.002&rft_id=info%3Apmid%2F16818091&rft.aulast=Cuenca-Guerra&rft.aufirst=Ramon&rft.au=Lugo-Beltran%2C+Ignacio&rfr_id=info%3Asid%2Fen.wikipedia.org%3AButtock+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Avendano-Valenzuela, G.; Guerrerosantos, J. (2011). \"Contouring the Gluteal Region With Tumescent Liposculpture\". <i>Aesthetic Surgery Journal<\/i>. <b>31<\/b> (2): 200\u201313. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F1090820X10394815\" target=\"_blank\">10.1177\/1090820X10394815<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21317118\" target=\"_blank\">21317118<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Aesthetic+Surgery+Journal&rft.atitle=Contouring+the+Gluteal+Region+With+Tumescent+Liposculpture&rft.volume=31&rft.issue=2&rft.pages=200-13&rft.date=2011&rft_id=info%3Adoi%2F10.1177%2F1090820X10394815&rft_id=info%3Apmid%2F21317118&rft.aulast=Avendano-Valenzuela&rft.aufirst=G.&rft.au=Guerrerosantos%2C+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AButtock+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ali, Ahmed (2011). \"Contouring of the Gluteal Region in Women\". <i>Annals of Plastic Surgery<\/i>. <b>67<\/b> (3): 209\u201314. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FSAP.0b013e318206595b\" target=\"_blank\">10.1097\/SAP.0b013e318206595b<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21587056\" target=\"_blank\">21587056<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+Plastic+Surgery&rft.atitle=Contouring+of+the+Gluteal+Region+in+Women&rft.volume=67&rft.issue=3&rft.pages=209-14&rft.date=2011&rft_id=info%3Adoi%2F10.1097%2FSAP.0b013e318206595b&rft_id=info%3Apmid%2F21587056&rft.aulast=Ali&rft.aufirst=Ahmed&rfr_id=info%3Asid%2Fen.wikipedia.org%3AButtock+augmentation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1331\nCached time: 20181206085736\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.424 seconds\nReal time usage: 0.522 seconds\nPreprocessor visited node count: 2270\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 80501\/2097152 bytes\nTemplate argument size: 9152\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 40597\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.202\/10.000 seconds\nLua memory usage: 5.12 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 402.770 1 -total\n<\/p>\n<pre>39.95% 160.891 1 Template:Reflist\n31.89% 128.458 11 Template:Cite_journal\n23.63% 95.160 3 Template:Ambox\n20.46% 82.421 1 Template:Multiple_issues\n16.74% 67.438 6 Template:Citation_needed\n14.76% 59.452 6 Template:Fix\n11.19% 45.056 1 Template:Infobox_medical_intervention\n10.17% 40.972 1 Template:Infobox\n 7.74% 31.169 6 Template:Delink\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2359530-1!canonical and timestamp 20181206085735 and revision id 862519271\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Buttock_augmentation\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212237\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.022 seconds\nReal time usage: 0.189 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 181.173 1 - wikipedia:Buttock_augmentation\n100.00% 181.173 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8189-0!*!*!*!*!*!* and timestamp 20181217212236 and revision id 24396\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Buttock_augmentation\">https:\/\/www.limswiki.org\/index.php\/Buttock_augmentation<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","428a36600e8c3d3691be72a6b610df2e_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/7\/70\/Posterior_Hip_Muscles_3.PNG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/c\/c6\/Gluteus_maximus_muscle.PNG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b1\/Portal_Transgender.svg\/32px-Portal_Transgender.svg.png"],"428a36600e8c3d3691be72a6b610df2e_timestamp":1545081756,"65c0731a776ef7e5551a292d37e5265f_type":"article","65c0731a776ef7e5551a292d37e5265f_title":"Aortic valve replacement","65c0731a776ef7e5551a292d37e5265f_url":"https:\/\/www.limswiki.org\/index.php\/Aortic_valve_replacement","65c0731a776ef7e5551a292d37e5265f_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tAortic valve replacement\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and when to remove these template messages)\n\n A major contributor to this article appears to have a close connection with its subject. It may require cleanup to comply with Wikipedia's content policies, particularly neutral point of view. Please discuss further on the talk page. (March 2015) (Learn how and when to remove this template message)\nThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2008) (Learn how and when to remove this template message)\n \n (Learn how and when to remove this template message)\nAortic valve replacementICD-9-CM35.21-35.22V43.3[edit on Wikidata]\nAortic valve replacement is a procedure in which a patient's failing aortic valve is replaced with an artificial heart valve. The aortic valve can be affected by a range of diseases; the valve can either become leaky (aortic insufficiency) or partially blocked (aortic stenosis). Current aortic valve replacement approaches include open heart surgery via a sternotomy, minimally invasive cardiac surgery (MICS) and transcatheter aortic valve replacement (TAVR).\n\nContents \n\n1 Medical uses \n\n1.1 Aortic stenosis \n1.2 Aortic insufficiency \n\n\n2 Types of valves \n\n2.1 Tissue valves \n2.2 Mechanical valves \n2.3 Valve selection \n\n\n3 Surgical procedure \n4 Hospital stay and recovery time \n5 Outcomes \n6 Minimally invasive surgery \n7 History \n8 See also \n9 References \n10 External links \n\n\nMedical uses \nAs risk of aortic valve surgery has decreased and long term data on the survival and quality of life of people after valve replacement has become available, evidence-based guidelines for aortic valve replacement have been developed. The American Heart Association and American College of Cardiology Guidelines for the Management of Patients with Valvular Heart Disease are a widely accepted source of information for cardiologists and surgeons.[1]\n\nAortic stenosis \nPatients with severe aortic stenosis, where the aortic valve is narrowed and blood flow from the heart is obstructed, are candidates for surgery when they develop symptoms or when the heart function is impacted. Certain asymptomatic patients may also be candidates for surgery, especially if exercise stress testing is positive.\n\nAortic insufficiency \nPatients with leaky aortic valves (aortic insufficiency) often tolerate even severe degrees of insufficiency for a relatively long time before symptoms develop. Surgery is indicated for symptoms such as shortness of breath, and in cases where the heart has begun to enlarge (dilate) from pumping the increased volume of blood that leaks back through the valve.\n\nTypes of valves \nMain article: Artificial heart valve\nThere are two basic types of artificial heart valve: mechanical valves and tissue valves.\n\nTissue valves \nTissue heart valves are usually made from animal tissue, either animal heart valve tissue or animal pericardial tissue. The tissue is treated to prevent rejection and calcification.\nThere are alternatives to animal tissue valves. In some cases a homograft \u2013 a human aortic valve \u2013 can be implanted. Homograft valves are donated by patients and recovered after the patient dies. The durability of homograft valves is comparable to porcine and bovine tissue valves.[citation needed ] Another procedure for aortic valve replacement is the Ross procedure (or pulmonary autograft). In a Ross procedure, the aortic valve is removed and replaced with the patient's own pulmonary valve. A pulmonary homograft (pulmonary valve taken from a cadaver) is then used to replace the patient's own pulmonary valve. This procedure was first used in 1967 and is used primarily in children, as the procedure allows the patient's own pulmonary valve (now in the aortic position) to grow with the child.\n\nMechanical valves \nMechanical valves are designed to outlast the patient, and have typically been stress-tested to last several hundred years. Although mechanical valves are long-lasting and generally present a one-surgery solution, there is an increased risk of blood clots forming with mechanical valves. As a result, mechanical valve recipients must take anticoagulant (blood thinning) drugs such as warfarin for the rest of their lives, making the patient more prone to bleeding. The sound of mechanical valves may be heard and decrease the quality of life.[2]\n\nValve selection \nTissue valves tend to wear out faster with increased flow demands \u2013 such as with a more active (typically younger) person. Tissue valves are increasing lasting longer \u2013 now typically approximately 20 years, but they may wear faster in younger people.[3]\nWhen a tissue valve wears out and needs replacement, the person must undergo another valve replacement surgery. For this reason, younger patients often receive mechanical valves to prevent the increased risk (and inconvenience) of another valve replacement.[citation needed ]\n\nSurgical procedure \n Diagram of the opened heart, viewed from the front. The aortic valve separates the left ventricle from the aorta.\n Heart viewed from above, with atria removed to expose the valves.\nAortic valve replacement is most frequently done through a median sternotomy, meaning the incision is made by cutting through the sternum. Once the pericardium has been opened, the patient is put on a cardiopulmonary bypass machine, also known as the heart-lung machine. This machine takes over the task of breathing for the patient and pumping their blood around while the surgeon replaces the heart valve.\nOnce the patient is on bypass, a cut is made in the aorta and a crossclamp applied. The surgeon then removes the patient's diseased aortic valve and a mechanical or tissue valve is put in its place. Once the valve is in place and the aorta has been closed, the patient is taken off the heart-lung machine. Transesophageal echocardiogram (TEE, an ultra-sound of the heart done through the esophagus) can be used to verify that the new valve is functioning properly. Pacing wires are usually put in place, so that the heart can be manually paced should any complications arise after surgery. Drainage tubes are also inserted to drain fluids from the chest and pericardium following surgery. These are usually removed within 36 hours while the pacing wires are generally left in place until right before the patient is discharged from the hospital.\n\nHospital stay and recovery time \nAfter aortic valve replacement, the patient will frequently stay in an intensive care unit for 12\u201336 hours. The patient is often able to go home after this, in about four days, unless complications arise. Common complications include heart block, which typically requires the permanent insertion of a cardiac pacemaker.\nRecovery from aortic valve replacement will take about three months, if the patient is in good health. Patients are advised not to do any heavy lifting for 4\u20136 months after surgery, to avoid damage to the sternum (the breast bone).\n\nOutcomes \nThe risk of death or serious complications from aortic valve replacement is typically quoted as being between 1-3%, depending on the health and age of the patient[4]. Older patients, as well as those who are frail and\/or have multiple comorbidities (i.e. other health problems), may face significantly higher surgical risk.\n\nMinimally invasive surgery \nMore recently, some cardiac surgeons have been performing aortic valve replacement procedures using an approach referred to as minimally invasive cardiac surgery (MICS), in which the surgeon replaces the valve through small incisions between two and four inches in length using specialized surgical instruments rather than by cutting a six to ten-inch incision down the center of the sternum. MICS typically involves shorter recovery time and more attractive cosmetic results.[5]\nAnother promising alternative for many high risk and older patients is transcatheter aortic valve replacement (TAVR), which delivers a new valve to the site of the diseased valve through a catheter.[6] The replacement valve is collapsed and packaged in a way similar to a stent. Once in place it is expanded, pushing the old valve\u2019s leaflets out of the way, and functions in place of the old valve. The catheter may be inserted through the femoral artery or through a small incision in the chest and then through a large artery or the tip of the left ventricle.[7]\nGuidelines suggest TAVR for most patients over 75 and surgical replacement for most patients less than 75.[8] Ultimately, the best treatment choice is a decision based on many individual factors.[8][9]\n\nHistory \nEarly surgical approaches to aortic valve disease were limited by the necessity of operating with the heart beating. In the 1950s the Hufnagel valve was implanted in the descending thoracic aorta in patients with aortic insufficiency. The first successful replacement of the aortic valve was reported in 1960 by Harken, and early adoption of this technique proceeded slowly based on the limitations of available replacement valves and relatively primitive techniques for protecting the heart during surgery which were available at the time. With the evolution of mechanical heart valves and gradual developments in cardiopulmonary bypass (the heart lung machine) and cardioplegia which allow the heart to be stopped safely during surgery, aortic valve replacement became accepted therapy for patients with severe aortic insufficiency or regurgitation.\n\nSee also \nAortic valve repair\nArtificial heart valve\nValvular heart disease\nMinimally invasive cardiac surgery\nPericardial heart valves\nOpen aortic surgery\nReferences \n\n\n^ \"2014 AHA\/ACC Guideline for the Management of Patients With Valvular Heart Disease\". \n\n^ Golczyk, K; Kompis M; Englberger L; Carrel TP; Stalder M (March 2010). \"Heart valve sound of various mechanical composite grafts, and the impact on patients' quality of life\". The Journal of heart valve disease. 19 (2): 228\u2013232. PMID 20369508. \n\n^ Foroutan F, Guyatt GH, O'Brien K, et al. (2016). \"Prognosis after surgical replacement with a bioprosthetic aortic valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies\". BMJ. 354: i5065. doi:10.1136\/bmj.i5065. PMC 5040922 . PMID 27683072. \n\n^ Pick, Adam. \"Dispelling The Patient Fear Of Heart Valve Surgery\". Retrieved 2018-05-23 . \n\n^ Torracca, MD, Lucia; et al. \"Totally Endoscopic Atrial Septal Defect Closure with a Robotic System: Experience with Seven Cases\" (PDF) . The Heart Surgery Forum #2001-6731 5 (2):125\u2013127, 2002. Forum Multimedia Publishing, LLC. [permanent dead link ] \n\n^ Siemieniuk RA, Agoritsas T, Manja V, et al. (2016). \"Transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis at low and intermediate risk: systematic review and meta-analysis\". BMJ. 354: i5130. doi:10.1136\/bmj.i5130. PMC 5040923 . PMID 27683246. \n\n^ \"What is TAVR?\". American Heart Association. 2014. Retrieved 2015-08-15 . \n\n^ a b Vandvik PO, Otto CM, Siemieniuk RA, Bagur R, Guyatt GH, Lytvyn L, Whitlock R, Vartdal T, Brieger D, Aertgeerts B, Price S, Foroutan F, Shapiro M, Mertz R, Spencer FA (2016). \"Transcatheter or surgical aortic valve replacement for patients with severe, symptomatic, aortic stenosis at low to intermediate surgical risk: a clinical practice guideline\". BMJ. 354: i5085. doi:10.1136\/bmj.i5085. PMID 27680583. \n\n^ Lytvyn L, Guyatt GH, Manja V, Siemieniuk RA, Zhang Y, Agoritsas T, Vandvik PO (2016). \"Patient values and preferences on transcatheter or surgical aortic valve replacement therapy for aortic stenosis: a systematic review\". BMJ Open. 6 (9): e014327. doi:10.1136\/bmjopen-2016-014327. PMC 5051506 . PMID 27687903. \n\n\nExternal links \nAortic Valve Replacement Information for Patients\nInformation on Aortic Valve Replacement\nAnimation of Aortic Valve Replacement\nvteSurgery and other procedures involving the heart (ICD-9-CM V3 35\u201337+89.4+99.6, ICD-10-PCS 02)Surgery and ICHeart valves\r\nand septa\nValve repair\nValvulotomy\nMitral valve repair\nValvuloplasty\naortic\nmitral\nValve replacement\nAortic valve repair\nAortic valve replacement\nRoss procedure\nPercutaneous aortic valve replacement\nMitral valve replacement\nproduction of septal defect in heart \nenlargement of existing septal defect\nAtrial septostomy\nBalloon septostomy<\/dd>\ncreation of septal defect in heart\n\nBlalock\u2013Hanlon procedure<\/dd>\nshunt from heart chamber to blood vessel \natrium to pulmonary artery\nFontan procedure<\/dd>\nleft ventricle to aorta\n\nRastelli procedure<\/dd>\nright ventricle to pulmonary artery\n\nSano shunt<\/dd>\ncompound procedures \nfor transposition of great vessels\nArterial switch operation\nMustard procedure\nSenning procedure<\/dd>\nfor univentricular defect\n\nNorwood procedure\nKawashima procedure<\/dd>\nshunt from blood vessel to blood vessel \nsystemic circulation to pulmonary artery shunt\nBlalock\u2013Taussig shunt<\/dd>\nSVC to the right PA\n\nGlenn procedure<\/dd>\nCardiac vessels\nCHD \nAngioplasty\nBypass\/Coronary artery bypass\nMIDCAB\nOff-pump CAB\nTECAB<\/dd>\nCoronary stent \nBare-metal stent\nDrug-eluting stent\nBentall procedure\nValve-sparing aortic root replacement\nLeCompte maneuver\nOther\nPericardium \nPericardiocentesis\nPericardial window\nPericardiectomy\nMyocardium \nCardiomyoplasty\nDor procedure\nSeptal myectomy\nVentricular reduction\nAlcohol septal ablation\nConduction system \nMaze procedure\nCox maze and minimaze<\/dd>\nCatheter ablation\n\nCryoablation\nRadiofrequency ablation<\/dd>\nPacemaker insertion\nLeft atrial appendage occlusion\nCardiotomy\nHeart transplantation\nDiagnostic\r\ntests and\r\nprocedures\nElectrophysiology \nElectrocardiography\nVectorcardiography<\/dd>\nHolter monitor\nImplantable loop recorder\nCardiac stress test\n\nBruce protocol<\/dd>\nElectrophysiology study\nCardiac imaging \nAngiocardiography\nEchocardiography\nTTE\nTEE<\/dd>\nMyocardial perfusion imaging\nCardiovascular MRI\nVentriculography\n\nRadionuclide ventriculography<\/dd>\nCardiac catheterization\/Coronary catheterization\nCardiac CT\n\nCardiac PET\nsound \nPhonocardiogram\nFunction tests\nImpedance cardiography\nBallistocardiography\nCardiotocography\nPacing\nCardioversion\nTranscutaneous pacing\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Aortic_valve_replacement\">https:\/\/www.limswiki.org\/index.php\/Aortic_valve_replacement<\/a>\n\t\t\t\t\tCategory: Medical 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noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","65c0731a776ef7e5551a292d37e5265f_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Aortic_valve_replacement skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Aortic valve replacement<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p><b>Aortic valve replacement<\/b> is a procedure in which a patient's failing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aortic_valve\" title=\"Aortic valve\" rel=\"external_link\" target=\"_blank\">aortic valve<\/a> is replaced with an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_heart_valve\" title=\"Artificial heart valve\" rel=\"external_link\" target=\"_blank\">artificial heart valve<\/a>. The aortic valve can be affected by a range of diseases; the valve can either become leaky (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Aortic_insufficiency\" title=\"Aortic insufficiency\" rel=\"external_link\" target=\"_blank\">aortic insufficiency<\/a>) or partially blocked (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Aortic_stenosis\" title=\"Aortic stenosis\" rel=\"external_link\" target=\"_blank\">aortic stenosis<\/a>). Current aortic valve replacement approaches include open heart surgery via a sternotomy, minimally invasive cardiac surgery (MICS) and transcatheter aortic valve replacement (TAVR).\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<p>As risk of aortic valve surgery has decreased and long term data on the survival and quality of life of people after valve replacement has become available, evidence-based guidelines for aortic valve replacement have been developed. The American Heart Association and American College of Cardiology Guidelines for the Management of Patients with Valvular Heart Disease are a widely accepted source of information for cardiologists and surgeons.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Aortic_stenosis\">Aortic stenosis<\/span><\/h3>\n<p>Patients with severe aortic stenosis, where the aortic valve is narrowed and blood flow from the heart is obstructed, are candidates for surgery when they develop symptoms or when the heart function is impacted. Certain asymptomatic patients may also be candidates for surgery, especially if exercise stress testing is positive.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Aortic_insufficiency\">Aortic insufficiency<\/span><\/h3>\n<p>Patients with leaky aortic valves (aortic insufficiency) often tolerate even severe degrees of insufficiency for a relatively long time before symptoms develop. Surgery is indicated for symptoms such as shortness of breath, and in cases where the heart has begun to enlarge (dilate) from pumping the increased volume of blood that leaks back through the valve.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types_of_valves\">Types of valves<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_heart_valve\" title=\"Artificial heart valve\" rel=\"external_link\" target=\"_blank\">Artificial heart valve<\/a><\/div>\n<p>There are two basic types of artificial heart valve: mechanical valves and tissue valves.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Tissue_valves\">Tissue valves<\/span><\/h3>\n<p>Tissue heart valves are usually made from animal tissue, either animal heart valve tissue or animal pericardial tissue. The tissue is treated to prevent rejection and calcification.\n<\/p><p>There are alternatives to animal tissue valves. In some cases a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Homograft\" class=\"mw-redirect\" title=\"Homograft\" rel=\"external_link\" target=\"_blank\">homograft<\/a> \u2013 a human aortic valve \u2013 can be implanted. Homograft valves are donated by patients and recovered after the patient dies. The durability of homograft valves is comparable to porcine and bovine tissue valves.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (September 2015)\">citation needed<\/span><\/a><\/i>]<\/sup> Another procedure for aortic valve replacement is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ross_procedure\" title=\"Ross procedure\" rel=\"external_link\" target=\"_blank\">Ross procedure<\/a> (or pulmonary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autograft\" class=\"mw-redirect\" title=\"Autograft\" rel=\"external_link\" target=\"_blank\">autograft<\/a>). In a Ross procedure, the aortic valve is removed and replaced with the patient's own <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulmonary_valve\" title=\"Pulmonary valve\" rel=\"external_link\" target=\"_blank\">pulmonary valve<\/a>. A pulmonary homograft (pulmonary valve taken from a cadaver) is then used to replace the patient's own pulmonary valve. This procedure was first used in 1967 and is used primarily in children, as the procedure allows the patient's own pulmonary valve (now in the aortic position) to grow with the child.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Mechanical_valves\">Mechanical valves<\/span><\/h3>\n<p>Mechanical valves are designed to outlast the patient, and have typically been stress-tested to last several hundred years. Although mechanical valves are long-lasting and generally present a one-surgery solution, there is an increased risk of blood clots forming with mechanical valves. As a result, mechanical valve recipients must take anticoagulant (blood thinning) drugs such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Warfarin\" title=\"Warfarin\" rel=\"external_link\" target=\"_blank\">warfarin<\/a> for the rest of their lives, making the patient more prone to bleeding. The sound of mechanical valves may be heard and decrease the quality of life.<sup id=\"rdp-ebb-cite_ref-valvenoise_2-0\" class=\"reference\"><a href=\"#cite_note-valvenoise-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Valve_selection\">Valve selection<\/span><\/h3>\n<p>Tissue valves tend to wear out faster with increased flow demands \u2013 such as with a more active (typically younger) person. Tissue valves are increasing lasting longer \u2013 now typically approximately 20 years, but they may wear faster in younger people.<sup id=\"rdp-ebb-cite_ref-foroutan_3-0\" class=\"reference\"><a href=\"#cite_note-foroutan-3\" rel=\"external_link\">[3]<\/a><\/sup>\nWhen a tissue valve wears out and needs replacement, the person must undergo another valve replacement surgery. For this reason, younger patients often receive mechanical valves to prevent the increased risk (and inconvenience) of another valve replacement.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"medical claim with no citation. Does this apply to children? Probably not. (November 2015)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Surgical_procedure\">Surgical procedure<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Diagram_of_the_human_heart_(cropped).svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e5\/Diagram_of_the_human_heart_%28cropped%29.svg\/220px-Diagram_of_the_human_heart_%28cropped%29.svg.png\" width=\"220\" height=\"216\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Diagram_of_the_human_heart_(cropped).svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Diagram of the opened heart, viewed from the front. The aortic valve separates the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Left_ventricle\" class=\"mw-redirect\" title=\"Left ventricle\" rel=\"external_link\" target=\"_blank\">left ventricle<\/a> from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aorta\" title=\"Aorta\" rel=\"external_link\" target=\"_blank\">aorta<\/a>.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gray495.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/50\/Gray495.png\/220px-Gray495.png\" width=\"220\" height=\"195\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gray495.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Heart viewed from above, with atria removed to expose the valves.<\/div><\/div><\/div>\n<p>Aortic valve replacement is most frequently done through a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Median_sternotomy\" title=\"Median sternotomy\" rel=\"external_link\" target=\"_blank\">median sternotomy<\/a>, meaning the incision is made by cutting through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_sternum\" class=\"mw-redirect\" title=\"Human sternum\" rel=\"external_link\" target=\"_blank\">sternum<\/a>. Once the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pericardium\" title=\"Pericardium\" rel=\"external_link\" target=\"_blank\">pericardium<\/a> has been opened, the patient is put on a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiopulmonary_bypass\" title=\"Cardiopulmonary bypass\" rel=\"external_link\" target=\"_blank\">cardiopulmonary bypass<\/a> machine, also known as the heart-lung machine. This machine takes over the task of breathing for the patient and pumping their blood around while the surgeon replaces the heart valve.\n<\/p><p>Once the patient is on bypass, a cut is made in the aorta and a crossclamp applied. The surgeon then removes the patient's diseased aortic valve and a mechanical or tissue valve is put in its place. Once the valve is in place and the aorta has been closed, the patient is taken off the heart-lung machine. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transesophageal_echocardiogram\" title=\"Transesophageal echocardiogram\" rel=\"external_link\" target=\"_blank\">Transesophageal echocardiogram<\/a> (TEE, an ultra-sound of the heart done through the esophagus) can be used to verify that the new valve is functioning properly. Pacing wires are usually put in place, so that the heart can be manually paced should any complications arise after surgery. Drainage tubes are also inserted to drain fluids from the chest and pericardium following surgery. These are usually removed within 36 hours while the pacing wires are generally left in place until right before the patient is discharged from the hospital.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Hospital_stay_and_recovery_time\">Hospital stay and recovery time<\/span><\/h2>\n<p>After aortic valve replacement, the patient will frequently stay in an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intensive_care_unit\" title=\"Intensive care unit\" rel=\"external_link\" target=\"_blank\">intensive care unit<\/a> for 12\u201336 hours. The patient is often able to go home after this, in about four days, unless complications arise. Common complications include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_block\" title=\"Heart block\" rel=\"external_link\" target=\"_blank\">heart block<\/a>, which typically requires the permanent insertion of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_cardiac_pacemaker\" title=\"Artificial cardiac pacemaker\" rel=\"external_link\" target=\"_blank\">cardiac pacemaker<\/a>.\n<\/p><p>Recovery from aortic valve replacement will take about three months, if the patient is in good health. Patients are advised not to do any heavy lifting for 4\u20136 months after surgery, to avoid damage to the sternum (the breast bone).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Outcomes\">Outcomes<\/span><\/h2>\n<p>The risk of death or serious complications from aortic valve replacement is typically quoted as being between 1-3%, depending on the health and age of the patient<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>. Older patients, as well as those who are frail and\/or have multiple comorbidities (i.e. other health problems), may face significantly higher surgical risk.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Minimally_invasive_surgery\">Minimally invasive surgery<\/span><\/h2>\n<p>More recently, some cardiac surgeons have been performing aortic valve replacement procedures using an approach referred to as minimally invasive cardiac surgery (MICS), in which the surgeon replaces the valve through small incisions between two and four inches in length using specialized surgical instruments rather than by cutting a six to ten-inch incision down the center of the sternum. MICS typically involves shorter recovery time and more attractive cosmetic results.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>Another promising alternative for many high risk and older patients is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous_aortic_valve_replacement\" title=\"Percutaneous aortic valve replacement\" rel=\"external_link\" target=\"_blank\">transcatheter aortic valve replacement<\/a> (TAVR), which delivers a new valve to the site of the diseased valve through a catheter.<sup id=\"rdp-ebb-cite_ref-siemieniuk_6-0\" class=\"reference\"><a href=\"#cite_note-siemieniuk-6\" rel=\"external_link\">[6]<\/a><\/sup> The replacement valve is collapsed and packaged in a way similar to a stent. Once in place it is expanded, pushing the old valve\u2019s leaflets out of the way, and functions in place of the old valve. The catheter may be inserted through the femoral artery or through a small incision in the chest and then through a large artery or the tip of the left ventricle.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>Guidelines suggest TAVR for most patients over 75 and surgical replacement for most patients less than 75.<sup id=\"rdp-ebb-cite_ref-vandvik_8-0\" class=\"reference\"><a href=\"#cite_note-vandvik-8\" rel=\"external_link\">[8]<\/a><\/sup> Ultimately, the best treatment choice is a decision based on many individual factors.<sup id=\"rdp-ebb-cite_ref-vandvik_8-1\" class=\"reference\"><a href=\"#cite_note-vandvik-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-lytvyn_9-0\" class=\"reference\"><a href=\"#cite_note-lytvyn-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Early surgical approaches to aortic valve disease were limited by the necessity of operating with the heart beating. In the 1950s the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hufnagel\" title=\"Hufnagel\" rel=\"external_link\" target=\"_blank\">Hufnagel<\/a> valve was implanted in the descending thoracic aorta in patients with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aortic_insufficiency\" title=\"Aortic insufficiency\" rel=\"external_link\" target=\"_blank\">aortic insufficiency<\/a>. The first successful replacement of the aortic valve was reported in 1960 by Harken, and early adoption of this technique proceeded slowly based on the limitations of available replacement valves and relatively primitive techniques for protecting the heart during surgery which were available at the time. With the evolution of mechanical heart valves and gradual developments in cardiopulmonary bypass (the heart lung machine) and cardioplegia which allow the heart to be stopped safely during surgery, aortic valve replacement became accepted therapy for patients with severe aortic insufficiency or regurgitation.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Aortic_valve_repair\" title=\"Aortic valve repair\" rel=\"external_link\" target=\"_blank\">Aortic valve repair<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_heart_valve\" title=\"Artificial heart valve\" rel=\"external_link\" target=\"_blank\">Artificial heart valve<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Valvular_heart_disease\" title=\"Valvular heart disease\" rel=\"external_link\" target=\"_blank\">Valvular heart disease<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive_cardiac_surgery\" title=\"Minimally invasive cardiac surgery\" rel=\"external_link\" target=\"_blank\">Minimally invasive cardiac surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pericardial_heart_valves\" title=\"Pericardial heart valves\" rel=\"external_link\" target=\"_blank\">Pericardial heart valves<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Open_aortic_surgery\" title=\"Open aortic surgery\" rel=\"external_link\" target=\"_blank\">Open aortic surgery<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/content.onlinejacc.org\/article.aspx?articleid=1838843\" target=\"_blank\">\"2014 AHA\/ACC Guideline for the Management of Patients With Valvular Heart Disease\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=2014+AHA%2FACC+Guideline+for+the+Management+of+Patients+With+Valvular+Heart+Disease&rft_id=http%3A%2F%2Fcontent.onlinejacc.org%2Farticle.aspx%3Farticleid%3D1838843&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAortic+valve+replacement\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-valvenoise-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-valvenoise_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Golczyk, K; Kompis M; Englberger L; Carrel TP; Stalder M (March 2010). \"Heart valve sound of various mechanical composite grafts, and the impact on patients' quality of life\". <i>The Journal of heart valve disease<\/i>. <b>19<\/b> (2): 228\u2013232. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20369508\" target=\"_blank\">20369508<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+heart+valve+disease&rft.atitle=Heart+valve+sound+of+various+mechanical+composite+grafts%2C+and+the+impact+on+patients%27+quality+of+life.&rft.volume=19&rft.issue=2&rft.pages=228-232&rft.date=2010-03&rft_id=info%3Apmid%2F20369508&rft.aulast=Golczyk&rft.aufirst=K&rft.au=Kompis+M&rft.au=Englberger+L&rft.au=Carrel+TP&rft.au=Stalder+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAortic+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-foroutan-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-foroutan_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Foroutan F, Guyatt GH, O'Brien K, et al. (2016). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bmj.com\/content\/354\/bmj.i5065.long\" target=\"_blank\">\"Prognosis after surgical replacement with a bioprosthetic aortic valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies\"<\/a>. <i>BMJ<\/i>. <b>354<\/b>: i5065. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmj.i5065\" target=\"_blank\">10.1136\/bmj.i5065<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5040922\" target=\"_blank\">5040922<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27683072\" target=\"_blank\">27683072<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMJ&rft.atitle=Prognosis+after+surgical+replacement+with+a+bioprosthetic+aortic+valve+in+patients+with+severe+symptomatic+aortic+stenosis%3A+systematic+review+of+observational+studies&rft.volume=354&rft.pages=i5065&rft.date=2016&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5040922&rft_id=info%3Apmid%2F27683072&rft_id=info%3Adoi%2F10.1136%2Fbmj.i5065&rft.aulast=Foroutan&rft.aufirst=F&rft.au=Guyatt%2C+GH&rft.au=O%27Brien%2C+K&rft_id=http%3A%2F%2Fwww.bmj.com%2Fcontent%2F354%2Fbmj.i5065.long&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAortic+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Pick, Adam. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.heart-valve-surgery.com\/valve-mortality-surgery-repair-replacement.php\" target=\"_blank\">\"Dispelling The Patient Fear Of Heart Valve Surgery\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-05-23<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Dispelling+The+Patient+Fear+Of+Heart+Valve+Surgery&rft.au=Pick%2C+Adam&rft_id=https%3A%2F%2Fwww.heart-valve-surgery.com%2Fvalve-mortality-surgery-repair-replacement.php&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAortic+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Torracca, MD, Lucia; et al. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/static.cjp.com\/gems\/pdfs\/2001-6731.pdf\" target=\"_blank\">\"Totally Endoscopic Atrial Septal Defect Closure with a Robotic System: Experience with Seven Cases\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>The Heart Surgery Forum #2001-6731 5 (2):125\u2013127, 2002<\/i>. Forum Multimedia Publishing, LLC.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=The+Heart+Surgery+Forum+%232001-6731+5+%282%29%3A125%E2%80%93127%2C+2002&rft.atitle=Totally+Endoscopic+Atrial+Septal+Defect+Closure+with+a+Robotic+System%3A+Experience+with+Seven+Cases&rft.aulast=Torracca%2C+MD&rft.aufirst=Lucia&rft_id=http%3A%2F%2Fstatic.cjp.com%2Fgems%2Fpdfs%2F2001-6731.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAortic+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><sup class=\"noprint Inline-Template\"><span style=\"white-space: nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Link_rot\" title=\"Wikipedia:Link rot\" rel=\"external_link\" target=\"_blank\"><span title=\" Dead link since July 2017\">permanent dead link<\/span><\/a><\/i>]<\/span><\/sup><\/span>\n<\/li>\n<li id=\"cite_note-siemieniuk-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-siemieniuk_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Siemieniuk RA, Agoritsas T, Manja V, et al. (2016). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bmj.com\/content\/354\/bmj.i5130.long\" target=\"_blank\">\"Transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis at low and intermediate risk: systematic review and meta-analysis\"<\/a>. <i>BMJ<\/i>. <b>354<\/b>: i5130. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmj.i5130\" target=\"_blank\">10.1136\/bmj.i5130<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5040923\" target=\"_blank\">5040923<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27683246\" target=\"_blank\">27683246<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMJ&rft.atitle=Transcatheter+versus+surgical+aortic+valve+replacement+in+patients+with+severe+aortic+stenosis+at+low+and+intermediate+risk%3A+systematic+review+and+meta-analysis.&rft.volume=354&rft.pages=i5130&rft.date=2016&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5040923&rft_id=info%3Apmid%2F27683246&rft_id=info%3Adoi%2F10.1136%2Fbmj.i5130&rft.aulast=Siemieniuk&rft.aufirst=RA&rft.au=Agoritsas%2C+T&rft.au=Manja%2C+V&rft_id=http%3A%2F%2Fwww.bmj.com%2Fcontent%2F354%2Fbmj.i5130.long&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAortic+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.heart.org\/HEARTORG\/Conditions\/More\/HeartValveProblemsandDisease\/What-is-TAVR_UCM_450827_Article.jsp\" target=\"_blank\">\"What is TAVR?\"<\/a>. American Heart Association. 2014<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-08-15<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=What+is+TAVR%3F&rft.pub=American+Heart+Association&rft.date=2014&rft_id=http%3A%2F%2Fwww.heart.org%2FHEARTORG%2FConditions%2FMore%2FHeartValveProblemsandDisease%2FWhat-is-TAVR_UCM_450827_Article.jsp&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAortic+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-vandvik-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-vandvik_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-vandvik_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vandvik PO, Otto CM, Siemieniuk RA, Bagur R, Guyatt GH, Lytvyn L, Whitlock R, Vartdal T, Brieger D, Aertgeerts B, Price S, Foroutan F, Shapiro M, Mertz R, Spencer FA (2016). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bmj.com\/content\/354\/bmj.i5085.long\" target=\"_blank\">\"Transcatheter or surgical aortic valve replacement for patients with severe, symptomatic, aortic stenosis at low to intermediate surgical risk: a clinical practice guideline\"<\/a>. <i>BMJ<\/i>. <b>354<\/b>: i5085. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmj.i5085\" target=\"_blank\">10.1136\/bmj.i5085<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27680583\" target=\"_blank\">27680583<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMJ&rft.atitle=Transcatheter+or+surgical+aortic+valve+replacement+for+patients+with+severe%2C+symptomatic%2C+aortic+stenosis+at+low+to+intermediate+surgical+risk%3A+a+clinical+practice+guideline&rft.volume=354&rft.pages=i5085&rft.date=2016&rft_id=info%3Adoi%2F10.1136%2Fbmj.i5085&rft_id=info%3Apmid%2F27680583&rft.aulast=Vandvik&rft.aufirst=PO&rft.au=Otto%2C+CM&rft.au=Siemieniuk%2C+RA&rft.au=Bagur%2C+R&rft.au=Guyatt%2C+GH&rft.au=Lytvyn%2C+L&rft.au=Whitlock%2C+R&rft.au=Vartdal%2C+T&rft.au=Brieger%2C+D&rft.au=Aertgeerts%2C+B&rft.au=Price%2C+S&rft.au=Foroutan%2C+F&rft.au=Shapiro%2C+M&rft.au=Mertz%2C+R&rft.au=Spencer%2C+FA&rft_id=http%3A%2F%2Fwww.bmj.com%2Fcontent%2F354%2Fbmj.i5085.long&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAortic+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-lytvyn-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-lytvyn_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lytvyn L, Guyatt GH, Manja V, Siemieniuk RA, Zhang Y, Agoritsas T, Vandvik PO (2016). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bmjopen.bmj.com\/content\/6\/9\/e014327\" target=\"_blank\">\"Patient values and preferences on transcatheter or surgical aortic valve replacement therapy for aortic stenosis: a systematic review\"<\/a>. <i>BMJ Open<\/i>. <b>6<\/b> (9): e014327. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmjopen-2016-014327\" target=\"_blank\">10.1136\/bmjopen-2016-014327<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5051506\" target=\"_blank\">5051506<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27687903\" target=\"_blank\">27687903<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMJ+Open&rft.atitle=Patient+values+and+preferences+on+transcatheter+or+surgical+aortic+valve+replacement+therapy+for+aortic+stenosis%3A+a+systematic+review&rft.volume=6&rft.issue=9&rft.pages=e014327&rft.date=2016&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5051506&rft_id=info%3Apmid%2F27687903&rft_id=info%3Adoi%2F10.1136%2Fbmjopen-2016-014327&rft.aulast=Lytvyn&rft.aufirst=L&rft.au=Guyatt%2C+GH&rft.au=Manja%2C+V&rft.au=Siemieniuk%2C+RA&rft.au=Zhang%2C+Y&rft.au=Agoritsas%2C+T&rft.au=Vandvik%2C+PO&rft_id=http%3A%2F%2Fbmjopen.bmj.com%2Fcontent%2F6%2F9%2Fe014327&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAortic+valve+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> <span style=\"position:relative; top: -2px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Open_access\" title=\"open access publication \u2013 free to read\" rel=\"external_link\" target=\"_blank\"><img alt=\"open access publication \u2013 free to read\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/77\/Open_Access_logo_PLoS_transparent.svg\/9px-Open_Access_logo_PLoS_transparent.svg.png\" width=\"9\" height=\"14\" \/><\/a><\/span><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.newheartvalve.com\" target=\"_blank\">Aortic Valve Replacement Information for Patients<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130502030808\/http:\/\/www.sts.org\/patient-information\/valve-repair\/replacement-surgery\/aortic-valve\" target=\"_blank\">Information on Aortic Valve Replacement<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.webmd.com\/heart-disease\/video\/aortic-valve-replacement\" target=\"_blank\">Animation of Aortic Valve Replacement<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1273\nCached time: 20181217132731\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.428 seconds\nReal time usage: 0.559 seconds\nPreprocessor visited node count: 1413\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 80423\/2097152 bytes\nTemplate argument size: 8139\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 7\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 30026\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.226\/10.000 seconds\nLua memory usage: 4.37 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 482.175 1 -total\n<\/p>\n<pre>39.73% 191.556 1 Template:Reflist\n25.37% 122.314 3 Template:Ambox\n21.58% 104.043 1 Template:Multiple_issues\n19.83% 95.629 4 Template:Cite_web\n15.98% 77.030 1 Template:Infobox_medical_intervention\n14.88% 71.769 1 Template:Infobox\n11.87% 57.242 5 Template:Cite_journal\n10.68% 51.506 3 Template:Fix\n10.59% 51.081 2 Template:Citation_needed\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1114065-1!canonical and timestamp 20181217132730 and revision id 874140590\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Aortic_valve_replacement\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212236\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.018 seconds\nReal time usage: 0.172 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 165.862 1 - wikipedia:Aortic_valve_replacement\n100.00% 165.862 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:7966-0!*!*!*!*!*!* and timestamp 20181217212236 and revision id 24084\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Aortic_valve_replacement\">https:\/\/www.limswiki.org\/index.php\/Aortic_valve_replacement<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","65c0731a776ef7e5551a292d37e5265f_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e5\/Diagram_of_the_human_heart_%28cropped%29.svg\/440px-Diagram_of_the_human_heart_%28cropped%29.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/50\/Gray495.png\/440px-Gray495.png"],"65c0731a776ef7e5551a292d37e5265f_timestamp":1545081756,"ff342e7a22b19a4ed09ac1f4f3f676cd_type":"article","ff342e7a22b19a4ed09ac1f4f3f676cd_title":"Ankle replacement","ff342e7a22b19a4ed09ac1f4f3f676cd_url":"https:\/\/www.limswiki.org\/index.php\/Ankle_replacement","ff342e7a22b19a4ed09ac1f4f3f676cd_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tAnkle replacement\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tAnkle replacementICD-9-CM81.56MedlinePlus007254 [edit on Wikidata]\nAnkle replacement, or ankle arthroplasty, is a surgical procedure to replace the damaged articular surfaces of the human ankle joint with prosthetic components. This procedure is becoming the treatment of choice for patients requiring arthroplasty, replacing the conventional use of arthrodesis, i.e. fusion of the bones. The restoration of range of motion is the key feature in favor of ankle replacement with respect to arthrodesis. However, clinical evidence of the superiority of the former has only been demonstrated for particular isolated implant designs.[1]\n\nContents \n\n1 History \n2 Prosthetic design \n3 Indications \n4 Outcome \n5 References \n6 External links \n\n\nHistory \nSince the early 1970s, the disadvantages of ankle arthrodesis and the excellent results attained by arthroplasty at other human joints have encouraged numerous prosthesis designs also for the ankle. In the following decade, the disappointing results of long-term follow-up clinical studies [2][3] of the pioneering designs has left ankle arthrodesis as the surgical treatment of choice for these patients. More modern designs have produced better results, contributing to a renewed interest in total ankle arthroplasty over the past decade.\nNearly all designs from pioneers featured two components; these designs have been categorized as incongruent and congruent, according to the shape of the two articular surfaces. After the early unsatisfactory results of the two-component designs, most of the more recent designs feature three components, with a polyethylene meniscal bearing interposed between the two metal bone-anchored components. This meniscal bearing should allow full congruence at the articular surfaces in all joint positions in order to minimize wear and deformation of the components.[4] Poor understanding of the functions of the structures guiding ankle motion in the natural joint (ligaments and articular surfaces), and poor restoration of these functions in the replaced joint may be responsible for the complications and revisions.\n[5]\n\n<\/p>\nProsthetic design \nThe main objectives of the prosthetic design for ankle joint replacements are: \n\nto replicate original joint function, by restoring an appropriate kinematics at the replaced joint;\nto permit a good fixation of the components, which would involve an appropriate load transfer to the bone and minimum risk of loosening;\nto guarantee longevity of the implant, which is mainly related to wear resistance;\nto attain feasibility of implantation given the small dimensions of the joint.\nAs with other joint replacements, the traditional dilemma between mobility and congruency must be addressed.[6] Unconstrained or semiconstrained designs allow the necessary mobility but require incongruent contact, thereby giving rise to large contact stresses and potentially high wear rates. Conversely, congruent designs produce large contact areas with low contact stresses but transmit undesirable constraint forces that can overload the fixation system at the bone-component interface.\n\nIndications \nThe indications for the operation in general are as follow: \n\npatients with primary or posttraumatic osteoarthritis with relatively low functional demand;\npatients with severe ankle rheumatoid arthritis but not severe osteoporosis of the ankle;\npatients suitable for arthrodesis but rejecting it.\nThe general contraindications are:\n\nvarus or valgus deformity greater than 15 degrees, severe bony erosion, severe talus subluxation;\nsubstantial osteoporosis or osteonecrosis particularly affecting the talus;\nprevious or current infections of the foot;\nvascular disease or severe neurologic disorders;\nprevious arthrodesis of the ipsilateral hip or knee or severe deformities of these joints.\nOther potential contraindications such as capsuloligamentous instability and hindfoot or forefoot deformities affecting correct posture, are not considered relevant if resolved before or during this surgery.[4]\n\nOutcome \nThe outcome of an ankle replacement includes factors like ankle function, pain, revision and implant survival. Outcome studies on modern designs show a five-year implant survival rate between 67% and 94%.[7][8][9] and ten-year survival rates around 75%.[7] Mobile bearing designs have enabled implant survival rates to continue to improve, reaching as high as 95% for five years and 90% for ten years.[10] Ankle replacements have a 30-day readmission rate of 2.2%, which is similar to that of knee replacement but lower than that of total hip replacement. 6.6% of patients undergoing primary TAR require a reoperation within 12 months of the index procedure. Early revision rates are significantly higher in low-volume centres.[11]\nClinical ankle scores, such as the American Orthopaedic Foot and Ankle Society (AOFAS) or the Manchester Oxford Foot & Ankle Questionnaire[12] are outcome rating system for ankle replacements. Further outcome instruments include radiographic assessment of component stability and migration, and the assessment of its functionality in daily life using gait analysis or videofluoroscopy; the latter is a tool for three-dimensional measuring of the position and orientation of implanted prosthetic components at the replaced joints.[13][14]\nResearch comparing the effects of ankle replacement against ankle fusion (the TARVA study) is ongoing in the United Kingdom, in a randomised controlled trial to compare the clinical and cost-effectiveness of these treatments.[15] The TARVA protocol has been published in the British Medical Journal.[16]\n\nReferences \n\n\n^ Saltzman, C.L.; Mann, R.A.; Ahrens, J.E.; Amendola, A.; Anderson, R.B.; Berlet, G.C.; Brodky, J.W.; Chou, L.B.; Clanton, T.O.; Deland, J.T.; Deorio, J.K.; Horton, G.A.; Lee, T.H.; Mann, J.A.; Nunley, J.A.; Thordarson, D.B.; Walling, A.K.; Wapner, K.L.; Coughlin, M.J. (2009). \"Prospective Controlled Trial of STAR Total Ankle Replacement Versus Ankle Fusion: Initial Results\". Foot & Ankle International. 30 (7): 579\u2013596. doi:10.3113\/FAI.2009.0579. PMID 19589303. \n\n^ Kitaoka, Harold B.; Patzer, Gary L. (1996). \"Clinical results of the Mayo total ankle arthroplasty\". Journal of Bone and Joint Surgery. 78A (11): 1658\u201364. PMID 8934479. \n\n^ Lachiewicz, PF (1994). \"Total ankle arthroplasty. Indications, techniques, and results\". Orthopaedic Review. 23 (4): 315\u201320. PMID 8008441. \n\n^ a b Giannini, Sandro; Romagnoli, Matteo; O\u2019connor, John J.; Malerba, Francesco; Leardini, Alberto (2010). \"Total Ankle Replacement Compatible with Ligament Function Produces Mobility, Good Clinical Scores, and Low Complication Rates: An Early Clinical Assessment\". Clinical Orthopaedics and Related Research. 468 (10): 2746\u201353. doi:10.1007\/s11999-010-1432-3. PMC 3049631 . \n\n^ Saltzman, CL; McIff, TE; Buckwalter, JA; Brown, TD (2000). \"Total ankle replacement revisited\". Journal of Orthopaedic & Sports Physical Therapy. 30 (2): 56\u201367. doi:10.2519\/jospt.2000.30.2.56. PMID 10693083. \n\n^ Goodfellow, John; O'Connor, John (1978). \"The mechanics of the knee and prosthesis design\". Journal of Bone and Joint Surgery. 60B (3): 358\u201369. PMID 581081. \n\n^ a b Haddad, S.L.; Coetzee, J.C.; Estok, R.; Fahrbach, K.; Banel, D.; Nalysnyk, L. (2007). \"Intermediate and Long-Term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis. A Systematic Review of the Literature\". Journal of Bone and Joint Surgery. 89A (9): 1899\u2013905. doi:10.2106\/JBJS.F.01149. PMID 17768184. \n\n^ Stengel, Dirk; Bauwens, Kai; Ekkernkamp, Axel; Cramer, J\u00f6rg (2005). \"Efficacy of total ankle replacement with meniscal-bearing devices: a systematic review and meta-analysis\". Archives of Orthopaedic and Trauma Surgery. 125 (2): 109\u201319. doi:10.1007\/s00402-004-0765-3. PMID 15690167. \n\n^ Gougoulias, Nikolaos; Khanna, Anil; Maffulli, Nicola (2009). \"How Successful are Current Ankle Replacements? All [sic] though most total ankle replacement are successful by reducing pain and improving mobility there is a very high possibility that the pain may be ten times worse. There have been several cases where the doctors have recommended amputation to resolve the issue of pain that was not there prior to the total ankle replacement. : A Systematic Review of the Literature\". Clinical Orthopaedics and Related Research. 468: 199\u2013208. doi:10.1007\/s11999-009-0987-3. PMC 2795846 . \n\n^ Mann, J.A.; Mann, R.A.; Horton, E. (2011). \"STAR ankle: long-term results\". Foot Ankle International. 32 (5): S473\u2013484. doi:10.3113\/FAI.2011.0473. PMID 21733455. \n\n^ Zaidi, Razi; Macgregor, Alexander J.; Goldberg, Andy (2016-05-01). \"Quality measures for total ankle replacement, 30-day readmission and reoperation rates within 1 year of surgery: a data linkage study using the NJR data set\". BMJ Open. 6 (5): e011332. doi:10.1136\/bmjopen-2016-011332. ISSN 2044-6055. PMC 4885469 . PMID 27217286. \n\n^ Morley, D.; Jenkinson, C.; Doll, H.; Lavis, G.; Sharp, R.; Cooke, P.; Dawson, J. (2013-04-01). \"The Manchester\u2013Oxford Foot Questionnaire (MOXFQ)\". Bone & Joint Research. 2 (4): 66\u201369. doi:10.1302\/2046-3758.24.2000147. ISSN 2046-3758. PMC 3638305 . PMID 23673374. \n\n^ Conti S, Lalonde KA, Martin R (November 2006). \"Kinematic analysis of the agility total ankle during gait\". Foot & Ankle International. 27 (11): 980\u20134. doi:10.1177\/107110070602701120. PMID 17144964. \n\n^ Banks SA, Hodge WA (June 1996). \"Accurate measurement of three-dimensional knee replacement kinematics using single-plane fluoroscopy\". IEEE Transactions on Bio-medical Engineering. 43 (6): 638\u201349. doi:10.1109\/10.495283. PMID 8987268. \n\n^ \"Trial Detail - UK Clinical Trial Gateway\". www.ukctg.nihr.ac.uk. Retrieved 2017-05-07 . \n\n^ Goldberg, Andrew J.; Zaidi, Razi; Thomson, Claire; Dor\u00e9, Caroline J.; Skene, Simon S.; Cro, Suzie; Round, Jeff; Molloy, Andrew; Davies, Mark (2016-09-01). \"Total ankle replacement versus arthrodesis (TARVA): protocol for a multicentre randomised controlled trial\". BMJ Open. 6 (9): e012716. doi:10.1136\/bmjopen-2016-012716. ISSN 2044-6055. PMC 5020669 . PMID 27601503. \n\n\nExternal links \nAmerican Orthopaedic Foot & Ankle Society\nAmerican Orthopaedic Foot & Ankle Society score (AOFAS) free online calculator\nTotal Ankle Replacement\nTotal Ankle Institute\nvteOrthopedic surgery, operations\/surgeries and other procedures on bones and joints (ICD-9-CM V3 76\u201381, ICD-10-PCS 0P\u2013S)BonesFacial\nJaw reduction\nDentofacial osteotomy\nGenioplasty\/Mentoplasty\nChin augmentation\nOrthognathic surgery\nSpine\nCoccygectomy\nLaminotomy\nLaminectomy\nLaminoplasty\nCorpectomy\nFacetectomy\nForaminotomy\nVertebral fixation\nPercutaneous vertebroplasty\nUpper extremity\nAcromioplasty\nLower extremity\nFemoral head ostectomy\nAstragalectomy\nDistraction osteogenesis\nIlizarov apparatus\nPhemister graft\nGeneral\nOstectomy\nBone grafting\nOsteotomy\nEpiphysiodesis\nReduction\nInternal fixation\nExternal fixation\nTension band wiring\nCartilage\nArticular cartilage repair\nMicrofracture surgery\nKnee cartilage replacement therapy\nAutologous chondrocyte implantation\nJointsSpine\nArthrodesis\nSpinal fusion\nIntervertebral discs\nDiscectomy\nAnnuloplasty\nArthroplasty\nUpper extremity\nShoulder surgery\nShoulder replacement\nBankart repair\nWeaver\u2013Dunn procedure\nUlnar collateral ligament reconstruction\nHand surgery\nBrunelli procedure\nLower extremity\nHip resurfacing\nHip replacement\nRotationplasty\nAnterior cruciate ligament reconstruction\nKnee replacement\/Unicompartmental knee arthroplasty\nAnkle replacement\nBrostr\u00f6m procedure\nTriple arthrodesis\nGeneral\nArthrotomy\nArthroplasty\nSynovectomy\nArthroscopy\nReplacement joint\nimaging: Arthrogram\nArthrocentesis\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 29 February 2016, at 23:06.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 514 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","ff342e7a22b19a4ed09ac1f4f3f676cd_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Ankle_replacement skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Ankle replacement<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Ankle replacement<\/b>, or <b>ankle arthroplasty<\/b>, is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical\" class=\"mw-redirect\" title=\"Surgical\" rel=\"external_link\" target=\"_blank\">surgical<\/a> procedure to replace the damaged articular surfaces of the human <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ankle_joint\" class=\"mw-redirect\" title=\"Ankle joint\" rel=\"external_link\" target=\"_blank\">ankle joint<\/a> with prosthetic components. This procedure is becoming the treatment of choice for patients requiring arthroplasty, replacing the conventional use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthrodesis\" title=\"Arthrodesis\" rel=\"external_link\" target=\"_blank\">arthrodesis<\/a>, i.e. fusion of the bones. The restoration of range of motion is the key feature in favor of ankle replacement with respect to arthrodesis. However, clinical evidence of the superiority of the former has only been demonstrated for particular isolated implant designs.<sup id=\"rdp-ebb-cite_ref-pmid19589303_1-0\" class=\"reference\"><a href=\"#cite_note-pmid19589303-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Since the early 1970s, the disadvantages of ankle <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthrodesis\" title=\"Arthrodesis\" rel=\"external_link\" target=\"_blank\">arthrodesis<\/a> and the excellent results attained by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroplasty\" title=\"Arthroplasty\" rel=\"external_link\" target=\"_blank\">arthroplasty<\/a> at other human joints have encouraged numerous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthesis<\/a> designs also for the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ankle\" title=\"Ankle\" rel=\"external_link\" target=\"_blank\">ankle<\/a>. In the following decade, the disappointing results of long-term follow-up clinical studies <sup id=\"rdp-ebb-cite_ref-pmid8934479_2-0\" class=\"reference\"><a href=\"#cite_note-pmid8934479-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid8008441_3-0\" class=\"reference\"><a href=\"#cite_note-pmid8008441-3\" rel=\"external_link\">[3]<\/a><\/sup> of the pioneering designs has left ankle arthrodesis as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical\" class=\"mw-redirect\" title=\"Surgical\" rel=\"external_link\" target=\"_blank\">surgical<\/a> treatment of choice for these patients. More modern designs have produced better results, contributing to a renewed interest in total ankle <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroplasty\" title=\"Arthroplasty\" rel=\"external_link\" target=\"_blank\">arthroplasty<\/a> over the past decade.\n<\/p><p>Nearly all designs from pioneers featured two components; these designs have been categorized as incongruent and congruent, according to the shape of the two articular surfaces. After the early unsatisfactory results of the two-component designs, most of the more recent designs feature three components, with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a> meniscal bearing interposed between the two metal bone-anchored components. This meniscal bearing should allow full congruence at the articular surfaces in all joint positions in order to minimize wear and deformation of the components.<sup id=\"rdp-ebb-cite_ref-pmid20559763_4-0\" class=\"reference\"><a href=\"#cite_note-pmid20559763-4\" rel=\"external_link\">[4]<\/a><\/sup> Poor understanding of the functions of the structures guiding ankle motion in the natural joint (ligaments and articular surfaces), and poor restoration of these functions in the replaced joint may be responsible for the complications and revisions.\n<p><sup id=\"rdp-ebb-cite_ref-pmid10693083_5-0\" class=\"reference\"><a href=\"#cite_note-pmid10693083-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Prosthetic_design\">Prosthetic design<\/span><\/h2>\n<p>The main objectives of the for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ankle\" title=\"Ankle\" rel=\"external_link\" target=\"_blank\">ankle<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement\" title=\"Joint replacement\" rel=\"external_link\" target=\"_blank\">joint replacements<\/a> are: \n<\/p>\n<ol><li>to replicate original joint function, by restoring an appropriate kinematics at the replaced joint;<\/li>\n<li>to permit a good fixation of the components, which would involve an appropriate load transfer to the bone and minimum risk of loosening;<\/li>\n<li>to guarantee longevity of the implant, which is mainly related to wear resistance;<\/li>\n<li>to attain feasibility of implantation given the small dimensions of the joint.<\/li><\/ol>\n<p>As with other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement\" title=\"Joint replacement\" rel=\"external_link\" target=\"_blank\">joint replacements<\/a>, the traditional dilemma between mobility and congruency must be addressed.<sup id=\"rdp-ebb-cite_ref-pmid581081_6-0\" class=\"reference\"><a href=\"#cite_note-pmid581081-6\" rel=\"external_link\">[6]<\/a><\/sup> Unconstrained or semiconstrained designs allow the necessary mobility but require incongruent contact, thereby giving rise to large contact stresses and potentially high wear rates. Conversely, congruent designs produce large contact areas with low contact stresses but transmit undesirable constraint forces that can overload the fixation system at the bone-component interface.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h2>\n<p>The indications for the operation in general are as follow: \n<\/p>\n<ol><li>patients with primary or posttraumatic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\" title=\"Osteoarthritis\" rel=\"external_link\" target=\"_blank\">osteoarthritis<\/a> with relatively low functional demand;<\/li>\n<li>patients with severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ankle\" title=\"Ankle\" rel=\"external_link\" target=\"_blank\">ankle<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\" title=\"Rheumatoid arthritis\" rel=\"external_link\" target=\"_blank\">rheumatoid arthritis<\/a> but not severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoporosis\" title=\"Osteoporosis\" rel=\"external_link\" target=\"_blank\">osteoporosis<\/a> of the ankle;<\/li>\n<li>patients suitable for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthrodesis\" title=\"Arthrodesis\" rel=\"external_link\" target=\"_blank\">arthrodesis<\/a> but rejecting it.<\/li><\/ol>\n<p>The general contraindications are:\n<\/p>\n<ol><li>varus or valgus deformity greater than 15 degrees, severe bony erosion, severe talus subluxation;<\/li>\n<li>substantial <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoporosis\" title=\"Osteoporosis\" rel=\"external_link\" target=\"_blank\">osteoporosis<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteonecrosis\" class=\"mw-redirect\" title=\"Osteonecrosis\" rel=\"external_link\" target=\"_blank\">osteonecrosis<\/a> particularly affecting the talus;<\/li>\n<li>previous or current infections of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foot\" title=\"Foot\" rel=\"external_link\" target=\"_blank\">foot<\/a>;<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular_disease\" title=\"Vascular disease\" rel=\"external_link\" target=\"_blank\">vascular disease<\/a> or severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurological_disorders\" class=\"mw-redirect\" title=\"Neurological disorders\" rel=\"external_link\" target=\"_blank\">neurologic disorders<\/a>;<\/li>\n<li>previous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthrodesis\" title=\"Arthrodesis\" rel=\"external_link\" target=\"_blank\">arthrodesis<\/a> of the ipsilateral <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip\" title=\"Hip\" rel=\"external_link\" target=\"_blank\">hip<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee\" title=\"Knee\" rel=\"external_link\" target=\"_blank\">knee<\/a> or severe deformities of these joints.<\/li><\/ol>\n<p>Other potential contraindications such as capsuloligamentous instability and hindfoot or forefoot deformities affecting correct posture, are not considered relevant if resolved before or during this surgery.<sup id=\"rdp-ebb-cite_ref-pmid20559763_4-1\" class=\"reference\"><a href=\"#cite_note-pmid20559763-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Outcome\">Outcome<\/span><\/h2>\n<p>The outcome of an ankle replacement includes factors like ankle function, pain, revision and implant survival. Outcome studies on modern designs show a five-year implant survival rate between 67% and 94%.<sup id=\"rdp-ebb-cite_ref-pmid17768184_7-0\" class=\"reference\"><a href=\"#cite_note-pmid17768184-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-stengel05_8-0\" class=\"reference\"><a href=\"#cite_note-stengel05-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-gougoulias10_9-0\" class=\"reference\"><a href=\"#cite_note-gougoulias10-9\" rel=\"external_link\">[9]<\/a><\/sup> and ten-year survival rates around 75%.<sup id=\"rdp-ebb-cite_ref-pmid17768184_7-1\" class=\"reference\"><a href=\"#cite_note-pmid17768184-7\" rel=\"external_link\">[7]<\/a><\/sup> Mobile bearing designs have enabled implant survival rates to continue to improve, reaching as high as 95% for five years and 90% for ten years.<sup id=\"rdp-ebb-cite_ref-pmid21733455_10-0\" class=\"reference\"><a href=\"#cite_note-pmid21733455-10\" rel=\"external_link\">[10]<\/a><\/sup> Ankle replacements have a 30-day readmission rate of 2.2%, which is similar to that of knee replacement but lower than that of total hip replacement. 6.6% of patients undergoing primary TAR require a reoperation within 12 months of the index procedure. Early revision rates are significantly higher in low-volume centres.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>Clinical ankle scores, such as the American Orthopaedic Foot and Ankle Society (AOFAS) or the Manchester Oxford Foot & Ankle Questionnaire<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> are outcome rating system for ankle replacements. Further outcome instruments include radiographic assessment of component stability and migration, and the assessment of its functionality in daily life using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gait_analysis\" title=\"Gait analysis\" rel=\"external_link\" target=\"_blank\">gait analysis<\/a> or video<a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroscopy\" title=\"Fluoroscopy\" rel=\"external_link\" target=\"_blank\">fluoroscopy<\/a>; the latter is a tool for three-dimensional measuring of the position and orientation of implanted prosthetic components at the replaced joints.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>Research comparing the effects of ankle replacement against ankle fusion (<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.anklearthritis.co.uk\" target=\"_blank\">the TARVA study<\/a>) is ongoing in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_Kingdom\" title=\"United Kingdom\" rel=\"external_link\" target=\"_blank\">United Kingdom<\/a>, in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Randomised_controlled_trial\" class=\"mw-redirect\" title=\"Randomised controlled trial\" rel=\"external_link\" target=\"_blank\">randomised controlled trial<\/a> to compare the clinical and cost-effectiveness of these treatments.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> The TARVA protocol has been published in the British Medical Journal.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-pmid19589303-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid19589303_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Saltzman, C.L.; Mann, R.A.; Ahrens, J.E.; Amendola, A.; Anderson, R.B.; Berlet, G.C.; Brodky, J.W.; Chou, L.B.; Clanton, T.O.; Deland, J.T.; Deorio, J.K.; Horton, G.A.; Lee, T.H.; Mann, J.A.; Nunley, J.A.; Thordarson, D.B.; Walling, A.K.; Wapner, K.L.; Coughlin, M.J. (2009). \"Prospective Controlled Trial of STAR Total Ankle Replacement Versus Ankle Fusion: Initial Results\". <i><\/i>. <b>30<\/b> (7): 579\u2013596. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3113%2FFAI.2009.0579\" target=\"_blank\">10.3113\/FAI.2009.0579<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19589303\" target=\"_blank\">19589303<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Foot+%26+Ankle+International&rft.atitle=Prospective+Controlled+Trial+of+STAR+Total+Ankle+Replacement+Versus+Ankle+Fusion%3A+Initial+Results&rft.volume=30&rft.issue=7&rft.pages=579-596&rft.date=2009&rft_id=info%3Adoi%2F10.3113%2FFAI.2009.0579&rft_id=info%3Apmid%2F19589303&rft.aulast=Saltzman&rft.aufirst=C.L.&rft.au=Mann%2C+R.A.&rft.au=Ahrens%2C+J.E.&rft.au=Amendola%2C+A.&rft.au=Anderson%2C+R.B.&rft.au=Berlet%2C+G.C.&rft.au=Brodky%2C+J.W.&rft.au=Chou%2C+L.B.&rft.au=Clanton%2C+T.O.&rft.au=Deland%2C+J.T.&rft.au=Deorio%2C+J.K.&rft.au=Horton%2C+G.A.&rft.au=Lee%2C+T.H.&rft.au=Mann%2C+J.A.&rft.au=Nunley%2C+J.A.&rft.au=Thordarson%2C+D.B.&rft.au=Walling%2C+A.K.&rft.au=Wapner%2C+K.L.&rft.au=Coughlin%2C+M.J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkle+replacement\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-pmid8934479-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid8934479_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kitaoka, Harold B.; Patzer, Gary L. (1996). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ejbjs.org\/cgi\/content\/full\/78\/11\/1658\" target=\"_blank\">\"Clinical results of the Mayo total ankle arthroplasty\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Journal_of_Bone_and_Joint_Surgery\" class=\"mw-redirect\" title=\"Journal of Bone and Joint Surgery\" rel=\"external_link\" target=\"_blank\">Journal of Bone and Joint Surgery<\/a><\/i>. <b>78A<\/b> (11): 1658\u201364. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8934479\" target=\"_blank\">8934479<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Bone+and+Joint+Surgery&rft.atitle=Clinical+results+of+the+Mayo+total+ankle+arthroplasty&rft.volume=78A&rft.issue=11&rft.pages=1658-64&rft.date=1996&rft_id=info%3Apmid%2F8934479&rft.aulast=Kitaoka&rft.aufirst=Harold+B.&rft.au=Patzer%2C+Gary+L.&rft_id=http%3A%2F%2Fwww.ejbjs.org%2Fcgi%2Fcontent%2Ffull%2F78%2F11%2F1658&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkle+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid8008441-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid8008441_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lachiewicz, PF (1994). \"Total ankle arthroplasty. Indications, techniques, and results\". <i><\/i>. <b>23<\/b> (4): 315\u201320. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8008441\" target=\"_blank\">8008441<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Orthopaedic+Review&rft.atitle=Total+ankle+arthroplasty.+Indications%2C+techniques%2C+and+results&rft.volume=23&rft.issue=4&rft.pages=315-20&rft.date=1994&rft_id=info%3Apmid%2F8008441&rft.aulast=Lachiewicz&rft.aufirst=PF&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkle+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid20559763-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-pmid20559763_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pmid20559763_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Giannini, Sandro; Romagnoli, Matteo; O\u2019connor, John J.; Malerba, Francesco; Leardini, Alberto (2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3049631\" target=\"_blank\">\"Total Ankle Replacement Compatible with Ligament Function Produces Mobility, Good Clinical Scores, and Low Complication Rates: An Early Clinical Assessment\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_Orthopaedics_and_Related_Research\" title=\"Clinical Orthopaedics and Related Research\" rel=\"external_link\" target=\"_blank\">Clinical Orthopaedics and Related Research<\/a><\/i>. <b>468<\/b> (10): 2746\u201353. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11999-010-1432-3\" target=\"_blank\">10.1007\/s11999-010-1432-3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3049631\" target=\"_blank\">3049631<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Orthopaedics+and+Related+Research&rft.atitle=Total+Ankle+Replacement+Compatible+with+Ligament+Function+Produces+Mobility%2C+Good+Clinical+Scores%2C+and+Low+Complication+Rates%3A+An+Early+Clinical+Assessment&rft.volume=468&rft.issue=10&rft.pages=2746-53&rft.date=2010&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3049631&rft_id=info%3Adoi%2F10.1007%2Fs11999-010-1432-3&rft.aulast=Giannini&rft.aufirst=Sandro&rft.au=Romagnoli%2C+Matteo&rft.au=O%E2%80%99connor%2C+John+J.&rft.au=Malerba%2C+Francesco&rft.au=Leardini%2C+Alberto&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3049631&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkle+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid10693083-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid10693083_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Saltzman, CL; McIff, TE; Buckwalter, JA; Brown, TD (2000). \"Total ankle replacement revisited\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Journal_of_Orthopaedic_%26_Sports_Physical_Therapy\" title=\"Journal of Orthopaedic & Sports Physical Therapy\" rel=\"external_link\" target=\"_blank\">Journal of Orthopaedic & Sports Physical Therapy<\/a><\/i>. <b>30<\/b> (2): 56\u201367. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2519%2Fjospt.2000.30.2.56\" target=\"_blank\">10.2519\/jospt.2000.30.2.56<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10693083\" target=\"_blank\">10693083<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Orthopaedic+%26+Sports+Physical+Therapy&rft.atitle=Total+ankle+replacement+revisited&rft.volume=30&rft.issue=2&rft.pages=56-67&rft.date=2000&rft_id=info%3Adoi%2F10.2519%2Fjospt.2000.30.2.56&rft_id=info%3Apmid%2F10693083&rft.aulast=Saltzman&rft.aufirst=CL&rft.au=McIff%2C+TE&rft.au=Buckwalter%2C+JA&rft.au=Brown%2C+TD&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkle+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid581081-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid581081_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Goodfellow, John; 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Coetzee, J.C.; Estok, R.; Fahrbach, K.; Banel, D.; Nalysnyk, L. (2007). \"Intermediate and Long-Term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis. A Systematic Review of the Literature\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Journal_of_Bone_and_Joint_Surgery\" class=\"mw-redirect\" title=\"Journal of Bone and Joint Surgery\" rel=\"external_link\" target=\"_blank\">Journal of Bone and Joint Surgery<\/a><\/i>. <b>89A<\/b> (9): 1899\u2013905. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.F.01149\" target=\"_blank\">10.2106\/JBJS.F.01149<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17768184\" target=\"_blank\">17768184<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Bone+and+Joint+Surgery&rft.atitle=Intermediate+and+Long-Term+Outcomes+of+Total+Ankle+Arthroplasty+and+Ankle+Arthrodesis.+A+Systematic+Review+of+the+Literature&rft.volume=89A&rft.issue=9&rft.pages=1899-905&rft.date=2007&rft_id=info%3Adoi%2F10.2106%2FJBJS.F.01149&rft_id=info%3Apmid%2F17768184&rft.aulast=Haddad&rft.aufirst=S.L.&rft.au=Coetzee%2C+J.C.&rft.au=Estok%2C+R.&rft.au=Fahrbach%2C+K.&rft.au=Banel%2C+D.&rft.au=Nalysnyk%2C+L.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkle+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-stengel05-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-stengel05_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stengel, Dirk; Bauwens, Kai; Ekkernkamp, Axel; Cramer, J\u00f6rg (2005). \"Efficacy of total ankle replacement with meniscal-bearing devices: a systematic review and meta-analysis\". <i><\/i>. <b>125<\/b> (2): 109\u201319. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00402-004-0765-3\" target=\"_blank\">10.1007\/s00402-004-0765-3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15690167\" target=\"_blank\">15690167<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+of+Orthopaedic+and+Trauma+Surgery&rft.atitle=Efficacy+of+total+ankle+replacement+with+meniscal-bearing+devices%3A+a+systematic+review+and+meta-analysis&rft.volume=125&rft.issue=2&rft.pages=109-19&rft.date=2005&rft_id=info%3Adoi%2F10.1007%2Fs00402-004-0765-3&rft_id=info%3Apmid%2F15690167&rft.aulast=Stengel&rft.aufirst=Dirk&rft.au=Bauwens%2C+Kai&rft.au=Ekkernkamp%2C+Axel&rft.au=Cramer%2C+J%C3%B6rg&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkle+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-gougoulias10-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-gougoulias10_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gougoulias, Nikolaos; Khanna, Anil; Maffulli, Nicola (2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2795846\" target=\"_blank\">\"How Successful are Current Ankle Replacements? All [<i>sic<\/i>] though most total ankle replacement are successful by reducing pain and improving mobility there is a very high possibility that the pain may be ten times worse. There have been several cases where the doctors have recommended amputation to resolve the issue of pain that was not there prior to the total ankle replacement. : A Systematic Review of the Literature\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_Orthopaedics_and_Related_Research\" title=\"Clinical Orthopaedics and Related Research\" rel=\"external_link\" target=\"_blank\">Clinical Orthopaedics and Related Research<\/a><\/i>. <b>468<\/b>: 199\u2013208. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11999-009-0987-3\" target=\"_blank\">10.1007\/s11999-009-0987-3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2795846\" target=\"_blank\">2795846<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Orthopaedics+and+Related+Research&rft.atitle=How+Successful+are+Current+Ankle+Replacements%3F+All%26%2332%3B%26%2391%3Bsic%26%2393%3B+though+most+total+ankle+replacement+are+successful+by+reducing+pain+and+improving+mobility+there+is+a+very+high+possibility+that+the+pain+may+be+ten+times+worse.+There+have+been+several+cases+where+the+doctors+have+recommended+amputation+to+resolve+the+issue+of+pain+that+was+not+there+prior+to+the+total+ankle+replacement.+%3A+A+Systematic+Review+of+the+Literature&rft.volume=468&rft.pages=199-208&rft.date=2009&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2795846&rft_id=info%3Adoi%2F10.1007%2Fs11999-009-0987-3&rft.aulast=Gougoulias&rft.aufirst=Nikolaos&rft.au=Khanna%2C+Anil&rft.au=Maffulli%2C+Nicola&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2795846&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkle+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid21733455-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid21733455_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mann, J.A.; Mann, R.A.; Horton, E. (2011). \"STAR ankle: long-term results\". <i><\/i>. <b>32<\/b> (5): S473\u2013484. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3113%2FFAI.2011.0473\" target=\"_blank\">10.3113\/FAI.2011.0473<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21733455\" target=\"_blank\">21733455<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Foot+Ankle+International&rft.atitle=STAR+ankle%3A+long-term+results&rft.volume=32&rft.issue=5&rft.pages=S473-484&rft.date=2011&rft_id=info%3Adoi%2F10.3113%2FFAI.2011.0473&rft_id=info%3Apmid%2F21733455&rft.aulast=Mann&rft.aufirst=J.A.&rft.au=Mann%2C+R.A.&rft.au=Horton%2C+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkle+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zaidi, Razi; Macgregor, Alexander J.; Goldberg, Andy (2016-05-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bmjopen.bmj.com\/content\/6\/5\/e011332\" target=\"_blank\">\"Quality measures for total ankle replacement, 30-day readmission and reoperation rates within 1 year of surgery: a data linkage study using the NJR data set\"<\/a>. <i>BMJ Open<\/i>. <b>6<\/b> (5): e011332. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmjopen-2016-011332\" target=\"_blank\">10.1136\/bmjopen-2016-011332<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2044-6055\" target=\"_blank\">2044-6055<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4885469\" target=\"_blank\">4885469<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27217286\" target=\"_blank\">27217286<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMJ+Open&rft.atitle=Quality+measures+for+total+ankle+replacement%2C+30-day+readmission+and+reoperation+rates+within+1+year+of+surgery%3A+a+data+linkage+study+using+the+NJR+data+set&rft.volume=6&rft.issue=5&rft.pages=e011332&rft.date=2016-05-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4885469&rft.issn=2044-6055&rft_id=info%3Apmid%2F27217286&rft_id=info%3Adoi%2F10.1136%2Fbmjopen-2016-011332&rft.aulast=Zaidi&rft.aufirst=Razi&rft.au=Macgregor%2C+Alexander+J.&rft.au=Goldberg%2C+Andy&rft_id=http%3A%2F%2Fbmjopen.bmj.com%2Fcontent%2F6%2F5%2Fe011332&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkle+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Morley, D.; Jenkinson, C.; Doll, H.; Lavis, G.; Sharp, R.; Cooke, P.; Dawson, J. (2013-04-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3638305\" target=\"_blank\">\"The Manchester\u2013Oxford Foot Questionnaire (MOXFQ)\"<\/a>. <i>Bone & Joint Research<\/i>. <b>2<\/b> (4): 66\u201369. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1302%2F2046-3758.24.2000147\" target=\"_blank\">10.1302\/2046-3758.24.2000147<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2046-3758\" target=\"_blank\">2046-3758<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3638305\" target=\"_blank\">3638305<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23673374\" target=\"_blank\">23673374<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Bone+%26+Joint+Research&rft.atitle=The+Manchester%E2%80%93Oxford+Foot+Questionnaire+%28MOXFQ%29&rft.volume=2&rft.issue=4&rft.pages=66-69&rft.date=2013-04-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3638305&rft.issn=2046-3758&rft_id=info%3Apmid%2F23673374&rft_id=info%3Adoi%2F10.1302%2F2046-3758.24.2000147&rft.aulast=Morley&rft.aufirst=D.&rft.au=Jenkinson%2C+C.&rft.au=Doll%2C+H.&rft.au=Lavis%2C+G.&rft.au=Sharp%2C+R.&rft.au=Cooke%2C+P.&rft.au=Dawson%2C+J.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3638305&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkle+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Conti S, Lalonde KA, Martin R (November 2006). \"Kinematic analysis of the agility total ankle during gait\". <i><\/i>. <b>27<\/b> (11): 980\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F107110070602701120\" target=\"_blank\">10.1177\/107110070602701120<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17144964\" target=\"_blank\">17144964<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Foot+%26+Ankle+International&rft.atitle=Kinematic+analysis+of+the+agility+total+ankle+during+gait&rft.volume=27&rft.issue=11&rft.pages=980-4&rft.date=2006-11&rft_id=info%3Adoi%2F10.1177%2F107110070602701120&rft_id=info%3Apmid%2F17144964&rft.aulast=Conti&rft.aufirst=S&rft.au=Lalonde%2C+KA&rft.au=Martin%2C+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkle+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Banks SA, Hodge WA (June 1996). \"Accurate measurement of three-dimensional knee replacement kinematics using single-plane fluoroscopy\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/IEEE_Transactions_on_Bio-medical_Engineering\" class=\"mw-redirect\" title=\"IEEE Transactions on Bio-medical Engineering\" rel=\"external_link\" target=\"_blank\">IEEE Transactions on Bio-medical Engineering<\/a><\/i>. <b>43<\/b> (6): 638\u201349. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2F10.495283\" target=\"_blank\">10.1109\/10.495283<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8987268\" target=\"_blank\">8987268<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=IEEE+Transactions+on+Bio-medical+Engineering&rft.atitle=Accurate+measurement+of+three-dimensional+knee+replacement+kinematics+using+single-plane+fluoroscopy&rft.volume=43&rft.issue=6&rft.pages=638-49&rft.date=1996-06&rft_id=info%3Adoi%2F10.1109%2F10.495283&rft_id=info%3Apmid%2F8987268&rft.aulast=Banks&rft.aufirst=SA&rft.au=Hodge%2C+WA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkle+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ukctg.nihr.ac.uk\/trials\/trial-details\/trial-details?trialNumber=ISRCTN60672307\" target=\"_blank\">\"Trial Detail - UK Clinical Trial Gateway\"<\/a>. <i>www.ukctg.nihr.ac.uk<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-05-07<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.ukctg.nihr.ac.uk&rft.atitle=Trial+Detail+-+UK+Clinical+Trial+Gateway&rft_id=https%3A%2F%2Fwww.ukctg.nihr.ac.uk%2Ftrials%2Ftrial-details%2Ftrial-details%3FtrialNumber%3DISRCTN60672307&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkle+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Goldberg, Andrew J.; Zaidi, Razi; Thomson, Claire; Dor\u00e9, Caroline J.; Skene, Simon S.; Cro, Suzie; Round, Jeff; Molloy, Andrew; Davies, Mark (2016-09-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bmjopen.bmj.com\/content\/6\/9\/e012716\" target=\"_blank\">\"Total ankle replacement versus arthrodesis (TARVA): protocol for a multicentre randomised controlled trial\"<\/a>. <i>BMJ Open<\/i>. <b>6<\/b> (9): e012716. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmjopen-2016-012716\" target=\"_blank\">10.1136\/bmjopen-2016-012716<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2044-6055\" target=\"_blank\">2044-6055<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5020669\" target=\"_blank\">5020669<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27601503\" target=\"_blank\">27601503<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMJ+Open&rft.atitle=Total+ankle+replacement+versus+arthrodesis+%28TARVA%29%3A+protocol+for+a+multicentre+randomised+controlled+trial&rft.volume=6&rft.issue=9&rft.pages=e012716&rft.date=2016-09-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5020669&rft.issn=2044-6055&rft_id=info%3Apmid%2F27601503&rft_id=info%3Adoi%2F10.1136%2Fbmjopen-2016-012716&rft.aulast=Goldberg&rft.aufirst=Andrew+J.&rft.au=Zaidi%2C+Razi&rft.au=Thomson%2C+Claire&rft.au=Dor%C3%A9%2C+Caroline+J.&rft.au=Skene%2C+Simon+S.&rft.au=Cro%2C+Suzie&rft.au=Round%2C+Jeff&rft.au=Molloy%2C+Andrew&rft.au=Davies%2C+Mark&rft_id=http%3A%2F%2Fbmjopen.bmj.com%2Fcontent%2F6%2F9%2Fe012716&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAnkle+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.aofas.org\" target=\"_blank\">American Orthopaedic Foot & Ankle Society<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/orthotoolkit.com\/index.php\/aofas-ankle-hindfoot\/\" target=\"_blank\">American Orthopaedic Foot & Ankle Society score (AOFAS) free online calculator<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.myankle.com\" target=\"_blank\">Total Ankle Replacement<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.totalankleinstitute.com\" target=\"_blank\">Total Ankle Institute<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1243\nCached time: 20181211024922\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.380 seconds\nReal time usage: 0.448 seconds\nPreprocessor visited node count: 1322\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 68721\/2097152 bytes\nTemplate argument size: 241\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 50969\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.230\/10.000 seconds\nLua memory usage: 3.88 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 384.102 1 -total\n<\/p>\n<pre>71.32% 273.950 1 Template:Reflist\n56.78% 218.110 15 Template:Cite_journal\n19.44% 74.680 1 Template:Infobox_medical_intervention\n18.05% 69.315 1 Template:Infobox\n 6.37% 24.473 3 Template:Navbox\n 6.06% 23.276 1 Template:Bone,_cartilage,_and_joint_procedures\n 2.62% 10.073 1 Template:Cite_web\n 0.93% 3.575 1 Template:Main_other\n 0.92% 3.520 1 Template:Sic\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:20337177-1!canonical and timestamp 20181211024921 and revision id 842506873\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ankle_replacement\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212235\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.015 seconds\nReal time usage: 0.157 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 149.783 1 - wikipedia:Ankle_replacement\n100.00% 149.783 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8199-0!*!*!*!*!*!* and timestamp 20181217212235 and revision id 24345\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Ankle_replacement\">https:\/\/www.limswiki.org\/index.php\/Ankle_replacement<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","ff342e7a22b19a4ed09ac1f4f3f676cd_images":[],"ff342e7a22b19a4ed09ac1f4f3f676cd_timestamp":1545081755,"e714ef7de25ee1b6ff169665206e555b_type":"article","e714ef7de25ee1b6ff169665206e555b_title":"Titanium biocompatibility","e714ef7de25ee1b6ff169665206e555b_url":"https:\/\/www.limswiki.org\/index.php\/Titanium_biocompatibility","e714ef7de25ee1b6ff169665206e555b_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tTitanium biocompatibility\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Medical grade titanium inserted to a bone.\nTitanium was first introduced into surgeries in the 1950s after having been used in dentistry for a decade prior. It is now the metal of choice for prosthetics, internal fixation, inner body devices, and instrumentation. Titanium is used from head to toe in biomedical implants. One can find titanium in neurosurgery, bone conduction hearing aids, false eye implants, spinal fusion cages, pacemakers, toe implants, and shoulder\/elbow\/hip\/knee replacements along with many more. The main reason why titanium is often used in the body is due to titanium's biocompatibility and, with surface modifications, bioactive surface. The surface characteristics that affect biocompatibility are surface texture, steric hindrance, binding sites, and hydrophobicity (wetting). These characteristics are optimized to create an ideal cellular response. Some medical implants, as well as parts of surgical instruments are coated with titanium nitride (TiN).\n\nContents \n\n1 Biocompatibility \n\n1.1 Osseointegration interaction and proliferation \n\n1.1.1 High energy surfaces induce angiogenesis during osseointegration \n1.1.2 Surface properties determine osseointegration \n\n\n\n\n2 Surface energy \n\n2.1 Redox potential \n2.2 Surface coating \n2.3 Wetting and solid surface \n\n\n3 Adsorption \n\n3.1 Corrosion \n3.2 Adhesion \n\n\n4 See also \n5 References \n\n\nBiocompatibility \nTitanium is considered the most biocompatible metal due to its resistance to corrosion from bodily fluids, bio-inertness, capacity for osseointegration, and high fatigue limit. Titanium's ability to withstand the harsh bodily environment is a result of the protective oxide film that forms naturally in the presence of oxygen. The oxide film is strongly adhered, insoluble, and chemically impermeable, preventing reactions between the metal and the surrounding environment. The mechanical properties of the material and the loading conditions in the host have, conventionally, influenced material selection for different clinical applications: predominantly Ti6Al4V in orthopaedics while commercially pure titanium in dentistry.[1]\n\nOsseointegration interaction and proliferation \nHigh energy surfaces induce angiogenesis during osseointegration \nIt has been suggested that titanium's capacity for osseointegration stems from the high dielectric constant of its surface oxide, which does not denature proteins (like tantalum, and cobalt alloys).[2] Its ability to physically bond with bone gives titanium an advantage over other materials that require the use of an adhesive to remain attached. Titanium implants last longer and much higher forces are required to break the bonds that join them to the body compared to their alternatives.[3]\n\nSurface properties determine osseointegration \nThe surface properties of a biomaterial play an important role in determining cellular response (cell adhesion and proliferation) to the material. Titanium's microstructure and high surface energy enable it to induce angiogenesis, which assists in the process of osseointegration.[4]\n\nSurface energy \nRedox potential \nTitanium can have many different standard electrode potentials depending on its oxidation state. Solid titanium has a standard electrode potential of -1.63V. Materials with a greater standard electrode potential are more easily reduced, making them better oxidizing agents.[5] As can be seen in the table below, solid titanium prefers to undergo oxidation, making it a better reducing agent.\n\n\n\n\nHalf Reaction\nStandard Electron Potential (V)\n\n\nTi2+ + 2\u200ae\u2212 \u2192 Ti(s)\n-1.63[5]\n\n\nTi3+ + 3\u200ae\u2212 \u2192 Ti(s)\n-1.21[6]\n\n\nTiO2+ + 2\u200aH+ + 4\u200ae\u2212 \u2192 Ti(s) + \u200aH2O\n-0.86[7]\n\n\n2\u200aTiO2(s) + 2\u200aH+ + 2\u200ae\u2212 \u2192 Ti2O3(s) + \u200aH2O\n-0.56[7]\n\n\nTi2+(aq)\/M3+(aq)\n-0.36[6]\n\n\nSurface coating \n Cellular binding to a titanium oxide surface\nTitanium naturally passivates, forming an oxide film that becomes heterogeneous and polarized as a function of exposure time to bodily environments.[8] This leads to the increased adsorption of hydroxyl groups, lipoproteins, and glycolipids over time.[8] The adsorption of these compounds changes how the material interacts with the body and can improve biocompatibility. In titanium alloys such as Ti-Zr and Ti-Nb, zirconium and niobium ions that are liberated due to corrosion are not released into the patient's body, but rather added to the passivation layer.[9] The alloying elements in the passive layer add a degree of biocompatibility and corrosion resistance depending on the original alloy composition of the bulk metal prior to corrosion.\nProtein surface concentration, (\n \n \n \n Γ\n \n \n {\\displaystyle \\Gamma }\n \n\n ), is defined by the equation\n\n<\/p>\n \n \n \n Γ\n =\n \n \n \n \n Q\n \n ADS\n \n \n M\n \n \n n\n F\n \n \n \n \n \n {\\displaystyle \\Gamma ={Q_{\\text{ADS}}M \\over nF}}\n \n\n [10]\n\n<\/p>where QADS is the surface charge density in C cm\u22122, M is the molar mass of the protein in g mol\u22121, n is the number of electrons transferred (in this case, one electron for each protonated amino group in the protein), and F is the Faraday constant in C mol\u22121.\nThe equation for collision frequency is as follows:\n\n \n \n \n \n v\n \n c\n \n \n =\n \n 2\n π\n D\n c\n d\n \n N\n \n A\n \n \n \n \n \n {\\displaystyle v_{\\text{c}}={2\\pi DcdN_{\\text{A}}}}\n \n\n [10]\n\n<\/p>where D = 8.83 \u00d7 10\u22127 cm2 s\u22121 is the diffusion coefficient of the BSA molecule at 310 K, d = 7.2 nm is the \u201cdiameter\u201d of the proteinwhich is equivalent to twice the Stokes radius, NA = 6.023 \u00d7 1023 mol\u22121 is Avogadro's number, and c* = 0.23 g L\u22121 (3.3 \u03bcM) is the critical bulk supersaturation concentration.\n\nWetting and solid surface \n The droplet on the left has a contact angle between 90 and 180 degrees, rendering the interaction between the solid and the liquid relatively weak. In contrast, the droplet on the right has a contact angle between 0 and 90 degrees making the interaction between the solid and the liquid strong.\nWetting occurs as a function of two parameters: surface roughness and surface fraction.[11] By increasing wetting, implants can decrease the time required for osseointegration by allowing cells to more readily bind to the surface of an implant.[3] Wetting of titanium can be modified by optimizing process parameters such as temperature, time, and pressure (shown in table below). Titanium with stable oxide layers predominantly consisting of TiO2 result in improved wetting of the implant in contact with physiological fluid.[12]\n\n\n\n\nSurface\nWetting Angle (degrees)\nPressure (mbar) During Processing\nTemperature (degrees C) During Processing\nOther Surface Processing\n\n\nBare Ti\n~50[10]\n-\n-\nNone\n\n\nTiO2 TiO Ti4O7 TiO4 (Planar)\n~33[12]\n2.2\n700\nOxidation\n\n\nTiO2 TiO Ti4O7 (Planar)\n~45[12]\n4\n700\nOxidation\n\n\nTiO2 TiO Ti4O7 TiO4 (Hollow)\n~32[12]\n2.2\n400\nOxidation\n\n\nTiO2 TiO Ti4O7 (Hollow)\n~25[12]\n2.6\n500\nOxidation\n\n\nTiO2 TiO Ti4O7 (Hollow)\n~8[12]\n4\n400\nOxidation\n\n\nTiO2 TiO Ti4O7 (Hollow)\n~20[12]\n4\n500\nOxidation\n\n\nTi with roughened surface\n79.5 \u00b1 4.6[13]\n-\n-\nMachined Surface\n\n\nTi with alkali-treated surface\n27.2 \u00b1 6.9[13]\n-\n-\nBio-surface\n\nAdsorption \nCorrosion \nMechanical abrasion of the titanium oxide film leads to an increased rate of corrosion.[14]\nTitanium and its alloys are not immune to corrosion when in the human body. Titanium alloys are susceptible to hydrogen absorption which can induce precipitation of hydrides and cause embrittlement, leading to material failure.[14] \"Hydrogen embrittlement was observed as an in vivo mechanism of degradation under fretting-crevice corrosion conditions resulting in TiH formation, surface reaction and cracking inside Ti\/Ti modular body tapers.\"[14] Studying and testing titanium behavior in the body allow us to avoid malpractices that would cause a fatal breakdown in the implant, like the usage of dental products with high fluoride concentration or substances capable of lowering the pH of the media around the implant.[15]\n\nAdhesion \n A metal surface with grafted polymers multimeric constructs to promote cell binding. The polymers grafted on the metal surface are brushed, increasing the contact area for cell integration\nThe cells at the implant interface are highly sensitive to foreign objects. When implants are installed into the body, the cells initiate an inflammatory response which could lead to encapsulation, impairing the functioning of the implanted device.[16]\nThe ideal cell response to a bioactive surface is characterized by biomaterial stabilization and integration, as well as the reduction of potential bacterial infection sites on the surface. One example of biomaterial integration is a titanium implant with an engineered biointerface covered with biomimetic motifs. Surfaces with these biomimetic motifs have shown to enhance integrin binding and signaling and stem cell differentiation. Increasing the density of ligand clustering also increased integrin binding. A coating consisting of trimers and pentamers increased the bone-implant contact area by 75% when compared to the current clinical standard of uncoated titanium.[17] This increase in area allows for increased cellular integration, and reduces rejection of implanted device. \nThe Langmuir isotherm:\n\n<\/p>\n \n \n \n Γ\n =\n \n \n \n \n B\n \n ADS\n \n \n \n Γ\n \n max\n \n \n \n \n (\n 1\n +\n c\n \n B\n \n ADS\n \n \n )\n \n \n \n \n \n {\\displaystyle \\Gamma ={B_{\\text{ADS}}\\Gamma _{\\text{max}} \\over (1+cB_{\\text{ADS}})}}\n \n\n ,[10]\n\n<\/p>where c is the concentration of the adsorbate \n \n \n \n Γ\n \n \n {\\displaystyle \\Gamma }\n \n\n is the max amount of adsorbed protein, BADS is the affinity of the adsorbate molecules toward adsorption sites. The Langmuir isotherm can be linearized by rearranging the equation to,\n\n<\/p>\n \n \n \n \n \n c\n Γ\n \n \n =\n \n \n \n 1\n \n \n B\n \n ADS\n \n \n \n Γ\n \n max\n \n \n \n \n \n +\n \n \n c\n \n Γ\n \n max\n \n \n \n \n \n \n \n {\\displaystyle {c \\over \\Gamma }={{1 \\over {B_{\\text{ADS}}\\Gamma _{\\text{max}}}}+{c \\over \\Gamma _{\\text{max}}}}}\n \n\n [10]\n\n<\/p>This simulation is a good approximation of adsorption to a surface when compared to experimental values.[10] The Langmuir isotherm for adsorption of elements onto the titanium surface can be determined by plotting the know parameters. An experiment of fibrinogen adsorption on a titanium surface \"confirmed the applicability of the Langmuir isotherm in the description of adsorption of fibrinogen onto Ti surface.\"[10]\n\nSee also \nBiomaterials: Mechanical Properties\nMetals in medicine\nTitanium adhesive bonding\nReferences \n\n\n^ Shah, Furqan A.; Trobos, Margarita; Thomsen, Peter; Palmquist, Anders (May 2016). \"Commercially pure titanium (cp-Ti) versus titanium alloy (Ti6Al4V) materials as bone anchored implants \u2014 Is one truly better than the other?\". Materials Science and Engineering: C. 62: 960\u2013966. doi:10.1016\/j.msec.2016.01.032. PMID 26952502. \n\n^ Black J (1994) Biological performance of tantalum. Clin Mater 16: 167\u2013173. \n\n^ a b Raines, Andrew L.; Olivares-Navarrete, Rene; Wieland, Marco; Cochran, David L.; Schwartz, Zvi; Boyan, Barbara D. (2010). \"Regulation of angiogenesis during osseointegration by titanium surface microstructure and energy\". Biomaterials. 31 (18): 4909\u201317. doi:10.1016\/j.biomaterials.2010.02.071. PMC 2896824 . PMID 20356623. \n\n^ http:\/\/titaniumthemetal.org\/Resources\/DataSheetMedical.pdf \n\n^ a b \"Standard Reduction Potentials (25oC)\". \n\n^ a b Brown, Doc. \"Chemistry of Titanium\". \n\n^ a b Winter, Mark. \"Titanium compounds\". \n\n^ a b Healy, Kevin E.; Ducheyne, Paul (1991). \"A physical model for the titanium-tissue interface\". ASAIO Transactions. 37 (3): M150\u20131. PMID 1751087. \n\n^ Long, Marc; Rack, H.J (1998). \"Titanium alloys in total joint replacement\u2014a materials science perspective\". Biomaterials. 19 (18): 1621\u201339. doi:10.1016\/S0142-9612(97)00146-4. PMID 9839998. \n\n^ a b c d e f g Jackson, Douglas R.; Omanovi\u0107, Sa\u0161a; Roscoe, Sharon G. (2000). \"Electrochemical Studies of the Adsorption Behavior of Serum Proteins on Titanium\". Langmuir. 16 (12): 5449\u201357. doi:10.1021\/la991497x. \n\n^ Bico, Jos\u00e9; Thiele, Uwe; Qu\u00e9r\u00e9, David (2002). \"Wetting of textured surfaces\". Colloids and Surfaces A: Physicochemical and Engineering Aspects. 206: 41\u20136. doi:10.1016\/S0927-7757(02)00061-4. \n\n^ a b c d e f g Silva, M.A.M.; Martinelli, A.E.; Alves, C.; Nascimento, R.M.; T\u00e1vora, M.P.; Vilar, C.D. (2006). \"Surface modification of Ti implants by plasma oxidation in hollow cathode discharge\". Surface and Coatings Technology. 200 (8): 2618\u201326. doi:10.1016\/j.surfcoat.2004.12.027. \n\n^ a b Strnad, Jakub; Strnad, Zden\u011bk; \u0160est\u00e1k, Jaroslav; Urban, Karel; Pov\u00fd\u0161il, Ctibor (2007). \"Bio-activated titanium surface utilizable for mimetic bone implantation in dentistry\u2014Part III: Surface characteristics and bone\u2013implant contact formation\". Journal of Physics and Chemistry of Solids. 68 (5\u20136): 841\u20135. Bibcode:2007JPCS...68..841S. doi:10.1016\/j.jpcs.2007.02.040. \n\n^ a b c Rodrigues, Danieli C.; Urban, Robert M.; Jacobs, Joshua J.; Gilbert, Jeremy L. (2009). \"In vivo severe corrosion and hydrogen embrittlement of retrieved modular body titanium alloy hip-implants\". Journal of Biomedical Materials Research Part B: Applied Biomaterials. 88 (1): 206\u201319. doi:10.1002\/jbm.b.31171. PMC 2667129 . PMID 18683224. \n\n^ http:\/\/www.dynadental.com\/editor\/download-121\/091102%20Nakagawa%20M%20-%20Effect%20of%20Fluoride%20and%20pH%20on%20Titanium%20-%20ENG.pdf \n\n^ Franz, Sandra; Rammelt, Stefan; Scharnweber, Dieter; Simon, Jan C. (2011). \"Immune responses to implants \u2013 A review of the implications for the design of immunomodulatory biomaterials\". Biomaterials. 32 (28): 6692\u2013709. doi:10.1016\/j.biomaterials.2011.05.078. PMID 21715002. \n\n^ Petrie, T. A.; Raynor, J. E.; Dumbauld, D. W.; Lee, T. T.; Jagtap, S.; Templeman, K. L.; Collard, D. M.; Garcia, A. J. (2010). \"Multivalent Integrin-Specific Ligands Enhance Tissue Healing and Biomaterial Integration\". Science Translational Medicine. 2 (45): 45ra60. doi:10.1126\/scitranslmed.3001002. PMC 3128787 . PMID 20720217. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Titanium_biocompatibility\">https:\/\/www.limswiki.org\/index.php\/Titanium_biocompatibility<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 11 March 2016, at 19:56.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,004 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","e714ef7de25ee1b6ff169665206e555b_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Titanium_biocompatibility skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Titanium biocompatibility<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Meditsiinilisest_titaanist_valmistatud_ja_aatomkihtsadestuse_meetodil_kaetud_hambaimplantaat_sea_reieluusse_sisestatuna.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ec\/Meditsiinilisest_titaanist_valmistatud_ja_aatomkihtsadestuse_meetodil_kaetud_hambaimplantaat_sea_reieluusse_sisestatuna.JPG\/200px-Meditsiinilisest_titaanist_valmistatud_ja_aatomkihtsadestuse_meetodil_kaetud_hambaimplantaat_sea_reieluusse_sisestatuna.JPG\" width=\"200\" height=\"113\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Meditsiinilisest_titaanist_valmistatud_ja_aatomkihtsadestuse_meetodil_kaetud_hambaimplantaat_sea_reieluusse_sisestatuna.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Medical grade titanium inserted to a bone.<\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">Titanium<\/a> was first introduced into surgeries in the 1950s after having been used in dentistry for a decade prior. It is now the metal of choice for prosthetics, internal fixation, inner body devices, and instrumentation. Titanium is used from head to toe in biomedical implants. One can find titanium in neurosurgery, bone conduction hearing aids, false eye implants, spinal fusion cages, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pacemakers\" class=\"mw-redirect\" title=\"Pacemakers\" rel=\"external_link\" target=\"_blank\">pacemakers<\/a>, toe implants, and shoulder\/elbow\/hip\/knee replacements along with many more. The main reason why titanium is often used in the body is due to titanium's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatibility<\/a> and, with surface modifications, bioactive surface. The surface characteristics that affect biocompatibility are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surface_texture\" class=\"mw-redirect\" title=\"Surface texture\" rel=\"external_link\" target=\"_blank\">surface texture<\/a>, steric hindrance, binding sites, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrophobicity\" class=\"mw-redirect\" title=\"Hydrophobicity\" rel=\"external_link\" target=\"_blank\">hydrophobicity<\/a> (wetting). These characteristics are optimized to create an ideal cellular response. Some medical implants, as well as parts of surgical instruments are coated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_nitride\" title=\"Titanium nitride\" rel=\"external_link\" target=\"_blank\">titanium nitride<\/a> (TiN).\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Biocompatibility\">Biocompatibility<\/span><\/h2>\n<p>Titanium is considered the most <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatible\" class=\"mw-redirect\" title=\"Biocompatible\" rel=\"external_link\" target=\"_blank\">biocompatible<\/a> metal due to its resistance to corrosion from bodily fluids, bio-inertness, capacity for osseointegration, and high fatigue limit. Titanium's ability to withstand the harsh bodily environment is a result of the protective oxide film that forms naturally in the presence of oxygen. The oxide film is strongly adhered, insoluble, and chemically impermeable, preventing reactions between the metal and the surrounding environment. The mechanical properties of the material and the loading conditions in the host have, conventionally, influenced material selection for different clinical applications: predominantly Ti6Al4V in orthopaedics while commercially pure titanium in dentistry.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Osseointegration_interaction_and_proliferation\">Osseointegration interaction and proliferation<\/span><\/h3>\n<h4><span class=\"mw-headline\" id=\"High_energy_surfaces_induce_angiogenesis_during_osseointegration\">High energy surfaces induce angiogenesis during osseointegration<\/span><\/h4>\n<p>It has been suggested that titanium's capacity for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseointegration\" title=\"Osseointegration\" rel=\"external_link\" target=\"_blank\">osseointegration<\/a> stems from the high dielectric constant of its surface oxide, which does not denature proteins (like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalum\" title=\"Tantalum\" rel=\"external_link\" target=\"_blank\">tantalum<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cobalt\" title=\"Cobalt\" rel=\"external_link\" target=\"_blank\">cobalt<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alloy\" title=\"Alloy\" rel=\"external_link\" target=\"_blank\">alloys<\/a>).<sup id=\"rdp-ebb-cite_ref-Black_2-0\" class=\"reference\"><a href=\"#cite_note-Black-2\" rel=\"external_link\">[2]<\/a><\/sup> Its ability to physically bond with bone gives titanium an advantage over other materials that require the use of an adhesive to remain attached. Titanium implants last longer and much higher forces are required to break the bonds that join them to the body compared to their alternatives.<sup id=\"rdp-ebb-cite_ref-raines_3-0\" class=\"reference\"><a href=\"#cite_note-raines-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Surface_properties_determine_osseointegration\">Surface properties determine osseointegration<\/span><\/h4>\n<p>The surface properties of a biomaterial play an important role in determining cellular response (cell adhesion and proliferation) to the material. Titanium's microstructure and high surface energy enable it to induce angiogenesis, which assists in the process of osseointegration.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Surface_energy\">Surface energy<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Redox_potential\">Redox potential<\/span><\/h3>\n<p>Titanium can have many different standard electrode potentials depending on its oxidation state. Solid titanium has a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Standard_electrode_potential\" title=\"Standard electrode potential\" rel=\"external_link\" target=\"_blank\">standard electrode potential<\/a> of -1.63V. Materials with a greater standard electrode potential are more easily reduced, making them better oxidizing agents.<sup id=\"rdp-ebb-cite_ref-poten_5-0\" class=\"reference\"><a href=\"#cite_note-poten-5\" rel=\"external_link\">[5]<\/a><\/sup> As can be seen in the table below, solid titanium prefers to undergo oxidation, making it a better reducing agent.\n<\/p>\n<table class=\"wikitable\" style=\"textalign:center\">\n\n<tbody><tr>\n<th><b>Half Reaction<\/b><\/th>\n<th><b>Standard Electron Potential (V)<\/b>\n<\/th><\/tr>\n<tr>\n<td>Ti<sub>2<\/sub><sup>+<\/sup> + 2\u200ae<sup>\u2212<\/sup> \u2192 Ti(s)<\/td>\n<td>-1.63<sup id=\"rdp-ebb-cite_ref-poten_5-1\" class=\"reference\"><a href=\"#cite_note-poten-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>Ti<sub>3<\/sub><sup>+<\/sup> + 3\u200ae<sup>\u2212<\/sup> \u2192 Ti(s)<\/td>\n<td>-1.21<sup id=\"rdp-ebb-cite_ref-compounds2_6-0\" class=\"reference\"><a href=\"#cite_note-compounds2-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>TiO<sub>2<\/sub><sup>+<\/sup> + 2\u200aH+ + 4\u200ae<sup>\u2212<\/sup> \u2192 Ti(s) + \u200aH<sub>2<\/sub>O<\/td>\n<td>-0.86<sup id=\"rdp-ebb-cite_ref-compounds_7-0\" class=\"reference\"><a href=\"#cite_note-compounds-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>2\u200aTiO<sub>2<\/sub>(s) + 2\u200aH<sup>+<\/sup> + 2\u200ae<sup>\u2212<\/sup> \u2192 Ti<sub>2<\/sub>O<sub>3<\/sub>(s) + \u200aH<sub>2<\/sub>O<\/td>\n<td>-0.56<sup id=\"rdp-ebb-cite_ref-compounds_7-1\" class=\"reference\"><a href=\"#cite_note-compounds-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>Ti<sub>2<\/sub><sup>+<\/sup>(aq)\/M<sub>3<\/sub><sup>+<\/sup>(aq)<\/td>\n<td>-0.36<sup id=\"rdp-ebb-cite_ref-compounds2_6-1\" class=\"reference\"><a href=\"#cite_note-compounds2-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/td><\/tr>\n<\/tbody><\/table>\n<h3><span class=\"mw-headline\" id=\"Surface_coating\">Surface coating<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Protein_Absorption_to_Oxide_Layer.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/50\/Protein_Absorption_to_Oxide_Layer.jpg\/220px-Protein_Absorption_to_Oxide_Layer.jpg\" width=\"220\" height=\"117\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Protein_Absorption_to_Oxide_Layer.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Cellular binding to a titanium oxide surface<\/div><\/div><\/div>\n<p>Titanium naturally passivates, forming an oxide film that becomes heterogeneous and polarized as a function of exposure time to bodily environments.<sup id=\"rdp-ebb-cite_ref-healy_8-0\" class=\"reference\"><a href=\"#cite_note-healy-8\" rel=\"external_link\">[8]<\/a><\/sup> This leads to the increased adsorption of hydroxyl groups, lipoproteins, and glycolipids over time.<sup id=\"rdp-ebb-cite_ref-healy_8-1\" class=\"reference\"><a href=\"#cite_note-healy-8\" rel=\"external_link\">[8]<\/a><\/sup> The adsorption of these compounds changes how the material interacts with the body and can improve biocompatibility. In titanium alloys such as Ti-Zr and Ti-Nb, zirconium and niobium ions that are liberated due to corrosion are not released into the patient's body, but rather added to the passivation layer.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> The alloying elements in the passive layer add a degree of biocompatibility and corrosion resistance depending on the original alloy composition of the bulk metal prior to corrosion.\n<\/p><p>Protein surface concentration, (<span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/4cfde86a3f7ec967af9955d0988592f0693d2b19\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.338ex; width:1.453ex; height:2.176ex;\" alt=\"\\Gamma \"\/><\/span>), is defined by the equation\n<\/p>\n<\/p><p><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/ae6bca0e05bc07d21a925892fd3f2d55d3b1003b\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -1.838ex; width:13.302ex; height:5.343ex;\" alt=\"\\Gamma={Q_{\\text{ADS}}M\\over nF}\"\/><\/span><sup id=\"rdp-ebb-cite_ref-jackson_10-0\" class=\"reference\"><a href=\"#cite_note-jackson-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<\/p><p>where Q<sub>ADS<\/sub> is the surface charge density in C cm<sup>\u22122<\/sup>, M is the molar mass of the protein in g mol<sup>\u22121<\/sup>, n is the number of electrons transferred (in this case, one electron for each protonated amino group in the protein), and F is the Faraday constant in C mol<sup>\u22121<\/sup>.\n<\/p><p>The equation for collision frequency is as follows:\n<\/p><p><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/e4115d9795de630718fd93a7ffccc252ef454887\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.671ex; width:15.161ex; height:2.509ex;\" alt=\"v_{\\text{c}}={2\\pi DcdN_{\\text{A}}}\"\/><\/span><sup id=\"rdp-ebb-cite_ref-jackson_10-1\" class=\"reference\"><a href=\"#cite_note-jackson-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<\/p><p>where D = 8.83 \u00d7 10<sup>\u22127<\/sup> cm<sup>2<\/sup> s<sup>\u22121<\/sup> is the diffusion coefficient of the BSA molecule at 310 K, d = 7.2 nm is the \u201cdiameter\u201d of the proteinwhich is equivalent to twice the Stokes radius, NA = 6.023 \u00d7 10<sup>23<\/sup> mol<sup>\u22121<\/sup> is Avogadro's number, and c* = 0.23 g L<sup>\u22121<\/sup> (3.3 \u03bcM) is the critical bulk supersaturation concentration.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Wetting_and_solid_surface\">Wetting and solid surface<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Wetting.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d5\/Wetting.jpg\/220px-Wetting.jpg\" width=\"220\" height=\"121\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Wetting.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The droplet on the left has a contact angle between 90 and 180 degrees, rendering the interaction between the solid and the liquid relatively weak. In contrast, the droplet on the right has a contact angle between 0 and 90 degrees making the interaction between the solid and the liquid strong.<\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wetting\" title=\"Wetting\" rel=\"external_link\" target=\"_blank\">Wetting<\/a> occurs as a function of two parameters: surface roughness and surface fraction.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> By increasing wetting, implants can decrease the time required for osseointegration by allowing cells to more readily bind to the surface of an implant.<sup id=\"rdp-ebb-cite_ref-raines_3-1\" class=\"reference\"><a href=\"#cite_note-raines-3\" rel=\"external_link\">[3]<\/a><\/sup> Wetting of titanium can be modified by optimizing process parameters such as temperature, time, and pressure (shown in table below). Titanium with stable oxide layers predominantly consisting of TiO2 result in improved wetting of the implant in contact with physiological fluid.<sup id=\"rdp-ebb-cite_ref-silva06_12-0\" class=\"reference\"><a href=\"#cite_note-silva06-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Surface<\/th>\n<th>Wetting Angle (degrees)<\/th>\n<th>Pressure (mbar) During Processing<\/th>\n<th>Temperature (degrees C) During Processing<\/th>\n<th>Other Surface Processing\n<\/th><\/tr>\n<tr>\n<td>Bare Ti<\/td>\n<td>~50<sup id=\"rdp-ebb-cite_ref-jackson_10-2\" class=\"reference\"><a href=\"#cite_note-jackson-10\" rel=\"external_link\">[10]<\/a><\/sup><\/td>\n<td>-<\/td>\n<td>-<\/td>\n<td>None\n<\/td><\/tr>\n<tr>\n<td>TiO<sub>2<\/sub> TiO Ti<sub>4<\/sub>O<sub>7<\/sub> TiO<sub>4<\/sub> (Planar)<\/td>\n<td>~33<sup id=\"rdp-ebb-cite_ref-silva06_12-1\" class=\"reference\"><a href=\"#cite_note-silva06-12\" rel=\"external_link\">[12]<\/a><\/sup><\/td>\n<td>2.2<\/td>\n<td>700<\/td>\n<td>Oxidation\n<\/td><\/tr>\n<tr>\n<td>TiO<sub>2<\/sub> TiO Ti<sub>4<\/sub>O<sub>7<\/sub> (Planar)<\/td>\n<td>~45<sup id=\"rdp-ebb-cite_ref-silva06_12-2\" class=\"reference\"><a href=\"#cite_note-silva06-12\" rel=\"external_link\">[12]<\/a><\/sup><\/td>\n<td>4<\/td>\n<td>700<\/td>\n<td>Oxidation\n<\/td><\/tr>\n<tr>\n<td>TiO<sub>2<\/sub> TiO Ti<sub>4<\/sub>O<sub>7<\/sub> TiO<sub>4<\/sub> (Hollow)<\/td>\n<td>~32<sup id=\"rdp-ebb-cite_ref-silva06_12-3\" class=\"reference\"><a href=\"#cite_note-silva06-12\" rel=\"external_link\">[12]<\/a><\/sup><\/td>\n<td>2.2<\/td>\n<td>400<\/td>\n<td>Oxidation\n<\/td><\/tr>\n<tr>\n<td>TiO<sub>2<\/sub> TiO Ti<sub>4<\/sub>O<sub>7<\/sub> (Hollow)<\/td>\n<td>~25<sup id=\"rdp-ebb-cite_ref-silva06_12-4\" class=\"reference\"><a href=\"#cite_note-silva06-12\" rel=\"external_link\">[12]<\/a><\/sup><\/td>\n<td>2.6<\/td>\n<td>500<\/td>\n<td>Oxidation\n<\/td><\/tr>\n<tr>\n<td>TiO<sub>2<\/sub> TiO Ti<sub>4<\/sub>O<sub>7<\/sub> (Hollow)<\/td>\n<td>~8<sup id=\"rdp-ebb-cite_ref-silva06_12-5\" class=\"reference\"><a href=\"#cite_note-silva06-12\" rel=\"external_link\">[12]<\/a><\/sup><\/td>\n<td>4<\/td>\n<td>400<\/td>\n<td>Oxidation\n<\/td><\/tr>\n<tr>\n<td>TiO<sub>2<\/sub> TiO Ti<sub>4<\/sub>O<sub>7<\/sub> (Hollow)<\/td>\n<td>~20<sup id=\"rdp-ebb-cite_ref-silva06_12-6\" class=\"reference\"><a href=\"#cite_note-silva06-12\" rel=\"external_link\">[12]<\/a><\/sup><\/td>\n<td>4<\/td>\n<td>500<\/td>\n<td>Oxidation\n<\/td><\/tr>\n<tr>\n<td>Ti with roughened surface<\/td>\n<td>79.5 \u00b1 4.6<sup id=\"rdp-ebb-cite_ref-Bio_13-0\" class=\"reference\"><a href=\"#cite_note-Bio-13\" rel=\"external_link\">[13]<\/a><\/sup><\/td>\n<td>-<\/td>\n<td>-<\/td>\n<td>Machined Surface\n<\/td><\/tr>\n<tr>\n<td>Ti with alkali-treated surface<\/td>\n<td>27.2 \u00b1 6.9<sup id=\"rdp-ebb-cite_ref-Bio_13-1\" class=\"reference\"><a href=\"#cite_note-Bio-13\" rel=\"external_link\">[13]<\/a><\/sup><\/td>\n<td>-<\/td>\n<td>-<\/td>\n<td>Bio-surface\n<\/td><\/tr><\/tbody><\/table>\n<h2><span class=\"mw-headline\" id=\"Adsorption\">Adsorption<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Corrosion\">Corrosion<\/span><\/h3>\n<p>Mechanical abrasion of the titanium oxide film leads to an increased rate of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corrosion\" title=\"Corrosion\" rel=\"external_link\" target=\"_blank\">corrosion<\/a>.<sup id=\"rdp-ebb-cite_ref-urban_14-0\" class=\"reference\"><a href=\"#cite_note-urban-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>Titanium and its alloys are not immune to corrosion when in the human body. Titanium alloys are susceptible to hydrogen absorption which can induce precipitation of hydrides and cause embrittlement, leading to material failure.<sup id=\"rdp-ebb-cite_ref-urban_14-1\" class=\"reference\"><a href=\"#cite_note-urban-14\" rel=\"external_link\">[14]<\/a><\/sup> \"Hydrogen embrittlement was observed as an in vivo mechanism of degradation under fretting-crevice corrosion conditions resulting in TiH formation, surface reaction and cracking inside Ti\/Ti modular body tapers.\"<sup id=\"rdp-ebb-cite_ref-urban_14-2\" class=\"reference\"><a href=\"#cite_note-urban-14\" rel=\"external_link\">[14]<\/a><\/sup> Studying and testing titanium behavior in the body allow us to avoid malpractices that would cause a fatal breakdown in the implant, like the usage of dental products with high fluoride concentration or substances capable of lowering the pH of the media around the implant.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Adhesion\">Adhesion<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bioactive_Surface_Coating_Sketch_On_a_Metal_Surface.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/49\/Bioactive_Surface_Coating_Sketch_On_a_Metal_Surface.jpg\/220px-Bioactive_Surface_Coating_Sketch_On_a_Metal_Surface.jpg\" width=\"220\" height=\"110\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bioactive_Surface_Coating_Sketch_On_a_Metal_Surface.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A metal surface with grafted polymers multimeric constructs to promote cell binding. The polymers grafted on the metal surface are brushed, increasing the contact area for cell integration<\/div><\/div><\/div>\n<p>The cells at the implant interface are highly sensitive to foreign objects. When implants are installed into the body, the cells initiate an inflammatory response which could lead to encapsulation, impairing the functioning of the implanted device.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>The ideal cell response to a bioactive surface is characterized by biomaterial stabilization and integration, as well as the reduction of potential bacterial infection sites on the surface. One example of biomaterial integration is a titanium implant with an engineered <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biointerface\" title=\"Biointerface\" rel=\"external_link\" target=\"_blank\">biointerface<\/a> covered with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomimetic\" class=\"mw-redirect\" title=\"Biomimetic\" rel=\"external_link\" target=\"_blank\">biomimetic<\/a> motifs. Surfaces with these biomimetic motifs have shown to enhance integrin binding and signaling and stem cell differentiation. Increasing the density of ligand clustering also increased integrin binding. A coating consisting of trimers and pentamers increased the bone-implant contact area by 75% when compared to the current clinical standard of uncoated titanium.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> This increase in area allows for increased cellular integration, and reduces rejection of implanted device. \n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Langmuir_isotherm\" class=\"mw-redirect\" title=\"Langmuir isotherm\" rel=\"external_link\" target=\"_blank\">Langmuir isotherm<\/a>:\n<\/p>\n<\/p><p><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/da444bbe8c3e7c6142304cb8c03e109bc67b3ecb\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -2.671ex; width:17.605ex; height:6.176ex;\" alt=\"\\Gamma={B_{\\text{ADS}}\\Gamma_{\\text{max}}\\over (1+cB_{\\text{ADS}})}\"\/><\/span>,<sup id=\"rdp-ebb-cite_ref-jackson_10-3\" class=\"reference\"><a href=\"#cite_note-jackson-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<\/p><p>where c is the concentration of the adsorbate <span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/4cfde86a3f7ec967af9955d0988592f0693d2b19\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.338ex; width:1.453ex; height:2.176ex;\" alt=\"\\Gamma \"\/><\/span> is the max amount of adsorbed protein, B<sub>ADS<\/sub> is the affinity of the adsorbate molecules toward adsorption sites. The Langmuir isotherm can be linearized by rearranging the equation to,\n<\/p>\n<\/p><p><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/95fbd7fda62646dc5db80cdf4c1f66c1cca53ff2\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -2.338ex; width:24.786ex; height:5.676ex;\" alt=\"{c\\over\\Gamma}={{1\\over {B_{\\text{ADS}}\\Gamma_{\\text{max}}}} + {c\\over \\Gamma_{\\text{max}}}}\"\/><\/span><sup id=\"rdp-ebb-cite_ref-jackson_10-4\" class=\"reference\"><a href=\"#cite_note-jackson-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<\/p><p>This simulation is a good approximation of adsorption to a surface when compared to experimental values.<sup id=\"rdp-ebb-cite_ref-jackson_10-5\" class=\"reference\"><a href=\"#cite_note-jackson-10\" rel=\"external_link\">[10]<\/a><\/sup> The Langmuir isotherm for adsorption of elements onto the titanium surface can be determined by plotting the know parameters. An experiment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibrinogen\" title=\"Fibrinogen\" rel=\"external_link\" target=\"_blank\">fibrinogen<\/a> adsorption on a titanium surface \"confirmed the applicability of the Langmuir isotherm in the description of adsorption of fibrinogen onto Ti surface.\"<sup id=\"rdp-ebb-cite_ref-jackson_10-6\" class=\"reference\"><a href=\"#cite_note-jackson-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterials:_Mechanical_Properties\" class=\"mw-redirect\" title=\"Biomaterials: Mechanical Properties\" rel=\"external_link\" target=\"_blank\">Biomaterials: Mechanical Properties<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Metals_in_medicine\" title=\"Metals in medicine\" rel=\"external_link\" target=\"_blank\">Metals in medicine<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_adhesive_bonding\" title=\"Titanium adhesive bonding\" rel=\"external_link\" target=\"_blank\">Titanium adhesive bonding<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Shah, Furqan A.; Trobos, Margarita; Thomsen, Peter; Palmquist, Anders (May 2016). \"Commercially pure titanium (cp-Ti) versus titanium alloy (Ti6Al4V) materials as bone anchored implants \u2014 Is one truly better than the other?\". <i>Materials Science and Engineering: C<\/i>. <b>62<\/b>: 960\u2013966. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.msec.2016.01.032\" target=\"_blank\">10.1016\/j.msec.2016.01.032<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26952502\" target=\"_blank\">26952502<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Materials+Science+and+Engineering%3A+C&rft.atitle=Commercially+pure+titanium+%28cp-Ti%29+versus+titanium+alloy+%28Ti6Al4V%29+materials+as+bone+anchored+implants+%E2%80%94+Is+one+truly+better+than+the+other%3F&rft.volume=62&rft.pages=960-966&rft.date=2016-05&rft_id=info%3Adoi%2F10.1016%2Fj.msec.2016.01.032&rft_id=info%3Apmid%2F26952502&rft.aulast=Shah&rft.aufirst=Furqan+A.&rft.au=Trobos%2C+Margarita&rft.au=Thomsen%2C+Peter&rft.au=Palmquist%2C+Anders&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium+biocompatibility\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Black-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Black_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Black J (1994) Biological performance of tantalum. Clin Mater 16: 167\u2013173.<\/span>\n<\/li>\n<li id=\"cite_note-raines-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-raines_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-raines_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Raines, Andrew L.; Olivares-Navarrete, Rene; Wieland, Marco; Cochran, David L.; Schwartz, Zvi; Boyan, Barbara D. (2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2896824\" target=\"_blank\">\"Regulation of angiogenesis during osseointegration by titanium surface microstructure and energy\"<\/a>. <i>Biomaterials<\/i>. <b>31<\/b> (18): 4909\u201317. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.biomaterials.2010.02.071\" target=\"_blank\">10.1016\/j.biomaterials.2010.02.071<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2896824\" target=\"_blank\">2896824<\/a><\/span>. <a 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rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-jackson_10-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-jackson_10-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-jackson_10-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-jackson_10-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jackson, Douglas R.; Omanovi\u0107, Sa\u0161a; Roscoe, Sharon G. (2000). \"Electrochemical Studies of the Adsorption Behavior of Serum Proteins on Titanium\". <i>Langmuir<\/i>. <b>16<\/b> (12): 5449\u201357. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1021%2Fla991497x\" target=\"_blank\">10.1021\/la991497x<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Langmuir&rft.atitle=Electrochemical+Studies+of+the+Adsorption+Behavior+of+Serum+Proteins+on+Titanium&rft.volume=16&rft.issue=12&rft.pages=5449-57&rft.date=2000&rft_id=info%3Adoi%2F10.1021%2Fla991497x&rft.aulast=Jackson&rft.aufirst=Douglas+R.&rft.au=Omanovi%C4%87%2C+Sa%C5%A1a&rft.au=Roscoe%2C+Sharon+G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium+biocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bico, Jos\u00e9; Thiele, Uwe; Qu\u00e9r\u00e9, David (2002). \"Wetting of textured surfaces\". <i>Colloids and Surfaces A: Physicochemical and Engineering Aspects<\/i>. <b>206<\/b>: 41\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0927-7757%2802%2900061-4\" target=\"_blank\">10.1016\/S0927-7757(02)00061-4<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Colloids+and+Surfaces+A%3A+Physicochemical+and+Engineering+Aspects&rft.atitle=Wetting+of+textured+surfaces&rft.volume=206&rft.pages=41-6&rft.date=2002&rft_id=info%3Adoi%2F10.1016%2FS0927-7757%2802%2900061-4&rft.aulast=Bico&rft.aufirst=Jos%C3%A9&rft.au=Thiele%2C+Uwe&rft.au=Qu%C3%A9r%C3%A9%2C+David&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium+biocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-silva06-12\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-silva06_12-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-silva06_12-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-silva06_12-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-silva06_12-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-silva06_12-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-silva06_12-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-silva06_12-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Silva, M.A.M.; Martinelli, A.E.; Alves, C.; Nascimento, R.M.; T\u00e1vora, M.P.; Vilar, C.D. (2006). \"Surface modification of Ti implants by plasma oxidation in hollow cathode discharge\". <i>Surface and Coatings Technology<\/i>. <b>200<\/b> (8): 2618\u201326. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.surfcoat.2004.12.027\" target=\"_blank\">10.1016\/j.surfcoat.2004.12.027<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Surface+and+Coatings+Technology&rft.atitle=Surface+modification+of+Ti+implants+by+plasma+oxidation+in+hollow+cathode+discharge&rft.volume=200&rft.issue=8&rft.pages=2618-26&rft.date=2006&rft_id=info%3Adoi%2F10.1016%2Fj.surfcoat.2004.12.027&rft.aulast=Silva&rft.aufirst=M.A.M.&rft.au=Martinelli%2C+A.E.&rft.au=Alves%2C+C.&rft.au=Nascimento%2C+R.M.&rft.au=T%C3%A1vora%2C+M.P.&rft.au=Vilar%2C+C.D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium+biocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Bio-13\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Bio_13-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Bio_13-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Strnad, Jakub; Strnad, Zden\u011bk; \u0160est\u00e1k, Jaroslav; Urban, Karel; Pov\u00fd\u0161il, Ctibor (2007). \"Bio-activated titanium surface utilizable for mimetic bone implantation in dentistry\u2014Part III: Surface characteristics and bone\u2013implant contact formation\". <i>Journal of Physics and Chemistry of Solids<\/i>. <b>68<\/b> (5\u20136): 841\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2007JPCS...68..841S\" target=\"_blank\">2007JPCS...68..841S<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jpcs.2007.02.040\" target=\"_blank\">10.1016\/j.jpcs.2007.02.040<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Physics+and+Chemistry+of+Solids&rft.atitle=Bio-activated+titanium+surface+utilizable+for+mimetic+bone+implantation+in+dentistry%E2%80%94Part+III%3A+Surface+characteristics+and+bone%E2%80%93implant+contact+formation&rft.volume=68&rft.issue=5%E2%80%936&rft.pages=841-5&rft.date=2007&rft_id=info%3Adoi%2F10.1016%2Fj.jpcs.2007.02.040&rft_id=info%3Abibcode%2F2007JPCS...68..841S&rft.aulast=Strnad&rft.aufirst=Jakub&rft.au=Strnad%2C+Zden%C4%9Bk&rft.au=%C5%A0est%C3%A1k%2C+Jaroslav&rft.au=Urban%2C+Karel&rft.au=Pov%C3%BD%C5%A1il%2C+Ctibor&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium+biocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-urban-14\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-urban_14-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-urban_14-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-urban_14-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rodrigues, Danieli C.; Urban, Robert M.; Jacobs, Joshua J.; Gilbert, Jeremy L. (2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2667129\" target=\"_blank\">\"<i>In vivo<\/i> severe corrosion and hydrogen embrittlement of retrieved modular body titanium alloy hip-implants\"<\/a>. <i>Journal of Biomedical Materials Research Part B: Applied Biomaterials<\/i>. <b>88<\/b> (1): 206\u201319. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fjbm.b.31171\" target=\"_blank\">10.1002\/jbm.b.31171<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2667129\" target=\"_blank\">2667129<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18683224\" target=\"_blank\">18683224<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Biomedical+Materials+Research+Part+B%3A+Applied+Biomaterials&rft.atitle=In+vivo+severe+corrosion+and+hydrogen+embrittlement+of+retrieved+modular+body+titanium+alloy+hip-implants&rft.volume=88&rft.issue=1&rft.pages=206-19&rft.date=2009&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2667129&rft_id=info%3Apmid%2F18683224&rft_id=info%3Adoi%2F10.1002%2Fjbm.b.31171&rft.aulast=Rodrigues&rft.aufirst=Danieli+C.&rft.au=Urban%2C+Robert+M.&rft.au=Jacobs%2C+Joshua+J.&rft.au=Gilbert%2C+Jeremy+L.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2667129&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium+biocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.dynadental.com\/editor\/download-121\/091102%20Nakagawa%20M%20-%20Effect%20of%20Fluoride%20and%20pH%20on%20Titanium%20-%20ENG.pdf\" target=\"_blank\">http:\/\/www.dynadental.com\/editor\/download-121\/091102%20Nakagawa%20M%20-%20Effect%20of%20Fluoride%20and%20pH%20on%20Titanium%20-%20ENG.pdf<\/a><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Franz, Sandra; Rammelt, Stefan; Scharnweber, Dieter; Simon, Jan C. (2011). \"Immune responses to implants \u2013 A review of the implications for the design of immunomodulatory biomaterials\". <i>Biomaterials<\/i>. <b>32<\/b> (28): 6692\u2013709. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.biomaterials.2011.05.078\" target=\"_blank\">10.1016\/j.biomaterials.2011.05.078<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21715002\" target=\"_blank\">21715002<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biomaterials&rft.atitle=Immune+responses+to+implants+%E2%80%93+A+review+of+the+implications+for+the+design+of+immunomodulatory+biomaterials&rft.volume=32&rft.issue=28&rft.pages=6692-709&rft.date=2011&rft_id=info%3Adoi%2F10.1016%2Fj.biomaterials.2011.05.078&rft_id=info%3Apmid%2F21715002&rft.aulast=Franz&rft.aufirst=Sandra&rft.au=Rammelt%2C+Stefan&rft.au=Scharnweber%2C+Dieter&rft.au=Simon%2C+Jan+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium+biocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Petrie, T. A.; Raynor, J. E.; Dumbauld, D. W.; Lee, T. T.; Jagtap, S.; Templeman, K. L.; Collard, D. M.; Garcia, A. J. (2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3128787\" target=\"_blank\">\"Multivalent Integrin-Specific Ligands Enhance Tissue Healing and Biomaterial Integration\"<\/a>. <i>Science Translational Medicine<\/i>. <b>2<\/b> (45): 45ra60. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1126%2Fscitranslmed.3001002\" target=\"_blank\">10.1126\/scitranslmed.3001002<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3128787\" target=\"_blank\">3128787<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20720217\" target=\"_blank\">20720217<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Science+Translational+Medicine&rft.atitle=Multivalent+Integrin-Specific+Ligands+Enhance+Tissue+Healing+and+Biomaterial+Integration&rft.volume=2&rft.issue=45&rft.pages=45ra60&rft.date=2010&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3128787&rft_id=info%3Apmid%2F20720217&rft_id=info%3Adoi%2F10.1126%2Fscitranslmed.3001002&rft.aulast=Petrie&rft.aufirst=T.+A.&rft.au=Raynor%2C+J.+E.&rft.au=Dumbauld%2C+D.+W.&rft.au=Lee%2C+T.+T.&rft.au=Jagtap%2C+S.&rft.au=Templeman%2C+K.+L.&rft.au=Collard%2C+D.+M.&rft.au=Garcia%2C+A.+J.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3128787&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium+biocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1321\nCached time: 20181201230833\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.320 seconds\nReal time usage: 0.424 seconds\nPreprocessor visited node count: 981\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 29303\/2097152 bytes\nTemplate argument size: 89\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 46556\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.166\/10.000 seconds\nLua memory usage: 3.45 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 241.513 1 Template:Reflist\n100.00% 241.513 1 -total\n<\/p>\n<pre>81.23% 196.191 11 Template:Cite_journal\n 5.29% 12.779 3 Template:Cite_web\n 1.02% 2.470 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:37422114-1!canonical!math=5 and timestamp 20181201230833 and revision id 868039988\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_biocompatibility\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212234\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.016 seconds\nReal time usage: 0.150 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 142.627 1 - wikipedia:Titanium_biocompatibility\n100.00% 142.627 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8395-0!*!*!*!*!*!* and timestamp 20181217212234 and revision id 24629\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Titanium_biocompatibility\">https:\/\/www.limswiki.org\/index.php\/Titanium_biocompatibility<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","e714ef7de25ee1b6ff169665206e555b_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ec\/Meditsiinilisest_titaanist_valmistatud_ja_aatomkihtsadestuse_meetodil_kaetud_hambaimplantaat_sea_reieluusse_sisestatuna.JPG\/400px-Meditsiinilisest_titaanist_valmistatud_ja_aatomkihtsadestuse_meetodil_kaetud_hambaimplantaat_sea_reieluusse_sisestatuna.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/5\/50\/Protein_Absorption_to_Oxide_Layer.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d5\/Wetting.jpg\/440px-Wetting.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/49\/Bioactive_Surface_Coating_Sketch_On_a_Metal_Surface.jpg\/440px-Bioactive_Surface_Coating_Sketch_On_a_Metal_Surface.jpg"],"e714ef7de25ee1b6ff169665206e555b_timestamp":1545081754,"9d58f5a54bdde92dc1b472f1e6599c07_type":"article","9d58f5a54bdde92dc1b472f1e6599c07_title":"Synthesis of bioglass","9d58f5a54bdde92dc1b472f1e6599c07_url":"https:\/\/www.limswiki.org\/index.php\/Synthesis_of_bioglass","9d58f5a54bdde92dc1b472f1e6599c07_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSynthesis of bioglass\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is an orphan, as no other articles link to it. Please introduce links to this page from related articles ; try the Find link tool for suggestions. (June 2013)\nUp to now, various methods have been developed for the synthesis of bioglass and its composites including conventional melt quench, sol\u2013gel, flame synthesis and microwave irradiation. Bioglass synthesis has been reviewed by various groups. In this section we will majorly focus on sol-gel synthesis of bioglass composites, which is the highly efficient technique for bioglass composites for tissue engineering applications.\n\nContents \n\n1 Melt quench synthesis \n2 Sol\u2013gel process \n3 Microwave synthesis \n4 References \n\n\nMelt quench synthesis \nThe first bioactive glass was developed by Hench in 1969 through melting mixture of the related oxide precursors at relatively high temperatures. The original bioactive glass was melt-derived (46.1 mol%, SiO2, 24.4 mol%, Na2O, 26.9 mol% CaO, and 2.6 mol% P2O5) and was named Bioglass\u00ae.The choice of the glass composition for a specific application should be based on a firm knowledge on the influence of all major components on the most relevant properties of the glass with regard to both the final use and the manufacture of the product. Despite extensive research during the past 40 years, only a few glass compositions have been accepted for clinical use. The two US Food and Drug Administration FDA approved melt-derived compositions 45S5 and S53P4 consist of four oxides: SiO2, Na2O, CaO and P2O5.[1][2] In general, a great number of elements can be dissolved in glasses. The effect of Al2O3, B2O3, Fe2O3, MgO, SrO, BaO, ZnO, Li2O, K2O, CaF2 and TiO2 on the in vitro or in vivo properties of certain compositions of bioactive glasses has been reported.[3][4][5][6][7][8][9][10] However, the influence of the composition on the properties and compatibility of bioactive and biodegradable glasses is not fully understood.\nThe scaffolds fabricated by melt quench technique have very less porosity which causes healing and defects in tissue integration during in-vivo testing.\n\n Sol\u2013gel process \nThe sol\u2013gel process has a long history of use for synthesis of silicate systems and other oxides and it has become a widely spread research field with high technological relevance, for example for the fabrication of thin films, coatings, nanoparticles and fibers. Sol-gel processing technology at low temperatures, an alternative to traditional melt processing of glasses, involves the synthesis of a solution (sol), typically composed of metal-organic and metal salt precursors followed by the formation of a gel by chemical reaction or aggregation, and lastly thermal treatment for drying, organic removal, and sometimes crystallization and cooling treatment. The synthesis of specific silicate bioactive glasses by the sol\u2013gel technique at low temperatures using metal alkoxides as precursors was shown in 1991 by Li et al.[11] For the synthesis of bioactive glasses, typical precursors used are tetraethyl orthosilicate, calcium nitrate and triethylphosphate. After hydrolysis and poly-condensation reactions a gel is formed which subsequently is calcinated at 600\u2013700\u00b0C to form the glass. Based on the preparation method, sol\u2013gel derived products, e.g. thin films or particles are highly porous exhibiting a high specific surface area. Recent work on fabricating bioactive silicate glass nanoparticles by sol\u2013gel process has been carried out by Hong et al.[12] In their research, nanoscale bioactive glass particles were obtained by the combination of two steps; sol\u2013gel route and co-precipitation method, wherein the mixture of precursors was hydrolyzed in acidic environment and condensed in alkaline condition separately, and then followed by a freeze-drying process. The morphology and size of bioactive glass nanoparticles could be tailored by varying the production conditions and the feeding ratio of reagents.\nDifferent ions can be added to bioactive glasses, such as zinc, magnesium, zirconium, titanium, boron, and silver in order to improve the glass functionality and bioactivity. However, it is usually difficult to synthesize bioactive glasses in nano-size scale with addition of those ions. More recently, Delben et al. have developed sol\u2013gel-derived bioactive glass doped with silver and reported that the Si\u2013O\u2013Si bond number increased with increasing silver concentration and this resulted in structural densification.[13] It was also observed that quartz and metallic silver crystallization increased with the increase in silver content in bioactive glass while hydroxyapatite crystallization decreased.\nThere is wide agreement about the versatility of the sol\u2013gel technique to synthesize inorganic materials and it has been shown to be suitable for production of a variety of bioactive glasses. However, the method is also limited in terms of compositions that can be produced. Moreover remaining water or residual solvent content may result in complications of the method for the intended biomedical applications of the nanoparticles or nanofibres produced. Usually a high temperature calcination step is required to eliminate organics remnants. In addition, sol\u2013gel processing is relatively time consuming and since it is not a continuous process, batch-to-batch variations may occur.\n\nMicrowave synthesis \nRecently ultrasonic assisted synthesis and microwave assisted synthesis is gaining attention as they can help to reaction in a short time and can modify the reaction environment to produce nano phase powders. It is a rapid and low cost powder synthesis method for powders.For synthesis, the precursors were dissolved in de-ionized water and transferred to the ultrasonic bath. The irradiation time was varied to obtain the optimum synthesis condition. Microwave operation was performed in a second batch of powders after the ultrasonic irradiation. The obtained amorphous powder was washed in de-ionized water and filtered. After drying for 24 hours in oven at 80\u00b0C the powders were calcined at 700\u00b0C temperatures for the development of bioglass.[14]\n\nReferences \n\n\n^ Hench, L.L. & Paschall, H.A. (1973) Direct chemical bond of bioactive glass-ceramic materials to bone and muscle, J Biomed Mater Res, Vol. 7, No. 3, pp. 25-42. \n\n^ Andersson, O.H., Karlsson, K.H., Kangasniemi, K. & Xli-Urpo, A. (1988). Models for physical properties and bioactivity of phosphate opal glasses. Glastechnische Berichte, 61(10):300-305. \n\n^ Andersson, \u00d6.H., Liu, G., Karlsson, K.H., Niemi, L., Miettinen, J. & Juhanoja, J. (1990) 'In vivo behaviour of glasses in the SiO2-Na2O-CaO-P2O5-Al2O3-B2O3 system', Journal of Materials Science: Materials in Medicine, 1(4): 219-227. \n\n^ W.C.A. Vrouwenvelder, C.G. Groot, K. Degroot, Better histology and biochemistry for osteoblasts cultured on titanium doped bioactive glass \u2014 Bioglass 45S5 com- pared with iron-containing, titanium-containing, fluorine containing and boron-containing bioactive glasses, Biomaterials 15 (1994) 97\u2013106. \n\n^ Brink M, Turunen T, Happonen R-P, Yli-Urpo A. Compositional dependence of bioactivity of glasses in the system Na2O-K2O-MgO-CaO-B2O3-P2O5-SiO2. J Biomed Mater Res 1997;37:114-121. \n\n^ Haimi, S., Gorianc, G., Moimas, L., Lindroos, B., Huhtala, H., R\u00e4ty, S., Kuokkanen, H., S\u00e1ndor, G.K., Schmid, C., Miettinen, S. & Suuronen, R. (2009) 'Characterization of zinc-releasing three Dimensional bioactive glass scaffolds and their effect on human adipose stem cell proliferation and osteogenic differentiation', Acta Biomaterialia, Vol. 5, No. 8, pp. 3122-3131. \n\n^ V. Aina, G. Lusvardi, G. Malavasi, L. Menabue, C. Morterra, Fluoride-containing bioactive glasses: surface reactivity in simulated body fluids, Acta Biomaterialia 5 (2009) 3548\u20133562. \n\n^ Zhang, J., Wang, M., Cha, JM. & Mantalaris, A. (2009). The incorporation of 70s bioactive glass to the osteogenic differentiation of murine embryonic stems cells in 3D bioreactors. J. Tissue Eng. Regen. Med. 3(1): 63-71. \n\n^ Gentleman, E., Fredholm, Y.C., Jell, G., Lotfibakhshaiesh, N., O'Donnell, M.D., Hill, R.G. & Stevens, M.M. (2010) 'The effects of strontium-substituted bioactive glasses on osteoblasts and osteoclasts in vitro', Biomaterials, 31(14): 3949-3956. \n\n^ Watts SJ, Hill RG, O\u2019Donnell MD, Law RV. Influence of magnesia on the structure and properties of bioactive glasses. J Non-Cryst Solids 2010;356:517-24. \n\n^ Li R, Clark AE, Hench LL. An Investigation of Bioactive Glass Powders by Sol- Gel Processing. J App Biomater 1991;2(4):231-239. \n\n^ Hong Z, Liu A, Chen L, Chen X, Jing X. Preparation of bioactive glass ceramic nanoparticles by combination of sol-gel and coprecipitation method. J Non- Cryst Solids 2009;355(6):368-372 \n\n^ Delben JRJ, Pimentel OM, Coelho MB, Candelorio PD, Furini LN, Santos FA, Vicente FS, Delben AAST. Synthesis and thermal properties of nanoparticles of bioactive glasses containing silver. J Therm Anal Calorim 2009;97:433\u2013436. \n\n^ Bioceramics Development and Applications Vol. 1 (2011), Article ID D110155, doi:10.4303\/bda\/D110155 \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Synthesis_of_bioglass\">https:\/\/www.limswiki.org\/index.php\/Synthesis_of_bioglass<\/a>\n\t\t\t\t\tCategories: BiomaterialsScientific techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 1 March 2016, at 19:25.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 408 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","9d58f5a54bdde92dc1b472f1e6599c07_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Synthesis_of_bioglass skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Synthesis of bioglass<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>Up to now, various methods have been developed for the <b>synthesis of bioglass<\/b> and its composites including conventional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Melt_(manufacturing)\" title=\"Melt (manufacturing)\" rel=\"external_link\" target=\"_blank\">melt<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quenching\" title=\"Quenching\" rel=\"external_link\" target=\"_blank\">quench<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sol%E2%80%93gel\" class=\"mw-redirect\" title=\"Sol\u2013gel\" rel=\"external_link\" target=\"_blank\">sol\u2013gel<\/a>, flame synthesis and microwave irradiation. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioglass\" title=\"Bioglass\" rel=\"external_link\" target=\"_blank\">Bioglass<\/a> synthesis has been reviewed by various groups. In this section we will majorly focus on sol-gel synthesis of bioglass composites, which is the highly efficient technique for bioglass composites for tissue engineering applications.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Melt_quench_synthesis\">Melt quench synthesis<\/span><\/h2>\n<p>The first bioactive glass was developed by Hench in 1969 through melting mixture of the related oxide precursors at relatively high temperatures. The original bioactive glass was melt-derived (46.1 mol%, SiO<sub>2<\/sub>, 24.4 mol%, Na<sub>2<\/sub>O, 26.9 mol% CaO, and 2.6 mol% P<sub>2<\/sub>O<sub>5<\/sub>) and was named Bioglass\u00ae.The choice of the glass composition for a specific application should be based on a firm knowledge on the influence of all major components on the most relevant properties of the glass with regard to both the final use and the manufacture of the product. Despite extensive research during the past 40 years, only a few glass compositions have been accepted for clinical use. The two US Food and Drug Administration FDA approved melt-derived compositions 45S5 and S53P4 consist of four oxides: SiO<sub>2<\/sub>, Na<sub>2<\/sub>O, CaO and P<sub>2<\/sub>O<sub>5<\/sub>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> In general, a great number of elements can be dissolved in glasses. The effect of Al<sub>2<\/sub>O<sub>3<\/sub>, B<sub>2<\/sub>O<sub>3<\/sub>, Fe<sub>2<\/sub>O<sub>3<\/sub>, MgO, SrO, BaO, ZnO, Li<sub>2<\/sub>O, K<sub>2<\/sub>O, CaF<sub>2<\/sub> and TiO<sub>2<\/sub> on the in vitro or in vivo properties of certain compositions of bioactive glasses has been reported.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> However, the influence of the composition on the properties and compatibility of bioactive and biodegradable glasses is not fully understood.\n<\/p><p>The scaffolds fabricated by melt quench technique have very less porosity which causes healing and defects in tissue integration during in-vivo testing.\n<\/p>\n<h2><span id=\"rdp-ebb-Sol.E2.80.93gel_process\"><\/span><span class=\"mw-headline\" id=\"Sol\u2013gel_process\">Sol\u2013gel process<\/span><\/h2>\n<p>The sol\u2013gel process has a long history of use for synthesis of silicate systems and other oxides and it has become a widely spread research field with high technological relevance, for example for the fabrication of thin films, coatings, nanoparticles and fibers. Sol-gel processing technology at low temperatures, an alternative to traditional melt processing of glasses, involves the synthesis of a solution (sol), typically composed of metal-organic and metal salt precursors followed by the formation of a gel by chemical reaction or aggregation, and lastly thermal treatment for drying, organic removal, and sometimes crystallization and cooling treatment. The synthesis of specific silicate bioactive glasses by the sol\u2013gel technique at low temperatures using metal alkoxides as precursors was shown in 1991 by Li et al.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> For the synthesis of bioactive glasses, typical precursors used are tetraethyl orthosilicate, calcium nitrate and triethylphosphate. After hydrolysis and poly-condensation reactions a gel is formed which subsequently is calcinated at 600\u2013700\u00b0C to form the glass. Based on the preparation method, sol\u2013gel derived products, e.g. thin films or particles are highly porous exhibiting a high specific surface area. Recent work on fabricating bioactive silicate glass nanoparticles by sol\u2013gel process has been carried out by Hong et al.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> In their research, nanoscale bioactive glass particles were obtained by the combination of two steps; sol\u2013gel route and co-precipitation method, wherein the mixture of precursors was hydrolyzed in acidic environment and condensed in alkaline condition separately, and then followed by a freeze-drying process. The morphology and size of bioactive glass nanoparticles could be tailored by varying the production conditions and the feeding ratio of reagents.\n<\/p><p>Different ions can be added to bioactive glasses, such as zinc, magnesium, zirconium, titanium, boron, and silver in order to improve the glass functionality and bioactivity. However, it is usually difficult to synthesize bioactive glasses in nano-size scale with addition of those ions. More recently, Delben et al. have developed sol\u2013gel-derived bioactive glass doped with silver and reported that the Si\u2013O\u2013Si bond number increased with increasing silver concentration and this resulted in structural densification.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> It was also observed that quartz and metallic silver crystallization increased with the increase in silver content in bioactive glass while hydroxyapatite crystallization decreased.\n<\/p><p>There is wide agreement about the versatility of the sol\u2013gel technique to synthesize inorganic materials and it has been shown to be suitable for production of a variety of bioactive glasses. However, the method is also limited in terms of compositions that can be produced. Moreover remaining water or residual solvent content may result in complications of the method for the intended biomedical applications of the nanoparticles or nanofibres produced. Usually a high temperature calcination step is required to eliminate organics remnants. In addition, sol\u2013gel processing is relatively time consuming and since it is not a continuous process, batch-to-batch variations may occur.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Microwave_synthesis\">Microwave synthesis<\/span><\/h2>\n<p>Recently ultrasonic assisted synthesis and microwave assisted synthesis is gaining attention as they can help to reaction in a short time and can modify the reaction environment to produce nano phase powders. It is a rapid and low cost powder synthesis method for powders.For synthesis, the precursors were dissolved in de-ionized water and transferred to the ultrasonic bath. The irradiation time was varied to obtain the optimum synthesis condition. Microwave operation was performed in a second batch of powders after the ultrasonic irradiation. The obtained amorphous powder was washed in de-ionized water and filtered. After drying for 24 hours in oven at 80\u00b0C the powders were calcined at 700\u00b0C temperatures for the development of bioglass.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Hench, L.L. & Paschall, H.A. (1973) Direct chemical bond of bioactive glass-ceramic materials to bone and muscle, J Biomed Mater Res, Vol. 7, No. 3, pp. 25-42.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Andersson, O.H., Karlsson, K.H., Kangasniemi, K. & Xli-Urpo, A. (1988). Models for physical properties and bioactivity of phosphate opal glasses. Glastechnische Berichte, 61(10):300-305.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Andersson, \u00d6.H., Liu, G., Karlsson, K.H., Niemi, L., Miettinen, J. & Juhanoja, J. (1990) 'In vivo behaviour of glasses in the SiO2-Na2O-CaO-P2O5-Al2O3-B2O3 system', Journal of Materials Science: Materials in Medicine, 1(4): 219-227.<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">W.C.A. Vrouwenvelder, C.G. Groot, K. Degroot, Better histology and biochemistry for osteoblasts cultured on titanium doped bioactive glass \u2014 Bioglass 45S5 com- pared with iron-containing, titanium-containing, fluorine containing and boron-containing bioactive glasses, Biomaterials 15 (1994) 97\u2013106.<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Brink M, Turunen T, Happonen R-P, Yli-Urpo A. Compositional dependence of bioactivity of glasses in the system Na2O-K2O-MgO-CaO-B2O3-P2O5-SiO2. J Biomed Mater Res 1997;37:114-121.<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Haimi, S., Gorianc, G., Moimas, L., Lindroos, B., Huhtala, H., R\u00e4ty, S., Kuokkanen, H., S\u00e1ndor, G.K., Schmid, C., Miettinen, S. & Suuronen, R. (2009) 'Characterization of zinc-releasing three Dimensional bioactive glass scaffolds and their effect on human adipose stem cell proliferation and osteogenic differentiation', Acta Biomaterialia, Vol. 5, No. 8, pp. 3122-3131.<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">V. Aina, G. Lusvardi, G. Malavasi, L. Menabue, C. Morterra, Fluoride-containing bioactive glasses: surface reactivity in simulated body fluids, Acta Biomaterialia 5 (2009) 3548\u20133562.<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Zhang, J., Wang, M., Cha, JM. & Mantalaris, A. (2009). The incorporation of 70s bioactive glass to the osteogenic differentiation of murine embryonic stems cells in 3D bioreactors. J. Tissue Eng. Regen. Med. 3(1): 63-71.<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Gentleman, E., Fredholm, Y.C., Jell, G., Lotfibakhshaiesh, N., O'Donnell, M.D., Hill, R.G. & Stevens, M.M. (2010) 'The effects of strontium-substituted bioactive glasses on osteoblasts and osteoclasts in vitro', Biomaterials, 31(14): 3949-3956.<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Watts SJ, Hill RG, O\u2019Donnell MD, Law RV. Influence of magnesia on the structure and properties of bioactive glasses. J Non-Cryst Solids 2010;356:517-24.<\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Li R, Clark AE, Hench LL. An Investigation of Bioactive Glass Powders by Sol- Gel Processing. J App Biomater 1991;2(4):231-239.<\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Hong Z, Liu A, Chen L, Chen X, Jing X. Preparation of bioactive glass ceramic nanoparticles by combination of sol-gel and coprecipitation method. J Non- Cryst Solids 2009;355(6):368-372<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Delben JRJ, Pimentel OM, Coelho MB, Candelorio PD, Furini LN, Santos FA, Vicente FS, Delben AAST. Synthesis and thermal properties of nanoparticles of bioactive glasses containing silver. J Therm Anal Calorim 2009;97:433\u2013436.<\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Bioceramics Development and Applications Vol. 1 (2011), Article ID D110155, doi:10.4303\/bda\/D110155<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1265\nCached time: 20181217212234\nCache expiry: 86400\nDynamic content: true\nCPU time usage: 0.068 seconds\nReal time usage: 0.116 seconds\nPreprocessor visited node count: 304\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 6442\/2097152 bytes\nTemplate argument size: 1061\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 6067\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.019\/10.000 seconds\nLua memory usage: 823 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 95.651 1 -total\n<\/p>\n<pre>73.28% 70.096 1 Template:Orphan\n53.58% 51.250 1 Template:Draft_other\n50.52% 48.321 1 Template:Ambox\n17.34% 16.588 1 Template:Reflist\n 2.55% 2.437 2 Template:PAGENAMEU\n 2.51% 2.397 1 Template:Monthyear-1\n 2.35% 2.248 1 Template:Main_other\n 2.30% 2.201 1 Template:Monthyear\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:39585748-1!canonical and timestamp 20181217212234 and revision id 830818329\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Synthesis_of_bioglass\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212234\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.016 seconds\nReal time usage: 0.297 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 291.966 1 - wikipedia:Synthesis_of_bioglass\n100.00% 291.966 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8220-0!*!*!*!*!*!* and timestamp 20181217212234 and revision id 24370\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Synthesis_of_bioglass\">https:\/\/www.limswiki.org\/index.php\/Synthesis_of_bioglass<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","9d58f5a54bdde92dc1b472f1e6599c07_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/6c\/Wiki_letter_w.svg\/80px-Wiki_letter_w.svg.png"],"9d58f5a54bdde92dc1b472f1e6599c07_timestamp":1545081754,"b96dd53424c418772e63f2af12ea4018_type":"article","b96dd53424c418772e63f2af12ea4018_title":"Surface modification of biomaterials with proteins","b96dd53424c418772e63f2af12ea4018_url":"https:\/\/www.limswiki.org\/index.php\/Surface_modification_of_biomaterials_with_proteins","b96dd53424c418772e63f2af12ea4018_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurface modification of biomaterials with proteins\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Protein patterning \u2013 chessboard pattern\nBiomaterials are materials that are used in contact with biological systems. Biocompatibility and applicability of surface modification with current uses of metallic, polymeric and ceramic biomaterials allow alteration of properties to enhance performance in a biological environment while retaining bulk properties of the desired device.\nSurface modification involves the fundamentals of physicochemical interactions between the biomaterial and the physiological environment at the molecular, cellular and tissue levels (reduce bacterial adhesion, promote cell adhesion). Currently, there are various methods of characterization and surface modification of biomaterials and useful applications of fundamental concepts in a several biomedical solutions.\n\nContents \n\n1 Function \n\n1.1 Biocompatibility \n1.2 Cell adhesion \n1.3 Biomedical materials \n\n\n2 Biological response \n\n2.1 Acute response \n2.2 Chronic response \n\n\n3 Fabrication techniques \n\n3.1 Physical modification \n3.2 Chemical modification \n3.3 Photochemical modification \n3.4 Composites and graft formation \n3.5 Plasma treatment \n\n\n4 Applications \n\n4.1 Bone tissue \n4.2 Neural tissue \n4.3 Cardiovascular tissue \n\n\n5 See also \n6 References \n\n\nFunction \nThe function of surface modification is to change the physical and chemical properties of surfaces to improve the functionality of the original material. Protein surface modification of various types biomaterials (ceramics, polymers, metals, composites) is performed to ultimately increase biocompatibility of the material and interact as a bioactive material for specific applications. In various biomedical applications of developing implantable medical devices (such as pacemakers and stents), surface properties\/interactions of proteins with a specific material must be evaluated with regards to biocompatibility as it plays a major role in determining a biological response. For instance, surface hydrophobicity or hydrophilicity of a material can be altered. Engineering biocompatibility between the physiological environment and the surface material allows new medical products, materials and surgical procedures with additional biofunctionality.\nSurface modification can be done through various methods, which can be classified through three main groups: physical (physical adsorption, Langmuir blodgett film), chemical (oxidation by strong acids, ozone treatment, chemisorption, and flame treatment) and radiation (glow discharge, corona discharge, photo activation (UV), laser, ion beam, plasma immersion ion implantation, electron beam lithography, and \u03b3-irradiation).[1]\n\nBiocompatibility \nIn a biomedical perspective, biocompatibility is the ability of a material to perform with an appropriate host response in a specific application. It is described to be non-toxic, no induced adverse reactions such as chronic inflammatory response with unusual tissue formation, and designed to function properly for a reasonable lifetime.[2] It is a requirement of biomaterials in which the surface modified material will cause no harm to the host, and the material itself will not harmed by the host. Although most synthetic biomaterials have the physical properties that meet or even exceed those of natural tissue, they often result in an unfavorable physiological reaction such as thrombosis formation, inflammation and infection.\nBiointegration is the ultimate goal in for example orthopedic implants that bones establish a mechanically solid interface with complete fusion between the artificial implanted material and bone tissues under good biocompatibility conditions.[3] Modifying the surface of a material can improve its biocompatibility, and can be done without changing its bulk properties. The properties of the uppermost molecular layers are critical in biomaterials[4] since the surface layers are in physicochemical contact with the biological environment.\nFurthermore, although some of the biomaterials have good biocompatibility, it may possess poor mechanical or physical properties such as wear resistance, anti-corrosion, or wettability or lubricity. In these cases, surface modification is utilized to deposit a layer of coating or mixing with substrate to form a composite layer.\n\nCell adhesion \nAs proteins are made up of different sequences of amino acids, proteins can have various functions as its structural shape driven by a number of molecular bonds can change. Amino acids exhibit different characteristics such as being polar, non-polar, positively or negatively charged which is determined by having different side chains. Thus, attachment of molecules with different protein for example, those containing Arginine-Glycine-Aspartate (RGD) sequences are expected to modify the surface of tissue scaffolds and result in improvement of cell adhesion when placed into its physiological environment.[5] Additional modifications of the surface could be through attachment of functional groups of 2D or 3D patterns on the surface so that cell alignment is guided and new tissue formation is improved.[6][7][8][9][10]\n\nBiomedical materials \nSome of the surface modification techniques listed above are particularly used for certain functions or kinds of materials. One of the advantages of plasma immersion ion implantation is its ability to treat most materials. Ion implantation is an effective surface treatment technique that be used to enhance the surface properties of biomaterials.[2][11][12][13] The unique advantage of plasma modification is that the surface properties and biocompatibility can be enhanced selectively while the favorable bulk attributes of the materials such as strength remain unchanged. Overall, it is an effective method to modify medical implants with complex shape. By altering the surface functionalities using plasma modification, the optimal surface, chemical and physical properties can be obtained.\nPlasma immersion implantation is a technique suitable for low melting point materials such as polymers, and widely accepted to improve adhesion between pinhole free layers and substrates. The ultimate goal is to enhance the properties of biomaterials such as biocompatibility, corrosion resistance and functionality with the fabrication of different types of biomedical thin films with various biologically important elements such as nitrogen,[14] calcium,[15][16] and sodium[17] implanted with them. Different thin films such as titanium oxide,[18] titanium nitride,[19] and diamond-like carbon[20] have been treated previously, and results show that the processed material exhibit better biocompatibility compared to the some current ones used in biomedical implants. In order to evaluate the biocompatibility of the fabricated thin films, various in vitro biological environment need to be conducted.\n\nBiological response \nThe immune system will react differently if an implant is coated in extra-cellular matrix proteins. The proteins surrounding the implant serve to \"hide\" the implant from the innate immune system. However, if the implant is coated in allergenic proteins, the patient's adaptive immune response may be initiated. To prevent such a negative immune reaction, immunosuppressive drugs may be prescribed, or autologous tissue may produce the protein coating.\n\nAcute response \nImmediately following insertion, an implant (and the tissue damage from surgery) will result in acute inflammation. The classic signs of acute inflammation are redness, swelling, heat, pain, and loss of function. Hemorrhaging from tissue damage results in clotting which stimulates latent mast cells. The mast cells release chemokines which activate blood vessel endothelium. The blood vessels dilate and become leaky, producing the redness and swelling associated with acute inflammation. The activated endothelium allows extravasation of blood plasma and white blood cells including macrophages which transmigrate to the implant and recognize it as non-biologic. Macrophages release oxidants to combat the foreign body. If antioxidants fail to destroy the foreign body, chronic inflammation begins.\n\nChronic response \nImplantation of non-degradable materials will eventually result in chronic inflammation and fibrous capsule formation. Macrophages that fail to destroy pathogens will merge to form a foreign-body giant cell which quarantines the implant. High levels of oxidants cause fibroblasts to secrete collagen, forming a layer of fibrous tissue around the implant.\nBy coating an implant with extracellular matrix proteins, macrophages will be unable to recognize the implant as non-biologic. The implant is then capable of continued interaction with the host, influencing the surrounding tissue toward various outcomes. For instance, the implant may improve healing by secreting angiogenic drugs.\n\nFabrication techniques \nPhysical modification \nPhysical immobilization is simply coating a material with a biomimetic material without changing the structure of either. Various biomimetic materials with cell adhesive proteins (such as collagen or laminin) have been used in vitro to direct new tissue formation and cell growth. Cell adhesion and proliferation occurs much better on protein-coated surfaces. However, since the proteins are generally isolated, it is more likely to elicit an immune response. Generally, chemistry qualities should be taken into consideration.\n\nChemical modification \n Covalent binding of protein with polymer graft\nAlkali hydrolysis, covalent immobilization, and the wet chemical method are only three of the many ways to chemically modify a surface. The surface is prepped with surface activation, where several functionalities are placed on the polymer to react better with the proteins. In alkali hydrolysis, small protons diffuse between polymer chains and cause surface hydrolysis which cleaves ester bonds. This results in the formation of carboxyl and hydroxyl functionalities which can attach to proteins. In covalent immobilization, small fragments of proteins or short peptides are bonded to the surface. The peptides are highly stable and studies have shown that this method improves biocompatibility. The wet chemical method is one of the preferred methods of protein immobilization. Chemical species are dissolved in an organic solution where reactions take place to reduce the hydrophobic nature of the polymer. Surface stability is higher in chemical modification than in physical adsorption. It also offers higher biocompatibility towards cell growth and bodily fluid flow.\n\nPhotochemical modification \n Cell adhesion for various functional groups. OH and CONH2 improve surface wetting compared with COOH\nSuccessful attempts at grafting biomolecules onto polymers have been made using photochemical modification of biomaterials. These techniques employ high energy photons (typically UV) to break chemical bonds and release free radicals. Protein adhesion can be encouraged by favorably altering the surface charge of a biomaterial. Improved protein adhesion leads to better integration between the host and the implant. Ma et al. compared cell adhesion for various surface groups and found that OH and CONH2 improved PLLA wettability more than COOH.[21]\nApplying a mask to the surface of the biomaterial allows selective surface modification. Areas that UV light penetrate will be modified such that cells will adhere to the region more favorably.\nThe minimum feature size attainable is given by:\n\n\n \n \n \n C\n D\n =\n \n k\n \n 1\n \n \n ⋅\n \n \n λ\n \n N\n A\n \n \n \n \n \n {\\displaystyle CD=k_{1}\\cdot {\\frac {\\lambda }{NA}}}\n \n \nwhere\n\n \n \n \n \n C\n D\n \n \n {\\displaystyle \\,CD}\n \n\n is the minimum feature size\n\n<\/p>\n \n \n \n \n \n k\n \n 1\n \n \n \n \n {\\displaystyle \\,k_{1}}\n \n\n (commonly called k1 factor) is a coefficient that encapsulates process-related factors, and typically equals 0.4 for production.\n\n<\/p>\n \n \n \n \n λ\n \n \n {\\displaystyle \\,\\lambda }\n \n\n is the wavelength of light used\n\n<\/p>\n \n \n \n \n N\n A\n \n \n {\\displaystyle \\,NA}\n \n\n is the numerical aperture of the lens as seen from the wafer\n\n<\/p>According to this equation, greater resolution can be obtained by decreasing the wavelength, and increasing the numerical aperture.\n\nComposites and graft formation \nGraft formation improves the overall hydrophilicity of the material through a ratio of how much glycolic acid and lactic acid is added. Block polymer, or PLGA, decreases hydrophobicity of the surface by controlling the amount of glycolic acid. However, this doesn't increase the hydrophilic tendency of the material.In brush grafting, hydrophilic polymers containing alcohol or hydroxyl groups are placed onto surfaces through photopolymerization.[22]\n\nPlasma treatment \nPlasma techniques are especially useful because they can deposit ultra thin (a few nm), adherent, conformal coatings.[23] Glow discharge plasma is created by filling a vacuum with a low-pressure gas (ex. argon, ammonia, or oxygen). The gas is then excited using microwaves or current which ionizes it. The ionized gas is then thrown onto a surface at a high velocity where the energy produced physically and chemically changes the surface.[24] After the changes occur, the ionized plasma gas is able to react with the surface to make it ready for protein adhesion.[25] However, the surfaces may lose mechanical strength or other inherent properties because of the high amounts of energy.\nSeveral plasma-based technologies have been developed to contently immobilize proteins depending on the final application of the resulting biomaterial.[26] This technique is a relatively fast approach to produce smart bioactive surfaces.\n\nApplications \nBone tissue \nExtra-cellular matrix (ECM) proteins greatly dictate the process of bone formation\u2014the attachment and proliferation of osteogenitor cells, differentiation to osteoblasts, matrix formation, and mineralization. It is beneficial to design biomaterials for bone-contacting devices with bone matrix proteins to promote bone growth.It is also possible to covalently and directionally immobilize osteoinductive peptides in the surface of the ceramic materials such as hydroxyapatite\/\u03b2-tricalcium phosphate to stimulate osteoblast differentiation and better bone regeneration [27]\nRGD peptides have been shown to increase the attachment and migration of osteoblasts on titanium implants, polymeric materials, and glass. Other adhesive peptides that can be recognized by molecules in the cell membrane can also affect binding of bone-derived cells. Particularly, the heparin binding domain in fibronectin is actively involved in specific interaction with osteogenic cells. Modification with heparin binding domains have the potential to enhance the binding of osteoblasts without affecting the attachment of endothelial cells and fibroblasts.Additionally, growth factors such as those in the bone morphogenic protein family are important polypeptides to induce bone formation. These growth factors can be covalently bound to materials to enhance the osteointegration of implants.\n\nNeural tissue \nPeripheral nervous system damage is typically treated by an autograft of nerve tissue to bridge a severed gap. This treatment requires successful regeneration of neural tissue; axons must grow from the proximal stump without interference in order to make a connection with the distal stump. Neural guidance channels (NGC), have been designed as a conduit for growth of new axons and the differentiation and morphogenesis of these tissues is affect by interaction between neural cells and the surrounding ECM. Studies of laminin have shown the protein to be an important ECM protein in the attachment of neural cells. The penta-peptide YIGSR and IKVAV, which are important sequences in laminin, have been shown to increase attachment of neural cells with the ability to control the spatial organization of the cells.\n\nCardiovascular tissue \nIt is important that cardiovascular devices such as stents or artificial vascular grafts be designed to mimic properties of the specific tissue region the device is serving to replace. In order to reduce thrombogenicity, surfaces can be coated with fibronectin and RGD containing peptides, which encourages attachment of endothelial cells. The peptides YIGSR and REDV have also been shown to enhance attachment and spreading of endothelial cells and ultimately reduce the thrombogenicity of the implant.[28] \n\n\n\n\nSurface protein sequence\nFunction[28]\n\n\nRGD\nPromotes cell adhesion\n\n\nOsteopontin-1\nImproves mineralization by osteoblasts\n\n\nLaminin\nPromotes neurite outgrowth\n\n\nGVPGI\nImproves mechanical stability of vascular grafts\n\n\nREDV\nEnhances endothelial cell adhesion\n\n\nYIGSR\nPromotes neural and endothelial cell attachment\n\n\nPHPMA-RGD\nPromotes axonal outgrowth\n\n\nIKVAV\nPromotes neural cell attachment\n\n\nKQAGDVA\nPromotes smooth muscle cell adhesion\n\n\nVIPGIG\nEnhances elastic modulus of artificial ECM\n\n\nFKRRIKA\nImproves mineralization by osteoblasts\n\n\nKRSR\nPromotes osteoblast adhesion\n\n\nMEPE[27]\nPromotes osteoblast differentiation\n\nSee also \nBovine Submaxillary Mucin Coatings\nReferences \n\n\n^ Q. F. Wei; W. D. Gao; D. Y. Hou; X. Q. 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Surface and Coating Technology. 156: 276\u2013283. doi:10.1016\/S0257-8972(02)00085-3. \n\n^ I. Bertoti, M. Mohai, A. Toth and T. Ujvari (2006). \"Nitrogen-PBII modification of ultra-high molecular weight polyethylene: composition, structure and nanomechanical properties\". Surface Coatings and Technology. 201 (15): 6839\u20136842. doi:10.1016\/j.surfcoat.2006.09.022. CS1 maint: Multiple names: authors list (link) \n\n^ X. Y. Liu, R. W. K. Poon, C. H. Kwok, P. K. Chu and C. X. Ding (2005). \"Structure and properties of Ca-plasma-implanted titanium\". Surface Coatings and Technology. 191: 43\u201348. doi:10.1016\/j.surfcoat.2004.08.118. CS1 maint: Multiple names: authors list (link) \n\n^ A. Dorner-Reisel, C. Sch\u00fcrer, C. Nischan, O. Seidel and E. M\u00fcller (2002). \"Diamond-like carbon: alteration of the biological acceptance due to Ca\u2013O incorporation\". Thin Solid Films. 420\u2013421: 263\u2013268. Bibcode:2002TSF...420..263D. doi:10.1016\/S0040-6090(02)00745-9. CS1 maint: Multiple names: authors list (link) \n\n^ M. F. Maitz, R. W. Y. Poon, X. Y. Liu, M. T. Pham and P. K. Chu (2005). \"Bioactivity of titanium following sodium plasma immersion ion implantation and deposition\". Biomaterials. 26 (27): 5465\u20135473. doi:10.1016\/j.biomaterials.2005.02.006. PMID 15860203. CS1 maint: Multiple names: authors list (link) \n\n^ X. L. Zhu, J. Chen, L. Scheideler, R. Reichl and J. Geis-Gerstorfer (2004). \"Effects of topography and composition of titanium surface oxides on osteoblast responses\". Biomaterials. 25 (18): 4087\u20134103. doi:10.1016\/j.biomaterials.2003.11.011. PMID 15046900. CS1 maint: Multiple names: authors list (link) \n\n^ Y. Fu, H. Du & S. Zhang (2003). \"Deposition of TiN layer on TiNi thin films to improve surface properties\". Surface Coatings and Technology. 167 (2\u20133): 129\u201313. doi:10.1016\/S0257-8972(02)00898-8. \n\n^ J. Lankford, C. R. Blanchard, C. M. Agrawal, D. M. Micallef, G. Dearnaley and A. R. McCabe (1993). \"Adherence of diamondlike carbon coatings on total joint substrate materials\". Nuclear Instruments and Methods in Physics Research B. 80\u201381: 1441\u20131445. Bibcode:1993NIMPB..80.1441L. doi:10.1016\/0168-583X(93)90816-O. CS1 maint: Multiple names: authors list (link) \n\n^ A. Ma; C. Gao; Y. Gong; J. Shen (2003). \"Chondrocyte behaviors on poly(lactic acid)(PLLA) membranes containing hydroxyl, amide or carboxyl groups\" (PDF) . Biomaterials. 24 (21): 3725\u201330. doi:10.1016\/S0142-9612(03)00247-3. PMID 12818544. \n\n^ Vasita, Rajesh; Shanmugam i, K; Katt, DS (2008). \"Improved biomaterials for tissue engineering applications: surface modification of polymers\". Current Topics in Medicinal Chemistry. 8 (4): 341\u2013353. doi:10.2174\/156802608783790893. PMID 18393896. \n\n^ Morra, M.; Cassinelli, C. (2006). \"Biomaterials surface characterization and modification\". The International Journal of Artificial Organs. 29 (9): 824\u2013833. PMID 17033989. \n\n^ R.E. Baier (1970). \"Surface properties influencing biological adhesion\". Adhesion in Biological Systems. New York: Academic Press. pp. 15\u201348. \n\n^ H. Kawahara (1983). \"Cellular responses to implant materials: biological, physical and chemical factors\". Int. Dent. J. 33 (4): 350\u2013375. PMID 6581129. \n\n^ A. Cifuentes and S. Borros (2013). \"Comparison of Two Different Plasma Surface-Modification Techniques for the Covalent Immobilization of Protein Monolayers\". Langmuir 29 (22), 6645\u20136651 http:\/\/pubs.acs.org\/doi\/abs\/10.1021\/la400597e \n\n^ a b Acharya, B; Chun, SY; Kim, SY; Moon, C; Shin, HI; Park, EK (2012). \"Surface immobilization of MEPE peptide onto HA\/\u03b2-TCP ceramic particles enhances bone regeneration and remodeling\". Journal of Biomedical Materials Research. Part B, Applied Biomaterials. 100 (3): 841\u20139. doi:10.1002\/jbm.b.32648. PMID 22278974. \n\n^ a b H. Shin; S. Jo & A. G. Mikos (2003). \"Biomimetic materials for tissue engineering\". Biomaterials. 24 (24): 4353\u20134364. doi:10.1016\/S0142-9612(03)00339-9. PMID 12922148. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surface_modification_of_biomaterials_with_proteins\">https:\/\/www.limswiki.org\/index.php\/Surface_modification_of_biomaterials_with_proteins<\/a>\n\t\t\t\t\tCategories: BiomaterialsScientific techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 1 March 2016, at 19:23.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 573 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","b96dd53424c418772e63f2af12ea4018_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Surface_modification_of_biomaterials_with_proteins skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Surface modification of biomaterials with proteins<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Protein_Patterning.tiff\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8b\/Protein_Patterning.tiff\/lossless-page1-220px-Protein_Patterning.tiff.png\" width=\"220\" height=\"123\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Protein_Patterning.tiff\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Protein patterning \u2013 chessboard pattern<\/div><\/div><\/div>\n<p>Biomaterials are materials that are used in contact with biological systems. Biocompatibility and applicability of surface modification with current uses of metallic, polymeric and ceramic biomaterials allow alteration of properties to enhance performance in a biological environment while retaining bulk properties of the desired device.\n<\/p><p>Surface modification involves the fundamentals of physicochemical interactions between the biomaterial and the physiological environment at the molecular, cellular and tissue levels (reduce bacterial adhesion, promote cell adhesion). Currently, there are various methods of characterization and surface modification of biomaterials and useful applications of fundamental concepts in a several biomedical solutions.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Function\">Function<\/span><\/h2>\n<p>The function of surface modification is to change the physical and chemical properties of surfaces to improve the functionality of the original material. Protein surface modification of various types <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterial\" title=\"Biomaterial\" rel=\"external_link\" target=\"_blank\">biomaterials<\/a> (ceramics, polymers, metals, composites) is performed to ultimately increase biocompatibility of the material and interact as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_activity\" title=\"Biological activity\" rel=\"external_link\" target=\"_blank\">bioactive<\/a> material for specific applications. In various biomedical applications of developing implantable medical devices (such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_pacemaker\" class=\"mw-redirect\" title=\"Artificial pacemaker\" rel=\"external_link\" target=\"_blank\">pacemakers<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stents<\/a>), surface properties\/interactions of proteins with a specific material must be evaluated with regards to biocompatibility as it plays a major role in determining a biological response. For instance, surface hydrophobicity or hydrophilicity of a material can be altered. Engineering biocompatibility between the physiological environment and the surface material allows new medical products, materials and surgical procedures with additional biofunctionality.\n<\/p><p>Surface modification can be done through various methods, which can be classified through three main groups: physical (physical adsorption, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Langmuir%E2%80%93Blodgett_film\" title=\"Langmuir\u2013Blodgett film\" rel=\"external_link\" target=\"_blank\">Langmuir blodgett film<\/a>), chemical (oxidation by strong acids, ozone treatment, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemisorption\" title=\"Chemisorption\" rel=\"external_link\" target=\"_blank\">chemisorption<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flame_treatment\" title=\"Flame treatment\" rel=\"external_link\" target=\"_blank\">flame treatment<\/a>) and radiation (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Electric_glow_discharge\" class=\"mw-redirect\" title=\"Electric glow discharge\" rel=\"external_link\" target=\"_blank\">glow discharge<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corona_discharge\" title=\"Corona discharge\" rel=\"external_link\" target=\"_blank\">corona discharge<\/a>, photo activation (UV), laser, ion beam, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ion_implantation\" title=\"Ion implantation\" rel=\"external_link\" target=\"_blank\">plasma immersion ion implantation<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electron_beam_lithography\" class=\"mw-redirect\" title=\"Electron beam lithography\" rel=\"external_link\" target=\"_blank\">electron beam lithography<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gamma_ray\" title=\"Gamma ray\" rel=\"external_link\" target=\"_blank\">\u03b3-irradiation<\/a>).<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Biocompatibility\">Biocompatibility<\/span><\/h3>\n<p>In a biomedical perspective, biocompatibility is the ability of a material to perform with an appropriate host response in a specific application. It is described to be non-toxic, no induced adverse reactions such as chronic inflammatory response with unusual tissue formation, and designed to function properly for a reasonable lifetime.<sup id=\"rdp-ebb-cite_ref-r1_2-0\" class=\"reference\"><a href=\"#cite_note-r1-2\" rel=\"external_link\">[2]<\/a><\/sup> It is a requirement of biomaterials in which the surface modified material will cause no harm to the host, and the material itself will not harmed by the host. Although most synthetic biomaterials have the physical properties that meet or even exceed those of natural tissue, they often result in an unfavorable physiological reaction such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thrombosis\" title=\"Thrombosis\" rel=\"external_link\" target=\"_blank\">thrombosis formation<\/a>, inflammation and infection.\n<\/p><p>Biointegration is the ultimate goal in for example orthopedic implants that bones establish a mechanically solid interface with complete fusion between the artificial implanted material and bone tissues under good biocompatibility conditions.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> Modifying the surface of a material can improve its biocompatibility, and can be done without changing its bulk properties. The properties of the uppermost molecular layers are critical in biomaterials<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> since the surface layers are in physicochemical contact with the biological environment.\n<\/p><p>Furthermore, although some of the biomaterials have good biocompatibility, it may possess poor mechanical or physical properties such as wear resistance, anti-corrosion, or wettability or lubricity. In these cases, surface modification is utilized to deposit a layer of coating or mixing with substrate to form a composite layer.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Cell_adhesion\">Cell adhesion<\/span><\/h3>\n<p>As proteins are made up of different sequences of amino acids, proteins can have various functions as its structural shape driven by a number of molecular bonds can change. Amino acids exhibit different characteristics such as being polar, non-polar, positively or negatively charged which is determined by having different side chains. Thus, attachment of molecules with different protein for example, those containing Arginine-Glycine-Aspartate (RGD) sequences are expected to modify the surface of tissue scaffolds and result in improvement of cell adhesion when placed into its physiological environment.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Additional modifications of the surface could be through attachment of functional groups of 2D or 3D patterns on the surface so that cell alignment is guided and new tissue formation is improved.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Biomedical_materials\">Biomedical materials<\/span><\/h3>\n<p>Some of the surface modification techniques listed above are particularly used for certain functions or kinds of materials. One of the advantages of plasma immersion ion implantation is its ability to treat most materials. Ion implantation is an effective surface treatment technique that be used to enhance the surface properties of biomaterials.<sup id=\"rdp-ebb-cite_ref-r1_2-1\" class=\"reference\"><a href=\"#cite_note-r1-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> The unique advantage of plasma modification is that the surface properties and biocompatibility can be enhanced selectively while the favorable bulk attributes of the materials such as strength remain unchanged. Overall, it is an effective method to modify medical implants with complex shape. By altering the surface functionalities using plasma modification, the optimal surface, chemical and physical properties can be obtained.\n<\/p><p>Plasma immersion implantation is a technique suitable for low melting point materials such as polymers, and widely accepted to improve adhesion between pinhole free layers and substrates. The ultimate goal is to enhance the properties of biomaterials such as biocompatibility, corrosion resistance and functionality with the fabrication of different types of biomedical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thin_film\" title=\"Thin film\" rel=\"external_link\" target=\"_blank\">thin films<\/a> with various biologically important elements such as nitrogen,<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> calcium,<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> and sodium<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> implanted with them. Different thin films such as titanium oxide,<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> titanium nitride,<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> and diamond-like carbon<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> have been treated previously, and results show that the processed material exhibit better biocompatibility compared to the some current ones used in biomedical implants. In order to evaluate the biocompatibility of the fabricated thin films, various in vitro biological environment need to be conducted.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Biological_response\">Biological response<\/span><\/h2>\n<p>The immune system will react differently if an implant is coated in extra-cellular matrix proteins. The proteins surrounding the implant serve to \"hide\" the implant from the innate immune system. However, if the implant is coated in allergenic proteins, the patient's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adaptive_immune_system\" title=\"Adaptive immune system\" rel=\"external_link\" target=\"_blank\">adaptive immune response<\/a> may be initiated. To prevent such a negative immune reaction, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immunosuppressive_drug\" title=\"Immunosuppressive drug\" rel=\"external_link\" target=\"_blank\">immunosuppressive drugs<\/a> may be prescribed, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autotransplantation\" title=\"Autotransplantation\" rel=\"external_link\" target=\"_blank\">autologous<\/a> tissue may produce the protein coating.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Acute_response\">Acute response<\/span><\/h3>\n<p>Immediately following insertion, an implant (and the tissue damage from surgery) will result in acute <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\" title=\"Inflammation\" rel=\"external_link\" target=\"_blank\">inflammation<\/a>. The classic signs of acute inflammation are redness, swelling, heat, pain, and loss of function. Hemorrhaging from tissue damage results in clotting which stimulates latent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mast_cells\" class=\"mw-redirect\" title=\"Mast cells\" rel=\"external_link\" target=\"_blank\">mast cells<\/a>. The mast cells release chemokines which activate blood vessel endothelium. The blood vessels dilate and become leaky, producing the redness and swelling associated with acute inflammation. The activated endothelium allows extravasation of blood plasma and white blood cells including macrophages which transmigrate to the implant and recognize it as non-biologic. Macrophages release <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxidizing_agent\" title=\"Oxidizing agent\" rel=\"external_link\" target=\"_blank\">oxidants<\/a> to combat the foreign body. If antioxidants fail to destroy the foreign body, chronic inflammation begins.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Chronic_response\">Chronic response<\/span><\/h3>\n<p>Implantation of non-degradable materials will eventually result in chronic inflammation and fibrous capsule formation. Macrophages that fail to destroy pathogens will merge to form a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foreign-body_giant_cell\" title=\"Foreign-body giant cell\" rel=\"external_link\" target=\"_blank\">foreign-body giant cell<\/a> which quarantines the implant. High levels of oxidants cause fibroblasts to secrete collagen, forming a layer of fibrous tissue around the implant.\n<\/p><p>By coating an implant with extracellular matrix proteins, macrophages will be unable to recognize the implant as non-biologic. The implant is then capable of continued interaction with the host, influencing the surrounding tissue toward various outcomes. For instance, the implant may improve healing by secreting angiogenic drugs.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Fabrication_techniques\">Fabrication techniques<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Physical_modification\">Physical modification<\/span><\/h3>\n<p>Physical immobilization is simply coating a material with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomimetic\" class=\"mw-redirect\" title=\"Biomimetic\" rel=\"external_link\" target=\"_blank\">biomimetic<\/a> material without changing the structure of either. Various biomimetic materials with cell adhesive proteins (such as collagen or laminin) have been used in vitro to direct new tissue formation and cell growth. Cell adhesion and proliferation occurs much better on protein-coated surfaces. However, since the proteins are generally isolated, it is more likely to elicit an immune response. Generally, chemistry qualities should be taken into consideration.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Chemical_modification\">Chemical modification<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Covalent_binding_for_Wiki_project.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/33\/Covalent_binding_for_Wiki_project.jpg\/220px-Covalent_binding_for_Wiki_project.jpg\" width=\"220\" height=\"57\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Covalent_binding_for_Wiki_project.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Covalent binding of protein with polymer graft<\/div><\/div><\/div>\n<p>Alkali hydrolysis, covalent immobilization, and the wet chemical method are only three of the many ways to chemically modify a surface. The surface is prepped with surface activation, where several functionalities are placed on the polymer to react better with the proteins. In alkali hydrolysis, small protons diffuse between polymer chains and cause surface hydrolysis which cleaves ester bonds. This results in the formation of carboxyl and hydroxyl functionalities which can attach to proteins. In covalent immobilization, small fragments of proteins or short peptides are bonded to the surface. The peptides are highly stable and studies have shown that this method improves biocompatibility. The wet chemical method is one of the preferred methods of protein immobilization. Chemical species are dissolved in an organic solution where reactions take place to reduce the hydrophobic nature of the polymer. Surface stability is higher in chemical modification than in physical adsorption. It also offers higher biocompatibility towards cell growth and bodily fluid flow.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Photochemical_modification\">Photochemical modification<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Improved_Cell_adhesion.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/de\/Improved_Cell_adhesion.png\/220px-Improved_Cell_adhesion.png\" width=\"220\" height=\"154\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Improved_Cell_adhesion.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Cell adhesion for various functional groups. OH and CONH<sub>2<\/sub> improve surface wetting compared with COOH<\/div><\/div><\/div>\n<p>Successful attempts at grafting biomolecules onto polymers have been made using photochemical modification of biomaterials. These techniques employ high energy photons (typically UV) to break chemical bonds and release free radicals. Protein adhesion can be encouraged by favorably altering the surface charge of a biomaterial. Improved protein adhesion leads to better integration between the host and the implant. Ma et al. compared cell adhesion for various surface groups and found that OH and CONH<sub>2<\/sub> improved PLLA <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wetting\" title=\"Wetting\" rel=\"external_link\" target=\"_blank\">wettability<\/a> more than COOH.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p><p>Applying a mask to the surface of the biomaterial allows selective surface modification. Areas that UV light penetrate will be modified such that cells will adhere to the region more favorably.\n<\/p><p>The minimum feature size attainable is given by:\n<\/p>\n<dl><dd><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/80295c94ebbed0284c823769212292847945c20c\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -2.005ex; width:15.376ex; height:5.509ex;\" alt=\"CD=k_{1}\\cdot {\\frac {\\lambda }{NA}}\"\/><\/span><\/dd><\/dl>\n<p>where\n<\/p><p><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/56961097ab8e70d72484e367beb92b7eb002c9d6\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.338ex; width:4.078ex; height:2.176ex;\" alt=\"\\,CD\"\/><\/span> is the <b>minimum feature size<\/b>\n<\/p>\n<\/p><p><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/771c1676f73e8cba7ac485089947375425983006\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.671ex; width:2.653ex; height:2.509ex;\" alt=\"\\,k_{1}\"\/><\/span> (commonly called <i>k1 factor<\/i>) is a coefficient that encapsulates process-related factors, and typically equals 0.4 for production.\n<\/p>\n<\/p><p><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/a4fb547bf232593dc98e480402a274f1746d8a4a\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.338ex; width:1.742ex; height:2.176ex;\" alt=\"\\,\\lambda \"\/><\/span> is the wavelength of light used\n<\/p>\n<\/p><p><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/b7a75b3b9a6e0c37dfa7b216e6ded24d5c36e5c6\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.338ex; width:4.194ex; height:2.176ex;\" alt=\"\\,NA\"\/><\/span> is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Numerical_aperture\" title=\"Numerical aperture\" rel=\"external_link\" target=\"_blank\">numerical aperture<\/a> of the lens as seen from the wafer\n<\/p>\n<\/p><p>According to this equation, greater resolution can be obtained by decreasing the wavelength, and increasing the numerical aperture.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Composites_and_graft_formation\">Composites and graft formation<\/span><\/h3>\n<p>Graft formation improves the overall hydrophilicity of the material through a ratio of how much glycolic acid and lactic acid is added. Block polymer, or PLGA, decreases hydrophobicity of the surface by controlling the amount of glycolic acid. However, this doesn't increase the hydrophilic tendency of the material.In brush grafting, hydrophilic polymers containing alcohol or hydroxyl groups are placed onto surfaces through photopolymerization.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Plasma_treatment\">Plasma treatment<\/span><\/h3>\n<p>Plasma techniques are especially useful because they can deposit ultra thin (a few nm), adherent, conformal coatings.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> Glow discharge plasma is created by filling a vacuum with a low-pressure gas (ex. argon, ammonia, or oxygen). The gas is then excited using microwaves or current which ionizes it. The ionized gas is then thrown onto a surface at a high velocity where the energy produced physically and chemically changes the surface.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> After the changes occur, the ionized plasma gas is able to react with the surface to make it ready for protein adhesion.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> However, the surfaces may lose mechanical strength or other inherent properties because of the high amounts of energy.\n<\/p><p>Several plasma-based technologies have been developed to contently immobilize proteins depending on the final application of the resulting biomaterial.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> This technique is a relatively fast approach to produce smart bioactive surfaces.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Bone_tissue\">Bone tissue<\/span><\/h3>\n<p>Extra-cellular matrix (ECM) proteins greatly dictate the process of bone formation\u2014the attachment and proliferation of osteogenitor cells, differentiation to osteoblasts, matrix formation, and mineralization. It is beneficial to design biomaterials for bone-contacting devices with bone matrix proteins to promote bone growth.It is also possible to covalently and directionally immobilize osteoinductive peptides in the surface of the ceramic materials such as hydroxyapatite\/\u03b2-tricalcium phosphate to stimulate osteoblast differentiation and better bone regeneration <sup id=\"rdp-ebb-cite_ref-r17_27-0\" class=\"reference\"><a href=\"#cite_note-r17-27\" rel=\"external_link\">[27]<\/a><\/sup>\nRGD peptides have been shown to increase the attachment and migration of osteoblasts on titanium implants, polymeric materials, and glass. Other adhesive peptides that can be recognized by molecules in the cell membrane can also affect binding of bone-derived cells. Particularly, the heparin binding domain in fibronectin is actively involved in specific interaction with osteogenic cells. Modification with heparin binding domains have the potential to enhance the binding of osteoblasts without affecting the attachment of endothelial cells and fibroblasts.Additionally, growth factors such as those in the bone morphogenic protein family are important polypeptides to induce bone formation. These growth factors can be covalently bound to materials to enhance the osteointegration of implants.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Neural_tissue\">Neural tissue<\/span><\/h3>\n<p>Peripheral nervous system damage is typically treated by an autograft of nerve tissue to bridge a severed gap. This treatment requires successful regeneration of neural tissue; axons must grow from the proximal stump without interference in order to make a connection with the distal stump. Neural guidance channels (NGC), have been designed as a conduit for growth of new axons and the differentiation and morphogenesis of these tissues is affect by interaction between neural cells and the surrounding ECM. Studies of laminin have shown the protein to be an important ECM protein in the attachment of neural cells. The penta-peptide YIGSR and IKVAV, which are important sequences in laminin, have been shown to increase attachment of neural cells with the ability to control the spatial organization of the cells.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Cardiovascular_tissue\">Cardiovascular tissue<\/span><\/h3>\n<p>It is important that cardiovascular devices such as stents or artificial vascular grafts be designed to mimic properties of the specific tissue region the device is serving to replace. In order to reduce thrombogenicity, surfaces can be coated with fibronectin and RGD containing peptides, which encourages attachment of endothelial cells. The peptides YIGSR and REDV have also been shown to enhance attachment and spreading of endothelial cells and ultimately reduce the thrombogenicity of the implant.<sup id=\"rdp-ebb-cite_ref-Shin2003_28-0\" class=\"reference\"><a href=\"#cite_note-Shin2003-28\" rel=\"external_link\">[28]<\/a><\/sup> \n<\/p>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Surface protein sequence<\/th>\n<th>Function<sup id=\"rdp-ebb-cite_ref-Shin2003_28-1\" class=\"reference\"><a href=\"#cite_note-Shin2003-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/th><\/tr>\n<tr>\n<td>RGD<\/td>\n<td>Promotes cell adhesion\n<\/td><\/tr>\n<tr>\n<td>Osteopontin-1<\/td>\n<td>Improves mineralization by osteoblasts\n<\/td><\/tr>\n<tr>\n<td>Laminin<\/td>\n<td>Promotes neurite outgrowth\n<\/td><\/tr>\n<tr>\n<td>GVPGI<\/td>\n<td>Improves mechanical stability of vascular grafts\n<\/td><\/tr>\n<tr>\n<td>REDV<\/td>\n<td>Enhances endothelial cell adhesion\n<\/td><\/tr>\n<tr>\n<td>YIGSR<\/td>\n<td>Promotes neural and endothelial cell attachment\n<\/td><\/tr>\n<tr>\n<td>PHPMA-RGD<\/td>\n<td>Promotes axonal outgrowth\n<\/td><\/tr>\n<tr>\n<td>IKVAV<\/td>\n<td>Promotes neural cell attachment\n<\/td><\/tr>\n<tr>\n<td>KQAGDVA<\/td>\n<td>Promotes smooth muscle cell adhesion\n<\/td><\/tr>\n<tr>\n<td>VIPGIG<\/td>\n<td>Enhances elastic modulus of artificial ECM\n<\/td><\/tr>\n<tr>\n<td>FKRRIKA<\/td>\n<td>Improves mineralization by osteoblasts\n<\/td><\/tr>\n<tr>\n<td>KRSR<\/td>\n<td>Promotes osteoblast adhesion\n<\/td><\/tr>\n<tr>\n<td>MEPE<sup id=\"rdp-ebb-cite_ref-r17_27-1\" class=\"reference\"><a href=\"#cite_note-r17-27\" rel=\"external_link\">[27]<\/a><\/sup><\/td>\n<td>Promotes osteoblast differentiation\n<\/td><\/tr><\/tbody><\/table>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bovine_Submaxillary_Mucin_Coatings\" class=\"mw-redirect\" title=\"Bovine Submaxillary Mucin Coatings\" rel=\"external_link\" target=\"_blank\">Bovine Submaxillary Mucin Coatings<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 36em; -webkit-column-width: 36em; column-width: 36em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Q. F. Wei; W. D. Gao; D. Y. Hou; X. Q. Wang (2005). \"Surface modification of polymer nanofibers by plasma treatment\". <i>Appl. Surf. Sci<\/i>. <b>245<\/b> (1\u20134): 16\u201320. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2005ApSS..245...16W\" target=\"_blank\">2005ApSS..245...16W<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.apsusc.2004.10.013\" target=\"_blank\">10.1016\/j.apsusc.2004.10.013<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Appl.+Surf.+Sci.&rft.atitle=Surface+modification+of+polymer+nanofibers+by+plasma+treatment&rft.volume=245&rft.issue=1%E2%80%934&rft.pages=16-20&rft.date=2005&rft_id=info%3Adoi%2F10.1016%2Fj.apsusc.2004.10.013&rft_id=info%3Abibcode%2F2005ApSS..245...16W&rft.au=Q.+F.+Wei&rft.au=W.+D.+Gao&rft.au=D.+Y.+Hou&rft.au=X.+Q.+Wang&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurface+modification+of+biomaterials+with+proteins\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-r1-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-r1_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-r1_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">P. K. Chu, J. Y. Chen, L. P. Wang and N. Huang (2002). \"Plasma-surface modification of biomaterials\". <i>Materials Science and Engineering R<\/i>. <b>36<\/b> (5\u20136): 143\u2013206. <a href=\"https:\/\/en.wikipedia.org\/wiki\/CiteSeerX\" title=\"CiteSeerX\" rel=\"external_link\" target=\"_blank\">CiteSeerX<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/citeseerx.ist.psu.edu\/viewdoc\/summary?doi=10.1.1.452.780\" target=\"_blank\">10.1.1.452.780<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0927-796X%2802%2900004-9\" target=\"_blank\">10.1016\/S0927-796X(02)00004-9<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Materials+Science+and+Engineering+R&rft.atitle=Plasma-surface+modification+of+biomaterials&rft.volume=36&rft.issue=5%E2%80%936&rft.pages=143-206&rft.date=2002&rft_id=%2F%2Fciteseerx.ist.psu.edu%2Fviewdoc%2Fsummary%3Fdoi%3D10.1.1.452.780&rft_id=info%3Adoi%2F10.1016%2FS0927-796X%2802%2900004-9&rft.au=P.+K.+Chu%2C+J.+Y.+Chen%2C+L.+P.+Wang+and+N.+Huang&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurface+modification+of+biomaterials+with+proteins\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">L. 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Mikos (2003). \"Biomimetic materials for tissue engineering\". <i>Biomaterials<\/i>. <b>24<\/b> (24): 4353\u20134364. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0142-9612%2803%2900339-9\" target=\"_blank\">10.1016\/S0142-9612(03)00339-9<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12922148\" target=\"_blank\">12922148<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biomaterials&rft.atitle=Biomimetic+materials+for+tissue+engineering&rft.volume=24&rft.issue=24&rft.pages=4353-4364&rft.date=2003&rft_id=info%3Adoi%2F10.1016%2FS0142-9612%2803%2900339-9&rft_id=info%3Apmid%2F12922148&rft.au=H.+Shin&rft.au=S.+Jo&rft.au=A.+G.+Mikos&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurface+modification+of+biomaterials+with+proteins\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1323\nCached time: 20181209235925\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.416 seconds\nReal time usage: 0.477 seconds\nPreprocessor visited node count: 1335\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 57070\/2097152 bytes\nTemplate argument size: 146\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 79723\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.252\/10.000 seconds\nLua memory usage: 3.48 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 347.984 1 Template:Reflist\n100.00% 347.984 1 -total\n<\/p>\n<pre>81.34% 283.060 24 Template:Cite_journal\n 5.20% 18.112 3 Template:Cite_book\n 0.78% 2.697 1 Template:Column-width\n 0.66% 2.302 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:32004278-1!canonical!math=5 and timestamp 20181209235924 and revision id 869264103\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surface_modification_of_biomaterials_with_proteins\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212233\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.021 seconds\nReal time usage: 0.169 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 160.807 1 - wikipedia:Surface_modification_of_biomaterials_with_proteins\n100.00% 160.807 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8219-0!*!*!*!*!*!* and timestamp 20181217212233 and revision id 24369\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surface_modification_of_biomaterials_with_proteins\">https:\/\/www.limswiki.org\/index.php\/Surface_modification_of_biomaterials_with_proteins<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","b96dd53424c418772e63f2af12ea4018_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8b\/Protein_Patterning.tiff\/lossless-page1-440px-Protein_Patterning.tiff.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/33\/Covalent_binding_for_Wiki_project.jpg\/440px-Covalent_binding_for_Wiki_project.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/de\/Improved_Cell_adhesion.png\/440px-Improved_Cell_adhesion.png"],"b96dd53424c418772e63f2af12ea4018_timestamp":1545081753,"9a6ea07ee8933b39b5944046ffd0e8c5_type":"article","9a6ea07ee8933b39b5944046ffd0e8c5_title":"Zirconium dioxide","9a6ea07ee8933b39b5944046ffd0e8c5_url":"https:\/\/www.limswiki.org\/index.php\/Zirconium_dioxide","9a6ea07ee8933b39b5944046ffd0e8c5_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tZirconium dioxide\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\"Zirconia\" redirects here. For the mineral, see Zircon.\n\nZirconium dioxide\n\n\n\n\n\n\n\n\n\nNames\n\n\n\nIUPAC names\nZirconium dioxide\r\nZirconium(IV) oxide\n\n\n\n\nOther names\nZirconia\r\nBaddeleyite\n\n\nIdentifiers\n\n\n\nCAS Number\n\n1314-23-4  Y \n\n\n\n\n\n\n\n\n\n\nECHA InfoCard \n\n100.013.844\n\n\nEC Number \n\n215-227-2\n\n\n\n\n\n\n\nPubChem CID\n\n62395 \n\n\n\n\n\n\nInChI\nInChI=1S\/2O.ZrKey: MCMNRKCIXSYSNV-UHFFFAOYSA-N\n\n\n\nProperties\n\n\nChemical formula\n\nZrO\r\n2  \n\n\nMolar mass\n\n123.218 g\/mol   \n\n\nAppearance\n\nwhite powder\n\n\n\nDensity\n\n5.68 g\/cm3\n\n\nMelting point\n\n 2,715 \u00b0C (4,919 \u00b0F; 2,988 K) \n\n\nBoiling point\n\n 4,300 \u00b0C (7,770 \u00b0F; 4,570 K) \n\n\n\n\nSolubility in water\n\nnegligible\n\n\n\nSolubility\n\nsoluble in HF, and hot H2SO4\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nRefractive index (nD)\n\n2.13\n\n\n\nThermochemistry\n\n\n\nStd molar\r\nentropy (So298)\n\n50.3 J K\u22121 mol\u22121\n\n\nStd enthalpy of\r\nformation (\u0394fHo298)\n\n\u20131080 kJ\/mol\n\n\n\n\nHazards\n\n\n\nSafety data sheet\n\nMSDS\n\n\nGHS pictograms\n\n\n\n\nGHS signal word\n\nWarning\n\n\nGHS hazard statements\n\nH315, H319, H335\n\n\nGHS precautionary statements\n\nP261, P264, P271, P280, P302+352, P304+340, P305+351+338, P312, P321, P332+313, P337+313, P362, P403+233, P405, P501\n\n\n\n\n\n\n\n\nFlash point\n\nNon-flammable  \n\n\n\n\n\nLethal dose or concentration (LD, LC):\n\n\n\n\n\nLD50 (median dose)\n\n> 8.8 g\/kg (oral, rat)\n\n\n\n\nRelated compounds\n\n\nOther anions\n\nZirconium disulfide\n\n\nOther cations\n\nTitanium dioxide\r\nHafnium dioxide\n\n\n\n\nExcept where otherwise noted, data are given for materials in their standard state (at 25 \u00b0C [77 \u00b0F], 100 kPa).\n\n\nY  verify  (what is Y N  ?)\n\n\nInfobox references\n\n\n\n\n\n\n\n Bearing balls\nZirconium dioxide (ZrO\r\n2 ), sometimes known as zirconia (not to be confused with zircon), is a white crystalline oxide of zirconium. Its most naturally occurring form, with a monoclinic crystalline structure, is the mineral baddeleyite. A dopant stabilized cubic structured zirconia, cubic zirconia, is synthesized in various colours for use as a gemstone and a diamond simulant.\n\nContents \n\n1 Production, chemical properties, occurrence \n\n1.1 Structure \n1.2 Chemical reactions \n\n\n2 Engineering properties \n3 Uses \n\n3.1 Niche uses \n3.2 Diamond simulant \n\n\n4 See also \n5 References \n6 Further reading \n7 External links \n\n\n Production, chemical properties, occurrence \nZirconia is produced by calcining zirconium compounds, exploiting its high thermal stability.[1]\n\nStructure \nThree phases are known: monoclinic below 1170 \u00b0C, tetragonal between 1170 \u00b0C and 2370 \u00b0C, and cubic above 2370 \u00b0C.[2] The trend is for higher symmetry at higher temperatures, as is usually the case. A small percentage of the oxides of calcium or yttrium stabilize in the cubic phase.[1] The very rare mineral tazheranite (Zr,Ti,Ca)O2 is cubic. Unlike TiO2, which features six-coordinate Ti in all phases, monoclinic zirconia consists of seven-coordinate zirconium centres. This difference is attributed to the larger size of Zr atom relative to the Ti atom.[3]\n\nChemical reactions \nZirconia is chemically unreactive. It is slowly attacked by concentrated hydrofluoric acid and sulfuric acid. When heated with carbon, it converts to zirconium carbide. When heated with carbon in the presence of chlorine, it converts to zirconium tetrachloride. This conversion is the basis for the purification of zirconium metal and is analogous to the Kroll process.\n\nEngineering properties \nZirconium dioxide is one of the most studied ceramic materials. ZrO2 adopts a monoclinic crystal structure at room temperature and transitions to tetragonal and cubic at higher temperatures. The change of volume caused by the structure transitions from tetragonal to monoclinic to cubic induces large stresses, causing it to crack upon cooling from high temperatures.[4] When the zirconia is blended with some other oxides, the tetragonal and\/or cubic phases are stabilized. Effective dopants include magnesium oxide (MgO), yttrium oxide (Y2O3, yttria), calcium oxide (CaO), and cerium(III) oxide (Ce2O3).[5]\nZirconia is often more useful in its phase 'stabilized' state. Upon heating, zirconia undergoes disruptive phase changes. By adding small percentages of yttria, these phase changes are eliminated, and the resulting material has superior thermal, mechanical, and electrical properties. In some cases, the tetragonal phase can be metastable. If sufficient quantities of the metastable tetragonal phase is present, then an applied stress, magnified by the stress concentration at a crack tip, can cause the tetragonal phase to convert to monoclinic, with the associated volume expansion. This phase transformation can then put the crack into compression, retarding its growth, and enhancing the fracture toughness. This mechanism is known as transformation toughening, and significantly extends the reliability and lifetime of products made with stabilized zirconia.[5][6]\nThe ZrO2 band gap is dependent on the phase (cubic, tetragonal, monoclinic, or amorphous) and preparation methods, with typical estimates from 5\u20137 eV.[7]\nA special case of zirconia is that of tetragonal zirconia polycrystal, or TZP, which is indicative of polycrystalline zirconia composed of only the metastable tetragonal phase.\n\nUses \nThe main use of zirconia is in the production of hard ceramics, such as in dentistry (see below),[8] with other uses including as a protective coating on particles of titanium dioxide pigments,[1] as a refractory material, in insulation, abrasives and enamels. Stabilized zirconia is used in oxygen sensors and fuel cell membranes because it has the ability to allow oxygen ions to move freely through the crystal structure at high temperatures. This high ionic conductivity (and a low electronic conductivity) makes it one of the most useful electroceramics.[1] Zirconium dioxide is also used as the solid electrolyte in electrochromic devices.\nZirconia is a precursor to the electroceramic lead zirconate titanate (PZT), which is a high-K dielectric, which is found in myriad components.\n\nNiche uses \nThe very low thermal conductivity of cubic phase of zirconia also has led to its use as a thermal barrier coating, or TBC, in jet and diesel engines to allow operation at higher temperatures.[9] Thermodynamically, the higher the operation temperature of an engine, the greater the possible efficiency. Another low thermal conductivity use is a ceramic fiber insulation for crystal growth furnaces, fuel cell stack insulation and infrared heating systems.\nThis material is also used in dentistry in the manufacture of 1) subframes for the construction of dental restorations such as crowns and bridges, which are then veneered with a conventional feldspathic porcelain for aesthetic reasons, or of 2) strong, extremely durable dental prostheses constructed entirely from monolithic zirconia, with limited but constantly improving aesthetics.[10] Zirconia stabilized with yttria (yttrium oxide), known as yttria-stabilized zirconia, can be used as a strong base material in some full ceramic crown restorations.[11] \n\n High translucent Zirconia bridge layered by porcelain and stained with luster paste\nTransformation toughened zirconia is used to make ceramic knives. Because of the hardness, ceramic-edged cutlery stays sharp longer than steel edged products.[12]\nDue to its infusibility and brilliant luminosity when incandescent, it was used as an ingredient of sticks for limelight.[citation needed ]\nZirconia has been proposed to electrolyze carbon monoxide and oxygen from the atmosphere of Mars to provide both fuel and oxidizer that could be used as a store of chemical energy for use with surface transportation on Mars. Carbon monoxide\/oxygen engines have been suggested for early surface transportation use as both carbon monoxide and oxygen can be straightforwardly produced by zirconia electrolysis without requiring use of any of the Martian water resources to obtain hydrogen, which would be needed for the production of methane or any hydrogen-based fuels.[13]\nZirconia is also a potential high-k dielectric material with potential applications as an insulator in transistors.\nZirconia is also employed in the deposition of optical coatings; it is a high-index material usable from the near-UV to the mid-IR, due to its low absorption in this spectral region. In such applications, it is typically deposited by PVD.[14]\nIn jewelry making, some watch cases are advertised as being \"black zirconium oxide\".[15] In 2015 Omega released a fully ZrO2 watch named \"The Dark Side of The Moon\" [16] with ceramic case, bezel, pushers and clasp, advertising it as four times harder than stainless steel and therefore much more resistant to scratches during everyday use.\n\nDiamond simulant \nMain article: Cubic zirconia\n Brilliant-cut cubic zirconia\nSingle crystals of the cubic phase of zirconia are commonly used as diamond simulant in jewellery. Like diamond, cubic zirconia has a cubic crystal structure and a high index of refraction. Visually discerning a good quality cubic zirconia gem from a diamond is difficult, and most jewellers will have a thermal conductivity tester to identify cubic zirconia by its low thermal conductivity (diamond is a very good thermal conductor). This state of zirconia is commonly called cubic zirconia, CZ, or zircon by jewellers, but the last name is not chemically accurate. Zircon is actually the mineral name for naturally occurring zirconium silicate (ZrSiO4).\n\nSee also \nQuenching\nSintering\nS-type star, emitting zirconium spectral lines\nYttria-stabilized zirconia\nReferences \n\n\n^ a b c d Ralph Nielsen \"Zirconium and Zirconium Compounds\" in Ullmann's Encyclopedia of Industrial Chemistry, 2005, Wiley-VCH, Weinheim. doi:10.1002\/14356007.a28_543 \n\n^ R. Stevens, 1986. Introduction to Zirconia. Magnesium Elektron Publication No 113 \n\n^ Greenwood, N. N.; & Earnshaw, A. (1997). Chemistry of the Elements (2nd Edn.), Oxford:Butterworth-Heinemann. ISBN 0-7506-3365-4. \n\n^ Platt, P.; Frankel, P.; Gass, M.; Howells, R.; Preuss, M. (November 2014). \"Finite element analysis of the tetragonal to monoclinic phase transformation during oxidation of zirconium alloys\". Journal of Nuclear Materials. 454 (1\u20133): 290\u2013297. doi:10.1016\/j.jnucmat.2014.08.020. \n\n^ a b Evans, A.G., Cannon, R.M. (1986). \"Toughening of brittle solids by martensitic transformations\". Acta Metall. 34: 761. doi:10.1016\/0001-6160(86)90052-0. CS1 maint: Multiple names: authors list (link) \n\n^ Porter, D.L., Evans, A.G., Heuer, A.H. (1979). \"Transformation toughening in PSZ\". Acta Metall. 27: 1649. doi:10.1016\/0001-6160(79)90046-4. CS1 maint: Multiple names: authors list (link) \n\n^ Chang, Jane P.; You-Sheng Lin; Karen Chu (2001). \"Rapid thermal chemical vapor deposition of zirconium oxide for metal-oxide-semiconductor field effect transistor application\". Journal of Vacuum Science and Technology B. 19 (5\u2026): 1782\u20131787. doi:10.1116\/1.1396639. \n\n^ Gambogi, Joseph. \"USGS Minerals Information: Zirconium and Hafnium\". minerals.usgs.gov. Archived from the original on 18 February 2018. Retrieved 5 May 2018 . \n\n^ \"Thermal-barrier coatings for more efficient gas-turbine engines\". studylib.net. Retrieved 2018-08-06 . \n\n^ Papaspyridakos, Panos; Kunal Lal (2008). \"Complete arch implant rehabilitation using subtractive rapid prototyping and porcelain fused to zirconia prosthesis: A clinical report\". The Journal of Prosthetic Dentistry. 100 (3): 165\u2013172. doi:10.1016\/S0022-3913(08)00110-8. PMID 18762028. \n\n^ Shen, edited by James (2013). Advanced ceramics for dentistry (1st ed.). Amsterdam: Elsevier\/BH. p. 271. ISBN 978-0123946195. CS1 maint: Extra text: authors list (link) \n\n^ \"Best Ceramic Knives, Cutlery, & Kitchenware - Kyocera Knives\". kyoceraadvancedceramics.com. Archived from the original on 21 December 2012. Retrieved 5 May 2018 . \n\n^ \nLandis (2001). \"Mars Rocket Vehicle Using In Situ Propellants\". Journal of Spacecraft and Rockets. 38 (5): 730\u201335. doi:10.2514\/2.3739. \n\n^ \"Archived copy\". Archived from the original on October 20, 2013. Retrieved April 30, 2013 . CS1 maint: Archived copy as title (link) \n\n^ \"Omega Co-Axial Chronograph 44.25 mm\". OMEGA Watches. Archived from the original on 2016-03-26. Retrieved 2016-03-27 . \n\n^ \"Speedmaster Moonwatch Dark Side Of The Moon | OMEGA\u00ae\". Omega. Archived from the original on 2018-02-09. Retrieved 2018-02-08 . \n\n\nFurther reading \nGreen, D. J.; Hannink, R.; Swain, M. V. (1989). Transformation Toughening of Ceramics. Boca Raton: CRC Press. ISBN 0-8493-6594-5. \nHeuer, A.H.; Hobbs, L.W., eds. (1981). Science and Technology of Zirconia. Advances in Ceramics. 3. Columbus, OH: American Ceramic Society. p. 475. \nClaussen, N.; R\u00fchle, M.; Heuer, A.H., eds. (1984). Proc. 2nd Int'l Conf. on Science and Technology of Zirconia. Advances in Ceramics. 11. Columbus, OH: American Ceramic Society. \nExternal links \nNIOSH Pocket Guide to Chemical Hazards\nvteZirconium compoundsZr(II)\nZrB2\nZrH2\nZrSi2\nZr(III)\nZrN\nZrCl3\nZr(IV)\nZrBr4\nZrC\nZrCl4\nZrF4\nZrI4\nZr(NO3)4\nZrOCl2\nZr(OH)4\nZrO2\nZrS2\nZr(SO4)2\nZrSiO4\nZr(WO4)2Organozirconium(IV)\nZr(acac)4\n\n\nvteOxidesMixed oxidation states\nAntimony tetroxide (Sb2O4)\nCobalt(II,III) oxide (Co3O4)\nEuropium(II,III) oxide (Eu3O4)\nIron(II,III) oxide (Fe3O4)\nLead(II,IV) oxide (Pb3O4)\nManganese(II,III) oxide (Mn3O4)\nSilver(I,III) oxide (Ag2O2)\nTriuranium octoxide (U3O8)\nCarbon suboxide (C3O2)\nMellitic anhydride (C12O9)\nPraseodymium(III,IV) oxide (Pr6O11)\nTerbium(III,IV) oxide (Tb4O7)\n+1 oxidation state\nCopper(I) oxide (Cu2O)\nDicarbon monoxide (C2O)\nDichlorine monoxide (Cl2O)\nGallium(I) oxide (Ga2O)\nLithium oxide (Li2O)\nPotassium oxide (K2O)\nRubidium oxide (Rb2O)\nSilver oxide (Ag2O)\nThallium(I) oxide (Tl2O)\nSodium oxide (Na2O)\nWater (hydrogen oxide) (H2O)\n+2 oxidation state\nAluminium(II) oxide (AlO)\nBarium oxide (BaO)\nBeryllium oxide (BeO)\nCadmium oxide (CdO)\nCalcium oxide (CaO)\nCarbon monoxide (CO)\nChromium(II) oxide (CrO)\nCobalt(II) oxide (CoO)\nCopper(II) oxide (CuO)\nEuropium(II) oxide (EuO)\nGermanium monoxide (GeO))\nIron(II) oxide (FeO)\nLead(II) oxide (PbO)\nMagnesium oxide (MgO)\nManganese(II) oxide (MnO)\nMercury(II) oxide (HgO)\nNickel(II) oxide (NiO)\nNitric oxide (NO)\nPalladium(II) oxide (PdO)\nSilicon monoxide (SiO)\nStrontium oxide (SrO)\nSulfur monoxide (SO)\nDisulfur dioxide (S2O2)\nThorium monoxide (ThO)\nTin(II) oxide (SnO)\nTitanium(II) oxide (TiO)\nVanadium(II) oxide (VO)\nZinc oxide (ZnO)\n+3 oxidation state\nAluminium oxide (Al2O3)\nAntimony trioxide (Sb2O3)\nArsenic trioxide (As2O3)\nBismuth(III) oxide (Bi2O3)\nBoron trioxide (B2O3)\nCerium(III) oxide (Ce2O3)\nDibromine trioxide (Br2O3)\nChromium(III) oxide (Cr2O3)\nDinitrogen trioxide (N2O3)\nDysprosium(III) oxide (Dy2O3)\nErbium(III) oxide (Er2O3)\nEuropium(III) oxide (Eu2O3)\nGadolinium(III) oxide (Gd2O3)\nGallium(III) oxide (Ga2O3)\nHolmium(III) oxide (Ho2O3)\nIndium(III) oxide (In2O3)\nIron(III) oxide (Fe2O3)\nLanthanum oxide (La2O3)\nLutetium(III) oxide (Lu2O3)\nManganese(III) oxide (Mn2O3)\nNeodymium(III) oxide (Nd2O3)\nNickel(III) oxide (Ni2O3)\nPhosphorus trioxide (P4O6)\nPraseodymium(III) oxide (Pr2O3)\nPromethium(III) oxide (Pm2O3)\nRhodium(III) oxide (Rh2O3)\nSamarium(III) oxide (Sm2O3)\nScandium oxide (Sc2O3)\nTerbium(III) oxide (Tb2O3)\nThallium(III) oxide (Tl2O3)\nThulium(III) oxide (Tm2O3)\nTitanium(III) oxide (Ti2O3)\nTungsten(III) oxide (W2O3)\nVanadium(III) oxide (V2O3)\nYtterbium(III) oxide (Yb2O3)\nYttrium(III) oxide (Y2O3)\n+4 oxidation state\nAmericium dioxide (AmO2)\nCarbon dioxide (CO2)\nCarbon trioxide (CO3)\nCerium(IV) oxide (CeO2)\nChlorine dioxide (ClO2)\nChromium(IV) oxide (CrO2)\nDinitrogen tetroxide (N2O4)\nGermanium dioxide (GeO2)\nHafnium(IV) oxide (HfO2)\nLead dioxide (PbO2)\nManganese dioxide (MnO2)\nNeptunium(IV) oxide (NpO2)\nNitrogen dioxide (NO2)\nOsmium dioxide (OsO2)\nPlutonium(IV) oxide (PuO2)\nPraseodymium(IV) oxide (PrO2)\nProtactinium(IV) oxide (PaO2)\nRhodium(IV) oxide (RhO2)\nRuthenium(IV) oxide (RuO2)\nSelenium dioxide (SeO2)\nSilicon dioxide (SiO2)\nSulfur dioxide (SO2)\nTellurium dioxide (TeO2)\nTerbium(IV) oxide (TbO2)\nThorium dioxide (ThO2)\nTin dioxide (SnO2)\nTitanium dioxide (TiO2)\nTungsten(IV) oxide (WO2)\nUranium dioxide (UO2)\nVanadium(IV) oxide (VO2)\nZirconium dioxide (ZrO2)\n+5 oxidation state\nAntimony pentoxide (Sb2O5)\nArsenic pentoxide (As2O5)\nDinitrogen pentoxide (N2O5)\nNiobium pentoxide (Nb2O5)\nPhosphorus pentoxide (P2O5)\nProtactinium(V) oxide (Pa2O5)\nTantalum pentoxide (Ta2O5)\nVanadium(V) oxide (V2O5)\n+6 oxidation state\nChromium trioxide (CrO3)\nMolybdenum trioxide (MoO3)\nRhenium trioxide (ReO3)\nSelenium trioxide (SeO3)\nSulfur trioxide (SO3)\nTellurium trioxide (TeO3)\nTungsten trioxide (WO3)\nUranium trioxide (UO3)\nXenon trioxide (XeO3)\nIridium trioxide (IrO3)\n+7 oxidation state\nDichlorine heptoxide (Cl2O7)\nManganese heptoxide (Mn2O7)\nRhenium(VII) oxide (Re2O7)\nTechnetium(VII) oxide (Tc2O7)\n+8 oxidation state\nOsmium tetroxide (OsO4)\nRuthenium tetroxide (RuO4)\nXenon tetroxide (XeO4)\nIridium tetroxide (IrO4)\nHassium tetroxide (HsO4)\nRelated\nOxocarbon\nSuboxide\nOxyanion\nOzonide\nPeroxide\nSuperoxide\nOxides are sorted by oxidation state.\nCategory:Oxides\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Zirconium_dioxide\">https:\/\/www.limswiki.org\/index.php\/Zirconium_dioxide<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","9a6ea07ee8933b39b5944046ffd0e8c5_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Zirconium_dioxide skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Zirconium dioxide<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">\"Zirconia\" redirects here. For the mineral, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zircon\" title=\"Zircon\" rel=\"external_link\" target=\"_blank\">Zircon<\/a>.<\/div>\n\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Zirconium_dioxide_ZrO2_bearing_balls.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/68\/Zirconium_dioxide_ZrO2_bearing_balls.jpg\/220px-Zirconium_dioxide_ZrO2_bearing_balls.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Zirconium_dioxide_ZrO2_bearing_balls.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Bearing balls<\/div><\/div><\/div>\n<p><b>Zirconium dioxide<\/b> (<span class=\"chemf nowrap\">ZrO<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">2<\/sub><\/span><\/span>), sometimes known as <b>zirconia<\/b> (not to be confused with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zircon\" title=\"Zircon\" rel=\"external_link\" target=\"_blank\">zircon<\/a>), is a white crystalline <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxide\" title=\"Oxide\" rel=\"external_link\" target=\"_blank\">oxide<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zirconium\" title=\"Zirconium\" rel=\"external_link\" target=\"_blank\">zirconium<\/a>. Its most naturally occurring form, with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monoclinic\" class=\"mw-redirect\" title=\"Monoclinic\" rel=\"external_link\" target=\"_blank\">monoclinic<\/a> crystalline structure, is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mineral\" title=\"Mineral\" rel=\"external_link\" target=\"_blank\">mineral<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Baddeleyite\" title=\"Baddeleyite\" rel=\"external_link\" target=\"_blank\">baddeleyite<\/a>. A dopant stabilized cubic structured zirconia, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cubic_zirconia\" title=\"Cubic zirconia\" rel=\"external_link\" target=\"_blank\">cubic zirconia<\/a>, is synthesized in various colours for use as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gemstone\" title=\"Gemstone\" rel=\"external_link\" target=\"_blank\">gemstone<\/a> and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diamond_simulant\" title=\"Diamond simulant\" rel=\"external_link\" target=\"_blank\">diamond simulant<\/a>.\n<\/p>\n\n<h2><span id=\"rdp-ebb-Production.2C_chemical_properties.2C_occurrence\"><\/span><span class=\"mw-headline\" id=\"Production,_chemical_properties,_occurrence\">Production, chemical properties, occurrence<\/span><\/h2>\n<p>Zirconia is produced by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcination\" title=\"Calcination\" rel=\"external_link\" target=\"_blank\">calcining<\/a> zirconium compounds, exploiting its high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_stability\" title=\"Thermal stability\" rel=\"external_link\" target=\"_blank\">thermal stability<\/a>.<sup id=\"rdp-ebb-cite_ref-Ullmann_1-0\" class=\"reference\"><a href=\"#cite_note-Ullmann-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Structure\">Structure<\/span><\/h3>\n<p>Three phases are known: monoclinic below 1170 \u00b0C, tetragonal between 1170 \u00b0C and 2370 \u00b0C, and cubic above 2370 \u00b0C.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> The trend is for higher symmetry at higher temperatures, as is usually the case. A small percentage of the oxides of calcium or yttrium stabilize in the cubic phase.<sup id=\"rdp-ebb-cite_ref-Ullmann_1-1\" class=\"reference\"><a href=\"#cite_note-Ullmann-1\" rel=\"external_link\">[1]<\/a><\/sup> The very rare mineral tazheranite (Zr,Ti,Ca)O<sub>2<\/sub> is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cubic_crystal_system\" title=\"Cubic crystal system\" rel=\"external_link\" target=\"_blank\">cubic<\/a>. Unlike TiO<sub>2<\/sub>, which features six-coordinate Ti in all phases, monoclinic zirconia consists of seven-coordinate zirconium centres. This difference is attributed to the larger size of Zr atom relative to the Ti atom.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Chemical_reactions\">Chemical reactions<\/span><\/h3>\n<p>Zirconia is chemically unreactive. It is slowly attacked by concentrated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrofluoric_acid\" title=\"Hydrofluoric acid\" rel=\"external_link\" target=\"_blank\">hydrofluoric acid<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sulfuric_acid\" title=\"Sulfuric acid\" rel=\"external_link\" target=\"_blank\">sulfuric acid<\/a>. When heated with carbon, it converts to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zirconium_carbide\" title=\"Zirconium carbide\" rel=\"external_link\" target=\"_blank\">zirconium carbide<\/a>. When heated with carbon in the presence of chlorine, it converts to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zirconium_tetrachloride\" class=\"mw-redirect\" title=\"Zirconium tetrachloride\" rel=\"external_link\" target=\"_blank\">zirconium tetrachloride<\/a>. This conversion is the basis for the purification of zirconium metal and is analogous to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kroll_process\" title=\"Kroll process\" rel=\"external_link\" target=\"_blank\">Kroll process<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Engineering_properties\">Engineering properties<\/span><\/h2>\n<p>Zirconium dioxide is one of the most studied <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic\" title=\"Ceramic\" rel=\"external_link\" target=\"_blank\">ceramic<\/a> materials. ZrO<sub>2<\/sub> adopts a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monoclinic\" class=\"mw-redirect\" title=\"Monoclinic\" rel=\"external_link\" target=\"_blank\">monoclinic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystal_structure\" title=\"Crystal structure\" rel=\"external_link\" target=\"_blank\">crystal structure<\/a> at room temperature and transitions to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tetragonal\" class=\"mw-redirect\" title=\"Tetragonal\" rel=\"external_link\" target=\"_blank\">tetragonal<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cubic_crystal_system\" title=\"Cubic crystal system\" rel=\"external_link\" target=\"_blank\">cubic<\/a> at higher temperatures. The change of volume caused by the structure transitions from tetragonal to monoclinic to cubic induces large stresses, causing it to crack upon cooling from high temperatures.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> When the zirconia is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Doping_(semiconductor)\" title=\"Doping (semiconductor)\" rel=\"external_link\" target=\"_blank\">blended with<\/a> some other oxides, the tetragonal and\/or cubic phases are stabilized. Effective dopants include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium_oxide\" title=\"Magnesium oxide\" rel=\"external_link\" target=\"_blank\">magnesium oxide<\/a> (MgO), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Yttrium_oxide\" class=\"mw-redirect\" title=\"Yttrium oxide\" rel=\"external_link\" target=\"_blank\">yttrium oxide<\/a> (Y<sub>2<\/sub>O<sub>3<\/sub>, yttria), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_oxide\" title=\"Calcium oxide\" rel=\"external_link\" target=\"_blank\">calcium oxide<\/a> (CaO), and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerium(III)_oxide\" title=\"Cerium(III) oxide\" rel=\"external_link\" target=\"_blank\">cerium(III) oxide<\/a> (Ce<sub>2<\/sub>O<sub>3<\/sub>).<sup id=\"rdp-ebb-cite_ref-evans_5-0\" class=\"reference\"><a href=\"#cite_note-evans-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>Zirconia is often more useful in its phase 'stabilized' state. Upon heating, zirconia undergoes disruptive phase changes. By adding small percentages of yttria, these phase changes are eliminated, and the resulting material has superior thermal, mechanical, and electrical properties. In some cases, the tetragonal phase can be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metastable\" class=\"mw-redirect\" title=\"Metastable\" rel=\"external_link\" target=\"_blank\">metastable<\/a>. If sufficient quantities of the metastable tetragonal phase is present, then an applied stress, magnified by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stress_concentration\" title=\"Stress concentration\" rel=\"external_link\" target=\"_blank\">stress concentration<\/a> at a crack tip, can cause the tetragonal phase to convert to monoclinic, with the associated volume expansion. This phase transformation can then put the crack into compression, retarding its growth, and enhancing the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fracture_toughness\" title=\"Fracture toughness\" rel=\"external_link\" target=\"_blank\">fracture toughness<\/a>. This mechanism is known as transformation toughening, and significantly extends the reliability and lifetime of products made with stabilized zirconia.<sup id=\"rdp-ebb-cite_ref-evans_5-1\" class=\"reference\"><a href=\"#cite_note-evans-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>The ZrO<sub>2<\/sub> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Band_gap\" title=\"Band gap\" rel=\"external_link\" target=\"_blank\">band gap<\/a> is dependent on the phase (cubic, tetragonal, monoclinic, or amorphous) and preparation methods, with typical estimates from 5\u20137 eV.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>A special case of zirconia is that of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tetragonal_polycrystalline_zirconia\" title=\"Tetragonal polycrystalline zirconia\" rel=\"external_link\" target=\"_blank\">tetragonal zirconia polycrystal<\/a>, or TZP, which is indicative of polycrystalline zirconia composed of only the metastable tetragonal phase.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Uses\">Uses<\/span><\/h2>\n<p>The main use of zirconia is in the production of hard ceramics, such as in dentistry (see below),<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> with other uses including as a protective coating on particles of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_dioxide\" title=\"Titanium dioxide\" rel=\"external_link\" target=\"_blank\">titanium dioxide<\/a> pigments,<sup id=\"rdp-ebb-cite_ref-Ullmann_1-2\" class=\"reference\"><a href=\"#cite_note-Ullmann-1\" rel=\"external_link\">[1]<\/a><\/sup> as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refractory\" title=\"Refractory\" rel=\"external_link\" target=\"_blank\">refractory<\/a> material, in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_insulation\" title=\"Thermal insulation\" rel=\"external_link\" target=\"_blank\">insulation<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abrasive\" title=\"Abrasive\" rel=\"external_link\" target=\"_blank\">abrasives<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vitreous_enamel\" title=\"Vitreous enamel\" rel=\"external_link\" target=\"_blank\">enamels<\/a>. Stabilized zirconia is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen_sensor\" title=\"Oxygen sensor\" rel=\"external_link\" target=\"_blank\">oxygen sensors<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fuel_cell\" title=\"Fuel cell\" rel=\"external_link\" target=\"_blank\">fuel cell<\/a> membranes because it has the ability to allow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen\" title=\"Oxygen\" rel=\"external_link\" target=\"_blank\">oxygen<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ion\" title=\"Ion\" rel=\"external_link\" target=\"_blank\">ions<\/a> to move freely through the crystal structure at high temperatures. This high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ionic_conductivity\" class=\"mw-redirect\" title=\"Ionic conductivity\" rel=\"external_link\" target=\"_blank\">ionic conductivity<\/a> (and a low electronic conductivity) makes it one of the most useful <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electroceramics\" title=\"Electroceramics\" rel=\"external_link\" target=\"_blank\">electroceramics<\/a>.<sup id=\"rdp-ebb-cite_ref-Ullmann_1-3\" class=\"reference\"><a href=\"#cite_note-Ullmann-1\" rel=\"external_link\">[1]<\/a><\/sup> Zirconium dioxide is also used as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solid_electrolyte\" class=\"mw-redirect\" title=\"Solid electrolyte\" rel=\"external_link\" target=\"_blank\">solid electrolyte<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrochromic_devices\" title=\"Electrochromic devices\" rel=\"external_link\" target=\"_blank\">electrochromic devices<\/a>.\n<\/p><p>Zirconia is a precursor to the electroceramic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lead_zirconate_titanate\" title=\"Lead zirconate titanate\" rel=\"external_link\" target=\"_blank\">lead zirconate titanate<\/a> (<i>PZT<\/i>), which is a high-K dielectric, which is found in myriad components.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Niche_uses\">Niche uses<\/span><\/h3>\n<p>The very low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_conductivity\" title=\"Thermal conductivity\" rel=\"external_link\" target=\"_blank\">thermal conductivity<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cubic_zirconia\" title=\"Cubic zirconia\" rel=\"external_link\" target=\"_blank\">cubic phase of zirconia<\/a> also has led to its use as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_barrier_coating\" title=\"Thermal barrier coating\" rel=\"external_link\" target=\"_blank\">thermal barrier coating<\/a>, or TBC, in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jet_engine\" title=\"Jet engine\" rel=\"external_link\" target=\"_blank\">jet<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diesel_engine\" title=\"Diesel engine\" rel=\"external_link\" target=\"_blank\">diesel engines<\/a> to allow operation at higher temperatures.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> Thermodynamically, the higher the operation temperature of an engine, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carnot_heat_engine\" title=\"Carnot heat engine\" rel=\"external_link\" target=\"_blank\">the greater the possible efficiency<\/a>. Another low thermal conductivity use is a ceramic fiber insulation for crystal growth furnaces, fuel cell stack insulation and infrared heating systems.\n<\/p><p>This material is also used in dentistry in the manufacture of 1) subframes for the construction of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_restoration\" title=\"Dental restoration\" rel=\"external_link\" target=\"_blank\">dental restorations<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crown_(dentistry)\" title=\"Crown (dentistry)\" rel=\"external_link\" target=\"_blank\">crowns<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bridge_(dentistry)\" title=\"Bridge (dentistry)\" rel=\"external_link\" target=\"_blank\">bridges<\/a>, which are then veneered with a conventional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Feldspar\" title=\"Feldspar\" rel=\"external_link\" target=\"_blank\">feldspathic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Porcelain\" title=\"Porcelain\" rel=\"external_link\" target=\"_blank\">porcelain<\/a> for aesthetic reasons, or of 2) strong, extremely durable dental prostheses constructed entirely from monolithic zirconia, with limited but constantly improving aesthetics.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> Zirconia stabilized with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Yttria\" class=\"mw-redirect\" title=\"Yttria\" rel=\"external_link\" target=\"_blank\">yttria<\/a> (yttrium oxide), known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Yttria-stabilized_zirconia\" title=\"Yttria-stabilized zirconia\" rel=\"external_link\" target=\"_blank\">yttria-stabilized zirconia<\/a>, can be used as a strong base material in some full ceramic crown restorations.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> \n<\/p>\n <div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Zirconia_bridge.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7a\/Zirconia_bridge.jpg\/220px-Zirconia_bridge.jpg\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Zirconia_bridge.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>High translucent Zirconia bridge layered by porcelain and stained with luster paste<\/div><\/div><\/div>\n<p>Transformation toughened zirconia is used to make ceramic knives. Because of the hardness, ceramic-edged cutlery stays sharp longer than steel edged products.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p>Due to its infusibility and brilliant luminosity when <a href=\"https:\/\/en.wikipedia.org\/wiki\/Incandescence\" title=\"Incandescence\" rel=\"external_link\" target=\"_blank\">incandescent<\/a>, it was used as an ingredient of sticks for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Limelight\" title=\"Limelight\" rel=\"external_link\" target=\"_blank\">limelight<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2012)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Zirconia has been proposed to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrolysis\" title=\"Electrolysis\" rel=\"external_link\" target=\"_blank\">electrolyze<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_monoxide\" title=\"Carbon monoxide\" rel=\"external_link\" target=\"_blank\">carbon monoxide<\/a> and oxygen from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atmosphere_of_Mars\" title=\"Atmosphere of Mars\" rel=\"external_link\" target=\"_blank\">atmosphere of Mars<\/a> to provide both fuel and oxidizer that could be used as a store of chemical energy for use with surface transportation on Mars. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_monoxide\/oxygen_engine\" class=\"mw-redirect\" title=\"Carbon monoxide\/oxygen engine\" rel=\"external_link\" target=\"_blank\">Carbon monoxide\/oxygen engines<\/a> have been suggested for early surface transportation use as both carbon monoxide and oxygen can be straightforwardly produced by zirconia electrolysis without requiring use of any of the Martian water resources to obtain hydrogen, which would be needed for the production of methane or any hydrogen-based fuels.<sup id=\"rdp-ebb-cite_ref-landis2001_13-0\" class=\"reference\"><a href=\"#cite_note-landis2001-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p><p>Zirconia is also a potential <a href=\"https:\/\/en.wikipedia.org\/wiki\/High-k_dielectric\" class=\"mw-redirect\" title=\"High-k dielectric\" rel=\"external_link\" target=\"_blank\">high-k dielectric<\/a> material with potential applications as an insulator in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transistor\" title=\"Transistor\" rel=\"external_link\" target=\"_blank\">transistors<\/a>.\n<\/p><p>Zirconia is also employed in the deposition of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_coating\" title=\"Optical coating\" rel=\"external_link\" target=\"_blank\">optical coatings<\/a>; it is a high-index material usable from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Near_UV#Subtypes\" class=\"mw-redirect\" title=\"Near UV\" rel=\"external_link\" target=\"_blank\">near-UV<\/a> to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mid-infrared#CIE_division_scheme\" class=\"mw-redirect\" title=\"Mid-infrared\" rel=\"external_link\" target=\"_blank\">mid-IR<\/a>, due to its low absorption in this spectral region. In such applications, it is typically deposited by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_vapor_deposition\" title=\"Physical vapor deposition\" rel=\"external_link\" target=\"_blank\">PVD<\/a>.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>In jewelry making, some watch cases are advertised as being \"black zirconium oxide\".<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> In 2015 Omega released a fully ZrO<sub>2<\/sub> watch named \"The Dark Side of The Moon\" <sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> with ceramic case, bezel, pushers and clasp, advertising it as four times harder than stainless steel and therefore much more resistant to scratches during everyday use.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Diamond_simulant\">Diamond simulant<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cubic_zirconia\" title=\"Cubic zirconia\" rel=\"external_link\" target=\"_blank\">Cubic zirconia<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CZ_brilliant.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/CZ_brilliant.jpg\/220px-CZ_brilliant.jpg\" width=\"220\" height=\"182\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CZ_brilliant.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Brilliant-cut cubic zirconia<\/div><\/div><\/div>\n<p>Single crystals of the cubic phase of zirconia are commonly used as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diamond_simulant\" title=\"Diamond simulant\" rel=\"external_link\" target=\"_blank\">diamond simulant<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jewellery\" title=\"Jewellery\" rel=\"external_link\" target=\"_blank\">jewellery<\/a>. Like diamond, cubic zirconia has a cubic crystal structure and a high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Index_of_refraction\" class=\"mw-redirect\" title=\"Index of refraction\" rel=\"external_link\" target=\"_blank\">index of refraction<\/a>. Visually discerning a good quality cubic zirconia gem from a diamond is difficult, and most jewellers will have a thermal conductivity tester to identify cubic zirconia by its low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_conductivity\" title=\"Thermal conductivity\" rel=\"external_link\" target=\"_blank\">thermal conductivity<\/a> (diamond is a very good thermal conductor). This state of zirconia is commonly called <i>cubic zirconia<\/i>, <i>CZ<\/i>, or <i>zircon<\/i> by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jewellery\" title=\"Jewellery\" rel=\"external_link\" target=\"_blank\">jewellers<\/a>, but the last name is not chemically accurate. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zircon\" title=\"Zircon\" rel=\"external_link\" target=\"_blank\">Zircon<\/a> is actually the mineral name for naturally occurring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zirconium_silicate\" class=\"mw-redirect\" title=\"Zirconium silicate\" rel=\"external_link\" target=\"_blank\">zirconium silicate<\/a> (ZrSiO<sub>4<\/sub>).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Quenching\" title=\"Quenching\" rel=\"external_link\" target=\"_blank\">Quenching<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sintering\" title=\"Sintering\" rel=\"external_link\" target=\"_blank\">Sintering<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/S-type_star\" title=\"S-type star\" rel=\"external_link\" target=\"_blank\">S-type star<\/a>, emitting zirconium spectral lines<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Yttria-stabilized_zirconia\" title=\"Yttria-stabilized zirconia\" rel=\"external_link\" target=\"_blank\">Yttria-stabilized zirconia<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-Ullmann-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Ullmann_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ullmann_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ullmann_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ullmann_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Ralph Nielsen \"Zirconium and Zirconium Compounds\" in Ullmann's Encyclopedia of Industrial Chemistry, 2005, Wiley-VCH, Weinheim. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14356007.a28_543\" target=\"_blank\">10.1002\/14356007.a28_543<\/a><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">R. Stevens, 1986. Introduction to Zirconia. Magnesium Elektron Publication No 113<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Greenwood, N. N.; & Earnshaw, A. (1997). Chemistry of the Elements (2nd Edn.), Oxford:Butterworth-Heinemann. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-7506-3365-4.<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Platt, P.; Frankel, P.; Gass, M.; Howells, R.; Preuss, M. (November 2014). \"Finite element analysis of the tetragonal to monoclinic phase transformation during oxidation of zirconium alloys\". <i>Journal of Nuclear Materials<\/i>. <b>454<\/b> (1\u20133): 290\u2013297. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jnucmat.2014.08.020\" target=\"_blank\">10.1016\/j.jnucmat.2014.08.020<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Nuclear+Materials&rft.atitle=Finite+element+analysis+of+the+tetragonal+to+monoclinic+phase+transformation+during+oxidation+of+zirconium+alloys&rft.volume=454&rft.issue=1%E2%80%933&rft.pages=290-297&rft.date=2014-11&rft_id=info%3Adoi%2F10.1016%2Fj.jnucmat.2014.08.020&rft.aulast=Platt&rft.aufirst=P.&rft.au=Frankel%2C+P.&rft.au=Gass%2C+M.&rft.au=Howells%2C+R.&rft.au=Preuss%2C+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AZirconium+dioxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-evans-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-evans_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-evans_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Evans, A.G., Cannon, R.M. (1986). \"Toughening of brittle solids by martensitic transformations\". <i>Acta Metall<\/i>. <b>34<\/b>: 761. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0001-6160%2886%2990052-0\" target=\"_blank\">10.1016\/0001-6160(86)90052-0<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Metall.&rft.atitle=Toughening+of+brittle+solids+by+martensitic+transformations&rft.volume=34&rft.pages=761&rft.date=1986&rft_id=info%3Adoi%2F10.1016%2F0001-6160%2886%2990052-0&rft.au=Evans%2C+A.G.%2C+Cannon%2C+R.M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AZirconium+dioxide\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Porter, D.L., Evans, A.G., Heuer, A.H. (1979). \"Transformation toughening in PSZ\". <i>Acta Metall<\/i>. <b>27<\/b>: 1649. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0001-6160%2879%2990046-4\" target=\"_blank\">10.1016\/0001-6160(79)90046-4<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Metall.&rft.atitle=Transformation+toughening+in+PSZ&rft.volume=27&rft.pages=1649&rft.date=1979&rft_id=info%3Adoi%2F10.1016%2F0001-6160%2879%2990046-4&rft.au=Porter%2C+D.L.%2C+Evans%2C+A.G.%2C+Heuer%2C+A.H.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AZirconium+dioxide\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chang, Jane P.; You-Sheng Lin; Karen Chu (2001). \"Rapid thermal chemical vapor deposition of zirconium oxide for metal-oxide-semiconductor field effect transistor application\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Journal_of_Vacuum_Science_and_Technology_B\" class=\"mw-redirect\" title=\"Journal of Vacuum Science and Technology B\" rel=\"external_link\" target=\"_blank\">Journal of Vacuum Science and Technology B<\/a><\/i>. <b>19<\/b> (5\u2026): 1782\u20131787. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1116%2F1.1396639\" target=\"_blank\">10.1116\/1.1396639<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Vacuum+Science+and+Technology+B&rft.atitle=Rapid+thermal+chemical+vapor+deposition+of+zirconium+oxide+for+metal-oxide-semiconductor+field+effect+transistor+application&rft.volume=19&rft.issue=5%E2%80%A6&rft.pages=1782-1787&rft.date=2001&rft_id=info%3Adoi%2F10.1116%2F1.1396639&rft.aulast=Chang&rft.aufirst=Jane+P.&rft.au=You-Sheng+Lin&rft.au=Karen+Chu&rfr_id=info%3Asid%2Fen.wikipedia.org%3AZirconium+dioxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Gambogi, Joseph. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/minerals.usgs.gov\/minerals\/pubs\/commodity\/zirconium\/\" target=\"_blank\">\"USGS Minerals Information: Zirconium and Hafnium\"<\/a>. <i>minerals.usgs.gov<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20180218030521\/https:\/\/minerals.usgs.gov\/minerals\/pubs\/commodity\/zirconium\/\" target=\"_blank\">Archived<\/a> from the original on 18 February 2018<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 May<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=minerals.usgs.gov&rft.atitle=USGS+Minerals+Information%3A+Zirconium+and+Hafnium&rft.aulast=Gambogi&rft.aufirst=Joseph&rft_id=http%3A%2F%2Fminerals.usgs.gov%2Fminerals%2Fpubs%2Fcommodity%2Fzirconium%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AZirconium+dioxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/studylib.net\/doc\/12141427\/thermal-barrier-coatings-for-more-efficient-gas-turbine-e...\" target=\"_blank\">\"Thermal-barrier coatings for more efficient gas-turbine engines\"<\/a>. <i>studylib.net<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-08-06<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=studylib.net&rft.atitle=Thermal-barrier+coatings+for+more+efficient+gas-turbine+engines&rft_id=https%3A%2F%2Fstudylib.net%2Fdoc%2F12141427%2Fthermal-barrier-coatings-for-more-efficient-gas-turbine-e...%23&rfr_id=info%3Asid%2Fen.wikipedia.org%3AZirconium+dioxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Papaspyridakos, Panos; Kunal Lal (2008). \"Complete arch implant rehabilitation using subtractive rapid prototyping and porcelain fused to zirconia prosthesis: A clinical report\". <i>The Journal of Prosthetic Dentistry<\/i>. <b>100<\/b> (3): 165\u2013172. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0022-3913%2808%2900110-8\" target=\"_blank\">10.1016\/S0022-3913(08)00110-8<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18762028\" target=\"_blank\">18762028<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Prosthetic+Dentistry&rft.atitle=Complete+arch+implant+rehabilitation+using+subtractive+rapid+prototyping+and+porcelain+fused+to+zirconia+prosthesis%3A+A+clinical+report&rft.volume=100&rft.issue=3&rft.pages=165-172&rft.date=2008&rft_id=info%3Adoi%2F10.1016%2FS0022-3913%2808%2900110-8&rft_id=info%3Apmid%2F18762028&rft.aulast=Papaspyridakos&rft.aufirst=Panos&rft.au=Kunal+Lal&rfr_id=info%3Asid%2Fen.wikipedia.org%3AZirconium+dioxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Shen, edited by James (2013). <i>Advanced ceramics for dentistry<\/i> (1st ed.). Amsterdam: Elsevier\/BH. p. 271. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0123946195.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Advanced+ceramics+for+dentistry&rft.place=Amsterdam&rft.pages=271&rft.edition=1st&rft.pub=Elsevier%2FBH&rft.date=2013&rft.isbn=978-0123946195&rft.aulast=Shen&rft.aufirst=edited+by+James&rfr_id=info%3Asid%2Fen.wikipedia.org%3AZirconium+dioxide\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Extra text: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Extra_text:_authors_list\" title=\"Category:CS1 maint: Extra text: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20121221085217\/http:\/\/kyoceraadvancedceramics.com\/ceramic-advantage\/kyocera-advantage-1\" target=\"_blank\">\"Best Ceramic Knives, Cutlery, & Kitchenware - Kyocera Knives\"<\/a>. <i>kyoceraadvancedceramics.com<\/i>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/kyoceraadvancedceramics.com\/ceramic-advantage\/kyocera-advantage-1\" target=\"_blank\">the original<\/a> on 21 December 2012<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 May<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=kyoceraadvancedceramics.com&rft.atitle=Best+Ceramic+Knives%2C+Cutlery%2C+%26+Kitchenware+-+Kyocera+Knives&rft_id=http%3A%2F%2Fkyoceraadvancedceramics.com%2Fceramic-advantage%2Fkyocera-advantage-1&rfr_id=info%3Asid%2Fen.wikipedia.org%3AZirconium+dioxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-landis2001-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-landis2001_13-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\n<cite class=\"citation journal\">Landis (2001). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/arc.aiaa.org\/doi\/abs\/10.2514\/2.3739?journalCode=jsr\" target=\"_blank\">\"Mars Rocket Vehicle Using In Situ Propellants\"<\/a>. <i>Journal of Spacecraft and Rockets<\/i>. <b>38<\/b> (5): 730\u201335. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2514%2F2.3739\" target=\"_blank\">10.2514\/2.3739<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Spacecraft+and+Rockets&rft.atitle=Mars+Rocket+Vehicle+Using+In+Situ+Propellants&rft.volume=38&rft.issue=5&rft.pages=730-35&rft.date=2001&rft_id=info%3Adoi%2F10.2514%2F2.3739&rft.au=Landis&rft_id=http%3A%2F%2Farc.aiaa.org%2Fdoi%2Fabs%2F10.2514%2F2.3739%3FjournalCode%3Djsr&rfr_id=info%3Asid%2Fen.wikipedia.org%3AZirconium+dioxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131020212333\/http:\/\/materion.com\/ResourceCenter\/ProductData\/InorganicChemicals\/Oxides\/BrochuresAndDataSheets\/ZirconiumOxideZr02.aspx\" target=\"_blank\">\"Archived copy\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/materion.com\/ResourceCenter\/ProductData\/InorganicChemicals\/Oxides\/BrochuresAndDataSheets\/ZirconiumOxideZr02.aspx\" target=\"_blank\">the original<\/a> on October 20, 2013<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">April 30,<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Archived+copy&rft_id=http%3A%2F%2Fmaterion.com%2FResourceCenter%2FProductData%2FInorganicChemicals%2FOxides%2FBrochuresAndDataSheets%2FZirconiumOxideZr02.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3AZirconium+dioxide\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Archived copy as title (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Archived_copy_as_title\" title=\"Category:CS1 maint: Archived copy as title\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.omegawatches.com\/watches\/speedmaster\/moonwatch\/omega-co-axial-chronograph\/31192445101003\/\" target=\"_blank\">\"Omega Co-Axial Chronograph 44.25 mm\"<\/a>. <i>OMEGA Watches<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160326103447\/http:\/\/www.omegawatches.com\/watches\/speedmaster\/moonwatch\/omega-co-axial-chronograph\/31192445101003\/\" target=\"_blank\">Archived<\/a> from the original on 2016-03-26<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-03-27<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=OMEGA+Watches&rft.atitle=Omega+Co-Axial+Chronograph+44.25+mm&rft_id=https%3A%2F%2Fwww.omegawatches.com%2Fwatches%2Fspeedmaster%2Fmoonwatch%2Fomega-co-axial-chronograph%2F31192445101003%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AZirconium+dioxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.omegawatches.com\/watches\/speedmaster\/moonwatch\/dark-side-of-the-moon\/product\/\" target=\"_blank\">\"Speedmaster Moonwatch Dark Side Of The Moon | OMEGA\u00ae\"<\/a>. <i>Omega<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20180209063908\/https:\/\/www.omegawatches.com\/watches\/speedmaster\/moonwatch\/dark-side-of-the-moon\/product\/\" target=\"_blank\">Archived<\/a> from the original on 2018-02-09<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-02-08<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Omega&rft.atitle=Speedmaster+Moonwatch+Dark+Side+Of+The+Moon++%7C+OMEGA%C2%AE&rft_id=https%3A%2F%2Fwww.omegawatches.com%2Fwatches%2Fspeedmaster%2Fmoonwatch%2Fdark-side-of-the-moon%2Fproduct%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AZirconium+dioxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation book\">Green, D. J.; Hannink, R.; Swain, M. V. (1989). <i>Transformation Toughening of Ceramics<\/i>. Boca Raton: CRC Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-8493-6594-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Transformation+Toughening+of+Ceramics&rft.place=Boca+Raton&rft.pub=CRC+Press&rft.date=1989&rft.isbn=0-8493-6594-5&rft.aulast=Green&rft.aufirst=D.+J.&rft.au=Hannink%2C+R.&rft.au=Swain%2C+M.+V.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AZirconium+dioxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Heuer, A.H.; Hobbs, L.W., eds. (1981). <i>Science and Technology of Zirconia<\/i>. Advances in Ceramics. <b>3<\/b>. Columbus, OH: American Ceramic Society. p. 475.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Science+and+Technology+of+Zirconia&rft.place=Columbus%2C+OH&rft.series=Advances+in+Ceramics&rft.pages=475&rft.pub=American+Ceramic+Society&rft.date=1981&rfr_id=info%3Asid%2Fen.wikipedia.org%3AZirconium+dioxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Claussen, N.; R\u00fchle, M.; Heuer, A.H., eds. (1984). <i>Proc. 2nd Int'l Conf. on Science and Technology of Zirconia<\/i>. Advances in Ceramics. <b>11<\/b>. Columbus, OH: American Ceramic Society.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Proc.+2nd+Int%27l+Conf.+on+Science+and+Technology+of+Zirconia&rft.place=Columbus%2C+OH&rft.series=Advances+in+Ceramics&rft.pub=American+Ceramic+Society&rft.date=1984&rfr_id=info%3Asid%2Fen.wikipedia.org%3AZirconium+dioxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cdc.gov\/niosh\/npg\/npgd0677.html\" target=\"_blank\">NIOSH Pocket Guide to Chemical Hazards<\/a><\/li><\/ul>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1328\nCached time: 20181217072901\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.948 seconds\nReal time usage: 1.253 seconds\nPreprocessor visited node count: 7871\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 177866\/2097152 bytes\nTemplate argument size: 31146\/2097152 bytes\nHighest expansion depth: 27\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 44673\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.340\/10.000 seconds\nLua memory usage: 7.07 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1031.177 1 -total\n<\/p>\n<pre>58.57% 603.933 1 Template:Chembox\n26.72% 275.512 1 Template:Chembox_Identifiers\n25.18% 259.655 1 Template:Reflist\n17.20% 177.392 6 Template:Chembox_headerbar\n17.18% 177.114 21 Template:Trim\n13.04% 134.418 1 Template:Chembox_Properties\n10.50% 108.280 6 Template:Cite_journal\n 9.17% 94.545 10 Template:Main_other\n 7.64% 78.833 1 Template:Chembox_Hazards\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:154750-1!canonical and timestamp 20181217072900 and revision id 866669694\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Zirconium_dioxide\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212233\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.157 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 149.812 1 - wikipedia:Zirconium_dioxide\n100.00% 149.812 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8396-0!*!*!*!*!*!* and timestamp 20181217212232 and revision id 24630\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Zirconium_dioxide\">https:\/\/www.limswiki.org\/index.php\/Zirconium_dioxide<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","9a6ea07ee8933b39b5944046ffd0e8c5_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8e\/ZrO2powder.jpg\/440px-ZrO2powder.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/Kristallstruktur_Zirconium%28IV%29-oxid.png\/440px-Kristallstruktur_Zirconium%28IV%29-oxid.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c3\/GHS-pictogram-exclam.svg\/100px-GHS-pictogram-exclam.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/68\/Zirconium_dioxide_ZrO2_bearing_balls.jpg\/440px-Zirconium_dioxide_ZrO2_bearing_balls.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7a\/Zirconia_bridge.jpg\/440px-Zirconia_bridge.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/b\/bd\/CZ_brilliant.jpg"],"9a6ea07ee8933b39b5944046ffd0e8c5_timestamp":1545081752,"cce648ab32283611b32d0e9f4b99a6a8_type":"article","cce648ab32283611b32d0e9f4b99a6a8_title":"Vitallium","cce648ab32283611b32d0e9f4b99a6a8_url":"https:\/\/www.limswiki.org\/index.php\/Vitallium","cce648ab32283611b32d0e9f4b99a6a8_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tVitallium\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tVitallium is a trademark for an alloy of 65% cobalt, 30% chromium, 5% molybdenum, and other substances. The alloy is used in dentistry and artificial joints, because of its resistance to corrosion. It is also used for components of turbochargers because of its thermal resistance. Vitallium was developed by Albert W. Merrick for the Austenal Laboratories in 1932.\n\n Subperiosteal maxillary implant made of vitallium 1977\nIn 2016 Norman Sharp, a 91 year old British man, was recognised as having the world's oldest hip replacement implants. The two vitallium implants were implanted in November 1948 at the Royal National Orthopaedic Hospital, under the newly formed NHS. The 67 year old implants had such an unusually long life, partly because they had not required the typical replacement of such implants, but also because of Mr Sharp's young age of 23 when they were implanted, owing to a childhood case of septic arthritis.[1]\nFor high-temperature use in engines, particularly turbochargers, the first alloy used was Haynes Stellite N\u00ba 21, similar to Vitallium. This was suggested by the British engineer, and denture wearer, S.D. Heron during WWII. Although the characteristics of the material obviously suggested itself for making turbocharger blades, it was thought impossible to cast it to the precision needed. Heron demonstrated that it could be, by showing his Vitallium dentures.[2]\n\nReferences \n\n\n^ \"Former RNOH patient has world's oldest hip replacements\". Royal National Orthopaedic Hospital. 21 March 2016. \n\n^ Setright, L.J.K. \"Supercharging\". Power To Fly. George Allen & Unwin. p. 195. ISBN 0-04-338041-7. \n\n\nWojnar, L (2001). \"Porosity structure and mechanical properties of vitalium-type alloy for implants\". Materials Characterization. 46 (2\u20133): 221\u2013225. doi:10.1016\/S1044-5803(01)00127-9. \nKaminski, M; Baszkiewicz, J; Kozubowski, J; Bednarska, A; Barcz, A; Gawlik, G; Jagielski, J (1997). \"Effect of silicon ion implantation on the properties of a cast Co\u2013Cr\u2013Mo alloy\". Journal of Materials Science. 32 (14): 3727\u20133732. Bibcode:1997JMatS..32.3727K. doi:10.1023\/A:1018607219482. \nExternal links \nArticles on Vitallium from DentalArticles.com\nNASA article mentioning Vitallium in turbochargers\nThis alloy-related article is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Vitallium\">https:\/\/www.limswiki.org\/index.php\/Vitallium<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 18:58.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 377 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","cce648ab32283611b32d0e9f4b99a6a8_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Vitallium skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Vitallium<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Vitallium<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trademark\" title=\"Trademark\" rel=\"external_link\" target=\"_blank\">trademark<\/a> for an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alloy\" title=\"Alloy\" rel=\"external_link\" target=\"_blank\">alloy<\/a> of 65% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cobalt\" title=\"Cobalt\" rel=\"external_link\" target=\"_blank\">cobalt<\/a>, 30% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium\" title=\"Chromium\" rel=\"external_link\" target=\"_blank\">chromium<\/a>, 5% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molybdenum\" title=\"Molybdenum\" rel=\"external_link\" target=\"_blank\">molybdenum<\/a>, and other substances. The alloy is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dentistry\" title=\"Dentistry\" rel=\"external_link\" target=\"_blank\">dentistry<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_joint\" class=\"mw-redirect\" title=\"Artificial joint\" rel=\"external_link\" target=\"_blank\">artificial joints<\/a>, because of its resistance to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corrosion\" title=\"Corrosion\" rel=\"external_link\" target=\"_blank\">corrosion<\/a>. It is also used for components of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Turbocharger\" title=\"Turbocharger\" rel=\"external_link\" target=\"_blank\">turbochargers<\/a> because of its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hot_strength\" class=\"mw-redirect\" title=\"Hot strength\" rel=\"external_link\" target=\"_blank\">thermal resistance<\/a>. Vitallium was developed by Albert W. Merrick for the Austenal Laboratories in 1932.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Subperiosteal_maxillary_implant.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5a\/Subperiosteal_maxillary_implant.jpg\/220px-Subperiosteal_maxillary_implant.jpg\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Subperiosteal_maxillary_implant.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Subperiosteal maxillary implant made of vitallium 1977<\/div><\/div><\/div>\n<p>In 2016 Norman Sharp, a 91 year old British man, was recognised as having the world's oldest <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">hip replacement<\/a> implants. The two vitallium implants were implanted in November 1948 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Royal_National_Orthopaedic_Hospital\" title=\"Royal National Orthopaedic Hospital\" rel=\"external_link\" target=\"_blank\">Royal National Orthopaedic Hospital<\/a>, under the newly formed <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Health_Service\" title=\"National Health Service\" rel=\"external_link\" target=\"_blank\">NHS<\/a>. The 67 year old implants had such an unusually long life, partly because they had not required the typical replacement of such implants, but also because of Mr Sharp's young age of 23 when they were implanted, owing to a childhood case of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Septic_arthritis\" title=\"Septic arthritis\" rel=\"external_link\" target=\"_blank\">septic arthritis<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>For high-temperature use in engines, particularly turbochargers, the first alloy used was <a href=\"https:\/\/en.wikipedia.org\/wiki\/Haynes_International\" title=\"Haynes International\" rel=\"external_link\" target=\"_blank\">Haynes<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stellite\" title=\"Stellite\" rel=\"external_link\" target=\"_blank\">Stellite<\/a> N\u00ba 21, similar to Vitallium. This was suggested by the British engineer, and denture wearer, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Samuel_Dalziel_Heron\" title=\"Samuel Dalziel Heron\" rel=\"external_link\" target=\"_blank\">S.D. Heron<\/a> during WWII. Although the characteristics of the material obviously suggested itself for making turbocharger blades, it was thought impossible to cast it to the precision needed. Heron demonstrated that it could be, by showing his Vitallium dentures.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.rnoh.nhs.uk\/home\/news\/16\/03\/former-rnoh-patient-has-worlds-oldest-hip-replacements\" target=\"_blank\">\"Former RNOH patient has world's oldest hip replacements\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Royal_National_Orthopaedic_Hospital\" title=\"Royal National Orthopaedic Hospital\" rel=\"external_link\" target=\"_blank\">Royal National Orthopaedic Hospital<\/a><\/i>. 21 March 2016.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Royal+National+Orthopaedic+Hospital&rft.atitle=Former+RNOH+patient+has+world%27s+oldest+hip+replacements&rft.date=2016-03-21&rft_id=https%3A%2F%2Fwww.rnoh.nhs.uk%2Fhome%2Fnews%2F16%2F03%2Fformer-rnoh-patient-has-worlds-oldest-hip-replacements&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVitallium\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/L.J.K._Setright\" class=\"mw-redirect\" title=\"L.J.K. Setright\" rel=\"external_link\" target=\"_blank\">Setright, L.J.K.<\/a> \"Supercharging\". <i>Power To Fly<\/i>. George Allen & Unwin. p. 195. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-04-338041-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Supercharging&rft.btitle=Power+To+Fly&rft.pages=195&rft.pub=George+Allen+%26+Unwin&rft.isbn=0-04-338041-7&rft.aulast=Setright&rft.aufirst=L.J.K.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVitallium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<ul><li><cite class=\"citation journal\">Wojnar, L (2001). \"Porosity structure and mechanical properties of vitalium-type alloy for implants\". <i>Materials Characterization<\/i>. <b>46<\/b> (2\u20133): 221\u2013225. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS1044-5803%2801%2900127-9\" target=\"_blank\">10.1016\/S1044-5803(01)00127-9<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Materials+Characterization&rft.atitle=Porosity+structure+and+mechanical+properties+of+vitalium-type+alloy+for+implants&rft.volume=46&rft.issue=2%E2%80%933&rft.pages=221-225&rft.date=2001&rft_id=info%3Adoi%2F10.1016%2FS1044-5803%2801%2900127-9&rft.au=Wojnar%2C+L&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVitallium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Kaminski, M; Baszkiewicz, J; Kozubowski, J; Bednarska, A; Barcz, A; Gawlik, G; Jagielski, J (1997). \"Effect of silicon ion implantation on the properties of a cast Co\u2013Cr\u2013Mo alloy\". <i>Journal of Materials Science<\/i>. <b>32<\/b> (14): 3727\u20133732. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/1997JMatS..32.3727K\" target=\"_blank\">1997JMatS..32.3727K<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1023%2FA%3A1018607219482\" target=\"_blank\">10.1023\/A:1018607219482<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Materials+Science&rft.atitle=Effect+of+silicon+ion+implantation+on+the+properties+of+a+cast+Co%E2%80%93Cr%E2%80%93Mo+alloy&rft.volume=32&rft.issue=14&rft.pages=3727-3732&rft.date=1997&rft_id=info%3Adoi%2F10.1023%2FA%3A1018607219482&rft_id=info%3Abibcode%2F1997JMatS..32.3727K&rft.au=Kaminski%2C+M&rft.au=Baszkiewicz%2C+J&rft.au=Kozubowski%2C+J&rft.au=Bednarska%2C+A&rft.au=Barcz%2C+A&rft.au=Gawlik%2C+G&rft.au=Jagielski%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVitallium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060528151502\/http:\/\/www.dentalarticles.com\/products\/20330.html\" target=\"_blank\">Articles on Vitallium from DentalArticles.com<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/history.nasa.gov\/SP-4306\/ch3.htm\" target=\"_blank\">NASA article mentioning Vitallium in turbochargers<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1270\nCached time: 20181203054747\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.140 seconds\nReal time usage: 0.192 seconds\nPreprocessor visited node count: 268\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 9379\/2097152 bytes\nTemplate argument size: 73\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 8165\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.094\/10.000 seconds\nLua memory usage: 2.43 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 163.455 1 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5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 143.035 1 - wikipedia:Vitallium\n100.00% 143.035 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8090-0!*!*!*!*!*!* and timestamp 20181217212232 and revision id 24209\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Vitallium\">https:\/\/www.limswiki.org\/index.php\/Vitallium<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","cce648ab32283611b32d0e9f4b99a6a8_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5a\/Subperiosteal_maxillary_implant.jpg\/440px-Subperiosteal_maxillary_implant.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/48\/Gussmetallschmelze.jpg\/65px-Gussmetallschmelze.jpg"],"cce648ab32283611b32d0e9f4b99a6a8_timestamp":1545081752,"f0f891d4b0577f61620704f7a4c841ec_type":"article","f0f891d4b0577f61620704f7a4c841ec_title":"Tricalcium phosphate","f0f891d4b0577f61620704f7a4c841ec_url":"https:\/\/www.limswiki.org\/index.php\/Tricalcium_phosphate","f0f891d4b0577f61620704f7a4c841ec_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tTricalcium phosphate\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\nTricalcium phosphate\n\n\n\n\n\n\n\n\n\n\nNames\n\n\n\nIUPAC name\nTricalcium bis(phosphate)\n\n\n\n\nOther names\nTribasic calcium phosphate\n\n\nIdentifiers\n\n\n\nCAS Number\n\n7758-87-4  Y \n\n\n3D model (JSmol)\n\nInteractive image \n\n\n\n\n\nChEBI\n\nCHEBI:9679  Y \n\n\n\nChemSpider\n\n22864  Y \n\n\n\nECHA InfoCard \n\n100.028.946\n\n\n\n\n\n\n\n\nPubChem CID\n\n516943 \n\n\n\nUNII\n\nK4C08XP666  Y \n\n\n\n\nInChI\nInChI=1S\/3Ca.2H3O4P\/c;;;2*1-5(2,3)4\/h;;;2*(H3,1,2,3,4)\/q3*+2;;\/p-6 Y Key: QORWJWZARLRLPR-UHFFFAOYSA-H Y InChI=1S\/3Ca.2H3O4P\/c;;;2*1-5(2,3)4\/h;;;2*(H3,1,2,3,4)\/q3*+2;;\/p-6Key: QORWJWZARLRLPR-CYFPFDDLACKey: QORWJWZARLRLPR-UHFFFAOYSA-H\n\n\n\n\nSMILES\n[O-]P(=O)([O-])[O-].[O-]P(=O)([O-])[O-].[Ca+2].[Ca+2].[Ca+2]\n\n\n\nProperties\n\n\nChemical formula\n\nCa3(PO4)2 \n\n\nMolar mass\n\n310.18   \n\n\nAppearance\n\nWhite amorphous powder\n\n\n\nDensity\n\n3.14 g\/cm3\n\n\nMelting point\n\nLiquifies under high pressure at 1670 K (1391 \u00b0C)  \n\n\n\n\n\nSolubility in water\n\n0.002 g\/100 g\n\n\n\n\nThermochemistry\n\n\n\n\nStd enthalpy of\r\nformation (\u0394fHo298)\n\n-4126 kcal\/mol (\u03b1-form)[1]\n\n\nPharmacology\n\n\n\nATC code\n\nA12AA01 (WHO ) \n\n\nHazards\n\n\n\n\n\n\n\n\n\n\n\n\n\nNFPA 704\n\n\n\n0 \n1 \n0 \n\n\nFlash point\n\nNon-flammable  \n\n\nRelated compounds\n\n\nOther anions\n\nCalcium pyrophosphate\n\n\nOther cations\n\nTrimagnesium phosphate\r\nTrisodium phosphate\r\nTripotassium phosphate\n\n\n\nRelated compounds\n\nMonocalcium phosphate\r\nDicalcium phosphate\n\n\n\n\nExcept where otherwise noted, data are given for materials in their standard state (at 25 \u00b0C [77 \u00b0F], 100 kPa).\n\n\nY  verify  (what is Y N  ?)\n\n\nInfobox references\n\n\n\n\n\n\n\nTricalcium phosphate (sometimes abbreviated TCP) is a calcium salt of phosphoric acid with the chemical formula Ca3(PO4)2. It is also known as tribasic calcium phosphate and bone phosphate of lime (BPL). It is a white solid of low solubility. Most commercial samples of \"tricalcium phosphate\" are in fact hydroxyapatite.[2]\nIt exists as three crystalline polymorphs \u03b1, \u03b1', and \u03b2. The \u03b1 and \u03b1' states are stable at high temperatures. As mineral, it is found in Whitlockite.[2]\n\nContents \n\n1 Nomenclature \n2 Preparation \n3 Structure of \u03b2-, \u03b1- and \u03b1'- Ca3(PO4)2 polymorphs \n4 Occurrence \n5 Biphasic tricalcium phosphate, BCP \n6 Uses \n\n6.1 Biomedical \n\n\n7 References \n\n\nNomenclature \nMain article: Calcium phosphate\nCalcium phosphate refers to numerous materials consisting of calcium ions (Ca2+) together with orthophosphates (PO43\u2212), metaphosphates or pyrophosphates (P2O74\u2212) and occasionally oxide and hydroxide ions. Especially, the common mineral apatite has formula Ca5(PO4)3X, where X is F, Cl, OH, or a mixture; it is hydroxyapatite if the extra ion is mainly hydroxide. Much of the \"tricalcium phosphate\" on the market is actually powdered hydroxyapatite.\n\nPreparation \nTricalcium phosphate is produced commercially by treating hydroxyapatite with phosphoric acid and slaked lime.[2]\nIt cannot be precipitated directly from aqueous solution. Typically double decomposition reactions are employed, involving a soluble phosphate and calcium salts, e.g. (NH4)2HPO4 + Ca(NO3)2.[3] is performed under carefully controlled pH conditions. The precipitate will either be \"amorphous tricalcium phosphate\", ATCP, or calcium deficient hydroxyapatite, CDHA, Ca9(HPO4)(PO4)5(OH), (note CDHA is sometimes termed apatitic calcium triphosphate).[3][4][5] Crystalline tricalcium phosphate can be obtained by calcining the precipitate. \u03b2-Ca3(PO4)2 is generally formed, higher temperatures are required to produce \u03b1-Ca3(PO4)2.\nAn alternative to the wet procedure entails heating a mixture of a calcium pyrophosphate and calcium carbonate:[4]\n\nCaCO3 + Ca2P2O7 \u2192 Ca3(PO4)2 + CO2\n Structure of \u03b2-, \u03b1- and \u03b1'- Ca3(PO4)2 polymorphs \nTricalcium phosphate has three recognised polymorphs, the rhombohedral \u03b2- form (shown above), and two high temperature forms, monoclinic \u03b1- and hexagonal \u03b1'-. \u03b2-tricalcium phosphate has a crystallographic density of 3.066 g cm\u22123 while the high temperature forms are less dense, \u03b1-tricalcium phosphate has a density of 2.866 g cm\u22123 and \u03b1'-tricalcium phosphate has a density of 2.702 g cm\u22123 All forms have complex structures consisting of tetrahedral phosphate centers linked through oxygen to the calcium ions.[6] The high temperature forms each have two types of columns, one containing only calcium ions and the other both calcium and phosphate.[7]\nThere are differences in chemical and biological properties between the beta and alpha forms, the alpha form is more soluble and biodegradeable. Both forms are available commercially and are present in formulations used in medical and dental applications.[7]\n\nOccurrence \nCalcium phosphate is one of the main combustion products of bone (see bone ash). Calcium phosphate is also commonly derived from inorganic sources such as mineral rock.[8]\nTricalcium phosphate occurs naturally in several forms, including:\n\nas a rock in Morocco, Israel, Philippines, Egypt, and Kola (Russia) and in smaller quantities in some other countries. The natural form is not completely pure, and there are some other components like sand and lime which can change the composition. In terms of P2O5, most calcium phosphate rocks have a content of 30% to 40% P2O5 in weight.\nin the skeletons and teeth of vertebrate animals\nin milk.\n Biphasic tricalcium phosphate, BCP \nBiphasic tricalcium phosphate, BCP, was originally reported as tricalcium phosphate, but X-Ray diffraction techniques showed that the material was an intimate mixture of two phases, hydroxyapatite (HA) and \u03b2-tricalcium phosphate.[9] It is a ceramic.[10]\nPreparation involves the sintering causing the irreversible decomposition of calcium deficient apatites[4] alternatively termed non-stoichiometric apatites or basic calcium phosphate,[11] an example is:[12]\n\nCa10\u2212\u03b4(PO4)6\u2212\u03b4(HPO4)\u03b4(OH)2\u2212\u03b4 \u2192 (1-\u03b4)Ca10(PO4)6(OH)2 + 3\u03b4Ca3(PO4)2\n\u03b2-TCP can contain impurities, for example calcium pyrophosphate, CaP2O7 and apatite. \u03b2-TCP is bioresorbable. The biodegradation of BCP involves faster dissolution of the \u03b2-TCP phase followed by elimination of HA crystals. \u03b2-TCP does not dissolve in body fluids at physiological pH levels, dissolution requires cell activity producing acidic pH.[4]\n\nUses \nTricalcium phosphate is used in powdered spices as an anticaking agent, e.g. to prevent table salt from caking. It is also found in baby powder and toothpaste.[2]\n\nBiomedical \nIt is also used as a nutritional supplement[13] and occurs naturally in cow milk[citation needed ], although the most common and economical forms for supplementation are calcium carbonate (which should be taken with food) and calcium citrate (which can be taken without food).[14] There is some debate about the different bioavailabilities of the different calcium salts.\nIt can be used as a tissue replacement for repairing bony defects when autogenous bone graft is not feasible or possible.[15][16][17] It may be used alone or in combination with a biodegradable, resorbable polymer such as polyglycolic acid.[18] It may also be combined with autologous materials for a bone graft.[19][20]\nPorous beta-Tricalcium phosphate scaffolds are employed as drug carrier systems for local drug delivery in bone.[21]\n\nReferences \n\n\n^ Zumdahl, Steven S. (2009). Chemical Principles 6th Ed. Houghton Mifflin Company. p. A21. ISBN 0-618-94690-X. \n\n^ a b c d Klaus Schr\u00f6dter; Gerhard Bettermann; Thomas Staffel; Friedrich Wahl; Thomas Klein; Thomas Hofmann (2008). Phosphoric Acid and Phosphates. Ullmann\u2019s Encyclopedia of Industrial Chemistry. Weinheim: Wiley-VCH. doi:10.1002\/14356007.a19_465.pub3. \n\n^ a b Destainville, A., Champion, E., Bernache-Assollant, D., Laborde, E. (2003). \"Synthesis, characterization and thermal behavior of apatitic tricalcium phosphate\". Materials Chemistry and Physics. 80 (1): 269\u2013277. doi:10.1016\/S0254-0584(02)00466-2. ISSN 1742-7061. CS1 maint: Uses authors parameter (link)  \u2013 via ScienceDirect  (Subscription may be required or content may be available in libraries.) \n\n^ a b c d Rey, C.; Combes, C.; Drouet, C.; Grossin, D. (2011). \"1.111 - Bioactive Ceramics: Physical Chemistry\". In Ducheyne, Paul. Comprehensive Biomaterials. 1. Elsevier. pp. 187\u2013281. doi:10.1016\/B978-0-08-055294-1.00178-1. ISBN 978-0-08-055294-1.  \u2013 via ScienceDirect  (Subscription may be required or content may be available in libraries.) \n\n^ Dorozhkin, Sergey V. (December 2012). \"Amorphous calcium (ortho)phosphates\". Acta Biomaterialia. 6 (12): 4457\u20134475. doi:10.1016\/j.actbio.2010.06.031. ISSN 1742-7061. CS1 maint: Uses authors parameter (link)  \u2013 via ScienceDirect  (Subscription may be required or content may be available in libraries.) \n\n^ Yashima, M.; Sakai, A.; Kamiyama, T.; Hoshikawa, A. (2003). \"Crystal structure analysis of beta-tricalcium phosphate Ca3(PO4)2 by neutron powder diffraction\". rnal of Solid State Chemistry. 175: 272-p277. \n\n^ a b Carrodeguas, R.G.; De Aza, S. (2011). \"\u03b1-Tricalcium phosphate: Synthesis, properties and biomedical applications\". Acta Biomaterialia. 7 (10): 3536\u20133546. doi:10.1016\/j.actbio.2011.06.019. ISSN 1742-7061. CS1 maint: Uses authors parameter (link)  \u2013 via ScienceDirect  (Subscription may be required or content may be available in libraries.) \n\n^ Yacoubou, Jeanne, MS. Vegetarian Journal's Guide To Food Ingredients \"Guide to Food Ingredients\". The Vegetarian Resource Group, n.d. Web. 14 Sept. 2012. \n\n^ Daculsi, G.; Legeros, R. (2008). \"17 - Tricalcium phosphate\/hydroxyapatite biphasic ceramics\". In Kokubo, Tadashi. Bioceramics and their Clinical Applications. Woodhead Publishing. pp. 395\u2013423. doi:10.1533\/9781845694227.2.395. ISBN 978-1-84569-204-9.  \u2013 via ScienceDirect  (Subscription may be required or content may be available in libraries.) \n\n^ Salinas, Antonio J.; Vallet-Regi, Maria (2013). \"Bioactive ceramics: from bone grafts to tissue engineering\". RSC Advances. Royal Society of Chemistry. 3 (28): 11116\u201311131. doi:10.1039\/C3RA00166K. Retrieved 15 February 2015 . (Subscription required (help )) . \n\n^ Elliott, J.C. (1994). \"3 - Hydroxyapatite and Nonstoichiometric Apatites\". Studies in Inorganic Chemistry. 18. Elsevier. pp. 111\u2013189. doi:10.1016\/B978-0-444-81582-8.50008-0. ISSN 0169-3158. Retrieved 15 February 2015 .  \u2013 via ScienceDirect  (Subscription may be required or content may be available in libraries.) \n\n^ Vallet-Reg\u00ed, M.;Rodr\u00edguez-Lorenzo, L.M. (November 1997). \"Synthesis and characterisation of calcium deficient apatite\". Solid State Ionics. 101\u2013103, Part 2: 1279\u20131285. doi:10.1016\/S0167-2738(97)00213-0. CS1 maint: Uses authors parameter (link)  \u2013 via ScienceDirect  (Subscription may be required or content may be available in libraries.) \n\n^ Bonjour JP, Carrie AL, Ferrari S, Clavien H, Slosman D, Theintz G, Rizzoli R (March 1997). \"Calcium-enriched foods and bone mass growth in prepubertal girls: a randomized, double-blind, placebo-controlled trial\". J. Clin. Invest. 99 (6): 1287\u201394. doi:10.1172\/JCI119287. PMC 507944 . PMID 9077538. \n\n^ Straub DA (June 2007). \"Calcium supplementation in clinical practice: a review of forms, doses, and indications\". Nutr Clin Pract. 22 (3): 286\u201396. doi:10.1177\/0115426507022003286. PMID 17507729. \n\n^ Paderni S, Terzi S, Amendola L (September 2009). \"Major bone defect treatment with an osteoconductive bone substitute\". Musculoskelet Surg. 93 (2): 89\u201396. doi:10.1007\/s12306-009-0028-0. PMID 19711008. \n\n^ Moore DC, Chapman MW, Manske D (1987). \"The evaluation of a biphasic calcium phosphate ceramic for use in grafting long-bone diaphyseal defects\". Journal of Orthopaedic Research. 5 (3): 356\u201365. doi:10.1002\/jor.1100050307. PMID 3040949. \n\n^ Lange TA, Zerwekh JE, Peek RD, Mooney V, Harrison BH (1986). \"Granular tricalcium phosphate in large cancellous defects\". Annals of Clinical and Laboratory Science. 16 (6): 467\u201372. PMID 3541772. \n\n^ Cao H, Kuboyama N (September 2009). \"A biodegradable porous composite scaffold of PGA\/beta-TCP for bone tissue engineering\". Bone. 46 (2): 386\u201395. doi:10.1016\/j.bone.2009.09.031. PMID 19800045. \n\n^ Erbe EM, Marx JG, Clineff TD, Bellincampi LD (October 2001). \"Potential of an ultraporous beta-tricalcium phosphate synthetic cancellous bone void filler and bone marrow aspirate composite graft\". European Spine Journal. 10 Suppl 2: S141\u20136. doi:10.1007\/s005860100287. PMC 3611552 . PMID 11716011. \n\n^ Bansal S, Chauhan V, Sharma S, Maheshwari R, Juyal A, Raghuvanshi S (July 2009). \"Evaluation of hydroxyapatite and beta-tricalcium phosphate mixed with bone marrow aspirate as a bone graft substitute for posterolateral spinal fusion\". Indian Journal of Orthopaedics. 43 (3): 234\u20139. doi:10.4103\/0019-5413.49387. PMC 2762171 . PMID 19838344. \n\n^ Kundu, B; Lemos A; Soundrapandian C; Sen PS; Datta S; Ferreira JMF; Basu D (2010). \"Development of porous HAp and \u03b2-TCP scaffolds by starch consolidation with foaming method and drug-chitosan bilayered scaffold based drug delivery system\". J Mater. Sci. Mater. Med. 21 (11): 2955\u201369. doi:10.1007\/s10856-010-4127-0. PMID 20644982. \n\n\nvteCalcium compounds\nCaAl2O4\nCaB6\nCaBr2\nCa(BrO3)2\nCaC2\nCaCN2\nCa(CN)2\nCaCO3\nCaC2O4\nCaCl2\nCa(ClO)2\nCa(ClO3)2\nCaCrO4\nCaF2\nCaH2\nCa(HCO3)2\nCaH2S2O6\nCaI2\nCa(IO3)2\nCa(MnO4)2\nCaN6\nCa(NO3)2\nCaO\nCaO2\nCa(OH)2\nCaP\nCaS\nCaSO3\nCaSO4\nCaSe\nCaSi\nCaSi2\nCaTiO3\nCa2P2O7\nCa2SiO4\nCa3Al2O6\nCa3(AsO4)2\nCa3(BO3)2\nCa3(C6H5O7)2\nCa3N2\nCa3P2\nCa4(PO4)2O\nCa3(PO4)2\nCa(H2PO4)2\nCaHPO4\nC36H70CaO4\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Tricalcium_phosphate\">https:\/\/www.limswiki.org\/index.php\/Tricalcium_phosphate<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 16:57.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 646 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","f0f891d4b0577f61620704f7a4c841ec_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Tricalcium_phosphate skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Tricalcium phosphate<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Tricalcium phosphate<\/b> (sometimes abbreviated <b>TCP<\/b>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium\" title=\"Calcium\" rel=\"external_link\" target=\"_blank\">calcium<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Salt_(chemistry)\" title=\"Salt (chemistry)\" rel=\"external_link\" target=\"_blank\">salt<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphoric_acid\" title=\"Phosphoric acid\" rel=\"external_link\" target=\"_blank\">phosphoric acid<\/a> with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_formula\" title=\"Chemical formula\" rel=\"external_link\" target=\"_blank\">chemical formula<\/a> Ca<sub>3<\/sub>(PO<sub>4<\/sub>)<sub>2<\/sub>. It is also known as <b>tribasic calcium phosphate<\/b> and <b>bone phosphate of lime<\/b> (<b>BPL<\/b>). It is a white solid of low solubility. Most commercial samples of \"tricalcium phosphate\" are in fact <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxyapatite\" title=\"Hydroxyapatite\" rel=\"external_link\" target=\"_blank\">hydroxyapatite<\/a>.<sup id=\"rdp-ebb-cite_ref-Ullmann_2-0\" class=\"reference\"><a href=\"#cite_note-Ullmann-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>It exists as three crystalline polymorphs \u03b1, \u03b1', and \u03b2. The \u03b1 and \u03b1' states are stable at high temperatures. As mineral, it is found in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Whitlockite\" title=\"Whitlockite\" rel=\"external_link\" target=\"_blank\">Whitlockite<\/a>.<sup id=\"rdp-ebb-cite_ref-Ullmann_2-1\" class=\"reference\"><a href=\"#cite_note-Ullmann-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Nomenclature\">Nomenclature<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_phosphate\" title=\"Calcium phosphate\" rel=\"external_link\" target=\"_blank\">Calcium phosphate<\/a><\/div>\n<p><i>Calcium phosphate<\/i> refers to numerous materials consisting of calcium ions (Ca<sup>2+<\/sup>) together with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthophosphate\" class=\"mw-redirect\" title=\"Orthophosphate\" rel=\"external_link\" target=\"_blank\">orthophosphates<\/a> (PO<sub>4<\/sub><sup>3\u2212<\/sup>), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metaphosphate\" title=\"Metaphosphate\" rel=\"external_link\" target=\"_blank\">metaphosphates<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyrophosphate\" title=\"Pyrophosphate\" rel=\"external_link\" target=\"_blank\">pyrophosphates<\/a> (P<sub>2<\/sub>O<sub>7<\/sub><sup>4\u2212<\/sup>) and occasionally oxide and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxide\" title=\"Hydroxide\" rel=\"external_link\" target=\"_blank\">hydroxide<\/a> ions. Especially, the common mineral <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apatite\" title=\"Apatite\" rel=\"external_link\" target=\"_blank\">apatite<\/a> has formula Ca<sub>5<\/sub>(PO<sub>4<\/sub>)<sub>3<\/sub><i>X<\/i>, where <i>X<\/i> is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoride\" title=\"Fluoride\" rel=\"external_link\" target=\"_blank\">F<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chloride\" title=\"Chloride\" rel=\"external_link\" target=\"_blank\">Cl<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxide\" title=\"Hydroxide\" rel=\"external_link\" target=\"_blank\">OH<\/a>, or a mixture; it is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxyapatite\" title=\"Hydroxyapatite\" rel=\"external_link\" target=\"_blank\">hydroxyapatite<\/a> if the extra ion is mainly hydroxide. Much of the \"tricalcium phosphate\" on the market is actually powdered <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxyapatite\" title=\"Hydroxyapatite\" rel=\"external_link\" target=\"_blank\">hydroxyapatite<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Preparation\">Preparation<\/span><\/h2>\n<p>Tricalcium phosphate is produced commercially by treating hydroxyapatite with phosphoric acid and slaked lime.<sup id=\"rdp-ebb-cite_ref-Ullmann_2-2\" class=\"reference\"><a href=\"#cite_note-Ullmann-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>It cannot be precipitated directly from aqueous solution. Typically double decomposition reactions are employed, involving a soluble phosphate and calcium salts, e.g. (NH<sub>4<\/sub>)<sub>2<\/sub>HPO<sub>4<\/sub> + Ca(NO<sub>3<\/sub>)<sub>2<\/sub>.<sup id=\"rdp-ebb-cite_ref-Destainville_3-0\" class=\"reference\"><a href=\"#cite_note-Destainville-3\" rel=\"external_link\">[3]<\/a><\/sup> is performed under carefully controlled pH conditions. The precipitate will either be \"amorphous tricalcium phosphate\", ATCP, or calcium deficient hydroxyapatite, CDHA, Ca<sub>9<\/sub>(HPO<sub>4<\/sub>)(PO<sub>4<\/sub>)<sub>5<\/sub>(OH), (note CDHA is sometimes termed apatitic calcium triphosphate).<sup id=\"rdp-ebb-cite_ref-Destainville_3-1\" class=\"reference\"><a href=\"#cite_note-Destainville-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Bioactive_4-0\" class=\"reference\"><a href=\"#cite_note-Bioactive-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Dorozhkin2012_5-0\" class=\"reference\"><a href=\"#cite_note-Dorozhkin2012-5\" rel=\"external_link\">[5]<\/a><\/sup> Crystalline tricalcium phosphate can be obtained by calcining the precipitate. \u03b2-Ca<sub>3<\/sub>(PO<sub>4<\/sub>)<sub>2<\/sub> is generally formed, higher temperatures are required to produce \u03b1-Ca<sub>3<\/sub>(PO<sub>4<\/sub>)<sub>2<\/sub>.\n<\/p><p>An alternative to the wet procedure entails heating a mixture of a calcium pyrophosphate and calcium carbonate:<sup id=\"rdp-ebb-cite_ref-Bioactive_4-1\" class=\"reference\"><a href=\"#cite_note-Bioactive-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<dl><dd>CaCO<sub>3<\/sub> + Ca<sub>2<\/sub>P<sub>2<\/sub>O<sub>7<\/sub> \u2192 Ca<sub>3<\/sub>(PO<sub>4<\/sub>)<sub>2<\/sub> + CO<sub>2<\/sub><\/dd><\/dl>\n<h2><span id=\"rdp-ebb-Structure_of_.CE.B2-.2C_.CE.B1-_and_.CE.B1.27-_Ca3.28PO4.292_polymorphs\"><\/span><span class=\"mw-headline\" id=\"Structure_of_\u03b2-,_\u03b1-_and_\u03b1'-_Ca3(PO4)2_polymorphs\">Structure of \u03b2-, \u03b1- and \u03b1'- Ca<sub>3<\/sub>(PO<sub>4<\/sub>)<sub>2<\/sub> polymorphs<\/span><\/h2>\n<p>Tricalcium phosphate has three recognised polymorphs, the rhombohedral \u03b2- form (shown above), and two high temperature forms, monoclinic \u03b1- and hexagonal \u03b1'-. \u03b2-tricalcium phosphate has a crystallographic density of 3.066 g cm<sup>\u22123<\/sup> while the high temperature forms are less dense, \u03b1-tricalcium phosphate has a density of 2.866 g cm<sup>\u22123<\/sup> and \u03b1'-tricalcium phosphate has a density of 2.702 g cm<sup>\u22123<\/sup> All forms have complex structures consisting of tetrahedral phosphate centers linked through oxygen to the calcium ions.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> The high temperature forms each have two types of columns, one containing only calcium ions and the other both calcium and phosphate.<sup id=\"rdp-ebb-cite_ref-Carrodeguas2011_7-0\" class=\"reference\"><a href=\"#cite_note-Carrodeguas2011-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>There are differences in chemical and biological properties between the beta and alpha forms, the alpha form is more soluble and biodegradeable. Both forms are available commercially and are present in formulations used in medical and dental applications.<sup id=\"rdp-ebb-cite_ref-Carrodeguas2011_7-1\" class=\"reference\"><a href=\"#cite_note-Carrodeguas2011-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Occurrence\">Occurrence<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_phosphate\" title=\"Calcium phosphate\" rel=\"external_link\" target=\"_blank\">Calcium phosphate<\/a> is one of the main <a href=\"https:\/\/en.wikipedia.org\/wiki\/Combustion\" title=\"Combustion\" rel=\"external_link\" target=\"_blank\">combustion<\/a> products of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> (see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_ash\" title=\"Bone ash\" rel=\"external_link\" target=\"_blank\">bone ash<\/a>). Calcium phosphate is also commonly derived from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inorganic\" class=\"mw-redirect\" title=\"Inorganic\" rel=\"external_link\" target=\"_blank\">inorganic<\/a> sources such as mineral rock.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\nTricalcium phosphate occurs naturally in several forms, including:\n<\/p>\n<ul><li>as a rock in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Morocco\" title=\"Morocco\" rel=\"external_link\" target=\"_blank\">Morocco<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Israel\" title=\"Israel\" rel=\"external_link\" target=\"_blank\">Israel<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Philippines\" title=\"Philippines\" rel=\"external_link\" target=\"_blank\">Philippines<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Egypt\" title=\"Egypt\" rel=\"external_link\" target=\"_blank\">Egypt<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kola_peninsula\" class=\"mw-redirect\" title=\"Kola peninsula\" rel=\"external_link\" target=\"_blank\">Kola<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Russia\" title=\"Russia\" rel=\"external_link\" target=\"_blank\">Russia<\/a>) and in smaller quantities in some other countries. The natural form is not completely pure, and there are some other components like sand and lime which can change the composition. In terms of P<sub>2<\/sub>O<sub>5<\/sub>, most calcium phosphate rocks have a content of 30% to 40% P<sub>2<\/sub>O<sub>5<\/sub> in weight.<\/li>\n<li>in the skeletons and teeth of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertebrate\" title=\"Vertebrate\" rel=\"external_link\" target=\"_blank\">vertebrate<\/a> animals<\/li>\n<li>in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Milk#Cow.27s_milk\" title=\"Milk\" rel=\"external_link\" target=\"_blank\">milk<\/a>.<\/li><\/ul>\n<h2><span id=\"rdp-ebb-Biphasic_tricalcium_phosphate.2C_BCP\"><\/span><span class=\"mw-headline\" id=\"Biphasic_tricalcium_phosphate,_BCP\">Biphasic tricalcium phosphate, BCP<\/span><\/h2>\n<p>Biphasic tricalcium phosphate, BCP, was originally reported as tricalcium phosphate, but X-Ray diffraction techniques showed that the material was an intimate mixture of two phases, hydroxyapatite (HA) and \u03b2-tricalcium phosphate.<sup id=\"rdp-ebb-cite_ref-Bioceramicschap17_9-0\" class=\"reference\"><a href=\"#cite_note-Bioceramicschap17-9\" rel=\"external_link\">[9]<\/a><\/sup> It is a ceramic.<sup id=\"rdp-ebb-cite_ref-Salinas2013_10-0\" class=\"reference\"><a href=\"#cite_note-Salinas2013-10\" rel=\"external_link\">[10]<\/a><\/sup>\nPreparation involves the sintering causing the irreversible decomposition of calcium deficient apatites<sup id=\"rdp-ebb-cite_ref-Bioactive_4-2\" class=\"reference\"><a href=\"#cite_note-Bioactive-4\" rel=\"external_link\">[4]<\/a><\/sup> alternatively termed non-stoichiometric apatites or basic calcium phosphate,<sup id=\"rdp-ebb-cite_ref-Elliot_11-0\" class=\"reference\"><a href=\"#cite_note-Elliot-11\" rel=\"external_link\">[11]<\/a><\/sup> an example is:<sup id=\"rdp-ebb-cite_ref-ValletRegi2011_12-0\" class=\"reference\"><a href=\"#cite_note-ValletRegi2011-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<dl><dd>Ca<sub>10\u2212\u03b4<\/sub>(PO<sub>4<\/sub>)<sub>6\u2212\u03b4<\/sub>(HPO<sub>4<\/sub>)<sub>\u03b4<\/sub>(OH)<sub>2\u2212\u03b4<\/sub> \u2192 (1-\u03b4)Ca<sub>10<\/sub>(PO<sub>4<\/sub>)<sub>6<\/sub>(OH)<sub>2<\/sub> + 3\u03b4Ca<sub>3<\/sub>(PO<sub>4<\/sub>)<sub>2<\/sub><\/dd><\/dl>\n<p>\u03b2-TCP can contain impurities, for example calcium pyrophosphate, CaP<sub>2<\/sub>O<sub>7<\/sub> and apatite. \u03b2-TCP is bioresorbable. The biodegradation of BCP involves faster dissolution of the \u03b2-TCP phase followed by elimination of HA crystals. \u03b2-TCP does not dissolve in body fluids at physiological pH levels, dissolution requires cell activity producing acidic pH.<sup id=\"rdp-ebb-cite_ref-Bioactive_4-3\" class=\"reference\"><a href=\"#cite_note-Bioactive-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Uses\">Uses<\/span><\/h2>\n<p>Tricalcium phosphate is used in powdered spices as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anticaking_agent\" title=\"Anticaking agent\" rel=\"external_link\" target=\"_blank\">anticaking agent<\/a>, e.g. to prevent table salt from caking. It is also found in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Baby_powder\" title=\"Baby powder\" rel=\"external_link\" target=\"_blank\">baby powder<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toothpaste\" title=\"Toothpaste\" rel=\"external_link\" target=\"_blank\">toothpaste<\/a>.<sup id=\"rdp-ebb-cite_ref-Ullmann_2-3\" class=\"reference\"><a href=\"#cite_note-Ullmann-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Biomedical\">Biomedical<\/span><\/h3>\n<p>It is also used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nutritional_supplement\" class=\"mw-redirect\" title=\"Nutritional supplement\" rel=\"external_link\" target=\"_blank\">nutritional supplement<\/a><sup id=\"rdp-ebb-cite_ref-pmid9077538_13-0\" class=\"reference\"><a href=\"#cite_note-pmid9077538-13\" rel=\"external_link\">[13]<\/a><\/sup> and occurs naturally in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cow\" class=\"mw-redirect\" title=\"Cow\" rel=\"external_link\" target=\"_blank\">cow<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Milk\" title=\"Milk\" rel=\"external_link\" target=\"_blank\">milk<\/a><sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>, although the most common and economical forms for supplementation are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_carbonate\" title=\"Calcium carbonate\" rel=\"external_link\" target=\"_blank\">calcium carbonate<\/a> (which should be taken with food) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_citrate\" title=\"Calcium citrate\" rel=\"external_link\" target=\"_blank\">calcium citrate<\/a> (which can be taken without food).<sup id=\"rdp-ebb-cite_ref-pmid17507729_14-0\" class=\"reference\"><a href=\"#cite_note-pmid17507729-14\" rel=\"external_link\">[14]<\/a><\/sup> There is some debate about the different <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioavailability\" title=\"Bioavailability\" rel=\"external_link\" target=\"_blank\">bioavailabilities<\/a> of the different calcium salts.\n<\/p><p>It can be used as a tissue replacement for repairing bony defects when <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autotransplantation\" title=\"Autotransplantation\" rel=\"external_link\" target=\"_blank\">autogenous<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_graft\" class=\"mw-redirect\" title=\"Bone graft\" rel=\"external_link\" target=\"_blank\">bone graft<\/a> is not feasible or possible.<sup id=\"rdp-ebb-cite_ref-pmid19711008_15-0\" class=\"reference\"><a href=\"#cite_note-pmid19711008-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid3040949_16-0\" class=\"reference\"><a href=\"#cite_note-pmid3040949-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid3541772_17-0\" class=\"reference\"><a href=\"#cite_note-pmid3541772-17\" rel=\"external_link\">[17]<\/a><\/sup> It may be used alone or in combination with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biodegradable\" class=\"mw-redirect\" title=\"Biodegradable\" rel=\"external_link\" target=\"_blank\">biodegradable<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyglycolic_acid\" class=\"mw-redirect\" title=\"Polyglycolic acid\" rel=\"external_link\" target=\"_blank\">polyglycolic acid<\/a>.<sup id=\"rdp-ebb-cite_ref-pmid19800045_18-0\" class=\"reference\"><a href=\"#cite_note-pmid19800045-18\" rel=\"external_link\">[18]<\/a><\/sup> It may also be combined with autologous materials for a bone graft.<sup id=\"rdp-ebb-cite_ref-pmid11716011_19-0\" class=\"reference\"><a href=\"#cite_note-pmid11716011-19\" rel=\"external_link\">[19]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid19838344_20-0\" class=\"reference\"><a href=\"#cite_note-pmid19838344-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><p>Porous beta-Tricalcium phosphate scaffolds are employed as drug carrier systems for local drug delivery in bone.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-b1-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-b1_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Zumdahl, Steven S. (2009). <i>Chemical Principles 6th Ed<\/i>. Houghton Mifflin Company. p. A21. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-618-94690-X.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Chemical+Principles+6th+Ed.&rft.pages=A21&rft.pub=Houghton+Mifflin+Company&rft.date=2009&rft.isbn=0-618-94690-X&rft.au=Zumdahl%2C+Steven+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATricalcium+phosphate\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Ullmann-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Ullmann_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ullmann_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ullmann_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ullmann_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Klaus Schr\u00f6dter; Gerhard Bettermann; Thomas Staffel; Friedrich Wahl; Thomas Klein; Thomas Hofmann (2008). <i>Phosphoric Acid and Phosphates<\/i>. Ullmann\u2019s Encyclopedia of Industrial Chemistry. Weinheim: Wiley-VCH. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14356007.a19_465.pub3\" target=\"_blank\">10.1002\/14356007.a19_465.pub3<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Phosphoric+Acid+and+Phosphates&rft.place=Weinheim&rft.series=Ullmann%E2%80%99s+Encyclopedia+of+Industrial+Chemistry&rft.pub=Wiley-VCH&rft.date=2008&rft_id=info%3Adoi%2F10.1002%2F14356007.a19_465.pub3&rft.au=Klaus+Schr%C3%B6dter&rft.au=Gerhard+Bettermann&rft.au=Thomas+Staffel&rft.au=Friedrich+Wahl&rft.au=Thomas+Klein&rft.au=Thomas+Hofmann&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATricalcium+phosphate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Destainville-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Destainville_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Destainville_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Destainville, A., Champion, E., Bernache-Assollant, D., Laborde, E. (2003). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0254058402004662\" target=\"_blank\">\"Synthesis, characterization and thermal behavior of apatitic tricalcium phosphate\"<\/a>. <i>Materials Chemistry and Physics<\/i>. <b>80<\/b> (1): 269\u2013277. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0254-0584%2802%2900466-2\" target=\"_blank\">10.1016\/S0254-0584(02)00466-2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1742-7061\" target=\"_blank\">1742-7061<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Materials+Chemistry+and+Physics&rft.atitle=Synthesis%2C+characterization+and+thermal+behavior+of+apatitic+tricalcium+phosphate&rft.volume=80&rft.issue=1&rft.pages=269-277&rft.date=2003&rft_id=info%3Adoi%2F10.1016%2FS0254-0584%2802%2900466-2&rft.issn=1742-7061&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS0254058402004662&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATricalcium+phosphate\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Uses authors parameter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Uses_authors_parameter\" title=\"Category:CS1 maint: Uses authors parameter\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>  \u2013 via <a href=\"https:\/\/en.wikipedia.org\/wiki\/ScienceDirect\" title=\"ScienceDirect\" rel=\"external_link\" target=\"_blank\">ScienceDirect<\/a><span class=\"nowrap\"> <\/span>(Subscription may be required or content may be available in libraries.)<\/span>\n<\/li>\n<li id=\"cite_note-Bioactive-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Bioactive_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Bioactive_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Bioactive_4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Bioactive_4-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Rey, C.; Combes, C.; Drouet, C.; Grossin, D. (2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/B9780080552941000234\" target=\"_blank\">\"1.111 - Bioactive Ceramics: Physical Chemistry\"<\/a>. In Ducheyne, Paul. <i>Comprehensive Biomaterials<\/i>. <b>1<\/b>. Elsevier. pp. 187\u2013281. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FB978-0-08-055294-1.00178-1\" target=\"_blank\">10.1016\/B978-0-08-055294-1.00178-1<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-08-055294-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=1.111+-+Bioactive+Ceramics%3A+Physical+Chemistry&rft.btitle=Comprehensive+Biomaterials&rft.pages=187-281&rft.pub=Elsevier&rft.date=2011&rft_id=info%3Adoi%2F10.1016%2FB978-0-08-055294-1.00178-1&rft.isbn=978-0-08-055294-1&rft.au=Rey%2C+C.&rft.au=Combes%2C+C.&rft.au=Drouet%2C+C.&rft.au=Grossin%2C+D.&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FB9780080552941000234&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATricalcium+phosphate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>  \u2013 via <a href=\"https:\/\/en.wikipedia.org\/wiki\/ScienceDirect\" title=\"ScienceDirect\" rel=\"external_link\" target=\"_blank\">ScienceDirect<\/a><span class=\"nowrap\"> <\/span>(Subscription may be required or content may be available in libraries.)<\/span>\n<\/li>\n<li id=\"cite_note-Dorozhkin2012-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Dorozhkin2012_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Dorozhkin, Sergey V. (December 2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S1742706110002977\" target=\"_blank\">\"Amorphous calcium (ortho)phosphates\"<\/a>. <i>Acta Biomaterialia<\/i>. <b>6<\/b> (12): 4457\u20134475. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.actbio.2010.06.031\" target=\"_blank\">10.1016\/j.actbio.2010.06.031<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1742-7061\" target=\"_blank\">1742-7061<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Biomaterialia&rft.atitle=Amorphous+calcium+%28ortho%29phosphates&rft.volume=6&rft.issue=12&rft.pages=4457-4475&rft.date=2012-12&rft_id=info%3Adoi%2F10.1016%2Fj.actbio.2010.06.031&rft.issn=1742-7061&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS1742706110002977&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATricalcium+phosphate\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Uses authors parameter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Uses_authors_parameter\" title=\"Category:CS1 maint: Uses authors parameter\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>  \u2013 via <a href=\"https:\/\/en.wikipedia.org\/wiki\/ScienceDirect\" title=\"ScienceDirect\" rel=\"external_link\" target=\"_blank\">ScienceDirect<\/a><span class=\"nowrap\"> <\/span>(Subscription may be required or content may be available in libraries.)<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Yashima, M.; Sakai, A.; Kamiyama, T.; Hoshikawa, A. (2003). \"Crystal structure analysis of beta-tricalcium phosphate Ca<sub>3<\/sub>(PO<sub>4<\/sub>)<sub>2<\/sub> by neutron powder diffraction\". <i>rnal of Solid State Chemistry<\/i>. <b>175<\/b>: 272-p277.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=rnal+of+Solid+State+Chemistry&rft.atitle=Crystal+structure+analysis+of+beta-tricalcium+phosphate+Ca%3Csub%3E3%3C%2Fsub%3E%28PO%3Csub%3E4%3C%2Fsub%3E%29%3Csub%3E2%3C%2Fsub%3E+by+neutron+powder+diffraction&rft.volume=175&rft.pages=272-p277&rft.date=2003&rft.au=Yashima%2C+M.&rft.au=Sakai%2C+A.&rft.au=Kamiyama%2C+T.&rft.au=Hoshikawa%2C+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATricalcium+phosphate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Carrodeguas2011-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Carrodeguas2011_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Carrodeguas2011_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Carrodeguas, R.G.; De Aza, S. (2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S174270611100256X\" target=\"_blank\">\"\u03b1-Tricalcium phosphate: Synthesis, properties and biomedical applications\"<\/a>. <i>Acta Biomaterialia<\/i>. <b>7<\/b> (10): 3536\u20133546. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.actbio.2011.06.019\" target=\"_blank\">10.1016\/j.actbio.2011.06.019<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1742-7061\" target=\"_blank\">1742-7061<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Biomaterialia&rft.atitle=%CE%B1-Tricalcium+phosphate%3A+Synthesis%2C+properties+and+biomedical+applications&rft.volume=7&rft.issue=10&rft.pages=3536-3546&rft.date=2011&rft_id=info%3Adoi%2F10.1016%2Fj.actbio.2011.06.019&rft.issn=1742-7061&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS174270611100256X&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATricalcium+phosphate\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Uses authors parameter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Uses_authors_parameter\" title=\"Category:CS1 maint: Uses authors parameter\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>  \u2013 via <a href=\"https:\/\/en.wikipedia.org\/wiki\/ScienceDirect\" title=\"ScienceDirect\" rel=\"external_link\" target=\"_blank\">ScienceDirect<\/a><span class=\"nowrap\"> <\/span>(Subscription may be required or content may be available in libraries.)<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Yacoubou, Jeanne, MS. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.vrg.org\/ingredients\/index.php\" target=\"_blank\">Vegetarian Journal's Guide To Food Ingredients<\/a> \"Guide to Food Ingredients\". The Vegetarian Resource Group, n.d. Web. 14 Sept. 2012.<\/span>\n<\/li>\n<li id=\"cite_note-Bioceramicschap17-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Bioceramicschap17_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Daculsi, G.; Legeros, R. (2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/B978184569204950017X\" target=\"_blank\">\"17 - Tricalcium phosphate\/hydroxyapatite biphasic ceramics\"<\/a>. In Kokubo, Tadashi. <i>Bioceramics and their Clinical Applications<\/i>. 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href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_(journal)\" title=\"Bone (journal)\" rel=\"external_link\" target=\"_blank\">Bone<\/a><\/i>. <b>46<\/b> (2): 386\u201395. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.bone.2009.09.031\" target=\"_blank\">10.1016\/j.bone.2009.09.031<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19800045\" target=\"_blank\">19800045<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Bone&rft.atitle=A+biodegradable+porous+composite+scaffold+of+PGA%2Fbeta-TCP+for+bone+tissue+engineering&rft.volume=46&rft.issue=2&rft.pages=386-95&rft.date=2009-09&rft_id=info%3Adoi%2F10.1016%2Fj.bone.2009.09.031&rft_id=info%3Apmid%2F19800045&rft.aulast=Cao&rft.aufirst=H&rft.au=Kuboyama%2C+N&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATricalcium+phosphate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid11716011-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid11716011_19-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Erbe EM, Marx JG, Clineff TD, Bellincampi LD (October 2001). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3611552\" target=\"_blank\">\"Potential of an ultraporous beta-tricalcium phosphate synthetic cancellous bone void filler and bone marrow aspirate composite graft\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/European_Spine_Journal\" title=\"European Spine Journal\" rel=\"external_link\" target=\"_blank\">European Spine Journal<\/a><\/i>. 10 Suppl 2: S141\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs005860100287\" target=\"_blank\">10.1007\/s005860100287<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3611552\" target=\"_blank\">3611552<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11716011\" target=\"_blank\">11716011<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Spine+Journal&rft.atitle=Potential+of+an+ultraporous+beta-tricalcium+phosphate+synthetic+cancellous+bone+void+filler+and+bone+marrow+aspirate+composite+graft&rft.volume=10+Suppl+2&rft.pages=S141-6&rft.date=2001-10&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3611552&rft_id=info%3Apmid%2F11716011&rft_id=info%3Adoi%2F10.1007%2Fs005860100287&rft.aulast=Erbe&rft.aufirst=EM&rft.au=Marx%2C+JG&rft.au=Clineff%2C+TD&rft.au=Bellincampi%2C+LD&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3611552&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATricalcium+phosphate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid19838344-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid19838344_20-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bansal S, Chauhan V, Sharma S, Maheshwari R, Juyal A, Raghuvanshi S (July 2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2762171\" target=\"_blank\">\"Evaluation of hydroxyapatite and beta-tricalcium phosphate mixed with bone marrow aspirate as a bone graft substitute for posterolateral spinal fusion\"<\/a>. <i><\/i>. <b>43<\/b> (3): 234\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4103%2F0019-5413.49387\" target=\"_blank\">10.4103\/0019-5413.49387<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2762171\" target=\"_blank\">2762171<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19838344\" target=\"_blank\">19838344<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Indian+Journal+of+Orthopaedics&rft.atitle=Evaluation+of+hydroxyapatite+and+beta-tricalcium+phosphate+mixed+with+bone+marrow+aspirate+as+a+bone+graft+substitute+for+posterolateral+spinal+fusion&rft.volume=43&rft.issue=3&rft.pages=234-9&rft.date=2009-07&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2762171&rft_id=info%3Apmid%2F19838344&rft_id=info%3Adoi%2F10.4103%2F0019-5413.49387&rft.aulast=Bansal&rft.aufirst=S&rft.au=Chauhan%2C+V&rft.au=Sharma%2C+S&rft.au=Maheshwari%2C+R&rft.au=Juyal%2C+A&rft.au=Raghuvanshi%2C+S&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2762171&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATricalcium+phosphate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kundu, B; Lemos A; Soundrapandian C; Sen PS; Datta S; Ferreira JMF; Basu D (2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.springerlink.com\/content\/92659025267n6482\/\" target=\"_blank\">\"Development of porous HAp and \u03b2-TCP scaffolds by starch consolidation with foaming method and drug-chitosan bilayered scaffold based drug delivery system\"<\/a>. <i>J Mater. Sci. Mater. Med<\/i>. <b>21<\/b> (11): 2955\u201369. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs10856-010-4127-0\" target=\"_blank\">10.1007\/s10856-010-4127-0<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20644982\" target=\"_blank\">20644982<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Mater.+Sci.+Mater.+Med.&rft.atitle=Development+of+porous+HAp+and+%CE%B2-TCP+scaffolds+by+starch+consolidation+with+foaming+method+and+drug-chitosan+bilayered+scaffold+based+drug+delivery+system&rft.volume=21&rft.issue=11&rft.pages=2955-69&rft.date=2010&rft_id=info%3Adoi%2F10.1007%2Fs10856-010-4127-0&rft_id=info%3Apmid%2F20644982&rft.aulast=Kundu&rft.aufirst=B&rft.au=Lemos+A&rft.au=Soundrapandian+C&rft.au=Sen+PS&rft.au=Datta+S&rft.au=Ferreira+JMF&rft.au=Basu+D&rft_id=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F92659025267n6482%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATricalcium+phosphate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1269\nCached time: 20181215095116\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.820 seconds\nReal time usage: 1.036 seconds\nPreprocessor visited node count: 7064\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 151382\/2097152 bytes\nTemplate argument size: 22388\/2097152 bytes\nHighest expansion depth: 20\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 66266\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.363\/10.000 seconds\nLua memory usage: 6.72 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 927.693 1 -total\n<\/p>\n<pre>62.34% 578.336 1 Template:Chembox\n35.60% 330.257 1 Template:Chembox_Identifiers\n27.52% 255.256 1 Template:Reflist\n22.94% 212.795 7 Template:Chembox_headerbar\n22.53% 208.999 21 Template:Trim\n12.84% 119.158 10 Template:Main_other\n11.55% 107.112 15 Template:Cite_journal\n11.33% 105.099 1 Template:Chembox_parametercheck\n10.40% 96.493 5 Template:Cite_book\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2655103-1!canonical and timestamp 20181215095115 and revision id 872356668\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tricalcium_phosphate\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212231\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.017 seconds\nReal time usage: 0.172 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 164.657 1 - wikipedia:Tricalcium_phosphate\n100.00% 164.657 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8299-0!*!*!*!*!*!* and timestamp 20181217212231 and revision id 24511\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Tricalcium_phosphate\">https:\/\/www.limswiki.org\/index.php\/Tricalcium_phosphate<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","f0f891d4b0577f61620704f7a4c841ec_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/85\/Ca3%28PO4%292_from_crystallography.jpg\/440px-Ca3%28PO4%292_from_crystallography.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/Tricalcium_phosphate.svg\/440px-Tricalcium_phosphate.svg.png"],"f0f891d4b0577f61620704f7a4c841ec_timestamp":1545081751,"5de4f7fb344e365ba5c6b965dec28c8e_type":"article","5de4f7fb344e365ba5c6b965dec28c8e_title":"Titanium","5de4f7fb344e365ba5c6b965dec28c8e_url":"https:\/\/www.limswiki.org\/index.php\/Titanium","5de4f7fb344e365ba5c6b965dec28c8e_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tTitanium\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is about the chemical element. For other uses, see Titanium (disambiguation).\n\n\n\nchemical element with atomic number 22Titanium,  22 Ti General propertiesPronunciation\/t \u026a \u02c8 t e\u026a n i \u0259 m , t a\u026a -\/ [1] ​(t\u0259-TAY -nee-\u0259m, ty-) Appearancesilvery grey-white metallicStandard atomic weight (Ar, standard) 7001478670000000000\u2660 47.867(1) [2]Titanium in the periodic table\n\n\n\n\n\n\n\n\n\n\nHydrogen \n\n\n\nHelium \n\n\nLithium \n\nBeryllium \n\n\n\nBoron \n\nCarbon \n\nNitrogen \n\nOxygen \n\nFluorine \n\nNeon \n\n\nSodium \n\nMagnesium \n\n\n\nAluminium \n\nSilicon \n\nPhosphorus \n\nSulfur \n\nChlorine \n\nArgon \n\n\nPotassium \n\nCalcium \n\nScandium \n\n\n\nTitanium \n\nVanadium \n\nChromium \n\nManganese \n\nIron \n\nCobalt \n\nNickel \n\nCopper \n\nZinc \n\nGallium \n\nGermanium \n\nArsenic \n\nSelenium \n\nBromine \n\nKrypton \n\n\nRubidium \n\nStrontium \n\nYttrium \n\n\n\n\n\nZirconium \n\nNiobium \n\nMolybdenum \n\nTechnetium \n\nRuthenium \n\nRhodium \n\nPalladium \n\nSilver \n\nCadmium \n\nIndium \n\nTin \n\nAntimony \n\nTellurium \n\nIodine \n\nXenon \n\n\nCaesium \n\nBarium \n\nLanthanum \n\nCerium \n\nPraseodymium \n\nNeodymium \n\nPromethium \n\nSamarium \n\nEuropium \n\nGadolinium \n\nTerbium \n\nDysprosium \n\nHolmium \n\nErbium \n\nThulium \n\nYtterbium \n\nLutetium \n\nHafnium \n\nTantalum \n\nTungsten \n\nRhenium \n\nOsmium \n\nIridium \n\nPlatinum \n\nGold \n\nMercury (element) \n\nThallium \n\nLead \n\nBismuth \n\nPolonium \n\nAstatine \n\nRadon \n\n\nFrancium \n\nRadium \n\nActinium \n\nThorium \n\nProtactinium \n\nUranium \n\nNeptunium \n\nPlutonium \n\nAmericium \n\nCurium \n\nBerkelium \n\nCalifornium \n\nEinsteinium \n\nFermium \n\nMendelevium \n\nNobelium \n\nLawrencium \n\nRutherfordium \n\nDubnium \n\nSeaborgium \n\nBohrium \n\nHassium \n\nMeitnerium \n\nDarmstadtium \n\nRoentgenium \n\nCopernicium \n\nNihonium \n\nFlerovium \n\nMoscovium \n\nLivermorium \n\nTennessine \n\nOganesson \n\n\n\n\u2013\r\n\u2191\r\nTi\r\n\u2193\r\nZr\n\n\nscandium \u2190 titanium \u2192 vanadium\n\nAtomic number (Z) 22Groupgroup 4 Periodperiod 4 Blockd-block Element category  transition metalElectron configuration[Ar] 3d2 4s2Electrons per shell2, 8, 10, 2Physical propertiesPhase at STP solidMelting point1941 K ​(1668 \u00b0C, ​3034 \u00b0F) Boiling point3560 K ​(3287 \u00b0C, ​5949 \u00b0F) Density (near r.t.) 4.506 g\/cm3when liquid (at m.p.) 4.11 g\/cm3 Heat of fusion14.15 kJ\/mol Heat of vaporization425 kJ\/mol Molar heat capacity25.060 J\/(mol\u00b7K) Vapor pressure\n\n\n\nP (Pa) \n\n1\n\n10\n\n100\n\n1 k\n\n10 k\n\n100 k\n\n\nat T (K) \n\n1982\n\n2171\n\n(2403)\n\n2692\n\n3064\n\n3558\n\nAtomic propertiesOxidation states\u22122, \u22121, +1, +2, +3, +4[3] (an amphoteric oxide)ElectronegativityPauling scale: 1.54 Ionization energies1st: 658.8 kJ\/mol 2nd: 1309.8 kJ\/mol 3rd: 2652.5 kJ\/mol (more) Atomic radiusempirical: 147 pm Covalent radius160\u00b18 pm Spectral lines of titaniumOther propertiesCrystal structure ​hexagonal close-packed (hcp)Speed of sound thin rod 5090 m\/s (at r.t.) Thermal expansion8.6 \u00b5m\/(m\u00b7K) (at 25 \u00b0C) Thermal conductivity21.9 W\/(m\u00b7K) Electrical resistivity420 n\u03a9\u00b7m (at 20 \u00b0C) Magnetic orderingparamagnetic Magnetic susceptibility+153.0\u00b710\u22126 cm3\/mol (293 K)[4]Young's modulus116 GPa Shear modulus44 GPa Bulk modulus110 GPa Poisson ratio0.32 Mohs hardness6.0 Vickers hardness830\u20133420 MPa Brinell hardness716\u20132770 MPa CAS Number7440-32-6 HistoryDiscoveryWilliam Gregor (1791) First isolationJ\u00f6ns Jakob Berzelius (1825) Named byMartin Heinrich Klaproth (1795) Main isotopes of titanium\n\n\n\nIso­tope\n\nAbun­dance\n\nHalf-life (t1\/2) \n\nDecay mode\n\nPro­duct\n\n\n44Ti\n\nsyn\n\n63 y\n\n\u03b5\n\n44Sc\n\n\n\u03b3\n\n\u2013\n\n\n46Ti\n\n8.25%\n\nstable\n\n\n47Ti\n\n7.44%\n\nstable\n\n\n48Ti\n\n73.72%\n\nstable\n\n\n49Ti\n\n5.41%\n\nstable\n\n\n50Ti\n\n5.18%\n\nstable\nview talk edit  | references\nTitanium is a chemical element with symbol Ti and atomic number 22. It is a lustrous transition metal with a silver color, low density, and high strength. Titanium is resistant to corrosion in sea water, aqua regia, and chlorine.\nTitanium was discovered in Cornwall, Great Britain, by William Gregor in 1791, and was named by Martin Heinrich Klaproth after the Titans of Greek mythology. The element occurs within a number of mineral deposits, principally rutile and ilmenite, which are widely distributed in the Earth's crust and lithosphere, and it is found in almost all living things, water bodies, rocks, and soils.[6] The metal is extracted from its principal mineral ores by the Kroll[7] and Hunter processes. The most common compound, titanium dioxide, is a popular photocatalyst and is used in the manufacture of white pigments.[8] Other compounds include titanium tetrachloride (TiCl4), a component of smoke screens and catalysts; and titanium trichloride (TiCl3), which is used as a catalyst in the production of polypropylene.[6]\nTitanium can be alloyed with iron, aluminium, vanadium, and molybdenum, among other elements, to produce strong, lightweight alloys for aerospace (jet engines, missiles, and spacecraft), military, industrial processes (chemicals and petrochemicals, desalination plants, pulp, and paper), automotive, agri-food, medical prostheses, orthopedic implants, dental and endodontic instruments and files, dental implants, sporting goods, jewelry, mobile phones, and other applications.[6]\nThe two most useful properties of the metal are corrosion resistance and strength-to-density ratio, the highest of any metallic element.[9] In its unalloyed condition, titanium is as strong as some steels, but less dense.[10] There are two allotropic forms[11] and five naturally occurring isotopes of this element, 46Ti through 50Ti, with 48Ti being the most abundant (73.8%).[12] Although they have the same number of valence electrons and are in the same group in the periodic table, titanium and zirconium differ in many chemical and physical properties.\n\nContents \n\n1 Characteristics \n\n1.1 Physical properties \n1.2 Chemical properties \n1.3 Occurrence \n1.4 Isotopes \n\n\n2 Compounds \n\n2.1 Oxides, sulfides, and alkoxides \n2.2 Nitrides and carbides \n2.3 Halides \n2.4 Organometallic complexes \n2.5 Anticancer therapy \n\n\n3 History \n4 Production and fabrication \n5 Applications \n\n5.1 Pigments, additives, and coatings \n5.2 Aerospace and marine \n5.3 Industrial \n5.4 Consumer and architectural \n5.5 Jewelry \n5.6 Medical \n5.7 Nuclear waste storage \n\n\n6 Bioremediation \n7 Precautions \n8 See also \n9 References \n10 Bibliography \n11 External links \n\n\nCharacteristics \nPhysical properties \nAs a metal, titanium is recognized for its high strength-to-weight ratio.[11] It is a strong metal with low density that is quite ductile (especially in an oxygen-free environment),[6] lustrous, and metallic-white in color.[13] The relatively high melting point (more than 1,650 \u00b0C or 3,000 \u00b0F) makes it useful as a refractory metal. It is paramagnetic and has fairly low electrical and thermal conductivity.[6]\nCommercially pure (99.2% pure) grades of titanium have ultimate tensile strength of about 434 MPa (63,000 psi), equal to that of common, low-grade steel alloys, but are less dense. Titanium is 60% denser than aluminium, but more than twice as strong[10] as the most commonly used 6061-T6 aluminium alloy. Certain titanium alloys (e.g., Beta C) achieve tensile strengths of over 1,400 MPa (200,000 psi).[14] However, titanium loses strength when heated above 430 \u00b0C (806 \u00b0F).[15]\nTitanium is not as hard as some grades of heat-treated steel; it is non-magnetic and a poor conductor of heat and electricity. Machining requires precautions, because the material can gall unless sharp tools and proper cooling methods are used. Like steel structures, those made from titanium have a fatigue limit that guarantees longevity in some applications.[13]\nThe metal is a dimorphic allotrope of an hexagonal \u03b1 form that changes into a body-centered cubic (lattice) \u03b2 form at 882 \u00b0C (1,620 \u00b0F).[15] The specific heat of the \u03b1 form increases dramatically as it is heated to this transition temperature but then falls and remains fairly constant for the \u03b2 form regardless of temperature.[15]\n\nChemical properties \n The Pourbaix diagram for titanium in pure water, perchloric acid, or sodium hydroxide[16]\nLike aluminium and magnesium, titanium metal and its alloys oxidize immediately upon exposure to air. Titanium readily reacts with oxygen at 1,200 \u00b0C (2,190 \u00b0F) in air, and at 610 \u00b0C (1,130 \u00b0F) in pure oxygen, forming titanium dioxide.[11] It is, however, slow to react with water and air at ambient temperatures because it forms a passive oxide coating that protects the bulk metal from further oxidation.[6] When it first forms, this protective layer is only 1\u20132 nm thick but continues to grow slowly; reaching a thickness of 25 nm in four years.[17]\nAtmospheric passivation gives titanium excellent resistance to corrosion, almost equivalent to platinum. Titanium is capable of withstanding attack by dilute sulfuric and hydrochloric acids, chloride solutions, and most organic acids.[7] However, titanium is corroded by concentrated acids.[18] As indicated by its negative redox potential, titanium is thermodynamically a very reactive metal that burns in normal atmosphere at lower temperatures than the melting point. Melting is possible only in an inert atmosphere or in a vacuum. At 550 \u00b0C (1,022 \u00b0F), it combines with chlorine.[7] It also reacts with the other halogens and absorbs hydrogen.[8]\nTitanium is one of the few elements that burns in pure nitrogen gas, reacting at 800 \u00b0C (1,470 \u00b0F) to form titanium nitride, which causes embrittlement.[19] Because of its high reactivity with oxygen, nitrogen, and some other gases, titanium filaments are applied in titanium sublimation pumps as scavengers for these gases. Such pumps inexpensively and reliably produce extremely low pressures in ultra-high vacuum systems.\n\nOccurrence \n\n2011 production of rutile and ilmenite[20]\n\n\nCountry\nthousand \r\ntonnes\n% of total\n\n\nAustralia\n1,300\n19.4\n\n\nSouth Africa\n1,160\n17.3\n\n\nCanada\n700\n10.4\n\n\nIndia\n574\n8.6\n\n\nMozambique\n516\n7.7\n\n\nChina\n500\n7.5\n\n\nVietnam\n490\n7.3\n\n\nUkraine\n357\n5.3\n\n\nWorld\n6,700\n100\n\nTitanium is the ninth-most abundant element in Earth's crust (0.63% by mass)[21] and the seventh-most abundant metal. It is present as oxides in most igneous rocks, in sediments derived from them, in living things, and natural bodies of water.[6][7] Of the 801 types of igneous rocks analyzed by the United States Geological Survey, 784 contained titanium. Its proportion in soils is approximately 0.5 to 1.5%.[21]\nCommon titanium-containing minerals are anatase, brookite, ilmenite, perovskite, rutile, and titanite (sphene).[17] Akaogiite is an extremely rare mineral consisting of titanium dioxide. Of these minerals, only rutile and ilmenite have economic importance, yet even they are difficult to find in high concentrations. About 6.0 and 0.7 million tonnes of those minerals were mined in 2011, respectively.[20] Significant titanium-bearing ilmenite deposits exist in western Australia, Canada, China, India, Mozambique, New Zealand, Norway, Sierra Leone, South Africa, and Ukraine.[17] About 186,000 tonnes of titanium metal sponge were produced in 2011, mostly in China (60,000 t), Japan (56,000 t), Russia (40,000 t), United States (32,000 t) and Kazakhstan (20,700 t). Total reserves of titanium are estimated to exceed 600 million tonnes.[20]\nThe concentration of titanium is about 4 picomolar in the ocean. At 100 \u00b0C, the concentration of titanium in water is estimated to be less than 10\u22127 M at pH 7. The identity of titanium species in aqueous solution remains unknown because of its low solubility and the lack of sensitive spectroscopic methods, although only the 4+ oxidation state is stable in air. No evidence exists for a biological role, although rare organisms are known to accumulate high concentrations of titanium.[22]\nTitanium is contained in meteorites, and it has been detected in the Sun and in M-type stars[7] (the coolest type) with a surface temperature of 3,200 \u00b0C (5,790 \u00b0F).[23] Rocks brought back from the Moon during the Apollo 17 mission are composed of 12.1% TiO2.[7] It is also found in coal ash, plants, and even the human body. Native titanium (pure metallic) is very rare.[24]\n\nIsotopes \nMain article: Isotopes of titanium\nNaturally occurring titanium is composed of 5 stable isotopes: 46Ti, 47Ti, 48Ti, 49Ti, and 50Ti, with 48Ti being the most abundant (73.8% natural abundance). Eleven radioisotopes have been characterized, the most stable being 44Ti with a half-life of 63 years; 45Ti, 184.8 minutes; 51Ti, 5.76 minutes; and 52Ti, 1.7 minutes. All the other radioactive isotopes have half-lives less than 33 seconds and the majority, less than half a second.[12]\nThe isotopes of titanium range in atomic weight from 39.99 u (40Ti) to 57.966 u (58Ti). The primary decay mode before the most abundant stable isotope, 48Ti, is electron capture and the primary mode after is beta emission. The primary decay products before 48Ti are element 21 (scandium) isotopes and the primary products after are element 23 (vanadium) isotopes.[12]\nTitanium becomes radioactive upon bombardment with deuterons, emitting mainly positrons and hard gamma rays.[7]\n\nCompounds \nSee also: the categories Titanium compounds and Titanium minerals.\n TiN-coated drill bit\nThe +4 oxidation state dominates titanium chemistry,[25] but compounds in the +3 oxidation state are also common.[26] Commonly, titanium adopts an octahedral coordination geometry in its complexes, but tetrahedral TiCl4 is a notable exception. Because of its high oxidation state, titanium(IV) compounds exhibit a high degree of covalent bonding. Unlike most other transition metals, simple aquo Ti(IV) complexes are unknown.\n\n Oxides, sulfides, and alkoxides \nThe most important oxide is TiO2, which exists in three important polymorphs; anatase, brookite, and rutile. All of these are white diamagnetic solids, although mineral samples can appear dark (see rutile). They adopt polymeric structures in which Ti is surrounded by six oxide ligands that link to other Ti centers.\nThe term titanates usually refers to titanium(IV) compounds, as represented by barium titanate (BaTiO3). With a perovskite structure, this material exhibits piezoelectric properties and is used as a transducer in the interconversion of sound and electricity.[11] Many minerals are titanates, e.g. ilmenite (FeTiO3). Star sapphires and rubies get their asterism (star-forming shine) from the presence of titanium dioxide impurities.[17]\nA variety of reduced oxides (suboxides) of titanium are known, mainly reduced stoichiometries of titanium dioxide obtained by atmospheric plasma spraying.Ti3O5, described as a Ti(IV)-Ti(III) species, is a purple semiconductor produced by reduction of TiO2 with hydrogen at high temperatures,[27] and is used industrially when surfaces need to be vapour-coated with titanium dioxide: it evaporates as pure TiO, whereas TiO2 evaporates as a mixture of oxides and deposits coatings with variable refractive index.[28] Also known is Ti2O3, with the corundum structure, and TiO, with the rock salt structure, although often nonstoichiometric.[29]\nThe alkoxides of titanium(IV), prepared by reacting TiCl4 with alcohols, are colourless compounds that convert to the dioxide on reaction with water. They are industrially useful for depositing solid TiO2 via the sol-gel process. Titanium isopropoxide is used in the synthesis of chiral organic compounds via the Sharpless epoxidation.\nTitanium forms a variety of sulfides, but only TiS2 has attracted significant interest. It adopts a layered structure and was used as a cathode in the development of lithium batteries. Because Ti(IV) is a \"hard cation\", the sulfides of titanium are unstable and tend to hydrolyze to the oxide with release of hydrogen sulfide.\n\nNitrides and carbides \nTitanium nitride (TiN) is a member of a family of refractory transition metal nitrides and exhibits properties similar to both covalent compounds including; thermodynamic stability, extreme hardness, thermal\/electrical conductivity, and a high melting point.[30] TiN has a hardness equivalent to sapphire and carborundum (9.0 on the Mohs Scale),[31] and is often used to coat cutting tools, such as drill bits.[32] It is also used as a gold-colored decorative finish and as a barrier metal in semiconductor fabrication.[33] Titanium carbide, which is also very hard, is found in cutting tools and coatings.[34]\n\n Titanium(III) compounds are characteristically violet, illustrated by this aqueous solution of titanium trichloride.\nHalides \nTitanium tetrachloride (titanium(IV) chloride, TiCl4[35]) is a colorless volatile liquid (commercial samples are yellowish) that, in air, hydrolyzes with spectacular emission of white clouds. Via the Kroll process, TiCl4 is produced in the conversion of titanium ores to titanium dioxide, e.g., for use in white paint.[36] It is widely used in organic chemistry as a Lewis acid, for example in the Mukaiyama aldol condensation.[37] In the van Arkel process, titanium tetraiodide (TiI4) is generated in the production of high purity titanium metal.\nTitanium(III) and titanium(II) also form stable chlorides. A notable example is titanium(III) chloride (TiCl3), which is used as a catalyst for production of polyolefins (see Ziegler-Natta catalyst) and a reducing agent in organic chemistry.\n\nOrganometallic complexes \nMain article: Organotitanium chemistry\nOwing to the important role of titanium compounds as polymerization catalyst, compounds with Ti-C bonds have been intensively studied. The most common organotitanium complex is titanocene dichloride ((C5H5)2TiCl2). Related compounds include Tebbe's reagent and Petasis reagent. Titanium forms carbonyl complexes, e.g. (C5H5)2Ti(CO)2.[38]\n\nAnticancer therapy \nFollowing the success of platinum-based chemotherapy, titanium(IV) complexes were among the first non-platinum compounds to be tested for cancer treatment. The advantage of titanium compounds lies in their high efficacy and low toxicity. In biological environments, hydrolysis leads to the safe and inert titanium dioxide. Despite these advantages the first candidate compounds failed clinical trials. Further development resulted in the creation of potentially effective, selective, and stable titanium-based drugs.[39] Their mode of action is not yet well understood.\n\nHistory \n Martin Heinrich Klaproth named titanium for the Titans of Greek mythology\nTitanium was discovered in 1791 by the clergyman and amateur geologist, William Gregor, as an inclusion of a mineral in Cornwall, Great Britain.[40] Gregor recognized the presence of a new element in ilmenite[8] when he found black sand by a stream and noticed the sand was attracted by a magnet.[40] Analyzing the sand, he determined the presence of two metal oxides: iron oxide (explaining the attraction to the magnet) and 45.25% of a white metallic oxide he could not identify.[21] Realizing that the unidentified oxide contained a metal that did not match any known element, Gregor reported his findings to the Royal Geological Society of Cornwall and in the German science journal Crell's Annalen.[40][41][42]\nAround the same time, Franz-Joseph M\u00fcller von Reichenstein produced a similar substance, but could not identify it.[8] The oxide was independently rediscovered in 1795 by Prussian chemist Martin Heinrich Klaproth in rutile from Boinik (German name Bajm\u00f3cska), a village in Hungary (now Bojni\u010dky in Slovakia).[40][43] Klaproth found that it contained a new element and named it for the Titans of Greek mythology.[23] After hearing about Gregor's earlier discovery, he obtained a sample of manaccanite and confirmed that it contained titanium.\nThe currently known processes for extracting titanium from its various ores are laborious and costly; it is not possible to reduce the ore by heating with carbon (as in iron smelting) because titanium combines with the carbon to produce titanium carbide.[40] Pure metallic titanium (99.9%) was first prepared in 1910 by Matthew A. Hunter at Rensselaer Polytechnic Institute by heating TiCl4 with sodium at 700\u2013800 \u00b0C under great pressure[44] in a batch process known as the Hunter process.[7] Titanium metal was not used outside the laboratory until 1932 when William Justin Kroll proved that it can be produced by reducing titanium tetrachloride (TiCl4) with calcium.[45] Eight years later he refined this process with magnesium and even sodium in what became known as the Kroll process.[45] Although research continues into more efficient and cheaper processes (e.g., FFC Cambridge, Armstrong), the Kroll process is still used for commercial production.[7][8]\n\n Titanium sponge, made by the Kroll process\nTitanium of very high purity was made in small quantities when Anton Eduard van Arkel and Jan Hendrik de Boer discovered the iodide, or crystal bar, process in 1925, by reacting with iodine and decomposing the formed vapours over a hot filament to pure metal.[46]\nIn the 1950s and 1960s, the Soviet Union pioneered the use of titanium in military and submarine applications[44] (Alfa class and Mike class)[47] as part of programs related to the Cold War.[48] Starting in the early 1950s, titanium came into use extensively in military aviation, particularly in high-performance jets, starting with aircraft such as the F-100 Super Sabre and Lockheed A-12 and SR-71.\nRecognizing the strategic importance of titanium,[49] the U.S. Department of Defense supported early efforts of commercialization.[50]\nThroughout the period of the Cold War, titanium was considered a strategic material by the U.S. government, and a large stockpile of titanium sponge was maintained by the Defense National Stockpile Center, which was finally depleted in the 2000s.[51] According to 2006 data, the world's largest producer, Russian-based VSMPO-AVISMA, was estimated to account for about 29% of the world market share.[52] As of 2015, titanium sponge metal was produced in six countries: China, Japan, Russia, Kazakhstan, the US, Ukraine, and India. (in order of output).[53][54]\nIn 2006, the U.S. Defense Advanced Research Projects Agency (DARPA) awarded $5.7 million to a two-company consortium to develop a new process for making titanium metal powder. Under heat and pressure, the powder can be used to create strong, lightweight items ranging from armour plating to components for the aerospace, transport, and chemical processing industries.[55]\n\nProduction and fabrication \n Titanium (mineral concentrate)\n Basic titanium products: plate, tube, rods, and powder\nThe processing of titanium metal occurs in four major steps:[56] reduction of titanium ore into \"sponge\", a porous form; melting of sponge, or sponge plus a master alloy to form an ingot; primary fabrication, where an ingot is converted into general mill products such as billet, bar, plate, sheet, strip, and tube; and secondary fabrication of finished shapes from mill products.\n\nMain article: Kroll process\nBecause it cannot be readily produced by reduction of its dioxide,[13] titanium metal is obtained by reduction of TiCl4 with magnesium metal in the Kroll process. The complexity of this batch production in the Kroll process explains the relatively high market value of titanium,[57] despite the Kroll process being less expensive than the Hunter process.[44] To produce the TiCl4 required by the Kroll process, the dioxide is subjected to carbothermic reduction in the presence of chlorine. In this process, the chlorine gas is passed over a red-hot mixture of rutile or ilmenite in the presence of carbon. After extensive purification by fractional distillation, the TiCl4 is reduced with 800 \u00b0C molten magnesium in an argon atmosphere.[11] Titanium metal can be further purified by the van Arkel\u2013de Boer process, which involves thermal decomposition of titanium tetraiodide.\n\nMain article: FFC Cambridge process\nA more recently developed batch production method, the FFC Cambridge process,[58] consumes titanium dioxide powder (a refined form of rutile) as feedstock and produces titanium metal, either powder or sponge. The process involves fewer steps than the Kroll process and takes less time.[59] If mixed oxide powders are used, the product is an alloy.\nCommon titanium alloys are made by reduction. For example, cuprotitanium (rutile with copper added is reduced), ferrocarbon titanium (ilmenite reduced with coke in an electric furnace), and manganotitanium (rutile with manganese or manganese oxides) are reduced.[60]\n\n2 FeTiO3 + 7 Cl2 + 6 C \u2192 2 TiCl4 + 2 FeCl3 + 6 CO (900 \u00b0C)\nTiCl4 + 2 Mg \u2192 2 MgCl2 + Ti (1,100 \u00b0C)\nAbout fifty grades of titanium and titanium alloys are designed and currently used, although only a couple of dozen are readily available commercially.[61] The ASTM International recognizes 31 grades of titanium metal and alloys, of which grades one through four are commercially pure (unalloyed). Those four vary in tensile strength as a function of oxygen content, with grade 1 being the most ductile (lowest tensile strength with an oxygen content of 0.18%), and grade 4 the least ductile (highest tensile strength with an oxygen content of 0.40%).[17] The remaining grades are alloys, each designed for specific properties of ductility, strength, hardness, electrical resistivity, creep resistance, specific corrosion resistance, and combinations thereof.[62]\nIn addition to the ASTM specifications, titanium alloys are also produced to meet aerospace and military specifications (SAE-AMS, MIL-T), ISO standards, and country-specific specifications, as well as proprietary end-user specifications for aerospace, military, medical, and industrial applications.[63]\nTitanium powder is manufactured using a flow production process known as the Armstrong process[64] that is similar to the batch production Hunter process. A stream of titanium tetrachloride gas is added to a stream of molten sodium metal; the products (sodium chloride salt and titanium particles) is filtered from the extra sodium. Titanium is then separated from the salt by water washing. Both sodium and chlorine are recycled to produce and process more titanium tetrachloride.[65]\nAll welding of titanium must be done in an inert atmosphere of argon or helium to shield it from contamination with atmospheric gases (oxygen, nitrogen, and hydrogen).[15] Contamination causes a variety of conditions, such as embrittlement, which reduce the integrity of the assembly welds and lead to joint failure.\nCommercially pure flat product (sheet, plate) can be formed readily, but processing must take into account the fact that the metal has a \"memory\" and tends to spring back. This is especially true of certain high-strength alloys.[66][67] Titanium cannot be soldered without first pre-plating it in a metal that is solderable.[68] The metal can be machined with the same equipment and the same processes as stainless steel.[15]\n\nApplications \n A titanium cylinder of \"grade 2\" quality\nTitanium is used in steel as an alloying element (ferro-titanium) to reduce grain size and as a deoxidizer, and in stainless steel to reduce carbon content.[6] Titanium is often alloyed with aluminium (to refine grain size), vanadium, copper (to harden), iron, manganese, molybdenum, and other metals.[69] Titanium mill products (sheet, plate, bar, wire, forgings, castings) find application in industrial, aerospace, recreational, and emerging markets. Powdered titanium is used in pyrotechnics as a source of bright-burning particles.\n\n Pigments, additives, and coatings \n Titanium dioxide is the most commonly used compound of titanium\nAbout 95% of all titanium ore is destined for refinement into titanium dioxide (TiO\r\n2 ), an intensely white permanent pigment used in paints, paper, toothpaste, and plastics.[20] It is also used in cement, in gemstones, as an optical opacifier in paper,[70] and a strengthening agent in graphite composite fishing rods and golf clubs.\nTiO\r\n2 powder is chemically inert, resists fading in sunlight, and is very opaque: it imparts a pure and brilliant white colour to the brown or grey chemicals that form the majority of household plastics.[8] In nature, this compound is found in the minerals anatase, brookite, and rutile.[6] Paint made with titanium dioxide does well in severe temperatures and marine environments.[8] Pure titanium dioxide has a very high index of refraction and an optical dispersion higher than diamond.[7] In addition to being a very important pigment, titanium dioxide is also used in sunscreens.[13]\n\nAerospace and marine \nBecause titanium alloys have high tensile strength to density ratio,[11] high corrosion resistance,[7] fatigue resistance, high crack resistance,[71] and ability to withstand moderately high temperatures without creeping, they are used in aircraft, armour plating, naval ships, spacecraft, and missiles.[7][8] For these applications, titanium is alloyed with aluminium, zirconium, nickel,[72] vanadium, and other elements to manufacture a variety of components including critical structural parts, fire walls, landing gear, exhaust ducts (helicopters), and hydraulic systems. In fact, about two thirds of all titanium metal produced is used in aircraft engines and frames.[73] The titanium 6AL-4V alloy accounts for almost 50% of all alloys used in aircraft applications.[74]\nThe Lockheed A-12 and its development the SR-71 \"Blackbird\" were two of the first aircraft frames where titanium was used, paving the way for much wider use in modern military and commercial aircraft. An estimated 59 metric tons (130,000 pounds) are used in the Boeing 777, 45 in the Boeing 747, 18 in the Boeing 737, 32 in the Airbus A340, 18 in the Airbus A330, and 12 in the Airbus A320. The Airbus A380 may use 77 metric tons, including about 11 tons in the engines.[75] In aero engine applications, titanium is used for rotors, compressor blades, hydraulic system components, and nacelles. An early use in jet engines was for the Orenda Iroquois in the 1950s.[76]:412 \nBecause titanium is resistant to corrosion by sea water, it is used to make propeller shafts, rigging, and heat exchangers in desalination plants;[7] heater-chillers for salt water aquariums, fishing line and leader, and divers' knives. Titanium is used in the housings and components of ocean-deployed surveillance and monitoring devices for science and the military. The former Soviet Union developed techniques for making submarines with hulls of titanium alloys[77] forging titanium in huge vacuum tubes.[72]\nTitanium is used in the walls of the Juno spacecraft's vault to shield on-board electronics.[78]\n\nIndustrial \n High-purity (99.999%) titanium with visible crystallites\nWelded titanium pipe and process equipment (heat exchangers, tanks, process vessels, valves) are used in the chemical and petrochemical industries primarily for corrosion resistance. Specific alloys are used in oil and gas downhole applications and nickel hydrometallurgy for their high strength (e. g.: titanium beta C alloy), corrosion resistance, or both. The pulp and paper industry uses titanium in process equipment exposed to corrosive media, such as sodium hypochlorite or wet chlorine gas (in the bleachery).[79] Other applications include ultrasonic welding, wave soldering,[80] and sputtering targets.[81]\nTitanium tetrachloride (TiCl4), a colorless liquid, is important as an intermediate in the process of making TiO2 and is also used to produce the Ziegler\u2013Natta catalyst. Titanium tetrachloride is also used to iridize glass and, because it fumes strongly in moist air, it is used to make smoke screens.[13]\n\n\nConsumer and architectural \n Titanium sealing stamps\nTitanium metal is used in automotive applications, particularly in automobile and motorcycle racing where low weight and high strength and rigidity are critical.[82] The metal is generally too expensive for the general consumer market, though some late model Corvettes have been manufactured with titanium exhausts,[83] and a Corvette Z06's LT4 supercharged engine uses lightweight, solid titanium intake valves for greater strength and resistance to heat.[84]\nTitanium is used in many sporting goods: tennis rackets, golf clubs, lacrosse stick shafts; cricket, hockey, lacrosse, and football helmet grills, and bicycle frames and components. Although not a mainstream material for bicycle production, titanium bikes have been used by racing teams and adventure cyclists.[85]\nTitanium alloys are used in spectacle frames that are rather expensive but highly durable, long lasting, light weight, and cause no skin allergies. Many backpackers use titanium equipment, including cookware, eating utensils, lanterns, and tent stakes. Though slightly more expensive than traditional steel or aluminium alternatives, titanium products can be significantly lighter without compromising strength. Titanium horseshoes are preferred to steel by farriers because they are lighter and more durable.[86]\n\n Titanium cladding of Frank Gehry's Guggenheim Museum, Bilbao\nTitanium has occasionally been used in architecture. The 42.5 m (139 ft) Monument to Yuri Gagarin, the first man to travel in space (55\u00b042\u203229.7\u2033N 37\u00b034\u203257.2\u2033E  \/  55.708250\u00b0N 37.582556\u00b0E  \/ 55.708250; 37.582556 ), as well as the 110 m (360 ft) Monument to the Conquerors of Space on top of the Cosmonaut Museum in Moscow are made of titanium for the metal's attractive colour and association with rocketry.[87][88] The Guggenheim Museum Bilbao and the Cerritos Millennium Library were the first buildings in Europe and North America, respectively, to be sheathed in titanium panels.[73] Titanium sheathing was used in the Frederic C. Hamilton Building in Denver, Colorado.[89]\nBecause of titanium's superior strength and light weight relative to other metals (steel, stainless steel, and aluminium), and because of recent advances in metalworking techniques, its use has become more widespread in the manufacture of firearms. Primary uses include pistol frames and revolver cylinders. For the same reasons, it is used in the body of laptop computers (for example, in Apple's PowerBook line).[90]\nSome upmarket lightweight and corrosion-resistant tools, such as shovels and flashlights, are made of titanium or titanium alloys.\n\nJewelry \n Relation between voltage and color for anodized titanium. (Cateb, 2010).\nBecause of its durability, titanium has become more popular for designer jewelry (particularly, titanium rings).[86] Its inertness makes it a good choice for those with allergies or those who will be wearing the jewelry in environments such as swimming pools. Titanium is also alloyed with gold to produce an alloy that can be marketed as 24-carat gold because the 1% of alloyed Ti is insufficient to require a lesser mark. The resulting alloy is roughly the hardness of 14-carat gold and is more durable than pure 24-carat gold.[91]\nTitanium's durability, light weight, and dent and corrosion resistance make it useful for watch cases.[86] Some artists work with titanium to produce sculptures, decorative objects and furniture.[92]\nTitanium may be anodized to vary the thickness of the surface oxide layer, causing optical interference fringes and a variety of bright colors.[93] With this coloration and chemical inertness, titanium is a popular metal for body piercing.[94]\nTitanium has a minor use in dedicated non-circulating coins and medals. In 1999, Gibraltar released world's first titanium coin for the millennium celebration.[95] The Gold Coast Titans, an Australian rugby league team, award a medal of pure titanium to their player of the year.[96]\n\nMedical \nMain article: Titanium biocompatibility\nBecause titanium is biocompatible (non-toxic and not rejected by the body), it has many medical uses, including surgical implements and implants, such as hip balls and sockets (joint replacement) and dental implants that can stay in place for up to 20 years.[40] The titanium is often alloyed with about 4% aluminium or 6% Al and 4% vanadium.[97]\n\n Medical screws and plate used for repair fracture of the wrist, scale is in centimeters.\nTitanium has the inherent ability to osseointegrate, enabling use in dental implants that can last for over 30 years. This property is also useful for orthopedic implant applications.[40] These benefit from titanium's lower modulus of elasticity (Young's modulus) to more closely match that of the bone that such devices are intended to repair. As a result, skeletal loads are more evenly shared between bone and implant, leading to a lower incidence of bone degradation due to stress shielding and periprosthetic bone fractures, which occur at the boundaries of orthopedic implants. However, titanium alloys' stiffness is still more than twice that of bone, so adjacent bone bears a greatly reduced load and may deteriorate.[98][99]\nBecause titanium is non-ferromagnetic, patients with titanium implants can be safely examined with magnetic resonance imaging (convenient for long-term implants). Preparing titanium for implantation in the body involves subjecting it to a high-temperature plasma arc which removes the surface atoms, exposing fresh titanium that is instantly oxidized.[40]\nTitanium is used for the surgical instruments used in image-guided surgery, as well as wheelchairs, crutches, and any other products where high strength and low weight are desirable.\nTitanium dioxide nanoparticles are widely used in electronics and the delivery of pharmaceuticals and cosmetics.[100]\n\nNuclear waste storage \nBecause of it is corrosion resistance, containers made of titanium have been studied for the long-term storage of nuclear waste. Containers lasting more than 100,000 years are thought possible with manufacturing conditions that minimize material defects.[101] A titanium \"drip shield\" could also be installed over containers of other types to enhance their longevity.[102]\n\nBioremediation \nThe fungal species Marasmius oreades and Hypholoma capnoides can bioconvert titanium in titanium polluted soils.[103]\n\nPrecautions \n Nettles contain up to 80 parts per million of titanium.\nTitanium is non-toxic even in large doses and does not play any natural role inside the human body.[23] An estimated quantity of 0.8 milligrams of titanium is ingested by humans each day, but most passes through without being absorbed in the tissues.[23] It does, however, sometimes bio-accumulate in tissues that contain silica. One study indicates a possible connection between titanium and yellow nail syndrome.[104] An unknown mechanism in plants may use titanium to stimulate the production of carbohydrates and encourage growth. This may explain why most plants contain about 1 part per million (ppm) of titanium, food plants have about 2 ppm, and horsetail and nettle contain up to 80 ppm.[23]\nAs a powder or in the form of metal shavings, titanium metal poses a significant fire hazard and, when heated in air, an explosion hazard.[105] Water and carbon dioxide are ineffective for extinguishing a titanium fire; Class D dry powder agents must be used instead.[8]\nWhen used in the production or handling of chlorine, titanium should not be exposed to dry chlorine gas because it may result in a titanium\u2013chlorine fire.[106] Even wet chlorine presents a fire hazard when extreme weather conditions cause unexpected drying.\nTitanium can catch fire when a fresh, non-oxidized surface comes in contact with liquid oxygen.[107] Fresh metal may be exposed when the oxidized surface is struck or scratched with a hard object, or when mechanical strain causes a crack. This poses a limitation to its use in liquid oxygen systems, such as those in the aerospace industry. Because titanium tubing impurities can cause fires when exposed to oxygen, titanium is prohibited in gaseous oxygen respiration systems. Steel tubing is used for high pressure systems (3,000 p.s.i.) and aluminium tubing for low pressure systems.\n\nSee also \n\nList of countries by titanium production\nSuboxide\nTitanium in Africa\nTitanium alloy\nTitanium coating\nTitanium Man\nTitanium Metals Corporation\nTitanium ring\nTitanium sublimation pump\nVSMPO-AVISMA\nTitanium in zircon geothermometry\n\nBooks \r\nView or order collections of articles Titanium Period 4 elements Group 4 elements Chemical elements (sorted alphabetically) Chemical elements (sorted by number) Portals \r\nAccess related topics Chemistry portal \nReferences \n\n\n^ \"titanium - definition of titanium in English | Oxford Dictionaries\". Oxford University Press. 2017. Retrieved 2017-03-28 . \n\n^ Meija, J.; et al. 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Titanium (First ed.). New York, NY: The Rosen Publishing Group. ISBN 978-1-4042-1412-5. \n\nExternal links \n\n titaniumat Wikipedia's sister projects \n \n \n Definitions from Wiktionary \n Media from Wikimedia Commons \n Resources from Wikiversity \n \n \n\nListen to this article (info\/dl)\n\n\n\r\n\n\n\nThis audio file was created from a revision of the article \"Titanium \" dated 2005-08-25, and does not reflect subsequent edits to the article. (Audio help)\nMore spoken articles\n\n\"Titanium: Our Next Major Metal\", Popular Science, October 1950\u2014one of first general public detailed articles on Titanium\nTitanium at The Periodic Table of Videos (University of Nottingham)\nTitanium at The Essential Chemical Industry \u2013 online (CIEC Promoting Science at the University of York)\nInternational Titanium Association\nMetallurgy of Titanium and its Alloys, Cambridge University\nWorld Production of Titanium Concentrates, by Country\nMetal of the gods\nvtePeriodic table (Large cells) \n\n\n\n\n\n1\n\n2\n\n3\n\n\n\n4\n\n5\n\n6\n\n7\n\n8\n\n9\n\n10\n\n11\n\n12\n\n13\n\n14\n\n15\n\n16\n\n17\n\n18\n\n\n1\n\nH \n\n\n\nHe \n\n\n2\n\nLi \n\nBe \n\n\n\nB \n\nC \n\nN \n\nO \n\nF \n\nNe \n\n\n3\n\nNa \n\nMg \n\n\n\nAl \n\nSi \n\nP \n\nS \n\nCl \n\nAr \n\n\n4\n\nK \n\nCa \n\nSc \n\n\n\nTi \n\nV \n\nCr \n\nMn \n\nFe \n\nCo \n\nNi \n\nCu \n\nZn \n\nGa \n\nGe \n\nAs \n\nSe \n\nBr \n\nKr \n\n\n5\n\nRb \n\nSr \n\nY \n\n\n\nZr \n\nNb \n\nMo \n\nTc \n\nRu \n\nRh \n\nPd \n\nAg \n\nCd \n\nIn \n\nSn \n\nSb \n\nTe \n\nI \n\nXe \n\n\n6\n\nCs \n\nBa \n\nLa \n\nCe \n\nPr \n\nNd \n\nPm \n\nSm \n\nEu \n\nGd \n\nTb \n\nDy \n\nHo \n\nEr \n\nTm \n\nYb \n\nLu \n\nHf \n\nTa \n\nW \n\nRe \n\nOs \n\nIr \n\nPt \n\nAu \n\nHg \n\nTl \n\nPb \n\nBi \n\nPo \n\nAt \n\nRn \n\n\n7\n\nFr \n\nRa \n\nAc \n\nTh \n\nPa \n\nU \n\nNp \n\nPu \n\nAm \n\nCm \n\nBk \n\nCf \n\nEs \n\nFm \n\nMd \n\nNo \n\nLr \n\nRf \n\nDb \n\nSg \n\nBh \n\nHs \n\nMt \n\nDs \n\nRg \n\nCn \n\nNh \n\nFl \n\nMc \n\nLv \n\nTs \n\nOg \n\n\n\n\nAlkali metal\n\nAlkaline earth metal\n\nLan­thanide\n\nActinide\n\nTransition metal\n\nPost-​transition metal\n\nMetalloid\n\nReactive nonmetal\n\nNoble gas\n\nUnknown\r\nchemical\r\nproperties\n\n\n\nvteTitanium compoundsTitanium(II)\nTiCl2\nTiH2\nTiO\nTiS\nTiSi2Organotitanium(II) compounds[(C5H5)2Ti(CO)2]\nTitanium(III)\nTiAl\nTiBr3\nTiCl3\nTiF3\nTiI3\nTiN\nTiP\nTi2O3\nTi2S3Organotitanium(III) compounds[(C5H5)2TiCl]2\nTitanium(IV)\nTiB2\nTiBr4\nTiC\nTiCl4\nTi(ClO4)4\nTiF4\nH2TiF6\nTiH4\nTiI4\nTi(NMe2)4\nTi(NO3)4\nTiO2\nH4TiO4\nTi4(OCH2CH3)16\nTi(OCH(CH3)2)4\nTi(OCH2CH2CH2CH3)4\nKTiOPO4\nNiO·Sb2O3·20TiO2\nTiS2\nTiSe2\nTiSi2Titanate compounds\nBaTiO3\nBa2TiO4\nBi4Ti3O12\nCaTiO3\nCaCu3Ti4O12\nCaZrTi2O7\nCs2TiO3\nDy2Ti2O7\nEuBaTiO4\nFeTiO3\nHo2Ti2O7\nLi2TiO3\nMnTiO3\nNa2Ti3O7\nNa0.5Bi0.5TiO3\nNiTiO3\nPbTiO3\nPb(Zr,Ti)O3\nSrTiO3\nZnTiO3\nOrganotitanium(IV) compounds\n[(C5H5)2TiCl2]\n[(C5H5)2Ti(CH3)2]\n[(C5H5)2TiS5]\n[(C5H5)2Ti(μ-Cl)(μ-CH2)Al(CH3)2]\n[(η5-C5H4-CH2C6H4OCH3)2TiCl2]\n\n\nvteTitanium mineralsOxide mineralsSimple\nAnatase\nBrookite\nGeikielite\nRutile\nMixed\nAeschynite-(Y)\nArmalcolite\nBetafite\nEuxenite\nFreudenbergite\nHaggertyite\nIlmenite\nKeilhauite\nLatrappite\nPerovskite\nPolycrase\nZimbabweite\nZirconolite\nZirkelite\nSilicate minerals\nAenigmatite\nGrossmanite\nKeilhauite\nLorenzenite\nMelanite\nNenadkevichite\nTitanite\nZircophyllite\nOther\nSabinaite (carbonate mineral)\nWarwickite (borate mineral)\n\nvteJewelleryForms\nAnklet\nBarrette\nBelt buckle\nBelly chain\nBindi\nBolo tie\nBracelet\nBrooch\nChatelaine\nCollar pin\nCrown\nCufflink\nEarring\nFerronni\u00e8re\nLapel pin\nNecklace\nPectoral\nPendant\nRing\nTiara\nTie chain\nTie clip\nTie pin\nToe ring\nWatch\npocket\nstrap\nMakingPeople\nBench jeweler\nClockmaker\nGoldsmith\nSilversmith\nJewelry designer\nLapidary\nWatchmaker\nProcesses\nCarving\nCasting\ncentrifugal\nlost-wax\nvacuum\nEnameling\nEngraving\nFiligree\nKazaziye\nMetal clay\nPlating\nPolishing\nRepouss\u00e9 and chasing\nSoldering\nStonesetting\nWire sculpture\nWire wrapped jewelry\nTools\nDraw plate\nFile\nHammer\nMandrel\nPliers\nMaterialsPrecious metals\nGold\nPalladium\nPlatinum\nRhodium\nSilver\nPrecious metal alloys\nBritannia silver\nColored gold\nCrown gold\nElectrum\nShakud\u014d\nShibuichi\nSterling silver\nTumbaga\nBase metals\nBrass\nBronze\nCopper\nNickel silver (alpac(c)a)\nMokume-gane\nPewter\nPinchbeck\nStainless steel\nTitanium\nTungsten\nMineral gemstones\nAventurine\nAgate\nAmazonite\nAmethyst\nBeryl\nCarnelian\nChrysoberyl\nChrysocolla\nDiamond\nDiopside\nEmerald\nFluorite\nGarnet\nHowlite\nJade\nJasper\nKyanite\nLabradorite\nLapis lazuli\nLarimar\nMalachite\nMarcasite\nMoonstone\nObsidian\nOnyx\nOpal\nPeridot\nPrasiolite\nQuartz\nRuby\nSapphire\nSodalite\nSpinel\nSunstone\nTanzanite\nTiger's eye\nTopaz\nTourmaline\nTurquoise\nVariscite\nZircon\nOrganic gemstones\nAbalone\nAmber\nAmmolite\nCopal\nCoral\nPrecious coral\nBlack coral\nIvory\nJet\nNacre\nOperculum\nPearl\nTortoiseshell\nOther natural objects\nBezoar\nBog-wood\nEbonite (vulcanite)\nGutta-percha\nHair\nShell jewelry\nSpondylus shell\nToadstone\nTerms\nCarat (mass)\nCarat (purity)\nFinding\nMillesimal fineness\nArt jewelry\n\nRelated topics\nBody piercing\nFashion\nGemology\nPhaleristics\nMetalworking\nWearable art\n\n\n\nAuthority control \nBNE: XX531321 \nBNF: cb119375205 (data) \nGND: 4140648-5 \nLCCN: sh85135605 \nNDL: 00573109 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Titanium\">https:\/\/www.limswiki.org\/index.php\/Titanium<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 11 March 2016, at 19:54.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 931 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","5de4f7fb344e365ba5c6b965dec28c8e_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Titanium skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Titanium<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">This article is about the chemical element. For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_(disambiguation)\" class=\"mw-disambig\" title=\"Titanium (disambiguation)\" rel=\"external_link\" target=\"_blank\">Titanium (disambiguation)<\/a>.<\/div>\n<p class=\"mw-empty-elt\">\n\n<\/p>\n<div class=\"shortdescription nomobile noexcerpt noprint searchaux\" style=\"display:none\">chemical element with atomic number 22<\/div>\n<p><b>Titanium<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_element\" title=\"Chemical element\" rel=\"external_link\" target=\"_blank\">chemical element<\/a> with symbol <b>Ti<\/b> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atomic_number\" title=\"Atomic number\" rel=\"external_link\" target=\"_blank\">atomic number<\/a> 22. It is a lustrous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transition_metal\" title=\"Transition metal\" rel=\"external_link\" target=\"_blank\">transition metal<\/a> with a silver color, low density, and high strength. Titanium is resistant to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corrosion\" title=\"Corrosion\" rel=\"external_link\" target=\"_blank\">corrosion<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sea_water\" class=\"mw-redirect\" title=\"Sea water\" rel=\"external_link\" target=\"_blank\">sea water<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aqua_regia\" title=\"Aqua regia\" rel=\"external_link\" target=\"_blank\">aqua regia<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chlorine\" title=\"Chlorine\" rel=\"external_link\" target=\"_blank\">chlorine<\/a>.\n<\/p><p>Titanium was discovered in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornwall\" title=\"Cornwall\" rel=\"external_link\" target=\"_blank\">Cornwall<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kingdom_of_Great_Britain\" title=\"Kingdom of Great Britain\" rel=\"external_link\" target=\"_blank\">Great Britain<\/a>, by <a href=\"https:\/\/en.wikipedia.org\/wiki\/William_Gregor\" title=\"William Gregor\" rel=\"external_link\" target=\"_blank\">William Gregor<\/a> in 1791, and was named by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Martin_Heinrich_Klaproth\" title=\"Martin Heinrich Klaproth\" rel=\"external_link\" target=\"_blank\">Martin Heinrich Klaproth<\/a> after the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titan_(mythology)\" title=\"Titan (mythology)\" rel=\"external_link\" target=\"_blank\">Titans<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greek_mythology\" title=\"Greek mythology\" rel=\"external_link\" target=\"_blank\">Greek mythology<\/a>. The element occurs within a number of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mineral\" title=\"Mineral\" rel=\"external_link\" target=\"_blank\">mineral<\/a> deposits, principally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rutile\" title=\"Rutile\" rel=\"external_link\" target=\"_blank\">rutile<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ilmenite\" title=\"Ilmenite\" rel=\"external_link\" target=\"_blank\">ilmenite<\/a>, which are widely distributed in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Earth%27s_crust\" class=\"mw-redirect\" title=\"Earth's crust\" rel=\"external_link\" target=\"_blank\">Earth's crust<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithosphere\" title=\"Lithosphere\" rel=\"external_link\" target=\"_blank\">lithosphere<\/a>, and it is found in almost all living things, water bodies, rocks, and soils.<sup id=\"rdp-ebb-cite_ref-EBC_6-0\" class=\"reference\"><a href=\"#cite_note-EBC-6\" rel=\"external_link\">[6]<\/a><\/sup> The metal is extracted from its principal mineral ores by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kroll_process\" title=\"Kroll process\" rel=\"external_link\" target=\"_blank\">Kroll<\/a><sup id=\"rdp-ebb-cite_ref-LANL_7-0\" class=\"reference\"><a href=\"#cite_note-LANL-7\" rel=\"external_link\">[7]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hunter_process\" title=\"Hunter process\" rel=\"external_link\" target=\"_blank\">Hunter processes<\/a>. The most common compound, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_dioxide\" title=\"Titanium dioxide\" rel=\"external_link\" target=\"_blank\">titanium dioxide<\/a>, is a popular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photocatalysis\" title=\"Photocatalysis\" rel=\"external_link\" target=\"_blank\">photocatalyst<\/a> and is used in the manufacture of white pigments.<sup id=\"rdp-ebb-cite_ref-HistoryAndUse_8-0\" class=\"reference\"><a href=\"#cite_note-HistoryAndUse-8\" rel=\"external_link\">[8]<\/a><\/sup> Other compounds include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_tetrachloride\" title=\"Titanium tetrachloride\" rel=\"external_link\" target=\"_blank\">titanium tetrachloride<\/a> (TiCl<sub>4<\/sub>), a component of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Smoke_screen\" title=\"Smoke screen\" rel=\"external_link\" target=\"_blank\">smoke screens<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalyst\" class=\"mw-redirect\" title=\"Catalyst\" rel=\"external_link\" target=\"_blank\">catalysts<\/a>; and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium(III)_chloride\" title=\"Titanium(III) chloride\" rel=\"external_link\" target=\"_blank\">titanium trichloride<\/a> (TiCl<sub>3<\/sub>), which is used as a catalyst in the production of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polypropylene\" title=\"Polypropylene\" rel=\"external_link\" target=\"_blank\">polypropylene<\/a>.<sup id=\"rdp-ebb-cite_ref-EBC_6-1\" class=\"reference\"><a href=\"#cite_note-EBC-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>Titanium can be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alloy\" title=\"Alloy\" rel=\"external_link\" target=\"_blank\">alloyed<\/a> with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron\" title=\"Iron\" rel=\"external_link\" target=\"_blank\">iron<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium\" title=\"Aluminium\" rel=\"external_link\" target=\"_blank\">aluminium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vanadium\" title=\"Vanadium\" rel=\"external_link\" target=\"_blank\">vanadium<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molybdenum\" title=\"Molybdenum\" rel=\"external_link\" target=\"_blank\">molybdenum<\/a>, among other elements, to produce strong, lightweight alloys for aerospace (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Jet_engine\" title=\"Jet engine\" rel=\"external_link\" target=\"_blank\">jet engines<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Missile\" title=\"Missile\" rel=\"external_link\" target=\"_blank\">missiles<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spacecraft\" title=\"Spacecraft\" rel=\"external_link\" target=\"_blank\">spacecraft<\/a>), military, industrial processes (chemicals and petrochemicals, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Desalination_plant\" class=\"mw-redirect\" title=\"Desalination plant\" rel=\"external_link\" target=\"_blank\">desalination plants<\/a>, pulp, and paper), automotive, agri-food, medical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostheses\" class=\"mw-redirect\" title=\"Prostheses\" rel=\"external_link\" target=\"_blank\">prostheses<\/a>, orthopedic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implants<\/a>, dental and endodontic instruments and files, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">dental implants<\/a>, sporting goods, jewelry, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mobile_phone\" title=\"Mobile phone\" rel=\"external_link\" target=\"_blank\">mobile phones<\/a>, and other applications.<sup id=\"rdp-ebb-cite_ref-EBC_6-2\" class=\"reference\"><a href=\"#cite_note-EBC-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>The two most useful properties of the metal are corrosion resistance and strength-to-density ratio, the highest of any metallic element.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> In its unalloyed condition, titanium is as strong as some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Steel\" title=\"Steel\" rel=\"external_link\" target=\"_blank\">steels<\/a>, but less dense.<sup id=\"rdp-ebb-cite_ref-Barksdale1968p738_10-0\" class=\"reference\"><a href=\"#cite_note-Barksdale1968p738-10\" rel=\"external_link\">[10]<\/a><\/sup> There are two <a href=\"https:\/\/en.wikipedia.org\/wiki\/Allotropy\" title=\"Allotropy\" rel=\"external_link\" target=\"_blank\">allotropic<\/a> forms<sup id=\"rdp-ebb-cite_ref-TICE6th_11-0\" class=\"reference\"><a href=\"#cite_note-TICE6th-11\" rel=\"external_link\">[11]<\/a><\/sup> and five naturally occurring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isotope\" title=\"Isotope\" rel=\"external_link\" target=\"_blank\">isotopes<\/a> of this element, <sup>46<\/sup>Ti through <sup>50<\/sup>Ti, with <sup>48<\/sup>Ti being the most <a href=\"https:\/\/en.wikipedia.org\/wiki\/Natural_abundance\" title=\"Natural abundance\" rel=\"external_link\" target=\"_blank\">abundant<\/a> (73.8%).<sup id=\"rdp-ebb-cite_ref-EnvChem_12-0\" class=\"reference\"><a href=\"#cite_note-EnvChem-12\" rel=\"external_link\">[12]<\/a><\/sup> Although they have the same number of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Valence_electron\" title=\"Valence electron\" rel=\"external_link\" target=\"_blank\">valence electrons<\/a> and are in the same <a href=\"https:\/\/en.wikipedia.org\/wiki\/Group_(periodic_table)\" title=\"Group (periodic table)\" rel=\"external_link\" target=\"_blank\">group<\/a> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Periodic_table\" title=\"Periodic table\" rel=\"external_link\" target=\"_blank\">periodic table<\/a>, titanium and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zirconium\" title=\"Zirconium\" rel=\"external_link\" target=\"_blank\">zirconium<\/a> differ in many chemical and physical properties.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Characteristics\">Characteristics<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Physical_properties\">Physical properties<\/span><\/h3>\n<p>As a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal\" title=\"Metal\" rel=\"external_link\" target=\"_blank\">metal<\/a>, titanium is recognized for its high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Strength-to-weight_ratio\" class=\"mw-redirect\" title=\"Strength-to-weight ratio\" rel=\"external_link\" target=\"_blank\">strength-to-weight ratio<\/a>.<sup id=\"rdp-ebb-cite_ref-TICE6th_11-1\" class=\"reference\"><a href=\"#cite_note-TICE6th-11\" rel=\"external_link\">[11]<\/a><\/sup> It is a strong metal with low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Density\" title=\"Density\" rel=\"external_link\" target=\"_blank\">density<\/a> that is quite <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ductility\" title=\"Ductility\" rel=\"external_link\" target=\"_blank\">ductile<\/a> (especially in an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen\" title=\"Oxygen\" rel=\"external_link\" target=\"_blank\">oxygen<\/a>-free environment),<sup id=\"rdp-ebb-cite_ref-EBC_6-3\" class=\"reference\"><a href=\"#cite_note-EBC-6\" rel=\"external_link\">[6]<\/a><\/sup> lustrous, and metallic-white in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Color\" title=\"Color\" rel=\"external_link\" target=\"_blank\">color<\/a>.<sup id=\"rdp-ebb-cite_ref-Stwertka1998_13-0\" class=\"reference\"><a href=\"#cite_note-Stwertka1998-13\" rel=\"external_link\">[13]<\/a><\/sup> The relatively high melting point (more than 1,650 \u00b0C or 3,000 \u00b0F) makes it useful as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refractory_metals\" title=\"Refractory metals\" rel=\"external_link\" target=\"_blank\">refractory metal<\/a>. It is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paramagnetism\" title=\"Paramagnetism\" rel=\"external_link\" target=\"_blank\">paramagnetic<\/a> and has fairly low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical_conductivity\" class=\"mw-redirect\" title=\"Electrical conductivity\" rel=\"external_link\" target=\"_blank\">electrical<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_conductivity\" title=\"Thermal conductivity\" rel=\"external_link\" target=\"_blank\">thermal conductivity<\/a>.<sup id=\"rdp-ebb-cite_ref-EBC_6-4\" class=\"reference\"><a href=\"#cite_note-EBC-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>Commercially pure (99.2% pure) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_alloy#Grades_of_titanium\" title=\"Titanium alloy\" rel=\"external_link\" target=\"_blank\">grades<\/a> of titanium have <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultimate_tensile_strength\" title=\"Ultimate tensile strength\" rel=\"external_link\" target=\"_blank\">ultimate tensile strength<\/a> of about 434 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Megapascal\" class=\"mw-redirect\" title=\"Megapascal\" rel=\"external_link\" target=\"_blank\">MPa<\/a> (63,000 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pounds_per_square_inch\" title=\"Pounds per square inch\" rel=\"external_link\" target=\"_blank\">psi<\/a>), equal to that of common, low-grade steel alloys, but are less dense. Titanium is 60% denser than aluminium, but more than twice as strong<sup id=\"rdp-ebb-cite_ref-Barksdale1968p738_10-1\" class=\"reference\"><a href=\"#cite_note-Barksdale1968p738-10\" rel=\"external_link\">[10]<\/a><\/sup> as the most commonly used <a href=\"https:\/\/en.wikipedia.org\/wiki\/6061_aluminium_alloy\" title=\"6061 aluminium alloy\" rel=\"external_link\" target=\"_blank\">6061-T6 aluminium alloy<\/a>. Certain titanium alloys (e.g., <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_Beta_C\" title=\"Titanium Beta C\" rel=\"external_link\" target=\"_blank\">Beta C<\/a>) achieve tensile strengths of over 1,400 MPa (200,000 psi).<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> However, titanium loses strength when heated above 430 \u00b0C (806 \u00b0F).<sup id=\"rdp-ebb-cite_ref-Barksdale1968p734_15-0\" class=\"reference\"><a href=\"#cite_note-Barksdale1968p734-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p>Titanium is not as hard as some grades of heat-treated steel; it is non-magnetic and a poor conductor of heat and electricity. Machining requires precautions, because the material can <a href=\"https:\/\/en.wikipedia.org\/wiki\/Galling\" title=\"Galling\" rel=\"external_link\" target=\"_blank\">gall<\/a> unless sharp tools and proper cooling methods are used. Like steel structures, those made from titanium have a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fatigue_limit\" title=\"Fatigue limit\" rel=\"external_link\" target=\"_blank\">fatigue limit<\/a> that guarantees longevity in some applications.<sup id=\"rdp-ebb-cite_ref-Stwertka1998_13-1\" class=\"reference\"><a href=\"#cite_note-Stwertka1998-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p><p>The metal is a dimorphic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Allotropy\" title=\"Allotropy\" rel=\"external_link\" target=\"_blank\">allotrope<\/a> of an hexagonal \u03b1 form that changes into a body-centered cubic (lattice) \u03b2 form at 882 \u00b0C (1,620 \u00b0F).<sup id=\"rdp-ebb-cite_ref-Barksdale1968p734_15-1\" class=\"reference\"><a href=\"#cite_note-Barksdale1968p734-15\" rel=\"external_link\">[15]<\/a><\/sup> The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Specific_heat_capacity\" class=\"mw-redirect\" title=\"Specific heat capacity\" rel=\"external_link\" target=\"_blank\">specific heat<\/a> of the \u03b1 form increases dramatically as it is heated to this transition temperature but then falls and remains fairly constant for the \u03b2 form regardless of temperature.<sup id=\"rdp-ebb-cite_ref-Barksdale1968p734_15-2\" class=\"reference\"><a href=\"#cite_note-Barksdale1968p734-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Chemical_properties\">Chemical properties<\/span><\/h3>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Titanium_in_water_Pourbaix_diagram.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8a\/Titanium_in_water_Pourbaix_diagram.png\/220px-Titanium_in_water_Pourbaix_diagram.png\" width=\"220\" height=\"226\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Titanium_in_water_Pourbaix_diagram.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pourbaix_diagram\" title=\"Pourbaix diagram\" rel=\"external_link\" target=\"_blank\">Pourbaix diagram<\/a> for titanium in pure water, perchloric acid, or sodium hydroxide<sup id=\"rdp-ebb-cite_ref-medusa_16-0\" class=\"reference\"><a href=\"#cite_note-medusa-16\" rel=\"external_link\">[16]<\/a><\/sup><\/div><\/div><\/div>\n<p>Like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium\" title=\"Aluminium\" rel=\"external_link\" target=\"_blank\">aluminium<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium\" title=\"Magnesium\" rel=\"external_link\" target=\"_blank\">magnesium<\/a>, titanium metal and its alloys <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxidize\" class=\"mw-redirect\" title=\"Oxidize\" rel=\"external_link\" target=\"_blank\">oxidize<\/a> immediately upon exposure to air. Titanium readily reacts with oxygen at 1,200 \u00b0C (2,190 \u00b0F) in air, and at 610 \u00b0C (1,130 \u00b0F) in pure oxygen, forming <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_dioxide\" title=\"Titanium dioxide\" rel=\"external_link\" target=\"_blank\">titanium dioxide<\/a>.<sup id=\"rdp-ebb-cite_ref-TICE6th_11-2\" class=\"reference\"><a href=\"#cite_note-TICE6th-11\" rel=\"external_link\">[11]<\/a><\/sup> It is, however, slow to react with water and air at ambient temperatures because it forms a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Passivation_(chemistry)\" title=\"Passivation (chemistry)\" rel=\"external_link\" target=\"_blank\">passive<\/a> oxide coating that protects the bulk metal from further oxidation.<sup id=\"rdp-ebb-cite_ref-EBC_6-5\" class=\"reference\"><a href=\"#cite_note-EBC-6\" rel=\"external_link\">[6]<\/a><\/sup> When it first forms, this protective layer is only 1\u20132 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nanometre\" title=\"Nanometre\" rel=\"external_link\" target=\"_blank\">nm<\/a> thick but continues to grow slowly; reaching a thickness of 25 nm in four years.<sup id=\"rdp-ebb-cite_ref-Emsley2001p453_17-0\" class=\"reference\"><a href=\"#cite_note-Emsley2001p453-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p><p>Atmospheric passivation gives titanium excellent resistance to corrosion, almost equivalent to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Platinum\" title=\"Platinum\" rel=\"external_link\" target=\"_blank\">platinum<\/a>. Titanium is capable of withstanding attack by dilute <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sulfuric_acid\" title=\"Sulfuric acid\" rel=\"external_link\" target=\"_blank\">sulfuric<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrochloric_acid\" title=\"Hydrochloric acid\" rel=\"external_link\" target=\"_blank\">hydrochloric acids<\/a>, chloride solutions, and most organic acids.<sup id=\"rdp-ebb-cite_ref-LANL_7-1\" class=\"reference\"><a href=\"#cite_note-LANL-7\" rel=\"external_link\">[7]<\/a><\/sup> However, titanium is corroded by concentrated acids.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> As indicated by its negative redox potential, titanium is thermodynamically a very reactive metal that burns in normal atmosphere at lower temperatures than the melting point. Melting is possible only in an inert atmosphere or in a vacuum. At 550 \u00b0C (1,022 \u00b0F), it combines with chlorine.<sup id=\"rdp-ebb-cite_ref-LANL_7-2\" class=\"reference\"><a href=\"#cite_note-LANL-7\" rel=\"external_link\">[7]<\/a><\/sup> It also reacts with the other halogens and absorbs hydrogen.<sup id=\"rdp-ebb-cite_ref-HistoryAndUse_8-1\" class=\"reference\"><a href=\"#cite_note-HistoryAndUse-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>Titanium is one of the few elements that burns in pure nitrogen gas, reacting at 800 \u00b0C (1,470 \u00b0F) to form <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_nitride\" title=\"Titanium nitride\" rel=\"external_link\" target=\"_blank\">titanium nitride<\/a>, which causes embrittlement.<sup id=\"rdp-ebb-cite_ref-titaniumindustry_19-0\" class=\"reference\"><a href=\"#cite_note-titaniumindustry-19\" rel=\"external_link\">[19]<\/a><\/sup> Because of its high reactivity with oxygen, nitrogen, and some other gases, titanium <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical_filament\" class=\"mw-redirect\" title=\"Electrical filament\" rel=\"external_link\" target=\"_blank\">filaments<\/a> are applied in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_sublimation_pump\" title=\"Titanium sublimation pump\" rel=\"external_link\" target=\"_blank\">titanium sublimation pumps<\/a> as scavengers for these gases. Such pumps inexpensively and reliably produce extremely low pressures in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultra-high_vacuum\" title=\"Ultra-high vacuum\" rel=\"external_link\" target=\"_blank\">ultra-high vacuum<\/a> systems.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Occurrence\">Occurrence<\/span><\/h3>\n<table class=\"wikitable\" style=\" text-align:center; margin-left:0.5em\">\n<caption>2011 production of rutile and ilmenite<sup id=\"rdp-ebb-cite_ref-USGS_20-0\" class=\"reference\"><a href=\"#cite_note-USGS-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/caption>\n<tbody><tr>\n<th>Country<\/th>\n<th>thousand <br \/>tonnes<\/th>\n<th>% of total\n<\/th><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Australia\" title=\"Australia\" rel=\"external_link\" target=\"_blank\">Australia<\/a><\/td>\n<td>1,300<\/td>\n<td>19.4\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/South_Africa\" title=\"South Africa\" rel=\"external_link\" target=\"_blank\">South Africa<\/a><\/td>\n<td>1,160<\/td>\n<td>17.3\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Canada\" title=\"Canada\" rel=\"external_link\" target=\"_blank\">Canada<\/a><\/td>\n<td>700<\/td>\n<td>10.4\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/India\" title=\"India\" rel=\"external_link\" target=\"_blank\">India<\/a><\/td>\n<td>574<\/td>\n<td>8.6\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mozambique\" title=\"Mozambique\" rel=\"external_link\" target=\"_blank\">Mozambique<\/a><\/td>\n<td>516<\/td>\n<td>7.7\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/China\" title=\"China\" rel=\"external_link\" target=\"_blank\">China<\/a><\/td>\n<td>500<\/td>\n<td>7.5\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vietnam\" title=\"Vietnam\" rel=\"external_link\" target=\"_blank\">Vietnam<\/a><\/td>\n<td>490<\/td>\n<td>7.3\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ukraine\" title=\"Ukraine\" rel=\"external_link\" target=\"_blank\">Ukraine<\/a><\/td>\n<td>357<\/td>\n<td>5.3\n<\/td><\/tr>\n<tr>\n<td><b>World<\/b><\/td>\n<td><b>6,700<\/b><\/td>\n<td><b>100<\/b>\n<\/td><\/tr><\/tbody><\/table>\n<p>Titanium is the ninth-most <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abundance_of_elements_in_Earth%27s_crust\" title=\"Abundance of elements in Earth's crust\" rel=\"external_link\" target=\"_blank\">abundant<\/a> element in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Earth\" title=\"Earth\" rel=\"external_link\" target=\"_blank\">Earth<\/a>'s crust (0.63% by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mass\" title=\"Mass\" rel=\"external_link\" target=\"_blank\">mass<\/a>)<sup id=\"rdp-ebb-cite_ref-Barksdale1968p732_21-0\" class=\"reference\"><a href=\"#cite_note-Barksdale1968p732-21\" rel=\"external_link\">[21]<\/a><\/sup> and the seventh-most abundant metal. It is present as oxides in most <a href=\"https:\/\/en.wikipedia.org\/wiki\/Igneous_rock\" title=\"Igneous rock\" rel=\"external_link\" target=\"_blank\">igneous rocks<\/a>, in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sedimentary_rock\" title=\"Sedimentary rock\" rel=\"external_link\" target=\"_blank\">sediments<\/a> derived from them, in living things, and natural bodies of water.<sup id=\"rdp-ebb-cite_ref-EBC_6-6\" class=\"reference\"><a href=\"#cite_note-EBC-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-LANL_7-3\" class=\"reference\"><a href=\"#cite_note-LANL-7\" rel=\"external_link\">[7]<\/a><\/sup> Of the 801 types of igneous rocks analyzed by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Geological_Survey\" title=\"United States Geological Survey\" rel=\"external_link\" target=\"_blank\">United States Geological Survey<\/a>, 784 contained titanium. Its proportion in soils is approximately 0.5 to 1.5%.<sup id=\"rdp-ebb-cite_ref-Barksdale1968p732_21-1\" class=\"reference\"><a href=\"#cite_note-Barksdale1968p732-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p><p>Common titanium-containing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mineral\" title=\"Mineral\" rel=\"external_link\" target=\"_blank\">minerals<\/a> are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatase\" title=\"Anatase\" rel=\"external_link\" target=\"_blank\">anatase<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brookite\" title=\"Brookite\" rel=\"external_link\" target=\"_blank\">brookite<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ilmenite\" title=\"Ilmenite\" rel=\"external_link\" target=\"_blank\">ilmenite<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Perovskite\" title=\"Perovskite\" rel=\"external_link\" target=\"_blank\">perovskite<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rutile\" title=\"Rutile\" rel=\"external_link\" target=\"_blank\">rutile<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanite\" title=\"Titanite\" rel=\"external_link\" target=\"_blank\">titanite<\/a> (sphene).<sup id=\"rdp-ebb-cite_ref-Emsley2001p453_17-1\" class=\"reference\"><a href=\"#cite_note-Emsley2001p453-17\" rel=\"external_link\">[17]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Akaogiite\" title=\"Akaogiite\" rel=\"external_link\" target=\"_blank\">Akaogiite<\/a> is an extremely rare mineral consisting of titanium dioxide. Of these minerals, only rutile and ilmenite have economic importance, yet even they are difficult to find in high concentrations. About 6.0 and 0.7 million tonnes of those minerals were mined in 2011, respectively.<sup id=\"rdp-ebb-cite_ref-USGS_20-1\" class=\"reference\"><a href=\"#cite_note-USGS-20\" rel=\"external_link\">[20]<\/a><\/sup> Significant titanium-bearing ilmenite deposits exist in western <a href=\"https:\/\/en.wikipedia.org\/wiki\/Australia\" title=\"Australia\" rel=\"external_link\" target=\"_blank\">Australia<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Canada\" title=\"Canada\" rel=\"external_link\" target=\"_blank\">Canada<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/China\" title=\"China\" rel=\"external_link\" target=\"_blank\">China<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/India\" title=\"India\" rel=\"external_link\" target=\"_blank\">India<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mozambique\" title=\"Mozambique\" rel=\"external_link\" target=\"_blank\">Mozambique<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/New_Zealand\" title=\"New Zealand\" rel=\"external_link\" target=\"_blank\">New Zealand<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Norway\" title=\"Norway\" rel=\"external_link\" target=\"_blank\">Norway<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sierra_Leone\" title=\"Sierra Leone\" rel=\"external_link\" target=\"_blank\">Sierra Leone<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/South_Africa\" title=\"South Africa\" rel=\"external_link\" target=\"_blank\">South Africa<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ukraine\" title=\"Ukraine\" rel=\"external_link\" target=\"_blank\">Ukraine<\/a>.<sup id=\"rdp-ebb-cite_ref-Emsley2001p453_17-2\" class=\"reference\"><a href=\"#cite_note-Emsley2001p453-17\" rel=\"external_link\">[17]<\/a><\/sup> About 186,000 tonnes of titanium <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal_sponge\" class=\"mw-redirect\" title=\"Metal sponge\" rel=\"external_link\" target=\"_blank\">metal sponge<\/a> were produced in 2011, mostly in China (60,000 t), Japan (56,000 t), Russia (40,000 t), United States (32,000 t) and Kazakhstan (20,700 t). Total reserves of titanium are estimated to exceed 600 million tonnes.<sup id=\"rdp-ebb-cite_ref-USGS_20-2\" class=\"reference\"><a href=\"#cite_note-USGS-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><p>The concentration of titanium is about 4 picomolar in the ocean. At 100 \u00b0C, the concentration of titanium in water is estimated to be less than 10<sup>\u22127<\/sup> M at pH 7. The identity of titanium species in aqueous solution remains unknown because of its low solubility and the lack of sensitive spectroscopic methods, although only the 4+ oxidation state is stable in air. No evidence exists for a biological role, although rare organisms are known to accumulate high concentrations of titanium.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p><p>Titanium is contained in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Meteorite\" title=\"Meteorite\" rel=\"external_link\" target=\"_blank\">meteorites<\/a>, and it has been detected in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sun\" title=\"Sun\" rel=\"external_link\" target=\"_blank\">Sun<\/a> and in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stellar_classification\" title=\"Stellar classification\" rel=\"external_link\" target=\"_blank\">M-type<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Star\" title=\"Star\" rel=\"external_link\" target=\"_blank\">stars<\/a><sup id=\"rdp-ebb-cite_ref-LANL_7-4\" class=\"reference\"><a href=\"#cite_note-LANL-7\" rel=\"external_link\">[7]<\/a><\/sup> (the coolest type) with a surface temperature of 3,200 \u00b0C (5,790 \u00b0F).<sup id=\"rdp-ebb-cite_ref-Emsley2001p451_23-0\" class=\"reference\"><a href=\"#cite_note-Emsley2001p451-23\" rel=\"external_link\">[23]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rock_(geology)\" title=\"Rock (geology)\" rel=\"external_link\" target=\"_blank\">Rocks<\/a> brought back from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Moon\" title=\"Moon\" rel=\"external_link\" target=\"_blank\">Moon<\/a> during the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apollo_17\" title=\"Apollo 17\" rel=\"external_link\" target=\"_blank\">Apollo 17<\/a> mission are composed of 12.1% TiO<sub>2<\/sub>.<sup id=\"rdp-ebb-cite_ref-LANL_7-5\" class=\"reference\"><a href=\"#cite_note-LANL-7\" rel=\"external_link\">[7]<\/a><\/sup> It is also found in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coal\" title=\"Coal\" rel=\"external_link\" target=\"_blank\">coal<\/a> ash, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plant\" title=\"Plant\" rel=\"external_link\" target=\"_blank\">plants<\/a>, and even the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human\" title=\"Human\" rel=\"external_link\" target=\"_blank\">human<\/a> body. Native titanium (pure metallic) is very rare.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Isotopes\">Isotopes<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isotopes_of_titanium\" title=\"Isotopes of titanium\" rel=\"external_link\" target=\"_blank\">Isotopes of titanium<\/a><\/div>\n<p>Naturally occurring titanium is composed of 5 stable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isotope\" title=\"Isotope\" rel=\"external_link\" target=\"_blank\">isotopes<\/a>: <sup>46<\/sup>Ti, <sup>47<\/sup>Ti, <sup>48<\/sup>Ti, <sup>49<\/sup>Ti, and <sup>50<\/sup>Ti, with <sup>48<\/sup>Ti being the most abundant (73.8% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Natural_abundance\" title=\"Natural abundance\" rel=\"external_link\" target=\"_blank\">natural abundance<\/a>). Eleven <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radioisotope\" class=\"mw-redirect\" title=\"Radioisotope\" rel=\"external_link\" target=\"_blank\">radioisotopes<\/a> have been characterized, the most stable being <sup>44<\/sup>Ti with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Half-life\" title=\"Half-life\" rel=\"external_link\" target=\"_blank\">half-life<\/a> of 63 years; <sup>45<\/sup>Ti, 184.8 minutes; <sup>51<\/sup>Ti, 5.76 minutes; and <sup>52<\/sup>Ti, 1.7 minutes. All the other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radioactive\" class=\"mw-redirect\" title=\"Radioactive\" rel=\"external_link\" target=\"_blank\">radioactive<\/a> isotopes have half-lives less than 33 seconds and the majority, less than half a second.<sup id=\"rdp-ebb-cite_ref-EnvChem_12-1\" class=\"reference\"><a href=\"#cite_note-EnvChem-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p>The isotopes of titanium range in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atomic_weight\" class=\"mw-redirect\" title=\"Atomic weight\" rel=\"external_link\" target=\"_blank\">atomic weight<\/a> from 39.99 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Unified_atomic_mass_unit\" class=\"mw-redirect\" title=\"Unified atomic mass unit\" rel=\"external_link\" target=\"_blank\">u<\/a> (<sup>40<\/sup>Ti) to 57.966 u (<sup>58<\/sup>Ti). The primary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Decay_mode\" class=\"mw-redirect\" title=\"Decay mode\" rel=\"external_link\" target=\"_blank\">decay mode<\/a> before the most abundant stable isotope, <sup>48<\/sup>Ti, is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electron_capture\" title=\"Electron capture\" rel=\"external_link\" target=\"_blank\">electron capture<\/a> and the primary mode after is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Beta_emission\" class=\"mw-redirect\" title=\"Beta emission\" rel=\"external_link\" target=\"_blank\">beta emission<\/a>. The primary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Decay_product\" title=\"Decay product\" rel=\"external_link\" target=\"_blank\">decay products<\/a> before <sup>48<\/sup>Ti are element 21 (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Scandium\" title=\"Scandium\" rel=\"external_link\" target=\"_blank\">scandium<\/a>) isotopes and the primary products after are element 23 (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Vanadium\" title=\"Vanadium\" rel=\"external_link\" target=\"_blank\">vanadium<\/a>) isotopes.<sup id=\"rdp-ebb-cite_ref-EnvChem_12-2\" class=\"reference\"><a href=\"#cite_note-EnvChem-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p>Titanium becomes radioactive upon bombardment with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deuterons\" class=\"mw-redirect\" title=\"Deuterons\" rel=\"external_link\" target=\"_blank\">deuterons<\/a>, emitting mainly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Positrons\" class=\"mw-redirect\" title=\"Positrons\" rel=\"external_link\" target=\"_blank\">positrons<\/a> and hard <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gamma_rays\" class=\"mw-redirect\" title=\"Gamma rays\" rel=\"external_link\" target=\"_blank\">gamma rays<\/a>.<sup id=\"rdp-ebb-cite_ref-LANL_7-6\" class=\"reference\"><a href=\"#cite_note-LANL-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Compounds\">Compounds<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable selfref\">See also: the categories <a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:Titanium_compounds\" title=\"Category:Titanium compounds\" rel=\"external_link\" target=\"_blank\">Titanium compounds<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:Titanium_minerals\" title=\"Category:Titanium minerals\" rel=\"external_link\" target=\"_blank\">Titanium minerals<\/a>.<\/div>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:62px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Titanium_nitride_coating.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"A steel colored twist drill bit with the spiral groove colored in a golden shade.\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2b\/Titanium_nitride_coating.jpg\/60px-Titanium_nitride_coating.jpg\" width=\"60\" height=\"369\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Titanium_nitride_coating.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>TiN-coated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drill\" title=\"Drill\" rel=\"external_link\" target=\"_blank\">drill<\/a> bit<\/div><\/div><\/div>\n<p>The +4 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxidation_state\" title=\"Oxidation state\" rel=\"external_link\" target=\"_blank\">oxidation state<\/a> dominates titanium chemistry,<sup id=\"rdp-ebb-cite_ref-Greenwood1997p958_25-0\" class=\"reference\"><a href=\"#cite_note-Greenwood1997p958-25\" rel=\"external_link\">[25]<\/a><\/sup> but compounds in the +3 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxidation_state\" title=\"Oxidation state\" rel=\"external_link\" target=\"_blank\">oxidation state<\/a> are also common.<sup id=\"rdp-ebb-cite_ref-Greenwood1997p970_26-0\" class=\"reference\"><a href=\"#cite_note-Greenwood1997p970-26\" rel=\"external_link\">[26]<\/a><\/sup> Commonly, titanium adopts an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Octahedral_coordination_geometry\" class=\"mw-redirect\" title=\"Octahedral coordination geometry\" rel=\"external_link\" target=\"_blank\">octahedral coordination geometry<\/a> in its complexes, but tetrahedral TiCl<sub>4<\/sub> is a notable exception. Because of its high oxidation state, titanium(IV) compounds exhibit a high degree of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Covalent_bond\" title=\"Covalent bond\" rel=\"external_link\" target=\"_blank\">covalent bonding<\/a>. Unlike most other transition metals, simple <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transition_metal_aquo_complex\" class=\"mw-redirect\" title=\"Transition metal aquo complex\" rel=\"external_link\" target=\"_blank\">aquo Ti(IV) complexes<\/a> are unknown.\n<\/p>\n<h3><span id=\"rdp-ebb-Oxides.2C_sulfides.2C_and_alkoxides\"><\/span><span class=\"mw-headline\" id=\"Oxides,_sulfides,_and_alkoxides\">Oxides, sulfides, and alkoxides<\/span><\/h3>\n<p>The most important oxide is TiO<sub>2<\/sub>, which exists in three important <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymorphism_(materials_science)\" title=\"Polymorphism (materials science)\" rel=\"external_link\" target=\"_blank\">polymorphs<\/a>; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatase\" title=\"Anatase\" rel=\"external_link\" target=\"_blank\">anatase<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brookite\" title=\"Brookite\" rel=\"external_link\" target=\"_blank\">brookite<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rutile\" title=\"Rutile\" rel=\"external_link\" target=\"_blank\">rutile<\/a>. All of these are white diamagnetic solids, although mineral samples can appear dark (see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rutile\" title=\"Rutile\" rel=\"external_link\" target=\"_blank\">rutile<\/a>). They adopt polymeric structures in which Ti is surrounded by six <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxide\" title=\"Oxide\" rel=\"external_link\" target=\"_blank\">oxide<\/a> ligands that link to other Ti centers.\n<\/p><p>The term <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanate\" title=\"Titanate\" rel=\"external_link\" target=\"_blank\">titanates<\/a><\/i> usually refers to titanium(IV) compounds, as represented by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Barium_titanate\" title=\"Barium titanate\" rel=\"external_link\" target=\"_blank\">barium titanate<\/a> (BaTiO<sub>3<\/sub>). With a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Perovskite\" title=\"Perovskite\" rel=\"external_link\" target=\"_blank\">perovskite<\/a> structure, this material exhibits <a href=\"https:\/\/en.wikipedia.org\/wiki\/Piezoelectric\" class=\"mw-redirect\" title=\"Piezoelectric\" rel=\"external_link\" target=\"_blank\">piezoelectric<\/a> properties and is used as a transducer in the interconversion of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sound\" title=\"Sound\" rel=\"external_link\" target=\"_blank\">sound<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electricity\" title=\"Electricity\" rel=\"external_link\" target=\"_blank\">electricity<\/a>.<sup id=\"rdp-ebb-cite_ref-TICE6th_11-3\" class=\"reference\"><a href=\"#cite_note-TICE6th-11\" rel=\"external_link\">[11]<\/a><\/sup> Many minerals are titanates, e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ilmenite\" title=\"Ilmenite\" rel=\"external_link\" target=\"_blank\">ilmenite<\/a> (FeTiO<sub>3<\/sub>). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Star_sapphire_(jewel)\" class=\"mw-redirect\" title=\"Star sapphire (jewel)\" rel=\"external_link\" target=\"_blank\">Star sapphires<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ruby\" title=\"Ruby\" rel=\"external_link\" target=\"_blank\">rubies<\/a> get their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Asterism_(gemmology)\" class=\"mw-redirect\" title=\"Asterism (gemmology)\" rel=\"external_link\" target=\"_blank\">asterism<\/a> (star-forming shine) from the presence of titanium dioxide impurities.<sup id=\"rdp-ebb-cite_ref-Emsley2001p453_17-3\" class=\"reference\"><a href=\"#cite_note-Emsley2001p453-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p><p>A variety of reduced oxides (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Suboxide\" title=\"Suboxide\" rel=\"external_link\" target=\"_blank\">suboxides<\/a>) of titanium are known, mainly reduced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stoichiometry\" title=\"Stoichiometry\" rel=\"external_link\" target=\"_blank\">stoichiometries<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_dioxide\" title=\"Titanium dioxide\" rel=\"external_link\" target=\"_blank\">titanium dioxide<\/a> obtained by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atmospheric_plasma_spraying\" class=\"mw-redirect\" title=\"Atmospheric plasma spraying\" rel=\"external_link\" target=\"_blank\">atmospheric plasma spraying<\/a>.Ti<sub>3<\/sub>O<sub>5<\/sub>, described as a Ti(IV)-Ti(III) species, is a purple semiconductor produced by reduction of TiO<sub>2<\/sub> with hydrogen at high temperatures,<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> and is used industrially when surfaces need to be vapour-coated with titanium dioxide: it evaporates as pure TiO, whereas TiO<sub>2<\/sub> evaporates as a mixture of oxides and deposits coatings with variable refractive index.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> Also known is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium(III)_oxide\" title=\"Titanium(III) oxide\" rel=\"external_link\" target=\"_blank\">Ti<sub>2<\/sub>O<sub>3<\/sub><\/a>, with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corundum\" title=\"Corundum\" rel=\"external_link\" target=\"_blank\">corundum<\/a> structure, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium(II)_oxide\" title=\"Titanium(II) oxide\" rel=\"external_link\" target=\"_blank\">TiO<\/a>, with the rock salt structure, although often nonstoichiometric.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alkoxide\" title=\"Alkoxide\" rel=\"external_link\" target=\"_blank\">alkoxides<\/a> of titanium(IV), prepared by reacting TiCl<sub>4<\/sub> with alcohols, are colourless compounds that convert to the dioxide on reaction with water. They are industrially useful for depositing solid TiO<sub>2<\/sub> via the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sol-gel_process\" class=\"mw-redirect\" title=\"Sol-gel process\" rel=\"external_link\" target=\"_blank\">sol-gel process<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_isopropoxide\" title=\"Titanium isopropoxide\" rel=\"external_link\" target=\"_blank\">Titanium isopropoxide<\/a> is used in the synthesis of chiral organic compounds via the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sharpless_epoxidation\" title=\"Sharpless epoxidation\" rel=\"external_link\" target=\"_blank\">Sharpless epoxidation<\/a>.\n<\/p><p>Titanium forms a variety of sulfides, but only <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_disulfide\" title=\"Titanium disulfide\" rel=\"external_link\" target=\"_blank\">TiS<sub>2<\/sub><\/a> has attracted significant interest. It adopts a layered structure and was used as a cathode in the development of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithium_batteries\" class=\"mw-redirect\" title=\"Lithium batteries\" rel=\"external_link\" target=\"_blank\">lithium batteries<\/a>. Because Ti(IV) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/HSAB_theory\" title=\"HSAB theory\" rel=\"external_link\" target=\"_blank\">\"hard cation\"<\/a>, the sulfides of titanium are unstable and tend to hydrolyze to the oxide with release of hydrogen sulfide.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Nitrides_and_carbides\">Nitrides and carbides<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_nitride\" title=\"Titanium nitride\" rel=\"external_link\" target=\"_blank\">Titanium nitride<\/a> (TiN) is a member of a family of refractory transition metal nitrides and exhibits properties similar to both covalent compounds including; thermodynamic stability, extreme hardness, thermal\/electrical conductivity, and a high melting point.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup> TiN has a hardness equivalent to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sapphire\" title=\"Sapphire\" rel=\"external_link\" target=\"_blank\">sapphire<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carborundum\" class=\"mw-redirect\" title=\"Carborundum\" rel=\"external_link\" target=\"_blank\">carborundum<\/a> (9.0 on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mohs_Scale\" class=\"mw-redirect\" title=\"Mohs Scale\" rel=\"external_link\" target=\"_blank\">Mohs Scale<\/a>),<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> and is often used to coat cutting tools, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drill_bit\" title=\"Drill bit\" rel=\"external_link\" target=\"_blank\">drill bits<\/a>.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> It is also used as a gold-colored decorative finish and as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copper-based_chips#Barrier_metal\" class=\"mw-redirect\" title=\"Copper-based chips\" rel=\"external_link\" target=\"_blank\">barrier metal<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semiconductor_fabrication\" class=\"mw-redirect\" title=\"Semiconductor fabrication\" rel=\"external_link\" target=\"_blank\">semiconductor fabrication<\/a>.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_carbide\" title=\"Titanium carbide\" rel=\"external_link\" target=\"_blank\">Titanium carbide<\/a>, which is also very hard, is found in cutting tools and coatings.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:102px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:TiCl3.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/TiCl3.jpg\/100px-TiCl3.jpg\" width=\"100\" height=\"145\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:TiCl3.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Titanium(III) compounds are characteristically violet, illustrated by this aqueous solution of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_trichloride\" class=\"mw-redirect\" title=\"Titanium trichloride\" rel=\"external_link\" target=\"_blank\">titanium trichloride<\/a>.<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Halides\">Halides<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_tetrachloride\" title=\"Titanium tetrachloride\" rel=\"external_link\" target=\"_blank\">Titanium tetrachloride<\/a> (titanium(IV) chloride, TiCl<sub>4<\/sub><sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup>) is a colorless volatile liquid (commercial samples are yellowish) that, in air, hydrolyzes with spectacular emission of white clouds. Via the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kroll_process\" title=\"Kroll process\" rel=\"external_link\" target=\"_blank\">Kroll process<\/a>, TiCl<sub>4<\/sub> is produced in the conversion of titanium ores to titanium dioxide, e.g., for use in white paint.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup> It is widely used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organic_chemistry\" title=\"Organic chemistry\" rel=\"external_link\" target=\"_blank\">organic chemistry<\/a> as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lewis_acids_and_bases\" title=\"Lewis acids and bases\" rel=\"external_link\" target=\"_blank\">Lewis acid<\/a>, for example in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mukaiyama_aldol_condensation\" class=\"mw-redirect\" title=\"Mukaiyama aldol condensation\" rel=\"external_link\" target=\"_blank\">Mukaiyama aldol condensation<\/a>.<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup> In the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Van_Arkel_process\" class=\"mw-redirect\" title=\"Van Arkel process\" rel=\"external_link\" target=\"_blank\">van Arkel process<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_tetraiodide\" title=\"Titanium tetraiodide\" rel=\"external_link\" target=\"_blank\">titanium tetraiodide<\/a> (TiI<sub>4<\/sub>) is generated in the production of high purity titanium metal.\n<\/p><p>Titanium(III) and titanium(II) also form stable chlorides. A notable example is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium(III)_chloride\" title=\"Titanium(III) chloride\" rel=\"external_link\" target=\"_blank\">titanium(III) chloride<\/a> (TiCl<sub>3<\/sub>), which is used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalyst\" class=\"mw-redirect\" title=\"Catalyst\" rel=\"external_link\" target=\"_blank\">catalyst<\/a> for production of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyolefin\" title=\"Polyolefin\" rel=\"external_link\" target=\"_blank\">polyolefins<\/a> (see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ziegler-Natta_catalyst\" class=\"mw-redirect\" title=\"Ziegler-Natta catalyst\" rel=\"external_link\" target=\"_blank\">Ziegler-Natta catalyst<\/a>) and a reducing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reagent\" title=\"Reagent\" rel=\"external_link\" target=\"_blank\">agent<\/a> in organic chemistry.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Organometallic_complexes\">Organometallic complexes<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organotitanium_chemistry\" class=\"mw-redirect\" title=\"Organotitanium chemistry\" rel=\"external_link\" target=\"_blank\">Organotitanium chemistry<\/a><\/div>\n<p>Owing to the important role of titanium compounds as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymerization\" title=\"Polymerization\" rel=\"external_link\" target=\"_blank\">polymerization<\/a> catalyst, compounds with Ti-C bonds have been intensively studied. The most common organotitanium complex is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanocene_dichloride\" title=\"Titanocene dichloride\" rel=\"external_link\" target=\"_blank\">titanocene dichloride<\/a> ((C<sub>5<\/sub>H<sub>5<\/sub>)<sub>2<\/sub>TiCl<sub>2<\/sub>). Related compounds include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tebbe%27s_reagent\" title=\"Tebbe's reagent\" rel=\"external_link\" target=\"_blank\">Tebbe's reagent<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Petasis_reagent\" title=\"Petasis reagent\" rel=\"external_link\" target=\"_blank\">Petasis reagent<\/a>. Titanium forms <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal_carbonyl\" title=\"Metal carbonyl\" rel=\"external_link\" target=\"_blank\">carbonyl complexes<\/a>, e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanocene_dicarbonyl\" title=\"Titanocene dicarbonyl\" rel=\"external_link\" target=\"_blank\">(C<sub>5<\/sub>H<sub>5<\/sub>)<sub>2<\/sub>Ti(CO)<sub>2<\/sub><\/a>.<sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Anticancer_therapy\">Anticancer therapy<\/span><\/h3>\n<p>Following the success of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cisplatin\" title=\"Cisplatin\" rel=\"external_link\" target=\"_blank\">platinum-based<\/a> chemotherapy, titanium(IV) complexes were among the first non-platinum compounds to be tested for cancer treatment. The advantage of titanium compounds lies in their high efficacy and low toxicity. In biological environments, hydrolysis leads to the safe and inert titanium dioxide. Despite these advantages the first candidate compounds failed clinical trials. Further development resulted in the creation of potentially effective, selective, and stable titanium-based drugs.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup> Their mode of action is not yet well understood.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Martin_Heinrich_Klaproth.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Engraved profile image of a mid-age male with high forehead. The person is wearing a coat and a neckerchief.\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cf\/Martin_Heinrich_Klaproth.jpg\/170px-Martin_Heinrich_Klaproth.jpg\" width=\"170\" height=\"222\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Martin_Heinrich_Klaproth.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Martin_Heinrich_Klaproth\" title=\"Martin Heinrich Klaproth\" rel=\"external_link\" target=\"_blank\">Martin Heinrich Klaproth<\/a> named titanium for the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titan_(mythology)\" title=\"Titan (mythology)\" rel=\"external_link\" target=\"_blank\">Titans<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greek_mythology\" title=\"Greek mythology\" rel=\"external_link\" target=\"_blank\">Greek mythology<\/a><\/div><\/div><\/div>\n<p>Titanium was <a href=\"https:\/\/en.wikipedia.org\/wiki\/Discovery_of_the_chemical_elements\" class=\"mw-redirect\" title=\"Discovery of the chemical elements\" rel=\"external_link\" target=\"_blank\">discovered<\/a> in 1791 by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clergy\" title=\"Clergy\" rel=\"external_link\" target=\"_blank\">clergyman<\/a> and amateur geologist, <a href=\"https:\/\/en.wikipedia.org\/wiki\/William_Gregor\" title=\"William Gregor\" rel=\"external_link\" target=\"_blank\">William Gregor<\/a>, as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inclusion_(mineral)\" title=\"Inclusion (mineral)\" rel=\"external_link\" target=\"_blank\">inclusion<\/a> of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mineral\" title=\"Mineral\" rel=\"external_link\" target=\"_blank\">mineral<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornwall\" title=\"Cornwall\" rel=\"external_link\" target=\"_blank\">Cornwall<\/a>, Great Britain.<sup id=\"rdp-ebb-cite_ref-Emsley2001p452_40-0\" class=\"reference\"><a href=\"#cite_note-Emsley2001p452-40\" rel=\"external_link\">[40]<\/a><\/sup> Gregor recognized the presence of a new element in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ilmenite\" title=\"Ilmenite\" rel=\"external_link\" target=\"_blank\">ilmenite<\/a><sup id=\"rdp-ebb-cite_ref-HistoryAndUse_8-2\" class=\"reference\"><a href=\"#cite_note-HistoryAndUse-8\" rel=\"external_link\">[8]<\/a><\/sup> when he found black sand by a stream and noticed the sand was attracted by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnet\" title=\"Magnet\" rel=\"external_link\" target=\"_blank\">magnet<\/a>.<sup id=\"rdp-ebb-cite_ref-Emsley2001p452_40-1\" class=\"reference\"><a href=\"#cite_note-Emsley2001p452-40\" rel=\"external_link\">[40]<\/a><\/sup> Analyzing the sand, he determined the presence of two metal oxides: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron_oxide\" title=\"Iron oxide\" rel=\"external_link\" target=\"_blank\">iron oxide<\/a> (explaining the attraction to the magnet) and 45.25% of a white metallic oxide he could not identify.<sup id=\"rdp-ebb-cite_ref-Barksdale1968p732_21-2\" class=\"reference\"><a href=\"#cite_note-Barksdale1968p732-21\" rel=\"external_link\">[21]<\/a><\/sup> Realizing that the unidentified oxide contained a metal that did not match any known element, Gregor reported his findings to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Royal_Geological_Society_of_Cornwall\" title=\"Royal Geological Society of Cornwall\" rel=\"external_link\" target=\"_blank\">Royal Geological Society of Cornwall<\/a> and in the German science journal <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Crell%27s_Annalen\" title=\"Crell's Annalen\" rel=\"external_link\" target=\"_blank\">Crell's Annalen<\/a><\/i>.<sup id=\"rdp-ebb-cite_ref-Emsley2001p452_40-2\" class=\"reference\"><a href=\"#cite_note-Emsley2001p452-40\" rel=\"external_link\">[40]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\" rel=\"external_link\">[41]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup>\n<\/p><p>Around the same time, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Franz-Joseph_M%C3%BCller_von_Reichenstein\" title=\"Franz-Joseph M\u00fcller von Reichenstein\" rel=\"external_link\" target=\"_blank\">Franz-Joseph M\u00fcller von Reichenstein<\/a> produced a similar substance, but could not identify it.<sup id=\"rdp-ebb-cite_ref-HistoryAndUse_8-3\" class=\"reference\"><a href=\"#cite_note-HistoryAndUse-8\" rel=\"external_link\">[8]<\/a><\/sup> The oxide was independently rediscovered in 1795 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prussia\" title=\"Prussia\" rel=\"external_link\" target=\"_blank\">Prussian<\/a> chemist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Martin_Heinrich_Klaproth\" title=\"Martin Heinrich Klaproth\" rel=\"external_link\" target=\"_blank\">Martin Heinrich Klaproth<\/a> in rutile from Boinik (German name Bajm\u00f3cska), a village in Hungary (now Bojni\u010dky in Slovakia).<sup id=\"rdp-ebb-cite_ref-Emsley2001p452_40-3\" class=\"reference\"><a href=\"#cite_note-Emsley2001p452-40\" rel=\"external_link\">[40]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup> Klaproth found that it contained a new element and named it for the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titan_(mythology)\" title=\"Titan (mythology)\" rel=\"external_link\" target=\"_blank\">Titans<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greek_mythology\" title=\"Greek mythology\" rel=\"external_link\" target=\"_blank\">Greek mythology<\/a>.<sup id=\"rdp-ebb-cite_ref-Emsley2001p451_23-1\" class=\"reference\"><a href=\"#cite_note-Emsley2001p451-23\" rel=\"external_link\">[23]<\/a><\/sup> After hearing about Gregor's earlier discovery, he obtained a sample of manaccanite and confirmed that it contained titanium.\n<\/p><p>The currently known processes for extracting titanium from its various ores are laborious and costly; it is not possible to reduce the ore by heating with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon\" title=\"Carbon\" rel=\"external_link\" target=\"_blank\">carbon<\/a> (as in iron smelting) because titanium combines with the carbon to produce <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_carbide\" title=\"Titanium carbide\" rel=\"external_link\" target=\"_blank\">titanium carbide<\/a>.<sup id=\"rdp-ebb-cite_ref-Emsley2001p452_40-4\" class=\"reference\"><a href=\"#cite_note-Emsley2001p452-40\" rel=\"external_link\">[40]<\/a><\/sup> Pure metallic titanium (99.9%) was first prepared in 1910 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Matthew_A._Hunter\" class=\"mw-redirect\" title=\"Matthew A. Hunter\" rel=\"external_link\" target=\"_blank\">Matthew A. Hunter<\/a> at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rensselaer_Polytechnic_Institute\" title=\"Rensselaer Polytechnic Institute\" rel=\"external_link\" target=\"_blank\">Rensselaer Polytechnic Institute<\/a> by heating TiCl<sub>4<\/sub> with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium\" title=\"Sodium\" rel=\"external_link\" target=\"_blank\">sodium<\/a> at 700\u2013800 \u00b0C under great pressure<sup id=\"rdp-ebb-cite_ref-Roza2008p9_44-0\" class=\"reference\"><a href=\"#cite_note-Roza2008p9-44\" rel=\"external_link\">[44]<\/a><\/sup> in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Batch_production\" title=\"Batch production\" rel=\"external_link\" target=\"_blank\">batch process<\/a> known as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hunter_process\" title=\"Hunter process\" rel=\"external_link\" target=\"_blank\">Hunter process<\/a>.<sup id=\"rdp-ebb-cite_ref-LANL_7-7\" class=\"reference\"><a href=\"#cite_note-LANL-7\" rel=\"external_link\">[7]<\/a><\/sup> Titanium metal was not used outside the laboratory until 1932 when <a href=\"https:\/\/en.wikipedia.org\/wiki\/William_Justin_Kroll\" title=\"William Justin Kroll\" rel=\"external_link\" target=\"_blank\">William Justin Kroll<\/a> proved that it can be produced by reducing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_tetrachloride\" title=\"Titanium tetrachloride\" rel=\"external_link\" target=\"_blank\">titanium tetrachloride<\/a> (TiCl<sub>4<\/sub>) with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium\" title=\"Calcium\" rel=\"external_link\" target=\"_blank\">calcium<\/a>.<sup id=\"rdp-ebb-cite_ref-Greenwood1997p955_45-0\" class=\"reference\"><a href=\"#cite_note-Greenwood1997p955-45\" rel=\"external_link\">[45]<\/a><\/sup> Eight years later he refined this process with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium\" title=\"Magnesium\" rel=\"external_link\" target=\"_blank\">magnesium<\/a> and even sodium in what became known as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kroll_process\" title=\"Kroll process\" rel=\"external_link\" target=\"_blank\">Kroll process<\/a>.<sup id=\"rdp-ebb-cite_ref-Greenwood1997p955_45-1\" class=\"reference\"><a href=\"#cite_note-Greenwood1997p955-45\" rel=\"external_link\">[45]<\/a><\/sup> Although research continues into more efficient and cheaper processes (e.g., <a href=\"https:\/\/en.wikipedia.org\/wiki\/FFC_Cambridge\" class=\"mw-redirect\" title=\"FFC Cambridge\" rel=\"external_link\" target=\"_blank\">FFC Cambridge<\/a>, ), the Kroll process is still used for commercial production.<sup id=\"rdp-ebb-cite_ref-LANL_7-8\" class=\"reference\"><a href=\"#cite_note-LANL-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-HistoryAndUse_8-4\" class=\"reference\"><a href=\"#cite_note-HistoryAndUse-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:TitaniumMetal_jpg.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/90\/TitaniumMetal_jpg.jpg\/220px-TitaniumMetal_jpg.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:TitaniumMetal_jpg.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Titanium sponge, made by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kroll_process\" title=\"Kroll process\" rel=\"external_link\" target=\"_blank\">Kroll process<\/a><\/div><\/div><\/div>\n<p>Titanium of very high purity was made in small quantities when <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anton_Eduard_van_Arkel\" title=\"Anton Eduard van Arkel\" rel=\"external_link\" target=\"_blank\">Anton Eduard van Arkel<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jan_Hendrik_de_Boer\" title=\"Jan Hendrik de Boer\" rel=\"external_link\" target=\"_blank\">Jan Hendrik de Boer<\/a> discovered the iodide, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystal_bar_process\" title=\"Crystal bar process\" rel=\"external_link\" target=\"_blank\">crystal bar<\/a>, process in 1925, by reacting with iodine and decomposing the formed vapours over a hot filament to pure metal.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup>\n<\/p><p>In the 1950s and 1960s, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soviet_Union\" title=\"Soviet Union\" rel=\"external_link\" target=\"_blank\">Soviet Union<\/a> pioneered the use of titanium in military and submarine applications<sup id=\"rdp-ebb-cite_ref-Roza2008p9_44-1\" class=\"reference\"><a href=\"#cite_note-Roza2008p9-44\" rel=\"external_link\">[44]<\/a><\/sup> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Alfa-class_submarine\" title=\"Alfa-class submarine\" rel=\"external_link\" target=\"_blank\">Alfa class<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soviet_submarine_K-278_Komsomolets\" title=\"Soviet submarine K-278 Komsomolets\" rel=\"external_link\" target=\"_blank\">Mike class<\/a>)<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup> as part of programs related to the Cold War.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup> Starting in the early 1950s, titanium came into use extensively in military aviation, particularly in high-performance jets, starting with aircraft such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/F-100_Super_Sabre\" class=\"mw-redirect\" title=\"F-100 Super Sabre\" rel=\"external_link\" target=\"_blank\">F-100 Super Sabre<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lockheed_A-12\" title=\"Lockheed A-12\" rel=\"external_link\" target=\"_blank\">Lockheed A-12<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/SR-71\" class=\"mw-redirect\" title=\"SR-71\" rel=\"external_link\" target=\"_blank\">SR-71<\/a>.\n<\/p><p>Recognizing the strategic importance of titanium,<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup> the U.S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Department_of_Defense\" title=\"United States Department of Defense\" rel=\"external_link\" target=\"_blank\">Department of Defense<\/a> supported early efforts of commercialization.<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup>\n<\/p><p>Throughout the period of the Cold War, titanium was considered a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Strategic_material\" title=\"Strategic material\" rel=\"external_link\" target=\"_blank\">strategic material<\/a> by the U.S. government, and a large stockpile of titanium sponge was maintained by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Defense_National_Stockpile_Center\" title=\"Defense National Stockpile Center\" rel=\"external_link\" target=\"_blank\">Defense National Stockpile Center<\/a>, which was finally depleted in the 2000s.<sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup> According to 2006 data, the world's largest producer, Russian-based <a href=\"https:\/\/en.wikipedia.org\/wiki\/VSMPO-AVISMA\" title=\"VSMPO-AVISMA\" rel=\"external_link\" target=\"_blank\">VSMPO-AVISMA<\/a>, was estimated to account for about 29% of the world market share.<sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup> As of 2015, titanium sponge metal was produced in six countries: China, Japan, Russia, Kazakhstan, the US, Ukraine, and India. (in order of output).<sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\" rel=\"external_link\">[54]<\/a><\/sup>\n<\/p><p>In 2006, the U.S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/DARPA\" title=\"DARPA\" rel=\"external_link\" target=\"_blank\">Defense Advanced Research Projects Agency<\/a> (DARPA) awarded $5.7 million to a two-company consortium to develop a new process for making titanium metal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Powder_metallurgy\" title=\"Powder metallurgy\" rel=\"external_link\" target=\"_blank\">powder<\/a>. Under heat and pressure, the powder can be used to create strong, lightweight items ranging from armour plating to components for the aerospace, transport, and chemical processing industries.<sup id=\"rdp-ebb-cite_ref-55\" class=\"reference\"><a href=\"#cite_note-55\" rel=\"external_link\">[55]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Production_and_fabrication\">Production and fabrication<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:TitaniumUSGOV.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"A small heap of uniform black grains smaller than 1mm diameter.\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/58\/TitaniumUSGOV.jpg\/220px-TitaniumUSGOV.jpg\" width=\"220\" height=\"199\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:TitaniumUSGOV.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Titanium (mineral concentrate)<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Titanium_products.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bf\/Titanium_products.jpg\/220px-Titanium_products.jpg\" width=\"220\" height=\"167\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Titanium_products.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Basic titanium products: plate, tube, rods, and powder<\/div><\/div><\/div>\n<p>The processing of titanium metal occurs in four major steps:<sup id=\"rdp-ebb-cite_ref-56\" class=\"reference\"><a href=\"#cite_note-56\" rel=\"external_link\">[56]<\/a><\/sup> reduction of titanium ore into \"sponge\", a porous form; melting of sponge, or sponge plus a master alloy to form an ingot; primary fabrication, where an ingot is converted into general mill products such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bar_stock\" title=\"Bar stock\" rel=\"external_link\" target=\"_blank\">billet<\/a>, bar, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plate_(metal)\" class=\"mw-redirect\" title=\"Plate (metal)\" rel=\"external_link\" target=\"_blank\">plate<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sheet_metal\" title=\"Sheet metal\" rel=\"external_link\" target=\"_blank\">sheet<\/a>, strip, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tube_(fluid_conveyance)\" class=\"mw-redirect\" title=\"Tube (fluid conveyance)\" rel=\"external_link\" target=\"_blank\">tube<\/a>; and secondary fabrication of finished shapes from mill products.\n<\/p>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kroll_process\" title=\"Kroll process\" rel=\"external_link\" target=\"_blank\">Kroll process<\/a><\/div>\n<p>Because it cannot be readily produced by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reduction_(chemistry)\" class=\"mw-redirect\" title=\"Reduction (chemistry)\" rel=\"external_link\" target=\"_blank\">reduction<\/a> of its dioxide,<sup id=\"rdp-ebb-cite_ref-Stwertka1998_13-2\" class=\"reference\"><a href=\"#cite_note-Stwertka1998-13\" rel=\"external_link\">[13]<\/a><\/sup> titanium metal is obtained by reduction of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_tetrachloride\" title=\"Titanium tetrachloride\" rel=\"external_link\" target=\"_blank\">TiCl<sub>4<\/sub><\/a> with magnesium metal in the Kroll process. The complexity of this batch production in the Kroll process explains the relatively high market value of titanium,<sup id=\"rdp-ebb-cite_ref-Barksdale1968p733_57-0\" class=\"reference\"><a href=\"#cite_note-Barksdale1968p733-57\" rel=\"external_link\">[57]<\/a><\/sup> despite the Kroll process being less expensive than the Hunter process.<sup id=\"rdp-ebb-cite_ref-Roza2008p9_44-2\" class=\"reference\"><a href=\"#cite_note-Roza2008p9-44\" rel=\"external_link\">[44]<\/a><\/sup> To produce the TiCl<sub>4<\/sub> required by the Kroll process, the dioxide is subjected to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbothermic_reduction\" class=\"mw-redirect\" title=\"Carbothermic reduction\" rel=\"external_link\" target=\"_blank\">carbothermic reduction<\/a> in the presence of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chlorine\" title=\"Chlorine\" rel=\"external_link\" target=\"_blank\">chlorine<\/a>. In this process, the chlorine gas is passed over a red-hot mixture of rutile or ilmenite in the presence of carbon. After extensive purification by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fractional_distillation\" title=\"Fractional distillation\" rel=\"external_link\" target=\"_blank\">fractional distillation<\/a>, the TiCl<sub>4<\/sub> is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reduction_(chemistry)\" class=\"mw-redirect\" title=\"Reduction (chemistry)\" rel=\"external_link\" target=\"_blank\">reduced<\/a> with 800 \u00b0C molten <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium\" title=\"Magnesium\" rel=\"external_link\" target=\"_blank\">magnesium<\/a> in an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Argon\" title=\"Argon\" rel=\"external_link\" target=\"_blank\">argon<\/a> atmosphere.<sup id=\"rdp-ebb-cite_ref-TICE6th_11-4\" class=\"reference\"><a href=\"#cite_note-TICE6th-11\" rel=\"external_link\">[11]<\/a><\/sup> Titanium metal can be further purified by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Van_Arkel%E2%80%93de_Boer_process\" class=\"mw-redirect\" title=\"Van Arkel\u2013de Boer process\" rel=\"external_link\" target=\"_blank\">van Arkel\u2013de Boer process<\/a>, which involves <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_vapor_transport\" class=\"mw-redirect\" title=\"Chemical vapor transport\" rel=\"external_link\" target=\"_blank\">thermal decomposition<\/a> of titanium tetraiodide.\n<\/p>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/FFC_Cambridge_process\" title=\"FFC Cambridge process\" rel=\"external_link\" target=\"_blank\">FFC Cambridge process<\/a><\/div>\n<p>A more recently developed batch production method, the FFC Cambridge process,<sup id=\"rdp-ebb-cite_ref-58\" class=\"reference\"><a href=\"#cite_note-58\" rel=\"external_link\">[58]<\/a><\/sup> consumes titanium dioxide powder (a refined form of rutile) as feedstock and produces titanium metal, either powder or sponge. The process involves fewer steps than the Kroll process and takes less time.<sup id=\"rdp-ebb-cite_ref-Roza2008p23_59-0\" class=\"reference\"><a href=\"#cite_note-Roza2008p23-59\" rel=\"external_link\">[59]<\/a><\/sup> If mixed oxide powders are used, the product is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alloy\" title=\"Alloy\" rel=\"external_link\" target=\"_blank\">alloy<\/a>.\n<\/p><p>Common titanium alloys are made by reduction. For example, cuprotitanium (rutile with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copper\" title=\"Copper\" rel=\"external_link\" target=\"_blank\">copper<\/a> added is reduced), ferrocarbon titanium (ilmenite reduced with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coke_(fuel)\" title=\"Coke (fuel)\" rel=\"external_link\" target=\"_blank\">coke<\/a> in an electric furnace), and manganotitanium (rutile with manganese or manganese oxides) are reduced.<sup id=\"rdp-ebb-cite_ref-TI_Encarta2005_60-0\" class=\"reference\"><a href=\"#cite_note-TI_Encarta2005-60\" rel=\"external_link\">[60]<\/a><\/sup>\n<\/p>\n<dl><dd>2 FeTiO<sub>3<\/sub> + 7 Cl<sub>2<\/sub> + 6 C \u2192 2 TiCl<sub>4<\/sub> + 2 FeCl<sub>3<\/sub> + 6 CO (900 \u00b0C)<\/dd>\n<dd>TiCl<sub>4<\/sub> + 2 Mg \u2192 2 MgCl<sub>2<\/sub> + Ti (1,100 \u00b0C)<\/dd><\/dl>\n<p>About fifty <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_alloy#Grades\" title=\"Titanium alloy\" rel=\"external_link\" target=\"_blank\">grades<\/a> of titanium and titanium alloys are designed and currently used, although only a couple of dozen are readily available commercially.<sup id=\"rdp-ebb-cite_ref-61\" class=\"reference\"><a href=\"#cite_note-61\" rel=\"external_link\">[61]<\/a><\/sup> The <a href=\"https:\/\/en.wikipedia.org\/wiki\/ASTM_International\" title=\"ASTM International\" rel=\"external_link\" target=\"_blank\">ASTM International<\/a> recognizes 31 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_alloy\" title=\"Titanium alloy\" rel=\"external_link\" target=\"_blank\">grades of titanium<\/a> metal and alloys, of which grades one through four are commercially pure (unalloyed). Those four vary in tensile strength as a function of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen\" title=\"Oxygen\" rel=\"external_link\" target=\"_blank\">oxygen<\/a> content, with grade 1 being the most ductile (lowest tensile strength with an oxygen content of 0.18%), and grade 4 the least ductile (highest tensile strength with an oxygen content of 0.40%).<sup id=\"rdp-ebb-cite_ref-Emsley2001p453_17-4\" class=\"reference\"><a href=\"#cite_note-Emsley2001p453-17\" rel=\"external_link\">[17]<\/a><\/sup> The remaining grades are alloys, each designed for specific properties of ductility, strength, hardness, electrical resistivity, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Creep_(deformation)\" title=\"Creep (deformation)\" rel=\"external_link\" target=\"_blank\">creep<\/a> resistance, specific corrosion resistance, and combinations thereof.<sup id=\"rdp-ebb-cite_ref-62\" class=\"reference\"><a href=\"#cite_note-62\" rel=\"external_link\">[62]<\/a><\/sup>\n<\/p><p>In addition to the ASTM specifications, titanium alloys are also produced to meet aerospace and military specifications (SAE-AMS, MIL-T), ISO standards, and country-specific specifications, as well as proprietary end-user specifications for aerospace, military, medical, and industrial applications.<sup id=\"rdp-ebb-cite_ref-63\" class=\"reference\"><a href=\"#cite_note-63\" rel=\"external_link\">[63]<\/a><\/sup>\n<\/p><p>Titanium powder is manufactured using a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flow_production\" class=\"mw-redirect\" title=\"Flow production\" rel=\"external_link\" target=\"_blank\">flow production<\/a> process known as the <sup id=\"rdp-ebb-cite_ref-Roza2008p25_64-0\" class=\"reference\"><a href=\"#cite_note-Roza2008p25-64\" rel=\"external_link\">[64]<\/a><\/sup> that is similar to the batch production Hunter process. A stream of titanium tetrachloride gas is added to a stream of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molten\" class=\"mw-redirect\" title=\"Molten\" rel=\"external_link\" target=\"_blank\">molten<\/a> sodium metal; the products (sodium chloride <a href=\"https:\/\/en.wikipedia.org\/wiki\/Salt\" title=\"Salt\" rel=\"external_link\" target=\"_blank\">salt<\/a> and titanium particles) is filtered from the extra sodium. Titanium is then separated from the salt by water washing. Both sodium and chlorine are recycled to produce and process more titanium tetrachloride.<sup id=\"rdp-ebb-cite_ref-ECI_online_65-0\" class=\"reference\"><a href=\"#cite_note-ECI_online-65\" rel=\"external_link\">[65]<\/a><\/sup>\n<\/p><p>All <a href=\"https:\/\/en.wikipedia.org\/wiki\/Welding\" title=\"Welding\" rel=\"external_link\" target=\"_blank\">welding<\/a> of titanium must be done in an inert atmosphere of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Argon\" title=\"Argon\" rel=\"external_link\" target=\"_blank\">argon<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Helium\" title=\"Helium\" rel=\"external_link\" target=\"_blank\">helium<\/a> to shield it from contamination with atmospheric gases (oxygen, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nitrogen\" title=\"Nitrogen\" rel=\"external_link\" target=\"_blank\">nitrogen<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrogen\" title=\"Hydrogen\" rel=\"external_link\" target=\"_blank\">hydrogen<\/a>).<sup id=\"rdp-ebb-cite_ref-Barksdale1968p734_15-3\" class=\"reference\"><a href=\"#cite_note-Barksdale1968p734-15\" rel=\"external_link\">[15]<\/a><\/sup> Contamination causes a variety of conditions, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Embrittlement\" title=\"Embrittlement\" rel=\"external_link\" target=\"_blank\">embrittlement<\/a>, which reduce the integrity of the assembly welds and lead to joint failure.\n<\/p><p>Commercially pure flat product (sheet, plate) can be formed readily, but processing must take into account the fact that the metal has a \"memory\" and tends to spring back. This is especially true of certain high-strength alloys.<sup id=\"rdp-ebb-cite_ref-66\" class=\"reference\"><a href=\"#cite_note-66\" rel=\"external_link\">[66]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-67\" class=\"reference\"><a href=\"#cite_note-67\" rel=\"external_link\">[67]<\/a><\/sup> Titanium cannot be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solder\" title=\"Solder\" rel=\"external_link\" target=\"_blank\">soldered<\/a> without first pre-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Plating\" title=\"Plating\" rel=\"external_link\" target=\"_blank\">plating<\/a> it in a metal that is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solderability\" title=\"Solderability\" rel=\"external_link\" target=\"_blank\">solderable<\/a>.<sup id=\"rdp-ebb-cite_ref-68\" class=\"reference\"><a href=\"#cite_note-68\" rel=\"external_link\">[68]<\/a><\/sup> The metal can be machined with the same equipment and the same processes as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a>.<sup id=\"rdp-ebb-cite_ref-Barksdale1968p734_15-4\" class=\"reference\"><a href=\"#cite_note-Barksdale1968p734-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Titanzylinder.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5b\/Titanzylinder.jpg\/220px-Titanzylinder.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Titanzylinder.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A titanium cylinder of \"grade 2\" quality<\/div><\/div><\/div>\n<p>Titanium is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Steel\" title=\"Steel\" rel=\"external_link\" target=\"_blank\">steel<\/a> as an alloying element (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferro-titanium\" class=\"mw-redirect\" title=\"Ferro-titanium\" rel=\"external_link\" target=\"_blank\">ferro-titanium<\/a>) to reduce <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystallite\" title=\"Crystallite\" rel=\"external_link\" target=\"_blank\">grain size<\/a> and as a deoxidizer, and in stainless steel to reduce carbon content.<sup id=\"rdp-ebb-cite_ref-EBC_6-7\" class=\"reference\"><a href=\"#cite_note-EBC-6\" rel=\"external_link\">[6]<\/a><\/sup> Titanium is often alloyed with aluminium (to refine grain size), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vanadium\" title=\"Vanadium\" rel=\"external_link\" target=\"_blank\">vanadium<\/a>, copper (to harden), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron\" title=\"Iron\" rel=\"external_link\" target=\"_blank\">iron<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manganese\" title=\"Manganese\" rel=\"external_link\" target=\"_blank\">manganese<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molybdenum\" title=\"Molybdenum\" rel=\"external_link\" target=\"_blank\">molybdenum<\/a>, and other metals.<sup id=\"rdp-ebb-cite_ref-ECE738_69-0\" class=\"reference\"><a href=\"#cite_note-ECE738-69\" rel=\"external_link\">[69]<\/a><\/sup> Titanium mill products (sheet, plate, bar, wire, forgings, castings) find application in industrial, aerospace, recreational, and emerging markets. Powdered titanium is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyrotechnics\" title=\"Pyrotechnics\" rel=\"external_link\" target=\"_blank\">pyrotechnics<\/a> as a source of bright-burning particles.\n<\/p>\n<h3><span id=\"rdp-ebb-Pigments.2C_additives.2C_and_coatings\"><\/span><span class=\"mw-headline\" id=\"Pigments,_additives,_and_coatings\">Pigments, additives, and coatings<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Titanium(IV)_oxide.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Watch glass on a black surface with a small portion of white powder\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a5\/Titanium%28IV%29_oxide.jpg\/220px-Titanium%28IV%29_oxide.jpg\" width=\"220\" height=\"161\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Titanium(IV)_oxide.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_dioxide\" title=\"Titanium dioxide\" rel=\"external_link\" target=\"_blank\">Titanium dioxide<\/a> is the most commonly used compound of titanium<\/div><\/div><\/div>\n<p>About 95% of all titanium ore is destined for refinement into <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_dioxide\" title=\"Titanium dioxide\" rel=\"external_link\" target=\"_blank\">titanium dioxide<\/a> (<span class=\"chemf nowrap\">Ti<a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen\" title=\"Oxygen\" rel=\"external_link\" target=\"_blank\">O<\/a><span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">2<\/sub><\/span><\/span>), an intensely white permanent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pigment\" title=\"Pigment\" rel=\"external_link\" target=\"_blank\">pigment<\/a> used in paints, paper, toothpaste, and plastics.<sup id=\"rdp-ebb-cite_ref-USGS_20-3\" class=\"reference\"><a href=\"#cite_note-USGS-20\" rel=\"external_link\">[20]<\/a><\/sup> It is also used in cement, in gemstones, as an optical opacifier in paper,<sup id=\"rdp-ebb-cite_ref-70\" class=\"reference\"><a href=\"#cite_note-70\" rel=\"external_link\">[70]<\/a><\/sup> and a strengthening agent in graphite composite fishing rods and golf clubs.\n<\/p><p><span class=\"chemf nowrap\">TiO<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">2<\/sub><\/span><\/span> powder is chemically inert, resists fading in sunlight, and is very opaque: it imparts a pure and brilliant white colour to the brown or grey chemicals that form the majority of household plastics.<sup id=\"rdp-ebb-cite_ref-HistoryAndUse_8-5\" class=\"reference\"><a href=\"#cite_note-HistoryAndUse-8\" rel=\"external_link\">[8]<\/a><\/sup> In nature, this compound is found in the minerals <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatase\" title=\"Anatase\" rel=\"external_link\" target=\"_blank\">anatase<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brookite\" title=\"Brookite\" rel=\"external_link\" target=\"_blank\">brookite<\/a>, and rutile.<sup id=\"rdp-ebb-cite_ref-EBC_6-8\" class=\"reference\"><a href=\"#cite_note-EBC-6\" rel=\"external_link\">[6]<\/a><\/sup> Paint made with titanium dioxide does well in severe temperatures and marine environments.<sup id=\"rdp-ebb-cite_ref-HistoryAndUse_8-6\" class=\"reference\"><a href=\"#cite_note-HistoryAndUse-8\" rel=\"external_link\">[8]<\/a><\/sup> Pure titanium dioxide has a very high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refractive_index\" title=\"Refractive index\" rel=\"external_link\" target=\"_blank\">index of refraction<\/a> and an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_dispersion\" class=\"mw-redirect\" title=\"Optical dispersion\" rel=\"external_link\" target=\"_blank\">optical dispersion<\/a> higher than <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diamond\" title=\"Diamond\" rel=\"external_link\" target=\"_blank\">diamond<\/a>.<sup id=\"rdp-ebb-cite_ref-LANL_7-9\" class=\"reference\"><a href=\"#cite_note-LANL-7\" rel=\"external_link\">[7]<\/a><\/sup> In addition to being a very important pigment, titanium dioxide is also used in sunscreens.<sup id=\"rdp-ebb-cite_ref-Stwertka1998_13-3\" class=\"reference\"><a href=\"#cite_note-Stwertka1998-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Aerospace_and_marine\">Aerospace and marine<\/span><\/h3>\n<p>Because titanium alloys have high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tensile_strength\" class=\"mw-redirect\" title=\"Tensile strength\" rel=\"external_link\" target=\"_blank\">tensile strength<\/a> to density ratio,<sup id=\"rdp-ebb-cite_ref-TICE6th_11-5\" class=\"reference\"><a href=\"#cite_note-TICE6th-11\" rel=\"external_link\">[11]<\/a><\/sup> high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corrosion_resistance\" class=\"mw-redirect\" title=\"Corrosion resistance\" rel=\"external_link\" target=\"_blank\">corrosion resistance<\/a>,<sup id=\"rdp-ebb-cite_ref-LANL_7-10\" class=\"reference\"><a href=\"#cite_note-LANL-7\" rel=\"external_link\">[7]<\/a><\/sup> fatigue resistance, high crack resistance,<sup id=\"rdp-ebb-cite_ref-Moiseyev_71-0\" class=\"reference\"><a href=\"#cite_note-Moiseyev-71\" rel=\"external_link\">[71]<\/a><\/sup> and ability to withstand moderately high temperatures without <a href=\"https:\/\/en.wikipedia.org\/wiki\/Creep_(deformation)\" title=\"Creep (deformation)\" rel=\"external_link\" target=\"_blank\">creeping<\/a>, they are used in aircraft, armour plating, naval ships, spacecraft, and missiles.<sup id=\"rdp-ebb-cite_ref-LANL_7-11\" class=\"reference\"><a href=\"#cite_note-LANL-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-HistoryAndUse_8-7\" class=\"reference\"><a href=\"#cite_note-HistoryAndUse-8\" rel=\"external_link\">[8]<\/a><\/sup> For these applications, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_alloy\" title=\"Titanium alloy\" rel=\"external_link\" target=\"_blank\">titanium is alloyed<\/a> with aluminium, zirconium, nickel,<sup id=\"rdp-ebb-cite_ref-NYT7513_72-0\" class=\"reference\"><a href=\"#cite_note-NYT7513-72\" rel=\"external_link\">[72]<\/a><\/sup> vanadium, and other elements to manufacture a variety of components including critical structural parts, fire walls, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Landing_gear\" title=\"Landing gear\" rel=\"external_link\" target=\"_blank\">landing gear<\/a>, exhaust ducts (helicopters), and hydraulic systems. In fact, about two thirds of all titanium metal produced is used in aircraft engines and frames.<sup id=\"rdp-ebb-cite_ref-Emsley2001p454_73-0\" class=\"reference\"><a href=\"#cite_note-Emsley2001p454-73\" rel=\"external_link\">[73]<\/a><\/sup> The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_6AL-4V\" class=\"mw-redirect\" title=\"Titanium 6AL-4V\" rel=\"external_link\" target=\"_blank\">titanium 6AL-4V<\/a> alloy accounts for almost 50% of all alloys used in aircraft applications.<sup id=\"rdp-ebb-cite_ref-74\" class=\"reference\"><a href=\"#cite_note-74\" rel=\"external_link\">[74]<\/a><\/sup>\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lockheed_A-12\" title=\"Lockheed A-12\" rel=\"external_link\" target=\"_blank\">Lockheed A-12<\/a> and its development the <a href=\"https:\/\/en.wikipedia.org\/wiki\/SR-71_Blackbird\" class=\"mw-redirect\" title=\"SR-71 Blackbird\" rel=\"external_link\" target=\"_blank\">SR-71 \"Blackbird\"<\/a> were two of the first aircraft frames where titanium was used, paving the way for much wider use in modern military and commercial aircraft. An estimated 59 metric tons (130,000 pounds) are used in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boeing_777\" title=\"Boeing 777\" rel=\"external_link\" target=\"_blank\">Boeing 777<\/a>, 45 in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boeing_747\" title=\"Boeing 747\" rel=\"external_link\" target=\"_blank\">Boeing 747<\/a>, 18 in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boeing_737\" title=\"Boeing 737\" rel=\"external_link\" target=\"_blank\">Boeing 737<\/a>, 32 in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Airbus_A340\" title=\"Airbus A340\" rel=\"external_link\" target=\"_blank\">Airbus A340<\/a>, 18 in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Airbus_A330\" title=\"Airbus A330\" rel=\"external_link\" target=\"_blank\">Airbus A330<\/a>, and 12 in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Airbus_A320\" class=\"mw-redirect\" title=\"Airbus A320\" rel=\"external_link\" target=\"_blank\">Airbus A320<\/a>. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Airbus_A380\" title=\"Airbus A380\" rel=\"external_link\" target=\"_blank\">Airbus A380<\/a> may use 77 metric tons, including about 11 tons in the engines.<sup id=\"rdp-ebb-cite_ref-75\" class=\"reference\"><a href=\"#cite_note-75\" rel=\"external_link\">[75]<\/a><\/sup> In aero engine applications, titanium is used for rotors, compressor blades, hydraulic system components, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nacelle\" title=\"Nacelle\" rel=\"external_link\" target=\"_blank\">nacelles<\/a>. An early use in jet engines was for the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orenda_Iroquois\" title=\"Orenda Iroquois\" rel=\"external_link\" target=\"_blank\">Orenda Iroquois<\/a> in the 1950s.<sup id=\"rdp-ebb-cite_ref-76\" class=\"reference\"><a href=\"#cite_note-76\" rel=\"external_link\">[76]<\/a><\/sup><sup class=\"reference\" style=\"white-space:nowrap;\">:<span>412<\/span><\/sup>\n<\/p><p>Because titanium is resistant to corrosion by sea water, it is used to make propeller shafts, rigging, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heat_exchanger\" title=\"Heat exchanger\" rel=\"external_link\" target=\"_blank\">heat exchangers<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Desalination_plant\" class=\"mw-redirect\" title=\"Desalination plant\" rel=\"external_link\" target=\"_blank\">desalination plants<\/a>;<sup id=\"rdp-ebb-cite_ref-LANL_7-12\" class=\"reference\"><a href=\"#cite_note-LANL-7\" rel=\"external_link\">[7]<\/a><\/sup> heater-chillers for salt water aquariums, fishing line and leader, and divers' knives. Titanium is used in the housings and components of ocean-deployed surveillance and monitoring devices for science and the military. The former <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soviet_Union\" title=\"Soviet Union\" rel=\"external_link\" target=\"_blank\">Soviet Union<\/a> developed techniques for making submarines with hulls of titanium alloys<sup id=\"rdp-ebb-cite_ref-77\" class=\"reference\"><a href=\"#cite_note-77\" rel=\"external_link\">[77]<\/a><\/sup> forging titanium in huge vacuum tubes.<sup id=\"rdp-ebb-cite_ref-NYT7513_72-1\" class=\"reference\"><a href=\"#cite_note-NYT7513-72\" rel=\"external_link\">[72]<\/a><\/sup>\n<\/p><p>Titanium is used in the walls of the Juno spacecraft's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Juno_Radiation_Vault\" title=\"Juno Radiation Vault\" rel=\"external_link\" target=\"_blank\">vault<\/a> to shield on-board electronics.<sup id=\"rdp-ebb-cite_ref-78\" class=\"reference\"><a href=\"#cite_note-78\" rel=\"external_link\">[78]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Industrial\">Industrial<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hochreines_Titan_(99.999)_mit_sichtbarer_Kristallstruktur.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/54\/Hochreines_Titan_%2899.999%29_mit_sichtbarer_Kristallstruktur.jpg\/220px-Hochreines_Titan_%2899.999%29_mit_sichtbarer_Kristallstruktur.jpg\" width=\"220\" height=\"146\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hochreines_Titan_(99.999)_mit_sichtbarer_Kristallstruktur.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>High-purity (99.999%) titanium with visible <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystallite\" title=\"Crystallite\" rel=\"external_link\" target=\"_blank\">crystallites<\/a><\/div><\/div><\/div>\n<p>Welded titanium pipe and process equipment (heat exchangers, tanks, process vessels, valves) are used in the chemical and petrochemical industries primarily for corrosion resistance. Specific alloys are used in oil and gas downhole applications and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nickel\" title=\"Nickel\" rel=\"external_link\" target=\"_blank\">nickel<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrometallurgy\" title=\"Hydrometallurgy\" rel=\"external_link\" target=\"_blank\">hydrometallurgy<\/a> for their high strength (e. g.: titanium beta C alloy), corrosion resistance, or both. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulp_and_paper_industry\" title=\"Pulp and paper industry\" rel=\"external_link\" target=\"_blank\">pulp and paper industry<\/a> uses titanium in process equipment exposed to corrosive media, such as sodium hypochlorite or wet chlorine gas (in the bleachery).<sup id=\"rdp-ebb-cite_ref-79\" class=\"reference\"><a href=\"#cite_note-79\" rel=\"external_link\">[79]<\/a><\/sup> Other applications include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasonic_welding\" title=\"Ultrasonic welding\" rel=\"external_link\" target=\"_blank\">ultrasonic welding<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wave_soldering\" title=\"Wave soldering\" rel=\"external_link\" target=\"_blank\">wave soldering<\/a>,<sup id=\"rdp-ebb-cite_ref-80\" class=\"reference\"><a href=\"#cite_note-80\" rel=\"external_link\">[80]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sputtering\" title=\"Sputtering\" rel=\"external_link\" target=\"_blank\">sputtering<\/a> targets.<sup id=\"rdp-ebb-cite_ref-81\" class=\"reference\"><a href=\"#cite_note-81\" rel=\"external_link\">[81]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_tetrachloride\" title=\"Titanium tetrachloride\" rel=\"external_link\" target=\"_blank\">Titanium tetrachloride<\/a> (TiCl<sub>4<\/sub>), a colorless liquid, is important as an intermediate in the process of making TiO<sub>2<\/sub> and is also used to produce the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ziegler%E2%80%93Natta_catalyst\" title=\"Ziegler\u2013Natta catalyst\" rel=\"external_link\" target=\"_blank\">Ziegler\u2013Natta catalyst<\/a>. Titanium tetrachloride is also used to iridize <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass\" title=\"Glass\" rel=\"external_link\" target=\"_blank\">glass<\/a> and, because it fumes strongly in moist air, it is used to make smoke screens.<sup id=\"rdp-ebb-cite_ref-Stwertka1998_13-4\" class=\"reference\"><a href=\"#cite_note-Stwertka1998-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<div style=\"clear:both;\"><\/div>\n<h3><span class=\"mw-headline\" id=\"Consumer_and_architectural\">Consumer and architectural<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Titanium-stamps.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5c\/Titanium-stamps.jpg\/220px-Titanium-stamps.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Titanium-stamps.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Titanium <a href=\"https:\/\/en.wikipedia.org\/wiki\/Seal_(East_Asia)\" title=\"Seal (East Asia)\" rel=\"external_link\" target=\"_blank\">sealing stamps<\/a><\/div><\/div><\/div>\n<p>Titanium metal is used in automotive applications, particularly in automobile and motorcycle racing where low weight and high strength and rigidity are critical.<sup id=\"rdp-ebb-cite_ref-82\" class=\"reference\"><a href=\"#cite_note-82\" rel=\"external_link\">[82]<\/a><\/sup> The metal is generally too expensive for the general consumer market, though some late model <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chevrolet_Corvette\" title=\"Chevrolet Corvette\" rel=\"external_link\" target=\"_blank\">Corvettes<\/a> have been manufactured with titanium exhausts,<sup id=\"rdp-ebb-cite_ref-83\" class=\"reference\"><a href=\"#cite_note-83\" rel=\"external_link\">[83]<\/a><\/sup> and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/GM_small-block_engine\" class=\"mw-redirect\" title=\"GM small-block engine\" rel=\"external_link\" target=\"_blank\">Corvette Z06's LT4<\/a> supercharged engine uses lightweight, solid titanium intake valves for greater strength and resistance to heat.<sup id=\"rdp-ebb-cite_ref-84\" class=\"reference\"><a href=\"#cite_note-84\" rel=\"external_link\">[84]<\/a><\/sup>\n<\/p><p>Titanium is used in many sporting goods: tennis rackets, golf clubs, lacrosse stick shafts; cricket, hockey, lacrosse, and football helmet grills, and bicycle frames and components. Although not a mainstream material for bicycle production, titanium bikes have been used by racing teams and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adventure_Cycling\" class=\"mw-redirect\" title=\"Adventure Cycling\" rel=\"external_link\" target=\"_blank\">adventure cyclists<\/a>.<sup id=\"rdp-ebb-cite_ref-85\" class=\"reference\"><a href=\"#cite_note-85\" rel=\"external_link\">[85]<\/a><\/sup>\n<\/p><p>Titanium alloys are used in spectacle frames that are rather expensive but highly durable, long lasting, light weight, and cause no skin allergies. Many backpackers use titanium equipment, including cookware, eating utensils, lanterns, and tent stakes. Though slightly more expensive than traditional steel or aluminium alternatives, titanium products can be significantly lighter without compromising strength. Titanium horseshoes are preferred to steel by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Farrier\" title=\"Farrier\" rel=\"external_link\" target=\"_blank\">farriers<\/a> because they are lighter and more durable.<sup id=\"rdp-ebb-cite_ref-Donachie2000_86-0\" class=\"reference\"><a href=\"#cite_note-Donachie2000-86\" rel=\"external_link\">[86]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:El_Guggenheim_vizca%C3%ADno._(1454058701).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a1\/El_Guggenheim_vizca%C3%ADno._%281454058701%29.jpg\/220px-El_Guggenheim_vizca%C3%ADno._%281454058701%29.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:El_Guggenheim_vizca%C3%ADno._(1454058701).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Titanium cladding of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Frank_Gehry\" title=\"Frank Gehry\" rel=\"external_link\" target=\"_blank\">Frank Gehry<\/a>'s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Guggenheim_Museum_Bilbao\" title=\"Guggenheim Museum Bilbao\" rel=\"external_link\" target=\"_blank\">Guggenheim Museum<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bilbao\" title=\"Bilbao\" rel=\"external_link\" target=\"_blank\">Bilbao<\/a><\/div><\/div><\/div>\n<p>Titanium has occasionally been used in architecture. The 42.5 m (139 ft) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monument_to_Yuri_Gagarin\" title=\"Monument to Yuri Gagarin\" rel=\"external_link\" target=\"_blank\">Monument to Yuri Gagarin<\/a>, the first man to travel in space (<span class=\"plainlinks nourlexpansion\"><a class=\"external text\" href=\"https:\/\/tools.wmflabs.org\/geohack\/geohack.php?pagename=Titanium¶ms=55_42_29.7_N_37_34_57.2_E_region:CN-62_type:landmark\" rel=\"external_link\" target=\"_blank\"><span class=\"geo-default\"><span class=\"geo-dms\" title=\"Maps, aerial photos, and other data for this location\"><span class=\"latitude\">55\u00b042\u203229.7\u2033N<\/span> <span class=\"longitude\">37\u00b034\u203257.2\u2033E<\/span><\/span><\/span><span class=\"geo-multi-punct\"> \/ <\/span><span class=\"geo-nondefault\"><span class=\"geo-dec\" title=\"Maps, aerial photos, and other data for this location\">55.708250\u00b0N 37.582556\u00b0E<\/span><span style=\"display:none\"> \/ <span class=\"geo\">55.708250; 37.582556<\/span><\/span><\/span><\/a><\/span>), as well as the 110 m (360 ft) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monument_to_the_Conquerors_of_Space\" title=\"Monument to the Conquerors of Space\" rel=\"external_link\" target=\"_blank\">Monument to the Conquerors of Space<\/a> on top of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Memorial_Museum_of_Cosmonautics\" title=\"Memorial Museum of Cosmonautics\" rel=\"external_link\" target=\"_blank\">Cosmonaut Museum<\/a> in Moscow are made of titanium for the metal's attractive colour and association with rocketry.<sup id=\"rdp-ebb-cite_ref-87\" class=\"reference\"><a href=\"#cite_note-87\" rel=\"external_link\">[87]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-88\" class=\"reference\"><a href=\"#cite_note-88\" rel=\"external_link\">[88]<\/a><\/sup> The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Guggenheim_Museum_Bilbao\" title=\"Guggenheim Museum Bilbao\" rel=\"external_link\" target=\"_blank\">Guggenheim Museum Bilbao<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerritos_Millennium_Library\" title=\"Cerritos Millennium Library\" rel=\"external_link\" target=\"_blank\">Cerritos Millennium Library<\/a> were the first buildings in Europe and North America, respectively, to be sheathed in titanium panels.<sup id=\"rdp-ebb-cite_ref-Emsley2001p454_73-1\" class=\"reference\"><a href=\"#cite_note-Emsley2001p454-73\" rel=\"external_link\">[73]<\/a><\/sup> Titanium sheathing was used in the Frederic C. Hamilton Building in Denver, Colorado.<sup id=\"rdp-ebb-cite_ref-89\" class=\"reference\"><a href=\"#cite_note-89\" rel=\"external_link\">[89]<\/a><\/sup>\n<\/p><p>Because of titanium's superior strength and light weight relative to other metals (steel, stainless steel, and aluminium), and because of recent advances in metalworking techniques, its use has become more widespread in the manufacture of firearms. Primary uses include pistol frames and revolver cylinders. For the same reasons, it is used in the body of laptop computers (for example, in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apple_Inc.\" title=\"Apple Inc.\" rel=\"external_link\" target=\"_blank\">Apple<\/a>'s PowerBook line).<sup id=\"rdp-ebb-cite_ref-90\" class=\"reference\"><a href=\"#cite_note-90\" rel=\"external_link\">[90]<\/a><\/sup>\n<\/p><p>Some upmarket lightweight and corrosion-resistant tools, such as shovels and flashlights, are made of titanium or titanium alloys.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Jewelry\">Jewelry<\/span><\/h3>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Anodized_titanium_table.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/be\/Anodized_titanium_table.jpg\/200px-Anodized_titanium_table.jpg\" width=\"200\" height=\"150\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Anodized_titanium_table.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Relation between voltage and color for anodized titanium. (Cateb, 2010).<\/div><\/div><\/div>\n<p>Because of its durability, titanium has become more popular for designer jewelry (particularly, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_ring\" title=\"Titanium ring\" rel=\"external_link\" target=\"_blank\">titanium rings<\/a>).<sup id=\"rdp-ebb-cite_ref-Donachie2000_86-1\" class=\"reference\"><a href=\"#cite_note-Donachie2000-86\" rel=\"external_link\">[86]<\/a><\/sup> Its inertness makes it a good choice for those with allergies or those who will be wearing the jewelry in environments such as swimming pools. Titanium is also <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_gold\" title=\"Titanium gold\" rel=\"external_link\" target=\"_blank\">alloyed with gold<\/a> to produce an alloy that can be marketed as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carat_(purity)\" class=\"mw-redirect\" title=\"Carat (purity)\" rel=\"external_link\" target=\"_blank\">24-carat<\/a> gold because the 1% of alloyed Ti is insufficient to require a lesser mark. The resulting alloy is roughly the hardness of 14-carat gold and is more durable than pure 24-carat gold.<sup id=\"rdp-ebb-cite_ref-91\" class=\"reference\"><a href=\"#cite_note-91\" rel=\"external_link\">[91]<\/a><\/sup>\n<\/p><p>Titanium's durability, light weight, and dent and corrosion resistance make it useful for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Watch\" title=\"Watch\" rel=\"external_link\" target=\"_blank\">watch<\/a> cases.<sup id=\"rdp-ebb-cite_ref-Donachie2000_86-2\" class=\"reference\"><a href=\"#cite_note-Donachie2000-86\" rel=\"external_link\">[86]<\/a><\/sup> Some artists work with titanium to produce sculptures, decorative objects and furniture.<sup id=\"rdp-ebb-cite_ref-92\" class=\"reference\"><a href=\"#cite_note-92\" rel=\"external_link\">[92]<\/a><\/sup>\n<\/p><p>Titanium may be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anodising\" class=\"mw-redirect\" title=\"Anodising\" rel=\"external_link\" target=\"_blank\">anodized<\/a> to vary the thickness of the surface oxide layer, causing optical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interference_fringe\" class=\"mw-redirect\" title=\"Interference fringe\" rel=\"external_link\" target=\"_blank\">interference fringes<\/a> and a variety of bright colors.<sup id=\"rdp-ebb-cite_ref-93\" class=\"reference\"><a href=\"#cite_note-93\" rel=\"external_link\">[93]<\/a><\/sup> With this coloration and chemical inertness, titanium is a popular metal for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_piercing\" title=\"Body piercing\" rel=\"external_link\" target=\"_blank\">body piercing<\/a>.<sup id=\"rdp-ebb-cite_ref-94\" class=\"reference\"><a href=\"#cite_note-94\" rel=\"external_link\">[94]<\/a><\/sup>\n<\/p><p>Titanium has a minor use in dedicated non-circulating coins and medals. In 1999, Gibraltar released world's first titanium coin for the millennium celebration.<sup id=\"rdp-ebb-cite_ref-95\" class=\"reference\"><a href=\"#cite_note-95\" rel=\"external_link\">[95]<\/a><\/sup> The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gold_Coast_Titans\" title=\"Gold Coast Titans\" rel=\"external_link\" target=\"_blank\">Gold Coast Titans<\/a>, an Australian rugby league team, award a medal of pure titanium to their player of the year.<sup id=\"rdp-ebb-cite_ref-96\" class=\"reference\"><a href=\"#cite_note-96\" rel=\"external_link\">[96]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Medical\">Medical<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_biocompatibility\" title=\"Titanium biocompatibility\" rel=\"external_link\" target=\"_blank\">Titanium biocompatibility<\/a><\/div>\n<p>Because titanium is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatible<\/a> (non-toxic and not rejected by the body), it has many medical uses, including surgical implements and implants, such as hip balls and sockets (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement\" title=\"Joint replacement\" rel=\"external_link\" target=\"_blank\">joint replacement<\/a>) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">dental implants<\/a> that can stay in place for up to 20 years.<sup id=\"rdp-ebb-cite_ref-Emsley2001p452_40-5\" class=\"reference\"><a href=\"#cite_note-Emsley2001p452-40\" rel=\"external_link\">[40]<\/a><\/sup> The titanium is often alloyed with about 4% aluminium or 6% Al and 4% vanadium.<sup id=\"rdp-ebb-cite_ref-97\" class=\"reference\"><a href=\"#cite_note-97\" rel=\"external_link\">[97]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Titanium_plaatje_voor_pols.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a0\/Titanium_plaatje_voor_pols.jpg\/200px-Titanium_plaatje_voor_pols.jpg\" width=\"200\" height=\"168\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Titanium_plaatje_voor_pols.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Medical screws and plate used for repair fracture of the wrist, scale is in centimeters.<\/div><\/div><\/div>\n<p>Titanium has the inherent ability to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseointegration\" title=\"Osseointegration\" rel=\"external_link\" target=\"_blank\">osseointegrate<\/a>, enabling use in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implants\" class=\"mw-redirect\" title=\"Dental implants\" rel=\"external_link\" target=\"_blank\">dental implants<\/a> that can last for over 30 years. This property is also useful for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Internal_fixator\" class=\"mw-redirect\" title=\"Internal fixator\" rel=\"external_link\" target=\"_blank\">orthopedic implant<\/a> applications.<sup id=\"rdp-ebb-cite_ref-Emsley2001p452_40-6\" class=\"reference\"><a href=\"#cite_note-Emsley2001p452-40\" rel=\"external_link\">[40]<\/a><\/sup> These benefit from titanium's lower modulus of elasticity (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Young%27s_modulus\" title=\"Young's modulus\" rel=\"external_link\" target=\"_blank\">Young's modulus<\/a>) to more closely match that of the bone that such devices are intended to repair. As a result, skeletal loads are more evenly shared between bone and implant, leading to a lower incidence of bone degradation due to stress shielding and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Periprosthetic\" title=\"Periprosthetic\" rel=\"external_link\" target=\"_blank\">periprosthetic<\/a> bone fractures, which occur at the boundaries of orthopedic implants. However, titanium alloys' stiffness is still more than twice that of bone, so adjacent bone bears a greatly reduced load and may deteriorate.<sup id=\"rdp-ebb-cite_ref-98\" class=\"reference\"><a href=\"#cite_note-98\" rel=\"external_link\">[98]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-99\" class=\"reference\"><a href=\"#cite_note-99\" rel=\"external_link\">[99]<\/a><\/sup>\n<\/p><p>Because titanium is non-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferromagnetic\" class=\"mw-redirect\" title=\"Ferromagnetic\" rel=\"external_link\" target=\"_blank\">ferromagnetic<\/a>, patients with titanium implants can be safely examined with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging\" title=\"Magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">magnetic resonance imaging<\/a> (convenient for long-term implants). Preparing titanium for implantation in the body involves subjecting it to a high-temperature <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plasma_(physics)\" title=\"Plasma (physics)\" rel=\"external_link\" target=\"_blank\">plasma<\/a> arc which removes the surface atoms, exposing fresh titanium that is instantly oxidized.<sup id=\"rdp-ebb-cite_ref-Emsley2001p452_40-7\" class=\"reference\"><a href=\"#cite_note-Emsley2001p452-40\" rel=\"external_link\">[40]<\/a><\/sup>\n<\/p><p>Titanium is used for the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_instrument\" title=\"Surgical instrument\" rel=\"external_link\" target=\"_blank\">surgical instruments<\/a> used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Image-guided_surgery\" title=\"Image-guided surgery\" rel=\"external_link\" target=\"_blank\">image-guided surgery<\/a>, as well as wheelchairs, crutches, and any other products where high strength and low weight are desirable.\n<\/p><p>Titanium dioxide <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nanoparticle\" title=\"Nanoparticle\" rel=\"external_link\" target=\"_blank\">nanoparticles<\/a> are widely used in electronics and the delivery of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmaceutical_drug\" class=\"mw-redirect\" title=\"Pharmaceutical drug\" rel=\"external_link\" target=\"_blank\">pharmaceuticals<\/a> and cosmetics.<sup id=\"rdp-ebb-cite_ref-100\" class=\"reference\"><a href=\"#cite_note-100\" rel=\"external_link\">[100]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Nuclear_waste_storage\">Nuclear waste storage<\/span><\/h3>\n<p>Because of it is corrosion resistance, containers made of titanium have been studied for the long-term storage of nuclear waste. Containers lasting more than 100,000 years are thought possible with manufacturing conditions that minimize material defects.<sup id=\"rdp-ebb-cite_ref-101\" class=\"reference\"><a href=\"#cite_note-101\" rel=\"external_link\">[101]<\/a><\/sup> A titanium \"drip shield\" could also be installed over containers of other types to enhance their longevity.<sup id=\"rdp-ebb-cite_ref-102\" class=\"reference\"><a href=\"#cite_note-102\" rel=\"external_link\">[102]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Bioremediation\">Bioremediation<\/span><\/h2>\n<p>The fungal species <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Marasmius_oreades\" title=\"Marasmius oreades\" rel=\"external_link\" target=\"_blank\">Marasmius oreades<\/a><\/i> and <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypholoma_capnoides\" title=\"Hypholoma capnoides\" rel=\"external_link\" target=\"_blank\">Hypholoma capnoides<\/a><\/i> can bioconvert titanium in titanium polluted soils.<sup id=\"rdp-ebb-cite_ref-103\" class=\"reference\"><a href=\"#cite_note-103\" rel=\"external_link\">[103]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Precautions\">Precautions<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kopiva.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"The dark green dentated elliptic leaves of a nettle\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/13\/Kopiva.JPG\/220px-Kopiva.JPG\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kopiva.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Urtica_dioica\" title=\"Urtica dioica\" rel=\"external_link\" target=\"_blank\">Nettles<\/a> contain up to 80 parts per million of titanium.<\/div><\/div><\/div>\n<p>Titanium is non-toxic even in large doses and does not play any natural role inside the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_body\" title=\"Human body\" rel=\"external_link\" target=\"_blank\">human body<\/a>.<sup id=\"rdp-ebb-cite_ref-Emsley2001p451_23-2\" class=\"reference\"><a href=\"#cite_note-Emsley2001p451-23\" rel=\"external_link\">[23]<\/a><\/sup> An estimated quantity of 0.8 milligrams of titanium is ingested by humans each day, but most passes through without being absorbed in the tissues.<sup id=\"rdp-ebb-cite_ref-Emsley2001p451_23-3\" class=\"reference\"><a href=\"#cite_note-Emsley2001p451-23\" rel=\"external_link\">[23]<\/a><\/sup> It does, however, sometimes <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioaccumulation\" title=\"Bioaccumulation\" rel=\"external_link\" target=\"_blank\">bio-accumulate<\/a> in tissues that contain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silica\" class=\"mw-redirect\" title=\"Silica\" rel=\"external_link\" target=\"_blank\">silica<\/a>. One study indicates a possible connection between titanium and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Yellow_nail_syndrome\" title=\"Yellow nail syndrome\" rel=\"external_link\" target=\"_blank\">yellow nail syndrome<\/a>.<sup id=\"rdp-ebb-cite_ref-104\" class=\"reference\"><a href=\"#cite_note-104\" rel=\"external_link\">[104]<\/a><\/sup> An unknown mechanism in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plant\" title=\"Plant\" rel=\"external_link\" target=\"_blank\">plants<\/a> may use titanium to stimulate the production of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbohydrate\" title=\"Carbohydrate\" rel=\"external_link\" target=\"_blank\">carbohydrates<\/a> and encourage growth. This may explain why most plants contain about 1 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Part_per_million\" class=\"mw-redirect\" title=\"Part per million\" rel=\"external_link\" target=\"_blank\">part per million<\/a> (ppm) of titanium, food plants have about 2 ppm, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Horsetail\" class=\"mw-redirect\" title=\"Horsetail\" rel=\"external_link\" target=\"_blank\">horsetail<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urtica\" title=\"Urtica\" rel=\"external_link\" target=\"_blank\">nettle<\/a> contain up to 80 ppm.<sup id=\"rdp-ebb-cite_ref-Emsley2001p451_23-4\" class=\"reference\"><a href=\"#cite_note-Emsley2001p451-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p><p>As a powder or in the form of metal shavings, titanium metal poses a significant fire hazard and, when heated in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Air\" class=\"mw-redirect\" title=\"Air\" rel=\"external_link\" target=\"_blank\">air<\/a>, an explosion hazard.<sup id=\"rdp-ebb-cite_ref-105\" class=\"reference\"><a href=\"#cite_note-105\" rel=\"external_link\">[105]<\/a><\/sup> Water and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_dioxide\" title=\"Carbon dioxide\" rel=\"external_link\" target=\"_blank\">carbon dioxide<\/a> are ineffective for extinguishing a titanium fire; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fire_classes\" class=\"mw-redirect\" title=\"Fire classes\" rel=\"external_link\" target=\"_blank\">Class D<\/a> dry powder agents must be used instead.<sup id=\"rdp-ebb-cite_ref-HistoryAndUse_8-8\" class=\"reference\"><a href=\"#cite_note-HistoryAndUse-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>When used in the production or handling of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chlorine\" title=\"Chlorine\" rel=\"external_link\" target=\"_blank\">chlorine<\/a>, titanium should not be exposed to dry chlorine gas because it may result in a titanium\u2013chlorine fire.<sup id=\"rdp-ebb-cite_ref-106\" class=\"reference\"><a href=\"#cite_note-106\" rel=\"external_link\">[106]<\/a><\/sup> Even wet chlorine presents a fire hazard when extreme weather conditions cause unexpected drying.\n<\/p><p>Titanium can catch fire when a fresh, non-oxidized surface comes in contact with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liquid_oxygen\" title=\"Liquid oxygen\" rel=\"external_link\" target=\"_blank\">liquid oxygen<\/a>.<sup id=\"rdp-ebb-cite_ref-107\" class=\"reference\"><a href=\"#cite_note-107\" rel=\"external_link\">[107]<\/a><\/sup> Fresh metal may be exposed when the oxidized surface is struck or scratched with a hard object, or when mechanical strain causes a crack. This poses a limitation to its use in liquid oxygen systems, such as those in the aerospace industry. Because titanium tubing impurities can cause fires when exposed to oxygen, titanium is prohibited in gaseous oxygen respiration systems. Steel tubing is used for high pressure systems (3,000 p.s.i.) and aluminium tubing for low pressure systems.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 20em; -webkit-column-width: 20em; column-width: 20em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_countries_by_titanium_production\" title=\"List of countries by titanium production\" rel=\"external_link\" target=\"_blank\">List of countries by titanium production<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Suboxide\" title=\"Suboxide\" rel=\"external_link\" target=\"_blank\">Suboxide<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_in_Africa\" title=\"Titanium in Africa\" rel=\"external_link\" target=\"_blank\">Titanium in Africa<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_alloy\" title=\"Titanium alloy\" rel=\"external_link\" target=\"_blank\">Titanium alloy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_nitride\" title=\"Titanium nitride\" rel=\"external_link\" target=\"_blank\">Titanium coating<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_Man\" title=\"Titanium Man\" rel=\"external_link\" target=\"_blank\">Titanium Man<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_Metals_Corporation\" title=\"Titanium Metals Corporation\" rel=\"external_link\" target=\"_blank\">Titanium Metals Corporation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_ring\" title=\"Titanium ring\" rel=\"external_link\" target=\"_blank\">Titanium ring<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_sublimation_pump\" title=\"Titanium sublimation pump\" rel=\"external_link\" target=\"_blank\">Titanium sublimation pump<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/VSMPO-AVISMA\" title=\"VSMPO-AVISMA\" rel=\"external_link\" target=\"_blank\">VSMPO-AVISMA<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_in_zircon_geothermometry\" title=\"Titanium in zircon geothermometry\" rel=\"external_link\" target=\"_blank\">Titanium in zircon geothermometry<\/a><\/li><\/ul>\n<\/div>\n\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.oxforddictionaries.com\/definition\/titanium\" target=\"_blank\">\"titanium - definition of titanium in English | Oxford Dictionaries\"<\/a>. Oxford University Press. 2017<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-03-28<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=titanium+-+definition+of+titanium+in+English+%7C+Oxford+Dictionaries&rft.pub=Oxford+University+Press&rft.date=2017&rft_id=https%3A%2F%2Fen.oxforddictionaries.com%2Fdefinition%2Ftitanium&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-CIAAW2016-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-CIAAW2016_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Meija, J.; et al. (2016). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.degruyter.com\/downloadpdf\/j\/pac.2016.88.issue-3\/pac-2015-0305\/pac-2015-0305.xml\" target=\"_blank\">\"Atomic weights of the elements 2013 (IUPAC Technical Report)\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pure_and_Applied_Chemistry\" title=\"Pure and Applied Chemistry\" rel=\"external_link\" target=\"_blank\">Pure and Applied Chemistry<\/a><\/i>. <b>88<\/b> (3): 265\u201391. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1515%2Fpac-2015-0305\" target=\"_blank\">10.1515\/pac-2015-0305<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pure+and+Applied+Chemistry&rft.atitle=Atomic+weights+of+the+elements+2013+%28IUPAC+Technical+Report%29&rft.volume=88&rft.issue=3&rft.pages=265-91&rft.date=2016&rft_id=info%3Adoi%2F10.1515%2Fpac-2015-0305&rft.aulast=Meija&rft.aufirst=J.&rft.au=Coplen%2C+T.+B.&rft.au=Berglund%2C+M.&rft.au=Brand%2C+W.A.&rft.au=De+Bi%C3%A8vre%2C+P.&rft.au=Gr%C3%B6ning%2C+M.&rft.au=Holden%2C+N.E.&rft.au=Irrgeher%2C+J.&rft.au=Loss%2C+R.D.&rft.au=Walczyk%2C+T.&rft.au=Prohaska%2C+T.&rft_id=https%3A%2F%2Fwww.degruyter.com%2Fdownloadpdf%2Fj%2Fpac.2016.88.issue-3%2Fpac-2015-0305%2Fpac-2015-0305.xml&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Andersson, N.; et al. (2003). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bernath.uwaterloo.ca\/media\/257.pdf\" target=\"_blank\">\"Emission spectra of TiH and TiD near 938 nm\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>J. Chem. Phys<\/i>. <b>118<\/b>: 10543. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2003JChPh.118.3543A\" target=\"_blank\">2003JChPh.118.3543A<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1063%2F1.1539848\" target=\"_blank\">10.1063\/1.1539848<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J.+Chem.+Phys.&rft.atitle=Emission+spectra+of+TiH+and+TiD+near+938+nm&rft.volume=118&rft.pages=10543&rft.date=2003&rft_id=info%3Adoi%2F10.1063%2F1.1539848&rft_id=info%3Abibcode%2F2003JChPh.118.3543A&rft.au=Andersson%2C+N.&rft_id=http%3A%2F%2Fbernath.uwaterloo.ca%2Fmedia%2F257.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Weast, Robert (1984). <i>CRC, Handbook of Chemistry and Physics<\/i>. Boca Raton, Florida: Chemical Rubber Company Publishing. pp. E110. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-8493-0464-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=CRC%2C+Handbook+of+Chemistry+and+Physics&rft.place=Boca+Raton%2C+Florida&rft.pages=E110&rft.pub=Chemical+Rubber+Company+Publishing&rft.date=1984&rft.isbn=0-8493-0464-4&rft.aulast=Weast&rft.aufirst=Robert&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Andersson, N.; et al. (2003). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bernath.uwaterloo.ca\/media\/257.pdf\" target=\"_blank\">\"Emission spectra of TiH and TiD near 938 nm\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>J. Chem. Phys<\/i>. <b>118<\/b>: 10543. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2003JChPh.118.3543A\" target=\"_blank\">2003JChPh.118.3543A<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1063%2F1.1539848\" target=\"_blank\">10.1063\/1.1539848<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J.+Chem.+Phys.&rft.atitle=Emission+spectra+of+TiH+and+TiD+near+938+nm&rft.volume=118&rft.pages=10543&rft.date=2003&rft_id=info%3Adoi%2F10.1063%2F1.1539848&rft_id=info%3Abibcode%2F2003JChPh.118.3543A&rft.au=Andersson%2C+N.&rft_id=http%3A%2F%2Fbernath.uwaterloo.ca%2Fmedia%2F257.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-EBC-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-EBC_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EBC_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EBC_6-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EBC_6-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EBC_6-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EBC_6-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EBC_6-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EBC_6-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EBC_6-8\" rel=\"external_link\"><sup><i><b>i<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation encyclopaedia\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.britannica.com\/eb\/article-9072643\/titanium\" target=\"_blank\">\"Titanium\"<\/a>. <i>Encyclop\u00e6dia Britannica<\/i>. 2006<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">29 December<\/span> 2006<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Titanium&rft.btitle=Encyclop%C3%A6dia+Britannica&rft.date=2006&rft_id=http%3A%2F%2Fwww.britannica.com%2Feb%2Farticle-9072643%2Ftitanium&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-LANL-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-LANL_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-LANL_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-LANL_7-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-LANL_7-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-LANL_7-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-LANL_7-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-LANL_7-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-LANL_7-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-LANL_7-8\" rel=\"external_link\"><sup><i><b>i<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-LANL_7-9\" rel=\"external_link\"><sup><i><b>j<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-LANL_7-10\" rel=\"external_link\"><sup><i><b>k<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-LANL_7-11\" rel=\"external_link\"><sup><i><b>l<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-LANL_7-12\" rel=\"external_link\"><sup><i><b>m<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Lide, D. R., ed. (2005). <i>CRC Handbook of Chemistry and Physics<\/i> (86th ed.). Boca Raton (FL): CRC Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-8493-0486-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=CRC+Handbook+of+Chemistry+and+Physics&rft.place=Boca+Raton+%28FL%29&rft.edition=86th&rft.pub=CRC+Press&rft.date=2005&rft.isbn=0-8493-0486-5&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-HistoryAndUse-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-HistoryAndUse_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HistoryAndUse_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HistoryAndUse_8-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HistoryAndUse_8-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HistoryAndUse_8-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HistoryAndUse_8-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HistoryAndUse_8-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HistoryAndUse_8-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HistoryAndUse_8-8\" rel=\"external_link\"><sup><i><b>i<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Krebs, Robert E. (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=yb9xTj72vNAC\" target=\"_blank\"><i>The History and Use of Our Earth's Chemical Elements: A Reference Guide<\/i><\/a> (2nd ed.). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Westport,_CT\" class=\"mw-redirect\" title=\"Westport, CT\" rel=\"external_link\" target=\"_blank\">Westport, CT<\/a>: Greenwood Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-313-33438-2.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+History+and+Use+of+Our+Earth%27s+Chemical+Elements%3A+A+Reference+Guide&rft.place=Westport%2C+CT&rft.edition=2nd&rft.pub=Greenwood+Press&rft.date=2006&rft.isbn=978-0-313-33438-2&rft.aulast=Krebs&rft.aufirst=Robert+E.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Dyb9xTj72vNAC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"#CITEREFDonachie1988\" rel=\"external_link\">Donachie 1988<\/a>, p. 11<\/span>\n<\/li>\n<li id=\"cite_note-Barksdale1968p738-10\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Barksdale1968p738_10-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Barksdale1968p738_10-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a href=\"#CITEREFBarksdale1968\" rel=\"external_link\">Barksdale 1968<\/a>, p. 738<\/span>\n<\/li>\n<li id=\"cite_note-TICE6th-11\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-TICE6th_11-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-TICE6th_11-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-TICE6th_11-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-TICE6th_11-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-TICE6th_11-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-TICE6th_11-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation encyclopaedia\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20111118151229\/http:\/\/www.answers.com\/Titanium\" target=\"_blank\">\"Titanium\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Columbia_Encyclopedia\" title=\"Columbia Encyclopedia\" rel=\"external_link\" target=\"_blank\">Columbia Encyclopedia<\/a><\/i> (6th ed.). New York: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Columbia_University_Press\" title=\"Columbia University Press\" rel=\"external_link\" target=\"_blank\">Columbia University Press<\/a>. 2000\u20132006. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-7876-5015-5. Archived from the original on 18 November 2011.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Titanium&rft.btitle=Columbia+Encyclopedia&rft.place=New+York&rft.edition=6th&rft.pub=Columbia+University+Press&rft.date=2000%2F2006&rft.isbn=978-0-7876-5015-5&rft_id=http%3A%2F%2Fwww.answers.com%2FTitanium&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: BOT: original-url status unknown (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_BOT:_original-url_status_unknown\" title=\"Category:CS1 maint: BOT: original-url status unknown\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-EnvChem-12\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-EnvChem_12-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EnvChem_12-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-EnvChem_12-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Barbalace, Kenneth L. (2006). <a rel=\"external_link\" class=\"external text\" href=\"#Nuclides\">\"Periodic Table of Elements: Ti \u2013 Titanium\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 December<\/span> 2006<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Periodic+Table+of+Elements%3A+Ti+%E2%80%93+Titanium&rft.date=2006&rft.au=Barbalace%2C+Kenneth+L.&rft_id=http%3A%2F%2Fenvironmentalchemistry.com%2Fyogi%2Fperiodic%2FTi-pg2.html%23Nuclides&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Stwertka1998-13\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Stwertka1998_13-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Stwertka1998_13-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Stwertka1998_13-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Stwertka1998_13-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Stwertka1998_13-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Stwertka, Albert (1998). \"Titanium\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=K3RWAAAAYAAJ\" target=\"_blank\"><i>Guide to the Elements<\/i><\/a> (Revised ed.). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxford_University_Press\" title=\"Oxford University Press\" rel=\"external_link\" target=\"_blank\">Oxford University Press<\/a>. pp. 81\u201382. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-19-508083-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Titanium&rft.btitle=Guide+to+the+Elements&rft.pages=81-82&rft.edition=Revised&rft.pub=Oxford+University+Press&rft.date=1998&rft.isbn=978-0-19-508083-4&rft.aulast=Stwertka&rft.aufirst=Albert&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DK3RWAAAAYAAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"#CITEREFDonachie1988\" rel=\"external_link\">Donachie 1988<\/a>, Appendix J, Table J.2<\/span>\n<\/li>\n<li id=\"cite_note-Barksdale1968p734-15\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Barksdale1968p734_15-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Barksdale1968p734_15-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Barksdale1968p734_15-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Barksdale1968p734_15-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Barksdale1968p734_15-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a href=\"#CITEREFBarksdale1968\" rel=\"external_link\">Barksdale 1968<\/a>, p. 734<\/span>\n<\/li>\n<li id=\"cite_note-medusa-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-medusa_16-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Puigdomenech, Ignasi (2004) <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130605034847\/http:\/\/www.kth.se\/che\/medusa\" target=\"_blank\"><i>Hydra\/Medusa Chemical Equilibrium Database and Plotting Software<\/i><\/a>, KTH Royal Institute of Technology.<\/span>\n<\/li>\n<li id=\"cite_note-Emsley2001p453-17\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Emsley2001p453_17-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Emsley2001p453_17-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Emsley2001p453_17-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Emsley2001p453_17-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Emsley2001p453_17-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a href=\"#CITEREFEmsley2001\" rel=\"external_link\">Emsley 2001<\/a>, p. 453<\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Casillas, N.; Charlebois, S.; Smyrl, W. H.; White, H. S. (1994). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.dtic.mil\/get-tr-doc\/pdf?AD=ADA274980\" target=\"_blank\">\"Pitting Corrosion of Titanium\"<\/a>. <i>J. Electrochem. Soc<\/i>. <b>141<\/b> (3): 636\u2013642. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1149%2F1.2054783\" target=\"_blank\">10.1149\/1.2054783<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J.+Electrochem.+Soc.&rft.atitle=Pitting+Corrosion+of+Titanium&rft.volume=141&rft.issue=3&rft.pages=636-642&rft.date=1994&rft_id=info%3Adoi%2F10.1149%2F1.2054783&rft.au=Casillas%2C+N.&rft.au=Charlebois%2C+S.&rft.au=Smyrl%2C+W.+H.&rft.au=White%2C+H.+S.&rft_id=http%3A%2F%2Fwww.dtic.mil%2Fget-tr-doc%2Fpdf%3FAD%3DADA274980&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-titaniumindustry-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-titaniumindustry_19-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Forrest, A. L. (1981). \"Effects of Metal Chemistry on Behavior of Titanium in Industrial Applications\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=0Adr4zleybgC&pg=PA112\" target=\"_blank\"><i>Industrial Applications of Titanium and Zirconium<\/i><\/a>. p. 112.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Effects+of+Metal+Chemistry+on+Behavior+of+Titanium+in+Industrial+Applications&rft.btitle=Industrial+Applications+of+Titanium+and+Zirconium&rft.pages=112&rft.date=1981&rft.aulast=Forrest&rft.aufirst=A.+L.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D0Adr4zleybgC%26pg%3DPA112&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-USGS-20\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-USGS_20-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-USGS_20-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-USGS_20-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-USGS_20-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Geological_Survey\" title=\"United States Geological Survey\" rel=\"external_link\" target=\"_blank\">United States Geological Survey<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/minerals.usgs.gov\/minerals\/pubs\/commodity\/titanium\/\" target=\"_blank\">\"USGS Minerals Information: Titanium\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=USGS+Minerals+Information%3A+Titanium&rft.au=United+States+Geological+Survey&rft_id=http%3A%2F%2Fminerals.usgs.gov%2Fminerals%2Fpubs%2Fcommodity%2Ftitanium%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Barksdale1968p732-21\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Barksdale1968p732_21-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Barksdale1968p732_21-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Barksdale1968p732_21-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a href=\"#CITEREFBarksdale1968\" rel=\"external_link\">Barksdale 1968<\/a>, p. 732<\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Buettner, K. M.; Valentine, A. M. (2012). \"Bioinorganic Chemistry of Titanium\". <i>Chemical Reviews<\/i>. <b>112<\/b> (3): 1863. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1021%2Fcr1002886\" target=\"_blank\">10.1021\/cr1002886<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22074443\" target=\"_blank\">22074443<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Chemical+Reviews&rft.atitle=Bioinorganic+Chemistry+of+Titanium&rft.volume=112&rft.issue=3&rft.pages=1863&rft.date=2012&rft_id=info%3Adoi%2F10.1021%2Fcr1002886&rft_id=info%3Apmid%2F22074443&rft.aulast=Buettner&rft.aufirst=K.+M.&rft.au=Valentine%2C+A.+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Emsley2001p451-23\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Emsley2001p451_23-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Emsley2001p451_23-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Emsley2001p451_23-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Emsley2001p451_23-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Emsley2001p451_23-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a href=\"#CITEREFEmsley2001\" rel=\"external_link\">Emsley 2001<\/a>, p. 451<\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mindat.org\/min-7339.html\" target=\"_blank\">Titanium<\/a>. Mindat<\/span>\n<\/li>\n<li id=\"cite_note-Greenwood1997p958-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Greenwood1997p958_25-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"#CITEREFGreenwood1997\" rel=\"external_link\">Greenwood 1997<\/a>, p. 958<\/span>\n<\/li>\n<li id=\"cite_note-Greenwood1997p970-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Greenwood1997p970_26-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"#CITEREFGreenwood1997\" rel=\"external_link\">Greenwood 1997<\/a>, p. 970<\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Liu, Gang; Huang, Wan-Xia; Yi, Yong (26 June 2013). \"Preparation and Optical Storage Properties of \u03bbTi<sub>3<\/sub>O<sub>5<\/sub> Powder\". <i>Journal of Inorganic Materials<\/i> (in Chinese). <b>28<\/b> (4): 425\u2013430. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3724%2FSP.J.1077.2013.12309\" target=\"_blank\">10.3724\/SP.J.1077.2013.12309<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Inorganic+Materials&rft.atitle=Preparation+and+Optical+Storage+Properties+of+%CE%BBTi%3Csub%3E3%3C%2Fsub%3EO%3Csub%3E5%3C%2Fsub%3E+Powder&rft.volume=28&rft.issue=4&rft.pages=425-430&rft.date=2013-06-26&rft_id=info%3Adoi%2F10.3724%2FSP.J.1077.2013.12309&rft.aulast=Liu&rft.aufirst=Gang&rft.au=Huang%2C+Wan-Xia&rft.au=Yi%2C+Yong&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bonardi, Antonio; P\u00fchlhofer, Gerd; Hermanutz, Stephan; Santangelo, Andrea (2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/arxiv.org\/pdf\/1406.0622\" target=\"_blank\">\"A new solution for mirror coating in $\u03b3$-ray Cherenkov Astronomy\"<\/a> <span class=\"cs1-format\">(Submitted manuscript)<\/span>. <i>Experimental Astronomy<\/i>. <b>38<\/b>: 1\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/ArXiv\" title=\"ArXiv\" rel=\"external_link\" target=\"_blank\">arXiv<\/a>:<span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/arxiv.org\/abs\/1406.0622\" target=\"_blank\">1406.0622<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2014ExA....38....1B\" target=\"_blank\">2014ExA....38....1B<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs10686-014-9398-x\" target=\"_blank\">10.1007\/s10686-014-9398-x<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Experimental+Astronomy&rft.atitle=A+new+solution+for+mirror+coating+in+%24%CE%B3%24-ray+Cherenkov+Astronomy&rft.volume=38&rft.pages=1-9&rft.date=2014&rft_id=info%3Aarxiv%2F1406.0622&rft_id=info%3Adoi%2F10.1007%2Fs10686-014-9398-x&rft_id=info%3Abibcode%2F2014ExA....38....1B&rft.aulast=Bonardi&rft.aufirst=Antonio&rft.au=P%C3%BChlhofer%2C+Gerd&rft.au=Hermanutz%2C+Stephan&rft.au=Santangelo%2C+Andrea&rft_id=https%3A%2F%2Farxiv.org%2Fpdf%2F1406.0622&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Norman_Greenwood\" title=\"Norman Greenwood\" rel=\"external_link\" target=\"_blank\">Greenwood, Norman N.<\/a>; Earnshaw, Alan (1997). <i>Chemistry of the Elements<\/i> (2nd ed.). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Butterworth-Heinemann\" title=\"Butterworth-Heinemann\" rel=\"external_link\" target=\"_blank\">Butterworth-Heinemann<\/a>. p. 962. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-08-037941-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Chemistry+of+the+Elements&rft.pages=962&rft.edition=2nd&rft.pub=Butterworth-Heinemann&rft.date=1997&rft.isbn=0-08-037941-9&rft.aulast=Greenwood&rft.aufirst=Norman++N.&rft.au=Earnshaw%2C+Alan&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Saha, Naresh (1992). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/aip.scitation.org\/doi\/pdf\/10.1063\/1.351465\" target=\"_blank\">\"Titanium nitride oxidation chemistry: An x-ray photoelectron spectroscopy study\"<\/a>. <i>Journal of Applied Physics<\/i>. no. 7 (7): 3072\u20133079. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/1992JAP....72.3072S\" target=\"_blank\">1992JAP....72.3072S<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1063%2F1.351465\" target=\"_blank\">10.1063\/1.351465<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Applied+Physics&rft.atitle=Titanium+nitride+oxidation+chemistry%3A+An+x-ray+photoelectron+spectroscopy+study&rft.volume=no.+7&rft.issue=7&rft.pages=3072-3079&rft.date=1992&rft_id=info%3Adoi%2F10.1063%2F1.351465&rft_id=info%3Abibcode%2F1992JAP....72.3072S&rft.aulast=Saha&rft.aufirst=Naresh&rft_id=http%3A%2F%2Faip.scitation.org%2Fdoi%2Fpdf%2F10.1063%2F1.351465&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Schubert, E.F. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100603075632\/http:\/\/www.rpi.edu\/~schubert\/Educational-resources\/Materials-Hardness.pdf\" target=\"_blank\">\"The hardness scale introduced by Friederich Mohs\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Archived from the original on 3 June 2010.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=The+hardness+scale+introduced+by+Friederich+Mohs&rft.au=Schubert%2C+E.F.&rft_id=http%3A%2F%2Fwww.rpi.edu%2F~schubert%2FEducational-resources%2FMaterials-Hardness.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: BOT: original-url status unknown (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_BOT:_original-url_status_unknown\" title=\"Category:CS1 maint: BOT: original-url status unknown\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Truini, Joseph (May 1988). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=Z-QDAAAAMBAJ&printsec=frontcover\" target=\"_blank\">\"Drill Bits\"<\/a>. <i>Popular Mechanics<\/i>. <b>165<\/b> (5): 91. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0032-4558\" target=\"_blank\">0032-4558<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Popular+Mechanics&rft.atitle=Drill+Bits&rft.volume=165&rft.issue=5&rft.pages=91&rft.date=1988-05&rft.issn=0032-4558&rft.aulast=Truini&rft.aufirst=Joseph&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3DZ-QDAAAAMBAJ%26printsec%3Dfrontcover&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Baliga, B. Jayant (2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=LNLVwAzhN7EC&printsec=frontcover\" target=\"_blank\"><i>Silicon carbide power devices<\/i><\/a>. World Scientific. p. 91. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-981-256-605-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Silicon+carbide+power+devices&rft.pages=91&rft.pub=World+Scientific&rft.date=2005&rft.isbn=978-981-256-605-8&rft.aulast=Baliga&rft.aufirst=B.+Jayant&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3DLNLVwAzhN7EC%26printsec%3Dfrontcover&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hcstarck.com\/titanium_carbide_tic\" target=\"_blank\">\"Titanium carbide product information\"<\/a>. H. C. Starck<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">16 November<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Titanium+carbide+product+information&rft.pub=H.+C.+Starck&rft_id=http%3A%2F%2Fwww.hcstarck.com%2Ftitanium_carbide_tic&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Seong, S.; et al. (2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=tIPFfYW304IC&pg=PA10\" target=\"_blank\"><i>Titanium: industrial base, price trends, and technology initiatives<\/i><\/a>. Rand Corporation. p. 10. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-8330-4575-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Titanium%3A+industrial+base%2C+price+trends%2C+and+technology+initiatives&rft.pages=10&rft.pub=Rand+Corporation&rft.date=2009&rft.isbn=978-0-8330-4575-1&rft.au=Seong%2C+S.&rft.au=Younossi%2C+O.&rft.au=Goldsmith%2C+B.+W.&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3DtIPFfYW304IC%26pg%3DPA10&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Johnson, Richard W. (1998). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=JBTlucgGdegC\" target=\"_blank\"><i>The Handbook of Fluid Dynamics<\/i><\/a>. Springer. pp. 38\u201321. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-540-64612-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Handbook+of+Fluid+Dynamics&rft.pages=38-21&rft.pub=Springer&rft.date=1998&rft.isbn=978-3-540-64612-9&rft.aulast=Johnson&rft.aufirst=Richard+W.&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3DJBTlucgGdegC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Coates, Robert M.; Paquette, Leo A. (2000). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=xxYjJgupBSMC\" target=\"_blank\"><i>Handbook of Reagents for Organic Synthesis<\/i><\/a>. John Wiley and Sons. p. 93. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-470-85625-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Handbook+of+Reagents+for+Organic+Synthesis&rft.pages=93&rft.pub=John+Wiley+and+Sons&rft.date=2000&rft.isbn=978-0-470-85625-3&rft.aulast=Coates&rft.aufirst=Robert+M.&rft.au=Paquette%2C+Leo+A.&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3DxxYjJgupBSMC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-38\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-38\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/John_F._Hartwig\" title=\"John F. Hartwig\" rel=\"external_link\" target=\"_blank\">Hartwig, J. F.<\/a> (2010) <i>Organotransition Metal Chemistry, from Bonding to Catalysis<\/i>. University Science Books: New York. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 189138953X<\/span>\n<\/li>\n<li id=\"cite_note-39\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-39\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Tshuva, Edit Y.; Miller, Maya (2018). \"Chapter 8. Coordination Complexes of Titanium(IV) for Anticancer Therapy\". In Sigel, Astrid; Sigel, Helmut; Freisinger, Eva; Sigel, Roland K. O. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=4nBLDwAAQBAJ\" target=\"_blank\"><i>Metallo-Drugs: Development and Action of Anticancer Agents<\/i><\/a>. <b>18<\/b>. Berlin: de Gruyter GmbH. pp. 219\u2013250. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1515%2F9783110470734-014\" target=\"_blank\">10.1515\/9783110470734-014<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9783110470734.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+8.+Coordination+Complexes+of+Titanium%28IV%29+for+Anticancer+Therapy&rft.btitle=Metallo-Drugs%3A+Development+and+Action+of+Anticancer+Agents&rft.place=Berlin&rft.pages=219-250&rft.pub=de+Gruyter+GmbH&rft.date=2018&rft_id=info%3Adoi%2F10.1515%2F9783110470734-014&rft.isbn=9783110470734&rft.aulast=Tshuva&rft.aufirst=Edit+Y.&rft.au=Miller%2C+Maya&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D4nBLDwAAQBAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Emsley2001p452-40\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Emsley2001p452_40-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Emsley2001p452_40-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Emsley2001p452_40-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Emsley2001p452_40-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Emsley2001p452_40-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Emsley2001p452_40-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Emsley2001p452_40-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Emsley2001p452_40-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a href=\"#CITEREFEmsley2001\" rel=\"external_link\">Emsley 2001<\/a>, p. 452<\/span>\n<\/li>\n<li id=\"cite_note-41\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-41\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Gregor, William (1791) \"Beobachtungen und Versuche \u00fcber den Menakanit, einen in Cornwall gefundenen magnetischen Sand\" (Observations and experiments regarding menaccanite [i.e., ilmenite], a magnetic sand found in Cornwall), <i>Chemische Annalen<\/i> \u2026, <b>1<\/b>, <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=false\">pp. 40\u201354<\/a>, <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=false\">103\u2013119.<\/a><\/span>\n<\/li>\n<li id=\"cite_note-42\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-42\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Gregor, William (1791) \"Sur le menakanite, esp\u00e8ce de sable attirable par l'aimant, trouv\u00e9 dans la province de Cornouilles\" (On menaccanite, a species of magnetic sand, found in the county of Cornwall), <i>Observations et M\u00e9moires sur la Physique<\/i>, <b>39<\/b>: <a rel=\"external_link\" class=\"external text\" href=\"#page\/n77\/mode\/1up\">72\u201378<\/a>, <a rel=\"external_link\" class=\"external text\" href=\"#page\/n159\/mode\/1up\">152\u2013160.<\/a><\/span>\n<\/li>\n<li id=\"cite_note-43\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-43\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Klaproth, Martin Heinrich (1795) <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=false\">\"Chemische Untersuchung des sogenannten hungarischen rothen Sch\u00f6rls\"<\/a> (Chemical investigation of the so-called Hungarian red tourmaline [rutile]) in: <i>Beitr\u00e4ge zur chemischen Kenntniss der Mineralk\u00f6rper<\/i> (Contributions to the chemical knowledge of mineral substances), vol. 1, (Berlin, (Germany): Heinrich August Rottmann, 233\u2013244. From page 244: <i>\"Diesem zufolge will ich den Namen f\u00fcr die gegenw\u00e4rtige metallische Substanz, gleichergestalt wie bei dem Uranium geschehen, aus der Mythologie, und zwar von den Urs\u00f6hnen der Erde, den Titanen, entlehnen, und benenne also diese neue Metallgeschlecht: Titanium; \u2026 \"<\/i> (By virtue of this I will derive the name for the present metallic substance \u2014 as happened similarly in the case of uranium \u2014 from mythology, namely from the first sons of the Earth, the Titans, and thus [I] name this new species of metal: \"titanium\"; \u2026 )<\/span>\n<\/li>\n<li id=\"cite_note-Roza2008p9-44\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Roza2008p9_44-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Roza2008p9_44-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Roza2008p9_44-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a href=\"#CITEREFRoza2008\" rel=\"external_link\">Roza 2008<\/a>, p. 9<\/span>\n<\/li>\n<li id=\"cite_note-Greenwood1997p955-45\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Greenwood1997p955_45-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Greenwood1997p955_45-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a href=\"#CITEREFGreenwood1997\" rel=\"external_link\">Greenwood 1997<\/a>, p. 955<\/span>\n<\/li>\n<li id=\"cite_note-46\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-46\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Anton_Eduard_van_Arkel\" title=\"Anton Eduard van Arkel\" rel=\"external_link\" target=\"_blank\">van Arkel, A. E.<\/a>; de Boer, J. H. (1925). \"Preparation of pure titanium, zirconium, hafnium, and thorium metal\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Zeitschrift_f%C3%BCr_anorganische_und_allgemeine_Chemie\" title=\"Zeitschrift f\u00fcr anorganische und allgemeine Chemie\" rel=\"external_link\" target=\"_blank\">Zeitschrift f\u00fcr anorganische und allgemeine Chemie<\/a><\/i>. <b>148<\/b>: 345\u201350. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fzaac.19251480133\" target=\"_blank\">10.1002\/zaac.19251480133<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Zeitschrift+f%C3%BCr+anorganische+und+allgemeine+Chemie&rft.atitle=Preparation+of+pure+titanium%2C+zirconium%2C+hafnium%2C+and+thorium+metal&rft.volume=148&rft.pages=345-50&rft.date=1925&rft_id=info%3Adoi%2F10.1002%2Fzaac.19251480133&rft.aulast=van+Arkel&rft.aufirst=A.+E.&rft.au=de+Boer%2C+J.+H.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-47\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-47\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Yanko, Eugene; Omsk VTTV Arms Exhibition and Military Parade JSC (2006). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/warfare.be\/?lang=&linkid=1756&catid=243\" target=\"_blank\">\"Submarines: general information\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2 February<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Submarines%3A+general+information&rft.date=2006&rft.aulast=Yanko&rft.aufirst=Eugene&rft.au=Omsk+VTTV+Arms+Exhibition+and+Military+Parade+JSC&rft_id=http%3A%2F%2Fwarfare.be%2F%3Flang%3D%26linkid%3D1756%26catid%3D243&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-48\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-48\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Stainless Steel World (July\u2013August 2001). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.stainless-steel-world.net\/pdf\/ssw0107.pdf?issueID=30\" target=\"_blank\">\"VSMPO Stronger Than Ever\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. KCI Publishing B.V. pp. 16\u201319<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2 January<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=VSMPO+Stronger+Than+Ever&rft.pages=16-19&rft.date=2001-07%2F2001-08&rft.au=Stainless+Steel+World&rft_id=http%3A%2F%2Fwww.stainless-steel-world.net%2Fpdf%2Fssw0107.pdf%3FissueID%3D30&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-49\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-49\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">National Materials Advisory Board, Commission on Engineering and Technical Systems (CETS), National Research Council (1983). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/books.nap.edu\/openbook.php?record_id=1712&page=R1\" target=\"_blank\"><i>Titanium: Past, Present, and Future<\/i><\/a>. Washington, D.C.: national Academy Press. p. R9. NMAB-392.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Titanium%3A+Past%2C+Present%2C+and+Future&rft.place=Washington%2C+D.C.&rft.pages=R9&rft.pub=national+Academy+Press&rft.date=1983&rft.au=National+Materials+Advisory+Board%2C+Commission+on+Engineering+and+Technical+Systems+%28CETS%29%2C+National+Research+Council&rft_id=http%3A%2F%2Fbooks.nap.edu%2Fopenbook.php%3Frecord_id%3D1712%26page%3DR1&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-50\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-50\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.answers.com\/topic\/titanium-metals-corporation\" target=\"_blank\">\"Titanium Metals Corporation. Answers.com. Encyclopedia of Company Histories\"<\/a>. Answers Corporation. 2006<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2 January<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Titanium+Metals+Corporation.+Answers.com.+Encyclopedia+of+Company+Histories&rft.pub=Answers+Corporation&rft.date=2006&rft_id=http%3A%2F%2Fwww.answers.com%2Ftopic%2Ftitanium-metals-corporation&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-51\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-51\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Defense_National_Stockpile_Center\" title=\"Defense National Stockpile Center\" rel=\"external_link\" target=\"_blank\">Defense National Stockpile Center<\/a> (2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100211093359\/https:\/\/www.dnsc.dla.mil\/Uploads\/Materials\/esolomon_5-21-2009_13-29-4_2008OpsReport.pdf\" target=\"_blank\"><i>Strategic and Critical Materials Report to the Congress. Operations under the Strategic and Critical Materials Stock Piling Act during the Period October 2007 through September 2008<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Department_of_Defense\" title=\"United States Department of Defense\" rel=\"external_link\" target=\"_blank\">United States Department of Defense<\/a>. p. 3304. Archived from the original on 11 February 2010.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Strategic+and+Critical+Materials+Report+to+the+Congress.+Operations+under+the+Strategic+and+Critical+Materials+Stock+Piling+Act+during+the+Period+October+2007+through+September+2008&rft.pages=3304&rft.pub=United+States+Department+of+Defense&rft.date=2008&rft.au=Defense+National+Stockpile+Center&rft_id=https%3A%2F%2Fwww.dnsc.dla.mil%2FUploads%2FMaterials%2Fesolomon_5-21-2009_13-29-4_2008OpsReport.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: BOT: original-url status unknown (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_BOT:_original-url_status_unknown\" title=\"Category:CS1 maint: BOT: original-url status unknown\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-52\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-52\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Bush, Jason (15 February 2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090409221829\/http:\/\/www.businessweek.com\/technology\/content\/feb2006\/tc20060215_694672.htm?campaign_id=search\" target=\"_blank\">\"Boeing's Plan to Land Aeroflot\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/BusinessWeek\" class=\"mw-redirect\" title=\"BusinessWeek\" rel=\"external_link\" target=\"_blank\">BusinessWeek<\/a><\/i>. Archived from the original on 9 April 2009<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">29 December<\/span> 2006<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BusinessWeek&rft.atitle=Boeing%27s+Plan+to+Land+Aeroflot&rft.date=2006-02-15&rft.aulast=Bush&rft.aufirst=Jason&rft_id=http%3A%2F%2Fwww.businessweek.com%2Ftechnology%2Fcontent%2Ffeb2006%2Ftc20060215_694672.htm%3Fcampaign_id%3Dsearch&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Unfit url (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Unfit_url\" title=\"Category:CS1 maint: Unfit url\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-53\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-53\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.prnewswire.com\/news-releases\/roskill-information-services-global-supply-of-titanium-is-forecast-to-increase-105243193.html\" target=\"_blank\">\"Roskill Information Services: Global Supply of Titanium is Forecast to Increase\"<\/a>, Titanium Metal: Market Outlook to 2015 (5th edition, 2010).<\/span>\n<\/li>\n<li id=\"cite_note-54\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-54\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/articles.economictimes.indiatimes.com\/2015-08-10\/news\/65415517_1_kmml-isro-indian-space-research-organisation\" target=\"_blank\">\"ISRO's titanium sponge plant in Kerala fully commissioned\"<\/a>. <i>timesofindia-economictimes<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-11-08<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=timesofindia-economictimes&rft.atitle=ISRO%27s+titanium+sponge+plant+in+Kerala+fully+commissioned&rft_id=http%3A%2F%2Farticles.economictimes.indiatimes.com%2F2015-08-10%2Fnews%2F65415517_1_kmml-isro-indian-space-research-organisation&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-55\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-55\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation pressrelease\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/DuPont\" title=\"DuPont\" rel=\"external_link\" target=\"_blank\">DuPont<\/a> (12 September 2006). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.prnewswire.com\/news-releases\/us-defense-agency-awards-57-million-to-dupont-and-mer-corporation-for-new-titanium-metal-powder-process-56045122.html\" target=\"_blank\">\"U.S. Defense Agency Awards $5.7 Million to DuPont and MER Corporation for New Titanium Metal Powder Process\"<\/a> (Press release)<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">1 August<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=U.S.+Defense+Agency+Awards+%245.7+Million+to+DuPont+and+MER+Corporation+for+New+Titanium+Metal+Powder+Process&rft.date=2006-09-12&rft.au=DuPont&rft_id=http%3A%2F%2Fwww.prnewswire.com%2Fnews-releases%2Fus-defense-agency-awards-57-million-to-dupont-and-mer-corporation-for-new-titanium-metal-powder-process-56045122.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-56\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-56\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"#CITEREFDonachie1988\" rel=\"external_link\">Donachie 1988<\/a>, Ch. 4<\/span>\n<\/li>\n<li id=\"cite_note-Barksdale1968p733-57\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Barksdale1968p733_57-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"#CITEREFBarksdale1968\" rel=\"external_link\">Barksdale 1968<\/a>, p. 733<\/span>\n<\/li>\n<li id=\"cite_note-58\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-58\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chen, George Zheng; Fray, Derek J.; Farthing, Tom W. (2000). \"Direct electrochemical reduction of titanium dioxide to titanium in molten calcium chloride\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nature_(journal)\" title=\"Nature (journal)\" rel=\"external_link\" target=\"_blank\">Nature<\/a><\/i>. <b>407<\/b> (6802): 361\u2013364. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2000Natur.407..361C\" target=\"_blank\">2000Natur.407..361C<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2F35030069\" target=\"_blank\">10.1038\/35030069<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11014188\" target=\"_blank\">11014188<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature&rft.atitle=Direct+electrochemical+reduction+of+titanium+dioxide+to+titanium+in+molten+calcium+chloride&rft.volume=407&rft.issue=6802&rft.pages=361-364&rft.date=2000&rft_id=info%3Apmid%2F11014188&rft_id=info%3Adoi%2F10.1038%2F35030069&rft_id=info%3Abibcode%2F2000Natur.407..361C&rft.aulast=Chen&rft.aufirst=George+Zheng&rft.au=Fray%2C+Derek+J.&rft.au=Farthing%2C+Tom+W.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Roza2008p23-59\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Roza2008p23_59-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"#CITEREFRoza2008\" rel=\"external_link\">Roza 2008<\/a>, p. 23<\/span>\n<\/li>\n<li id=\"cite_note-TI_Encarta2005-60\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-TI_Encarta2005_60-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation encyclopaedia\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20061027112633\/http:\/\/encarta.msn.com\/encyclopedia_761569280\/Titanium.html\" target=\"_blank\">\"Titanium\"<\/a>. <i>Microsoft Encarta<\/i>. 2005. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/encarta.msn.com\/encyclopedia_761569280\/Titanium.html\" target=\"_blank\">the original<\/a> on 27 October 2006<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">29 December<\/span> 2006<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Titanium&rft.btitle=Microsoft+Encarta&rft.date=2005&rft_id=http%3A%2F%2Fencarta.msn.com%2Fencyclopedia_761569280%2FTitanium.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-61\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-61\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"#CITEREFDonachie1988\" rel=\"external_link\">Donachie 1988<\/a>, p. 16, Appendix J<\/span>\n<\/li>\n<li id=\"cite_note-62\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-62\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/ASTM_International\" title=\"ASTM International\" rel=\"external_link\" target=\"_blank\">ASTM International<\/a> (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=yCGIPQAACAAJ\" target=\"_blank\"><i>Annual Book of ASTM Standards (Volume 02.04: Non-ferrous Metals)<\/i><\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/West_Conshohocken,_PA\" class=\"mw-redirect\" title=\"West Conshohocken, PA\" rel=\"external_link\" target=\"_blank\">West Conshohocken, PA<\/a>: ASTM International. section 2. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-8031-4086-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Annual+Book+of+ASTM+Standards+%28Volume+02.04%3A+Non-ferrous+Metals%29&rft.place=West+Conshohocken%2C+PA&rft.pages=section+2&rft.pub=ASTM+International&rft.date=2006&rft.isbn=978-0-8031-4086-8&rft.au=ASTM+International&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DyCGIPQAACAAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> <cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/ASTM_International\" title=\"ASTM International\" rel=\"external_link\" target=\"_blank\">ASTM International<\/a> (1998). <i>Annual Book of ASTM Standards (Volume 13.01: Medical Devices; Emergency Medical Services)<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/West_Conshohocken,_PA\" class=\"mw-redirect\" title=\"West Conshohocken, PA\" rel=\"external_link\" target=\"_blank\">West Conshohocken, PA<\/a>: ASTM International. sections 2 & 13. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-8031-2452-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Annual+Book+of+ASTM+Standards+%28Volume+13.01%3A+Medical+Devices%3B+Emergency+Medical+Services%29&rft.place=West+Conshohocken%2C+PA&rft.pages=sections+2+%26+13&rft.pub=ASTM+International&rft.date=1998&rft.isbn=978-0-8031-2452-3&rft.au=ASTM+International&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-63\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-63\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"#CITEREFDonachie1988\" rel=\"external_link\">Donachie 1988<\/a>, pp. 13\u201316, Appendices H and J<\/span>\n<\/li>\n<li id=\"cite_note-Roza2008p25-64\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Roza2008p25_64-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"#CITEREFRoza2008\" rel=\"external_link\">Roza 2008<\/a>, p. 25<\/span>\n<\/li>\n<li id=\"cite_note-ECI_online-65\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ECI_online_65-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.essentialchemicalindustry.org\/metals\/titanium.html\" target=\"_blank\">\"Titanium\"<\/a>. <i>The Essential Chemical Industry online<\/i>. York, UK: CIEC Promoting Science at the University of York. 15 January 2015.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=The+Essential+Chemical+Industry+online&rft.atitle=Titanium&rft.date=2015-01-15&rft_id=http%3A%2F%2Fwww.essentialchemicalindustry.org%2Fmetals%2Ftitanium.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-66\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-66\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20101210022045\/http:\/\/pdfcast.org\/pdf\/titanium-design-and-fabrication-handbook-for-industrial-applications\" target=\"_blank\"><i>AWS G2.4\/G2.4M:2007 Guide for the Fusion Welding of Titanium and Titanium Alloys<\/i><\/a>. Miami: American Welding Society. 2006. Archived from the original on 10 December 2010.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=AWS+G2.4%2FG2.4M%3A2007+Guide+for+the+Fusion+Welding+of+Titanium+and+Titanium+Alloys&rft.place=Miami&rft.pub=American+Welding+Society&rft.date=2006&rft_id=http%3A%2F%2Fpdfcast.org%2Fpdf%2Ftitanium-design-and-fabrication-handbook-for-industrial-applications&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: BOT: original-url status unknown (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_BOT:_original-url_status_unknown\" title=\"Category:CS1 maint: BOT: original-url status unknown\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-67\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-67\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_Metals_Corporation\" title=\"Titanium Metals Corporation\" rel=\"external_link\" target=\"_blank\">Titanium Metals Corporation<\/a> (1997). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090209014255\/http:\/\/www.timet.com\/design%26fabframe.html\" target=\"_blank\"><i>Titanium design and fabrication handbook for industrial applications<\/i><\/a>. Dallas: Titanium Metals Corporation. Archived from the original on 9 February 2009.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Titanium+design+and+fabrication+handbook+for+industrial+applications&rft.place=Dallas&rft.pub=Titanium+Metals+Corporation&rft.date=1997&rft.au=Titanium+Metals+Corporation&rft_id=http%3A%2F%2Fwww.timet.com%2Fdesign%2526fabframe.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: BOT: original-url status unknown (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_BOT:_original-url_status_unknown\" title=\"Category:CS1 maint: BOT: original-url status unknown\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-68\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-68\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.efunda.com\/materials\/solders\/solderability.cfm\" target=\"_blank\">\"Solderability\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">16 June<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Solderability&rft_id=http%3A%2F%2Fwww.efunda.com%2Fmaterials%2Fsolders%2Fsolderability.cfm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ECE738-69\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ECE738_69-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Hampel, Clifford A. (1968). <i>The Encyclopedia of the Chemical Elements<\/i>. Van Nostrand Reinhold. p. 738. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-442-15598-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Encyclopedia+of+the+Chemical+Elements&rft.pages=738&rft.pub=Van+Nostrand+Reinhold&rft.date=1968&rft.isbn=978-0-442-15598-8&rft.aulast=Hampel&rft.aufirst=Clifford+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-70\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-70\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Smook, Gary A. (2002). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=TgtFPgAACAAJ\" target=\"_blank\"><i>Handbook for Pulp & Paper Technologists<\/i><\/a> (3rd ed.). Angus Wilde Publications. p. 223. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-9694628-5-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Handbook+for+Pulp+%26+Paper+Technologists&rft.pages=223&rft.edition=3rd&rft.pub=Angus+Wilde+Publications&rft.date=2002&rft.isbn=978-0-9694628-5-9&rft.aulast=Smook&rft.aufirst=Gary+A.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DTgtFPgAACAAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Moiseyev-71\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Moiseyev_71-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Moiseyev, Valentin N. (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=legtmQEACAAJ\" target=\"_blank\"><i>Titanium Alloys: Russian Aircraft and Aerospace Applications<\/i><\/a>. Taylor and Francis, LLC. p. 196. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-8493-3273-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Titanium+Alloys%3A+Russian+Aircraft+and+Aerospace+Applications&rft.pages=196&rft.pub=Taylor+and+Francis%2C+LLC&rft.date=2006&rft.isbn=978-0-8493-3273-9&rft.aulast=Moiseyev&rft.aufirst=Valentin+N.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DlegtmQEACAAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-NYT7513-72\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-NYT7513_72-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-NYT7513_72-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Kramer, Andrew E. (5 July 2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2013\/07\/06\/business\/global\/titanium-fills-vital-role-for-boeing-and-russia.html\" target=\"_blank\">\"Titanium Fills Vital Role for Boeing and Russia\"<\/a>. <i>The New York Times<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">6 July<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=Titanium+Fills+Vital+Role+for+Boeing+and+Russia&rft.date=2013-07-05&rft.au=Kramer%2C+Andrew+E.&rft_id=https%3A%2F%2Fwww.nytimes.com%2F2013%2F07%2F06%2Fbusiness%2Fglobal%2Ftitanium-fills-vital-role-for-boeing-and-russia.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Emsley2001p454-73\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Emsley2001p454_73-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Emsley2001p454_73-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a href=\"#CITEREFEmsley2001\" rel=\"external_link\">Emsley 2001<\/a>, p. 454<\/span>\n<\/li>\n<li id=\"cite_note-74\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-74\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"#CITEREFDonachie1988\" rel=\"external_link\">Donachie 1988<\/a>, p. 13<\/span>\n<\/li>\n<li id=\"cite_note-75\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-75\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Sevan, Vardan (23 September 2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20121111061856\/http:\/\/www.sevanco.net\/news\/full_story.php?id=1122\" target=\"_blank\">\"Rosoboronexport controls titanium in Russia\"<\/a>. Sevanco Strategic Consulting. Archived from the original on 11 November 2012<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 December<\/span> 2006<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Rosoboronexport+controls+titanium+in+Russia&rft.pub=Sevanco+Strategic+Consulting&rft.date=2006-09-23&rft.aulast=Sevan&rft.aufirst=Vardan&rft_id=http%3A%2F%2Fwww.sevanco.net%2Fnews%2Ffull_story.php%3Fid%3D1122&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Unfit url (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Unfit_url\" title=\"Category:CS1 maint: Unfit url\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-76\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-76\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.flightglobal.com\/pdfarchive\/view\/1957\/1957%20-%201324.html\" target=\"_blank\">\"Iroquois\" a 1957 Flight article<\/a><\/span>\n<\/li>\n<li id=\"cite_note-77\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-77\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.globalsecurity.org\/military\/world\/russia\/705.htm\" target=\"_blank\">\"GlobalSecurity\"<\/a>. GlobalSecurity.org. April 2006<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">23 April<\/span> 2008<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=GlobalSecurity&rft.pub=GlobalSecurity.org&rft.date=2006-04&rft_id=http%3A%2F%2Fwww.globalsecurity.org%2Fmilitary%2Fworld%2Frussia%2F705.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-78\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-78\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Scharf, Caleb A. (June 17, 2016) <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/blogs.scientificamerican.com\/life-unbounded\/the-jupiter-vault\/\" target=\"_blank\">The Jupiter Vault<\/a>. <i>Scientific American<\/i>.<\/span>\n<\/li>\n<li id=\"cite_note-79\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-79\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"#CITEREFDonachie1988\" rel=\"external_link\">Donachie 1988<\/a>, pp. 11\u201316<\/span>\n<\/li>\n<li id=\"cite_note-80\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-80\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Kleefisch, E.W., ed. (1981). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=cX2HK0osYA4C\" target=\"_blank\"><i>Industrial Application of Titanium and Zirconium<\/i><\/a>. West Conshohocken, PA: ASTM International. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-8031-0745-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Industrial+Application+of+Titanium+and+Zirconium&rft.place=West+Conshohocken%2C+PA&rft.pub=ASTM+International&rft.date=1981&rft.isbn=978-0-8031-0745-8&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DcX2HK0osYA4C&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-81\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-81\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Bunshah, Rointan F., ed. (2001). \"Ch. 8\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=daamnz8el2sC&pg=PA413\" target=\"_blank\"><i>Handbook of Hard Coatings<\/i><\/a>. Norwich, NY: William Andrew Inc. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-8155-1438-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Ch.+8&rft.btitle=Handbook+of+Hard+Coatings&rft.place=Norwich%2C+NY&rft.pub=William+Andrew+Inc.&rft.date=2001&rft.isbn=978-0-8155-1438-1&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3Ddaamnz8el2sC%26pg%3DPA413&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-82\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-82\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Bell, Tom; et al. (2001). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=4F1zYT4FHyMC\" target=\"_blank\"><i>Heat Treating<\/i><\/a>. Proceedings of the 20th Conference, 9\u201312 October 2000. ASM International. p. 141. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-87170-727-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Heat+Treating&rft.series=Proceedings+of+the+20th+Conference%2C+9%E2%80%9312+October+2000&rft.pages=141&rft.pub=ASM+International&rft.date=2001&rft.isbn=978-0-87170-727-7&rft.aulast=Bell&rft.aufirst=Tom&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3D4F1zYT4FHyMC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-83\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-83\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">National Corvette Museum (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/archive.is\/20130103075117\/http:\/\/www.iglou.com\/corvette\/specs\/2001\/exhaust.htm\" target=\"_blank\">\"Titanium Exhausts\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.iglou.com\/corvette\/specs\/2001\/exhaust.htm\" target=\"_blank\">the original<\/a> on 3 January 2013<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 December<\/span> 2006<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Titanium+Exhausts&rft.date=2006&rft.au=National+Corvette+Museum&rft_id=http%3A%2F%2Fwww.iglou.com%2Fcorvette%2Fspecs%2F2001%2Fexhaust.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-84\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-84\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/media.gm.com\/media\/us\/en\/chevrolet\/vehicles\/corvette-z06\/2015.detail.html\/content\/Pages\/news\/us\/en\/2014\/Aug\/0820-8speed\/0820-compact-powerhouse.html\" target=\"_blank\">Compact Powerhouse: Inside Corvette Z06\u2019s LT4 Engine 650-hp supercharged 6.2L V-8 makes world-class power in more efficient package<\/a>. media.gm.com. 20 August 2014<\/span>\n<\/li>\n<li id=\"cite_note-85\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-85\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Davis, Joseph R. (1998). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=IpEnvBtSfPQC\" target=\"_blank\"><i>Metals Handbook<\/i><\/a>. ASM International. p. 584. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-87170-654-6.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Metals+Handbook&rft.pages=584&rft.pub=ASM+International&rft.date=1998&rft.isbn=978-0-87170-654-6&rft.aulast=Davis&rft.aufirst=Joseph+R.&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3DIpEnvBtSfPQC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Donachie2000-86\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Donachie2000_86-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Donachie2000_86-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Donachie2000_86-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a href=\"#CITEREFDonachie1988\" rel=\"external_link\">Donachie 1988<\/a>, pp. 11, 255<\/span>\n<\/li>\n<li id=\"cite_note-87\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-87\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Gruntman, Mike (2004). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=2XY9KXxF8OEC\" target=\"_blank\"><i>Blazing the Trail: The Early History of Spacecraft and Rocketry<\/i><\/a>. Reston, VA: American Institute of Aeronautics and Astronautics. p. 457. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-56347-705-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Blazing+the+Trail%3A+The+Early+History+of+Spacecraft+and+Rocketry&rft.place=Reston%2C+VA&rft.pages=457&rft.pub=American+Institute+of+Aeronautics+and+Astronautics&rft.date=2004&rft.isbn=978-1-56347-705-8&rft.aulast=Gruntman&rft.aufirst=Mike&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3D2XY9KXxF8OEC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-88\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-88\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">L\u00fctjering, Gerd; Williams, James Case (12 June 2007). \"Appearance Related Applications\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=41EqJFxjA4wC&pg=PA408\" target=\"_blank\"><i>Titanium<\/i><\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-540-71397-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Appearance+Related+Applications&rft.btitle=Titanium&rft.date=2007-06-12&rft.isbn=978-3-540-71397-5&rft.au=L%C3%BCtjering%2C+Gerd&rft.au=Williams%2C+James+Case&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D41EqJFxjA4wC%26pg%3DPA408&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-89\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-89\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.designbuild-network.com\/projects\/dam\/\" target=\"_blank\">\"Denver Art Museum, Frederic C. Hamilton Building\"<\/a>. SPG Media. 2006<span class=\"reference-accessdate\">. 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Retrieved <span class=\"nowrap\">8 August<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=everymac.com&rft.atitle=Apple+PowerBook+G4+400+%28Original+%E2%80%93+Ti%29+Specs&rft_id=http%3A%2F%2Fwww.everymac.com%2Fsystems%2Fapple%2Fpowerbook_g4%2Fstats%2Fpowerbook_g4_400.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-91\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-91\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gafner, G. (1989). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20101129195740\/http:\/\/goldbulletin.org\/assets\/file\/goldbulletin\/downloads\/Gafner_4_22.pdf\" target=\"_blank\">\"The development of 990 Gold-Titanium: its Production, use and Properties\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Gold Bulletin<\/i>. <b>22<\/b> (4): 112\u2013122. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2FBF03214709\" target=\"_blank\">10.1007\/BF03214709<\/a>. Archived from the original on 29 November 2010.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gold+Bulletin&rft.atitle=The+development+of+990+Gold-Titanium%3A+its+Production%2C+use+and+Properties&rft.volume=22&rft.issue=4&rft.pages=112-122&rft.date=1989&rft_id=info%3Adoi%2F10.1007%2FBF03214709&rft.au=Gafner%2C+G.&rft_id=http%3A%2F%2Fgoldbulletin.org%2Fassets%2Ffile%2Fgoldbulletin%2Fdownloads%2FGafner_4_22.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Unfit url (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Unfit_url\" title=\"Category:CS1 maint: Unfit url\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-92\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-92\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080513171451\/http:\/\/www.titanium-arts.com\/home.html\" target=\"_blank\">\"Fine Art and Functional Works in Titanium and Other Earth Elements\"<\/a>. Archived from the original on 13 May 2008<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">8 August<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Fine+Art+and+Functional+Works+in+Titanium+and+Other+Earth+Elements&rft_id=http%3A%2F%2Fwww.titanium-arts.com%2Fhome.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: BOT: original-url status unknown (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_BOT:_original-url_status_unknown\" title=\"Category:CS1 maint: BOT: original-url status unknown\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-93\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-93\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Alwitt, Robert S. 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(2005). \"Proof of Safety at Yucca Mountain\". <i>Science<\/i>. <b>310<\/b> (5747): 447. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1126%2Fscience.1112786\" target=\"_blank\">10.1126\/science.1112786<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16239463\" target=\"_blank\">16239463<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Science&rft.atitle=Proof+of+Safety+at+Yucca+Mountain&rft.volume=310&rft.issue=5747&rft.pages=447&rft.date=2005&rft_id=info%3Adoi%2F10.1126%2Fscience.1112786&rft_id=info%3Apmid%2F16239463&rft.au=Carter%2C+L.+J.&rft.au=Pigford%2C+T.+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-103\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-103\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Elekes, Carmen Cristina; Busuioc, Gabriela. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160303231241\/http:\/\/www.wseas.us\/e-library\/conferences\/2010\/Corfu\/EDUCATION\/EDUCATION-04.pdf\" target=\"_blank\">\"The Mycoremediation of Metals Polluted Soils Using Wild Growing Species of Mushrooms\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Engineering Education<\/i>. 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Retrieved <span class=\"nowrap\">28 January<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Engineering+Education&rft.atitle=The+Mycoremediation+of+Metals+Polluted+Soils+Using+Wild+Growing+Species+of+Mushrooms&rft.au=Elekes%2C+Carmen+Cristina&rft.au=Busuioc%2C+Gabriela&rft_id=http%3A%2F%2Fwww.wseas.us%2Fe-library%2Fconferences%2F2010%2FCorfu%2FEDUCATION%2FEDUCATION-04.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-104\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-104\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Berglund, Fredrik; Carlmark, Bjorn (October 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3176400\" target=\"_blank\">\"Titanium, Sinusitis, and the Yellow Nail Syndrome\"<\/a>. <i>Biological Trace Element Research<\/i>. <b>143<\/b> (1): 1\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs12011-010-8828-5\" target=\"_blank\">10.1007\/s12011-010-8828-5<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3176400\" target=\"_blank\">3176400<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20809268\" target=\"_blank\">20809268<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biological+Trace+Element+Research&rft.atitle=Titanium%2C+Sinusitis%2C+and+the+Yellow+Nail+Syndrome&rft.volume=143&rft.issue=1&rft.pages=1-7&rft.date=2011-10&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3176400&rft_id=info%3Apmid%2F20809268&rft_id=info%3Adoi%2F10.1007%2Fs12011-010-8828-5&rft.aulast=Berglund&rft.aufirst=Fredrik&rft.au=Carlmark%2C+Bjorn&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3176400&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-105\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-105\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Cotell, Catherine Mary; Sprague, J. A.; Smidt, F. A. (1994). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=RGtsPjqUwy0C\" target=\"_blank\"><i>ASM Handbook: Surface Engineering<\/i><\/a> (10th ed.). ASM International. p. 836. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-87170-384-2.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=ASM+Handbook%3A+Surface+Engineering&rft.pages=836&rft.edition=10th&rft.pub=ASM+International&rft.date=1994&rft.isbn=978-0-87170-384-2&rft.aulast=Cotell&rft.aufirst=Catherine+Mary&rft.au=Sprague%2C+J.+A.&rft.au=Smidt%2C+F.+A.&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3DRGtsPjqUwy0C&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-106\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-106\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Compressed Gas Association (1999). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=WSLULtCG9JgC\" target=\"_blank\"><i>Handbook of compressed gases<\/i><\/a> (4th ed.). Springer. p. 323. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-412-78230-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Handbook+of+compressed+gases&rft.pages=323&rft.edition=4th&rft.pub=Springer&rft.date=1999&rft.isbn=978-0-412-78230-5&rft.au=Compressed+Gas+Association&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3DWSLULtCG9JgC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-107\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-107\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Solomon, Robert E. (2002). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=2fHsoobsCNwC\" target=\"_blank\"><i>Fire and Life Safety Inspection Manual<\/i><\/a>. National Fire Prevention Association (8th ed.). Jones & Bartlett Publishers. p. 45. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-87765-472-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Fire+and+Life+Safety+Inspection+Manual&rft.pages=45&rft.edition=8th&rft.pub=Jones+%26+Bartlett+Publishers&rft.date=2002&rft.isbn=978-0-87765-472-8&rft.aulast=Solomon&rft.aufirst=Robert+E.&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3D2fHsoobsCNwC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Bibliography\">Bibliography<\/span><\/h2>\n<div class=\"refbegin\" style=\"\">\n<ul><li><cite id=\"rdp-ebb-CITEREFBarksdale1968\" class=\"citation book\">Barksdale, Jelks (1968). \"Titanium\". In Clifford A. Hampel. <i>The Encyclopedia of the Chemical Elements<\/i>. New York: Reinhold Book Corporation. pp. 732\u2013738. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Library_of_Congress_Control_Number\" title=\"Library of Congress Control Number\" rel=\"external_link\" target=\"_blank\">LCCN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/lccn.loc.gov\/68029938\" target=\"_blank\">68029938<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Titanium&rft.btitle=The+Encyclopedia+of+the+Chemical+Elements&rft.place=New+York&rft.pages=732-738&rft.pub=Reinhold+Book+Corporation&rft.date=1968&rft_id=info%3Alccn%2F68029938&rft.aulast=Barksdale&rft.aufirst=Jelks&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite id=\"rdp-ebb-CITEREFDonachie1988\" class=\"citation book\">Donachie, Matthew J., Jr. (1988). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=Ct9RAAAAMAAJ\" target=\"_blank\"><i>TITANIUM: A Technical Guide<\/i><\/a>. Metals Park, OH: ASM International. p. 11. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-87170-309-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=TITANIUM%3A+A+Technical+Guide&rft.place=Metals+Park%2C+OH&rft.pages=11&rft.pub=ASM+International&rft.date=1988&rft.isbn=978-0-87170-309-5&rft.aulast=Donachie&rft.aufirst=Matthew+J.%2C+Jr.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DCt9RAAAAMAAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite id=\"rdp-ebb-CITEREFEmsley2001\" class=\"citation book\">Emsley, John (2001). \"Titanium\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=j-Xu07p3cKwC\" target=\"_blank\"><i>Nature's Building Blocks: An A-Z Guide to the Elements<\/i><\/a>. Oxford, England, UK: Oxford University Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-19-850340-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Titanium&rft.btitle=Nature%27s+Building+Blocks%3A+An+A-Z+Guide+to+the+Elements&rft.place=Oxford%2C+England%2C+UK&rft.pub=Oxford+University+Press&rft.date=2001&rft.isbn=978-0-19-850340-8&rft.aulast=Emsley&rft.aufirst=John&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Dj-Xu07p3cKwC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Flower, Harvey M. (2000). \"Materials Science: A moving oxygen story\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nature_(journal)\" title=\"Nature (journal)\" rel=\"external_link\" target=\"_blank\">Nature<\/a><\/i>. <b>407<\/b> (6802): 305\u2013306. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2F35030266\" target=\"_blank\">10.1038\/35030266<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11014169\" target=\"_blank\">11014169<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature&rft.atitle=Materials+Science%3A+A+moving+oxygen+story&rft.volume=407&rft.issue=6802&rft.pages=305-306&rft.date=2000&rft_id=info%3Adoi%2F10.1038%2F35030266&rft_id=info%3Apmid%2F11014169&rft.aulast=Flower&rft.aufirst=Harvey+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite id=\"rdp-ebb-CITEREFGreenwood1997\" class=\"citation book\">Greenwood, N. N.; Earnshaw, A. (1997). <i>Chemistry of the Elements<\/i> (2nd ed.). Oxford: Butterworth-Heinemann. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-7506-3365-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Chemistry+of+the+Elements&rft.place=Oxford&rft.edition=2nd&rft.pub=Butterworth-Heinemann&rft.date=1997&rft.isbn=978-0-7506-3365-9&rft.aulast=Greenwood&rft.aufirst=N.+N.&rft.au=Earnshaw%2C+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite id=\"rdp-ebb-CITEREFRoza2008\" class=\"citation book\">Roza, Greg (2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=rsAGRf7j7fQC\" target=\"_blank\"><i>Titanium<\/i><\/a> (First ed.). New York, NY: The Rosen Publishing Group. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-4042-1412-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Titanium&rft.place=New+York%2C+NY&rft.edition=First&rft.pub=The+Rosen+Publishing+Group&rft.date=2008&rft.isbn=978-1-4042-1412-5&rft.aulast=Roza&rft.aufirst=Greg&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DrsAGRf7j7fQC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATitanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=7iwDAAAAMBAJ&pg=RA2-PA46\" target=\"_blank\">\"Titanium: Our Next Major Metal\"<\/a>, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Popular_Science\" title=\"Popular Science\" rel=\"external_link\" target=\"_blank\">Popular Science<\/a><\/i>, October 1950\u2014one of first general public detailed articles on Titanium<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.periodicvideos.com\/videos\/022.htm\" target=\"_blank\">Titanium<\/a> at <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Periodic_Table_of_Videos\" class=\"mw-redirect\" title=\"The Periodic Table of Videos\" rel=\"external_link\" target=\"_blank\">The Periodic Table of Videos<\/a><\/i> (University of Nottingham)<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.essentialchemicalindustry.org\/metals\/titanium.html\" target=\"_blank\">Titanium<\/a> at The Essential Chemical Industry \u2013 online (CIEC Promoting Science at the University of York)<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/titanium.org\" target=\"_blank\">International Titanium Association<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.msm.cam.ac.uk\/phase-trans\/2003\/titanium.movies\/titanium.html\" target=\"_blank\">Metallurgy of Titanium and its Alloys, Cambridge University<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/indexmundi.com\/en\/commodities\/minerals\/titanium\/titanium_table15.html\" target=\"_blank\">World Production of Titanium Concentrates, by Country<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/seekingalpha.com\/article\/194965-titanium-metal-of-the-gods?source=email\" target=\"_blank\">Metal of the gods<\/a><\/li><\/ul>\n\n\n\n\n<p class=\"mw-empty-elt\">\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1324\nCached time: 20181217070557\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 2.196 seconds\nReal time usage: 2.576 seconds\nPreprocessor visited node count: 26203\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 612884\/2097152 bytes\nTemplate argument size: 30995\/2097152 bytes\nHighest expansion depth: 16\/40\nExpensive parser function count: 15\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 243660\/5000000 bytes\nNumber of Wikibase entities loaded: 7\/400\nLua time usage: 0.951\/10.000 seconds\nLua memory usage: 12.27 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 2070.020 1 -total\n<\/p>\n<pre>35.50% 734.812 1 Template:Infobox_titanium\n35.23% 729.313 1 Template:Infobox_element\n32.49% 672.491 1 Template:Infobox\n28.66% 593.181 1 Template:Reflist\n13.50% 279.465 11 Template:Navbox\n13.42% 277.871 19 Template:Cite_journal\n11.20% 231.870 1 Template:Periodic_table_(32_columns,_compact)\n 9.48% 196.172 1 Template:Infobox_element\/periodic_table\n 9.29% 192.408 1 Template:Infobox_element\/standard_atomic_weight\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:30040-1!canonical and timestamp 20181217070554 and revision id 871468088\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212230\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.035 seconds\nReal time usage: 0.232 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 215.645 1 - wikipedia:Titanium\n100.00% 215.645 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8394-0!*!*!*!*!*!* and timestamp 20181217212230 and revision id 24628\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Titanium\">https:\/\/www.limswiki.org\/index.php\/Titanium<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","5de4f7fb344e365ba5c6b965dec28c8e_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/db\/Titan-crystal_bar.JPG\/440px-Titan-crystal_bar.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/aa\/Titanium_spectrum_visible.png\/480px-Titanium_spectrum_visible.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cb\/Hexagonal_close_packed.svg\/100px-Hexagonal_close_packed.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8a\/Titanium_in_water_Pourbaix_diagram.png\/440px-Titanium_in_water_Pourbaix_diagram.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2b\/Titanium_nitride_coating.jpg\/120px-Titanium_nitride_coating.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/TiCl3.jpg\/200px-TiCl3.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cf\/Martin_Heinrich_Klaproth.jpg\/340px-Martin_Heinrich_Klaproth.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/90\/TitaniumMetal_jpg.jpg\/440px-TitaniumMetal_jpg.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/58\/TitaniumUSGOV.jpg\/440px-TitaniumUSGOV.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bf\/Titanium_products.jpg\/440px-Titanium_products.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5b\/Titanzylinder.jpg\/440px-Titanzylinder.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a5\/Titanium%28IV%29_oxide.jpg\/440px-Titanium%28IV%29_oxide.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/54\/Hochreines_Titan_%2899.999%29_mit_sichtbarer_Kristallstruktur.jpg\/440px-Hochreines_Titan_%2899.999%29_mit_sichtbarer_Kristallstruktur.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5c\/Titanium-stamps.jpg\/440px-Titanium-stamps.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a1\/El_Guggenheim_vizca%C3%ADno._%281454058701%29.jpg\/440px-El_Guggenheim_vizca%C3%ADno._%281454058701%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/be\/Anodized_titanium_table.jpg\/400px-Anodized_titanium_table.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a0\/Titanium_plaatje_voor_pols.jpg\/400px-Titanium_plaatje_voor_pols.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/13\/Kopiva.JPG\/440px-Kopiva.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ed\/Papapishu-Lab-icon-6.svg\/60px-Papapishu-Lab-icon-6.svg.png"],"5de4f7fb344e365ba5c6b965dec28c8e_timestamp":1545081750,"0ee5dd4c8aa69c05aa857659ad74759c_type":"article","0ee5dd4c8aa69c05aa857659ad74759c_title":"Ti-6Al-7Nb","0ee5dd4c8aa69c05aa857659ad74759c_url":"https:\/\/www.limswiki.org\/index.php\/Ti-6Al-7Nb","0ee5dd4c8aa69c05aa857659ad74759c_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tTi-6Al-7Nb\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tTi-6Al-7Nb (UNS designation R56700) is an alpha-beta titanium alloy first synthesized in 1977. It features high strength and has similar properties as the cytotoxic vanadium containing alloy Ti-6Al-4V. Ti-6Al-7Nb is used as a material for hip protheses.[1] \nTi\u20156Al\u20157Nb is one of the titanium alloys that built of hexagonal \u03b1 phase (stabilised with aluminium) and regular body-centred phase \u03b2 (stabilised with niobium). The alloy is characterized by added advantageous mechanical properties, it has higher corrosion resistance and biotolerance in relation to Ti-6Al-V alloys.[2][3][4]\n\n<\/p>\nContents \n\n1 Mechanical properties \n2 Production \n3 Heat treatment \n4 Applications \n5 Biocompatibility \n6 Specification[17] \n7 References \n\n\nMechanical properties \nMechanical properties of the alloy are mostly dependent on the morphology and the fractions volume of the phases presence from the parameters obtained from the manufacturing process.[5][6]\n\n\n\n\nProperty\nMinimum Value\nMaximum Value\nUnit\n\n\nDensity\n4.51\n4.53\ng\/cm3\n\n\nHardness\n2700\n2900\nMpa\n\n\nMelting point\n1800\n1860\nK\n\n\nSpecific heat\n540\n560\nJ\/kg*K\n\n\nElastic limit\n895\n905\nMPa\n\n\nEnergy content\n750\n1250\nMJ\/kg\n\n\nLatent heat of fusion\n360\n370\nkJ\/kg\n\n[7]\nAs shown in the above table, alloying is one of the effective methods to improve the mechanical properties and since Niobium belongs to the same group of Vanadium in the periodic table it is of course acts as \u03b1 \u2013\u03b2 stabilizing elements (similar to Ti-6AL-4V alloy), however the strength of Nb alloy is little less than that of Ti-6AL-4V .The main difference between Ti-6AL-4V and Ti\u20156Al\u20157Nb is related to different factors such as solid-solution strengthening, the structure-refining strengthening provided by the refined two-phase structure and the difference in the microstructure between the two alloys.[8]\n\nProduction \nTi-6Al-7Nb is produced by powder metallurgy methods. The most common methods are hot pressing, metal injection mouldering and blending and pressing. In the production of Ti-6Al-7Nb a sintering temperature between 900-1400o C usually are used. Altering the sintering temperature gives the Ti-6Al-7Nb different properties such as different porosity and microstructure. It also gives a different composition between alpha, beta and alpha+beta phases. In the recent years Ti-6Al-7Nb alloys could also be made by different 3D-printer technique such as SLM and EBM.[9][10]\n\nHeat treatment \nHeat treatment of titanium is demonstrated to have significant influences on reducing the residual stresses, improving the mechanical properties (i.e. tensile strength or fatigue strength by solution treatment and ageing). Moreover, heat treatment provides an ideal combination of ductility, machinability and structural stability due to the differences in microstructure and cooling rates between \u03b1 and \u03b2 phases.[11]\nThe cooling rate have an impact of the morphology . When the cooling rate is reduced for example from air cool to slow cooling, the morphology of the transformed \u03b1 increases in thickness and length and is contained within fewer, larger \u03b1 colonies.[12] The \u03b1 colony size is the most important microstructural properties due to its influences the fatigue properties and deformation mechanics of \u03b2 processed \u03b1+ \u03b2 alloys.[13]\n\nApplications \nImplant devices replacing such as : failed hard tissue, artificial hip joints, artificial knee joints, bone plates, screws for fracture fixation, cardiac valve prostheses, pacemakers, and artificial hearts.[14]\nDental application [15]\nAircraft materials\nBiocompatibility \nTi-6Al-7Nb has a high biocompatibility. The oxides from Ti-6Al-7Nb is saturated in the body and are not transported in vivo or are a bioburden. The alloy will not create adverse tissue tolerance reactions and creates fewer giant cell nucleis. Ti-6Al-7Nb also shows a high compatibility to ingrowth to the human body.[16]\n\n Specification[17] \nUNS: R56700\nASTM standard: ASTM F 1295\nISO Standard: ISO 5832-11\nReferences \n\n\n^ Mamoun Fellah, Mohamed Laba\u00efz, Omar Assala, et al., \u201cTribological behavior of Ti-6Al-4V and Ti-6Al-7Nb Alloys for Total Hip Prosthesis,\u201d Advances in Tribology, vol. 2014, Article ID 451387, 13 pages, 2014. doi:10.1155\/2014\/451387 \n\n^ Chlebus, Edward, et al. \"Microstructure and mechanical behaviour of Ti\u20156Al\u20157Nb alloy produced by selective laser melting.\" Materials Characterization 62.5 (2011): 488-495. \n\n^ X. Liu, P.-K. Chu, C. Ding Surface modification of titanium, titanium alloys, and related materials for biomedical application. Materials Science and Engineering, R47 (2004), pp. 49\u2013121 \n\n^ M.-F. L\u00f3pez, A. Guti\u00e9rrez, J.-A. Jim\u00e9nez. In vitro corrosion behaviour of titanium alloys without vanadium. Electrochimica Acta, 47 (2002), pp. 1359\u20131364 \n\n^ G. L\u00fctjering. Influence of processing on microstructure and mechanical properties of (\u03b1 + \u03b2) titanium alloys. Materials Science and Engineering, A243 (1998), pp. 32\u201345 \n\n^ S.A. Ajeel, T.L. Alzubaydi, A.K. Swadi. Influence of heat treatment conditions on microstructure of Ti\u20156Al\u20157Nb alloy as used surgical implant materials. Engineering and Technology, 25 (2007), pp. 431\u2013442 \n\n^ http:\/\/www.azom.com\/properties.aspx?ArticleID=2064 \n\n^ Kobayashi, Equo, et al. \"Mechanical properties and corrosion resistance of Ti\u20136Al\u20137Nb alloy dental castings.\" Journal of Materials Science: Materials in Medicine 9.10 (1998): 567-574. \n\n^ Bolzoni, Leandro, et al. \"Comparison of Microstructure and Properties of Ti-6Al-7Nb Alloy Processed by Different Powder Metallurgy Routes.\" Key Engineering Materials. Vol. 551. 2013. \n\n^ http:\/\/www.scielo.br\/scielo.php?pid=S0104-66321998000400002&script=sci_arttext \n\n^ Sercombe, Tim, et al. \"Heat treatment of Ti-6Al-7Nb components produced by selective laser melting.\" Rapid Prototyping Journal 14.5 (2008): 300-304. \n\n^ 2.\tTim Sercombe Noel Jones Rob Day Alan Kop, (2008),\"Heat treatment of Ti-6Al-7Nb components produced by selective laser melting\", Rapid Prototyping Journal, Vol. 14 Iss 5 pp. 300 - 304 \n\n^ 1.\tL\u00fctjering, G. \"Influence of processing on microstructure and mechanical properties of (\u03b1+ \u03b2) titanium alloys.\" Materials Science and Engineering: A 243.1 (1998): 32-45. \n\n^ Elias, C. N., et al. \"Biomedical applications of titanium and its alloys.\" Jom 60.3 (2008): 46-49. \n\n^ Kobayashi, Equo, et al. \"Mechanical properties and corrosion resistance of Ti\u20136Al\u20137Nb alloy dental castings.\" Journal of Materials Science: Materials in Medicine 9.10 (1998): 567-574. \n\n^ http:\/\/www.synthes.com\/sites\/NA\/NAContent\/Docs\/Product%20Support%20Materials\/Materials%20Booklets\/Implant%20Materials%20-%20Titanium--6_%20Aluminum--7_%20Niobium.pdf \n\n^ https:\/\/www.atimetals.com\/Documents\/ati_tja-1537_tds_en_v2.pdf \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Ti-6Al-7Nb\">https:\/\/www.limswiki.org\/index.php\/Ti-6Al-7Nb<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 11 March 2016, at 19:53.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,062 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","0ee5dd4c8aa69c05aa857659ad74759c_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Ti-6Al-7Nb skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Ti-6Al-7Nb<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Ti-6Al-7Nb<\/b> (UNS designation <b>R56700<\/b>) is an alpha-beta <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_alloy\" title=\"Titanium alloy\" rel=\"external_link\" target=\"_blank\">titanium alloy<\/a> first synthesized in 1977. It features high strength and has similar properties as the cytotoxic vanadium containing alloy Ti-6Al-4V. Ti-6Al-7Nb is used as a material for hip protheses.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> \n<p>Ti\u20156Al\u20157Nb is one of the titanium alloys that built of hexagonal \u03b1 phase (stabilised with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium\" title=\"Aluminium\" rel=\"external_link\" target=\"_blank\">aluminium<\/a>) and regular body-centred phase \u03b2 (stabilised with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Niobium\" title=\"Niobium\" rel=\"external_link\" target=\"_blank\">niobium<\/a>). The alloy is characterized by added advantageous mechanical properties, it has higher corrosion resistance and biotolerance in relation to alloys.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Mechanical_properties\">Mechanical properties<\/span><\/h2>\n<p>Mechanical properties of the alloy are mostly dependent on the morphology and the fractions volume of the phases presence from the parameters obtained from the manufacturing process.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Property<\/th>\n<th>Minimum Value<\/th>\n<th>Maximum Value<\/th>\n<th>Unit\n<\/th><\/tr>\n<tr>\n<td>Density<\/td>\n<td>4.51<\/td>\n<td>4.53<\/td>\n<td>g\/cm<sup>3<\/sup>\n<\/td><\/tr>\n<tr>\n<td>Hardness<\/td>\n<td>2700<\/td>\n<td>2900<\/td>\n<td>Mpa\n<\/td><\/tr>\n<tr>\n<td>Melting point<\/td>\n<td>1800<\/td>\n<td>1860<\/td>\n<td>K\n<\/td><\/tr>\n<tr>\n<td>Specific heat<\/td>\n<td>540<\/td>\n<td>560<\/td>\n<td>J\/kg*K\n<\/td><\/tr>\n<tr>\n<td>Elastic limit<\/td>\n<td>895<\/td>\n<td>905<\/td>\n<td>MPa\n<\/td><\/tr>\n<tr>\n<td>Energy content<\/td>\n<td>750<\/td>\n<td>1250<\/td>\n<td>MJ\/kg\n<\/td><\/tr>\n<tr>\n<td>Latent heat of fusion<\/td>\n<td>360<\/td>\n<td>370<\/td>\n<td>kJ\/kg\n<\/td><\/tr><\/tbody><\/table>\n<p><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>As shown in the above table, alloying is one of the effective methods to improve the mechanical properties and since Niobium belongs to the same group of Vanadium in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Periodic_table\" title=\"Periodic table\" rel=\"external_link\" target=\"_blank\">periodic table<\/a> it is of course acts as \u03b1 \u2013\u03b2 stabilizing elements (similar to Ti-6AL-4V alloy), however the strength of Nb alloy is little less than that of Ti-6AL-4V .The main difference between Ti-6AL-4V and Ti\u20156Al\u20157Nb is related to different factors such as solid-solution strengthening, the structure-refining strengthening provided by the refined two-phase structure and the difference in the microstructure between the two alloys.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Production\">Production<\/span><\/h2>\n<p>Ti-6Al-7Nb is produced by powder metallurgy methods. The most common methods are hot pressing, metal injection mouldering and blending and pressing. In the production of Ti-6Al-7Nb a sintering temperature between 900-1400<sup>o<\/sup> C usually are used. Altering the sintering temperature gives the Ti-6Al-7Nb different properties such as different porosity and microstructure. It also gives a different composition between alpha, beta and alpha+beta phases. In the recent years Ti-6Al-7Nb alloys could also be made by different 3D-printer technique such as SLM and EBM.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Heat_treatment\">Heat treatment<\/span><\/h2>\n<p>Heat treatment of titanium is demonstrated to have significant influences on reducing the residual stresses, improving the mechanical properties (i.e. tensile strength or fatigue strength by solution treatment and ageing). Moreover, heat treatment provides an ideal combination of ductility, machinability and structural stability due to the differences in microstructure and cooling rates between \u03b1 and \u03b2 phases.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>The cooling rate have an impact of the morphology . When the cooling rate is reduced for example from air cool to slow cooling, the morphology of the transformed \u03b1 increases in thickness and length and is contained within fewer, larger \u03b1 colonies.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> The \u03b1 colony size is the most important microstructural properties due to its influences the fatigue properties and deformation mechanics of \u03b2 processed \u03b1+ \u03b2 alloys.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<ul><li>Implant devices replacing such as : failed hard tissue, artificial hip joints, artificial knee joints, bone plates, screws for fracture fixation, cardiac valve prostheses, pacemakers, and artificial hearts.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><\/li>\n<li>Dental application <sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup><\/li>\n<li>Aircraft materials<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Biocompatibility\">Biocompatibility<\/span><\/h2>\n<p>Ti-6Al-7Nb has a high biocompatibility. The oxides from Ti-6Al-7Nb is saturated in the body and are not transported in vivo or are a bioburden. The alloy will not create adverse tissue tolerance reactions and creates fewer giant cell nucleis. Ti-6Al-7Nb also shows a high compatibility to ingrowth to the human body.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h2><span id=\"rdp-ebb-Specification.5B17.5D\"><\/span><span class=\"mw-headline\" id=\"Specification[17]\">Specification<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup><\/span><\/h2>\n<ul><li>UNS: R56700<\/li>\n<li>ASTM standard: ASTM F 1295<\/li>\n<li>ISO Standard: ISO 5832-11<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Mamoun Fellah, Mohamed Laba\u00efz, Omar Assala, et al., \u201cTribological behavior of Ti-6Al-4V and Ti-6Al-7Nb Alloys for Total Hip Prosthesis,\u201d Advances in Tribology, vol. 2014, Article ID 451387, 13 pages, 2014. doi:10.1155\/2014\/451387<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Chlebus, Edward, et al. \"Microstructure and mechanical behaviour of Ti\u20156Al\u20157Nb alloy produced by selective laser melting.\" Materials Characterization 62.5 (2011): 488-495.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">X. Liu, P.-K. Chu, C. Ding Surface modification of titanium, titanium alloys, and related materials for biomedical application. Materials Science and Engineering, R47 (2004), pp. 49\u2013121<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">M.-F. L\u00f3pez, A. Guti\u00e9rrez, J.-A. Jim\u00e9nez. In vitro corrosion behaviour of titanium alloys without vanadium. Electrochimica Acta, 47 (2002), pp. 1359\u20131364<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">G. L\u00fctjering. Influence of processing on microstructure and mechanical properties of (\u03b1 + \u03b2) titanium alloys. Materials Science and Engineering, A243 (1998), pp. 32\u201345<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">S.A. Ajeel, T.L. Alzubaydi, A.K. Swadi. Influence of heat treatment conditions on microstructure of Ti\u20156Al\u20157Nb alloy as used surgical implant materials. Engineering and Technology, 25 (2007), pp. 431\u2013442<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.azom.com\/properties.aspx?ArticleID=2064\" target=\"_blank\">http:\/\/www.azom.com\/properties.aspx?ArticleID=2064<\/a><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Kobayashi, Equo, et al. \"Mechanical properties and corrosion resistance of Ti\u20136Al\u20137Nb alloy dental castings.\" Journal of Materials Science: Materials in Medicine 9.10 (1998): 567-574.<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Bolzoni, Leandro, et al. \"Comparison of Microstructure and Properties of Ti-6Al-7Nb Alloy Processed by Different Powder Metallurgy Routes.\" Key Engineering Materials. Vol. 551. 2013.<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.scielo.br\/scielo.php?pid=S0104-66321998000400002&script=sci_arttext\" target=\"_blank\">http:\/\/www.scielo.br\/scielo.php?pid=S0104-66321998000400002&script=sci_arttext<\/a><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Sercombe, Tim, et al. \"Heat treatment of Ti-6Al-7Nb components produced by selective laser melting.\" Rapid Prototyping Journal 14.5 (2008): 300-304.<\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">2.\tTim Sercombe Noel Jones Rob Day Alan Kop, (2008),\"Heat treatment of Ti-6Al-7Nb components produced by selective laser melting\", Rapid Prototyping Journal, Vol. 14 Iss 5 pp. 300 - 304<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">1.\tL\u00fctjering, G. \"Influence of processing on microstructure and mechanical properties of (\u03b1+ \u03b2) titanium alloys.\" Materials Science and Engineering: A 243.1 (1998): 32-45.<\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Elias, C. N., et al. \"Biomedical applications of titanium and its alloys.\" Jom 60.3 (2008): 46-49.<\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Kobayashi, Equo, et al. \"Mechanical properties and corrosion resistance of Ti\u20136Al\u20137Nb alloy dental castings.\" Journal of Materials Science: Materials in Medicine 9.10 (1998): 567-574.<\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.synthes.com\/sites\/NA\/NAContent\/Docs\/Product%20Support%20Materials\/Materials%20Booklets\/Implant%20Materials%20-%20Titanium--6_%20Aluminum--7_%20Niobium.pdf\" target=\"_blank\">http:\/\/www.synthes.com\/sites\/NA\/NAContent\/Docs\/Product%20Support%20Materials\/Materials%20Booklets\/Implant%20Materials%20-%20Titanium--6_%20Aluminum--7_%20Niobium.pdf<\/a><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.atimetals.com\/Documents\/ati_tja-1537_tds_en_v2.pdf\" target=\"_blank\">https:\/\/www.atimetals.com\/Documents\/ati_tja-1537_tds_en_v2.pdf<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1319\nCached time: 20181127102149\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.048 seconds\nReal time usage: 0.058 seconds\nPreprocessor visited node count: 254\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 314\/2097152 bytes\nTemplate argument size: 74\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 7177\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.003\/10.000 seconds\nLua memory usage: 521 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 28.017 1 Template:Reflist\n100.00% 28.017 1 -total\n<\/p>\n<pre>10.06% 2.818 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:49076334-1!canonical and timestamp 20181127102149 and revision id 852855341\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ti-6Al-7Nb\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212229\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.015 seconds\nReal time usage: 0.146 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 140.412 1 - wikipedia:Ti-6Al-7Nb\n100.00% 140.412 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8393-0!*!*!*!*!*!* and timestamp 20181217212229 and revision id 24627\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Ti-6Al-7Nb\">https:\/\/www.limswiki.org\/index.php\/Ti-6Al-7Nb<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","0ee5dd4c8aa69c05aa857659ad74759c_images":[],"0ee5dd4c8aa69c05aa857659ad74759c_timestamp":1545081749,"0a7c94f3c786708efd795d8a15a4ebb8_type":"article","0a7c94f3c786708efd795d8a15a4ebb8_title":"Thermoplastic elastomer","0a7c94f3c786708efd795d8a15a4ebb8_url":"https:\/\/www.limswiki.org\/index.php\/Thermoplastic_elastomer","0a7c94f3c786708efd795d8a15a4ebb8_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tThermoplastic elastomer\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article includes a list of references, but its sources remain unclear because it has insufficient inline citations. Please help to improve this article by introducing more precise citations. (May 2014) (Learn how and when to remove this template message)\nThermoplastic elastomers (TPE), sometimes referred to as thermoplastic rubbers, are a class of copolymers or a physical mix of polymers (usually a plastic and a rubber) which consist of materials with both thermoplastic and elastomeric properties. While most elastomers are thermosets, thermoplastics are in contrast relatively easy to use in manufacturing, for example, by injection molding. Thermoplastic elastomers show advantages typical of both rubbery materials and plastic materials. The benefit of using thermoplastic elastomers is the ability to stretch to moderate elongations and return to its near original shape creating a longer life and better physical range than other materials.[1] The principal difference between thermoset elastomers and thermoplastic elastomers is the type of cross-linking bond in their structures. In fact, crosslinking is a critical structural factor which imparts high elastic properties.\n\n\nIUPAC definition\nThermoplastic elastomer: Elastomer comprising a thermoreversible network.[2]\n\nContents \n\n1 Types \n2 Background \n3 Advantages \n4 Processing \n5 Applications \n6 References \n7 Further reading \n\n\nTypes \n Thermoplastic polyurethanes\nThere are six generic classes of commercial TPEs (designations acc. to ISO 18064):\n\nStyrenic block copolymers, TPS (TPE-s)\nThermoplastic polyolefinelastomers, TPO (TPE-o)\nThermoplastic Vulcanizates, TPV (TPE-v or TPV)\nThermoplastic polyurethanes, TPU (TPU)\nThermoplastic copolyester, TPC (TPE-E)\nThermoplastic polyamides, TPA (TPE-A)\nNot classified thermoplastic elastomers, TPZ\nExamples of TPE materials that come from block copolymers group are amongst others CAWITON\u00ae , THERMOLAST\u00ae K, THERMOLAST\u00ae M, Arnitel, Hytrel, Dryflex, Mediprene, Kraton, Pibiflex, Sofprene, and Laprene. Out of these styrenic block copolymers (TPE-s) are CAWITON\u00ae, THERMOLAST\u00ae K, THERMOLAST\u00ae M, Sofprene, Dryflex and Laprene. Desmopan or Elastollan are examples of Thermoplastic polyurethanes (TPU). Santoprene, Termoton, Solprene, THERMOLAST\u00ae V, Vegaprene,[3] or Forprene are examples of TPV materials. Examples of Thermoplastic olefin elastomers (TPO) compound are For-Tec E or Engage. Ninjaflex used for 3D printing.\nIn order to qualify as a thermoplastic elastomer, a material must have these three essential characteristics:\n\nThe ability to be stretched to moderate elongations and, upon the removal of stress, return to something close to its original shape\nProcessable as a melt at elevated temperature\nAbsence of significant creep\nBackground \n SBS block copolymer schematic microstructure\nIt was not until the 1950s, when thermoplastic polyurethane polymers became available, that TPE became a commercial reality. During the 1960s styrene block copolymer became available, and in the 1970s a wide range of TPEs came on the scene. The worldwide usage of TPEs (680,000 tons\/year in 1990) is growing at about nine percent per year. The styrene-butadiene materials possess a two-phase microstructure due to incompatibility between the polystyrene and polybutadiene blocks, the former separating into spheres or rods depending on the exact composition. With low polystyrene content, the material is elastomeric with the properties of the polybutadiene predominating. Generally they offer a much wider range of properties than conventional cross-linked rubbers because the composition can vary to suit final construction goals.\n\n SBS block copolymer in TEM\nBlock copolymers are interesting because they can \"microphase separate\" to form periodic nanostructures, as in the styrene-butadiene-styrene (SBS) block copolymer shown at right. The polymer is known as Kraton and is used for shoe soles and adhesives. Owing to the microfine structure, the transmission electron microscope or TEM was needed to examine the structure. The butadiene matrix was stained with osmium tetroxide to provide contrast in the image. The material was made by living polymerization so that the blocks are almost monodisperse, so helping to create a very regular microstructure. The molecular weight of the polystyrene blocks in the main picture is 102,000; the inset picture has a molecular weight of 91,000, producing slightly smaller domains. The spacing between domains has been confirmed by small-angle X-ray scattering, a technique which gives information about microstructure.\nSince most polymers are incompatible with one another, forming a block polymer will usually result in phase separation, and the principle has been widely exploited since the introduction of the SBS block polymers, especially where one of the block is highly crystalline. One exception to the rule of incompatibility is the material Noryl, where polystyrene and polyphenylene oxide or PPO form a continuous blend with one another.\n\n Schematic crystalline block copolymer\nOther TPEs have crystalline domains where one kind of block co-crystallizes with other block in adjacent chains, such as in copolyester rubbers, achieving the same effect as in the SBS block polymers. Depending on the block length, the domains are generally more stable than the latter owing to the higher crystal melting point. That point determines the processing temperatures needed to shape the material, as well as the ultimate service use temperatures of the product. Such materials include Hytrel, a polyester-polyether copolymer and Pebax, a nylon or polyamide-polyether copolymer.\n\nAdvantages \nTPE materials have the potential to be recyclable since they can be molded, extruded and reused like plastics, but they have typical elastic properties of rubbers which are not recyclable owing to their thermosetting characteristics. They can also be ground up and turned into 3D printing filament with a recyclebot. TPE also require little or no compounding, with no need to add reinforcing agents, stabilizers or cure systems. Hence, batch-to-batch variations in weighting and metering components are absent, leading to improved consistency in both raw materials and fabricated articles. Depending on the environment, TPEs have outstanding thermal properties and material stability when exposed to a broad range of temperatures and non-polar materials.[1] TPEs consume less energy to produce, can be colored easily by most dyes, and allow economical quality control.\n\nProcessing \nThe two most important manufacturing methods with TPEs are extrusion and injection molding. TPEs can now be 3D printed and have been shown to be economically advantageous to make products using distributed manufacturing.[4][5] Compression molding is seldom, if ever, used. Fabrication via injection molding is extremely rapid and highly economical. Both the equipment and methods normally used for the extrusion or injection molding of a conventional thermoplastic are generally suitable for TPEs. TPEs can also be processed by blow molding, melt calendaring,[6] thermoforming, and heat welding.\n\nApplications \nTPEs are used where conventional elastomers cannot provide the range of physical properties needed in the product. These materials find large application in the automotive sector and in household appliances sector. In 2014 the world market for TPEs reached a volume of ca. 16.7 billion US dollars. About 40% of all TPE products are used in the manufacturing of vehicles.[7] For instance copolyester TPEs are used in snowmobile tracks where stiffness and abrasion resistance are at a premium. Thermoplastic olefins (TPO) are increasingly used as a roofing material[8]. TPEs are also widely used for catheters where nylon block copolymers offer a range of softness ideal for patients. Thermoplastic silicone and olefin blends are used for extrusion of glass run and dynamic weatherstripping car profiles. Styrene block copolymers are used in shoe soles for their ease of processing, and widely as adhesives. Owing to their unrivaled abilities in two-component injection molding to various thermoplastic substrates, engineered TPS materials also cover a broad range of technical applications ranging from automotive market to consumer and medical products. Examples of those are soft grip surfaces, design elements, back-lit switches and surfaces, as well as sealings, gaskets, or damping elements. TPE is commonly used to make suspension bushings for automotive performance applications because of its greater resistance to deformation when compared to regular rubber bushings. Thermoplastics have experienced growth in the heating, ventilation, and air conditioning (HVAC) industry due to the function, cost effectiveness and adaptability to modify plastic resins into a variety of covers, fans and housings. TPE may also be used in medical devices and is also finding more and more uses as an electrical cable jacket and inner insulation. You'll also be able to find TPE used in some headphone cables.\n\nReferences \n\n\n^ a b Levensalor, Alex. \"The Benefits of Hytrel in Modern Belting\". Retrieved 2016-10-27 . \n\n^ Alem\u00e1n, J. V.; Chadwick, A. V.; He, J.; Hess, M.; Horie, K.; Jones, R. G.; Kratochv\u00edl, P.; Meisel, I.; Mita, I.; Moad, G.; Penczek, S.; Stepto, R. F. T. (1 January 2007). \"Definitions of terms relating to the structure and processing of sols, gels, networks, and inorganic-organic hybrid materials (IUPAC Recommendations 2007)\". Pure and Applied Chemistry. 79 (10): 1801\u20131829. doi:10.1351\/pac200779101801. \n\n^ \"Innovation in materials\". www.hutchinson.com. Retrieved 2017-02-27 . \n\n^ Woern, Aubrey L.; Pearce, Joshua M. (2017-10-30). \"Distributed Manufacturing of Flexible Products: Technical Feasibility and Economic Viability\". Technologies. 5 (4): 71. doi:10.3390\/technologies5040071. \n\n^ \"Is Flexible 3D Printer Filament Worth the Investment? | 3DPrint.com | The Voice of 3D Printing \/ Additive Manufacturing\". 3dprint.com. Retrieved 2018-03-10 . \n\n^ \"Processing methods for thermoplastic elastomers-TPE - Introduction\". www.tut.fi. Retrieved 2016-10-27 . \n\n^ Kuehner, Marcel. \"Thermoplastic Elastomers (TPE) - Market Study - Ceresana\". www.ceresana.com. \n\n^ \"ASTM D6878 \/ D6878M - 17 Standard Specification for Thermoplastic Polyolefin Based Sheet Roofing\". www.astm.org. Retrieved 2018-03-18 . \n\n\nFurther reading \nPR Lewis and C Price, Polymer, 13, 20 (1972)\nModern Plastic Mid-October Encyclopedia Issue, Introduction to TPEs, page:109-110\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Thermoplastic_elastomer\">https:\/\/www.limswiki.org\/index.php\/Thermoplastic_elastomer<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 16:56.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 932 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","0a7c94f3c786708efd795d8a15a4ebb8_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Thermoplastic_elastomer skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Thermoplastic elastomer<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Thermoplastic elastomers<\/b> (<b>TPE<\/b>), sometimes referred to as <b>thermoplastic rubbers<\/b>, are a class of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copolymer\" title=\"Copolymer\" rel=\"external_link\" target=\"_blank\">copolymers<\/a> or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer_blend\" title=\"Polymer blend\" rel=\"external_link\" target=\"_blank\">physical mix of polymers<\/a> (usually a plastic and a rubber) which consist of materials with both <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoplastic\" title=\"Thermoplastic\" rel=\"external_link\" target=\"_blank\">thermoplastic<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastomer\" title=\"Elastomer\" rel=\"external_link\" target=\"_blank\">elastomeric<\/a> properties. While most elastomers are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoset\" class=\"mw-redirect\" title=\"Thermoset\" rel=\"external_link\" target=\"_blank\">thermosets<\/a>, thermoplastics are in contrast relatively easy to use in manufacturing, for example, by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Injection_molding\" class=\"mw-redirect\" title=\"Injection molding\" rel=\"external_link\" target=\"_blank\">injection molding<\/a>. Thermoplastic elastomers show advantages typical of both rubbery materials and plastic materials. The benefit of using thermoplastic elastomers is the ability to stretch to moderate elongations and return to its near original shape creating a longer life and better physical range than other materials.<sup id=\"rdp-ebb-cite_ref-:0_1-0\" class=\"reference\"><a href=\"#cite_note-:0-1\" rel=\"external_link\">[1]<\/a><\/sup> The principal difference between thermoset elastomers and thermoplastic elastomers is the type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cross-link\" title=\"Cross-link\" rel=\"external_link\" target=\"_blank\">cross-linking<\/a> bond in their structures. In fact, crosslinking is a critical structural factor which imparts high elastic properties.\n<\/p>\n<div class=\"quotebox pullquote floatright\" style=\"width:30%; ;\">\n<div class=\"quotebox-title\" style=\"\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Union_of_Pure_and_Applied_Chemistry\" title=\"International Union of Pure and Applied Chemistry\" rel=\"external_link\" target=\"_blank\">IUPAC<\/a> definition<\/div>\n<div class=\"quotebox-quote left-aligned\" style=\"\"><b>Thermoplastic elastomer:<\/b> Elastomer comprising a thermoreversible network.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><\/div>\n<\/div>\n\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Chips_TPU_con_eurocent.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/dc\/Chips_TPU_con_eurocent.jpg\/220px-Chips_TPU_con_eurocent.jpg\" width=\"220\" height=\"146\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Chips_TPU_con_eurocent.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Thermoplastic polyurethanes<\/div><\/div><\/div>\n<p>There are six generic classes of commercial TPEs (designations acc. to ISO 18064):\n<\/p>\n<ul><li>Styrenic block copolymers, TPS (TPE-s)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoplastic_polyolefin\" class=\"mw-redirect\" title=\"Thermoplastic polyolefin\" rel=\"external_link\" target=\"_blank\">Thermoplastic polyolefinelastomers<\/a>, TPO (TPE-o)<\/li>\n<li>Thermoplastic Vulcanizates, TPV (TPE-v or TPV)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoplastic_polyurethane\" title=\"Thermoplastic polyurethane\" rel=\"external_link\" target=\"_blank\">Thermoplastic polyurethanes<\/a>, TPU (TPU)<\/li>\n<li>Thermoplastic copolyester, TPC (TPE-E)<\/li>\n<li>Thermoplastic polyamides, TPA (TPE-A)<\/li>\n<li>Not classified thermoplastic elastomers, TPZ<\/li><\/ul>\n<p>Examples of TPE materials that come from block copolymers group are amongst others CAWITON\u00ae , THERMOLAST\u00ae K, THERMOLAST\u00ae M, Arnitel, Hytrel, Dryflex, Mediprene, Kraton, Pibiflex, Sofprene, and Laprene. Out of these styrenic block copolymers (TPE-s) are CAWITON\u00ae, THERMOLAST\u00ae K, THERMOLAST\u00ae M, Sofprene, Dryflex and Laprene. Desmopan or Elastollan are examples of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoplastic_polyurethane\" title=\"Thermoplastic polyurethane\" rel=\"external_link\" target=\"_blank\">Thermoplastic polyurethanes<\/a> (TPU). Santoprene, Termoton, Solprene, THERMOLAST\u00ae V, Vegaprene,<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> or Forprene are examples of TPV materials. Examples of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoplastic_olefin\" title=\"Thermoplastic olefin\" rel=\"external_link\" target=\"_blank\">Thermoplastic olefin<\/a> elastomers (TPO) compound are For-Tec E or Engage. used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/3D_printing\" title=\"3D printing\" rel=\"external_link\" target=\"_blank\">3D printing<\/a>.\n<\/p><p>In order to qualify as a thermoplastic elastomer, a material must have these three essential characteristics:\n<\/p>\n<ul><li>The ability to be stretched to moderate elongations and, upon the removal of stress, return to something close to its original shape<\/li>\n<li>Processable as a melt at elevated temperature<\/li>\n<li>Absence of significant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Creep_(deformation)\" title=\"Creep (deformation)\" rel=\"external_link\" target=\"_blank\">creep<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Background\">Background<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:SBSstructure.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/86\/SBSstructure.svg\/220px-SBSstructure.svg.png\" width=\"220\" height=\"200\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:SBSstructure.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>SBS block copolymer schematic microstructure<\/div><\/div><\/div>\n<p>It was not until the 1950s, when thermoplastic polyurethane polymers became available, that TPE became a commercial reality. During the 1960s styrene block copolymer became available, and in the 1970s a wide range of TPEs came on the scene. The worldwide usage of TPEs (680,000 tons\/year in 1990) is growing at about nine percent per year. The styrene-butadiene materials possess a two-phase microstructure due to incompatibility between the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polystyrene\" title=\"Polystyrene\" rel=\"external_link\" target=\"_blank\">polystyrene<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polybutadiene\" title=\"Polybutadiene\" rel=\"external_link\" target=\"_blank\">polybutadiene<\/a> blocks, the former separating into spheres or rods depending on the exact composition. With low polystyrene content, the material is elastomeric with the properties of the polybutadiene predominating. Generally they offer a much wider range of properties than conventional cross-linked rubbers because the composition can vary to suit final construction goals.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sbs_block_copolymer.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Sbs_block_copolymer.jpg\/220px-Sbs_block_copolymer.jpg\" width=\"220\" height=\"155\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sbs_block_copolymer.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>SBS block copolymer in TEM<\/div><\/div><\/div>\n<p>Block copolymers are interesting because they can \"microphase separate\" to form periodic nanostructures, as in the styrene-butadiene-styrene (SBS) block copolymer shown at right. The polymer is known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kraton_(polymer)\" title=\"Kraton (polymer)\" rel=\"external_link\" target=\"_blank\">Kraton<\/a> and is used for shoe soles and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adhesive\" title=\"Adhesive\" rel=\"external_link\" target=\"_blank\">adhesives<\/a>. Owing to the microfine structure, the transmission electron microscope or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transmission_electron_microscopy\" title=\"Transmission electron microscopy\" rel=\"external_link\" target=\"_blank\">TEM<\/a> was needed to examine the structure. The butadiene matrix was stained with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osmium_tetroxide\" title=\"Osmium tetroxide\" rel=\"external_link\" target=\"_blank\">osmium tetroxide<\/a> to provide contrast in the image. The material was made by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Living_polymerization\" title=\"Living polymerization\" rel=\"external_link\" target=\"_blank\">living polymerization<\/a> so that the blocks are almost <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monodisperse\" class=\"mw-redirect\" title=\"Monodisperse\" rel=\"external_link\" target=\"_blank\">monodisperse<\/a>, so helping to create a very regular microstructure. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_weight\" class=\"mw-redirect\" title=\"Molecular weight\" rel=\"external_link\" target=\"_blank\">molecular weight<\/a> of the polystyrene blocks in the main picture is 102,000; the inset picture has a molecular weight of 91,000, producing slightly smaller domains. The spacing between domains has been confirmed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Small-angle_X-ray_scattering\" title=\"Small-angle X-ray scattering\" rel=\"external_link\" target=\"_blank\">small-angle X-ray scattering<\/a>, a technique which gives information about <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microstructure\" title=\"Microstructure\" rel=\"external_link\" target=\"_blank\">microstructure<\/a>.\nSince most polymers are incompatible with one another, forming a block polymer will usually result in phase separation, and the principle has been widely exploited since the introduction of the SBS block polymers, especially where one of the block is highly crystalline. One exception to the rule of incompatibility is the material <a href=\"https:\/\/en.wikipedia.org\/wiki\/Noryl\" title=\"Noryl\" rel=\"external_link\" target=\"_blank\">Noryl<\/a>, where polystyrene and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyphenylene_oxide\" class=\"mw-redirect\" title=\"Polyphenylene oxide\" rel=\"external_link\" target=\"_blank\">polyphenylene oxide<\/a> or PPO form a continuous blend with one another.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CrystTPE.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3e\/CrystTPE.svg\/170px-CrystTPE.svg.png\" width=\"170\" height=\"188\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CrystTPE.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Schematic crystalline block copolymer<\/div><\/div><\/div>\n<p>Other TPEs have crystalline domains where one kind of block co-crystallizes with other block in adjacent chains, such as in copolyester rubbers, achieving the same effect as in the SBS block polymers. Depending on the block length, the domains are generally more stable than the latter owing to the higher crystal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Melting_point\" title=\"Melting point\" rel=\"external_link\" target=\"_blank\">melting point<\/a>. That point determines the processing temperatures needed to shape the material, as well as the ultimate service use temperatures of the product. Such materials include Hytrel, a polyester-polyether copolymer and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pebax\" class=\"mw-redirect\" title=\"Pebax\" rel=\"external_link\" target=\"_blank\">Pebax<\/a>, a nylon or polyamide-polyether copolymer.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Advantages\">Advantages<\/span><\/h2>\n<p>TPE materials have the potential to be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Recycling\" title=\"Recycling\" rel=\"external_link\" target=\"_blank\">recyclable<\/a> since they can be molded, extruded and reused like plastics, but they have typical elastic properties of rubbers which are not recyclable owing to their thermosetting characteristics. They can also be ground up and turned into 3D printing filament with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Recyclebot\" title=\"Recyclebot\" rel=\"external_link\" target=\"_blank\">recyclebot<\/a>. TPE also require little or no compounding, with no need to add reinforcing agents, stabilizers or cure systems. Hence, batch-to-batch variations in weighting and metering components are absent, leading to improved consistency in both raw materials and fabricated articles. Depending on the environment, TPEs have outstanding thermal properties and material stability when exposed to a broad range of temperatures and non-polar materials.<sup id=\"rdp-ebb-cite_ref-:0_1-1\" class=\"reference\"><a href=\"#cite_note-:0-1\" rel=\"external_link\">[1]<\/a><\/sup> TPEs consume less energy to produce, can be colored easily by most dyes, and allow economical quality control.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Processing\">Processing<\/span><\/h2>\n<p>The two most important manufacturing methods with TPEs are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Extrusion\" title=\"Extrusion\" rel=\"external_link\" target=\"_blank\">extrusion<\/a> and injection molding. TPEs can now be <a href=\"https:\/\/en.wikipedia.org\/wiki\/3D_printing\" title=\"3D printing\" rel=\"external_link\" target=\"_blank\">3D printed<\/a> and have been shown to be economically advantageous to make products using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Distributed_manufacturing\" title=\"Distributed manufacturing\" rel=\"external_link\" target=\"_blank\">distributed manufacturing<\/a>.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Compression_molding\" title=\"Compression molding\" rel=\"external_link\" target=\"_blank\">Compression molding<\/a> is seldom, if ever, used. Fabrication via injection molding is extremely rapid and highly economical. Both the equipment and methods normally used for the extrusion or injection molding of a conventional thermoplastic are generally suitable for TPEs. TPEs can also be processed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blow_molding\" title=\"Blow molding\" rel=\"external_link\" target=\"_blank\">blow molding<\/a>, melt calendaring,<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoforming\" title=\"Thermoforming\" rel=\"external_link\" target=\"_blank\">thermoforming<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heat_welding\" class=\"mw-redirect\" title=\"Heat welding\" rel=\"external_link\" target=\"_blank\">heat welding<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>TPEs are used where conventional elastomers cannot provide the range of physical properties needed in the product. These materials find large application in the automotive sector and in household appliances sector. In 2014 the world market for TPEs reached a volume of ca. 16.7 billion US dollars. About 40% of all TPE products are used in the manufacturing of vehicles.<sup id=\"rdp-ebb-cite_ref-ceresana.com_7-0\" class=\"reference\"><a href=\"#cite_note-ceresana.com-7\" rel=\"external_link\">[7]<\/a><\/sup> For instance copolyester TPEs are used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Snowmobile\" title=\"Snowmobile\" rel=\"external_link\" target=\"_blank\">snowmobile<\/a> tracks where stiffness and abrasion resistance are at a premium. Thermoplastic olefins (TPO) are increasingly used as a roofing material<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>. TPEs are also widely used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheters<\/a> where nylon block copolymers offer a range of softness ideal for patients. Thermoplastic silicone and olefin blends are used for extrusion of glass run and dynamic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Weatherstripping\" title=\"Weatherstripping\" rel=\"external_link\" target=\"_blank\">weatherstripping<\/a> car profiles. Styrene block copolymers are used in shoe soles for their ease of processing, and widely as adhesives. Owing to their unrivaled abilities in two-component injection molding to various thermoplastic substrates, engineered TPS materials also cover a broad range of technical applications ranging from automotive market to consumer and medical products. Examples of those are soft grip surfaces, design elements, back-lit switches and surfaces, as well as sealings, gaskets, or damping elements. TPE is commonly used to make suspension <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bushing_(isolator)\" title=\"Bushing (isolator)\" rel=\"external_link\" target=\"_blank\">bushings<\/a> for automotive performance applications because of its greater resistance to deformation when compared to regular rubber bushings. Thermoplastics have experienced growth in the heating, ventilation, and air conditioning (<a href=\"https:\/\/en.wikipedia.org\/wiki\/HVAC\" title=\"HVAC\" rel=\"external_link\" target=\"_blank\">HVAC<\/a>) industry due to the function, cost effectiveness and adaptability to modify <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microplastics\" title=\"Microplastics\" rel=\"external_link\" target=\"_blank\">plastic resins<\/a> into a variety of covers, fans and housings. TPE may also be used in medical devices and is also finding more and more uses as an electrical cable jacket and inner <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulator_(electrical)\" class=\"mw-redirect\" title=\"Insulator (electrical)\" rel=\"external_link\" target=\"_blank\">insulation<\/a>. You'll also be able to find TPE used in some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Headphones\" title=\"Headphones\" rel=\"external_link\" target=\"_blank\">headphone<\/a> cables.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-:0-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Levensalor, Alex. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/industrial.beltcorp.com\/blog\/the-benefits-of-hytrel-in-modern-belting\" target=\"_blank\">\"The Benefits of Hytrel in Modern Belting\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-10-27<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=The+Benefits+of+Hytrel+in+Modern+Belting&rft.aulast=Levensalor&rft.aufirst=Alex&rft_id=http%3A%2F%2Findustrial.beltcorp.com%2Fblog%2Fthe-benefits-of-hytrel-in-modern-belting&rfr_id=info%3Asid%2Fen.wikipedia.org%3AThermoplastic+elastomer\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Alem\u00e1n, J. V.; Chadwick, A. V.; He, J.; Hess, M.; Horie, K.; Jones, R. G.; Kratochv\u00edl, P.; Meisel, I.; Mita, I.; Moad, G.; Penczek, S.; Stepto, R. F. T. (1 January 2007). \"Definitions of terms relating to the structure and processing of sols, gels, networks, and inorganic-organic hybrid materials (IUPAC Recommendations 2007)\". <i>Pure and Applied Chemistry<\/i>. <b>79<\/b> (10): 1801\u20131829. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1351%2Fpac200779101801\" target=\"_blank\">10.1351\/pac200779101801<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pure+and+Applied+Chemistry&rft.atitle=Definitions+of+terms+relating+to+the+structure+and+processing+of+sols%2C+gels%2C+networks%2C+and+inorganic-organic+hybrid+materials+%28IUPAC+Recommendations+2007%29&rft.volume=79&rft.issue=10&rft.pages=1801-1829&rft.date=2007-01-01&rft_id=info%3Adoi%2F10.1351%2Fpac200779101801&rft.aulast=Alem%C3%A1n&rft.aufirst=J.+V.&rft.au=Chadwick%2C+A.+V.&rft.au=He%2C+J.&rft.au=Hess%2C+M.&rft.au=Horie%2C+K.&rft.au=Jones%2C+R.+G.&rft.au=Kratochv%C3%ADl%2C+P.&rft.au=Meisel%2C+I.&rft.au=Mita%2C+I.&rft.au=Moad%2C+G.&rft.au=Penczek%2C+S.&rft.au=Stepto%2C+R.+F.+T.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AThermoplastic+elastomer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hutchinson.com\/en\/innovation-materials\" target=\"_blank\">\"Innovation in materials\"<\/a>. <i>www.hutchinson.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-02-27<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.hutchinson.com&rft.atitle=Innovation+in+materials&rft_id=http%3A%2F%2Fwww.hutchinson.com%2Fen%2Finnovation-materials&rfr_id=info%3Asid%2Fen.wikipedia.org%3AThermoplastic+elastomer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Woern, Aubrey L.; Pearce, Joshua M. (2017-10-30). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mdpi.com\/2227-7080\/5\/4\/71\" target=\"_blank\">\"Distributed Manufacturing of Flexible Products: Technical Feasibility and Economic Viability\"<\/a>. <i>Technologies<\/i>. <b>5<\/b> (4): 71. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3390%2Ftechnologies5040071\" target=\"_blank\">10.3390\/technologies5040071<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Technologies&rft.atitle=Distributed+Manufacturing+of+Flexible+Products%3A+Technical+Feasibility+and+Economic+Viability&rft.volume=5&rft.issue=4&rft.pages=71&rft.date=2017-10-30&rft_id=info%3Adoi%2F10.3390%2Ftechnologies5040071&rft.aulast=Woern&rft.aufirst=Aubrey+L.&rft.au=Pearce%2C+Joshua+M.&rft_id=http%3A%2F%2Fwww.mdpi.com%2F2227-7080%2F5%2F4%2F71&rfr_id=info%3Asid%2Fen.wikipedia.org%3AThermoplastic+elastomer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/3dprint.com\/192599\/flexible-3d-printer-filament\/\" target=\"_blank\">\"Is Flexible 3D Printer Filament Worth the Investment? | 3DPrint.com | The Voice of 3D Printing \/ Additive Manufacturing\"<\/a>. <i>3dprint.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-03-10<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=3dprint.com&rft.atitle=Is+Flexible+3D+Printer+Filament+Worth+the+Investment%3F+%7C+3DPrint.com+%7C+The+Voice+of+3D+Printing+%2F+Additive+Manufacturing&rft_id=https%3A%2F%2F3dprint.com%2F192599%2Fflexible-3d-printer-filament%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AThermoplastic+elastomer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.tut.fi\/ms\/muo\/vert\/8_processing\/5.1.htm\" target=\"_blank\">\"Processing methods for thermoplastic elastomers-TPE - Introduction\"<\/a>. <i>www.tut.fi<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-10-27<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.tut.fi&rft.atitle=Processing+methods+for+thermoplastic+elastomers-TPE+-+Introduction&rft_id=https%3A%2F%2Fwww.tut.fi%2Fms%2Fmuo%2Fvert%2F8_processing%2F5.1.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AThermoplastic+elastomer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ceresana.com-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ceresana.com_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Kuehner, Marcel. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ceresana.com\/en\/market-studies\/plastics\/thermoplastic-elastomers\/\" target=\"_blank\">\"Thermoplastic Elastomers (TPE) - Market Study - Ceresana\"<\/a>. <i>www.ceresana.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.ceresana.com&rft.atitle=Thermoplastic+Elastomers+%28TPE%29+-+Market+Study+-+Ceresana&rft.aulast=Kuehner&rft.aufirst=Marcel&rft_id=http%3A%2F%2Fwww.ceresana.com%2Fen%2Fmarket-studies%2Fplastics%2Fthermoplastic-elastomers%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AThermoplastic+elastomer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.astm.org\/Standards\/D6878.htm\" target=\"_blank\">\"ASTM D6878 \/ D6878M - 17 Standard Specification for Thermoplastic Polyolefin Based Sheet Roofing\"<\/a>. <i>www.astm.org<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-03-18<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.astm.org&rft.atitle=ASTM+D6878+%2F+D6878M+-+17+Standard+Specification+for++Thermoplastic+Polyolefin+Based+Sheet+Roofing&rft_id=https%3A%2F%2Fwww.astm.org%2FStandards%2FD6878.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AThermoplastic+elastomer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li>PR Lewis and C Price, <i>Polymer<\/i>, 13, 20 (1972)<\/li>\n<li>Modern Plastic Mid-October Encyclopedia Issue, Introduction to TPEs, <i>page:109-110<\/i><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1238\nCached time: 20181129165413\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.216 seconds\nReal time usage: 0.295 seconds\nPreprocessor visited node count: 684\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 18471\/2097152 bytes\nTemplate argument size: 486\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 22927\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.108\/10.000 seconds\nLua memory usage: 2.9 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 246.462 1 -total\n<\/p>\n<pre>56.70% 139.755 1 Template:Reflist\n30.36% 74.833 1 Template:More_footnotes\n23.98% 59.113 1 Template:Cite_news\n19.81% 48.821 1 Template:Ambox\n14.68% 36.185 2 Template:Cite_journal\n10.88% 26.805 1 Template:Quote_box\n10.32% 25.447 5 Template:Cite_web\n 2.38% 5.858 2 Template:Yesno-no\n 1.35% 3.329 2 Template:Yesno\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:4085687-1!canonical and timestamp 20181129165413 and revision id 849928587\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoplastic_elastomer\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212229\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.142 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 135.934 1 - wikipedia:Thermoplastic_elastomer\n100.00% 135.934 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8298-0!*!*!*!*!*!* and timestamp 20181217212229 and revision id 24510\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Thermoplastic_elastomer\">https:\/\/www.limswiki.org\/index.php\/Thermoplastic_elastomer<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","0a7c94f3c786708efd795d8a15a4ebb8_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/dc\/Chips_TPU_con_eurocent.jpg\/440px-Chips_TPU_con_eurocent.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/86\/SBSstructure.svg\/440px-SBSstructure.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Sbs_block_copolymer.jpg\/440px-Sbs_block_copolymer.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3e\/CrystTPE.svg\/340px-CrystTPE.svg.png"],"0a7c94f3c786708efd795d8a15a4ebb8_timestamp":1545081749,"8d3be78eb4777fc2c36709842ad86ba8_type":"article","8d3be78eb4777fc2c36709842ad86ba8_title":"Tantalum","8d3be78eb4777fc2c36709842ad86ba8_url":"https:\/\/www.limswiki.org\/index.php\/Tantalum","8d3be78eb4777fc2c36709842ad86ba8_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tTantalum\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tchemical element with atomic number 73Tantalum,  73 Ta General propertiesPronunciation\/\u02c8 t \u00e6 n t \u0259l \u0259 m \/  ​(TAN -t\u0259l-\u0259m) Appearancegray blueStandard atomic weight (Ar, standard) 7002180947880000000\u2660 180.94788 (2) [1]Tantalum in the periodic table\n\n\n\n\n\n\n\n\n\n\nHydrogen \n\n\n\nHelium \n\n\nLithium \n\nBeryllium \n\n\n\nBoron \n\nCarbon \n\nNitrogen \n\nOxygen \n\nFluorine \n\nNeon \n\n\nSodium \n\nMagnesium \n\n\n\nAluminium \n\nSilicon \n\nPhosphorus \n\nSulfur \n\nChlorine \n\nArgon \n\n\nPotassium \n\nCalcium \n\nScandium \n\n\n\nTitanium \n\nVanadium \n\nChromium \n\nManganese \n\nIron \n\nCobalt \n\nNickel \n\nCopper \n\nZinc \n\nGallium \n\nGermanium \n\nArsenic \n\nSelenium \n\nBromine \n\nKrypton \n\n\nRubidium \n\nStrontium \n\nYttrium \n\n\n\n\n\nZirconium \n\nNiobium \n\nMolybdenum \n\nTechnetium \n\nRuthenium \n\nRhodium \n\nPalladium \n\nSilver \n\nCadmium \n\nIndium \n\nTin \n\nAntimony \n\nTellurium \n\nIodine \n\nXenon \n\n\nCaesium \n\nBarium \n\nLanthanum \n\nCerium \n\nPraseodymium \n\nNeodymium \n\nPromethium \n\nSamarium \n\nEuropium \n\nGadolinium \n\nTerbium \n\nDysprosium \n\nHolmium \n\nErbium \n\nThulium \n\nYtterbium \n\nLutetium \n\nHafnium \n\nTantalum \n\nTungsten \n\nRhenium \n\nOsmium \n\nIridium \n\nPlatinum \n\nGold \n\nMercury (element) \n\nThallium \n\nLead \n\nBismuth \n\nPolonium \n\nAstatine \n\nRadon \n\n\nFrancium \n\nRadium \n\nActinium \n\nThorium \n\nProtactinium \n\nUranium \n\nNeptunium \n\nPlutonium \n\nAmericium \n\nCurium \n\nBerkelium \n\nCalifornium \n\nEinsteinium \n\nFermium \n\nMendelevium \n\nNobelium \n\nLawrencium \n\nRutherfordium \n\nDubnium \n\nSeaborgium \n\nBohrium \n\nHassium \n\nMeitnerium \n\nDarmstadtium \n\nRoentgenium \n\nCopernicium \n\nNihonium \n\nFlerovium \n\nMoscovium \n\nLivermorium \n\nTennessine \n\nOganesson \n\n\n\nNb\r\n\u2191\r\nTa\r\n\u2193\r\nDb\n\n\nhafnium \u2190 tantalum \u2192 tungsten\n\nAtomic number (Z) 73Groupgroup 5 Periodperiod 6 Blockd-block Element category  transition metalElectron configuration[Xe] 4f14 5d3 6s2Electrons per shell2, 8, 18, 32, 11, 2Physical propertiesPhase at STP solidMelting point3290 K ​(3017 \u00b0C, ​5463 \u00b0F) Boiling point5731 K ​(5458 \u00b0C, ​9856 \u00b0F) Density (near r.t.) 16.69 g\/cm3when liquid (at m.p.) 15 g\/cm3 Heat of fusion36.57 kJ\/mol Heat of vaporization753 kJ\/mol Molar heat capacity25.36 J\/(mol\u00b7K) Vapor pressure\n\n\n\nP (Pa) \n\n1\n\n10\n\n100\n\n1 k\n\n10 k\n\n100 k\n\n\nat T (K) \n\n3297\n\n3597\n\n3957\n\n4395\n\n4939\n\n5634\n\nAtomic propertiesOxidation states\u22123, \u22121, +1, +2, +3, +4, +5 (a mildly acidic oxide)ElectronegativityPauling scale: 1.5 Ionization energies1st: 761 kJ\/mol 2nd: 1500 kJ\/mol  Atomic radiusempirical: 146 pm Covalent radius170\u00b18 pm Spectral lines of tantalumOther propertiesCrystal structure ​body-centered cubic (bcc)[2]\r\nα-TaCrystal structure ​tetragonal[2]\r\nβ-TaSpeed of sound  thin rod 3400 m\/s (at 20 \u00b0C) Thermal expansion6.3 \u00b5m\/(m\u00b7K) (at 25 \u00b0C) Thermal conductivity57.5 W\/(m\u00b7K) Electrical resistivity131 n\u03a9\u00b7m (at 20 \u00b0C) Magnetic orderingparamagnetic[3] Magnetic susceptibility+154.0\u00b710\u22126 cm3\/mol (293 K)[4]Young's modulus186 GPa Shear modulus69 GPa Bulk modulus200 GPa Poisson ratio0.34 Mohs hardness6.5 Vickers hardness870\u20131200 MPa Brinell hardness440\u20133430 MPa CAS Number7440-25-7 HistoryDiscoveryAnders Gustaf Ekeberg (1802) Recognized as a distinct element byHeinrich Rose (1844)Main isotopes of tantalum\n\n\n\nIso­tope\n\nAbun­dance\n\nHalf-life (t1\/2) \n\nDecay mode\n\nPro­duct\n\n\n177Ta\n\nsyn\n\n56.56 h\n\n\u03b5\n\n177Hf\n\n\n178Ta\n\nsyn\n\n2.36 h\n\n\u03b5\n\n178Hf\n\n\n179Ta\n\nsyn\n\n1.82 y\n\n\u03b5\n\n179Hf\n\n\n180Ta\n\nsyn\n\n8.125 h\n\n\u03b5\n\n180Hf\n\n\n\u03b2\u2212\n\n180W\n\n\n180mTa\n\n0.012%\n\nstable\n\n\n181Ta\n\n99.988%\n\nstable\n\n\n182Ta\n\nsyn\n\n114.43 d\n\n\u03b2\u2212\n\n182W\n\n\n183Ta\n\nsyn\n\n5.1 d\n\n\u03b2\u2212\n\n183W\nview talk edit  | references\nTantalum is a chemical element with symbol Ta and atomic number 73. Previously known as tantalium, its name comes from Tantalus, a villain from Greek mythology.[5] Tantalum is a rare, hard, blue-gray, lustrous transition metal that is highly corrosion-resistant. It is part of the refractory metals group, which are widely used as minor components in alloys. The chemical inertness of tantalum makes it a valuable substance for laboratory equipment and a substitute for platinum. Its main use today is in tantalum capacitors in electronic equipment such as mobile phones, DVD players, video game systems and computers.\nTantalum, always together with the chemically similar niobium, occurs in the mineral groups tantalite, columbite and coltan (a mix of columbite and tantalite, though not recognised as a separate mineral species).[6]\n\nContents \n\n1 History \n2 Characteristics \n\n2.1 Physical properties \n2.2 Isotopes \n\n\n3 Chemical compounds \n\n3.1 Oxides, nitrides, carbides, sulfides \n3.2 Halides \n3.3 Organotantalum compounds \n\n\n4 Occurrence \n5 Status as a conflict resource \n6 Production and fabrication \n\n6.1 Refining \n6.2 Electrolysis \n6.3 Fabrication and metalworking \n\n\n7 Applications \n\n7.1 Electronics \n7.2 Alloys \n7.3 Other uses \n\n\n8 Environmental issues \n9 Precautions \n10 References \n11 External links \n\n\nHistory \nTantalum was discovered in Sweden in 1802 by Anders Ekeberg.[7][8] One year earlier, Charles Hatchett had discovered columbium (now niobium),[9] and in 1809 the English chemist William Hyde Wollaston compared its oxide, columbite with a density of 5.918 g\/cm3, to that of tantalum, tantalite with a density of 7.935 g\/cm3. He concluded that the two oxides, despite their difference in measured density, were identical and kept the name tantalum.[10] After Friedrich W\u00f6hler confirmed these results, it was thought that columbium and tantalum were the same element. This conclusion was disputed in 1846 by the German chemist Heinrich Rose, who argued that there were two additional elements in the tantalite sample, and he named them after the children of Tantalus: niobium (from Niobe, the goddess of tears), and pelopium (from Pelops).[11][12] The supposed element \"pelopium\" was later identified as a mixture of tantalum and niobium, and it was found that the niobium was identical to the columbium already discovered in 1801 by Hatchett.\nThe differences between tantalum and niobium were demonstrated unequivocally in 1864 by Christian Wilhelm Blomstrand,[13] and Henri Etienne Sainte-Claire Deville, as well as by Louis J. Troost, who determined the empirical formulas of some of their compounds in 1865.[13][14] Further confirmation came from the Swiss chemist Jean Charles Galissard de Marignac,[15] in 1866, who proved that there were only two elements. These discoveries did not stop scientists from publishing articles about the so-called ilmenium until 1871.[16] De Marignac was the first to produce the metallic form of tantalum in 1864, when he reduced tantalum chloride by heating it in an atmosphere of hydrogen.[17] Early investigators had only been able to produce impure tantalum, and the first relatively pure ductile metal was produced by Werner von Bolton in Charlottenburg in 1903. Wires made with metallic tantalum were used for light bulb filaments until tungsten replaced it in widespread use.[18]\nThe name tantalum was derived from the name of the mythological Tantalus, the father of Niobe in Greek mythology. In the story, he had been punished after death by being condemned to stand knee-deep in water with perfect fruit growing above his head, both of which eternally tantalized him. (If he bent to drink the water, it drained below the level he could reach, and if he reached for the fruit, the branches moved out of his grasp.)[19] Anders Ekeberg wrote \"This metal I call tantalum ... partly in allusion to its incapacity, when immersed in acid, to absorb any and be saturated.\"[20]\nFor decades, the commercial technology for separating tantalum from niobium involved the fractional crystallization of potassium heptafluorotantalate away from potassium oxypentafluoroniobate monohydrate, a process that was discovered by Jean Charles Galissard de Marignac in 1866. This method has been supplanted by solvent extraction from fluoride-containing solutions of tantalum.[14]\n\nCharacteristics \nPhysical properties \nTantalum is dark (blue-gray),[21] dense, ductile, very hard, easily fabricated, and highly conductive of heat and electricity. The metal is renowned for its resistance to corrosion by acids; in fact, at temperatures below 150 \u00b0C tantalum is almost completely immune to attack by the normally aggressive aqua regia. It can be dissolved with hydrofluoric acid or acidic solutions containing the fluoride ion and sulfur trioxide, as well as with a solution of potassium hydroxide. Tantalum's high melting point of 3017 \u00b0C (boiling point 5458 \u00b0C) is exceeded among the elements only by tungsten, rhenium and osmium for metals, and carbon.\nTantalum exists in two crystalline phases, alpha and beta. The alpha phase is relatively ductile and soft; it has body-centered cubic structure (space group Im3m, lattice constant a = 0.33058 nm), Knoop hardness 200\u2013400 HN and electrical resistivity 15\u201360 \u00b5\u03a9\u22c5cm. The beta phase is hard and brittle; its crystal symmetry is tetragonal (space group P42\/mnm, a = 1.0194 nm, c = 0.5313 nm), Knoop hardness is 1000\u20131300 HN and electrical resistivity is relatively high at 170\u2013210 \u00b5\u03a9\u22c5cm. The beta phase is metastable and converts to the alpha phase upon heating to 750\u2013775 \u00b0C. Bulk tantalum is almost entirely alpha phase, and the beta phase usually exists as thin films[22] obtained by magnetron\nsputtering, chemical vapor deposition or electrochemical deposition from an eutectic molten salt solution.[23]\n\n<\/p>\nIsotopes \nMain article: Isotopes of tantalum\nNatural tantalum consists of two isotopes: 180mTa (0.012%) and 181Ta (99.988%). 181Ta is a stable isotope. 180mTa (m denotes a metastable state) is predicted to decay in three ways: isomeric transition to the ground state of 180Ta, beta decay to 180W, or electron capture to 180Hf. However, radioactivity of this nuclear isomer has never been observed, and only a lower limit on its half-life of 2.0 \u00d7 1016 years has been set.[24] The ground state of 180Ta has a half-life of only 8 hours. 180mTa is the only naturally occurring nuclear isomer (excluding radiogenic and cosmogenic short-living nuclides). It is also the rarest isotope in the Universe, taking into account the elemental abundance of tantalum and isotopic abundance of 180mTa in the natural mixture of isotopes (and again excluding radiogenic and cosmogenic short-living nuclides).[25]\nTantalum has been examined theoretically as a \"salting\" material for nuclear weapons (cobalt is the better-known hypothetical salting material). An external shell of 181Ta would be irradiated by the intensive high-energy neutron flux from a hypothetical exploding nuclear weapon. This would transmute the tantalum into the radioactive isotope 182Ta, which has a half-life of 114.4 days and produces gamma rays with approximately 1.12 million electron-volts (MeV) of energy apiece, which would significantly increase the radioactivity of the nuclear fallout from the explosion for several months. Such \"salted\" weapons have never been built or tested, as far as is publicly known, and certainly never used as weapons.[26]\nTantalum can be used as a target material for accelerated proton beams for the production of various short-lived isotopes including 8Li, 80Rb, and 160Yb.[27]\n\nChemical compounds \nTantalum forms compounds in oxidation states -III to V. Most commonly encountered are oxides of Ta(V), which includes all minerals. The chemical properties of Ta and Nb are very similar.\n\n Oxides, nitrides, carbides, sulfides \nTantalum pentoxide (Ta2O5) is the most important compound from the perspective of applications. Oxides of tantalum in lower oxidation states are numerous, including many defect structures, are lightly studied or poorly characterized.[28]\nTantalates, compounds containing [TaO4]3- or [TaO3]\u2212 are numerous. Lithium tantalate (LiTaO3) adopts a perovskite structure. Lanthanum tantalate (LaTaO4) contains isolated TaO3\u2212\r\n4 tetrahedra.[29]\nAs in the cases of other refractory metals, the hardest known compounds of tantalum are nitrides and carbides. Tantalum carbide, TaC, like the more commonly used tungsten carbide, is a hard ceramic that is used in cutting tools. Tantalum(III) nitride is used as a thin film insulator in some microelectronic fabrication processes.[30]\nThe best studied chalcogenide is TaS2, a layered semiconductor, as seen for other transition metal dichalcogenides. A tantalum-tellurium alloy forms quasicrystals.[29]\n\nHalides \nTantalum halides span the oxidation states of +5, +4, and +3. Tantalum pentafluoride (TaF5) is a white solid with a melting point of 97.0 \u00b0C. The anion [TaF7]2- is used for its separation from niobium.[31] The chloride TaCl\r\n5 , which exists as a dimer, is the main reagent in synthesis of new Ta compounds. It hydrolyzes readily to an oxychloride. The lower halides TaX\r\n4 and TaX\r\n3 , feature Ta-Ta bonds.[29][32][29]\n\nOrganotantalum compounds \nOrganotantalum compounds include pentamethyltantalum, mixed alkyltantalum chlorides, alkyltantalum hydrides, alkylidene complexes as well as cyclopentadienyl derivatives of the same.[33][34] Diverse salts and substituted derivatives are known for the hexacarbonyl [Ta(CO)6]\u2212 and related isocyanides.\n\n Ta(CH3)5.\nOccurrence \n Tantalite, Pilbara district, Australia\nTantalum is estimated to make up about 1 ppm[35] or 2 ppm[32] of the Earth's crust by weight. There are many species of tantalum minerals, only some of which are so far being used by industry as raw materials: tantalite (a series consisting of tantalite-(Fe), tantalite-(Mn) and tantalite-(Mg)) microlite (now a group name), wodginite, euxenite (actually euxenite-(Y)), and polycrase (actually polycrase-(Y)).[6] Tantalite (Fe, Mn)Ta2O6 is the most important mineral for tantalum extraction. Tantalite has the same mineral structure as columbite (Fe, Mn) (Ta, Nb)2O6; when there is more tantalum than niobium it is called tantalite and when there is more niobium than tantalum is it called columbite (or niobite). The high density of tantalite and other tantalum containing minerals makes the use of gravitational separation the best method. Other minerals include samarskite and fergusonite.\n\n Tantalum producers in 2015 with Rwanda being the main producer\nThe primary mining of tantalum is in Australia, where the largest producer, Global Advanced Metals, formerly known as Talison Minerals, operates two mines in Western Australia, Greenbushes in the Southwest and Wodgina in the Pilbara region. The Wodgina mine was reopened in January 2011 after mining at the site was suspended in late-2008 due to the global financial crisis.[36] Less than a year after it reopened, Global Advanced Metals announced that due to again \"... softening tantalum demand ...\", and other factors, tantalum mining operations were to cease at the end of February 2012.[37] Wodgina produces a primary tantalum concentrate which is further upgraded at the Greenbushes operation before being sold to customers.[38] Whereas the large-scale producers of niobium are in Brazil and Canada, the ore there also yields a small percentage of tantalum. Some other countries such as China, Ethiopia, and Mozambique mine ores with a higher percentage of tantalum, and they produce a significant percentage of the world's output of it. Tantalum is also produced in Thailand and Malaysia as a by-product of the tin mining there. During gravitational separation of the ores from placer deposits, not only is cassiterite (SnO2) found, but a small percentage of tantalite also included. The slag from the tin smelters then contains economically useful amounts of tantalum, which is leached from the slag.[14][39]\n\n Tantalum producers in 2006 with Australia being the main producer\nWorld tantalum mine production has undergone an important geographic shift since the start of the 21st century when production was predominantly from Australia and Brazil. Beginning in 2007 and through 2014, the major sources of tantalum production from mines dramatically shifted to the DRC, Rwanda, and some other African countries.[40] Future sources of supply of tantalum, in order of estimated size, are being explored in Saudi Arabia, Egypt, Greenland, China, Mozambique, Canada, Australia, the United States, Finland, and Brazil.[41][42]\nIt is estimated that there are less than 50 years left of tantalum resources, based on extraction at current rates, demonstrating the need for increased recycling.[43]\n\nStatus as a conflict resource \nSee also: Coltan mining and ethics and Coltan \u00a7 Ethics of mining in the Democratic Republic of Congo\nTantalum is considered a conflict resource. Coltan, the industrial name for a columbite\u2013tantalite mineral from which niobium and tantalum are extracted,[44] can also be found in Central Africa, which is why tantalum is being linked to warfare in the Democratic Republic of the Congo (formerly Zaire). According to an October 23, 2003 United Nations report,[45] the smuggling and exportation of coltan has helped fuel the war in the Congo, a crisis that has resulted in approximately 5.4 million deaths since 1998[46] \u2013 making it the world\u2019s deadliest documented conflict since World War II. Ethical questions have been raised about responsible corporate behavior, human rights, and endangering wildlife, due to the exploitation of resources such as coltan in the armed conflict regions of the Congo Basin.[47][48][49][50] However, although important for the local economy in Congo, the contribution of coltan mining in Congo to the world supply of tantalum is usually small. The United States Geological Survey reports in its yearbook that this region produced a little less than 1% of the world's tantalum output in 2002\u20132006, peaking at 10% in 2000 and 2008.[39]\nThe stated aim of the Solutions for Hope Tantalum Project is to \"source conflict-free tantalum from the Democratic Republic of Congo\"[51]\n\nProduction and fabrication \n Time trend of tantalum production until 2012[52]\nSeveral steps are involved in the extraction of tantalum from tantalite. First, the mineral is crushed and concentrated by gravity separation. This is generally carried out near the mine site.\n\nRefining \nThe refining of tantalum from its ores is one of the more demanding separation processes in industrial metallurgy. The chief problem is that tantalum ores contain significant amounts of niobium, which has chemical properties almost identical to those of Ta. A large number of procedures have been developed to address this challenge.\nIn modern times, the separation is achieved by hydrometallurgy.[53] Extraction begins with leaching the ore with hydrofluoric acid together with sulfuric acid or hydrochloric acid. This step allows the tantalum and niobium to be separated from the various non-metallic impurities in the rock. Although Ta occurs as various minerals, it is conveniently represented as the pentoxide, since most oxides of tantalum(V) behave similarly under these conditions. A simplified equation for its extraction is thus:\n\nTa2O5 + 14 HF \u2192 2 H2[TaF7] + 5 H2O\nCompletely analogous reactions occur for the niobium component, but the hexafluoride is typically predominant under the conditions of the extraction.\n\nNb2O5 + 12 HF \u2192 2 H[NbF6] + 5 H2O\nThese equations are simplified: it is suspected that bisulfate (HSO4\u2212) and chloride compete as ligands for the Nb(V) and Ta(V) ions, when sulfuric and hydrochloric acids are used, respectively.[53] The tantalum and niobium fluoride complexes are then removed from the aqueous solution by liquid-liquid extraction into organic solvents, such as cyclohexanone, octanol, and methyl isobutyl ketone. This simple procedure allows the removal of most metal-containing impurities (e.g. iron, manganese, titanium, zirconium), which remain in the aqueous phase in the form of their fluorides and other complexes.\nSeparation of the tantalum from niobium is then achieved by lowering the ionic strength of the acid mixture, which causes the niobium to dissolve in the aqueous phase. It is proposed that oxyfluoride H2[NbOF5] is formed under these conditions. Subsequent to removal of the niobium, the solution of purified H2TaF7] is neutralised with aqueous ammonia to precipitate hydrated tantalum oxide as a solid, which can be calcined to tantalum pentoxide (Ta2O5).[54]\nInstead of hydrolysis, the H2[TaF7] can be treated with potassium fluoride to produce potassium heptafluorotantalate:\n\nH2[TaF7] + 2 KF \u2192 K2[TaF7] + 2 HF\nUnlike H2[TaF7], the potassium salt is readily crystallized and handled as a solid.\nK2[TaF7] can be converted to metallic tantalum by reduction with sodium, at approximately 800 \u00b0C in molten salt.[55]\n\nK2[TaF7] + 5 Na \u2192 Ta + 5 NaF + 2 KF\nIn an older method, called the Marignac process, the mixture of H2[TaF7] and H2[NbOF5] was converted to a mixture of K2[TaF7] and K2[NbOF5], which was then be separated by fractional crystallization, exploiting their different water solubilities.\n\nElectrolysis \nSee also: FFC Cambridge process\nElectrolysis using a modified version of the Hall\u2013H\u00e9roult process. Instead of requiring the input oxide and output metal to be in liquid form, tantalum electrolysis operates on non-liquid powdered oxides. The initial discovery came in 1997 when Cambridge University researchers immersed small samples of certain oxides in baths of molten salt and reduced the oxide with electric current. The cathode uses powdered metal oxide. The anode is made of carbon. The molten salt at 1,000 \u00b0C (1,830 \u00b0F) is the electrolyte. The first refinery has enough capacity to supply 3\u20134% of annual global demand.[56]\n\nFabrication and metalworking \nAll welding of tantalum must be done in an inert atmosphere of argon or helium in order to shield it from contamination with atmospheric gases. Tantalum is not solderable. Grinding tantalum is difficult, especially so for annealed tantalum. In the annealed condition, tantalum is extremely ductile and can be readily formed as metal sheets.[57]\n\nApplications \nElectronics \n Tantalum electrolytic capacitor\nThe major use for tantalum, as the metal powder, is in the production of electronic components, mainly capacitors and some high-power resistors. Tantalum electrolytic capacitors exploit the tendency of tantalum to form a protective oxide surface layer, using tantalum powder, pressed into a pellet shape, as one \"plate\" of the capacitor, the oxide as the dielectric, and an electrolytic solution or conductive solid as the other \"plate\". Because the dielectric layer can be very thin (thinner than the similar layer in, for instance, an aluminium electrolytic capacitor), a high capacitance can be achieved in a small volume. Because of the size and weight advantages, tantalum capacitors are attractive for portable telephones, personal computers, automotive electronics and cameras.[58]\n\nAlloys \nTantalum is also used to produce a variety of alloys that have high melting points, strength, and ductility. Alloyed with other metals, it is also used in making carbide tools for metalworking equipment and in the production of superalloys for jet engine components, chemical process equipment, nuclear reactors, missile parts, heat exchangers, tanks, and vessels.[59][58][60] Because of its ductility, tantalum can be drawn into fine wires or filaments, which are used for evaporating metals such as aluminium. Since it resists attack by body fluids and is nonirritating, tantalum is widely used in making surgical instruments and implants. For example, porous tantalum coatings are used in the construction of orthopedic implants due to tantalum's ability to form a direct bond to hard tissue.[61]\nTantalum is inert against most acids except hydrofluoric acid and hot sulfuric acid, and hot alkaline solutions also cause tantalum to corrode. This property makes it a useful metal for chemical reaction vessels and pipes for corrosive liquids. Heat exchanging coils for the steam heating of hydrochloric acid are made from tantalum.[62] Tantalum was extensively used in the production of ultra high frequency electron tubes for radio transmitters. Tantalum is capable of capturing oxygen and nitrogen by forming nitrides and oxides and therefore helped to sustain the high vacuum needed for the tubes when used for internal parts such as grids and plates.[31][62]\n\nOther uses \n Bimetallic coins minted by the Bank of Kazakhstan with silver ring and tantalum center.\nThe high melting point and oxidation resistance lead to the use of the metal in the production of vacuum furnace parts. Tantalum is extremely inert and is therefore formed into a variety of corrosion resistant parts, such as thermowells, valve bodies, and tantalum fasteners. Due to its high density, shaped charge and explosively formed penetrator liners have been constructed from tantalum.[63] Tantalum greatly increases the armor penetration capabilities of a shaped charge due to its high density and high melting point.[64][65] It is also occasionally used in precious watches e.g. from Audemars Piguet, F.P. Journe, Hublot, Montblanc, Omega, and Panerai. Tantalum is also highly bioinert and is used as an orthopedic implant material.[66] The high stiffness of tantalum makes it necessary to use it as highly porous foam or scaffold with lower stiffness for hip replacement implants to avoid stress shielding.[67] Because tantalum is a non-ferrous, non-magnetic metal, these implants are considered to be acceptable for patients undergoing MRI procedures.[68] The oxide is used to make special high refractive index glass for camera lenses.[69]\n\nEnvironmental issues \nTantalum receives far less attention in the environmental field than it does in other geosciences. Upper Crust Concentrations (UCC) and the Nb\/Ta ratio in the upper crust and in minerals are available because these measurements are useful as a geochemical tool.[70] The latest values for UCC and the Nb\/Ta(w\/w) ratio in the upper crust stand at 0.92 ppm and 12.7 respectively.[71]\nLittle data is available on tantalum concentrations in the different environmental compartments, especially in natural waters where reliable estimates of \u2018dissolved\u2019 tantalum concentrations in seawater and freshwaters have not even been produced.[72] Some values on dissolved concentrations in oceans have been published, but they are contradictory. Values in freshwaters fare little better, but, in all cases, they are probably below 1 ng L\u22121,since \u2018dissolved\u2019 concentrations in natural waters are well below most current analytical capabilities.[73] Analysis requires pre-concentration procedures that, for the moment, do not give consistent results. And in any case, tantalum appears to be present in natural waters mostly as particulate matter rather than dissolved.[72]\nValues for concentrations in soils, bed sediments and atmospheric aerosols are easier to come by.[72] Values in soils are close to 1 ppm and thus to UCC values. This indicates detrital origin. For atmospheric aerosols the values available are scattered and limited. When tantalum enrichment is observed, it is probably due to loss of more water-soluble elements in aerosols in the clouds.[74]\nPollution linked to human use of the element has not been detected.[75] Tantalum appears to be a very conservative element in biogeochemical terms, but its cycling and reactivity are still not fully understood.\n\nPrecautions \nCompounds containing tantalum are rarely encountered in the laboratory. The metal is highly biocompatible[66] and is used for body implants and coatings, therefore attention may be focused on other elements or the physical nature of the chemical compound.[76]\nPeople can be exposed to tantalum in the workplace by breathing it in, skin contact, or eye contact. The Occupational Safety and Health Administration (OSHA) has set the legal limit (permissible exposure limit) for tantalum exposure in the workplace as 5 mg\/m3 over an 8-hour workday. The National Institute for Occupational Safety and Health (NIOSH) has set a recommended exposure limit (REL) of 5 mg\/m3 over an 8-hour workday and a short-term limit of 10 mg\/m3. At levels of 2500 mg\/m3, tantalum is immediately dangerous to life and health.[77]\n\nReferences \n\n\n^ Meija, J.; et al. (2016). \"Atomic weights of the elements 2013 (IUPAC Technical Report)\". Pure and Applied Chemistry. 88 (3): 265\u201391. doi:10.1515\/pac-2015-0305. \n\n^ a b Moseley, P. T.; Seabrook, C. J. 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Nature's Building Blocks: An A-Z Guide to the Elements. Oxford, England, UK: Oxford University Press. p. 420. ISBN 978-0-19-850340-8. \n\n^ \"Talison Tantalum eyes mid-2011 Wodgina restart 2010-06-09\". Reuters. 2010-06-09. Retrieved 2010-08-27 . \n\n^ Emery, Kate (24 Jan 2012). \"GAM closes Wodgina tantalum mine\". The West Australian. Archived from the original on 4 December 2012. Retrieved 20 March 2012 . Worldwide softening tantalum demand and delays in receiving Governmental approval for installation of necessary crushing equipment are among contributing factors in this decision \n\n^ \"Wodgina Operations\". Global Advanced Metals. 2008. Retrieved 2011-03-28 . \n\n^ a b Papp, John F. (2006). \"2006 Minerals Yearbook Nb & Ta\". US Geological Survey. Retrieved 2008-06-03 . \n\n^ Bleiwas, Donald I.; Papp, John F.; Yager, Thomas R. (2015). \"Shift in Global Tantalum Mine Production, 2000\u20132014\" (PDF) . U.S. Geological Survey. \n\n^ M. J. (November 2007). \"Tantalum supplement\" (PDF) . Mining Journal. Retrieved 2008-06-03 . \n\n^ \"International tantalum resources \u2014 exploration and mining\" (PDF) . GSWA Mineral Resources Bulletin. 22 (10). Archived from the original (PDF) on 2007-09-26. \n\n^ \"How much is left?\". Retrieved 2013-01-13 . \n\n^ Tantalum-Niobium International Study Center: Coltan Retrieved 2008-01-27 \n\n^ \"S\/2003\/1027\". 2003-10-26. Retrieved 2008-04-19 . \n\n^ \"Special Report: Congo\". International Rescue Committee. Retrieved 2008-04-19 . \n\n^ Hayes, Karen; Burge, Richard (2003). Coltan Mining in the Democratic Republic of Congo: How tantalum-using industries can commit to the reconstruction of the DRC. Fauna & Flora. pp. 1\u201364. ISBN 978-1-903703-10-6. \n\n^ Dizolele, Mvemba Phezo (January 6, 2011). \"Congo's Bloody Coltan\". Pulitzer Center on Crisis Reporting. Retrieved 2009-08-08 . \n\n^ \"Congo War and the Role of Coltan\". Archived from the original on 2009-07-13. Retrieved 2009-08-08 . \n\n^ \"Coltan mining in the Congo River Basin\". Archived from the original on 2009-03-30. Retrieved 2009-08-08 . \n\n^ \"' Solutions for Hope' Tantalum Project Offers Solutions and Brings Hope to the People of the DRC\". Solutions Network. Retrieved 18 September 2014 . \n\n^ U.S. Geological Survey Archived 2013-06-04 at the Wayback Machine. \n\n^ a b Zhaowu Zhu; Chu Yong Cheng (2011). \"Solvent extraction technology for the separation and purification of niobium and tantalum: A review\". Hydrometallurgy. 107: 1\u201312. doi:10.1016\/j.hydromet.2010.12.015. \n\n^ Agulyanski, Anatoly (2004). Chemistry of Tantalum and Niobium Fluoride Compounds (1st ed.). Burlington: Elsevier. ISBN 9780080529028. \n\n^ Okabe, Toru H.; Sadoway, Donald R. (1998). \"Metallothermic reduction as an electronically mediated reaction\". Journal of Materials Research. 13 (12): 3372\u20133377. Bibcode:1998JMatR..13.3372O. doi:10.1557\/JMR.1998.0459. \n\n^ \"Manufacturing metals: A tantalising prospect\". The Economist. 2013-02-16. Retrieved 2013-04-17 . \n\n^ \"NFPA 484 \u2013 Standard for Combustible Metals, Metal Powders, and Metal Dusts \u2013 2002 Edition\" (PDF) . National Fire Protection Association. NFPA. 2002-08-13. Retrieved 2016-02-12 . \n\n^ a b \"Commodity Report 2008: Tantalum\" (PDF) . United States Geological Survey. Retrieved 2008-10-24 . \n\n^ \"Tantalum Products: Tantalum Sheet & Plate | Admat Inc\". Admat Inc. Retrieved 2018-08-28 . \n\n^ Buckman Jr., R. W. (2000). \"New applications for tantalum and tantalum alloys\". JOM Journal of the Minerals, Metals and Materials Society. 52 (3): 40. Bibcode:2000JOM....52c..40B. doi:10.1007\/s11837-000-0100-6. \n\n^ Cohen, R.; Della Valle, C. J.; Jacobs, J. J. (2006). \"Applications of porous tantalum in total hip arthroplasty\". Journal of the American Academy of Orthopaedic Surgeons. 14 (12): 646\u201355. PMID 17077337. \n\n^ a b Balke, Clarence W. (1935). \"Columbium and Tantalum\". Industrial and Engineering Chemistry. 20 (10): 1166. doi:10.1021\/ie50310a022. \n\n^ Nemat-Nasser, Sia; Isaacs, Jon B.; Liu, Mingqi (1998). \"Microstructure of high-strain, high-strain-rate deformed tantalum\". Acta Materialia. 46 (4): 1307. doi:10.1016\/S1359-6454(97)00746-5. \n\n^ Walters, William; Cooch, William; Burkins, Matthew; Burkins, Matthew (2001). \"The penetration resistance of a titanium alloy against jets from tantalum shaped charge liners\". International Journal of Impact Engineering. 26: 823. doi:10.1016\/S0734-743X(01)00135-X. \n\n^ Russell, Alan M.; Lee, Kok Loong (2005). Structure-property relations in nonferrous metals. Hoboken, NJ: Wiley-Interscience. p. 218. ISBN 978-0-471-64952-6. \n\n^ a b Gerald L. Burke (1940). \"The Corrosion of Metals in Tissues; and An Introduction to Tantalum\". Canadian Medical Association Journal. 43. \n\n^ Black, J. (1994). \"Biological performance of tantalum\". Clinical Materials. 16 (3): 167\u2013173. doi:10.1016\/0267-6605(94)90113-9. PMID 10172264. \n\n^ Paganias, Christos G.; Tsakotos, George A.; Koutsostathis, Stephanos D.; Macheras, George A. (2012). \"Osseous integration in porous tantalum implants\". Indian Journal of Orthopaedics. 46 (5): 505\u201313. doi:10.4103\/0019-5413.101032. ISSN 0019-5413. PMC 3491782 . PMID 23162141. \n\n^ Musikant, Solomon (1985). \"Optical Glass Composition\". Optical Materials: An Introduction to Selection and Application. CRC Press. p. 28. ISBN 978-0-8247-7309-0. \n\n^ Green, TH. (1995). \"Significance of Nb\/Ta as an indicator of geochemical processes in the crust-mantle system\". Chemical Geology. 120 (3\u20134): 347\u2013359. Bibcode:1995ChGeo.120..347G. doi:10.1016\/0009-2541(94)00145-X. \n\n^ Hu, Z.; Gao, S. (2008). \"Upper crustal abundances of trace elements: a revision and update\". Chemical Geology. 253 (3\u20134): 205. Bibcode:2008ChGeo.253..205H. doi:10.1016\/j.chemgeo.2008.05.010. \n\n^ a b c Filella, M. (2017). \"Tantalum in the environment\". Earth-Science Reviews. 173: 122\u2013140. doi:10.1016\/j.earscirev.2017.07.002. \n\n^ Filella, M.; Rodushkin, I. (2018). \"A concise guide for the determination of less-studied technology-critical elements (Nb, Ta, Ga, In, Ge, Te) by inductively coupled plasma mass spectrometry in environmental samples\". Spectrochimica Acta Part B. 141: 80\u201384. doi:10.1016\/j.sab.2018.01.004. \n\n^ Vlastelic, I.; Suchorski, K.; Sellegri, K.; Colomb, A.; Nauret, F.; Bouvier, L.; Piro, J-L. (2015). \"The high field strength element budget of atmospheric aerosols (puy de D\u00f4me, France)\". Geochimica et Cosmochimica Acta. 167: 253\u2013268. Bibcode:2015GeCoA.167..253V. doi:10.1016\/j.gca.2015.07.006. \n\n^ Filella, M.; Rodr\u00edguez-Murillo, JC. (2017). \"Less-studied TCE: are their environmental concentrations increasing due to their use in new technologies?\". Chemosphere. 182: 605\u2013616. doi:10.1016\/j.chemosphere.2017.05.024. PMID 28525874. \n\n^ Matsuno H; Yokoyama A; Watari F; Uo M; Kawasaki T. (2001). \"Biocompatibility and osteogenesis of refractory metal implants, titanium, hafnium, niobium, tantalum and rhenium. Biocompatibility of tantalum\". Biomaterials. 22 (11): 1253\u201362. doi:10.1016\/S0142-9612(00)00275-1. PMID 11336297. \n\n^ \"CDC \u2013 NIOSH Pocket Guide to Chemical Hazards \u2013 Tantalum (metal and oxide dust, as Ta)\". www.cdc.gov. Retrieved 2015-11-24 . \n\n\nExternal links \n\n\n\nLook up tantalum in Wiktionary, the free dictionary.\n\n\n\nWikimedia Commons has media related to Tantalum.\nTantalum-Niobium International Study Center\nCDC \u2013 NIOSH Pocket Guide to Chemical Hazards\n\nvtePeriodic table (Large cells) \n\n\n\n\n\n1\n\n2\n\n3\n\n\n\n4\n\n5\n\n6\n\n7\n\n8\n\n9\n\n10\n\n11\n\n12\n\n13\n\n14\n\n15\n\n16\n\n17\n\n18\n\n\n1\n\nH \n\n\n\nHe \n\n\n2\n\nLi \n\nBe \n\n\n\nB \n\nC \n\nN \n\nO \n\nF \n\nNe \n\n\n3\n\nNa \n\nMg \n\n\n\nAl \n\nSi \n\nP \n\nS \n\nCl \n\nAr \n\n\n4\n\nK \n\nCa \n\nSc \n\n\n\nTi \n\nV \n\nCr \n\nMn \n\nFe \n\nCo \n\nNi \n\nCu \n\nZn \n\nGa \n\nGe \n\nAs \n\nSe \n\nBr \n\nKr \n\n\n5\n\nRb \n\nSr \n\nY \n\n\n\nZr \n\nNb \n\nMo \n\nTc \n\nRu \n\nRh \n\nPd \n\nAg \n\nCd \n\nIn \n\nSn \n\nSb \n\nTe \n\nI \n\nXe \n\n\n6\n\nCs \n\nBa \n\nLa \n\nCe \n\nPr \n\nNd \n\nPm \n\nSm \n\nEu \n\nGd \n\nTb \n\nDy \n\nHo \n\nEr \n\nTm \n\nYb \n\nLu \n\nHf \n\nTa \n\nW \n\nRe \n\nOs \n\nIr \n\nPt \n\nAu \n\nHg \n\nTl \n\nPb \n\nBi \n\nPo \n\nAt \n\nRn \n\n\n7\n\nFr \n\nRa \n\nAc \n\nTh \n\nPa \n\nU \n\nNp \n\nPu \n\nAm \n\nCm \n\nBk \n\nCf \n\nEs \n\nFm \n\nMd \n\nNo \n\nLr \n\nRf \n\nDb \n\nSg \n\nBh \n\nHs \n\nMt \n\nDs \n\nRg \n\nCn \n\nNh \n\nFl \n\nMc \n\nLv \n\nTs \n\nOg \n\n\n\n\nAlkali metal\n\nAlkaline earth metal\n\nLan­thanide\n\nActinide\n\nTransition metal\n\nPost-​transition metal\n\nMetalloid\n\nReactive nonmetal\n\nNoble gas\n\nUnknown\r\nchemical\r\nproperties\n\n\n\nvteTantalum compoundsTantalum(II)\nTaB2\nTantalum(III)\nTaAl3\nTaN\nTantalum(IV)\nTaS2\nTaC\nTaTe2\nTa4HfC5\nTantalum(V)\nTaF5\nTaCl5\nTaBr5\nTaI5\nTa2O5\nLiTaO3\nLuTaO4\nK2TaF7\nH2TaF7\nK2Ta2O3F6Organotantalum(V)\nTa2(OC2H5)10\nTaC5H15\nTa(C2H6N)5\n\n\n\n\nAuthority control \nGND: 4059023-9 \nLCCN: sh85132346 \nNDL: 00572700 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Tantalum\">https:\/\/www.limswiki.org\/index.php\/Tantalum<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 11 March 2016, at 19:50.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,025 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","8d3be78eb4777fc2c36709842ad86ba8_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Tantalum skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Tantalum<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"shortdescription nomobile noexcerpt noprint searchaux\" style=\"display:none\">chemical element with atomic number 73<\/div>\n<p><b>Tantalum<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_element\" title=\"Chemical element\" rel=\"external_link\" target=\"_blank\">chemical element<\/a> with symbol <b>Ta<\/b> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atomic_number\" title=\"Atomic number\" rel=\"external_link\" target=\"_blank\">atomic number<\/a> 73. Previously known as <i>tantalium<\/i>, its name comes from <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalus\" title=\"Tantalus\" rel=\"external_link\" target=\"_blank\">Tantalus<\/a><\/i>, a villain from Greek mythology.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Tantalum is a rare, hard, blue-gray, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lustre_(mineralogy)\" title=\"Lustre (mineralogy)\" rel=\"external_link\" target=\"_blank\">lustrous<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transition_metal\" title=\"Transition metal\" rel=\"external_link\" target=\"_blank\">transition metal<\/a> that is highly corrosion-resistant. It is part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refractory_metals\" title=\"Refractory metals\" rel=\"external_link\" target=\"_blank\">refractory metals<\/a> group, which are widely used as minor components in alloys. The chemical inertness of tantalum makes it a valuable substance for laboratory equipment and a substitute for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Platinum\" title=\"Platinum\" rel=\"external_link\" target=\"_blank\">platinum<\/a>. Its main use today is in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalum_capacitor\" title=\"Tantalum capacitor\" rel=\"external_link\" target=\"_blank\">tantalum capacitors<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electronics\" title=\"Electronics\" rel=\"external_link\" target=\"_blank\">electronic<\/a> equipment such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mobile_phone\" title=\"Mobile phone\" rel=\"external_link\" target=\"_blank\">mobile phones<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/DVD_player\" title=\"DVD player\" rel=\"external_link\" target=\"_blank\">DVD players<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Video_game_systems\" class=\"mw-redirect\" title=\"Video game systems\" rel=\"external_link\" target=\"_blank\">video game systems<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Personal_computer\" title=\"Personal computer\" rel=\"external_link\" target=\"_blank\">computers<\/a>.\nTantalum, always together with the chemically similar <a href=\"https:\/\/en.wikipedia.org\/wiki\/Niobium\" title=\"Niobium\" rel=\"external_link\" target=\"_blank\">niobium<\/a>, occurs in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mineral\" title=\"Mineral\" rel=\"external_link\" target=\"_blank\">mineral<\/a> groups <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalite\" title=\"Tantalite\" rel=\"external_link\" target=\"_blank\">tantalite<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Columbite\" title=\"Columbite\" rel=\"external_link\" target=\"_blank\">columbite<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coltan\" title=\"Coltan\" rel=\"external_link\" target=\"_blank\">coltan<\/a> (a mix of columbite and tantalite, though not recognised as a separate mineral species).<sup id=\"rdp-ebb-cite_ref-mindat.org_6-0\" class=\"reference\"><a href=\"#cite_note-mindat.org-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Tantalum was discovered in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sweden\" title=\"Sweden\" rel=\"external_link\" target=\"_blank\">Sweden<\/a> in 1802 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anders_Ekeberg\" class=\"mw-redirect\" title=\"Anders Ekeberg\" rel=\"external_link\" target=\"_blank\">Anders Ekeberg<\/a>.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> One year earlier, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Charles_Hatchett\" title=\"Charles Hatchett\" rel=\"external_link\" target=\"_blank\">Charles Hatchett<\/a> had discovered <a href=\"https:\/\/en.wikipedia.org\/wiki\/Columbium\" class=\"mw-redirect\" title=\"Columbium\" rel=\"external_link\" target=\"_blank\">columbium<\/a> (now niobium),<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> and in 1809 the English chemist <a href=\"https:\/\/en.wikipedia.org\/wiki\/William_Hyde_Wollaston\" title=\"William Hyde Wollaston\" rel=\"external_link\" target=\"_blank\">William Hyde Wollaston<\/a> compared its oxide, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Columbite\" title=\"Columbite\" rel=\"external_link\" target=\"_blank\">columbite<\/a> with a density of 5.918 g\/cm<sup>3<\/sup>, to that of tantalum, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalite\" title=\"Tantalite\" rel=\"external_link\" target=\"_blank\">tantalite<\/a> with a density of 7.935 g\/cm<sup>3<\/sup>. He concluded that the two oxides, despite their difference in measured density, were identical and kept the name tantalum.<sup id=\"rdp-ebb-cite_ref-Wolla_10-0\" class=\"reference\"><a href=\"#cite_note-Wolla-10\" rel=\"external_link\">[10]<\/a><\/sup> After <a href=\"https:\/\/en.wikipedia.org\/wiki\/Friedrich_W%C3%B6hler\" title=\"Friedrich W\u00f6hler\" rel=\"external_link\" target=\"_blank\">Friedrich W\u00f6hler<\/a> confirmed these results, it was thought that columbium and tantalum were the same element. This conclusion was disputed in 1846 by the German chemist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heinrich_Rose\" title=\"Heinrich Rose\" rel=\"external_link\" target=\"_blank\">Heinrich Rose<\/a>, who argued that there were two additional elements in the tantalite sample, and he named them after the children of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalus\" title=\"Tantalus\" rel=\"external_link\" target=\"_blank\">Tantalus<\/a>: niobium (from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Niobe\" title=\"Niobe\" rel=\"external_link\" target=\"_blank\">Niobe<\/a>, the goddess of tears), and pelopium (from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pelops\" title=\"Pelops\" rel=\"external_link\" target=\"_blank\">Pelops<\/a>).<sup id=\"rdp-ebb-cite_ref-Pelop_11-0\" class=\"reference\"><a href=\"#cite_note-Pelop-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> The supposed element \"pelopium\" was later identified as a mixture of tantalum and niobium, and it was found that the niobium was identical to the columbium already discovered in 1801 by Hatchett.\n<\/p><p>The differences between tantalum and niobium were demonstrated unequivocally in 1864 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Christian_Wilhelm_Blomstrand\" title=\"Christian Wilhelm Blomstrand\" rel=\"external_link\" target=\"_blank\">Christian Wilhelm Blomstrand<\/a>,<sup id=\"rdp-ebb-cite_ref-Ilmen_13-0\" class=\"reference\"><a href=\"#cite_note-Ilmen-13\" rel=\"external_link\">[13]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Henri_Etienne_Sainte-Claire_Deville\" class=\"mw-redirect\" title=\"Henri Etienne Sainte-Claire Deville\" rel=\"external_link\" target=\"_blank\">Henri Etienne Sainte-Claire Deville<\/a>, as well as by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Louis_J._Troost\" class=\"mw-redirect\" title=\"Louis J. Troost\" rel=\"external_link\" target=\"_blank\">Louis J. Troost<\/a>, who determined the empirical formulas of some of their compounds in 1865.<sup id=\"rdp-ebb-cite_ref-Ilmen_13-1\" class=\"reference\"><a href=\"#cite_note-Ilmen-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Gupta_14-0\" class=\"reference\"><a href=\"#cite_note-Gupta-14\" rel=\"external_link\">[14]<\/a><\/sup> Further confirmation came from the Swiss chemist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jean_Charles_Galissard_de_Marignac\" title=\"Jean Charles Galissard de Marignac\" rel=\"external_link\" target=\"_blank\">Jean Charles Galissard de Marignac<\/a>,<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> in 1866, who proved that there were only two elements. These discoveries did not stop scientists from publishing articles about the so-called <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ilmenium\" title=\"Ilmenium\" rel=\"external_link\" target=\"_blank\">ilmenium<\/a><\/i> until 1871.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> De Marignac was the first to produce the metallic form of tantalum in 1864, when he <a href=\"https:\/\/en.wikipedia.org\/wiki\/Redox\" title=\"Redox\" rel=\"external_link\" target=\"_blank\">reduced<\/a> tantalum chloride by heating it in an atmosphere of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrogen\" title=\"Hydrogen\" rel=\"external_link\" target=\"_blank\">hydrogen<\/a>.<sup id=\"rdp-ebb-cite_ref-nauti_17-0\" class=\"reference\"><a href=\"#cite_note-nauti-17\" rel=\"external_link\">[17]<\/a><\/sup> Early investigators had only been able to produce impure tantalum, and the first relatively pure ductile metal was produced by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Werner_von_Bolton\" title=\"Werner von Bolton\" rel=\"external_link\" target=\"_blank\">Werner von Bolton<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Charlottenburg\" title=\"Charlottenburg\" rel=\"external_link\" target=\"_blank\">Charlottenburg<\/a> in 1903. Wires made with metallic tantalum were used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Light_bulb\" class=\"mw-redirect\" title=\"Light bulb\" rel=\"external_link\" target=\"_blank\">light bulb<\/a> filaments until <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tungsten\" title=\"Tungsten\" rel=\"external_link\" target=\"_blank\">tungsten<\/a> replaced it in widespread use.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p><p>The name tantalum was derived from the name of the mythological <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalus\" title=\"Tantalus\" rel=\"external_link\" target=\"_blank\">Tantalus<\/a>, the father of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Niobe\" title=\"Niobe\" rel=\"external_link\" target=\"_blank\">Niobe<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greek_mythology\" title=\"Greek mythology\" rel=\"external_link\" target=\"_blank\">Greek mythology<\/a>. In the story, he had been punished after death by being condemned to stand knee-deep in water with perfect fruit growing above his head, both of which eternally <i>tantalized<\/i> him. (If he bent to drink the water, it drained below the level he could reach, and if he reached for the fruit, the branches moved out of his grasp.)<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> Anders Ekeberg wrote \"This metal I call <i>tantalum<\/i> ... partly in allusion to its incapacity, when immersed in acid, to absorb any and be saturated.\"<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><p>For decades, the commercial technology for separating tantalum from niobium involved the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fractional_crystallization_(chemistry)\" title=\"Fractional crystallization (chemistry)\" rel=\"external_link\" target=\"_blank\">fractional crystallization<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Potassium_heptafluorotantalate\" title=\"Potassium heptafluorotantalate\" rel=\"external_link\" target=\"_blank\">potassium heptafluorotantalate<\/a> away from potassium oxypentafluoroniobate monohydrate, a process that was discovered by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jean_Charles_Galissard_de_Marignac\" title=\"Jean Charles Galissard de Marignac\" rel=\"external_link\" target=\"_blank\">Jean Charles Galissard de Marignac<\/a> in 1866. This method has been supplanted by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solvent_extraction\" class=\"mw-redirect\" title=\"Solvent extraction\" rel=\"external_link\" target=\"_blank\">solvent extraction<\/a> from fluoride-containing solutions of tantalum.<sup id=\"rdp-ebb-cite_ref-Gupta_14-1\" class=\"reference\"><a href=\"#cite_note-Gupta-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Characteristics\">Characteristics<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Physical_properties\">Physical properties<\/span><\/h3>\n<p>Tantalum is dark (blue-gray),<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> dense, ductile, very hard, easily fabricated, and highly conductive of heat and electricity. The metal is renowned for its resistance to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corrosion\" title=\"Corrosion\" rel=\"external_link\" target=\"_blank\">corrosion<\/a> by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acid\" title=\"Acid\" rel=\"external_link\" target=\"_blank\">acids<\/a>; in fact, at temperatures below 150 \u00b0<a href=\"https:\/\/en.wikipedia.org\/wiki\/Celsius\" title=\"Celsius\" rel=\"external_link\" target=\"_blank\">C<\/a> tantalum is almost completely immune to attack by the normally aggressive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aqua_regia\" title=\"Aqua regia\" rel=\"external_link\" target=\"_blank\">aqua regia<\/a>. It can be dissolved with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrofluoric_acid\" title=\"Hydrofluoric acid\" rel=\"external_link\" target=\"_blank\">hydrofluoric acid<\/a> or acidic solutions containing the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoride\" title=\"Fluoride\" rel=\"external_link\" target=\"_blank\">fluoride<\/a> ion and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sulfur_trioxide\" title=\"Sulfur trioxide\" rel=\"external_link\" target=\"_blank\">sulfur trioxide<\/a>, as well as with a solution of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Potassium_hydroxide\" title=\"Potassium hydroxide\" rel=\"external_link\" target=\"_blank\">potassium hydroxide<\/a>. Tantalum's high melting point of 3017 \u00b0C (boiling point 5458 \u00b0C) is exceeded among the elements only by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tungsten\" title=\"Tungsten\" rel=\"external_link\" target=\"_blank\">tungsten<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rhenium\" title=\"Rhenium\" rel=\"external_link\" target=\"_blank\">rhenium<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osmium\" title=\"Osmium\" rel=\"external_link\" target=\"_blank\">osmium<\/a> for metals, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon\" title=\"Carbon\" rel=\"external_link\" target=\"_blank\">carbon<\/a>.\n<\/p><p>Tantalum exists in two crystalline phases, alpha and beta. The alpha phase is relatively <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ductility\" title=\"Ductility\" rel=\"external_link\" target=\"_blank\">ductile<\/a> and soft; it has <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body-centered_cubic\" class=\"mw-redirect\" title=\"Body-centered cubic\" rel=\"external_link\" target=\"_blank\">body-centered cubic<\/a> structure (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Space_group\" title=\"Space group\" rel=\"external_link\" target=\"_blank\">space group<\/a> <i>Im3m<\/i>, lattice constant <i>a<\/i> = 0.33058 nm), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Knoop_hardness_test\" title=\"Knoop hardness test\" rel=\"external_link\" target=\"_blank\">Knoop hardness<\/a> 200\u2013400 HN and electrical resistivity 15\u201360 \u00b5\u03a9\u22c5cm. The beta phase is hard and brittle; its crystal symmetry is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tetragonal\" class=\"mw-redirect\" title=\"Tetragonal\" rel=\"external_link\" target=\"_blank\">tetragonal<\/a> (space group <i>P42\/mnm<\/i>, <i>a<\/i> = 1.0194 nm, <i>c<\/i> = 0.5313 nm), Knoop hardness is 1000\u20131300 HN and electrical resistivity is relatively high at 170\u2013210 \u00b5\u03a9\u22c5cm. The beta phase is metastable and converts to the alpha phase upon heating to 750\u2013775 \u00b0C. Bulk tantalum is almost entirely alpha phase, and the beta phase usually exists as thin films<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> obtained by magnetron\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sputtering\" title=\"Sputtering\" rel=\"external_link\" target=\"_blank\">sputtering<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_vapor_deposition\" title=\"Chemical vapor deposition\" rel=\"external_link\" target=\"_blank\">chemical vapor deposition<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrochemistry\" title=\"Electrochemistry\" rel=\"external_link\" target=\"_blank\">electrochemical deposition<\/a> from an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eutectic_system\" title=\"Eutectic system\" rel=\"external_link\" target=\"_blank\">eutectic<\/a> molten salt solution.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Isotopes\">Isotopes<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isotopes_of_tantalum\" title=\"Isotopes of tantalum\" rel=\"external_link\" target=\"_blank\">Isotopes of tantalum<\/a><\/div>\n<p>Natural tantalum consists of two <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isotope\" title=\"Isotope\" rel=\"external_link\" target=\"_blank\">isotopes<\/a>: <sup>180m<\/sup>Ta (0.012%) and <sup>181<\/sup>Ta (99.988%). <sup>181<\/sup>Ta is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stable_isotope\" class=\"mw-redirect\" title=\"Stable isotope\" rel=\"external_link\" target=\"_blank\">stable isotope<\/a>. <sup>180m<\/sup>Ta (<i>m<\/i> denotes a metastable state) is predicted to decay in three ways: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isomeric_transition\" class=\"mw-redirect\" title=\"Isomeric transition\" rel=\"external_link\" target=\"_blank\">isomeric transition<\/a> to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ground_state\" title=\"Ground state\" rel=\"external_link\" target=\"_blank\">ground state<\/a> of <sup>180<\/sup>Ta, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Beta_decay\" title=\"Beta decay\" rel=\"external_link\" target=\"_blank\">beta decay<\/a> to <sup>180<\/sup><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tungsten\" title=\"Tungsten\" rel=\"external_link\" target=\"_blank\">W<\/a>, or electron capture to <sup>180<\/sup><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hafnium\" title=\"Hafnium\" rel=\"external_link\" target=\"_blank\">Hf<\/a>. However, radioactivity of this <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_isomer\" title=\"Nuclear isomer\" rel=\"external_link\" target=\"_blank\">nuclear isomer<\/a> has never been observed, and only a lower limit on its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Half-life\" title=\"Half-life\" rel=\"external_link\" target=\"_blank\">half-life<\/a> of 2.0 \u00d7 10<sup>16<\/sup> years has been set.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> The ground state of <sup>180<\/sup>Ta has a half-life of only 8 hours. <sup>180m<\/sup>Ta is the only naturally occurring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_isomer\" title=\"Nuclear isomer\" rel=\"external_link\" target=\"_blank\">nuclear isomer<\/a> (excluding radiogenic and cosmogenic short-living nuclides). It is also the rarest isotope in the Universe, taking into account the elemental abundance of tantalum and isotopic abundance of <sup>180m<\/sup>Ta in the natural mixture of isotopes (and again excluding radiogenic and cosmogenic short-living nuclides).<sup id=\"rdp-ebb-cite_ref-NUBASE_25-0\" class=\"reference\"><a href=\"#cite_note-NUBASE-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p><p>Tantalum has been examined theoretically as a \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Salted_bomb\" title=\"Salted bomb\" rel=\"external_link\" target=\"_blank\">salting<\/a>\" material for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_weapon\" title=\"Nuclear weapon\" rel=\"external_link\" target=\"_blank\">nuclear weapons<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Cobalt\" title=\"Cobalt\" rel=\"external_link\" target=\"_blank\">cobalt<\/a> is the better-known hypothetical salting material). An external shell of <sup>181<\/sup>Ta would be irradiated by the intensive high-energy neutron flux from a hypothetical exploding nuclear weapon. This would transmute the tantalum into the radioactive isotope <sup>182<\/sup>Ta, which has a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Half-life\" title=\"Half-life\" rel=\"external_link\" target=\"_blank\">half-life<\/a> of 114.4 days and produces <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gamma_ray\" title=\"Gamma ray\" rel=\"external_link\" target=\"_blank\">gamma rays<\/a> with approximately 1.12 million electron-volts (MeV) of energy apiece, which would significantly increase the radioactivity of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_fallout\" title=\"Nuclear fallout\" rel=\"external_link\" target=\"_blank\">nuclear fallout<\/a> from the explosion for several months. Such \"salted\" weapons have never been built or tested, as far as is publicly known, and certainly never used as weapons.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p><p>Tantalum can be used as a target material for accelerated proton beams for the production of various short-lived isotopes including <sup>8<\/sup>Li, <sup>80<\/sup>Rb, and <sup>160<\/sup>Yb.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Chemical_compounds\">Chemical compounds<\/span><\/h2>\n<p>Tantalum forms compounds in oxidation states -III to V. Most commonly encountered are oxides of Ta(V), which includes all minerals. The chemical properties of Ta and Nb are very similar.\n<\/p>\n<h3><span id=\"rdp-ebb-Oxides.2C_nitrides.2C_carbides.2C_sulfides\"><\/span><span class=\"mw-headline\" id=\"Oxides,_nitrides,_carbides,_sulfides\">Oxides, nitrides, carbides, sulfides<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalum_pentoxide\" title=\"Tantalum pentoxide\" rel=\"external_link\" target=\"_blank\">Tantalum pentoxide<\/a> (Ta<sub>2<\/sub>O<sub>5<\/sub>) is the most important compound from the perspective of applications. Oxides of tantalum in lower oxidation states are numerous, including many , are lightly studied or poorly characterized.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/p><p>Tantalates, compounds containing [TaO<sub>4<\/sub>]<sup>3-<\/sup> or [TaO<sub>3<\/sub>]<sup>\u2212<\/sup> are numerous. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithium_tantalate\" title=\"Lithium tantalate\" rel=\"external_link\" target=\"_blank\">Lithium tantalate<\/a> (LiTaO<sub>3<\/sub>) adopts a perovskite structure. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lanthanum\" title=\"Lanthanum\" rel=\"external_link\" target=\"_blank\">Lanthanum<\/a> tantalate (LaTaO<sub>4<\/sub>) contains isolated <span class=\"chemf nowrap\">TaO<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">3\u2212<\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">4<\/sub><\/span><\/span> tetrahedra.<sup id=\"rdp-ebb-cite_ref-HollemanAF_29-0\" class=\"reference\"><a href=\"#cite_note-HollemanAF-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p><p>As in the cases of other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refractory_metals\" title=\"Refractory metals\" rel=\"external_link\" target=\"_blank\">refractory metals<\/a>, the hardest known compounds of tantalum are nitrides and carbides. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalum_carbide\" title=\"Tantalum carbide\" rel=\"external_link\" target=\"_blank\">Tantalum carbide<\/a>, TaC, like the more commonly used <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tungsten_carbide\" title=\"Tungsten carbide\" rel=\"external_link\" target=\"_blank\">tungsten carbide<\/a>, is a hard ceramic that is used in cutting tools. Tantalum(III) nitride is used as a thin film insulator in some microelectronic fabrication processes.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p><p>The best studied chalcogenide is TaS<sub>2<\/sub>, a layered <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semiconductor\" title=\"Semiconductor\" rel=\"external_link\" target=\"_blank\">semiconductor<\/a>, as seen for other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transition_metal_dichalcogenide\" class=\"mw-redirect\" title=\"Transition metal dichalcogenide\" rel=\"external_link\" target=\"_blank\">transition metal dichalcogenides<\/a>. A tantalum-tellurium alloy forms <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quasicrystal\" title=\"Quasicrystal\" rel=\"external_link\" target=\"_blank\">quasicrystals<\/a>.<sup id=\"rdp-ebb-cite_ref-HollemanAF_29-1\" class=\"reference\"><a href=\"#cite_note-HollemanAF-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Halides\">Halides<\/span><\/h3>\n<p>Tantalum halides span the oxidation states of +5, +4, and +3. Tantalum pentafluoride (TaF<sub>5<\/sub>) is a white solid with a melting point of 97.0 \u00b0C. The anion [TaF<sub>7<\/sub>]<sup>2-<\/sup> is used for its separation from niobium.<sup id=\"rdp-ebb-cite_ref-ICE_31-0\" class=\"reference\"><a href=\"#cite_note-ICE-31\" rel=\"external_link\">[31]<\/a><\/sup> The chloride <span class=\"chemf nowrap\">TaCl<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">5<\/sub><\/span><\/span>, which exists as a dimer, is the main reagent in synthesis of new Ta compounds. It hydrolyzes readily to an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxychloride\" class=\"mw-redirect\" title=\"Oxychloride\" rel=\"external_link\" target=\"_blank\">oxychloride<\/a>. The lower halides <span class=\"chemf nowrap\">TaX<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">4<\/sub><\/span><\/span> and <span class=\"chemf nowrap\">TaX<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">3<\/sub><\/span><\/span>, feature Ta-Ta bonds.<sup id=\"rdp-ebb-cite_ref-HollemanAF_29-2\" class=\"reference\"><a href=\"#cite_note-HollemanAF-29\" rel=\"external_link\">[29]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Aguly_32-0\" class=\"reference\"><a href=\"#cite_note-Aguly-32\" rel=\"external_link\">[32]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-HollemanAF_29-3\" class=\"reference\"><a href=\"#cite_note-HollemanAF-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Organotantalum_compounds\">Organotantalum compounds<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Organotantalum_chemistry\" title=\"Organotantalum chemistry\" rel=\"external_link\" target=\"_blank\">Organotantalum compounds<\/a> include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pentamethyltantalum\" title=\"Pentamethyltantalum\" rel=\"external_link\" target=\"_blank\">pentamethyltantalum<\/a>, mixed alkyltantalum chlorides, alkyltantalum hydrides, alkylidene complexes as well as cyclopentadienyl derivatives of the same.<sup id=\"rdp-ebb-cite_ref-Schrock_33-0\" class=\"reference\"><a href=\"#cite_note-Schrock-33\" rel=\"external_link\">[33]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup> Diverse salts and substituted derivatives are known for the hexacarbonyl [Ta(CO)<sub>6<\/sub>]<sup>\u2212<\/sup> and related <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isocyanide\" title=\"Isocyanide\" rel=\"external_link\" target=\"_blank\">isocyanides<\/a>.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:146px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:DOSBIWoneRotamer.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/85\/DOSBIWoneRotamer.png\/144px-DOSBIWoneRotamer.png\" width=\"144\" height=\"144\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:DOSBIWoneRotamer.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Ta(CH<sub>3<\/sub>)<sub>5<\/sub>.<\/div><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Occurrence\">Occurrence<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tantalite.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c0\/Tantalite.jpg\/220px-Tantalite.jpg\" width=\"220\" height=\"199\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tantalite.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><b>Tantalite<\/b>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pilbara\" title=\"Pilbara\" rel=\"external_link\" target=\"_blank\">Pilbara district<\/a>, Australia<\/div><\/div><\/div>\n<p>Tantalum is estimated to make up about 1 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parts_per_million\" class=\"mw-redirect\" title=\"Parts per million\" rel=\"external_link\" target=\"_blank\">ppm<\/a><sup id=\"rdp-ebb-cite_ref-Emsley_35-0\" class=\"reference\"><a href=\"#cite_note-Emsley-35\" rel=\"external_link\">[35]<\/a><\/sup> or 2 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parts_per_million\" class=\"mw-redirect\" title=\"Parts per million\" rel=\"external_link\" target=\"_blank\">ppm<\/a><sup id=\"rdp-ebb-cite_ref-Aguly_32-1\" class=\"reference\"><a href=\"#cite_note-Aguly-32\" rel=\"external_link\">[32]<\/a><\/sup> of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abundance_of_elements_in_Earth%27s_crust\" title=\"Abundance of elements in Earth's crust\" rel=\"external_link\" target=\"_blank\">Earth's crust by weight<\/a>. There are many species of tantalum minerals, only some of which are so far being used by industry as raw materials: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalite\" title=\"Tantalite\" rel=\"external_link\" target=\"_blank\">tantalite<\/a> (a series consisting of tantalite-(Fe), tantalite-(Mn) and tantalite-(Mg)) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microlite\" title=\"Microlite\" rel=\"external_link\" target=\"_blank\">microlite<\/a> (now a group name), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wodginite\" title=\"Wodginite\" rel=\"external_link\" target=\"_blank\">wodginite<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Euxenite\" title=\"Euxenite\" rel=\"external_link\" target=\"_blank\">euxenite<\/a> (actually euxenite-(Y)), and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polycrase\" title=\"Polycrase\" rel=\"external_link\" target=\"_blank\">polycrase<\/a> (actually polycrase-(Y)).<sup id=\"rdp-ebb-cite_ref-mindat.org_6-1\" class=\"reference\"><a href=\"#cite_note-mindat.org-6\" rel=\"external_link\">[6]<\/a><\/sup> Tantalite (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron\" title=\"Iron\" rel=\"external_link\" target=\"_blank\">Fe<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manganese\" title=\"Manganese\" rel=\"external_link\" target=\"_blank\">Mn<\/a>)Ta<sub>2<\/sub><a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen\" title=\"Oxygen\" rel=\"external_link\" target=\"_blank\">O<\/a><sub>6<\/sub> is the most important mineral for tantalum extraction. Tantalite has the same mineral structure as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Columbite\" title=\"Columbite\" rel=\"external_link\" target=\"_blank\">columbite<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron\" title=\"Iron\" rel=\"external_link\" target=\"_blank\">Fe<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manganese\" title=\"Manganese\" rel=\"external_link\" target=\"_blank\">Mn<\/a>) (Ta, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Niobium\" title=\"Niobium\" rel=\"external_link\" target=\"_blank\">Nb<\/a>)<sub>2<\/sub><a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen\" title=\"Oxygen\" rel=\"external_link\" target=\"_blank\">O<\/a><sub>6<\/sub>; when there is more tantalum than niobium it is called tantalite and when there is more niobium than tantalum is it called columbite (or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Niobite\" class=\"mw-redirect\" title=\"Niobite\" rel=\"external_link\" target=\"_blank\">niobite<\/a>). The high density of tantalite and other tantalum containing minerals makes the use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gravity_separation\" title=\"Gravity separation\" rel=\"external_link\" target=\"_blank\">gravitational separation<\/a> the best method. Other minerals include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Samarskite\" class=\"mw-redirect\" title=\"Samarskite\" rel=\"external_link\" target=\"_blank\">samarskite<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fergusonite\" title=\"Fergusonite\" rel=\"external_link\" target=\"_blank\">fergusonite<\/a>.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:312px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:World_Tantalum_Production_2015.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Grey and white world map with China, Australia, Brazil and Kongo colored blue representing less than 10% of the tantalum world production each and Rwanda colored in green representing 60% of tantalum world production\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/90\/World_Tantalum_Production_2015.svg\/310px-World_Tantalum_Production_2015.svg.png\" width=\"310\" height=\"137\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:World_Tantalum_Production_2015.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Tantalum producers in 2015 with Rwanda being the main producer<\/div><\/div><\/div>\n<p>The primary mining of tantalum is in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Australia\" title=\"Australia\" rel=\"external_link\" target=\"_blank\">Australia<\/a>, where the largest producer, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Global_Advanced_Metals\" class=\"mw-redirect\" title=\"Global Advanced Metals\" rel=\"external_link\" target=\"_blank\">Global Advanced Metals<\/a>, formerly known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Talison_Minerals\" title=\"Talison Minerals\" rel=\"external_link\" target=\"_blank\">Talison Minerals<\/a>, operates two mines in Western Australia, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greenbushes,_Western_Australia\" title=\"Greenbushes, Western Australia\" rel=\"external_link\" target=\"_blank\">Greenbushes<\/a> in the Southwest and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wodgina_mine\" title=\"Wodgina mine\" rel=\"external_link\" target=\"_blank\">Wodgina<\/a> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pilbara\" title=\"Pilbara\" rel=\"external_link\" target=\"_blank\">Pilbara<\/a> region. The Wodgina mine was reopened in January 2011 after mining at the site was suspended in late-2008 due to the global financial crisis.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup> Less than a year after it reopened, Global Advanced Metals announced that due to again \"... softening tantalum demand ...\", and other factors, tantalum mining operations were to cease at the end of February 2012.<sup id=\"rdp-ebb-cite_ref-Wodgina-tant-closed_37-0\" class=\"reference\"><a href=\"#cite_note-Wodgina-tant-closed-37\" rel=\"external_link\">[37]<\/a><\/sup> Wodgina produces a primary tantalum concentrate which is further upgraded at the Greenbushes operation before being sold to customers.<sup id=\"rdp-ebb-cite_ref-Talison_38-0\" class=\"reference\"><a href=\"#cite_note-Talison-38\" rel=\"external_link\">[38]<\/a><\/sup> Whereas the large-scale producers of niobium are in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brazil\" title=\"Brazil\" rel=\"external_link\" target=\"_blank\">Brazil<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Canada\" title=\"Canada\" rel=\"external_link\" target=\"_blank\">Canada<\/a>, the ore there also yields a small percentage of tantalum. Some other countries such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/China\" title=\"China\" rel=\"external_link\" target=\"_blank\">China<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethiopia\" title=\"Ethiopia\" rel=\"external_link\" target=\"_blank\">Ethiopia<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mozambique\" title=\"Mozambique\" rel=\"external_link\" target=\"_blank\">Mozambique<\/a> mine ores with a higher percentage of tantalum, and they produce a significant percentage of the world's output of it. Tantalum is also produced in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thailand\" title=\"Thailand\" rel=\"external_link\" target=\"_blank\">Thailand<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Malaysia\" title=\"Malaysia\" rel=\"external_link\" target=\"_blank\">Malaysia<\/a> as a by-product of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tin\" title=\"Tin\" rel=\"external_link\" target=\"_blank\">tin<\/a> mining there. During gravitational separation of the ores from placer deposits, not only is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cassiterite\" title=\"Cassiterite\" rel=\"external_link\" target=\"_blank\">cassiterite<\/a> (SnO<sub>2<\/sub>) found, but a small percentage of tantalite also included. The slag from the tin smelters then contains economically useful amounts of tantalum, which is leached from the slag.<sup id=\"rdp-ebb-cite_ref-Gupta_14-2\" class=\"reference\"><a href=\"#cite_note-Gupta-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-USGS2006_39-0\" class=\"reference\"><a href=\"#cite_note-USGS2006-39\" rel=\"external_link\">[39]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:312px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:World_Tantalum_Production_2006.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Grey and white world map with Canada, Brazil and Mozambique colored blue representing less than 20% of the tantalum world production each and Australia colored in green representing 60% of tantalum world production\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/75\/World_Tantalum_Production_2006.svg\/310px-World_Tantalum_Production_2006.svg.png\" width=\"310\" height=\"137\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:World_Tantalum_Production_2006.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Tantalum producers in 2006 with Australia being the main producer<\/div><\/div><\/div>\n<p>World tantalum mine production has undergone an important geographic shift since the start of the 21st century when production was predominantly from Australia and Brazil. Beginning in 2007 and through 2014, the major sources of tantalum production from mines dramatically shifted to the DRC, Rwanda, and some other African countries.<sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup> Future sources of supply of tantalum, in order of estimated size, are being explored in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saudi_Arabia\" title=\"Saudi Arabia\" rel=\"external_link\" target=\"_blank\">Saudi Arabia<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Egypt\" title=\"Egypt\" rel=\"external_link\" target=\"_blank\">Egypt<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greenland\" title=\"Greenland\" rel=\"external_link\" target=\"_blank\">Greenland<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/China\" title=\"China\" rel=\"external_link\" target=\"_blank\">China<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mozambique\" title=\"Mozambique\" rel=\"external_link\" target=\"_blank\">Mozambique<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Canada\" title=\"Canada\" rel=\"external_link\" target=\"_blank\">Canada<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Australia\" title=\"Australia\" rel=\"external_link\" target=\"_blank\">Australia<\/a>, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Finland\" title=\"Finland\" rel=\"external_link\" target=\"_blank\">Finland<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brazil\" title=\"Brazil\" rel=\"external_link\" target=\"_blank\">Brazil<\/a>.<sup id=\"rdp-ebb-cite_ref-Mining_Journal_41-0\" class=\"reference\"><a href=\"#cite_note-Mining_Journal-41\" rel=\"external_link\">[41]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup>\n<\/p><p>It is estimated that there are less than 50 years left of tantalum resources, based on extraction at current rates, demonstrating the need for increased <a href=\"https:\/\/en.wikipedia.org\/wiki\/Recycling\" title=\"Recycling\" rel=\"external_link\" target=\"_blank\">recycling<\/a>.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Status_as_a_conflict_resource\">Status as a conflict resource<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coltan_mining_and_ethics\" title=\"Coltan mining and ethics\" rel=\"external_link\" target=\"_blank\">Coltan mining and ethics<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coltan#Ethics_of_mining_in_the_Democratic_Republic_of_Congo\" title=\"Coltan\" rel=\"external_link\" target=\"_blank\">Coltan \u00a7 Ethics of mining in the Democratic Republic of Congo<\/a><\/div>\n<p>Tantalum is considered a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Conflict_resource\" title=\"Conflict resource\" rel=\"external_link\" target=\"_blank\">conflict resource<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coltan\" title=\"Coltan\" rel=\"external_link\" target=\"_blank\">Coltan<\/a>, the industrial name for a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Columbite\" title=\"Columbite\" rel=\"external_link\" target=\"_blank\">columbite<\/a>\u2013<a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalite\" title=\"Tantalite\" rel=\"external_link\" target=\"_blank\">tantalite<\/a> mineral from which niobium and tantalum are extracted,<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup> can also be found in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Central_Africa\" title=\"Central Africa\" rel=\"external_link\" target=\"_blank\">Central Africa<\/a>, which is why tantalum is being linked to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Second_Congo_War\" title=\"Second Congo War\" rel=\"external_link\" target=\"_blank\">warfare in the Democratic Republic of the Congo<\/a> (formerly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zaire\" title=\"Zaire\" rel=\"external_link\" target=\"_blank\">Zaire<\/a>). According to an October 23, 2003 <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_Nations\" title=\"United Nations\" rel=\"external_link\" target=\"_blank\">United Nations<\/a> report,<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup> the smuggling and exportation of coltan has helped fuel the war in the Congo, a crisis that has resulted in approximately 5.4 million deaths since 1998<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup> \u2013 making it the world\u2019s deadliest documented conflict since <a href=\"https:\/\/en.wikipedia.org\/wiki\/World_War_II\" title=\"World War II\" rel=\"external_link\" target=\"_blank\">World War II<\/a>. Ethical questions have been raised about responsible corporate behavior, human rights, and endangering wildlife, due to the exploitation of resources such as coltan in the armed conflict regions of the Congo Basin.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup> However, although important for the local economy in Congo, the contribution of coltan mining in Congo to the world supply of tantalum is usually small. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Geological_Survey\" title=\"United States Geological Survey\" rel=\"external_link\" target=\"_blank\">United States Geological Survey<\/a> reports in its yearbook that this region produced a little less than 1% of the world's tantalum output in 2002\u20132006, peaking at 10% in 2000 and 2008.<sup id=\"rdp-ebb-cite_ref-USGS2006_39-1\" class=\"reference\"><a href=\"#cite_note-USGS2006-39\" rel=\"external_link\">[39]<\/a><\/sup>\n<\/p><p>The stated aim of the <i>Solutions for Hope Tantalum Project<\/i> is to \"source conflict-free tantalum from the Democratic Republic of Congo\"<sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Production_and_fabrication\">Production and fabrication<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tantalum_world_production.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6a\/Tantalum_world_production.svg\/220px-Tantalum_world_production.svg.png\" width=\"220\" height=\"135\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tantalum_world_production.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Time trend of tantalum production until 2012<sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup><\/div><\/div><\/div>\n<p>Several steps are involved in the extraction of tantalum from tantalite. First, the mineral is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crusher\" title=\"Crusher\" rel=\"external_link\" target=\"_blank\">crushed<\/a> and concentrated by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gravity_separation\" title=\"Gravity separation\" rel=\"external_link\" target=\"_blank\">gravity separation<\/a>. This is generally carried out near the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mining\" title=\"Mining\" rel=\"external_link\" target=\"_blank\">mine<\/a> site.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Refining\">Refining<\/span><\/h3>\n<p>The refining of tantalum from its ores is one of the more demanding separation processes in industrial metallurgy. The chief problem is that tantalum ores contain significant amounts of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Niobium\" title=\"Niobium\" rel=\"external_link\" target=\"_blank\">niobium<\/a>, which has chemical properties almost identical to those of Ta. A large number of procedures have been developed to address this challenge.\n<\/p><p>In modern times, the separation is achieved by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrometallurgy\" title=\"Hydrometallurgy\" rel=\"external_link\" target=\"_blank\">hydrometallurgy<\/a>.<sup id=\"rdp-ebb-cite_ref-Chang_53-0\" class=\"reference\"><a href=\"#cite_note-Chang-53\" rel=\"external_link\">[53]<\/a><\/sup> Extraction begins with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Leaching_(metallurgy)\" title=\"Leaching (metallurgy)\" rel=\"external_link\" target=\"_blank\">leaching<\/a> the ore with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrofluoric_acid\" title=\"Hydrofluoric acid\" rel=\"external_link\" target=\"_blank\">hydrofluoric acid<\/a> together with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sulfuric_acid\" title=\"Sulfuric acid\" rel=\"external_link\" target=\"_blank\">sulfuric acid<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrochloric_acid\" title=\"Hydrochloric acid\" rel=\"external_link\" target=\"_blank\">hydrochloric acid<\/a>. This step allows the tantalum and niobium to be separated from the various non-metallic impurities in the rock. Although Ta occurs as various minerals, it is conveniently represented as the pentoxide, since most oxides of tantalum(V) behave similarly under these conditions. A simplified equation for its extraction is thus:\n<\/p>\n<dl><dd>Ta<sub>2<\/sub>O<sub>5<\/sub> + 14 HF \u2192 2 H<sub>2<\/sub>[TaF<sub>7<\/sub>] + 5 H<sub>2<\/sub>O<\/dd><\/dl>\n<p>Completely analogous reactions occur for the niobium component, but the hexafluoride is typically predominant under the conditions of the extraction.\n<\/p>\n<dl><dd>Nb<sub>2<\/sub>O<sub>5<\/sub> + 12 HF \u2192 2 H[NbF<sub>6<\/sub>] + 5 H<sub>2<\/sub>O<\/dd><\/dl>\n<p>These equations are simplified: it is suspected that bisulfate (HSO<sub>4<\/sub><sup>\u2212<\/sup>) and chloride compete as ligands for the Nb(V) and Ta(V) ions, when sulfuric and hydrochloric acids are used, respectively.<sup id=\"rdp-ebb-cite_ref-Chang_53-1\" class=\"reference\"><a href=\"#cite_note-Chang-53\" rel=\"external_link\">[53]<\/a><\/sup> The tantalum and niobium fluoride complexes are then removed from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aqueous\" class=\"mw-redirect\" title=\"Aqueous\" rel=\"external_link\" target=\"_blank\">aqueous<\/a> solution by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liquid%E2%80%93liquid_extraction\" title=\"Liquid\u2013liquid extraction\" rel=\"external_link\" target=\"_blank\">liquid-liquid extraction<\/a> into <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organic_solvents\" class=\"mw-redirect\" title=\"Organic solvents\" rel=\"external_link\" target=\"_blank\">organic solvents<\/a>, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyclohexanone\" title=\"Cyclohexanone\" rel=\"external_link\" target=\"_blank\">cyclohexanone<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Octanol\" title=\"Octanol\" rel=\"external_link\" target=\"_blank\">octanol<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methyl_isobutyl_ketone\" title=\"Methyl isobutyl ketone\" rel=\"external_link\" target=\"_blank\">methyl isobutyl ketone<\/a>. This simple procedure allows the removal of most metal-containing impurities (e.g. iron, manganese, titanium, zirconium), which remain in the aqueous phase in the form of their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoride\" title=\"Fluoride\" rel=\"external_link\" target=\"_blank\">fluorides<\/a> and other complexes.\n<\/p><p>Separation of the tantalum <i>from<\/i> niobium is then achieved by lowering the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ionic_strength\" title=\"Ionic strength\" rel=\"external_link\" target=\"_blank\">ionic strength<\/a> of the acid mixture, which causes the niobium to dissolve in the aqueous phase. It is proposed that <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxyfluoride\" class=\"mw-redirect\" title=\"Oxyfluoride\" rel=\"external_link\" target=\"_blank\">oxyfluoride<\/a> H<sub>2<\/sub>[NbOF<sub>5<\/sub>] is formed under these conditions. Subsequent to removal of the niobium, the solution of purified H<sub>2<\/sub>TaF<sub>7<\/sub>] is neutralised with aqueous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ammonia\" title=\"Ammonia\" rel=\"external_link\" target=\"_blank\">ammonia<\/a> to precipitate hydrated tantalum oxide as a solid, which can be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcination\" title=\"Calcination\" rel=\"external_link\" target=\"_blank\">calcined<\/a> to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalum_pentoxide\" title=\"Tantalum pentoxide\" rel=\"external_link\" target=\"_blank\">tantalum pentoxide<\/a> (Ta<sub>2<\/sub>O<sub>5<\/sub>).<sup id=\"rdp-ebb-cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\" rel=\"external_link\">[54]<\/a><\/sup>\n<\/p><p>Instead of hydrolysis, the H<sub>2<\/sub>[TaF<sub>7<\/sub>] can be treated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Potassium_fluoride\" title=\"Potassium fluoride\" rel=\"external_link\" target=\"_blank\">potassium fluoride<\/a> to produce <a href=\"https:\/\/en.wikipedia.org\/wiki\/Potassium_heptafluorotantalate\" title=\"Potassium heptafluorotantalate\" rel=\"external_link\" target=\"_blank\">potassium heptafluorotantalate<\/a>:\n<\/p>\n<dl><dd>H<sub>2<\/sub>[TaF<sub>7<\/sub>] + 2 KF \u2192 K<sub>2<\/sub>[TaF<sub>7<\/sub>] + 2 HF<\/dd><\/dl>\n<p>Unlike H<sub>2<\/sub>[TaF<sub>7<\/sub>], the potassium salt is readily crystallized and handled as a solid.\n<\/p><p>K<sub>2<\/sub>[TaF<sub>7<\/sub>] can be converted to metallic tantalum by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reduction-oxidation\" class=\"mw-redirect\" title=\"Reduction-oxidation\" rel=\"external_link\" target=\"_blank\">reduction<\/a> with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium\" title=\"Sodium\" rel=\"external_link\" target=\"_blank\">sodium<\/a>, at approximately 800 \u00b0C in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molten_salt\" title=\"Molten salt\" rel=\"external_link\" target=\"_blank\">molten salt<\/a>.<sup id=\"rdp-ebb-cite_ref-55\" class=\"reference\"><a href=\"#cite_note-55\" rel=\"external_link\">[55]<\/a><\/sup>\n<\/p>\n<dl><dd>K<sub>2<\/sub>[TaF<sub>7<\/sub>] + 5 Na \u2192 Ta + 5 NaF + 2 KF<\/dd><\/dl>\n<p>In an older method, called the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jean_Charles_Galissard_de_Marignac\" title=\"Jean Charles Galissard de Marignac\" rel=\"external_link\" target=\"_blank\">Marignac<\/a> process, the mixture of H<sub>2<\/sub>[TaF<sub>7<\/sub>] and H<sub>2<\/sub>[NbOF<sub>5<\/sub>] was converted to a <i>mixture<\/i> of K<sub>2<\/sub>[TaF<sub>7<\/sub>] and K<sub>2<\/sub>[NbOF<sub>5<\/sub>], which was then be separated by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fractional_crystallization_(chemistry)\" title=\"Fractional crystallization (chemistry)\" rel=\"external_link\" target=\"_blank\">fractional crystallization<\/a>, exploiting their different water solubilities.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Electrolysis\">Electrolysis<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/FFC_Cambridge_process\" title=\"FFC Cambridge process\" rel=\"external_link\" target=\"_blank\">FFC Cambridge process<\/a><\/div>\n<p>Electrolysis using a modified version of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hall%E2%80%93H%C3%A9roult_process\" title=\"Hall\u2013H\u00e9roult process\" rel=\"external_link\" target=\"_blank\">Hall\u2013H\u00e9roult process<\/a>. Instead of requiring the input oxide and output metal to be in liquid form, tantalum electrolysis operates on non-liquid powdered oxides. The initial discovery came in 1997 when Cambridge University researchers immersed small samples of certain oxides in baths of molten salt and reduced the oxide with electric current. The cathode uses powdered metal oxide. The anode is made of carbon. The molten salt at 1,000 \u00b0C (1,830 \u00b0F) is the electrolyte. The first refinery has enough capacity to supply 3\u20134% of annual global demand.<sup id=\"rdp-ebb-cite_ref-56\" class=\"reference\"><a href=\"#cite_note-56\" rel=\"external_link\">[56]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Fabrication_and_metalworking\">Fabrication and metalworking<\/span><\/h3>\n<p>All <a href=\"https:\/\/en.wikipedia.org\/wiki\/Welding\" title=\"Welding\" rel=\"external_link\" target=\"_blank\">welding<\/a> of tantalum must be done in an inert atmosphere of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Argon\" title=\"Argon\" rel=\"external_link\" target=\"_blank\">argon<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Helium\" title=\"Helium\" rel=\"external_link\" target=\"_blank\">helium<\/a> in order to shield it from contamination with atmospheric gases. Tantalum is not <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solderable\" class=\"mw-redirect\" title=\"Solderable\" rel=\"external_link\" target=\"_blank\">solderable<\/a>. Grinding tantalum is difficult, especially so for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Annealing_(metallurgy)\" title=\"Annealing (metallurgy)\" rel=\"external_link\" target=\"_blank\">annealed<\/a> tantalum. In the annealed condition, tantalum is extremely <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ductile\" class=\"mw-redirect\" title=\"Ductile\" rel=\"external_link\" target=\"_blank\">ductile<\/a> and can be readily formed as metal sheets.<sup id=\"rdp-ebb-cite_ref-57\" class=\"reference\"><a href=\"#cite_note-57\" rel=\"external_link\">[57]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Electronics\">Electronics<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tantal-Perle-Wiki-07-02-25-P1040364b.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fe\/Tantal-Perle-Wiki-07-02-25-P1040364b.jpg\/170px-Tantal-Perle-Wiki-07-02-25-P1040364b.jpg\" width=\"170\" height=\"225\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tantal-Perle-Wiki-07-02-25-P1040364b.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Tantalum electrolytic capacitor<\/div><\/div><\/div>\n<p>The major use for tantalum, as the metal powder, is in the production of electronic components, mainly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capacitor\" title=\"Capacitor\" rel=\"external_link\" target=\"_blank\">capacitors<\/a> and some high-power <a href=\"https:\/\/en.wikipedia.org\/wiki\/Resistor\" title=\"Resistor\" rel=\"external_link\" target=\"_blank\">resistors<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalum_capacitor\" title=\"Tantalum capacitor\" rel=\"external_link\" target=\"_blank\">Tantalum electrolytic capacitors<\/a> exploit the tendency of tantalum to form a protective <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxide\" title=\"Oxide\" rel=\"external_link\" target=\"_blank\">oxide<\/a> surface layer, using tantalum powder, pressed into a pellet shape, as one \"plate\" of the capacitor, the oxide as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dielectric\" title=\"Dielectric\" rel=\"external_link\" target=\"_blank\">dielectric<\/a>, and an electrolytic solution or conductive solid as the other \"plate\". Because the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Relative_static_permittivity\" class=\"mw-redirect\" title=\"Relative static permittivity\" rel=\"external_link\" target=\"_blank\">dielectric layer<\/a> can be very thin (thinner than the similar layer in, for instance, an aluminium electrolytic capacitor), a high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capacitance\" title=\"Capacitance\" rel=\"external_link\" target=\"_blank\">capacitance<\/a> can be achieved in a small volume. Because of the size and weight advantages, tantalum capacitors are attractive for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Portable_telephone\" class=\"mw-redirect\" title=\"Portable telephone\" rel=\"external_link\" target=\"_blank\">portable telephones<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Personal_computer\" title=\"Personal computer\" rel=\"external_link\" target=\"_blank\">personal computers<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Automotive_electronics\" title=\"Automotive electronics\" rel=\"external_link\" target=\"_blank\">automotive electronics<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cameras\" class=\"mw-redirect\" title=\"Cameras\" rel=\"external_link\" target=\"_blank\">cameras<\/a>.<sup id=\"rdp-ebb-cite_ref-USGSCR08_58-0\" class=\"reference\"><a href=\"#cite_note-USGSCR08-58\" rel=\"external_link\">[58]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Alloys\">Alloys<\/span><\/h3>\n<p>Tantalum is also used to produce a variety of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alloy\" title=\"Alloy\" rel=\"external_link\" target=\"_blank\">alloys<\/a> that have high melting points, strength, and ductility. Alloyed with other metals, it is also used in making carbide tools for metalworking equipment and in the production of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superalloy\" title=\"Superalloy\" rel=\"external_link\" target=\"_blank\">superalloys<\/a> for jet engine components, chemical process equipment, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_reactor\" title=\"Nuclear reactor\" rel=\"external_link\" target=\"_blank\">nuclear reactors<\/a>, missile parts, heat exchangers, tanks, and vessels.<sup id=\"rdp-ebb-cite_ref-59\" class=\"reference\"><a href=\"#cite_note-59\" rel=\"external_link\">[59]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-USGSCR08_58-1\" class=\"reference\"><a href=\"#cite_note-USGSCR08-58\" rel=\"external_link\">[58]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-60\" class=\"reference\"><a href=\"#cite_note-60\" rel=\"external_link\">[60]<\/a><\/sup> Because of its ductility, tantalum can be drawn into fine wires or filaments, which are used for evaporating metals such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium\" title=\"Aluminium\" rel=\"external_link\" target=\"_blank\">aluminium<\/a>. Since it resists attack by body fluids and is nonirritating, tantalum is widely used in making surgical instruments and implants. For example, porous tantalum coatings are used in the construction of orthopedic implants due to tantalum's ability to form a direct bond to hard tissue.<sup id=\"rdp-ebb-cite_ref-61\" class=\"reference\"><a href=\"#cite_note-61\" rel=\"external_link\">[61]<\/a><\/sup>\n<\/p><p>Tantalum is inert against most acids except <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrofluoric_acid\" title=\"Hydrofluoric acid\" rel=\"external_link\" target=\"_blank\">hydrofluoric acid<\/a> and hot <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sulfuric_acid\" title=\"Sulfuric acid\" rel=\"external_link\" target=\"_blank\">sulfuric acid<\/a>, and hot <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alkaline\" class=\"mw-redirect\" title=\"Alkaline\" rel=\"external_link\" target=\"_blank\">alkaline<\/a> solutions also cause tantalum to corrode. This property makes it a useful metal for chemical reaction vessels and pipes for corrosive liquids. Heat exchanging coils for the steam heating of hydrochloric acid are made from tantalum.<sup id=\"rdp-ebb-cite_ref-Balke_62-0\" class=\"reference\"><a href=\"#cite_note-Balke-62\" rel=\"external_link\">[62]<\/a><\/sup> Tantalum was extensively used in the production of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultra_high_frequency\" title=\"Ultra high frequency\" rel=\"external_link\" target=\"_blank\">ultra high frequency<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vacuum_tube\" title=\"Vacuum tube\" rel=\"external_link\" target=\"_blank\">electron tubes<\/a> for radio transmitters. Tantalum is capable of capturing oxygen and nitrogen by forming nitrides and oxides and therefore helped to sustain the high vacuum needed for the tubes when used for internal parts such as grids and plates.<sup id=\"rdp-ebb-cite_ref-ICE_31-1\" class=\"reference\"><a href=\"#cite_note-ICE-31\" rel=\"external_link\">[31]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Balke_62-1\" class=\"reference\"><a href=\"#cite_note-Balke-62\" rel=\"external_link\">[62]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Other_uses\">Other uses<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:322px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tantalio.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/70\/Tantalio.png\/320px-Tantalio.png\" width=\"320\" height=\"159\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tantalio.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bi-metallic_coin\" title=\"Bi-metallic coin\" rel=\"external_link\" target=\"_blank\">Bimetallic<\/a> coins minted by the Bank of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kazakhstan\" title=\"Kazakhstan\" rel=\"external_link\" target=\"_blank\">Kazakhstan<\/a> with silver ring and tantalum center.<\/div><\/div><\/div>\n<p>The high melting point and oxidation resistance lead to the use of the metal in the production of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vacuum_furnace\" title=\"Vacuum furnace\" rel=\"external_link\" target=\"_blank\">vacuum furnace<\/a> parts. Tantalum is extremely inert and is therefore formed into a variety of corrosion resistant parts, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermowell\" title=\"Thermowell\" rel=\"external_link\" target=\"_blank\">thermowells<\/a>, valve bodies, and tantalum fasteners. Due to its high density, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shaped_charge\" title=\"Shaped charge\" rel=\"external_link\" target=\"_blank\">shaped charge<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Explosively_formed_penetrator\" title=\"Explosively formed penetrator\" rel=\"external_link\" target=\"_blank\">explosively formed penetrator<\/a> liners have been constructed from tantalum.<sup id=\"rdp-ebb-cite_ref-63\" class=\"reference\"><a href=\"#cite_note-63\" rel=\"external_link\">[63]<\/a><\/sup> Tantalum greatly increases the armor penetration capabilities of a shaped charge due to its high density and high melting point.<sup id=\"rdp-ebb-cite_ref-64\" class=\"reference\"><a href=\"#cite_note-64\" rel=\"external_link\">[64]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-65\" class=\"reference\"><a href=\"#cite_note-65\" rel=\"external_link\">[65]<\/a><\/sup> It is also occasionally used in precious <a href=\"https:\/\/en.wikipedia.org\/wiki\/Watch\" title=\"Watch\" rel=\"external_link\" target=\"_blank\">watches<\/a> e.g. from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Audemars_Piguet\" title=\"Audemars Piguet\" rel=\"external_link\" target=\"_blank\">Audemars Piguet<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/F.P._Journe\" class=\"mw-redirect\" title=\"F.P. Journe\" rel=\"external_link\" target=\"_blank\">F.P. Journe<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hublot\" title=\"Hublot\" rel=\"external_link\" target=\"_blank\">Hublot<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Montblanc_(pens)\" class=\"mw-redirect\" title=\"Montblanc (pens)\" rel=\"external_link\" target=\"_blank\">Montblanc<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Omega_Watches\" class=\"mw-redirect\" title=\"Omega Watches\" rel=\"external_link\" target=\"_blank\">Omega<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Panerai\" title=\"Panerai\" rel=\"external_link\" target=\"_blank\">Panerai<\/a>. Tantalum is also highly bioinert and is used as an orthopedic implant material.<sup id=\"rdp-ebb-cite_ref-Gerald_L._Burke_1940_66-0\" class=\"reference\"><a href=\"#cite_note-Gerald_L._Burke_1940-66\" rel=\"external_link\">[66]<\/a><\/sup> The high stiffness of tantalum makes it necessary to use it as highly porous foam or scaffold with lower stiffness for hip replacement implants to avoid <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stress_shielding\" title=\"Stress shielding\" rel=\"external_link\" target=\"_blank\">stress shielding<\/a>.<sup id=\"rdp-ebb-cite_ref-67\" class=\"reference\"><a href=\"#cite_note-67\" rel=\"external_link\">[67]<\/a><\/sup> Because tantalum is a non-ferrous, non-magnetic metal, these implants are considered to be acceptable for patients undergoing MRI procedures.<sup id=\"rdp-ebb-cite_ref-PaganiasTsakotos2012_68-0\" class=\"reference\"><a href=\"#cite_note-PaganiasTsakotos2012-68\" rel=\"external_link\">[68]<\/a><\/sup> The oxide is used to make special high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refractive_index\" title=\"Refractive index\" rel=\"external_link\" target=\"_blank\">refractive index<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass\" title=\"Glass\" rel=\"external_link\" target=\"_blank\">glass<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Camera\" title=\"Camera\" rel=\"external_link\" target=\"_blank\">camera<\/a> lenses.<sup id=\"rdp-ebb-cite_ref-69\" class=\"reference\"><a href=\"#cite_note-69\" rel=\"external_link\">[69]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Environmental_issues\">Environmental issues<\/span><\/h2>\n<p>Tantalum receives far less attention in the environmental field than it does in other geosciences. Upper Crust Concentrations (UCC) and the Nb\/Ta ratio in the upper crust and in minerals are available because these measurements are useful as a geochemical tool.<sup id=\"rdp-ebb-cite_ref-70\" class=\"reference\"><a href=\"#cite_note-70\" rel=\"external_link\">[70]<\/a><\/sup> The latest values for UCC and the Nb\/Ta(w\/w) ratio in the upper crust stand at 0.92 ppm and 12.7 respectively.<sup id=\"rdp-ebb-cite_ref-71\" class=\"reference\"><a href=\"#cite_note-71\" rel=\"external_link\">[71]<\/a><\/sup>\n<\/p><p>Little data is available on tantalum concentrations in the different environmental compartments, especially in natural waters where reliable estimates of \u2018dissolved\u2019 tantalum concentrations in seawater and freshwaters have not even been produced.<sup id=\"rdp-ebb-cite_ref-:0_72-0\" class=\"reference\"><a href=\"#cite_note-:0-72\" rel=\"external_link\">[72]<\/a><\/sup> Some values on dissolved concentrations in oceans have been published, but they are contradictory. Values in freshwaters fare little better, but, in all cases, they are probably below 1 ng L<sup>\u22121,<\/sup>since \u2018dissolved\u2019 concentrations in natural waters are well below most current analytical capabilities.<sup id=\"rdp-ebb-cite_ref-73\" class=\"reference\"><a href=\"#cite_note-73\" rel=\"external_link\">[73]<\/a><\/sup> Analysis requires pre-concentration procedures that, for the moment, do not give consistent results. And in any case, tantalum appears to be present in natural waters mostly as particulate matter rather than dissolved.<sup id=\"rdp-ebb-cite_ref-:0_72-1\" class=\"reference\"><a href=\"#cite_note-:0-72\" rel=\"external_link\">[72]<\/a><\/sup>\n<\/p><p>Values for concentrations in soils, bed sediments and atmospheric aerosols are easier to come by.<sup id=\"rdp-ebb-cite_ref-:0_72-2\" class=\"reference\"><a href=\"#cite_note-:0-72\" rel=\"external_link\">[72]<\/a><\/sup> Values in soils are close to 1 ppm and thus to UCC values. This indicates detrital origin. For atmospheric aerosols the values available are scattered and limited. When tantalum enrichment is observed, it is probably due to loss of more water-soluble elements in aerosols in the clouds.<sup id=\"rdp-ebb-cite_ref-74\" class=\"reference\"><a href=\"#cite_note-74\" rel=\"external_link\">[74]<\/a><\/sup>\n<\/p><p>Pollution linked to human use of the element has not been detected.<sup id=\"rdp-ebb-cite_ref-75\" class=\"reference\"><a href=\"#cite_note-75\" rel=\"external_link\">[75]<\/a><\/sup> Tantalum appears to be a very conservative element in biogeochemical terms, but its cycling and reactivity are still not fully understood.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Precautions\">Precautions<\/span><\/h2>\n<p>Compounds containing tantalum are rarely encountered in the laboratory. The metal is highly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatible\" class=\"mw-redirect\" title=\"Biocompatible\" rel=\"external_link\" target=\"_blank\">biocompatible<\/a><sup id=\"rdp-ebb-cite_ref-Gerald_L._Burke_1940_66-1\" class=\"reference\"><a href=\"#cite_note-Gerald_L._Burke_1940-66\" rel=\"external_link\">[66]<\/a><\/sup> and is used for body <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implants<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coating\" title=\"Coating\" rel=\"external_link\" target=\"_blank\">coatings<\/a>, therefore attention may be focused on other elements or the physical nature of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_compound\" title=\"Chemical compound\" rel=\"external_link\" target=\"_blank\">chemical compound<\/a>.<sup id=\"rdp-ebb-cite_ref-76\" class=\"reference\"><a href=\"#cite_note-76\" rel=\"external_link\">[76]<\/a><\/sup>\n<\/p><p>People can be exposed to tantalum in the workplace by breathing it in, skin contact, or eye contact. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Occupational_Safety_and_Health_Administration\" title=\"Occupational Safety and Health Administration\" rel=\"external_link\" target=\"_blank\">Occupational Safety and Health Administration<\/a> (OSHA) has set the legal limit (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Permissible_exposure_limit\" title=\"Permissible exposure limit\" rel=\"external_link\" target=\"_blank\">permissible exposure limit<\/a>) for tantalum exposure in the workplace as 5 mg\/m<sup>3<\/sup> over an 8-hour workday. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Institute_for_Occupational_Safety_and_Health\" title=\"National Institute for Occupational Safety and Health\" rel=\"external_link\" target=\"_blank\">National Institute for Occupational Safety and Health<\/a> (NIOSH) has set a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Recommended_exposure_limit\" title=\"Recommended exposure limit\" rel=\"external_link\" target=\"_blank\">recommended exposure limit<\/a> (REL) of 5 mg\/m<sup>3<\/sup> over an 8-hour workday and a short-term limit of 10 mg\/m<sup>3<\/sup>. At levels of 2500 mg\/m<sup>3<\/sup>, tantalum is <a href=\"https:\/\/en.wikipedia.org\/wiki\/IDLH\" class=\"mw-redirect\" title=\"IDLH\" rel=\"external_link\" target=\"_blank\">immediately dangerous to life and health<\/a>.<sup id=\"rdp-ebb-cite_ref-77\" class=\"reference\"><a href=\"#cite_note-77\" rel=\"external_link\">[77]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-CIAAW2016-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-CIAAW2016_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Meija, J.; et al. (2016). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.degruyter.com\/downloadpdf\/j\/pac.2016.88.issue-3\/pac-2015-0305\/pac-2015-0305.xml\" target=\"_blank\">\"Atomic weights of the elements 2013 (IUPAC Technical Report)\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pure_and_Applied_Chemistry\" title=\"Pure and Applied Chemistry\" rel=\"external_link\" target=\"_blank\">Pure and Applied Chemistry<\/a><\/i>. <b>88<\/b> (3): 265\u201391. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1515%2Fpac-2015-0305\" target=\"_blank\">10.1515\/pac-2015-0305<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pure+and+Applied+Chemistry&rft.atitle=Atomic+weights+of+the+elements+2013+%28IUPAC+Technical+Report%29&rft.volume=88&rft.issue=3&rft.pages=265-91&rft.date=2016&rft_id=info%3Adoi%2F10.1515%2Fpac-2015-0305&rft.aulast=Meija&rft.aufirst=J.&rft.au=Coplen%2C+T.+B.&rft.au=Berglund%2C+M.&rft.au=Brand%2C+W.A.&rft.au=De+Bi%C3%A8vre%2C+P.&rft.au=Gr%C3%B6ning%2C+M.&rft.au=Holden%2C+N.E.&rft.au=Irrgeher%2C+J.&rft.au=Loss%2C+R.D.&rft.au=Walczyk%2C+T.&rft.au=Prohaska%2C+T.&rft_id=https%3A%2F%2Fwww.degruyter.com%2Fdownloadpdf%2Fj%2Fpac.2016.88.issue-3%2Fpac-2015-0305%2Fpac-2015-0305.xml&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-crystal_structure-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-crystal_structure_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-crystal_structure_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Moseley, P. T.; Seabrook, C. J. (1973). \"The crystal structure of \u03b2-tantalum\". <i>Acta Crystallographica Section B Structural Crystallography and Crystal Chemistry<\/i>. <b>29<\/b> (5): 1170\u20131171. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1107%2FS0567740873004140\" target=\"_blank\">10.1107\/S0567740873004140<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Crystallographica+Section+B+Structural+Crystallography+and+Crystal+Chemistry&rft.atitle=The+crystal+structure+of+%CE%B2-tantalum&rft.volume=29&rft.issue=5&rft.pages=1170-1171&rft.date=1973&rft_id=info%3Adoi%2F10.1107%2FS0567740873004140&rft.aulast=Moseley&rft.aufirst=P.+T.&rft.au=Seabrook%2C+C.+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-magnet-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-magnet_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Lide, D. R., ed. (2005). \"Magnetic susceptibility of the elements and inorganic compounds\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110303222309\/http:\/\/www-d0.fnal.gov\/hardware\/cal\/lvps_info\/engineering\/elementmagn.pdf\" target=\"_blank\"><i>CRC Handbook of Chemistry and Physics<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span> (86th ed.). Boca Raton (FL): CRC Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-8493-0486-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Magnetic+susceptibility+of+the+elements+and+inorganic+compounds&rft.btitle=CRC+Handbook+of+Chemistry+and+Physics&rft.place=Boca+Raton+%28FL%29&rft.edition=86th&rft.pub=CRC+Press&rft.date=2005&rft.isbn=0-8493-0486-5&rft_id=https%3A%2F%2Fweb.archive.org%2Fweb%2F20110303222309%2Fhttp%3A%2F%2Fwww-d0.fnal.gov%2Fhardware%2Fcal%2Flvps_info%2Fengineering%2Felementmagn.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Weast, Robert (1984). <i>CRC, Handbook of Chemistry and Physics<\/i>. Boca Raton, Florida: Chemical Rubber Company Publishing. pp. E110. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-8493-0464-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=CRC%2C+Handbook+of+Chemistry+and+Physics&rft.place=Boca+Raton%2C+Florida&rft.pages=E110&rft.pub=Chemical+Rubber+Company+Publishing&rft.date=1984&rft.isbn=0-8493-0464-4&rft.aulast=Weast&rft.aufirst=Robert&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Euripides\" title=\"Euripides\" rel=\"external_link\" target=\"_blank\">Euripides<\/a>, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Orestes_(play)\" title=\"Orestes (play)\" rel=\"external_link\" target=\"_blank\">Orestes<\/a><\/i><\/span>\n<\/li>\n<li id=\"cite_note-mindat.org-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-mindat.org_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-mindat.org_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mindat.org\" target=\"_blank\">\"Mindat.org - Mines, Minerals and More\"<\/a>. <i>www.mindat.org<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.mindat.org&rft.atitle=Mindat.org+-+Mines%2C+Minerals+and+More&rft_id=http%3A%2F%2Fwww.mindat.org&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ekeberg, Anders (1802). <a rel=\"external_link\" class=\"external text\" href=\"#page\/265\/mode\/1up\">\"Of the Properties of the Earth Yttria, compared with those of Glucine; of Fossils, in which the first of these Earths in contained; and of the Discovery of a metallic Nature (Tantalium)\"<\/a>. <i>Journal of Natural Philosophy, Chemistry, and the Arts<\/i>. <b>3<\/b>: 251\u2013255.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Natural+Philosophy%2C+Chemistry%2C+and+the+Arts&rft.atitle=Of+the+Properties+of+the+Earth+Yttria%2C+compared+with+those+of+Glucine%3B+of+Fossils%2C+in+which+the+first+of+these+Earths+in+contained%3B+and+of+the+Discovery+of+a+metallic+Nature+%28Tantalium%29&rft.volume=3&rft.pages=251-255&rft.date=1802&rft.aulast=Ekeberg&rft.aufirst=Anders&rft_id=https%3A%2F%2Fwww.biodiversitylibrary.org%2Fitem%2F15589%23page%2F265%2Fmode%2F1up&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ekeberg, Anders (1802). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/archive.org\/details\/kungligasvenskav2231kung\" target=\"_blank\">\"Uplysning om Ytterjorden egenskaper, i synnerhet i aemforelse med Berylljorden:om de Fossilier, havari f\u00f6rstnemnde jord innehales, samt om en ny upt\u00e4ckt kropp af metallik natur\"<\/a>. <i>Kungliga Svenska Vetenskapsakademiens Handlingar<\/i>. <b>23<\/b>: 68\u201383.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Kungliga+Svenska+Vetenskapsakademiens+Handlingar&rft.atitle=Uplysning+om+Ytterjorden+egenskaper%2C+i+synnerhet+i+aemforelse+med+Berylljorden%3Aom+de+Fossilier%2C+havari+f%C3%B6rstnemnde+jord+innehales%2C+samt+om+en+ny+upt%C3%A4ckt+kropp+af+metallik+natur&rft.volume=23&rft.pages=68-83&rft.date=1802&rft.aulast=Ekeberg&rft.aufirst=Anders&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fkungligasvenskav2231kung&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Griffith, William P.; Morris, Peter J. T. (2003). \"Charles Hatchett FRS (1765\u20131847), Chemist and Discoverer of Niobium\". <i>Notes and Records of the Royal Society of London<\/i>. <b>57<\/b> (3): 299. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1098%2Frsnr.2003.0216\" target=\"_blank\">10.1098\/rsnr.2003.0216<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/JSTOR\" title=\"JSTOR\" rel=\"external_link\" target=\"_blank\">JSTOR<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.jstor.org\/stable\/3557720\" target=\"_blank\">3557720<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Notes+and+Records+of+the+Royal+Society+of+London&rft.atitle=Charles+Hatchett+FRS+%281765%E2%80%931847%29%2C+Chemist+and+Discoverer+of+Niobium&rft.volume=57&rft.issue=3&rft.pages=299&rft.date=2003&rft_id=info%3Adoi%2F10.1098%2Frsnr.2003.0216&rft_id=%2F%2Fwww.jstor.org%2Fstable%2F3557720&rft.aulast=Griffith&rft.aufirst=William+P.&rft.au=Morris%2C+Peter+J.+T.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Wolla-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Wolla_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/William_Hyde_Wollaston\" title=\"William Hyde Wollaston\" rel=\"external_link\" target=\"_blank\">Wollaston, William Hyde<\/a> (1809). \"On the Identity of Columbium and Tantalum\". <i>Philosophical Transactions of the Royal Society of London<\/i>. <b>99<\/b>: 246\u2013252. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1098%2Frstl.1809.0017\" target=\"_blank\">10.1098\/rstl.1809.0017<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/JSTOR\" title=\"JSTOR\" rel=\"external_link\" target=\"_blank\">JSTOR<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.jstor.org\/stable\/107264\" target=\"_blank\">107264<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Philosophical+Transactions+of+the+Royal+Society+of+London&rft.atitle=On+the+Identity+of+Columbium+and+Tantalum&rft.volume=99&rft.pages=246-252&rft.date=1809&rft_id=info%3Adoi%2F10.1098%2Frstl.1809.0017&rft_id=%2F%2Fwww.jstor.org%2Fstable%2F107264&rft.aulast=Wollaston&rft.aufirst=William+Hyde&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Pelop-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Pelop_11-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Heinrich_Rose\" title=\"Heinrich Rose\" rel=\"external_link\" target=\"_blank\">Rose, Heinrich<\/a> (1844). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/gallica.bnf.fr\/ark:\/12148\/bpt6k15148n\/f327.table\" target=\"_blank\">\"Ueber die Zusammensetzung der Tantalite und ein im Tantalite von Baiern enthaltenes neues Metall\"<\/a>. <i>Annalen der Physik<\/i> (in German). <b>139<\/b> (10): 317\u2013341. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/1844AnP...139..317R\" target=\"_blank\">1844AnP...139..317R<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fandp.18441391006\" target=\"_blank\">10.1002\/andp.18441391006<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annalen+der+Physik&rft.atitle=Ueber+die+Zusammensetzung+der+Tantalite+und+ein+im+Tantalite+von+Baiern+enthaltenes+neues+Metall&rft.volume=139&rft.issue=10&rft.pages=317-341&rft.date=1844&rft_id=info%3Adoi%2F10.1002%2Fandp.18441391006&rft_id=info%3Abibcode%2F1844AnP...139..317R&rft.aulast=Rose&rft.aufirst=Heinrich&rft_id=http%3A%2F%2Fgallica.bnf.fr%2Fark%3A%2F12148%2Fbpt6k15148n%2Ff327.table&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Heinrich_Rose\" title=\"Heinrich Rose\" rel=\"external_link\" target=\"_blank\">Rose, Heinrich<\/a> (1847). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/gallica.bnf.fr\/ark:\/12148\/bpt6k15155x\/f586.table\" target=\"_blank\">\"Ueber die S\u00e4ure im Columbit von Nordam\u00e9rika\"<\/a>. <i>Annalen der Physik<\/i> (in German). <b>146<\/b> (4): 572\u2013577. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/1847AnP...146..572R\" target=\"_blank\">1847AnP...146..572R<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fandp.18471460410\" target=\"_blank\">10.1002\/andp.18471460410<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annalen+der+Physik&rft.atitle=Ueber+die+S%C3%A4ure+im+Columbit+von+Nordam%C3%A9rika&rft.volume=146&rft.issue=4&rft.pages=572-577&rft.date=1847&rft_id=info%3Adoi%2F10.1002%2Fandp.18471460410&rft_id=info%3Abibcode%2F1847AnP...146..572R&rft.aulast=Rose&rft.aufirst=Heinrich&rft_id=http%3A%2F%2Fgallica.bnf.fr%2Fark%3A%2F12148%2Fbpt6k15155x%2Ff586.table&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Ilmen-13\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Ilmen_13-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ilmen_13-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Marignac, Blomstrand; H. Deville; L. Troost & R. Hermann (1866). \"Tantals\u00e4ure, Niobs\u00e4ure, (Ilmens\u00e4ure) und Titans\u00e4ure\". <i>Fresenius' Journal of Analytical Chemistry<\/i>. <b>5<\/b> (1): 384\u2013389. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2FBF01302537\" target=\"_blank\">10.1007\/BF01302537<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Fresenius%27+Journal+of+Analytical+Chemistry&rft.atitle=Tantals%C3%A4ure%2C+Niobs%C3%A4ure%2C+%28Ilmens%C3%A4ure%29+und+Titans%C3%A4ure&rft.volume=5&rft.issue=1&rft.pages=384-389&rft.date=1866&rft_id=info%3Adoi%2F10.1007%2FBF01302537&rft.au=Marignac%2C+Blomstrand&rft.au=H.+Deville&rft.au=L.+Troost&rft.au=R.+Hermann&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Gupta-14\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Gupta_14-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gupta_14-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gupta_14-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Gupta, C. K.; Suri, A. K. (1994). <i>Extractive Metallurgy of Niobium<\/i>. CRC Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-8493-6071-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Extractive+Metallurgy+of+Niobium&rft.pub=CRC+Press&rft.date=1994&rft.isbn=978-0-8493-6071-8&rft.aulast=Gupta&rft.aufirst=C.+K.&rft.au=Suri%2C+A.+K.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Jean_Charles_Galissard_de_Marignac\" title=\"Jean Charles Galissard de Marignac\" rel=\"external_link\" target=\"_blank\">Marignac, M. C.<\/a> (1866). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/gallica.bnf.fr\/ark:\/12148\/bpt6k34818t\/f4.table\" target=\"_blank\">\"Recherches sur les combinaisons du niobium\"<\/a>. <i>Annales de Chimie et de Physique<\/i> (in French). <b>4<\/b> (8): 7\u201375.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annales+de+Chimie+et+de+Physique&rft.atitle=Recherches+sur+les+combinaisons+du+niobium&rft.volume=4&rft.issue=8&rft.pages=7-75&rft.date=1866&rft.aulast=Marignac&rft.aufirst=M.+C.&rft_id=http%3A%2F%2Fgallica.bnf.fr%2Fark%3A%2F12148%2Fbpt6k34818t%2Ff4.table&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hermann, R. (1871). \"Fortgesetzte Untersuchungen \u00fcber die Verbindungen von Ilmenium und Niobium, sowie \u00fcber die Zusammensetzung der Niobmineralien (Further research about the compounds of ilmenium and niobium, as well as the composition of niobium minerals)\". <i>Journal f\u00fcr Praktische Chemie<\/i> (in German). <b>3<\/b> (1): 373\u2013427. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fprac.18710030137\" target=\"_blank\">10.1002\/prac.18710030137<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+f%C3%BCr+Praktische+Chemie&rft.atitle=Fortgesetzte+Untersuchungen+%C3%BCber+die+Verbindungen+von+Ilmenium+und+Niobium%2C+sowie+%C3%BCber+die+Zusammensetzung+der+Niobmineralien+%28Further+research+about+the+compounds+of+ilmenium+and+niobium%2C+as+well+as+the+composition+of+niobium+minerals%29&rft.volume=3&rft.issue=1&rft.pages=373-427&rft.date=1871&rft_id=info%3Adoi%2F10.1002%2Fprac.18710030137&rft.aulast=Hermann&rft.aufirst=R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-nauti-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-nauti_17-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/nautilus.fis.uc.pt\/st2.5\/scenes-e\/elem\/e04100.html\" target=\"_blank\">\"Niobium\"<\/a>. Universidade de Coimbra<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2008-09-05<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Niobium&rft.pub=Universidade+de+Coimbra&rft_id=http%3A%2F%2Fnautilus.fis.uc.pt%2Fst2.5%2Fscenes-e%2Felem%2Fe04100.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bowers, B. (2001). \"Scanning Our Past from London The Filament Lamp and New Materials\". <i>Proceedings of the IEEE<\/i>. <b>89<\/b> (3): 413. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2F5.915382\" target=\"_blank\">10.1109\/5.915382<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+the+IEEE&rft.atitle=Scanning+Our+Past+from+London+The+Filament+Lamp+and+New+Materials&rft.volume=89&rft.issue=3&rft.pages=413&rft.date=2001&rft_id=info%3Adoi%2F10.1109%2F5.915382&rft.au=Bowers%2C+B.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Aycan, Sule (2005). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/thescipub.com\/PDF\/jssp.2005.238.239.pdf\" target=\"_blank\">\"Chemistry Education and Mythology\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Journal of Social Sciences<\/i>. <b>1<\/b> (4): 238\u2013239. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3844%2Fjssp.2005.238.239\" target=\"_blank\">10.3844\/jssp.2005.238.239<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Social+Sciences&rft.atitle=Chemistry+Education+and+Mythology&rft.volume=1&rft.issue=4&rft.pages=238-239&rft.date=2005&rft_id=info%3Adoi%2F10.3844%2Fjssp.2005.238.239&rft.aulast=Aycan&rft.aufirst=Sule&rft_id=http%3A%2F%2Fthescipub.com%2FPDF%2Fjssp.2005.238.239.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Norman_Greenwood\" title=\"Norman Greenwood\" rel=\"external_link\" target=\"_blank\">Greenwood, Norman N.<\/a>; Earnshaw, Alan (1997). <i>Chemistry of the Elements<\/i> (2nd ed.). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Butterworth-Heinemann\" title=\"Butterworth-Heinemann\" rel=\"external_link\" target=\"_blank\">Butterworth-Heinemann<\/a>. p. 1138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-08-037941-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Chemistry+of+the+Elements&rft.pages=1138&rft.edition=2nd&rft.pub=Butterworth-Heinemann&rft.date=1997&rft.isbn=0-08-037941-9&rft.aulast=Greenwood&rft.aufirst=Norman++N.&rft.au=Earnshaw%2C+Alan&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Colakis, Marianthe; Masello, Mary Joan (2007-06-30). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=5o3Lr2Swz8sC&pg=PA204\" target=\"_blank\">\"Tantalum\"<\/a>. <i>Classical Mythology & More: A Reader Workbook<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-86516-573-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Tantalum&rft.btitle=Classical+Mythology+%26+More%3A+A+Reader+Workbook&rft.date=2007-06-30&rft.isbn=978-0-86516-573-1&rft.au=Colakis%2C+Marianthe&rft.au=Masello%2C+Mary+Joan&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3D5o3Lr2Swz8sC%26pg%3DPA204&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Magnuson, M.; 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(2004). \"Texture, structure and phase transformation in sputter beta tantalum coating\". <i>Surface and Coatings Technology<\/i>. 177\u2013178: 44. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.surfcoat.2003.06.008\" target=\"_blank\">10.1016\/j.surfcoat.2003.06.008<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Surface+and+Coatings+Technology&rft.atitle=Texture%2C+structure+and+phase+transformation+in+sputter+beta+tantalum+coating&rft.volume=177%E2%80%93178&rft.pages=44&rft.date=2004&rft_id=info%3Adoi%2F10.1016%2Fj.surfcoat.2003.06.008&rft.aulast=Lee&rft.aufirst=S.&rft.au=Doxbeck%2C+M.&rft.au=Mueller%2C+J.&rft.au=Cipollo%2C+M.&rft.au=Cote%2C+P.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hult, Mikael; Wieslander, J. 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Elisabeth; Marissens, Gerd; Gasparro, Jo\u00ebl; W\u00e4tjen, Uwe; Misiaszek, Marcin (2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0969804309000657\" target=\"_blank\">\"Search for the radioactivity of 180mTa using an underground HPGe sandwich spectrometer\"<\/a>. <i>Applied Radiation and Isotopes<\/i>. <b>67<\/b> (5): 918\u2013921. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.apradiso.2009.01.057\" target=\"_blank\">10.1016\/j.apradiso.2009.01.057<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19246206\" target=\"_blank\">19246206<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">23 September<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Applied+Radiation+and+Isotopes&rft.atitle=Search+for+the+radioactivity+of+180mTa+using+an+underground+HPGe+sandwich+spectrometer&rft.volume=67&rft.issue=5&rft.pages=918-921&rft.date=2009&rft_id=info%3Adoi%2F10.1016%2Fj.apradiso.2009.01.057&rft_id=info%3Apmid%2F19246206&rft.aulast=Hult&rft.aufirst=Mikael&rft.au=Wieslander%2C+J.+S.+Elisabeth&rft.au=Marissens%2C+Gerd&rft.au=Gasparro%2C+Jo%C3%ABl&rft.au=W%C3%A4tjen%2C+Uwe&rft.au=Misiaszek%2C+Marcin&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS0969804309000657&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-NUBASE-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-NUBASE_25-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Georges, Audi; Bersillon, O.; Blachot, J.; Wapstra, A. H. (2003). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/hal.in2p3.fr\/in2p3-00014184\" target=\"_blank\">\"The NUBASE Evaluation of Nuclear and Decay Properties\"<\/a>. <i>Nuclear Physics A<\/i>. <b>729<\/b> (1): 3\u2013128. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2003NuPhA.729....3A\" target=\"_blank\">2003NuPhA.729....3A<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/CiteSeerX\" title=\"CiteSeerX\" rel=\"external_link\" target=\"_blank\">CiteSeerX<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/citeseerx.ist.psu.edu\/viewdoc\/summary?doi=10.1.1.692.8504\" target=\"_blank\">10.1.1.692.8504<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.nuclphysa.2003.11.001\" target=\"_blank\">10.1016\/j.nuclphysa.2003.11.001<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nuclear+Physics+A&rft.atitle=The+NUBASE+Evaluation+of+Nuclear+and+Decay+Properties&rft.volume=729&rft.issue=1&rft.pages=3-128&rft.date=2003&rft_id=%2F%2Fciteseerx.ist.psu.edu%2Fviewdoc%2Fsummary%3Fdoi%3D10.1.1.692.8504&rft_id=info%3Adoi%2F10.1016%2Fj.nuclphysa.2003.11.001&rft_id=info%3Abibcode%2F2003NuPhA.729....3A&rft.aulast=Georges&rft.aufirst=Audi&rft.au=Bersillon%2C+O.&rft.au=Blachot%2C+J.&rft.au=Wapstra%2C+A.+H.&rft_id=http%3A%2F%2Fhal.in2p3.fr%2Fin2p3-00014184&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Win, David Tin; 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Earnshaw, Alan (1997). <i>Chemistry of the Elements<\/i> (2nd ed.). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Butterworth-Heinemann\" title=\"Butterworth-Heinemann\" rel=\"external_link\" target=\"_blank\">Butterworth-Heinemann<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-08-037941-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Chemistry+of+the+Elements&rft.edition=2nd&rft.pub=Butterworth-Heinemann&rft.date=1997&rft.isbn=0-08-037941-9&rft.aulast=Greenwood&rft.aufirst=Norman++N.&rft.au=Earnshaw%2C+Alan&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-HollemanAF-29\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-HollemanAF_29-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HollemanAF_29-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HollemanAF_29-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HollemanAF_29-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Holleman, A. F.; Wiberg, E.; Wiberg, N. (2007). <i>Lehrbuch der Anorganischen Chemie<\/i> (in German) (102nd ed.). de Gruyter. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-11-017770-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Lehrbuch+der+Anorganischen+Chemie&rft.edition=102nd&rft.pub=de+Gruyter&rft.date=2007&rft.isbn=978-3-11-017770-1&rft.au=Holleman%2C+A.+F.&rft.au=Wiberg%2C+E.&rft.au=Wiberg%2C+N.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tsukimoto, S.; Moriyama, M.; Murakami, Masanori (1961). \"Microstructure of amorphous tantalum nitride thin films\". <i>Thin Solid Films<\/i>. <b>460<\/b> (1\u20132): 222\u2013226. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2004TSF...460..222T\" target=\"_blank\">2004TSF...460..222T<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.tsf.2004.01.073\" target=\"_blank\">10.1016\/j.tsf.2004.01.073<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Thin+Solid+Films&rft.atitle=Microstructure+of+amorphous+tantalum+nitride+thin+films&rft.volume=460&rft.issue=1%E2%80%932&rft.pages=222-226&rft.date=1961&rft_id=info%3Adoi%2F10.1016%2Fj.tsf.2004.01.073&rft_id=info%3Abibcode%2F2004TSF...460..222T&rft.aulast=Tsukimoto&rft.aufirst=S.&rft.au=Moriyama%2C+M.&rft.au=Murakami%2C+Masanori&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ICE-31\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ICE_31-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ICE_31-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Soisson, Donald J.; McLafferty, J. J.; Pierret, James A. (1961). \"Staff-Industry Collaborative Report: Tantalum and Niobium\". <i>Ind. Eng. Chem<\/i>. <b>53<\/b> (11): 861\u2013868. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1021%2Fie50623a016\" target=\"_blank\">10.1021\/ie50623a016<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ind.+Eng.+Chem.&rft.atitle=Staff-Industry+Collaborative+Report%3A+Tantalum+and+Niobium&rft.volume=53&rft.issue=11&rft.pages=861-868&rft.date=1961&rft_id=info%3Adoi%2F10.1021%2Fie50623a016&rft.aulast=Soisson&rft.aufirst=Donald+J.&rft.au=McLafferty%2C+J.+J.&rft.au=Pierret%2C+James+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Aguly-32\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Aguly_32-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Aguly_32-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Agulyansky, Anatoly (2004). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=Z-4QXNB5Hp8C\" target=\"_blank\"><i>The Chemistry of Tantalum and Niobium Fluoride Compounds<\/i><\/a>. Elsevier. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-444-51604-6<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2008-09-02<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Chemistry+of+Tantalum+and+Niobium+Fluoride+Compounds&rft.pub=Elsevier&rft.date=2004&rft.isbn=978-0-444-51604-6&rft.aulast=Agulyansky&rft.aufirst=Anatoly&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3DZ-4QXNB5Hp8C&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Schrock-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Schrock_33-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Schrock, Richard R. (1979-03-01). \"Alkylidene complexes of niobium and tantalum\". <i>Accounts of Chemical Research<\/i>. <b>12<\/b> (3): 98\u2013104. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1021%2Far50135a004\" target=\"_blank\">10.1021\/ar50135a004<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0001-4842\" target=\"_blank\">0001-4842<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Accounts+of+Chemical+Research&rft.atitle=Alkylidene+complexes+of+niobium+and+tantalum&rft.volume=12&rft.issue=3&rft.pages=98-104&rft.date=1979-03-01&rft_id=info%3Adoi%2F10.1021%2Far50135a004&rft.issn=0001-4842&rft.aulast=Schrock&rft.aufirst=Richard+R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Morse, P. M.; et al. (2008). \"Ethylene Complexes of the Early Transition Metals: Crystal Structures of <span class=\"chemf nowrap\">[HfEt<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">4<\/sub><\/span>(C<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">2<\/sub><\/span>H<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">4<\/sub><\/span>)<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:0.8em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">2\u2212<\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sub><\/span>]<\/span> and the Negative-Oxidation-State Species <span class=\"chemf nowrap\">[TaHEt(C<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">2<\/sub><\/span>H<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">4<\/sub><\/span>)<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">3\u2212<\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">3<\/sub><\/span>]<\/span> and <span class=\"chemf nowrap\">[WH(C<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">2<\/sub><\/span>H<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">4<\/sub><\/span>)<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">3\u2212<\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">4<\/sub><\/span>]<\/span>\". <i>Organometallics<\/i>. <b>27<\/b> (5): 984. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1021%2Fom701189e\" target=\"_blank\">10.1021\/om701189e<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Organometallics&rft.atitle=Ethylene+Complexes+of+the+Early+Transition+Metals%3A+Crystal+Structures+of+%3Cspan+class%3D%22chemf+nowrap%22%3E%5BHfEt%3Cspan+style%3D%22display%3Ainline-block%3Bmargin-bottom%3A-0.3em%3Bvertical-align%3A-0.4em%3Bline-height%3A1em%3Bfont-size%3A80%25%3Btext-align%3Aleft%22%3E%3Csup+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E%3C%2Fsup%3E%3Cbr+%2F%3E%3Csub+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E4%3C%2Fsub%3E%3C%2Fspan%3E%28C%3Cspan+style%3D%22display%3Ainline-block%3Bmargin-bottom%3A-0.3em%3Bvertical-align%3A-0.4em%3Bline-height%3A1em%3Bfont-size%3A80%25%3Btext-align%3Aleft%22%3E%3Csup+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E%3C%2Fsup%3E%3Cbr+%2F%3E%3Csub+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E2%3C%2Fsub%3E%3C%2Fspan%3EH%3Cspan+style%3D%22display%3Ainline-block%3Bmargin-bottom%3A-0.3em%3Bvertical-align%3A-0.4em%3Bline-height%3A1em%3Bfont-size%3A80%25%3Btext-align%3Aleft%22%3E%3Csup+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E%3C%2Fsup%3E%3Cbr+%2F%3E%3Csub+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E4%3C%2Fsub%3E%3C%2Fspan%3E%29%3Cspan+style%3D%22display%3Ainline-block%3Bmargin-bottom%3A-0.3em%3Bvertical-align%3A0.8em%3Bline-height%3A1em%3Bfont-size%3A80%25%3Btext-align%3Aleft%22%3E%3Csup+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E2%E2%88%92%3C%2Fsup%3E%3Cbr+%2F%3E%3Csub+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E%3C%2Fsub%3E%3C%2Fspan%3E%5D%3C%2Fspan%3E+and+the+Negative-Oxidation-State+Species+%3Cspan+class%3D%22chemf+nowrap%22%3E%5BTaHEt%28C%3Cspan+style%3D%22display%3Ainline-block%3Bmargin-bottom%3A-0.3em%3Bvertical-align%3A-0.4em%3Bline-height%3A1em%3Bfont-size%3A80%25%3Btext-align%3Aleft%22%3E%3Csup+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E%3C%2Fsup%3E%3Cbr+%2F%3E%3Csub+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E2%3C%2Fsub%3E%3C%2Fspan%3EH%3Cspan+style%3D%22display%3Ainline-block%3Bmargin-bottom%3A-0.3em%3Bvertical-align%3A-0.4em%3Bline-height%3A1em%3Bfont-size%3A80%25%3Btext-align%3Aleft%22%3E%3Csup+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E%3C%2Fsup%3E%3Cbr+%2F%3E%3Csub+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E4%3C%2Fsub%3E%3C%2Fspan%3E%29%3Cspan+style%3D%22display%3Ainline-block%3Bmargin-bottom%3A-0.3em%3Bvertical-align%3A-0.4em%3Bline-height%3A1em%3Bfont-size%3A80%25%3Btext-align%3Aleft%22%3E%3Csup+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E3%E2%88%92%3C%2Fsup%3E%3Cbr+%2F%3E%3Csub+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E3%3C%2Fsub%3E%3C%2Fspan%3E%5D%3C%2Fspan%3E+and+%3Cspan+class%3D%22chemf+nowrap%22%3E%5BWH%28C%3Cspan+style%3D%22display%3Ainline-block%3Bmargin-bottom%3A-0.3em%3Bvertical-align%3A-0.4em%3Bline-height%3A1em%3Bfont-size%3A80%25%3Btext-align%3Aleft%22%3E%3Csup+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E%3C%2Fsup%3E%3Cbr+%2F%3E%3Csub+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E2%3C%2Fsub%3E%3C%2Fspan%3EH%3Cspan+style%3D%22display%3Ainline-block%3Bmargin-bottom%3A-0.3em%3Bvertical-align%3A-0.4em%3Bline-height%3A1em%3Bfont-size%3A80%25%3Btext-align%3Aleft%22%3E%3Csup+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E%3C%2Fsup%3E%3Cbr+%2F%3E%3Csub+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E4%3C%2Fsub%3E%3C%2Fspan%3E%29%3Cspan+style%3D%22display%3Ainline-block%3Bmargin-bottom%3A-0.3em%3Bvertical-align%3A-0.4em%3Bline-height%3A1em%3Bfont-size%3A80%25%3Btext-align%3Aleft%22%3E%3Csup+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E3%E2%88%92%3C%2Fsup%3E%3Cbr+%2F%3E%3Csub+style%3D%22font-size%3Ainherit%3Bline-height%3Ainherit%3Bvertical-align%3Abaseline%22%3E4%3C%2Fsub%3E%3C%2Fspan%3E%5D%3C%2Fspan%3E&rft.volume=27&rft.issue=5&rft.pages=984&rft.date=2008&rft_id=info%3Adoi%2F10.1021%2Fom701189e&rft.au=Morse%2C+P.+M.&rft.au=Shelby%2C+Q.+D.&rft.au=Kim%2C+D.+Y.&rft.au=Girolami%2C+G.+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Emsley-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Emsley_35-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Emsley, John (2001). \"Tantalum\". <i>Nature's Building Blocks: An A-Z Guide to the Elements<\/i>. Oxford, England, UK: Oxford University Press. p. 420. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-19-850340-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Tantalum&rft.btitle=Nature%27s+Building+Blocks%3A+An+A-Z+Guide+to+the+Elements&rft.place=Oxford%2C+England%2C+UK&rft.pages=420&rft.pub=Oxford+University+Press&rft.date=2001&rft.isbn=978-0-19-850340-8&rft.aulast=Emsley&rft.aufirst=John&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/af.reuters.com\/article\/drcNews\/idAFLDE6530TW20100609\" target=\"_blank\">\"Talison Tantalum eyes mid-2011 Wodgina restart 2010-06-09\"<\/a>. Reuters. 2010-06-09<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2010-08-27<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Talison+Tantalum+eyes+mid-2011+Wodgina+restart+2010-06-09&rft.date=2010-06-09&rft_id=https%3A%2F%2Faf.reuters.com%2Farticle%2FdrcNews%2FidAFLDE6530TW20100609&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Wodgina-tant-closed-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Wodgina-tant-closed_37-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Emery, Kate (24 Jan 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20121204055041\/http:\/\/au.news.yahoo.com\/thewest\/business\/a\/-\/business\/12702333\/gam-closes-wodgina-tantalum-mine\/\" target=\"_blank\">\"GAM closes Wodgina tantalum mine\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_West_Australian\" title=\"The West Australian\" rel=\"external_link\" target=\"_blank\">The West Australian<\/a><\/i>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/au.news.yahoo.com\/thewest\/business\/a\/-\/business\/12702333\/gam-closes-wodgina-tantalum-mine\/\" target=\"_blank\">the original<\/a> on 4 December 2012<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">20 March<\/span> 2012<\/span>. <q>Worldwide softening tantalum demand and delays in receiving Governmental approval for installation of necessary crushing equipment are among contributing factors in this decision<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+West+Australian&rft.atitle=GAM+closes+Wodgina+tantalum+mine&rft.date=2012-01-24&rft.aulast=Emery&rft.aufirst=Kate&rft_id=http%3A%2F%2Fau.news.yahoo.com%2Fthewest%2Fbusiness%2Fa%2F-%2Fbusiness%2F12702333%2Fgam-closes-wodgina-tantalum-mine%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Talison-38\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Talison_38-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/globaladvancedmetals.com\/our-operations\/gam-resources\/wodgina-australia.aspx\" target=\"_blank\">\"Wodgina Operations\"<\/a>. 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(2006). <a rel=\"external_link\" class=\"external text\" href=\"#pubs\">\"2006 Minerals Yearbook Nb & Ta\"<\/a>. US Geological Survey<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2008-06-03<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=2006+Minerals+Yearbook+Nb+%26+Ta&rft.pub=US+Geological+Survey&rft.date=2006&rft.aulast=Papp&rft.aufirst=John+F.&rft_id=http%3A%2F%2Fminerals.usgs.gov%2Fminerals%2Fpubs%2Fcommodity%2Fniobium%2F%23pubs&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-40\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-40\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Bleiwas, Donald I.; Papp, John F.; Yager, Thomas R. 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Retrieved <span class=\"nowrap\">2008-06-03<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Mining+Journal&rft.atitle=Tantalum+supplement&rft.date=2007-11&rft.au=M.+J.&rft_id=http%3A%2F%2Fwww.noventa.net%2Fpdf%2Fpresentations%2FtanatalumSCR_presentation.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-42\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-42\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070926195547\/http:\/\/www.doir.wa.gov.au\/documents\/gswa\/gsdMRB_22_chap10.pdf\" target=\"_blank\">\"International tantalum resources \u2014 exploration and mining\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>GSWA Mineral Resources Bulletin<\/i>. <b>22<\/b> (10). 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Retrieved <span class=\"nowrap\">2013-01-13<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=How+much+is+left%3F&rft_id=http%3A%2F%2Fwww.scientificamerican.com%2Farticle.cfm%3Fid%3Dhow-much-is-left&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-44\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-44\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.tanb.org\/coltan\" target=\"_blank\">Tantalum-Niobium International Study Center: Coltan<\/a> Retrieved 2008-01-27<\/span>\n<\/li>\n<li id=\"cite_note-45\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-45\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.un.org\/Docs\/journal\/asp\/ws.asp?m=S\/2003\/1027\" target=\"_blank\">\"S\/2003\/1027\"<\/a>. 2003-10-26<span class=\"reference-accessdate\">. 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Retrieved <span class=\"nowrap\">2008-04-19<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Special+Report%3A+Congo&rft.pub=International+Rescue+Committee&rft_id=http%3A%2F%2Fwww.rescue.org%2Fspecial-reports%2Fspecial-report-congo-y&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-47\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-47\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Hayes, Karen; Burge, Richard (2003). <i>Coltan Mining in the Democratic Republic of Congo: How tantalum-using industries can commit to the reconstruction of the DRC<\/i>. <i>Fauna & Flora<\/i>. pp. 1\u201364. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-903703-10-6.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Coltan+Mining+in+the+Democratic+Republic+of+Congo%3A+How+tantalum-using+industries+can+commit+to+the+reconstruction+of+the+DRC&rft.pages=1-64&rft.date=2003&rft.isbn=978-1-903703-10-6&rft.aulast=Hayes&rft.aufirst=Karen&rft.au=Burge%2C+Richard&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-48\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-48\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Dizolele, Mvemba Phezo (January 6, 2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pulitzercenter.org\/video\/congos-bloody-coltan\" target=\"_blank\">\"Congo's Bloody Coltan\"<\/a>. <i>Pulitzer Center on Crisis Reporting<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2009-08-08<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Pulitzer+Center+on+Crisis+Reporting&rft.atitle=Congo%27s+Bloody+Coltan&rft.date=2011-01-06&rft.au=Dizolele%2C+Mvemba+Phezo&rft_id=http%3A%2F%2Fpulitzercenter.org%2Fvideo%2Fcongos-bloody-coltan&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-49\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-49\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090713173610\/http:\/\/www1.american.edu\/TED\/ice\/congo-coltan.htm\" target=\"_blank\">\"Congo War and the Role of Coltan\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www1.american.edu\/ted\/ice\/congo-coltan.htm\" target=\"_blank\">the original<\/a> on 2009-07-13<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2009-08-08<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Congo+War+and+the+Role+of+Coltan&rft_id=http%3A%2F%2Fwww1.american.edu%2Fted%2Fice%2Fcongo-coltan.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-50\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-50\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090330005811\/http:\/\/www.panda.org\/what_we_do\/where_we_work\/congo_basin_forests\/problems\/mining\/coltan_mining\/\" target=\"_blank\">\"Coltan mining in the Congo River Basin\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.panda.org\/what_we_do\/where_we_work\/congo_basin_forests\/problems\/mining\/coltan_mining\/\" target=\"_blank\">the original<\/a> on 2009-03-30<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2009-08-08<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Coltan+mining+in+the+Congo+River+Basin&rft_id=http%3A%2F%2Fwww.panda.org%2Fwhat_we_do%2Fwhere_we_work%2Fcongo_basin_forests%2Fproblems%2Fmining%2Fcoltan_mining%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-51\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-51\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/solutions-network.org\/site-sfhtantalum\/\" target=\"_blank\">\"<span class=\"cs1-kern-left\">'<\/span>Solutions for Hope' Tantalum Project Offers Solutions and Brings Hope to the People of the DRC\"<\/a>. <i>Solutions Network<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">18 September<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Solutions+Network&rft.atitle=%27Solutions+for+Hope%27+Tantalum+Project+Offers+Solutions+and+Brings+Hope+to+the+People+of+the+DRC&rft_id=http%3A%2F%2Fsolutions-network.org%2Fsite-sfhtantalum%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-52\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-52\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/minerals.usgs.gov\/ds\/2005\/140\" target=\"_blank\">U.S. Geological Survey<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130604121254\/http:\/\/minerals.usgs.gov\/ds\/2005\/140\/\" target=\"_blank\">Archived<\/a> 2013-06-04 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-Chang-53\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Chang_53-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Chang_53-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zhaowu Zhu; Chu Yong Cheng (2011). \"Solvent extraction technology for the separation and purification of niobium and tantalum: A review\". <i>Hydrometallurgy<\/i>. <b>107<\/b>: 1\u201312. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.hydromet.2010.12.015\" target=\"_blank\">10.1016\/j.hydromet.2010.12.015<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Hydrometallurgy&rft.atitle=Solvent+extraction+technology+for+the+separation+and+purification+of+niobium+and+tantalum%3A+A+review&rft.volume=107&rft.pages=1-12&rft.date=2011&rft_id=info%3Adoi%2F10.1016%2Fj.hydromet.2010.12.015&rft.au=Zhaowu+Zhu&rft.au=Chu+Yong+Cheng&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-54\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-54\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Agulyanski, Anatoly (2004). <i>Chemistry of Tantalum and Niobium Fluoride Compounds<\/i> (1st ed.). Burlington: Elsevier. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780080529028.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Chemistry+of+Tantalum+and+Niobium+Fluoride+Compounds&rft.place=Burlington&rft.edition=1st&rft.pub=Elsevier&rft.date=2004&rft.isbn=9780080529028&rft.aulast=Agulyanski&rft.aufirst=Anatoly&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-55\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-55\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Okabe, Toru H.; Sadoway, Donald R. 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Retrieved <span class=\"nowrap\">2013-04-17<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Manufacturing+metals%3A+A+tantalising+prospect&rft.date=2013-02-16&rft_id=https%3A%2F%2Fwww.economist.com%2Fnews%2Fscience-and-technology%2F21571847-exotic-useful-metals-such-tantalum-and-titanium-are-about-become-cheap&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-57\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-57\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nfpa.org\/assets\/files\/aboutthecodes\/484\/nfpa484-2002.pdf\" target=\"_blank\">\"NFPA 484 \u2013 Standard for Combustible Metals, Metal Powders, and Metal Dusts \u2013 2002 Edition\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>National Fire Protection Association<\/i>. 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Retrieved <span class=\"nowrap\">2016-02-12<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=National+Fire+Protection+Association&rft.atitle=NFPA+484+%E2%80%93+Standard+for+Combustible+Metals%2C+Metal+Powders%2C+and+Metal+Dusts+%E2%80%93+2002+Edition&rft.date=2002-08-13&rft_id=http%3A%2F%2Fwww.nfpa.org%2Fassets%2Ffiles%2Faboutthecodes%2F484%2Fnfpa484-2002.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-USGSCR08-58\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-USGSCR08_58-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-USGSCR08_58-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/minerals.usgs.gov\/minerals\/pubs\/commodity\/niobium\/mcs-2008-tanta.pdf\" target=\"_blank\">\"Commodity Report 2008: Tantalum\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. 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Retrieved <span class=\"nowrap\">2008-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Commodity+Report+2008%3A+Tantalum&rft.pub=United+States+Geological+Survey&rft_id=http%3A%2F%2Fminerals.usgs.gov%2Fminerals%2Fpubs%2Fcommodity%2Fniobium%2Fmcs-2008-tanta.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-59\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-59\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.admatinc.com\/tantalum\/sheetplate\/\" target=\"_blank\">\"Tantalum Products: Tantalum Sheet & Plate | Admat Inc\"<\/a>. <i>Admat Inc<\/i><span class=\"reference-accessdate\">. 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(2000). \"New applications for tantalum and tantalum alloys\". <i>JOM Journal of the Minerals, Metals and Materials Society<\/i>. <b>52<\/b> (3): 40. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2000JOM....52c..40B\" target=\"_blank\">2000JOM....52c..40B<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11837-000-0100-6\" target=\"_blank\">10.1007\/s11837-000-0100-6<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JOM+Journal+of+the+Minerals%2C+Metals+and+Materials+Society&rft.atitle=New+applications+for+tantalum+and+tantalum+alloys&rft.volume=52&rft.issue=3&rft.pages=40&rft.date=2000&rft_id=info%3Adoi%2F10.1007%2Fs11837-000-0100-6&rft_id=info%3Abibcode%2F2000JOM....52c..40B&rft.aulast=Buckman+Jr.&rft.aufirst=R.+W.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-61\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-61\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cohen, R.; Della Valle, C. J.; Jacobs, J. J. (2006). \"Applications of porous tantalum in total hip arthroplasty\". <i>Journal of the American Academy of Orthopaedic Surgeons<\/i>. <b>14<\/b> (12): 646\u201355. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17077337\" target=\"_blank\">17077337<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+American+Academy+of+Orthopaedic+Surgeons&rft.atitle=Applications+of+porous+tantalum+in+total+hip+arthroplasty&rft.volume=14&rft.issue=12&rft.pages=646-55&rft.date=2006&rft_id=info%3Apmid%2F17077337&rft.aulast=Cohen&rft.aufirst=R.&rft.au=Della+Valle%2C+C.+J.&rft.au=Jacobs%2C+J.+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Balke-62\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Balke_62-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Balke_62-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Balke, Clarence W. (1935). \"Columbium and Tantalum\". <i>Industrial and Engineering Chemistry<\/i>. <b>20<\/b> (10): 1166. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1021%2Fie50310a022\" target=\"_blank\">10.1021\/ie50310a022<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Industrial+and+Engineering+Chemistry&rft.atitle=Columbium+and+Tantalum&rft.volume=20&rft.issue=10&rft.pages=1166&rft.date=1935&rft_id=info%3Adoi%2F10.1021%2Fie50310a022&rft.aulast=Balke&rft.aufirst=Clarence+W.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-63\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-63\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Nemat-Nasser, Sia; Isaacs, Jon B.; Liu, Mingqi (1998). \"Microstructure of high-strain, high-strain-rate deformed tantalum\". <i>Acta Materialia<\/i>. <b>46<\/b> (4): 1307. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS1359-6454%2897%2900746-5\" target=\"_blank\">10.1016\/S1359-6454(97)00746-5<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Materialia&rft.atitle=Microstructure+of+high-strain%2C+high-strain-rate+deformed+tantalum&rft.volume=46&rft.issue=4&rft.pages=1307&rft.date=1998&rft_id=info%3Adoi%2F10.1016%2FS1359-6454%2897%2900746-5&rft.aulast=Nemat-Nasser&rft.aufirst=Sia&rft.au=Isaacs%2C+Jon+B.&rft.au=Liu%2C+Mingqi&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-64\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-64\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Walters, William; Cooch, William; Burkins, Matthew; Burkins, Matthew (2001). \"The penetration resistance of a titanium alloy against jets from tantalum shaped charge liners\". <i>International Journal of Impact Engineering<\/i>. <b>26<\/b>: 823. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0734-743X%2801%2900135-X\" target=\"_blank\">10.1016\/S0734-743X(01)00135-X<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Impact+Engineering&rft.atitle=The+penetration+resistance+of+a+titanium+alloy+against+jets+from+tantalum+shaped+charge+liners&rft.volume=26&rft.pages=823&rft.date=2001&rft_id=info%3Adoi%2F10.1016%2FS0734-743X%2801%2900135-X&rft.aulast=Walters&rft.aufirst=William&rft.au=Cooch%2C+William&rft.au=Burkins%2C+Matthew&rft.au=Burkins%2C+Matthew&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-65\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-65\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Russell, Alan M.; Lee, Kok Loong (2005). <a rel=\"external_link\" class=\"external text\" href=\"#PPA218\"><i>Structure-property relations in nonferrous metals<\/i><\/a>. 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Burke (1940). \"The Corrosion of Metals in Tissues; and An Introduction to Tantalum\". <i>Canadian Medical Association Journal<\/i>. <b>43<\/b>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Canadian+Medical+Association+Journal&rft.atitle=The+Corrosion+of+Metals+in+Tissues%3B+and+An+Introduction+to+Tantalum&rft.volume=43&rft.date=1940&rft.au=Gerald+L.+Burke&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-67\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-67\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Black, J. (1994). \"Biological performance of tantalum\". <i>Clinical Materials<\/i>. <b>16<\/b> (3): 167\u2013173. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0267-6605%2894%2990113-9\" target=\"_blank\">10.1016\/0267-6605(94)90113-9<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10172264\" target=\"_blank\">10172264<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Materials&rft.atitle=Biological+performance+of+tantalum&rft.volume=16&rft.issue=3&rft.pages=167-173&rft.date=1994&rft_id=info%3Adoi%2F10.1016%2F0267-6605%2894%2990113-9&rft_id=info%3Apmid%2F10172264&rft.aulast=Black&rft.aufirst=J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-PaganiasTsakotos2012-68\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-PaganiasTsakotos2012_68-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Paganias, Christos G.; Tsakotos, George A.; Koutsostathis, Stephanos D.; Macheras, George A. (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3491782\" target=\"_blank\">\"Osseous integration in porous tantalum implants\"<\/a>. <i>Indian Journal of Orthopaedics<\/i>. <b>46<\/b> (5): 505\u201313. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4103%2F0019-5413.101032\" target=\"_blank\">10.4103\/0019-5413.101032<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0019-5413\" target=\"_blank\">0019-5413<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3491782\" target=\"_blank\">3491782<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23162141\" target=\"_blank\">23162141<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Indian+Journal+of+Orthopaedics&rft.atitle=Osseous+integration+in+porous+tantalum+implants&rft.volume=46&rft.issue=5&rft.pages=505-13&rft.date=2012&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3491782&rft.issn=0019-5413&rft_id=info%3Apmid%2F23162141&rft_id=info%3Adoi%2F10.4103%2F0019-5413.101032&rft.aulast=Paganias&rft.aufirst=Christos+G.&rft.au=Tsakotos%2C+George+A.&rft.au=Koutsostathis%2C+Stephanos+D.&rft.au=Macheras%2C+George+A.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3491782&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-69\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-69\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Musikant, Solomon (1985). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=iJEXMF3JBtQC&pg=PA28\" target=\"_blank\">\"Optical Glass Composition\"<\/a>. <i>Optical Materials: An Introduction to Selection and Application<\/i>. 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(2018). \"A concise guide for the determination of less-studied technology-critical elements (Nb, Ta, Ga, In, Ge, Te) by inductively coupled plasma mass spectrometry in environmental samples\". <i>Spectrochimica Acta Part B<\/i>. <b>141<\/b>: 80\u201384. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.sab.2018.01.004\" target=\"_blank\">10.1016\/j.sab.2018.01.004<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Spectrochimica+Acta+Part+B&rft.atitle=A+concise+guide+for+the+determination+of+less-studied+technology-critical+elements+%28Nb%2C+Ta%2C+Ga%2C+In%2C+Ge%2C+Te%29+by+inductively+coupled+plasma+mass+spectrometry+in+environmental+samples&rft.volume=141&rft.pages=80-84&rft.date=2018&rft_id=info%3Adoi%2F10.1016%2Fj.sab.2018.01.004&rft.aulast=Filella&rft.aufirst=M.&rft.au=Rodushkin%2C+I.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-74\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-74\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vlastelic, I.; Suchorski, K.; Sellegri, K.; Colomb, A.; Nauret, F.; Bouvier, L.; Piro, J-L. (2015). \"The high field strength element budget of atmospheric aerosols (puy de D\u00f4me, France)\". <i>Geochimica et Cosmochimica Acta<\/i>. <b>167<\/b>: 253\u2013268. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2015GeCoA.167..253V\" target=\"_blank\">2015GeCoA.167..253V<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.gca.2015.07.006\" target=\"_blank\">10.1016\/j.gca.2015.07.006<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Geochimica+et+Cosmochimica+Acta&rft.atitle=The+high+field+strength+element+budget+of+atmospheric+aerosols+%28puy+de+D%C3%B4me%2C+France%29&rft.volume=167&rft.pages=253-268&rft.date=2015&rft_id=info%3Adoi%2F10.1016%2Fj.gca.2015.07.006&rft_id=info%3Abibcode%2F2015GeCoA.167..253V&rft.aulast=Vlastelic&rft.aufirst=I.&rft.au=Suchorski%2C+K.&rft.au=Sellegri%2C+K.&rft.au=Colomb%2C+A.&rft.au=Nauret%2C+F.&rft.au=Bouvier%2C+L.&rft.au=Piro%2C+J-L.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-75\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-75\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Filella, M.; Rodr\u00edguez-Murillo, JC. (2017). \"Less-studied TCE: are their environmental concentrations increasing due to their use in new technologies?\". <i>Chemosphere<\/i>. <b>182<\/b>: 605\u2013616. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.chemosphere.2017.05.024\" target=\"_blank\">10.1016\/j.chemosphere.2017.05.024<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28525874\" target=\"_blank\">28525874<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Chemosphere&rft.atitle=Less-studied+TCE%3A+are+their+environmental+concentrations+increasing+due+to+their+use+in+new+technologies%3F&rft.volume=182&rft.pages=605-616&rft.date=2017&rft_id=info%3Adoi%2F10.1016%2Fj.chemosphere.2017.05.024&rft_id=info%3Apmid%2F28525874&rft.aulast=Filella&rft.aufirst=M.&rft.au=Rodr%C3%ADguez-Murillo%2C+JC.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-76\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-76\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Matsuno H; Yokoyama A; Watari F; Uo M; Kawasaki T. (2001). \"Biocompatibility and osteogenesis of refractory metal implants, titanium, hafnium, niobium, tantalum and rhenium. Biocompatibility of tantalum\". <i>Biomaterials<\/i>. <b>22<\/b> (11): 1253\u201362. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0142-9612%2800%2900275-1\" target=\"_blank\">10.1016\/S0142-9612(00)00275-1<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11336297\" target=\"_blank\">11336297<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biomaterials&rft.atitle=Biocompatibility+and+osteogenesis+of+refractory+metal+implants%2C+titanium%2C+hafnium%2C+niobium%2C+tantalum+and+rhenium.+Biocompatibility+of+tantalum.&rft.volume=22&rft.issue=11&rft.pages=1253-62&rft.date=2001&rft_id=info%3Adoi%2F10.1016%2FS0142-9612%2800%2900275-1&rft_id=info%3Apmid%2F11336297&rft.au=Matsuno+H&rft.au=Yokoyama+A&rft.au=Watari+F&rft.au=Uo+M&rft.au=Kawasaki+T.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-77\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-77\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cdc.gov\/niosh\/npg\/npgd0585.html\" target=\"_blank\">\"CDC \u2013 NIOSH Pocket Guide to Chemical Hazards \u2013 Tantalum (metal and oxide dust, as Ta)\"<\/a>. <i>www.cdc.gov<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-11-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.cdc.gov&rft.atitle=CDC+%E2%80%93+NIOSH+Pocket+Guide+to+Chemical+Hazards+%E2%80%93+Tantalum+%28metal+and+oxide+dust%2C+as+Ta%29&rft_id=https%3A%2F%2Fwww.cdc.gov%2Fniosh%2Fnpg%2Fnpgd0585.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATantalum\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/tanb.org\/\" target=\"_blank\">Tantalum-Niobium International Study Center<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cdc.gov\/niosh\/npg\/npgd0585.html\" target=\"_blank\">CDC \u2013 NIOSH Pocket Guide to Chemical Hazards<\/a><\/li><\/ul>\n<div style=\"clear:both;\"><\/div>\n\n\n<p class=\"mw-empty-elt\">\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1262\nCached time: 20181215191124\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 1.836 seconds\nReal time usage: 2.123 seconds\nPreprocessor visited node count: 26221\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 592119\/2097152 bytes\nTemplate argument size: 35750\/2097152 bytes\nHighest expansion depth: 22\/40\nExpensive parser function count: 9\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 215167\/5000000 bytes\nNumber of Wikibase entities loaded: 7\/400\nLua time usage: 0.807\/10.000 seconds\nLua memory usage: 10.1 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1802.057 1 -total\n<\/p>\n<pre>43.43% 782.655 1 Template:Infobox_tantalum\n43.10% 776.646 1 Template:Infobox_element\n37.83% 681.802 1 Template:Infobox\n27.97% 504.008 1 Template:Reflist\n21.97% 395.934 41 Template:Cite_journal\n16.92% 304.851 1 Template:Compact_periodic_table\n16.52% 297.618 3 Template:Navbox\n13.30% 239.643 118 Template:Element_cell-compact\n10.54% 189.941 1 Template:Infobox_element\/periodic_table\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:30048-1!canonical and timestamp 20181215191122 and revision id 870594001\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalum\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212228\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.064 seconds\nReal time usage: 0.234 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 218.446 1 - wikipedia:Tantalum\n100.00% 218.446 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8392-0!*!*!*!*!*!* and timestamp 20181217212228 and revision id 24626\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Tantalum\">https:\/\/www.limswiki.org\/index.php\/Tantalum<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","8d3be78eb4777fc2c36709842ad86ba8_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/83\/Tantalum_single_crystal_and_1cm3_cube.jpg\/440px-Tantalum_single_crystal_and_1cm3_cube.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a6\/Tantalum_spectrum_visible.png\/480px-Tantalum_spectrum_visible.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a3\/Cubic-body-centered.svg\/100px-Cubic-body-centered.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0a\/Tetragonal.svg\/100px-Tetragonal.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/85\/DOSBIWoneRotamer.png\/288px-DOSBIWoneRotamer.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c0\/Tantalite.jpg\/440px-Tantalite.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/90\/World_Tantalum_Production_2015.svg\/620px-World_Tantalum_Production_2015.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/75\/World_Tantalum_Production_2006.svg\/620px-World_Tantalum_Production_2006.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6a\/Tantalum_world_production.svg\/440px-Tantalum_world_production.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/fe\/Tantal-Perle-Wiki-07-02-25-P1040364b.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/70\/Tantalio.png\/640px-Tantalio.png"],"8d3be78eb4777fc2c36709842ad86ba8_timestamp":1545081748,"07b7c93dcefac3d0c3203b59105c3755_type":"article","07b7c93dcefac3d0c3203b59105c3755_title":"Synthetic biodegradable polymer","07b7c93dcefac3d0c3203b59105c3755_url":"https:\/\/www.limswiki.org\/index.php\/Synthetic_biodegradable_polymer","07b7c93dcefac3d0c3203b59105c3755_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSynthetic biodegradable polymer\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor environmentally degradable polymers, see Biodegradable plastic. For natural and synthetic degradable polymers, see Biodegradable polymer.\nMany opportunities exist for the application of synthetic biodegradable polymers in the biomedical area particularly in the fields of tissue engineering and controlled drug delivery. Degradation is important in biomedicine for many reasons. Degradation of the polymeric implant means surgical intervention may not be required in order to remove the implant at the end of its functional life, eliminating the need for a second surgery.[1] In tissue engineering, biodegradable polymers can be designed such to approximate tissues, providing a polymer scaffold that can withstand mechanical stresses, provide a suitable surface for cell attachment and growth, and degrade at a rate that allows the load to be transferred to the new tissue.[2][3] In the field of controlled drug delivery, biodegradable polymers offer tremendous potential either as a drug delivery system alone or in conjunction to functioning as a medical device.[4]\nIn the development of applications of biodegradable polymers, the chemistry of some polymers including synthesis and degradation is reviewed below. A description of how properties can be controlled by proper synthetic controls such as copolymer composition, special requirements for processing and handling, and some of the commercial devices based on these materials are discussed.\n\nContents \n\n1 Polymer chemistry and material selection \n2 Processing \n3 Degradation \n4 Applications \n5 References \n6 Further reading \n7 External links \n\n\nPolymer chemistry and material selection \nWhen investigating the selection of the polymer for biomedical applications, important criteria to consider are;\n\nThe mechanical properties must match the application and remain sufficiently strong until the surrounding tissue has healed.\nThe degradation time must match the time required.\nIt does not invoke a toxic response.\nIt is metabolized in the body after fulfilling its purpose.\nIt is easily processable in the final product form with an acceptable shelf life and easily sterilized.\nMechanical performance of a biodegradable polymer depends on various factors which include monomer selection, initiator selection, process conditions and the presence of additives. These factors influence the polymers crystallinity, melt and glass transition temperatures and molecular weight. Each of these factors needs to be assessed on how they affect the biodegradation of the polymer.[5] Biodegradation can be accomplished by synthesizing polymers with hydrolytically unstable linkages in the backbone. This is commonly achieved by the use of chemical functional groups such as esters, anhydrides, orthoesters and amides. Most biodegradable polymers are synthesized by ring opening polymerization.\n\nProcessing \nBiodegradable polymers can be melt processed by conventional means such as compression or injection molding. Special consideration must be given to the need to exclude moisture from the material. Care must be taken to dry the polymers before processing to exclude humidity. As most biodegradable polymers have been synthesized by ring opening polymerization, a thermodynamic equilibrium exists between the forward polymerization reaction and the reverse reaction that results in monomer formation. Care needs to be taken to avoid an excessively high processing temperature that may result in monomer formation during the molding and extrusion process. It must be followed carefully\n\nDegradation \nOnce implanted, a biodegradable device should maintain its mechanical properties until it is no longer needed and then be absorbed by the body leaving no trace. The backbone of the polymer is hydrolytically unstable. That is, the polymer is unstable in a water based environment. This is the prevailing mechanism for the polymers degradation. This occurs in two stages.\n1. Water penetrates the bulk of the device, attacking the chemical bonds in the amorphous phase and converting long polymer chains into shorter water-soluble fragments. This causes a reduction in molecular weight without the loss of physical properties as the polymer is still held together by the crystalline regions. Water penetrates the device leading to metabolization of the fragments and bulk erosion.\n2. Surface erosion of the polymer occurs when the rate at which the water penetrating the device is slower than the rate of conversion of the polymer into water-soluble materials.\nBiomedical engineers can tailor a polymer to slowly degrade and transfer stress at the appropriate rate to surrounding tissues as they heal by balancing the chemical stability of the polymer backbone, the geometry of the device, and the presence of catalysts, additives or plasticisers.\n\nApplications \nBiodegradable polymers are used commercially in both the tissue engineering and drug delivery field of biomedicine. Specific applications include.\n\nSutures\nDental devices (PLGA)\nOrthopedic fixation devices\nTissue engineering scaffolds\nBiodegradable vascular stents\nBiodegradable soft tissue anchors\nReferences \n\n\n^ Gilding, D.K.; Reed, A.M. (1979). \"Biodegradable polymers for use in surgery\u2014polyglycolic\/poly(actic acid) homo- and copolymers: 1\". Polymer. 20 (12): 1459. doi:10.1016\/0032-3861(79)90009-0. \n\n^ Pietrzak, WS; Verstynen, ML; Sarver, DR (1997). \"Bioabsorbable fixation devices: Status for the craniomaxillofacial surgeon\". The Journal of craniofacial surgery. 8 (2): 92\u20136. doi:10.1097\/00001665-199703000-00005. PMID 10332273. \n\n^ Pietrzak, WS; Sarver, DR; Verstynen, ML (1997). \"Bioabsorbable polymer science for the practicing surgeon\". The Journal of craniofacial surgery. 8 (2): 87\u201391. doi:10.1097\/00001665-199703000-00004. PMID 10332272. \n\n^ Middleton, John C. and Tipton, Arthur J. (March 1998) Synthetic Biodegradable Polymers as Medical Devices, Medical Plastics and Biomaterials Magazine, Retrieved (2009-11-09) \n\n^ Kohn J, and Langer R, \"Bioresorbable and Bioerodible Materials,\" in Biomaterials Science: An Introduction to Materials in Medicine, Ratner BD (ed.), New York, Academic Press, 2004 ISBN 0125824637, pp. 115 ff \n\n\nFurther reading \nSome biodegradable polymers, their properties and degradation times can be found in Table 2 in this document.\nAn example of the structure of some of the types of polymer degradation can be viewed in Fig. 1 in this article\nBellin, I., Kelch, S., Langer, R. & Lendlein, A. Polymeric triple-shape materials. Proc. Natl. Acad. Sci. U.S.A. 103, 18043-18047 (2006. Copyright (2006) National Academy of Sciences, U.S.A.\nLendlein, A., Jiang, H., J\u00fcnger, O. & Langer, R. Light-induced shape-memory polymers. Nature 434, 879\u2013882 (2005).\nLendlein, A., Langer, R.: Biodegradable, Elastic Shape Memory Polymers for Potential Biomedical Applications, Science 296, 1673\u20131675 (2002).\nLendlein, A., Schmidt, A.M. & Langer, R. AB-polymer networks based on oligo (e-caprolactone) segments showing shape-memory properties and this article. Proc. Natl. Acad. Sci. U.S.A. 98(3), 842\u2013847 (2001). Copyright (2001) National Academy of Sciences, U.S.A.\nDamodaran, V., Bhatnagar, D., Murthy, Sanjeeva.: Biomedical Polymers Synthesis and Processing, SpringerBriefs in Applied Sciences and Technology, DOI: 10.1007\/978-3-319-32053-3 (2016).\nExternal links \nBiodegradable plastics a year in review, Environment and Plastics Industry Council\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Synthetic_biodegradable_polymer\">https:\/\/www.limswiki.org\/index.php\/Synthetic_biodegradable_polymer<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 12 March 2016, at 03:02.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 458 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","07b7c93dcefac3d0c3203b59105c3755_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Synthetic_biodegradable_polymer skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Synthetic biodegradable polymer<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For environmentally degradable polymers, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biodegradable_plastic\" title=\"Biodegradable plastic\" rel=\"external_link\" target=\"_blank\">Biodegradable plastic<\/a>. For natural and synthetic degradable polymers, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biodegradable_polymer\" title=\"Biodegradable polymer\" rel=\"external_link\" target=\"_blank\">Biodegradable polymer<\/a>.<\/div>\n<p>Many opportunities exist for the application of <b><a href=\"https:\/\/en.wikipedia.org\/wiki\/Synthetic_compound\" class=\"mw-redirect\" title=\"Synthetic compound\" rel=\"external_link\" target=\"_blank\">synthetic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biodegradable\" class=\"mw-redirect\" title=\"Biodegradable\" rel=\"external_link\" target=\"_blank\">biodegradable<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymers<\/a><\/b> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical\" class=\"mw-redirect\" title=\"Biomedical\" rel=\"external_link\" target=\"_blank\">biomedical<\/a> area particularly in the fields of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_engineering\" title=\"Tissue engineering\" rel=\"external_link\" target=\"_blank\">tissue engineering<\/a> and controlled <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug_delivery\" title=\"Drug delivery\" rel=\"external_link\" target=\"_blank\">drug delivery<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_decomposition\" title=\"Chemical decomposition\" rel=\"external_link\" target=\"_blank\">Degradation<\/a> is important in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedicine\" title=\"Biomedicine\" rel=\"external_link\" target=\"_blank\">biomedicine<\/a> for many reasons. Degradation of the polymeric implant means surgical intervention may not be required in order to remove the implant at the end of its functional life, eliminating the need for a second surgery.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_engineering\" title=\"Tissue engineering\" rel=\"external_link\" target=\"_blank\">tissue engineering<\/a>, biodegradable polymers can be designed such to approximate tissues, providing a polymer scaffold that can withstand mechanical stresses, provide a suitable surface for cell attachment and growth, and degrade at a rate that allows the load to be transferred to the new tissue.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> In the field of controlled drug delivery, biodegradable polymers offer tremendous potential either as a drug delivery system alone or in conjunction to functioning as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a>.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>In the development of applications of biodegradable polymers, the chemistry of some polymers including synthesis and degradation is reviewed below. A description of how properties can be controlled by proper synthetic controls such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copolymer\" title=\"Copolymer\" rel=\"external_link\" target=\"_blank\">copolymer<\/a> composition, special requirements for processing and handling, and some of the commercial devices based on these materials are discussed.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Polymer_chemistry_and_material_selection\">Polymer chemistry and material selection<\/span><\/h2>\n<p>When investigating the selection of the polymer for biomedical applications, important criteria to consider are;\n<\/p>\n<ul><li>The mechanical properties must match the application and remain sufficiently strong until the surrounding tissue has healed.<\/li>\n<li>The degradation time must match the time required.<\/li>\n<li>It does not invoke a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxic\" class=\"mw-redirect\" title=\"Toxic\" rel=\"external_link\" target=\"_blank\">toxic<\/a> response.<\/li>\n<li>It is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metabolized\" class=\"mw-redirect\" title=\"Metabolized\" rel=\"external_link\" target=\"_blank\">metabolized<\/a> in the body after fulfilling its purpose.<\/li>\n<li>It is easily processable in the final product form with an acceptable shelf life and easily <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">sterilized<\/a>.<\/li><\/ul>\n<p>Mechanical performance of a biodegradable polymer depends on various factors which include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomer<\/a> selection, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radical_initiator\" title=\"Radical initiator\" rel=\"external_link\" target=\"_blank\">initiator<\/a> selection, process conditions and the presence of additives. These factors influence the polymers <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystallinity\" title=\"Crystallinity\" rel=\"external_link\" target=\"_blank\">crystallinity<\/a>, melt and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass_transition\" title=\"Glass transition\" rel=\"external_link\" target=\"_blank\">glass transition<\/a> temperatures and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_weight\" class=\"mw-redirect\" title=\"Molecular weight\" rel=\"external_link\" target=\"_blank\">molecular weight<\/a>. Each of these factors needs to be assessed on how they affect the biodegradation of the polymer.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Biodegradation can be accomplished by synthesizing polymers with hydrolytically unstable linkages in the backbone. This is commonly achieved by the use of chemical functional groups such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esters\" class=\"mw-redirect\" title=\"Esters\" rel=\"external_link\" target=\"_blank\">esters<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anhydrides\" class=\"mw-redirect\" title=\"Anhydrides\" rel=\"external_link\" target=\"_blank\">anhydrides<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthoesters\" class=\"mw-redirect\" title=\"Orthoesters\" rel=\"external_link\" target=\"_blank\">orthoesters<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amide\" title=\"Amide\" rel=\"external_link\" target=\"_blank\">amides<\/a>. Most biodegradable polymers are synthesized by ring opening polymerization.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Processing\">Processing<\/span><\/h2>\n<p>Biodegradable polymers can be melt processed by conventional means such as compression or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Injection_molding\" class=\"mw-redirect\" title=\"Injection molding\" rel=\"external_link\" target=\"_blank\">injection molding<\/a>. Special consideration must be given to the need to exclude moisture from the material. Care must be taken to dry the polymers before processing to exclude humidity. As most biodegradable polymers have been synthesized by ring opening polymerization, a thermodynamic equilibrium exists between the forward polymerization reaction and the reverse reaction that results in monomer formation. Care needs to be taken to avoid an excessively high processing temperature that may result in monomer formation during the molding and extrusion process. It must be followed carefully\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Degradation\">Degradation<\/span><\/h2>\n<p>Once implanted, a biodegradable device should maintain its mechanical properties until it is no longer needed and then be absorbed by the body leaving no trace. The backbone of the polymer is hydrolytically unstable. That is, the polymer is unstable in a water based environment. This is the prevailing mechanism for the polymers degradation. This occurs in two stages.\n<\/p><p>1. Water penetrates the bulk of the device, attacking the chemical bonds in the amorphous phase and converting long polymer chains into shorter water-soluble fragments. This causes a reduction in molecular weight without the loss of physical properties as the polymer is still held together by the crystalline regions. Water penetrates the device leading to metabolization of the fragments and bulk <a href=\"https:\/\/en.wikipedia.org\/wiki\/Erosion\" title=\"Erosion\" rel=\"external_link\" target=\"_blank\">erosion<\/a>.\n<\/p><p>2. Surface erosion of the polymer occurs when the rate at which the water penetrating the device is slower than the rate of conversion of the polymer into water-soluble materials.\n<\/p><p>Biomedical engineers can tailor a polymer to slowly degrade and transfer stress at the appropriate rate to surrounding tissues as they heal by balancing the chemical stability of the polymer backbone, the geometry of the device, and the presence of catalysts, additives or plasticisers.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>Biodegradable polymers are used commercially in both the tissue engineering and drug delivery field of biomedicine. Specific applications include.\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" title=\"Surgical suture\" rel=\"external_link\" target=\"_blank\">Sutures<\/a><\/li>\n<li>Dental devices (<a href=\"https:\/\/en.wikipedia.org\/wiki\/PLGA\" title=\"PLGA\" rel=\"external_link\" target=\"_blank\">PLGA<\/a>)<\/li>\n<li>Orthopedic fixation devices<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_engineering\" title=\"Tissue engineering\" rel=\"external_link\" target=\"_blank\">Tissue engineering<\/a> scaffolds<\/li>\n<li>Biodegradable vascular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stents\" class=\"mw-redirect\" title=\"Stents\" rel=\"external_link\" target=\"_blank\">stents<\/a><\/li>\n<li>Biodegradable soft tissue anchors<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gilding, D.K.; Reed, A.M. (1979). \"Biodegradable polymers for use in surgery\u2014polyglycolic\/poly(actic acid) homo- and copolymers: 1\". <i>Polymer<\/i>. <b>20<\/b> (12): 1459. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0032-3861%2879%2990009-0\" target=\"_blank\">10.1016\/0032-3861(79)90009-0<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Polymer&rft.atitle=Biodegradable+polymers+for+use+in+surgery%E2%80%94polyglycolic%2Fpoly%28actic+acid%29+homo-+and+copolymers%3A+1&rft.volume=20&rft.issue=12&rft.pages=1459&rft.date=1979&rft_id=info%3Adoi%2F10.1016%2F0032-3861%2879%2990009-0&rft.aulast=Gilding&rft.aufirst=D.K.&rft.au=Reed%2C+A.M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASynthetic+biodegradable+polymer\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pietrzak, WS; Verstynen, ML; Sarver, DR (1997). \"Bioabsorbable fixation devices: Status for the craniomaxillofacial surgeon\". <i>The Journal of craniofacial surgery<\/i>. <b>8<\/b> (2): 92\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00001665-199703000-00005\" target=\"_blank\">10.1097\/00001665-199703000-00005<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10332273\" target=\"_blank\">10332273<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+craniofacial+surgery&rft.atitle=Bioabsorbable+fixation+devices%3A+Status+for+the+craniomaxillofacial+surgeon&rft.volume=8&rft.issue=2&rft.pages=92-6&rft.date=1997&rft_id=info%3Adoi%2F10.1097%2F00001665-199703000-00005&rft_id=info%3Apmid%2F10332273&rft.aulast=Pietrzak&rft.aufirst=WS&rft.au=Verstynen%2C+ML&rft.au=Sarver%2C+DR&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASynthetic+biodegradable+polymer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pietrzak, WS; Sarver, DR; Verstynen, ML (1997). \"Bioabsorbable polymer science for the practicing surgeon\". <i>The Journal of craniofacial surgery<\/i>. <b>8<\/b> (2): 87\u201391. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00001665-199703000-00004\" target=\"_blank\">10.1097\/00001665-199703000-00004<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10332272\" target=\"_blank\">10332272<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+craniofacial+surgery&rft.atitle=Bioabsorbable+polymer+science+for+the+practicing+surgeon&rft.volume=8&rft.issue=2&rft.pages=87-91&rft.date=1997&rft_id=info%3Adoi%2F10.1097%2F00001665-199703000-00004&rft_id=info%3Apmid%2F10332272&rft.aulast=Pietrzak&rft.aufirst=WS&rft.au=Sarver%2C+DR&rft.au=Verstynen%2C+ML&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASynthetic+biodegradable+polymer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Middleton, John C. and Tipton, Arthur J. (March 1998) <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mddionline.com\/article\/synthetic-biodegradable-polymers-medical-devices\" target=\"_blank\">Synthetic Biodegradable Polymers as Medical Devices<\/a>, Medical Plastics and Biomaterials Magazine, Retrieved (2009-11-09)<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Kohn J, and Langer R, <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=Uzmrq7LO7loC&pg=PA115\" target=\"_blank\">\"Bioresorbable and Bioerodible Materials,\"<\/a> in <i>Biomaterials Science: An Introduction to Materials in Medicine<\/i>, Ratner BD (ed.), New York, Academic Press, 2004 <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0125824637, pp. 115 ff<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li>Some biodegradable polymers, their properties and degradation times can be found in Table 2 in <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070312013555\/http:\/\/www.devicelink.com\/mpb\/archive\/98\/03\/002.html\" target=\"_blank\">this document<\/a>.<\/li>\n<li>An example of the structure of some of the types of polymer degradation can be viewed in Fig. 1 in <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080805105125\/http:\/\/www.azom.com\/details.asp?ArticleID=2768\" target=\"_blank\">this article<\/a><\/li>\n<li>Bellin, I., Kelch, S., Langer, R. & Lendlein, A. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.pedresearch.org\/pt\/re\/pedresearch\/abstract.00006450-200805000-00006.htm;jsessionid=LtnCVSpxfcc11Tt91G8sKtSNPWNRPXvfBMSWynjPp8Zy1xTqXsQy!-1586968322!181195628!8091!-1\" target=\"_blank\">Polymeric triple-shape materials<\/a>. Proc. Natl. Acad. Sci. U.S.A. 103, 18043-18047 (2006. Copyright (2006) National Academy of Sciences, U.S.A.<\/li>\n<li>Lendlein, A., Jiang, H., J\u00fcnger, O. & Langer, R. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nature.com\/nature\/journal\/v434\/n7035\/abs\/nature03496.html\" target=\"_blank\">Light-induced shape-memory polymers<\/a>. Nature 434, 879\u2013882 (2005).<\/li>\n<li>Lendlein, A., Langer, R.: Biodegradable, Elastic Shape Memory Polymers for Potential Biomedical Applications, Science 296, 1673\u20131675 (2002).<\/li>\n<li>Lendlein, A., Schmidt, A.M. & Langer, R. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.pnas.org\/content\/98\/3\/842.full.pdf\" target=\"_blank\">AB-polymer networks based on oligo (e-caprolactone) segments showing shape-memory properties<\/a> and <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.pnas.org\/cgi\/reprint\/103\/48\/18043.pdf\" target=\"_blank\">this article<\/a>. Proc. Natl. Acad. Sci. U.S.A. 98(3), 842\u2013847 (2001). Copyright (2001) National Academy of Sciences, U.S.A.<\/li>\n<li>Damodaran, V., Bhatnagar, D., Murthy, Sanjeeva.: Biomedical Polymers Synthesis and Processing, SpringerBriefs in Applied Sciences and Technology, DOI: 10.1007\/978-3-319-32053-3 (2016).<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20040905133347\/http:\/\/www.cpia.ca\/anti-litter\/pdf\/BIODEGRADEABLE%20POLYMERS%20A%20REVIEW%2024%20Nov.%202000.%20Final.PDF\" target=\"_blank\">Biodegradable plastics a year in review<\/a>, Environment and Plastics Industry Council<\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1246\nCached time: 20181217110839\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.160 seconds\nReal time usage: 0.235 seconds\nPreprocessor visited node count: 466\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 7482\/2097152 bytes\nTemplate argument size: 284\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 11377\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.087\/10.000 seconds\nLua memory usage: 2.74 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 205.658 1 -total\n<\/p>\n<pre>75.53% 155.326 1 Template:Reflist\n46.81% 96.264 3 Template:Cite_journal\n22.72% 46.726 1 Template:About\n20.13% 41.396 1 Template:ISBN\n 8.32% 17.103 1 Template:Catalog_lookup_link\n 4.12% 8.480 1 Template:Error-small\n 2.98% 6.131 3 Template:Yesno-no\n 1.61% 3.313 3 Template:Yesno\n 1.57% 3.224 2 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:17088944-1!canonical and timestamp 20181217110839 and revision id 845188749\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Synthetic_biodegradable_polymer#External_links\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212228\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.149 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 143.714 1 - wikipedia:Synthetic_biodegradable_polymer\n100.00% 143.714 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8428-0!*!*!*!*!*!* and timestamp 20181217212227 and revision id 24670\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Synthetic_biodegradable_polymer\">https:\/\/www.limswiki.org\/index.php\/Synthetic_biodegradable_polymer<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","07b7c93dcefac3d0c3203b59105c3755_images":[],"07b7c93dcefac3d0c3203b59105c3755_timestamp":1545081747,"c787a4c272c521485cad32a993c63b62_type":"article","c787a4c272c521485cad32a993c63b62_title":"Surgical stainless steel","c787a4c272c521485cad32a993c63b62_url":"https:\/\/www.limswiki.org\/index.php\/Surgical_stainless_steel","c787a4c272c521485cad32a993c63b62_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurgical stainless steel\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\"Surgical steel\" redirects here. For the Carcass album, see Surgical Steel (album).\nSurgical stainless steel is a grade of stainless steel used in biomedical applications. The most common \"surgical steels\" are austenitic 316 stainless and martensitic 440 and 420 stainless steels.[1] There is no formal definition on what constitutes a \"surgical stainless steel\", so product manufacturers and distributors apply the term to refer to any grade of corrosion resistant steel.\n316 stainless steel, also referred to as marine grade stainless steel, is a chromium, nickel, molybdenum alloy of steel that exhibits relatively good strength and corrosion resistance. Along with the titanium alloy Ti6Al4V, 316 stainless is a common choice of material for biomedical implants. Although Ti6Al4V provides greater strength per weight and corrosion resistance, 316 stainless components can be more economical to produce. However, immune system reaction to nickel is a potential complication of 316.[2][3] \nImplants and equipment that are put under pressure (bone fixation screws, prostheses, body piercing jewelry) are made out of austenitic steel, often 316L and 316LVM compliant to ASTM F138,.[4]\n316 surgical steel is used in the manufacture and handling of food and pharmaceutical products where it is often required in order to minimize metallic contamination. \nASTM F138[4]-compliant steel is also used in the manufacture of body piercing jewellery[5] and body modification implants.\n\n<\/p>440 and 420 stainless steels, known also by the name \"Cutlery Stainless Steel\", are high carbon steels alloyed with chromium. They have very good corrosion resistance compared to other cutlery steels, but their corrosion resistance is inferior to 316 stainless. Biomedical cutting instruments are often made from 440 or 420 stainless due to its high hardness coupled with acceptable corrosion resistance. This type of stainless steel may be slightly magnetic.\n\nSee also \nInstruments used in general surgery\nReferences \n\n\n^ \"Stainless Surgical Instruments\" (video) . YouTube. Boston Career Institute (BCI Inc.) - Brookline. Retrieved 2018-08-04 . at ~6:00 martensitic and austenitic are described, albeit simply as 400 and 300 series \n\n^ Thomas, P.; Schuh, A.; Ring, J.; Thomsen, M. (2007). \"Orthop\u00e4disch-chirurgische Implantate und Allergien\" [Orthopedic surgical implants and allergies]. Der Orthop\u00e4de (in German). 37 (1): 75\u201388. doi:10.1007\/s00132-007-1183-3. PMID 18210082. \n\n^ Thomas, P.; Thomsen, M. (2010). \"Implantatallergien\" [Implant allergies]. Der Hautarzt (in German). 61 (3): 255\u201362, quiz 263\u20134. doi:10.1007\/s00105-009-1907-x. PMID 20204719. \n\n^ a b ASTM F138 standard \n\n^ Jewelry Standards - Association of Professional Piercers \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_stainless_steel\">https:\/\/www.limswiki.org\/index.php\/Surgical_stainless_steel<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 11 March 2016, at 19:49.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 251 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","c787a4c272c521485cad32a993c63b62_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Surgical_stainless_steel skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Surgical stainless steel<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">\"Surgical steel\" redirects here. For the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carcass_(band)\" title=\"Carcass (band)\" rel=\"external_link\" target=\"_blank\">Carcass<\/a> album, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_Steel_(album)\" title=\"Surgical Steel (album)\" rel=\"external_link\" target=\"_blank\">Surgical Steel (album)<\/a>.<\/div>\n<p><b>Surgical stainless steel<\/b> is a grade of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a> used in biomedical applications. The most common \"surgical steels\" are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Austenite\" title=\"Austenite\" rel=\"external_link\" target=\"_blank\">austenitic<\/a> 316 stainless and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Martensite\" title=\"Martensite\" rel=\"external_link\" target=\"_blank\">martensitic<\/a> 440 and 420 stainless steels.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> There is no formal definition on what constitutes a \"surgical stainless steel\", so product manufacturers and distributors apply the term to refer to any grade of corrosion resistant steel.\n<\/p><p>316 stainless steel, also referred to as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Marine_grade_stainless\" title=\"Marine grade stainless\" rel=\"external_link\" target=\"_blank\">marine grade stainless steel<\/a>, is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium\" title=\"Chromium\" rel=\"external_link\" target=\"_blank\">chromium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nickel\" title=\"Nickel\" rel=\"external_link\" target=\"_blank\">nickel<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molybdenum\" title=\"Molybdenum\" rel=\"external_link\" target=\"_blank\">molybdenum<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alloy\" title=\"Alloy\" rel=\"external_link\" target=\"_blank\">alloy<\/a> of steel that exhibits relatively good strength and corrosion resistance. Along with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a> alloy Ti6Al4V, 316 stainless is a common choice of material for biomedical implants. Although Ti6Al4V provides greater strength per weight and corrosion resistance, 316 stainless components can be more economical to produce. However, immune system reaction to nickel is a potential complication of 316.<sup id=\"rdp-ebb-cite_ref-nickel_complication_2-0\" class=\"reference\"><a href=\"#cite_note-nickel_complication-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-implant_allergies_3-0\" class=\"reference\"><a href=\"#cite_note-implant_allergies-3\" rel=\"external_link\">[3]<\/a><\/sup> \n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">Implants<\/a> and equipment that are put under pressure (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> fixation <a href=\"https:\/\/en.wikipedia.org\/wiki\/Screw\" title=\"Screw\" rel=\"external_link\" target=\"_blank\">screws<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prostheses<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_piercing_jewelry\" class=\"mw-redirect\" title=\"Body piercing jewelry\" rel=\"external_link\" target=\"_blank\">body piercing jewelry<\/a>) are made out of austenitic steel, often 316L and 316LVM compliant to ASTM F138,.<sup id=\"rdp-ebb-cite_ref-ASTM_F138_4-0\" class=\"reference\"><a href=\"#cite_note-ASTM_F138-4\" rel=\"external_link\">[4]<\/a><\/sup>\n316 surgical steel is used in the manufacture and handling of food and pharmaceutical products where it is often required in order to minimize metallic contamination. \nASTM F138<sup id=\"rdp-ebb-cite_ref-ASTM_F138_4-1\" class=\"reference\"><a href=\"#cite_note-ASTM_F138-4\" rel=\"external_link\">[4]<\/a><\/sup>-compliant steel is also used in the manufacture of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_piercing_jewellery\" title=\"Body piercing jewellery\" rel=\"external_link\" target=\"_blank\">body piercing jewellery<\/a><sup id=\"rdp-ebb-cite_ref-APP_Jewelry_Standards_5-0\" class=\"reference\"><a href=\"#cite_note-APP_Jewelry_Standards-5\" rel=\"external_link\">[5]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_modification\" title=\"Body modification\" rel=\"external_link\" target=\"_blank\">body modification<\/a> implants.\n<\/p>\n<\/p><p>440 and 420 stainless steels, known also by the name \"Cutlery Stainless Steel\", are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_steel\" title=\"Carbon steel\" rel=\"external_link\" target=\"_blank\">high carbon steels<\/a> alloyed with chromium. They have very good corrosion resistance compared to other cutlery steels, but their corrosion resistance is inferior to 316 stainless. Biomedical cutting instruments are often made from 440 or 420 stainless due to its high hardness coupled with acceptable corrosion resistance. This type of stainless steel may be slightly magnetic.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Instruments_used_in_general_surgery\" title=\"Instruments used in general surgery\" rel=\"external_link\" target=\"_blank\">Instruments used in general surgery<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=C8Y3PhtO_tY\" target=\"_blank\">\"Stainless Surgical Instruments\"<\/a> <span class=\"cs1-format\">(video)<\/span>. <i>YouTube<\/i>. Boston Career Institute (BCI Inc.) - Brookline<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-08-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=YouTube&rft.atitle=Stainless+Surgical+Instruments&rft_id=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DC8Y3PhtO_tY&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+stainless+steel\" class=\"Z3988\"><\/span> at ~6:00 martensitic and austenitic are described, albeit simply as 400 and 300 series<\/span>\n<\/li>\n<li id=\"cite_note-nickel_complication-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-nickel_complication_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Thomas, P.; Schuh, A.; Ring, J.; Thomsen, M. (2007). \"Orthop\u00e4disch-chirurgische Implantate und Allergien\" [Orthopedic surgical implants and allergies]. <i>Der Orthop\u00e4de<\/i> (in German). <b>37<\/b> (1): 75\u201388. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00132-007-1183-3\" target=\"_blank\">10.1007\/s00132-007-1183-3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18210082\" target=\"_blank\">18210082<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Der+Orthop%C3%A4de&rft.atitle=Orthop%C3%A4disch-chirurgische+Implantate+und+Allergien&rft.volume=37&rft.issue=1&rft.pages=75-88&rft.date=2007&rft_id=info%3Adoi%2F10.1007%2Fs00132-007-1183-3&rft_id=info%3Apmid%2F18210082&rft.aulast=Thomas&rft.aufirst=P.&rft.au=Schuh%2C+A.&rft.au=Ring%2C+J.&rft.au=Thomsen%2C+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+stainless+steel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-implant_allergies-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-implant_allergies_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Thomas, P.; Thomsen, M. (2010). \"Implantatallergien\" [Implant allergies]. <i>Der Hautarzt<\/i> (in German). <b>61<\/b> (3): 255\u201362, quiz 263\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00105-009-1907-x\" target=\"_blank\">10.1007\/s00105-009-1907-x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20204719\" target=\"_blank\">20204719<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Der+Hautarzt&rft.atitle=Implantatallergien&rft.volume=61&rft.issue=3&rft.pages=255-62%2C+quiz+263-4&rft.date=2010&rft_id=info%3Adoi%2F10.1007%2Fs00105-009-1907-x&rft_id=info%3Apmid%2F20204719&rft.aulast=Thomas&rft.aufirst=P.&rft.au=Thomsen%2C+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+stainless+steel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ASTM_F138-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ASTM_F138_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ASTM_F138_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.astm.org\/Standards\/F138.htm\" target=\"_blank\">ASTM F138 standard<\/a><\/span>\n<\/li>\n<li id=\"cite_note-APP_Jewelry_Standards-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-APP_Jewelry_Standards_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/safepiercing.org\/jewelry_standards.php\" target=\"_blank\">Jewelry Standards - Association of Professional Piercers<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1248\nCached time: 20181212004513\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.120 seconds\nReal time usage: 0.167 seconds\nPreprocessor visited node count: 267\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 5914\/2097152 bytes\nTemplate argument size: 88\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 9506\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.080\/10.000 seconds\nLua memory usage: 2.41 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 152.688 1 -total\n<\/p>\n<pre>77.47% 118.294 1 Template:Reflist\n41.71% 63.690 1 Template:Cite_web\n24.25% 37.023 2 Template:Cite_journal\n19.81% 30.252 1 Template:Redirect\n 1.95% 2.982 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:270806-1!canonical and timestamp 20181212004513 and revision id 873234899\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_stainless_steel\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212227\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.008 seconds\nReal time usage: 0.135 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 129.858 1 - wikipedia:Surgical_stainless_steel\n100.00% 129.858 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8391-0!*!*!*!*!*!* and timestamp 20181217212227 and revision id 24625\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_stainless_steel\">https:\/\/www.limswiki.org\/index.php\/Surgical_stainless_steel<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","c787a4c272c521485cad32a993c63b62_images":[],"c787a4c272c521485cad32a993c63b62_timestamp":1545081747,"08dbb1ba38c87713174cbe68c4bebc8e_type":"article","08dbb1ba38c87713174cbe68c4bebc8e_title":"Shrilk","08dbb1ba38c87713174cbe68c4bebc8e_url":"https:\/\/www.limswiki.org\/index.php\/Shrilk","08dbb1ba38c87713174cbe68c4bebc8e_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tShrilk\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t[Template fetch failed for https:\/\/en.wikipedia.org\/wiki\/Shrilk?action=render: HTTP 404]\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Shrilk\">https:\/\/www.limswiki.org\/index.php\/Shrilk<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 1 March 2016, at 19:12.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 360 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","08dbb1ba38c87713174cbe68c4bebc8e_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Shrilk skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Shrilk<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><p>[Template fetch failed for https:\/\/en.wikipedia.org\/wiki\/Shrilk?action=render: HTTP 404]\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Shrilk\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212227\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.341 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 335.786 1 - wikipedia:Shrilk\n100.00% 335.786 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8217-0!*!*!*!*!*!* and timestamp 20181217212226 and revision id 24367\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Shrilk\">https:\/\/www.limswiki.org\/index.php\/Shrilk<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","08dbb1ba38c87713174cbe68c4bebc8e_images":[],"08dbb1ba38c87713174cbe68c4bebc8e_timestamp":1545081746,"28453c0bd55482177ac8cc295eba539c_type":"article","28453c0bd55482177ac8cc295eba539c_title":"Self-healing material","28453c0bd55482177ac8cc295eba539c_url":"https:\/\/www.limswiki.org\/index.php\/Self-healing_material","28453c0bd55482177ac8cc295eba539c_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSelf-healing material\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Animation 1. 3D measurement of self-healing material from Tosoh Corporation measured by digital holographic microscopy. The surface has been scratched by a metallic tool.\n Animation 2. Section of self-healing material recovering from a scratch\nSelf-healing materials are artificial or synthetically-created substances which have the built-in ability to automatically repair damage to themselves without any external diagnosis of the problem or human intervention. Generally, materials will degrade over time due to fatigue, environmental conditions, or damage incurred during operation. Cracks and other types of damage on a microscopic level have been shown to change thermal, electrical, and acoustical properties of materials, and the propagation of cracks can lead to eventual failure of the material. In general, cracks are hard to detect at an early stage, and manual intervention is required for periodic inspections and repairs. In contrast, self-healing materials counter degradation through the initiation of a repair mechanism which responds to the micro-damage.[1]:1\u20132 Some self-healing materials are classed as smart structures, and can adapt to various environmental conditions according to their sensing and actuation properties.[1]:145 \nAlthough the most common types of self-healing materials are polymers or elastomers, self-healing covers all classes of materials, including metals, ceramics, and cementitious materials. Healing mechanisms vary from an instrinsic repair of the material to the addition of a repair agent contained in a microscopic vessel. For a material to be strictly defined as autonomously self-healing, it is necessary that the healing process occurs without human intervention. Self-healing polymers may, however, activate in response to an external stimulus (light, temperature change, etc.) to initiate the healing process.\nA material which can intrinsically correct damage caused by normal usage could prevent costs incurred by material failure and lower costs of a number of different industrial processes through longer part lifetime, and reduction of inefficiency caused by degradation over time.[2]\n\nContents \n\n1 History \n\n1.1 Roman concrete \n1.2 Materials science \n\n\n2 Biomimetics \n3 Self-healing polymers and elastomers \n\n3.1 Polymer breakdown \n\n3.1.1 Homolytic bond cleavage \n3.1.2 Heterolytic bond cleavage \n3.1.3 Reversible bond cleavage \n3.1.4 Supramolecular breakdown \n\n\n3.2 Intrinsic polymer-based systems \n\n3.2.1 Reversible bond-based polymers \n3.2.2 Polymer systems based on covalent bond formation and breakage \n\n3.2.2.1 Diels-Alder and retro-Diels-Alder \n\n3.2.2.1.1 Cross-linked polymers \n3.2.2.1.2 Polymerization of multifunctional monomers \n\n\n3.2.2.2 Thiol-based polymers \n3.2.2.3 Poly(urea-urethane) \n\n\n\n\n3.3 Extrinsic polymer-based systems \n\n3.3.1 Microcapsule healing \n3.3.2 Vascular approaches \n3.3.3 Hollow tube approach \n\n3.3.3.1 Discrete channels \n3.3.3.2 Interconnected networks \n3.3.3.3 Direct ink writing \n3.3.3.4 Carbon nanotube networks \n3.3.3.5 SLIPS \n3.3.3.6 Sacrificial thread stitching \n\n\n\n\n\n\n4 Self-healing fibre-reinforced polymer composites \n\n4.1 Capsule-based systems \n4.2 Vascular systems \n\n\n5 Self-healing coatings \n6 Self-healing cementitious materials \n\n6.1 Autogenous healing \n6.2 Chemical additives based healing \n6.3 Bio-based healing \n\n\n7 Self-healing ceramics \n\n7.1 Self-healing metals \n\n\n8 Self-healing organic dyes \n9 Further applications \n10 Assessment of self-healing efficacy \n11 Commercialization \n12 References \n\n\n\nHistory \nRoman concrete \nThe ancient Romans used a form of lime mortar that has been found to have self-healing properties.[3] Geologist Marie Jackson and her colleagues have recreated the type of mortar used in Trajan's Market and other Roman structures such as the Pantheon and the Colosseum and studied its response to cracking.[4] The Romans mixed a particular type of volcanic ash called Pozzolane Rosse, from the Alban Hills volcano, with quicklime and water. They used it to bind together decimeter-sized chunks of tuff, an aggregate of volcanic rock.[3]\nAs a result of Pozzolanic activity as the material cured, the lime interacted with other chemicals in the mix and was replaced by crystals of a calcium aluminosilicate mineral called Str\u00e4tlingite. Crystals of platey str\u00e4tlingite grow in the cementitious matrix of the material including the interfacial zones where cracks would tend to develop. This ongoing crystal formation holds together the mortar and the coarse aggregate, countering crack formation and resulting in a material that has lasted for 1,900 years.[5][6]\n\nMaterials science \nRelated processes in concrete have been studied microscopically since the 19th century.\nSelf healing materials only emerged as a widely recognized field of study in the 21st century. The first international conference on self-healing materials was held in 2007.[7] The field of self-healing materials is related to biomimetic materials as well as to other novel materials and surfaces with the embedded capacity for self-organization, such as the self-lubricating and self-cleaning materials.[8]\n\nBiomimetics \nPlants and animals have the capacity to seal and heal wounds. In all plants and animals examined, firstly a self-sealing phase and secondly a self-healing phase can be identified. In plants, the rapid self-sealing prevents the plants from desiccation and from infection by pathogenic germs. This gives time for the subsequent self-healing of the injury which in addition to wound closure also results in the (partly) restoration of mechanical properties of the plant organ. Based on a variety of self-sealing and self-healing processes in plants, different functional principles were transferred into bio-inspired self-repairing materials.[9][10][11] The connecting link between the biological model and the technical application is an abstraction describing the underlying functional principle of the biological model which can be for example an analytical model[12] or a numerical model. In cases where mainly physical-chemical processes are involved a transfer is especially promising. \nThere is evidence in the academic literature[13] of these biomimetic design approaches being used in the development of self-healing systems for polymer composites.[14]\nThe DIW structure from above can be used to essentially mimic the structure of skin. Toohey et al. did this with an epoxy substrate containing a grid of microchannels containing dicyclopentadiene (DCPD), and incorporated Grubbs' catalyst to the surface. This showed partial recovery of toughness after fracture, and could be repeated several times because of the ability to replenish the channels after use. The process is not repeatable forever, because the polymer in the crack plane from previous healings would build up over time.[15]\nInspired by rapid self-sealing processes in the twining liana Aristolochia macrophylla and related species (pipevines) a biomimetic PU-foam coating for pneumatic structures was developed.[16][17] With respect to low coating weight and thickness of the foam layer maximum repair efficiencies of 99.9% and more have been obtained.[18][19][20] Other role models are latex bearing plants as the weeping fig (Ficus benjamina), the rubber tree (Hevea brasiliensis) and spurges (Euphorbia spp.), in which the coagulation of latex is involved in the sealing of lesions.[21][22][23] Different self-sealing strategies for elastomeric materials were developed showing significant mechanical restoration after a macroscopic lesion.[24][25]\n\nSelf-healing polymers and elastomers \nIn the last century, polymers became a base material in everyday life for products like plastics, rubbers, films, fibres or paints. This huge demand has forced to extend their reliability and maximum lifetime, and a new design class of polymeric materials that are able to restore their functionality after damage or fatigue was envisaged. These polymer materials can be divided into two different groups based on the approach to the self-healing mechanism: intrinsic or extrinsic.[26]\nAutonomous self-healing polymers follow a three-step process very similar to that of a biological response. In the event of damage, the first response is triggering or actuation, which happens almost immediately after damage is sustained. The second response is transport of materials to the effected area, which also happens very quickly. The third response is the chemical repair process. This process differs depending on the type of healing mechanism that is in place (e.g., polymerization, entanglement, reversible cross-linking). These self-healing materials can be classified in three different ways: capsule based, vascular, and intrinsic. While similar in some ways, these three ways differ in the ways that response is hidden or prevented until actual damage is sustained.\n\nPolymer breakdown \nFrom a molecular perspective, traditional polymers yield to mechanical stress through cleavage of sigma bonds.[27] While newer polymers can yield in other ways, traditional polymers typically yield through homolytic or heterolytic bond cleavage. The factors that determine how a polymer will yield include: type of stress, chemical properties inherent to the polymer, level and type of solvation, and temperature.[27]\nFrom a macromolecular perspective, stress induced damage at the molecular level leads to larger scale damage called microcracks.[28] A microcrack is formed where neighboring polymer chains have been damaged in close proximity, ultimately leading to the weakening of the fiber as a whole.[28]\n\nHomolytic bond cleavage \n Scheme 1. Homolytic cleavage of poly(methyl methacrylate) (PMMA).\nPolymers have been observed to undergo homolytic bond cleavage through the use of radical reporters such as DPPH (2,2-diphenyl-1-picrylhydrazyl) and PMNB (pentamethylnitrosobenzene.) When a bond is cleaved homolytically, two radical species are formed which can recombine to repair damage or can initiate other homolytic cleavages which can in turn lead to more damage.[27]\n\nHeterolytic bond cleavage \n Scheme 2. Heterolytic cleavage of polyethylene glycol.\nPolymers have also been observed to undergo heterolytic bond cleavage through isotope labeling experiments. When a bond is cleaved heterolytically, cationic and anionic species are formed which can in turn recombine to repair damage, can be quenched by solvent, or can react destructively with nearby polymers.[27]\n\nReversible bond cleavage \nCertain polymers yield to mechanical stress in an atypical, reversible manner.[29] Diels-Alder-based polymers undergo a reversible cycloaddition, where mechanical stress cleaves two sigma bonds in a retro Diels-Alder reaction. This stress results in additional pi-bonded electrons as opposed to radical or charged moieties.[2]\n\nSupramolecular breakdown \nSupramolecular polymers are composed of monomers that interact non-covalently.[30] Common interactions include hydrogen bonds, metal coordination, and van der Waals forces.[30] Mechanical stress in supramolecular polymers causes the disruption of these specific non-covalent interactions, leading to monomer separation and polymer breakdown.\n\nIntrinsic polymer-based systems \nIn intrinsic systems, the material is inherently able to restore its integrity. While extrinsic approaches are generally autonomous, intrinsic systems often require an external trigger for the healing to take place (such as thermo-mechanical, electrical, photo-stimuli, etc.). It is possible to distinguish among 5 main intrinsic self-healing strategies. The first one is based on reversible reactions, and the most widely used reaction scheme is based on Diels-Alder (DA) and retro-Diels-Alder (rDA) reactions.[31] Another strategy achieves the self-healing in thermoset matrices by incorporating meltable thermoplastic additives. A temperature trigger allows the redispertion of thermoplastic additives into cracks, giving rise to mechanical interlocking.[32] Polymer interlockings based on dynamic supramolecular bonds or ionomers represent a third and fourth scheme. The involved supramolecular interactions and ionomeric clusters are generally reversible and act as reversible cross-links, thus can equip polymers with self-healing ability.[33][34] Finally, an alternative method for achieving intrinsic self-healing is based on molecular diffusion.[35]\n\nReversible bond-based polymers \nReversible systems are polymeric systems that can revert to the initial state whether it is monomeric, oligomeric, or non-cross-linked. Since the polymer is stable under normal condition, the reversible process usually requires an external stimulus for it to occur. For a reversible healing polymer, if the material is damaged by means such as heating and reverted to its constituents, it can be repaired or \"healed\" to its polymer form by applying the original condition used to polymerize it.\n\nPolymer systems based on covalent bond formation and breakage \nDiels-Alder and retro-Diels-Alder \nAmong the examples of reversible healing polymers, the Diels-Alder (DA) reaction and its retro-Diels-Alder (RDA) analogue seems to be very promising due to its thermal reversibility. In general, the monomer containing the functional groups such as furan or maleimide form two carbon-carbon bonds in a specific manner and construct the polymer through DA reaction. This polymer, upon heating, breaks down to its original monomeric units via RDA reaction and then reforms the polymer upon cooling or through any other conditions that were initially used to make the polymer. During the last few decades, two types of reversible polymers have been studied: (i) polymers where the pendant groups, such as furan or maleimide groups, cross-link through successive DA coupling reactions; (ii) polymers where the multifunctional monomers link to each other through successive DA coupling reactions.[29]\n\nCross-linked polymers \nIn this type of polymer, the polymer forms through the cross linking of the pendant groups from the linear thermoplastics. For example, Saegusa et al. have shown the reversible cross-linking of modified poly(N-acetylethyleneimine)s containing either maleimide or furancarbonyl pendant moideties. The reaction is shown in Scheme 3. They mixed the two complementary polymers to make a highly cross-linked material through DA reaction of furan and maleimide units at room temperature, as the cross-linked polymer is more thermodynamically stable than the individual starting materials. However, upon heating the polymer to 80 \u00b0C for two hours in a polar solvent, two monomers were regenerated via RDA reaction, indicating the breaking of polymers.[36] This was possible because the heating energy provided enough energy to go over the energy barrier and results in the two monomers. Cooling the two starting monomers, or damaged polymer, to room temperature for 7 days healed and reformed the polymer. \n\n Scheme 3. Reversible polymer cross-linking via Diels-Alder cycloaddition reaction between furan and maleimide.[36]\nThe reversible DA\/RDA reaction is not limited to furan-meleimides based polymers as it is shown by the work of Schiraldi et al. They have shown the reversible cross-linking of polymers bearing pendent anthracene group with maleimides. However, the reversible reaction occurred only partially upon heating to 250 \u00b0C due to the competing decomposition reaction.[37]\n\nPolymerization of multifunctional monomers \nIn these systems, the DA reaction takes place in the backbone itself to construct the polymer, not as a link. For polymerization and healing processes of a DA-step-growth furan-maleimide based polymer (3M4F) were demonstrated by subjecting it to heating\/cooling cycles. Tris-maleimide (3M) and tetra-furan (4F) formed a polymer through DA reaction and, when heated to 120 \u00b0C, de-polymerized through RDA reaction, resulting in the starting materials. Subsequent heating to 90\u2013120 \u00b0C and cooling to room temperature healed the polymer, partially restoring its mechanical properties through intervention.[31][38] The reaction is shown in Scheme 4. \n\n Scheme 4. Reversible highly cross-linked furan-maleimide based polymer network.[31]\nThiol-based polymers \nThe thiol-based polymers have disulfide bonds that can be reversibly cross-linked through oxidation and reduction. Under reducing condition, the disulfide (SS) bridges in the polymer breaks and results in monomers, however, under oxidizing condition, the thiols (SH) of each monomer forms the disulfide bond, cross-linking the starting materials to form the polymer. Chujo et al. have shown the thiol-based reversible cross-linked polymer using poly(N-acetylethyleneimine). (Scheme 5) [39]\n\n Scheme 5. Reversible polymer cross-linking by disulfide bridges.[39]\n Poly(urea-urethane) \nA soft poly(urea-urethane) network uses the metathesis reaction in aromatic disulphides to provide room-temperature self-healing properties, without the need for external catalysts. This chemical reaction is naturally able to create covalent bonds at room temperature, allowing the polymer to autonomously heal without an external source of energy. Left to rest at room temperature, the material mended itself with 80 percent efficiency after only two hours and 97 percent after 24 hours.[citation needed ]\nIn 2014 a polyurea elastomer-based material was shown to be self-healing, melding together after being cut in half, without the addition of catalysts or other chemicals. The material also include inexpensive commercially available compounds. The elastomer molecules were tweaked, making the bonds between them longer. The resulting molecules are easier to pull apart from one another and better able to rebond at room temperature with almost the same strength. The rebonding can be repeated. Stretchy, self-healing paints and other coatings recently took a step closer to common use, thanks to research being conducted at the University of Illinois. Scientists there have used \"off-the-shelf\" components to create a polymer that melds back together after being cut in half, without the addition of catalysts or other chemicals.[40][41]\nThe urea-urethane polymers however have glassy transition temperatures below 273 K therefore at room temperature they are gels and their tensile strength is low.[42] To optimize the tensile strength the reversible bonding energy, or the polymer length must be increased to increase the degree of covalent or mechanical interlocking respectively. However, increase polymer length inhibits mobility and thereby impairs the ability for polymers to re-reversibly bond. Thus at each polymer length an optimal reversible bonding energy exists.[43]\n\nExtrinsic polymer-based systems \nIn extrinsic systems, the healing chemistries are separated from the surrounding polymer in microcapsules or vascular networks, which after material damage\/cracking release their content into the crack plane, reacting and allowing the restoration of material functionalities.[44] \nThese systems can be further subdivided in several categories. While capsule-based polymers sequester the healing agents in little capsules that only release the agents if they are ruptured, vascular self-healing materials sequester the healing agent in capillary type hollow channels which can be interconnected one dimensionally, two dimensionally, or three dimensionally. After one of these capillaries is damaged, the network can be refilled by an outside source or another channel that was not damaged. Intrinsic self-healing materials do not have a sequestered healing agent but instead have a latent self-healing functionality that is triggered by damage or by an outside stimulus.[44] Extrinsic self-healing materials can achieve healing efficiencies over 100% even when the damage is large.[45]\n\nMicrocapsule healing \nCapsule-based systems have in common that healing agents are encapsulated into suitable microstructures that rupture upon crack formation and lead to a follow up process in order to restore the materials' properties. If the walls of the capsule are created too thick, they may not fracture when the crack approaches, but if they are too thin, they may rupture prematurely.[46] \nIn order for this process to happen at room temperature, and for the reactants to remain in a monomeric state within the capsule, a catalyst is also imbedded into the thermoset. The catalyst lowers the energy barrier of the reaction and allows the monomer to polymerize without the addition of heat. The capsules (often made of wax) around the monomer and the catalyst are important to maintain separation until the crack facilitates the reaction.[29][47]\nIn the capsule-catalyst system, the encapsulated healing agent is released into the polymer matrix and reacts with the catalyst, already present in the matrix.[48] \nThere are many challenges in designing this type of material. First, the reactivity of the catalyst must be maintained even after it is enclosed in wax. Additionally, the monomer must flow at a sufficient rate (have low enough viscosity) to cover the entire crack before it is polymerized, or full healing capacity will not be reached. Finally, the catalyst must quickly dissolve into the monomer in order to react efficiently and prevent the crack from spreading further.[47]\n\n Scheme 6. ROMP of DCPD via Grubbs' catalyst\nThis process has been demonstrated with dicyclopentadiene (DCPD) and Grubbs' catalyst (benzylidene-bis(tricyclohexylphosphine)dichlororuthenium). Both DCPD and Grubbs' catalyst are imbedded in an epoxy resin. The monomer on its own is relatively unreactive and polymerization does not take place. When a microcrack reaches both the capsule containing DCPD and the catalyst, the monomer is released from the core\u2013shell microcapsule and comes in contact with exposed catalyst, upon which the monomer undergoes ring opening metathesis polymerization (ROMP).[47] The metathesis reaction of the monomer involves the severance of the two double bonds in favor of new bonds. The presence of the catalyst allows for the energy barrier (energy of activation) to be lowered, and the polymerization reaction can proceed at room temperature.[49] The resulting polymer allows the epoxy composite material to regain 67% of its former strength.\nGrubbs' catalyst is a good choice for this type of system because it is insensitive to air and water, thus robust enough to maintain reactivity within the material. Using a live catalyst is important to promote multiple healing actions.[50] The major drawback is the cost. It was shown that using more of the catalyst corresponded directly to higher degree of healing. Ruthenium is quite costly, which makes it impractical for commercial applications.\n\n Figure 1. Depiction of crack propagation through microcapsule-imbedded material. Monomer microcapsules are represented by pink circles and catalyst is shown by purple dots.\nIn contrast, in multicapsule systems both the catalyst and the healing agent are encapsulated in different capsules.[51] In a third system, called latent functionality, a healing agent is encapsulated, that can react with the polymerizer component that is present in the matrix in the form of residual reactive functionalities.[52] In the last approach (phase separation), either the healing agent or the polymerizer is phase-separated in the matrix material.[53]\n\nVascular approaches \nThe same strategies can be applied in 1D, 2D and 3D vascular based systems.[54][55][15]\n\nHollow tube approach \nFor the first method, fragile glass capillaries or fibers are imbedded within a composite material. (Note: this is already a commonly used practice for strengthening materials. See Fiber-reinforced plastic.)[56] The resulting porous network is filled with monomer. When damage occurs in the material from regular use, the tubes also crack and the monomer is released into the cracks. Other tubes containing a hardening agent also crack and mix with the monomer, causing the crack to be healed.[50] There are many things to take into account when introducing hollow tubes into a crystalline structure. First to consider is that the created channels may compromise the load bearing ability of the material due to the removal of load bearing material.[57] Also, the channel diameter, degree of branching, location of branch points, and channel orientation are some of the main things to consider when building up microchannels within a material. Materials that don\u2019t need to withstand much mechanical strain, but want self-healing properties, can introduce more microchannels than materials that are meant to be load bearing.[57] There are two types of hollow tubes: discrete channels, and interconnected channels.[57]\n\nDiscrete channels \nDiscrete channels can be built independently of building the material and are placed in an array throughout the material.[57] When creating these microchannels, one major factor to take into account is that the closer the tubes are together, the lower the strength will be, but the more efficient the recovery will be.[57] A sandwich structure is a type of discrete channels that consists of tubes in the center of the material, and heals outwards from the middle.[58] The stiffness of sandwich structures is high, making it an attractive option for pressurized chambers.[58] For the most part in sandwich structures, the strength of the material is maintained as compared to vascular networks. Also, material shows almost full recovery from damage.[58]\n\nInterconnected networks \nInterconnected networks are more efficient than discrete channels, but are harder and more expensive to create.[57] The most basic way to create these channels is to apply basic machining principles to create micro scale channel grooves. These techniques yield channels from 600\u2013700 micrometers.[57] This technique works great on the two-dimensional plane, but when trying to create a three-dimensional network, they are limited.[57]\n\nDirect ink writing \nThe Direct Ink Writing (DIW) technique is a controlled extrusion of viscoelastic inks to create three-dimensional interconnected networks.[57] It works by first setting organic ink in a defined pattern. Then the structure is infiltrated with a material like an epoxy. This epoxy is then solidified, and the ink can be sucked out with a modest vacuum, creating the hollow tubes.[57]\n\nCarbon nanotube networks \nThrough dissolving a linear polymer inside a solid three-dimensional epoxy matrix, so that they are miscible to each other, the linear polymer becomes mobile at a certain temperature[59] When carbon nanotubes are also incorporated into epoxy material, and a direct current is run through the tubes, a significant shift in sensing curve indicates permanent damage to the polymer, thus \u2018sensing\u2019 a crack.[60] When the carbon nanotubes sense a crack within the structure, they can be used as thermal transports to heat up the matrix so the linear polymers can diffuse to fill the cracks in the epoxy matrix. Thus healing the material.[59]\n\nSLIPS \nA different approach was suggested by Prof. J. Aizenberg from Harvard University, who suggested to use Slippery Liquid-Infused Porous Surfaces (SLIPS), a porous material inspired by the carnivorous pitcher plant and filled with a lubricating liquid immiscible with both water and oil.[61] SLIPS possess self-healing and self-lubricating properties as well as icephobicity and were successfully used for many purposes.\n\nSacrificial thread stitching \nOrganic threads (such as polylactide filament for example) are stitched through laminate layers of fiber reinforced polymer, which are then boiled and vacuumed out of the material after curing of the polymer, leaving behind empty channels than can be filled with healing agents.[62]\n\nSelf-healing fibre-reinforced polymer composites \nMethods for the implementation of self-healing functionality into filled composites and fibre reinforced polymers (FRPs) are almost exclusively based on extrinsic systems and thus can be broadly classified into two approaches; discrete capsule-based systems and continuous vascular systems. In contrast to non-filled polymers, the success of an intrinsic approach based on bond reversibility has yet to be proven in FRPs. \nTo date, self-healing of FRPs has mostly been applied to simple structures such as flat plates and panels. There is however a somewhat limited application of self-healing in flat panels, as access to the panel surface is relatively simple and repair methods are very well established in industry. Instead, there has been a strong focus on implementing self-healing in more complex and industrially relevant structures such as T-Joints[63][64] and Aircraft Fuselages.[65]\n\nCapsule-based systems \nThe creation of a capsule-based system was first reported by White et al. in 2001,[46] and this approach has since been adapted by a number of authors for introduction into fibre reinforced materials.[66][67][68] This method relies on the release of an encapsulated healing agent into the damage zone, and is generally a once off process as the functionality of the encapsulated healing agent cannot be restored. Even so, implemented systems are able to restore material integrity to almost 100% and remain stable over the material lifetime.\n\nVascular systems \nA vascular or fibre-based approach may be more appropriate for self-healing impact damage in fibre-reinforced polymer composite materials. \nIn this method, a network of hollow channels known as vascules, similar to the blood vessels within human tissue, are placed within the structure and used for the introduction of a healing agent. During a damage event cracks propagate through the material and into the vascules causing them to be cleaved open. A liquid resin is then passed through the vascules and into the damage plane, allowing the cracks to be repaired. Vascular systems have a number of advantages over microcapsule based systems, such as the ability to continuously deliver large volumes of repair agents and the potential to be used for repeated healing. The hollow channels themselves can also be used for additional functionality, such as thermal management and structural health monitoring.[69] A number of methods have been proposed for the introduction of these vascules, including the use of hollow glass fibres (HGFs),[70] \n[71] 3D printing,[15] a \u2018lost wax\u2019 process [72][73] and a solid preform route.[74]\n\nSelf-healing coatings \nCoatings allow the retention and improvement of bulk properties of a material. They can provide protection for a substrate from environmental exposure. Thus, when damage occurs (often in the form of microcracks), environmental elements like water and oxygen can diffuse through the coating and may cause material damage or failure. Microcracking in coatings can result in mechanical degradation or delamination of the coating, or in electrical failure in fibre-reinforced composites and microelectronics, respectively. As the damage is on such a small scale, repair, if possible, is often difficult and costly. Therefore, a coating that can automatically heal itself (\u201cself-healing coating\u201d) could prove beneficial by automatic recovering properties (such as mechanical, electrical and aesthetic properties), and thus extending the lifetime of the coating. The majority of the approaches that are described in literature regarding self-healing materials can be applied to make \u201cself-healing\u201d coatings, including microencapsulation[75][46] and the introduction of reversible physical bonds such as hydrogen bonding,[76] ionomers\n[77][78] and chemical bonds (Diels-Alder chemistry).[79] Microencapsulation is the most common method to develop self-healing coatings. The capsule approach originally described by White et al., using microencapsulated dicyclopentadiene (DCPD) monomer and Grubbs\u2019 catalyst to self-heal epoxy polymer[46] was later adapted to epoxy adhesive films that are commonly used in the aerospace and automotive industries for bonding metallic and composite substrates.[80] Recently, microencapsulated liquid suspensions of metal or carbon black were used to restore electrical conductivity in a multilayer microelectronic device and battery electrodes respectively;[81][82] however the use of microencapsulation for restoration of electrical properties in coatings is limited.\nLiquid metal microdroplets have also been suspended within silicone elastomer to create stretchable electrical conductors that maintain electrical conductivity when damaged, mimicking the resilience of soft biological tissue.[83] The most common application of this technique is proven in polymer coatings for corrosion protection. Corrosion protection of metallic materials is of significant importance on an economical and ecological scale. To prove the effectiveness of microcapsules in polymer coatings for corrosion protection, researchers have encapsulated a number of materials. These materials include isocyanates[84][85] monomers such as DCPD[48][67] GMA[86] epoxy resin,[87] linseed oil[88][89] and tung oil.[90] By using the aforementioned materials for self healing in coatings, it was proven that microencapsulation effectively protects the metal against corrosion and extends the lifetime of a coating.\n\nSelf-healing cementitious materials \nCementitious materials have existed since the Roman era. These materials have a natural ability to self-heal, which was first reported by the French Academy of Science in 1836.[91] This ability can be improved by the integration of chemical and biochemical strategies.\n\nAutogenous healing \nAutogenous healing is the natural ability of cementitious materials to repair cracks. This ability is principally attributed to further hydration of unhydrated cement particles and carbonation of dissolved calcium hydroxide.[91] Cementitious materials in fresh-water systems can autogenously heal cracks up to 0.2 mm over a period of 7 weeks.[92]\n\nChemical additives based healing \nSelf-healing of cementitious materials can be achieved through the reaction of certain chemical agents. Two main strategies exist for housing these agents, namely capsules and vascular tubes. These capsules and vascular tubes, once ruptured, release these agents and heal the crack damage. Studies have mainly focused on improving the quality of these housings and encapsulated materials in this field.[93]\n\nBio-based healing \nThe self-healing ability of concrete has been improved by the incorporation of bacteria, which can induce calcium carbonate precipitation through their metabolic activity.[94] These precipitates can build up and form an effective seal against crack related water ingress. Jonkers et al. first incorporated bacteria within cement paste for the development of self-healing concrete.[95] It was found that the bacteria directly added to the paste only remained viable for 4 months. Later studies saw Jonkers use expanded clay particles[96] and Van Tittlelboom use glass tubes,[97] to protect the bacteria inside the concrete. Other strategies to protect the bacteria have also since been reported.[98]\n\nSelf-healing ceramics \nGenerally, ceramics are superior in strength to metals at high temperatures, however, they are brittle and sensitive to flaws, and this brings into question their integrity and reliability as structural materials.[99]\n\n \n \n \n \n \n M\n \n \n \n n\n \n \n +\n 1\n \n \n \n \n \n \n AX\n \n \n n\n \n \n \n \n \n \n \n \n \n {\\displaystyle {\\ce {M_{{\\mathit {n}}+1}AX_{\\mathit {n}}}}}\n \n phase ceramics, also known as MAX Phases, can autonomously heal crack damage by an intrinsic healing mechanism. Micro cracks caused by wear or thermal stress are filled with oxides formed from the MAX phase constituents, commonly the A-element, during high temperature exposure to air.[100]\nCrack gap filling was first demonstrated for Ti3AlC2 by oxidation at 1200 \u00b0C in air.[101] Ti2AlC and Cr2AlC have also demonstrated said ability, and more ternary carbides and nitrides are expected to be able to autonomously self-heal.[102] The process is repeatable up to the point of element depletion, distinguishing MAX phases from other self-healing materials that require external healing agents (extrinsic healing) for single crack gap filling. Depending on the filling-oxide, improvement of the initial properties such as local strength can be achieved.[103]\nOn the other hand, mullite, alumina and zirconia do not have the ability to heal intrinsically, but could be endowed with self-healing capabilities by embedding second phase components into the matrix. Upon cracking, these particles are exposed to oxygen, and in the presence of heat, they react to form new materials which fill the crack gap under volume expansion.[104]\nThis concept has been proven using SiC to heal cracks in an Alumina matrix,[105] and further studies have investigated the high temperature strength,[106] and the static and cyclic fatigue strength of the healed part.[107] The strength and bonding between the matrix and the healing agent are of prime importance and thus govern the selection of the healing particles.\n\nSelf-healing metals \nWhen exposed for long times to high temperatures and moderate stresses, metals exhibit premature and low-ductility creep fracture, arising from the formation and growth of cavities. Those defects coalesce into cracks which ultimately cause macroscopic failure. Self-healing of early stage damage is thus a promising new approach to extend the lifetime of the metallic components. In metals, self-healing is intrinsically more difficult to achieve than in most other material classes, due to their high melting point and, as a result, low atom mobility. Generally, defects in the metals are healed by the formation of precipitates at the defect sites that immobilize further crack growth.\nImproved creep and fatigue properties have been reported for underaged aluminium alloys compared to the peak hardening Al alloys, which is due to the heterogeneous precipitation at the crack tip and its plastic zone.[108] The first attempts to heal creep damage in steels were focused on the dynamic precipitation of either Cu or BN at the creep-cavity surface.[109][110] Cu precipitation has only a weak preference for deformation-induced defects as a large fraction of spherical Cu precipitates is simultaneously formed with the matrix.[111][112] \nRecently, gold atoms were recognized as a highly efficient healing agents in Fe-based alloys. A defect-induced mechanism is indicated for the Au precipitation, i.e. the Au solute remains dissolved until defects are formed.[113] Autonomous repair of high-temperature creep damage was reported by alloying with a small amount of Au. Healing agents selectively precipitate at the free surface of a creep cavity, resulting in pore filling. For the lower stress levels up to 80% filling of the creep cavities with Au precipitates is achieved[114] resulting in a substantial increase in creep life time. Work to translate the concept of creep damage healing in simple binary or ternary model systems to real multicomponent creep steels is ongoing.\n\nSelf-healing organic dyes \nRecently, a several classes of organic dyes are discovered that self-heal after photo-degradation when doped in PMMA and other polymer matrices.[115] This is also knows as reversible photo-degradation. It was shown that, unlike common process like molecular diffusion,[116] the mechanism is caused by dye-polymer interaction.[117]\n\nFurther applications \nSelf-healing epoxies can be incorporated on to metals in order to prevent corrosion.\nA substrate metal showed major degradation and rust formation after 72 hours of exposure. But after being coated with the self-healing epoxy, there was no visible damage under SEM after 72 hours of same exposure.[118]\n\nAssessment of self-healing efficacy \nNumerous methodologies for the assessment of self-healing capabilities have been developed for each material class (Table 1).\n\n\nTable 1. Damaging methods for self-healing assessment of different classes of material.\n\n\nMaterial class\nDamage mechanism\nHealing\n\n\nPolymers\nRazor blade\/scalpel cut; Tensile test with rupture; Ballistic impact\nAutonomic healing supramolecular networks\n\n\nPolymers\nRazor blade\/scalpel cut\nTemperature triggered supramolecular networks\n\n\nFibre Reinforced Composite\nDelamination BVID (Barely Visible Impact Damage)\nVascular self-healing; Microcapsule self-healing\n\n\nCoatings\nMicrocutting with corrosion; Corrosion\/erosion; Pull-out tests (adhesion); Microscratching\nMolecular inter-diffusion (solvent); Encapsulated agent\n\n\nConcrete\nCrack initiation by bending compression\nActivation of microencapsulated agent\n\n\nCeramic\nCrack initiation by indentation\nTemperature triggered oxidation reaction\n\n\nCeramic coating\nCrack initiation by indentation\nTemperature triggered oxidation reaction\n\n\nPolyurethane foam coating\nPuncturing with a spike\nReduction of the effective leakage area by negative strains pushing the walls of the fissure in the foam coatings to one another.[18]\n\nHence, when self-healing is assessed, different parameters need to be considered: type of stimulus (if any), healing time, maximum amount of healing cycles the material can tolerate, and degree of recovery, all whilst considering the material's virgin properties.[119][120][76]\nThis typically takes account of relevant physical parameters such as tensile modulus, elongation at break, fatigue-resistance, barrier properties, colour and transparency.\nThe self-healing ability of a given material generally refers to the recovery of a specific property relative to the virgin material, designated as the self-healing efficiency. The self-healing efficiency can be quantified by comparing the respective experimental value obtained for the undamaged virgin sample (fvirgin) with the healed sample (fhealed) (eq. 1)[121]\n\n\n\n\n\u03b7 = fhealed \/ fvirgin \n\n\n\n\n\n \n\n \n\n \n\n\n\n \n\n\n\n(1 )\n\nIn a variation of this definition that is relevant to extrinsic self-healing materials, the healing efficiency takes into consideration the modification of properties caused by introducing the healing agent. Accordingly, the healed sample property is compared to that of an undamaged control equipped with self-healing agent fnon-healed (equation 2).\n\n\n\n\n\u03b7 = fhealed \/ fnon-healed \n\n\n\n\n\n \n\n \n\n \n\n\n\n \n\n\n\n(2 )\n\nFor a certain property Pi of a specific material, an optimal self-healing mechanism and process is characterized by the full restoration of the respective material property after a suitable, normalized damaging process. For a material where 3 different properties are assessed, it should be determined 3 efficiencies given as \u019e1(P1), \u019e2(P2) and \u019e3(P3).\nThe final average efficiency based on a number n of properties for a self-healing material is accordingly determined as the harmonic mean given by equation 3. The harmonic mean is more appropriate than the traditional arithmetic mean, as it is less sensitive to large outliers.\n\n\n\n\n\n \n \n \n \n \n \n η\n ¯\n \n \n \n =\n \n \n n\n \n \n ∑\n \n i\n =\n 1\n \n \n n\n \n \n \n (\n \n \n 1\n \n \n η\n \n i\n \n \n (\n P\n )\n \n \n \n )\n \n \n \n \n \n \n {\\displaystyle {\\bar {\\eta }}={\\frac {n}{\\sum _{i=1}^{n}\\left({\\frac {1}{\\eta _{i}(P)}}\\right)}}}\n \n\n \n\n\n\n\n\n \n\n \n\n \n\n\n\n \n\n\n\n(3 )\n\nCommercialization \nAt least two companies are attempting to bring the newer applications of self-healing materials to the market. 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PMID 22894369. \n\n^ Yang, Zhao; Wei, Zhang; Le-ping, Liao; Hong-mei, Wang; Wu-jun, Li (2011). \"The self-healing composite anticorrosion coating\". Physics Procedia. 18: 216\u2013221. Bibcode:2011PhPro..18..216Y. doi:10.1016\/j.phpro.2011.06.084. ISSN 1875-3892. \n\n^ Zhu M, Rong MZ, Zhang MQ (2014). \"Self-healing polymeric materials towards non-structural recovery of functional properties\". Polymer International. 63 (10): 741\u20131749. doi:10.1002\/pi.4723. CS1 maint: Multiple names: authors list (link) \n\n^ Pacheco J, \u0160avija B, Schlangen E, Polder RB (2014). \"Assessment of cracks in reinforced concrete by means of electrical resistance and image analysis\". Construction and Building Materials. 65: 417\u2013426. doi:10.1016\/j.conbuildmat.2014.05.001. CS1 maint: Multiple names: authors list (link) \n\n^ Mauldin, T C; Kessler, M R (2010). \"Self-healing polymers and composites\". International Materials Reviews. 55 (6): 317\u2013346. doi:10.1179\/095066010X12646898728408. \n\n^ \"Self-healing elastomer enters industrial production\". www.arkema.com. Retrieved 2015-12-13 . \n\n^ Bourzac, Katherine (December 12, 2008). \"First Self-Healing Coatings\". technologyreview.com. Retrieved 18 November 2016 . \n\n^ Rincon, Paul (30 October 2010). \"Time to heal: The materials that repair themselves\". BBC. Retrieved 19 May 2013 . \n\n\n\n\n\nWikimedia Commons has media related to Self-healing material.\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Self-healing_material\">https:\/\/www.limswiki.org\/index.php\/Self-healing_material<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 16:55.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 485 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","28453c0bd55482177ac8cc295eba539c_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Self-healing_material skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Self-healing material<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Self-Healing-Polymer-DHM-Digital-Holographic-Microscopy-lyncee-Tosoh-Corporation.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c5\/Self-Healing-Polymer-DHM-Digital-Holographic-Microscopy-lyncee-Tosoh-Corporation.gif\/220px-Self-Healing-Polymer-DHM-Digital-Holographic-Microscopy-lyncee-Tosoh-Corporation.gif\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Self-Healing-Polymer-DHM-Digital-Holographic-Microscopy-lyncee-Tosoh-Corporation.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><b>Animation 1.<\/b> 3D measurement of self-healing material from Tosoh Corporation measured by digital holographic microscopy. The surface has been scratched by a metallic tool.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Self-Healing-Polymer-DHM-Digital-Holographic-Microscopy-profile.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ac\/Self-Healing-Polymer-DHM-Digital-Holographic-Microscopy-profile.gif\/220px-Self-Healing-Polymer-DHM-Digital-Holographic-Microscopy-profile.gif\" width=\"220\" height=\"152\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Self-Healing-Polymer-DHM-Digital-Holographic-Microscopy-profile.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><b>Animation 2.<\/b> Section of self-healing material recovering from a scratch<\/div><\/div><\/div>\n<p><b>Self-healing materials<\/b> are artificial or synthetically-created <a href=\"https:\/\/en.wikipedia.org\/wiki\/Materials\" class=\"mw-redirect\" title=\"Materials\" rel=\"external_link\" target=\"_blank\">substances<\/a> which have the built-in ability to automatically repair damage to themselves without any external diagnosis of the problem or human intervention. Generally, materials will degrade over time due to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fatigue_(material)\" title=\"Fatigue (material)\" rel=\"external_link\" target=\"_blank\">fatigue<\/a>, environmental conditions, or damage incurred during operation. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fracture_mechanics\" title=\"Fracture mechanics\" rel=\"external_link\" target=\"_blank\">Cracks<\/a> and other types of damage on a microscopic level have been shown to change <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal\" title=\"Thermal\" rel=\"external_link\" target=\"_blank\">thermal<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical\" class=\"mw-redirect\" title=\"Electrical\" rel=\"external_link\" target=\"_blank\">electrical<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acoustical\" class=\"mw-redirect\" title=\"Acoustical\" rel=\"external_link\" target=\"_blank\">acoustical<\/a> properties of materials, and the propagation of cracks can lead to eventual <a href=\"https:\/\/en.wikipedia.org\/wiki\/Failure\" title=\"Failure\" rel=\"external_link\" target=\"_blank\">failure<\/a> of the material. In general, cracks are hard to detect at an early stage, and manual intervention is required for periodic inspections and repairs. In contrast, self-healing materials counter degradation through the initiation of a repair mechanism which responds to the micro-damage.<sup id=\"rdp-ebb-cite_ref-Ghosh_1-0\" class=\"reference\"><a href=\"#cite_note-Ghosh-1\" rel=\"external_link\">[1]<\/a><\/sup><sup class=\"reference\" style=\"white-space:nowrap;\">:<span>1\u20132<\/span><\/sup> Some self-healing materials are classed as smart structures, and can adapt to various environmental conditions according to their sensing and actuation properties.<sup id=\"rdp-ebb-cite_ref-Ghosh_1-1\" class=\"reference\"><a href=\"#cite_note-Ghosh-1\" rel=\"external_link\">[1]<\/a><\/sup><sup class=\"reference\" style=\"white-space:nowrap;\">:<span>145<\/span><\/sup>\n<\/p><p>Although the most common types of self-healing materials are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymers\" class=\"mw-redirect\" title=\"Polymers\" rel=\"external_link\" target=\"_blank\">polymers<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastomers\" class=\"mw-redirect\" title=\"Elastomers\" rel=\"external_link\" target=\"_blank\">elastomers<\/a>, self-healing covers all classes of materials, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metals\" class=\"mw-redirect\" title=\"Metals\" rel=\"external_link\" target=\"_blank\">metals<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramics\" class=\"mw-redirect\" title=\"Ceramics\" rel=\"external_link\" target=\"_blank\">ceramics<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cement\" title=\"Cement\" rel=\"external_link\" target=\"_blank\">cementitious materials<\/a>. Healing mechanisms vary from an instrinsic repair of the material to the addition of a repair agent contained in a microscopic vessel. For a material to be strictly defined as autonomously self-healing, it is necessary that the healing process occurs without human intervention. Self-healing polymers may, however, activate in response to an external stimulus (light, temperature change, etc.) to initiate the healing process.\n<\/p><p>A material which can intrinsically correct damage caused by normal usage could prevent costs incurred by material failure and lower costs of a number of different industrial processes through longer part lifetime, and reduction of inefficiency caused by degradation over time.<sup id=\"rdp-ebb-cite_ref-polylett_2-0\" class=\"reference\"><a href=\"#cite_note-polylett-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<div class=\"toclimit-3\">\n<\/div>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Roman_concrete\">Roman concrete<\/span><\/h3>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Rome\" title=\"Ancient Rome\" rel=\"external_link\" target=\"_blank\">ancient Romans<\/a> used a form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lime_mortar\" title=\"Lime mortar\" rel=\"external_link\" target=\"_blank\">lime mortar<\/a> that has been found to have self-healing properties.<sup id=\"rdp-ebb-cite_ref-Wayman_3-0\" class=\"reference\"><a href=\"#cite_note-Wayman-3\" rel=\"external_link\">[3]<\/a><\/sup> Geologist Marie Jackson and her colleagues have recreated the type of mortar used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trajan%27s_Market\" title=\"Trajan's Market\" rel=\"external_link\" target=\"_blank\">Trajan's Market<\/a> and other Roman structures such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pantheon,_Rome\" title=\"Pantheon, Rome\" rel=\"external_link\" target=\"_blank\">Pantheon<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colosseum\" title=\"Colosseum\" rel=\"external_link\" target=\"_blank\">Colosseum<\/a> and studied its response to cracking.<sup id=\"rdp-ebb-cite_ref-Berkeley_4-0\" class=\"reference\"><a href=\"#cite_note-Berkeley-4\" rel=\"external_link\">[4]<\/a><\/sup> The Romans mixed a particular type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Volcanic_ash\" title=\"Volcanic ash\" rel=\"external_link\" target=\"_blank\">volcanic ash<\/a> called , from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alban_Hills\" title=\"Alban Hills\" rel=\"external_link\" target=\"_blank\">Alban Hills<\/a> volcano, with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quicklime\" class=\"mw-redirect\" title=\"Quicklime\" rel=\"external_link\" target=\"_blank\">quicklime<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Water\" title=\"Water\" rel=\"external_link\" target=\"_blank\">water<\/a>. They used it to bind together decimeter-sized chunks of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tuff\" title=\"Tuff\" rel=\"external_link\" target=\"_blank\">tuff<\/a>, an aggregate of volcanic rock.<sup id=\"rdp-ebb-cite_ref-Wayman_3-1\" class=\"reference\"><a href=\"#cite_note-Wayman-3\" rel=\"external_link\">[3]<\/a><\/sup>\nAs a result of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pozzolanic_activity\" title=\"Pozzolanic activity\" rel=\"external_link\" target=\"_blank\">Pozzolanic activity<\/a> as the material cured, the lime interacted with other chemicals in the mix and was replaced by crystals of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_aluminosilicate\" title=\"Calcium aluminosilicate\" rel=\"external_link\" target=\"_blank\">calcium aluminosilicate<\/a> mineral called . Crystals of platey str\u00e4tlingite grow in the cementitious matrix of the material including the interfacial zones where cracks would tend to develop. This ongoing crystal formation holds together the mortar and the coarse aggregate, countering crack formation and resulting in a material that has lasted for 1,900 years.<sup id=\"rdp-ebb-cite_ref-Hartnett_5-0\" class=\"reference\"><a href=\"#cite_note-Hartnett-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Jackson_6-0\" class=\"reference\"><a href=\"#cite_note-Jackson-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Materials_science\">Materials science<\/span><\/h3>\n<p>Related processes in concrete have been studied microscopically since the 19th century.\n<\/p><p>Self healing materials only emerged as a widely recognized field of study in the 21st century. The first international conference on self-healing materials was held in 2007.<sup id=\"rdp-ebb-cite_ref-Delft_University_of_Technology_7-0\" class=\"reference\"><a href=\"#cite_note-Delft_University_of_Technology-7\" rel=\"external_link\">[7]<\/a><\/sup> The field of self-healing materials is related to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomimetic\" class=\"mw-redirect\" title=\"Biomimetic\" rel=\"external_link\" target=\"_blank\">biomimetic<\/a> materials as well as to other novel materials and surfaces with the embedded capacity for self-organization, such as the self-lubricating and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Self-cleaning\" class=\"mw-redirect\" title=\"Self-cleaning\" rel=\"external_link\" target=\"_blank\">self-cleaning<\/a> materials.<sup id=\"rdp-ebb-cite_ref-Nosonovsky_8-0\" class=\"reference\"><a href=\"#cite_note-Nosonovsky-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Biomimetics\">Biomimetics<\/span><\/h2>\n<p>Plants and animals have the capacity to seal and heal wounds. In all plants and animals examined, firstly a self-sealing phase and secondly a self-healing phase can be identified. In plants, the rapid self-sealing prevents the plants from desiccation and from infection by pathogenic germs. This gives time for the subsequent self-healing of the injury which in addition to wound closure also results in the (partly) restoration of mechanical properties of the plant organ. Based on a variety of self-sealing and self-healing processes in plants, different functional principles were transferred into bio-inspired self-repairing materials.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> The connecting link between the biological model and the technical application is an abstraction describing the underlying functional principle of the biological model which can be for example an analytical model<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> or a numerical model. In cases where mainly physical-chemical processes are involved a transfer is especially promising. \nThere is evidence in the academic literature<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> of these <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomimicry\" class=\"mw-redirect\" title=\"Biomimicry\" rel=\"external_link\" target=\"_blank\">biomimetic<\/a> design approaches being used in the development of self-healing systems for polymer composites.<sup id=\"rdp-ebb-cite_ref-gr1_14-0\" class=\"reference\"><a href=\"#cite_note-gr1-14\" rel=\"external_link\">[14]<\/a><\/sup>\nThe DIW structure from above can be used to essentially mimic the structure of skin. Toohey <i>et al.<\/i> did this with an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epoxy\" title=\"Epoxy\" rel=\"external_link\" target=\"_blank\">epoxy<\/a> substrate containing a grid of microchannels containing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dicyclopentadiene\" title=\"Dicyclopentadiene\" rel=\"external_link\" target=\"_blank\">dicyclopentadiene<\/a> (DCPD), and incorporated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grubbs%27_catalyst\" title=\"Grubbs' catalyst\" rel=\"external_link\" target=\"_blank\">Grubbs' catalyst<\/a> to the surface. This showed partial recovery of toughness after fracture, and could be repeated several times because of the ability to replenish the channels after use. The process is not repeatable forever, because the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> in the crack plane from previous healings would build up over time.<sup id=\"rdp-ebb-cite_ref-Toohey,_K.S._2007_15-0\" class=\"reference\"><a href=\"#cite_note-Toohey,_K.S._2007-15\" rel=\"external_link\">[15]<\/a><\/sup>\nInspired by rapid self-sealing processes in the twining liana Aristolochia macrophylla and related species (pipevines) a biomimetic PU-foam coating for pneumatic structures was developed.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> With respect to low coating weight and thickness of the foam layer maximum repair efficiencies of 99.9% and more have been obtained.<sup id=\"rdp-ebb-cite_ref-Rampf,_M._2012_18-0\" class=\"reference\"><a href=\"#cite_note-Rampf,_M._2012-18\" rel=\"external_link\">[18]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> Other role models are latex bearing plants as the weeping fig (Ficus benjamina), the rubber tree (Hevea brasiliensis) and spurges (Euphorbia spp.), in which the coagulation of latex is involved in the sealing of lesions.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> Different self-sealing strategies for elastomeric materials were developed showing significant mechanical restoration after a macroscopic lesion.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Self-healing_polymers_and_elastomers\">Self-healing polymers and elastomers<\/span><\/h2>\n<p>In the last century, polymers became a base material in everyday life for products like plastics, rubbers, films, fibres or paints. This huge demand has forced to extend their reliability and maximum lifetime, and a new design class of polymeric materials that are able to restore their functionality after damage or fatigue was envisaged. These polymer materials can be divided into two different groups based on the approach to the self-healing mechanism: intrinsic or extrinsic.<sup id=\"rdp-ebb-cite_ref-Yang_26-0\" class=\"reference\"><a href=\"#cite_note-Yang-26\" rel=\"external_link\">[26]<\/a><\/sup>\nAutonomous self-healing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymers<\/a> follow a three-step process very similar to that of a biological response. In the event of damage, the first response is triggering or actuation, which happens almost immediately after damage is sustained. The second response is transport of materials to the effected area, which also happens very quickly. The third response is the chemical repair process. This process differs depending on the type of healing mechanism that is in place (e.g., <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymerization\" title=\"Polymerization\" rel=\"external_link\" target=\"_blank\">polymerization<\/a>, entanglement, reversible cross-linking). These self-healing materials can be classified in three different ways: capsule based, vascular, and intrinsic. While similar in some ways, these three ways differ in the ways that response is hidden or prevented until actual damage is sustained.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Polymer_breakdown\">Polymer breakdown<\/span><\/h3>\n<p>From a molecular perspective, traditional polymers yield to mechanical stress through cleavage of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sigma_bond\" title=\"Sigma bond\" rel=\"external_link\" target=\"_blank\">sigma bonds<\/a>.<sup id=\"rdp-ebb-cite_ref-chemreview_27-0\" class=\"reference\"><a href=\"#cite_note-chemreview-27\" rel=\"external_link\">[27]<\/a><\/sup> While newer polymers can yield in other ways, traditional polymers typically yield through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Homolysis_bond_cleavage\" class=\"mw-redirect\" title=\"Homolysis bond cleavage\" rel=\"external_link\" target=\"_blank\">homolytic<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heterolytic_bond_cleavage\" class=\"mw-redirect\" title=\"Heterolytic bond cleavage\" rel=\"external_link\" target=\"_blank\">heterolytic bond cleavage<\/a>. The factors that determine how a polymer will yield include: type of stress, chemical properties inherent to the polymer, level and type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solvation\" title=\"Solvation\" rel=\"external_link\" target=\"_blank\">solvation<\/a>, and temperature.<sup id=\"rdp-ebb-cite_ref-chemreview_27-1\" class=\"reference\"><a href=\"#cite_note-chemreview-27\" rel=\"external_link\">[27]<\/a><\/sup>\nFrom a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Macromolecular\" class=\"mw-redirect\" title=\"Macromolecular\" rel=\"external_link\" target=\"_blank\">macromolecular<\/a> perspective, stress induced damage at the molecular level leads to larger scale damage called microcracks.<sup id=\"rdp-ebb-cite_ref-jrs_28-0\" class=\"reference\"><a href=\"#cite_note-jrs-28\" rel=\"external_link\">[28]<\/a><\/sup> A microcrack is formed where neighboring polymer chains have been damaged in close proximity, ultimately leading to the weakening of the fiber as a whole.<sup id=\"rdp-ebb-cite_ref-jrs_28-1\" class=\"reference\"><a href=\"#cite_note-jrs-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Homolytic_bond_cleavage\">Homolytic bond cleavage<\/span><\/h4>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:281px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HomolyticcleavageofPMMA.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/2\/24\/HomolyticcleavageofPMMA.gif\" width=\"279\" height=\"107\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HomolyticcleavageofPMMA.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><b>Scheme 1.<\/b> Homolytic cleavage of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Poly(methyl_methacrylate)\" title=\"Poly(methyl methacrylate)\" rel=\"external_link\" target=\"_blank\">poly(methyl methacrylate)<\/a> (PMMA).<\/div><\/div><\/div>\n<p>Polymers have been observed to undergo homolytic bond cleavage through the use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radical_(chemistry)\" title=\"Radical (chemistry)\" rel=\"external_link\" target=\"_blank\">radical<\/a> reporters such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/DPPH\" title=\"DPPH\" rel=\"external_link\" target=\"_blank\">DPPH<\/a> (2,2-diphenyl-1-picrylhydrazyl) and PMNB (pentamethylnitrosobenzene.) When a bond is cleaved homolytically, two radical species are formed which can recombine to repair damage or can initiate other homolytic cleavages which can in turn lead to more damage.<sup id=\"rdp-ebb-cite_ref-chemreview_27-2\" class=\"reference\"><a href=\"#cite_note-chemreview-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Heterolytic_bond_cleavage\">Heterolytic bond cleavage<\/span><\/h4>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:290px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HeterolyticcleavageofPEG.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/a\/ae\/HeterolyticcleavageofPEG.gif\" width=\"288\" height=\"92\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HeterolyticcleavageofPEG.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><b>Scheme 2.<\/b> Heterolytic cleavage of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene_glycol\" title=\"Polyethylene glycol\" rel=\"external_link\" target=\"_blank\">polyethylene glycol<\/a>.<\/div><\/div><\/div>\n<p>Polymers have also been observed to undergo heterolytic bond cleavage through isotope labeling experiments. When a bond is cleaved heterolytically, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cationic\" class=\"mw-redirect\" title=\"Cationic\" rel=\"external_link\" target=\"_blank\">cationic<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anionic\" class=\"mw-redirect\" title=\"Anionic\" rel=\"external_link\" target=\"_blank\">anionic<\/a> species are formed which can in turn recombine to repair damage, can be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quenched\" class=\"mw-redirect\" title=\"Quenched\" rel=\"external_link\" target=\"_blank\">quenched<\/a> by solvent, or can react destructively with nearby polymers.<sup id=\"rdp-ebb-cite_ref-chemreview_27-3\" class=\"reference\"><a href=\"#cite_note-chemreview-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Reversible_bond_cleavage\">Reversible bond cleavage<\/span><\/h4>\n<p>Certain polymers yield to mechanical stress in an atypical, reversible manner.<sup id=\"rdp-ebb-cite_ref-mendablepolymers_29-0\" class=\"reference\"><a href=\"#cite_note-mendablepolymers-29\" rel=\"external_link\">[29]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diels-Alder\" class=\"mw-redirect\" title=\"Diels-Alder\" rel=\"external_link\" target=\"_blank\">Diels-Alder<\/a>-based polymers undergo a reversible <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cycloaddition\" title=\"Cycloaddition\" rel=\"external_link\" target=\"_blank\">cycloaddition<\/a>, where mechanical stress cleaves two <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sigma_bond\" title=\"Sigma bond\" rel=\"external_link\" target=\"_blank\">sigma bonds<\/a> in a retro <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diels-Alder\" class=\"mw-redirect\" title=\"Diels-Alder\" rel=\"external_link\" target=\"_blank\">Diels-Alder<\/a> reaction. This stress results in additional pi-bonded electrons as opposed to radical or charged moieties.<sup id=\"rdp-ebb-cite_ref-polylett_2-1\" class=\"reference\"><a href=\"#cite_note-polylett-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Supramolecular_breakdown\">Supramolecular breakdown<\/span><\/h4>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Supramolecular\" class=\"mw-redirect\" title=\"Supramolecular\" rel=\"external_link\" target=\"_blank\">Supramolecular<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymers<\/a> are composed of monomers that interact <a href=\"https:\/\/en.wikipedia.org\/wiki\/Non-covalent\" class=\"mw-redirect\" title=\"Non-covalent\" rel=\"external_link\" target=\"_blank\">non-covalently<\/a>.<sup id=\"rdp-ebb-cite_ref-JMS_30-0\" class=\"reference\"><a href=\"#cite_note-JMS-30\" rel=\"external_link\">[30]<\/a><\/sup> Common interactions include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrogen_bond\" title=\"Hydrogen bond\" rel=\"external_link\" target=\"_blank\">hydrogen bonds<\/a>, metal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coordination_complex\" title=\"Coordination complex\" rel=\"external_link\" target=\"_blank\">coordination<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Van_der_Waals_forces\" class=\"mw-redirect\" title=\"Van der Waals forces\" rel=\"external_link\" target=\"_blank\">van der Waals forces<\/a>.<sup id=\"rdp-ebb-cite_ref-JMS_30-1\" class=\"reference\"><a href=\"#cite_note-JMS-30\" rel=\"external_link\">[30]<\/a><\/sup> Mechanical stress in supramolecular polymers causes the disruption of these specific non-covalent interactions, leading to monomer separation and polymer breakdown.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Intrinsic_polymer-based_systems\">Intrinsic polymer-based systems<\/span><\/h3>\n<p>In intrinsic systems, the material is inherently able to restore its integrity. While extrinsic approaches are generally autonomous, intrinsic systems often require an external trigger for the healing to take place (such as thermo-mechanical, electrical, photo-stimuli, etc.). It is possible to distinguish among 5 main intrinsic self-healing strategies. The first one is based on reversible reactions, and the most widely used reaction scheme is based on Diels-Alder (DA) and retro-Diels-Alder (rDA) reactions.<sup id=\"rdp-ebb-cite_ref-dendrimer_31-0\" class=\"reference\"><a href=\"#cite_note-dendrimer-31\" rel=\"external_link\">[31]<\/a><\/sup> Another strategy achieves the self-healing in thermoset matrices by incorporating meltable thermoplastic additives. A temperature trigger allows the redispertion of thermoplastic additives into cracks, giving rise to mechanical interlocking.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> Polymer interlockings based on dynamic supramolecular bonds or ionomers represent a third and fourth scheme. The involved supramolecular interactions and ionomeric clusters are generally reversible and act as reversible cross-links, thus can equip polymers with self-healing ability.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup> Finally, an alternative method for achieving intrinsic self-healing is based on molecular diffusion.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Reversible_bond-based_polymers\">Reversible bond-based polymers<\/span><\/h4>\n<p>Reversible systems are polymeric systems that can revert to the initial state whether it is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomeric\" class=\"mw-redirect\" title=\"Monomeric\" rel=\"external_link\" target=\"_blank\">monomeric<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oligomeric\" class=\"mw-redirect\" title=\"Oligomeric\" rel=\"external_link\" target=\"_blank\">oligomeric<\/a>, or non-cross-linked. Since the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> is stable under normal condition, the reversible process usually requires an external stimulus for it to occur. For a reversible healing polymer, if the material is damaged by means such as heating and reverted to its constituents, it can be repaired or \"healed\" to its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> form by applying the original condition used to polymerize it.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Polymer_systems_based_on_covalent_bond_formation_and_breakage\">Polymer systems based on covalent bond formation and breakage<\/span><\/h4>\n<h5><span class=\"mw-headline\" id=\"Diels-Alder_and_retro-Diels-Alder\">Diels-Alder and retro-Diels-Alder<\/span><\/h5>\n<p>Among the examples of reversible healing polymers, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diels-Alder\" class=\"mw-redirect\" title=\"Diels-Alder\" rel=\"external_link\" target=\"_blank\">Diels-Alder<\/a> (DA) reaction and its retro-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Diels-Alder\" class=\"mw-redirect\" title=\"Diels-Alder\" rel=\"external_link\" target=\"_blank\">Diels-Alder<\/a> (RDA) analogue seems to be very promising due to its thermal reversibility. In general, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomer<\/a> containing the functional groups such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Furan\" title=\"Furan\" rel=\"external_link\" target=\"_blank\">furan<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Maleimide\" title=\"Maleimide\" rel=\"external_link\" target=\"_blank\">maleimide<\/a> form two carbon-carbon bonds in a specific manner and construct the polymer through DA reaction. This polymer, upon heating, breaks down to its original monomeric units via RDA reaction and then reforms the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> upon cooling or through any other conditions that were initially used to make the polymer. During the last few decades, two types of reversible <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymers<\/a> have been studied: (i) polymers where the pendant groups, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Furan\" title=\"Furan\" rel=\"external_link\" target=\"_blank\">furan<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Maleimide\" title=\"Maleimide\" rel=\"external_link\" target=\"_blank\">maleimide<\/a> groups, cross-link through successive DA coupling reactions; (ii) polymers where the multifunctional monomers link to each other through successive DA coupling reactions.<sup id=\"rdp-ebb-cite_ref-mendablepolymers_29-1\" class=\"reference\"><a href=\"#cite_note-mendablepolymers-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p>\n<h6><span class=\"mw-headline\" id=\"Cross-linked_polymers\">Cross-linked polymers<\/span><\/h6>\n<p>In this type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a>, the polymer forms through the cross linking of the pendant groups from the linear <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoplastics\" class=\"mw-redirect\" title=\"Thermoplastics\" rel=\"external_link\" target=\"_blank\">thermoplastics<\/a>. For example, Saegusa <i>et al.<\/i> have shown the reversible cross-linking of modified poly(<i>N<\/i>-acetylethyleneimine)s containing either <a href=\"https:\/\/en.wikipedia.org\/wiki\/Maleimide\" title=\"Maleimide\" rel=\"external_link\" target=\"_blank\">maleimide<\/a> or furancarbonyl pendant moideties. The reaction is shown in Scheme 3. They mixed the two complementary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymers<\/a> to make a highly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cross-linked\" class=\"mw-redirect\" title=\"Cross-linked\" rel=\"external_link\" target=\"_blank\">cross-linked<\/a> material through DA reaction of furan and maleimide units at room temperature, as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cross-linked\" class=\"mw-redirect\" title=\"Cross-linked\" rel=\"external_link\" target=\"_blank\">cross-linked<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> is more thermodynamically stable than the individual starting materials. However, upon heating the polymer to 80 \u00b0C for two hours in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_polarity\" title=\"Chemical polarity\" rel=\"external_link\" target=\"_blank\">polar<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solvent\" title=\"Solvent\" rel=\"external_link\" target=\"_blank\">solvent<\/a>, two <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomers<\/a> were regenerated via RDA reaction, indicating the breaking of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymers<\/a>.<sup id=\"rdp-ebb-cite_ref-macromolecules_36-0\" class=\"reference\"><a href=\"#cite_note-macromolecules-36\" rel=\"external_link\">[36]<\/a><\/sup> This was possible because the heating energy provided enough energy to go over the energy barrier and results in the two <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomers<\/a>. Cooling the two starting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomers<\/a>, or damaged <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a>, to room temperature for 7 days healed and reformed the polymer. \n<\/p>\n<div class=\"center\"><div class=\"thumb tnone\"><div class=\"thumbinner\" style=\"width:602px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cross-linking_DA.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/eb\/Cross-linking_DA.png\/600px-Cross-linking_DA.png\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cross-linking_DA.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><b>Scheme 3.<\/b> Reversible polymer cross-linking via <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diels-Alder\" class=\"mw-redirect\" title=\"Diels-Alder\" rel=\"external_link\" target=\"_blank\">Diels-Alder<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cycloaddition\" title=\"Cycloaddition\" rel=\"external_link\" target=\"_blank\">cycloaddition<\/a> reaction between furan and maleimide.<sup id=\"rdp-ebb-cite_ref-macromolecules_36-1\" class=\"reference\"><a href=\"#cite_note-macromolecules-36\" rel=\"external_link\">[36]<\/a><\/sup><\/div><\/div><\/div><\/div>\n<p>The reversible DA\/RDA reaction is not limited to furan-meleimides based <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymers<\/a> as it is shown by the work of Schiraldi <i>et al.<\/i> They have shown the reversible cross-linking of polymers bearing pendent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anthracene\" title=\"Anthracene\" rel=\"external_link\" target=\"_blank\">anthracene<\/a> group with maleimides. However, the reversible reaction occurred only partially upon heating to 250 \u00b0C due to the competing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Decomposition\" title=\"Decomposition\" rel=\"external_link\" target=\"_blank\">decomposition<\/a> reaction.<sup id=\"rdp-ebb-cite_ref-Jones_37-0\" class=\"reference\"><a href=\"#cite_note-Jones-37\" rel=\"external_link\">[37]<\/a><\/sup>\n<\/p>\n<h6><span class=\"mw-headline\" id=\"Polymerization_of_multifunctional_monomers\">Polymerization of multifunctional monomers<\/span><\/h6>\n<p>In these systems, the DA reaction takes place in the backbone itself to construct the polymer, not as a link. For polymerization and healing processes of a DA-step-growth <a href=\"https:\/\/en.wikipedia.org\/wiki\/Furan\" title=\"Furan\" rel=\"external_link\" target=\"_blank\">furan<\/a>-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Maleimide\" title=\"Maleimide\" rel=\"external_link\" target=\"_blank\">maleimide<\/a> based polymer (3M4F) were demonstrated by subjecting it to heating\/cooling cycles. Tris-maleimide (3M) and tetra-furan (4F) formed a polymer through DA reaction and, when heated to 120 \u00b0C, de-polymerized through RDA reaction, resulting in the starting materials. Subsequent heating to 90\u2013120 \u00b0C and cooling to room temperature healed the polymer, partially restoring its mechanical properties through intervention.<sup id=\"rdp-ebb-cite_ref-dendrimer_31-1\" class=\"reference\"><a href=\"#cite_note-dendrimer-31\" rel=\"external_link\">[31]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup> The reaction is shown in Scheme 4. \n<\/p>\n<div class=\"center\"><div class=\"thumb tnone\"><div class=\"thumbinner\" style=\"width:402px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:DAstepgrowthpolymer.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fc\/DAstepgrowthpolymer.png\/400px-DAstepgrowthpolymer.png\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:DAstepgrowthpolymer.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><b>Scheme 4.<\/b> Reversible highly cross-linked furan-maleimide based polymer network.<sup id=\"rdp-ebb-cite_ref-dendrimer_31-2\" class=\"reference\"><a href=\"#cite_note-dendrimer-31\" rel=\"external_link\">[31]<\/a><\/sup><\/div><\/div><\/div><\/div>\n<h5><span class=\"mw-headline\" id=\"Thiol-based_polymers\">Thiol-based polymers<\/span><\/h5>\n<p>The thiol-based polymers have <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disulfide_bonds\" class=\"mw-redirect\" title=\"Disulfide bonds\" rel=\"external_link\" target=\"_blank\">disulfide bonds<\/a> that can be reversibly cross-linked through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxidation\" class=\"mw-redirect\" title=\"Oxidation\" rel=\"external_link\" target=\"_blank\">oxidation<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Redox\" title=\"Redox\" rel=\"external_link\" target=\"_blank\">reduction<\/a>. Under reducing condition, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disulfide\" title=\"Disulfide\" rel=\"external_link\" target=\"_blank\">disulfide<\/a> (SS) bridges in the polymer breaks and results in monomers, however, under oxidizing condition, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thiols\" class=\"mw-redirect\" title=\"Thiols\" rel=\"external_link\" target=\"_blank\">thiols<\/a> (SH) of each monomer forms the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disulfide_bond\" class=\"mw-redirect\" title=\"Disulfide bond\" rel=\"external_link\" target=\"_blank\">disulfide bond<\/a>, cross-linking the starting materials to form the polymer. Chujo <i>et al.<\/i> have shown the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thiol\" title=\"Thiol\" rel=\"external_link\" target=\"_blank\">thiol<\/a>-based reversible cross-linked polymer using poly(<i>N<\/i>-acetylethyleneimine). (Scheme 5) <sup id=\"rdp-ebb-cite_ref-disulfidebridge_39-0\" class=\"reference\"><a href=\"#cite_note-disulfidebridge-39\" rel=\"external_link\">[39]<\/a><\/sup>\n<\/p>\n<div class=\"center\"><div class=\"thumb tnone\"><div class=\"thumbinner\" style=\"width:502px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Disulfidebridge.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0c\/Disulfidebridge.png\/500px-Disulfidebridge.png\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Disulfidebridge.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><b>Scheme 5.<\/b> Reversible polymer cross-linking by disulfide bridges.<sup id=\"rdp-ebb-cite_ref-disulfidebridge_39-1\" class=\"reference\"><a href=\"#cite_note-disulfidebridge-39\" rel=\"external_link\">[39]<\/a><\/sup><\/div><\/div><\/div><\/div>\n<h5><span id=\"rdp-ebb-Poly.28urea-urethane.29\"><\/span><span class=\"mw-headline\" id=\"Poly(urea-urethane)\">Poly(urea-urethane)<\/span><\/h5>\n<p>A soft poly(urea-urethane) network uses the metathesis reaction in aromatic disulphides to provide room-temperature self-healing properties, without the need for external catalysts. This chemical reaction is naturally able to create covalent bonds at room temperature, allowing the polymer to autonomously heal without an external source of energy. Left to rest at room temperature, the material mended itself with 80 percent efficiency after only two hours and 97 percent after 24 hours.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2014)\">citation needed<\/span><\/a><\/i>]<\/sup>\nIn 2014 a polyurea <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastomer\" title=\"Elastomer\" rel=\"external_link\" target=\"_blank\">elastomer<\/a>-based material was shown to be self-healing, melding together after being cut in half, without the addition of catalysts or other chemicals. The material also include inexpensive commercially available compounds. The elastomer molecules were tweaked, making the bonds between them longer. The resulting molecules are easier to pull apart from one another and better able to rebond at room temperature with almost the same strength. The rebonding can be repeated. Stretchy, self-healing paints and other coatings recently took a step closer to common use, thanks to research being conducted at the University of Illinois. Scientists there have used \"off-the-shelf\" components to create a polymer that melds back together after being cut in half, without the addition of catalysts or other chemicals.<sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/p><p>The urea-urethane polymers however have glassy transition temperatures below 273 K therefore at room temperature they are gels and their tensile strength is low.<sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup> To optimize the tensile strength the reversible bonding energy, or the polymer length must be increased to increase the degree of covalent or mechanical interlocking respectively. However, increase polymer length inhibits mobility and thereby impairs the ability for polymers to re-reversibly bond. Thus at each polymer length an optimal reversible bonding energy exists.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Extrinsic_polymer-based_systems\">Extrinsic polymer-based systems<\/span><\/h3>\n<p>In extrinsic systems, the healing chemistries are separated from the surrounding polymer in microcapsules or vascular networks, which after material damage\/cracking release their content into the crack plane, reacting and allowing the restoration of material functionalities.<sup id=\"rdp-ebb-cite_ref-BlaiszikKramer2010_44-0\" class=\"reference\"><a href=\"#cite_note-BlaiszikKramer2010-44\" rel=\"external_link\">[44]<\/a><\/sup> \nThese systems can be further subdivided in several categories. While capsule-based polymers sequester the healing agents in little capsules that only release the agents if they are ruptured, vascular self-healing materials sequester the healing agent in capillary type hollow channels which can be interconnected one dimensionally, two dimensionally, or three dimensionally. After one of these capillaries is damaged, the network can be refilled by an outside source or another channel that was not damaged. Intrinsic self-healing materials do not have a sequestered healing agent but instead have a latent self-healing functionality that is triggered by damage or by an outside stimulus.<sup id=\"rdp-ebb-cite_ref-BlaiszikKramer2010_44-1\" class=\"reference\"><a href=\"#cite_note-BlaiszikKramer2010-44\" rel=\"external_link\">[44]<\/a><\/sup> Extrinsic self-healing materials can achieve healing efficiencies over 100% even when the damage is large.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Microcapsule_healing\">Microcapsule healing<\/span><\/h4>\n<p>Capsule-based systems have in common that healing agents are encapsulated into suitable microstructures that rupture upon crack formation and lead to a follow up process in order to restore the materials' properties. If the walls of the capsule are created too thick, they may not fracture when the crack approaches, but if they are too thin, they may rupture prematurely.<sup id=\"rdp-ebb-cite_ref-White2001_46-0\" class=\"reference\"><a href=\"#cite_note-White2001-46\" rel=\"external_link\">[46]<\/a><\/sup> \nIn order for this process to happen at room <a href=\"https:\/\/en.wikipedia.org\/wiki\/Temperature\" title=\"Temperature\" rel=\"external_link\" target=\"_blank\">temperature<\/a>, and for the reactants to remain in a monomeric state within the capsule, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalyst\" class=\"mw-redirect\" title=\"Catalyst\" rel=\"external_link\" target=\"_blank\">catalyst<\/a> is also imbedded into the thermoset. The catalyst lowers the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Energy_barrier\" class=\"mw-redirect\" title=\"Energy barrier\" rel=\"external_link\" target=\"_blank\">energy barrier<\/a> of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_reaction\" title=\"Chemical reaction\" rel=\"external_link\" target=\"_blank\">reaction<\/a> and allows the monomer to polymerize without the addition of heat. The capsules (often made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wax\" title=\"Wax\" rel=\"external_link\" target=\"_blank\">wax<\/a>) around the monomer and the catalyst are important to maintain separation until the crack facilitates the reaction.<sup id=\"rdp-ebb-cite_ref-mendablepolymers_29-2\" class=\"reference\"><a href=\"#cite_note-mendablepolymers-29\" rel=\"external_link\">[29]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Solventpromotedselfhealing_47-0\" class=\"reference\"><a href=\"#cite_note-Solventpromotedselfhealing-47\" rel=\"external_link\">[47]<\/a><\/sup>\nIn the capsule-catalyst system, the encapsulated healing agent is released into the polymer matrix and reacts with the catalyst, already present in the matrix.<sup id=\"rdp-ebb-cite_ref-Brown2002_48-0\" class=\"reference\"><a href=\"#cite_note-Brown2002-48\" rel=\"external_link\">[48]<\/a><\/sup> \nThere are many challenges in designing this type of material. First, the reactivity of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalyst\" class=\"mw-redirect\" title=\"Catalyst\" rel=\"external_link\" target=\"_blank\">catalyst<\/a> must be maintained even after it is enclosed in wax. Additionally, the monomer must flow at a sufficient rate (have low enough <a href=\"https:\/\/en.wikipedia.org\/wiki\/Viscosity\" title=\"Viscosity\" rel=\"external_link\" target=\"_blank\">viscosity<\/a>) to cover the entire crack before it is polymerized, or full healing capacity will not be reached. Finally, the catalyst must quickly dissolve into the monomer in order to react efficiently and prevent the crack from spreading further.<sup id=\"rdp-ebb-cite_ref-Solventpromotedselfhealing_47-1\" class=\"reference\"><a href=\"#cite_note-Solventpromotedselfhealing-47\" rel=\"external_link\">[47]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:302px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dicyclpentadiene_ring-opening_polymerization.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d8\/Dicyclpentadiene_ring-opening_polymerization.png\/300px-Dicyclpentadiene_ring-opening_polymerization.png\" width=\"300\" height=\"87\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dicyclpentadiene_ring-opening_polymerization.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><b>Scheme 6.<\/b> ROMP of DCPD via <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grubbs%27_catalyst\" title=\"Grubbs' catalyst\" rel=\"external_link\" target=\"_blank\">Grubbs' catalyst<\/a><\/div><\/div><\/div>\n<p>This process has been demonstrated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dicyclopentadiene\" title=\"Dicyclopentadiene\" rel=\"external_link\" target=\"_blank\">dicyclopentadiene<\/a> (DCPD) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grubbs%27_catalyst\" title=\"Grubbs' catalyst\" rel=\"external_link\" target=\"_blank\">Grubbs' catalyst<\/a> (benzylidene-bis(tricyclohexylphosphine)dichlororuthenium). Both DCPD and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grubbs%27_catalyst\" title=\"Grubbs' catalyst\" rel=\"external_link\" target=\"_blank\">Grubbs' catalyst<\/a> are imbedded in an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epoxy\" title=\"Epoxy\" rel=\"external_link\" target=\"_blank\">epoxy<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Resin\" title=\"Resin\" rel=\"external_link\" target=\"_blank\">resin<\/a>. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomer<\/a> on its own is relatively unreactive and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymerization\" title=\"Polymerization\" rel=\"external_link\" target=\"_blank\">polymerization<\/a> does not take place. When a microcrack reaches both the capsule containing DCPD and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalyst\" class=\"mw-redirect\" title=\"Catalyst\" rel=\"external_link\" target=\"_blank\">catalyst<\/a>, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomer<\/a> is released from the core\u2013shell microcapsule and comes in contact with exposed catalyst, upon which the monomer undergoes <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ring_opening_metathesis_polymerization\" class=\"mw-redirect\" title=\"Ring opening metathesis polymerization\" rel=\"external_link\" target=\"_blank\">ring opening metathesis polymerization<\/a> (ROMP).<sup id=\"rdp-ebb-cite_ref-Solventpromotedselfhealing_47-2\" class=\"reference\"><a href=\"#cite_note-Solventpromotedselfhealing-47\" rel=\"external_link\">[47]<\/a><\/sup> The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metathesis_reaction\" class=\"mw-redirect\" title=\"Metathesis reaction\" rel=\"external_link\" target=\"_blank\">metathesis<\/a> reaction of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomer<\/a> involves the severance of the two double bonds in favor of new bonds. The presence of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalyst\" class=\"mw-redirect\" title=\"Catalyst\" rel=\"external_link\" target=\"_blank\">catalyst<\/a> allows for the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Energy_barrier\" class=\"mw-redirect\" title=\"Energy barrier\" rel=\"external_link\" target=\"_blank\">energy barrier<\/a> (energy of activation) to be lowered, and the polymerization <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_reaction\" title=\"Chemical reaction\" rel=\"external_link\" target=\"_blank\">reaction<\/a> can proceed at room temperature.<sup id=\"rdp-ebb-cite_ref-grubbs_49-0\" class=\"reference\"><a href=\"#cite_note-grubbs-49\" rel=\"external_link\">[49]<\/a><\/sup> The resulting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> allows the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epoxy\" title=\"Epoxy\" rel=\"external_link\" target=\"_blank\">epoxy<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Composite_material\" title=\"Composite material\" rel=\"external_link\" target=\"_blank\">composite material<\/a> to regain 67% of its former strength.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Grubbs%27_catalyst\" title=\"Grubbs' catalyst\" rel=\"external_link\" target=\"_blank\">Grubbs' catalyst<\/a> is a good choice for this type of system because it is insensitive to air and water, thus robust enough to maintain reactivity within the material. Using a live catalyst is important to promote multiple healing actions.<sup id=\"rdp-ebb-cite_ref-pangbond_50-0\" class=\"reference\"><a href=\"#cite_note-pangbond-50\" rel=\"external_link\">[50]<\/a><\/sup> The major drawback is the cost. It was shown that using more of the catalyst corresponded directly to higher degree of healing. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ruthenium\" title=\"Ruthenium\" rel=\"external_link\" target=\"_blank\">Ruthenium<\/a> is quite costly, which makes it impractical for commercial applications.\n<\/p>\n<div class=\"center\"><div class=\"thumb tnone\"><div class=\"thumbinner\" style=\"width:575px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Polymerization_in_situ.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/2\/28\/Polymerization_in_situ.jpg\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Polymerization_in_situ.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><b>Figure 1.<\/b> Depiction of crack propagation through microcapsule-imbedded material. Monomer microcapsules are represented by pink circles and catalyst is shown by purple dots.<\/div><\/div><\/div><\/div>\n<p>In contrast, in multicapsule systems both the catalyst and the healing agent are encapsulated in different capsules.<sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup> In a third system, called latent functionality, a healing agent is encapsulated, that can react with the polymerizer component that is present in the matrix in the form of residual reactive functionalities.<sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup> In the last approach (phase separation), either the healing agent or the polymerizer is phase-separated in the matrix material.<sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Vascular_approaches\">Vascular approaches<\/span><\/h4>\n<p>The same strategies can be applied in 1D, 2D and 3D vascular based systems.<sup id=\"rdp-ebb-cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\" rel=\"external_link\">[54]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-55\" class=\"reference\"><a href=\"#cite_note-55\" rel=\"external_link\">[55]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Toohey,_K.S._2007_15-1\" class=\"reference\"><a href=\"#cite_note-Toohey,_K.S._2007-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Hollow_tube_approach\">Hollow tube approach<\/span><\/h4>\n<p>For the first method, fragile glass capillaries or fibers are imbedded within a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Composite_material\" title=\"Composite material\" rel=\"external_link\" target=\"_blank\">composite material<\/a>. (Note: this is already a commonly used practice for strengthening materials. See <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiber-reinforced_plastic\" class=\"mw-redirect\" title=\"Fiber-reinforced plastic\" rel=\"external_link\" target=\"_blank\">Fiber-reinforced plastic<\/a>.)<sup id=\"rdp-ebb-cite_ref-cdry_56-0\" class=\"reference\"><a href=\"#cite_note-cdry-56\" rel=\"external_link\">[56]<\/a><\/sup> The resulting porous network is filled with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomer<\/a>. When damage occurs in the material from regular use, the tubes also crack and the monomer is released into the cracks. Other tubes containing a hardening agent also crack and mix with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomer<\/a>, causing the crack to be healed.<sup id=\"rdp-ebb-cite_ref-pangbond_50-1\" class=\"reference\"><a href=\"#cite_note-pangbond-50\" rel=\"external_link\">[50]<\/a><\/sup> There are many things to take into account when introducing hollow tubes into a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystalline_structure\" class=\"mw-redirect\" title=\"Crystalline structure\" rel=\"external_link\" target=\"_blank\">crystalline structure<\/a>. First to consider is that the created channels may compromise the load bearing ability of the material due to the removal of load bearing material.<sup id=\"rdp-ebb-cite_ref-OlugebefolaAragon2010_57-0\" class=\"reference\"><a href=\"#cite_note-OlugebefolaAragon2010-57\" rel=\"external_link\">[57]<\/a><\/sup> Also, the channel diameter, degree of branching, location of branch points, and channel orientation are some of the main things to consider when building up microchannels within a material. Materials that don\u2019t need to withstand much mechanical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deformation_(mechanics)\" title=\"Deformation (mechanics)\" rel=\"external_link\" target=\"_blank\">strain<\/a>, but want self-healing properties, can introduce more microchannels than materials that are meant to be load bearing.<sup id=\"rdp-ebb-cite_ref-OlugebefolaAragon2010_57-1\" class=\"reference\"><a href=\"#cite_note-OlugebefolaAragon2010-57\" rel=\"external_link\">[57]<\/a><\/sup> There are two types of hollow tubes: discrete channels, and interconnected channels.<sup id=\"rdp-ebb-cite_ref-OlugebefolaAragon2010_57-2\" class=\"reference\"><a href=\"#cite_note-OlugebefolaAragon2010-57\" rel=\"external_link\">[57]<\/a><\/sup>\n<\/p>\n<h5><span class=\"mw-headline\" id=\"Discrete_channels\">Discrete channels<\/span><\/h5>\n<p>Discrete channels can be built independently of building the material and are placed in an array throughout the material.<sup id=\"rdp-ebb-cite_ref-OlugebefolaAragon2010_57-3\" class=\"reference\"><a href=\"#cite_note-OlugebefolaAragon2010-57\" rel=\"external_link\">[57]<\/a><\/sup> When creating these microchannels, one major factor to take into account is that the closer the tubes are together, the lower the strength will be, but the more efficient the recovery will be.<sup id=\"rdp-ebb-cite_ref-OlugebefolaAragon2010_57-4\" class=\"reference\"><a href=\"#cite_note-OlugebefolaAragon2010-57\" rel=\"external_link\">[57]<\/a><\/sup> A sandwich structure is a type of discrete channels that consists of tubes in the center of the material, and heals outwards from the middle.<sup id=\"rdp-ebb-cite_ref-WilliamsTrask2007_58-0\" class=\"reference\"><a href=\"#cite_note-WilliamsTrask2007-58\" rel=\"external_link\">[58]<\/a><\/sup> The stiffness of sandwich structures is high, making it an attractive option for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pressurized\" class=\"mw-redirect\" title=\"Pressurized\" rel=\"external_link\" target=\"_blank\">pressurized<\/a> chambers.<sup id=\"rdp-ebb-cite_ref-WilliamsTrask2007_58-1\" class=\"reference\"><a href=\"#cite_note-WilliamsTrask2007-58\" rel=\"external_link\">[58]<\/a><\/sup> For the most part in sandwich structures, the strength of the material is maintained as compared to vascular networks. Also, material shows almost full recovery from damage.<sup id=\"rdp-ebb-cite_ref-WilliamsTrask2007_58-2\" class=\"reference\"><a href=\"#cite_note-WilliamsTrask2007-58\" rel=\"external_link\">[58]<\/a><\/sup>\n<\/p>\n<h5><span class=\"mw-headline\" id=\"Interconnected_networks\">Interconnected networks<\/span><\/h5>\n<p>Interconnected networks are more <a href=\"https:\/\/en.wikipedia.org\/wiki\/Efficiency\" title=\"Efficiency\" rel=\"external_link\" target=\"_blank\">efficient<\/a> than discrete channels, but are harder and more expensive to create.<sup id=\"rdp-ebb-cite_ref-OlugebefolaAragon2010_57-5\" class=\"reference\"><a href=\"#cite_note-OlugebefolaAragon2010-57\" rel=\"external_link\">[57]<\/a><\/sup> The most basic way to create these channels is to apply basic machining principles to create micro scale channel grooves. These techniques yield channels from 600\u2013700 micrometers.<sup id=\"rdp-ebb-cite_ref-OlugebefolaAragon2010_57-6\" class=\"reference\"><a href=\"#cite_note-OlugebefolaAragon2010-57\" rel=\"external_link\">[57]<\/a><\/sup> This technique works great on the two-dimensional plane, but when trying to create a three-dimensional network, they are limited.<sup id=\"rdp-ebb-cite_ref-OlugebefolaAragon2010_57-7\" class=\"reference\"><a href=\"#cite_note-OlugebefolaAragon2010-57\" rel=\"external_link\">[57]<\/a><\/sup>\n<\/p>\n<h5><span class=\"mw-headline\" id=\"Direct_ink_writing\">Direct ink writing<\/span><\/h5>\n<p>The Direct Ink Writing (DIW) technique is a controlled extrusion of viscoelastic inks to create three-dimensional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interconnected\" class=\"mw-redirect\" title=\"Interconnected\" rel=\"external_link\" target=\"_blank\">interconnected<\/a> networks.<sup id=\"rdp-ebb-cite_ref-OlugebefolaAragon2010_57-8\" class=\"reference\"><a href=\"#cite_note-OlugebefolaAragon2010-57\" rel=\"external_link\">[57]<\/a><\/sup> It works by first setting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organic_compound\" title=\"Organic compound\" rel=\"external_link\" target=\"_blank\">organic<\/a> ink in a defined pattern. Then the structure is infiltrated with a material like an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epoxy\" title=\"Epoxy\" rel=\"external_link\" target=\"_blank\">epoxy<\/a>. This epoxy is then <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solidified\" class=\"mw-redirect\" title=\"Solidified\" rel=\"external_link\" target=\"_blank\">solidified<\/a>, and the ink can be sucked out with a modest vacuum, creating the hollow tubes.<sup id=\"rdp-ebb-cite_ref-OlugebefolaAragon2010_57-9\" class=\"reference\"><a href=\"#cite_note-OlugebefolaAragon2010-57\" rel=\"external_link\">[57]<\/a><\/sup>\n<\/p>\n<h5><span class=\"mw-headline\" id=\"Carbon_nanotube_networks\">Carbon nanotube networks<\/span><\/h5>\n<p>Through dissolving a linear <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> inside a solid three-dimensional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epoxy\" title=\"Epoxy\" rel=\"external_link\" target=\"_blank\">epoxy<\/a> matrix, so that they are miscible to each other, the linear polymer becomes mobile at a certain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Temperature\" title=\"Temperature\" rel=\"external_link\" target=\"_blank\">temperature<\/a><sup id=\"rdp-ebb-cite_ref-HayesJones2007_59-0\" class=\"reference\"><a href=\"#cite_note-HayesJones2007-59\" rel=\"external_link\">[59]<\/a><\/sup> When <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_nanotube\" title=\"Carbon nanotube\" rel=\"external_link\" target=\"_blank\">carbon nanotubes<\/a> are also incorporated into epoxy material, and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Direct_current\" title=\"Direct current\" rel=\"external_link\" target=\"_blank\">direct current<\/a> is run through the tubes, a significant shift in sensing curve indicates permanent damage to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a>, thus \u2018sensing\u2019 a crack.<sup id=\"rdp-ebb-cite_ref-ThostensonChou2006_60-0\" class=\"reference\"><a href=\"#cite_note-ThostensonChou2006-60\" rel=\"external_link\">[60]<\/a><\/sup> When the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_nanotube\" title=\"Carbon nanotube\" rel=\"external_link\" target=\"_blank\">carbon nanotubes<\/a> sense a crack within the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Structure\" title=\"Structure\" rel=\"external_link\" target=\"_blank\">structure<\/a>, they can be used as thermal transports to heat up the matrix so the linear <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymers<\/a> can diffuse to fill the cracks in the epoxy matrix. Thus healing the material.<sup id=\"rdp-ebb-cite_ref-HayesJones2007_59-1\" class=\"reference\"><a href=\"#cite_note-HayesJones2007-59\" rel=\"external_link\">[59]<\/a><\/sup>\n<\/p>\n<h5><span class=\"mw-headline\" id=\"SLIPS\">SLIPS<\/span><\/h5>\n<p>A different approach was suggested by Prof. J. Aizenberg from Harvard University, who suggested to use (SLIPS), a porous material inspired by the carnivorous pitcher plant and filled with a lubricating liquid immiscible with both water and oil.<sup id=\"rdp-ebb-cite_ref-aizenberg2011_61-0\" class=\"reference\"><a href=\"#cite_note-aizenberg2011-61\" rel=\"external_link\">[61]<\/a><\/sup> SLIPS possess self-healing and self-lubricating properties as well as icephobicity and were successfully used for many purposes.\n<\/p>\n<h5><span class=\"mw-headline\" id=\"Sacrificial_thread_stitching\">Sacrificial thread stitching<\/span><\/h5>\n<p>Organic threads (such as polylactide filament for example) are stitched through laminate layers of fiber reinforced polymer, which are then boiled and vacuumed out of the material after curing of the polymer, leaving behind empty channels than can be filled with healing agents.<sup id=\"rdp-ebb-cite_ref-Beckman_62-0\" class=\"reference\"><a href=\"#cite_note-Beckman-62\" rel=\"external_link\">[62]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Self-healing_fibre-reinforced_polymer_composites\">Self-healing fibre-reinforced polymer composites<\/span><\/h2>\n<p>Methods for the implementation of self-healing functionality into filled composites and fibre reinforced polymers (FRPs) are almost exclusively based on extrinsic systems and thus can be broadly classified into two approaches; discrete capsule-based systems and continuous vascular systems. In contrast to non-filled polymers, the success of an intrinsic approach based on bond reversibility has yet to be proven in FRPs. \nTo date, self-healing of FRPs has mostly been applied to simple structures such as flat plates and panels. There is however a somewhat limited application of self-healing in flat panels, as access to the panel surface is relatively simple and repair methods are very well established in industry. Instead, there has been a strong focus on implementing self-healing in more complex and industrially relevant structures such as T-Joints<sup id=\"rdp-ebb-cite_ref-63\" class=\"reference\"><a href=\"#cite_note-63\" rel=\"external_link\">[63]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-64\" class=\"reference\"><a href=\"#cite_note-64\" rel=\"external_link\">[64]<\/a><\/sup> and Aircraft Fuselages.<sup id=\"rdp-ebb-cite_ref-65\" class=\"reference\"><a href=\"#cite_note-65\" rel=\"external_link\">[65]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Capsule-based_systems\">Capsule-based systems<\/span><\/h3>\n<p>The creation of a capsule-based system was first reported by White et al. in 2001,<sup id=\"rdp-ebb-cite_ref-White2001_46-1\" class=\"reference\"><a href=\"#cite_note-White2001-46\" rel=\"external_link\">[46]<\/a><\/sup> and this approach has since been adapted by a number of authors for introduction into fibre reinforced materials.<sup id=\"rdp-ebb-cite_ref-KW2001_66-0\" class=\"reference\"><a href=\"#cite_note-KW2001-66\" rel=\"external_link\">[66]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-KSW2003_67-0\" class=\"reference\"><a href=\"#cite_note-KSW2003-67\" rel=\"external_link\">[67]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Patel_68-0\" class=\"reference\"><a href=\"#cite_note-Patel-68\" rel=\"external_link\">[68]<\/a><\/sup> This method relies on the release of an encapsulated healing agent into the damage zone, and is generally a once off process as the functionality of the encapsulated healing agent cannot be restored. Even so, implemented systems are able to restore material integrity to almost 100% and remain stable over the material lifetime.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Vascular_systems\">Vascular systems<\/span><\/h3>\n<p>A vascular or fibre-based approach may be more appropriate for self-healing impact damage in fibre-reinforced polymer composite materials. \nIn this method, a network of hollow channels known as vascules, similar to the blood vessels within human tissue, are placed within the structure and used for the introduction of a healing agent. During a damage event cracks propagate through the material and into the vascules causing them to be cleaved open. A liquid resin is then passed through the vascules and into the damage plane, allowing the cracks to be repaired. Vascular systems have a number of advantages over microcapsule based systems, such as the ability to continuously deliver large volumes of repair agents and the potential to be used for repeated healing. The hollow channels themselves can also be used for additional functionality, such as thermal management and structural health monitoring.<sup id=\"rdp-ebb-cite_ref-Norris_69-0\" class=\"reference\"><a href=\"#cite_note-Norris-69\" rel=\"external_link\">[69]<\/a><\/sup> A number of methods have been proposed for the introduction of these vascules, including the use of hollow glass fibres (HGFs),<sup id=\"rdp-ebb-cite_ref-Bleay_70-0\" class=\"reference\"><a href=\"#cite_note-Bleay-70\" rel=\"external_link\">[70]<\/a><\/sup> \n<sup id=\"rdp-ebb-cite_ref-71\" class=\"reference\"><a href=\"#cite_note-71\" rel=\"external_link\">[71]<\/a><\/sup> 3D printing,<sup id=\"rdp-ebb-cite_ref-Toohey,_K.S._2007_15-2\" class=\"reference\"><a href=\"#cite_note-Toohey,_K.S._2007-15\" rel=\"external_link\">[15]<\/a><\/sup> a \u2018lost wax\u2019 process <sup id=\"rdp-ebb-cite_ref-72\" class=\"reference\"><a href=\"#cite_note-72\" rel=\"external_link\">[72]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-73\" class=\"reference\"><a href=\"#cite_note-73\" rel=\"external_link\">[73]<\/a><\/sup> and a solid preform route.<sup id=\"rdp-ebb-cite_ref-74\" class=\"reference\"><a href=\"#cite_note-74\" rel=\"external_link\">[74]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Self-healing_coatings\">Self-healing coatings<\/span><\/h2>\n<p>Coatings allow the retention and improvement of bulk properties of a material. They can provide protection for a substrate from environmental exposure. Thus, when damage occurs (often in the form of microcracks), environmental elements like water and oxygen can diffuse through the coating and may cause material damage or failure. Microcracking in coatings can result in mechanical degradation or delamination of the coating, or in electrical failure in fibre-reinforced composites and microelectronics, respectively. As the damage is on such a small scale, repair, if possible, is often difficult and costly. Therefore, a coating that can automatically heal itself (\u201cself-healing coating\u201d) could prove beneficial by automatic recovering properties (such as mechanical, electrical and aesthetic properties), and thus extending the lifetime of the coating. The majority of the approaches that are described in literature regarding self-healing materials can be applied to make \u201cself-healing\u201d coatings, including microencapsulation<sup id=\"rdp-ebb-cite_ref-75\" class=\"reference\"><a href=\"#cite_note-75\" rel=\"external_link\">[75]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-White2001_46-2\" class=\"reference\"><a href=\"#cite_note-White2001-46\" rel=\"external_link\">[46]<\/a><\/sup> and the introduction of reversible physical bonds such as hydrogen bonding,<sup id=\"rdp-ebb-cite_ref-Chen2014_76-0\" class=\"reference\"><a href=\"#cite_note-Chen2014-76\" rel=\"external_link\">[76]<\/a><\/sup> ionomers\n<sup id=\"rdp-ebb-cite_ref-Binder_77-0\" class=\"reference\"><a href=\"#cite_note-Binder-77\" rel=\"external_link\">[77]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Varley_78-0\" class=\"reference\"><a href=\"#cite_note-Varley-78\" rel=\"external_link\">[78]<\/a><\/sup> and chemical bonds (Diels-Alder chemistry).<sup id=\"rdp-ebb-cite_ref-79\" class=\"reference\"><a href=\"#cite_note-79\" rel=\"external_link\">[79]<\/a><\/sup> Microencapsulation is the most common method to develop self-healing coatings. The capsule approach originally described by White et al., using microencapsulated dicyclopentadiene (DCPD) monomer and Grubbs\u2019 catalyst to self-heal epoxy polymer<sup id=\"rdp-ebb-cite_ref-White2001_46-3\" class=\"reference\"><a href=\"#cite_note-White2001-46\" rel=\"external_link\">[46]<\/a><\/sup> was later adapted to epoxy adhesive films that are commonly used in the aerospace and automotive industries for bonding metallic and composite substrates.<sup id=\"rdp-ebb-cite_ref-80\" class=\"reference\"><a href=\"#cite_note-80\" rel=\"external_link\">[80]<\/a><\/sup> Recently, microencapsulated liquid suspensions of metal or carbon black were used to restore electrical conductivity in a multilayer microelectronic device and battery electrodes respectively;<sup id=\"rdp-ebb-cite_ref-81\" class=\"reference\"><a href=\"#cite_note-81\" rel=\"external_link\">[81]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-82\" class=\"reference\"><a href=\"#cite_note-82\" rel=\"external_link\">[82]<\/a><\/sup> however the use of microencapsulation for restoration of electrical properties in coatings is limited.\nLiquid metal microdroplets have also been suspended within silicone elastomer to create stretchable electrical conductors that maintain electrical conductivity when damaged, mimicking the resilience of soft biological tissue.<sup id=\"rdp-ebb-cite_ref-83\" class=\"reference\"><a href=\"#cite_note-83\" rel=\"external_link\">[83]<\/a><\/sup> The most common application of this technique is proven in polymer coatings for corrosion protection. Corrosion protection of metallic materials is of significant importance on an economical and ecological scale. To prove the effectiveness of microcapsules in polymer coatings for corrosion protection, researchers have encapsulated a number of materials. These materials include isocyanates<sup id=\"rdp-ebb-cite_ref-84\" class=\"reference\"><a href=\"#cite_note-84\" rel=\"external_link\">[84]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-85\" class=\"reference\"><a href=\"#cite_note-85\" rel=\"external_link\">[85]<\/a><\/sup> monomers such as DCPD<sup id=\"rdp-ebb-cite_ref-Brown2002_48-1\" class=\"reference\"><a href=\"#cite_note-Brown2002-48\" rel=\"external_link\">[48]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-KSW2003_67-1\" class=\"reference\"><a href=\"#cite_note-KSW2003-67\" rel=\"external_link\">[67]<\/a><\/sup> GMA<sup id=\"rdp-ebb-cite_ref-86\" class=\"reference\"><a href=\"#cite_note-86\" rel=\"external_link\">[86]<\/a><\/sup> epoxy resin,<sup id=\"rdp-ebb-cite_ref-87\" class=\"reference\"><a href=\"#cite_note-87\" rel=\"external_link\">[87]<\/a><\/sup> linseed oil<sup id=\"rdp-ebb-cite_ref-88\" class=\"reference\"><a href=\"#cite_note-88\" rel=\"external_link\">[88]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-89\" class=\"reference\"><a href=\"#cite_note-89\" rel=\"external_link\">[89]<\/a><\/sup> and tung oil.<sup id=\"rdp-ebb-cite_ref-90\" class=\"reference\"><a href=\"#cite_note-90\" rel=\"external_link\">[90]<\/a><\/sup> By using the aforementioned materials for self healing in coatings, it was proven that microencapsulation effectively protects the metal against corrosion and extends the lifetime of a coating.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Self-healing_cementitious_materials\">Self-healing cementitious materials<\/span><\/h2>\n<p>Cementitious materials have existed since the Roman era. These materials have a natural ability to self-heal, which was first reported by the French Academy of Science in 1836.<sup id=\"rdp-ebb-cite_ref-State_of_the_art_report_91-0\" class=\"reference\"><a href=\"#cite_note-State_of_the_art_report-91\" rel=\"external_link\">[91]<\/a><\/sup> This ability can be improved by the integration of chemical and biochemical strategies.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Autogenous_healing\">Autogenous healing<\/span><\/h3>\n<p>Autogenous healing is the natural ability of cementitious materials to repair cracks. This ability is principally attributed to further hydration of unhydrated cement particles and carbonation of dissolved calcium hydroxide.<sup id=\"rdp-ebb-cite_ref-State_of_the_art_report_91-1\" class=\"reference\"><a href=\"#cite_note-State_of_the_art_report-91\" rel=\"external_link\">[91]<\/a><\/sup> Cementitious materials in fresh-water systems can autogenously heal cracks up to 0.2 mm over a period of 7 weeks.<sup id=\"rdp-ebb-cite_ref-Carola_92-0\" class=\"reference\"><a href=\"#cite_note-Carola-92\" rel=\"external_link\">[92]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Chemical_additives_based_healing\">Chemical additives based healing<\/span><\/h3>\n<p>Self-healing of cementitious materials can be achieved through the reaction of certain chemical agents. Two main strategies exist for housing these agents, namely capsules and vascular tubes. These capsules and vascular tubes, once ruptured, release these agents and heal the crack damage. Studies have mainly focused on improving the quality of these housings and encapsulated materials in this field.<sup id=\"rdp-ebb-cite_ref-93\" class=\"reference\"><a href=\"#cite_note-93\" rel=\"external_link\">[93]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Bio-based_healing\">Bio-based healing<\/span><\/h3>\n<p>The self-healing ability of concrete has been improved by the incorporation of bacteria, which can induce calcium carbonate precipitation through their metabolic activity.<sup id=\"rdp-ebb-cite_ref-94\" class=\"reference\"><a href=\"#cite_note-94\" rel=\"external_link\">[94]<\/a><\/sup> These precipitates can build up and form an effective seal against crack related water ingress. Jonkers et al. first incorporated bacteria within cement paste for the development of self-healing concrete.<sup id=\"rdp-ebb-cite_ref-95\" class=\"reference\"><a href=\"#cite_note-95\" rel=\"external_link\">[95]<\/a><\/sup> It was found that the bacteria directly added to the paste only remained viable for 4 months. Later studies saw Jonkers use expanded clay particles<sup id=\"rdp-ebb-cite_ref-96\" class=\"reference\"><a href=\"#cite_note-96\" rel=\"external_link\">[96]<\/a><\/sup> and Van Tittlelboom use glass tubes,<sup id=\"rdp-ebb-cite_ref-97\" class=\"reference\"><a href=\"#cite_note-97\" rel=\"external_link\">[97]<\/a><\/sup> to protect the bacteria inside the concrete. Other strategies to protect the bacteria have also since been reported.<sup id=\"rdp-ebb-cite_ref-98\" class=\"reference\"><a href=\"#cite_note-98\" rel=\"external_link\">[98]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Self-healing_ceramics\">Self-healing ceramics<\/span><\/h2>\n<p>Generally, ceramics are superior in strength to metals at high temperatures, however, they are brittle and sensitive to flaws, and this brings into question their integrity and reliability as structural materials.<sup id=\"rdp-ebb-cite_ref-99\" class=\"reference\"><a href=\"#cite_note-99\" rel=\"external_link\">[99]<\/a><\/sup>\n<span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/7526656bf20bfeb73ce603c4be54a4c43a33a504\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -1.171ex; width:10.03ex; height:3.009ex;\" alt=\"{\\displaystyle {\\ce {M_{{\\mathit {n}}+1}AX_{\\mathit {n}}}}}\"\/><\/span> phase ceramics, also known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/MAX_Phases\" class=\"mw-redirect\" title=\"MAX Phases\" rel=\"external_link\" target=\"_blank\">MAX Phases<\/a>, can autonomously heal crack damage by an intrinsic healing mechanism. Micro cracks caused by wear or thermal stress are filled with oxides formed from the MAX phase constituents, commonly the A-element, during high temperature exposure to air.<sup id=\"rdp-ebb-cite_ref-Number_2_100-0\" class=\"reference\"><a href=\"#cite_note-Number_2-100\" rel=\"external_link\">[100]<\/a><\/sup>\nCrack gap filling was first demonstrated for Ti<sub>3<\/sub>AlC<sub>2<\/sub> by oxidation at 1200 \u00b0C in air.<sup id=\"rdp-ebb-cite_ref-101\" class=\"reference\"><a href=\"#cite_note-101\" rel=\"external_link\">[101]<\/a><\/sup> Ti<sub>2<\/sub>AlC and Cr<sub>2<\/sub>AlC have also demonstrated said ability, and more ternary carbides and nitrides are expected to be able to autonomously self-heal.<sup id=\"rdp-ebb-cite_ref-102\" class=\"reference\"><a href=\"#cite_note-102\" rel=\"external_link\">[102]<\/a><\/sup> The process is repeatable up to the point of element depletion, distinguishing MAX phases from other self-healing materials that require external healing agents (extrinsic healing) for single crack gap filling. Depending on the filling-oxide, improvement of the initial properties such as local strength can be achieved.<sup id=\"rdp-ebb-cite_ref-103\" class=\"reference\"><a href=\"#cite_note-103\" rel=\"external_link\">[103]<\/a><\/sup>\nOn the other hand, mullite, alumina and zirconia do not have the ability to heal intrinsically, but could be endowed with self-healing capabilities by embedding second phase components into the matrix. Upon cracking, these particles are exposed to oxygen, and in the presence of heat, they react to form new materials which fill the crack gap under volume expansion.<sup id=\"rdp-ebb-cite_ref-104\" class=\"reference\"><a href=\"#cite_note-104\" rel=\"external_link\">[104]<\/a><\/sup>\nThis concept has been proven using SiC to heal cracks in an Alumina matrix,<sup id=\"rdp-ebb-cite_ref-105\" class=\"reference\"><a href=\"#cite_note-105\" rel=\"external_link\">[105]<\/a><\/sup> and further studies have investigated the high temperature strength,<sup id=\"rdp-ebb-cite_ref-106\" class=\"reference\"><a href=\"#cite_note-106\" rel=\"external_link\">[106]<\/a><\/sup> and the static and cyclic fatigue strength of the healed part.<sup id=\"rdp-ebb-cite_ref-107\" class=\"reference\"><a href=\"#cite_note-107\" rel=\"external_link\">[107]<\/a><\/sup> The strength and bonding between the matrix and the healing agent are of prime importance and thus govern the selection of the healing particles.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Self-healing_metals\">Self-healing metals<\/span><\/h3>\n<p>When exposed for long times to high temperatures and moderate stresses, metals exhibit premature and low-ductility creep fracture, arising from the formation and growth of cavities. Those defects coalesce into cracks which ultimately cause macroscopic failure. Self-healing of early stage damage is thus a promising new approach to extend the lifetime of the metallic components. In metals, self-healing is intrinsically more difficult to achieve than in most other material classes, due to their high melting point and, as a result, low atom mobility. Generally, defects in the metals are healed by the formation of precipitates at the defect sites that immobilize further crack growth.\nImproved creep and fatigue properties have been reported for underaged aluminium alloys compared to the peak hardening Al alloys, which is due to the heterogeneous precipitation at the crack tip and its plastic zone.<sup id=\"rdp-ebb-cite_ref-108\" class=\"reference\"><a href=\"#cite_note-108\" rel=\"external_link\">[108]<\/a><\/sup> The first attempts to heal creep damage in steels were focused on the dynamic precipitation of either Cu or BN at the creep-cavity surface.<sup id=\"rdp-ebb-cite_ref-109\" class=\"reference\"><a href=\"#cite_note-109\" rel=\"external_link\">[109]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-110\" class=\"reference\"><a href=\"#cite_note-110\" rel=\"external_link\">[110]<\/a><\/sup> Cu precipitation has only a weak preference for deformation-induced defects as a large fraction of spherical Cu precipitates is simultaneously formed with the matrix.<sup id=\"rdp-ebb-cite_ref-111\" class=\"reference\"><a href=\"#cite_note-111\" rel=\"external_link\">[111]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-112\" class=\"reference\"><a href=\"#cite_note-112\" rel=\"external_link\">[112]<\/a><\/sup> \nRecently, gold atoms were recognized as a highly efficient healing agents in Fe-based alloys. A defect-induced mechanism is indicated for the Au precipitation, i.e. the Au solute remains dissolved until defects are formed.<sup id=\"rdp-ebb-cite_ref-113\" class=\"reference\"><a href=\"#cite_note-113\" rel=\"external_link\">[113]<\/a><\/sup> Autonomous repair of high-temperature creep damage was reported by alloying with a small amount of Au. Healing agents selectively precipitate at the free surface of a creep cavity, resulting in pore filling. For the lower stress levels up to 80% filling of the creep cavities with Au precipitates is achieved<sup id=\"rdp-ebb-cite_ref-114\" class=\"reference\"><a href=\"#cite_note-114\" rel=\"external_link\">[114]<\/a><\/sup> resulting in a substantial increase in creep life time. Work to translate the concept of creep damage healing in simple binary or ternary model systems to real multicomponent creep steels is ongoing.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Self-healing_organic_dyes\">Self-healing organic dyes<\/span><\/h2>\n<p>Recently, a several classes of organic dyes are discovered that self-heal after <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photodegradation\" title=\"Photodegradation\" rel=\"external_link\" target=\"_blank\">photo-degradation<\/a> when doped in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Poly(methyl_methacrylate)\" title=\"Poly(methyl methacrylate)\" rel=\"external_link\" target=\"_blank\">PMMA<\/a> and other polymer matrices.<sup id=\"rdp-ebb-cite_ref-115\" class=\"reference\"><a href=\"#cite_note-115\" rel=\"external_link\">[115]<\/a><\/sup> This is also knows as reversible <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photodegradation\" title=\"Photodegradation\" rel=\"external_link\" target=\"_blank\">photo-degradation<\/a>. It was shown that, unlike common process like molecular diffusion,<sup id=\"rdp-ebb-cite_ref-116\" class=\"reference\"><a href=\"#cite_note-116\" rel=\"external_link\">[116]<\/a><\/sup> the mechanism is caused by dye-polymer interaction.<sup id=\"rdp-ebb-cite_ref-117\" class=\"reference\"><a href=\"#cite_note-117\" rel=\"external_link\">[117]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Further_applications\">Further applications<\/span><\/h2>\n<p>Self-healing epoxies can be incorporated on to metals in order to prevent corrosion.\nA substrate metal showed major degradation and rust formation after 72 hours of exposure. But after being coated with the self-healing epoxy, there was no visible damage under SEM after 72 hours of same exposure.<sup id=\"rdp-ebb-cite_ref-YangWei2011_118-0\" class=\"reference\"><a href=\"#cite_note-YangWei2011-118\" rel=\"external_link\">[118]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Assessment_of_self-healing_efficacy\">Assessment of self-healing efficacy<\/span><\/h2>\n<p>Numerous methodologies for the assessment of self-healing capabilities have been developed for each material class (Table 1).\n<\/p>\n<table class=\"wikitable\" style=\"\">\n<caption>Table 1. Damaging methods for self-healing assessment of different classes of material.\n<\/caption>\n<tbody><tr>\n<th>Material class<\/th>\n<th>Damage mechanism<\/th>\n<th>Healing\n<\/th><\/tr>\n<tr>\n<td>Polymers<\/td>\n<td>Razor blade\/scalpel cut; Tensile test with rupture; Ballistic impact<\/td>\n<td>Autonomic healing supramolecular networks\n<\/td><\/tr>\n<tr>\n<td>Polymers<\/td>\n<td>Razor blade\/scalpel cut<\/td>\n<td>Temperature triggered supramolecular networks\n<\/td><\/tr>\n<tr>\n<td>Fibre Reinforced Composite<\/td>\n<td>Delamination BVID (Barely Visible Impact Damage)<\/td>\n<td>Vascular self-healing; Microcapsule self-healing\n<\/td><\/tr>\n<tr>\n<td>Coatings<\/td>\n<td>Microcutting with corrosion; Corrosion\/erosion; Pull-out tests (adhesion); Microscratching<\/td>\n<td>Molecular inter-diffusion (solvent); Encapsulated agent\n<\/td><\/tr>\n<tr>\n<td>Concrete<\/td>\n<td>Crack initiation by bending compression<\/td>\n<td>Activation of microencapsulated agent\n<\/td><\/tr>\n<tr>\n<td>Ceramic<\/td>\n<td>Crack initiation by indentation<\/td>\n<td>Temperature triggered oxidation reaction\n<\/td><\/tr>\n<tr>\n<td>Ceramic coating<\/td>\n<td>Crack initiation by indentation<\/td>\n<td>Temperature triggered oxidation reaction\n<\/td><\/tr>\n<tr>\n<td>Polyurethane foam coating<\/td>\n<td>Puncturing with a spike<\/td>\n<td>Reduction of the effective leakage area by negative strains pushing the walls of the fissure in the foam coatings to one another.<sup id=\"rdp-ebb-cite_ref-Rampf,_M._2012_18-1\" class=\"reference\"><a href=\"#cite_note-Rampf,_M._2012-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/td><\/tr><\/tbody><\/table>\n<p>Hence, when self-healing is assessed, different parameters need to be considered: type of stimulus (if any), healing time, maximum amount of healing cycles the material can tolerate, and degree of recovery, all whilst considering the material's virgin properties.<sup id=\"rdp-ebb-cite_ref-119\" class=\"reference\"><a href=\"#cite_note-119\" rel=\"external_link\">[119]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-120\" class=\"reference\"><a href=\"#cite_note-120\" rel=\"external_link\">[120]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Chen2014_76-1\" class=\"reference\"><a href=\"#cite_note-Chen2014-76\" rel=\"external_link\">[76]<\/a><\/sup>\nThis typically takes account of relevant physical parameters such as tensile modulus, elongation at break, fatigue-resistance, barrier properties, colour and transparency.\nThe self-healing ability of a given material generally refers to the recovery of a specific property relative to the virgin material, designated as the self-healing efficiency. The self-healing efficiency can be quantified by comparing the respective experimental value obtained for the undamaged virgin sample (<i>f<\/i><sub>virgin<\/sub>) with the healed sample (<i>f<\/i><sub>healed<\/sub>) (eq. <b><a href=\"#math_1\" rel=\"external_link\">1<\/a><\/b>)<sup id=\"rdp-ebb-cite_ref-Mauldin_121-0\" class=\"reference\"><a href=\"#cite_note-Mauldin-121\" rel=\"external_link\">[121]<\/a><\/sup>\n<\/p>\n<dl><dd>\n<table style=\"border-collapse:collapse; background:none; margin:0; border:none;\">\n<tbody><tr>\n<td style=\"vertical-align:middle; border:none; padding:0.08em;\" class=\"nowrap\"><p style=\"margin:0;\"><i>\u03b7<\/i> = <span class=\"sfrac nowrap\" style=\"display:inline-block; vertical-align:-0.5em; font-size:85%; text-align:center;\"><span style=\"display:block; line-height:1em; margin:0 0.1em;\"><i>f<\/i><sub>healed<\/sub><\/span><span class=\"visualhide\">\/<\/span><span style=\"display:block; line-height:1em; margin:0 0.1em; border-top:1px solid;\"><i>f<\/i><sub>virgin<\/sub><\/span><\/span><\/p>\n<\/td>\n<td style=\"vertical-align:middle; width:99%; border:none; padding:0.08em;\">\n<div style=\"margin:0;\">\n<table style=\"border-collapse:collapse; background:none; margin:0; border:none; width:99%;\">\n<tbody><tr>\n<td style=\"border:none; padding:0.08em;\" rowspan=\"2\"><p style=\"margin:0; font-size:4pt;\"> <\/p>\n<\/td>\n<td style=\"width:100%; border:none; padding:0.08em;\"><p style=\"margin:0; font-size:1pt;\"> <\/p>\n<\/td>\n<td style=\"border:none; padding:0.08em;\" rowspan=\"2\"><p style=\"margin:0; font-size:4pt;\"> <\/p>\n<\/td><\/tr>\n<tr>\n<td style=\"border-left:none; border-top:0px none #e5e5e5; border-right:none; border-bottom:none; padding:0.08em;\">\n<p style=\"margin:0; font-size:1pt;\"> <\/p>\n<\/td><\/tr><\/tbody><\/table>\n<\/div>\n<\/td>\n<td style=\"vertical-align:middle; border:none; padding:0.08em;\" class=\"nowrap\"><p style=\"margin:0pt;\"><b>(<span id=\"rdp-ebb-math_1\" class=\"reference nourlexpansion\" style=\"font-weight:bold; font-style:italic;\">1<\/span>)<\/b><\/p>\n<\/td><\/tr><\/tbody><\/table><\/dd><\/dl>\n<p>In a variation of this definition that is relevant to extrinsic self-healing materials, the healing efficiency takes into consideration the modification of properties caused by introducing the healing agent. Accordingly, the healed sample property is compared to that of an undamaged control equipped with self-healing agent f<sub>non-healed<\/sub> (equation <b><a href=\"#math_2\" rel=\"external_link\">2<\/a><\/b>).\n<\/p>\n<dl><dd>\n<table style=\"border-collapse:collapse; background:none; margin:0; border:none;\">\n<tbody><tr>\n<td style=\"vertical-align:middle; border:none; padding:0.08em;\" class=\"nowrap\"><p style=\"margin:0;\"><i>\u03b7<\/i> = <span class=\"sfrac nowrap\" style=\"display:inline-block; vertical-align:-0.5em; font-size:85%; text-align:center;\"><span style=\"display:block; line-height:1em; margin:0 0.1em;\"><i>f<\/i><sub>healed<\/sub><\/span><span class=\"visualhide\">\/<\/span><span style=\"display:block; line-height:1em; margin:0 0.1em; border-top:1px solid;\"><i>f<\/i><sub>non-healed<\/sub><\/span><\/span><\/p>\n<\/td>\n<td style=\"vertical-align:middle; width:99%; border:none; padding:0.08em;\">\n<div style=\"margin:0;\">\n<table style=\"border-collapse:collapse; background:none; margin:0; border:none; width:99%;\">\n<tbody><tr>\n<td style=\"border:none; padding:0.08em;\" rowspan=\"2\"><p style=\"margin:0; font-size:4pt;\"> <\/p>\n<\/td>\n<td style=\"width:100%; border:none; padding:0.08em;\"><p style=\"margin:0; font-size:1pt;\"> <\/p>\n<\/td>\n<td style=\"border:none; padding:0.08em;\" rowspan=\"2\"><p style=\"margin:0; font-size:4pt;\"> <\/p>\n<\/td><\/tr>\n<tr>\n<td style=\"border-left:none; border-top:0px none #e5e5e5; border-right:none; border-bottom:none; padding:0.08em;\">\n<p style=\"margin:0; font-size:1pt;\"> <\/p>\n<\/td><\/tr><\/tbody><\/table>\n<\/div>\n<\/td>\n<td style=\"vertical-align:middle; border:none; padding:0.08em;\" class=\"nowrap\"><p style=\"margin:0pt;\"><b>(<span id=\"rdp-ebb-math_2\" class=\"reference nourlexpansion\" style=\"font-weight:bold; font-style:italic;\">2<\/span>)<\/b><\/p>\n<\/td><\/tr><\/tbody><\/table><\/dd><\/dl>\n<p>For a certain property Pi of a specific material, an optimal self-healing mechanism and process is characterized by the full restoration of the respective material property after a suitable, normalized damaging process. For a material where 3 different properties are assessed, it should be determined 3 efficiencies given as <i>\u019e<\/i><sub>1<\/sub>(<i>P<\/i><sub>1<\/sub>), <i>\u019e<\/i><sub>2<\/sub>(<i>P<\/i><sub>2<\/sub>) and <i>\u019e<\/i><sub>3<\/sub>(<i>P<\/i><sub>3<\/sub>).\nThe final average efficiency based on a number n of properties for a self-healing material is accordingly determined as the harmonic mean given by equation <b><a href=\"#math_3\" rel=\"external_link\">3<\/a><\/b>. The harmonic mean is more appropriate than the traditional arithmetic mean, as it is less sensitive to large outliers.\n<\/p>\n<dl><dd>\n<table style=\"border-collapse:collapse; background:none; margin:0; border:none;\">\n<tbody><tr>\n<td style=\"vertical-align:middle; border:none; padding:0.08em;\" class=\"nowrap\"><p style=\"margin:0;\"><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/1e22658b5ab39257ddc4dfb03dcf839cf1e060da\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -4.505ex; width:18.547ex; height:7.343ex;\" alt=\"{\\displaystyle {\\bar {\\eta }}={\\frac {n}{\\sum _{i=1}^{n}\\left({\\frac {1}{\\eta _{i}(P)}}\\right)}}}\"\/><\/span><\/p>\n<\/td>\n<td style=\"vertical-align:middle; width:99%; border:none; padding:0.08em;\">\n<div style=\"margin:0;\">\n<table style=\"border-collapse:collapse; background:none; margin:0; border:none; width:99%;\">\n<tbody><tr>\n<td style=\"border:none; padding:0.08em;\" rowspan=\"2\"><p style=\"margin:0; font-size:4pt;\"> <\/p>\n<\/td>\n<td style=\"width:100%; border:none; padding:0.08em;\"><p style=\"margin:0; font-size:1pt;\"> <\/p>\n<\/td>\n<td style=\"border:none; padding:0.08em;\" rowspan=\"2\"><p style=\"margin:0; font-size:4pt;\"> <\/p>\n<\/td><\/tr>\n<tr>\n<td style=\"border-left:none; border-top:0px none #e5e5e5; border-right:none; border-bottom:none; padding:0.08em;\">\n<p style=\"margin:0; font-size:1pt;\"> <\/p>\n<\/td><\/tr><\/tbody><\/table>\n<\/div>\n<\/td>\n<td style=\"vertical-align:middle; border:none; padding:0.08em;\" class=\"nowrap\"><p style=\"margin:0pt;\"><b>(<span id=\"rdp-ebb-math_3\" class=\"reference nourlexpansion\" style=\"font-weight:bold; font-style:italic;\">3<\/span>)<\/b><\/p>\n<\/td><\/tr><\/tbody><\/table><\/dd><\/dl>\n<h2><span class=\"mw-headline\" id=\"Commercialization\">Commercialization<\/span><\/h2>\n<p>At least two companies are attempting to bring the newer applications of self-healing materials to the market. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arkema\" title=\"Arkema\" rel=\"external_link\" target=\"_blank\">Arkema<\/a>, a leading chemicals company, announced in 2009 the beginning of industrial production of self-healing elastomers.<sup id=\"rdp-ebb-cite_ref-122\" class=\"reference\"><a href=\"#cite_note-122\" rel=\"external_link\">[122]<\/a><\/sup> As of 2012, Autonomic Materials Inc., had raised over three million US dollars.<sup id=\"rdp-ebb-cite_ref-Bourzac_123-0\" class=\"reference\"><a href=\"#cite_note-Bourzac-123\" rel=\"external_link\">[123]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-124\" class=\"reference\"><a href=\"#cite_note-124\" rel=\"external_link\">[124]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-Ghosh-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Ghosh_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ghosh_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Ghosh, Swapan Kumar (2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=4NH64BONX94C&pg=PA145\" target=\"_blank\"><i>Self-healing materials : fundamentals, design Strategies, and applications<\/i><\/a> (1st ed.). Weinheim: Wiley - VCH. p. 145. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-527-31829-2.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Self-healing+materials+%3A+fundamentals%2C+design+Strategies%2C+and+applications&rft.place=Weinheim&rft.pages=145&rft.edition=1st&rft.pub=Wiley+-+VCH&rft.date=2008&rft.isbn=978-3-527-31829-2&rft.aulast=Ghosh&rft.aufirst=Swapan+Kumar&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3D4NH64BONX94C%26pg%3DPA145&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-polylett-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-polylett_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-polylett_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zang, M.Q. (2008). \"Self healing in polymers and polymer composites. Concepts, realization and outlook: A review\". <i>Polymer Letters<\/i>. <b>2<\/b> (4): 238\u2013250. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3144%2Fexpresspolymlett.2008.29\" target=\"_blank\">10.3144\/expresspolymlett.2008.29<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Polymer+Letters&rft.atitle=Self+healing+in+polymers+and+polymer+composites.+Concepts%2C+realization+and+outlook%3A+A+review&rft.volume=2&rft.issue=4&rft.pages=238-250&rft.date=2008&rft_id=info%3Adoi%2F10.3144%2Fexpresspolymlett.2008.29&rft.au=Zang%2C+M.Q.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Wayman-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Wayman_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Wayman_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wayman, Erin (November 16, 2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.smithsonianmag.com\/history\/the-secrets-of-ancient-romes-buildings-234992\/?no-ist\" target=\"_blank\">\"The Secrets of Ancient Rome's Buildings\"<\/a>. <i>Smithsonian<\/i><span class=\"reference-accessdate\">. 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Retrieved <span class=\"nowrap\">17 November<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Boston+Globe&rft.atitle=Why+is+ancient+Roman+concrete+still+standing%3F&rft.date=2014-12-19&rft.aulast=Hartnett&rft.aufirst=Kevin&rft_id=https%3A%2F%2Fwww.bostonglobe.com%2Fideas%2F2014%2F12%2F19%2Fwhy-ancient-roman-concrete-still-standing%2FED4F1Mg8FJSBO6bGo5ekIP%2Fstory.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Jackson-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Jackson_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jackson, Marie D.; Landis, Eric N.; Brune, Philip F.; Vitti, Massimo; Chen, Heng; Li, Qinfei; Kunz, Martin; Wenk, Hans-Rudolf; Monteiro, Paulo J. 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(30 December 2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4284584\" target=\"_blank\">\"Mechanical resilience and cementitious processes in Imperial Roman architectural mortar\"<\/a>. <i>Proceedings of the National Academy of Sciences<\/i>. <b>111<\/b> (52): 18484\u201318489. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2014PNAS..11118484J\" target=\"_blank\">2014PNAS..11118484J<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1073%2Fpnas.1417456111\" target=\"_blank\">10.1073\/pnas.1417456111<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4284584\" target=\"_blank\">4284584<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25512521\" target=\"_blank\">25512521<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+the+National+Academy+of+Sciences&rft.atitle=Mechanical+resilience+and+cementitious+processes+in+Imperial+Roman+architectural+mortar&rft.volume=111&rft.issue=52&rft.pages=18484-18489&rft.date=2014-12-30&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4284584&rft_id=info%3Apmid%2F25512521&rft_id=info%3Adoi%2F10.1073%2Fpnas.1417456111&rft_id=info%3Abibcode%2F2014PNAS..11118484J&rft.aulast=Jackson&rft.aufirst=Marie+D.&rft.au=Landis%2C+Eric+N.&rft.au=Brune%2C+Philip+F.&rft.au=Vitti%2C+Massimo&rft.au=Chen%2C+Heng&rft.au=Li%2C+Qinfei&rft.au=Kunz%2C+Martin&rft.au=Wenk%2C+Hans-Rudolf&rft.au=Monteiro%2C+Paulo+J.+M.&rft.au=Ingraffea%2C+Anthony+R.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4284584&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Delft_University_of_Technology-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Delft_University_of_Technology_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/tudelft.nl\/en\/current\/latest-news\/article\/detail\/eerste-internationale-conferentie-over-zelfherstellende-materialen-1\/\" target=\"_blank\">\"First international conference on self-healing materials\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Delft_University_of_Technology\" title=\"Delft University of Technology\" rel=\"external_link\" target=\"_blank\">Delft University of Technology<\/a>. 12 April 2007<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 May<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=First+international+conference+on+self-healing+materials&rft.date=2007-04-12&rft_id=http%3A%2F%2Ftudelft.nl%2Fen%2Fcurrent%2Flatest-news%2Farticle%2Fdetail%2Feerste-internationale-conferentie-over-zelfherstellende-materialen-1%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Nosonovsky-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Nosonovsky_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\n<cite class=\"citation book\">Nosonovsky, M.; Rohatgi, P. (2011). <i>Biomimetics in Materials Science: Self-healing, self-lubricating, and self-cleaning materials<\/i>. Springer Series in Materials Science. <b>152<\/b>. Springer. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-4614-0925-0.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Biomimetics+in+Materials+Science%3A+Self-healing%2C+self-lubricating%2C+and+self-cleaning+materials&rft.series=Springer+Series+in+Materials+Science&rft.pub=Springer&rft.date=2011&rft.isbn=978-1-4614-0925-0&rft.aulast=Nosonovsky&rft.aufirst=M.&rft.au=Rohatgi%2C+P.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Speck, T.; M\u00fclhaupt, R.; Speck, O. 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The Royal Chemical Society. pp. 359\u2013389.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Bio-inspired+self-healing+materials&rft.btitle=Materials+Design+Inspired+by+Nature%3A+Function+through+Inner+Architecture&rft.series=RSC+Smart+Materials&rft.pages=359-389&rft.pub=The+Royal+Chemical+Society&rft.date=2013&rft.aulast=Speck&rft.aufirst=T.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Uses editors parameter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Uses_editors_parameter\" title=\"Category:CS1 maint: Uses editors parameter\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Speck, O.; Luchsinger, R.; Rampf, M.; Speck, T. (2014). \"Selbstreparatur in Natur und Technik. \u2013 Konstruktion\": 9: 72\u201375 + 82.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Selbstreparatur+in+Natur+und+Technik.+%E2%80%93+Konstruktion.&rft.pages=9%3A+72-75+%2B+82&rft.date=2014&rft.aulast=Speck&rft.aufirst=O.&rft.au=Luchsinger%2C+R.&rft.au=Rampf%2C+M.&rft.au=Speck%2C+T.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Konrad, W., Flues, F., Schmich, F., Speck, T., Speck, O. 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(2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2880149\" target=\"_blank\">\"Morphological aspects of self-repair of lesions caused by internal growth stresses in stems of Aristolochia macrophylla and Aristolochia ringens\"<\/a>. <i>Proceedings of the Royal Society of London B<\/i>. <b>277<\/b> (1691): 2113\u20132120. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1098%2Frspb.2010.0075\" target=\"_blank\">10.1098\/rspb.2010.0075<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2880149\" target=\"_blank\">2880149<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20236971\" target=\"_blank\">20236971<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+the+Royal+Society+of+London+B&rft.atitle=Morphological+aspects+of+self-repair+of+lesions+caused+by+internal+growth+stresses+in+stems+of+Aristolochia+macrophylla+and+Aristolochia+ringens&rft.volume=277&rft.issue=1691&rft.pages=2113-2120&rft.date=2010&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2880149&rft_id=info%3Apmid%2F20236971&rft_id=info%3Adoi%2F10.1098%2Frspb.2010.0075&rft.au=Busch%2C+S.%2C+Seidel%2C+R.%2C+Speck%2C+O.%2C+Speck%2C+T.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2880149&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Rampf,_M._2012-18\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Rampf,_M._2012_18-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Rampf,_M._2012_18-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rampf, M., Speck, O., Speck, T., Luchsinger, R. 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(2011). \"Self-repairing membranes for inflatable structures inspired by a rapid wound sealing process of climbing plants\". <i>Journal of Bionic Engineering<\/i>. <b>8<\/b> (3): 242\u2013250. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS1672-6529%2811%2960028-0\" target=\"_blank\">10.1016\/S1672-6529(11)60028-0<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Bionic+Engineering&rft.atitle=Self-repairing+membranes+for+inflatable+structures+inspired+by+a+rapid+wound+sealing+process+of+climbing+plants&rft.volume=8&rft.issue=3&rft.pages=242-250&rft.date=2011&rft_id=info%3Adoi%2F10.1016%2FS1672-6529%2811%2960028-0&rft.au=Rampf%2C+M.%2C+Speck%2C+O.%2C+Speck%2C+T.%2C+Luchsinger%2C+R.+H.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bauer, G., Speck, T. 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(2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3836322\" target=\"_blank\">\"Investigating the rheological properties of native plant latex\"<\/a>. <i>Journal of the Royal Society Interface<\/i>. <b>11<\/b> (90): 90. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1098%2Frsif.2013.0847\" target=\"_blank\">10.1098\/rsif.2013.0847<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3836322\" target=\"_blank\">3836322<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24173604\" target=\"_blank\">24173604<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+Royal+Society+Interface&rft.atitle=Investigating+the+rheological+properties+of+native+plant+latex&rft.volume=11&rft.issue=90&rft.pages=90&rft.date=2014&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3836322&rft_id=info%3Apmid%2F24173604&rft_id=info%3Adoi%2F10.1098%2Frsif.2013.0847&rft.au=Bauer%2C+G.%2C+Friedrich%2C+C.%2C+Gillig%2C+C.%2C+Vollrath%2C+F.%2C+Speck%2C+T.%2C+Holland%2C+C.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3836322&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bauer, G., Gorb, S., Klein, M.C., Nellesen, A., Tapavicza, M. v., Speck, T. 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(2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4438999\" target=\"_blank\">\"Dynamic urea bond for the design of reversible and self-healing polymers\"<\/a>. <i>Nature Communications<\/i>. <b>5<\/b>: 3218. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2014NatCo...5E3218Y\" target=\"_blank\">2014NatCo...5E3218Y<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fncomms4218\" target=\"_blank\">10.1038\/ncomms4218<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4438999\" target=\"_blank\">4438999<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24492620\" target=\"_blank\">24492620<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Communications&rft.atitle=Dynamic+urea+bond+for+the+design+of+reversible+and+self-healing+polymers&rft.volume=5&rft.pages=3218&rft.date=2014&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4438999&rft_id=info%3Apmid%2F24492620&rft_id=info%3Adoi%2F10.1038%2Fncomms4218&rft_id=info%3Abibcode%2F2014NatCo...5E3218Y&rft.aulast=Ying&rft.aufirst=H.&rft.au=Zhang%2C+Y.&rft.au=Cheng%2C+J.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4438999&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-42\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-42\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ying, Hanze; Zhang, Yanfeng; Cheng, Jianjun (2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4438999\" target=\"_blank\">\"Dynamic urea bond for the design of reversible and self-healing polymers\"<\/a>. <i>Nature Communications<\/i>. <b>5<\/b>: 3218. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2014NatCo...5E3218Y\" target=\"_blank\">2014NatCo...5E3218Y<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fncomms4218\" target=\"_blank\">10.1038\/ncomms4218<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2041-1723\" target=\"_blank\">2041-1723<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4438999\" target=\"_blank\">4438999<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24492620\" target=\"_blank\">24492620<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Communications&rft.atitle=Dynamic+urea+bond+for+the+design+of+reversible+and+self-healing+polymers&rft.volume=5&rft.pages=3218&rft.date=2014&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4438999&rft_id=info%3Abibcode%2F2014NatCo...5E3218Y&rft_id=info%3Apmid%2F24492620&rft_id=info%3Adoi%2F10.1038%2Fncomms4218&rft.issn=2041-1723&rft.aulast=Ying&rft.aufirst=Hanze&rft.au=Zhang%2C+Yanfeng&rft.au=Cheng%2C+Jianjun&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4438999&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-43\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-43\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/meetings.aps.org\/Meeting\/MAR17\/Session\/H18.2\" target=\"_blank\">\"Molecular dynamics of reversible self-healing materials\"<\/a>. <i>Bulletin of the American Physical Society<\/i>. <b>62<\/b> (4). 2017-03-14.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Bulletin+of+the+American+Physical+Society&rft.atitle=Molecular+dynamics+of+reversible+self-healing+materials&rft.volume=62&rft.issue=4&rft.date=2017-03-14&rft_id=http%3A%2F%2Fmeetings.aps.org%2FMeeting%2FMAR17%2FSession%2FH18.2&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-BlaiszikKramer2010-44\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-BlaiszikKramer2010_44-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-BlaiszikKramer2010_44-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Blaiszik, B.J.; 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color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-87\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-87\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jin, H.H., Mangun, C.L., Stradley, D.S., Moore, J.S., Sottos, N.R., White, S.R (2012). \"Self-healing thermoset using encapsulated epoxy-amine healing chemistry\". <i>Polymer<\/i>. <b>53<\/b> (2): 581\u2013587. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.polymer.2011.12.005\" target=\"_blank\">10.1016\/j.polymer.2011.12.005<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Polymer&rft.atitle=Self-healing+thermoset+using+encapsulated+epoxy-amine+healing+chemistry&rft.volume=53&rft.issue=2&rft.pages=581-587&rft.date=2012&rft_id=info%3Adoi%2F10.1016%2Fj.polymer.2011.12.005&rft.au=Jin%2C+H.H.%2C+Mangun%2C+C.L.%2C+Stradley%2C+D.S.%2C+Moore%2C+J.S.%2C+Sottos%2C+N.R.%2C+White%2C+S.R&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-88\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-88\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Suryanarayana, C., Rao, K.C. and Kumar, D (2008). \"Preparation and characterization of microcapsules containing linseed oil and its use in self-healing coatings\". <i>Progress in Organic Coatings<\/i>. <b>63<\/b>: 72\u201378. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.porgcoat.2008.04.008\" target=\"_blank\">10.1016\/j.porgcoat.2008.04.008<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Progress+in+Organic+Coatings&rft.atitle=Preparation+and+characterization+of+microcapsules+containing+linseed+oil+and+its+use+in+self-healing+coatings&rft.volume=63&rft.pages=72-78&rft.date=2008&rft_id=info%3Adoi%2F10.1016%2Fj.porgcoat.2008.04.008&rft.au=Suryanarayana%2C+C.%2C+Rao%2C+K.C.+and+Kumar%2C+D&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; 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color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-90\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-90\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Samadzadeha, M., Bouraa, S.H., Peikaria, M., Ashrafib, A. and Kasirihac, M (2011). \"Tung oil: An autonomous repairing agent for self-healing epoxy coatings\". <i>Progress in Organic Coatings<\/i>. <b>70<\/b> (4): 383\u2013387. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.porgcoat.2010.08.017\" target=\"_blank\">10.1016\/j.porgcoat.2010.08.017<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Progress+in+Organic+Coatings&rft.atitle=Tung+oil%3A+An+autonomous+repairing+agent+for+self-healing+epoxy+coatings&rft.volume=70&rft.issue=4&rft.pages=383-387&rft.date=2011&rft_id=info%3Adoi%2F10.1016%2Fj.porgcoat.2010.08.017&rft.au=Samadzadeha%2C+M.%2C+Bouraa%2C+S.H.%2C+Peikaria%2C+M.%2C+Ashrafib%2C+A.+and+Kasirihac%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; 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(2011-10-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.osapublishing.org\/josab\/abstract.cfm?uri=josab-28-10-2408\" target=\"_blank\">\"Testing the diffusion hypothesis as a mechanism of self-healing in Disperse Orange 11 doped in poly(methyl methacrylate)\"<\/a>. <i>JOSA B<\/i>. <b>28<\/b> (10): 2408\u20132412. <a href=\"https:\/\/en.wikipedia.org\/wiki\/ArXiv\" title=\"ArXiv\" rel=\"external_link\" target=\"_blank\">arXiv<\/a>:<span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/arxiv.org\/abs\/1106.2732\" target=\"_blank\">1106.2732<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1364%2FJOSAB.28.002408\" target=\"_blank\">10.1364\/JOSAB.28.002408<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1520-8540\" target=\"_blank\">1520-8540<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JOSA+B&rft.atitle=Testing+the+diffusion+hypothesis+as+a+mechanism+of+self-healing+in+Disperse+Orange+11+doped+in+poly%28methyl+methacrylate%29&rft.volume=28&rft.issue=10&rft.pages=2408-2412&rft.date=2011-10-01&rft_id=info%3Aarxiv%2F1106.2732&rft.issn=1520-8540&rft_id=info%3Adoi%2F10.1364%2FJOSAB.28.002408&rft.aulast=Ramini&rft.aufirst=Shiva+K.&rft.au=Dawson%2C+Nathan&rft.au=Kuzyk%2C+Mark+G.&rft_id=https%3A%2F%2Fwww.osapublishing.org%2Fjosab%2Fabstract.cfm%3Furi%3Djosab-28-10-2408&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-117\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-117\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ramini, Shiva K.; Kuzyk, Mark G. (2012-08-07). \"A self healing model based on polymer-mediated chromophore correlations\". <i>The Journal of Chemical Physics<\/i>. <b>137<\/b> (5): 054705. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1063%2F1.4739295\" target=\"_blank\">10.1063\/1.4739295<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0021-9606\" target=\"_blank\">0021-9606<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22894369\" target=\"_blank\">22894369<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Chemical+Physics&rft.atitle=A+self+healing+model+based+on+polymer-mediated+chromophore+correlations&rft.volume=137&rft.issue=5&rft.pages=054705&rft.date=2012-08-07&rft.issn=0021-9606&rft_id=info%3Apmid%2F22894369&rft_id=info%3Adoi%2F10.1063%2F1.4739295&rft.aulast=Ramini&rft.aufirst=Shiva+K.&rft.au=Kuzyk%2C+Mark+G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-YangWei2011-118\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-YangWei2011_118-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Yang, Zhao; Wei, Zhang; Le-ping, Liao; Hong-mei, Wang; Wu-jun, Li (2011). \"The self-healing composite anticorrosion coating\". <i>Physics Procedia<\/i>. <b>18<\/b>: 216\u2013221. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2011PhPro..18..216Y\" target=\"_blank\">2011PhPro..18..216Y<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.phpro.2011.06.084\" target=\"_blank\">10.1016\/j.phpro.2011.06.084<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1875-3892\" target=\"_blank\">1875-3892<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Physics+Procedia&rft.atitle=The+self-healing+composite+anticorrosion+coating&rft.volume=18&rft.pages=216-221&rft.date=2011&rft.issn=1875-3892&rft_id=info%3Adoi%2F10.1016%2Fj.phpro.2011.06.084&rft_id=info%3Abibcode%2F2011PhPro..18..216Y&rft.aulast=Yang&rft.aufirst=Zhao&rft.au=Wei%2C+Zhang&rft.au=Le-ping%2C+Liao&rft.au=Hong-mei%2C+Wang&rft.au=Wu-jun%2C+Li&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-119\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-119\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zhu M, Rong MZ, Zhang MQ (2014). \"Self-healing polymeric materials towards non-structural recovery of functional properties\". <i>Polymer International<\/i>. <b>63<\/b> (10): 741\u20131749. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fpi.4723\" target=\"_blank\">10.1002\/pi.4723<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Polymer+International&rft.atitle=Self-healing+polymeric+materials+towards+non-structural+recovery+of+functional+properties&rft.volume=63&rft.issue=10&rft.pages=741-1749&rft.date=2014&rft_id=info%3Adoi%2F10.1002%2Fpi.4723&rft.au=Zhu+M%2C+Rong+MZ%2C+Zhang+MQ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-120\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-120\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pacheco J, \u0160avija B, Schlangen E, Polder RB (2014). \"Assessment of cracks in reinforced concrete by means of electrical resistance and image analysis\". <i>Construction and Building Materials<\/i>. <b>65<\/b>: 417\u2013426. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.conbuildmat.2014.05.001\" target=\"_blank\">10.1016\/j.conbuildmat.2014.05.001<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Construction+and+Building+Materials&rft.atitle=Assessment+of+cracks+in+reinforced+concrete+by+means+of+electrical+resistance+and+image+analysis&rft.volume=65&rft.pages=417-426&rft.date=2014&rft_id=info%3Adoi%2F10.1016%2Fj.conbuildmat.2014.05.001&rft.au=Pacheco+J%2C+%C5%A0avija+B%2C+Schlangen+E%2C+Polder+RB&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Mauldin-121\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Mauldin_121-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mauldin, T C; Kessler, M R (2010). \"Self-healing polymers and composites\". <i>International Materials Reviews<\/i>. <b>55<\/b> (6): 317\u2013346. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1179%2F095066010X12646898728408\" target=\"_blank\">10.1179\/095066010X12646898728408<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Materials+Reviews&rft.atitle=Self-healing+polymers+and+composites&rft.volume=55&rft.issue=6&rft.pages=317-346&rft.date=2010&rft_id=info%3Adoi%2F10.1179%2F095066010X12646898728408&rft.aulast=Mauldin&rft.aufirst=T+C&rft.au=Kessler%2C+M+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-122\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-122\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.arkema.com\/en\/media\/news\/news-details\/Self-healing-elastomer-enters-industrial-production\/\" target=\"_blank\">\"Self-healing elastomer enters industrial production\"<\/a>. <i>www.arkema.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-12-13<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.arkema.com&rft.atitle=Self-healing+elastomer+enters+industrial+production&rft_id=http%3A%2F%2Fwww.arkema.com%2Fen%2Fmedia%2Fnews%2Fnews-details%2FSelf-healing-elastomer-enters-industrial-production%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Bourzac-123\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Bourzac_123-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Bourzac, Katherine (December 12, 2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.technologyreview.com\/business\/21812\/?a=f\" target=\"_blank\">\"First Self-Healing Coatings\"<\/a>. <i>technologyreview.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">18 November<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=technologyreview.com&rft.atitle=First+Self-Healing+Coatings&rft.date=2008-12-12&rft.aulast=Bourzac&rft.aufirst=Katherine&rft_id=http%3A%2F%2Fwww.technologyreview.com%2Fbusiness%2F21812%2F%3Fa%3Df&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-124\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-124\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Rincon, Paul (30 October 2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.bbc.co.uk\/news\/science-environment-19781862\" target=\"_blank\">\"Time to heal: The materials that repair themselves\"<\/a>. BBC<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 May<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Time+to+heal%3A+The+materials+that+repair+themselves&rft.date=2010-10-30&rft.aulast=Rincon&rft.aufirst=Paul&rft_id=https%3A%2F%2Fwww.bbc.co.uk%2Fnews%2Fscience-environment-19781862&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-healing+material\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1240\nCached time: 20181207074041\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 1.644 seconds\nReal time usage: 1.791 seconds\nPreprocessor visited node count: 6963\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 269242\/2097152 bytes\nTemplate argument size: 2170\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 8\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 371072\/5000000 bytes\nNumber of Wikibase entities loaded: 7\/400\nLua time usage: 1.023\/10.000 seconds\nLua memory usage: 5.24 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1491.720 1 -total\n<\/p>\n<pre>81.08% 1209.559 1 Template:Reflist\n60.53% 902.888 106 Template:Cite_journal\n 6.74% 100.579 8 Template:Cite_book\n 4.42% 65.897 1 Template:Citation_needed\n 4.08% 60.810 1 Template:Commons_category\n 3.21% 47.951 1 Template:Fix\n 2.10% 31.331 2 Template:Category_handler\n 1.89% 28.152 3 Template:NumBlk\n 1.69% 25.152 5 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:5824713-1!canonical!math=5 and timestamp 20181207074039 and revision id 870456597\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Self-healing_material\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212226\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.031 seconds\nReal time usage: 0.217 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 201.729 1 - wikipedia:Self-healing_material\n100.00% 201.729 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8297-0!*!*!*!*!*!* and timestamp 20181217212225 and revision id 24509\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Self-healing_material\">https:\/\/www.limswiki.org\/index.php\/Self-healing_material<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","28453c0bd55482177ac8cc295eba539c_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c5\/Self-Healing-Polymer-DHM-Digital-Holographic-Microscopy-lyncee-Tosoh-Corporation.gif\/440px-Self-Healing-Polymer-DHM-Digital-Holographic-Microscopy-lyncee-Tosoh-Corporation.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/a\/ac\/Self-Healing-Polymer-DHM-Digital-Holographic-Microscopy-profile.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/2\/24\/HomolyticcleavageofPMMA.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/a\/ae\/HeterolyticcleavageofPEG.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/eb\/Cross-linking_DA.png\/1200px-Cross-linking_DA.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fc\/DAstepgrowthpolymer.png\/800px-DAstepgrowthpolymer.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0c\/Disulfidebridge.png\/1000px-Disulfidebridge.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d8\/Dicyclpentadiene_ring-opening_polymerization.png\/600px-Dicyclpentadiene_ring-opening_polymerization.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/2\/28\/Polymerization_in_situ.jpg"],"28453c0bd55482177ac8cc295eba539c_timestamp":1545081745,"b8c5af96880f409729329d3807af7da1_type":"article","b8c5af96880f409729329d3807af7da1_title":"Polyvinylidene fluoride","b8c5af96880f409729329d3807af7da1_url":"https:\/\/www.limswiki.org\/index.php\/Polyvinylidene_fluoride","b8c5af96880f409729329d3807af7da1_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPolyvinylidene fluoride\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\nPolyvinylidene fluoride\n\n\n\n\n\n\nNames\n\n\n\nIUPAC name\nPoly(1,1-difluoroethylene) [1]\n\n\n\n\nOther names\nPolyvinylidene difluoride; poly(vinylene fluoride); Kynar; Hylar; Solef; Sygef; poly(1,1-difluoroethane)\n\n\nIdentifiers\n\n\n\nCAS Number\n\n24937-79-9  Y \n\n\n\n\n\n\nChEBI\n\nCHEBI:53250  N \n\n\n\nChemSpider\n\nnone\n\n\n\nECHA InfoCard \n\n100.133.181\n\n\n\n\n\n\n\nMeSH\n\npolyvinylidene+fluoride \n\n\nPubChem CID\n\n6369 \n\n\nProperties\n\n\nChemical formula\n\n\u2212(C2H2F2)n\u2212 \n\n\n\nAppearance\n\nWhitish or translucent solid\n\n\n\n\n\n\n\n\nSolubility in water\n\nInsoluble\n\n\nStructure\n\n\n\n\n\n\n\n\n\n\n\nDipole moment\n\n2.1 D[2]\n\n\n\n\n\n\nRelated compounds\n\n\n\n\n\nRelated compounds\n\nPVF, PVC, PTFE\n\n\n\n\nExcept where otherwise noted, data are given for materials in their standard state (at 25 \u00b0C [77 \u00b0F], 100 kPa).\n\n\nN  verify  (what is Y N  ?)\n\n\nInfobox references\n\n\n\n\n\n\n\nPolyvinylidene fluoride or polyvinylidene difluoride (PVDF) is a highly non-reactive thermoplastic fluoropolymer produced by the polymerization of vinylidene difluoride.\nPVDF is a specialty plastic used in applications requiring the highest purity, as well as resistance to solvents, acids and bases. Compared to other fluoropolymers, like polytetrafluoroethylene (Teflon), PVDF has a low density (1.78 g\/cm3).\nIt is available as piping products, sheet, tubing, films, plate and an insulator for premium wire. It can be injected, molded or welded and is commonly used in the chemical, semiconductor, medical and defense industries, as well as in lithium-ion batteries. It is also available as a crosslinked closed-cell foam, used increasingly in aviation and aerospace applications. It can also be used in repeated contact with food products, as it is FDA-compliant and absolutely non-toxic.[3]\nAs a fine powder grade, it is an ingredient in high-end paints for metals. These PVDF paints have extremely good gloss and color retention. They are in use on many prominent buildings around the world, such as the Petronas Towers in Malaysia and Taipei 101 in Taiwan, as well as on commercial and residential metal roofing.\nPVDF membranes are used in western blots for the immobilization of proteins, due to its non-specific affinity for amino acids.\nPVDF is also used as a binder component for the carbon electrode in supercapacitors and for other electrochemical applications.\n\nContents \n\n1 Names \n2 Properties \n3 Processing \n4 Applications \n5 Other forms \n\n5.1 Copolymers \n5.2 Terpolymers \n\n\n6 See also \n7 References \n\n\nNames \nPVDF is sold under a variety of brand names including KF (Kureha), Hylar (Solvay), Kynar (Arkema) and Solef (Solvay).\n\nProperties \nIn 1969, strong piezoelectricity was observed in PVDF, with the piezoelectric coefficient of poled (placed under a strong electric field to induce a net dipole moment) thin films as large as 6\u20137 pC\/N: 10 times larger than that observed in any other polymer.[4]\nPVDF has a glass transition temperature (Tg) of about \u221235 \u00b0C and is typically 50\u201360% crystalline. To give the material its piezoelectric properties, it is mechanically stretched to orient the molecular chains and then poled under tension. PVDF exists in several forms: alpha (TGTG'), beta (TTTT), and gamma (TTTGTTTG') phases, depending on the chain conformations as trans (T) or gauche (G) linkages. When poled, PVDF is a ferroelectric polymer, exhibiting efficient piezoelectric and pyroelectric properties.[5] These characteristics make it useful in sensor and battery applications. Thin films of PVDF are used in some newer thermal camera sensors.\nUnlike other popular piezoelectric materials, such as lead zirconate titanate (PZT), PVDF has a negative d33 value. Physically, this means that PVDF will compress instead of expand or vice versa when exposed to the same electric field.[6]\n\nProcessing \nPVDF may be synthesized from the gaseous vinylidene fluoride (VDF) monomer via a free radical (or controlled radical) polymerization process. This may be followed by processes such as melt casting, or processing from a solution (e.g. solution casting, spin coating, and film casting). Langmuir-Blodgett films have also been made. In the case of solution-based processing, typical solvents used include dimethylformamide and the more volatile butanone. In aqueous emulsion polymerization, the fluorosurfactant perfluorononanoic acid is used in anion form as a processing aid by solubilizing monomers.[7] Compared to other fluoropolymers, it has an easier melt process because of its relatively low melting point of around 177 \u00b0C.\nProcessed materials are typically in the non-piezoelectric alpha phase. The material must either be stretched or annealed to obtain the piezoelectric beta phase. The exception to this is for PVDF thin films (thickness in the order of micrometres). Residual stresses between thin films and the substrates on which they are processed are great enough to cause the beta phase to form.\nIn order to obtain a piezoelectric response, the material must first be poled in a large electric field. Poling of the material typically requires an external field of above 30 MV\/m. Thick films (typically >100 \u00b5m) must be heated during the poling process in order to achieve a large piezoelectric response. Thick films are usually heated to 70\u2013100 \u00b0C during the poling process.\nA quantitative defluorination process was described by mechanochemistry,[8] for safe eco-friendly PVDF waste processing.\n\nApplications \n PVDF piping used to carry ultrapure water.\nPVDF is commonly used as insulation on electrical wires, because of its combination of flexibility, low weight, low thermal conductivity, high chemical corrosion resistance, and heat resistance. Most of the narrow 30-gauge wire used in wire wrap circuit assembly and printed circuit board rework is PVDF-insulated. In this use the wire is generally referred to as \"Kynar wire\", from the trade name.\nThe piezoelectric properties of PVDF are exploited in the manufacture of tactile sensor arrays, inexpensive strain gauges, and lightweight audio transducers. Piezoelectric panels made of PVDF are used on the Venetia Burney Student Dust Counter, a scientific instrument of the New Horizons space probe that measures dust density in the outer solar system.[citation needed ]\nPVDF is the standard binder material used in the production of composite electrodes for lithium-ion batteries.[citation needed ] 1\u22122% weight solution of PVDF dissolved in N-methyl-2-pyrrolidone (NMP) is mixed with an active lithium storage material such as graphite, silicon, tin, LiCoO2, LiMn2O4, or LiFePO4 and a conductive additive such as carbon black or carbon nanofibers. This slurry is cast onto a metallic current collector and the NMP is evaporated to form a composite or paste electrode. PVDF is used because it is chemically inert over the potential range used, and does not react with the electrolyte or lithium.\nIn the biomedical sciences, PVDF is used in immunoblotting as an artificial membrane (usually with 0.22 or 0.45 micrometre pore sizes), on which proteins are transferred using electricity (see western blotting). PVDF is resistant to solvents and, therefore, these membranes can be easily stripped and reused to look at other proteins. PVDF membranes may be used in other biomedical applications as part of a membrane filtration device, often in the form of a syringe filter or wheel filter. The various properties of this material, such as heat resistance, resistance to chemical corrosion, and low protein binding properties, make this material valuable in the biomedical sciences for preparation of medications as a sterilizing filter, and as a filter to prepare samples for analytical techniques such as high performance liquid chromatography (HPLC), where small amounts of particulate matter can damage sensitive and expensive equipment.\nPVDF is used for specialty monofilament fishing lines, sold as fluorocarbon replacements for nylon monofilament. The surface is harder, so it is more resistant to abrasion and sharp fish teeth. Its optical density is lower than nylon, which makes the line less discernible to sharp fish eyes. It is also denser than nylon, making it sink faster towards fish.[9]\nPVDF transducers have the advantage of being dynamically more suitable for modal testing than semiconductor piezoresistive transducers, and more compliant for structural integration than piezoceramic transducers. For those reasons, the use of PVDF active sensors is a keystone for the development of future structural health monitoring methods, due to their low cost and compliance.[10]\n\nOther forms \nCopolymers \nCopolymers of PVDF are also used in piezoelectric and electrostrictive applications. One of the most commonly used copolymers is P(VDF-trifluoroethylene), usually available in ratios of about 50:50 wt% and 65:35 wt% (equivalent to about 56:44 mol% and 70:30 mol%). Another one is P(VDF-tetrafluoroethylene). They improve the piezoelectric response by improving the crystallinity of the material.\nWhile the copolymers' unit structures are less polar than that of pure PVDF, the copolymers typically have a much higher crystallinity. This results in a larger piezoelectric response: d33 values for P(VDF-TFE) have been recorded to be as high as \u221238 pC\/N[11] versus \u221233 pC\/N in pure PVDF.[12]\n\nTerpolymers \nTerpolymers of PVDF are the most promising one in terms of electromechanically induced strain. The most commonly used PVDF-based terpolymers are P(VDF-TrFE-CTFE) and P(VDF-TrFE-CFE).[13][14] This relaxor-based ferroelectric terpolymer is produced by random incorporation of the bulky third monomer (chlorotrifluoroethylene, CTFE) into the polymer chain of P(VDF-TrFE) copolymer (which is ferroelectric in nature). This random incorporation of CTFE in P(VDF-TrFE) copolymer disrupts the long-range ordering of the ferroelectric polar phase, resulting in the formation of nano-polar domains. When an electric field is applied, the disordered nano-polar domains change their conformation to all-trans conformation, which leads to large electrostrictive strain and a high room-temperature dielectric constant of ~50.[15]\n\nSee also \nFerroelectric polymers\nKlaiber's law\nFerroelectricity\nPiezoelectricity\nPyroelectricity\nPlastic\nPolymer\nLithium ion battery\nReferences \n\n\n^ \"poly(vinylene fluoride) (CHEBI:53250)\". Retrieved July 14, 2012 . \n\n^ Zhang, Q. M., Bharti, V., Kavarnos, G., Schwartz, M. (Ed.), (2002). \"Poly (Vinylidene Fluoride) (PVDF) and its Copolymers\", Encyclopedia of Smart Materials, Volumes 1\u20132, John Wiley & Sons, 807\u2013825. \n\n^ http:\/\/www.plasticsintl.com\/pvdf.htm \n\n^ Kawai, Heiji (1969). \"The Piezoelectricity of Poly (vinylidene Fluoride)\". Japanese Journal of Applied Physics. 8 (7): 975. doi:10.1143\/JJAP.8.975. \n\n^ Lolla, Dinesh; Gorse, Joseph; Kisielowski, Christian; Miao, Jiayuan; Taylor, Philip L.; Chase, George G.; Reneker, Darrell H. (2015-12-17). \"Polyvinylidene fluoride molecules in nanofibers, imaged at atomic scale by aberration corrected electron microscopy\". Nanoscale. 8 (1): 120\u2013128. doi:10.1039\/c5nr01619c. ISSN 2040-3372. \n\n^ Lolla, Dinesh; Lolla, Manideep; Abutaleb, Ahmed; Shin, Hyeon U.; Reneker, Darrell H.; Chase, George G. (2016-08-09). \"Fabrication, Polarization of Electrospun Polyvinylidene Fluoride Electret Fibers and Effect on Capturing Nanoscale Solid Aerosols\". Materials. 9 (8): 671. doi:10.3390\/ma9080671. \n\n^ Prevedouros K, Cousins IT, Buck RC, Korzeniowski SH (January 2006). \"Sources, fate and transport of perfluorocarboxylates\". Environ Sci Technol. 40 (1): 32\u201344. doi:10.1021\/es0512475. PMID 16433330. \n\n^ Zhang, Qiwu; Lu, Jinfeng; Saito, Fumio; Baron, Michel (2001). \"Mechanochemical solid-phase reaction between polyvinylidene fluoride and sodium hydroxide\". Journal of Applied Polymer Science. 81 (9): 2249. doi:10.1002\/app.1663. \n\n^ Seaguar history \u2014 Kureha America, Inc. manufacturer's site Archived 2010-06-20 at the Wayback Machine. \n\n^ Guzman, E.; Cugnoni, J; Gm\u00fcr, T (2013). \"Survivability of integrated PVDF film sensors to accelerated ageing conditions in aeronautical\/aerospace structures\". Smart Mater Struct. 22 (6): 065020. doi:10.1088\/0964-1726\/22\/6\/065020. \n\n^ Omote, Kenji; Ohigashi, Hiroji; Koga, Keiko (1997). \"Temperature dependence of elastic, dielectric, and piezoelectric properties of \"single crystalline films of vinylidene fluoride trifluoroethylene copolymer\". Journal of Applied Physics. 81 (6): 2760. doi:10.1063\/1.364300. \n\n^ Nix, E. L.; Ward, I. M. (1986). \"The measurement of the shear piezoelectric coefficients of polyvinylidene fluoride\". Ferroelectrics. 67: 137. doi:10.1080\/00150198608245016. \n\n^ Xu, Haisheng; Cheng, Z.-Y.; Olson, Dana; Mai, T.; Zhang, Q. M.; Kavarnos, G. (16 April 2001). \"Ferroelectric and electromechanical properties of poly(vinylidene-fluoride\u2013trifluoroethylene\u2013chlorotrifluoroethylene) terpolymer\". Applied Physics Letters. AIP Publishing LLC, American Institute of Physics. 78 (16): 2360\u20132362. doi:10.1063\/1.1358847. \n\n^ Bao, Hui-Min; Song, Jiao-Fan; Zhang, Juan; Shen, Qun-Dong; Yang, Chang-Zheng; Zhang, Q. M. (3 April 2007). \"Phase Transitions and Ferroelectric Relaxor Behavior in P(VDF\u2212TrFE\u2212CFE) Terpolymers\". Macromolecules. ACS Publications. 40 (7): 2371\u20132379. doi:10.1021\/ma062800l. \n\n^ Ahmed, Saad; Arrojado, Erika; Sigamani, Nirmal; Ounaies, Zoubeida (14 May 2015). Goulbourne, Nakhiah C., ed. \"Electric field responsive origami structures using electrostriction-based active materials\". Proceedings of SPIE: Behavior and Mechanics of Multifunctional Materials and Composites 2015. Society of Photographic Instrumentation Engineers (SPIE). 9432. doi:10.1117\/12.2084785. 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Compared to other fluoropolymers, like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polytetrafluoroethylene\" title=\"Polytetrafluoroethylene\" rel=\"external_link\" target=\"_blank\">polytetrafluoroethylene<\/a> (Teflon), PVDF has a low density (1.78 g\/cm<sup>3<\/sup>).\n<\/p><p>It is available as piping products, sheet, tubing, films, plate and an insulator for premium wire. It can be injected, molded or welded and is commonly used in the chemical, semiconductor, medical and defense industries, as well as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithium-ion_battery\" title=\"Lithium-ion battery\" rel=\"external_link\" target=\"_blank\">lithium-ion batteries<\/a>. It is also available as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cross-link\" title=\"Cross-link\" rel=\"external_link\" target=\"_blank\">crosslinked<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Closed-cell_foam\" class=\"mw-redirect\" title=\"Closed-cell foam\" rel=\"external_link\" target=\"_blank\">closed-cell foam<\/a>, used increasingly in aviation and aerospace applications. It can also be used in repeated contact with food products, as it is FDA-compliant and absolutely non-toxic.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>As a fine powder grade, it is an ingredient in high-end paints for metals. These PVDF paints have extremely good <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gloss_paint\" class=\"mw-redirect\" title=\"Gloss paint\" rel=\"external_link\" target=\"_blank\">gloss<\/a> and color retention. They are in use on many prominent buildings around the world, such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Petronas_Towers\" title=\"Petronas Towers\" rel=\"external_link\" target=\"_blank\">Petronas Towers<\/a> in Malaysia and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Taipei_101\" title=\"Taipei 101\" rel=\"external_link\" target=\"_blank\">Taipei 101<\/a> in Taiwan, as well as on commercial and residential metal roofing.\n<\/p><p>PVDF membranes are used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Western_blot\" title=\"Western blot\" rel=\"external_link\" target=\"_blank\">western blots<\/a> for the immobilization of proteins, due to its non-specific affinity for amino acids.\n<\/p><p>PVDF is also used as a binder component for the carbon electrode in supercapacitors and for other electrochemical applications.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Names\">Names<\/span><\/h2>\n<p>PVDF is sold under a variety of brand names including KF (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Kureha_Chemical_Industries\" class=\"mw-redirect\" title=\"Kureha Chemical Industries\" rel=\"external_link\" target=\"_blank\">Kureha<\/a>), Hylar (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Solvay_S.A.\" title=\"Solvay S.A.\" rel=\"external_link\" target=\"_blank\">Solvay<\/a>), Kynar (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Arkema\" title=\"Arkema\" rel=\"external_link\" target=\"_blank\">Arkema<\/a>) and Solef (Solvay).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Properties\">Properties<\/span><\/h2>\n<p>In 1969, strong <a href=\"https:\/\/en.wikipedia.org\/wiki\/Piezoelectricity\" title=\"Piezoelectricity\" rel=\"external_link\" target=\"_blank\">piezoelectricity<\/a> was observed in PVDF, with the piezoelectric coefficient of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Piezoelectricity#Mechanism\" title=\"Piezoelectricity\" rel=\"external_link\" target=\"_blank\">poled<\/a> (placed under a strong electric field to induce a net dipole moment) thin films as large as 6\u20137 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Picocoulomb\" class=\"mw-redirect\" title=\"Picocoulomb\" rel=\"external_link\" target=\"_blank\">pC<\/a>\/<a href=\"https:\/\/en.wikipedia.org\/wiki\/Newton_(units)\" class=\"mw-redirect\" title=\"Newton (units)\" rel=\"external_link\" target=\"_blank\">N<\/a>: 10 times larger than that observed in any other polymer.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>PVDF has a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass_transition_temperature\" class=\"mw-redirect\" title=\"Glass transition temperature\" rel=\"external_link\" target=\"_blank\">glass transition temperature<\/a> (T<sub>g<\/sub>) of about \u221235 \u00b0<a href=\"https:\/\/en.wikipedia.org\/wiki\/Celsius\" title=\"Celsius\" rel=\"external_link\" target=\"_blank\">C<\/a> and is typically 50\u201360% crystalline. To give the material its piezoelectric properties, it is mechanically stretched to orient the molecular chains and then poled under tension. PVDF exists in several forms: alpha (TGTG'), beta (TTTT), and gamma (TTTGTTTG') phases, depending on the chain conformations as trans (T) or gauche (G) linkages. When poled, PVDF is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferroelectric\" class=\"mw-redirect\" title=\"Ferroelectric\" rel=\"external_link\" target=\"_blank\">ferroelectric<\/a> polymer, exhibiting efficient <a href=\"https:\/\/en.wikipedia.org\/wiki\/Piezoelectric\" class=\"mw-redirect\" title=\"Piezoelectric\" rel=\"external_link\" target=\"_blank\">piezoelectric<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyroelectric\" class=\"mw-redirect\" title=\"Pyroelectric\" rel=\"external_link\" target=\"_blank\">pyroelectric<\/a> properties.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> These characteristics make it useful in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sensor\" title=\"Sensor\" rel=\"external_link\" target=\"_blank\">sensor<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Battery_(electricity)\" class=\"mw-redirect\" title=\"Battery (electricity)\" rel=\"external_link\" target=\"_blank\">battery<\/a> applications. Thin films of PVDF are used in some newer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_camera\" class=\"mw-redirect\" title=\"Thermal camera\" rel=\"external_link\" target=\"_blank\">thermal camera<\/a> sensors.\n<\/p><p>Unlike other popular piezoelectric materials, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lead_zirconate_titanate\" title=\"Lead zirconate titanate\" rel=\"external_link\" target=\"_blank\">lead zirconate titanate<\/a> (PZT), PVDF has a negative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Piezoelectric_coefficient\" title=\"Piezoelectric coefficient\" rel=\"external_link\" target=\"_blank\">d<sub>33<\/sub><\/a> value. Physically, this means that PVDF will compress instead of expand or vice versa when exposed to the same electric field.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Processing\">Processing<\/span><\/h2>\n<p>PVDF may be synthesized from the gaseous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vinylidene_fluoride\" class=\"mw-redirect\" title=\"Vinylidene fluoride\" rel=\"external_link\" target=\"_blank\">vinylidene fluoride<\/a> (VDF) monomer via a free radical (or controlled radical) polymerization process. This may be followed by processes such as melt casting, or processing from a solution (e.g. solution casting, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin_coating\" title=\"Spin coating\" rel=\"external_link\" target=\"_blank\">spin coating<\/a>, and film casting). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Langmuir-Blodgett_film\" class=\"mw-redirect\" title=\"Langmuir-Blodgett film\" rel=\"external_link\" target=\"_blank\">Langmuir-Blodgett films<\/a> have also been made. In the case of solution-based processing, typical solvents used include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dimethylformamide\" title=\"Dimethylformamide\" rel=\"external_link\" target=\"_blank\">dimethylformamide<\/a> and the more volatile <a href=\"https:\/\/en.wikipedia.org\/wiki\/Butanone\" title=\"Butanone\" rel=\"external_link\" target=\"_blank\">butanone<\/a>. In aqueous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Emulsion_polymerization\" title=\"Emulsion polymerization\" rel=\"external_link\" target=\"_blank\">emulsion polymerization<\/a>, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorosurfactant\" title=\"Fluorosurfactant\" rel=\"external_link\" target=\"_blank\">fluorosurfactant<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Perfluorononanoic_acid\" title=\"Perfluorononanoic acid\" rel=\"external_link\" target=\"_blank\">perfluorononanoic acid<\/a> is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anion\" class=\"mw-redirect\" title=\"Anion\" rel=\"external_link\" target=\"_blank\">anion<\/a> form as a processing aid by solubilizing monomers.<sup id=\"rdp-ebb-cite_ref-Prevedouros2006_7-0\" class=\"reference\"><a href=\"#cite_note-Prevedouros2006-7\" rel=\"external_link\">[7]<\/a><\/sup> Compared to other fluoropolymers, it has an easier process because of its relatively low melting point of around 177 \u00b0C.\n<\/p><p>Processed materials are typically in the non-piezoelectric alpha phase. The material must either be stretched or annealed to obtain the piezoelectric beta phase. The exception to this is for PVDF <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thin_films\" class=\"mw-redirect\" title=\"Thin films\" rel=\"external_link\" target=\"_blank\">thin films<\/a> (thickness in the order of micrometres). Residual stresses between thin films and the substrates on which they are processed are great enough to cause the beta phase to form.\n<\/p><p>In order to obtain a piezoelectric response, the material must first be poled in a large electric field. Poling of the material typically requires an external field of above 30 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mega-\" title=\"Mega-\" rel=\"external_link\" target=\"_blank\">M<\/a><a href=\"https:\/\/en.wikipedia.org\/wiki\/Volt\" title=\"Volt\" rel=\"external_link\" target=\"_blank\">V<\/a>\/m. Thick films (typically >100 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Micrometre\" title=\"Micrometre\" rel=\"external_link\" target=\"_blank\">\u00b5m<\/a>) must be heated during the poling process in order to achieve a large piezoelectric response. Thick films are usually heated to 70\u2013100 \u00b0C during the poling process.\n<\/p><p>A quantitative defluorination process was described by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mechanochemistry\" title=\"Mechanochemistry\" rel=\"external_link\" target=\"_blank\">mechanochemistry<\/a>,<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> for safe eco-friendly PVDF waste processing.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:A_UPW_Installation_using_PVDF_Piping.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/55\/A_UPW_Installation_using_PVDF_Piping.png\/220px-A_UPW_Installation_using_PVDF_Piping.png\" width=\"220\" height=\"146\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:A_UPW_Installation_using_PVDF_Piping.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>PVDF piping used to carry <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrapure_water\" title=\"Ultrapure water\" rel=\"external_link\" target=\"_blank\">ultrapure water<\/a>.<\/div><\/div><\/div>\n<p>PVDF is commonly used as insulation on electrical wires, because of its combination of flexibility, low weight, low thermal conductivity, high chemical corrosion resistance, and heat resistance. Most of the narrow 30-gauge wire used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wire_wrap\" title=\"Wire wrap\" rel=\"external_link\" target=\"_blank\">wire wrap<\/a> circuit assembly and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Printed_circuit_board\" title=\"Printed circuit board\" rel=\"external_link\" target=\"_blank\">printed circuit board<\/a> rework is PVDF-insulated. In this use the wire is generally referred to as \"Kynar wire\", from the trade name.\n<\/p><p>The piezoelectric properties of PVDF are exploited in the manufacture of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tactile_sensor#Tactile_sensor_arrays\" title=\"Tactile sensor\" rel=\"external_link\" target=\"_blank\">tactile sensor arrays<\/a>, inexpensive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Strain_gauges\" class=\"mw-redirect\" title=\"Strain gauges\" rel=\"external_link\" target=\"_blank\">strain gauges<\/a>, and lightweight audio <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transducer\" title=\"Transducer\" rel=\"external_link\" target=\"_blank\">transducers<\/a>. Piezoelectric panels made of PVDF are used on the Venetia Burney Student Dust Counter, a scientific instrument of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/New_Horizons\" title=\"New Horizons\" rel=\"external_link\" target=\"_blank\">New Horizons<\/a> space probe that measures dust density in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Outer_solar_system\" class=\"mw-redirect\" title=\"Outer solar system\" rel=\"external_link\" target=\"_blank\">outer solar system<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>PVDF is the standard binder material used in the production of composite electrodes for lithium-ion batteries.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (September 2013)\">citation needed<\/span><\/a><\/i>]<\/sup> <span class=\"nowrap\">1\u22122%<\/span> weight solution of PVDF dissolved in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methylpyrrolidone\" class=\"mw-redirect\" title=\"Methylpyrrolidone\" rel=\"external_link\" target=\"_blank\"><i>N<\/i>-methyl-2-pyrrolidone<\/a> (NMP) is mixed with an active lithium storage material such as graphite, silicon, tin, LiCoO<sub>2<\/sub>, LiMn<sub>2<\/sub>O<sub>4<\/sub>, or LiFePO<sub>4<\/sub> and a conductive additive such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_black\" title=\"Carbon black\" rel=\"external_link\" target=\"_blank\">carbon black<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_nanofiber\" title=\"Carbon nanofiber\" rel=\"external_link\" target=\"_blank\">carbon nanofibers<\/a>. This slurry is cast onto a metallic current collector and the NMP is evaporated to form a composite or . PVDF is used because it is chemically inert over the potential range used, and does not react with the electrolyte or lithium.\n<\/p><p>In the biomedical sciences, PVDF is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immunoblotting\" class=\"mw-redirect\" title=\"Immunoblotting\" rel=\"external_link\" target=\"_blank\">immunoblotting<\/a> as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_membrane\" class=\"mw-redirect\" title=\"Artificial membrane\" rel=\"external_link\" target=\"_blank\">artificial membrane<\/a> (usually with 0.22 or 0.45 micrometre pore sizes), on which proteins are transferred using electricity (see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Western_blotting\" class=\"mw-redirect\" title=\"Western blotting\" rel=\"external_link\" target=\"_blank\">western blotting<\/a>). PVDF is resistant to solvents and, therefore, these membranes can be easily stripped and reused to look at other proteins. PVDF membranes may be used in other biomedical applications as part of a membrane filtration device, often in the form of a syringe filter or wheel filter. The various properties of this material, such as heat resistance, resistance to chemical corrosion, and low protein binding properties, make this material valuable in the biomedical sciences for preparation of medications as a sterilizing filter, and as a filter to prepare samples for analytical techniques such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/High_performance_liquid_chromatography\" class=\"mw-redirect\" title=\"High performance liquid chromatography\" rel=\"external_link\" target=\"_blank\">high performance liquid chromatography<\/a> (HPLC), where small amounts of particulate matter can damage sensitive and expensive equipment.\n<\/p><p>PVDF is used for specialty <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monofilament_fishing_line\" title=\"Monofilament fishing line\" rel=\"external_link\" target=\"_blank\">monofilament fishing lines<\/a>, sold as fluorocarbon replacements for nylon monofilament. The surface is harder, so it is more resistant to abrasion and sharp fish teeth. Its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_density\" class=\"mw-redirect\" title=\"Optical density\" rel=\"external_link\" target=\"_blank\">optical density<\/a> is lower than nylon, which makes the line less discernible to sharp fish eyes. It is also denser than nylon, making it sink faster towards fish.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>PVDF transducers have the advantage of being dynamically more suitable for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Modal_testing\" title=\"Modal testing\" rel=\"external_link\" target=\"_blank\">modal testing<\/a> than semiconductor , and more compliant for structural integration than . For those reasons, the use of PVDF active sensors is a keystone for the development of future structural health monitoring methods, due to their low cost and compliance.<sup id=\"rdp-ebb-cite_ref-Guzman_10-0\" class=\"reference\"><a href=\"#cite_note-Guzman-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Other_forms\">Other forms<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Copolymers\">Copolymers<\/span><\/h3>\n<p>Copolymers of PVDF are also used in piezoelectric and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrostriction\" title=\"Electrostriction\" rel=\"external_link\" target=\"_blank\">electrostrictive<\/a> applications. One of the most commonly used copolymers is P(VDF-trifluoroethylene), usually available in ratios of about 50:50 wt% and 65:35 wt% (equivalent to about 56:44 mol% and 70:30 mol%). Another one is P(VDF-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Tetrafluoroethylene\" title=\"Tetrafluoroethylene\" rel=\"external_link\" target=\"_blank\">tetrafluoroethylene<\/a>). They improve the piezoelectric response by improving the crystallinity of the material.\n<\/p><p>While the copolymers' unit structures are less polar than that of pure PVDF, the copolymers typically have a much higher crystallinity. This results in a larger piezoelectric response: d<sub>33<\/sub> values for P(VDF-TFE) have been recorded to be as high as \u221238 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pico-\" title=\"Pico-\" rel=\"external_link\" target=\"_blank\">p<\/a><a href=\"https:\/\/en.wikipedia.org\/wiki\/Coulomb\" title=\"Coulomb\" rel=\"external_link\" target=\"_blank\">C<\/a>\/N<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> versus \u221233 pC\/N in pure PVDF.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Terpolymers\">Terpolymers<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Terpolymer\" class=\"mw-redirect\" title=\"Terpolymer\" rel=\"external_link\" target=\"_blank\">Terpolymers<\/a> of PVDF are the most promising one in terms of electromechanically induced strain. The most commonly used PVDF-based terpolymers are P(VDF-TrFE-CTFE) and P(VDF-TrFE-CFE).<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> This <a href=\"https:\/\/en.wikipedia.org\/wiki\/Relaxor\" class=\"mw-redirect\" title=\"Relaxor\" rel=\"external_link\" target=\"_blank\">relaxor<\/a>-based <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferroelectric\" class=\"mw-redirect\" title=\"Ferroelectric\" rel=\"external_link\" target=\"_blank\">ferroelectric<\/a> terpolymer is produced by random incorporation of the bulky third monomer (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Chlorotrifluoroethylene\" title=\"Chlorotrifluoroethylene\" rel=\"external_link\" target=\"_blank\">chlorotrifluoroethylene<\/a>, CTFE) into the polymer chain of P(VDF-TrFE) copolymer (which is ferroelectric in nature). This random incorporation of CTFE in P(VDF-TrFE) copolymer disrupts the long-range ordering of the ferroelectric polar phase, resulting in the formation of nano-polar domains. When an electric field is applied, the disordered nano-polar domains change their conformation to all-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Cis-trans_isomerism\" class=\"mw-redirect\" title=\"Cis-trans isomerism\" rel=\"external_link\" target=\"_blank\">trans<\/a> conformation, which leads to large electrostrictive strain and a high room-temperature <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dielectric_constant\" class=\"mw-redirect\" title=\"Dielectric constant\" rel=\"external_link\" target=\"_blank\">dielectric constant<\/a> of ~50.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferroelectric_polymers\" title=\"Ferroelectric polymers\" rel=\"external_link\" target=\"_blank\">Ferroelectric polymers<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Klaiber%27s_law\" title=\"Klaiber's law\" rel=\"external_link\" target=\"_blank\">Klaiber's law<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferroelectricity\" title=\"Ferroelectricity\" rel=\"external_link\" target=\"_blank\">Ferroelectricity<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Piezoelectricity\" title=\"Piezoelectricity\" rel=\"external_link\" target=\"_blank\">Piezoelectricity<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyroelectricity\" title=\"Pyroelectricity\" rel=\"external_link\" target=\"_blank\">Pyroelectricity<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic\" title=\"Plastic\" rel=\"external_link\" target=\"_blank\">Plastic<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">Polymer<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithium_ion_battery\" class=\"mw-redirect\" title=\"Lithium ion battery\" rel=\"external_link\" target=\"_blank\">Lithium ion battery<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ebi.ac.uk\/chebi\/searchId.do;A89DFCA7829681968B0AF2A1DD6CC9E5?chebiId=CHEBI:53250\" target=\"_blank\">\"poly(vinylene fluoride) (CHEBI:53250)\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">July 14,<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=poly%28vinylene+fluoride%29+%28CHEBI%3A53250%29&rft_id=http%3A%2F%2Fwww.ebi.ac.uk%2Fchebi%2FsearchId.do%3BA89DFCA7829681968B0AF2A1DD6CC9E5%3FchebiId%3DCHEBI%3A53250&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyvinylidene+fluoride\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Zhang, Q. M., Bharti, V., Kavarnos, G., Schwartz, M. 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(2015-12-17). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/xlink.rsc.org\/?DOI=C5NR01619C\" target=\"_blank\">\"Polyvinylidene fluoride molecules in nanofibers, imaged at atomic scale by aberration corrected electron microscopy\"<\/a>. <i>Nanoscale<\/i>. <b>8<\/b> (1): 120\u2013128. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1039%2Fc5nr01619c\" target=\"_blank\">10.1039\/c5nr01619c<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2040-3372\" target=\"_blank\">2040-3372<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nanoscale&rft.atitle=Polyvinylidene+fluoride+molecules+in+nanofibers%2C+imaged+at+atomic+scale+by+aberration+corrected+electron+microscopy&rft.volume=8&rft.issue=1&rft.pages=120-128&rft.date=2015-12-17&rft_id=info%3Adoi%2F10.1039%2Fc5nr01619c&rft.issn=2040-3372&rft.aulast=Lolla&rft.aufirst=Dinesh&rft.au=Gorse%2C+Joseph&rft.au=Kisielowski%2C+Christian&rft.au=Miao%2C+Jiayuan&rft.au=Taylor%2C+Philip+L.&rft.au=Chase%2C+George+G.&rft.au=Reneker%2C+Darrell+H.&rft_id=http%3A%2F%2Fxlink.rsc.org%2F%3FDOI%3DC5NR01619C&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyvinylidene+fluoride\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lolla, Dinesh; Lolla, Manideep; Abutaleb, Ahmed; Shin, Hyeon U.; Reneker, Darrell H.; Chase, George G. (2016-08-09). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mdpi.com\/1996-1944\/9\/8\/671\" target=\"_blank\">\"Fabrication, Polarization of Electrospun Polyvinylidene Fluoride Electret Fibers and Effect on Capturing Nanoscale Solid Aerosols\"<\/a>. <i>Materials<\/i>. <b>9<\/b> (8): 671. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3390%2Fma9080671\" target=\"_blank\">10.3390\/ma9080671<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Materials&rft.atitle=Fabrication%2C+Polarization+of+Electrospun+Polyvinylidene+Fluoride+Electret+Fibers+and+Effect+on+Capturing+Nanoscale+Solid+Aerosols&rft.volume=9&rft.issue=8&rft.pages=671&rft.date=2016-08-09&rft_id=info%3Adoi%2F10.3390%2Fma9080671&rft.aulast=Lolla&rft.aufirst=Dinesh&rft.au=Lolla%2C+Manideep&rft.au=Abutaleb%2C+Ahmed&rft.au=Shin%2C+Hyeon+U.&rft.au=Reneker%2C+Darrell+H.&rft.au=Chase%2C+George+G.&rft_id=http%3A%2F%2Fwww.mdpi.com%2F1996-1944%2F9%2F8%2F671&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyvinylidene+fluoride\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Prevedouros2006-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Prevedouros2006_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Prevedouros K, Cousins IT, Buck RC, Korzeniowski SH (January 2006). \"Sources, fate and transport of perfluorocarboxylates\". <i>Environ Sci Technol<\/i>. <b>40<\/b> (1): 32\u201344. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1021%2Fes0512475\" target=\"_blank\">10.1021\/es0512475<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16433330\" target=\"_blank\">16433330<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Environ+Sci+Technol&rft.atitle=Sources%2C+fate+and+transport+of+perfluorocarboxylates&rft.volume=40&rft.issue=1&rft.pages=32-44&rft.date=2006-01&rft_id=info%3Adoi%2F10.1021%2Fes0512475&rft_id=info%3Apmid%2F16433330&rft.aulast=Prevedouros&rft.aufirst=K&rft.au=Cousins%2C+IT&rft.au=Buck%2C+RC&rft.au=Korzeniowski%2C+SH&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyvinylidene+fluoride\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zhang, Qiwu; Lu, Jinfeng; Saito, Fumio; Baron, Michel (2001). \"Mechanochemical solid-phase reaction between polyvinylidene fluoride and sodium hydroxide\". <i>Journal of Applied Polymer Science<\/i>. <b>81<\/b> (9): 2249. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fapp.1663\" target=\"_blank\">10.1002\/app.1663<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Applied+Polymer+Science&rft.atitle=Mechanochemical+solid-phase+reaction+between+polyvinylidene+fluoride+and+sodium+hydroxide&rft.volume=81&rft.issue=9&rft.pages=2249&rft.date=2001&rft_id=info%3Adoi%2F10.1002%2Fapp.1663&rft.aulast=Zhang&rft.aufirst=Qiwu&rft.au=Lu%2C+Jinfeng&rft.au=Saito%2C+Fumio&rft.au=Baron%2C+Michel&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyvinylidene+fluoride\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.seaguar.com\/about-seaguar\/seaguar-history-01.htm\" target=\"_blank\">Seaguar history \u2014 Kureha America, Inc. manufacturer's site<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100620214019\/http:\/\/www.seaguar.com\/about-seaguar\/seaguar-history-01.htm\" target=\"_blank\">Archived<\/a> 2010-06-20 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-Guzman-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Guzman_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Guzman, E.; Cugnoni, J; Gm\u00fcr, T (2013). \"Survivability of integrated PVDF film sensors to accelerated ageing conditions in aeronautical\/aerospace structures\". <i>Smart Mater Struct<\/i>. <b>22<\/b> (6): 065020. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1088%2F0964-1726%2F22%2F6%2F065020\" target=\"_blank\">10.1088\/0964-1726\/22\/6\/065020<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Smart+Mater+Struct&rft.atitle=Survivability+of+integrated+PVDF+film+sensors+to+accelerated+ageing+conditions+in+aeronautical%2Faerospace+structures&rft.volume=22&rft.issue=6&rft.pages=065020&rft.date=2013&rft_id=info%3Adoi%2F10.1088%2F0964-1726%2F22%2F6%2F065020&rft.aulast=Guzman&rft.aufirst=E.&rft.au=Cugnoni%2C+J&rft.au=Gm%C3%BCr%2C+T&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyvinylidene+fluoride\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Omote, Kenji; Ohigashi, Hiroji; Koga, Keiko (1997). \"Temperature dependence of elastic, dielectric, and piezoelectric properties of \"single crystalline<i> films of vinylidene fluoride trifluoroethylene copolymer\". <\/i>Journal of Applied Physics<i>. <b>81<\/b> (6): 2760. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1063%2F1.364300\" target=\"_blank\">10.1063\/1.364300<\/a>.<\/i><\/cite><i><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Applied+Physics&rft.atitle=Temperature+dependence+of+elastic%2C+dielectric%2C+and+piezoelectric+properties+of+%22single+crystalline+films+of+vinylidene+fluoride+trifluoroethylene+copolymer&rft.volume=81&rft.issue=6&rft.pages=2760&rft.date=1997&rft_id=info%3Adoi%2F10.1063%2F1.364300&rft.aulast=Omote&rft.aufirst=Kenji&rft.au=Ohigashi%2C+Hiroji&rft.au=Koga%2C+Keiko&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyvinylidene+fluoride\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/i><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Nix, E. 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M. (3 April 2007). \"Phase Transitions and Ferroelectric Relaxor Behavior in P(VDF\u2212TrFE\u2212CFE) Terpolymers\". <i>Macromolecules<\/i>. ACS Publications. <b>40<\/b> (7): 2371\u20132379. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1021%2Fma062800l\" target=\"_blank\">10.1021\/ma062800l<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Macromolecules&rft.atitle=Phase+Transitions+and+Ferroelectric+Relaxor+Behavior+in+P%28VDF%E2%88%92TrFE%E2%88%92CFE%29+Terpolymers&rft.volume=40&rft.issue=7&rft.pages=2371-2379&rft.date=2007-04-03&rft_id=info%3Adoi%2F10.1021%2Fma062800l&rft.aulast=Bao&rft.aufirst=Hui-Min&rft.au=Song%2C+Jiao-Fan&rft.au=Zhang%2C+Juan&rft.au=Shen%2C+Qun-Dong&rft.au=Yang%2C+Chang-Zheng&rft.au=Zhang%2C+Q.+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyvinylidene+fluoride\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ahmed, Saad; Arrojado, Erika; Sigamani, Nirmal; Ounaies, Zoubeida (14 May 2015). Goulbourne, Nakhiah C., ed. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/spie.org\/Publications\/Proceedings\/Paper\/10.1117\/12.2084785?origin_id=x4323&start_year=2015\" target=\"_blank\">\"Electric field responsive origami structures using electrostriction-based active materials\"<\/a>. <i>Proceedings of SPIE: Behavior and Mechanics of Multifunctional Materials and Composites 2015<\/i>. Society of Photographic Instrumentation Engineers (SPIE). <b>9432<\/b>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1117%2F12.2084785\" target=\"_blank\">10.1117\/12.2084785<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781628415353.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+SPIE%3A+Behavior+and+Mechanics+of+Multifunctional+Materials+and+Composites+2015&rft.atitle=Electric+field+responsive+origami+structures+using+electrostriction-based+active+materials&rft.volume=9432&rft.date=2015-05-14&rft_id=info%3Adoi%2F10.1117%2F12.2084785&rft.isbn=9781628415353&rft.aulast=Ahmed&rft.aufirst=Saad&rft.au=Arrojado%2C+Erika&rft.au=Sigamani%2C+Nirmal&rft.au=Ounaies%2C+Zoubeida&rft_id=http%3A%2F%2Fspie.org%2FPublications%2FProceedings%2FPaper%2F10.1117%2F12.2084785%3Forigin_id%3Dx4323%26start_year%3D2015&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyvinylidene+fluoride\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1258\nCached time: 20181215092027\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.620 seconds\nReal time usage: 0.817 seconds\nPreprocessor visited node count: 5350\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 72533\/2097152 bytes\nTemplate argument size: 10996\/2097152 bytes\nHighest expansion depth: 22\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 36532\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.279\/10.000 seconds\nLua memory usage: 5.74 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 747.737 1 -total\n<\/p>\n<pre>64.53% 482.526 1 Template:Chembox\n38.19% 285.551 1 Template:Chembox_Identifiers\n25.89% 193.614 1 Template:Reflist\n23.40% 174.989 5 Template:Chembox_headerbar\n22.89% 171.164 15 Template:Trim\n13.06% 97.658 10 Template:Main_other\n12.62% 94.341 11 Template:Cite_journal\n11.00% 82.250 1 Template:Chembox_parametercheck\n 8.81% 65.844 10 Template:Unbulleted_list\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:371942-1!canonical and timestamp 20181215092026 and revision id 861085082\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Polyvinylidene_fluoride\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212225\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.016 seconds\nReal time usage: 0.159 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 152.702 1 - wikipedia:Polyvinylidene_fluoride\n100.00% 152.702 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8296-0!*!*!*!*!*!* and timestamp 20181217212225 and revision id 24508\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polyvinylidene_fluoride\">https:\/\/www.limswiki.org\/index.php\/Polyvinylidene_fluoride<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","b8c5af96880f409729329d3807af7da1_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ea\/Polyvinylidenfluorid.svg\/300px-Polyvinylidenfluorid.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/55\/A_UPW_Installation_using_PVDF_Piping.png\/440px-A_UPW_Installation_using_PVDF_Piping.png"],"b8c5af96880f409729329d3807af7da1_timestamp":1545081745,"31670fc19e00e5b9da56359ed47aec32_type":"article","31670fc19e00e5b9da56359ed47aec32_title":"Polytetrafluoroethylene","31670fc19e00e5b9da56359ed47aec32_url":"https:\/\/www.limswiki.org\/index.php\/Polytetrafluoroethylene","31670fc19e00e5b9da56359ed47aec32_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPolytetrafluoroethylene\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\"Teflon\" redirects here. For other uses, see Teflon (disambiguation).\n\n\n\nPolytetrafluoroethylene\n\n\n\n\n\n\n\n\nNames\n\n\n\nIUPAC name\npoly(tetrafluoroethylene)[1]\n\n\n\n\nOther names\nSyncolon, Fluon, Poly(tetrafluroethene), Poly(difluoromethylene), Poly(tetrafluoroethylene)\n\n\nIdentifiers\n\n\n\nCAS Number\n\n9002-84-0  Y \n\n\n\n\nAbbreviations\n\nPTFE\n\n\n\nChEBI\n\nCHEBI:53251  N \n\n\n\nChemSpider\n\nnone\n\n\n\nECHA InfoCard \n\n100.120.367\n\n\n\n\n\n\nKEGG\n\nD08974  N \n\n\nProperties\n\n\nChemical formula\n\n(C2F4)n \n\n\n\n\n\nDensity\n\n2200 kg\/m3\n\n\nMelting point\n\n600 K\r\n327 \u00b0C  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nThermal conductivity\n\n0.25 W\/(m\u00b7K)\n\n\n\n\n\n\nHazards\n\n\n\n\n\n\n\n\n\n\n\n\n\nNFPA 704\n\n\n\n0 \n1 \n0 \n\n\n\n\n\nExcept where otherwise noted, data are given for materials in their standard state (at 25 \u00b0C [77 \u00b0F], 100 kPa).\n\n\nN  verify  (what is Y N  ?)\n\n\nInfobox references\n\n\n\n\n\n\n\nPolytetrafluoroethylene (PTFE) is a synthetic fluoropolymer of tetrafluoroethylene that has numerous applications. The best known brand name of PTFE-based formulas is Teflon by Chemours.[2] Chemours is a spin-off of DuPont, which originally discovered the compound in 1938.[2]\nPTFE is a fluorocarbon solid, as it is a high-molecular-weight compound consisting wholly of carbon and fluorine. PTFE is hydrophobic: neither water nor water-containing substances wet PTFE, as fluorocarbons demonstrate mitigated London dispersion forces due to the high electronegativity of fluorine. PTFE has one of the lowest coefficients of friction of any solid.\nPTFE is used as a non-stick coating for pans and other cookware. It is nonreactive, partly because of the strength of carbon\u2013fluorine bonds, and so it is often used in containers and pipework for reactive and corrosive chemicals. Where used as a lubricant, PTFE reduces friction, wear, and energy consumption of machinery. It is commonly used as a graft material in surgical interventions. Also, it is frequently employed as coating on catheters; this interferes with the ability of bacteria and other infectious agents to adhere to catheters and cause hospital-acquired infections.\n\nContents \n\n1 History \n2 Production \n3 Properties \n4 Processing \n5 Applications and uses \n6 Safety \n\n6.1 PFOA \n\n\n7 Similar polymers \n8 See also \n9 References \n10 Further reading \n11 External links \n\n\nHistory \n Advertisement of the Happy Pan, a Teflon-coated pan from the 1960s\nExternal audio \"From stove tops to outer space... Teflon touches every one of us some way almost every day.\", Roy Plunkett, Science History Institute\n Teflon thermal cover showing impact craters, from NASA's Ultra Heavy Cosmic Ray Experiment (UHCRE)\nPTFE was accidentally discovered in 1938 by Roy J. Plunkett while he was working in New Jersey for DuPont. As Plunkett attempted to make a new chlorofluorocarbon refrigerant, the tetrafluoroethylene gas in its pressure bottle stopped flowing before the bottle's weight had dropped to the point signaling \"empty.\" Since Plunkett was measuring the amount of gas used by weighing the bottle, he became curious as to the source of the weight, and finally resorted to sawing the bottle apart. He found the bottle's interior coated with a waxy white material that was oddly slippery. Analysis showed that it was polymerized perfluoroethylene, with the iron from the inside of the container having acted as a catalyst at high pressure. Kinetic Chemicals patented the new fluorinated plastic (analogous to the already known polyethylene) in 1941,[3] and registered the Teflon trademark in 1945.[4][5]\nBy 1948, DuPont, which founded Kinetic Chemicals in partnership with General Motors, was producing over two million pounds (900 tons) of Teflon brand PTFE per year in Parkersburg, West Virginia.[6] An early use was in the Manhattan Project as a material to coat valves and seals in the pipes holding highly reactive uranium hexafluoride at the vast K-25 uranium enrichment plant in Oak Ridge, Tennessee.[7]\nIn 1954, the wife of French engineer Marc Gr\u00e9goire urged him to try the material he had been using on fishing tackle on her cooking pans. He subsequently created the first PTFE-coated, non-stick pans under the brandname Tefal (combining \"Tef\" from \"Teflon\" and \"al\" from aluminium).[8] In the United States, Marion A. Trozzolo, who had been using the substance on scientific utensils, marketed the first US-made PTFE-coated pan, \"The Happy Pan\", in 1961.[9]\nHowever, Tefal was not the only company to utilize PTFE in nonstick cookware coatings. In subsequent years, many cookware manufacturers developed proprietary PTFE-based formulas, including Swiss Diamond International, which uses a diamond-reinforced PTFE formula;[10] Scanpan, which uses a titanium-reinforced PTFE formula;[11] and both All-Clad[12] and Newell Rubbermaid's Calphalon, which use a non-reinforced PTFE-based nonstick.[13] Other cookware companies, such as Meyer Corporation's Anolon, use Teflon[14] nonstick coatings purchased from Chemours. Chemours is a 2015 corporate spin-off of DuPont.[15]\nIn the 1990s, it was found that PTFE could be radiation cross-linked above its melting point in an oxygen-free environment.[16] Electron beam processing is one example of radiation processing. Cross-linked PTFE has improved high-temperature mechanical properties and radiation stability. This was significant because, for many years, irradiation at ambient conditions has been used to break down PTFE for recycling.[17] This radiation-induced chain scission allows it to be more easily reground and reused.\n\nProduction \nPTFE is produced by free-radical polymerization of tetrafluoroethylene. The net equation is\n\nn F2C=CF2 \u2192 \u2212(F2C\u2212CF2)n\u2212\nBecause tetrafluoroethylene can explosively decompose to tetrafluoromethane and carbon, special apparatus is required for the polymerization to prevent hot spots that might initiate this dangerous side reaction. The process is typically initiated with persulfate, which homolyzes to generate sulfate radicals:\n\n[O3SO\u2212OSO3]2\u2212 \u21cc 2 SO4\u2022\u2212\nThe resulting polymer is terminated with sulfate ester groups, which can be hydrolyzed to give OH end-groups.[18]\nBecause PTFE is poorly soluble in almost all solvents, the polymerization is conducted as an emulsion in water. This process gives a suspension of polymer particles. Alternatively, the polymerization is conducted using a surfactant such as PFOS.\n\nProperties \n PTFE is often used to coat non-stick pans as it is hydrophobic and possesses fairly high heat resistance.\nPTFE is a thermoplastic polymer, which is a white solid at room temperature, with a density of about 2200 kg\/m3. According to Chemours, its melting point is 600 K (327 \u00b0C; 620 \u00b0F).[19] It maintains high strength, toughness and self-lubrication at low temperatures down to 5 K (\u2212268.15 \u00b0C; \u2212450.67 \u00b0F), and good flexibility at temperatures above 194 K (\u221279 \u00b0C; \u2212110 \u00b0F).[20] PTFE gains its properties from the aggregate effect of carbon-fluorine bonds, as do all fluorocarbons. The only chemicals known to affect these carbon-fluorine bonds are highly reactive metals like the alkali metals, and at higher temperatures also such metals as aluminium and magnesium, and fluorinating agents such as xenon difluoride and cobalt(III) fluoride.[21]\n\n\n\n\nProperty\n\nValue\n\n\nDensity\n\n2200 kg\/m3\n\n\nGlass temperature\n\n114.85 \u00b0C (238.73 \u00b0F; 388.00 K) [22]\n\n\nMelting point\n\n326.85 \u00b0C (620.33 \u00b0F; 600.00 K)\n\n\nThermal expansion\n\n112\u2013125 \u00b7 10\u22126 K\u22121 [23]\n\n\nThermal diffusivity\n\n0.124 mm2\/s [24]\n\n\nYoung's modulus\n\n0.5 GPa\n\n\nYield strength\n\n23 MPa\n\n\nBulk resistivity\n\n1016 \u03a9\u00b7m [25]\n\n\nCoefficient of friction\n\n0.05\u20130.10\n\n\nDielectric constant\n\n\u03b5 = 2.1 , tan(\u03b4) < 5(-4) \n\n\nDielectric constant (60 Hz)\n\n\u03b5 = 2.1 , tan(\u03b4) < 2(-4) \n\n\nDielectric strength (1 MHz)\n\n60 MV\/m\n\n\nMagnetic susceptibility (SI, 22 \u00b0C)\n\n\u221210.28\u00d710\u22126 [26]\n\nPlay media Geckos cannot crawl up on teflon.\nThe coefficient of friction of plastics is usually measured against polished steel.[27] PTFE's coefficient of friction is 0.05 to 0.10,[19] which is the third-lowest of any known solid material (BAM being the first, with a coefficient of friction of 0.02; diamond-like carbon being second-lowest at 0.05). PTFE's resistance to van der Waals forces means that it is the only known surface to which a gecko cannot stick.[28] In fact, PTFE can be used to prevent insects climbing up surfaces painted with the material. PTFE is so slippery that insects cannot get a grip and tend to fall off. For example, PTFE is used to prevent ants climbing out of formicaria.\nBecause of its chemical inertness, PTFE cannot be cross-linked like an elastomer. Therefore, it has no \"memory\" and is subject to creep. Because of its superior chemical and thermal properties, PTFE is often used as a gasket material within industries that require resistance to aggressive chemicals such as pharmaceuticals or chemical processing.[29] However, because of the propensity to creep, the long-term performance of such seals is worse than for elastomers which exhibit zero, or near-zero, levels of creep. In critical applications, Belleville washers are often used to apply continuous force to PTFE gaskets, ensuring a minimal loss of performance over the lifetime of the gasket.[30]\n\nProcessing \nProcessing PTFE can be difficult and expensive, because the high melting temperature, 327 \u00b0C (621 \u00b0F), is above the initial decomposition temperature, 200 \u00b0C (392 \u00b0F).[31] Even when melted, PTFE does not flow, but instead behaves as a gel due to the absence of crystalline phase[32] and high melt viscosity.[33]\nSome PTFE parts are made by cold-moulding, a form of compression molding.[34] Here, fine powdered PTFE is forced into a mould under high pressure (10\u2013100 MPa).[34] After a settling period, lasting from minutes to days, the mould is heated at 360 to 380 \u00b0C (680 to 716 \u00b0F),[34] allowing the fine particles to fuse into a single mass.[35]\n\nApplications and uses \nThis section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (May 2017) (Learn how and when to remove this template message)\nThe major application of PTFE, consuming about 50% of production, is for wiring in aerospace and computer applications (e.g. hookup wire, coaxial cables). This application exploits the fact that PTFE has excellent dielectric properties,[36] especially at high radio frequencies,[36] making it suitable for use as an excellent insulator in connector assemblies and cables, and in printed circuit boards used at microwave frequencies. Combined with its high melting temperature, this makes it the material of choice as a high-performance substitute for the weaker and lower-melting-point polyethylene commonly used in low-cost applications.\nIn industrial applications, owing to its low friction, PTFE is used for plain bearings, gears, slide plates, seals, gaskets, bushings[37], and more applications with sliding action of parts, where it outperforms acetal and nylon.[38]\nIts extremely high bulk resistivity makes it an ideal material for fabricating long-life electrets, the electrostatic analogues of permanent magnets.\nPTFE film is also widely used in the production of carbon fiber composites as well as fiberglass composites, notably in the aerospace industry. PTFE film is used as a barrier between the carbon or fiberglass part being built, and breather and bagging materials used to incapsulate the bondment when debulking (vacuum removal of air from between layers of laid-up plies of material) and when curing the composite, usually in an autoclave. The PTFE, used here as a film, prevents the non-production materials from sticking to the part being built, which is sticky due to the carbon-graphite or fiberglass plies being pre-pregnated with bismaleimide resin. Non-production materials such as Teflon, Airweave Breather and the bag itself would be considered F.O.D. (foreign object debris\/damage) if left in layup.\nBecause of its extreme non-reactivity and high temperature rating, PTFE is often used as the liner in hose assemblies, expansion joints, and in industrial pipe lines, particularly in applications using acids, alkalis, or other chemicals. Its frictionless qualities allow improved flow of highly viscous liquids, and for uses in applications such as brake hoses.\nGore-Tex is a brand of expanded PTFE (ePTFE), a material incorporating a fluoropolymer membrane with micropores. The roof of the Hubert H. Humphrey Metrodome in Minneapolis, US, was one of the largest applications of PTFE coatings. 20 acres (81,000 m2) of the material was used in the creation of the white double-layered PTFE-coated fiberglass dome.\nPTFE is often found in musical instrument lubrication product; most commonly, valve oil.\nPTFE is used in some aerosol lubricant sprays, including in micronized and polarized form. It is notable for its extremely low coefficient of friction, its hydrophobia (which serves to inhibit rust), and for the dry film it forms after application, which allows it to resist collecting particles that might otherwise form an abrasive paste. [39]\nPTFE (Teflon) is best known for its use in coating non-stick frying pans and other cookware, as it is hydrophobic and possesses fairly high heat resistance.\n\n PTFE tapes with pressure-sensitive adhesive backing\nThe sole plates of some clothes irons are coated with PTFE (Teflon).[40]\nOther niche applications include:\n\nIt is often found in ski bindings as a non-mechanical AFD (anti-friction device)\nIt can be stretched to contain small pores of varying sizes and is then placed between fabric layers to make a waterproof, breathable fabric in outdoor apparel.[41]\nIt is used widely as a fabric protector to repel stains on formal school-wear, like uniform blazers.[42]\nIt is used as a film interface patch for sports and medical applications, featuring a pressure-sensitive adhesive backing, which is installed in strategic high friction areas of footwear, insoles, ankle-foot orthosis, and other medical devices to prevent and relieve friction-induced blisters, calluses and foot ulceration.[43]\nExpanded PTFE membranes have been used in trials to assist trabeculectomy surgery to treat glaucoma.[44]\nPowdered PTFE is used in pyrotechnic compositions as an oxidizer with powdered metals such as aluminium and magnesium. Upon ignition, these mixtures form carbonaceous soot and the corresponding metal fluoride, and release large amounts of heat. They are used in infrared decoy flares and as igniters for solid-fuel rocket propellants.[45] Aluminium and PTFE is also used in some thermobaric fuel compositions.\nPowdered PTFE is used in a suspension with a low-viscosity, azeotropic mixture of siloxane ethers to create a lubricant for use in twisty puzzles.[46]\nIn optical radiometry, sheets of PTFE are used as measuring heads in spectroradiometers and broadband radiometers (e.g., illuminance meters and UV radiometers) due to PTFE's capability to diffuse a transmitting light nearly perfectly. Moreover, optical properties of PTFE stay constant over a wide range of wavelengths, from UV down to near infrared. In this region, the ratio of its regular transmittance to diffuse transmittance is negligibly small, so light transmitted through a diffuser (PTFE sheet) radiates like Lambert's cosine law. Thus PTFE enables cosinusoidal angular response for a detector measuring the power of optical radiation at a surface, e.g. in solar irradiance measurements.\nCertain types of bullets are coated with PTFE to reduce wear on the rifling of firearms that uncoated projectiles would cause. PTFE itself does not give a projectile an armor-piercing property.[47]\nIts high corrosion resistance makes PTFE useful in laboratory environments, where it is used for lining containers, as a coating for magnetic stirrers, and as tubing for highly corrosive chemicals such as hydrofluoric acid, which will dissolve glass containers. It is used in containers for storing fluoroantimonic acid, a superacid.[48]\nPTFE tubes are used in gas-gas heat exchangers in gas cleaning of waste incinerators. Unit power capacity is typically several megawatts.\nPTFE is widely used as a thread seal tape in plumbing applications, largely replacing paste thread dope.\nPTFE membrane filters are among the most efficient industrial air filters. PTFE-coated filters are often used in dust collection systems to collect particulate matter from air streams in applications involving high temperatures and high particulate loads such as coal-fired power plants, cement production and steel foundries.[49]\nPTFE grafts can be used to bypass stenotic arteries in peripheral vascular disease if a suitable autologous vein graft is not available.\nMany bicycle lubricants and greases contain PTFE and are used on chains and other moving parts subjected to frictional forces (such as hub bearings).\nPTFE can also be used for dental fillings, to isolate the contacts of the anterior tooth so the filling materials will not stick to the adjacent tooth.[50][51]\nPTFE sheets are used in the production of butane hash oil due to its non-stick properties and resistance to non-polar solvents.[52]\nPTFE, associated with a slightly textured laminate, makes the plain bearing system of a Dobsonian telescope.\nPTFE is widely used as a non-stick coating for food processing equipment;[53] dough hoppers, mixing bowls, conveyor systems, rollers, and chutes. PTFE can also be reinforced where abrasion is present \u2013 for equipment processing seeded or grainy dough for example.[54]\nPTFE has been experimented with for electroless nickel plating.\nSafety \nPyrolysis of PTFE is detectable at 200 \u00b0C (392 \u00b0F), and it evolves several fluorocarbon gases and a sublimate. An animal study conducted in 1955 concluded that it is unlikely that these products would be generated in amounts significant to health at temperatures below 250 \u00b0C (482 \u00b0F).[31]\nWhile PTFE is stable and nontoxic at lower temperatures, it begins to deteriorate after the temperature of cookware reaches about 260 \u00b0C (500 \u00b0F), and decomposes above 350 \u00b0C (662 \u00b0F).[55] The degradation by-products can be lethal to birds,[56] and can cause flu-like symptoms[57] in humans\u2014see polymer fume fever. Meat is usually fried between 204 and 232 \u00b0C (399 and 450 \u00b0F), and most oils start to smoke before a temperature of 260 \u00b0C (500 \u00b0F) is reached, but there are at least two cooking oils (refined safflower oil at 265 \u00b0C (509 \u00b0F) and avocado oil at 271 \u00b0C (520 \u00b0F)) that have a higher smoke point.\n\nPFOA \nMain article: Perfluorooctanoic acid\nPerfluorooctanoic acid (PFOA, or C8) has been used as a surfactant in the emulsion polymerization of PTFE, although several manufacturers have entirely discontinued its use.\nPFOA persists indefinitely in the environment. It is a toxicant and carcinogen in animals. PFOA has been detected in the blood of more than 98% of the general US population in the low and sub-parts per billion range, and levels are higher in chemical plant employees and surrounding subpopulations. The general population has been exposed to PFOA through massive dumping of C8 waste into the ocean and near the Ohio River Valley.[58][59][60] PFOA has been detected in industrial waste, stain resistant carpets, carpet cleaning liquids, house dust, microwave popcorn bags, water, food and Teflon cookware.\nAs a result of a class-action lawsuit and community settlement with DuPont, three epidemiologists conducted studies on the population surrounding a chemical plant that was exposed to PFOA at levels greater than in the general population. The studies concluded that there was probably an association between PFOA exposure and six health outcomes: kidney cancer, testicular cancer, ulcerative colitis, thyroid disease, hypercholesterolemia (high cholesterol), and pregnancy-induced hypertension.[61]\n\n<\/p>Overall, PTFE cookware is considered an insignificant exposure pathway to PFOA.[62][63]\n\nSimilar polymers \n Teflon is also used as the trade name for a polymer with similar properties, perfluoroalkoxy polymer resin (PFA)\nThe Teflon trade name is also used for other polymers with similar compositions:\n\nPerfluoroalkoxy alkane (PFA)\nFluorinated ethylene propylene (FEP)\nThese retain the useful PTFE properties of low friction and nonreactivity, but are more easily formable. For example, FEP is softer than PTFE and melts at 533 K (260 \u00b0C; 500 \u00b0F); it is also highly transparent and resistant to sunlight.[64]\n\nSee also \nSuperhydrophobic coating\nETFE\nMagnesium\/Teflon\/Viton pyrolant thermite composition\nPolymer adsorption\nPolymer fume fever\nBS 4994 PTFE as a thermoplastic lining for dual laminate chemical process plant equipment\n\nReferences \n\n\n^ \"poly(tetrafluoroethylene) (CHEBI:53251)\". ebi.ac.uk. Retrieved 12 July 2012 . \n\n^ a b \"Teflon \u2122| Chemours Teflon\u2122 Nonstick Coatings and Additives\". www.chemours.com. Retrieved 2016-03-01 . \n\n^ US 2230654, Plunkett, Roy J, \"Tetrafluoroethylene polymers\", issued 4 February 1941   \n\n^ \"History Timeline 1930: The Fluorocarbon Boom\". DuPont. Retrieved 10 June 2009 . \n\n^ \"Roy Plunkett: 1938\". Retrieved 10 June 2009 . \n\n^ American Heritage of Invention & Technology, Fall 2010, vol. 25, no. 3, p. 42 \n\n^ \nRhodes, Richard (1986). The Making of the Atomic Bomb. New York, New York: Simon and Schuster. p. 494. ISBN 0-671-65719-4. Retrieved 31 October 2010 . \n\n^ \"Teflon History \", home.nycap.rr.com, Retrieved 25 January 2009. \n\n^ Robbins, William (21 December 1986) \"Teflon Maker: Out Of Frying Pan Into Fame \", New York Times, Retrieved 21 December 1986 (Subscription) \n\n^ Swiss Diamond Technology Swiss Diamond International \n\n^ About SCANPAN SCANPAN \n\n^ FAQ's \"Is Nonstick Safe,\" All-Clad FAQ \n\n^ FAQ's \"Does your cookware contain Teflon\u00ae?\" Calphalon FAQ \n\n^ Knowledge Base Analon \n\n^ \"DuPont - DuPont Completes Spin-off of The Chemours Company\". investors.dupont.com. Retrieved 2016-03-01 . \n\n^ Sun, J.Z.; et al. (1994). \"Modification of polytetrafluoroethylene by radiation\u20141. Improvement in high temperature properties and radiation stability\". Radiat. Phys. Chem. 44 (6): 655\u2013679. Bibcode:1994RaPC...44..655S. doi:10.1016\/0969-806X(94)90226-7. \n\n^ Electron Beam Processing of PTFE E-BEAM Services website. Accessed 21 May 2013 \n\n^ Carlson, D. Peter and Schmiegel, Walter (2000) \"Fluoropolymers, Organic\" in Ullmann's Encyclopedia of Industrial Chemistry, Wiley-VCH, Weinheim. doi:10.1002\/14356007.a11_393 \n\n^ a b Fluoroplastic Comparison - Typical Properties Retrieved 16 January 2018. \n\n^ Teflon PTFE Properties Handbook Retrieved 11 October 2012. \n\n^ DuPont Teflon\u00ae Coatings. plastechcoatings.com \n\n^ Nicholson, John W. (2011). The Chemistry of Polymers (4, Revised ed.). Royal Society of Chemistry. p. 50. ISBN 9781849733915. \n\n^ \"Reference Tables \u2013 Thermal Expansion Coefficients \u2013 Plastics\". engineershandbook.com. \n\n^ Blumm, J.; Lindemann, A.; Meyer, M.; Strasser, C. (2011). \"Characterization of PTFE Using Advanced Thermal Analysis Technique\". International Journal of Thermophysics. 40 (3\u20134): 311. Bibcode:2010IJT....31.1919B. doi:10.1007\/s10765-008-0512-z. \n\n^ \"PTFE\". Microwaves101. \n\n^ Wapler, M. C.; Leupold, J.; Dragonu, I.; von Elverfeldt, D.; Zaitsev, M.; Wallrabe, U. (2014). \"Magnetic properties of materials for MR engineering, micro-MR and beyond\". JMR. 242: 233\u2013242. arXiv:1403.4760 . Bibcode:2014JMagR.242..233W. doi:10.1016\/j.jmr.2014.02.005. \n\n^ Coefficient of Friction (COF) Testing of Plastics MatWeb Material Property Data Retrieved 1 January 2007. \n\n^ \"Research into Gecko Adhesion \", Berkeley, 2007-10-14, Retrieved 8 April 2010. \n\n^ Inc., Gasket Resources. \"PTFE Sheet | Gasket Resources Inc\". www.gasketresources.com. Retrieved 2017-08-16 . \n\n^ Davet, George P. \"Using Belleville Springs To Maintain Bolt Preload\" (PDF) . Solon Mfg. Co. Retrieved 18 May 2014 . \n\n^ a b Zapp JA, Limperos G, Brinker KC (26 April 1955). \"Toxicity of pyrolysis products of 'Teflon' tetrafluoroethylene resin\". Proceedings of the American Industrial Hygiene Association Annual Meeting. \n\n^ \"Free Flow Granular PTFE\" (PDF) . Inoflon Fluoropolymers. 2017-08-16. \n\n^ \"COWIE TECHNOLOGY - PTFE: High Thermal Stability\". www.cowie.com. Retrieved 2017-08-16 . \n\n^ a b c \"Polyflon PTFE Molding Powder\" (PDF) . Daikin Chemical. 2017-08-16. \n\n^ \"Unraveling Polymers: PTFE\". Poly Fouoro Ltd. 26 April 2011. Retrieved 23 April 2017 . \n\n^ a b Mishra, Munmaya; Yagci, Yusuf (208). Handbook of Vinyl Polymers: Radical Polymerization, Process, and Technology, Second Edition (2nd, illustrated, revised ed.). CRC Press. p. 574. ISBN 978-0-8247-2595-2. Extract of page 574 \n\n^ \"Teflon Machining & Fabrication | ESPE\". www.espemfg.com. Retrieved 2018-08-28 . \n\n^ Mishra & Yagci, p 573 \n\n^ \"What is MicPol?\". Lubrication. Retrieved 2018-10-03 . \n\n^ Fers \u00e0 repasser semelle teflon - Fiche pratique - Le Parisien. Pratique.leparisien.fr. Retrieved on 2016-11-17. \n\n^ \"A Motorcyclist's Guide To Gore-Tex\". Infinity Motorcycles. \n\n^ \"Advantages and Disadvantages of Teflon-coated Covert Cloth\". The Cutter and Tailor. \n\n^ \"Film Interface Patch\". American Academy of Orthotists & Prosthetists. \n\n^ Wang X, Khan R, Coleman A (2015). \"Device-modified trabeculectomy for glaucoma\". Cochrane Database Syst Rev. 12: CD010472. doi:10.1002\/14651858.CD010472.pub2. PMC 4715269 . PMID 26625212. \n\n^ Koch, E.-C. (2002). \"Metal-Fluorocarbon Pyrolants:III. Development and Application of Magnesium\/Teflon\/Viton\". Propellants, Explosives, Pyrotechnics. 27 (5): 262\u2013266. doi:10.1002\/1521-4087(200211)27:5<262::AID-PREP262>3.0.CO;2-8. \n\n^ \"Lubicle 1\". TheCubicle.us. Retrieved 2017-05-20 . \n\n^ \"Interview with an inventor of the KTW bullet\". NRAction newsletter. 4 (5). May 1990. \n\n^ Pomeroy, Ross (2013-08-24). \"The World's Strongest Acids: Like Fire and Ice\". Retrieved 2016-04-09 . \n\n^ \"Industrial Air Permits - New Clean Air Regulations And Baghouses\". Baghouse.com. \n\n^ Brown, DDS, Dennis E. \"Using Plumber's Teflon Tape to Enhance Bonding Procedures\". Dentistry Today. \n\n^ Dunn, WJ; et al. \"Polytetrafluoroethylene (PTFE) tape as a matrix in operative dentistry\". Operative Dentistry. 29: 470\u20132. PMID 15279489. \n\n^ Rosenthal, Ed (21 October 2014). Beyond Buds (Revised ed.). Quick American Archives. ISBN 1936807238. \n\n^ http:\/\/www.surfacetechnology.co.uk\/surface-coatings\/fluoropolymer-coating\/ \n\n^ \"Fluoropolymer PTFE coating services from Surface Technology UK\". Surface Technology. Retrieved 2018-02-26 . \n\n^ \"Polytetrafluouroethylene: PTFE Sheets & PTFE Coatings from Porex\". www.porex.com. Retrieved 2016-01-21 . \n\n^ \"Key Safety Questions About Teflon Nonstick Coatings\". DuPont. Retrieved 28 November 2014 . \n\n^ \"Key Safety Questions about the Safety of Nonstick Cookware\". DuPont. \n\n^ RIch, Nathaniel. \"The Lawyer Who Became Dupont's Worst Nightmare\". The New York Times Magazine. Retrieved 7 January 2016 . \n\n^ Blake, Mariah. \"Welcome to Beautiful Parkersburg, West Virginia Home to one of the most brazen, deadly corporate gambits in U.S. history\". Huffington Post. Retrieved 31 August 2015 . \n\n^ Fellner, Carrie (16 June 2018). \"Toxic Secrets: Professor 'bragged about burying bad science' on 3M chemicals\". Sydney Morning Herald. Retrieved 25 June 2018 . \n\n^ Nicole, W. (2013). \"PFOA and Cancer in a Highly Exposed Community: New Findings from the C8 Science Panel\". Environmental Health Perspectives. 121 (11\u201312): A340. doi:10.1289\/ehp.121-A340. PMC 3855507 . PMID 24284021. \n\n^ Trudel D, Horowitz L, Wormuth M, Scheringer M, Cousins IT, Hungerb\u00fchler K (April 2008). \"Estimating consumer exposure to PFOS and PFOA\". Risk Anal. 28 (2): 251\u201369. doi:10.1111\/j.1539-6924.2008.01017.x. PMID 18419647. \n\n^ \"Nonstick pans: Nonstick coating risks\". Consumer Reports. Retrieved 4 July 2009 . \n\n^ FEP Detailed Properties, Parker-TexLoc, 13 April 2006. Retrieved 10 September 2006. \n\n\nFurther reading \nEllis, D.A.; Mabury, S.A.; Martin, J.W.; Muir, D.C.G.; Mabury, S.A.; Martin, J.W.; Muir, D.C.G. (2001). \"Thermolysis of fluoropolymers as a potential source of halogenated organic acids in the environment\". Nature. 412 (6844): 321\u2013324. doi:10.1038\/35085548. PMID 11460160. \nExternal links \nEPA: Compound in Teflon may cause cancer [1], Tom Costello, NBC News, 29 June 2005. (Flash video required)\nPlasma Processes and Adhesive Bonding of Polytetrafluoroethylene\nPTFE Tubing Properties\nvteDuPontCorporate directors\nEdward D. Breen\nLamberto Andreotti\nRobert A. Brown\nBertrand P. Collomb\nAlexander M. Cutler\nTh\u00e8re du Pont\nJames L. Gallogly\nMarillyn Hewson\nLois Juliber\nUlf M. \u201cMark\u201d Schneider\nLee M. Thomas\nPatrick J. 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For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Teflon_(disambiguation)\" class=\"mw-disambig\" title=\"Teflon (disambiguation)\" rel=\"external_link\" target=\"_blank\">Teflon (disambiguation)<\/a>.<\/div>\n<p class=\"mw-empty-elt\">\n<\/p>\n\n<p><b>Polytetrafluoroethylene<\/b> (<b>PTFE<\/b>) is a synthetic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoropolymer\" title=\"Fluoropolymer\" rel=\"external_link\" target=\"_blank\">fluoropolymer<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tetrafluoroethylene\" title=\"Tetrafluoroethylene\" rel=\"external_link\" target=\"_blank\">tetrafluoroethylene<\/a> that has numerous applications. The best known brand name of PTFE-based formulas is <b>Teflon<\/b> by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemours\" title=\"Chemours\" rel=\"external_link\" target=\"_blank\">Chemours<\/a>.<sup id=\"rdp-ebb-cite_ref-:0_2-0\" class=\"reference\"><a href=\"#cite_note-:0-2\" rel=\"external_link\">[2]<\/a><\/sup> Chemours is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corporate_spin-off\" title=\"Corporate spin-off\" rel=\"external_link\" target=\"_blank\">spin-off<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/DuPont\" title=\"DuPont\" rel=\"external_link\" target=\"_blank\">DuPont<\/a>, which originally discovered the compound in 1938.<sup id=\"rdp-ebb-cite_ref-:0_2-1\" class=\"reference\"><a href=\"#cite_note-:0-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>PTFE is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorocarbon\" title=\"Fluorocarbon\" rel=\"external_link\" target=\"_blank\">fluorocarbon<\/a> solid, as it is a high-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular-weight\" class=\"mw-redirect\" title=\"Molecular-weight\" rel=\"external_link\" target=\"_blank\">molecular-weight<\/a> compound consisting wholly of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon\" title=\"Carbon\" rel=\"external_link\" target=\"_blank\">carbon<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorine\" title=\"Fluorine\" rel=\"external_link\" target=\"_blank\">fluorine<\/a>. PTFE is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrophobic\" class=\"mw-redirect\" title=\"Hydrophobic\" rel=\"external_link\" target=\"_blank\">hydrophobic<\/a>: neither water nor water-containing substances wet PTFE, as fluorocarbons demonstrate mitigated <a href=\"https:\/\/en.wikipedia.org\/wiki\/London_dispersion_force\" title=\"London dispersion force\" rel=\"external_link\" target=\"_blank\">London dispersion forces<\/a> due to the high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electronegativity\" title=\"Electronegativity\" rel=\"external_link\" target=\"_blank\">electronegativity<\/a> of fluorine. PTFE has one of the lowest coefficients of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Friction\" title=\"Friction\" rel=\"external_link\" target=\"_blank\">friction<\/a> of any solid.\n<\/p><p>PTFE is used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Non-stick_coating\" class=\"mw-redirect\" title=\"Non-stick coating\" rel=\"external_link\" target=\"_blank\">non-stick coating<\/a> for pans and other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cookware\" class=\"mw-redirect\" title=\"Cookware\" rel=\"external_link\" target=\"_blank\">cookware<\/a>. It is nonreactive, partly because of the strength of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon%E2%80%93fluorine_bond\" title=\"Carbon\u2013fluorine bond\" rel=\"external_link\" target=\"_blank\">carbon\u2013fluorine bonds<\/a>, and so it is often used in containers and pipework for reactive and corrosive chemicals. Where used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lubricant\" title=\"Lubricant\" rel=\"external_link\" target=\"_blank\">lubricant<\/a>, PTFE reduces friction, wear, and energy consumption of machinery. It is commonly used as a graft material in surgical interventions. Also, it is frequently employed as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coating\" title=\"Coating\" rel=\"external_link\" target=\"_blank\">coating<\/a> on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheters<\/a>; this interferes with the ability of bacteria and other infectious agents to adhere to catheters and cause <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital-acquired_infection\" title=\"Hospital-acquired infection\" rel=\"external_link\" target=\"_blank\">hospital-acquired infections<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Happy_Pan_Poster.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/73\/Happy_Pan_Poster.jpg\/220px-Happy_Pan_Poster.jpg\" width=\"220\" height=\"363\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Happy_Pan_Poster.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Advertisement of the Happy Pan, a Teflon-coated pan from the 1960s<\/div><\/div><\/div>\n\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:EL-1994-00019.jpeg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/14\/EL-1994-00019.jpeg\/220px-EL-1994-00019.jpeg\" width=\"220\" height=\"222\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:EL-1994-00019.jpeg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Teflon thermal cover showing impact craters, from NASA's (UHCRE)<\/div><\/div><\/div>\n<p>PTFE was accidentally discovered in 1938 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Roy_J._Plunkett\" title=\"Roy J. Plunkett\" rel=\"external_link\" target=\"_blank\">Roy J. Plunkett<\/a> while he was working in New Jersey for <a href=\"https:\/\/en.wikipedia.org\/wiki\/DuPont\" title=\"DuPont\" rel=\"external_link\" target=\"_blank\">DuPont<\/a>. As Plunkett attempted to make a new <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chlorofluorocarbon\" title=\"Chlorofluorocarbon\" rel=\"external_link\" target=\"_blank\">chlorofluorocarbon<\/a> refrigerant, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tetrafluoroethylene\" title=\"Tetrafluoroethylene\" rel=\"external_link\" target=\"_blank\">tetrafluoroethylene<\/a> gas in its pressure bottle stopped flowing before the bottle's weight had dropped to the point signaling \"empty.\" Since Plunkett was measuring the amount of gas used by weighing the bottle, he became curious as to the source of the weight, and finally resorted to sawing the bottle apart. He found the bottle's interior coated with a waxy white material that was oddly slippery. Analysis showed that it was polymerized perfluoroethylene, with the iron from the inside of the container having acted as a catalyst at high pressure. Kinetic Chemicals patented the new fluorinated plastic (analogous to the already known <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a>) in 1941,<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> and registered the Teflon trademark in 1945.<sup id=\"rdp-ebb-cite_ref-fluoroboom_4-0\" class=\"reference\"><a href=\"#cite_note-fluoroboom-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>By 1948, DuPont, which founded Kinetic Chemicals in partnership with <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_Motors\" title=\"General Motors\" rel=\"external_link\" target=\"_blank\">General Motors<\/a>, was producing over two million pounds (900 tons) of Teflon brand PTFE per year in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parkersburg,_West_Virginia\" title=\"Parkersburg, West Virginia\" rel=\"external_link\" target=\"_blank\">Parkersburg, West Virginia<\/a>.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> An early use was in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manhattan_Project\" title=\"Manhattan Project\" rel=\"external_link\" target=\"_blank\">Manhattan Project<\/a> as a material to coat valves and seals in the pipes holding highly reactive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Uranium_hexafluoride\" title=\"Uranium hexafluoride\" rel=\"external_link\" target=\"_blank\">uranium hexafluoride<\/a> at the vast <a href=\"https:\/\/en.wikipedia.org\/wiki\/K-25\" title=\"K-25\" rel=\"external_link\" target=\"_blank\">K-25<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Enriched_uranium\" title=\"Enriched uranium\" rel=\"external_link\" target=\"_blank\">uranium enrichment<\/a> plant in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oak_Ridge,_Tennessee\" title=\"Oak Ridge, Tennessee\" rel=\"external_link\" target=\"_blank\">Oak Ridge, Tennessee<\/a>.<sup id=\"rdp-ebb-cite_ref-rhodes_7-0\" class=\"reference\"><a href=\"#cite_note-rhodes-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>In 1954, the wife of French engineer Marc Gr\u00e9goire urged him to try the material he had been using on fishing tackle on her cooking pans. He subsequently created the first PTFE-coated, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Non-stick_pans\" class=\"mw-redirect\" title=\"Non-stick pans\" rel=\"external_link\" target=\"_blank\">non-stick pans<\/a> under the brandname <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tefal\" title=\"Tefal\" rel=\"external_link\" target=\"_blank\">Tefal<\/a> (combining \"Tef\" from \"Teflon\" and \"al\" from aluminium).<sup id=\"rdp-ebb-cite_ref-history_8-0\" class=\"reference\"><a href=\"#cite_note-history-8\" rel=\"external_link\">[8]<\/a><\/sup> In the United States, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Marion_A._Trozzolo\" title=\"Marion A. Trozzolo\" rel=\"external_link\" target=\"_blank\">Marion A. Trozzolo<\/a>, who had been using the substance on scientific utensils, marketed the first US-made PTFE-coated pan, \"The Happy Pan\", in 1961.<sup id=\"rdp-ebb-cite_ref-intofire_9-0\" class=\"reference\"><a href=\"#cite_note-intofire-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>However, Tefal was not the only company to utilize PTFE in nonstick cookware coatings. In subsequent years, many cookware manufacturers developed proprietary PTFE-based formulas, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Swiss_Diamond_International\" title=\"Swiss Diamond International\" rel=\"external_link\" target=\"_blank\">Swiss Diamond International<\/a>, which uses a diamond-reinforced PTFE formula;<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> Scanpan, which uses a titanium-reinforced PTFE formula;<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> and both <a href=\"https:\/\/en.wikipedia.org\/wiki\/All-Clad\" title=\"All-Clad\" rel=\"external_link\" target=\"_blank\">All-Clad<\/a><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Newell_Rubbermaid\" class=\"mw-redirect\" title=\"Newell Rubbermaid\" rel=\"external_link\" target=\"_blank\">Newell Rubbermaid<\/a>'s Calphalon, which use a non-reinforced PTFE-based nonstick.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> Other cookware companies, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Meyer_Corporation\" title=\"Meyer Corporation\" rel=\"external_link\" target=\"_blank\">Meyer Corporation<\/a>'s Anolon, use Teflon<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> nonstick coatings purchased from Chemours. Chemours is a 2015 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corporate_spin-off\" title=\"Corporate spin-off\" rel=\"external_link\" target=\"_blank\">corporate spin-off<\/a> of DuPont.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p>In the 1990s, it was found that PTFE could be radiation <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cross-linked\" class=\"mw-redirect\" title=\"Cross-linked\" rel=\"external_link\" target=\"_blank\">cross-linked<\/a> above its melting point in an oxygen-free environment.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electron_beam_processing\" class=\"mw-redirect\" title=\"Electron beam processing\" rel=\"external_link\" target=\"_blank\">Electron beam processing<\/a> is one example of radiation processing. Cross-linked PTFE has improved high-temperature mechanical properties and radiation stability. This was significant because, for many years, irradiation at ambient conditions has been used to break down PTFE for recycling.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> This radiation-induced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chain_scission\" title=\"Chain scission\" rel=\"external_link\" target=\"_blank\">chain scission<\/a> allows it to be more easily reground and reused.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Production\">Production<\/span><\/h2>\n<p>PTFE is produced by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Free-radical\" class=\"mw-redirect\" title=\"Free-radical\" rel=\"external_link\" target=\"_blank\">free-radical<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymerization\" title=\"Polymerization\" rel=\"external_link\" target=\"_blank\">polymerization<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tetrafluoroethylene\" title=\"Tetrafluoroethylene\" rel=\"external_link\" target=\"_blank\">tetrafluoroethylene<\/a>. The net equation is\n<\/p>\n<dl><dd><i>n<\/i> F<sub>2<\/sub>C=CF<sub>2<\/sub> \u2192 \u2212(F<sub>2<\/sub>C\u2212CF<sub>2<\/sub>)<sub><i>n<\/i><\/sub>\u2212<\/dd><\/dl>\n<p>Because tetrafluoroethylene can explosively decompose to tetrafluoromethane and carbon, special apparatus is required for the polymerization to prevent hot spots that might initiate this dangerous side reaction. The process is typically initiated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Persulfate\" title=\"Persulfate\" rel=\"external_link\" target=\"_blank\">persulfate<\/a>, which homolyzes to generate sulfate radicals:\n<\/p>\n<dl><dd>[O<sub>3<\/sub>SO\u2212OSO<sub>3<\/sub>]<sup>2\u2212<\/sup> \u21cc 2 SO<sub>4<\/sub>\u2022<sup>\u2212<\/sup><\/dd><\/dl>\n<p>The resulting polymer is terminated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sulfate_ester\" class=\"mw-redirect\" title=\"Sulfate ester\" rel=\"external_link\" target=\"_blank\">sulfate ester<\/a> groups, which can be hydrolyzed to give OH <a href=\"https:\/\/en.wikipedia.org\/wiki\/End-group\" title=\"End-group\" rel=\"external_link\" target=\"_blank\">end-groups<\/a>.<sup id=\"rdp-ebb-cite_ref-Ullmann_18-0\" class=\"reference\"><a href=\"#cite_note-Ullmann-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p><p>Because PTFE is poorly soluble in almost all solvents, the polymerization is conducted as an emulsion in water. This process gives a suspension of polymer particles. Alternatively, the polymerization is conducted using a surfactant such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/PFOS\" class=\"mw-redirect\" title=\"PFOS\" rel=\"external_link\" target=\"_blank\">PFOS<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Properties\">Properties<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Blintzes_in_frying_pan.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b7\/Blintzes_in_frying_pan.jpg\/220px-Blintzes_in_frying_pan.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Blintzes_in_frying_pan.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>PTFE is often used to coat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Non-stick_pans\" class=\"mw-redirect\" title=\"Non-stick pans\" rel=\"external_link\" target=\"_blank\">non-stick pans<\/a> as it is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrophobic\" class=\"mw-redirect\" title=\"Hydrophobic\" rel=\"external_link\" target=\"_blank\">hydrophobic<\/a> and possesses fairly high heat resistance.<\/div><\/div><\/div>\n<p>PTFE is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoplastic\" title=\"Thermoplastic\" rel=\"external_link\" target=\"_blank\">thermoplastic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a>, which is a white solid at room temperature, with a density of about 2200 kg\/m<sup>3<\/sup>. According to Chemours, its melting point is 600 K (327 \u00b0C; 620 \u00b0F).<sup id=\"rdp-ebb-cite_ref-chemours_19-0\" class=\"reference\"><a href=\"#cite_note-chemours-19\" rel=\"external_link\">[19]<\/a><\/sup> It maintains high strength, toughness and self-lubrication at low temperatures down to 5 K (\u2212268.15 \u00b0C; \u2212450.67 \u00b0F), and good flexibility at temperatures above 194 K (\u221279 \u00b0C; \u2212110 \u00b0F).<sup id=\"rdp-ebb-cite_ref-ptfe_handbook_20-0\" class=\"reference\"><a href=\"#cite_note-ptfe_handbook-20\" rel=\"external_link\">[20]<\/a><\/sup> PTFE gains its properties from the aggregate effect of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon-fluorine_bond\" class=\"mw-redirect\" title=\"Carbon-fluorine bond\" rel=\"external_link\" target=\"_blank\">carbon-fluorine bonds<\/a>, as do all fluorocarbons. The only chemicals known to affect these carbon-fluorine bonds are highly reactive metals like the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alkali_metal\" title=\"Alkali metal\" rel=\"external_link\" target=\"_blank\">alkali metals<\/a>, and at higher temperatures also such metals as aluminium and magnesium, and fluorinating agents such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Xenon_difluoride\" title=\"Xenon difluoride\" rel=\"external_link\" target=\"_blank\">xenon difluoride<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cobalt(III)_fluoride\" title=\"Cobalt(III) fluoride\" rel=\"external_link\" target=\"_blank\">cobalt(III) fluoride<\/a>.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<table class=\"wikitable\" style=\"text-align:center;\">\n\n<tbody><tr>\n<th>Property\n<\/th>\n<th>Value\n<\/th><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Density\" title=\"Density\" rel=\"external_link\" target=\"_blank\">Density<\/a>\n<\/td>\n<td>2200 kg\/m<sup>3<\/sup>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass_transition_temperature\" class=\"mw-redirect\" title=\"Glass transition temperature\" rel=\"external_link\" target=\"_blank\">Glass temperature<\/a>\n<\/td>\n<td>114.85 \u00b0C (238.73 \u00b0F; 388.00 K) <sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Melting_point\" title=\"Melting point\" rel=\"external_link\" target=\"_blank\">Melting point<\/a>\n<\/td>\n<td>326.85 \u00b0C (620.33 \u00b0F; 600.00 K)\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_expansion\" title=\"Thermal expansion\" rel=\"external_link\" target=\"_blank\">Thermal expansion<\/a>\n<\/td>\n<td>112\u2013125 \u00b7 10<sup>\u22126<\/sup> K<sup>\u22121<\/sup> <sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_diffusivity\" title=\"Thermal diffusivity\" rel=\"external_link\" target=\"_blank\">Thermal diffusivity<\/a>\n<\/td>\n<td>0.124 mm<sup>2<\/sup>\/s <sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Young%27s_modulus\" title=\"Young's modulus\" rel=\"external_link\" target=\"_blank\">Young's modulus<\/a>\n<\/td>\n<td>0.5 GPa\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Yield_strength\" class=\"mw-redirect\" title=\"Yield strength\" rel=\"external_link\" target=\"_blank\">Yield strength<\/a>\n<\/td>\n<td>23 MPa\n<\/td><\/tr>\n<tr>\n<td>Bulk resistivity\n<\/td>\n<td>10<sup>16<\/sup> \u03a9\u00b7m <sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Friction#Coefficient_of_friction\" title=\"Friction\" rel=\"external_link\" target=\"_blank\">Coefficient of friction<\/a>\n<\/td>\n<td>0.05\u20130.10\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dielectric_constant\" class=\"mw-redirect\" title=\"Dielectric constant\" rel=\"external_link\" target=\"_blank\">Dielectric constant<\/a>\n<\/td>\n<td><span class=\"nowrap\">\u03b5 = 2.1<\/span>, <span class=\"nowrap\">tan(\u03b4) < 5(-4)<\/span>\n<\/td><\/tr>\n<tr>\n<td>Dielectric constant (60 Hz)\n<\/td>\n<td><span class=\"nowrap\">\u03b5 = 2.1<\/span>, <span class=\"nowrap\">tan(\u03b4) < 2(-4)<\/span>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dielectric_strength\" title=\"Dielectric strength\" rel=\"external_link\" target=\"_blank\">Dielectric strength<\/a> (1 MHz)\n<\/td>\n<td>60 MV\/m\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_susceptibility\" title=\"Magnetic susceptibility\" rel=\"external_link\" target=\"_blank\">Magnetic susceptibility<\/a> (SI, 22 \u00b0C)\n<\/td>\n<td>\u221210.28\u00d710<sup>\u22126<\/sup> <sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/td><\/tr><\/tbody><\/table>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><div id=\"rdp-ebb-mwe_player_0\" class=\"PopUpMediaTransform\" style=\"width:220px;\" videopayload=\"<div class="mediaContainer" style="width:854px"><video id="mwe_player_1" poster="\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/01\/Hemidactylus_turcicus_on_teflon.webm\/854px--Hemidactylus_turcicus_on_teflon.webm.jpg" controls="" preload="none" autoplay="" style="width:854px;height:480px" class="kskin" data-durationhint="70.659" data-startoffset="0" data-mwtitle="Hemidactylus_turcicus_on_teflon.webm" data-mwprovider="wikimediacommons"><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/0\/01\/Hemidactylus_turcicus_on_teflon.webm\/Hemidactylus_turcicus_on_teflon.webm.480p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="SD WebM (480P)" data-shorttitle="WebM 480P" data-transcodekey="480p.webm" data-width="854" data-height="480" data-bandwidth="1102704" data-framerate="30000.3"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/0\/01\/Hemidactylus_turcicus_on_teflon.webm\/Hemidactylus_turcicus_on_teflon.webm.480p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="SD VP9 (480P)" data-shorttitle="VP9 480P" data-transcodekey="480p.vp9.webm" data-width="854" data-height="480" data-bandwidth="1214272" data-framerate="30000.3"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/0\/01\/Hemidactylus_turcicus_on_teflon.webm\/Hemidactylus_turcicus_on_teflon.webm.720p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="HD WebM (720P)" data-shorttitle="WebM 720P" data-transcodekey="720p.webm" data-width="1280" data-height="720" data-bandwidth="2130592" data-framerate="30000.3"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/0\/01\/Hemidactylus_turcicus_on_teflon.webm\/Hemidactylus_turcicus_on_teflon.webm.720p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="HD VP9 (720P)" data-shorttitle="VP9 720P" data-transcodekey="720p.vp9.webm" data-width="1280" data-height="720" data-bandwidth="2626528" data-framerate="30000.3"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/0\/01\/Hemidactylus_turcicus_on_teflon.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Original WebM file, 1,280 \u00d7 720 (22.76 Mbps)" data-shorttitle="WebM source" data-width="1280" data-height="720" data-bandwidth="22757443" data-framerate="30000.3"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/0\/01\/Hemidactylus_turcicus_on_teflon.webm\/Hemidactylus_turcicus_on_teflon.webm.120p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Lowest bandwidth VP9 (120P)" data-shorttitle="VP9 120P" data-transcodekey="120p.vp9.webm" data-width="214" data-height="120" data-bandwidth="166456" data-framerate="30000.3"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/0\/01\/Hemidactylus_turcicus_on_teflon.webm\/Hemidactylus_turcicus_on_teflon.webm.160p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Low bandwidth WebM (160P)" data-shorttitle="WebM 160P" data-transcodekey="160p.webm" data-width="284" data-height="160" data-bandwidth="210192" data-framerate="30000.3"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/0\/01\/Hemidactylus_turcicus_on_teflon.webm\/Hemidactylus_turcicus_on_teflon.webm.180p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Low bandwidth VP9 (180P)" data-shorttitle="VP9 180P" data-transcodekey="180p.vp9.webm" data-width="320" data-height="180" data-bandwidth="243752" data-framerate="30000.3"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/0\/01\/Hemidactylus_turcicus_on_teflon.webm\/Hemidactylus_turcicus_on_teflon.webm.240p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Small WebM (240P)" data-shorttitle="WebM 240P" data-transcodekey="240p.webm" data-width="426" data-height="240" data-bandwidth="328376" data-framerate="30000.3"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/0\/01\/Hemidactylus_turcicus_on_teflon.webm\/Hemidactylus_turcicus_on_teflon.webm.240p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Small VP9 (240P)" data-shorttitle="VP9 240P" data-transcodekey="240p.vp9.webm" data-width="426" data-height="240" data-bandwidth="349552" data-framerate="30000.3"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/0\/01\/Hemidactylus_turcicus_on_teflon.webm\/Hemidactylus_turcicus_on_teflon.webm.360p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="WebM (360P)" data-shorttitle="WebM 360P" data-transcodekey="360p.webm" data-width="640" data-height="360" data-bandwidth="584464" data-framerate="30000.3"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/0\/01\/Hemidactylus_turcicus_on_teflon.webm\/Hemidactylus_turcicus_on_teflon.webm.360p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="VP9 (360P)" data-shorttitle="VP9 360P" data-transcodekey="360p.vp9.webm" data-width="640" data-height="360" data-bandwidth="642096" data-framerate="30000.3"\/><\/video><\/div>\"><img alt=\"File:Hemidactylus turcicus on teflon.webm\" style=\"width:220px;height:124px\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/01\/Hemidactylus_turcicus_on_teflon.webm\/220px--Hemidactylus_turcicus_on_teflon.webm.jpg\" \/><a href=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/0\/01\/Hemidactylus_turcicus_on_teflon.webm\" title=\"Play media\" target=\"_blank\" rel=\"external_link\"><span class=\"play-btn-large\"><span class=\"mw-tmh-playtext\">Play media<\/span><\/span><\/a><\/div> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hemidactylus_turcicus_on_teflon.webm\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gecko\" title=\"Gecko\" rel=\"external_link\" target=\"_blank\">Geckos<\/a> cannot crawl up on teflon.<\/div><\/div><\/div>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coefficient_of_friction\" class=\"mw-redirect\" title=\"Coefficient of friction\" rel=\"external_link\" target=\"_blank\">coefficient of friction<\/a> of plastics is usually measured against polished steel.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> PTFE's coefficient of friction is 0.05 to 0.10,<sup id=\"rdp-ebb-cite_ref-chemours_19-1\" class=\"reference\"><a href=\"#cite_note-chemours-19\" rel=\"external_link\">[19]<\/a><\/sup> which is the third-lowest of any known solid material (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium_magnesium_boride\" title=\"Aluminium magnesium boride\" rel=\"external_link\" target=\"_blank\">BAM<\/a> being the first, with a coefficient of friction of 0.02; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diamond-like_carbon\" title=\"Diamond-like carbon\" rel=\"external_link\" target=\"_blank\">diamond-like carbon<\/a> being second-lowest at 0.05). PTFE's resistance to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Van_der_Waals_force\" title=\"Van der Waals force\" rel=\"external_link\" target=\"_blank\">van der Waals forces<\/a> means that it is the only known surface to which a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gecko\" title=\"Gecko\" rel=\"external_link\" target=\"_blank\">gecko<\/a> cannot stick.<sup id=\"rdp-ebb-cite_ref-gecko_28-0\" class=\"reference\"><a href=\"#cite_note-gecko-28\" rel=\"external_link\">[28]<\/a><\/sup> In fact, PTFE can be used to prevent insects climbing up surfaces painted with the material. PTFE is so slippery that insects cannot get a grip and tend to fall off. For example, PTFE is used to prevent ants climbing out of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Formicarium\" title=\"Formicarium\" rel=\"external_link\" target=\"_blank\">formicaria<\/a>.\n<\/p><p>Because of its chemical inertness, PTFE cannot be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cross-link\" title=\"Cross-link\" rel=\"external_link\" target=\"_blank\">cross-linked<\/a> like an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastomer\" title=\"Elastomer\" rel=\"external_link\" target=\"_blank\">elastomer<\/a>. Therefore, it has no \"memory\" and is subject to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Creep_(deformation)\" title=\"Creep (deformation)\" rel=\"external_link\" target=\"_blank\">creep<\/a>. Because of its superior chemical and thermal properties, PTFE is often used as a gasket material within industries that require resistance to aggressive chemicals such as pharmaceuticals or chemical processing.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> However, because of the propensity to creep, the long-term performance of such seals is worse than for elastomers which exhibit zero, or near-zero, levels of creep. In critical applications, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Belleville_washer\" title=\"Belleville washer\" rel=\"external_link\" target=\"_blank\">Belleville washers<\/a> are often used to apply continuous force to PTFE gaskets, ensuring a minimal loss of performance over the lifetime of the gasket.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Processing\">Processing<\/span><\/h2>\n<p>Processing PTFE can be difficult and expensive, because the high melting temperature, 327 \u00b0C (621 \u00b0F), is above the initial decomposition temperature, 200 \u00b0C (392 \u00b0F).<sup id=\"rdp-ebb-cite_ref-zapp_31-0\" class=\"reference\"><a href=\"#cite_note-zapp-31\" rel=\"external_link\">[31]<\/a><\/sup> Even when melted, PTFE does not flow, but instead behaves as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gel\" title=\"Gel\" rel=\"external_link\" target=\"_blank\">gel<\/a> due to the absence of crystalline phase<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> and high melt viscosity.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p><p>Some PTFE parts are made by cold-moulding, a form of compression molding.<sup id=\"rdp-ebb-cite_ref-:1_34-0\" class=\"reference\"><a href=\"#cite_note-:1-34\" rel=\"external_link\">[34]<\/a><\/sup> Here, fine powdered PTFE is forced into a mould under high pressure (10\u2013100 MPa).<sup id=\"rdp-ebb-cite_ref-:1_34-1\" class=\"reference\"><a href=\"#cite_note-:1-34\" rel=\"external_link\">[34]<\/a><\/sup> After a settling period, lasting from minutes to days, the mould is heated at 360 to 380 \u00b0C (680 to 716 \u00b0F),<sup id=\"rdp-ebb-cite_ref-:1_34-2\" class=\"reference\"><a href=\"#cite_note-:1-34\" rel=\"external_link\">[34]<\/a><\/sup> allowing the fine particles to fuse into a single mass.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications_and_uses\">Applications and uses<\/span><\/h2>\n\n<p>The major application of PTFE, consuming about 50% of production, is for wiring in aerospace and computer applications (e.g. hookup wire, coaxial cables). This application exploits the fact that PTFE has excellent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dielectric\" title=\"Dielectric\" rel=\"external_link\" target=\"_blank\">dielectric<\/a> properties,<sup id=\"rdp-ebb-cite_ref-MishraYagci_36-0\" class=\"reference\"><a href=\"#cite_note-MishraYagci-36\" rel=\"external_link\">[36]<\/a><\/sup> especially at high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radio_frequency\" title=\"Radio frequency\" rel=\"external_link\" target=\"_blank\">radio frequencies<\/a>,<sup id=\"rdp-ebb-cite_ref-MishraYagci_36-1\" class=\"reference\"><a href=\"#cite_note-MishraYagci-36\" rel=\"external_link\">[36]<\/a><\/sup> making it suitable for use as an excellent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical_insulation\" class=\"mw-redirect\" title=\"Electrical insulation\" rel=\"external_link\" target=\"_blank\">insulator<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical_connector\" title=\"Electrical connector\" rel=\"external_link\" target=\"_blank\">connector<\/a> assemblies and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical_cable\" title=\"Electrical cable\" rel=\"external_link\" target=\"_blank\">cables<\/a>, and in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Printed_circuit_board\" title=\"Printed circuit board\" rel=\"external_link\" target=\"_blank\">printed circuit boards<\/a> used at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microwave\" title=\"Microwave\" rel=\"external_link\" target=\"_blank\">microwave<\/a> frequencies. Combined with its high melting temperature, this makes it the material of choice as a high-performance substitute for the weaker and lower-melting-point <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a> commonly used in low-cost applications.\n<\/p><p>In industrial applications, owing to its low friction, PTFE is used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plain_bearing\" title=\"Plain bearing\" rel=\"external_link\" target=\"_blank\">plain bearings<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gear\" title=\"Gear\" rel=\"external_link\" target=\"_blank\">gears<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Slide_plate\" title=\"Slide plate\" rel=\"external_link\" target=\"_blank\">slide plates<\/a>, seals, gaskets, bushings<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup>, and more applications with sliding action of parts, where it outperforms <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyoxymethylene\" title=\"Polyoxymethylene\" rel=\"external_link\" target=\"_blank\">acetal<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nylon\" title=\"Nylon\" rel=\"external_link\" target=\"_blank\">nylon<\/a>.<sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup>\n<\/p><p>Its extremely high bulk <a href=\"https:\/\/en.wikipedia.org\/wiki\/Resistivity\" class=\"mw-redirect\" title=\"Resistivity\" rel=\"external_link\" target=\"_blank\">resistivity<\/a> makes it an ideal material for fabricating long-life <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electret\" title=\"Electret\" rel=\"external_link\" target=\"_blank\">electrets<\/a>, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrostatic\" class=\"mw-redirect\" title=\"Electrostatic\" rel=\"external_link\" target=\"_blank\">electrostatic<\/a> analogues of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnet\" title=\"Magnet\" rel=\"external_link\" target=\"_blank\">permanent magnets<\/a>.\n<\/p><p>PTFE film is also widely used in the production of carbon fiber composites as well as fiberglass composites, notably in the aerospace industry. PTFE film is used as a barrier between the carbon or fiberglass part being built, and breather and bagging materials used to incapsulate the bondment when debulking (vacuum removal of air from between layers of laid-up plies of material) and when curing the composite, usually in an autoclave. The PTFE, used here as a film, prevents the non-production materials from sticking to the part being built, which is sticky due to the carbon-graphite or fiberglass plies being pre-pregnated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bismaleimide\" class=\"mw-redirect\" title=\"Bismaleimide\" rel=\"external_link\" target=\"_blank\">bismaleimide<\/a> resin. Non-production materials such as Teflon, Airweave Breather and the bag itself would be considered F.O.D. (foreign object debris\/damage) if left in layup.\n<\/p><p>Because of its extreme non-reactivity and high temperature rating, PTFE is often used as the liner in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hose\" title=\"Hose\" rel=\"external_link\" target=\"_blank\">hose<\/a> assemblies, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Expansion_joint#Pipe_expansion_joints\" title=\"Expansion joint\" rel=\"external_link\" target=\"_blank\">expansion joints<\/a>, and in industrial pipe lines, particularly in applications using acids, alkalis, or other chemicals. Its frictionless qualities allow improved flow of highly viscous liquids, and for uses in applications such as brake hoses.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gore-Tex\" title=\"Gore-Tex\" rel=\"external_link\" target=\"_blank\">Gore-Tex<\/a> is a brand of expanded PTFE (ePTFE), a material incorporating a fluoropolymer membrane with micropores. The roof of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hubert_H._Humphrey_Metrodome\" title=\"Hubert H. Humphrey Metrodome\" rel=\"external_link\" target=\"_blank\">Hubert H. Humphrey Metrodome<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minneapolis\" title=\"Minneapolis\" rel=\"external_link\" target=\"_blank\">Minneapolis<\/a>, US, was one of the largest applications of PTFE coatings. 20 acres (81,000 m<sup>2<\/sup>) of the material was used in the creation of the white double-layered PTFE-coated fiberglass dome.\n<\/p><p>PTFE is often found in musical instrument lubrication product; most commonly, valve oil.\n<\/p><p>PTFE is used in some aerosol lubricant sprays, including in micronized and polarized form. It is notable for its extremely low coefficient of friction, its hydrophobia (which serves to inhibit rust), and for the dry film it forms after application, which allows it to resist collecting particles that might otherwise form an abrasive paste. <sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup>\n<\/p><p>PTFE (Teflon) is best known for its use in coating non-stick <a href=\"https:\/\/en.wikipedia.org\/wiki\/Frying_pan\" title=\"Frying pan\" rel=\"external_link\" target=\"_blank\">frying pans<\/a> and other cookware, as it is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrophobic\" class=\"mw-redirect\" title=\"Hydrophobic\" rel=\"external_link\" target=\"_blank\">hydrophobic<\/a> and possesses fairly high heat resistance.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PTFE_tapes_with_pressure-sensitive_adhesive_backing,_rolls_of_15_and_25_mm_widths.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/PTFE_tapes_with_pressure-sensitive_adhesive_backing%2C_rolls_of_15_and_25_mm_widths.jpg\/220px-PTFE_tapes_with_pressure-sensitive_adhesive_backing%2C_rolls_of_15_and_25_mm_widths.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PTFE_tapes_with_pressure-sensitive_adhesive_backing,_rolls_of_15_and_25_mm_widths.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>PTFE tapes with pressure-sensitive adhesive backing<\/div><\/div><\/div>\n<p>The sole plates of some clothes irons are coated with PTFE (Teflon).<sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup>\n<\/p><p>Other niche applications include:\n<\/p>\n<ul><li>It is often found in ski bindings as a non-mechanical AFD (anti-friction device)<\/li>\n<li>It can be stretched to contain small pores of varying sizes and is then placed between fabric layers to make a waterproof, breathable fabric in outdoor apparel.<sup id=\"rdp-ebb-cite_ref-gore_41-0\" class=\"reference\"><a href=\"#cite_note-gore-41\" rel=\"external_link\">[41]<\/a><\/sup><\/li>\n<li>It is used widely as a fabric protector to repel stains on formal school-wear, like uniform blazers.<sup id=\"rdp-ebb-cite_ref-CutterAndTailor_42-0\" class=\"reference\"><a href=\"#cite_note-CutterAndTailor-42\" rel=\"external_link\">[42]<\/a><\/sup><\/li>\n<li>It is used as a film interface patch for sports and medical applications, featuring a pressure-sensitive adhesive backing, which is installed in strategic high friction areas of footwear, insoles, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ankle-foot_orthosis\" class=\"mw-redirect\" title=\"Ankle-foot orthosis\" rel=\"external_link\" target=\"_blank\">ankle-foot orthosis<\/a>, and other medical devices to prevent and relieve friction-induced blisters, calluses and foot ulceration.<sup id=\"rdp-ebb-cite_ref-FilmInterfacePatch_43-0\" class=\"reference\"><a href=\"#cite_note-FilmInterfacePatch-43\" rel=\"external_link\">[43]<\/a><\/sup><\/li>\n<li>Expanded PTFE membranes have been used in trials to assist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trabeculectomy\" title=\"Trabeculectomy\" rel=\"external_link\" target=\"_blank\">trabeculectomy<\/a> surgery to treat glaucoma.<sup id=\"rdp-ebb-cite_ref-wang_44-0\" class=\"reference\"><a href=\"#cite_note-wang-44\" rel=\"external_link\">[44]<\/a><\/sup><\/li>\n<li>Powdered PTFE is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyrotechnic_composition\" title=\"Pyrotechnic composition\" rel=\"external_link\" target=\"_blank\">pyrotechnic compositions<\/a> as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxidizer\" class=\"mw-redirect\" title=\"Oxidizer\" rel=\"external_link\" target=\"_blank\">oxidizer<\/a> with powdered metals such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium\" title=\"Aluminium\" rel=\"external_link\" target=\"_blank\">aluminium<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium\" title=\"Magnesium\" rel=\"external_link\" target=\"_blank\">magnesium<\/a>. Upon ignition, these mixtures form carbonaceous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soot\" title=\"Soot\" rel=\"external_link\" target=\"_blank\">soot<\/a> and the corresponding metal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoride\" title=\"Fluoride\" rel=\"external_link\" target=\"_blank\">fluoride<\/a>, and release large amounts of heat. They are used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infrared_decoy_flare\" class=\"mw-redirect\" title=\"Infrared decoy flare\" rel=\"external_link\" target=\"_blank\">infrared decoy flares<\/a> and as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Igniter\" class=\"mw-redirect\" title=\"Igniter\" rel=\"external_link\" target=\"_blank\">igniters<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solid-fuel_rocket\" class=\"mw-redirect\" title=\"Solid-fuel rocket\" rel=\"external_link\" target=\"_blank\">solid-fuel rocket<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Propellant\" title=\"Propellant\" rel=\"external_link\" target=\"_blank\">propellants<\/a>.<sup id=\"rdp-ebb-cite_ref-koch_45-0\" class=\"reference\"><a href=\"#cite_note-koch-45\" rel=\"external_link\">[45]<\/a><\/sup> Aluminium and PTFE is also used in some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermobaric\" class=\"mw-redirect\" title=\"Thermobaric\" rel=\"external_link\" target=\"_blank\">thermobaric<\/a> fuel compositions.<\/li>\n<li>Powdered PTFE is used in a suspension with a low-viscosity, azeotropic mixture of siloxane ethers to create a lubricant for use in twisty puzzles.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup><\/li>\n<li>In optical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiometry\" title=\"Radiometry\" rel=\"external_link\" target=\"_blank\">radiometry<\/a>, sheets of PTFE are used as measuring heads in spectroradiometers and broadband radiometers (e.g., <a href=\"https:\/\/en.wikipedia.org\/wiki\/Illuminance\" title=\"Illuminance\" rel=\"external_link\" target=\"_blank\">illuminance<\/a> meters and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultraviolet\" title=\"Ultraviolet\" rel=\"external_link\" target=\"_blank\">UV<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiometer\" title=\"Radiometer\" rel=\"external_link\" target=\"_blank\">radiometers<\/a>) due to PTFE's capability to diffuse a transmitting light nearly perfectly. Moreover, optical properties of PTFE stay constant over a wide range of wavelengths, from UV down to near <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infrared\" title=\"Infrared\" rel=\"external_link\" target=\"_blank\">infrared<\/a>. In this region, the ratio of its regular transmittance to diffuse transmittance is negligibly small, so light transmitted through a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffuser_(optics)\" title=\"Diffuser (optics)\" rel=\"external_link\" target=\"_blank\">diffuser<\/a> (PTFE sheet) radiates like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lambert%27s_cosine_law\" title=\"Lambert's cosine law\" rel=\"external_link\" target=\"_blank\">Lambert's cosine law<\/a>. Thus PTFE enables cosinusoidal angular response for a detector measuring the power of optical radiation at a surface, e.g. in solar <a href=\"https:\/\/en.wikipedia.org\/wiki\/Irradiance\" title=\"Irradiance\" rel=\"external_link\" target=\"_blank\">irradiance<\/a> measurements.<\/li>\n<li>Certain types of bullets are coated with PTFE to reduce wear on the rifling of firearms that uncoated projectiles would cause. PTFE itself does not give a projectile an armor-piercing property.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup><\/li>\n<li>Its high corrosion resistance makes PTFE useful in laboratory environments, where it is used for lining containers, as a coating for magnetic stirrers, and as tubing for highly corrosive chemicals such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrofluoric_acid\" title=\"Hydrofluoric acid\" rel=\"external_link\" target=\"_blank\">hydrofluoric acid<\/a>, which will dissolve glass containers. It is used in containers for storing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroantimonic_acid\" title=\"Fluoroantimonic acid\" rel=\"external_link\" target=\"_blank\">fluoroantimonic acid<\/a>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superacid\" title=\"Superacid\" rel=\"external_link\" target=\"_blank\">superacid<\/a>.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup><\/li>\n<li>PTFE tubes are used in gas-gas heat exchangers in gas cleaning of waste incinerators. Unit power capacity is typically several megawatts.<\/li>\n<li>PTFE is widely used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thread_seal_tape\" title=\"Thread seal tape\" rel=\"external_link\" target=\"_blank\">thread seal tape<\/a> in plumbing applications, largely replacing paste thread dope.<\/li>\n<li>PTFE membrane filters are among the most efficient industrial air filters. PTFE-coated filters are often used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dust_collection_system\" title=\"Dust collection system\" rel=\"external_link\" target=\"_blank\">dust collection systems<\/a> to collect <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aerosol\" title=\"Aerosol\" rel=\"external_link\" target=\"_blank\">particulate matter<\/a> from air streams in applications involving high temperatures and high particulate loads such as coal-fired power plants, cement production and steel foundries.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup><\/li>\n<li>PTFE grafts can be used to bypass <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">stenotic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">arteries<\/a> in peripheral vascular disease if a suitable autologous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">vein<\/a> graft is not available.<\/li>\n<li>Many bicycle lubricants and greases contain PTFE and are used on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bicycle_chain\" title=\"Bicycle chain\" rel=\"external_link\" target=\"_blank\">chains<\/a> and other moving parts subjected to frictional forces (such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bicycle_wheel#Bearings\" title=\"Bicycle wheel\" rel=\"external_link\" target=\"_blank\">hub bearings<\/a>).<\/li>\n<li>PTFE can also be used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_fillings\" class=\"mw-redirect\" title=\"Dental fillings\" rel=\"external_link\" target=\"_blank\">dental fillings<\/a>, to isolate the contacts of the anterior tooth so the filling materials will not stick to the adjacent tooth.<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup><\/li>\n<li>PTFE sheets are used in the production of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Butane_hash_oil\" class=\"mw-redirect\" title=\"Butane hash oil\" rel=\"external_link\" target=\"_blank\">butane hash oil<\/a> due to its non-stick properties and resistance to non-polar solvents.<sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup><\/li>\n<li>PTFE, associated with a slightly textured laminate, makes the plain bearing system of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dobsonian_telescope\" title=\"Dobsonian telescope\" rel=\"external_link\" target=\"_blank\">Dobsonian telescope<\/a>.<\/li>\n<li>PTFE is widely used as a non-stick coating for food processing equipment;<sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup> dough hoppers, mixing bowls, conveyor systems, rollers, and chutes. PTFE can also be reinforced where abrasion is present \u2013 for equipment processing seeded or grainy dough for example.<sup id=\"rdp-ebb-cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\" rel=\"external_link\">[54]<\/a><\/sup><\/li>\n<li>PTFE has been experimented with for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electroless_nickel_plating\" title=\"Electroless nickel plating\" rel=\"external_link\" target=\"_blank\">electroless nickel plating<\/a>.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Safety\">Safety<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyrolysis\" title=\"Pyrolysis\" rel=\"external_link\" target=\"_blank\">Pyrolysis<\/a> of PTFE is detectable at 200 \u00b0C (392 \u00b0F), and it evolves several <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorocarbon\" title=\"Fluorocarbon\" rel=\"external_link\" target=\"_blank\">fluorocarbon<\/a> gases and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sublimation_(phase_transition)\" title=\"Sublimation (phase transition)\" rel=\"external_link\" target=\"_blank\">sublimate<\/a>. An animal study conducted in 1955 concluded that it is unlikely that these products would be generated in amounts significant to health at temperatures below 250 \u00b0C (482 \u00b0F).<sup id=\"rdp-ebb-cite_ref-zapp_31-1\" class=\"reference\"><a href=\"#cite_note-zapp-31\" rel=\"external_link\">[31]<\/a><\/sup>\n<\/p><p>While PTFE is stable and nontoxic at lower temperatures, it begins to deteriorate after the temperature of cookware reaches about 260 \u00b0C (500 \u00b0F), and decomposes above 350 \u00b0C (662 \u00b0F).<sup id=\"rdp-ebb-cite_ref-55\" class=\"reference\"><a href=\"#cite_note-55\" rel=\"external_link\">[55]<\/a><\/sup> The degradation by-products can be lethal to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bird\" title=\"Bird\" rel=\"external_link\" target=\"_blank\">birds<\/a>,<sup id=\"rdp-ebb-cite_ref-56\" class=\"reference\"><a href=\"#cite_note-56\" rel=\"external_link\">[56]<\/a><\/sup> and can cause <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flu-like_symptoms\" class=\"mw-redirect\" title=\"Flu-like symptoms\" rel=\"external_link\" target=\"_blank\">flu-like symptoms<\/a><sup id=\"rdp-ebb-cite_ref-57\" class=\"reference\"><a href=\"#cite_note-57\" rel=\"external_link\">[57]<\/a><\/sup> in humans\u2014see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer_fume_fever\" title=\"Polymer fume fever\" rel=\"external_link\" target=\"_blank\">polymer fume fever<\/a>. Meat is usually fried between 204 and 232 \u00b0C (399 and 450 \u00b0F), and most oils start to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Smoke_point\" title=\"Smoke point\" rel=\"external_link\" target=\"_blank\">smoke<\/a> before a temperature of 260 \u00b0C (500 \u00b0F) is reached, but there are at least two cooking oils (refined <a href=\"https:\/\/en.wikipedia.org\/wiki\/Safflower_oil\" class=\"mw-redirect\" title=\"Safflower oil\" rel=\"external_link\" target=\"_blank\">safflower oil<\/a> at 265 \u00b0C (509 \u00b0F) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Avocado_oil\" title=\"Avocado oil\" rel=\"external_link\" target=\"_blank\">avocado oil<\/a> at 271 \u00b0C (520 \u00b0F)) that have a higher <a href=\"https:\/\/en.wikipedia.org\/wiki\/Smoke_point\" title=\"Smoke point\" rel=\"external_link\" target=\"_blank\">smoke point<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"PFOA\">PFOA<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Perfluorooctanoic_acid\" title=\"Perfluorooctanoic acid\" rel=\"external_link\" target=\"_blank\">Perfluorooctanoic acid<\/a><\/div>\n<p>Perfluorooctanoic acid (PFOA, or C8) has been used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surfactant\" title=\"Surfactant\" rel=\"external_link\" target=\"_blank\">surfactant<\/a> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Emulsion_polymerization\" title=\"Emulsion polymerization\" rel=\"external_link\" target=\"_blank\">emulsion polymerization<\/a> of PTFE, although several manufacturers have entirely discontinued its use.\n<\/p><p>PFOA persists indefinitely in the environment. It is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxicant\" title=\"Toxicant\" rel=\"external_link\" target=\"_blank\">toxicant<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carcinogen\" title=\"Carcinogen\" rel=\"external_link\" target=\"_blank\">carcinogen<\/a> in animals. PFOA has been detected in the blood of more than 98% of the general US population in the low and sub-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Parts_per_billion\" class=\"mw-redirect\" title=\"Parts per billion\" rel=\"external_link\" target=\"_blank\">parts per billion<\/a> range, and levels are higher in chemical plant employees and surrounding subpopulations. The general population has been exposed to PFOA through massive dumping of C8 waste into the ocean and near the Ohio River Valley.<sup id=\"rdp-ebb-cite_ref-NYTmagazine_58-0\" class=\"reference\"><a href=\"#cite_note-NYTmagazine-58\" rel=\"external_link\">[58]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Blake_59-0\" class=\"reference\"><a href=\"#cite_note-Blake-59\" rel=\"external_link\">[59]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Fellner-16June2018_60-0\" class=\"reference\"><a href=\"#cite_note-Fellner-16June2018-60\" rel=\"external_link\">[60]<\/a><\/sup> PFOA has been detected in industrial waste, stain resistant carpets, carpet cleaning liquids, <a href=\"https:\/\/en.wikipedia.org\/wiki\/House_dust\" class=\"mw-redirect\" title=\"House dust\" rel=\"external_link\" target=\"_blank\">house dust<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Popcorn_bag\" class=\"mw-redirect\" title=\"Popcorn bag\" rel=\"external_link\" target=\"_blank\">microwave popcorn bags<\/a>, water, food and Teflon cookware.\n<p>As a result of a class-action lawsuit and community settlement with <a href=\"https:\/\/en.wikipedia.org\/wiki\/DuPont\" title=\"DuPont\" rel=\"external_link\" target=\"_blank\">DuPont<\/a>, three <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epidemiology\" title=\"Epidemiology\" rel=\"external_link\" target=\"_blank\">epidemiologists<\/a> conducted studies on the population surrounding a chemical plant that was exposed to PFOA at levels greater than in the general population. The studies concluded that there was probably an association between PFOA exposure and six health outcomes: kidney cancer, testicular cancer, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ulcerative_colitis\" title=\"Ulcerative colitis\" rel=\"external_link\" target=\"_blank\">ulcerative colitis<\/a>, thyroid disease, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypercholesterolemia\" title=\"Hypercholesterolemia\" rel=\"external_link\" target=\"_blank\">hypercholesterolemia<\/a> (high cholesterol), and pregnancy-induced hypertension.<sup id=\"rdp-ebb-cite_ref-61\" class=\"reference\"><a href=\"#cite_note-61\" rel=\"external_link\">[61]<\/a><\/sup>\n<\/p>\n<\/p><p>Overall, PTFE cookware is considered an insignificant exposure pathway to PFOA.<sup id=\"rdp-ebb-cite_ref-62\" class=\"reference\"><a href=\"#cite_note-62\" rel=\"external_link\">[62]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-63\" class=\"reference\"><a href=\"#cite_note-63\" rel=\"external_link\">[63]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Similar_polymers\">Similar polymers<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PFA_structure.PNG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e8\/PFA_structure.PNG\/220px-PFA_structure.PNG\" width=\"220\" height=\"156\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PFA_structure.PNG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Teflon is also used as the trade name for a polymer with similar properties, perfluoroalkoxy polymer resin (PFA)<\/div><\/div><\/div>\n<p>The Teflon trade name is also used for other polymers with similar compositions:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Perfluoroalkoxy_alkane\" title=\"Perfluoroalkoxy alkane\" rel=\"external_link\" target=\"_blank\">Perfluoroalkoxy alkane<\/a> (PFA)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorinated_ethylene_propylene\" title=\"Fluorinated ethylene propylene\" rel=\"external_link\" target=\"_blank\">Fluorinated ethylene propylene<\/a> (FEP)<\/li><\/ul>\n<p>These retain the useful PTFE properties of low friction and nonreactivity, but are more easily formable. For example, FEP is softer than PTFE and melts at 533 K (260 \u00b0C; 500 \u00b0F); it is also highly transparent and resistant to sunlight.<sup id=\"rdp-ebb-cite_ref-64\" class=\"reference\"><a href=\"#cite_note-64\" rel=\"external_link\">[64]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Superhydrophobic_coating\" title=\"Superhydrophobic coating\" rel=\"external_link\" target=\"_blank\">Superhydrophobic coating<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/ETFE\" title=\"ETFE\" rel=\"external_link\" target=\"_blank\">ETFE<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium\/Teflon\/Viton\" title=\"Magnesium\/Teflon\/Viton\" rel=\"external_link\" target=\"_blank\">Magnesium\/Teflon\/Viton<\/a> pyrolant thermite composition<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer_adsorption\" title=\"Polymer adsorption\" rel=\"external_link\" target=\"_blank\">Polymer adsorption<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer_fume_fever\" title=\"Polymer fume fever\" rel=\"external_link\" target=\"_blank\">Polymer fume fever<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/BS_4994\" title=\"BS 4994\" rel=\"external_link\" target=\"_blank\">BS 4994<\/a> PTFE as a thermoplastic lining for dual laminate chemical process plant equipment<\/li><\/ul>\n<div style=\"clear:both;\"><\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ebi.ac.uk\/chebi\/searchId.do?chebiId=53251\" target=\"_blank\">\"poly(tetrafluoroethylene) (CHEBI:53251)\"<\/a>. <i>ebi.ac.uk<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">12 July<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=ebi.ac.uk&rft.atitle=poly%28tetrafluoroethylene%29+%28CHEBI%3A53251%29&rft_id=http%3A%2F%2Fwww.ebi.ac.uk%2Fchebi%2FsearchId.do%3FchebiId%3D53251&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-:0-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.chemours.com\/Teflon\/en_US\/\" target=\"_blank\">\"Teflon \u2122| Chemours Teflon\u2122 Nonstick Coatings and Additives\"<\/a>. <i>www.chemours.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-03-01<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.chemours.com&rft.atitle=Teflon+%E2%84%A2%7C+Chemours+Teflon%E2%84%A2+Nonstick+Coatings+and+Additives&rft_id=https%3A%2F%2Fwww.chemours.com%2FTeflon%2Fen_US%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><span class=\"citation patent\" id=\"rdp-ebb-CITEREFPlunkett1941\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/worldwide.espacenet.com\/textdoc?DB=EPODOC&IDX=US2230654\" target=\"_blank\">US 2230654<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Roy_Plunkett\" class=\"mw-redirect\" title=\"Roy Plunkett\" rel=\"external_link\" target=\"_blank\">Plunkett, Roy J<\/a>, \"Tetrafluoroethylene polymers\", issued 4 February 1941<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Apatent&rft.number=2230654&rft.cc=US&rft.title=Tetrafluoroethylene+polymers&rft.inventor=Plunkett&rft.date=4 February 1941\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-fluoroboom-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-fluoroboom_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www2.dupont.com\/Refrigerants\/en_US\/sales_support\/history_1930.html\" target=\"_blank\">\"History Timeline 1930: The Fluorocarbon Boom\"<\/a>. <i>DuPont<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">10 June<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=History+Timeline+1930%3A+The+Fluorocarbon+Boom&rft_id=http%3A%2F%2Fwww2.dupont.com%2FRefrigerants%2Fen_US%2Fsales_support%2Fhistory_1930.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www2.dupont.com\/Heritage\/en_US\/1938_dupont\/1938_indepth.html\" target=\"_blank\">\"Roy Plunkett: 1938\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">10 June<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Roy+Plunkett%3A+1938&rft_id=http%3A%2F%2Fwww2.dupont.com%2FHeritage%2Fen_US%2F1938_dupont%2F1938_indepth.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Heritage_of_Invention_%26_Technology\" title=\"American Heritage of Invention & Technology\" rel=\"external_link\" target=\"_blank\">American Heritage of Invention & Technology<\/a><\/i>, Fall 2010, vol. 25, no. 3, p. 42<\/span>\n<\/li>\n<li id=\"cite_note-rhodes-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-rhodes_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\n<cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Richard_Rhodes\" title=\"Richard Rhodes\" rel=\"external_link\" target=\"_blank\">Rhodes, Richard<\/a> (1986). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=aSgFMMNQ6G4C&printsec=frontcover\" target=\"_blank\"><i>The Making of the Atomic Bomb<\/i><\/a>. New York, New York: Simon and Schuster. p. 494. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-671-65719-4<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">31 October<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Making+of+the+Atomic+Bomb&rft.place=New+York%2C+New+York&rft.pages=494&rft.pub=Simon+and+Schuster&rft.date=1986&rft.isbn=0-671-65719-4&rft.aulast=Rhodes&rft.aufirst=Richard&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DaSgFMMNQ6G4C%26printsec%3Dfrontcover&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-history-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-history_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080214150646\/http:\/\/home.nycap.rr.com\/useless\/teflon\/index.html\" target=\"_blank\">Teflon History <\/a>\", <i>home.nycap.rr.com<\/i>, Retrieved 25 January 2009.<\/span>\n<\/li>\n<li id=\"cite_note-intofire-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-intofire_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Robbins, William (21 December 1986) \"<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/1986\/12\/21\/us\/teflon-maker-out-of-frying-pan-into-fame.html\" target=\"_blank\">Teflon Maker: Out Of Frying Pan Into Fame <\/a>\", <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/New_York_Times\" class=\"mw-redirect\" title=\"New York Times\" rel=\"external_link\" target=\"_blank\">New York Times<\/a><\/i>, Retrieved 21 December 1986 (Subscription)<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.swissdiamond.com\/about-us\/our-nonstick-technology\" target=\"_blank\">Swiss Diamond Technology<\/a> Swiss Diamond International<\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/scanpan.eu\/en-GB\/About-SCANPAN\/Made-in-Denmark.aspx\" target=\"_blank\">About SCANPAN<\/a> SCANPAN<\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.all-clad.com\/Pages\/Customer%20Service\/faqs.aspx\" target=\"_blank\">FAQ's<\/a> \"Is Nonstick Safe,\" All-Clad FAQ<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.calphalon.com\/Product-Support\/Pages\/FAQs.aspx\" target=\"_blank\">FAQ's<\/a> \"Does your cookware contain Teflon\u00ae?\" Calphalon FAQ<\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/meyer.custhelp.com\/app\/answers\/detail\/a_id\/189\/kw\/nonstick%20coating%20made%20of\" target=\"_blank\">Knowledge Base<\/a> Analon<\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/investors.dupont.com\/investor-relations\/investor-news\/investor-news-details\/2015\/DuPont-Completes-Spin-off-of-The-Chemours-Company\/default.aspx\" target=\"_blank\">\"DuPont - DuPont Completes Spin-off of The Chemours Company\"<\/a>. <i>investors.dupont.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-03-01<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=investors.dupont.com&rft.atitle=DuPont+-+DuPont+Completes+Spin-off+of+The+Chemours+Company&rft_id=http%3A%2F%2Finvestors.dupont.com%2Finvestor-relations%2Finvestor-news%2Finvestor-news-details%2F2015%2FDuPont-Completes-Spin-off-of-The-Chemours-Company%2Fdefault.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sun, J.Z.; et al. (1994). \"Modification of polytetrafluoroethylene by radiation\u20141. Improvement in high temperature properties and radiation stability\". <i>Radiat. Phys. Chem<\/i>. <b>44<\/b> (6): 655\u2013679. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/1994RaPC...44..655S\" target=\"_blank\">1994RaPC...44..655S<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0969-806X%2894%2990226-7\" target=\"_blank\">10.1016\/0969-806X(94)90226-7<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Radiat.+Phys.+Chem.&rft.atitle=Modification+of+polytetrafluoroethylene+by+radiation%E2%80%941.+Improvement+in+high+temperature+properties+and+radiation+stability&rft.volume=44&rft.issue=6&rft.pages=655-679&rft.date=1994&rft_id=info%3Adoi%2F10.1016%2F0969-806X%2894%2990226-7&rft_id=info%3Abibcode%2F1994RaPC...44..655S&rft.au=Sun%2C+J.Z.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.e-beamservices.com\/chain.htm\" target=\"_blank\">Electron Beam Processing of PTFE<\/a> E-BEAM Services website. Accessed 21 May 2013<\/span>\n<\/li>\n<li id=\"cite_note-Ullmann-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Ullmann_18-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Carlson, D. Peter and Schmiegel, Walter (2000) \"Fluoropolymers, Organic\" in <i>Ullmann's Encyclopedia of Industrial Chemistry<\/i>, Wiley-VCH, Weinheim. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14356007.a11_393\" target=\"_blank\">10.1002\/14356007.a11_393<\/a><\/span>\n<\/li>\n<li id=\"cite_note-chemours-19\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-chemours_19-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-chemours_19-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.chemours.com\/Teflon_Industrial\/en_US\/tech_info\/techinfo_compare.html\" target=\"_blank\">Fluoroplastic Comparison - Typical Properties<\/a> Retrieved 16 January 2018.<\/span>\n<\/li>\n<li id=\"cite_note-ptfe_handbook-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ptfe_handbook_20-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.rjchase.com\/ptfe_handbook.pdf\" target=\"_blank\">Teflon PTFE Properties Handbook<\/a> Retrieved 11 October 2012.<\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080704112712\/http:\/\/www.plastechcoatings.com\/dupont_teflon_coating.html\" target=\"_blank\">DuPont Teflon\u00ae Coatings<\/a>. plastechcoatings.com<\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Nicholson, John W. (2011). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=polymer%20chemistry&f=false\"><i>The Chemistry of Polymers<\/i><\/a> (4, Revised ed.). Royal Society of Chemistry. p. 50. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781849733915.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Chemistry+of+Polymers&rft.pages=50&rft.edition=4%2C+Revised&rft.pub=Royal+Society+of+Chemistry&rft.date=2011&rft.isbn=9781849733915&rft.au=Nicholson%2C+John+W.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D5XFsT69cX_YC%26printsec%3Dfrontcover%26dq%3Dpolymer%2Bchemistry%23v%3Donepage%26q%3Dpolymer%2520chemistry%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.engineershandbook.com\/Tables\/plasticthermalexp.htm\" target=\"_blank\">\"Reference Tables \u2013 Thermal Expansion Coefficients \u2013 Plastics\"<\/a>. <i>engineershandbook.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=engineershandbook.com&rft.atitle=Reference+Tables+%E2%80%93++Thermal+Expansion+Coefficients+%E2%80%93+Plastics&rft_id=http%3A%2F%2Fwww.engineershandbook.com%2FTables%2Fplasticthermalexp.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Blumm, J.; Lindemann, A.; Meyer, M.; Strasser, C. (2011). \"Characterization of PTFE Using Advanced Thermal Analysis Technique\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Journal_of_Thermophysics\" title=\"International Journal of Thermophysics\" rel=\"external_link\" target=\"_blank\">International Journal of Thermophysics<\/a><\/i>. <b>40<\/b> (3\u20134): 311. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2010IJT....31.1919B\" target=\"_blank\">2010IJT....31.1919B<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs10765-008-0512-z\" target=\"_blank\">10.1007\/s10765-008-0512-z<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Thermophysics&rft.atitle=Characterization+of+PTFE+Using+Advanced+Thermal+Analysis+Technique&rft.volume=40&rft.issue=3%E2%80%934&rft.pages=311&rft.date=2011&rft_id=info%3Adoi%2F10.1007%2Fs10765-008-0512-z&rft_id=info%3Abibcode%2F2010IJT....31.1919B&rft.au=Blumm%2C+J.&rft.au=Lindemann%2C+A.&rft.au=Meyer%2C+M.&rft.au=Strasser%2C+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.microwaves101.com\/encyclopedia\/PTFE.cfm\" target=\"_blank\">\"PTFE\"<\/a>. <i>Microwaves101<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Microwaves101&rft.atitle=PTFE&rft_id=http%3A%2F%2Fwww.microwaves101.com%2Fencyclopedia%2FPTFE.cfm&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wapler, M. C.; Leupold, J.; Dragonu, I.; von Elverfeldt, D.; Zaitsev, M.; Wallrabe, U. (2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/arxiv.org\/pdf\/1403.4760\" target=\"_blank\">\"Magnetic properties of materials for MR engineering, micro-MR and beyond\"<\/a>. <i>JMR<\/i>. <b>242<\/b>: 233\u2013242. <a href=\"https:\/\/en.wikipedia.org\/wiki\/ArXiv\" title=\"ArXiv\" rel=\"external_link\" target=\"_blank\">arXiv<\/a>:<span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/arxiv.org\/abs\/1403.4760\" target=\"_blank\">1403.4760<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2014JMagR.242..233W\" target=\"_blank\">2014JMagR.242..233W<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jmr.2014.02.005\" target=\"_blank\">10.1016\/j.jmr.2014.02.005<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JMR&rft.atitle=Magnetic+properties+of+materials+for+MR+engineering%2C+micro-MR+and+beyond&rft.volume=242&rft.pages=233-242&rft.date=2014&rft_id=info%3Aarxiv%2F1403.4760&rft_id=info%3Adoi%2F10.1016%2Fj.jmr.2014.02.005&rft_id=info%3Abibcode%2F2014JMagR.242..233W&rft.aulast=Wapler&rft.aufirst=M.+C.&rft.au=Leupold%2C+J.&rft.au=Dragonu%2C+I.&rft.au=von+Elverfeldt%2C+D.&rft.au=Zaitsev%2C+M.&rft.au=Wallrabe%2C+U.&rft_id=https%3A%2F%2Farxiv.org%2Fpdf%2F1403.4760&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.matweb.com\/reference\/coefficient-of-friction.asp\" target=\"_blank\">Coefficient of Friction (COF) Testing of Plastics<\/a> MatWeb Material Property Data Retrieved 1 January 2007.<\/span>\n<\/li>\n<li id=\"cite_note-gecko-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-gecko_28-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20071014063923\/http:\/\/socrates.berkeley.edu\/~peattiea\/research_main.html\" target=\"_blank\">Research into Gecko Adhesion <\/a>\", <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_California,_Berkeley\" title=\"University of California, Berkeley\" rel=\"external_link\" target=\"_blank\">Berkeley<\/a><\/i>, 2007-10-14, Retrieved 8 April 2010.<\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Inc., Gasket Resources. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gasketresources.com\/ptfe-gaskets\" target=\"_blank\">\"PTFE Sheet | Gasket Resources Inc\"<\/a>. <i>www.gasketresources.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-08-16<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.gasketresources.com&rft.atitle=PTFE+Sheet+%7C+Gasket+Resources+Inc&rft.aulast=Inc.&rft.aufirst=Gasket+Resources&rft_id=http%3A%2F%2Fwww.gasketresources.com%2Fptfe-gaskets&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Davet, George P. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sealing.com\/fileadmin\/docs\/Using_Bellville_springs_to_maintain_bolt_preload.pdf\" target=\"_blank\">\"Using Belleville Springs To Maintain Bolt Preload\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Solon Mfg. 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Retrieved <span class=\"nowrap\">18 May<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Solon+Mfg.+Co.&rft.atitle=Using+Belleville+Springs+To+Maintain+Bolt+Preload&rft.aulast=Davet&rft.aufirst=George+P.&rft_id=http%3A%2F%2Fwww.sealing.com%2Ffileadmin%2Fdocs%2FUsing_Bellville_springs_to_maintain_bolt_preload.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-zapp-31\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-zapp_31-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-zapp_31-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zapp JA, Limperos G, Brinker KC (26 April 1955). \"Toxicity of pyrolysis products of 'Teflon' tetrafluoroethylene resin\". <i>Proceedings of the American Industrial Hygiene Association Annual Meeting<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+the+American+Industrial+Hygiene+Association+Annual+Meeting&rft.atitle=Toxicity+of+pyrolysis+products+of+%27Teflon%27+tetrafluoroethylene+resin&rft.date=1955-04-26&rft.aulast=Zapp&rft.aufirst=JA&rft.au=Limperos%2C+G&rft.au=Brinker%2C+KC&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.inoflon.com\/pdf\/PG_Free%20flow%20granular%20PTFE.pdf\" target=\"_blank\">\"Free Flow Granular PTFE\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Inoflon Fluoropolymers<\/i>. 2017-08-16.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Inoflon+Fluoropolymers&rft.atitle=Free+Flow+Granular+PTFE&rft.date=2017-08-16&rft_id=http%3A%2F%2Fwww.inoflon.com%2Fpdf%2FPG_Free%2520flow%2520granular%2520PTFE.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cowie.com\/thermal.htm\" target=\"_blank\">\"COWIE TECHNOLOGY - PTFE: High Thermal Stability\"<\/a>. <i>www.cowie.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-08-16<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.cowie.com&rft.atitle=COWIE+TECHNOLOGY+-+PTFE%3A+High+Thermal+Stability&rft_id=http%3A%2F%2Fwww.cowie.com%2Fthermal.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:1-34\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:1_34-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_34-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_34-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.daikinchem.de\/downloads\/PTFE-M.pdf\" target=\"_blank\">\"Polyflon PTFE Molding Powder\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Daikin Chemical<\/i>. 2017-08-16.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Daikin+Chemical&rft.atitle=Polyflon+PTFE+Molding+Powder&rft.date=2017-08-16&rft_id=http%3A%2F%2Fwww.daikinchem.de%2Fdownloads%2FPTFE-M.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/polyfluoroltd.blogspot.com\/2011\/04\/ptfe-myths-busted.html\" target=\"_blank\">\"Unraveling Polymers: PTFE\"<\/a>. Poly Fouoro Ltd. 26 April 2011<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">23 April<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Unraveling+Polymers%3A+PTFE&rft.pub=Poly+Fouoro+Ltd.&rft.date=2011-04-26&rft_id=http%3A%2F%2Fpolyfluoroltd.blogspot.com%2F2011%2F04%2Fptfe-myths-busted.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-MishraYagci-36\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-MishraYagci_36-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-MishraYagci_36-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Mishra, Munmaya; Yagci, Yusuf (208). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=CoFE-itPBPgC\" target=\"_blank\"><i>Handbook of Vinyl Polymers: Radical Polymerization, Process, and Technology, Second Edition<\/i><\/a> (2nd, illustrated, revised ed.). CRC Press. p. 574. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-8247-2595-2.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Handbook+of+Vinyl+Polymers%3A+Radical+Polymerization%2C+Process%2C+and+Technology%2C+Second+Edition&rft.pages=574&rft.edition=2nd%2C+illustrated%2C+revised&rft.pub=CRC+Press&rft.date=208&rft.isbn=978-0-8247-2595-2&rft.aulast=Mishra&rft.aufirst=Munmaya&rft.au=Yagci%2C+Yusuf&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DCoFE-itPBPgC&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=CoFE-itPBPgC&pg=PA574\" target=\"_blank\">Extract of page 574<\/a><\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.espemfg.com\/teflon-machining-fabrication.html\" target=\"_blank\">\"Teflon Machining & Fabrication | ESPE\"<\/a>. <i>www.espemfg.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-08-28<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.espemfg.com&rft.atitle=Teflon+Machining+%26+Fabrication+%7C+ESPE&rft_id=https%3A%2F%2Fwww.espemfg.com%2Fteflon-machining-fabrication.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-38\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-38\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Mishra & Yagci, <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=CoFE-itPBPgC&pg=PA573\" target=\"_blank\">p 573<\/a><\/span>\n<\/li>\n<li id=\"cite_note-39\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-39\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"#assembly\">\"What is MicPol?\"<\/a>. <i>Lubrication<\/i><span class=\"reference-accessdate\">. 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Retrieved on 2016-11-17.<\/span>\n<\/li>\n<li id=\"cite_note-gore-41\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-gore_41-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.infinitymotorcycles.com\/news\/a-motorcyclists-guide-to-gore-tex\/119\" target=\"_blank\">\"A Motorcyclist's Guide To Gore-Tex\"<\/a>. 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Retrieved <span class=\"nowrap\">28 November<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Key+Safety+Questions+About+Teflon+Nonstick+Coatings&rft_id=http%3A%2F%2Fwww2.dupont.com%2FTeflon%2Fen_US%2Fproducts%2Fsafety%2Fkey_questions.html%23q6&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-57\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-57\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"#q5\">\"Key Safety Questions about the Safety of Nonstick Cookware\"<\/a>. DuPont.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Key+Safety+Questions+about+the+Safety+of+Nonstick+Cookware&rft.pub=DuPont&rft_id=http%3A%2F%2Fwww2.dupont.com%2FTeflon%2Fen_US%2Fproducts%2Fsafety%2Fkey_questions.html%23q5&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-NYTmagazine-58\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-NYTmagazine_58-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">RIch, Nathaniel. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2016\/01\/10\/magazine\/the-lawyer-who-became-duponts-worst-nightmare.html\" target=\"_blank\">\"The Lawyer Who Became Dupont's Worst Nightmare\"<\/a>. <i>The New York Times Magazine<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">7 January<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times+Magazine&rft.atitle=The+Lawyer+Who+Became+Dupont%27s+Worst+Nightmare&rft.aulast=RIch&rft.aufirst=Nathaniel&rft_id=https%3A%2F%2Fwww.nytimes.com%2F2016%2F01%2F10%2Fmagazine%2Fthe-lawyer-who-became-duponts-worst-nightmare.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Blake-59\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Blake_59-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Blake, Mariah. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/highline.huffingtonpost.com\/articles\/en\/welcome-to-beautiful-parkersburg\/\" target=\"_blank\">\"Welcome to Beautiful Parkersburg, West Virginia Home to one of the most brazen, deadly corporate gambits in U.S. history\"<\/a>. <i>Huffington Post<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">31 August<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Huffington+Post&rft.atitle=Welcome+to+Beautiful+Parkersburg%2C+West+Virginia+Home+to+one+of+the+most+brazen%2C+deadly+corporate+gambits+in+U.S.+history.&rft.aulast=Blake&rft.aufirst=Mariah&rft_id=http%3A%2F%2Fhighline.huffingtonpost.com%2Farticles%2Fen%2Fwelcome-to-beautiful-parkersburg%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Fellner-16June2018-60\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Fellner-16June2018_60-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Fellner, Carrie (16 June 2018). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.smh.com.au\/lifestyle\/health-and-wellness\/toxic-secrets-professor-bragged-about-burying-bad-science-on-3m-chemicals-20180615-p4zlsc.html\" target=\"_blank\">\"Toxic Secrets: Professor 'bragged about burying bad science' on 3M chemicals\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sydney_Morning_Herald\" class=\"mw-redirect\" title=\"Sydney Morning Herald\" rel=\"external_link\" target=\"_blank\">Sydney Morning Herald<\/a><\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">25 June<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Sydney+Morning+Herald&rft.atitle=Toxic+Secrets%3A+Professor+%E2%80%98bragged+about+burying+bad+science%E2%80%99+on+3M+chemicals&rft.date=2018-06-16&rft.aulast=Fellner&rft.aufirst=Carrie&rft_id=https%3A%2F%2Fwww.smh.com.au%2Flifestyle%2Fhealth-and-wellness%2Ftoxic-secrets-professor-bragged-about-burying-bad-science-on-3m-chemicals-20180615-p4zlsc.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-61\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-61\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Nicole, W. (2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3855507\" target=\"_blank\">\"PFOA and Cancer in a Highly Exposed Community: New Findings from the C8 Science Panel\"<\/a>. <i>Environmental Health Perspectives<\/i>. <b>121<\/b> (11\u201312): A340. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1289%2Fehp.121-A340\" target=\"_blank\">10.1289\/ehp.121-A340<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3855507\" target=\"_blank\">3855507<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24284021\" target=\"_blank\">24284021<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Environmental+Health+Perspectives&rft.atitle=PFOA+and+Cancer+in+a+Highly+Exposed+Community%3A+New+Findings+from+the+C8+Science+Panel&rft.volume=121&rft.issue=11%E2%80%9312&rft.pages=A340&rft.date=2013&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3855507&rft_id=info%3Apmid%2F24284021&rft_id=info%3Adoi%2F10.1289%2Fehp.121-A340&rft.aulast=Nicole&rft.aufirst=W.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3855507&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-62\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-62\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Trudel D, Horowitz L, Wormuth M, Scheringer M, Cousins IT, Hungerb\u00fchler K (April 2008). \"Estimating consumer exposure to PFOS and PFOA\". <i>Risk Anal<\/i>. <b>28<\/b> (2): 251\u201369. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1539-6924.2008.01017.x\" target=\"_blank\">10.1111\/j.1539-6924.2008.01017.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18419647\" target=\"_blank\">18419647<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Risk+Anal.&rft.atitle=Estimating+consumer+exposure+to+PFOS+and+PFOA&rft.volume=28&rft.issue=2&rft.pages=251-69&rft.date=2008-04&rft_id=info%3Adoi%2F10.1111%2Fj.1539-6924.2008.01017.x&rft_id=info%3Apmid%2F18419647&rft.aulast=Trudel&rft.aufirst=D&rft.au=Horowitz%2C+L&rft.au=Wormuth%2C+M&rft.au=Scheringer%2C+M&rft.au=Cousins%2C+IT&rft.au=Hungerb%C3%BChler%2C+K&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-63\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-63\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.consumerreports.org\/cro\/home-garden\/kitchen\/cookware-bakeware-cutlery\/nonstick-pans-6-07\/overview\/0607_pans_ov_1.htm\" target=\"_blank\">\"Nonstick pans: Nonstick coating risks\"<\/a>. <i>Consumer Reports<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">4 July<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Consumer+Reports&rft.atitle=Nonstick+pans%3A+Nonstick+coating+risks&rft_id=http%3A%2F%2Fwww.consumerreports.org%2Fcro%2Fhome-garden%2Fkitchen%2Fcookware-bakeware-cutlery%2Fnonstick-pans-6-07%2Foverview%2F0607_pans_ov_1.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-64\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-64\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100724195156\/http:\/\/www.texloc.com\/closet\/cl_fep_properties.htm\" target=\"_blank\">FEP Detailed Properties<\/a>, Parker-TexLoc, 13 April 2006. Retrieved 10 September 2006.<\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation journal\">Ellis, D.A.; Mabury, S.A.; Martin, J.W.; Muir, D.C.G.; Mabury, S.A.; Martin, J.W.; Muir, D.C.G. (2001). \"Thermolysis of fluoropolymers as a potential source of halogenated organic acids in the environment\". <i>Nature<\/i>. <b>412<\/b> (6844): 321\u2013324. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2F35085548\" target=\"_blank\">10.1038\/35085548<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11460160\" target=\"_blank\">11460160<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature&rft.atitle=Thermolysis+of+fluoropolymers+as+a+potential+source+of+halogenated+organic+acids+in+the+environment&rft.volume=412&rft.issue=6844&rft.pages=321-324&rft.date=2001&rft_id=info%3Adoi%2F10.1038%2F35085548&rft_id=info%3Apmid%2F11460160&rft.aulast=Ellis&rft.aufirst=D.A.&rft.au=Mabury%2C+S.A.&rft.au=Martin%2C+J.W.&rft.au=Muir%2C+D.C.G.&rft.au=Mabury%2C+S.A.&rft.au=Martin%2C+J.W.&rft.au=Muir%2C+D.C.G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolytetrafluoroethylene\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.msnbc.msn.com\/id\/8408729\/\" target=\"_blank\">EPA: Compound in Teflon may cause cancer<\/a> <a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.msnbc.msn.com\/id\/8404384\" target=\"_blank\">[1]<\/a>, Tom Costello, NBC News, 29 June 2005. (Flash video required)<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.plasmatechsystems.com\/about\/pubs\/Plasma%20Processes%20Polytetrafluoroethylene.pdf\" target=\"_blank\">Plasma Processes and Adhesive Bonding of Polytetrafluoroethylene<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/fluorotherm.com\/Properties-PTFE.asp\" target=\"_blank\">PTFE Tubing Properties<\/a><\/li><\/ul>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1240\nCached time: 20181215054339\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 1.500 seconds\nReal time usage: 1.823 seconds\nPreprocessor visited node count: 7998\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 189399\/2097152 bytes\nTemplate argument size: 13177\/2097152 bytes\nHighest expansion depth: 22\/40\nExpensive parser function count: 8\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 129579\/5000000 bytes\nNumber of Wikibase entities loaded: 5\/400\nLua time usage: 0.696\/10.000 seconds\nLua memory usage: 10.02 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1526.051 1 -total\n<\/p>\n<pre>36.80% 561.572 1 Template:Chembox\n35.83% 546.719 1 Template:Reflist\n21.34% 325.651 1 Template:Chembox_Identifiers\n14.71% 224.518 23 Template:Cite_web\n14.64% 223.384 4 Template:Chembox_headerbar\n14.34% 218.825 12 Template:Trim\n 9.26% 141.387 11 Template:Cite_journal\n 8.42% 128.488 11 Template:Main_other\n 7.03% 107.348 1 Template:Chembox_parametercheck\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:30791-1!canonical and timestamp 20181215054337 and revision id 873611621\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Polytetrafluoroethylene\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212224\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.019 seconds\nReal time usage: 0.189 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 179.284 1 - wikipedia:Polytetrafluoroethylene\n100.00% 179.284 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8295-0!*!*!*!*!*!* and timestamp 20181217212224 and revision id 24507\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polytetrafluoroethylene\">https:\/\/www.limswiki.org\/index.php\/Polytetrafluoroethylene<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","31670fc19e00e5b9da56359ed47aec32_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/1\/17\/Teflon_structure.PNG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/eb\/Perfluorodecyl-chain-from-xtal-Mercury-3D-balls.png\/500px-Perfluorodecyl-chain-from-xtal-Mercury-3D-balls.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/73\/Happy_Pan_Poster.jpg\/440px-Happy_Pan_Poster.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/14\/EL-1994-00019.jpeg\/440px-EL-1994-00019.jpe","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b7\/Blintzes_in_frying_pan.jpg\/440px-Blintzes_in_frying_pan.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/PTFE_tapes_with_pressure-sensitive_adhesive_backing%2C_rolls_of_15_and_25_mm_widths.jpg\/440px-PTFE_tapes_with_pressure-sensitive_adhesive_backing%2C_rolls_of_15_and_25_mm_widths.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/e\/e8\/PFA_structure.PNG"],"31670fc19e00e5b9da56359ed47aec32_timestamp":1545081744,"c24db4ecd9edd29e812a0d9e02257517_type":"article","c24db4ecd9edd29e812a0d9e02257517_title":"Polyimide","c24db4ecd9edd29e812a0d9e02257517_url":"https:\/\/www.limswiki.org\/index.php\/Polyimide","c24db4ecd9edd29e812a0d9e02257517_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPolyimide\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t General chemical structure of a polyimide\nPolyimide (sometimes abbreviated PI) is a polymer of imide monomers. Polyimides have been in mass production since 1955. With their high heat-resistance, polyimides enjoy diverse applications in roles demanding rugged organic materials, e.g. high temperature fuel cells, displays, and various military roles. A classic polyimide is Kapton, which is produced by condensation of pyromellitic dianhydride and 4,4'-oxydianiline.[1]\n\nContents \n\n1 Classification \n2 Synthesis \n3 Properties \n4 Applications \n\n4.1 Insulation and passivation films \n4.2 Mechanical parts \n4.3 Filters \n4.4 Other \n\n\n5 See also \n6 References \n7 Further reading \n8 External links \n\n\nClassification \nAccording to the composition of their main chain, polyimides can be:\n\nAliphatic (linear polyimides),\nSemi-aromatic,\nAromatic: these are the most used polyimides because of their thermostability.\nAccording to the type of interactions between the main chains, polyimides can be:\n\nThermoplastic: very often called pseudothermoplastic.\nThermosetting: commercially available as uncured resins, polyimide solutions, stock shapes, thin sheets, laminates and machined parts.\nSynthesis \nSeveral methods are possible to prepare polyimides, among them:\n\nThe reaction between a dianhydride and a diamine (the most used method).\nThe reaction between a dianhydride and a diisocyanate.\nDianhydrides used as precursors to these materials include pyromellitic dianhydride, benzoquinonetetracarboxylic dianhydride and naphthalene tetracarboxylic dianhydride. Common diamine building blocks include 4,4'-diaminodiphenyl ether (\"DAPE\"), meta-phenylenediamine (\"MDA\"), and 3,3-diaminodiphenylmethane.[1] Hundreds of diamines and dianhydrides have been examined to tune the physical and especially the processing properties of these materials. These materials tend to be insoluble and have high softening temperatures, arising from charge-transfer interactions between the planar subunits.[2]\n\nProperties \nThermosetting polyimides are known for thermal stability, good chemical resistance, excellent mechanical properties, and characteristic orange\/yellow color. Polyimides compounded with graphite or glass fiber reinforcements have flexural strengths of up to 50,000 psi (340 MPa) and flexural moduli of 3,000,000 psi (21,000 MPa). Thermoset polymer matrix polyimides exhibit very low creep and high tensile strength. These properties are maintained during continuous use to temperatures of up to 232 \u00b0C (450 \u00b0F) and for short excursions, as high as 400 \u00b0C (752 \u00b0F).[3] Molded polyimide parts and laminates have very good heat resistance. Normal operating temperatures for such parts and laminates range from cryogenic to those exceeding 260 \u00b0C (500 \u00b0F). Polyimides are also inherently resistant to flame combustion and do not usually need to be mixed with flame retardants. Most carry a UL rating of VTM-0. Polyimide laminates have a flexural strength half life at 249 \u00b0C (480 \u00b0F) of 400 hours.\nTypical polyimide parts are not affected by commonly used solvents and oils \u2014 including hydrocarbons, esters, ethers, alcohols and freons. They also resist weak acids but are not recommended for use in environments that contain alkalis or inorganic acids. Some polyimides, such as CP1 and CORIN XLS, are solvent-soluble and exhibit high optical clarity. The solubility properties lend them towards spray and low temperature cure applications.\n\nApplications \nInsulation and passivation films \nPolyimide materials are lightweight, flexible, resistant to heat and chemicals. Therefore, they are used in the electronics industry for flexible cables and as an insulating film on magnet wire. For example, in a laptop computer, the cable that connects the main logic board to the display (which must flex every time the laptop is opened or closed) is often a polyimide base with copper conductors. Examples of polyimide films include Apical, Kapton, UPILEX, VTEC PI, Norton TH and Kaptrex.\n\n Structure of poly-oxydiphenylene-pyromellitimide, \"Kapton\".\nPolyimide is used to coat optical fibers for medical or high temperature applications.[4]\nAn additional use of polyimide resin is as an insulating and passivation[5] layer in the manufacture of digital semiconductor and MEMS chips. The polyimide layers have good mechanical elongation and tensile strength, which also helps the adhesion between the polyimide layers or between polyimide layer and deposited metal layer. The minimum interaction between the gold film and the polyimide film, coupled with high temperature stability of the polyimide film, results in a system that provides reliable insulation when subjected to various types of environmental stresses.[6][7]\nMulti-layer insulation used on spacecraft is usually made of polyimide coated with thin layers of aluminum. The gold-like material often seen on the outside of spacecraft is actually single aluminized polyimide, with the single layer of aluminum facing in.[8] The yellowish-brown polyimide gives the surface its gold-like color.\n\nMechanical parts \nPolyimide powder can be used to produce parts and shapes by sintering technologies (hot compression molding, direct forming, and isostatic pressing). Because of their high mechanical stability even at elevated temperatures they are used as bushings, bearings, sockets or constructive parts in demanding applications. To improve tribological properties, compounds with solid lubricants like graphite, PTFE, or molybdenum sulfide are common. Polyimide parts and shapes include P84 NT, VTEC PI, Meldin, Vespel, and Plavis.\n\nFilters \nIn coal-fired power plants, waste incinerators, or cement plants, polyimide fibres are used to filter hot gases. In this application, a polyimide needle felt separates dust and particulate matter from the exhaust gas.\nPolyimide is also the most common material used for the reverse osmotic film in purification of water, or the concentration of dilute materials from water, such as maple syrup production.[9][10]\n\nOther \nPolyimide is used for medical tubing, e.g. vascular catheters, for its burst pressure resistance combined with flexibility and chemical resistance.\nThe semiconductor industry uses polyimide as a high-temperature adhesive; it is also used as a mechanical stress buffer. \nSome polyimide can be used like a photoresist; both \"positive\" and \"negative\" types of photoresist-like polyimide exist in the market.\nThe IKAROS solar sailing spacecraft uses polyimide resin sails to operate without rocket engines.[11]\n\nSee also \nPolyamide\nPolyamide-imide\nPolymerization\nReferences \n\n\n^ a b Wright, Walter W. and Hallden-Abberton, Michael (2002) \"Polyimides\" in Ullmann's Encyclopedia of Industrial Chemistry, Wiley-VCH, Weinheim. doi:10.1002\/14356007.a21_253 \n\n^ Liaw, Der-Jang; Wang, Kung-Li; Huang, Ying-Chi; Lee, Kueir-Rarn; Lai, Juin-Yih; Ha, Chang-Sik (2012). \"Advanced polyimide materials: Syntheses, physical properties and applications\". Progress in Polymer Science. 37 (7): 907\u2013974. doi:10.1016\/j.progpolymsci.2012.02.005. \n\n^ P2SI 900HT Tech Sheet. proofresearchacd.com \n\n^ Huang, Lei; Dyer, Robert S.; Lago, Ralph J.; Stolov, Andrei A.; Li, Jie (2016). \"Mechanical properties of polyimide coated optical fibers at elevated temperatures\". Optical Fibers and Sensors for Medical Diagnostics and Treatment Applications XVI. Optical Fibers and Sensors for Medical Diagnostics and Treatment Applications XVI. 9702. pp. 97020Y. doi:10.1117\/12.2210957. \n\n^ Jiang, Jiann-Shan; Chiou, Bi-Shiou (2001). \"The effect of polyimide passivation on the electromigration of Cu multilayer interconnections\". Journal of Materials Science: Materials in Electronics. 12 (11): 655\u2013659. doi:10.1023\/A:1012802117916. \n\n^ Krakauer, David (December 2006) Digital Isolation Offers Compact, Low-Cost Solutions to Challenging Design Problems. analog.com \n\n^ Chen, Baoxing. iCoupler Products with isoPower Technology: Signal and Power Transfer Across Isolation Barrier Using Microtransformers. analog.com \n\n^ \"Thermal Control Overview\" (PDF) . Sheldahl Multi Layer Insulation. Retrieved 28 December 2015 . \n\n^ What is a reverse osmosis water softener? wisegeek.net \n\n^ Shuey, Harry F. and Wan, Wankei (1983-12-22) U.S. Patent 4,532,041 Asymmetric polyimide reverse osmosis membrane, method for preparation of same and use thereof for organic liquid separations. \n\n^ Courtland, Rachel (10 May 2010). \"Maiden voyage for first true space sail\". The New Scientist. Retrieved 11 June 2010 . \n\n\nFurther reading \nModern Plastic Mid-October Encyclopedia Issue, Polyimide, thermoset, page 146.\nVarun Ratta: POLYIMIDES: Chemistry & structure-property relationships \u2013 literature review (Chapter 1).\nExternal links \nMaterial Property Database, MIT\nvtePlasticsChemical types\nAcrylonitrile butadiene styrene (ABS)\nCross-linked polyethylene (PEX, XLPE)\nEthylene vinyl acetate (EVA)\nPoly(methyl methacrylate) (PMMA)\nPolyacrylic acid (PAA)\nPolyamide (PA)\nPolybutylene (PB)\nPolybutylene terephthalate (PBT)\nPolycarbonate (PC)\nPolyetheretherketone (PEEK)\nPolyester (PEs)\nPolyethylene (PE)\nPolyethylene terephthalate (PET, PETE)\nPolyimide (PI)\nPolylactic acid (PLA)\nPolyoxymethylene (POM)\nPolyphenyl ether (PPE)\nPolypropylene (PP)\nPolystyrene (PS)\nPolysulfone (PES)\nPolytetrafluoroethylene (PTFE)\nPolyurethane (PU)\nPolyvinyl chloride (PVC)\nPolyvinylidene chloride (PVDC)\nStyrene maleic anhydride (SMA)\nStyrene-acrylonitrile (SAN)\nMechanical types\nThermoplastic\nDuroplast\nCorrugated plastic\nPolymeric foam\nHigh performance plastics\nAdditives\nPolymer additive\nColorants\nPlasticizer\nStabilizer for polymers\nBiodegradable additives\nProducts\nPlastic industry\nCommodity plastics\nEngineering plastics\nHigh-performance plastics\nPlastic film\nPlastic bottle\nPlastic bag\nPlastic shopping bag\nPlastic cutlery\nBlister pack\nFoam food container\nConstruction\nGeosynthetics\nCategory:Plastics applications\nEnvironment and healthvteHealth issues of plastics and polyhalogenated compounds (PHCs)Plasticizers: Phthalates\nDIBP\nDBP\nBBP (BBzP)\nDIHP\nDEHP (DOP)\nDIDP\nDINP\nMiscellaneous plasticizers\nOrganophosphates\nAdipates (DEHA\nDOA)\nMonomers\nBisphenol A (BPA, in Polycarbonates)\nVinyl chloride (in PVC)\nMiscellaneous additives incl. PHCs\nPBDEs\nPCBs\nOrganotins\nPFCs\nPerfluorooctanoic acid\nHealth issues\nTeratogen\nCarcinogen\nEndocrine disruptor\nDiabetes\nObesity\nObesogen\nPolymer fume fever\nPollution\nPlastic pollution\nGreat Pacific garbage patch\nPersistent organic pollutant\nDioxins\nList of environmental health hazards\nRegulations\nCalifornia Proposition 65\nEuropean REACH regulation\nJapan Toxic Substances Law\nToxic Substances Control Act\nWaste\nPlastic pollution\nGreat Pacific garbage patch\nPersistent organic pollutant\nDioxins\nList of environmental health hazards\nPlastic recycling\nBiodegradable plastic\nIdentification codes\n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polyimide\">https:\/\/www.limswiki.org\/index.php\/Polyimide<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 20:56.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 585 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","c24db4ecd9edd29e812a0d9e02257517_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Polyimide skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Polyimide<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Polyimide.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0a\/Polyimide.svg\/220px-Polyimide.svg.png\" width=\"220\" height=\"172\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Polyimide.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>General chemical structure of a polyimide<\/div><\/div><\/div>\n<p><b>Polyimide<\/b> (sometimes abbreviated <b>PI<\/b>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Imide\" title=\"Imide\" rel=\"external_link\" target=\"_blank\">imide<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomers<\/a>. Polyimides have been in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mass_production\" title=\"Mass production\" rel=\"external_link\" target=\"_blank\">mass production<\/a> since 1955. With their high heat-resistance, polyimides enjoy diverse applications in roles demanding rugged organic materials, e.g. high temperature <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fuel_cell\" title=\"Fuel cell\" rel=\"external_link\" target=\"_blank\">fuel cells<\/a>, displays, and various military roles. A classic polyimide is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kapton\" title=\"Kapton\" rel=\"external_link\" target=\"_blank\">Kapton<\/a>, which is produced by condensation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyromellitic_dianhydride\" title=\"Pyromellitic dianhydride\" rel=\"external_link\" target=\"_blank\">pyromellitic dianhydride<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/4,4%27-Oxydianiline\" title=\"4,4'-Oxydianiline\" rel=\"external_link\" target=\"_blank\">4,4'-oxydianiline<\/a>.<sup id=\"rdp-ebb-cite_ref-Ullmann_1-0\" class=\"reference\"><a href=\"#cite_note-Ullmann-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Classification\">Classification<\/span><\/h2>\n<p>According to the composition of their main chain, polyimides can be:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Aliphatic\" class=\"mw-redirect\" title=\"Aliphatic\" rel=\"external_link\" target=\"_blank\">Aliphatic<\/a> (linear polyimides),<\/li>\n<li>Semi-aromatic,<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Aromaticity\" title=\"Aromaticity\" rel=\"external_link\" target=\"_blank\">Aromatic<\/a>: these are the most used polyimides because of their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermostability\" title=\"Thermostability\" rel=\"external_link\" target=\"_blank\">thermostability<\/a>.<\/li><\/ul>\n<p>According to the type of interactions between the main chains, polyimides can be:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoplastic\" title=\"Thermoplastic\" rel=\"external_link\" target=\"_blank\">Thermoplastic<\/a>: very often called <i>pseudothermoplastic<\/i>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoset\" class=\"mw-redirect\" title=\"Thermoset\" rel=\"external_link\" target=\"_blank\">Thermosetting<\/a>: commercially available as uncured resins, polyimide solutions, stock shapes, thin sheets, laminates and machined parts.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Synthesis\">Synthesis<\/span><\/h2>\n<p>Several methods are possible to prepare polyimides, among them:\n<\/p>\n<ul><li>The reaction between a di<a href=\"https:\/\/en.wikipedia.org\/wiki\/Acid_anhydride\" title=\"Acid anhydride\" rel=\"external_link\" target=\"_blank\">anhydride<\/a> and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diamine\" title=\"Diamine\" rel=\"external_link\" target=\"_blank\">diamine<\/a> (the most used method).<\/li>\n<li>The reaction between a dianhydride and a di<a href=\"https:\/\/en.wikipedia.org\/wiki\/Isocyanate\" title=\"Isocyanate\" rel=\"external_link\" target=\"_blank\">isocyanate<\/a>.<\/li><\/ul>\n<p>Dianhydrides used as precursors to these materials include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyromellitic_dianhydride\" title=\"Pyromellitic dianhydride\" rel=\"external_link\" target=\"_blank\">pyromellitic dianhydride<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Benzoquinonetetracarboxylic_dianhydride\" title=\"Benzoquinonetetracarboxylic dianhydride\" rel=\"external_link\" target=\"_blank\">benzoquinonetetracarboxylic dianhydride<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Naphthalene_tetracarboxylic_dianhydride\" class=\"mw-redirect\" title=\"Naphthalene tetracarboxylic dianhydride\" rel=\"external_link\" target=\"_blank\">naphthalene tetracarboxylic dianhydride<\/a>. Common diamine building blocks include <a href=\"https:\/\/en.wikipedia.org\/wiki\/4,4%27-Diaminodiphenyl_ether\" class=\"mw-redirect\" title=\"4,4'-Diaminodiphenyl ether\" rel=\"external_link\" target=\"_blank\">4,4'-diaminodiphenyl ether<\/a> (\"DAPE\"), <a href=\"https:\/\/en.wikipedia.org\/wiki\/M-Phenylenediamine\" title=\"M-Phenylenediamine\" rel=\"external_link\" target=\"_blank\">meta-phenylenediamine<\/a> (\"MDA\"), and 3,3-diaminodiphenylmethane.<sup id=\"rdp-ebb-cite_ref-Ullmann_1-1\" class=\"reference\"><a href=\"#cite_note-Ullmann-1\" rel=\"external_link\">[1]<\/a><\/sup> Hundreds of diamines and dianhydrides have been examined to tune the physical and especially the processing properties of these materials. These materials tend to be insoluble and have high softening temperatures, arising from charge-transfer interactions between the planar subunits.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Properties\">Properties<\/span><\/h2>\n<p>Thermosetting polyimides are known for thermal stability, good chemical resistance, excellent mechanical properties, and characteristic orange\/yellow color. Polyimides compounded with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_(fiber)\" class=\"mw-redirect\" title=\"Carbon (fiber)\" rel=\"external_link\" target=\"_blank\">graphite<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass_fiber\" title=\"Glass fiber\" rel=\"external_link\" target=\"_blank\">glass fiber<\/a> reinforcements have <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flexural_strength\" title=\"Flexural strength\" rel=\"external_link\" target=\"_blank\">flexural strengths<\/a> of up to 50,000 psi (340 MPa) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flexural_modulus\" title=\"Flexural modulus\" rel=\"external_link\" target=\"_blank\">flexural moduli<\/a> of 3,000,000 psi (21,000 MPa). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoset_polymer_matrix\" title=\"Thermoset polymer matrix\" rel=\"external_link\" target=\"_blank\">Thermoset polymer matrix<\/a> polyimides exhibit very low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Creep_(deformation)\" title=\"Creep (deformation)\" rel=\"external_link\" target=\"_blank\">creep<\/a> and high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tensile_strength\" class=\"mw-redirect\" title=\"Tensile strength\" rel=\"external_link\" target=\"_blank\">tensile strength<\/a>. These properties are maintained during continuous use to temperatures of up to 232 \u00b0C (450 \u00b0F) and for short excursions, as high as 400 \u00b0C (752 \u00b0F).<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> Molded polyimide parts and laminates have very good heat resistance. Normal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Operating_temperature\" title=\"Operating temperature\" rel=\"external_link\" target=\"_blank\">operating temperatures<\/a> for such parts and laminates range from cryogenic to those exceeding 260 \u00b0C (500 \u00b0F). Polyimides are also inherently resistant to flame combustion and do not usually need to be mixed with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flame_retardant\" title=\"Flame retardant\" rel=\"external_link\" target=\"_blank\">flame retardants<\/a>. Most carry a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Certification_listing\" title=\"Certification listing\" rel=\"external_link\" target=\"_blank\">UL rating<\/a> of VTM-0. Polyimide laminates have a flexural strength half life at 249 \u00b0C (480 \u00b0F) of 400 hours.\n<\/p><p>Typical polyimide parts are not affected by commonly used solvents and oils \u2014 including hydrocarbons, esters, ethers, alcohols and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Freon\" title=\"Freon\" rel=\"external_link\" target=\"_blank\">freons<\/a>. They also resist weak acids but are not recommended for use in environments that contain alkalis or inorganic acids. Some polyimides, such as CP1 and CORIN XLS, are solvent-soluble and exhibit high optical clarity. The solubility properties lend them towards spray and low temperature cure applications.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Insulation_and_passivation_films\">Insulation and passivation films<\/span><\/h3>\n<p>Polyimide materials are lightweight, flexible, resistant to heat and chemicals. Therefore, they are used in the electronics industry for flexible cables and as an insulating film on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnet_wire\" title=\"Magnet wire\" rel=\"external_link\" target=\"_blank\">magnet wire<\/a>. For example, in a laptop computer, the cable that connects the main logic board to the display (which must flex every time the laptop is opened or closed) is often a polyimide base with copper conductors. Examples of polyimide films include Apical, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kapton\" title=\"Kapton\" rel=\"external_link\" target=\"_blank\">Kapton<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/UPILEX\" title=\"UPILEX\" rel=\"external_link\" target=\"_blank\">UPILEX<\/a>, VTEC PI, Norton TH and .\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Poly-oxydiphenylene-pyromellitimide.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2a\/Poly-oxydiphenylene-pyromellitimide.svg\/220px-Poly-oxydiphenylene-pyromellitimide.svg.png\" width=\"220\" height=\"70\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Poly-oxydiphenylene-pyromellitimide.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Structure of poly-oxydiphenylene-pyromellitimide, \"Kapton\".<\/div><\/div><\/div>\n<p>Polyimide is used to coat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_fiber#Coatings\" title=\"Optical fiber\" rel=\"external_link\" target=\"_blank\">optical fibers<\/a> for medical or high temperature applications.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>An additional use of polyimide resin is as an insulating and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Passivation_(chemistry)\" title=\"Passivation (chemistry)\" rel=\"external_link\" target=\"_blank\">passivation<\/a><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> layer in the manufacture of digital semiconductor and <a href=\"https:\/\/en.wikipedia.org\/wiki\/MEMs\" class=\"mw-redirect\" title=\"MEMs\" rel=\"external_link\" target=\"_blank\">MEMS chips<\/a>. The polyimide layers have good mechanical elongation and tensile strength, which also helps the adhesion between the polyimide layers or between polyimide layer and deposited metal layer. The minimum interaction between the gold film and the polyimide film, coupled with high temperature stability of the polyimide film, results in a system that provides reliable insulation when subjected to various types of environmental stresses.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>Multi-layer insulation used on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spacecraft\" title=\"Spacecraft\" rel=\"external_link\" target=\"_blank\">spacecraft<\/a> is usually made of polyimide coated with thin layers of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminum\" class=\"mw-redirect\" title=\"Aluminum\" rel=\"external_link\" target=\"_blank\">aluminum<\/a>. The gold-like material often seen on the outside of spacecraft is actually single aluminized polyimide, with the single layer of aluminum facing in.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> The yellowish-brown polyimide gives the surface its gold-like color.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Mechanical_parts\">Mechanical parts<\/span><\/h3>\n<p>Polyimide powder can be used to produce parts and shapes by sintering technologies (, , and ). Because of their high mechanical stability even at elevated temperatures they are used as bushings, bearings, sockets or constructive parts in demanding applications. To improve <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tribological\" class=\"mw-redirect\" title=\"Tribological\" rel=\"external_link\" target=\"_blank\">tribological<\/a> properties, compounds with solid lubricants like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Graphite\" title=\"Graphite\" rel=\"external_link\" target=\"_blank\">graphite<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/PTFE\" class=\"mw-redirect\" title=\"PTFE\" rel=\"external_link\" target=\"_blank\">PTFE<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molybdenum_sulfide\" class=\"mw-redirect\" title=\"Molybdenum sulfide\" rel=\"external_link\" target=\"_blank\">molybdenum sulfide<\/a> are common. Polyimide parts and shapes include P84 NT, VTEC PI, Meldin, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vespel\" title=\"Vespel\" rel=\"external_link\" target=\"_blank\">Vespel<\/a>, and .\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Filters\">Filters<\/span><\/h3>\n<p>In coal-fired power plants, waste incinerators, or cement plants, polyimide fibres are used to filter hot gases. In this application, a polyimide needle felt separates dust and particulate matter from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Exhaust_gas\" title=\"Exhaust gas\" rel=\"external_link\" target=\"_blank\">exhaust gas<\/a>.\n<\/p><p>Polyimide is also the most common material used for the reverse osmotic film in purification of water, or the concentration of dilute materials from water, such as maple syrup production.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Other\">Other<\/span><\/h3>\n<p>Polyimide is used for medical tubing, e.g. vascular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheters\" class=\"mw-redirect\" title=\"Catheters\" rel=\"external_link\" target=\"_blank\">catheters<\/a>, for its burst pressure resistance combined with flexibility and chemical resistance.\n<\/p><p>The semiconductor industry uses polyimide as a high-temperature <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adhesive\" title=\"Adhesive\" rel=\"external_link\" target=\"_blank\">adhesive<\/a>; it is also used as a mechanical stress buffer. \n<\/p><p>Some polyimide can be used like a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photoresist\" title=\"Photoresist\" rel=\"external_link\" target=\"_blank\">photoresist<\/a>; both \"positive\" and \"negative\" types of photoresist-like polyimide exist in the market.\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/IKAROS\" title=\"IKAROS\" rel=\"external_link\" target=\"_blank\">IKAROS<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solar_sailing\" class=\"mw-redirect\" title=\"Solar sailing\" rel=\"external_link\" target=\"_blank\">solar sailing<\/a> spacecraft uses polyimide resin sails to operate without rocket engines.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyamide\" title=\"Polyamide\" rel=\"external_link\" target=\"_blank\">Polyamide<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyamide-imide\" title=\"Polyamide-imide\" rel=\"external_link\" target=\"_blank\">Polyamide-imide<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymerization\" title=\"Polymerization\" rel=\"external_link\" target=\"_blank\">Polymerization<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-Ullmann-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Ullmann_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ullmann_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Wright, Walter W. and Hallden-Abberton, Michael (2002) \"Polyimides\" in <i>Ullmann's Encyclopedia of Industrial Chemistry<\/i>, Wiley-VCH, Weinheim. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14356007.a21_253\" target=\"_blank\">10.1002\/14356007.a21_253<\/a><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Liaw, Der-Jang; Wang, Kung-Li; Huang, Ying-Chi; Lee, Kueir-Rarn; Lai, Juin-Yih; Ha, Chang-Sik (2012). \"Advanced polyimide materials: Syntheses, physical properties and applications\". <i>Progress in Polymer Science<\/i>. <b>37<\/b> (7): 907\u2013974. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.progpolymsci.2012.02.005\" target=\"_blank\">10.1016\/j.progpolymsci.2012.02.005<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Progress+in+Polymer+Science&rft.atitle=Advanced+polyimide+materials%3A+Syntheses%2C+physical+properties+and+applications&rft.volume=37&rft.issue=7&rft.pages=907-974&rft.date=2012&rft_id=info%3Adoi%2F10.1016%2Fj.progpolymsci.2012.02.005&rft.aulast=Liaw&rft.aufirst=Der-Jang&rft.au=Wang%2C+Kung-Li&rft.au=Huang%2C+Ying-Chi&rft.au=Lee%2C+Kueir-Rarn&rft.au=Lai%2C+Juin-Yih&rft.au=Ha%2C+Chang-Sik&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyimide\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/proofresearchacd.com\/wp-content\/uploads\/2015\/10\/PROOF-ACD_data_sheet_900HT_update_10-16-15v2.pdf\" target=\"_blank\">P2SI 900HT Tech Sheet<\/a>. proofresearchacd.com<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Huang, Lei; Dyer, Robert S.; Lago, Ralph J.; Stolov, Andrei A.; Li, Jie (2016). \"Mechanical properties of polyimide coated optical fibers at elevated temperatures\". <i>Optical Fibers and Sensors for Medical Diagnostics and Treatment Applications XVI<\/i>. Optical Fibers and Sensors for Medical Diagnostics and Treatment Applications XVI. <b>9702<\/b>. pp. 97020Y. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1117%2F12.2210957\" target=\"_blank\">10.1117\/12.2210957<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Mechanical+properties+of+polyimide+coated+optical+fibers+at+elevated+temperatures&rft.btitle=Optical+Fibers+and+Sensors+for+Medical+Diagnostics+and+Treatment+Applications+XVI&rft.series=Optical+Fibers+and+Sensors+for+Medical+Diagnostics+and+Treatment+Applications+XVI&rft.pages=97020Y&rft.date=2016&rft_id=info%3Adoi%2F10.1117%2F12.2210957&rft.aulast=Huang&rft.aufirst=Lei&rft.au=Dyer%2C+Robert+S.&rft.au=Lago%2C+Ralph+J.&rft.au=Stolov%2C+Andrei+A.&rft.au=Li%2C+Jie&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyimide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jiang, Jiann-Shan; Chiou, Bi-Shiou (2001). \"The effect of polyimide passivation on the electromigration of Cu multilayer interconnections\". <i>Journal of Materials Science: Materials in Electronics<\/i>. <b>12<\/b> (11): 655\u2013659. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1023%2FA%3A1012802117916\" target=\"_blank\">10.1023\/A:1012802117916<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Materials+Science%3A+Materials+in+Electronics&rft.atitle=The+effect+of+polyimide+passivation+on+the+electromigration+of+Cu+multilayer+interconnections&rft.volume=12&rft.issue=11&rft.pages=655-659&rft.date=2001&rft_id=info%3Adoi%2F10.1023%2FA%3A1012802117916&rft.aulast=Jiang&rft.aufirst=Jiann-Shan&rft.au=Chiou%2C+Bi-Shiou&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyimide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Krakauer, David (December 2006) <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.analog.com\/library\/analogdialogue\/archives\/40-12\/iso_power.html\" target=\"_blank\">Digital Isolation Offers Compact, Low-Cost Solutions to Challenging Design Problems<\/a>. analog.com<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Chen, Baoxing. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.analog.com\/static\/imported-files\/overviews\/isoPower.pdf\" target=\"_blank\">iCoupler Products with isoPower Technology: Signal and Power Transfer Across Isolation Barrier Using Microtransformers<\/a>. analog.com<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sheldahl.com\/Documents\/Aerospace\/Thermal%20Control%20Overview.pdf\" target=\"_blank\">\"Thermal Control Overview\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Sheldahl Multi Layer Insulation<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">28 December<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Sheldahl+Multi+Layer+Insulation&rft.atitle=Thermal+Control+Overview&rft_id=http%3A%2F%2Fwww.sheldahl.com%2FDocuments%2FAerospace%2FThermal%2520Control%2520Overview.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyimide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.wisegeek.net\/what-is-a-reverse-osmosis-water-softener.htm\" target=\"_blank\">What is a reverse osmosis water softener?<\/a> wisegeek.net<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Shuey, Harry F. and Wan, Wankei (1983-12-22) <span><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.google.com\/patents\/US4532041\" target=\"_blank\">U.S. Patent 4,532,041<\/a><\/span> Asymmetric polyimide reverse osmosis membrane, method for preparation of same and use thereof for organic liquid separations.<\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Courtland, Rachel (10 May 2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.newscientist.com\/article\/mg20627603.800-maiden-voyage-for-first-true-space-sail.html\" target=\"_blank\">\"Maiden voyage for first true space sail\"<\/a>. The New Scientist<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 June<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Maiden+voyage+for+first+true+space+sail&rft.date=2010-05-10&rft.aulast=Courtland&rft.aufirst=Rachel&rft_id=https%3A%2F%2Fwww.newscientist.com%2Farticle%2Fmg20627603.800-maiden-voyage-for-first-true-space-sail.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyimide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li>Modern Plastic Mid-October Encyclopedia Issue, Polyimide, thermoset, page 146.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/scholar.lib.vt.edu\/theses\/available\/etd-051799-162256\/\" target=\"_blank\">Varun Ratta: POLYIMIDES: Chemistry & structure-property relationships \u2013 literature review<\/a> (Chapter 1).<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mit.edu\/~6.777\/matprops\/polyimide.htm\" target=\"_blank\">Material Property Database<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Massachusetts_Institute_of_Technology\" title=\"Massachusetts Institute of Technology\" rel=\"external_link\" target=\"_blank\">MIT<\/a><\/li><\/ul>\n\n<p class=\"mw-empty-elt\">\n<\/p>\n<p><!-- \nNewPP limit report\nParsed by mw1326\nCached time: 20181214090507\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.252 seconds\nReal time usage: 0.320 seconds\nPreprocessor visited node count: 795\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 51885\/2097152 bytes\nTemplate argument size: 419\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 17012\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.111\/10.000 seconds\nLua memory usage: 4.13 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 244.361 1 -total\n<\/p>\n<pre>55.67% 136.028 1 Template:Reflist\n37.01% 90.448 3 Template:Cite_journal\n21.57% 52.716 6 Template:Convert\n12.78% 31.237 2 Template:Navbox\n12.38% 30.245 1 Template:Plastics\n 8.17% 19.960 1 Template:Use_dmy_dates\n 5.88% 14.361 1 Template:DMCA\n 4.95% 12.087 1 Template:Dated_maintenance_category\n 4.45% 10.872 1 Template:DOI\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:884897-1!canonical and timestamp 20181214090507 and revision id 867702956\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Polyimide\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212224\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.024 seconds\nReal time usage: 0.154 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 147.629 1 - wikipedia:Polyimide\n100.00% 147.629 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8321-0!*!*!*!*!*!* and timestamp 20181217212224 and revision id 24546\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polyimide\">https:\/\/www.limswiki.org\/index.php\/Polyimide<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","c24db4ecd9edd29e812a0d9e02257517_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0a\/Polyimide.svg\/440px-Polyimide.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2a\/Poly-oxydiphenylene-pyromellitimide.svg\/440px-Poly-oxydiphenylene-pyromellitimide.svg.png"],"c24db4ecd9edd29e812a0d9e02257517_timestamp":1545081744,"ba62e12ce478842a129ef1ee11bd9ba2_type":"article","ba62e12ce478842a129ef1ee11bd9ba2_title":"Polyhydroxyalkanoates","ba62e12ce478842a129ef1ee11bd9ba2_url":"https:\/\/www.limswiki.org\/index.php\/Polyhydroxyalkanoates","ba62e12ce478842a129ef1ee11bd9ba2_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPolyhydroxyalkanoates\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Structure of poly-(R)-3-hydroxybutyrate (P3HB), a polyhydroxyalkanoate\n Chemical structures of P3HB, PHV and their copolymer PHBV\nPolyhydroxyalkanoates or PHAs are polyesters produced in nature by numerous microorganisms, including through bacterial fermentation of sugar or lipids.[1] When produced by bacteria they serve as both a source of energy and as a carbon store. More than 150 different monomers can be combined within this family to give materials with extremely different properties.[2] These plastics are biodegradable and are used in the production of bioplastics.\nThey can be either thermoplastic or elastomeric materials, with melting points ranging from 40 to 180 \u00b0C.\nThe mechanical properties and biocompatibility of PHA can also be changed by blending, modifying the surface or combining PHA with other polymers, enzymes and inorganic materials, making it possible for a wider range of applications.[3]\n\nContents \n\n1 Biosynthesis \n2 Industrial production \n3 Material properties \n4 Applications \n5 References \n6 Further reading \n\n\nBiosynthesis \n Certain strains of Bacillus subtilis bacteria can be used to produce polyhydroxyalkanoates\nTo produce PHA, a culture of a micro-organism such as Cupriavidus necator is placed in a suitable medium and fed appropriate nutrients so that it multiplies rapidly. Once the population has reached a substantial level, the nutrient composition is changed to force the micro-organism to synthesize PHA. The yield of PHA obtained from the intracellular granule inclusions can be as high as 80% of the organism's dry weight.\nThe biosynthesis of PHA is usually caused by certain deficiency conditions (e.g. lack of macro elements such as phosphorus, nitrogen, trace elements, or lack of oxygen) and the excess supply of carbon sources.[4]\nPolyesters are deposited in the form of highly refractive granules in the cells. Depending upon the microorganism and the cultivation conditions, homo- or copolyesters with different hydroxyalkanic acids are generated. PHA granules are then recovered by disrupting the cells.[5] Recombinant Bacillus subtilis str. pBE2C1 and Bacillus subtilis str. pBE2C1AB were used in production of polyhydroxyalkanoates (PHA) and it was shown that they could use malt waste as carbon source for lower cost of PHA production.\nPHA synthases are the key enzymes of PHA biosynthesis. They use the coenzyme A - thioester of (r)-hydroxy fatty acids as substrates. The two classes of PHA synthases differ in the specific use of hydroxy fatty acids of short or medium chain length.\nThe resulting PHA is of the two types:\n\nPoly (HA SCL) from hydroxy fatty acids with short chain lengths including three to five carbon atoms are synthesized by numerous bacteria, including Cupriavidus necator and Alcaligenes latus (PHB).\nPoly (HA MCL) from hydroxy fatty acids with medium chain lengths including six to 14 carbon atoms, can be made for example, by Pseudomonas putida.\nA few bacteria, including Aeromonas hydrophila and Thiococcus pfennigii, synthesize copolyester from the above two types of hydroxy fatty acids, or at least possess enzymes that are capable of part of this synthesis.\nAnother even larger scale synthesis can be done with the help of soil organisms. For lack of nitrogen and phosphorus they produce a kilogram of PHA per three kilograms of sugar.\nThe simplest and most commonly occurring form of PHA is the fermentative production of poly-beta-hydroxybutyrate (poly-3-hydroxybutyrate, P3HB), which consists of 1000 to 30000 hydroxy fatty acid monomers.\n\nIndustrial production \nIn the industrial production of PHA, the polyester is extracted and purified from the bacteria by optimizing the conditions of microbial fermentation of sugar or glucose.\nIn the 1980s, Imperial Chemical Industries developed poly(3-hydroxybutyrate-co-3-hydroxyvalerate) obtained via fermentation that was named \"Biopol\". It was sold under the name \"Biopol\" and distributed in the U.S. by Monsanto and later Metabolix.[6]\nAs raw material for the fermentation, carbohydrates such as glucose and sucrose can be used, but also vegetable oil or glycerine from biodiesel production. Researchers in industry are working on methods with which transgenic crops will be developed that express PHA synthesis routes from bacteria and so produce PHA as energy storage in their tissues. Several companies are working to develop methods of producing PHA from waste water, including start-up Micromidas[7] and Veolia subsidiary Anoxkaldnes.[8]\nPHAs are processed mainly via injection molding, extrusion and extrusion bubbles into films and hollow bodies.\n\nMaterial properties \nPHA polymers are thermoplastic, can be processed on conventional processing equipment, and are, depending on their composition, ductile and more or less elastic. They differ in their properties according to their chemical composition (homo-or copolyester, contained hydroxy fatty acids).\nThey are UV stable, in contrast to other bioplastics from polymers such as polylactic acid, partial ca. temperatures up to 180 \u00b0C , and show a low permeation of water. The crystallinity can lie in the range of a few to 70%. Processability, impact strength and flexibility improves with a higher percentage of valerate in the material. PHAs are soluble in halogenated solvents such chloroform, dichloromethane or dichloroethane.[9]\nPHB is similar in its material properties to polypropylene (PP), has a good resistance to moisture and aroma barrier properties. Polyhydroxybutyric acid synthesized from pure PHB is relatively brittle and stiff. PHB copolymers, which may include other fatty acids such as beta-hydroxyvaleriate acid, may be elastic.\n\nApplications \n\n\t\t\n\t\t\t\n\t\t\t\nStructure of poly-3-hydroxyvalerate (PHV)\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nStructure of poly-4-hydroxybutyrate (P4HB)\n\n\t\t\t\n\t\t\n\nDue to its biodegradability and potential to create bioplastics with novel properties, much interest exists to develop the use of PHA-based materials. PHA fits into the green economy as a means to create plastics from non-fossil fuel sources. Furthermore, active research is being carried out for the biotransformation \"upcycling\" of plastic waste (e.g., polyethylene terephthalate and polyurethane) into PHA using Pseudomonas putida bacteria.[10]\nA PHA copolymer called PHBV (poly(3-hydroxybutyrate-co-3-hydroxyvalerate)) is less stiff and tougher, and it may be used as packaging material.\nIn June 2005, a US company (Metabolix, Inc.) received the US Presidential Green Chemistry Challenge Award (small business category) for their development and commercialisation of a cost-effective method for manufacturing PHAs.\nThere are potential applications for PHA produced by micro-organisms[2] within the medical and pharmaceutical industries, primarily due to their biodegradability.\nFixation and orthopaedic applications have included sutures, suture fasteners, meniscus repair devices, rivets, tacks, staples, screws (including interference screws), bone plates and bone plating systems, surgical mesh, repair patches, slings, cardiovascular patches, orthopedic pins (including bone.lling augmentation material), adhesion barriers, stents, guided tissue repair\/regeneration devices, articular cartilage repair devices, nerve guides, tendon repair devices, atrial septal defect repair devices, pericardial patches, bulking and filling agents, vein valves, bone marrow scaffolds, meniscus regeneration devices, ligament and tendon grafts, ocular cell implants, spinal fusion cages, skin substitutes, dural substitutes, bone graft substitutes, bone dowels, wound dressings, and hemostats.[11]\n\nReferences \n\n\n^ Lu, Jingnan; Tappel, Ryan C.; Nomura, Christopher T. (2009-08-05). \"Mini-Review: Biosynthesis of Poly(hydroxyalkanoates)\". Polymer Reviews. 49 (3): 226\u2013248. doi:10.1080\/15583720903048243. ISSN 1558-3724. \n\n^ a b Doi, Yoshiharu; Steinbuchel, Alexander (2002). Biopolymers. Weinheim, Germany: Wiley-VCH. ISBN 978-3-527-30225-3. [page needed ] \n\n^ Michael, Anne John (September 12, 2004). \"Polyhydroxyalkanoates for tissue engineering\". Archived from the original on January 28, 2007. \n\n^ Kim, Y. B.; Lenz, R. W. (2001). \"Polyesters from microorganisms\". Advances in Biochemical Engineering\/Biotechnology. 71: 51\u201379. ISSN 0724-6145. PMID 11217417. \n\n^ Jacquel, Nicolas; Lo, Chi-Wei; Wei, Yu-Hong; Wu, Ho-Shing; Wang, Shaw S. (2008). \"Isolation and purification of bacterial poly(3-hydroxyalkanoates)\". Biochemical Engineering Journal. 39 (1): 15\u201327. doi:10.1016\/j.bej.2007.11.029. \n\n^ Ewa Rudnik (3 January 2008). Compostable Polymer Materials. Elsevier. p. 21. ISBN 978-0-08-045371-2. Retrieved 10 July 2012 . \n\n^ Martin Lamonica (May 27, 2010). \"Micromidas to test sludge-to-plastic tech\". CNET. Retrieved October 23, 2015 . \n\n^ Seb Egerton-Read (September 9, 2015). \"A New Way to Make Plastic\". Circulate. Retrieved October 23, 2015 . \n\n^ Jacquel, Nicolas; Lo, Chi-Wei; Wu, Ho-Shing; Wei, Yu-Hong; Wang, Shaw S. (2007). \"Solubility of polyhydroxyalkanoates by experiment and thermodynamic correlations\". AIChE Journal. 53 (10): 2704\u201314. doi:10.1002\/aic.11274. \n\n^ \"Homepage - P4SB\". www.p4sb.eu. Retrieved 2017-10-26 . \n\n^ Chen, Guo-Qiang; Wu, Qiong (2005). \"The application of polyhydroxyalkanoates as tissue engineering materials\". Biomaterials. 26 (33): 6565\u201378. doi:10.1016\/j.biomaterials.2005.04.036. PMID 15946738. \n\n\nFurther reading \nMohapatra, S.; Sarkar, B.; Samantaray, D. P.; Daware, A.; Maity, S.; Pattnaik, S.; Bhattacharjee, S. (2017). \"Bioconversion of fish solid waste into PHB using Bacillus subtilis based submerged fermentation process\". Environmental Technology. 38 (24): 1\u20138. doi:10.1080\/09593330.2017.1291759. PMID 28162048. \nMohapatra, Swati; Maity, Sudipta; Dash, Hirak Ranjan; Das, Surajit; Pattnaik, Swati; Rath, Chandi Charan; Samantaray, Deviprasad (December 2017). \"Bacillus and biopolymer: Prospects and challenges\". Biochemistry and Biophysics Reports. 12: 206\u201313. doi:10.1016\/j.bbrep.2017.10.001. PMC 5651552 . PMID 29090283. \n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polyhydroxyalkanoates\">https:\/\/www.limswiki.org\/index.php\/Polyhydroxyalkanoates<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 16:52.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 364 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","ba62e12ce478842a129ef1ee11bd9ba2_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Polyhydroxyalkanoates skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Polyhydroxyalkanoates<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Poly-(R)-3-hydroxybutyrat.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8d\/Poly-%28R%29-3-hydroxybutyrat.svg\/200px-Poly-%28R%29-3-hydroxybutyrat.svg.png\" width=\"200\" height=\"108\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Poly-(R)-3-hydroxybutyrat.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Structure of poly-(R)-3-hydroxybutyrate (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyhydroxybutyrate\" title=\"Polyhydroxybutyrate\" rel=\"external_link\" target=\"_blank\">P3HB<\/a>), a <b>polyhydroxyalkanoate<\/b><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:402px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Polyhydroxyalkanoates.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/24\/Polyhydroxyalkanoates.png\/400px-Polyhydroxyalkanoates.png\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Polyhydroxyalkanoates.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Chemical structures of P3HB, PHV and their copolymer PHBV<\/div><\/div><\/div>\n<p><b>Polyhydroxyalkanoates<\/b> or <b>PHAs<\/b> are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyester\" title=\"Polyester\" rel=\"external_link\" target=\"_blank\">polyesters<\/a> produced in nature by numerous microorganisms, including through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bacteria\" title=\"Bacteria\" rel=\"external_link\" target=\"_blank\">bacterial<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fermentation_(biochemistry)\" class=\"mw-redirect\" title=\"Fermentation (biochemistry)\" rel=\"external_link\" target=\"_blank\">fermentation<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sugar\" title=\"Sugar\" rel=\"external_link\" target=\"_blank\">sugar<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lipid\" title=\"Lipid\" rel=\"external_link\" target=\"_blank\">lipids<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> When produced by bacteria they serve as both a source of energy and as a carbon store. More than 150 different <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomers<\/a> can be combined within this family to give materials with extremely different properties.<sup id=\"rdp-ebb-cite_ref-doi-2002_2-0\" class=\"reference\"><a href=\"#cite_note-doi-2002-2\" rel=\"external_link\">[2]<\/a><\/sup> These plastics are biodegradable and are used in the production of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioplastics\" class=\"mw-redirect\" title=\"Bioplastics\" rel=\"external_link\" target=\"_blank\">bioplastics<\/a>.\n<\/p><p>They can be either <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoplastic\" title=\"Thermoplastic\" rel=\"external_link\" target=\"_blank\">thermoplastic<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastomer\" title=\"Elastomer\" rel=\"external_link\" target=\"_blank\">elastomeric<\/a> materials, with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Melting_point\" title=\"Melting point\" rel=\"external_link\" target=\"_blank\">melting points<\/a> ranging from 40 to 180 \u00b0C.\n<\/p><p>The mechanical properties and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatibility<\/a> of PHA can also be changed by blending, modifying the surface or combining PHA with other polymers, enzymes and inorganic materials, making it possible for a wider range of applications.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Biosynthesis\">Biosynthesis<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bacillus_subtilis_Gram.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b9\/Bacillus_subtilis_Gram.jpg\/220px-Bacillus_subtilis_Gram.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bacillus_subtilis_Gram.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Certain strains of <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bacillus_subtilis\" title=\"Bacillus subtilis\" rel=\"external_link\" target=\"_blank\">Bacillus subtilis<\/a><\/i> bacteria can be used to produce polyhydroxyalkanoates<\/div><\/div><\/div>\n<p>To produce PHA, a culture of a micro-organism such as <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cupriavidus_necator\" title=\"Cupriavidus necator\" rel=\"external_link\" target=\"_blank\">Cupriavidus necator<\/a><\/i> is placed in a suitable medium and fed appropriate nutrients so that it multiplies rapidly. Once the population has reached a substantial level, the nutrient composition is changed to force the micro-organism to synthesize PHA. The yield of PHA obtained from the intracellular granule inclusions can be as high as 80% of the organism's dry weight.\n<\/p><p>The biosynthesis of PHA is usually caused by certain deficiency conditions (e.g. lack of macro elements such as phosphorus, nitrogen, trace elements, or lack of oxygen) and the excess supply of carbon sources.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>Polyesters are deposited in the form of highly refractive granules in the cells. Depending upon the microorganism and the cultivation conditions, homo- or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copolyester\" title=\"Copolyester\" rel=\"external_link\" target=\"_blank\">copolyesters<\/a> with different hydroxyalkanic acids are generated. PHA granules are then recovered by disrupting the cells.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Recombinant <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bacillus_subtilis\" title=\"Bacillus subtilis\" rel=\"external_link\" target=\"_blank\">Bacillus subtilis<\/a><\/i> str. pBE2C1 and <i>Bacillus subtilis<\/i> str. pBE2C1AB were used in production of polyhydroxyalkanoates (PHA) and it was shown that they could use <a href=\"https:\/\/en.wikipedia.org\/wiki\/Malt\" title=\"Malt\" rel=\"external_link\" target=\"_blank\">malt<\/a> waste as carbon source for lower cost of PHA production.\n<\/p><p>PHA synthases are the key enzymes of PHA biosynthesis. They use the coenzyme A - thioester of (r)-hydroxy fatty acids as substrates. The two classes of PHA synthases differ in the specific use of hydroxy fatty acids of short or medium chain length.\n<\/p><p>The resulting PHA is of the two types:\n<\/p>\n<ul><li>Poly (HA SCL) from hydroxy fatty acids with short chain lengths including three to five carbon atoms are synthesized by numerous bacteria, including <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cupriavidus_necator\" title=\"Cupriavidus necator\" rel=\"external_link\" target=\"_blank\">Cupriavidus necator<\/a><\/i> and <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Alcaligenes_latus\" class=\"mw-redirect\" title=\"Alcaligenes latus\" rel=\"external_link\" target=\"_blank\">Alcaligenes latus<\/a><\/i> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyhydroxybutyrate\" title=\"Polyhydroxybutyrate\" rel=\"external_link\" target=\"_blank\">PHB<\/a>).<\/li>\n<li>Poly (HA MCL) from hydroxy fatty acids with medium chain lengths including six to 14 carbon atoms, can be made for example, by <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pseudomonas_putida\" title=\"Pseudomonas putida\" rel=\"external_link\" target=\"_blank\">Pseudomonas putida<\/a><\/i>.<\/li><\/ul>\n<p>A few bacteria, including <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Aeromonas_hydrophila\" title=\"Aeromonas hydrophila\" rel=\"external_link\" target=\"_blank\">Aeromonas hydrophila<\/a><\/i> and <i><\/i>, synthesize copolyester from the above two types of hydroxy fatty acids, or at least possess enzymes that are capable of part of this synthesis.\n<\/p><p>Another even larger scale synthesis can be done with the help of soil organisms. For lack of nitrogen and phosphorus they produce a kilogram of PHA per three kilograms of sugar.\n<\/p><p>The simplest and most commonly occurring form of PHA is the fermentative production of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyhydroxybutyrate\" title=\"Polyhydroxybutyrate\" rel=\"external_link\" target=\"_blank\">poly-beta-hydroxybutyrate<\/a> (poly-3-hydroxybutyrate, P3HB), which consists of 1000 to 30000 hydroxy fatty acid monomers.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Industrial_production\">Industrial production<\/span><\/h2>\n<p>In the industrial production of PHA, the polyester is extracted and purified from the bacteria by optimizing the conditions of microbial fermentation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sugar\" title=\"Sugar\" rel=\"external_link\" target=\"_blank\">sugar<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose\" title=\"Glucose\" rel=\"external_link\" target=\"_blank\">glucose<\/a>.\n<\/p><p>In the 1980s, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Imperial_Chemical_Industries\" title=\"Imperial Chemical Industries\" rel=\"external_link\" target=\"_blank\">Imperial Chemical Industries<\/a> developed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Poly(3-hydroxybutyrate-co-3-hydroxyvalerate)\" class=\"mw-redirect\" title=\"Poly(3-hydroxybutyrate-co-3-hydroxyvalerate)\" rel=\"external_link\" target=\"_blank\">poly(3-hydroxybutyrate-<i>co<\/i>-3-hydroxyvalerate)<\/a> obtained via fermentation that was named \"Biopol\". It was sold under the name \"Biopol\" and distributed in the U.S. by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monsanto\" title=\"Monsanto\" rel=\"external_link\" target=\"_blank\">Monsanto<\/a> and later <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metabolix\" class=\"mw-redirect\" title=\"Metabolix\" rel=\"external_link\" target=\"_blank\">Metabolix<\/a>.<sup id=\"rdp-ebb-cite_ref-Rudnik2008_6-0\" class=\"reference\"><a href=\"#cite_note-Rudnik2008-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>As raw material for the fermentation, carbohydrates such as glucose and sucrose can be used, but also vegetable oil or glycerine from biodiesel production. Researchers in industry are working on methods with which transgenic crops will be developed that express PHA synthesis routes from bacteria and so produce PHA as energy storage in their tissues. Several companies are working to develop methods of producing PHA from waste water, including start-up Micromidas<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Veolia\" title=\"Veolia\" rel=\"external_link\" target=\"_blank\">Veolia<\/a> subsidiary Anoxkaldnes.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>PHAs are processed mainly via injection molding, extrusion and extrusion bubbles into films and hollow bodies.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Material_properties\">Material properties<\/span><\/h2>\n<p>PHA polymers are thermoplastic, can be processed on conventional processing equipment, and are, depending on their composition, ductile and more or less elastic. They differ in their properties according to their chemical composition (homo-or copolyester, contained hydroxy fatty acids).\n<\/p><p>They are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultraviolet\" title=\"Ultraviolet\" rel=\"external_link\" target=\"_blank\">UV<\/a> stable, in contrast to other bioplastics from polymers such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polylactic_acid\" title=\"Polylactic acid\" rel=\"external_link\" target=\"_blank\">polylactic acid<\/a>, partial ca. temperatures up to <span class=\"nowrap\">180 \u00b0C<\/span>, and show a low permeation of water. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystallinity\" title=\"Crystallinity\" rel=\"external_link\" target=\"_blank\">crystallinity<\/a> can lie in the range of a few to 70%. Processability, impact strength and flexibility improves with a higher percentage of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Valerate\" title=\"Valerate\" rel=\"external_link\" target=\"_blank\">valerate<\/a> in the material. PHAs are soluble in halogenated solvents such <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chloroform\" title=\"Chloroform\" rel=\"external_link\" target=\"_blank\">chloroform<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dichloromethane\" title=\"Dichloromethane\" rel=\"external_link\" target=\"_blank\">dichloromethane<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dichloroethane\" title=\"Dichloroethane\" rel=\"external_link\" target=\"_blank\">dichloroethane<\/a>.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>PHB is similar in its material properties to polypropylene (PP), has a good resistance to moisture and aroma barrier properties. Polyhydroxybutyric acid synthesized from pure PHB is relatively brittle and stiff. PHB copolymers, which may include other fatty acids such as beta-hydroxyvaleriate acid, may be elastic.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:36.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Poly-3-hydroxyvalerat.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/90\/Poly-3-hydroxyvalerat.svg\/120px-Poly-3-hydroxyvalerat.svg.png\" width=\"120\" height=\"77\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Structure of poly-3-hydroxyvalerate (PHV)\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:47px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Poly-4-hydroxybutyrat.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d7\/Poly-4-hydroxybutyrat.svg\/120px-Poly-4-hydroxybutyrat.svg.png\" width=\"120\" height=\"56\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Structure of poly-4-hydroxybutyrate (P4HB)\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<p>Due to its biodegradability and potential to create <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioplastic\" title=\"Bioplastic\" rel=\"external_link\" target=\"_blank\">bioplastics<\/a> with novel properties, much interest exists to develop the use of PHA-based materials. PHA fits into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Green_economy\" title=\"Green economy\" rel=\"external_link\" target=\"_blank\">green economy<\/a> as a means to create plastics from non-fossil fuel sources. Furthermore, active research is being carried out for the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biotransformation\" title=\"Biotransformation\" rel=\"external_link\" target=\"_blank\">biotransformation<\/a> \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Upcycling\" title=\"Upcycling\" rel=\"external_link\" target=\"_blank\">upcycling<\/a>\" of plastic waste (e.g., <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene_terephthalate\" title=\"Polyethylene terephthalate\" rel=\"external_link\" target=\"_blank\">polyethylene terephthalate<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyurethane\" title=\"Polyurethane\" rel=\"external_link\" target=\"_blank\">polyurethane<\/a>) into PHA using <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pseudomonas_putida\" title=\"Pseudomonas putida\" rel=\"external_link\" target=\"_blank\">Pseudomonas putida<\/a><\/i> bacteria.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>A PHA copolymer called <a href=\"https:\/\/en.wikipedia.org\/wiki\/PHBV\" title=\"PHBV\" rel=\"external_link\" target=\"_blank\">PHBV<\/a> (poly(3-hydroxybutyrate-co-3-hydroxyvalerate)) is less stiff and tougher, and it may be used as packaging material.\n<\/p><p>In June 2005, a US company (Metabolix, Inc.) received the US <a href=\"https:\/\/en.wikipedia.org\/wiki\/Presidential_Green_Chemistry_Challenge_Award\" class=\"mw-redirect\" title=\"Presidential Green Chemistry Challenge Award\" rel=\"external_link\" target=\"_blank\">Presidential Green Chemistry Challenge Award<\/a> (small business category) for their development and commercialisation of a cost-effective method for manufacturing PHAs.\n<\/p><p>There are potential applications for PHA produced by micro-organisms<sup id=\"rdp-ebb-cite_ref-doi-2002_2-1\" class=\"reference\"><a href=\"#cite_note-doi-2002-2\" rel=\"external_link\">[2]<\/a><\/sup> within the medical and pharmaceutical industries, primarily due to their biodegradability.\n<\/p><p>Fixation and orthopaedic applications have included <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" title=\"Surgical suture\" rel=\"external_link\" target=\"_blank\">sutures<\/a>, suture fasteners, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Meniscus_(anatomy)\" title=\"Meniscus (anatomy)\" rel=\"external_link\" target=\"_blank\">meniscus<\/a> repair devices, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rivet\" title=\"Rivet\" rel=\"external_link\" target=\"_blank\">rivets<\/a>, tacks, staples, screws (including interference screws), bone plates and bone plating systems, surgical mesh, repair patches, slings, cardiovascular patches, orthopedic pins (including bone.lling augmentation material), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adhesion_barrier\" title=\"Adhesion barrier\" rel=\"external_link\" target=\"_blank\">adhesion barriers<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stents<\/a>, guided tissue repair\/regeneration devices, articular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cartilage\" title=\"Cartilage\" rel=\"external_link\" target=\"_blank\">cartilage<\/a> repair devices, nerve guides, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tendon\" title=\"Tendon\" rel=\"external_link\" target=\"_blank\">tendon<\/a> repair devices, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrial_septal_defect\" title=\"Atrial septal defect\" rel=\"external_link\" target=\"_blank\">atrial septal defect<\/a> repair devices, pericardial patches, bulking and filling agents, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">vein<\/a> valves, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_marrow\" title=\"Bone marrow\" rel=\"external_link\" target=\"_blank\">bone marrow<\/a> scaffolds, meniscus regeneration devices, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ligament\" title=\"Ligament\" rel=\"external_link\" target=\"_blank\">ligament<\/a> and tendon grafts, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_eye\" title=\"Human eye\" rel=\"external_link\" target=\"_blank\">ocular<\/a> cell implants, spinal fusion cages, skin substitutes, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dural\" class=\"mw-redirect\" title=\"Dural\" rel=\"external_link\" target=\"_blank\">dural<\/a> substitutes, bone graft substitutes, bone dowels, wound dressings, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemostat\" title=\"Hemostat\" rel=\"external_link\" target=\"_blank\">hemostats<\/a>.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lu, Jingnan; Tappel, Ryan C.; Nomura, Christopher T. (2009-08-05). \"Mini-Review: Biosynthesis of Poly(hydroxyalkanoates)\". <i>Polymer Reviews<\/i>. <b>49<\/b> (3): 226\u2013248. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1080%2F15583720903048243\" target=\"_blank\">10.1080\/15583720903048243<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1558-3724\" target=\"_blank\">1558-3724<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Polymer+Reviews&rft.atitle=Mini-Review%3A+Biosynthesis+of+Poly%28hydroxyalkanoates%29&rft.volume=49&rft.issue=3&rft.pages=226-248&rft.date=2009-08-05&rft_id=info%3Adoi%2F10.1080%2F15583720903048243&rft.issn=1558-3724&rft.aulast=Lu&rft.aufirst=Jingnan&rft.au=Tappel%2C+Ryan+C.&rft.au=Nomura%2C+Christopher+T.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyhydroxyalkanoates\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-doi-2002-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-doi-2002_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-doi-2002_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Doi, Yoshiharu; Steinbuchel, Alexander (2002). <i>Biopolymers<\/i>. Weinheim, Germany: Wiley-VCH. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-527-30225-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Biopolymers&rft.place=Weinheim%2C+Germany&rft.pub=Wiley-VCH&rft.date=2002&rft.isbn=978-3-527-30225-3&rft.aulast=Doi&rft.aufirst=Yoshiharu&rft.au=Steinbuchel%2C+Alexander&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyhydroxyalkanoates\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citing_sources\" title=\"Wikipedia:Citing sources\" rel=\"external_link\" target=\"_blank\"><span title=\"This citation requires a reference to the specific page or range of pages in which the material appears. (August 2017)\">page needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Michael, Anne John (September 12, 2004). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070128234757\/http:\/\/tissue.medicalengineer.co.uk\/Polyhydroxyalkanoates+for+tissue+engineering.php\" target=\"_blank\">\"Polyhydroxyalkanoates for tissue engineering\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/tissue.medicalengineer.co.uk\/Polyhydroxyalkanoates+for+tissue+engineering.php\" target=\"_blank\">the original<\/a> on January 28, 2007.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Polyhydroxyalkanoates+for+tissue+engineering&rft.date=2004-09-12&rft.aulast=Michael&rft.aufirst=Anne+John&rft_id=http%3A%2F%2Ftissue.medicalengineer.co.uk%2FPolyhydroxyalkanoates%2Bfor%2Btissue%2Bengineering.php&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyhydroxyalkanoates\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kim, Y. B.; Lenz, R. W. (2001). \"Polyesters from microorganisms\". <i>Advances in Biochemical Engineering\/Biotechnology<\/i>. <b>71<\/b>: 51\u201379. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0724-6145\" target=\"_blank\">0724-6145<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11217417\" target=\"_blank\">11217417<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Advances+in+Biochemical+Engineering%2FBiotechnology&rft.atitle=Polyesters+from+microorganisms&rft.volume=71&rft.pages=51-79&rft.date=2001&rft_id=info%3Apmid%2F11217417&rft.issn=0724-6145&rft.aulast=Kim&rft.aufirst=Y.+B.&rft.au=Lenz%2C+R.+W.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyhydroxyalkanoates\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jacquel, Nicolas; Lo, Chi-Wei; Wei, Yu-Hong; Wu, Ho-Shing; Wang, Shaw S. (2008). \"Isolation and purification of bacterial poly(3-hydroxyalkanoates)\". <i>Biochemical Engineering Journal<\/i>. <b>39<\/b> (1): 15\u201327. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.bej.2007.11.029\" target=\"_blank\">10.1016\/j.bej.2007.11.029<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biochemical+Engineering+Journal&rft.atitle=Isolation+and+purification+of+bacterial+poly%283-hydroxyalkanoates%29&rft.volume=39&rft.issue=1&rft.pages=15-27&rft.date=2008&rft_id=info%3Adoi%2F10.1016%2Fj.bej.2007.11.029&rft.aulast=Jacquel&rft.aufirst=Nicolas&rft.au=Lo%2C+Chi-Wei&rft.au=Wei%2C+Yu-Hong&rft.au=Wu%2C+Ho-Shing&rft.au=Wang%2C+Shaw+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyhydroxyalkanoates\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Rudnik2008-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Rudnik2008_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Ewa Rudnik (3 January 2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=ZrQwn8XzKlEC&pg=PA21\" target=\"_blank\"><i>Compostable Polymer Materials<\/i><\/a>. Elsevier. p. 21. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-08-045371-2<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">10 July<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Compostable+Polymer+Materials&rft.pages=21&rft.pub=Elsevier&rft.date=2008-01-03&rft.isbn=978-0-08-045371-2&rft.au=Ewa+Rudnik&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DZrQwn8XzKlEC%26pg%3DPA21&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyhydroxyalkanoates\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Martin Lamonica (May 27, 2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cnet.com\/news\/micromidas-to-test-sludge-to-plastic-tech\/\" target=\"_blank\">\"Micromidas to test sludge-to-plastic tech\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/CNET\" title=\"CNET\" rel=\"external_link\" target=\"_blank\">CNET<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">October 23,<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Micromidas+to+test+sludge-to-plastic+tech&rft.date=2010-05-27&rft.au=Martin+Lamonica&rft_id=http%3A%2F%2Fwww.cnet.com%2Fnews%2Fmicromidas-to-test-sludge-to-plastic-tech%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyhydroxyalkanoates\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Seb Egerton-Read (September 9, 2015). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/circulatenews.org\/2015\/09\/a-new-way-to-make-plastic\/\" target=\"_blank\">\"A New Way to Make Plastic\"<\/a>. Circulate<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">October 23,<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=A+New+Way+to+Make+Plastic&rft.date=2015-09-09&rft.au=Seb+Egerton-Read&rft_id=http%3A%2F%2Fcirculatenews.org%2F2015%2F09%2Fa-new-way-to-make-plastic%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyhydroxyalkanoates\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jacquel, Nicolas; Lo, Chi-Wei; Wu, Ho-Shing; Wei, Yu-Hong; Wang, Shaw S. (2007). \"Solubility of polyhydroxyalkanoates by experiment and thermodynamic correlations\". <i>AIChE Journal<\/i>. <b>53<\/b> (10): 2704\u201314. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Faic.11274\" target=\"_blank\">10.1002\/aic.11274<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AIChE+Journal&rft.atitle=Solubility+of+polyhydroxyalkanoates+by+experiment+and+thermodynamic+correlations&rft.volume=53&rft.issue=10&rft.pages=2704-14&rft.date=2007&rft_id=info%3Adoi%2F10.1002%2Faic.11274&rft.aulast=Jacquel&rft.aufirst=Nicolas&rft.au=Lo%2C+Chi-Wei&rft.au=Wu%2C+Ho-Shing&rft.au=Wei%2C+Yu-Hong&rft.au=Wang%2C+Shaw+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyhydroxyalkanoates\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.p4sb.eu\/\" target=\"_blank\">\"Homepage - P4SB\"<\/a>. <i>www.p4sb.eu<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-10-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.p4sb.eu&rft.atitle=Homepage+-+P4SB&rft_id=http%3A%2F%2Fwww.p4sb.eu%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyhydroxyalkanoates\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chen, Guo-Qiang; Wu, Qiong (2005). \"The application of polyhydroxyalkanoates as tissue engineering materials\". <i>Biomaterials<\/i>. <b>26<\/b> (33): 6565\u201378. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.biomaterials.2005.04.036\" target=\"_blank\">10.1016\/j.biomaterials.2005.04.036<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15946738\" target=\"_blank\">15946738<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biomaterials&rft.atitle=The+application+of+polyhydroxyalkanoates+as+tissue+engineering+materials&rft.volume=26&rft.issue=33&rft.pages=6565-78&rft.date=2005&rft_id=info%3Adoi%2F10.1016%2Fj.biomaterials.2005.04.036&rft_id=info%3Apmid%2F15946738&rft.aulast=Chen&rft.aufirst=Guo-Qiang&rft.au=Wu%2C+Qiong&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyhydroxyalkanoates\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation journal\">Mohapatra, S.; Sarkar, B.; Samantaray, D. P.; Daware, A.; Maity, S.; Pattnaik, S.; Bhattacharjee, S. (2017). \"Bioconversion of fish solid waste into PHB using Bacillus subtilis based submerged fermentation process\". <i>Environmental Technology<\/i>. <b>38<\/b> (24): 1\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1080%2F09593330.2017.1291759\" target=\"_blank\">10.1080\/09593330.2017.1291759<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28162048\" target=\"_blank\">28162048<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Environmental+Technology&rft.atitle=Bioconversion+of+fish+solid+waste+into+PHB+using+Bacillus+subtilis+based+submerged+fermentation+process&rft.volume=38&rft.issue=24&rft.pages=1-8&rft.date=2017&rft_id=info%3Adoi%2F10.1080%2F09593330.2017.1291759&rft_id=info%3Apmid%2F28162048&rft.aulast=Mohapatra&rft.aufirst=S.&rft.au=Sarkar%2C+B.&rft.au=Samantaray%2C+D.+P.&rft.au=Daware%2C+A.&rft.au=Maity%2C+S.&rft.au=Pattnaik%2C+S.&rft.au=Bhattacharjee%2C+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyhydroxyalkanoates\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Mohapatra, Swati; Maity, Sudipta; Dash, Hirak Ranjan; Das, Surajit; Pattnaik, Swati; Rath, Chandi Charan; Samantaray, Deviprasad (December 2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S2405580817301309\" target=\"_blank\">\"<i>Bacillus<\/i> and biopolymer: Prospects and challenges\"<\/a>. <i>Biochemistry and Biophysics Reports<\/i>. <b>12<\/b>: 206\u201313. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.bbrep.2017.10.001\" target=\"_blank\">10.1016\/j.bbrep.2017.10.001<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5651552\" target=\"_blank\">5651552<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29090283\" target=\"_blank\">29090283<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biochemistry+and+Biophysics+Reports&rft.atitle=Bacillus+and+biopolymer%3A+Prospects+and+challenges&rft.volume=12&rft.pages=206-13&rft.date=2017-12&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5651552&rft_id=info%3Apmid%2F29090283&rft_id=info%3Adoi%2F10.1016%2Fj.bbrep.2017.10.001&rft.aulast=Mohapatra&rft.aufirst=Swati&rft.au=Maity%2C+Sudipta&rft.au=Dash%2C+Hirak+Ranjan&rft.au=Das%2C+Surajit&rft.au=Pattnaik%2C+Swati&rft.au=Rath%2C+Chandi+Charan&rft.au=Samantaray%2C+Deviprasad&rft_id=https%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS2405580817301309&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyhydroxyalkanoates\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1326\nCached time: 20181211114425\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.268 seconds\nReal time usage: 0.347 seconds\nPreprocessor visited node count: 860\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 25210\/2097152 bytes\nTemplate argument size: 568\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 34553\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.165\/10.000 seconds\nLua memory usage: 4.03 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 291.036 1 -total\n<\/p>\n<pre>89.53% 260.560 1 Template:Reflist\n51.15% 148.878 7 Template:Cite_journal\n22.92% 66.695 1 Template:Page_needed\n20.30% 59.086 1 Template:Fix\n12.81% 37.281 2 Template:Category_handler\n 5.99% 17.423 1 Template:Delink\n 5.60% 16.293 2 Template:Cite_web\n 4.13% 12.022 2 Template:Cite_book\n 3.66% 10.666 2 Template:Cite_news\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1991352-1!canonical and timestamp 20181211114424 and revision id 860611255\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Polyhydroxyalkanoates\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212223\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.016 seconds\nReal time usage: 0.156 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 150.394 1 - wikipedia:Polyhydroxyalkanoates\n100.00% 150.394 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8294-0!*!*!*!*!*!* and timestamp 20181217212223 and revision id 24506\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polyhydroxyalkanoates\">https:\/\/www.limswiki.org\/index.php\/Polyhydroxyalkanoates<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","ba62e12ce478842a129ef1ee11bd9ba2_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8d\/Poly-%28R%29-3-hydroxybutyrat.svg\/400px-Poly-%28R%29-3-hydroxybutyrat.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/24\/Polyhydroxyalkanoates.png\/800px-Polyhydroxyalkanoates.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b9\/Bacillus_subtilis_Gram.jpg\/440px-Bacillus_subtilis_Gram.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/90\/Poly-3-hydroxyvalerat.svg\/240px-Poly-3-hydroxyvalerat.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d7\/Poly-4-hydroxybutyrat.svg\/240px-Poly-4-hydroxybutyrat.svg.png"],"ba62e12ce478842a129ef1ee11bd9ba2_timestamp":1545081743,"c2114a1a4e5bce923579ff571c296b27_type":"article","c2114a1a4e5bce923579ff571c296b27_title":"Polyglycolide","c2114a1a4e5bce923579ff571c296b27_url":"https:\/\/www.limswiki.org\/index.php\/Polyglycolide","c2114a1a4e5bce923579ff571c296b27_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPolyglycolide\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\nPolyglycolide\n\n\n\n\n\n\nNames\n\n\n\nIUPAC name\nPoly[oxy(1-oxo-1,2-ethanediyl)]\n\n\nIdentifiers\n\n\n\nCAS Number\n\n26009-03-0  N \n\n\n3D model (JSmol)\n\nInteractive image \n\n\n\n\n\n\n\nChemSpider\n\nnone\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nSMILES\n*C(=O)CO*\n\n\n\nProperties\n\n\nChemical formula\n\n(C2H2O2)n \n\n\nMolar mass\n\n(58.04)n   \n\n\n\n\nDensity\n\n1.530 g\/cm3 at 25 \u00b0C\n\n\nMelting point\n\n 225 to 230 \u00b0C (437 to 446 \u00b0F; 498 to 503 K) \n\n\nBoiling point\n\nDecomposes  \n\n\n\n\n\n\n\n\n\n\nExcept where otherwise noted, data are given for materials in their standard state (at 25 \u00b0C [77 \u00b0F], 100 kPa).\n\n\nN  verify  (what is Y N  ?)\n\n\nInfobox references\n\n\n\n\n\n\n\nPolyglycolide or poly(glycolic acid) (PGA), also spelled as polyglycolic acid, is a biodegradable, thermoplastic polymer and the simplest linear, aliphatic polyester. It can be prepared starting from glycolic acid by means of polycondensation or ring-opening polymerization. PGA has been known since 1954 as a tough fiber-forming polymer. Owing to its hydrolytic instability, however, its use has initially been limited.[1] Currently polyglycolide and its copolymers (poly(lactic-co-glycolic acid) with lactic acid, poly(glycolide-co-caprolactone) with \u03b5-caprolactone and poly (glycolide-co-trimethylene carbonate) with trimethylene carbonate) are widely used as a material for the synthesis of absorbable sutures and are being evaluated in the biomedical field.[2]\n\nContents \n\n1 Physical properties \n2 Synthesis \n3 Degradation \n4 Uses \n5 References \n\n\nPhysical properties \nPolyglycolide has a glass transition temperature between 35 and 40 \u00b0C and its melting point is reported to be in the range of 225-230 \u00b0C. PGA also exhibits an elevated degree of crystallinity, around 45\u201355%, thus resulting in insolubility in water.[2] The solubility of this polyester is somewhat unusual, in that its high molecular weight form is insoluble in almost all common organic solvents (acetone, dichloromethane, chloroform, ethyl acetate, tetrahydrofuran), while low molecular weight oligomers sufficiently differ in their physical properties to be more soluble. However, polyglycolide is soluble in highly fluorinated solvents like hexafluoroisopropanol (HFIP) and hexafluoroacetone sesquihydrate, that can be used to prepare solutions of the high MW polymer for melt spinning and film preparation.[3] Fibers of PGA exhibit high strength and modulus (7 GPa) and are particularly stiff.[2]\n\nSynthesis \nPolyglycolide can be obtained through several different processes starting with different materials:\n\npolycondensation of glycolic acid;\nring-opening polymerization of glycolide;\nsolid-state polycondensation of halogenoacetates\nPolycondensation of glycolic acid is the simplest process available to prepare PGA, but it is not the most efficient because it yields a low molecular weight product. Briefly, the procedure is as follows: glycolic acid is heated at atmospheric pressure and a temperature of about 175-185 \u00b0C is maintained until water ceases to distill. Subsequently, pressure is reduced to 150 mm Hg, still keeping the temperature unaltered for about two hours and the low MW polyglycolide is obtained.[4]\nThe most common synthesis used to produce a high molecular weight form of the polymer is ring-opening polymerization of \"glycolide\", the cyclic diester of glycolic acid. Glycolide can be prepared by heating under reduced pressure low MW PGA, collecting the diester by means of distillation. Ring-opening polymerization of glycolide can be catalyzed using different catalysts, including antimony compounds, such as antimony trioxide or antimony trihalides, zinc compounds (zinc lactate) and tin compounds like stannous octoate (tin(II) 2-ethylhexanoate) or tin alkoxides. Stannous octoate is the most commonly used initiator, since it is approved by the FDA as a food stabilizer. Usage of other catalysts has been disclosed as well, among these are aluminium isopropoxide, calcium acetylacetonate, and several lanthanide alkoxides (e.g. yttrium isopropoxide).[4][5][6] The procedure followed for ring-opening polymerization is briefly outlined: a catalytic amount of initiator is added to glycolide under a nitrogen atmosphere at a temperature of 195 \u00b0C. The reaction is allowed to proceed for about two hours, then temperature is raised to 230 \u00b0C for about half an hour. After solidification the resulting high MW polymer is collected.[4]\n\n Ring-opening polymerization of glycolide to polyglycolide\nAnother procedure consists in the thermally induced solid-state polycondensation of halogenoacetates with general formula\nX-—CH2COO\u2212M+ (where M is a monovalent metal like sodium and X is a halogen like chlorine), resulting in the production of polyglycolide and small crystals of a salt. Polycondensation is carried out by heating an halogenoacetate, like sodium chloroacetate, at a temperature between 160-180 \u00b0C, continuously passing nitrogen through the reaction vessel. During the reaction polyglycolide is formed along with sodium chloride which precipitates within the polymeric matrix; the salt can be conveniently removed by washing the product of the reaction with water.[7]\nPGA can also be obtained by reacting carbon monoxide, formaldehyde or one of its related compounds like paraformaldehyde or trioxane, in presence of an acidic catalyst. In a carbon monoxide atmosphere an autoclave is loaded with the catalyst (chlorosulfonic acid), dichloromethane and trioxane, then it is charged with carbon monoxide until a specific pressure is reached; the reaction is stirred and allowed to proceed at a temperature of about 180 \u00b0C for two hours. Upon completion the unreacted carbon monoxide is discharged and a mixture of low and high MW polyglycolide is collected.[8]\n\nDegradation \nPolyglycolide is characterized by hydrolytic instability owing to the presence of the ester linkage in its backbone. The degradation process is erosive and appears to take place in two steps during which the polymer is converted back to its monomer glycolic acid: first water diffuses into the amorphous (non-crystalline) regions of the polymer matrix, cleaving the ester bonds; the second step starts after the amorphous regions have been eroded, leaving the crystalline portion of the polymer susceptible to hydrolytic attack. Upon collapse of the crystalline regions the polymer chain dissolves.\nWhen exposed to physiological conditions, polyglycolide is degraded by random hydrolysis, and apparently it is also broken down by certain enzymes, especially those with esterase activity. The degradation product, glycolic acid, is nontoxic, and it can enter the tricarboxylic acid cycle, after which it is excreted as water and carbon dioxide. A part of the glycolic acid is also excreted by urine.[9]\nStudies undergone using polyglycolide-made sutures have shown that the material loses half of its strength after two weeks and 100% after four weeks. The polymer is completely resorbed by the organism in a time frame of four to six months.[2] Degradation is faster in vivo than in vitro, this phenomenon thought to be due to cellular enzymatic activity.[10]\n\nUses \n Sutures made from Polyglycolic acid. These sutures are absorbable and are degraded by the body over time.\nWhile known since 1954, PGA had found little use because of its sensitivity to hydrolysis when compared with other synthetic polymers. However, in 1962 this polymer was used to develop the first synthetic absorbable suture which was marketed under the tradename of Dexon[1] by the Davis & Geck subsidiary of the American Cyanamid Corporation. After its coating with Polycaprolactone and Calcium Stearate is being sold under the brand name of Assucryl.\nPGA suture is classified as a synthetic, absorbable, braided multifilament. It is coated with N-laurin and L-lysine, which render the thread extremely smooth, soft and safe for knotting. It is also coated with magnesium stearate and finally sterilized with ethylene oxide gas. It is naturally degraded in the body by hydrolysis and is absorbed as water-soluble monomers, completed between 60 and 90 days. Elderly, anemic and malnourished patients may absorb the suture more quickly. Its color is either violet or undyed and it is sold in sizes USP 6-0 (1 metric) to USP 2 (5 metric). It has the advantages of high initial tensile strength, smooth passage through tissue, easy handling, excellent knotting ability, and secure knot tying. It is commonly used for subcutaneous sutures, intracutaneous closures, abdominal and thoracic surgeries.\nThe traditional role of PGA as a biodegradable suture material has led to its evaluation in other biomedical fields. Implantable medical devices have been produced with PGA, including anastomosis rings, pins, rods, plates and screws.[2] It has also been explored for tissue engineering or controlled drug delivery. Tissue engineering scaffolds made with polyglycolide have been produced following different approaches, but generally most of these are obtained through textile technologies in the form of non-woven meshes.\nThe Kureha Chemical Industries has commercialized high molecular weight polyglycolide for food packaging applications under the tradename of Kuredux.[1] Production is at Belle, West Virginia, with an intended capacity of 4000 annual metric tons.[2] Its attributes as a barrier material result from its high degree of crystallization, the basis for a tortuous path mechanism for low permeability. It is anticipated that the high molecular weight version will have use as an interlayer between layers of polyethylene terephthalate to provide improved barrier protection for perishable foods, including carbonated beverages and foods that lose freshness on prolonged exposure to air. Thinner plastic bottles which still retain desirable barrier properties may also be enabled by this polyglycolide interlayer technology. A low molecular weight version (approximately 600 amu) is available from The Chemours Company. and is purported to be useful in oil and gas applications.[3]\n\nReferences \n\n^ a b Gilding, D. K.; A. M. Reed (December 1979). \"Biodegradable polymers for use in surgery - polyglycolic\/poly (lactic acid) homo- and copolymers: 1\". Polymer. 20 (12): 1459\u20131464. doi:10.1016\/0032-3861(79)90009-0. \n\n^ a b c d e Middleton, J.; A. Tipton (March 1998). \"Synthetic biodegradable polymers as medical devices\". Medical Plastics and Biomaterials Magazine. Retrieved 2006-07-04 . \n\n^ Schmitt, E.: \"Polyglycolic acid in solutions\", U.S. Pat 3 737 440, 1973 \n\n^ a b c Lowe, C. E.: \"Preparation of high molecular weight polyhydroxyacetic ester\", U.S. Pat 2 668 162, 1954 \n\n^ Bero, Maciej; Piotr Dobrzynski; Janusz Kasperczyk (18 June 1999). \"Application of Calcium Acetylacetonate to the Polymerization of Glycolide and Copolymerization of Glycolide with \u03b5-Caprolactone and L-Lactide\". Macromolecules. ACS. 32 (14): 4735\u20134737. doi:10.1021\/ma981969z. \n\n^ Stridsberg, Kajsa M.; Maria Ryner; Ann-Christine Albertsson (2002). \"Controlled Ring-Opening Polymerization: Polymers with designed Macromolecular Architecture\". Advances in Polymer Science. Advances in Polymer Science. Springer. 157: 41\u201365. doi:10.1007\/3-540-45734-8_2. ISBN 978-3-540-42249-5. \n\n^ Epple, Matthias; Epple, Matthias (1999). \"A detailed characterization of polyglycolide prepared by solid-state polycondensation reaction\". Macromolecular Chemistry and Physics. Wiley. 200 (10): 2221\u20132229. doi:10.1002\/(SICI)1521-3935(19991001)200:10<2221::AID-MACP2221>3.0.CO;2-Q. \n\n^ Masuda et al.: \"Biodegradable plastic composition\", U.S. Pat 5 227 415, 1993 \n\n^ Gunatillake, Pathiraja A.; Raju Adhikari (2003). \"Biodegradable Synthetic Polymers for tissue engineering\" (PDF) . European Cells and Materials. 5: 1\u201316. PMID 14562275. Retrieved 2015-02-08 . \n\n^ Tiberiu Ni\u021b\u0103 (Mar 2011). \"Concepts in biological analysis of resorbable materials in oro-maxillofacial surgery\". Rev. chir. oro-maxilo-fac. implantol. (in Romanian). 2 (1): 33\u201338. ISSN 2069-3850. 23. Retrieved 2012-06-06 . (webpage has a translation button) \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polyglycolide\">https:\/\/www.limswiki.org\/index.php\/Polyglycolide<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 16:51.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 689 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","c2114a1a4e5bce923579ff571c296b27_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Polyglycolide skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Polyglycolide<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Polyglycolide<\/b> or <b>poly(glycolic acid)<\/b> (<b>PGA<\/b>), also spelled as <b>polyglycolic acid<\/b>, is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biodegradable\" class=\"mw-redirect\" title=\"Biodegradable\" rel=\"external_link\" target=\"_blank\">biodegradable<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoplastic\" title=\"Thermoplastic\" rel=\"external_link\" target=\"_blank\">thermoplastic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> and the simplest linear, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aliphatic\" class=\"mw-redirect\" title=\"Aliphatic\" rel=\"external_link\" target=\"_blank\">aliphatic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyester\" title=\"Polyester\" rel=\"external_link\" target=\"_blank\">polyester<\/a>. It can be prepared starting from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glycolic_acid\" title=\"Glycolic acid\" rel=\"external_link\" target=\"_blank\">glycolic acid<\/a> by means of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Condensation_reaction\" title=\"Condensation reaction\" rel=\"external_link\" target=\"_blank\">polycondensation<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ring-opening_polymerization\" title=\"Ring-opening polymerization\" rel=\"external_link\" target=\"_blank\">ring-opening polymerization<\/a>. PGA has been known since 1954 as a tough <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiber\" title=\"Fiber\" rel=\"external_link\" target=\"_blank\">fiber<\/a>-forming polymer. Owing to its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrolysis\" title=\"Hydrolysis\" rel=\"external_link\" target=\"_blank\">hydrolytic<\/a> instability, however, its use has initially been limited.<sup id=\"rdp-ebb-cite_ref-Gilding_1-0\" class=\"reference\"><a href=\"#cite_note-Gilding-1\" rel=\"external_link\">[1]<\/a><\/sup> Currently polyglycolide and its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copolymer\" title=\"Copolymer\" rel=\"external_link\" target=\"_blank\">copolymers<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/PLGA\" title=\"PLGA\" rel=\"external_link\" target=\"_blank\">poly(lactic-<i>co<\/i>-glycolic acid)<\/a> with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lactic_acid\" title=\"Lactic acid\" rel=\"external_link\" target=\"_blank\">lactic acid<\/a>, poly(glycolide-<i>co<\/i>-caprolactone) with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Caprolactone\" title=\"Caprolactone\" rel=\"external_link\" target=\"_blank\">\u03b5-caprolactone<\/a> and poly (glycolide-<i>co<\/i>-trimethylene carbonate) with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trimethylene_carbonate\" title=\"Trimethylene carbonate\" rel=\"external_link\" target=\"_blank\">trimethylene carbonate<\/a>) are widely used as a material for the synthesis of absorbable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" title=\"Surgical suture\" rel=\"external_link\" target=\"_blank\">sutures<\/a> and are being evaluated in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical_engineering\" title=\"Biomedical engineering\" rel=\"external_link\" target=\"_blank\">biomedical<\/a> field.<sup id=\"rdp-ebb-cite_ref-middleton_2-0\" class=\"reference\"><a href=\"#cite_note-middleton-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Physical_properties\">Physical properties<\/span><\/h2>\n<p>Polyglycolide has a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass_transition_temperature\" class=\"mw-redirect\" title=\"Glass transition temperature\" rel=\"external_link\" target=\"_blank\">glass transition temperature<\/a> between 35 and 40 \u00b0C and its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Melting_point\" title=\"Melting point\" rel=\"external_link\" target=\"_blank\">melting point<\/a> is reported to be in the range of 225-230 \u00b0C. PGA also exhibits an elevated degree of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystallinity\" title=\"Crystallinity\" rel=\"external_link\" target=\"_blank\">crystallinity<\/a>, around 45\u201355%, thus resulting in insolubility in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Water_(molecule)\" class=\"mw-redirect\" title=\"Water (molecule)\" rel=\"external_link\" target=\"_blank\">water<\/a>.<sup id=\"rdp-ebb-cite_ref-middleton_2-1\" class=\"reference\"><a href=\"#cite_note-middleton-2\" rel=\"external_link\">[2]<\/a><\/sup> The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solubility\" title=\"Solubility\" rel=\"external_link\" target=\"_blank\">solubility<\/a> of this polyester is somewhat unusual, in that its high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_weight\" class=\"mw-redirect\" title=\"Molecular weight\" rel=\"external_link\" target=\"_blank\">molecular weight<\/a> form is insoluble in almost all common <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organic_solvent\" class=\"mw-redirect\" title=\"Organic solvent\" rel=\"external_link\" target=\"_blank\">organic solvents<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetone\" title=\"Acetone\" rel=\"external_link\" target=\"_blank\">acetone<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dichloromethane\" title=\"Dichloromethane\" rel=\"external_link\" target=\"_blank\">dichloromethane<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chloroform\" title=\"Chloroform\" rel=\"external_link\" target=\"_blank\">chloroform<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethyl_acetate\" title=\"Ethyl acetate\" rel=\"external_link\" target=\"_blank\">ethyl acetate<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tetrahydrofuran\" title=\"Tetrahydrofuran\" rel=\"external_link\" target=\"_blank\">tetrahydrofuran<\/a>), while low molecular weight <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oligomer\" title=\"Oligomer\" rel=\"external_link\" target=\"_blank\">oligomers<\/a> sufficiently differ in their physical properties to be more soluble. However, polyglycolide is soluble in highly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorine\" title=\"Fluorine\" rel=\"external_link\" target=\"_blank\">fluorinated<\/a> solvents like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hexafluoro-2-propanol\" title=\"Hexafluoro-2-propanol\" rel=\"external_link\" target=\"_blank\">hexafluoroisopropanol<\/a> (HFIP) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hexafluoroacetone\" title=\"Hexafluoroacetone\" rel=\"external_link\" target=\"_blank\">hexafluoroacetone sesquihydrate<\/a>, that can be used to prepare solutions of the high MW polymer for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Melt_spinning\" title=\"Melt spinning\" rel=\"external_link\" target=\"_blank\">melt spinning<\/a> and film preparation.<sup id=\"rdp-ebb-cite_ref-PGA_solutions_3-0\" class=\"reference\"><a href=\"#cite_note-PGA_solutions-3\" rel=\"external_link\">[3]<\/a><\/sup> Fibers of PGA exhibit high strength and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Young%27s_modulus\" title=\"Young's modulus\" rel=\"external_link\" target=\"_blank\">modulus<\/a> (7 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pascal_(unit)\" title=\"Pascal (unit)\" rel=\"external_link\" target=\"_blank\">GPa<\/a>) and are particularly stiff.<sup id=\"rdp-ebb-cite_ref-middleton_2-2\" class=\"reference\"><a href=\"#cite_note-middleton-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Synthesis\">Synthesis<\/span><\/h2>\n<p>Polyglycolide can be obtained through several different processes starting with different materials:\n<\/p>\n<ol><li>polycondensation of glycolic acid;<\/li>\n<li>ring-opening polymerization of glycolide;<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Solid-state_chemistry\" title=\"Solid-state chemistry\" rel=\"external_link\" target=\"_blank\">solid-state<\/a> polycondensation of <\/li><\/ol>\n<p>Polycondensation of glycolic acid is the simplest process available to prepare PGA, but it is not the most efficient because it yields a low molecular weight product. Briefly, the procedure is as follows: glycolic acid is heated at atmospheric pressure and a temperature of about 175-185 \u00b0C is maintained until water ceases to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Distillation\" title=\"Distillation\" rel=\"external_link\" target=\"_blank\">distill<\/a>. Subsequently, pressure is reduced to 150 mm Hg, still keeping the temperature unaltered for about two hours and the low MW polyglycolide is obtained.<sup id=\"rdp-ebb-cite_ref-PGA_dupont_4-0\" class=\"reference\"><a href=\"#cite_note-PGA_dupont-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>The most common synthesis used to produce a high molecular weight form of the polymer is ring-opening polymerization of \"glycolide\", the cyclic diester of glycolic acid. Glycolide can be prepared by heating under reduced pressure low MW PGA, collecting the diester by means of distillation. Ring-opening polymerization of glycolide can be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalysis\" title=\"Catalysis\" rel=\"external_link\" target=\"_blank\">catalyzed<\/a> using different <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalyst\" class=\"mw-redirect\" title=\"Catalyst\" rel=\"external_link\" target=\"_blank\">catalysts<\/a>, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antimony\" title=\"Antimony\" rel=\"external_link\" target=\"_blank\">antimony<\/a> compounds, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antimony_trioxide\" title=\"Antimony trioxide\" rel=\"external_link\" target=\"_blank\">antimony trioxide<\/a> or antimony trihalides, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zinc\" title=\"Zinc\" rel=\"external_link\" target=\"_blank\">zinc<\/a> compounds (zinc lactate) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tin\" title=\"Tin\" rel=\"external_link\" target=\"_blank\">tin<\/a> compounds like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stannous_octoate\" class=\"mw-redirect\" title=\"Stannous octoate\" rel=\"external_link\" target=\"_blank\">stannous octoate<\/a> (tin(II) 2-ethylhexanoate) or tin alkoxides. Stannous octoate is the most commonly used initiator, since it is approved by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">FDA<\/a> as a food stabilizer. Usage of other catalysts has been disclosed as well, among these are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium_isopropoxide\" title=\"Aluminium isopropoxide\" rel=\"external_link\" target=\"_blank\">aluminium isopropoxide<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium\" title=\"Calcium\" rel=\"external_link\" target=\"_blank\">calcium<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetylacetonate\" class=\"mw-redirect\" title=\"Acetylacetonate\" rel=\"external_link\" target=\"_blank\">acetylacetonate<\/a>, and several <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lanthanide\" title=\"Lanthanide\" rel=\"external_link\" target=\"_blank\">lanthanide<\/a> alkoxides (e.g. ).<sup id=\"rdp-ebb-cite_ref-PGA_dupont_4-1\" class=\"reference\"><a href=\"#cite_note-PGA_dupont-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Bero_5-0\" class=\"reference\"><a href=\"#cite_note-Bero-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Stridsberg_6-0\" class=\"reference\"><a href=\"#cite_note-Stridsberg-6\" rel=\"external_link\">[6]<\/a><\/sup> The procedure followed for ring-opening polymerization is briefly outlined: a catalytic amount of initiator is added to glycolide under a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nitrogen\" title=\"Nitrogen\" rel=\"external_link\" target=\"_blank\">nitrogen<\/a> atmosphere at a temperature of 195 \u00b0C. The reaction is allowed to proceed for about two hours, then temperature is raised to 230 \u00b0C for about half an hour. After solidification the resulting high MW polymer is collected.<sup id=\"rdp-ebb-cite_ref-PGA_dupont_4-2\" class=\"reference\"><a href=\"#cite_note-PGA_dupont-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<div class=\"center\"><div class=\"thumb tnone\"><div class=\"thumbinner\" style=\"width:418px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pga_synthesis.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/2\/27\/Pga_synthesis.png\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\">Ring-opening polymerization of glycolide to polyglycolide<\/div><\/div><\/div><\/div>\n<p>Another procedure consists in the thermally induced solid-state polycondensation of halogenoacetates with general formula\nX-—CH<sub>2<\/sub>COO<sup>\u2212<\/sup>M<sup>+<\/sup> (where M is a monovalent metal like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium\" title=\"Sodium\" rel=\"external_link\" target=\"_blank\">sodium<\/a> and X is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Halogen\" title=\"Halogen\" rel=\"external_link\" target=\"_blank\">halogen<\/a> like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chlorine\" title=\"Chlorine\" rel=\"external_link\" target=\"_blank\">chlorine<\/a>), resulting in the production of polyglycolide and small <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystal\" title=\"Crystal\" rel=\"external_link\" target=\"_blank\">crystals<\/a> of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Salt_(chemistry)\" title=\"Salt (chemistry)\" rel=\"external_link\" target=\"_blank\">salt<\/a>. Polycondensation is carried out by heating an halogenoacetate, like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_chloroacetate\" title=\"Sodium chloroacetate\" rel=\"external_link\" target=\"_blank\">sodium chloroacetate<\/a>, at a temperature between 160-180 \u00b0C, continuously passing nitrogen through the reaction vessel. During the reaction polyglycolide is formed along with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_chloride\" title=\"Sodium chloride\" rel=\"external_link\" target=\"_blank\">sodium chloride<\/a> which precipitates within the polymeric matrix; the salt can be conveniently removed by washing the product of the reaction with water.<sup id=\"rdp-ebb-cite_ref-apple_7-0\" class=\"reference\"><a href=\"#cite_note-apple-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>PGA can also be obtained by reacting carbon monoxide, formaldehyde or one of its related compounds like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paraformaldehyde\" title=\"Paraformaldehyde\" rel=\"external_link\" target=\"_blank\">paraformaldehyde<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trioxane\" title=\"Trioxane\" rel=\"external_link\" target=\"_blank\">trioxane<\/a>, in presence of an acidic catalyst. In a carbon monoxide atmosphere an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autoclave\" title=\"Autoclave\" rel=\"external_link\" target=\"_blank\">autoclave<\/a> is loaded with the catalyst (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Chlorosulfonic_acid\" class=\"mw-redirect\" title=\"Chlorosulfonic acid\" rel=\"external_link\" target=\"_blank\">chlorosulfonic acid<\/a>), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dichloromethane\" title=\"Dichloromethane\" rel=\"external_link\" target=\"_blank\">dichloromethane<\/a> and trioxane, then it is charged with carbon monoxide until a specific pressure is reached; the reaction is stirred and allowed to proceed at a temperature of about 180 \u00b0C for two hours. Upon completion the unreacted carbon monoxide is discharged and a mixture of low and high MW polyglycolide is collected.<sup id=\"rdp-ebb-cite_ref-Masuda_8-0\" class=\"reference\"><a href=\"#cite_note-Masuda-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Degradation\">Degradation<\/span><\/h2>\n<p>Polyglycolide is characterized by hydrolytic instability owing to the presence of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ester\" title=\"Ester\" rel=\"external_link\" target=\"_blank\">ester<\/a> linkage in its backbone. The degradation process is erosive and appears to take place in two steps during which the polymer is converted back to its monomer glycolic acid: first water diffuses into the amorphous (non-crystalline) regions of the polymer matrix, cleaving the ester bonds; the second step starts after the amorphous regions have been eroded, leaving the crystalline portion of the polymer susceptible to hydrolytic attack. Upon collapse of the crystalline regions the polymer chain dissolves.\n<\/p><p>When exposed to physiological conditions, polyglycolide is degraded by random hydrolysis, and apparently it is also broken down by certain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Enzyme\" title=\"Enzyme\" rel=\"external_link\" target=\"_blank\">enzymes<\/a>, especially those with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esterase\" title=\"Esterase\" rel=\"external_link\" target=\"_blank\">esterase<\/a> activity. The degradation product, glycolic acid, is nontoxic, and it can enter the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tricarboxylic_acid_cycle\" class=\"mw-redirect\" title=\"Tricarboxylic acid cycle\" rel=\"external_link\" target=\"_blank\">tricarboxylic acid cycle<\/a>, after which it is excreted as water and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_dioxide\" title=\"Carbon dioxide\" rel=\"external_link\" target=\"_blank\">carbon dioxide<\/a>. A part of the glycolic acid is also excreted by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urine\" title=\"Urine\" rel=\"external_link\" target=\"_blank\">urine<\/a>.<sup id=\"rdp-ebb-cite_ref-gunatillake_9-0\" class=\"reference\"><a href=\"#cite_note-gunatillake-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>Studies undergone using polyglycolide-made sutures have shown that the material loses half of its strength after two weeks and 100% after four weeks. The polymer is completely resorbed by the organism in a time frame of four to six months.<sup id=\"rdp-ebb-cite_ref-middleton_2-3\" class=\"reference\"><a href=\"#cite_note-middleton-2\" rel=\"external_link\">[2]<\/a><\/sup> Degradation is faster <a href=\"https:\/\/en.wikipedia.org\/wiki\/In_vivo\" title=\"In vivo\" rel=\"external_link\" target=\"_blank\">in vivo<\/a> than <a href=\"https:\/\/en.wikipedia.org\/wiki\/In_vitro\" title=\"In vitro\" rel=\"external_link\" target=\"_blank\">in vitro<\/a>, this phenomenon thought to be due to cellular enzymatic activity.<sup id=\"rdp-ebb-cite_ref-Nita_10-0\" class=\"reference\"><a href=\"#cite_note-Nita-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Uses\">Uses<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Polyglycolic_acid_suture_(_PGA-Dexon)_01.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/54\/Polyglycolic_acid_suture_%28_PGA-Dexon%29_01.JPG\/250px-Polyglycolic_acid_suture_%28_PGA-Dexon%29_01.JPG\" width=\"250\" height=\"167\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Polyglycolic_acid_suture_(_PGA-Dexon)_01.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Sutures made from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyglycolic_acid\" class=\"mw-redirect\" title=\"Polyglycolic acid\" rel=\"external_link\" target=\"_blank\">Polyglycolic acid<\/a>. These sutures are absorbable and are degraded by the body over time.<\/div><\/div><\/div>\n<p>While known since 1954, PGA had found little use because of its sensitivity to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrolysis\" title=\"Hydrolysis\" rel=\"external_link\" target=\"_blank\">hydrolysis<\/a> when compared with other synthetic polymers. However, in 1962 this polymer was used to develop the first synthetic absorbable suture which was marketed under the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tradename\" class=\"mw-redirect\" title=\"Tradename\" rel=\"external_link\" target=\"_blank\">tradename<\/a> of Dexon<sup id=\"rdp-ebb-cite_ref-Gilding_1-1\" class=\"reference\"><a href=\"#cite_note-Gilding-1\" rel=\"external_link\">[1]<\/a><\/sup> by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Davis_%26_Geck\" title=\"Davis & Geck\" rel=\"external_link\" target=\"_blank\">Davis & Geck<\/a> subsidiary of the American Cyanamid Corporation. After its coating with Polycaprolactone and Calcium Stearate is being sold under the brand name of Assucryl.\n<\/p><p>PGA suture is classified as a synthetic, absorbable, braided multifilament. It is coated with N-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Laurin\" title=\"Laurin\" rel=\"external_link\" target=\"_blank\">laurin<\/a> and L-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Lysine\" title=\"Lysine\" rel=\"external_link\" target=\"_blank\">lysine<\/a>, which render the thread extremely smooth, soft and safe for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Knot\" title=\"Knot\" rel=\"external_link\" target=\"_blank\">knotting<\/a>. It is also coated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium_stearate\" title=\"Magnesium stearate\" rel=\"external_link\" target=\"_blank\">magnesium stearate<\/a> and finally sterilized with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_oxide\" title=\"Ethylene oxide\" rel=\"external_link\" target=\"_blank\">ethylene oxide<\/a> gas. It is naturally degraded in the body by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrolysis\" title=\"Hydrolysis\" rel=\"external_link\" target=\"_blank\">hydrolysis<\/a> and is absorbed as water-soluble monomers, completed between 60 and 90 days. Elderly, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anemia\" title=\"Anemia\" rel=\"external_link\" target=\"_blank\">anemic<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Malnutrition\" title=\"Malnutrition\" rel=\"external_link\" target=\"_blank\">malnourished<\/a> patients may absorb the suture more quickly. Its color is either <a href=\"https:\/\/en.wikipedia.org\/wiki\/Violet_(color)\" title=\"Violet (color)\" rel=\"external_link\" target=\"_blank\">violet<\/a> or undyed and it is sold in sizes USP 6-0 (1 metric) to USP 2 (5 metric). It has the advantages of high initial tensile strength, smooth passage through tissue, easy handling, excellent knotting ability, and secure knot tying. It is commonly used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subcutaneous_tissue\" title=\"Subcutaneous tissue\" rel=\"external_link\" target=\"_blank\">subcutaneous<\/a> sutures, intracutaneous closures, abdominal and thoracic surgeries.\n<\/p><p>The traditional role of PGA as a biodegradable suture material has led to its evaluation in other biomedical fields. Implantable medical devices have been produced with PGA, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anastomosis\" title=\"Anastomosis\" rel=\"external_link\" target=\"_blank\">anastomosis<\/a> rings, pins, rods, plates and screws.<sup id=\"rdp-ebb-cite_ref-middleton_2-4\" class=\"reference\"><a href=\"#cite_note-middleton-2\" rel=\"external_link\">[2]<\/a><\/sup> It has also been explored for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_engineering\" title=\"Tissue engineering\" rel=\"external_link\" target=\"_blank\">tissue engineering<\/a> or controlled drug delivery. Tissue engineering scaffolds made with polyglycolide have been produced following different approaches, but generally most of these are obtained through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Textile\" title=\"Textile\" rel=\"external_link\" target=\"_blank\">textile<\/a> technologies in the form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nonwovens\" class=\"mw-redirect\" title=\"Nonwovens\" rel=\"external_link\" target=\"_blank\">non-woven meshes<\/a>.\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kureha_Chemical_Industries\" class=\"mw-redirect\" title=\"Kureha Chemical Industries\" rel=\"external_link\" target=\"_blank\">Kureha Chemical Industries<\/a> has commercialized high molecular weight polyglycolide for food packaging applications under the tradename of Kuredux.<a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.kureha.com\/product-groups\/pga.htm\" target=\"_blank\">[1]<\/a> Production is at Belle, West Virginia, with an intended capacity of 4000 annual metric tons.<a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.chemicals-technology.com\/projects\/kurehacorporationpol\/\" target=\"_blank\">[2]<\/a> Its attributes as a barrier material result from its high degree of crystallization, the basis for a tortuous path mechanism for low permeability. It is anticipated that the high molecular weight version will have use as an interlayer between layers of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene_terephthalate\" title=\"Polyethylene terephthalate\" rel=\"external_link\" target=\"_blank\">polyethylene terephthalate<\/a> to provide improved barrier protection for perishable foods, including carbonated beverages and foods that lose freshness on prolonged exposure to air. Thinner plastic bottles which still retain desirable barrier properties may also be enabled by this polyglycolide interlayer technology. A low molecular weight version (approximately 600 amu) is available from The Chemours Company<a href=\"https:\/\/en.wikipedia.org\/wiki\/DuPont_Co.\" class=\"mw-redirect\" title=\"DuPont Co.\" rel=\"external_link\" target=\"_blank\">.<\/a> and is purported to be useful in oil and gas applications.<a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www2.dupont.com\/Oil_and_Gas\/en_CA\/assets\/downloads\/DuPont_Polyglycolic_Acid_Sheet.pdf\" target=\"_blank\">[3]<\/a>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-Gilding-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Gilding_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gilding_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gilding, D. K.; A. M. Reed (December 1979). \"Biodegradable polymers for use in surgery - polyglycolic\/poly (lactic acid) homo- and copolymers: 1\". <i>Polymer<\/i>. <b>20<\/b> (12): 1459\u20131464. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0032-3861%2879%2990009-0\" target=\"_blank\">10.1016\/0032-3861(79)90009-0<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Polymer&rft.atitle=Biodegradable+polymers+for+use+in+surgery+-+polyglycolic%2Fpoly+%28lactic+acid%29+homo-+and+copolymers%3A+1&rft.volume=20&rft.issue=12&rft.pages=1459-1464&rft.date=1979-12&rft_id=info%3Adoi%2F10.1016%2F0032-3861%2879%2990009-0&rft.aulast=Gilding&rft.aufirst=D.+K.&rft.au=A.+M.+Reed&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyglycolide\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-middleton-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-middleton_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-middleton_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-middleton_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-middleton_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-middleton_2-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Middleton, J.; A. 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Retrieved <span class=\"nowrap\">2006-07-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Medical+Plastics+and+Biomaterials+Magazine&rft.atitle=Synthetic+biodegradable+polymers+as+medical+devices&rft.date=1998-03&rft.aulast=Middleton&rft.aufirst=J.&rft.au=A.+Tipton&rft_id=http%3A%2F%2Fwww.devicelink.com%2Fmpb%2Farchive%2F98%2F03%2F002.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyglycolide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-PGA_solutions-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-PGA_solutions_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Schmitt, E.: \"Polyglycolic acid in solutions\", U.S. Pat 3 737 440, 1973<\/span>\n<\/li>\n<li id=\"cite_note-PGA_dupont-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-PGA_dupont_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-PGA_dupont_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-PGA_dupont_4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Lowe, C. E.: \"Preparation of high molecular weight polyhydroxyacetic ester\", U.S. Pat 2 668 162, 1954<\/span>\n<\/li>\n<li id=\"cite_note-Bero-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Bero_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bero, Maciej; Piotr Dobrzynski; Janusz Kasperczyk (18 June 1999). \"Application of Calcium Acetylacetonate to the Polymerization of Glycolide and Copolymerization of Glycolide with \u03b5-Caprolactone and L-Lactide\". <i>Macromolecules<\/i>. ACS. <b>32<\/b> (14): 4735\u20134737. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1021%2Fma981969z\" target=\"_blank\">10.1021\/ma981969z<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Macromolecules&rft.atitle=Application+of+Calcium+Acetylacetonate+to+the+Polymerization+of+Glycolide+and+Copolymerization+of+Glycolide+with+%CE%B5-Caprolactone+and+L-Lactide&rft.volume=32&rft.issue=14&rft.pages=4735-4737&rft.date=1999-06-18&rft_id=info%3Adoi%2F10.1021%2Fma981969z&rft.aulast=Bero&rft.aufirst=Maciej&rft.au=Piotr+Dobrzynski&rft.au=Janusz+Kasperczyk&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyglycolide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Stridsberg-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Stridsberg_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stridsberg, Kajsa M.; Maria Ryner; Ann-Christine Albertsson (2002). \"Controlled Ring-Opening Polymerization: Polymers with designed Macromolecular Architecture\". <i>Advances in Polymer Science<\/i>. Advances in Polymer Science. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Springer_Science%2BBusiness_Media\" title=\"Springer Science+Business Media\" rel=\"external_link\" target=\"_blank\">Springer<\/a>. <b>157<\/b>: 41\u201365. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2F3-540-45734-8_2\" target=\"_blank\">10.1007\/3-540-45734-8_2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-540-42249-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Advances+in+Polymer+Science&rft.atitle=Controlled+Ring-Opening+Polymerization%3A+Polymers+with+designed+Macromolecular+Architecture&rft.volume=157&rft.pages=41-65&rft.date=2002&rft_id=info%3Adoi%2F10.1007%2F3-540-45734-8_2&rft.isbn=978-3-540-42249-5&rft.aulast=Stridsberg&rft.aufirst=Kajsa+M.&rft.au=Maria+Ryner&rft.au=Ann-Christine+Albertsson&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyglycolide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-apple-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-apple_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Epple, Matthias; Epple, Matthias (1999). \"A detailed characterization of polyglycolide prepared by solid-state polycondensation reaction\". <i>Macromolecular Chemistry and Physics<\/i>. Wiley. <b>200<\/b> (10): 2221\u20132229. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F%28SICI%291521-3935%2819991001%29200%3A10%3C2221%3A%3AAID-MACP2221%3E3.0.CO%3B2-Q\" target=\"_blank\">10.1002\/(SICI)1521-3935(19991001)200:10<2221::AID-MACP2221>3.0.CO;2-Q<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Macromolecular+Chemistry+and+Physics&rft.atitle=A+detailed+characterization+of+polyglycolide+prepared+by+solid-state+polycondensation+reaction&rft.volume=200&rft.issue=10&rft.pages=2221-2229&rft.date=1999&rft_id=info%3Adoi%2F10.1002%2F%28SICI%291521-3935%2819991001%29200%3A10%3C2221%3A%3AAID-MACP2221%3E3.0.CO%3B2-Q&rft.aulast=Epple&rft.aufirst=Matthias&rft.au=Epple%2C+Matthias&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyglycolide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Masuda-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Masuda_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Masuda et al.: \"Biodegradable plastic composition\", U.S. Pat 5 227 415, 1993<\/span>\n<\/li>\n<li id=\"cite_note-gunatillake-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-gunatillake_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gunatillake, Pathiraja A.; Raju Adhikari (2003). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ecmjournal.org\/journal\/papers\/vol005\/pdf\/v005a01.pdf\" target=\"_blank\">\"Biodegradable Synthetic Polymers for tissue engineering\"<\/a> <span class=\"cs1-format\">(<a href=\"https:\/\/en.wikipedia.org\/wiki\/PDF\" title=\"PDF\" rel=\"external_link\" target=\"_blank\">PDF<\/a>)<\/span>. <i>European Cells and Materials<\/i>. <b>5<\/b>: 1\u201316. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14562275\" target=\"_blank\">14562275<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-02-08<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Cells+and+Materials&rft.atitle=Biodegradable+Synthetic+Polymers+for+tissue+engineering&rft.volume=5&rft.pages=1-16&rft.date=2003&rft_id=info%3Apmid%2F14562275&rft.aulast=Gunatillake&rft.aufirst=Pathiraja+A.&rft.au=Raju+Adhikari&rft_id=http%3A%2F%2Fwww.ecmjournal.org%2Fjournal%2Fpapers%2Fvol005%2Fpdf%2Fv005a01.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyglycolide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Nita-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Nita_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"> (Mar 2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.revistaomf.ro\/(23)\" target=\"_blank\">\"Concepts in biological analysis of resorbable materials in oro-maxillofacial surgery\"<\/a>. <i><\/i> (in Romanian). <b>2<\/b> (1): 33\u201338. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2069-3850\" target=\"_blank\">2069-3850<\/a>. 23<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2012-06-06<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Rev.+chir.+oro-maxilo-fac.+implantol.&rft.atitle=Concepts+in+biological+analysis+of+resorbable+materials+in+oro-maxillofacial+surgery&rft.volume=2&rft.issue=1&rft.pages=33-38&rft.date=2011-03&rft.issn=2069-3850&rft.au=Tiberiu+Ni%C8%9B%C4%83&rft_id=http%3A%2F%2Fwww.revistaomf.ro%2F%2823%29&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyglycolide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>(webpage has a translation button)<\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1263\nCached time: 20181217110838\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.472 seconds\nReal time usage: 0.624 seconds\nPreprocessor visited node count: 3753\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 48653\/2097152 bytes\nTemplate argument size: 7508\/2097152 bytes\nHighest expansion depth: 22\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 22642\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.217\/10.000 seconds\nLua memory usage: 5.37 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 562.242 1 -total\n<\/p>\n<pre>79.64% 447.743 1 Template:Chembox\n47.50% 267.041 1 Template:Chembox_Identifiers\n28.70% 161.360 3 Template:Chembox_headerbar\n28.14% 158.211 9 Template:Trim\n17.97% 101.059 7 Template:Cite_journal\n16.63% 93.527 6 Template:Main_other\n14.68% 82.516 1 Template:Chembox_Properties\n14.46% 81.307 1 Template:Chembox_parametercheck\n 9.42% 52.971 10 Template:Unbulleted_list\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1405072-1!canonical and timestamp 20181217110837 and revision id 858170475\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Polyglycolide\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212223\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.135 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 128.782 1 - wikipedia:Polyglycolide\n100.00% 128.782 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8293-0!*!*!*!*!*!* and timestamp 20181217212223 and revision id 24505\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polyglycolide\">https:\/\/www.limswiki.org\/index.php\/Polyglycolide<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","c2114a1a4e5bce923579ff571c296b27_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b1\/PGA.png\/440px-PGA.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/2\/27\/Pga_synthesis.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/54\/Polyglycolic_acid_suture_%28_PGA-Dexon%29_01.JPG\/500px-Polyglycolic_acid_suture_%28_PGA-Dexon%29_01.JPG"],"c2114a1a4e5bce923579ff571c296b27_timestamp":1545081743,"3d4a244ce30949af99a3f7e14e78e59a_type":"article","3d4a244ce30949af99a3f7e14e78e59a_title":"Polyethylene terephthalate","3d4a244ce30949af99a3f7e14e78e59a_url":"https:\/\/www.limswiki.org\/index.php\/Polyethylene_terephthalate","3d4a244ce30949af99a3f7e14e78e59a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPolyethylene terephthalate\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t \n\n\"PETE\" redirects here. For other uses of \"PET\", see PET (disambiguation). For other uses, see Pete (disambiguation).\nPolymer\n\n\n\nPolyethylene terephthalate\n\n\n\n\n\n\n\n\n\n\n\n\n\nNames\n\n\n\nIUPAC name\nPoly(ethyl benzene-1,4-dicarboxylate)\n\n\nIdentifiers\n\n\n\nCAS Number\n\n25038-59-9  Y \n\n\n\n\nAbbreviations\n\nPET, PETE\n\n\n\n\n\nChemSpider\n\nnone\n\n\n\nECHA InfoCard \n\n100.121.858\n\n\nProperties\n\n\nChemical formula\n\n(C10H8O4)n[1] \n\n\nMolar mass\n\nvariable   \n\n\n\n\nDensity\n\n1.38 g\/cm3 (20 \u00b0C),[2] amorphous: 1.370 g\/cm3,[1] single crystal: 1.455 g\/cm3[1]\n\n\nMelting point\n\n> 250 \u00b0C (482 \u00b0F; 523 K)[2] 260 \u00b0C[1] \n\n\nBoiling point\n\n> 350 \u00b0C (662 \u00b0F; 623 K) (decomposes)\n\n\n\n\nSolubility in water\n\npractically insoluble[2]\n\n\n\n\n\n\n\n\n\n\nlog P\n\n0.94540[3]\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nThermal conductivity\n\n0.15[4] to 0.24 W m\u22121 K\u22121[1]\n\n\nRefractive index (nD)\n\n1.57\u20131.58,[4] 1.5750[1]\n\n\n\nThermochemistry\n\n\nHeat capacity (C)\n\n1.0 kJ\/(kg\u00b7K)[1]\n\n\n\n\n\nRelated compounds\n\n\n\n\nRelated Monomers\n\nTerephthalic acid\r\nEthylene glycol\n\n\n\n\nExcept where otherwise noted, data are given for materials in their standard state (at 25 \u00b0C [77 \u00b0F], 100 kPa).\n\n\nN  verify  (what is Y N  ?)\n\n\nInfobox references\n\n\n\n\n\n\n\nPolyethylene terephthalate (sometimes written poly(ethylene terephthalate)), commonly abbreviated PET, PETE, or the obsolete PETP or PET-P, is the most common thermoplastic polymer resin of the polyester family and is used in fibres for clothing, containers for liquids and foods, thermoforming for manufacturing, and in combination with glass fibre for engineering resins.\nIt may also be referred to by the brand names Terylene in the UK,[5] Lavsan in Russia and the former Soviet Union, and Dacron in the US.\nThe majority of the world's PET production is for synthetic fibres (in excess of 60%), with bottle production accounting for about 30% of global demand.[6] In the context of textile applications, PET is referred to by its common name, polyester, whereas the acronym PET is generally used in relation to packaging. Polyester makes up about 18% of world polymer production and is the fourth-most-produced polymer after polyethylene (PE), polypropylene (PP) and polyvinyl chloride (PVC).\nPET consists of polymerized units of the monomer ethylene terephthalate, with repeating (C10H8O4) units. PET is commonly recycled, and has the number \"1\" as its resin identification code (RIC).\nDepending on its processing and thermal history, polyethylene terephthalate may exist both as an amorphous (transparent) and as a semi-crystalline polymer. The semicrystalline material might appear transparent (particle size less than 500 nm) or opaque and white (particle size up to a few micrometers) depending on its crystal structure and particle size.\nThe monomer bis(2-hydroxyethyl) terephthalate can be synthesized by the esterification reaction between terephthalic acid and ethylene glycol with water as a byproduct, or by transesterification reaction between ethylene glycol and dimethyl terephthalate (DMT) with methanol as a byproduct. Polymerization is through a polycondensation reaction of the monomers (done immediately after esterification\/transesterification) with water as the byproduct.\n\nContents \n\n1 Uses \n2 History \n3 Physical properties \n\n3.1 Intrinsic viscosity \n\n\n4 Drying \n5 Copolymers \n6 Production \n\n6.1 Dimethyl terephthalate process (DMT) \n6.2 Terephthalic acid process \n\n\n7 Degradation \n\n7.1 Acetaldehyde \n7.2 Antimony \n7.3 Biodegradation \n\n\n8 Safety \n9 Bottle processing equipment \n10 Polyester recycling industry \n\n10.1 PET bottle recycling \n\n10.1.1 Purification and decontamination \n10.1.2 Impurities and material defects \n\n\n10.2 Processing examples for recycled polyester \n\n10.2.1 Simple re-pelletizing of bottle flakes \n10.2.2 Manufacture of PET-pellets or flakes for bottles (bottle to bottle) and A-PET \n10.2.3 Direct conversion of bottle flakes \n\n\n10.3 Recycling to the monomers \n\n10.3.1 Partial glycolysis \n\n\n10.4 Total glycolysis, methanolysis, and hydrolysis \n\n\n11 See also \n12 References \n13 External links \n\n\n\n\n\n\nYoung's modulus (E)\n\n2800\u20133100 MPa\n\n\nTensile strength (\u03c3t)\n\n55\u201375 MPa\n\n\nElastic limit\n\n50\u2013150%\n\n\nnotch test\n\n3.6 kJ\/m2\n\n\nGlass transition temperature (Tg)\n\n67\u201381 \u00b0C\n\n\nVicat B\n\n82 \u00b0C\n\n\nlinear expansion coefficient (\u03b1)\n\n6995700000000000000\u2660 7\u00d7 10\u22125 K\u22121 \n\n\nWater absorption (ASTM)\n\n0.16\n\n\nSource[1]\n\nUses \nPlastic bottles made from PET are widely used for soft drinks (see carbonation). For certain specialty bottles, such as those designated for beer containment, PET sandwiches an additional polyvinyl alcohol (PVOH) layer to further reduce its oxygen permeability.\nBiaxially oriented PET film (often known by one of its trade names, \"Mylar\") can be aluminized by evaporating a thin film of metal onto it to reduce its permeability, and to make it reflective and opaque (MPET). These properties are useful in many applications, including flexible food packaging and thermal insulation (such as space blankets). Because of its high mechanical strength, PET film is often used in tape applications, such as the carrier for magnetic tape or backing for pressure-sensitive adhesive tapes.\nNon-oriented PET sheet can be thermoformed to make packaging trays and blister packs.[7] If crystallizable PET is used, the trays can be used for frozen dinners, since they withstand both freezing and oven baking temperatures. Both amorphous PET and BoPET are transparent to the naked eye. Color-conferring dyes can easily be formulated into PET sheet.\nWhen filled with glass particles or fibres, it becomes significantly stiffer and more durable.\nPET is also used as a substrate in thin film solar cells.\nTerylene (a trademark formed by inversion of (polyeth)ylene ter(ephthalate)) is also spliced into bell rope tops to help prevent wear on the ropes as they pass through the ceiling.\nPET is used since late 2014 as liner material in type IV composite high pressure gas cylinders. PET works as a much better barrier to oxygen than earlier used (LD)PE.[8]\nPET is used as a 3D printing filament, as well as in the 3D printing plastic PETG.\n\nHistory \nPET was patented in 1941 by John Rex Whinfield, James Tennant Dickson and their employer the Calico Printers' Association of Manchester, England. E. I. DuPont de Nemours in Delaware, United States, first used the trademark Mylar in June 1951 and received registration of it in 1952.[9] It is still the best-known name used for polyester film. The current owner of the trademark is DuPont Teijin Films US, a partnership with a Japanese company.[10]\nIn the Soviet Union, PET was first manufactured in the laboratories of the Institute of High-Molecular Compounds of the USSR Academy of Sciences in 1949, and its name \"Lavsan\" is an acronym thereof (\u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u0438\u0438 \u0418\u043d\u0441\u0442\u0438\u0442\u0443\u0442\u0430 \u0432\u044b\u0441\u043e\u043a\u043e\u043c\u043e\u043b\u0435\u043a\u0443\u043b\u044f\u0440\u043d\u044b\u0445 \u0441\u043e\u0435\u0434\u0438\u043d\u0435\u043d\u0438\u0439 \u0410\u043a\u0430\u0434\u0435\u043c\u0438\u0438 \u043d\u0430\u0443\u043a \u0421\u0421\u0421\u0420).[11]\nThe PET bottle was patented in 1973 by Nathaniel Wyeth.[12]\n\nPhysical properties \n Sailcloth is typically made from PET fibers also known as polyester or under the brand name Dacron; colorful lightweight spinnakers are usually made of nylon.\nPET in its natural state is a colorless, semi-crystalline resin. Based on how it is processed, PET can be semi-rigid to rigid, and it is very lightweight. It makes a good gas and fair moisture barrier, as well as a good barrier to alcohol (requires additional \"barrier\" treatment) and solvents. It is strong and impact-resistant. PET becomes white when exposed to chloroform and also certain other chemicals such as toluene.[13]\nAbout 60% crystallization is the upper limit for commercial products[citation needed ], with the exception of polyester fibers. Clear products can be produced by rapidly cooling molten polymer below Tg glass transition temperature to form an amorphous solid. Like glass, amorphous PET forms when its molecules are not given enough time to arrange themselves in an orderly, crystalline fashion as the melt is cooled. At room temperature the molecules are frozen in place, but, if enough heat energy is put back into them by heating above Tg, they begin to move again, allowing crystals to nucleate and grow. This procedure is known as solid-state crystallization.\nWhen allowed to cool slowly, the molten polymer forms a more crystalline material. This material has spherulites containing many small crystallites when crystallized from an amorphous solid, rather than forming one large single crystal. Light tends to scatter as it crosses the boundaries between crystallites and the amorphous regions between them. This scattering means that crystalline PET is opaque and white in most cases. Fiber drawing is among the few industrial processes that produce a nearly single-crystal product.\n\nIntrinsic viscosity \nOne of the most important characteristics of PET is referred to as intrinsic viscosity (IV).[14]\nThe intrinsic viscosity of the material, found by extrapolating to zero concentration of relative viscosity to concentration which is measured in deciliters per gram (d\u2113\/g). Intrinsic viscosity is dependent upon the length of its polymer chains but has no units due to being extrapolated to zero concentration. The longer the polymer chains the more entanglements between chains and therefore the higher the viscosity. The average chain length of a particular batch of resin can be controlled during polycondensation.\nThe intrinsic viscosity range of PET:[15]\nFiber grade:\n\n0.40\u20130.70 Textile\n0.72\u20130.98 Technical, tire cord\nFilm grade:\n\n0.60\u20130.70 BoPET (biaxially oriented PET film)\n0.70\u20131.00 Sheet grade for thermoforming\nBottle grade:\n\n0.70\u20130.78 Water bottles (flat)\n0.78\u20130.85 Carbonated soft drink grade\nMonofilament, engineering plastic\n\n1.00\u20132.00\nDrying \nPET is hygroscopic, meaning that it absorbs water from its surroundings. However, when this \"damp\" PET is then heated, the water hydrolyzes the PET, decreasing its resilience. Thus, before the resin can be processed in a molding machine, it must be dried. Drying is achieved through the use of a desiccant or dryers before the PET is fed into the processing equipment.\nInside the dryer, hot dry air is pumped into the bottom of the hopper containing the resin so that it flows up through the pellets, removing moisture on its way. The hot wet air leaves the top of the hopper and is first run through an after-cooler, because it is easier to remove moisture from cold air than hot air. The resulting cool wet air is then passed through a desiccant bed. Finally, the cool dry air leaving the desiccant bed is re-heated in a process heater and sent back through the same processes in a closed loop. Typically, residual moisture levels in the resin must be less than 50 parts per million (parts of water per million parts of resin, by weight) before processing. Dryer residence time should not be shorter than about four hours. This is because drying the material in less than 4 hours would require a temperature above 160 \u00b0C, at which level hydrolysis would begin inside the pellets before they could be dried out.\nPET can also be dried in compressed air resin dryers. Compressed air dryers do not reuse drying air. Dry, heated compressed air is circulated through the PET pellets as in the desiccant dryer, then released to the atmosphere.\n\nCopolymers \nIn addition to pure (homopolymer) PET, PET modified by copolymerization is also available.\nIn some cases, the modified properties of copolymer are more desirable for a particular application. For example, cyclohexane dimethanol (CHDM) can be added to the polymer backbone in place of ethylene glycol. Since this building block is much larger (6 additional carbon atoms) than the ethylene glycol unit it replaces, it does not fit in with the neighboring chains the way an ethylene glycol unit would. This interferes with crystallization and lowers the polymer's melting temperature. In general, such PET is known as PETG or PET-G (Polyethylene terephthalate glycol-modified; Eastman Chemical, SK Chemicals Selenis are some PETG manufacturers). PETG is a clear amorphous thermoplastic that can be injection molded, sheet extruded or extruded as filament for 3D printing. It can be colored during processing.\n\n Replacing terephthalic acid (right) with isophthalic acid (center) creates a kink in the PET chain, interfering with crystallization and lowering the polymer's melting point.\nAnother common modifier is isophthalic acid, replacing some of the 1,4-(para-) linked terephthalate units. The 1,2-(ortho-) or 1,3-(meta-) linkage produces an angle in the chain, which also disturbs crystallinity.\nSuch copolymers are advantageous for certain molding applications, such as thermoforming, which is used for example to make tray or blister packaging from co-PET film, or amorphous PET sheet (A-PET\/PETA) or PETG sheet. On the other hand, crystallization is important in other applications where mechanical and dimensional stability are important, such as seat belts. For PET bottles, the use of small amounts of isophthalic acid, CHDM, diethylene glycol (DEG) or other comonomers can be useful: if only small amounts of comonomers are used, crystallization is slowed but not prevented entirely. As a result, bottles are obtainable via stretch blow molding (\"SBM\"), which are both clear and crystalline enough to be an adequate barrier to aromas and even gases, such as carbon dioxide in carbonated beverages.\n\nProduction \nPolyethylene terephthalate is produced from ethylene glycol and dimethyl terephthalate(DMT) (C6H4(CO2CH3)2) or terephthalic acid.[16]\nThe former is a transesterification reaction, whereas the latter is an esterification reaction.\n\n Dimethyl terephthalate process (DMT) \n Polyesterification reaction in the production of PET\nIn dimethyl terephthalate(DMT) process, this compound and excess ethylene glycol are reacted in the melt at 150\u2013200 \u00b0C with a basic catalyst. Methanol (CH3OH) is removed by distillation to drive the reaction forward. Excess ethylene glycol is distilled off at higher temperature with the aid of vacuum. The second transesterification step proceeds at 270\u2013280 \u00b0C, with continuous distillation of ethylene glycol as well.[16]\nThe reactions are idealized as follows:\n\nFirst step\nC6H4(CO2CH3)2 + 2 HOCH2CH2OH \u2192 C6H4(CO2CH2CH2OH)2 + 2 CH3OH\nSecond step\nn C6H4(CO2CH2CH2OH)2 \u2192 [(CO)C6H4(CO2CH2CH2O)]n + n HOCH2CH2OH\nTerephthalic acid process \n Polycondensation reaction in the production of PET\nIn the terephthalic acid process, esterification of ethylene glycol and terephthalic acid is conducted directly at moderate pressure (2.7\u20135.5 bar) and high temperature (220\u2013260 \u00b0C). Water is eliminated in the reaction, and it is also continuously removed by distillation:[16]\n\nn C6H4(CO2H)2 + n HOCH2CH2OH \u2192 [(CO)C6H4(CO2CH2CH2O)]n + 2n H2O\nDegradation \nPET is subjected to various types of degradations during processing. The main degradations that can occur are hydrolytic, and probably most important, thermal oxidation. When PET degrades, several things happen: discoloration, chain scissions resulting in reduced molecular weight, formation of acetaldehyde, and cross-links (\"gel\" or \"fish-eye\" formation). Discoloration is due to the formation of various chromophoric systems following prolonged thermal treatment at elevated temperatures. This becomes a problem when the optical requirements of the polymer are very high, such as in packaging applications. The thermal and thermooxidative degradation results in poor processibility characteristics and performance of the material.\nOne way to alleviate this is to use a copolymer. Comonomers such as CHDM or isophthalic acid lower the melting temperature and reduce the degree of crystallinity of PET (especially important when the material is used for bottle manufacturing). Thus, the resin can be plastically formed at lower temperatures and\/or with lower force. This helps to prevent degradation, reducing the acetaldehyde content of the finished product to an acceptable (that is, unnoticeable) level. See copolymers, above. Another way to improve the stability of the polymer is to use stabilizers, mainly antioxidants such as phosphites. Recently, molecular level stabilization of the material using nanostructured chemicals has also been considered.\n\nAcetaldehyde \nAcetaldehyde is a colorless, volatile substance with a fruity smell. Although it forms naturally in some fruit, it can cause an off-taste in bottled water. Acetaldehyde forms by degradation of PET through the mishandling of the material. High temperatures (PET decomposes above 300 \u00b0C or 570 \u00b0F), high pressures, extruder speeds (excessive shear flow raises temperature), and long barrel residence times all contribute to the production of acetaldehyde. When acetaldehyde is produced, some of it remains dissolved in the walls of a container and then diffuses into the product stored inside, altering the taste and aroma. This is not such a problem for non-consumables (such as shampoo), for fruit juices (which already contain acetaldehyde), or for strong-tasting drinks like soft drinks. For bottled water, however, low acetaldehyde content is quite important, because, if nothing masks the aroma, even extremely low concentrations (10\u201320 parts per billion in the water) of acetaldehyde can produce an off-taste.\n\nAntimony \nAntimony (Sb) is a metalloid element that is used as a catalyst in the form of compounds such as antimony trioxide (Sb2O3) or antimony triacetate in the production of PET. After manufacturing, a detectable amount of antimony can be found on the surface of the product. This residue can be removed with washing. Antimony also remains in the material itself and can, thus, migrate out into food and drinks. Exposing PET to boiling or microwaving can increase the levels of antimony significantly, possibly above USEPA maximum contamination levels.[17]\nThe drinking water limit assessed by WHO is 20 parts per billion (WHO, 2003), and the drinking water limit in the United States is 6 parts per billion.[18] Although antimony trioxide is of low toxicity when taken orally,[19] its presence is still of concern. The Swiss Federal Office of Public Health investigated the amount of antimony migration, comparing waters bottled in PET and glass: The antimony concentrations of the water in PET bottles were higher, but still well below the allowed maximum concentration. The Swiss Federal Office of Public Health concluded that small amounts of antimony migrate from the PET into bottled water, but that the health risk of the resulting low concentrations is negligible (1% of the \"tolerable daily intake\" determined by the WHO). A later (2006) but more widely publicized study found similar amounts of antimony in water in PET bottles.[20]\nThe WHO has published a risk assessment for antimony in drinking water.[19]\nFruit juice concentrates (for which no guidelines are established), however, that were produced and bottled in PET in the UK were found to contain up to 44.7 \u00b5g\/L of antimony, well above the EU limits for tap water of 5 \u00b5g\/L.[21][22]\n\nBiodegradation \nAt least one species of bacterium in the genus Nocardia can degrade PET with an esterase enzyme.[23]\nJapanese scientists have isolated a bacterium Ideonella sakaiensis that possesses two enzymes which can break down the PET into smaller pieces that the bacterium can digest. A colony of I. sakaiensis can disintegrate a plastic film in about six weeks.[24][25]\n\nSafety \nCommentary published in Environmental Health Perspectives in April 2010 suggested that PET might yield endocrine disruptors under conditions of common use and recommended research on this topic.[26] Proposed mechanisms include leaching of phthalates as well as leaching of antimony.\nAn article published in Journal of Environmental Monitoring in April 2012 concludes that antimony concentration in deionized water stored in PET bottles stays within EU's acceptable limit even if stored briefly at temperatures up to 60 \u00b0C (140 \u00b0F), while bottled contents (water or soft drinks) may occasionally exceed the EU limit after less than a year of storage at room temperature.[27]\n\nBottle processing equipment \n A finished PET drink bottle compared to the preform from which it is made. Worldwide, 480 billion plastic drinking bottles were made in 2016 (and less than half were recycled).[28]\nThere are two basic molding methods for PET bottles, one-step and two-step. In two-step molding, two separate machines are used. The first machine injection molds the preform, which resembles a test tube, with the bottle-cap threads already molded into place. The body of the tube is significantly thicker, as it will be inflated into its final shape in the second step using stretch blow molding.\nIn the second step, the preforms are heated rapidly and then inflated against a two-part mold to form them into the final shape of the bottle. Preforms (uninflated bottles) are now also used as robust and unique containers themselves; besides novelty candy, some Red Cross chapters distribute them as part of the Vial of Life program to homeowners to store medical history for emergency responders.\nIn one-step machines, the entire process from raw material to finished container is conducted within one machine, making it especially suitable for molding non-standard shapes (custom molding), including jars, flat oval, flask shapes, etc. Its greatest merit is the reduction in space, product handling and energy, and far higher visual quality than can be achieved by the two-step system.[citation needed ]\n\nPolyester recycling industry \nMain article: PET bottle recycling\nThis section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2011) (Learn how and when to remove this template message)\n\nIn 2016, it was estimated that 56 million tons of PET are produced each year.[29] While most thermoplastics can, in principle, be recycled, PET bottle recycling is more practical than many other plastic applications because of the high value of the resin and the almost exclusive use of PET for widely used water and carbonated soft drink bottling. PET has a resin identification code of 1.[30] The prime uses for recycled PET are polyester fiber, strapping, and non-food containers.[30]\nBecause of the recyclability of PET and the relative abundance of post-consumer waste in the form of bottles, PET is rapidly gaining market share as a carpet fiber. Mohawk Industries released everSTRAND in 1999, a 100% post-consumer recycled content PET fiber. Since that time, more than 17 billion bottles have been recycled into carpet fiber.[31] Pharr Yarns, a supplier to numerous carpet manufacturers including Looptex, Dobbs Mills, and Berkshire Flooring,[32] produces a BCF (bulk continuous filament) PET carpet fiber containing a minimum of 25% post-consumer recycled content.\nPET, like many plastics, is also an excellent candidate for thermal disposal (incineration), as it is composed of carbon, hydrogen, and oxygen, with only trace amounts of catalyst elements (but no sulfur). PET has the energy content of soft coal.\nWhen recycling polyethylene terephthalate or PET or polyester, in general three ways have to be differentiated:\n\nThe chemical recycling back to the initial raw materials purified terephthalic acid (PTA) or dimethyl terephthalate (DMT) and ethylene glycol (EG) where the polymer structure is destroyed completely, or in process intermediates like bis(2-hydroxyethyl) terephthalate\nThe mechanical recycling where the original polymer properties are being maintained or reconstituted.\nThe chemical recycling where transesterification takes place and other glycols\/polyols or glycerol are added to make a polyol which may be used in other ways such as polyurethane production or PU foam production[33]\nChemical recycling of PET will become cost-efficient only applying high capacity recycling lines of more than 50,000 tons\/year. Such lines could only be seen, if at all, within the production sites of very large polyester producers. Several attempts of industrial magnitude to establish such chemical recycling plants have been made in the past but without resounding success. Even the promising chemical recycling in Japan has not become an industrial breakthrough so far. The two reasons for this are: at first, the difficulty of consistent and continuous waste bottles sourcing in such a huge amount at one single site, and, at second, the steadily increased prices and price volatility of collected bottles. The prices of baled bottles increased for instance between the years 2000 and 2008 from about 50 Euro\/ton to over 500 Euro\/ton in 2008.\nMechanical recycling or direct circulation of PET in the polymeric state is operated in most diverse variants today. These kinds of processes are typical of small and medium-size industry. Cost-efficiency can already be achieved with plant capacities within a range of 5000\u201320,000 tons\/year. In this case, nearly all kinds of recycled-material feedback into the material circulation are possible today. These diverse recycling processes are being discussed hereafter in detail.\nBesides chemical contaminants and degradation products generated during first processing and usage, mechanical impurities are representing the main part of quality depreciating impurities in the recycling stream. Recycled materials are increasingly introduced into manufacturing processes, which were originally designed for new materials only. Therefore, efficient sorting, separation and cleaning processes become most important for high quality recycled polyester.\nWhen talking about polyester recycling industry, we are concentrating mainly on recycling of PET bottles, which are meanwhile used for all kinds of liquid packaging like water, carbonated soft drinks, juices, beer, sauces, detergents, household chemicals and so on. Bottles are easy to distinguish because of shape and consistency and separate from waste plastic streams either by automatic or by hand-sorting processes. The established polyester recycling industry consists of three major sections:\n\nPET bottle collection and waste separation: waste logistics\nProduction of clean bottle flakes: flake production\nConversion of PET flakes to final products: flake processing\nIntermediate product from the first section is baled bottle waste with a PET content greater than 90%. Most common trading form is the bale but also bricked or even loose, pre-cut bottles are common in the market. In the second section, the collected bottles are converted to clean PET bottle flakes. This step can be more or less complex and complicated depending on required final flake quality. During the third step, PET bottle flakes are processed to any kind of products like film, bottles, fiber, filament, strapping or intermediates like pellets for further processing and engineering plastics.\nBesides this external (post-consumer) polyester bottle recycling, numbers of internal (pre-consumer) recycling processes exist, where the wasted polymer material does not exit the production site to the free market, and instead is reused in the same production circuit. In this way, fiber waste is directly reused to produce fiber, preform waste is directly reused to produce preforms, and film waste is directly reused to produce film.\n\nPET bottle recycling \nMain article: PET bottle recycling\nPurification and decontamination \nThe success of any recycling concept is hidden in the efficiency of purification and decontamination at the right place during processing and to the necessary or desired extent.\nIn general, the following applies: The earlier in the process foreign substances are removed, and the more thoroughly this is done, the more efficient the process is.\nThe high plasticization temperature of PET in the range of 280 \u00b0C (536 \u00b0F) is the reason why almost all common organic impurities such as PVC, PLA, polyolefin, chemical wood-pulp and paper fibers, polyvinyl acetate, melt adhesive, coloring agents, sugar, and protein residues are transformed into colored degradation products that, in their turn, might release in addition reactive degradation products.[clarification needed ][citation needed ] Then, the number of defects in the polymer chain increases considerably. The particle size distribution of impurities is very wide, the big particles of 60\u20131000 \u00b5m\u2014which are visible by naked eye and easy to filter\u2014representing the lesser evil, since their total surface is relatively small and the degradation speed is therefore lower. The influence of the microscopic particles, which\u2014because they are many\u2014increase the frequency of defects in the polymer, is relatively greater.\nThe motto \"What the eye does not see the heart cannot grieve over\" is considered to be very important in many recycling processes. Therefore, besides efficient sorting, the removal of visible impurity particles by melt filtration processes plays a particular part in this case.\n\n Workers sort an incoming stream of various plastics, mixed with some pieces of un-recyclable litter.\n Bales of crushed blue PET bottles.\n Bales of crushed PET bottles sorted according to color: green, transparent, and blue.\nIn general, one can say that the processes to make PET bottle flakes from collected bottles are as versatile as the different waste streams are different in their composition and quality. In view of technology there isn't just one way to do it. Meanwhile, there are many engineering companies that are offering flake production plants and components, and it is difficult to decide for one or other plant design. Nevertheless, there are processes that are sharing most of these principles. Depending on composition and impurity level of input material, the general following process steps are applied.[34]\n\nBale opening, briquette opening\nSorting and selection for different colors, foreign polymers especially PVC, foreign matter, removal of film, paper, glass, sand, soil, stones, and metals\nPre-washing without cutting\nCoarse cutting dry or combined to pre-washing\nRemoval of stones, glass, and metal\nAir sifting to remove film, paper, and labels\nGrinding, dry and \/ or wet\nRemoval of low-density polymers (cups) by density differences\nHot-wash\nCaustic wash, and surface etching, maintaining intrinsic viscosity and decontamination\nRinsing\nClean water rinsing\nDrying\nAir-sifting of flakes\nAutomatic flake sorting\nWater circuit and water treatment technology\nFlake quality control\nImpurities and material defects \nThe number of possible impurities and material defects that accumulate in the polymeric material is increasing permanently\u2014when processing as well as when using polymers\u2014taking into account a growing service lifetime, growing final applications and repeated recycling. As far as recycled PET bottles are concerned, the defects mentioned can be sorted in the following groups:\n\nReactive polyester OH- or COOH- end groups are transformed into dead or non-reactive end groups, e.g. formation of vinyl ester end groups through dehydration or decarboxylation of terephthalate acid, reaction of the OH- or COOH- end groups with mono-functional degradation products like mono-carbonic acids or alcohols. Results are decreased reactivity during re-polycondensation or re-SSP and broadening the molecular weight distribution.\nThe end group proportion shifts toward the direction of the COOH end groups built up through a thermal and oxidative degradation. The results are decrease in reactivity, and increase in the acid autocatalytic decomposition during thermal treatment in presence of humidity.\nNumber of polyfunctional macromolecules increases. Accumulation of gels and long-chain branching defects.\nNumber, concentration, and variety of nonpolymer-identical organic and inorganic foreign substances are increasing. With every new thermal stress, the organic foreign substances will react by decomposition. This is causing the liberation of further degradation-supporting substances and coloring substances.\nHydroxide and peroxide groups build up at the surface of the products made of polyester in presence of air (oxygen) and humidity. This process is accelerated by ultraviolet light. During an ulterior treatment process, hydro peroxides are a source of oxygen radicals, which are source of oxidative degradation. Destruction of hydro peroxides is to happen before the first thermal treatment or during plasticization and can be supported by suitable additives like antioxidants.\nTaking into consideration the above-mentioned chemical defects and impurities, there is an ongoing modification of the following polymer characteristics during each recycling cycle, which are detectable by chemical and physical laboratory analysis.\nIn particular:\n\nIncrease of COOH end-groups\nIncrease of color number b\nIncrease of haze (transparent products)\nIncrease of oligomer content\nReduction in filterability\nIncrease of by-products content such as acetaldehyde, formaldehyde\nIncrease of extractable foreign contaminants\nDecrease in color L\nDecrease of intrinsic viscosity or dynamic viscosity\nDecrease of crystallization temperature and increase of crystallization speed\nDecrease of the mechanical properties like tensile strength, elongation at break or elastic modulus\nBroadening of molecular weight distribution\nThe recycling of PET bottles is meanwhile an industrial standard process that is offered by a wide variety of engineering companies.[35]\n\nProcessing examples for recycled polyester \nRecycling processes with polyester are almost as varied as the manufacturing processes based on primary pellets or melt. Depending on purity of the recycled materials, polyester can be used today in most of the polyester manufacturing processes as blend with virgin polymer or increasingly as 100% recycled polymer. Some exceptions like BOPET-film of low thickness, special applications like optical film or yarns through FDY-spinning at > 6000 m\/min, microfilaments, and micro-fibers are produced from virgin polyester only.\n\nSimple re-pelletizing of bottle flakes \nThis process consists of transforming bottle waste into flakes, by drying and crystallizing the flakes, by plasticizing and filtering, as well as by pelletizing.\nProduct is an amorphous re-granulate of an intrinsic viscosity in the range of 0.55\u20130.7 d\u2113\/g, depending on how complete pre-drying of PET flakes has been done.\nSpecial feature are: Acetaldehyde and oligomers are contained in the pellets at lower level; the viscosity is reduced somehow, the pellets are amorphous and have to be crystallized and dried before further processing.\nProcessing to:\n\nA-PET film for thermoforming\nAddition to PET virgin production\nBoPET packaging film\nPET Bottle resin by SSP\nCarpet yarn\nEngineering plastic\nFilaments\nNon-woven\nPackaging stripes\nStaple fibre.\nChoosing the re-pelletizing way means having an additional conversion process that is, at the one side, energy-intensive and cost-consuming, and causes thermal destruction. At the other side, the pelletizing step is providing the following advantages:\n\nIntensive melt filtration\nIntermediate quality control\nModification by additives\nProduct selection and separation by quality\nProcessing flexibility increased\nQuality uniformization.\n Manufacture of PET-pellets or flakes for bottles (bottle to bottle) and A-PET \nThis process is, in principle, similar to the one described above; however, the pellets produced are directly (continuously or discontinuously) crystallized and then subjected to a solid-state polycondensation (SSP) in a tumbling drier or a vertical tube reactor. During this processing step, the corresponding intrinsic viscosity of 0.80\u20130.085 d\u2113\/g is rebuild again and, at the same time, the acetaldehyde content is reduced to < 1 ppm.\nThe fact that some machine manufacturers and line builders in Europe and the United States make efforts to offer independent recycling processes, e.g. the so-called bottle-to-bottle (B-2-B) process, such as BePET,[36] Starlinger,[37] URRC or B\u00dcHLER, aims at generally furnishing proof of the \"existence\" of the required extraction residues and of the removal of model contaminants according to FDA applying the so-called challenge test, which is necessary for the application of the treated polyester in the food sector. Besides this process approval it is nevertheless necessary that any user of such processes has to constantly check the FDA limits for the raw materials manufactured by themselves for their process.\n\nDirect conversion of bottle flakes \nIn order to save costs, an increasing number of polyester intermediate producers like spinning mills, strapping mills, or cast film mills are working on the direct use of the PET-flakes, from the treatment of used bottles, with a view to manufacturing an increasing number of polyester intermediates. For the adjustment of the necessary viscosity, besides an efficient drying of the flakes, it is possibly necessary to also reconstitute the viscosity through polycondensation in the melt phase or solid-state polycondensation of the flakes. The latest PET flake conversion processes are applying twin screw extruders, multi-screw extruders or multi-rotation systems and coincidental vacuum degassing to remove moisture and avoid flake pre-drying. These processes allow the conversion of undried PET flakes without substantial viscosity decrease caused by hydrolysis.\nWith regard to the consumption of PET bottle flakes, the main portion of about 70% is converted to fibers and filaments. When using directly secondary materials such as bottle flakes in spinning processes, there are a few processing principles to obtain.\nHigh-speed spinning processes for the manufacture of POY normally need a viscosity of 0.62\u20130.64 d\u2113\/g. Starting from bottle flakes, the viscosity can be set via the degree of drying. The additional use of TiO2 is necessary for full dull or semi dull yarn. In order to protect the spinnerets, an efficient filtration of the melt is, in any case is necessary. For the time-being, the amount of POY made of 100% recycling polyester is rather low because this process requires high purity of spinning melt. Most of the time, a blend of virgin and recycled pellets is used.\nStaple fibers are spun in an intrinsic viscosity range that lies rather somewhat lower and that should be between 0.58 and 0.62 d\u2113\/g. In this case, too, the required viscosity can be adjusted via drying or vacuum adjustment in case of vacuum extrusion. For adjusting the viscosity, however, an addition of chain length modifier like ethylene glycol or diethylene glycol can also be used.\nSpinning non-woven\u2014in the fine titer field for textile applications as well as heavy spinning non-woven as basic materials, e.g. for roof covers or in road building\u2014can be manufactured by spinning bottle flakes. The spinning viscosity is again within a range of 0.58\u20130.65 d\u2113\/g.\nOne field of increasing interest where recycled materials are used is the manufacture of high-tenacity packaging stripes, and monofilaments. In both cases, the initial raw material is a mainly recycled material of higher intrinsic viscosity. High-tenacity packaging stripes as well as monofilament are then manufactured in the melt spinning process.\n\nRecycling to the monomers \nPolyethylene terephthalate can be depolymerized to yield the constituent monomers. After purification, the monomers can be used to prepare new polyethylene terephthalate. The ester bonds in polyethylene terephthalate may be cleaved by hydrolysis, or by transesterification. The reactions are simply the reverse of those used in production.\n\nPartial glycolysis \nPartial glycolysis (transesterification with ethylene glycol) converts the rigid polymer into short-chained oligomers that can be melt-filtered at low temperature. Once freed of the impurities, the oligomers can be fed back into the production process for polymerization.\nThe task consists in feeding 10\u201325% bottle flakes while maintaining the quality of the bottle pellets that are manufactured on the line. This aim is solved by degrading the PET bottle flakes\u2014already during their first plasticization, which can be carried out in a single- or multi-screw extruder\u2014to an intrinsic viscosity of about 0.30 d\u2113\/g by adding small quantities of ethylene glycol and by subjecting the low-viscosity melt stream to an efficient filtration directly after plasticization. Furthermore, temperature is brought to the lowest possible limit. In addition, with this way of processing, the possibility of a chemical decomposition of the hydro peroxides is possible by adding a corresponding P-stabilizer directly when plasticizing.\nThe destruction of the hydro peroxide groups is, with other processes, already carried out during the last step of flake treatment for instance by adding H3PO3.[38] The partially glycolyzed and finely filtered recycled material is continuously fed to the esterification or prepolycondensation reactor, the dosing quantities of the raw materials are being adjusted accordingly.\n\n<\/p>\n Total glycolysis, methanolysis, and hydrolysis \nThe treatment of polyester waste through total glycolysis to fully convert the polyester to bis(2-hydroxyethyl) terephthalate (C6H4(CO2CH2CH2OH)2). This compound is purified by vacuum distillation, and is one of the intermediates used in polyester manufacture (see production). The reaction involved is as follows:\n\n[(CO)C6H4(CO2CH2CH2O)]n + n HOCH2CH2OH → n C6H4(CO2CH2CH2OH)2\nThis recycling route has been executed on an industrial scale in Japan as experimental production.[citation needed ]\nSimilar to total glycolysis, methanolysis converts the polyester to dimethyl terephthalate(DMT), which can be filtered and vacuum distilled:\n\n[(CO)C6H4(CO2CH2CH2O)]n + 2n CH3OH → n C6H4(CO2CH3)2\nMethanolysis is only rarely carried out in industry today because polyester production based on dimethyl terephthalate(DMT) has shrunk tremendously, and many dimethyl terephthalate (DMT) producers have disappeared.[39]\nAlso as above, polyethylene terephthalate can be hydrolyzed to terephthalic acid and ethylene glycol under high temperature and pressure. The resultant crude terephthalic acid can be purified by recrystallization to yield material suitable for re-polymerization:\n\n[(CO)C6H4(CO2CH2CH2O)]n + 2n H2O → n C6H4(CO2H)2 + n HOCH2CH2OH\nThis method does not appear to have been commercialized yet.[citation needed ]\n\nSee also \n\n\n Chemistry portal \nBoPET (biaxially oriented PET)\nBioplastic\nPET bottle recycling\nPlastic recycling\nPolycyclohexylenedimethylene terephthalate\u2014a polyester with a similar structure to PET\nPolyester\nSolar water disinfection\u2014a method of disinfecting water using only sunlight and plastic PET bottles\nReferences \n\n\n^ a b c d e f g h van der Vegt, A. K.; Govaert, L. E. (2005). Polymeren, van keten tot kunstof. VSSD. ISBN 9071301486. \n\n^ a b c Record of Polyethylenterephthalat in the GESTIS Substance Database of the Institute for Occupational Safety and Health, accessed on 7 November 2007. \n\n^ \"poly(ethylene terephthalate) macromolecule_msds\". \n\n^ a b Speight, J. G.; Lange, Norbert Adolph (2005). McGraw-Hill, ed. Lange's Handbook of Chemistry (16th ed.). pp. 2807\u20132758. ISBN 0-07-143220-5. \n\n^ The name Terylene was formed by inversion of (polyeth)ylene ter(ephthalate) and dates to the 1940s. Oxford Dictionary. Terylene was first registered as a UK trademark in April 1946.[citation needed ] UK Intellectual Property Office UK00000646992 \n\n^ Ji, Li Na (June 2013). \"Study on Preparation Process and Properties of Polyethylene Terephthalate (PET)\". Applied Mechanics and Materials. 312: 406\u2013410. doi:10.4028\/www.scientific.net\/AMM.312.406. \n\n^ Pasbrig, Erwin (Mar 29, 2007), Cover film for blister packs, retrieved 2016-11-20 \n\n^ SIPA: Lightweight compressed gas cylinders have plastic liners \/ PET provides high oxygen barrier https:\/\/www.plasteurope.com, 18 November 2014, retrieved 16 May 2017. \n\n^ Whinfield, John Rex and Dickson, James Tennant (1941) \"Improvements Relating to the Manufacture of Highly Polymeric Substances\", UK Patent 578,079; \"Polymeric Linear Terephthalic Esters\", U.S. Patent 2,465,319 Publication date: 22 March 1949; Filing date: 24 September 1945; Priority date: 29 July 1941 \n\n^ TEIJIN: Trademarks \"Mylar and Melinex are the registered trademarks or trademarks of Dupont Teijin Films U.S. Limited Partnership and have been licensed to Teijin DuPont Films Japan Limited\" \n\n^ Ryazanova-Clarke, Larissa; Wade, Terence (31 January 2002). The Russian Language Today. Taylor & Francis. pp. 49\u2013. ISBN 978-0-203-06587-7. \n\n^ Wyeth, Nathaniel C. \"Biaxially Oriented Poly(ethylene terephthalate) Bottle\" US patent 3733309, Issued May 1973 \n\n^ NPCS Board of Consultants & Engineers (2014) Chapter 6, p. 56 in Disposable Products Manufacturing Handbook, NIIR Project Consultancy Services, Delhi, ISBN 978-9-381-03932-8 \n\n^ Thiele, Ulrich K. (2007) Polyester Bottle Resins, Production, Processing, Properties and Recycling, Heidelberg, Germany, pp. 85 ff, ISBN 978-3-9807497-4-9 \n\n^ Gupta, V.B. and Bashir, Z. (2002) Chapter 7, p. 320 in Fakirov, Stoyko (ed.) Handbook of Thermoplastic Polyesters, Wiley-VCH, Weinheim, ISBN 3-527-30113-5. \n\n^ a b c \"Polyesters\", Ullmann's Encyclopedia of Industrial Chemistry, A21, Weinheim: Wiley-VCH, pp. 233\u2013238, doi:10.1002\/14356007.a21_227 \n\n^ Cheng, X.; et al. (2010). \"Assessment of metal contaminations leaching out from recycling plastic bottles upon treatments\". Environmental science and pollution research international. 17 (7): 1323\u201330. doi:10.1007\/s11356-010-0312-4. PMID 20309737. \n\n^ Consumer Factsheet on: Antimony, EPA archive 2003-06-23 \n\n^ a b Guidelines for drinking \u2013 water quality. who.int \n\n^ Shotyk, William; et al. (2006). \"Contamination of Canadian and European bottled waters with antimony from PET containers\". Journal of Environmental Monitoring. 8 (2): 288\u201392. doi:10.1039\/b517844b. PMID 16470261. \n\n^ Hansen, Claus; et al. (2010). \"Elevated antimony concentrations in commercial juices\". Journal of Environmental Monitoring. 12 (4): 822\u20134. doi:10.1039\/b926551a. PMID 20383361. \n\n^ Borland, Sophie (1 March 2010). \"Fruit juice cancer warning as scientists find harmful chemical in 16 drinks\". Daily Mail. \n\n^ Sharon, Chetna; Sharon, Madhuri (2012). \"Studies on Biodegradation of Polyethylene terephthalate: A synthetic polymer\" (PDF) . Journal of Microbiology and Biotechnology Research. 2 (2): 248\u2013257. \n\n^ Yoshida, S.; Hiraga, K.; Takehana, T.; Taniguchi, I.; Yamaji, H.; Maeda, Y.; Toyohara, K.; Miyamoto, K.; Kimura, Y.; Oda, K. (11 March 2016). \"A bacterium that degrades and assimilates poly(ethylene terephthalate)\". Science. 351 (6278): 1196. doi:10.1126\/science.aad6359. PMID 26965627. \n\n^ \"Could a new plastic-eating bacteria help combat this pollution scourge?\". The Guardian. 10 March 2016. Retrieved 11 March 2016 . \n\n^ Sax, Leonard (2010). \"Polyethylene Terephthalate May Yield Endocrine Disruptors\". Environmental Health Perspectives. 118 (4): 445\u20138. doi:10.1289\/ehp.0901253. PMC 2854718 . PMID 20368129. \n\n^ Tukur, Aminu (2012). \"PET bottle use patterns and antimony migration into bottled water and soft drinks: the case of British and Nigerian bottles\". Journal of Environmental Monitoring. 14 (4): 1236\u20131246. doi:10.1039\/C2EM10917D. \n\n^ Sandra Laville and Matthew Taylor, \"A million bottles a minute: world's plastic binge 'as dangerous as climate change'\", TheGuardian.com, 28 June 2017 (page visited on 20 July 2017). \n\n^ Saxena, Shalini (19 March 2016). \"Newly identified bacteria cleans up common plastic\". Ars Technica. Retrieved 21 March 2016 . \n\n^ a b \"Plastic Packaging Resins\" (PDF) . American Chemistry Council. Archived from the original (PDF) on 21 July 2011. \n\n^ everSTRAND\u2122[permanent dead link ] Carpet-inspectors-experts.com archive 2008-03-17 \n\n^ Simply Green Carpet \u2013 A Berkshire Flooring Brand. simplygreencarpet.com \n\n^ Makuska, Ricardas (2008 Vol 19. No 2 P. 29-34). \"Glycolysis of industrial poly(ethylene terephthalate) waste directed to bis(hydroxyethylene) terephthalate and aromatic polyester polyols\". CHEMIJA. 19: 29\u201334. Check date values in: |date= (help) \n\n^ PET-Recycling Forum; \"Current Technological Trends in Polyester Recycling\"; 9th International Polyester Recycling Forum Washington, 2006; S\u00e3o Paulo; ISBN 3-00-019765-6 \n\n^ Thiele, Ulrich K. (2007) Polyester Bottle Resins Production, Processing, Properties and Recycling, PETplanet Publisher GmbH, Heidelberg, Germany, pp. 259 ff, ISBN 978-3-9807497-4-9 \n\n^ BePET \n\n^ Starlinger \n\n^ Boos, Frank and Thiele, Ulrich \"Reprocessing pulverised polyester waste without yellowing\", German Patent DE19503055, Publication date: 8 August 1996 \n\n^ Fakirov, Stoyko (ed.) (2002) Handbook of Thermoplastic Polyesters, Wiley-VCH, Weinheim, pp. 1223 ff, ISBN 3-527-30113-5 \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Polyethylene terephthalate.\nAmerican Plastics Council: PlasticInfo.org\nKenPlas Industry Ltd.: \"What is PET (Polyethylene Terephthalate)\"\n\"WAVE Polymer Technology: PET (Polyethylene Terephthalate) flakes processing\"\nvtePlasticsChemical types\nAcrylonitrile butadiene styrene (ABS)\nCross-linked polyethylene (PEX, XLPE)\nEthylene vinyl acetate (EVA)\nPoly(methyl methacrylate) (PMMA)\nPolyacrylic acid (PAA)\nPolyamide (PA)\nPolybutylene (PB)\nPolybutylene terephthalate (PBT)\nPolycarbonate (PC)\nPolyetheretherketone (PEEK)\nPolyester (PEs)\nPolyethylene (PE)\nPolyethylene terephthalate (PET, PETE)\nPolyimide (PI)\nPolylactic acid (PLA)\nPolyoxymethylene (POM)\nPolyphenyl ether (PPE)\nPolypropylene (PP)\nPolystyrene (PS)\nPolysulfone (PES)\nPolytetrafluoroethylene (PTFE)\nPolyurethane (PU)\nPolyvinyl chloride (PVC)\nPolyvinylidene chloride (PVDC)\nStyrene maleic anhydride (SMA)\nStyrene-acrylonitrile (SAN)\nMechanical types\nThermoplastic\nDuroplast\nCorrugated plastic\nPolymeric foam\nHigh performance plastics\nAdditives\nPolymer additive\nColorants\nPlasticizer\nStabilizer for polymers\nBiodegradable additives\nProducts\nPlastic industry\nCommodity plastics\nEngineering plastics\nHigh-performance plastics\nPlastic film\nPlastic bottle\nPlastic bag\nPlastic shopping bag\nPlastic cutlery\nBlister pack\nFoam food container\nConstruction\nGeosynthetics\nCategory:Plastics applications\nEnvironment and healthvteHealth issues of plastics and polyhalogenated compounds (PHCs)Plasticizers: Phthalates\nDIBP\nDBP\nBBP (BBzP)\nDIHP\nDEHP (DOP)\nDIDP\nDINP\nMiscellaneous plasticizers\nOrganophosphates\nAdipates (DEHA\nDOA)\nMonomers\nBisphenol A (BPA, in Polycarbonates)\nVinyl chloride (in PVC)\nMiscellaneous additives incl. PHCs\nPBDEs\nPCBs\nOrganotins\nPFCs\nPerfluorooctanoic acid\nHealth issues\nTeratogen\nCarcinogen\nEndocrine disruptor\nDiabetes\nObesity\nObesogen\nPolymer fume fever\nPollution\nPlastic pollution\nGreat Pacific garbage patch\nPersistent organic pollutant\nDioxins\nList of environmental health hazards\nRegulations\nCalifornia Proposition 65\nEuropean REACH regulation\nJapan Toxic Substances Law\nToxic Substances Control Act\nWaste\nPlastic pollution\nGreat Pacific garbage patch\nPersistent organic pollutant\nDioxins\nList of environmental health hazards\nPlastic recycling\nBiodegradable plastic\nIdentification codes\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polyethylene_terephthalate\">https:\/\/www.limswiki.org\/index.php\/Polyethylene_terephthalate<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 16:50.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 912 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","3d4a244ce30949af99a3f7e14e78e59a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Polyethylene_terephthalate skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Polyethylene terephthalate<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p class=\"mw-empty-elt\"> \n<\/p>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">\"PETE\" redirects here. For other uses of \"PET\", see <a href=\"https:\/\/en.wikipedia.org\/wiki\/PET_(disambiguation)\" class=\"mw-redirect mw-disambig\" title=\"PET (disambiguation)\" rel=\"external_link\" target=\"_blank\">PET (disambiguation)<\/a>. For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pete_(disambiguation)\" class=\"mw-redirect mw-disambig\" title=\"Pete (disambiguation)\" rel=\"external_link\" target=\"_blank\">Pete (disambiguation)<\/a>.<\/div>\n<div class=\"shortdescription nomobile noexcerpt noprint searchaux\" style=\"display:none\">Polymer<\/div>\n<p class=\"mw-empty-elt\">\n<\/p>\n\n<p><b>Polyethylene terephthalate<\/b> (sometimes written poly(ethylene terephthalate)), commonly abbreviated <b>PET<\/b>, <b>PETE<\/b>, or the obsolete PETP or PET-P, is the most common <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoplastic\" title=\"Thermoplastic\" rel=\"external_link\" target=\"_blank\">thermoplastic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> resin of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyester\" title=\"Polyester\" rel=\"external_link\" target=\"_blank\">polyester<\/a> family and is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Synthetic_fibre\" class=\"mw-redirect\" title=\"Synthetic fibre\" rel=\"external_link\" target=\"_blank\">fibres<\/a> for clothing, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Packaging\" class=\"mw-redirect\" title=\"Packaging\" rel=\"external_link\" target=\"_blank\">containers<\/a> for liquids and foods, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoforming\" title=\"Thermoforming\" rel=\"external_link\" target=\"_blank\">thermoforming<\/a> for manufacturing, and in combination with glass fibre for engineering <a href=\"https:\/\/en.wikipedia.org\/wiki\/Resins\" class=\"mw-redirect\" title=\"Resins\" rel=\"external_link\" target=\"_blank\">resins<\/a>.\n<\/p><p>It may also be referred to by the brand names <b>Terylene<\/b> in the UK,<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> <b>Lavsan<\/b> in Russia and the former Soviet Union, and <b>Dacron<\/b> in the US.\n<\/p><p>The majority of the world's PET production is for synthetic fibres (in excess of 60%), with bottle production accounting for about 30% of global demand.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> In the context of textile applications, PET is referred to by its common name, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyester\" title=\"Polyester\" rel=\"external_link\" target=\"_blank\">polyester<\/a>, whereas the acronym <i>PET<\/i> is generally used in relation to packaging. Polyester makes up about 18% of world polymer production and is the fourth-most-produced polymer after <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a> (PE), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polypropylene\" title=\"Polypropylene\" rel=\"external_link\" target=\"_blank\">polypropylene<\/a> (PP) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyvinyl_chloride\" title=\"Polyvinyl chloride\" rel=\"external_link\" target=\"_blank\">polyvinyl chloride<\/a> (PVC).\n<\/p><p>PET consists of polymerized units of the monomer ethylene terephthalate, with repeating (C<sub>10<\/sub>H<sub>8<\/sub>O<sub>4<\/sub>) units. PET is commonly <a href=\"https:\/\/en.wikipedia.org\/wiki\/PET_bottle_recycling\" title=\"PET bottle recycling\" rel=\"external_link\" target=\"_blank\">recycled<\/a>, and has the number \"1\" as its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Resin_identification_code\" title=\"Resin identification code\" rel=\"external_link\" target=\"_blank\">resin identification code<\/a> (RIC).\n<\/p><p>Depending on its processing and thermal history, polyethylene terephthalate may exist both as an amorphous (transparent) and as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semi-crystalline_polymer\" class=\"mw-redirect\" title=\"Semi-crystalline polymer\" rel=\"external_link\" target=\"_blank\">semi-crystalline polymer<\/a>. The semicrystalline material might appear transparent (particle size less than 500 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nanometre\" title=\"Nanometre\" rel=\"external_link\" target=\"_blank\">nm<\/a>) or opaque and white (particle size up to a few <a href=\"https:\/\/en.wikipedia.org\/wiki\/Micrometre\" title=\"Micrometre\" rel=\"external_link\" target=\"_blank\">micrometers<\/a>) depending on its crystal structure and particle size.\n<\/p><p>The monomer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bis(2-hydroxyethyl)_terephthalate\" class=\"mw-redirect\" title=\"Bis(2-hydroxyethyl) terephthalate\" rel=\"external_link\" target=\"_blank\">bis(2-hydroxyethyl) terephthalate<\/a> can be synthesized by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esterification\" class=\"mw-redirect\" title=\"Esterification\" rel=\"external_link\" target=\"_blank\">esterification<\/a> reaction between <a href=\"https:\/\/en.wikipedia.org\/wiki\/Terephthalic_acid\" title=\"Terephthalic acid\" rel=\"external_link\" target=\"_blank\">terephthalic acid<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_glycol\" title=\"Ethylene glycol\" rel=\"external_link\" target=\"_blank\">ethylene glycol<\/a> with water as a byproduct, or by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transesterification\" title=\"Transesterification\" rel=\"external_link\" target=\"_blank\">transesterification<\/a> reaction between <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_glycol\" title=\"Ethylene glycol\" rel=\"external_link\" target=\"_blank\">ethylene glycol<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dimethyl_terephthalate\" title=\"Dimethyl terephthalate\" rel=\"external_link\" target=\"_blank\">dimethyl terephthalate<\/a> (DMT) with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methanol\" title=\"Methanol\" rel=\"external_link\" target=\"_blank\">methanol<\/a> as a byproduct. Polymerization is through a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polycondensation\" class=\"mw-redirect\" title=\"Polycondensation\" rel=\"external_link\" target=\"_blank\">polycondensation<\/a> reaction of the monomers (done immediately after esterification\/transesterification) with water as the byproduct.\n<\/p>\n<div class=\"toclimit-3\">\n<\/div>\n<dl><dd><table class=\"wikitable\" style=\"float: right; clear: right; width:300px\">\n\n<tbody><tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Young%27s_modulus\" title=\"Young's modulus\" rel=\"external_link\" target=\"_blank\">Young's modulus<\/a> (<i>E<\/i>)\n<\/td>\n<td>2800\u20133100 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pascal_(unit)\" title=\"Pascal (unit)\" rel=\"external_link\" target=\"_blank\">MPa<\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tensile_strength\" class=\"mw-redirect\" title=\"Tensile strength\" rel=\"external_link\" target=\"_blank\">Tensile strength<\/a> (<i>\u03c3<\/i><sub>t<\/sub>)\n<\/td>\n<td>55\u201375 MPa\n<\/td><\/tr>\n<tr>\n<td>Elastic limit\n<\/td>\n<td>50\u2013150%\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Notch_test\" class=\"mw-redirect\" title=\"Notch test\" rel=\"external_link\" target=\"_blank\">notch test<\/a>\n<\/td>\n<td>3.6 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kilojoule\" class=\"mw-redirect\" title=\"Kilojoule\" rel=\"external_link\" target=\"_blank\">kJ<\/a>\/m<sup>2<\/sup>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass_transition_temperature\" class=\"mw-redirect\" title=\"Glass transition temperature\" rel=\"external_link\" target=\"_blank\">Glass transition temperature (<i>T<\/i><sub>g<\/sub>)<\/a>\n<\/td>\n<td>67\u201381 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Degree_Celsius\" class=\"mw-redirect\" title=\"Degree Celsius\" rel=\"external_link\" target=\"_blank\">\u00b0C<\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vicat_softening_point\" title=\"Vicat softening point\" rel=\"external_link\" target=\"_blank\">Vicat<\/a> <i>B<\/i>\n<\/td>\n<td>82 \u00b0C\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Coefficient_of_thermal_expansion\" class=\"mw-redirect\" title=\"Coefficient of thermal expansion\" rel=\"external_link\" target=\"_blank\">linear expansion coefficient (<i>\u03b1<\/i>)<\/a>\n<\/td>\n<td><span class=\"nowrap\"><span style=\"display:none\" class=\"sortkey\">6995700000000000000\u2660<\/span>7<span style=\"margin-left:0.25em;margin-right:0.15em;\">\u00d7<\/span>10<sup>\u22125<\/sup> K<sup>\u22121<\/sup><\/span>\n<\/td><\/tr>\n<tr>\n<td>Water absorption (ASTM)\n<\/td>\n<td>0.16\n<\/td><\/tr>\n<tr>\n<th colspan=\"2\" style=\"text-align:left;\">Source<sup id=\"rdp-ebb-cite_ref-van_der_Vegt_1-7\" class=\"reference\"><a href=\"#cite_note-van_der_Vegt-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/th><\/tr><\/tbody><\/table><\/dd><\/dl>\n<h2><span class=\"mw-headline\" id=\"Uses\">Uses<\/span><\/h2>\n<p>Plastic bottles made from PET are widely used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soft_drink\" title=\"Soft drink\" rel=\"external_link\" target=\"_blank\">soft drinks<\/a> (see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbonation\" title=\"Carbonation\" rel=\"external_link\" target=\"_blank\">carbonation<\/a>). For certain specialty bottles, such as those designated for beer containment, PET sandwiches an additional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyvinyl_alcohol\" title=\"Polyvinyl alcohol\" rel=\"external_link\" target=\"_blank\">polyvinyl alcohol<\/a> (PVOH) layer to further reduce its oxygen permeability.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/BoPET\" title=\"BoPET\" rel=\"external_link\" target=\"_blank\">Biaxially oriented PET<\/a> film (often known by one of its trade names, \"Mylar\") can be aluminized by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Evaporation\" title=\"Evaporation\" rel=\"external_link\" target=\"_blank\">evaporating<\/a> a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thin-film_deposition\" class=\"mw-redirect\" title=\"Thin-film deposition\" rel=\"external_link\" target=\"_blank\">thin film<\/a> of metal onto it to reduce its permeability, and to make it reflective and opaque (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Metallized_polyethylene_terephthalate\" class=\"mw-redirect\" title=\"Metallized polyethylene terephthalate\" rel=\"external_link\" target=\"_blank\">MPET<\/a>). These properties are useful in many applications, including flexible food <a href=\"https:\/\/en.wikipedia.org\/wiki\/Packaging_and_labeling\" title=\"Packaging and labeling\" rel=\"external_link\" target=\"_blank\">packaging<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_insulation\" title=\"Thermal insulation\" rel=\"external_link\" target=\"_blank\">thermal insulation<\/a> (such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Space_blanket\" title=\"Space blanket\" rel=\"external_link\" target=\"_blank\">space blankets<\/a>). Because of its high mechanical strength, PET film is often used in tape applications, such as the carrier for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_tape\" title=\"Magnetic tape\" rel=\"external_link\" target=\"_blank\">magnetic tape<\/a> or backing for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pressure-sensitive_tape\" title=\"Pressure-sensitive tape\" rel=\"external_link\" target=\"_blank\">pressure-sensitive adhesive tapes<\/a>.\n<\/p><p>Non-oriented PET sheet can be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoforming\" title=\"Thermoforming\" rel=\"external_link\" target=\"_blank\">thermoformed<\/a> to make packaging trays and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blister_packs\" class=\"mw-redirect\" title=\"Blister packs\" rel=\"external_link\" target=\"_blank\">blister packs<\/a>.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> If crystallizable PET is used, the trays can be used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/TV_dinner\" title=\"TV dinner\" rel=\"external_link\" target=\"_blank\">frozen dinners<\/a>, since they withstand both freezing and oven baking temperatures. Both amorphous PET and BoPET are transparent to the naked eye. Color-conferring dyes can easily be formulated into PET sheet.\n<\/p><p>When filled with glass <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aggregate_(composite)\" title=\"Aggregate (composite)\" rel=\"external_link\" target=\"_blank\">particles<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiber-reinforced_plastic\" class=\"mw-redirect\" title=\"Fiber-reinforced plastic\" rel=\"external_link\" target=\"_blank\">fibres<\/a>, it becomes significantly stiffer and more durable.\n<\/p><p>PET is also used as a substrate in thin film solar cells.\n<\/p><p>Terylene (a trademark formed by inversion of (polyeth)ylene ter(ephthalate)) is also spliced into bell rope tops to help prevent wear on the ropes as they pass through the ceiling.\n<\/p><p>PET is used since late 2014 as liner material in type IV composite high pressure <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gas_cylinder\" title=\"Gas cylinder\" rel=\"external_link\" target=\"_blank\">gas cylinders<\/a>. PET works as a much better barrier to oxygen than earlier used (LD)PE.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>PET is used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/3D_printing\" title=\"3D printing\" rel=\"external_link\" target=\"_blank\">3D printing<\/a> filament, as well as in the 3D printing plastic PETG.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>PET was patented in 1941 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/John_Rex_Whinfield\" title=\"John Rex Whinfield\" rel=\"external_link\" target=\"_blank\">John Rex Whinfield<\/a>, and their employer the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calico_Printers%27_Association\" title=\"Calico Printers' Association\" rel=\"external_link\" target=\"_blank\">Calico Printers' Association<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manchester\" title=\"Manchester\" rel=\"external_link\" target=\"_blank\">Manchester<\/a>, England. <a href=\"https:\/\/en.wikipedia.org\/wiki\/DuPont\" title=\"DuPont\" rel=\"external_link\" target=\"_blank\">E. I. DuPont de Nemours<\/a> in Delaware, United States, first used the trademark Mylar in June 1951 and received registration of it in 1952.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> It is still the best-known name used for polyester film. The current owner of the trademark is DuPont Teijin Films US, a partnership with a Japanese company.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>In the Soviet Union, PET was first manufactured in the laboratories of the Institute of High-Molecular Compounds of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/USSR_Academy_of_Sciences\" class=\"mw-redirect\" title=\"USSR Academy of Sciences\" rel=\"external_link\" target=\"_blank\">USSR Academy of Sciences<\/a> in 1949, and its name \"Lavsan\" is an acronym thereof (<b>\u043b\u0430<\/b>\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u0438\u0438 \u0418\u043d\u0441\u0442\u0438\u0442\u0443\u0442\u0430 <b>\u0432<\/b>\u044b\u0441\u043e\u043a\u043e\u043c\u043e\u043b\u0435\u043a\u0443\u043b\u044f\u0440\u043d\u044b\u0445 <b>\u0441<\/b>\u043e\u0435\u0434\u0438\u043d\u0435\u043d\u0438\u0439 <b>\u0410<\/b>\u043a\u0430\u0434\u0435\u043c\u0438\u0438 <b>\u043d<\/b>\u0430\u0443\u043a \u0421\u0421\u0421\u0420).<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>The PET bottle was patented in 1973 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nathaniel_Wyeth_(inventor)\" title=\"Nathaniel Wyeth (inventor)\" rel=\"external_link\" target=\"_blank\">Nathaniel Wyeth<\/a>.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Physical_properties\">Physical properties<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Thistle_dinghy_with_skipper_Terry_Lettenmaier_sailing_downwind.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/63\/Thistle_dinghy_with_skipper_Terry_Lettenmaier_sailing_downwind.jpg\/220px-Thistle_dinghy_with_skipper_Terry_Lettenmaier_sailing_downwind.jpg\" width=\"220\" height=\"308\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Thistle_dinghy_with_skipper_Terry_Lettenmaier_sailing_downwind.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sailcloth\" title=\"Sailcloth\" rel=\"external_link\" target=\"_blank\">Sailcloth<\/a> is typically made from PET fibers also known as polyester or under the brand name Dacron; colorful lightweight <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinnaker\" title=\"Spinnaker\" rel=\"external_link\" target=\"_blank\">spinnakers<\/a> are usually made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nylon\" title=\"Nylon\" rel=\"external_link\" target=\"_blank\">nylon<\/a>.<\/div><\/div><\/div>\n<p>PET in its natural state is a colorless, semi-crystalline resin. Based on how it is processed, PET can be semi-rigid to rigid, and it is very lightweight. It makes a good gas and fair moisture barrier, as well as a good barrier to alcohol (requires additional \"barrier\" treatment) and solvents. It is strong and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toughness\" title=\"Toughness\" rel=\"external_link\" target=\"_blank\">impact-resistant<\/a>. PET becomes white when exposed to chloroform and also certain other chemicals such as toluene.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p><p>About 60% crystallization is the upper limit for commercial products<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>, with the exception of polyester fibers. Clear products can be produced by rapidly cooling molten polymer below T<sub>g<\/sub> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass_transition_temperature\" class=\"mw-redirect\" title=\"Glass transition temperature\" rel=\"external_link\" target=\"_blank\">glass transition temperature<\/a> to form an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amorphous_solid\" title=\"Amorphous solid\" rel=\"external_link\" target=\"_blank\">amorphous solid<\/a>. Like glass, amorphous PET forms when its molecules are not given enough time to arrange themselves in an orderly, crystalline fashion as the melt is cooled. At room temperature the molecules are frozen in place, but, if enough heat energy is put back into them by heating above T<sub>g<\/sub>, they begin to move again, allowing crystals to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nucleation\" title=\"Nucleation\" rel=\"external_link\" target=\"_blank\">nucleate<\/a> and grow. This procedure is known as solid-state crystallization.\n<\/p><p>When allowed to cool slowly, the molten polymer forms a more crystalline material. This material has <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spherulite_(polymer_physics)\" title=\"Spherulite (polymer physics)\" rel=\"external_link\" target=\"_blank\">spherulites<\/a> containing many small <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystallite\" title=\"Crystallite\" rel=\"external_link\" target=\"_blank\">crystallites<\/a> when crystallized from an amorphous solid, rather than forming one large single crystal. Light tends to scatter as it crosses the boundaries between crystallites and the amorphous regions between them. This scattering means that crystalline PET is opaque and white in most cases. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cold_drawing\" class=\"mw-redirect\" title=\"Cold drawing\" rel=\"external_link\" target=\"_blank\">Fiber drawing<\/a> is among the few industrial processes that produce a nearly single-crystal product.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Intrinsic_viscosity\">Intrinsic viscosity<\/span><\/h3>\n<p>One of the most important characteristics of PET is referred to as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intrinsic_viscosity\" title=\"Intrinsic viscosity\" rel=\"external_link\" target=\"_blank\">intrinsic viscosity<\/a> (IV).<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>The intrinsic viscosity of the material, found by extrapolating to zero concentration of relative viscosity to concentration which is measured in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deciliter\" class=\"mw-redirect\" title=\"Deciliter\" rel=\"external_link\" target=\"_blank\">deciliters<\/a> per gram (d\u2113\/g). Intrinsic viscosity is dependent upon the length of its polymer chains but has no units due to being extrapolated to zero concentration. The longer the polymer chains the more entanglements between chains and therefore the higher the viscosity. The average chain length of a particular batch of resin can be controlled during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polycondensation\" class=\"mw-redirect\" title=\"Polycondensation\" rel=\"external_link\" target=\"_blank\">polycondensation<\/a>.\n<\/p><p>The intrinsic viscosity range of PET:<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p>Fiber grade:\n<\/p>\n<dl><dd>0.40\u20130.70 Textile<\/dd>\n<dd>0.72\u20130.98 Technical, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tire\" title=\"Tire\" rel=\"external_link\" target=\"_blank\">tire<\/a> cord<\/dd><\/dl>\n<p>Film grade:\n<\/p>\n<dl><dd>0.60\u20130.70 <a href=\"https:\/\/en.wikipedia.org\/wiki\/BoPET\" title=\"BoPET\" rel=\"external_link\" target=\"_blank\">BoPET<\/a> (biaxially oriented PET film)<\/dd>\n<dd>0.70\u20131.00 <a href=\"https:\/\/en.wiktionary.org\/wiki\/sheet\" class=\"extiw\" title=\"wikt:sheet\" rel=\"external_link\" target=\"_blank\">Sheet<\/a> grade for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoforming\" title=\"Thermoforming\" rel=\"external_link\" target=\"_blank\">thermoforming<\/a><\/dd><\/dl>\n<p>Bottle grade:\n<\/p>\n<dl><dd>0.70\u20130.78 Water bottles (flat)<\/dd>\n<dd>0.78\u20130.85 Carbonated soft drink grade<\/dd><\/dl>\n<p>Monofilament, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Engineering_plastic\" title=\"Engineering plastic\" rel=\"external_link\" target=\"_blank\">engineering plastic<\/a>\n<\/p>\n<dl><dd>1.00\u20132.00<\/dd><\/dl>\n<h2><span class=\"mw-headline\" id=\"Drying\">Drying<\/span><\/h2>\n<p>PET is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hygroscopic\" class=\"mw-redirect\" title=\"Hygroscopic\" rel=\"external_link\" target=\"_blank\">hygroscopic<\/a>, meaning that it absorbs water from its surroundings. However, when this \"damp\" PET is then heated, the water <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrolysis\" title=\"Hydrolysis\" rel=\"external_link\" target=\"_blank\">hydrolyzes<\/a> the PET, decreasing its resilience. Thus, before the resin can be processed in a molding machine, it must be dried. Drying is achieved through the use of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Desiccant\" title=\"Desiccant\" rel=\"external_link\" target=\"_blank\">desiccant<\/a> or dryers before the PET is fed into the processing equipment.\n<\/p><p>Inside the dryer, hot dry air is pumped into the bottom of the hopper containing the resin so that it flows up through the pellets, removing moisture on its way. The hot wet air leaves the top of the hopper and is first run through an after-cooler, because it is easier to remove moisture from cold air than hot air. The resulting cool wet air is then passed through a desiccant bed. Finally, the cool dry air leaving the desiccant bed is re-heated in a process heater and sent back through the same processes in a closed loop. Typically, residual moisture levels in the resin must be less than 50 parts per million (parts of water per million parts of resin, by weight) before processing. Dryer residence time should not be shorter than about four hours. This is because drying the material in less than 4 hours would require a temperature above 160 \u00b0C, at which level <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrolysis\" title=\"Hydrolysis\" rel=\"external_link\" target=\"_blank\">hydrolysis<\/a> would begin inside the pellets before they could be dried out.\n<\/p><p>PET can also be dried in compressed air resin dryers. Compressed air dryers do not reuse drying air. Dry, heated compressed air is circulated through the PET pellets as in the desiccant dryer, then released to the atmosphere.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Copolymers\">Copolymers<\/span><\/h2>\n<p>In addition to pure (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Homopolymer\" class=\"mw-redirect\" title=\"Homopolymer\" rel=\"external_link\" target=\"_blank\">homopolymer<\/a>) PET, PET modified by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copolymer\" title=\"Copolymer\" rel=\"external_link\" target=\"_blank\">copolymerization<\/a> is also available.\n<\/p><p>In some cases, the modified properties of copolymer are more desirable for a particular application. For example, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyclohexane_dimethanol\" class=\"mw-redirect\" title=\"Cyclohexane dimethanol\" rel=\"external_link\" target=\"_blank\">cyclohexane dimethanol<\/a> (CHDM) can be added to the polymer backbone in place of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_glycol\" title=\"Ethylene glycol\" rel=\"external_link\" target=\"_blank\">ethylene glycol<\/a>. Since this building block is much larger (6 additional carbon atoms) than the ethylene glycol unit it replaces, it does not fit in with the neighboring chains the way an ethylene glycol unit would. This interferes with crystallization and lowers the polymer's melting temperature. In general, such PET is known as PETG or PET-G (Polyethylene terephthalate glycol-modified; Eastman Chemical, SK Chemicals Selenis are some PETG manufacturers). PETG is a clear amorphous thermoplastic that can be injection molded, sheet extruded or extruded as filament for <a href=\"https:\/\/en.wikipedia.org\/wiki\/3D_printing\" title=\"3D printing\" rel=\"external_link\" target=\"_blank\">3D printing<\/a>. It can be colored during processing.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Phthalic_acid_isomers.PNG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f4\/Phthalic_acid_isomers.PNG\/220px-Phthalic_acid_isomers.PNG\" width=\"220\" height=\"89\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Phthalic_acid_isomers.PNG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Replacing terephthalic acid (right) with isophthalic acid (center) creates a kink in the PET chain, interfering with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystallization\" title=\"Crystallization\" rel=\"external_link\" target=\"_blank\">crystallization<\/a> and lowering the polymer's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Melting_point\" title=\"Melting point\" rel=\"external_link\" target=\"_blank\">melting point<\/a>.<\/div><\/div><\/div>\n<p>Another common modifier is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isophthalic_acid\" title=\"Isophthalic acid\" rel=\"external_link\" target=\"_blank\">isophthalic acid<\/a>, replacing some of the 1,4-(<i>para-<\/i>) linked <a href=\"https:\/\/en.wikipedia.org\/wiki\/Terephthalic_acid\" title=\"Terephthalic acid\" rel=\"external_link\" target=\"_blank\">terephthalate<\/a> units. The 1,2-(<i>ortho-<\/i>) or 1,3-(<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arene_substitution_patterns\" class=\"mw-redirect\" title=\"Arene substitution patterns\" rel=\"external_link\" target=\"_blank\">meta<\/a><\/i>-) linkage produces an angle in the chain, which also disturbs crystallinity.\n<\/p><p>Such copolymers are advantageous for certain molding applications, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoforming\" title=\"Thermoforming\" rel=\"external_link\" target=\"_blank\">thermoforming<\/a>, which is used for example to make tray or blister packaging from co-PET film, or amorphous PET sheet (A-PET\/PETA) or PETG sheet. On the other hand, crystallization is important in other applications where mechanical and dimensional stability are important, such as seat belts. For PET bottles, the use of small amounts of isophthalic acid, CHDM, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diethylene_glycol\" title=\"Diethylene glycol\" rel=\"external_link\" target=\"_blank\">diethylene glycol<\/a> (DEG) or other comonomers can be useful: if only small amounts of comonomers are used, crystallization is slowed but not prevented entirely. As a result, bottles are obtainable via <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stretch_blow_molding\" class=\"mw-redirect\" title=\"Stretch blow molding\" rel=\"external_link\" target=\"_blank\">stretch blow molding<\/a> (\"SBM\"), which are both clear and crystalline enough to be an adequate barrier to aromas and even gases, such as carbon dioxide in carbonated beverages.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Production\">Production<\/span><\/h2>\n<p>Polyethylene terephthalate is produced from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_glycol\" title=\"Ethylene glycol\" rel=\"external_link\" target=\"_blank\">ethylene glycol<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dimethyl_terephthalate\" title=\"Dimethyl terephthalate\" rel=\"external_link\" target=\"_blank\">dimethyl terephthalate<\/a>(DMT) (C<sub>6<\/sub>H<sub>4<\/sub>(CO<sub>2<\/sub>CH<sub>3<\/sub>)<sub>2<\/sub>) or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Terephthalic_acid\" title=\"Terephthalic acid\" rel=\"external_link\" target=\"_blank\">terephthalic acid<\/a>.<sup id=\"rdp-ebb-cite_ref-polyesters_16-0\" class=\"reference\"><a href=\"#cite_note-polyesters-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>The former is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transesterification\" title=\"Transesterification\" rel=\"external_link\" target=\"_blank\">transesterification<\/a> reaction, whereas the latter is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esterification\" class=\"mw-redirect\" title=\"Esterification\" rel=\"external_link\" target=\"_blank\">esterification<\/a> reaction.\n<\/p>\n<h3><span id=\"rdp-ebb-Dimethyl_terephthalate_process_.28DMT.29\"><\/span><span class=\"mw-headline\" id=\"Dimethyl_terephthalate_process_(DMT)\">Dimethyl terephthalate process (DMT)<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PET_by_Transesterification_V1.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b5\/PET_by_Transesterification_V1.svg\/220px-PET_by_Transesterification_V1.svg.png\" width=\"220\" height=\"107\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PET_by_Transesterification_V1.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Polyesterification reaction in the production of PET<\/div><\/div><\/div>\n<p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dimethyl_terephthalate\" title=\"Dimethyl terephthalate\" rel=\"external_link\" target=\"_blank\">dimethyl terephthalate<\/a>(DMT) process, this compound and excess ethylene glycol are reacted in the melt at 150\u2013200 \u00b0C with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Base_(chemistry)\" title=\"Base (chemistry)\" rel=\"external_link\" target=\"_blank\">basic catalyst<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methanol\" title=\"Methanol\" rel=\"external_link\" target=\"_blank\">Methanol<\/a> (CH<sub>3<\/sub>OH) is removed by distillation to drive the reaction forward. Excess ethylene glycol is distilled off at higher temperature with the aid of vacuum. The second transesterification step proceeds at 270\u2013280 \u00b0C, with continuous distillation of ethylene glycol as well.<sup id=\"rdp-ebb-cite_ref-polyesters_16-1\" class=\"reference\"><a href=\"#cite_note-polyesters-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>The reactions are idealized as follows:\n<\/p>\n<dl><dt>First step<\/dt>\n<dd>C<sub>6<\/sub>H<sub>4<\/sub>(CO<sub>2<\/sub>CH<sub>3<\/sub>)<sub>2<\/sub> + 2 HOCH<sub>2<\/sub>CH<sub>2<\/sub>OH \u2192 C<sub>6<\/sub>H<sub>4<\/sub>(CO<sub>2<\/sub>CH<sub>2<\/sub>CH<sub>2<\/sub>OH)<sub>2<\/sub> + 2 CH<sub>3<\/sub>OH<\/dd><\/dl>\n<dl><dt>Second step<\/dt>\n<dd><i>n<\/i> C<sub>6<\/sub>H<sub>4<\/sub>(CO<sub>2<\/sub>CH<sub>2<\/sub>CH<sub>2<\/sub>OH)<sub>2<\/sub> \u2192 [(CO)C<sub>6<\/sub>H<sub>4<\/sub>(CO<sub>2<\/sub>CH<sub>2<\/sub>CH<sub>2<\/sub>O)]<sub>n<\/sub> + <i>n<\/i> HOCH<sub>2<\/sub>CH<sub>2<\/sub>OH<\/dd><\/dl>\n<h3><span class=\"mw-headline\" id=\"Terephthalic_acid_process\">Terephthalic acid process<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PET_by_Polycondensation_V1.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/83\/PET_by_Polycondensation_V1.svg\/220px-PET_by_Polycondensation_V1.svg.png\" width=\"220\" height=\"121\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PET_by_Polycondensation_V1.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Polycondensation reaction in the production of PET<\/div><\/div><\/div>\n<p>In the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Terephthalic_acid\" title=\"Terephthalic acid\" rel=\"external_link\" target=\"_blank\">terephthalic acid<\/a> process, esterification of ethylene glycol and terephthalic acid is conducted directly at moderate pressure (2.7\u20135.5 bar) and high temperature (220\u2013260 \u00b0C). Water is eliminated in the reaction, and it is also continuously removed by distillation:<sup id=\"rdp-ebb-cite_ref-polyesters_16-2\" class=\"reference\"><a href=\"#cite_note-polyesters-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<dl><dd><i>n<\/i> C<sub>6<\/sub>H<sub>4<\/sub>(CO<sub>2<\/sub>H)<sub>2<\/sub> + <i>n<\/i> HOCH<sub>2<\/sub>CH<sub>2<\/sub>OH \u2192 [(CO)C<sub>6<\/sub>H<sub>4<\/sub>(CO<sub>2<\/sub>CH<sub>2<\/sub>CH<sub>2<\/sub>O)]<sub>n<\/sub> + 2<i>n<\/i> H<sub>2<\/sub>O<\/dd><\/dl>\n<h2><span class=\"mw-headline\" id=\"Degradation\">Degradation<\/span><\/h2>\n<p>PET is subjected to various types of degradations during processing. The main degradations that can occur are hydrolytic, and probably most important, thermal oxidation. When PET degrades, several things happen: discoloration, chain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bond_cleavage\" title=\"Bond cleavage\" rel=\"external_link\" target=\"_blank\">scissions<\/a> resulting in reduced molecular weight, formation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetaldehyde\" title=\"Acetaldehyde\" rel=\"external_link\" target=\"_blank\">acetaldehyde<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cross-link\" title=\"Cross-link\" rel=\"external_link\" target=\"_blank\">cross-links<\/a> (\"gel\" or \"fish-eye\" formation). Discoloration is due to the formation of various chromophoric systems following prolonged thermal treatment at elevated temperatures. This becomes a problem when the optical requirements of the polymer are very high, such as in packaging applications. The thermal and thermooxidative degradation results in poor processibility characteristics and performance of the material.\n<\/p><p>One way to alleviate this is to use a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copolymer\" title=\"Copolymer\" rel=\"external_link\" target=\"_blank\">copolymer<\/a>. Comonomers such as CHDM or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isophthalic_acid\" title=\"Isophthalic acid\" rel=\"external_link\" target=\"_blank\">isophthalic acid<\/a> lower the melting temperature and reduce the degree of crystallinity of PET (especially important when the material is used for bottle manufacturing). Thus, the resin can be plastically formed at lower temperatures and\/or with lower force. This helps to prevent degradation, reducing the acetaldehyde content of the finished product to an acceptable (that is, unnoticeable) level. See <a href=\"#Copolymers\" rel=\"external_link\">copolymers<\/a>, above. Another way to improve the stability of the polymer is to use stabilizers, mainly antioxidants such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphites\" class=\"mw-redirect\" title=\"Phosphites\" rel=\"external_link\" target=\"_blank\">phosphites<\/a>. Recently, molecular level stabilization of the material using nanostructured chemicals has also been considered.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Acetaldehyde\">Acetaldehyde<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetaldehyde\" title=\"Acetaldehyde\" rel=\"external_link\" target=\"_blank\">Acetaldehyde<\/a> is a colorless, volatile substance with a fruity smell. Although it forms naturally in some fruit, it can cause an off-taste in bottled water. Acetaldehyde forms by degradation of PET through the mishandling of the material. High temperatures (PET decomposes above 300 \u00b0C or 570 \u00b0F), high pressures, extruder speeds (excessive shear flow raises temperature), and long barrel residence times all contribute to the production of acetaldehyde. When acetaldehyde is produced, some of it remains dissolved in the walls of a container and then <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion\" title=\"Diffusion\" rel=\"external_link\" target=\"_blank\">diffuses<\/a> into the product stored inside, altering the taste and aroma. This is not such a problem for non-consumables (such as shampoo), for fruit juices (which already contain acetaldehyde), or for strong-tasting drinks like soft drinks. For bottled water, however, low acetaldehyde content is quite important, because, if nothing masks the aroma, even extremely low concentrations (10\u201320 parts per billion in the water) of acetaldehyde can produce an off-taste.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Antimony\">Antimony<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Antimony\" title=\"Antimony\" rel=\"external_link\" target=\"_blank\">Antimony<\/a> (Sb) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metalloid\" title=\"Metalloid\" rel=\"external_link\" target=\"_blank\">metalloid<\/a> element that is used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalyst\" class=\"mw-redirect\" title=\"Catalyst\" rel=\"external_link\" target=\"_blank\">catalyst<\/a> in the form of compounds such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antimony_trioxide\" title=\"Antimony trioxide\" rel=\"external_link\" target=\"_blank\">antimony trioxide<\/a> (Sb<sub>2<\/sub>O<sub>3<\/sub>) or antimony triacetate in the production of PET. After manufacturing, a detectable amount of antimony can be found on the surface of the product. This residue can be removed with washing. Antimony also remains in the material itself and can, thus, migrate out into food and drinks. Exposing PET to boiling or microwaving can increase the levels of antimony significantly, possibly above USEPA maximum contamination levels.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup>\nThe drinking water limit assessed by WHO is 20 parts per billion (WHO, 2003), and the drinking water limit in the United States is 6 parts per billion.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> Although antimony trioxide is of low toxicity when taken orally,<sup id=\"rdp-ebb-cite_ref-who.int_19-0\" class=\"reference\"><a href=\"#cite_note-who.int-19\" rel=\"external_link\">[19]<\/a><\/sup> its presence is still of concern. The Swiss <a href=\"https:\/\/en.wikipedia.org\/wiki\/Federal_Office_of_Public_Health\" title=\"Federal Office of Public Health\" rel=\"external_link\" target=\"_blank\">Federal Office of Public Health<\/a> investigated the amount of antimony migration, comparing waters bottled in PET and glass: The antimony concentrations of the water in PET bottles were higher, but still well below the allowed maximum concentration. The Swiss Federal Office of Public Health concluded that small amounts of antimony migrate from the PET into bottled water, but that the health risk of the resulting low concentrations is negligible (1% of the \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Tolerable_daily_intake\" title=\"Tolerable daily intake\" rel=\"external_link\" target=\"_blank\">tolerable daily intake<\/a>\" determined by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/World_Health_Organization\" title=\"World Health Organization\" rel=\"external_link\" target=\"_blank\">WHO<\/a>). A later (2006) but more widely publicized study found similar amounts of antimony in water in PET bottles.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\nThe WHO has published a risk assessment for antimony in drinking water.<sup id=\"rdp-ebb-cite_ref-who.int_19-1\" class=\"reference\"><a href=\"#cite_note-who.int-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p><p>Fruit juice concentrates (for which no guidelines are established), however, that were produced and bottled in PET in the UK were found to contain up to 44.7 \u00b5g\/L of antimony, well above the EU limits for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tap_water\" title=\"Tap water\" rel=\"external_link\" target=\"_blank\">tap water<\/a> of 5 \u00b5g\/L.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Biodegradation\">Biodegradation<\/span><\/h3>\n<p>At least one species of bacterium in the genus <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nocardia\" title=\"Nocardia\" rel=\"external_link\" target=\"_blank\">Nocardia<\/a><\/i> can degrade PET with an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esterase\" title=\"Esterase\" rel=\"external_link\" target=\"_blank\">esterase<\/a> enzyme.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p><p>Japanese scientists have isolated a bacterium <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ideonella_sakaiensis\" title=\"Ideonella sakaiensis\" rel=\"external_link\" target=\"_blank\">Ideonella sakaiensis<\/a><\/i> that possesses two enzymes which can break down the PET into smaller pieces that the bacterium can digest. A colony of <i>I. sakaiensis<\/i> can disintegrate a plastic film in about six weeks.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Safety\">Safety<\/span><\/h2>\n<p>Commentary published in <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Environmental_Health_Perspectives\" title=\"Environmental Health Perspectives\" rel=\"external_link\" target=\"_blank\">Environmental Health Perspectives<\/a><\/i> in April 2010 suggested that PET might yield <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endocrine_disruptor\" title=\"Endocrine disruptor\" rel=\"external_link\" target=\"_blank\">endocrine disruptors<\/a> under conditions of common use and recommended research on this topic.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> Proposed mechanisms include leaching of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phthalates\" class=\"mw-redirect\" title=\"Phthalates\" rel=\"external_link\" target=\"_blank\">phthalates<\/a> as well as leaching of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antimony\" title=\"Antimony\" rel=\"external_link\" target=\"_blank\">antimony<\/a>.\nAn article published in <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Journal_of_Environmental_Monitoring\" class=\"mw-redirect\" title=\"Journal of Environmental Monitoring\" rel=\"external_link\" target=\"_blank\">Journal of Environmental Monitoring<\/a><\/i> in April 2012 concludes that antimony concentration in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deionized_water\" class=\"mw-redirect\" title=\"Deionized water\" rel=\"external_link\" target=\"_blank\">deionized water<\/a> stored in PET bottles stays within EU's acceptable limit even if stored briefly at temperatures up to 60 \u00b0C (140 \u00b0F), while bottled contents (water or soft drinks) may occasionally exceed the EU limit after less than a year of storage at room temperature.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Bottle_processing_equipment\">Bottle processing equipment<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Plastic_bottle.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d4\/Plastic_bottle.jpg\/220px-Plastic_bottle.jpg\" width=\"220\" height=\"316\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Plastic_bottle.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A finished PET drink bottle compared to the preform from which it is made. Worldwide, 480 billion plastic drinking bottles were made in 2016 (and less than half were recycled).<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup><\/div><\/div><\/div>\n<p>There are two basic molding methods for PET bottles, one-step and two-step. In two-step molding, two separate machines are used. The first machine injection molds the preform, which resembles a test tube, with the bottle-cap threads already molded into place. The body of the tube is significantly thicker, as it will be inflated into its final shape in the second step using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stretch_blow_molding\" class=\"mw-redirect\" title=\"Stretch blow molding\" rel=\"external_link\" target=\"_blank\">stretch blow molding<\/a>.\n<\/p><p>In the second step, the preforms are heated rapidly and then inflated against a two-part mold to form them into the final shape of the bottle. Preforms (uninflated bottles) are now also used as robust and unique containers themselves; besides novelty candy, some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Red_Cross\" class=\"mw-redirect\" title=\"Red Cross\" rel=\"external_link\" target=\"_blank\">Red Cross<\/a> chapters distribute them as part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vial_of_Life\" title=\"Vial of Life\" rel=\"external_link\" target=\"_blank\">Vial of Life<\/a> program to homeowners to store medical history for emergency responders.\n<\/p><p>In one-step machines, the entire process from raw material to finished container is conducted within one machine, making it especially suitable for molding non-standard shapes (custom molding), including jars, flat oval, flask shapes, etc. Its greatest merit is the reduction in space, product handling and energy, and far higher visual quality than can be achieved by the two-step system.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Polyester_recycling_industry\">Polyester recycling industry<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/PET_bottle_recycling\" title=\"PET bottle recycling\" rel=\"external_link\" target=\"_blank\">PET bottle recycling<\/a><\/div>\n\n<div class=\"floatleft\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Symbol_Resin_Code_1_PETE.svg\" class=\"image\" title=\"title=1-PETE\" rel=\"external_link\" target=\"_blank\"><img alt=\"title=1-PETE\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/89\/Symbol_Resin_Code_1_PETE.svg\/50px-Symbol_Resin_Code_1_PETE.svg.png\" width=\"50\" height=\"60\" \/><\/a><\/div>\n<p>In 2016, it was estimated that 56 million tons of PET are produced each year.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> While most thermoplastics can, in principle, be recycled, <a href=\"https:\/\/en.wikipedia.org\/wiki\/PET_bottle_recycling\" title=\"PET bottle recycling\" rel=\"external_link\" target=\"_blank\">PET bottle recycling<\/a> is more practical than many other plastic applications because of the high value of the resin and the almost exclusive use of PET for widely used water and carbonated soft drink bottling. PET has a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Resin_identification_code\" title=\"Resin identification code\" rel=\"external_link\" target=\"_blank\">resin identification code<\/a> of 1.<sup id=\"rdp-ebb-cite_ref-ac_30-0\" class=\"reference\"><a href=\"#cite_note-ac-30\" rel=\"external_link\">[30]<\/a><\/sup> The prime uses for recycled PET are polyester <a href=\"https:\/\/en.wikipedia.org\/wiki\/Synthetic_fiber\" title=\"Synthetic fiber\" rel=\"external_link\" target=\"_blank\">fiber<\/a>, strapping, and non-food containers.<sup id=\"rdp-ebb-cite_ref-ac_30-1\" class=\"reference\"><a href=\"#cite_note-ac-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p><p>Because of the recyclability of PET and the relative abundance of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Post-consumer_waste\" title=\"Post-consumer waste\" rel=\"external_link\" target=\"_blank\">post-consumer waste<\/a> in the form of bottles, PET is rapidly gaining market share as a carpet fiber. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mohawk_Industries\" title=\"Mohawk Industries\" rel=\"external_link\" target=\"_blank\">Mohawk Industries<\/a> released everSTRAND in 1999, a 100% post-consumer recycled content PET fiber. Since that time, more than 17 billion bottles have been recycled into carpet fiber.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> Pharr Yarns, a supplier to numerous carpet manufacturers including Looptex, Dobbs Mills, and Berkshire Flooring,<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> produces a BCF (bulk continuous filament) PET carpet fiber containing a minimum of 25% post-consumer recycled content.\n<\/p><p>PET, like many plastics, is also an excellent candidate for thermal disposal (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Incineration\" title=\"Incineration\" rel=\"external_link\" target=\"_blank\">incineration<\/a>), as it is composed of carbon, hydrogen, and oxygen, with only trace amounts of catalyst elements (but no sulfur). PET has the energy content of soft coal.\n<\/p><p>When recycling polyethylene terephthalate or PET or polyester, in general three ways have to be differentiated:\n<\/p>\n<ol><li>The chemical recycling back to the initial raw materials purified <a href=\"https:\/\/en.wikipedia.org\/wiki\/Terephthalic_acid\" title=\"Terephthalic acid\" rel=\"external_link\" target=\"_blank\">terephthalic acid<\/a> (PTA) or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dimethyl_terephthalate\" title=\"Dimethyl terephthalate\" rel=\"external_link\" target=\"_blank\">dimethyl terephthalate<\/a> (DMT) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_glycol\" title=\"Ethylene glycol\" rel=\"external_link\" target=\"_blank\">ethylene glycol<\/a> (EG) where the polymer structure is destroyed completely, or in process intermediates like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bis(2-hydroxyethyl)_terephthalate\" class=\"mw-redirect\" title=\"Bis(2-hydroxyethyl) terephthalate\" rel=\"external_link\" target=\"_blank\">bis(2-hydroxyethyl) terephthalate<\/a><\/li>\n<li>The mechanical recycling where the original polymer properties are being maintained or reconstituted.<\/li>\n<li>The chemical recycling where transesterification takes place and other glycols\/polyols or glycerol are added to make a polyol which may be used in other ways such as polyurethane production or PU foam production<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup><\/li><\/ol>\n<p>Chemical recycling of PET will become cost-efficient only applying high capacity recycling lines of more than 50,000 tons\/year. Such lines could only be seen, if at all, within the production sites of very large polyester producers. Several attempts of industrial magnitude to establish such chemical recycling plants have been made in the past but without resounding success. Even the promising chemical recycling in Japan has not become an industrial breakthrough so far. The two reasons for this are: at first, the difficulty of consistent and continuous waste bottles sourcing in such a huge amount at one single site, and, at second, the steadily increased prices and price volatility of collected bottles. The prices of baled bottles increased for instance between the years 2000 and 2008 from about 50 Euro\/ton to over 500 Euro\/ton in 2008.\n<\/p><p>Mechanical recycling or direct circulation of PET in the polymeric state is operated in most diverse variants today. These kinds of processes are typical of small and medium-size industry. Cost-efficiency can already be achieved with plant capacities within a range of 5000\u201320,000 tons\/year. In this case, nearly all kinds of recycled-material feedback into the material circulation are possible today. These diverse recycling processes are being discussed hereafter in detail.\n<\/p><p>Besides chemical contaminants and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_decomposition\" title=\"Chemical decomposition\" rel=\"external_link\" target=\"_blank\">degradation<\/a> products generated during first processing and usage, mechanical impurities are representing the main part of quality depreciating impurities in the recycling stream. Recycled materials are increasingly introduced into manufacturing processes, which were originally designed for new materials only. Therefore, efficient sorting, separation and cleaning processes become most important for high quality recycled polyester.\n<\/p><p>When talking about polyester recycling industry, we are concentrating mainly on recycling of PET bottles, which are meanwhile used for all kinds of liquid packaging like water, carbonated soft drinks, juices, beer, sauces, detergents, household chemicals and so on. Bottles are easy to distinguish because of shape and consistency and separate from waste plastic streams either by automatic or by hand-sorting processes. The established polyester recycling industry consists of three major sections:\n<\/p>\n<ul><li>PET bottle collection and waste separation: waste logistics<\/li>\n<li>Production of clean bottle flakes: flake production<\/li>\n<li>Conversion of PET flakes to final products: flake processing<\/li><\/ul>\n<p>Intermediate product from the first section is baled bottle waste with a PET content greater than 90%. Most common trading form is the bale but also bricked or even loose, pre-cut bottles are common in the market. In the second section, the collected bottles are converted to clean PET bottle flakes. This step can be more or less complex and complicated depending on required final flake quality. During the third step, PET bottle flakes are processed to any kind of products like film, bottles, fiber, filament, strapping or intermediates like pellets for further processing and engineering plastics.\n<\/p><p>Besides this external (post-consumer) polyester bottle recycling, numbers of internal (pre-consumer) recycling processes exist, where the wasted polymer material does not exit the production site to the free market, and instead is reused in the same production circuit. In this way, fiber waste is directly reused to produce fiber, preform waste is directly reused to produce preforms, and film waste is directly reused to produce film.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"PET_bottle_recycling\">PET bottle recycling<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/PET_bottle_recycling\" title=\"PET bottle recycling\" rel=\"external_link\" target=\"_blank\">PET bottle recycling<\/a><\/div>\n<h4><span class=\"mw-headline\" id=\"Purification_and_decontamination\">Purification and decontamination<\/span><\/h4>\n<p>The success of any recycling concept is hidden in the efficiency of purification and decontamination at the right place during processing and to the necessary or desired extent.\n<\/p><p>In general, the following applies: The earlier in the process foreign substances are removed, and the more thoroughly this is done, the more efficient the process is.\n<\/p><p>The high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plasticization\" class=\"mw-redirect\" title=\"Plasticization\" rel=\"external_link\" target=\"_blank\">plasticization<\/a> temperature of PET in the range of 280 \u00b0C (536 \u00b0F) is the reason why almost all common organic impurities such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyvinyl_chloride\" title=\"Polyvinyl chloride\" rel=\"external_link\" target=\"_blank\">PVC<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polylactic_acid\" title=\"Polylactic acid\" rel=\"external_link\" target=\"_blank\">PLA<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyolefin\" title=\"Polyolefin\" rel=\"external_link\" target=\"_blank\">polyolefin<\/a>, chemical wood-pulp and paper fibers, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyvinyl_acetate\" title=\"Polyvinyl acetate\" rel=\"external_link\" target=\"_blank\">polyvinyl acetate<\/a>, melt adhesive, coloring agents, sugar, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Protein\" title=\"Protein\" rel=\"external_link\" target=\"_blank\">protein<\/a> residues are transformed into colored degradation products that, in their turn, might release in addition reactive degradation products.<sup class=\"noprint Inline-Template\" style=\"margin-left:0.1em; white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Please_clarify\" title=\"Wikipedia:Please clarify\" rel=\"external_link\" target=\"_blank\"><span title=\"The text near this tag may need clarification or removal of jargon. (May 2016)\">clarification needed<\/span><\/a><\/i>]<\/sup><sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (May 2016)\">citation needed<\/span><\/a><\/i>]<\/sup> Then, the number of defects in the polymer chain increases considerably. The particle size distribution of impurities is very wide, the big particles of 60\u20131000 \u00b5m\u2014which are visible by naked eye and easy to filter\u2014representing the lesser evil, since their total surface is relatively small and the degradation speed is therefore lower. The influence of the microscopic particles, which\u2014because they are many\u2014increase the frequency of defects in the polymer, is relatively greater.\n<\/p><p>The motto \"What the eye does not see the heart cannot grieve over\" is considered to be very important in many recycling processes. Therefore, besides efficient sorting, the removal of visible impurity particles by melt filtration processes plays a particular part in this case.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Materials_recovery_facility_2.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c7\/Materials_recovery_facility_2.jpg\/220px-Materials_recovery_facility_2.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Materials_recovery_facility_2.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Workers sort an incoming stream of various plastics, mixed with some pieces of un-recyclable litter.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bales_of_PET_bottles_3.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/13\/Bales_of_PET_bottles_3.jpg\/220px-Bales_of_PET_bottles_3.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bales_of_PET_bottles_3.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Bales of crushed blue PET bottles.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bales_of_PET_bottles_4.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/be\/Bales_of_PET_bottles_4.png\/220px-Bales_of_PET_bottles_4.png\" width=\"220\" height=\"92\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bales_of_PET_bottles_4.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Bales of crushed PET bottles sorted according to color: green, transparent, and blue.<\/div><\/div><\/div>\n<p>In general, one can say that the processes to make PET bottle flakes from collected bottles are as versatile as the different waste streams are different in their composition and quality. In view of technology there isn't just one way to do it. Meanwhile, there are many engineering companies that are offering flake production plants and components, and it is difficult to decide for one or other plant design. Nevertheless, there are processes that are sharing most of these principles. Depending on composition and impurity level of input material, the general following process steps are applied.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p>\n<ol><li>Bale opening, briquette opening<\/li>\n<li>Sorting and selection for different colors, foreign polymers especially PVC, foreign matter, removal of film, paper, glass, sand, soil, stones, and metals<\/li>\n<li>Pre-washing without cutting<\/li>\n<li>Coarse cutting dry or combined to pre-washing<\/li>\n<li>Removal of stones, glass, and metal<\/li>\n<li>Air sifting to remove film, paper, and labels<\/li>\n<li>Grinding, dry and \/ or wet<\/li>\n<li>Removal of low-density polymers (cups) by density differences<\/li>\n<li>Hot-wash<\/li>\n<li>Caustic wash, and surface etching, maintaining intrinsic viscosity and decontamination<\/li>\n<li>Rinsing<\/li>\n<li>Clean water rinsing<\/li>\n<li>Drying<\/li>\n<li>Air-sifting of flakes<\/li>\n<li>Automatic flake sorting<\/li>\n<li>Water circuit and water treatment technology<\/li>\n<li>Flake quality control<\/li><\/ol>\n<h4><span class=\"mw-headline\" id=\"Impurities_and_material_defects\">Impurities and material defects<\/span><\/h4>\n<p>The number of possible impurities and material defects that accumulate in the polymeric material is increasing permanently\u2014when processing as well as when using polymers\u2014taking into account a growing service lifetime, growing final applications and repeated recycling. As far as recycled PET bottles are concerned, the defects mentioned can be sorted in the following groups:\n<\/p>\n<ol><li>Reactive polyester OH- or COOH- end groups are transformed into dead or non-reactive end groups, e.g. formation of vinyl ester end groups through dehydration or decarboxylation of terephthalate acid, reaction of the OH- or COOH- end groups with mono-functional degradation products like mono-carbonic acids or alcohols. Results are decreased reactivity during re-polycondensation or re-SSP and broadening the molecular weight distribution.<\/li>\n<li>The end group proportion shifts toward the direction of the COOH end groups built up through a thermal and oxidative degradation. The results are decrease in reactivity, and increase in the acid autocatalytic decomposition during thermal treatment in presence of humidity.<\/li>\n<li>Number of polyfunctional macromolecules increases. Accumulation of gels and long-chain branching defects.<\/li>\n<li>Number, concentration, and variety of nonpolymer-identical organic and inorganic foreign substances are increasing. With every new thermal stress, the organic foreign substances will react by decomposition. This is causing the liberation of further degradation-supporting substances and coloring substances.<\/li>\n<li>Hydroxide and peroxide groups build up at the surface of the products made of polyester in presence of air (oxygen) and humidity. This process is accelerated by ultraviolet light. During an ulterior treatment process, hydro peroxides are a source of oxygen radicals, which are source of oxidative degradation. Destruction of hydro peroxides is to happen before the first thermal treatment or during plasticization and can be supported by suitable additives like antioxidants.<\/li><\/ol>\n<p>Taking into consideration the above-mentioned chemical defects and impurities, there is an ongoing modification of the following polymer characteristics during each recycling cycle, which are detectable by chemical and physical laboratory analysis.\n<\/p><p>In particular:\n<\/p>\n<ul><li>Increase of COOH end-groups<\/li>\n<li>Increase of color number b<\/li>\n<li>Increase of haze (transparent products)<\/li>\n<li>Increase of oligomer content<\/li>\n<li>Reduction in filterability<\/li>\n<li>Increase of by-products content such as acetaldehyde, formaldehyde<\/li>\n<li>Increase of extractable foreign contaminants<\/li>\n<li>Decrease in color L<\/li>\n<li>Decrease of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intrinsic_viscosity\" title=\"Intrinsic viscosity\" rel=\"external_link\" target=\"_blank\">intrinsic viscosity<\/a> or dynamic viscosity<\/li>\n<li>Decrease of crystallization temperature and increase of crystallization speed<\/li>\n<li>Decrease of the mechanical properties like tensile strength, elongation at break or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastic_modulus\" title=\"Elastic modulus\" rel=\"external_link\" target=\"_blank\">elastic modulus<\/a><\/li>\n<li>Broadening of molecular weight distribution<\/li><\/ul>\n<p>The recycling of PET bottles is meanwhile an industrial standard process that is offered by a wide variety of engineering companies.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Processing_examples_for_recycled_polyester\">Processing examples for recycled polyester<\/span><\/h3>\n<p>Recycling processes with polyester are almost as varied as the manufacturing processes based on primary pellets or melt. Depending on purity of the recycled materials, polyester can be used today in most of the polyester manufacturing processes as blend with virgin polymer or increasingly as 100% recycled polymer. Some exceptions like BOPET-film of low thickness, special applications like optical film or yarns through FDY-spinning at > 6000 m\/min, microfilaments, and micro-fibers are produced from virgin polyester only.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Simple_re-pelletizing_of_bottle_flakes\">Simple re-pelletizing of bottle flakes<\/span><\/h4>\n<p>This process consists of transforming bottle waste into flakes, by drying and crystallizing the flakes, by plasticizing and filtering, as well as by pelletizing.\nProduct is an amorphous re-granulate of an intrinsic viscosity in the range of 0.55\u20130.7 d\u2113\/g, depending on how complete pre-drying of PET flakes has been done.\n<\/p><p>Special feature are: Acetaldehyde and oligomers are contained in the pellets at lower level; the viscosity is reduced somehow, the pellets are amorphous and have to be crystallized and dried before further processing.\n<\/p><p>Processing to:\n<\/p>\n<ul><li>A-PET film for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoforming\" title=\"Thermoforming\" rel=\"external_link\" target=\"_blank\">thermoforming<\/a><\/li>\n<li>Addition to PET virgin production<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/BoPET\" title=\"BoPET\" rel=\"external_link\" target=\"_blank\">BoPET<\/a> packaging film<\/li>\n<li>PET Bottle <a href=\"https:\/\/en.wikipedia.org\/wiki\/Resin\" title=\"Resin\" rel=\"external_link\" target=\"_blank\">resin<\/a> by SSP<\/li>\n<li>Carpet yarn<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Engineering_plastic\" title=\"Engineering plastic\" rel=\"external_link\" target=\"_blank\">Engineering plastic<\/a><\/li>\n<li>Filaments<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Non-woven\" class=\"mw-redirect\" title=\"Non-woven\" rel=\"external_link\" target=\"_blank\">Non-woven<\/a><\/li>\n<li>Packaging stripes<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Staple_fibre\" class=\"mw-redirect\" title=\"Staple fibre\" rel=\"external_link\" target=\"_blank\">Staple fibre<\/a>.<\/li><\/ul>\n<p>Choosing the re-pelletizing way means having an additional conversion process that is, at the one side, energy-intensive and cost-consuming, and causes thermal destruction. At the other side, the pelletizing step is providing the following advantages:\n<\/p>\n<ul><li>Intensive melt filtration<\/li>\n<li>Intermediate quality control<\/li>\n<li>Modification by additives<\/li>\n<li>Product selection and separation by quality<\/li>\n<li>Processing flexibility increased<\/li>\n<li>Quality uniformization.<\/li><\/ul>\n<h4><span id=\"rdp-ebb-Manufacture_of_PET-pellets_or_flakes_for_bottles_.28bottle_to_bottle.29_and_A-PET\"><\/span><span class=\"mw-headline\" id=\"Manufacture_of_PET-pellets_or_flakes_for_bottles_(bottle_to_bottle)_and_A-PET\">Manufacture of PET-pellets or flakes for bottles (bottle to bottle) and A-PET<\/span><\/h4>\n<p>This process is, in principle, similar to the one described above; however, the pellets produced are directly (continuously or discontinuously) crystallized and then subjected to a solid-state polycondensation (SSP) in a tumbling drier or a vertical tube reactor. During this processing step, the corresponding intrinsic viscosity of 0.80\u20130.085 d\u2113\/g is rebuild again and, at the same time, the acetaldehyde content is reduced to < 1 ppm.\n<\/p><p>The fact that some machine manufacturers and line builders in Europe and the United States make efforts to offer independent recycling processes, e.g. the so-called bottle-to-bottle (B-2-B) process, such as BePET,<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup> Starlinger,<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup> URRC or B\u00dcHLER, aims at generally furnishing proof of the \"existence\" of the required extraction residues and of the removal of model contaminants according to FDA applying the so-called challenge test, which is necessary for the application of the treated polyester in the food sector. Besides this process approval it is nevertheless necessary that any user of such processes has to constantly check the FDA limits for the raw materials manufactured by themselves for their process.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Direct_conversion_of_bottle_flakes\">Direct conversion of bottle flakes<\/span><\/h4>\n<p>In order to save costs, an increasing number of polyester intermediate producers like spinning mills, strapping mills, or cast film mills are working on the direct use of the PET-flakes, from the treatment of used bottles, with a view to manufacturing an increasing number of polyester intermediates. For the adjustment of the necessary viscosity, besides an efficient drying of the flakes, it is possibly necessary to also reconstitute the viscosity through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polycondensation\" class=\"mw-redirect\" title=\"Polycondensation\" rel=\"external_link\" target=\"_blank\">polycondensation<\/a> in the melt phase or solid-state polycondensation of the flakes. The latest PET flake conversion processes are applying twin screw extruders, multi-screw extruders or multi-rotation systems and coincidental vacuum degassing to remove moisture and avoid flake pre-drying. These processes allow the conversion of undried PET flakes without substantial viscosity decrease caused by hydrolysis.\n<\/p><p>With regard to the consumption of PET bottle flakes, the main portion of about 70% is converted to fibers and filaments. When using directly secondary materials such as bottle flakes in spinning processes, there are a few processing principles to obtain.\n<\/p><p>High-speed spinning processes for the manufacture of POY normally need a viscosity of 0.62\u20130.64 d\u2113\/g. Starting from bottle flakes, the viscosity can be set via the degree of drying. The additional use of TiO<sub>2<\/sub> is necessary for full dull or semi dull yarn. In order to protect the spinnerets, an efficient filtration of the melt is, in any case is necessary. For the time-being, the amount of POY made of 100% recycling polyester is rather low because this process requires high purity of spinning melt. Most of the time, a blend of virgin and recycled pellets is used.\n<\/p><p>Staple fibers are spun in an intrinsic viscosity range that lies rather somewhat lower and that should be between 0.58 and 0.62 d\u2113\/g. In this case, too, the required viscosity can be adjusted via drying or vacuum adjustment in case of vacuum extrusion. For adjusting the viscosity, however, an addition of chain length modifier like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_glycol\" title=\"Ethylene glycol\" rel=\"external_link\" target=\"_blank\">ethylene glycol<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diethylene_glycol\" title=\"Diethylene glycol\" rel=\"external_link\" target=\"_blank\">diethylene glycol<\/a> can also be used.\n<\/p><p>Spinning non-woven\u2014in the fine titer field for textile applications as well as heavy spinning non-woven as basic materials, e.g. for roof covers or in road building\u2014can be manufactured by spinning bottle flakes. The spinning viscosity is again within a range of 0.58\u20130.65 d\u2113\/g.\n<\/p><p>One field of increasing interest where recycled materials are used is the manufacture of high-tenacity packaging stripes, and monofilaments. In both cases, the initial raw material is a mainly recycled material of higher intrinsic viscosity. High-tenacity packaging stripes as well as monofilament are then manufactured in the melt spinning process.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Recycling_to_the_monomers\">Recycling to the monomers<\/span><\/h3>\n<p>Polyethylene terephthalate can be depolymerized to yield the constituent monomers. After purification, the monomers can be used to prepare new polyethylene terephthalate. The ester bonds in polyethylene terephthalate may be cleaved by hydrolysis, or by transesterification. The reactions are simply the reverse of those used <a href=\"#Production\" rel=\"external_link\">in production<\/a>.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Partial_glycolysis\">Partial glycolysis<\/span><\/h4>\n<p>Partial glycolysis (transesterification with ethylene glycol) converts the rigid polymer into short-chained oligomers that can be melt-filtered at low temperature. Once freed of the impurities, the oligomers can be fed back into the production process for polymerization.\n<\/p><p>The task consists in feeding 10\u201325% bottle flakes while maintaining the quality of the bottle pellets that are manufactured on the line. This aim is solved by degrading the PET bottle flakes\u2014already during their first plasticization, which can be carried out in a single- or multi-screw extruder\u2014to an intrinsic viscosity of about 0.30 d\u2113\/g by adding small quantities of ethylene glycol and by subjecting the low-viscosity melt stream to an efficient filtration directly after plasticization. Furthermore, temperature is brought to the lowest possible limit. In addition, with this way of processing, the possibility of a chemical decomposition of the hydro peroxides is possible by adding a corresponding P-stabilizer directly when plasticizing.\n<p>The destruction of the hydro peroxide groups is, with other processes, already carried out during the last step of flake treatment for instance by adding H<sub>3<\/sub>PO<sub>3<\/sub>.<sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup> The partially glycolyzed and finely filtered recycled material is continuously fed to the esterification or prepolycondensation reactor, the dosing quantities of the raw materials are being adjusted accordingly.\n<\/p>\n<\/p>\n<h3><span id=\"rdp-ebb-Total_glycolysis.2C_methanolysis.2C_and_hydrolysis\"><\/span><span class=\"mw-headline\" id=\"Total_glycolysis,_methanolysis,_and_hydrolysis\">Total glycolysis, methanolysis, and hydrolysis<\/span><\/h3>\n<p>The treatment of polyester waste through total glycolysis to fully convert the polyester to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bis(2-hydroxyethyl)_terephthalate\" class=\"mw-redirect\" title=\"Bis(2-hydroxyethyl) terephthalate\" rel=\"external_link\" target=\"_blank\">bis(2-hydroxyethyl) terephthalate<\/a> (C<sub>6<\/sub>H<sub>4<\/sub>(CO<sub>2<\/sub>CH<sub>2<\/sub>CH<sub>2<\/sub>OH)<sub>2<\/sub>). This compound is purified by vacuum distillation, and is one of the intermediates used in polyester manufacture (see <a href=\"#Production\" rel=\"external_link\">production<\/a>). The reaction involved is as follows:\n<\/p>\n<dl><dd>[(CO)C<sub>6<\/sub>H<sub>4<\/sub>(CO<sub>2<\/sub>CH<sub>2<\/sub>CH<sub>2<\/sub>O)]<sub>n<\/sub> + <i>n<\/i> HOCH<sub>2<\/sub>CH<sub>2<\/sub>OH → <i>n<\/i> C<sub>6<\/sub>H<sub>4<\/sub>(CO<sub>2<\/sub>CH<sub>2<\/sub>CH<sub>2<\/sub>OH)<sub>2<\/sub><\/dd><\/dl>\n<p>This recycling route has been executed on an industrial scale in Japan as experimental production.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2012)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Similar to total glycolysis, methanolysis converts the polyester to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dimethyl_terephthalate\" title=\"Dimethyl terephthalate\" rel=\"external_link\" target=\"_blank\">dimethyl terephthalate<\/a>(DMT), which can be filtered and vacuum distilled:\n<\/p>\n<dl><dd>[(CO)C<sub>6<\/sub>H<sub>4<\/sub>(CO<sub>2<\/sub>CH<sub>2<\/sub>CH<sub>2<\/sub>O)]<sub>n<\/sub> + <i>2n<\/i> CH<sub>3<\/sub>OH → <i>n<\/i> C<sub>6<\/sub>H<sub>4<\/sub>(CO<sub>2<\/sub>CH<sub>3<\/sub>)<sub>2<\/sub><\/dd><\/dl>\n<p>Methanolysis is only rarely carried out in industry today because polyester production based on dimethyl terephthalate(DMT) has shrunk tremendously, and many dimethyl terephthalate (DMT) producers have disappeared.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup>\n<\/p><p>Also as above, polyethylene terephthalate can be hydrolyzed to terephthalic acid and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_glycol\" title=\"Ethylene glycol\" rel=\"external_link\" target=\"_blank\">ethylene glycol<\/a> under high temperature and pressure. The resultant crude terephthalic acid can be purified by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Recrystallization_(chemistry)\" title=\"Recrystallization (chemistry)\" rel=\"external_link\" target=\"_blank\">recrystallization<\/a> to yield material suitable for re-polymerization:\n<\/p>\n<dl><dd>[(CO)C<sub>6<\/sub>H<sub>4<\/sub>(CO<sub>2<\/sub>CH<sub>2<\/sub>CH<sub>2<\/sub>O)]<sub>n<\/sub> + 2<i>n<\/i> H<sub>2<\/sub>O → <i>n<\/i> C<sub>6<\/sub>H<sub>4<\/sub>(CO<sub>2<\/sub>H)<sub>2<\/sub> + <i>n<\/i> HOCH<sub>2<\/sub>CH<sub>2<\/sub>OH<\/dd><\/dl>\n<p>This method does not appear to have been commercialized yet.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2012)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div role=\"navigation\" aria-label=\"Portals\" class=\"noprint portal plainlist tright\" style=\"margin:0.5em 0 0.5em 1em;border:solid #aaa 1px\">\n<ul style=\"display:table;box-sizing:border-box;padding:0.1em;max-width:175px;background:#f9f9f9;font-size:85%;line-height:110%;font-style:italic;font-weight:bold\">\n<li style=\"display:table-row\"><span style=\"display:table-cell;padding:0.2em;vertical-align:middle;text-align:center\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ed\/Papapishu-Lab-icon-6.svg\/28px-Papapishu-Lab-icon-6.svg.png\" width=\"28\" height=\"28\" class=\"noviewer\" \/><\/span><span style=\"display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Chemistry\" title=\"Portal:Chemistry\" rel=\"external_link\" target=\"_blank\">Chemistry portal<\/a><\/span><\/li><\/ul><\/div>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/BoPET\" title=\"BoPET\" rel=\"external_link\" target=\"_blank\">BoPET<\/a> (biaxially oriented PET)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioplastic\" title=\"Bioplastic\" rel=\"external_link\" target=\"_blank\">Bioplastic<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/PET_bottle_recycling\" title=\"PET bottle recycling\" rel=\"external_link\" target=\"_blank\">PET bottle recycling<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_recycling\" title=\"Plastic recycling\" rel=\"external_link\" target=\"_blank\">Plastic recycling<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polycyclohexylenedimethylene_terephthalate\" title=\"Polycyclohexylenedimethylene terephthalate\" rel=\"external_link\" target=\"_blank\">Polycyclohexylenedimethylene terephthalate<\/a>\u2014a polyester with a similar structure to PET<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyester\" title=\"Polyester\" rel=\"external_link\" target=\"_blank\">Polyester<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Solar_water_disinfection\" title=\"Solar water disinfection\" rel=\"external_link\" target=\"_blank\">Solar water disinfection<\/a>\u2014a method of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disinfection\" class=\"mw-redirect\" title=\"Disinfection\" rel=\"external_link\" target=\"_blank\">disinfecting<\/a> water using only <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sunlight\" title=\"Sunlight\" rel=\"external_link\" target=\"_blank\">sunlight<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic\" title=\"Plastic\" rel=\"external_link\" target=\"_blank\">plastic<\/a> PET bottles<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 35em; -webkit-column-width: 35em; column-width: 35em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-van_der_Vegt-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-van_der_Vegt_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-van_der_Vegt_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-van_der_Vegt_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-van_der_Vegt_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-van_der_Vegt_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-van_der_Vegt_1-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-van_der_Vegt_1-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-van_der_Vegt_1-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">van der Vegt, A. K.; Govaert, L. E. (2005). <i>Polymeren, van keten tot kunstof<\/i>. VSSD. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9071301486.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Polymeren%2C+van+keten+tot+kunstof&rft.pub=VSSD&rft.date=2005&rft.isbn=9071301486&rft.aulast=van+der+Vegt&rft.aufirst=A.+K.&rft.au=Govaert%2C+L.+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+terephthalate\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-GESTIS-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-GESTIS_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-GESTIS_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-GESTIS_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/gestis-en.itrust.de\/nxt\/gateway.dll?f=id$t=default.htm$vid=gestiseng:sdbeng$id=530566\" target=\"_blank\">Record of <i>Polyethylenterephthalat<\/i><\/a> in the GESTIS Substance Database of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Institute_for_Occupational_Safety_and_Health\" class=\"mw-redirect\" title=\"Institute for Occupational Safety and Health\" rel=\"external_link\" target=\"_blank\">Institute for Occupational Safety and Health<\/a>, accessed on 7 November 2007.<\/span>\n<\/li>\n<li id=\"cite_note-chemsrc-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-chemsrc_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.chemsrc.com\/en\/cas\/25038-59-9_894380.html\" target=\"_blank\">\"poly(ethylene terephthalate) macromolecule_msds\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=poly%28ethylene+terephthalate%29+macromolecule_msds&rft_id=https%3A%2F%2Fwww.chemsrc.com%2Fen%2Fcas%2F25038-59-9_894380.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+terephthalate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Lange_16ed-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Lange_16ed_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Lange_16ed_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Speight, J. G.; Lange, Norbert Adolph (2005). McGraw-Hill, ed. <i>Lange's Handbook of Chemistry<\/i> (16th ed.). pp. 2807\u20132758. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-07-143220-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Lange%27s+Handbook+of+Chemistry&rft.pages=2807-2758&rft.edition=16th&rft.date=2005&rft.isbn=0-07-143220-5&rft.aulast=Speight&rft.aufirst=J.+G.&rft.au=Lange%2C+Norbert+Adolph&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+terephthalate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">The name Terylene was formed by inversion of (polyeth)ylene ter(ephthalate) and dates to the 1940s. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.oxforddictionaries.com\/definition\/english\/Terylene\" target=\"_blank\">Oxford Dictionary<\/a>. Terylene was first registered as a UK trademark in April 1946.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (May 2016)\">citation needed<\/span><\/a><\/i>]<\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intellectual_Property_Office_(United_Kingdom)\" title=\"Intellectual Property Office (United Kingdom)\" rel=\"external_link\" target=\"_blank\">UK Intellectual Property Office<\/a> <span class=\"plainlinks\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ipo.gov.uk\/tmcase\/Results\/1\/UK00000646992?legacySearch=False\" target=\"_blank\">UK00000646992<\/a><\/span><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ji, Li Na (June 2013). \"Study on Preparation Process and Properties of Polyethylene Terephthalate (PET)\". <i>Applied Mechanics and Materials<\/i>. <b>312<\/b>: 406\u2013410. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4028%2Fwww.scientific.net%2FAMM.312.406\" target=\"_blank\">10.4028\/www.scientific.net\/AMM.312.406<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Applied+Mechanics+and+Materials&rft.atitle=Study+on+Preparation+Process+and+Properties+of+Polyethylene+Terephthalate+%28PET%29&rft.volume=312&rft.pages=406-410&rft.date=2013-06&rft_id=info%3Adoi%2F10.4028%2Fwww.scientific.net%2FAMM.312.406&rft.aulast=Ji&rft.aufirst=Li+Na&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+terephthalate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFPasbrig2007\" class=\"citation\">Pasbrig, Erwin (Mar 29, 2007), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.google.com\/patents\/US20070068842\" target=\"_blank\"><i>Cover film for blister packs<\/i><\/a><span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">2016-11-20<\/span><\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Cover+film+for+blister+packs&rft.date=2007-03-29&rft.aulast=Pasbrig&rft.aufirst=Erwin&rft_id=http%3A%2F%2Fwww.google.com%2Fpatents%2FUS20070068842&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+terephthalate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.plasteurope.com\/news\/SIPA_t229769\/\" target=\"_blank\">SIPA: Lightweight compressed gas cylinders have plastic liners \/ PET provides high oxygen barrier<\/a> <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.plasteurope.com\" target=\"_blank\">https:\/\/www.plasteurope.com<\/a>, 18 November 2014, retrieved 16 May 2017.<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Whinfield, John Rex and Dickson, James Tennant (1941) \"Improvements Relating to the Manufacture of Highly Polymeric Substances\", UK Patent 578,079; \"Polymeric Linear Terephthalic Esters\", <span><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.google.com\/patents\/US2465319\" target=\"_blank\">U.S. Patent 2,465,319<\/a><\/span> Publication date: 22 March 1949; Filing date: 24 September 1945; Priority date: 29 July 1941<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.teijin.com\/terms_conditions\/trademark.html\" target=\"_blank\">TEIJIN: Trademarks<\/a> \"<i>Mylar and Melinex are the registered trademarks or trademarks of Dupont Teijin Films U.S. Limited Partnership and have been licensed to Teijin DuPont Films Japan Limited<\/i>\"<\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Ryazanova-Clarke, Larissa; Wade, Terence (31 January 2002). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=J_OFr8TgcwMC&pg=PA49\" target=\"_blank\"><i>The Russian Language Today<\/i><\/a>. Taylor & Francis. pp. 49\u2013. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-203-06587-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Russian+Language+Today&rft.pages=49-&rft.pub=Taylor+%26+Francis&rft.date=2002-01-31&rft.isbn=978-0-203-06587-7&rft.au=Ryazanova-Clarke%2C+Larissa&rft.au=Wade%2C+Terence&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DJ_OFr8TgcwMC%26pg%3DPA49&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+terephthalate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Wyeth, Nathaniel C. \"Biaxially Oriented Poly(ethylene terephthalate) Bottle\" <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.google.com\/patents\/about?id=hl49AAAAEBAJ&dq=intitle:Biaxially+intitle:Oriented\" target=\"_blank\">US patent 3733309<\/a>, Issued May 1973<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">NPCS Board of Consultants & Engineers (2014) Chapter 6, p. 56 in <i>Disposable Products Manufacturing Handbook<\/i>, NIIR Project Consultancy Services, Delhi, <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-9-381-03932-8<\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Thiele, Ulrich K. (2007) <i>Polyester Bottle Resins, Production, Processing, Properties and Recycling<\/i>, Heidelberg, Germany, pp. 85 ff, <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-9807497-4-9<\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Gupta, V.B. and Bashir, Z. (2002) Chapter 7, p. 320 in Fakirov, Stoyko (ed.) <i>Handbook of Thermoplastic Polyesters<\/i>, Wiley-VCH, Weinheim, <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 3-527-30113-5.<\/span>\n<\/li>\n<li id=\"cite_note-polyesters-16\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-polyesters_16-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-polyesters_16-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-polyesters_16-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation\">\"Polyesters\", <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ullmann%27s_Encyclopedia_of_Industrial_Chemistry\" title=\"Ullmann's Encyclopedia of Industrial Chemistry\" rel=\"external_link\" target=\"_blank\">Ullmann's Encyclopedia of Industrial Chemistry<\/a><\/i>, <b>A21<\/b>, Weinheim: Wiley-VCH, pp. 233\u2013238, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14356007.a21_227\" target=\"_blank\">10.1002\/14356007.a21_227<\/a><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Polyesters&rft.btitle=Ullmann%27s+Encyclopedia+of+Industrial+Chemistry&rft.place=Weinheim&rft.pages=233-238&rft.pub=Wiley-VCH&rft_id=info%3Adoi%2F10.1002%2F14356007.a21_227&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+terephthalate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cheng, X.; et al. (2010). \"Assessment of metal contaminations leaching out from recycling plastic bottles upon treatments\". <i>Environmental science and pollution research international<\/i>. <b>17<\/b> (7): 1323\u201330. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11356-010-0312-4\" target=\"_blank\">10.1007\/s11356-010-0312-4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20309737\" target=\"_blank\">20309737<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Environmental+science+and+pollution+research+international&rft.atitle=Assessment+of+metal+contaminations+leaching+out+from+recycling+plastic+bottles+upon+treatments&rft.volume=17&rft.issue=7&rft.pages=1323-30&rft.date=2010&rft_id=info%3Adoi%2F10.1007%2Fs11356-010-0312-4&rft_id=info%3Apmid%2F20309737&rft.au=Cheng%2C+X.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+terephthalate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/epa.gov\/ogwdw\/pdfs\/factsheets\/ioc\/antimony.pdf\" target=\"_blank\">Consumer Factsheet on: Antimony<\/a>, EPA <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20030623135029\/http:\/\/www.epa.gov\/ogwdw000\/contaminants\/dw_contamfs\/antimony.html\" target=\"_blank\">archive 2003-06-23<\/a><\/span>\n<\/li>\n<li id=\"cite_note-who.int-19\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-who.int_19-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-who.int_19-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.who.int\/water_sanitation_health\/dwq\/chemicals\/antimonysum.pdf\" target=\"_blank\">Guidelines for drinking \u2013 water quality<\/a>. who.int<\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Shotyk, William; et al. (2006). \"Contamination of Canadian and European bottled waters with antimony from PET containers\". <i>Journal of Environmental Monitoring<\/i>. <b>8<\/b> (2): 288\u201392. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1039%2Fb517844b\" target=\"_blank\">10.1039\/b517844b<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16470261\" target=\"_blank\">16470261<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Environmental+Monitoring&rft.atitle=Contamination+of+Canadian+and+European+bottled+waters+with+antimony+from+PET+containers&rft.volume=8&rft.issue=2&rft.pages=288-92&rft.date=2006&rft_id=info%3Adoi%2F10.1039%2Fb517844b&rft_id=info%3Apmid%2F16470261&rft.au=Shotyk%2C+William&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+terephthalate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hansen, Claus; et al. 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target=\"_blank\">\"Polyethylene Terephthalate May Yield Endocrine Disruptors\"<\/a>. <i>Environmental Health Perspectives<\/i>. <b>118<\/b> (4): 445\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1289%2Fehp.0901253\" target=\"_blank\">10.1289\/ehp.0901253<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2854718\" target=\"_blank\">2854718<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Environmental+Monitoring&rft.atitle=PET+bottle+use+patterns+and+antimony+migration+into+bottled+water+and+soft+drinks%3A+the+case+of+British+and+Nigerian+bottles&rft.volume=14&rft.issue=4&rft.pages=1236-1246&rft.date=2012&rft_id=info%3Adoi%2F10.1039%2FC2EM10917D&rft.au=Tukur%2C+Aminu&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+terephthalate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Sandra Laville and Matthew Taylor, <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.theguardian.com\/environment\/2017\/jun\/28\/a-million-a-minute-worlds-plastic-bottle-binge-as-dangerous-as-climate-change\" target=\"_blank\">\"A million bottles a minute: world's plastic binge 'as dangerous as climate change'\"<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/TheGuardian.com\" title=\"TheGuardian.com\" rel=\"external_link\" target=\"_blank\">TheGuardian.com<\/a>, 28 June 2017 (page visited on 20 July 2017).<\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Saxena, Shalini (19 March 2016). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/arstechnica.com\/science\/2016\/03\/does-newly-discovered-bacteria-recycle-plastic\/\" target=\"_blank\">\"Newly identified bacteria cleans up common plastic\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ars_Technica\" title=\"Ars Technica\" rel=\"external_link\" target=\"_blank\">Ars Technica<\/a><\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">21 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Ars+Technica&rft.atitle=Newly+identified+bacteria+cleans+up+common+plastic&rft.date=2016-03-19&rft.au=Saxena%2C+Shalini&rft_id=https%3A%2F%2Farstechnica.com%2Fscience%2F2016%2F03%2Fdoes-newly-discovered-bacteria-recycle-plastic%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+terephthalate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ac-30\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ac_30-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ac_30-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110721103005\/http:\/\/www.americanchemistry.com\/s_plastics\/bin.asp?CID=1102&DID=4645&DOC=FILE.PDF\" target=\"_blank\">\"Plastic Packaging Resins\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. American Chemistry Council. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.americanchemistry.com\/s_plastics\/bin.asp?CID=1102&DID=4645&DOC=FILE.PDF\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 21 July 2011.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Plastic+Packaging+Resins&rft.pub=American+Chemistry+Council&rft_id=http%3A%2F%2Fwww.americanchemistry.com%2Fs_plastics%2Fbin.asp%3FCID%3D1102%26DID%3D4645%26DOC%3DFILE.PDF&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+terephthalate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/carpet-inspectors-experts.com\/old\/everstrand-smartstrand.htm\" target=\"_blank\">everSTRAND\u2122<\/a><sup class=\"noprint Inline-Template\"><span style=\"white-space: nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Link_rot\" title=\"Wikipedia:Link rot\" rel=\"external_link\" target=\"_blank\"><span title=\" Dead link since March 2018\">permanent dead link<\/span><\/a><\/i>]<\/span><\/sup> Carpet-inspectors-experts.com <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080317233830\/http:\/\/carpet-inspectors-experts.com\/everstrand-smartstrand.htm\" target=\"_blank\">archive 2008-03-17<\/a><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.simplygreencarpet.com\/\" target=\"_blank\">Simply Green Carpet \u2013 A Berkshire Flooring Brand<\/a>. simplygreencarpet.com<\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Makuska, Ricardas (2008 Vol 19. No 2 P. 29-34). \"Glycolysis of industrial poly(ethylene terephthalate) waste directed to bis(hydroxyethylene) terephthalate and aromatic polyester polyols\". <i>CHEMIJA<\/i>. <b>19<\/b>: 29\u201334.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=CHEMIJA&rft.atitle=Glycolysis+of+industrial+poly%28ethylene+terephthalate%29+waste+directed+to+bis%28hydroxyethylene%29+terephthalate+and+aromatic+polyester+polyols&rft.chron=2008+Vol+19.+No+2+P.+29-34&rft.volume=19&rft.pages=29-34&rft.aulast=Makuska&rft.aufirst=Ricardas&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+terephthalate\" class=\"Z3988\"><\/span> <span class=\"cs1-visible-error error citation-comment\">Check date values in: <code class=\"cs1-code\">|date=<\/code> (<a href=\"#bad_date\" title=\"Help:CS1 errors\" rel=\"external_link\">help<\/a>)<\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">PET-Recycling Forum; \"Current Technological Trends in Polyester Recycling\"; 9th International Polyester Recycling Forum Washington, 2006; S\u00e3o Paulo; <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 3-00-019765-6<\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Thiele, Ulrich K. (2007) <i>Polyester Bottle Resins Production, Processing, Properties and Recycling<\/i>, PETplanet Publisher GmbH, Heidelberg, Germany, pp. 259 ff, <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-9807497-4-9<\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bepet.com\" target=\"_blank\">BePET<\/a><\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.starlinger.com\" target=\"_blank\">Starlinger<\/a><\/span>\n<\/li>\n<li id=\"cite_note-38\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-38\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Boos, Frank and Thiele, Ulrich \"Reprocessing pulverised polyester waste without yellowing\", German Patent <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.google.com\/patents\/DE19503055A1?cl=en\" target=\"_blank\">DE19503055<\/a>, Publication date: 8 August 1996<\/span>\n<\/li>\n<li id=\"cite_note-39\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-39\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Fakirov, Stoyko (ed.) (2002) <i>Handbook of Thermoplastic Polyesters<\/i>, Wiley-VCH, Weinheim, pp. 1223 ff, <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 3-527-30113-5<\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/plasticsinfo.org\/beveragebottles\/index.html\" target=\"_blank\">American Plastics Council: PlasticInfo.org<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.kenplas.com\/project\/pet\/\" target=\"_blank\">KenPlas Industry Ltd.: \"What is PET (Polyethylene Terephthalate)\"<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100309112752\/http:\/\/wavepolymertechnology.com\/PROCESSING.aspx\" target=\"_blank\">\"WAVE Polymer Technology: PET (Polyethylene Terephthalate) flakes processing\"<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1266\nCached time: 20181217070211\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.984 seconds\nReal time usage: 1.321 seconds\nPreprocessor visited node count: 8031\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 154318\/2097152 bytes\nTemplate argument size: 17814\/2097152 bytes\nHighest expansion depth: 22\/40\nExpensive parser function count: 15\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 74721\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.441\/10.000 seconds\nLua memory usage: 11.49 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1146.299 1 -total\n<\/p>\n<pre>38.81% 444.867 1 Template:Chembox\n28.16% 322.763 1 Template:Reflist\n19.37% 221.984 1 Template:Chembox_Identifiers\n12.53% 143.579 5 Template:Chembox_headerbar\n12.38% 141.864 27 Template:Trim\n10.04% 115.070 1 Template:Chembox_Properties\n 6.92% 79.377 15 Template:Main_other\n 6.90% 79.075 6 Template:Citation_needed\n 6.68% 76.525 9 Template:Cite_journal\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:292941-1!canonical and timestamp 20181217070210 and revision id 871084514\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene_terephthalate\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212222\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.017 seconds\nReal time usage: 0.175 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 165.662 1 - wikipedia:Polyethylene_terephthalate\n100.00% 165.662 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8292-0!*!*!*!*!*!* and timestamp 20181217212222 and revision id 24504\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polyethylene_terephthalate\">https:\/\/www.limswiki.org\/index.php\/Polyethylene_terephthalate<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","3d4a244ce30949af99a3f7e14e78e59a_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cf\/PET.svg\/500px-PET.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/36\/Polyethylene-terephthalate-3D-spacefill.png\/500px-Polyethylene-terephthalate-3D-spacefill.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2c\/Polyethylene-terephthalate-3D-balls.png\/500px-Polyethylene-terephthalate-3D-balls.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/63\/Thistle_dinghy_with_skipper_Terry_Lettenmaier_sailing_downwind.jpg\/440px-Thistle_dinghy_with_skipper_Terry_Lettenmaier_sailing_downwind.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f4\/Phthalic_acid_isomers.PNG\/440px-Phthalic_acid_isomers.PNG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b5\/PET_by_Transesterification_V1.svg\/440px-PET_by_Transesterification_V1.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/83\/PET_by_Polycondensation_V1.svg\/440px-PET_by_Polycondensation_V1.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d4\/Plastic_bottle.jpg\/440px-Plastic_bottle.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/89\/Symbol_Resin_Code_1_PETE.svg\/100px-Symbol_Resin_Code_1_PETE.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c7\/Materials_recovery_facility_2.jpg\/440px-Materials_recovery_facility_2.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/13\/Bales_of_PET_bottles_3.jpg\/440px-Bales_of_PET_bottles_3.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/be\/Bales_of_PET_bottles_4.png\/440px-Bales_of_PET_bottles_4.png"],"3d4a244ce30949af99a3f7e14e78e59a_timestamp":1545081742,"70c8dc35eb67e7a793ef2d5954896ff3_type":"article","70c8dc35eb67e7a793ef2d5954896ff3_title":"Polyethylene glycol","70c8dc35eb67e7a793ef2d5954896ff3_url":"https:\/\/www.limswiki.org\/index.php\/Polyethylene_glycol","70c8dc35eb67e7a793ef2d5954896ff3_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPolyethylene glycol\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tNot to be confused with Ethylene glycol or Diethylene glycol.\nFor medical uses of polyethylene glycol, see Macrogol.\n\n\n\nPolyethylene glycol\n\n\n\n\n\nNames\n\n\n\nIUPAC names\npoly(oxyethylene) {structure-based},\r\n poly(ethylene oxide) {source-based}[1]\n\n\n\n\nOther names\nCarbowax, GoLYTELY, GlycoLax, Fortrans, TriLyte, Colyte, Halflytely, Macrogol, MiraLAX, MoviPrep\n\n\nIdentifiers\n\n\n\nCAS Number\n\n25322-68-3  Y \n\n\n\n\n\n\n\nChEMBL\n\nChEMBL1201478  N \n\n\nChemSpider\n\nnone\n\n\n\nECHA InfoCard \n\n100.105.546\n\n\n\nE number \n\nE1521 (additional chemicals)\n\n\n\n\n\n\n\n\nUNII\n\n3WJQ0SDW1A  N \n\n\nProperties\n\n\nChemical formula\n\nC2nH4n+2On+1 \n\n\nMolar mass\n\n18.02 + 44.05n g\/mol    \n\n\n\n\nDensity\n\n1.125[2]\n\n\n\n\n\nPharmacology\n\n\n\nATC code\n\nA06AD15 (WHO ) \n\n\nHazards\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFlash point\n\n182\u2013287 \u00b0C; 360\u2013549 \u00b0F; 455\u2013560 K  \n\n\n\n\n\nExcept where otherwise noted, data are given for materials in their standard state (at 25 \u00b0C [77 \u00b0F], 100 kPa).\n\n\nN  verify  (what is Y N  ?)\n\n\nInfobox references\n\n\n\n\n\n\n\nPolyethylene glycol (PEG) is a polyether compound with many applications, from industrial manufacturing to medicine. PEG is also known as polyethylene oxide (PEO) or polyoxyethylene (POE), depending on its molecular weight. The structure of PEG is commonly expressed as H\u2212(O\u2212CH2\u2212CH2)n\u2212OH.\n\nContents \n\n1 Available forms and nomenclature \n2 Production \n3 Uses \n\n3.1 Medical uses \n3.2 Chemical uses \n3.3 Biological uses \n3.4 Commercial uses \n3.5 Industrial uses \n\n\n4 Health effects \n5 See also \n6 References \n7 External links \n\n\nAvailable forms and nomenclature \nPEG, PEO, and POE refer to an oligomer or polymer of ethylene oxide. The three names are chemically synonymous, but historically PEG is preferred in the biomedical field, whereas PEO is more prevalent in the field of polymer chemistry. Because different applications require different polymer chain lengths, PEG has tended to refer to oligomers and polymers with a molecular mass below 20,000  g\/mol, PEO to polymers with a molecular mass above 20,000  g\/mol, and POE to a polymer of any molecular mass.[3] PEGs are prepared by polymerization of ethylene oxide and are commercially available over a wide range of molecular weights from 300  g\/mol to 10,000,000  g\/mol.[4]\nPEG and PEO are liquids or low-melting solids, depending on their molecular weights. While PEG and PEO with different molecular weights find use in different applications, and have different physical properties (e.g. viscosity) due to chain length effects, their chemical properties are nearly identical. Different forms of PEG are also available, depending on the initiator used for the polymerization process \u2013 the most common initiator is a monofunctional methyl ether PEG, or methoxypoly(ethylene glycol), abbreviated mPEG. Lower-molecular-weight PEGs are also available as purer oligomers, referred to as monodisperse, uniform, or discrete. Very high purity PEG has recently been shown to be crystalline, allowing determination of a crystal structure by x-ray diffraction.[4] Since purification and separation of pure oligomers is difficult, the price for this type of quality is often 10\u20131000 fold that of polydisperse PEG.\nPEGs are also available with different geometries.\n\nBranched PEGs have three to ten PEG chains emanating from a central core group.\nStar PEGs have 10 to 100 PEG chains emanating from a central core group.\nComb PEGs have multiple PEG chains normally grafted onto a polymer backbone.\nThe numbers that are often included in the names of PEGs indicate their average molecular weights (e.g. a PEG with n = 9 would have an average molecular weight of approximately 400 daltons, and would be labeled PEG 400.) Most PEGs include molecules with a distribution of molecular weights (i.e. they are polydisperse). The size distribution can be characterized statistically by its weight average molecular weight (Mw) and its number average molecular weight (Mn), the ratio of which is called the polydispersity index (Mw\/Mn). Mw and Mn can be measured by mass spectrometry.\nPEGylation is the act of covalently coupling a PEG structure to another larger molecule, for example, a therapeutic protein, which is then referred to as a PEGylated protein. PEGylated interferon alfa-2a or \u22122b are commonly used injectable treatments for hepatitis C infection.\nPEG is soluble in water, methanol, ethanol, acetonitrile, benzene, and dichloromethane, and is insoluble in diethyl ether and hexane. It is coupled to hydrophobic molecules to produce non-ionic surfactants.[5]\nPEGs potentially contain toxic impurities, such as ethylene oxide and 1,4-dioxane.[6] Ethylene Glycol and its ethers are nephrotoxic if applied to damaged skin.[7]\n\n Polyethylene oxide (PEO, Mw 4  kDa) nanometric crystallites (4 nm)\nPolyethylene glycol (PEG) and related polymers (PEG phospholipid constructs) are often sonicated when used in biomedical applications. However, as reported by Murali et al., PEG is very sensitive to sonolytic degradation and PEG degradation products can be toxic to mammalian cells. It is, thus, imperative to assess potential PEG degradation to ensure that the final material does not contain undocumented contaminants that can introduce artifacts into experimental results.[8]\nPEGs and methoxypolyethylene glycols are manufactured by Dow Chemical under the tradename Carbowax for industrial use, and Carbowax Sentry for food and pharmaceutical use. They vary in consistency from liquid to solid, depending on the molecular weight, as indicated by a number following the name. They are used commercially in numerous applications, including as surfactants, in foods, in cosmetics, in pharmaceutics, in biomedicine, as dispersing agents, as solvents, in ointments, in suppository bases, as tablet excipients, and as laxatives. Some specific groups are lauromacrogols, nonoxynols, octoxynols, and poloxamers.\nMacrogol, used as a laxative, is a form of polyethylene glycol. The name may be followed by a number which represents the average molecular weight (e.g. macrogol 3350, macrogol 4000 or macrogol 6000).\n\nProduction \n Polyethylene glycol 400, pharmaceutical quality\n Polyethylene glycol 4000, pharmaceutical quality\nThe production of polyethylene glycol was first reported in 1859. Both A. V. Laurence and Charles Adolphe Wurtz independently isolated products that were polyethylene glycols.[9] Polyethylene glycol is produced by the interaction of ethylene oxide with water, ethylene glycol, or ethylene glycol oligomers.[10] The reaction is catalyzed by acidic or basic catalysts. Ethylene glycol and its oligomers are preferable as a starting material instead of water, because they allow the creation of polymers with a low polydispersity (narrow molecular weight distribution). Polymer chain length depends on the ratio of reactants.\n\nHOCH2CH2OH + n(CH2CH2O) \u2192 HO(CH2CH2O)n+1H\nDepending on the catalyst type, the mechanism of polymerization can be cationic or anionic. The anionic mechanism is preferable because it allows one to obtain PEG with a low polydispersity. Polymerization of ethylene oxide is an exothermic process. Overheating or contaminating ethylene oxide with catalysts such as alkalis or metal oxides can lead to runaway polymerization, which can end in an explosion after a few hours.\nPolyethylene oxide, or high-molecular weight polyethylene glycol, is synthesized by suspension polymerization. It is necessary to hold the growing polymer chain in solution in the course of the polycondensation process. The reaction is catalyzed by magnesium-, aluminium-, or calcium-organoelement compounds. To prevent coagulation of polymer chains from solution, chelating additives such as dimethylglyoxime are used.\nAlkaline catalysts such as sodium hydroxide (NaOH), potassium hydroxide (KOH), or sodium carbonate (Na2CO3) are used to prepare low-molecular-weight polyethylene glycol.\n\nUses \nMedical uses \nMain article: Macrogol\nPEG is the basis of a number of laxatives.[11] Whole bowel irrigation with polyethylene glycol and added electrolytes is used for bowel preparation before surgery or colonoscopy.\nPEG is also used as an excipient in many pharmaceutical products.\nWhen attached to various protein medications, polyethylene glycol allows a slowed clearance of the carried protein from the blood.[12]\nThe possibility that PEG could be used to fuse nerve cells is being explored by researchers studying spinal cord injury.[11]\nChemical uses \n The remains of the 16th century carrack Mary Rose undergoing conservation treatment with PEG in the 1980s\n Terra cotta warrior, showing traces of original color\nBecause PEG is hydrophilic molecule, it has been used to passivate microscope glass slides for avoiding non-specific sticking of proteins in single-molecule fluorescence studies.[13]\nPolyethylene glycol has a low toxicity and is used in a variety of products.[14] The polymer is used as a lubricating coating for various surfaces in aqueous and non-aqueous environments.[15]\nSince PEG is a flexible, water-soluble polymer, it can be used to create very high osmotic pressures (on the order of tens of atmospheres). It also is unlikely to have specific interactions with biological chemicals. These properties make PEG one of the most useful molecules for applying osmotic pressure in biochemistry and biomembranes experiments, in particular when using the osmotic stress technique.\nPolyethylene glycol is also commonly used as a polar stationary phase for gas chromatography, as well as a heat transfer fluid in electronic testers.\nPEG has also been used to preserve objects that have been salvaged from underwater, as was the case with the warship Vasa in Stockholm,[16] and similar cases. It replaces water in wooden objects, making the wood dimensionally stable and preventing warping or shrinking of the wood when it dries.[11] In addition, PEG is used when working with green wood as a stabilizer, and to prevent shrinkage.[17]\nPEG has been used to preserve the painted colors on Terra-Cotta Warriors unearthed at a UNESCO World Heritage site in China.[18] These painted artifacts were created during the Qin Shi Huang Di dynasty (first emperor of China). Within 15 seconds of the terra-cotta pieces being unearthed during excavations, the lacquer beneath the paint begins to curl after being exposed to the dry Xian air. The paint would subsequently flake off in about four minutes. The German Bavarian State Conservation Office developed a PEG preservative that when immediately applied to unearthed artifacts has aided in preserving the colors painted on the pieces of clay soldiers.[19]\nPEG is often used (as an internal calibration compound) in mass spectrometry experiments, with its characteristic fragmentation pattern allowing accurate and reproducible tuning.\nPEG derivatives, such as narrow range ethoxylates, are used as surfactants.\nPEG is a polyol and can be reacted with an isocyanate to make polyurethane.\nPEG has been used as the hydrophilic block of amphiphilic block copolymers used to create some polymersomes.[20]\nBiological uses \nPEG is commonly used as a crowding agent in in vitro assays to mimic highly crowded cellular conditions.[13]\nPEG is commonly used as a precipitant for plasmid DNA isolation and protein crystallization. X-ray diffraction of protein crystals can reveal the atomic structure of the proteins.\nPEG is used to fuse two different types of cells, most often B-cells and myelomas in order to create hybridomas. C\u00e9sar Milstein and Georges J. F. K\u00f6hler originated this technique, which they used for antibody production, winning a Nobel Prize in Physiology or Medicine in 1984.[11]\nPolymer segments derived from PEG polyols impart flexibility to polyurethanes for applications such as elastomeric fibers (spandex) and foam cushions.\nIn microbiology, PEG precipitation is used to concentrate viruses. PEG is also used to induce complete fusion (mixing of both inner and outer leaflets) in liposomes reconstituted in vitro.\nGene therapy vectors (such as viruses) can be PEG-coated to shield them from inactivation by the immune system and to de-target them from organs where they may build up and have a toxic effect.[21] The size of the PEG polymer has been shown to be important, with larger polymers achieving the best immune protection.\nPEG is a component of stable nucleic acid lipid particles (SNALPs) used to package siRNA for use in vivo.[22][23]\nIn blood banking, PEG is used as a potentiator to enhance detection of antigens and antibodies.[24][11]\nWhen working with phenol in a laboratory situation, PEG 300 can be used on phenol skin burns to deactivate any residual phenol.\nIn biophysics, polyethylene glycols are the molecules of choice for the functioning ion channels diameter studies, because in aqueous solutions they have a spherical shape and can block ion channel conductance.[25]\nCommercial uses \nPEG is the basis of many skin creams (as cetomacrogol) and personal lubricants (frequently combined with glycerin).\nPEG is used in a number of toothpastes[11] as a dispersant. In this application, it binds water and helps keep xanthan gum uniformly distributed throughout the toothpaste.\nPEG is also under investigation for use in body armor, and in tattoos to monitor diabetes.[26][27]\nIn low-molecular-weight formulations (i.e. PEG 400), it is used in Hewlett-Packard designjet printers as an ink solvent and lubricant for the print heads.\nPEG is also one of the main ingredients in paintball fills, because of its thickness and flexibility. However, as early as 2006, some paintball manufacturers began substituting cheaper oil-based alternatives for PEG.[citation needed ]\nPEG is also used as an anti-foaming agent in food[28] \u2013 its INS number is 1521[29] or E1521 in the EU.[30]\nIndustrial uses \nA nitrate ester-plasticized polyethylene glycol (NEPE-75) is used in Trident II submarine-launched ballistic missile solid rocket fuel.[31]\nDimethyl ethers of PEG are the key ingredient of Selexol, a solvent used by coal-burning, integrated gasification combined cycle (IGCC) power plants to remove carbon dioxide and hydrogen sulfide from the gas waste stream.\nPEG has been used as the gate insulator in an electric double-layer transistor to induce superconductivity in an insulator.[32]\nPEG is also used as a polymer host for solid polymer electrolytes. Although not yet in commercial production, many groups around the globe are engaged in research on solid polymer electrolytes involving PEG, with the aim of improving their properties, and in permitting their use in batteries, electro-chromic display systems, and other products in the future.\nPEG is injected into industrial processes to reduce foaming in separation equipment.\nPEG is used as a binder in the preparation of technical ceramics.[33]\nHealth effects \nPEG is generally considered biologically inert and safe. However, studies of clinical safety are generally based on adults, not children. The FDA has been asked to investigate the possible effects of PEG in laxatives for children.[34] Also, a minority of people are allergic to it. Allergy to PEG is usually discovered after a person has been diagnosed with an allergy to an increasing number of seemingly unrelated products, including processed foods, cosmetics, drugs, and other substances that contain PEG or were manufactured with PEG.[35]\n\nSee also: Multiple chemical sensitivity\nWhen PEG is chemically attached to therapeutic molecules (such as protein drugs or nanoparticles), it can sometimes be antigenic, stimulating an anti-PEG antibody response in some patients. This effect has only been shown for a few of the many available PEGylated therapeutics, but it has significant effects on clinical outcomes of affected patients.[36] Other than these few instances where patients have anti-PEG immune responses, it is generally considered to be a safe component of drug formulations.\n\nSee also \nEthylene\nPropylene glycol\nMonoethylene glycol\nDiethylene glycol\nPEGylation\nPEG-PVA\nLauryl methyl gluceth-10 hydroxypropyl dimonium chloride\nReferences \n\n\n^ Kahovec, J.; Fox, R. B.; Hatada, K. (2002). \"Nomenclature of regular single-strand organic polymers\". Pure and Applied Chemistry. 74 (10): 1921\u20131956. doi:10.1351\/pac200274101921. \n\n^ \"Poly(ethylene glycol)_msds\". \n\n^ For example, in the online catalog Archived 29 December 2006 at the Wayback Machine. of Scientific Polymer Products, Inc., poly(ethylene glycol) molecular weights run up to about 20,000, while those of poly(ethylene oxide) have six or seven digits. \n\n^ a b French, Alister C.; Thompson, Amber L.; Davis, Benjamin G. (2009). \"High Purity Discrete PEG Oligomer Crystals Allow Structural Insight\" (PDF) . Angewandte Chemie International Edition. 48 (7): 1248\u20131252. doi:10.1002\/anie.200804623. PMID 19142918. \n\n^ Winger, Moritz; De Vries, Alex H.; Van Gunsteren, Wilfred F. (2009). \"Force-field dependence of the conformational properties of \u03b1,\u03c9-dimethoxypolyethylene glycol\". Molecular Physics. 107 (13): 1313. Bibcode:2009MolPh.107.1313W. doi:10.1080\/00268970902794826. \n\n^ Nutrition, Center for Food Safety and Applied. \"Potential Contaminants - 1,4-Dioxane A Manufacturing Byproduct\". www.fda.gov. Retrieved 2017-05-26 . \n\n^ Andersen, F. A. (1999). \"Special Report: Reproductive and Developmental Toxicity of Ethylene Glycol and Its Ethers\". International Journal of Toxicology. 18 (3): 53\u201367. doi:10.1177\/109158189901800208. \n\n^ Murali, V. S.; Wang, R.; Mikoryak, C. A.; et al. (2015). \"Rapid detection of polyethylene glycol sonolysis upon functionalization of carbon nanomaterials\". Experimental Biology and Medicine. 240 (9): 1147\u20131151. doi:10.1177\/1535370214567615. PMC 4527952 . PMID 25662826. \n\n^ Bailey, Jr., Frederick E.; Koleske, Joseph V. (1990). Alkylene oxides and their polymers. New York: Dekker. pp. 27\u201328. ISBN 9780824783846. Retrieved 17 July 2017 . \n\n^ Polyethylene glycol, Chemindustry.ru \n\n^ a b c d e f Kean, Sam (2017). \"Chemical Hope\". Distillations. 2 (4): 5. Retrieved 22 March 2018 . \n\n^ Bowman, Lee (4 December 2004). \"Study on dogs yields hope in human paralysis treatment\". seattlepi.com. \n\n^ a b Ganji, Mahipal; Docter, Margreet; Le Grice, Stuart F. J.; Abbondanzieri, Elio A. (2016-09-30). \"DNA binding proteins explore multiple local configurations during docking via rapid rebinding\". Nucleic Acids Research. 44 (17): 8376\u20138384. doi:10.1093\/nar\/gkw666. ISSN 0305-1048. PMC 5041478 . PMID 27471033. \n\n^ Sheftel, Victor O. (2000). Indirect Food Additives and Polymers: Migration and Toxicology. CRC. pp. 1114\u20131116. \n\n^ Nalam, Prathima C.; Clasohm, Jarred N.; Mashaghi, Alireza; Spencer, Nicholas D. (2009). \"Macrotribological Studies of Poly(L-lysine)-graft-Poly(ethylene glycol) in Aqueous Glycerol Mixtures\" (PDF) . Tribology Letters (Submitted manuscript). 37 (3): 541\u2013552. doi:10.1007\/s11249-009-9549-9. \n\n^ Lars-\u00c5ke Kvarning, Bengt Ohrelius (1998), The Vasa \u2013 The Royal Ship, ISBN 91-7486-581-1, pp. 133\u2013141 \n\n^ Anti-Freeze is Not a Green Wood Stabilizer \u2013 Buzz Saw, The Rockler Blog. Rockler.com (2 May 2006). Retrieved on 30 November 2012. \n\n^ Reiffert, Stefanie (18 March 2015). \"Conservators preserve the paint layers of the Terracotta Army\". www.tum.de. Technische Universit\u00e4t M\u00fcnchen. Retrieved 19 December 2015 . \n\n^ Larmer, Brook (June 2012). \"Terra-Cotta Warriors in Color\". National Geographic. 221 (6): 74\u201387. \n\n^ Rameez, Shahid; Alosta, Houssam; Palmer, Andre F. (2008). \"Biocompatible and Biodegradable Polymersome Encapsulated Hemoglobin: A Potential Oxygen Carrier\". Bioconjugate Chemistry. 19 (5): 1025\u201332. doi:10.1021\/bc700465v. PMID 18442283. \n\n^ Kreppel, Florian; Kochanek, Stefan (2007). \"Modification of Adenovirus Gene Transfer Vectors With Synthetic Polymers: A Scientific Review and Technical Guide\". Molecular Therapy. 16 (1): 16\u201329. doi:10.1038\/sj.mt.6300321. PMID 17912234. \n\n^ Rossi, J.J. (2006). \"RNAi therapeutics: SNALPing siRNAs in vivo\". Gene Therapy. 13 (7): 583\u2013584. doi:10.1038\/sj.gt.3302661. PMID 17526070. \n\n^ Geisbert, Thomas W.; Lee, Amy CH; Robbins, Marjorie; et al. (29 May 2010). \"Postexposure protection of non-human primates against a lethal Ebola virus challenge with RNA interference: a proof-of-concept study\". The Lancet. 375 (9729): 1896\u2013905. doi:10.1016\/S0140-6736(10)60357-1. PMID 20511019. (free with registration) \n\n^ Harmening, Denise M. (2005). Modern Blood Banking & Transfusion Practices. F. A. Davis Company. ISBN 978-0-8036-1248-8. \n\n^ B\u00e1rcena-Uribarri, I. et al. (2013), \"Size and Oligomeric Constitution of the Borrelia burgdorferi P66 Porin\", PLOS One, 8 (11) CS1 maint: Uses authors parameter (link) \n\n^ Johnson,\u3000Tonya (21 April 2004). \"Army Scientists, Engineers develop Liquid Body Armor\". \n\n^ \"Tattoo to monitor diabetes\". BBC News. 1 September 2002. \n\n^ US Government \u2013 Food and Drug Agency \"Food Additive Status List\". Retrieved 2 May 2017 . \n\n^ \"Codex Alimentarius\". codexalimentarius.net. Archived from the original on 7 January 2012. CS1 maint: Unfit url (link) \n\n^ \"Current EU approved additives and their E Numbers\". UK Government \u2013 Food Standards Agency. Retrieved 21 October 2010 . \n\n^ Spinardi, Graham (1994). From Polaris to Trident : the development of US fleet ballistic missile technology. Cambridge: Cambridge Univ. Press. p. 159. ISBN 978-0-521-41357-2. \n\n^ Ueno, K.; Nakamura, S.; Shimotani, H.; et al. (2008). \"Electric-field-induced superconductivity in an insulator\". Nature Materials. 7 (11): 855\u2013858. Bibcode:2008NatMa...7..855U. doi:10.1038\/nmat2298. PMID 18849974. \n\n^ Schneider, Samuel J. (1991) Engineered Materials Handbook: Ceramics and Glasses, Vol. 4. ASM International. ISBN 0-87170-282-7. p. 49. \n\n^ Banville, Laurence (April 4, 2017). \"FDA Asks Philly Scientists To Study Miralax Side Effects In Kids\". The Legal Examiner. Retrieved 17 July 2017 . \n\n^ Wenande, E.; Garvey, L. H. (2016-07-01). \"Immediate-type hypersensitivity to polyethylene glycols: a review\". Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology. 46 (7): 907\u2013922. doi:10.1111\/cea.12760. PMID 27196817. \n\n^ McSweeney, MD.; et al. (2018). \"Physician Awareness of Immune Responses to Polyethylene Glycol\u2010Drug Conjugates\". Clinical and Translational Science. 11 (2): 162\u2013165. doi:10.1111\/cts.12537. PMC 5866984 . PMID 29383836. CS1 maint: Explicit use of et al. (link) \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Poly(ethylene glycol).\n\n\n\nWikimedia Commons has media related to Polyethylene glycols.\nOregon State University informational paper on using PEG as a wood stabilizer\nvteDrugs for constipation (laxatives and cathartics) (A06)Stool softeners\nDocusate\nStimulant laxatives\nBisacodyl\nBisoxatin\nCascara\nCastor oil\nDantron\nOxyphenisatine\nPhenolphthalein\nSenna glycosides\nSodium picosulfate\nBulk-forming laxatives\nDietary fiber\nEthulose\nIspaghula\nMethylcellulose\nPolycarbophil calcium\nSterculia\nTriticum\nLubricant laxatives\nLiquid paraffin\nMineral oil\nWhite petrolatum (petroleum jelly)\nOsmotic laxatives\nLactitol\nLactulose\nLaminarid\nMagnesium carbonate\nMagnesium citrate\nMagnesium hydroxide (milk of magnesia)\nMagnesium oxide\nMagnesium peroxide\nMagnesium sulfate\nMannitol\nPentaerythritol\nPolyethylene glycol (macrogol)\nSodium phosphate\nSodium sulfate\nSodium tartrate\nSorbitol\nEnemas\nBisacodyl\nDantron\nGlycerol\nOil\nSodium laurilsulfate\nSodium lauryl sulfoacetate\nSodium phosphate\nSorbitol\nOpioid antagonists\nAlvimopan\nMethylnaltrexone bromide\nNaloxegol\nNaloxone (Oxycodone\/naloxone)\nOthers\nLinaclotide\nLubiprostone\nOxyphenisatine\nPrucalopride\nTegaserod\nUlimorelin\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polyethylene_glycol\">https:\/\/www.limswiki.org\/index.php\/Polyethylene_glycol<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView 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PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 12 March 2016, at 17:03.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,686 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","70c8dc35eb67e7a793ef2d5954896ff3_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Polyethylene_glycol skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Polyethylene glycol<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">Not to be confused with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_glycol\" title=\"Ethylene glycol\" rel=\"external_link\" target=\"_blank\">Ethylene glycol<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diethylene_glycol\" title=\"Diethylene glycol\" rel=\"external_link\" target=\"_blank\">Diethylene glycol<\/a>.<\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">For medical uses of polyethylene glycol, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Macrogol\" title=\"Macrogol\" rel=\"external_link\" target=\"_blank\">Macrogol<\/a>.<\/div>\n<p class=\"mw-empty-elt\">\n<\/p>\n\n<p><b>Polyethylene glycol<\/b> (<b>PEG<\/b>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyether\" class=\"mw-redirect\" title=\"Polyether\" rel=\"external_link\" target=\"_blank\">polyether<\/a> compound with many applications, from industrial manufacturing to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medicine<\/a>. PEG is also known as <b>polyethylene oxide<\/b> (<b>PEO<\/b>) or <b>polyoxyethylene<\/b> (<b>POE<\/b>), depending on its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_weight\" class=\"mw-redirect\" title=\"Molecular weight\" rel=\"external_link\" target=\"_blank\">molecular weight<\/a>. The structure of PEG is commonly expressed as H\u2212(O\u2212CH<sub>2<\/sub>\u2212CH<sub>2<\/sub>)<sub>n<\/sub>\u2212OH.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Available_forms_and_nomenclature\">Available forms and nomenclature<\/span><\/h2>\n<p><i>PEG<\/i>, <i>PEO<\/i>, and <i>POE<\/i> refer to an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oligomer\" title=\"Oligomer\" rel=\"external_link\" target=\"_blank\">oligomer<\/a> or polymer of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_oxide\" title=\"Ethylene oxide\" rel=\"external_link\" target=\"_blank\">ethylene oxide<\/a>. The three names are chemically synonymous, but historically <i>PEG<\/i> is preferred in the biomedical field, whereas <i>PEO<\/i> is more prevalent in the field of polymer chemistry. Because different applications require different polymer chain lengths, <i>PEG<\/i> has tended to refer to oligomers and polymers with a molecular mass below 20,000<span class=\"nowrap\"> <\/span>g\/mol, <i>PEO<\/i> to polymers with a molecular mass above 20,000<span class=\"nowrap\"> <\/span>g\/mol, and <i>POE<\/i> to a polymer of any molecular mass.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> PEGs are prepared by polymerization of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_oxide\" title=\"Ethylene oxide\" rel=\"external_link\" target=\"_blank\">ethylene oxide<\/a> and are commercially available over a wide range of molecular weights from 300<span class=\"nowrap\"> <\/span>g\/mol to 10,000,000<span class=\"nowrap\"> <\/span>g\/mol.<sup id=\"rdp-ebb-cite_ref-french2009angewandte_4-0\" class=\"reference\"><a href=\"#cite_note-french2009angewandte-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>PEG and PEO are liquids or low-melting solids, depending on their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_weight\" class=\"mw-redirect\" title=\"Molecular weight\" rel=\"external_link\" target=\"_blank\">molecular weights<\/a>. While PEG and PEO with different molecular weights find use in different applications, and have different physical properties (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Viscosity\" title=\"Viscosity\" rel=\"external_link\" target=\"_blank\">viscosity<\/a>) due to chain length effects, their chemical properties are nearly identical. Different forms of PEG are also available, depending on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radical_initiator\" title=\"Radical initiator\" rel=\"external_link\" target=\"_blank\">initiator<\/a> used for the polymerization process \u2013 the most common initiator is a monofunctional methyl ether PEG, or methoxypoly(ethylene glycol), abbreviated mPEG. Lower-molecular-weight PEGs are also available as purer oligomers, referred to as monodisperse, uniform, or discrete. Very high purity PEG has recently been shown to be crystalline, allowing determination of a crystal structure by x-ray diffraction.<sup id=\"rdp-ebb-cite_ref-french2009angewandte_4-1\" class=\"reference\"><a href=\"#cite_note-french2009angewandte-4\" rel=\"external_link\">[4]<\/a><\/sup> Since purification and separation of pure oligomers is difficult, the price for this type of quality is often 10\u20131000 fold that of polydisperse PEG.\n<\/p><p>PEGs are also available with different geometries.\n<\/p>\n<ul><li><i>Branched<\/i> PEGs have three to ten PEG chains emanating from a central core group.<\/li>\n<li><i>Star<\/i> PEGs have 10 to 100 PEG chains emanating from a central core group.<\/li>\n<li><i>Comb<\/i> PEGs have multiple PEG chains normally grafted onto a polymer backbone.<\/li><\/ul>\n<p>The numbers that are often included in the names of PEGs indicate their average molecular weights (e.g. a PEG with <span class=\"nowrap\">n = 9<\/span> would have an average molecular weight of approximately 400 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atomic_mass_unit\" title=\"Atomic mass unit\" rel=\"external_link\" target=\"_blank\">daltons<\/a>, and would be labeled <a href=\"https:\/\/en.wikipedia.org\/wiki\/PEG_400\" title=\"PEG 400\" rel=\"external_link\" target=\"_blank\">PEG 400<\/a>.) Most PEGs include molecules with a distribution of molecular weights (i.e. they are polydisperse). The size distribution can be characterized statistically by its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Weight_average_molecular_weight\" class=\"mw-redirect\" title=\"Weight average molecular weight\" rel=\"external_link\" target=\"_blank\">weight average molecular weight<\/a> (Mw) and its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Number_average_molecular_weight\" class=\"mw-redirect\" title=\"Number average molecular weight\" rel=\"external_link\" target=\"_blank\">number average molecular weight<\/a> (Mn), the ratio of which is called the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polydispersity_index\" class=\"mw-redirect\" title=\"Polydispersity index\" rel=\"external_link\" target=\"_blank\">polydispersity index<\/a> (Mw\/Mn). Mw and Mn can be measured by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mass_spectrometry\" title=\"Mass spectrometry\" rel=\"external_link\" target=\"_blank\">mass spectrometry<\/a>.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/PEGylation\" title=\"PEGylation\" rel=\"external_link\" target=\"_blank\">PEGylation<\/a> is the act of covalently coupling a PEG structure to another larger <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecule\" title=\"Molecule\" rel=\"external_link\" target=\"_blank\">molecule<\/a>, for example, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Therapeutic_protein\" class=\"mw-redirect\" title=\"Therapeutic protein\" rel=\"external_link\" target=\"_blank\">therapeutic protein<\/a>, which is then referred to as a <i>PEGylated<\/i> protein. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PEGylated_interferon_alfa-2a\" class=\"mw-redirect\" title=\"PEGylated interferon alfa-2a\" rel=\"external_link\" target=\"_blank\">PEGylated interferon alfa-2a<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/PEGylated_interferon_alfa-2b\" class=\"mw-redirect\" title=\"PEGylated interferon alfa-2b\" rel=\"external_link\" target=\"_blank\">\u22122b<\/a> are commonly used injectable treatments for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatitis_C\" title=\"Hepatitis C\" rel=\"external_link\" target=\"_blank\">hepatitis C<\/a> infection.\n<\/p><p>PEG is soluble in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Water\" title=\"Water\" rel=\"external_link\" target=\"_blank\">water<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methanol\" title=\"Methanol\" rel=\"external_link\" target=\"_blank\">methanol<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethanol\" title=\"Ethanol\" rel=\"external_link\" target=\"_blank\">ethanol<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetonitrile\" title=\"Acetonitrile\" rel=\"external_link\" target=\"_blank\">acetonitrile<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Benzene\" title=\"Benzene\" rel=\"external_link\" target=\"_blank\">benzene<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dichloromethane\" title=\"Dichloromethane\" rel=\"external_link\" target=\"_blank\">dichloromethane<\/a>, and is insoluble in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diethyl_ether\" title=\"Diethyl ether\" rel=\"external_link\" target=\"_blank\">diethyl ether<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hexane\" title=\"Hexane\" rel=\"external_link\" target=\"_blank\">hexane<\/a>. It is coupled to hydrophobic molecules to produce non-ionic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surfactant\" title=\"Surfactant\" rel=\"external_link\" target=\"_blank\">surfactants<\/a>.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>PEGs potentially contain toxic impurities, such as ethylene oxide and <a href=\"https:\/\/en.wikipedia.org\/wiki\/1,4-dioxane\" class=\"mw-redirect\" title=\"1,4-dioxane\" rel=\"external_link\" target=\"_blank\">1,4-dioxane<\/a>.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> Ethylene Glycol and its ethers are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nephrotoxicity\" title=\"Nephrotoxicity\" rel=\"external_link\" target=\"_blank\">nephrotoxic<\/a> if applied to damaged skin.<sup id=\"rdp-ebb-cite_ref-ReferenceA_7-0\" class=\"reference\"><a href=\"#cite_note-ReferenceA-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:SArfus_PEO.3D.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a6\/SArfus_PEO.3D.jpg\/220px-SArfus_PEO.3D.jpg\" width=\"220\" height=\"145\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:SArfus_PEO.3D.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Polyethylene oxide (PEO, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molar_mass_distribution\" title=\"Molar mass distribution\" rel=\"external_link\" target=\"_blank\">M<sub>w<\/sub><\/a> 4<span class=\"nowrap\"> <\/span><a href=\"https:\/\/en.wikipedia.org\/wiki\/Atomic_mass_unit\" title=\"Atomic mass unit\" rel=\"external_link\" target=\"_blank\">kDa<\/a>) nanometric crystallites (4 nm)<\/div><\/div><\/div>\n<p>Polyethylene glycol (PEG) and related polymers (PEG phospholipid constructs) are often <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sonication\" title=\"Sonication\" rel=\"external_link\" target=\"_blank\">sonicated<\/a> when used in biomedical applications. However, as reported by Murali et al., PEG is very sensitive to sonolytic degradation and PEG degradation products can be toxic to mammalian cells. It is, thus, imperative to assess potential PEG degradation to ensure that the final material does not contain undocumented contaminants that can introduce artifacts into experimental results.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>PEGs and are manufactured by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dow_Chemical_Company\" title=\"Dow Chemical Company\" rel=\"external_link\" target=\"_blank\">Dow Chemical<\/a> under the tradename <i>Carbowax<\/i> for industrial use, and <i>Carbowax Sentry<\/i> for food and pharmaceutical use. They vary in consistency from liquid to solid, depending on the molecular weight, as indicated by a number following the name. They are used commercially in numerous applications, including as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surfactant\" title=\"Surfactant\" rel=\"external_link\" target=\"_blank\">surfactants<\/a>, in foods, in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cosmetics\" title=\"Cosmetics\" rel=\"external_link\" target=\"_blank\">cosmetics<\/a>, in pharmaceutics, in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedicine\" title=\"Biomedicine\" rel=\"external_link\" target=\"_blank\">biomedicine<\/a>, as dispersing agents, as solvents, in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ointment\" class=\"mw-redirect\" title=\"Ointment\" rel=\"external_link\" target=\"_blank\">ointments<\/a>, in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Suppository\" title=\"Suppository\" rel=\"external_link\" target=\"_blank\">suppository<\/a> bases, as tablet <a href=\"https:\/\/en.wikipedia.org\/wiki\/Excipient\" title=\"Excipient\" rel=\"external_link\" target=\"_blank\">excipients<\/a>, and as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laxative\" title=\"Laxative\" rel=\"external_link\" target=\"_blank\">laxatives<\/a>. Some specific groups are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lauromacrogol\" class=\"mw-redirect\" title=\"Lauromacrogol\" rel=\"external_link\" target=\"_blank\">lauromacrogols<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nonoxynol\" class=\"mw-redirect\" title=\"Nonoxynol\" rel=\"external_link\" target=\"_blank\">nonoxynols<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Octoxynol\" class=\"mw-redirect\" title=\"Octoxynol\" rel=\"external_link\" target=\"_blank\">octoxynols<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Poloxamer\" title=\"Poloxamer\" rel=\"external_link\" target=\"_blank\">poloxamers<\/a>.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Macrogol\" title=\"Macrogol\" rel=\"external_link\" target=\"_blank\">Macrogol<\/a>, used as a laxative, is a form of polyethylene glycol. The name may be followed by a number which represents the average molecular weight (e.g. macrogol 3350, macrogol 4000 or macrogol 6000).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Production\">Production<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Polyethylene_glycol_400.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5e\/Polyethylene_glycol_400.jpg\/220px-Polyethylene_glycol_400.jpg\" width=\"220\" height=\"330\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Polyethylene_glycol_400.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Polyethylene glycol 400, pharmaceutical quality<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Polyethylene_glycol_4000.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/74\/Polyethylene_glycol_4000.jpg\/220px-Polyethylene_glycol_4000.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Polyethylene_glycol_4000.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Polyethylene glycol 4000, pharmaceutical quality<\/div><\/div><\/div>\n<p>The production of polyethylene glycol was first reported in 1859. Both and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Charles_Adolphe_Wurtz\" title=\"Charles Adolphe Wurtz\" rel=\"external_link\" target=\"_blank\">Charles Adolphe Wurtz<\/a> independently isolated products that were polyethylene glycols.<sup id=\"rdp-ebb-cite_ref-Bailey_9-0\" class=\"reference\"><a href=\"#cite_note-Bailey-9\" rel=\"external_link\">[9]<\/a><\/sup> Polyethylene glycol is produced by the interaction of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_oxide\" title=\"Ethylene oxide\" rel=\"external_link\" target=\"_blank\">ethylene oxide<\/a> with water, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_glycol\" title=\"Ethylene glycol\" rel=\"external_link\" target=\"_blank\">ethylene glycol<\/a>, or ethylene glycol oligomers.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> The reaction is catalyzed by acidic or basic catalysts. Ethylene glycol and its oligomers are preferable as a starting material instead of water, because they allow the creation of polymers with a low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polydispersity\" class=\"mw-redirect\" title=\"Polydispersity\" rel=\"external_link\" target=\"_blank\">polydispersity<\/a> (narrow molecular weight distribution). Polymer chain length depends on the ratio of reactants.\n<\/p>\n<dl><dd>HOCH<sub>2<\/sub>CH<sub>2<\/sub>OH + n(CH<sub>2<\/sub>CH<sub>2<\/sub>O) \u2192 HO(CH<sub>2<\/sub>CH<sub>2<\/sub>O)<sub>n+1<\/sub>H<\/dd><\/dl>\n<p>Depending on the catalyst type, the mechanism of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymerization\" title=\"Polymerization\" rel=\"external_link\" target=\"_blank\">polymerization<\/a> can be cationic or anionic. The anionic mechanism is preferable because it allows one to obtain PEG with a low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polydispersity\" class=\"mw-redirect\" title=\"Polydispersity\" rel=\"external_link\" target=\"_blank\">polydispersity<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymerization\" title=\"Polymerization\" rel=\"external_link\" target=\"_blank\">Polymerization<\/a> of ethylene oxide is an exothermic process. Overheating or contaminating ethylene oxide with catalysts such as alkalis or metal oxides can lead to runaway polymerization, which can end in an explosion after a few hours.\n<\/p><p>Polyethylene oxide, or high-molecular weight polyethylene glycol, is synthesized by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Suspension_polymerization\" title=\"Suspension polymerization\" rel=\"external_link\" target=\"_blank\">suspension polymerization<\/a>. It is necessary to hold the growing polymer chain in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer_solution\" title=\"Polymer solution\" rel=\"external_link\" target=\"_blank\">solution<\/a> in the course of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polycondensation\" class=\"mw-redirect\" title=\"Polycondensation\" rel=\"external_link\" target=\"_blank\">polycondensation<\/a> process. The reaction is catalyzed by magnesium-, aluminium-, or calcium-organoelement compounds. To prevent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coagulation\" title=\"Coagulation\" rel=\"external_link\" target=\"_blank\">coagulation<\/a> of polymer chains from solution, chelating additives such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dimethylglyoxime\" title=\"Dimethylglyoxime\" rel=\"external_link\" target=\"_blank\">dimethylglyoxime<\/a> are used.\n<\/p><p>Alkaline catalysts such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_hydroxide\" title=\"Sodium hydroxide\" rel=\"external_link\" target=\"_blank\">sodium hydroxide<\/a> (NaOH), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Potassium_hydroxide\" title=\"Potassium hydroxide\" rel=\"external_link\" target=\"_blank\">potassium hydroxide<\/a> (KOH), or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_carbonate\" title=\"Sodium carbonate\" rel=\"external_link\" target=\"_blank\">sodium carbonate<\/a> (Na<sub>2<\/sub>CO<sub>3<\/sub>) are used to prepare low-molecular-weight polyethylene glycol.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Uses\">Uses<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Macrogol\" title=\"Macrogol\" rel=\"external_link\" target=\"_blank\">Macrogol<\/a><\/div>\n<ul><li>PEG is the basis of a number of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laxative\" title=\"Laxative\" rel=\"external_link\" target=\"_blank\">laxatives<\/a>.<sup id=\"rdp-ebb-cite_ref-Distillations_11-0\" class=\"reference\"><a href=\"#cite_note-Distillations-11\" rel=\"external_link\">[11]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Whole_bowel_irrigation\" title=\"Whole bowel irrigation\" rel=\"external_link\" target=\"_blank\">Whole bowel irrigation<\/a> with polyethylene glycol and added <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrolyte\" title=\"Electrolyte\" rel=\"external_link\" target=\"_blank\">electrolytes<\/a> is used for bowel preparation before <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colonoscopy\" title=\"Colonoscopy\" rel=\"external_link\" target=\"_blank\">colonoscopy<\/a>.<\/li>\n<li>PEG is also used as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Excipient\" title=\"Excipient\" rel=\"external_link\" target=\"_blank\">excipient<\/a> in many pharmaceutical products.<\/li>\n<li>When attached to various protein <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medication\" title=\"Medication\" rel=\"external_link\" target=\"_blank\">medications<\/a>, polyethylene glycol allows a slowed clearance of the carried protein from the blood.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><\/li>\n<li>The possibility that PEG could be used to fuse nerve cells is being explored by researchers studying <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_injury\" title=\"Spinal cord injury\" rel=\"external_link\" target=\"_blank\">spinal cord injury<\/a>.<sup id=\"rdp-ebb-cite_ref-Distillations_11-1\" class=\"reference\"><a href=\"#cite_note-Distillations-11\" rel=\"external_link\">[11]<\/a><\/sup><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Chemical_uses\">Chemical uses<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MaryRose-conservation2.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/92\/MaryRose-conservation2.jpg\/220px-MaryRose-conservation2.jpg\" width=\"220\" height=\"223\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MaryRose-conservation2.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The remains of the 16th century <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carrack\" title=\"Carrack\" rel=\"external_link\" target=\"_blank\">carrack<\/a> <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mary_Rose\" title=\"Mary Rose\" rel=\"external_link\" target=\"_blank\">Mary Rose<\/a><\/i> undergoing conservation treatment with PEG in the 1980s<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Terra_Cotta_Warriors,_Guardians_of_China%E2%80%99s_First_Emperor_1.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bc\/Terra_Cotta_Warriors%2C_Guardians_of_China%E2%80%99s_First_Emperor_1.jpg\/220px-Terra_Cotta_Warriors%2C_Guardians_of_China%E2%80%99s_First_Emperor_1.jpg\" width=\"220\" height=\"330\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Terra_Cotta_Warriors,_Guardians_of_China%E2%80%99s_First_Emperor_1.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Terra cotta warrior, showing traces of original color<\/div><\/div><\/div>\n<ul><li>Because PEG is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrophile\" title=\"Hydrophile\" rel=\"external_link\" target=\"_blank\">hydrophilic<\/a> molecule, it has been used to passivate microscope glass slides for avoiding non-specific sticking of proteins in single-molecule fluorescence studies.<sup id=\"rdp-ebb-cite_ref-:0_13-0\" class=\"reference\"><a href=\"#cite_note-:0-13\" rel=\"external_link\">[13]<\/a><\/sup><\/li>\n<li>Polyethylene glycol has a low toxicity and is used in a variety of products.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> The polymer is used as a lubricating coating for various surfaces in aqueous and non-aqueous environments.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup><\/li>\n<li>Since PEG is a flexible, water-soluble polymer, it can be used to create very high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osmotic_pressure\" title=\"Osmotic pressure\" rel=\"external_link\" target=\"_blank\">osmotic pressures<\/a> (on the order of tens of atmospheres). It also is unlikely to have specific interactions with biological chemicals. These properties make PEG one of the most useful molecules for applying osmotic pressure in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biochemistry\" title=\"Biochemistry\" rel=\"external_link\" target=\"_blank\">biochemistry<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomembrane\" class=\"mw-redirect\" title=\"Biomembrane\" rel=\"external_link\" target=\"_blank\">biomembranes<\/a> experiments, in particular when using the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osmotic_stress_technique\" title=\"Osmotic stress technique\" rel=\"external_link\" target=\"_blank\">osmotic stress technique<\/a>.<\/li>\n<li>Polyethylene glycol is also commonly used as a polar stationary phase for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gas_chromatography\" title=\"Gas chromatography\" rel=\"external_link\" target=\"_blank\">gas chromatography<\/a>, as well as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coolant\" title=\"Coolant\" rel=\"external_link\" target=\"_blank\">heat transfer fluid<\/a> in electronic testers.<\/li>\n<li>PEG has also been used to preserve objects that have been salvaged from underwater, as was the case with the warship <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vasa_(ship)\" title=\"Vasa (ship)\" rel=\"external_link\" target=\"_blank\">Vasa<\/a><\/i> in Stockholm,<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> and similar cases. It replaces water in wooden objects, making the wood dimensionally stable and preventing warping or shrinking of the wood when it dries.<sup id=\"rdp-ebb-cite_ref-Distillations_11-2\" class=\"reference\"><a href=\"#cite_note-Distillations-11\" rel=\"external_link\">[11]<\/a><\/sup> In addition, PEG is used when working with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Green_wood\" title=\"Green wood\" rel=\"external_link\" target=\"_blank\">green wood<\/a> as a stabilizer, and to prevent shrinkage.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup><\/li>\n<li>PEG has been used to preserve the painted colors on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Terracotta_Army\" title=\"Terracotta Army\" rel=\"external_link\" target=\"_blank\">Terra-Cotta Warriors<\/a> unearthed at a UNESCO World Heritage site in China.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> These painted artifacts were created during the Qin Shi Huang Di dynasty (first emperor of China). Within 15 seconds of the terra-cotta pieces being unearthed during excavations, the lacquer beneath the paint begins to curl after being exposed to the dry Xian air. The paint would subsequently flake off in about four minutes. The German Bavarian State Conservation Office developed a PEG preservative that when immediately applied to unearthed artifacts has aided in preserving the colors painted on the pieces of clay soldiers.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup><\/li>\n<li>PEG is often used (as an internal calibration compound) in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mass_spectrometry\" title=\"Mass spectrometry\" rel=\"external_link\" target=\"_blank\">mass spectrometry<\/a> experiments, with its characteristic fragmentation pattern allowing accurate and reproducible tuning.<\/li>\n<li>PEG derivatives, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Narrow_range_ethoxylate\" class=\"mw-redirect\" title=\"Narrow range ethoxylate\" rel=\"external_link\" target=\"_blank\">narrow range ethoxylates<\/a>, are used as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surfactant\" title=\"Surfactant\" rel=\"external_link\" target=\"_blank\">surfactants<\/a>.<\/li>\n<li>PEG is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyol\" title=\"Polyol\" rel=\"external_link\" target=\"_blank\">polyol<\/a> and can be reacted with an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isocyanate\" title=\"Isocyanate\" rel=\"external_link\" target=\"_blank\">isocyanate<\/a> to make <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyurethane\" title=\"Polyurethane\" rel=\"external_link\" target=\"_blank\">polyurethane<\/a>.<\/li>\n<li>PEG has been used as the hydrophilic block of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amphiphilic\" class=\"mw-redirect\" title=\"Amphiphilic\" rel=\"external_link\" target=\"_blank\">amphiphilic<\/a> block <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copolymers\" class=\"mw-redirect\" title=\"Copolymers\" rel=\"external_link\" target=\"_blank\">copolymers<\/a> used to create some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymersome\" title=\"Polymersome\" rel=\"external_link\" target=\"_blank\">polymersomes<\/a>.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Biological_uses\">Biological uses<\/span><\/h3>\n<ul><li>PEG is commonly used as a crowding agent in in vitro assays to mimic highly crowded cellular conditions.<sup id=\"rdp-ebb-cite_ref-:0_13-1\" class=\"reference\"><a href=\"#cite_note-:0-13\" rel=\"external_link\">[13]<\/a><\/sup><\/li>\n<li>PEG is commonly used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Precipitant\" class=\"mw-redirect\" title=\"Precipitant\" rel=\"external_link\" target=\"_blank\">precipitant<\/a> for plasmid DNA isolation and <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray_crystallography\" title=\"X-ray crystallography\" rel=\"external_link\" target=\"_blank\">protein crystallization<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray_diffraction\" class=\"mw-redirect\" title=\"X-ray diffraction\" rel=\"external_link\" target=\"_blank\">X-ray diffraction<\/a> of protein crystals can reveal the atomic structure of the proteins.<\/li>\n<li>PEG is used to fuse two different types of cells, most often B-cells and myelomas in order to create <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hybridomas\" class=\"mw-redirect\" title=\"Hybridomas\" rel=\"external_link\" target=\"_blank\">hybridomas<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/C%C3%A9sar_Milstein\" title=\"C\u00e9sar Milstein\" rel=\"external_link\" target=\"_blank\">C\u00e9sar Milstein<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Georges_J._F._K%C3%B6hler\" title=\"Georges J. F. K\u00f6hler\" rel=\"external_link\" target=\"_blank\">Georges J. F. K\u00f6hler<\/a> originated this technique, which they used for antibody production, winning a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nobel_Prize_in_Physiology_or_Medicine\" title=\"Nobel Prize in Physiology or Medicine\" rel=\"external_link\" target=\"_blank\">Nobel Prize in Physiology or Medicine<\/a> in 1984.<sup id=\"rdp-ebb-cite_ref-Distillations_11-3\" class=\"reference\"><a href=\"#cite_note-Distillations-11\" rel=\"external_link\">[11]<\/a><\/sup><\/li>\n<li>Polymer segments derived from PEG <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyols\" class=\"mw-redirect\" title=\"Polyols\" rel=\"external_link\" target=\"_blank\">polyols<\/a> impart flexibility to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyurethane\" title=\"Polyurethane\" rel=\"external_link\" target=\"_blank\">polyurethanes<\/a> for applications such as elastomeric <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiber\" title=\"Fiber\" rel=\"external_link\" target=\"_blank\">fibers<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Spandex\" title=\"Spandex\" rel=\"external_link\" target=\"_blank\">spandex<\/a>) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foam\" title=\"Foam\" rel=\"external_link\" target=\"_blank\">foam<\/a> cushions.<\/li>\n<li>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microbiology\" title=\"Microbiology\" rel=\"external_link\" target=\"_blank\">microbiology<\/a>, PEG precipitation is used to concentrate viruses. PEG is also used to induce complete fusion (mixing of both inner and outer leaflets) in liposomes reconstituted <i>in vitro<\/i>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gene_therapy\" title=\"Gene therapy\" rel=\"external_link\" target=\"_blank\">Gene therapy<\/a> vectors (such as viruses) can be PEG-coated to shield them from inactivation by the immune system and to de-target them from organs where they may build up and have a toxic effect.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> The size of the PEG polymer has been shown to be important, with larger polymers achieving the best immune protection.<\/li>\n<li>PEG is a component of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stable_nucleic_acid_lipid_particle\" title=\"Stable nucleic acid lipid particle\" rel=\"external_link\" target=\"_blank\">stable nucleic acid lipid particles<\/a> (SNALPs) used to package <a href=\"https:\/\/en.wikipedia.org\/wiki\/SiRNA\" class=\"mw-redirect\" title=\"SiRNA\" rel=\"external_link\" target=\"_blank\">siRNA<\/a> for use <i>in vivo<\/i>.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup><\/li>\n<li>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_banking\" class=\"mw-redirect\" title=\"Blood banking\" rel=\"external_link\" target=\"_blank\">blood banking<\/a>, PEG is used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Potentiator\" title=\"Potentiator\" rel=\"external_link\" target=\"_blank\">potentiator<\/a> to enhance detection of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antigen\" title=\"Antigen\" rel=\"external_link\" target=\"_blank\">antigens<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antibodies\" class=\"mw-redirect\" title=\"Antibodies\" rel=\"external_link\" target=\"_blank\">antibodies<\/a>.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Distillations_11-4\" class=\"reference\"><a href=\"#cite_note-Distillations-11\" rel=\"external_link\">[11]<\/a><\/sup><\/li>\n<li>When working with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phenol\" title=\"Phenol\" rel=\"external_link\" target=\"_blank\">phenol<\/a> in a laboratory situation, can be used on phenol skin burns to deactivate any residual phenol.<\/li>\n<li>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biophysics\" title=\"Biophysics\" rel=\"external_link\" target=\"_blank\">biophysics<\/a>, polyethylene glycols are the molecules of choice for the functioning ion channels diameter studies, because in aqueous solutions they have a spherical shape and can block ion channel conductance.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Commercial_uses\">Commercial uses<\/span><\/h3>\n<ul><li>PEG is the basis of many <a href=\"https:\/\/en.wikipedia.org\/wiki\/Moisturizer\" title=\"Moisturizer\" rel=\"external_link\" target=\"_blank\">skin creams<\/a> (as <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cetomacrogol\" class=\"mw-redirect\" title=\"Cetomacrogol\" rel=\"external_link\" target=\"_blank\">cetomacrogol<\/a><\/i>) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Personal_lubricant\" title=\"Personal lubricant\" rel=\"external_link\" target=\"_blank\">personal lubricants<\/a> (frequently combined with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glycerin\" class=\"mw-redirect\" title=\"Glycerin\" rel=\"external_link\" target=\"_blank\">glycerin<\/a>).<\/li>\n<li>PEG is used in a number of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toothpaste\" title=\"Toothpaste\" rel=\"external_link\" target=\"_blank\">toothpastes<\/a><sup id=\"rdp-ebb-cite_ref-Distillations_11-5\" class=\"reference\"><a href=\"#cite_note-Distillations-11\" rel=\"external_link\">[11]<\/a><\/sup> as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dispersant\" title=\"Dispersant\" rel=\"external_link\" target=\"_blank\">dispersant<\/a>. In this application, it binds water and helps keep <a href=\"https:\/\/en.wikipedia.org\/wiki\/Xanthan_gum\" title=\"Xanthan gum\" rel=\"external_link\" target=\"_blank\">xanthan gum<\/a> uniformly distributed throughout the toothpaste.<\/li>\n<li>PEG is also under investigation for use in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_armor\" title=\"Body armor\" rel=\"external_link\" target=\"_blank\">body armor<\/a>, and in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tattoo\" title=\"Tattoo\" rel=\"external_link\" target=\"_blank\">tattoos<\/a> to monitor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetes\" class=\"mw-redirect\" title=\"Diabetes\" rel=\"external_link\" target=\"_blank\">diabetes<\/a>.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup><\/li>\n<li>In low-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_weight\" class=\"mw-redirect\" title=\"Molecular weight\" rel=\"external_link\" target=\"_blank\">molecular-weight<\/a> formulations (i.e. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PEG_400\" title=\"PEG 400\" rel=\"external_link\" target=\"_blank\">PEG 400<\/a>), it is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hewlett-Packard\" title=\"Hewlett-Packard\" rel=\"external_link\" target=\"_blank\">Hewlett-Packard<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Designjet\" class=\"mw-redirect\" title=\"Designjet\" rel=\"external_link\" target=\"_blank\">designjet<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Printer_(computing)\" title=\"Printer (computing)\" rel=\"external_link\" target=\"_blank\">printers<\/a> as an ink solvent and lubricant for the print heads.<\/li>\n<li>PEG is also one of the main ingredients in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paintball\" title=\"Paintball\" rel=\"external_link\" target=\"_blank\">paintball<\/a> fills, because of its thickness and flexibility. However, as early as 2006, some paintball manufacturers began substituting cheaper oil-based alternatives for PEG.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2010)\">citation needed<\/span><\/a><\/i>]<\/sup><\/li>\n<li>PEG is also used as an anti-foaming agent in food<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> \u2013 its INS number is 1521<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> or E1521 in the EU.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Industrial_uses\">Industrial uses<\/span><\/h3>\n<ul><li>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nitrate\" title=\"Nitrate\" rel=\"external_link\" target=\"_blank\">nitrate<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ester\" title=\"Ester\" rel=\"external_link\" target=\"_blank\">ester<\/a>-plasticized polyethylene glycol (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Solid-fuel_rocket#Composite_modified_double_base_propellants\" class=\"mw-redirect\" title=\"Solid-fuel rocket\" rel=\"external_link\" target=\"_blank\">NEPE-75<\/a>) is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/UGM-133_Trident_II#Design\" title=\"UGM-133 Trident II\" rel=\"external_link\" target=\"_blank\">Trident II<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Submarine-launched_ballistic_missile\" title=\"Submarine-launched ballistic missile\" rel=\"external_link\" target=\"_blank\">submarine-launched ballistic missile<\/a> solid rocket fuel.<sup id=\"rdp-ebb-cite_ref-spinardi_31-0\" class=\"reference\"><a href=\"#cite_note-spinardi-31\" rel=\"external_link\">[31]<\/a><\/sup><\/li>\n<li>Dimethyl ethers of PEG are the key ingredient of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Selexol\" title=\"Selexol\" rel=\"external_link\" target=\"_blank\">Selexol<\/a>, a solvent used by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coal\" title=\"Coal\" rel=\"external_link\" target=\"_blank\">coal<\/a>-burning, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Integrated_gasification_combined_cycle\" title=\"Integrated gasification combined cycle\" rel=\"external_link\" target=\"_blank\">integrated gasification combined cycle<\/a> (IGCC) power plants to remove <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_dioxide\" title=\"Carbon dioxide\" rel=\"external_link\" target=\"_blank\">carbon dioxide<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrogen_sulfide\" title=\"Hydrogen sulfide\" rel=\"external_link\" target=\"_blank\">hydrogen sulfide<\/a> from the gas waste stream.<\/li>\n<li>PEG has been used as the gate insulator in an electric double-layer transistor to induce superconductivity in an insulator.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup><\/li>\n<li>PEG is also used as a polymer host for solid polymer electrolytes. Although not yet in commercial production, many groups around the globe are engaged in research on solid polymer electrolytes involving PEG, with the aim of improving their properties, and in permitting their use in batteries, electro-chromic display systems, and other products in the future.<\/li>\n<li>PEG is injected into industrial processes to reduce foaming in separation equipment.<\/li>\n<li>PEG is used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Binder_(material)\" title=\"Binder (material)\" rel=\"external_link\" target=\"_blank\">binder<\/a> in the preparation of technical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic\" title=\"Ceramic\" rel=\"external_link\" target=\"_blank\">ceramics<\/a>.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Health_effects\">Health effects<\/span><\/h2>\n<p>PEG is generally considered biologically inert and safe. However, studies of clinical safety are generally based on adults, not children. The FDA has been asked to investigate the possible effects of PEG in laxatives for children.<sup id=\"rdp-ebb-cite_ref-Banville_34-0\" class=\"reference\"><a href=\"#cite_note-Banville-34\" rel=\"external_link\">[34]<\/a><\/sup> Also, a minority of people are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Allergic\" class=\"mw-redirect\" title=\"Allergic\" rel=\"external_link\" target=\"_blank\">allergic<\/a> to it. Allergy to PEG is usually discovered after a person has been diagnosed with an allergy to an increasing number of seemingly unrelated products, including processed foods, cosmetics, drugs, and other substances that contain PEG or were manufactured with PEG.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup>\n<\/p>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Multiple_chemical_sensitivity\" title=\"Multiple chemical sensitivity\" rel=\"external_link\" target=\"_blank\">Multiple chemical sensitivity<\/a><\/div>\n<p>When PEG is chemically attached to therapeutic molecules (such as protein drugs or nanoparticles), it can sometimes be antigenic, stimulating an anti-PEG antibody response in some patients. This effect has only been shown for a few of the many available PEGylated therapeutics, but it has significant effects on clinical outcomes of affected patients.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup> Other than these few instances where patients have anti-PEG immune responses, it is generally considered to be a safe component of drug formulations.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene\" title=\"Ethylene\" rel=\"external_link\" target=\"_blank\">Ethylene<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Propylene_glycol\" title=\"Propylene glycol\" rel=\"external_link\" target=\"_blank\">Propylene glycol<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Monoethylene_glycol\" class=\"mw-redirect\" title=\"Monoethylene glycol\" rel=\"external_link\" target=\"_blank\">Monoethylene glycol<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Diethylene_glycol\" title=\"Diethylene glycol\" rel=\"external_link\" target=\"_blank\">Diethylene glycol<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/PEGylation\" title=\"PEGylation\" rel=\"external_link\" target=\"_blank\">PEGylation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/PEG-PVA\" title=\"PEG-PVA\" rel=\"external_link\" target=\"_blank\">PEG-PVA<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lauryl_methyl_gluceth-10_hydroxypropyl_dimonium_chloride\" title=\"Lauryl methyl gluceth-10 hydroxypropyl dimonium chloride\" rel=\"external_link\" target=\"_blank\">Lauryl methyl gluceth-10 hydroxypropyl dimonium chloride<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kahovec, J.; Fox, R. B.; Hatada, K. (2002). \"Nomenclature of regular single-strand organic polymers\". <i>Pure and Applied Chemistry<\/i>. <b>74<\/b> (10): 1921\u20131956. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1351%2Fpac200274101921\" target=\"_blank\">10.1351\/pac200274101921<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pure+and+Applied+Chemistry&rft.atitle=Nomenclature+of+regular+single-strand+organic+polymers&rft.volume=74&rft.issue=10&rft.pages=1921-1956&rft.date=2002&rft_id=info%3Adoi%2F10.1351%2Fpac200274101921&rft.aulast=Kahovec&rft.aufirst=J.&rft.au=Fox%2C+R.+B.&rft.au=Hatada%2C+K.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+glycol\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-chemsrc-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-chemsrc_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.chemsrc.com\/en\/cas\/25038-59-9_894380.html\" target=\"_blank\">\"Poly(ethylene glycol)_msds\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Poly%28ethylene+glycol%29_msds&rft_id=https%3A%2F%2Fwww.chemsrc.com%2Fen%2Fcas%2F25038-59-9_894380.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+glycol\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">For example, in the <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.scientificpolymer.com\/utils\/search.asp\" target=\"_blank\">online catalog<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20061229131736\/http:\/\/www.scientificpolymer.com\/utils\/search.asp\" target=\"_blank\">Archived<\/a> 29 December 2006 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>. of Scientific Polymer Products, Inc., poly(ethylene glycol) molecular weights run up to about 20,000, while those of poly(ethylene oxide) have six or seven digits.<\/span>\n<\/li>\n<li id=\"cite_note-french2009angewandte-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-french2009angewandte_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-french2009angewandte_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">French, Alister C.; Thompson, Amber L.; Davis, Benjamin G. (2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/users.ox.ac.uk\/~dplb0149\/publication\/pub108.pdf\" target=\"_blank\">\"High Purity Discrete PEG Oligomer Crystals Allow Structural Insight\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Angewandte_Chemie\" title=\"Angewandte Chemie\" rel=\"external_link\" target=\"_blank\">Angewandte Chemie International Edition<\/a><\/i>. <b>48<\/b> (7): 1248\u20131252. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fanie.200804623\" target=\"_blank\">10.1002\/anie.200804623<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19142918\" target=\"_blank\">19142918<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Angewandte+Chemie+International+Edition&rft.atitle=High+Purity+Discrete+PEG+Oligomer+Crystals+Allow+Structural+Insight&rft.volume=48&rft.issue=7&rft.pages=1248-1252&rft.date=2009&rft_id=info%3Adoi%2F10.1002%2Fanie.200804623&rft_id=info%3Apmid%2F19142918&rft.aulast=French&rft.aufirst=Alister+C.&rft.au=Thompson%2C+Amber+L.&rft.au=Davis%2C+Benjamin+G.&rft_id=http%3A%2F%2Fusers.ox.ac.uk%2F~dplb0149%2Fpublication%2Fpub108.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+glycol\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Winger, Moritz; De Vries, Alex H.; Van Gunsteren, Wilfred F. 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Retrieved <span class=\"nowrap\">2017-05-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.fda.gov&rft.atitle=Potential+Contaminants+-+1%2C4-Dioxane+A+Manufacturing+Byproduct&rft.aulast=Nutrition&rft.aufirst=Center+for+Food+Safety+and+Applied&rft_id=https%3A%2F%2Fwww.fda.gov%2Fcosmetics%2Fproductsingredients%2Fpotentialcontaminants%2Fucm101566.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+glycol\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ReferenceA-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ReferenceA_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Andersen, F. A. 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Retrieved <span class=\"nowrap\">22 March<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Distillations&rft.atitle=Chemical+Hope&rft.volume=2&rft.issue=4&rft.pages=5&rft.date=2017&rft.aulast=Kean&rft.aufirst=Sam&rft_id=https%3A%2F%2Fwww.sciencehistory.org%2Fdistillations%2Fmagazine%2Fchemical-hope&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+glycol\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Bowman, Lee (4 December 2004). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.seattlepi.com\/health\/202292_spinal04.html\" target=\"_blank\">\"Study on dogs yields hope in human paralysis treatment\"<\/a>. seattlepi.com.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Study+on+dogs+yields+hope+in+human+paralysis+treatment&rft.date=2004-12-04&rft.au=Bowman%2C+Lee&rft_id=http%3A%2F%2Fwww.seattlepi.com%2Fhealth%2F202292_spinal04.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+glycol\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:0-13\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_13-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_13-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ganji, Mahipal; Docter, Margreet; Le Grice, Stuart F. 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Press. p. 159. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-521-41357-2.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=From+Polaris+to+Trident+%3A+the+development+of+US+fleet+ballistic+missile+technology&rft.place=Cambridge&rft.pages=159&rft.pub=Cambridge+Univ.+Press&rft.date=1994&rft.isbn=978-0-521-41357-2&rft.aulast=Spinardi&rft.aufirst=Graham&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+glycol\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ueno, K.; Nakamura, S.; Shimotani, H.; et al. (2008). \"Electric-field-induced superconductivity in an insulator\". <i>Nature Materials<\/i>. <b>7<\/b> (11): 855\u2013858. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2008NatMa...7..855U\" target=\"_blank\">2008NatMa...7..855U<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnmat2298\" target=\"_blank\">10.1038\/nmat2298<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18849974\" target=\"_blank\">18849974<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Materials&rft.atitle=Electric-field-induced+superconductivity+in+an+insulator&rft.volume=7&rft.issue=11&rft.pages=855-858&rft.date=2008&rft_id=info%3Apmid%2F18849974&rft_id=info%3Adoi%2F10.1038%2Fnmat2298&rft_id=info%3Abibcode%2F2008NatMa...7..855U&rft.aulast=Ueno&rft.aufirst=K.&rft.au=Nakamura%2C+S.&rft.au=Shimotani%2C+H.&rft.au=Ohtomo%2C+A.&rft.au=Kimura%2C+N.&rft.au=Nojima%2C+T.&rft.au=Aoki%2C+H.&rft.au=Iwasa%2C+Y.&rft.au=Kawasaki%2C+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+glycol\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Schneider, Samuel J. (1991) <i>Engineered Materials Handbook: Ceramics and Glasses<\/i>, Vol. 4. ASM International. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-87170-282-7. p. 49.<\/span>\n<\/li>\n<li id=\"cite_note-Banville-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Banville_34-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Banville, Laurence (April 4, 2017). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/newyorkcity.legalexaminer.com\/defective-dangerous-products\/fda-asks-philly-scientists-to-study-miralax-side-effects-in-kids\/\" target=\"_blank\">\"FDA Asks Philly Scientists To Study Miralax Side Effects In Kids\"<\/a>. <i>The Legal Examiner<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">17 July<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Legal+Examiner&rft.atitle=FDA+Asks+Philly+Scientists+To+Study+Miralax+Side+Effects+In+Kids&rft.date=2017-04-04&rft.aulast=Banville&rft.aufirst=Laurence&rft_id=http%3A%2F%2Fnewyorkcity.legalexaminer.com%2Fdefective-dangerous-products%2Ffda-asks-philly-scientists-to-study-miralax-side-effects-in-kids%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+glycol\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wenande, E.; Garvey, L. H. (2016-07-01). \"Immediate-type hypersensitivity to polyethylene glycols: a review\". <i>Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology<\/i>. <b>46<\/b> (7): 907\u2013922. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fcea.12760\" target=\"_blank\">10.1111\/cea.12760<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27196817\" target=\"_blank\">27196817<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+and+Experimental+Allergy%3A+Journal+of+the+British+Society+for+Allergy+and+Clinical+Immunology&rft.atitle=Immediate-type+hypersensitivity+to+polyethylene+glycols%3A+a+review&rft.volume=46&rft.issue=7&rft.pages=907-922&rft.date=2016-07-01&rft_id=info%3Adoi%2F10.1111%2Fcea.12760&rft_id=info%3Apmid%2F27196817&rft.aulast=Wenande&rft.aufirst=E.&rft.au=Garvey%2C+L.+H.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+glycol\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">McSweeney, MD.; et al. (2018). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5866984\" target=\"_blank\">\"Physician Awareness of Immune Responses to Polyethylene Glycol\u2010Drug Conjugates\"<\/a>. <i>Clinical and Translational Science<\/i>. <b>11<\/b> (2): 162\u2013165. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fcts.12537\" target=\"_blank\">10.1111\/cts.12537<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5866984\" target=\"_blank\">5866984<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29383836\" target=\"_blank\">29383836<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+and+Translational+Science&rft.atitle=Physician+Awareness+of+Immune+Responses+to+Polyethylene+Glycol%E2%80%90Drug+Conjugates&rft.volume=11&rft.issue=2&rft.pages=162-165&rft.date=2018&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5866984&rft_id=info%3Apmid%2F29383836&rft_id=info%3Adoi%2F10.1111%2Fcts.12537&rft.aulast=McSweeney&rft.aufirst=MD.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5866984&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyethylene+glycol\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Explicit use of et al. (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Explicit_use_of_et_al.\" title=\"Category:CS1 maint: Explicit use of et al.\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/owic.oregonstate.edu\/sites\/default\/files\/pubs\/peg.pdf\" target=\"_blank\">Oregon State University informational paper on using PEG as a wood stabilizer<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1251\nCached time: 20181217084134\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.944 seconds\nReal time usage: 1.252 seconds\nPreprocessor visited node count: 6700\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 128217\/2097152 bytes\nTemplate argument size: 12907\/2097152 bytes\nHighest expansion depth: 22\/40\nExpensive parser function count: 7\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 93803\/5000000 bytes\nNumber of Wikibase entities loaded: 5\/400\nLua time usage: 0.437\/10.000 seconds\nLua memory usage: 10.66 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1085.621 1 -total\n<\/p>\n<pre>44.00% 477.652 1 Template:Chembox\n34.33% 372.684 1 Template:Reflist\n24.31% 263.869 1 Template:Chembox_Identifiers\n17.99% 195.299 16 Template:Cite_journal\n15.88% 172.373 5 Template:Chembox_headerbar\n15.58% 169.090 19 Template:Trim\n 8.84% 95.947 14 Template:Main_other\n 7.40% 80.316 1 Template:Chembox_parametercheck\n 5.42% 58.803 1 Template:Chembox_Properties\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:147203-1!canonical and timestamp 20181217084133 and revision id 872407146\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene_glycol\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212222\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.022 seconds\nReal time usage: 0.136 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 127.745 1 - wikipedia:Polyethylene_glycol\n100.00% 127.745 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8455-0!*!*!*!*!*!* and timestamp 20181217212221 and revision id 24705\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polyethylene_glycol\">https:\/\/www.limswiki.org\/index.php\/Polyethylene_glycol<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","70c8dc35eb67e7a793ef2d5954896ff3_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/64\/PEG_Structural_Formula_V1.svg\/440px-PEG_Structural_Formula_V1.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a6\/SArfus_PEO.3D.jpg\/440px-SArfus_PEO.3D.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5e\/Polyethylene_glycol_400.jpg\/440px-Polyethylene_glycol_400.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/74\/Polyethylene_glycol_4000.jpg\/440px-Polyethylene_glycol_4000.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/92\/MaryRose-conservation2.jpg\/440px-MaryRose-conservation2.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bc\/Terra_Cotta_Warriors%2C_Guardians_of_China%E2%80%99s_First_Emperor_1.jpg\/440px-Terra_Cotta_Warriors%2C_Guardians_of_China%E2%80%99s_First_Emperor_1.jpg"],"70c8dc35eb67e7a793ef2d5954896ff3_timestamp":1545081741,"974f6a5e1cebf150767490807e013fd9_type":"article","974f6a5e1cebf150767490807e013fd9_title":"Polydioxanone","974f6a5e1cebf150767490807e013fd9_url":"https:\/\/www.limswiki.org\/index.php\/Polydioxanone","974f6a5e1cebf150767490807e013fd9_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPolydioxanone\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t poly(p-dioxanone) structure\nPolydioxanone (PDO, PDS) or poly-p-dioxanone is a colorless, crystalline, biodegradable synthetic polymer.\n\nContents \n\n1 Chemistry \n2 Medical use \n3 See also \n4 References \n\n\nChemistry \nChemically, polydioxanone is a polymer of multiple repeating ether-ester units. It is obtained by ring-opening polymerization of the monomer p-dioxanone. The process requires heat and an organometallic catalyst like zirconium acetylacetone or zinc L-lactate. It is characterized by a glass transition temperature in the range of −10 and 0 \u00b0C and a crystallinity of about 55%. For the production of sutures, polydioxanone is generally extruded into fibers, however care should be taken to process the polymer to the lowest possible temperature, in order to avoid its spontaneous depolymerization back to the monomer. The ether oxygen group in the backbone of the polymer chain is responsible for its flexibility.\n\n Ring opening polymerization of p-dioxanone to polydioxanone\nMedical use \nPolydioxanone is used for biomedical applications, particularly in the preparation of surgical sutures. Other biomedical applications include orthopedics, maxillofacial surgery, plastic surgery, drug delivery, cardiovascular applications, and tissue engineering.[1][2]\nIt is degraded by hydrolysis, and the end products are mainly excreted in urine, the remainder being eliminated by digestive or exhaled as CO2. The biomaterial is completely reabsorbed in 6 months and can be seen only a minimal foreign body reaction tissue in the vicinity of the implant. Materials made of PDS can be sterilized with ethylene oxide.[3]\n\nSee also \nOther biodegradable polymers:\n\npolycaprolactone\npolyglycolide\npolylactic acid\npoly(lactic-co-glycolic acid)\npoly-3-hydroxybutyrate\nReferences \n\n\n^ Boland, Eugene D.; Coleman Branch D.; Barnes Catherine P.; Simpson David G.; Wnek Gary E.; Bowlin Gary L. (January 2005). \"Electrospinning polydioxanone for biomedical applications\". Acta Biomaterialia. Elsevier. 1 (1): 115\u2013123. doi:10.1016\/j.actbio.2004.09.003. PMID 16701785. \n\n^ Middleton, J.; A. Tipton (March 1998). \"Synthetic biodegradable polymers as medical devices\". Medical Plastics and Biomaterials Magazine. Retrieved 2007-02-12 . \n\n^ Tiberiu Ni\u021b\u0103 (Mar 2011). \"Concepts in biological analysis of resorbable materials in oro-maxillofacial surgery\". Rev. chir. oro-maxilo-fac. implantol. (in Romanian). 2 (1): 33\u201338. ISSN 2069-3850. 23. Retrieved 2012-06-06 . (webpage has a translation button) \n\n\nThis article about polymer science is a stub. 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It is obtained by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ring-opening_polymerization\" title=\"Ring-opening polymerization\" rel=\"external_link\" target=\"_blank\">ring-opening polymerization<\/a> of the monomer <a href=\"https:\/\/en.wikipedia.org\/wiki\/P-dioxanone\" class=\"mw-redirect\" title=\"P-dioxanone\" rel=\"external_link\" target=\"_blank\"><i>p<\/i>-dioxanone<\/a>. The process requires heat and an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organometallic\" class=\"mw-redirect\" title=\"Organometallic\" rel=\"external_link\" target=\"_blank\">organometallic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalyst\" class=\"mw-redirect\" title=\"Catalyst\" rel=\"external_link\" target=\"_blank\">catalyst<\/a> like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zirconium\" title=\"Zirconium\" rel=\"external_link\" target=\"_blank\">zirconium<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetylacetone\" title=\"Acetylacetone\" rel=\"external_link\" target=\"_blank\">acetylacetone<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zinc\" title=\"Zinc\" rel=\"external_link\" target=\"_blank\">zinc<\/a> L-lactate. It is characterized by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass_transition_temperature\" class=\"mw-redirect\" title=\"Glass transition temperature\" rel=\"external_link\" target=\"_blank\">glass transition temperature<\/a> in the range of −10 and 0 \u00b0C and a crystallinity of about 55%. For the production of sutures, polydioxanone is generally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Extrusion\" title=\"Extrusion\" rel=\"external_link\" target=\"_blank\">extruded<\/a> into <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiber\" title=\"Fiber\" rel=\"external_link\" target=\"_blank\">fibers<\/a>, however care should be taken to process the polymer to the lowest possible temperature, in order to avoid its spontaneous depolymerization back to the monomer. The ether <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen\" title=\"Oxygen\" rel=\"external_link\" target=\"_blank\">oxygen<\/a> group in the backbone of the polymer chain is responsible for its flexibility.\n<\/p>\n<div class=\"center\"><div class=\"thumb tnone\"><div class=\"thumbinner\" style=\"width:427px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pdo_synthesis.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/0\/02\/Pdo_synthesis.png\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\">Ring opening polymerization of <i>p<\/i>-dioxanone to polydioxanone<\/div><\/div><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Medical_use\">Medical use<\/span><\/h2>\n<p><b>Polydioxanone<\/b> is used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical\" class=\"mw-redirect\" title=\"Biomedical\" rel=\"external_link\" target=\"_blank\">biomedical<\/a> applications, particularly in the preparation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" title=\"Surgical suture\" rel=\"external_link\" target=\"_blank\">surgical sutures<\/a>. Other biomedical applications include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedics\" class=\"mw-redirect\" title=\"Orthopedics\" rel=\"external_link\" target=\"_blank\">orthopedics<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Maxillofacial_surgery\" class=\"mw-redirect\" title=\"Maxillofacial surgery\" rel=\"external_link\" target=\"_blank\">maxillofacial surgery<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">plastic surgery<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug_delivery\" title=\"Drug delivery\" rel=\"external_link\" target=\"_blank\">drug delivery<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiovascular\" class=\"mw-redirect\" title=\"Cardiovascular\" rel=\"external_link\" target=\"_blank\">cardiovascular<\/a> applications, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_engineering\" title=\"Tissue engineering\" rel=\"external_link\" target=\"_blank\">tissue engineering<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>It is degraded by hydrolysis, and the end products are mainly excreted in urine, the remainder being eliminated by digestive or exhaled as <a href=\"https:\/\/en.wikipedia.org\/wiki\/CO2\" class=\"mw-redirect\" title=\"CO2\" rel=\"external_link\" target=\"_blank\">CO<sub>2<\/sub><\/a>. The biomaterial is completely reabsorbed in 6 months and can be seen only a minimal foreign body reaction tissue in the vicinity of the implant. Materials made of PDS can be sterilized with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_oxide\" title=\"Ethylene oxide\" rel=\"external_link\" target=\"_blank\">ethylene oxide<\/a>.<sup id=\"rdp-ebb-cite_ref-Nita_3-0\" class=\"reference\"><a href=\"#cite_note-Nita-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<p>Other biodegradable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymers<\/a>:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polycaprolactone\" title=\"Polycaprolactone\" rel=\"external_link\" target=\"_blank\">polycaprolactone<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyglycolide\" title=\"Polyglycolide\" rel=\"external_link\" target=\"_blank\">polyglycolide<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polylactic_acid\" title=\"Polylactic acid\" rel=\"external_link\" target=\"_blank\">polylactic acid<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/PLGA\" title=\"PLGA\" rel=\"external_link\" target=\"_blank\">poly(lactic-<i>co<\/i>-glycolic acid)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Poly-3-hydroxybutyrate\" class=\"mw-redirect\" title=\"Poly-3-hydroxybutyrate\" rel=\"external_link\" target=\"_blank\">poly-3-hydroxybutyrate<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Boland, Eugene D.; Coleman Branch D.; Barnes Catherine P.; Simpson David G.; Wnek Gary E.; Bowlin Gary L. (January 2005). \"Electrospinning polydioxanone for biomedical applications\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Acta_Biomaterialia\" title=\"Acta Biomaterialia\" rel=\"external_link\" target=\"_blank\">Acta Biomaterialia<\/a><\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elsevier\" title=\"Elsevier\" rel=\"external_link\" target=\"_blank\">Elsevier<\/a>. <b>1<\/b> (1): 115\u2013123. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.actbio.2004.09.003\" target=\"_blank\">10.1016\/j.actbio.2004.09.003<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16701785\" target=\"_blank\">16701785<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Biomaterialia&rft.atitle=Electrospinning+polydioxanone+for+biomedical+applications&rft.volume=1&rft.issue=1&rft.pages=115-123&rft.date=2005-01&rft_id=info%3Adoi%2F10.1016%2Fj.actbio.2004.09.003&rft_id=info%3Apmid%2F16701785&rft.aulast=Boland&rft.aufirst=Eugene+D.&rft.au=Coleman+Branch+D.&rft.au=Barnes+Catherine+P.&rft.au=Simpson+David+G.&rft.au=Wnek+Gary+E.&rft.au=Bowlin+Gary+L.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydioxanone\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Middleton, J.; A. Tipton (March 1998). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.devicelink.com\/mpb\/archive\/98\/03\/002.html\" target=\"_blank\">\"Synthetic biodegradable polymers as medical devices\"<\/a>. <i>Medical Plastics and Biomaterials Magazine<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2007-02-12<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Medical+Plastics+and+Biomaterials+Magazine&rft.atitle=Synthetic+biodegradable+polymers+as+medical+devices&rft.date=1998-03&rft.aulast=Middleton&rft.aufirst=J.&rft.au=A.+Tipton&rft_id=http%3A%2F%2Fwww.devicelink.com%2Fmpb%2Farchive%2F98%2F03%2F002.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydioxanone\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Nita-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Nita_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"> (Mar 2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.revistaomf.ro\/(23)\" target=\"_blank\">\"Concepts in biological analysis of resorbable materials in oro-maxillofacial surgery\"<\/a>. <i><\/i> (in Romanian). <b>2<\/b> (1): 33\u201338. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2069-3850\" target=\"_blank\">2069-3850<\/a>. 23<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2012-06-06<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Rev.+chir.+oro-maxilo-fac.+implantol.&rft.atitle=Concepts+in+biological+analysis+of+resorbable+materials+in+oro-maxillofacial+surgery&rft.volume=2&rft.issue=1&rft.pages=33-38&rft.date=2011-03&rft.issn=2069-3850&rft.au=Tiberiu+Ni%C8%9B%C4%83&rft_id=http%3A%2F%2Fwww.revistaomf.ro%2F%2823%29&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydioxanone\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>(webpage has a translation button)<\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1269\nCached time: 20181216182445\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.144 seconds\nReal time usage: 0.212 seconds\nPreprocessor visited node count: 287\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 9321\/2097152 bytes\nTemplate argument size: 109\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 8618\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.087\/10.000 seconds\nLua memory usage: 2.44 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 164.763 1 -total\n<\/p>\n<pre>84.98% 140.015 1 Template:Reflist\n72.71% 119.800 3 Template:Cite_journal\n14.96% 24.648 1 Template:Polymer-stub\n13.38% 22.041 1 Template:Asbox\n 1.57% 2.588 1 Template:Main_other\n 1.54% 2.538 1 Template:Column-width\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:4579730-1!canonical and timestamp 20181216182445 and revision id 873928530\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Polydioxanone\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212221\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.015 seconds\nReal time usage: 0.141 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 135.479 1 - wikipedia:Polydioxanone\n100.00% 135.479 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8291-0!*!*!*!*!*!* and timestamp 20181217212221 and revision id 24503\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polydioxanone\">https:\/\/www.limswiki.org\/index.php\/Polydioxanone<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","974f6a5e1cebf150767490807e013fd9_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5d\/Polyparadioxanone.svg\/440px-Polyparadioxanone.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/0\/02\/Pdo_synthesis.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/23\/Polymers_Logo_svg.svg\/60px-Polymers_Logo_svg.svg.png"],"974f6a5e1cebf150767490807e013fd9_timestamp":1545081741,"e6bc16ee42f94cc190f3bb11da2f1f6a_type":"article","e6bc16ee42f94cc190f3bb11da2f1f6a_title":"Polydimethylsiloxane","e6bc16ee42f94cc190f3bb11da2f1f6a_url":"https:\/\/www.limswiki.org\/index.php\/Polydimethylsiloxane","e6bc16ee42f94cc190f3bb11da2f1f6a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPolydimethylsiloxane\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\nPolydimethylsiloxane\n\n\n\n\n\n\n\n\n\nNames\n\n\n\nIUPAC name\npoly(dimethylsiloxane)\n\n\n\n\nOther names\nPDMS\r\ndimethicone\r\ndimethylpolysiloxane\r\nE900\n\n\nIdentifiers\n\n\n\nCAS Number\n\n63148-62-9  N \n\n\n\n\n\n\n\n\nChemSpider\n\nnone\n\n\n\nECHA InfoCard \n\n100.126.442\n\n\n\nE number \n\nE900 (glazing agents, ...)\n\n\n\n\n\n\n\n\nUNII\n\n92RU3N3Y1O  Y \n\n\nProperties\n\n\nChemical formula\n\n(C2H6OSi)n \n\n\n\n\n\nDensity\n\n965 kg m\u22123\n\n\nMelting point\n\nN\/A (vitrifies)  \n\n\nBoiling point\n\nN\/A (vitrifies)  \n\n\n\n\n\nPharmacology\n\n\n\nATC code\n\nP03AX05 (WHO ) \n\n\nHazards\n\n\n\n\n\n\n\n\n\n\n\n\n\nNFPA 704\n\n\n\n1 \n2 \n0 \n\n\n\n\n\nExcept where otherwise noted, data are given for materials in their standard state (at 25 \u00b0C [77 \u00b0F], 100 kPa).\n\n\nN  verify  (what is Y N  ?)\n\n\nInfobox references\n\n\n\n\n\n\n\nPolydimethylsiloxane (PDMS), also known as dimethylpolysiloxane or dimethicone, belongs to a group of polymeric organosilicon compounds that are commonly referred to as silicones.[1] PDMS is the most widely used silicon-based organic polymer, and is particularly known for its unusual rheological (or flow) properties. PDMS is optically clear, and, in general, inert, non-toxic, and non-flammable. It is one of several types of silicone oil (polymerized siloxane). Its applications range from contact lenses and medical devices to elastomers; it is also present in shampoos (as dimethicone makes hair shiny and slippery), food (antifoaming agent), caulking, lubricants and heat-resistant tiles.\n\nContents \n\n1 Structure \n\n1.1 Branching and capping \n\n\n2 Mechanical properties \n3 Chemical compatibility \n4 Applications \n\n4.1 Surfactants and antifoaming agents \n4.2 Hydraulic fluids and related applications \n4.3 Soft lithography \n4.4 Medicine and cosmetics \n\n4.4.1 Skin \n4.4.2 Hair \n\n\n4.5 Foods \n4.6 Condom Lubricant \n4.7 Domestic and niche uses \n\n\n5 Safety and environmental considerations \n6 See also \n7 References \n8 External links \n\n\nStructure \nThe chemical formula for PDMS is CH3[Si(CH3)2O]nSi(CH3)3, where n is the number of repeating monomer [SiO(CH3)2] units.[2] Industrial synthesis can begin from dimethyldichlorosilane and water by the following net reaction:\n\n\n \n \n \n n\n \n Si\n \n \n (\n \n CH\n \n 3\n \n \n \n \n \n )\n \n \n 2\n \n \n \n \n \n \n Cl\n \n 2\n \n \n \n \n \n \n +\n (\n n\n +\n 1\n )\n \n \n H\n \n 2\n \n \n \n \n \n O\n ⟶\n HO\n \n \n [\n \n −\n \n Si\n \n \n (\n \n CH\n \n 3\n \n \n \n \n \n )\n \n \n 2\n \n \n \n \n \n O\n \n −\n \n ]\n \n \n \n n\n \n \n \n \n \n \n H\n \n +\n 2\n n\n \n HCl\n \n \n \n {\\displaystyle n{\\ce {Si(CH3)2Cl2}}+(n+1){\\ce {H2O->HO[-Si(CH3)2O-]_{\\mathit {n}}H}}+2n{\\ce {HCl}}}\n \n \nThe polymerization reaction evolves hydrochloric acid. For medical and domestic applications, a process was developed in which the chlorine atoms in the silane precursor were replaced with acetate groups. In this case, the polymerization produces acetic acid, which is less chemically aggressive than HCl. As a side-effect, the curing process is also much slower in this case. The acetate is used in consumer applications, such as silicone caulk and adhesives.\n\nBranching and capping \nHydrolysis of Si(CH3)2Cl2 generates a polymer that is terminated with silanol groups (-Si(CH3)2OH]). These reactive centers are typically \"capped\" by reaction with trimethylsilyl chloride:\n\n2 Si(CH3)3Cl + [Si(CH3)2O]n -2[Si(CH3)2OH]2 \u2192 [Si(CH3)2O]n -2[Si(CH3)2O Si(CH3)3]2 + 2 HCl\nSilane precursors with more acid-forming groups and fewer methyl groups, such as methyltrichlorosilane, can be used to introduce branches or cross-links in the polymer chain. Under ideal conditions, each molecule of such a compound becomes a branch point. This can be used to produce hard silicone resins. In a similar manner, precursors with three methyl groups can be used to limit molecular weight, since each such molecule has only one reactive site and so forms the end of a siloxane chain.\nWell-defined PDMS with a low polydispersity index and high homogeneity is produced by controlled anionic ring-opening polymerization of hexamethylcyclotrisiloxane. Using this methodology it is possible to synthesize linear block copolymers, heteroarm star-shaped block copolymers and many other macromolecular architectures.\nThe polymer is manufactured in multiple viscosities, ranging from a thin pourable liquid (when n is very low), to a thick rubbery semi-solid (when n is very high). PDMS molecules have quite flexible polymer backbones (or chains) due to their siloxane linkages, which are analogous to the ether linkages used to impart rubberiness to polyurethanes. Such flexible chains become loosely entangled when molecular weight is high, which results in PDMS' unusually high level of viscoelasticity.\n\nMechanical properties \n Hardened PDMS cylinder on the glass of a stereomicroscope light.\nPDMS is viscoelastic, meaning that at long flow times (or high temperatures), it acts like a viscous liquid, similar to honey. However, at short flow times (or low temperatures), it acts like an elastic solid, similar to rubber. In other words, if some PDMS is left on a surface overnight (long flow time), it will flow to cover the surface and mold to any surface imperfections. However, if the same PDMS is rolled into a sphere and thrown onto the same surface (short flow time), it will bounce like a rubber ball.[2]\nAlthough the viscoelastic properties of PDMS can be intuitively observed using the simple experiment described above, they can be more precisely measured using dynamic mechanical analysis. This method requires determination of the material's flow characteristics over a wide range of temperatures, flow rates, and deformations. Because of PDMS's chemical stability, it is often used as a calibration fluid for this type of experiment.\nThe shear modulus of PDMS varies with preparation conditions, but is typically in the range of 100 kPa to 3 MPa. The loss tangent is very low (tan \u03b4 \u226a 0.001) .[3]\n\nChemical compatibility \nAfter polymerization and cross-linking, solid PDMS samples will present an external hydrophobic surface.[4] This surface will appear metallic and shiny, although the substrate is clear. This surface chemistry makes it difficult for polar solvents (such as water) to wet the PDMS surface, and may lead to adsorption of hydrophobic contaminants. Plasma oxidation can be used to alter the surface chemistry, adding silanol (SiOH) groups to the surface. Atmospheric air plasma and argon plasma will work for this application. This treatment renders the PDMS surface hydrophilic, allowing water to wet it. This is frequently required for water-based microfluidics. The oxidized surface resists adsorption of hydrophobic and negatively charged species. The oxidized surface can be further functionalized by reaction with trichlorosilanes. After a certain amount of time, recovery of the surface's hydrophobicity is inevitable, regardless of whether the surrounding medium is vacuum, air, or water; the oxidized surface is stable in air for about 30 minutes.[5]\nSolid PDMS samples (whether surface oxidized or not) will not allow aqueous solvents to infiltrate and swell the material. Thus PDMS structures can be used in combination with water and alcohol solvents without material deformation. However most organic solvents will diffuse into the material and cause it to swell,[4] making them incompatible with PDMS devices. Despite this, some organic solvents lead to sufficiently small swelling that they can be used with PDMS, for instance within the channels of PDMS microfluidic devices. The swelling ratio is roughly inversely related to the solubility parameter of the solvent. Diisopropylamine swells PDMS to the greatest extent; solvents such as chloroform, ether, and THF swell the material to a large extent. Solvents such as acetone, 1-propanol, and pyridine swell the material to a small extent. Alcohols and polar solvents such as methanol, glycerol and water do not swell the material appreciably.[6]\n\nApplications \nSurfactants and antifoaming agents \nPDMS is a common surfactant and is a component of defoamers, which are used to suppress the formation of foams.[7] PDMS, in a modified form, is used as an herbicidal penetrant[8] and is a critical ingredient in water-repelling coatings, such as Rain-X.[9]\n\nHydraulic fluids and related applications \nDimethicone is also the active silicone fluid in automotive viscous limited slip differentials and couplings. This is usually a non-serviceable OEM component but can be replaced with mixed performance results due to variances in effectiveness caused by refill weights or non-standard pressurizations.[citation needed ]\n\nSoft lithography \nPDMS is commonly used as a stamp resin in the procedure of soft lithography, making it one of the most common materials used for flow delivery in microfluidics chips.[10] The process of soft lithography consists of creating an elastic stamp, which enables the transfer of patterns of only a few nanometers in size onto glass, silicon or polymer surfaces. With this type of technique, it is possible to produce devices that can be used in the areas of optic telecommunications or biomedical research. The stamp is produced from the normal techniques of photolithography or electron-beam lithography. The resolution depends on the mask used and can reach 6 nm.[11]\nIn biomedical (or biological) microelectromechanical systems (bio-MEMS), soft lithography is used extensively for microfluidics in both organic and inorganic contexts. Silicon wafers are used to design channels, and PDMS is then poured over these wafers and left to harden. When removed, even the smallest of details is left imprinted in the PDMS. With this particular PDMS block, hydrophilic surface modification is conducted using plasma etching techniques. Plasma treatment disrupts surface silicon-oxygen bonds, and a plasma-treated glass slide is usually placed on the activated side of the PDMS (the plasma-treated, now hydrophilic side with imprints). Once activation wears off and bonds begin to reform, silicon-oxygen bonds are formed between the surface atoms of the glass and the surface atoms of the PDMS, and the slide becomes permanently sealed to the PDMS, thus creating a waterproof channel. With these devices, researchers can utilize various surface chemistry techniques for different functions creating unique lab-on-a-chip devices for rapid parallel testing.[12]\nPDMS can be cross-linked into networks and is a commonly used system for studying the elasticity of polymer networks.[citation needed ] PDMS can be directly patterned by surface-charge lithography.[13]\n\n<\/p>PDMS is being used in the making of synthetic gecko adhesion dry adhesive materials, to date only in laboratory test quantities.[14]\nSome flexible electronics researchers use PDMS because of its low cost, easy fabrication, flexibility, and optical transparency.[15]\n\nMedicine and cosmetics \nActivated dimethicone, a mixture of polydimethylsiloxanes and silicon dioxide (sometimes called simethicone), is often used in over-the-counter drugs as an antifoaming agent and carminative.[16][17] It has also been at least proposed for use in contact lenses.[18]\n\nSkin \nPDMS is used variously in the cosmetic and consumer product industry as well. For example, PDMS can be used in the treatment of head lice on the scalp[19] and dimethicone is used widely in skin-moisturizing lotions where it is listed as an active ingredient whose purpose is \"skin protection.\" Some cosmetic formulations use dimethicone and related siloxane polymers in concentrations of use up to 15%. The Cosmetic Ingredient Review's (CIR) Expert Panel, has concluded that dimethicone and related polymers are \"safe as used in cosmetic formulations.\"[20]\n\nHair \nPDMS compounds such as amodimethicone, are effective conditioners when formulated to consist of small particles and be soluble in water or alcohol\/act as surfactants[21][22] (especially for damaged hair[23]), and are even more conditioning to the hair than common dimethicone and\/or dimethicone copolyols.[24]\n\nFoods \nPDMS is added to many cooking oils (as an antifoaming agent) to prevent oil splatter during the cooking process. As a result of this, PDMS can be found in trace quantities in many fast food items such as McDonald's Chicken McNuggets, french fries, hash browns, milkshakes and smoothies[25] and Wendy's french fries.[26] It is known as E number reference E900.\n\nCondom Lubricant \nPDMS are widely used as a condom lubricant.[27][28]\n\nDomestic and niche uses \nMany people are indirectly familiar with PDMS because it is an important component in Silly Putty, to which PDMS imparts its characteristic viscoelastic properties.[29] Another toy PDMS is used in is Kinetic Sand. The rubbery, vinegary-smelling silicone caulks, adhesives, and aquarium sealants are also well-known. PDMS is also used as a component in silicone grease and other silicone based lubricants, as well as in defoaming agents, mold release agents, damping fluids, heat transfer fluids, polishes, cosmetics, hair conditioners and other applications. PDMS has also been used as a filler fluid in breast implants.\nIt can be used as a sorbent for the analysis of headspace (dissolved gas analysis) of food.[30]\n\nSafety and environmental considerations \nAccording to Ullmann's Encyclopedia, no \"marked harmful effects on organisms in the environment\" have been noted for siloxanes. PDMS is nonbiodegradable, but is absorbed in waste water treatment facilities. Its degradation is catalyzed by various clays.[31]\n\nSee also \nSilicone\nCyclomethicone\nSiloxanes and other organosilicon compounds\nPolymethylhydrosiloxane (PMHS)\nSilicone rubber\nReferences \n\n\n^ \"Linear Polydimethylsiloxanes\" Joint Assessment of Commodity Chemicals, September 1994 (Report No. 26) ISSN 0773-6339-26. \n\n^ a b Mark, J. E.; Allcock, H. R.; West, R. \u201cInorganic Polymers\u201d Prentice Hall, Englewood, NJ: 1992. ISBN 0-13-465881-7. \n\n^ Lotters, J. C.; Olthuis, W.; Veltink, P. H.; Bergveld, P. (1997). \"The mechanical properties of the rubber elastic polymer polydimethylsiloxane for sensor applications\". J Micromech Microeng. 7 (3): 145\u2013147. Bibcode:1997JMiMi...7..145L. doi:10.1088\/0960-1317\/7\/3\/017. \n\n^ a b McDonald, J. C.; Duffy, D. C.; Anderson, J. R.; Chiu, D. T.; Wu, H.; Schueller, O. J. A.; Whitesides, G. M. (2000). \"Fabrication of microfluidic systems in poly(dimethylsiloxane)\". Electrophoresis. 21 (1): 27\u201340. doi:10.1002\/(SICI)1522-2683(20000101)21:1<27::AID-ELPS27>3.0.CO;2-C. PMID 10634468. \n\n^ H. Hillborg; J.F. Ankner; U.W. Gedde; G.D. Smith; H.K. Yasuda; K. Wikstrom (2000). \"Crosslinked polydimethylsiloxane exposed to oxygen plasma studied by neutron reflectometry and other surface specific techniques\". Polymer. 41 (18): 6851\u20136863. doi:10.1016\/S0032-3861(00)00039-2. \n\n^ Lee, J. N.; Park, C.; Whitesides, G. M. (2003). \"Solvent Compatibility of Poly(dimethylsiloxane)-Based Microfluidic Devices\". Anal. Chem. 75 (23): 6544\u20136554. doi:10.1021\/ac0346712. PMID 14640726. \n\n^ Rainer H\u00f6fer, Franz Jost, Milan J. Schwuger, Rolf Scharf, J\u00fcrgen Geke, Josef Kresse, Herbert Lingmann, Rudolf Veitenhansl and Werner Erwied \"Foams and Foam Control\" Ullmann's Encyclopedia of Industrial Chemistry, 2000, Wiley-VCH, Weinheim. doi:10.1002\/14356007.a11_465 \n\n^ \"Pulse Penetrant\". Archived from the original on February 20, 2012. Retrieved 3 March 2009 . \n\n^ Rain X The Invisible Windshield Wiper. householdproducts.nlm.nih.gov \n\n^ PDMS in microfluidics : a review and tutorial. elveflow.com \n\n^ Waldner, Jean-Baptiste (2008). Nanocomputers and Swarm Intelligence. London: John Wiley & Sons. pp. 92\u201393. ISBN 1-84704-002-0. \n\n^ Rogers, J. A.; Nuzzo, R. G. (2005). \"Recent progress in Soft Lithography. In\". Materials Today. 8 (2): 50\u201356. doi:10.1016\/S1369-7021(05)00702-9. \n\n^ S. Grilli; V. Vespini; P. Ferraro (2008). \"Surface-charge lithography for direct pdms micro-patterning\". Langmuir. 24 (23): 13262\u201313265. doi:10.1021\/la803046j. PMID 18986187. \n\n^ Inspired by Gecko Feet, UMass Amherst Scientists Invent Super-Adhesive Material Archived 2012-02-23 at the Wayback Machine.. 16 Feb 2012, UMass Press Release \n\n^ Zhang, B.; Dong, Q.; Korman, C. E.; Li, Z.; Zaghloul, M. E. (2013). \"Flexible packaging of solid-state integrated circuit chips with elastomeric microfluidics\". Scientific Reports. 3: 1098. Bibcode:2013NatSR...3E1098Z. doi:10.1038\/srep01098. \n\n^ Prentice, William E. & Voight, Michael L. (2001). Techniques in musculoskeletal rehabilitation. McGraw-Hill Professional. p. 369. ISBN 0-07-135498-0. \n\n^ Hunt, Richard H.; Tytgat, G. N. J. & Pharma, Axcan (1998). Helicobacter Pylori: Basic Mechanisms to Clinical Cure 1998. Springer. p. 447. ISBN 0-7923-8739-2. \n\n^ Horn, Gerald. \"Silicone polymer contact lens compositions and methods of use Patent US 20050288196\". Retrieved 17 July 2015 . \n\n^ Burgess, Ian F. (2009). \"The mode of action of dimeticone 4% lotion against head lice, Pediculus capitis\". BMC Pharmacology. 9: 3. doi:10.1186\/1471-2210-9-3. PMC 2652450 . PMID 19232080. \n\n^ Nair, B; Cosmetic Ingredients Review Expert Panel (2003). \"Final Report on the Safety Assessment of Stearoxy Dimethicone, Dimethicone, Methicone, Amino Bispropyl Dimethicone, Aminopropyl Dimethicone, Amodimethicone, Amodimethicone Hydroxystearate, Behenoxy Dimethicone, C24-28 Alkyl Methicone, C30-45 Alkyl Methicone, C30-45 Alkyl Dimethicone, Cetearyl Methicone, Cetyl Dimethicone, Dimethoxysilyl Ethylenediaminopropyl Dimethicone, Hexyl Methicone, Hydroxypropyldimethicone, Stearamidopropyl Dimethicone, Stearyl Dimethicone, Stearyl Methicone, and Vinyldimethicone\". International Journal of Toxicology. 22 (2 Suppl): 11\u201335. doi:10.1177\/1091581803022S204. PMID 14555417. \n\n^ Schueller, Randy; Romanowski, Perry (1999). Conditioning Agents for Hair and Skin. CRC Press. p. 273. ISBN 978-0-8247-1921-0. Amodimethicone is recognized for its extremely robust conditioning and for its ability to form clear products when used in high-surfactant shampoos. Amodimethicone is a useful ingredient in conditioners, gels, mousses, and permanents, but its use in shampoos has proved troublesome due to interactions between the cationic and the anionic surfactants, which can result in compatibility problems. However, the amodimethicone emulsion can be made compatible in high-surfactant-level shampoos \n\n^ Goddard, E. Desmond; Gruber, James V. (1999). Principles of Polymer Science and Technology in Cosmetics and Personal Care. CRC Press. p. 299. ISBN 978-0-8247-1923-4. Amodimethicone is typically an emulsion-polymerized polymer; however, utilizing linear processing technology amodimethicone fluids may be prepared as neat fluids, and then emulsified by a mechanical process as desired. The most widely utilized amodimethicone emulsions contain as the surfactant pair either (1) tallowtrimonium chloride (and) nonoxy- nol-10, or (2) cetrimonium chloride (and) trideceth-10 or -12. These \"uncapped\" amino- functional silicone compounds may be characterized by a linear or branched structure. In either case, amodimethicone polymers will undergo a condensation cure reaction during drying to form a somewhat durable elastomeric film on the hair, providing wet- and dry- combing benefits, lowering triboelectric charging effects, and increasing softness of the dry hair. They are excellent conditioning agents, often found in conditioners, mousses, setting lotions, and less frequently in 2-in-l shampoos \n\n^ Iwata, Hiroshi (2012). Formulas, Ingredients and Production of Cosmetics: Technology of Skin- and Hair-Care Products in Japan. Springer Science & Business Media. p. 144. ISBN 978-4-431-54060-1. Amodimethicone is the most widely used amino-modified silicone. It has an aminopropyl group attached to the methyl group of Dimethicone. Amodimethicone of various degrees of amino modification are available as well as those that have POP, POE, or an alkyl group attached. Amino-modified silicones are cationic and affinitive to hair keratin. They are particularly highly affinitive to damaged hair, which is anionic due to the presence of cysteic acid \n\n^ Barel, Andr\u00e9 O.; Paye, Marc; Maibach, Howard I. (2014). Handbook of Cosmetic Science and Technology, Fourth Edition. CRC Press. p. 567. ISBN 978-1-84214-564-7. ...and amodimethicone, which is an amino-substituted silicone and silicone quats, which contain permanently quaternized ammonium groups. In general, amodimethicones and silicone quats condition better than dimethicones, which condition better than dimethicone copolyols \n\n^ \"McDonald's Food Facts: Ingredients\" (PDF) . McDonald's Restaurants of Canada Limited. 2013-09-08. p. 13. \n\n^ \"Wendy's: Menu: French Fries\". Wendy's International, Inc. \n\n^ Tiernan Coyle, Naveed Anwar: A novel approach to condom lubricant analysis: In-situ analysis of swabs by FT-Raman Spectroscopy and its effects on DNA analysis. In: Science & Justice. 49, 2009, S. 32\u201340, doi:10.1016\/j.scijus.2008.04.003. \n\n^ R. D. Blackledge, M. Vincenti: Identification of polydimethylsiloxane lubricant traces from latex condoms in cases of sexual assault. In: Journal - Forensic Science Society. vol. 34, no. 4, 1994 Oct-Dec, S. 245\u2013256, PMID 7844517. \n\n^ Micro Total Analysis Systems, Silly Putty, and Fluorous Peptides. fluorous.com. January 18, 2008 \n\n^ Bicchi, C.; Iori, C.; Rubiolo, P.; Sandra, P. (2002). \"Headspace Sorptive Extraction (HSSE), Stir Bar Sorptive Extraction (SBSE), and Solid Phase Microextraction (SPME) Applied to the Analysis of Roasted Arabica Coffee and Coffee Brew\". Journal of Agricultural and Food Chemistry. 50 (3): 449. doi:10.1021\/jf010877x. PMID 11804511. \n\n^ Moretto, Hans-Heinrich; Schulze, Manfred and Wagner, Gebhard (2005) \"Silicones\" in Ullmann's Encyclopedia of Industrial Chemistry, Wiley-VCH, Weinheim. doi:10.1002\/14356007.a24_057 \n\n\nExternal links \nAmodimethicone Amodimethicone structure and properties\nvteE numbers\nColours (E100\u2013199)\nPreservatives (E200\u2013299)\nAntioxidants & Acidity regulators (E300\u2013399)\nThickeners, stabilisers & emulsifiers (E400\u2013499)\npH regulators & anticaking agents (E500\u2013599)\nFlavour enhancers (E600\u2013699)\nMiscellaneous (E900\u2013999)\nAdditional chemicals (E1000\u20131599)\n\nWaxes (E900\u2013909)\nSynthetic glazes (E910\u2013919)\nImproving agents (E920\u2013929)\nPackaging gases (E930\u2013949)\nSweeteners (E950\u2013969)\nFoaming agents (E990\u2013999)\n\nDimethyl polysiloxane (E900)\nBeeswax (E901)\nCandelilla wax (E902)\nCarnauba wax (E903)\nShellac (E904)\nParaffins (E905)\nMineral oil (E905a)\nVaseline (E905b)\nMicrocrystalline wax (E905c)\nGum benzoic (E906)\nCrystalline wax (E907)\nRice bran wax (E908)\n\nvteEctoparasiticides \/ arthropod (P03A)Insecticide\/pediculicideChlorine-containing products\nLindane\nChloride channel\nIvermectin\nOrganophosphate\nMalathion\nAcaricide\/miticide\/scabicidePyrethrines\nPermethrin#\nPyrethrum\nPhenothrin\nBioallethrin\nChloride channel\nIvermectin\nSulfur-containing products\nDisulfiram\nDixanthogen\nMesulfen\nThiram\nChlorine-containing products\nLindane\nBenzoate\nBenzyl benzoate#\nOrganophosphate\nMalathion\nOther\/ungrouped\nDimethicone\nQuassia\ntoluidine (Crotamiton)\n\n#WHO-EM\n\u2021Withdrawn from market\nClinical trials:\n\u2020Phase III\n\u00a7Never to phase III\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polydimethylsiloxane\">https:\/\/www.limswiki.org\/index.php\/Polydimethylsiloxane<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 16:48.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,236 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","e6bc16ee42f94cc190f3bb11da2f1f6a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Polydimethylsiloxane skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Polydimethylsiloxane<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Polydimethylsiloxane<\/b> (<b>PDMS<\/b>), also known as <b>dimethylpolysiloxane<\/b> or <b>dimethicone<\/b>, belongs to a group of polymeric <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organosilicon\" title=\"Organosilicon\" rel=\"external_link\" target=\"_blank\">organosilicon<\/a> compounds that are commonly referred to as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicones<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> PDMS is the most widely used <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon\" title=\"Silicon\" rel=\"external_link\" target=\"_blank\">silicon<\/a>-based <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organic_compound\" title=\"Organic compound\" rel=\"external_link\" target=\"_blank\">organic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a>, and is particularly known for its unusual <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rheology\" title=\"Rheology\" rel=\"external_link\" target=\"_blank\">rheological<\/a> (or flow) properties. PDMS is optically clear, and, in general, inert, non-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxicity\" title=\"Toxicity\" rel=\"external_link\" target=\"_blank\">toxic<\/a>, and non-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Flammability\" class=\"mw-redirect\" title=\"Flammability\" rel=\"external_link\" target=\"_blank\">flammable<\/a>. It is one of several types of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone_oil\" title=\"Silicone oil\" rel=\"external_link\" target=\"_blank\">silicone oil<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymerized<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Siloxane\" title=\"Siloxane\" rel=\"external_link\" target=\"_blank\">siloxane<\/a>). Its applications range from contact lenses and medical devices to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastomer\" title=\"Elastomer\" rel=\"external_link\" target=\"_blank\">elastomers<\/a>; it is also present in shampoos (as dimethicone makes hair shiny and slippery), food (antifoaming agent), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Caulking\" class=\"mw-redirect\" title=\"Caulking\" rel=\"external_link\" target=\"_blank\">caulking<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lubricant\" title=\"Lubricant\" rel=\"external_link\" target=\"_blank\">lubricants<\/a> and heat-resistant tiles.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Structure\">Structure<\/span><\/h2>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_formula\" title=\"Chemical formula\" rel=\"external_link\" target=\"_blank\">chemical formula<\/a> for PDMS is CH<sub>3<\/sub>[Si(CH<sub>3<\/sub>)<sub>2<\/sub>O]<sub><i>n<\/i><\/sub>Si(CH<sub>3<\/sub>)<sub>3<\/sub>, where <i>n<\/i> is the number of repeating <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomer<\/a> [SiO(CH<sub>3<\/sub>)<sub>2<\/sub>] units.<sup id=\"rdp-ebb-cite_ref-West_2-0\" class=\"reference\"><a href=\"#cite_note-West-2\" rel=\"external_link\">[2]<\/a><\/sup> Industrial synthesis can begin from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dimethyldichlorosilane\" title=\"Dimethyldichlorosilane\" rel=\"external_link\" target=\"_blank\">dimethyldichlorosilane<\/a> and water by the following net reaction:\n<\/p>\n<dl><dd><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/10568ead2be7a0d6946bf52a9a42c033b9707047\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -1.171ex; width:65.713ex; height:3.176ex;\" alt=\"{\\displaystyle n{\\ce {Si(CH3)2Cl2}}+(n+1){\\ce {H2O->HO[-Si(CH3)2O-]_{\\mathit {n}}H}}+2n{\\ce {HCl}}}\"\/><\/span><\/dd><\/dl>\n<p>The polymerization reaction evolves <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrochloric_acid\" title=\"Hydrochloric acid\" rel=\"external_link\" target=\"_blank\">hydrochloric acid<\/a>. For medical and domestic applications, a process was developed in which the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chlorine\" title=\"Chlorine\" rel=\"external_link\" target=\"_blank\">chlorine<\/a> atoms in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silane\" title=\"Silane\" rel=\"external_link\" target=\"_blank\">silane<\/a> precursor were replaced with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetate\" title=\"Acetate\" rel=\"external_link\" target=\"_blank\">acetate<\/a> groups. In this case, the polymerization produces <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetic_acid\" title=\"Acetic acid\" rel=\"external_link\" target=\"_blank\">acetic acid<\/a>, which is less chemically aggressive than HCl. As a side-effect, the curing process is also much slower in this case. The acetate is used in consumer applications, such as silicone <a href=\"https:\/\/en.wikipedia.org\/wiki\/Caulk\" title=\"Caulk\" rel=\"external_link\" target=\"_blank\">caulk<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adhesive\" title=\"Adhesive\" rel=\"external_link\" target=\"_blank\">adhesives<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Branching_and_capping\">Branching and capping<\/span><\/h3>\n<p>Hydrolysis of Si(CH<sub>3<\/sub>)<sub>2<\/sub>Cl<sub>2<\/sub> generates a polymer that is terminated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silanol\" title=\"Silanol\" rel=\"external_link\" target=\"_blank\">silanol<\/a> groups (-Si(CH<sub>3<\/sub>)<sub>2<\/sub>OH]). These reactive centers are typically \"capped\" by reaction with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trimethylsilyl_chloride\" title=\"Trimethylsilyl chloride\" rel=\"external_link\" target=\"_blank\">trimethylsilyl chloride<\/a>:\n<\/p>\n<dl><dd>2 Si(CH<sub>3<\/sub>)<sub>3<\/sub>Cl + [Si(CH<sub>3<\/sub>)<sub>2<\/sub>O]<sub><span class=\"texhtml mvar\" style=\"font-style:italic;\">n<\/span>-2<\/sub>[Si(CH<sub>3<\/sub>)<sub>2<\/sub>OH]<sub>2<\/sub> \u2192 [Si(CH<sub>3<\/sub>)<sub>2<\/sub>O]<sub><span class=\"texhtml mvar\" style=\"font-style:italic;\">n<\/span>-2<\/sub>[Si(CH<sub>3<\/sub>)<sub>2<\/sub>O Si(CH<sub>3<\/sub>)<sub>3<\/sub>]<sub>2<\/sub> + 2 HCl<\/dd><\/dl>\n<p>Silane precursors with more acid-forming groups and fewer methyl groups, such as methyltrichlorosilane, can be used to introduce <a href=\"https:\/\/en.wikipedia.org\/wiki\/Branching_(chemistry)\" class=\"mw-redirect\" title=\"Branching (chemistry)\" rel=\"external_link\" target=\"_blank\">branches<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cross-link\" title=\"Cross-link\" rel=\"external_link\" target=\"_blank\">cross-links<\/a> in the polymer chain. Under ideal conditions, each molecule of such a compound becomes a branch point. This can be used to produce hard <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone_resin\" title=\"Silicone resin\" rel=\"external_link\" target=\"_blank\">silicone resins<\/a>. In a similar manner, precursors with three methyl groups can be used to limit molecular weight, since each such molecule has only one reactive site and so forms the end of a siloxane chain.\n<\/p><p>Well-defined PDMS with a low polydispersity index and high homogeneity is produced by controlled anionic ring-opening polymerization of hexamethylcyclotrisiloxane. Using this methodology it is possible to synthesize linear block copolymers, heteroarm star-shaped block copolymers and many other macromolecular architectures.\n<\/p><p>The polymer is manufactured in multiple <a href=\"https:\/\/en.wikipedia.org\/wiki\/Viscosity\" title=\"Viscosity\" rel=\"external_link\" target=\"_blank\">viscosities<\/a>, ranging from a thin pourable liquid (when <i>n<\/i> is very low), to a thick rubbery semi-solid (when <i>n<\/i> is very high). PDMS <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecule\" title=\"Molecule\" rel=\"external_link\" target=\"_blank\">molecules<\/a> have quite flexible polymer backbones (or chains) due to their siloxane linkages, which are analogous to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ether\" title=\"Ether\" rel=\"external_link\" target=\"_blank\">ether<\/a> linkages used to impart rubberiness to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyurethane\" title=\"Polyurethane\" rel=\"external_link\" target=\"_blank\">polyurethanes<\/a>. Such flexible chains become loosely entangled when <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_weight\" class=\"mw-redirect\" title=\"Molecular weight\" rel=\"external_link\" target=\"_blank\">molecular weight<\/a> is high, which results in PDMS' unusually high level of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Viscoelasticity\" title=\"Viscoelasticity\" rel=\"external_link\" target=\"_blank\">viscoelasticity<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Mechanical_properties\">Mechanical properties<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PDMS-cylindertje_onder_stereomicroscoop.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/27\/PDMS-cylindertje_onder_stereomicroscoop.jpg\/220px-PDMS-cylindertje_onder_stereomicroscoop.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PDMS-cylindertje_onder_stereomicroscoop.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Hardened PDMS cylinder on the glass of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stereomicroscope\" class=\"mw-redirect\" title=\"Stereomicroscope\" rel=\"external_link\" target=\"_blank\">stereomicroscope<\/a> light.<\/div><\/div><\/div>\n<p>PDMS is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Viscoelastic\" class=\"mw-redirect\" title=\"Viscoelastic\" rel=\"external_link\" target=\"_blank\">viscoelastic<\/a>, meaning that at long flow times (or high temperatures), it acts like a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Viscosity\" title=\"Viscosity\" rel=\"external_link\" target=\"_blank\">viscous liquid<\/a>, similar to honey. However, at short flow times (or low temperatures), it acts like an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elasticity_(physics)\" title=\"Elasticity (physics)\" rel=\"external_link\" target=\"_blank\">elastic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solid\" title=\"Solid\" rel=\"external_link\" target=\"_blank\">solid<\/a>, similar to rubber. In other words, if some PDMS is left on a surface overnight (long flow time), it will flow to cover the surface and mold to any surface imperfections. However, if the same PDMS is rolled into a sphere and thrown onto the same surface (short flow time), it will bounce like a rubber ball.<sup id=\"rdp-ebb-cite_ref-West_2-1\" class=\"reference\"><a href=\"#cite_note-West-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Although the viscoelastic properties of PDMS can be intuitively observed using the simple experiment described above, they can be more precisely measured using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dynamic_mechanical_analysis\" title=\"Dynamic mechanical analysis\" rel=\"external_link\" target=\"_blank\">dynamic mechanical analysis<\/a>. This method requires determination of the material's flow characteristics over a wide range of temperatures, flow rates, and deformations. Because of PDMS's chemical stability, it is often used as a calibration fluid for this type of experiment.\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shear_modulus\" title=\"Shear modulus\" rel=\"external_link\" target=\"_blank\">shear modulus<\/a> of PDMS varies with preparation conditions, but is typically in the range of 100 kPa to 3 MPa. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Loss_tangent\" class=\"mw-redirect\" title=\"Loss tangent\" rel=\"external_link\" target=\"_blank\">loss tangent<\/a> is very low <span class=\"nowrap\">(tan \u03b4 \u226a 0.001)<\/span>.<sup id=\"rdp-ebb-cite_ref-pdms_mechanical_3-0\" class=\"reference\"><a href=\"#cite_note-pdms_mechanical-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Chemical_compatibility\">Chemical compatibility<\/span><\/h2>\n<p>After <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymerization\" title=\"Polymerization\" rel=\"external_link\" target=\"_blank\">polymerization<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cross-link\" title=\"Cross-link\" rel=\"external_link\" target=\"_blank\">cross-linking<\/a>, solid PDMS samples will present an external <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrophobic\" class=\"mw-redirect\" title=\"Hydrophobic\" rel=\"external_link\" target=\"_blank\">hydrophobic<\/a> surface.<sup id=\"rdp-ebb-cite_ref-pdms_review_4-0\" class=\"reference\"><a href=\"#cite_note-pdms_review-4\" rel=\"external_link\">[4]<\/a><\/sup> This surface will appear metallic and shiny, although the substrate is clear. This surface chemistry makes it difficult for polar solvents (such as water) to wet the PDMS surface, and may lead to adsorption of hydrophobic contaminants. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plasma_(physics)\" title=\"Plasma (physics)\" rel=\"external_link\" target=\"_blank\">Plasma<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxidation\" class=\"mw-redirect\" title=\"Oxidation\" rel=\"external_link\" target=\"_blank\">oxidation<\/a> can be used to alter the surface chemistry, adding <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silanol\" title=\"Silanol\" rel=\"external_link\" target=\"_blank\">silanol<\/a> (SiOH) groups to the surface. Atmospheric air plasma and argon plasma will work for this application. This treatment renders the PDMS surface <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrophilic\" class=\"mw-redirect\" title=\"Hydrophilic\" rel=\"external_link\" target=\"_blank\">hydrophilic<\/a>, allowing water to wet it. This is frequently required for water-based <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microfluidics\" title=\"Microfluidics\" rel=\"external_link\" target=\"_blank\">microfluidics<\/a>. The oxidized surface resists <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adsorption\" title=\"Adsorption\" rel=\"external_link\" target=\"_blank\">adsorption<\/a> of hydrophobic and negatively charged species. The oxidized surface can be further functionalized by reaction with trichlorosilanes. After a certain amount of time, recovery of the surface's hydrophobicity is inevitable, regardless of whether the surrounding medium is vacuum, air, or water; the oxidized surface is stable in air for about 30 minutes.<sup id=\"rdp-ebb-cite_ref-hydrophobic_recovery_5-0\" class=\"reference\"><a href=\"#cite_note-hydrophobic_recovery-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>Solid PDMS samples (whether surface oxidized or not) will not allow aqueous solvents to infiltrate and swell the material. Thus PDMS structures can be used in combination with water and alcohol solvents without material deformation. However most <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organic_compound\" title=\"Organic compound\" rel=\"external_link\" target=\"_blank\">organic<\/a> solvents will <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion\" title=\"Diffusion\" rel=\"external_link\" target=\"_blank\">diffuse<\/a> into the material and cause it to swell,<sup id=\"rdp-ebb-cite_ref-pdms_review_4-1\" class=\"reference\"><a href=\"#cite_note-pdms_review-4\" rel=\"external_link\">[4]<\/a><\/sup> making them incompatible with PDMS devices. Despite this, some organic solvents lead to sufficiently small swelling that they can be used with PDMS, for instance within the channels of PDMS microfluidic devices. The swelling ratio is roughly inversely related to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solubility\" title=\"Solubility\" rel=\"external_link\" target=\"_blank\">solubility parameter<\/a> of the solvent. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diisopropylamine\" title=\"Diisopropylamine\" rel=\"external_link\" target=\"_blank\">Diisopropylamine<\/a> swells PDMS to the greatest extent; solvents such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chloroform\" title=\"Chloroform\" rel=\"external_link\" target=\"_blank\">chloroform<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ether\" title=\"Ether\" rel=\"external_link\" target=\"_blank\">ether<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/THF\" class=\"mw-redirect\" title=\"THF\" rel=\"external_link\" target=\"_blank\">THF<\/a> swell the material to a large extent. Solvents such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetone\" title=\"Acetone\" rel=\"external_link\" target=\"_blank\">acetone<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/1-propanol\" class=\"mw-redirect\" title=\"1-propanol\" rel=\"external_link\" target=\"_blank\">1-propanol<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyridine\" title=\"Pyridine\" rel=\"external_link\" target=\"_blank\">pyridine<\/a> swell the material to a small extent. Alcohols and polar solvents such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methanol\" title=\"Methanol\" rel=\"external_link\" target=\"_blank\">methanol<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glycerol\" title=\"Glycerol\" rel=\"external_link\" target=\"_blank\">glycerol<\/a> and water do not swell the material appreciably.<sup id=\"rdp-ebb-cite_ref-solvent_review_6-0\" class=\"reference\"><a href=\"#cite_note-solvent_review-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Surfactants_and_antifoaming_agents\">Surfactants and antifoaming agents<\/span><\/h3>\n<p>PDMS is a common <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surfactant\" title=\"Surfactant\" rel=\"external_link\" target=\"_blank\">surfactant<\/a> and is a component of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Defoamer\" title=\"Defoamer\" rel=\"external_link\" target=\"_blank\">defoamers<\/a>, which are used to suppress the formation of foams.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> PDMS, in a modified form, is used as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Herbicide\" title=\"Herbicide\" rel=\"external_link\" target=\"_blank\">herbicidal<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Penetrant_(biochemical)\" title=\"Penetrant (biochemical)\" rel=\"external_link\" target=\"_blank\">penetrant<\/a><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> and is a critical ingredient in water-repelling coatings, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rain-X\" title=\"Rain-X\" rel=\"external_link\" target=\"_blank\">Rain-X<\/a>.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hydraulic_fluids_and_related_applications\">Hydraulic fluids and related applications<\/span><\/h3>\n<p>Dimethicone is also the active silicone fluid in automotive viscous limited slip differentials and couplings. This is usually a non-serviceable OEM component but can be replaced with mixed performance results due to variances in effectiveness caused by refill weights or non-standard pressurizations.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (July 2012)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Soft_lithography\">Soft lithography<\/span><\/h3>\n<p>PDMS is commonly used as a stamp resin in the procedure of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soft_lithography\" title=\"Soft lithography\" rel=\"external_link\" target=\"_blank\">soft lithography<\/a>, making it one of the most common materials used for flow delivery in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microfluidics\" title=\"Microfluidics\" rel=\"external_link\" target=\"_blank\">microfluidics<\/a> chips.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> The process of soft lithography consists of creating an elastic stamp, which enables the transfer of patterns of only a few nanometers in size onto glass, silicon or polymer surfaces. With this type of technique, it is possible to produce devices that can be used in the areas of optic telecommunications or biomedical research. The stamp is produced from the normal techniques of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photolithography\" title=\"Photolithography\" rel=\"external_link\" target=\"_blank\">photolithography<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electron-beam_lithography\" title=\"Electron-beam lithography\" rel=\"external_link\" target=\"_blank\">electron-beam lithography<\/a>. The resolution depends on the mask used and can reach 6 nm.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bio-MEMS\" title=\"Bio-MEMS\" rel=\"external_link\" target=\"_blank\">biomedical (or biological) microelectromechanical systems<\/a> (bio-MEMS), soft lithography is used extensively for microfluidics in both organic and inorganic contexts. Silicon wafers are used to design channels, and PDMS is then poured over these wafers and left to harden. When removed, even the smallest of details is left imprinted in the PDMS. With this particular PDMS block, hydrophilic surface modification is conducted using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plasma_etcher\" title=\"Plasma etcher\" rel=\"external_link\" target=\"_blank\">plasma etching<\/a> techniques. Plasma treatment disrupts surface silicon-oxygen bonds, and a plasma-treated glass slide is usually placed on the activated side of the PDMS (the plasma-treated, now hydrophilic side with imprints). Once activation wears off and bonds begin to reform, silicon-oxygen bonds are formed between the surface atoms of the glass and the surface atoms of the PDMS, and the slide becomes permanently sealed to the PDMS, thus creating a waterproof channel. With these devices, researchers can utilize various surface chemistry techniques for different functions creating unique lab-on-a-chip devices for rapid parallel testing.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<p>PDMS can be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cross-link\" title=\"Cross-link\" rel=\"external_link\" target=\"_blank\">cross-linked<\/a> into networks and is a commonly used system for studying the elasticity of polymer networks.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2009)\">citation needed<\/span><\/a><\/i>]<\/sup> PDMS can be directly patterned by surface-charge lithography.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<\/p><p>PDMS is being used in the making of synthetic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gecko_adhesion\" class=\"mw-redirect\" title=\"Gecko adhesion\" rel=\"external_link\" target=\"_blank\">gecko adhesion<\/a> dry adhesive materials, to date only in laboratory test quantities.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>Some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flexible_electronics\" title=\"Flexible electronics\" rel=\"external_link\" target=\"_blank\">flexible electronics<\/a> researchers use PDMS because of its low cost, easy fabrication, flexibility, and optical transparency.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Medicine_and_cosmetics\">Medicine and cosmetics<\/span><\/h3>\n<p>Activated dimethicone, a mixture of polydimethylsiloxanes and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_dioxide\" title=\"Silicon dioxide\" rel=\"external_link\" target=\"_blank\">silicon dioxide<\/a> (sometimes called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Simeticone\" title=\"Simeticone\" rel=\"external_link\" target=\"_blank\">simethicone<\/a>), is often used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Over-the-counter_drug\" title=\"Over-the-counter drug\" rel=\"external_link\" target=\"_blank\">over-the-counter drugs<\/a> as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Defoamer\" title=\"Defoamer\" rel=\"external_link\" target=\"_blank\">antifoaming agent<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carminative\" title=\"Carminative\" rel=\"external_link\" target=\"_blank\">carminative<\/a>.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> It has also been at least proposed for use in contact lenses.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Skin\">Skin<\/span><\/h4>\n<p>PDMS is used variously in the cosmetic and consumer product industry as well. For example, PDMS can be used in the treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Head_lice\" class=\"mw-redirect\" title=\"Head lice\" rel=\"external_link\" target=\"_blank\">head lice<\/a> on the scalp<sup id=\"rdp-ebb-cite_ref-Burgess_19-0\" class=\"reference\"><a href=\"#cite_note-Burgess-19\" rel=\"external_link\">[19]<\/a><\/sup> and dimethicone is used widely in skin-moisturizing lotions where it is listed as an active ingredient whose purpose is \"skin protection.\" Some cosmetic formulations use dimethicone and related siloxane polymers in concentrations of use up to 15%. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cosmetic_Ingredient_Review\" title=\"Cosmetic Ingredient Review\" rel=\"external_link\" target=\"_blank\">Cosmetic Ingredient Review<\/a>'s (CIR) Expert Panel, has concluded that dimethicone and related polymers are \"safe as used in cosmetic formulations.\"<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Hair\">Hair<\/span><\/h4>\n<p>PDMS compounds such as amodimethicone, are effective conditioners when formulated to consist of small particles and be soluble in water or alcohol\/act as surfactants<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> (especially for damaged hair<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup>), and are even more conditioning to the hair than common dimethicone and\/or dimethicone copolyols.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Foods\">Foods<\/span><\/h3>\n<p>PDMS is added to many cooking oils (as an antifoaming agent) to prevent oil splatter during the cooking process. As a result of this, PDMS can be found in trace quantities in many fast food items such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/McDonald%27s\" title=\"McDonald's\" rel=\"external_link\" target=\"_blank\">McDonald's<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chicken_McNuggets\" title=\"Chicken McNuggets\" rel=\"external_link\" target=\"_blank\">Chicken McNuggets<\/a>, french fries, hash browns, milkshakes and smoothies<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> and Wendy's french fries.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> It is known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/E_number\" title=\"E number\" rel=\"external_link\" target=\"_blank\">E number<\/a> reference <b>E900<\/b>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Condom_Lubricant\">Condom Lubricant<\/span><\/h3>\n<p>PDMS are widely used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Condom\" title=\"Condom\" rel=\"external_link\" target=\"_blank\">condom<\/a> lubricant.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Domestic_and_niche_uses\">Domestic and niche uses<\/span><\/h3>\n<p>Many people are indirectly familiar with PDMS because it is an important component in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silly_Putty\" title=\"Silly Putty\" rel=\"external_link\" target=\"_blank\">Silly Putty<\/a>, to which PDMS imparts its characteristic viscoelastic properties.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> Another toy PDMS is used in is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kinetic_Sand\" title=\"Kinetic Sand\" rel=\"external_link\" target=\"_blank\">Kinetic Sand<\/a>. The rubbery, vinegary-smelling silicone caulks, adhesives, and aquarium sealants are also well-known. PDMS is also used as a component in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone_grease\" title=\"Silicone grease\" rel=\"external_link\" target=\"_blank\">silicone grease<\/a> and other silicone based <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lubricant\" title=\"Lubricant\" rel=\"external_link\" target=\"_blank\">lubricants<\/a>, as well as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Defoamer\" title=\"Defoamer\" rel=\"external_link\" target=\"_blank\">defoaming agents<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Release_agent\" title=\"Release agent\" rel=\"external_link\" target=\"_blank\">mold release agents<\/a>, damping fluids, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heat_transfer\" title=\"Heat transfer\" rel=\"external_link\" target=\"_blank\">heat transfer<\/a> fluids, polishes, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cosmetics\" title=\"Cosmetics\" rel=\"external_link\" target=\"_blank\">cosmetics<\/a>, hair conditioners and other applications. PDMS has also been used as a filler fluid in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_implant\" title=\"Breast implant\" rel=\"external_link\" target=\"_blank\">breast implants<\/a>.\n<\/p><p>It can be used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sorbent\" title=\"Sorbent\" rel=\"external_link\" target=\"_blank\">sorbent<\/a> for the analysis of headspace (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Dissolved_gas_analysis\" title=\"Dissolved gas analysis\" rel=\"external_link\" target=\"_blank\">dissolved gas analysis<\/a>) of food.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Safety_and_environmental_considerations\">Safety and environmental considerations<\/span><\/h2>\n<p>According to <i>Ullmann's Encyclopedia<\/i>, no \"marked harmful effects on organisms in the environment\" have been noted for siloxanes. PDMS is nonbiodegradable, but is absorbed in waste water treatment facilities. Its degradation is catalyzed by various <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clay\" title=\"Clay\" rel=\"external_link\" target=\"_blank\">clays<\/a>.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">Silicone<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyclomethicone\" class=\"mw-redirect\" title=\"Cyclomethicone\" rel=\"external_link\" target=\"_blank\">Cyclomethicone<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dimethylsiloxane\" class=\"mw-redirect\" title=\"Dimethylsiloxane\" rel=\"external_link\" target=\"_blank\">Siloxanes<\/a> and other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organosilicon\" title=\"Organosilicon\" rel=\"external_link\" target=\"_blank\">organosilicon<\/a> compounds<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymethylhydrosiloxane\" title=\"Polymethylhydrosiloxane\" rel=\"external_link\" target=\"_blank\">Polymethylhydrosiloxane<\/a> (PMHS)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone_rubber\" title=\"Silicone rubber\" rel=\"external_link\" target=\"_blank\">Silicone rubber<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ecetoc.org\/jacc-reports\" target=\"_blank\">\"Linear Polydimethylsiloxanes\"<\/a> Joint Assessment of Commodity Chemicals, September 1994 (Report No. 26) <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/search?fq=x0:jrnl&q=n2:0773-6339\" target=\"_blank\">0773-6339<\/a>-26.<\/span>\n<\/li>\n<li id=\"cite_note-West-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-West_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-West_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Mark, J. E.; Allcock, H. R.; West, R. \u201cInorganic Polymers\u201d Prentice Hall, Englewood, NJ: 1992. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-13-465881-7.<\/span>\n<\/li>\n<li id=\"cite_note-pdms_mechanical-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pdms_mechanical_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lotters, J. C.; Olthuis, W.; Veltink, P. H.; Bergveld, P. (1997). \"The mechanical properties of the rubber elastic polymer polydimethylsiloxane for sensor applications\". <i>J Micromech Microeng<\/i>. <b>7<\/b> (3): 145\u2013147. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/1997JMiMi...7..145L\" target=\"_blank\">1997JMiMi...7..145L<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1088%2F0960-1317%2F7%2F3%2F017\" target=\"_blank\">10.1088\/0960-1317\/7\/3\/017<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Micromech+Microeng&rft.atitle=The+mechanical+properties+of+the+rubber+elastic+polymer+polydimethylsiloxane+for+sensor+applications&rft.volume=7&rft.issue=3&rft.pages=145-147&rft.date=1997&rft_id=info%3Adoi%2F10.1088%2F0960-1317%2F7%2F3%2F017&rft_id=info%3Abibcode%2F1997JMiMi...7..145L&rft.au=Lotters%2C+J.+C.&rft.au=Olthuis%2C+W.&rft.au=Veltink%2C+P.+H.&rft.au=Bergveld%2C+P.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pdms_review-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-pdms_review_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-pdms_review_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">McDonald, J. C.; Duffy, D. C.; Anderson, J. R.; Chiu, D. T.; Wu, H.; Schueller, O. J. A.; Whitesides, G. M. (2000). \"Fabrication of microfluidic systems in poly(dimethylsiloxane)\". <i>Electrophoresis<\/i>. <b>21<\/b> (1): 27\u201340. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F%28SICI%291522-2683%2820000101%2921%3A1%3C27%3A%3AAID-ELPS27%3E3.0.CO%3B2-C\" target=\"_blank\">10.1002\/(SICI)1522-2683(20000101)21:1<27::AID-ELPS27>3.0.CO;2-C<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10634468\" target=\"_blank\">10634468<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Electrophoresis&rft.atitle=Fabrication+of+microfluidic+systems+in+poly%28dimethylsiloxane%29&rft.volume=21&rft.issue=1&rft.pages=27-40&rft.date=2000&rft_id=info%3Adoi%2F10.1002%2F%28SICI%291522-2683%2820000101%2921%3A1%3C27%3A%3AAID-ELPS27%3E3.0.CO%3B2-C&rft_id=info%3Apmid%2F10634468&rft.aulast=McDonald&rft.aufirst=J.+C.&rft.au=Duffy%2C+D.+C.&rft.au=Anderson%2C+J.+R.&rft.au=Chiu%2C+D.+T.&rft.au=Wu%2C+H.&rft.au=Schueller%2C+O.+J.+A.&rft.au=Whitesides%2C+G.+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-hydrophobic_recovery-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-hydrophobic_recovery_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">H. 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Wikstrom (2000). \"Crosslinked polydimethylsiloxane exposed to oxygen plasma studied by neutron reflectometry and other surface specific techniques\". <i>Polymer<\/i>. <b>41<\/b> (18): 6851\u20136863. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0032-3861%2800%2900039-2\" target=\"_blank\">10.1016\/S0032-3861(00)00039-2<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Polymer&rft.atitle=Crosslinked+polydimethylsiloxane+exposed+to+oxygen+plasma+studied+by+neutron+reflectometry+and+other+surface+specific+techniques&rft.volume=41&rft.issue=18&rft.pages=6851-6863&rft.date=2000&rft_id=info%3Adoi%2F10.1016%2FS0032-3861%2800%2900039-2&rft.au=H.+Hillborg&rft.au=J.F.+Ankner&rft.au=U.W.+Gedde&rft.au=G.D.+Smith&rft.au=H.K.+Yasuda&rft.au=K.+Wikstrom&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-solvent_review-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-solvent_review_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lee, J. N.; Park, C.; Whitesides, G. M. (2003). \"Solvent Compatibility of Poly(dimethylsiloxane)-Based Microfluidic Devices\". <i>Anal. Chem<\/i>. <b>75<\/b> (23): 6544\u20136554. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1021%2Fac0346712\" target=\"_blank\">10.1021\/ac0346712<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14640726\" target=\"_blank\">14640726<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anal.+Chem.&rft.atitle=Solvent+Compatibility+of+Poly%28dimethylsiloxane%29-Based+Microfluidic+Devices&rft.volume=75&rft.issue=23&rft.pages=6544-6554&rft.date=2003&rft_id=info%3Adoi%2F10.1021%2Fac0346712&rft_id=info%3Apmid%2F14640726&rft.au=Lee%2C+J.+N.&rft.au=Park%2C+C.&rft.au=Whitesides%2C+G.+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Rainer H\u00f6fer, Franz Jost, Milan J. Schwuger, Rolf Scharf, J\u00fcrgen Geke, Josef Kresse, Herbert Lingmann, Rudolf Veitenhansl and Werner Erwied \"Foams and Foam Control\" Ullmann's Encyclopedia of Industrial Chemistry, 2000, Wiley-VCH, Weinheim. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14356007.a11_465\" target=\"_blank\">10.1002\/14356007.a11_465<\/a><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120220150630\/http:\/\/www.nrrbs.com.au\/chemicalspulse.htm\" target=\"_blank\">\"Pulse Penetrant\"<\/a>. 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London: John Wiley & Sons. pp. 92\u201393. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-84704-002-0.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Nanocomputers+and+Swarm+Intelligence&rft.place=London&rft.pages=92-93&rft.pub=John+Wiley+%26+Sons&rft.date=2008&rft.isbn=1-84704-002-0&rft.aulast=Waldner&rft.aufirst=Jean-Baptiste&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rogers, J. A.; Nuzzo, R. G. (2005). \"Recent progress in Soft Lithography. In\". <i>Materials Today<\/i>. <b>8<\/b> (2): 50\u201356. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS1369-7021%2805%2900702-9\" target=\"_blank\">10.1016\/S1369-7021(05)00702-9<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Materials+Today&rft.atitle=Recent+progress+in+Soft+Lithography.+In&rft.volume=8&rft.issue=2&rft.pages=50-56&rft.date=2005&rft_id=info%3Adoi%2F10.1016%2FS1369-7021%2805%2900702-9&rft.aulast=Rogers&rft.aufirst=J.+A.&rft.au=Nuzzo%2C+R.+G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">S. 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Ferraro (2008). \"Surface-charge lithography for direct pdms micro-patterning\". <i>Langmuir<\/i>. <b>24<\/b> (23): 13262\u201313265. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1021%2Fla803046j\" target=\"_blank\">10.1021\/la803046j<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18986187\" target=\"_blank\">18986187<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Langmuir&rft.atitle=Surface-charge+lithography+for+direct+pdms+micro-patterning&rft.volume=24&rft.issue=23&rft.pages=13262-13265&rft.date=2008&rft_id=info%3Adoi%2F10.1021%2Fla803046j&rft_id=info%3Apmid%2F18986187&rft.au=S.+Grilli&rft.au=V.+Vespini&rft.au=P.+Ferraro&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.umass.edu\/newsoffice\/newsreleases\/articles\/146885.php\" target=\"_blank\">Inspired by Gecko Feet, UMass Amherst Scientists Invent Super-Adhesive Material<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120223092733\/http:\/\/www.umass.edu\/newsoffice\/newsreleases\/articles\/146885.php\" target=\"_blank\">Archived<\/a> 2012-02-23 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. 16 Feb 2012, UMass Press Release<\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zhang, B.; Dong, Q.; Korman, C. E.; Li, Z.; Zaghloul, M. E. (2013). \"Flexible packaging of solid-state integrated circuit chips with elastomeric microfluidics\". <i>Scientific Reports<\/i>. <b>3<\/b>: 1098. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2013NatSR...3E1098Z\" target=\"_blank\">2013NatSR...3E1098Z<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fsrep01098\" target=\"_blank\">10.1038\/srep01098<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Scientific+Reports&rft.atitle=Flexible+packaging+of+solid-state+integrated+circuit+chips+with+elastomeric+microfluidics&rft.volume=3&rft.pages=1098&rft.date=2013&rft_id=info%3Adoi%2F10.1038%2Fsrep01098&rft_id=info%3Abibcode%2F2013NatSR...3E1098Z&rft.aulast=Zhang&rft.aufirst=B.&rft.au=Dong%2C+Q.&rft.au=Korman%2C+C.+E.&rft.au=Li%2C+Z.&rft.au=Zaghloul%2C+M.+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Prentice, William E. & Voight, Michael L. 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McGraw-Hill Professional. p. 369. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-07-135498-0.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Techniques+in+musculoskeletal+rehabilitation&rft.pages=369&rft.pub=McGraw-Hill+Professional&rft.date=2001&rft.isbn=0-07-135498-0&rft.au=Prentice%2C+William+E.&rft.au=Voight%2C+Michael+L.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D7FXXQzQ_zf0C%26pg%3DPA369&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Hunt, Richard H.; Tytgat, G. N. J. & Pharma, Axcan (1998). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=Xhe2wLrSz58C&pg=PA447\" target=\"_blank\"><i>Helicobacter Pylori: Basic Mechanisms to Clinical Cure 1998<\/i><\/a>. Springer. p. 447. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-7923-8739-2.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Helicobacter+Pylori%3A+Basic+Mechanisms+to+Clinical+Cure+1998&rft.pages=447&rft.pub=Springer&rft.date=1998&rft.isbn=0-7923-8739-2&rft.au=Hunt%2C+Richard+H.&rft.au=Tytgat%2C+G.+N.+J.&rft.au=Pharma%2C+Axcan&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DXhe2wLrSz58C%26pg%3DPA447&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Horn, Gerald. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.google.com\/patents\/US20050288196\" target=\"_blank\">\"Silicone polymer contact lens compositions and methods of use Patent US 20050288196\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">17 July<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Silicone+polymer+contact+lens+compositions+and+methods+of+use+Patent+US+20050288196&rft.aulast=Horn&rft.aufirst=Gerald&rft_id=https%3A%2F%2Fwww.google.com%2Fpatents%2FUS20050288196&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Burgess-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Burgess_19-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Burgess, Ian F. (2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2652450\" target=\"_blank\">\"The mode of action of dimeticone 4% lotion against head lice, <i>Pediculus capitis<\/i>\"<\/a>. <i>BMC Pharmacology<\/i>. <b>9<\/b>: 3. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2F1471-2210-9-3\" target=\"_blank\">10.1186\/1471-2210-9-3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2652450\" target=\"_blank\">2652450<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19232080\" target=\"_blank\">19232080<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMC+Pharmacology&rft.atitle=The+mode+of+action+of+dimeticone+4%25+lotion+against+head+lice%2C+Pediculus+capitis&rft.volume=9&rft.pages=3&rft.date=2009&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2652450&rft_id=info%3Apmid%2F19232080&rft_id=info%3Adoi%2F10.1186%2F1471-2210-9-3&rft.au=Burgess%2C+Ian+F.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2652450&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Nair, B; Cosmetic Ingredients Review Expert Panel (2003). \"Final Report on the Safety Assessment of Stearoxy Dimethicone, Dimethicone, Methicone, Amino Bispropyl Dimethicone, Aminopropyl Dimethicone, Amodimethicone, Amodimethicone Hydroxystearate, Behenoxy Dimethicone, C24-28 Alkyl Methicone, C30-45 Alkyl Methicone, C30-45 Alkyl Dimethicone, Cetearyl Methicone, Cetyl Dimethicone, Dimethoxysilyl Ethylenediaminopropyl Dimethicone, Hexyl Methicone, Hydroxypropyldimethicone, Stearamidopropyl Dimethicone, Stearyl Dimethicone, Stearyl Methicone, and Vinyldimethicone\". <i>International Journal of Toxicology<\/i>. <b>22<\/b> (2 Suppl): 11\u201335. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F1091581803022S204\" target=\"_blank\">10.1177\/1091581803022S204<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14555417\" target=\"_blank\">14555417<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Toxicology&rft.atitle=Final+Report+on+the+Safety+Assessment+of+Stearoxy+Dimethicone%2C+Dimethicone%2C+Methicone%2C+Amino+Bispropyl+Dimethicone%2C+Aminopropyl+Dimethicone%2C+Amodimethicone%2C+Amodimethicone+Hydroxystearate%2C+Behenoxy+Dimethicone%2C+C24-28+Alkyl+Methicone%2C+C30-45+Alkyl+Methicone%2C+C30-45+Alkyl+Dimethicone%2C+Cetearyl+Methicone%2C+Cetyl+Dimethicone%2C+Dimethoxysilyl+Ethylenediaminopropyl+Dimethicone%2C+Hexyl+Methicone%2C+Hydroxypropyldimethicone%2C+Stearamidopropyl+Dimethicone%2C+Stearyl+Dimethicone%2C+Stearyl+Methicone%2C+and+Vinyldimethicone&rft.volume=22&rft.issue=2+Suppl&rft.pages=11-35&rft.date=2003&rft_id=info%3Adoi%2F10.1177%2F1091581803022S204&rft_id=info%3Apmid%2F14555417&rft.aulast=Nair&rft.aufirst=B&rft.au=Cosmetic+Ingredients+Review+Expert+Panel&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Schueller, Randy; Romanowski, Perry (1999). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=f_ETtcJM_0gC\" target=\"_blank\"><i>Conditioning Agents for Hair and Skin<\/i><\/a>. CRC Press. p. 273. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-8247-1921-0. <q>Amodimethicone is recognized for its extremely robust conditioning and for its ability to form clear products when used in high-surfactant shampoos. Amodimethicone is a useful ingredient in conditioners, gels, mousses, and permanents, but its use in shampoos has proved troublesome due to interactions between the cationic and the anionic surfactants, which can result in compatibility problems. However, the amodimethicone emulsion can be made compatible in high-surfactant-level shampoos<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Conditioning+Agents+for+Hair+and+Skin&rft.pages=273&rft.pub=CRC+Press&rft.date=1999&rft.isbn=978-0-8247-1921-0&rft.au=Schueller%2C+Randy&rft.au=Romanowski%2C+Perry&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Df_ETtcJM_0gC&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Goddard, E. Desmond; Gruber, James V. (1999). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=56R-6Wyyo6IC\" target=\"_blank\"><i>Principles of Polymer Science and Technology in Cosmetics and Personal Care<\/i><\/a>. CRC Press. p. 299. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-8247-1923-4. <q>Amodimethicone is typically an emulsion-polymerized polymer; however, utilizing linear processing technology amodimethicone fluids may be prepared as neat fluids, and then emulsified by a mechanical process as desired. The most widely utilized amodimethicone emulsions contain as the surfactant pair either (1) tallowtrimonium chloride (and) nonoxy- nol-10, or (2) cetrimonium chloride (and) trideceth-10 or -12. These \"uncapped\" amino- functional silicone compounds may be characterized by a linear or branched structure. In either case, amodimethicone polymers will undergo a condensation cure reaction during drying to form a somewhat durable elastomeric film on the hair, providing wet- and dry- combing benefits, lowering triboelectric charging effects, and increasing softness of the dry hair. They are excellent conditioning agents, often found in conditioners, mousses, , and less frequently in 2-in-l shampoos<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Principles+of+Polymer+Science+and+Technology+in+Cosmetics+and+Personal+Care&rft.pages=299&rft.pub=CRC+Press&rft.date=1999&rft.isbn=978-0-8247-1923-4&rft.au=Goddard%2C+E.+Desmond&rft.au=Gruber%2C+James+V.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D56R-6Wyyo6IC&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Iwata, Hiroshi (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=5miBgSRcD4cC\" target=\"_blank\"><i>Formulas, Ingredients and Production of Cosmetics: Technology of Skin- and Hair-Care Products in Japan<\/i><\/a>. Springer Science & Business Media. p. 144. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-4-431-54060-1. <q>Amodimethicone is the most widely used amino-modified silicone. It has an aminopropyl group attached to the methyl group of Dimethicone. Amodimethicone of various degrees of amino modification are available as well as those that have POP, POE, or an alkyl group attached. Amino-modified silicones are cationic and affinitive to hair keratin. They are particularly highly affinitive to damaged hair, which is anionic due to the presence of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cysteic_acid\" title=\"Cysteic acid\" rel=\"external_link\" target=\"_blank\">cysteic acid<\/a><\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Formulas%2C+Ingredients+and+Production+of+Cosmetics%3A+Technology+of+Skin-+and+Hair-Care+Products+in+Japan&rft.pages=144&rft.pub=Springer+Science+%26+Business+Media&rft.date=2012&rft.isbn=978-4-431-54060-1&rft.au=Iwata%2C+Hiroshi&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D5miBgSRcD4cC&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Barel, Andr\u00e9 O.; Paye, Marc; Maibach, Howard I. (2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=FAYNAwAAQBAJ\" target=\"_blank\"><i>Handbook of Cosmetic Science and Technology, Fourth Edition<\/i><\/a>. CRC Press. p. 567. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-84214-564-7. <q>...and amodimethicone, which is an amino-substituted silicone and silicone quats, which contain permanently quaternized ammonium groups. In general, amodimethicones and silicone quats condition better than dimethicones, which condition better than dimethicone copolyols<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Handbook+of+Cosmetic+Science+and+Technology%2C+Fourth+Edition&rft.pages=567&rft.pub=CRC+Press&rft.date=2014&rft.isbn=978-1-84214-564-7&rft.au=Barel%2C+Andr%C3%A9+O.&rft.au=Paye%2C+Marc&rft.au=Maibach%2C+Howard+I.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DFAYNAwAAQBAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www1.mcdonalds.ca\/NutritionCalculator\/IngredientFactsEN.pdf\" target=\"_blank\">\"McDonald's Food Facts: Ingredients\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. McDonald's Restaurants of Canada Limited. 2013-09-08. p. 13.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=McDonald%27s+Food+Facts%3A+Ingredients&rft.pages=13&rft.pub=McDonald%27s+Restaurants+of+Canada+Limited&rft.date=2013-09-08&rft_id=http%3A%2F%2Fwww1.mcdonalds.ca%2FNutritionCalculator%2FIngredientFactsEN.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/menu.wendys.com\/en_US\/product\/french-fries\/\" target=\"_blank\">\"Wendy's: Menu: French Fries\"<\/a>. Wendy's International, Inc.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Wendy%27s%3A+Menu%3A+French+Fries&rft.pub=Wendy%27s+International%2C+Inc.&rft_id=https%3A%2F%2Fmenu.wendys.com%2Fen_US%2Fproduct%2Ffrench-fries%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Tiernan Coyle, Naveed Anwar: <i>A novel approach to condom lubricant analysis: In-situ analysis of swabs by FT-Raman Spectroscopy and its effects on DNA analysis.<\/i> In: <i>Science & Justice.<\/i> 49, 2009, S. 32\u201340, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.scijus.2008.04.003\" target=\"_blank\">10.1016\/j.scijus.2008.04.003<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">R. D. Blackledge, M. Vincenti: <i>Identification of polydimethylsiloxane lubricant traces from latex condoms in cases of sexual assault.<\/i> In: <i>Journal - Forensic Science Society.<\/i> vol. 34, no. 4, 1994 Oct-Dec, S. 245\u2013256, <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7844517\" target=\"_blank\">7844517<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fluorous.com\/journal\/?p=86\" target=\"_blank\">Micro Total Analysis Systems, Silly Putty, and Fluorous Peptides<\/a>. fluorous.com. January 18, 2008<\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bicchi, C.; Iori, C.; Rubiolo, P.; Sandra, P. (2002). \"Headspace Sorptive Extraction (HSSE), Stir Bar Sorptive Extraction (SBSE), and Solid Phase Microextraction (SPME) Applied to the Analysis of Roasted Arabica Coffee and Coffee Brew\". <i>Journal of Agricultural and Food Chemistry<\/i>. <b>50<\/b> (3): 449. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1021%2Fjf010877x\" target=\"_blank\">10.1021\/jf010877x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11804511\" target=\"_blank\">11804511<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Agricultural+and+Food+Chemistry&rft.atitle=Headspace+Sorptive+Extraction+%28HSSE%29%2C+Stir+Bar+Sorptive+Extraction+%28SBSE%29%2C+and+Solid+Phase+Microextraction+%28SPME%29+Applied+to+the+Analysis+of+Roasted+Arabica+Coffee+and+Coffee+Brew&rft.volume=50&rft.issue=3&rft.pages=449&rft.date=2002&rft_id=info%3Adoi%2F10.1021%2Fjf010877x&rft_id=info%3Apmid%2F11804511&rft.aulast=Bicchi&rft.aufirst=C.&rft.au=Iori%2C+C.&rft.au=Rubiolo%2C+P.&rft.au=Sandra%2C+P.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolydimethylsiloxane\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Moretto, Hans-Heinrich; Schulze, Manfred and Wagner, Gebhard (2005) \"Silicones\" in <i>Ullmann's Encyclopedia of Industrial Chemistry<\/i>, Wiley-VCH, Weinheim. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14356007.a24_057\" target=\"_blank\">10.1002\/14356007.a24_057<\/a><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.silicone.jp\/e\/products\/personalcare\/pdf\/KF\/KF-8004.pdf\" target=\"_blank\">Amodimethicone<\/a> Amodimethicone structure and properties<\/li><\/ul>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1333\nCached time: 20181217075313\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.884 seconds\nReal time usage: 1.152 seconds\nPreprocessor visited node count: 7077\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 135961\/2097152 bytes\nTemplate argument size: 12533\/2097152 bytes\nHighest expansion depth: 22\/40\nExpensive parser function count: 6\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 74349\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.377\/10.000 seconds\nLua memory usage: 5.72 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1022.961 1 -total\n<\/p>\n<pre>53.72% 549.510 1 Template:Chembox\n33.37% 341.379 1 Template:Reflist\n28.86% 295.238 1 Template:Chembox_Identifiers\n19.91% 203.644 5 Template:Chembox_headerbar\n19.58% 200.277 19 Template:Trim\n13.40% 137.027 10 Template:Cite_journal\n10.77% 110.149 13 Template:Main_other\n 8.87% 90.730 1 Template:Chembox_parametercheck\n 7.86% 80.388 1 Template:Chembox_Properties\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1151127-1!canonical!math=5 and timestamp 20181217075312 and revision id 872392953\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Polydimethylsiloxane\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212221\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.016 seconds\nReal time usage: 0.178 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 168.685 1 - wikipedia:Polydimethylsiloxane\n100.00% 168.685 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8290-0!*!*!*!*!*!* and timestamp 20181217212220 and revision id 24502\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polydimethylsiloxane\">https:\/\/www.limswiki.org\/index.php\/Polydimethylsiloxane<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","e6bc16ee42f94cc190f3bb11da2f1f6a_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ac\/PmdsStructure.png\/440px-PmdsStructure.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/de\/Silicone-3D-vdW.png\/440px-Silicone-3D-vdW.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/27\/PDMS-cylindertje_onder_stereomicroscoop.jpg\/440px-PDMS-cylindertje_onder_stereomicroscoop.jpg"],"e6bc16ee42f94cc190f3bb11da2f1f6a_timestamp":1545081740,"97063e0cc3ba0ecf1c29ddb1aab5b704_type":"article","97063e0cc3ba0ecf1c29ddb1aab5b704_title":"Polyanhydrides","97063e0cc3ba0ecf1c29ddb1aab5b704_url":"https:\/\/www.limswiki.org\/index.php\/Polyanhydrides","97063e0cc3ba0ecf1c29ddb1aab5b704_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPolyanhydrides\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tPolyanhydrides are a class of biodegradable polymers characterized by anhydride bonds that connect repeat units of the polymer backbone chain. Their main application is in the medical device and pharmaceutical industry. In vivo, polyanhydrides degrade into non-toxic diacid monomers that can be metabolized and eliminated from the body. Owing to their safe degradation products, polyanhydrides are considered to be biocompatible. \n\nContents \n\n1 Applications \n2 Classes \n3 Synthesis and characterization \n\n3.1 Polymerization \n3.2 Chemical structure and composition analysis \n3.3 Molecular weight analysis \n3.4 Thermal properties \n\n\n4 Degradation \n5 Biocompatibility \n6 References \n\n\nApplications \nThe characteristic anhydride bonds in polyanhydrides are water-labile (the polymer chain breaks apart at the anhydride bond). This results in two carboxylic acid groups which are easily metabolized and biocompatible. \nBiodegradable polymers, such as polyanhydrides, are capable of releasing physically entrapped or encapsulated drugs by well-defined kinetics and are a growing area of medical research. Polyanhydrides have been investigated as an important material for the short-term release of drugs or bioactive agents. The rapid degradation and limited mechanical properties of polyanhydrides render them ideal as controlled drug delivery devices. \nOne example, Gliadel[1], is a device in clinical use for the treatment of brain cancer. This product is made of a polyanhydride wafer containing a chemotherapeutic agent. After removal of a cancerous brain tumor, the wafer is inserted into the brain releasing a chemotherapy agent at a controlled rate proportional to the degradation rate of the polymer. The localized treatment of chemotherapy protects the immune system from high levels of radiation. \nOther applications of polyanhydrides include the use of unsaturated polyanhydrides in bone replacement, as well as polyanhydride copolymers as vehicles for vaccine delivery.\n\nClasses \n The structure of a polyanhydride molecule with n repeating units.\nThere are three main classes of polyanhydrides: aliphatic, unsaturated, and aromatic. These classes are determined by examining their R groups (the chemistry of the molecule between the anhydride bonds). \nAliphatic polyanhydrides consist of R groups containing carbon atoms bonded in straight or branched chains. This class of polymers is characterized by a crystalline structure, melting temperature range of 50\u201390 \u00b0C, and solubility in chlorinated hydrocarbons. They degrade and are eliminated from the body within weeks of being introduced to the bodily environment. \nUnsaturated polyanhydrides consist of organic R groups with one or more double bonds (or degrees of unsaturation). This class of polymers has a highly crystalline structure and is insoluble in common organic solvents. \nAromatic polyanhydrides consist of R groups containing a benzene (aromatic) ring. Properties of this class include a crystalline structure, insolubility in common organic solvents, and melting points greater than 100 \u00b0C. They are very hydrophobic and therefore degrade slowly when in the bodily environment. This slow degradation rate makes aromatic polyanhydrides less suitable for drug delivery when used as homopolymers, but they can be copolymerized with the aliphatic class to achieve the desired degradation rate.\n\nSynthesis and characterization \nPolyanhydrides are synthesized using either melt condensation or solution polymerization. Depending on the synthesis method used,\nvarious characteristics of polyanhydrides can be altered to achieve the desired product. Characterization of polyanhydrides determines the structure, composition, molecular weight, and thermal properties of the molecule. These properties are determined by using various light-scattering and size-exclusion methods. \n\nPolymerization \nPolyanhydrides can be easily prepared by using available, low cost resources. The process can be varied to achieve desirable characteristics. Traditionally, polyanhydrides have been prepared by melt condensation polymerization, which results in high molecular weight polymers. Melt condensation polymerization involves reacting dicarboxylic acid monomers with excess acetic anhydride at a high temperature and under a vacuum to form the polymers. Catalysts may be used to achieve higher molecular weights and shorter reaction times. Generally, a one-step synthesis (method involving only one reaction) is used which does not require purification. \nThere are many other methods used to synthesize polyanhydrides. Some of the other methods include: microwave heating, high-throughput synthesis (synthesis of polymers in parallel), ring opening polymerization (removal of cyclic monomers), interfacial condensation (high temperature reaction of two monomers), dehydrative coupling agents (removing the water group from two carboxyl groups), and solution polymerization (reacting in a solution).\n\nChemical structure and composition analysis \nThe chemical structure and composition of polyanhydrides can be determined by H1NMR spectroscopy. This will determine the class of polanhydride (aromatic, aliphatic, or unsaturated) as well as the structural features of the polymer. For example, the analysis of nuclear magnetic resonance(NMR) peaks allows one to determine if a copolymer has a random or block-like structure. Molecular weight and degradation rate can also determined by NMR. \n\nMolecular weight analysis \nAside from using NMR to determine a polyanhydride\u2019s molecular weight, gel permeation chromatography (GPC), and viscosity measurements may also be used. \n\nThermal properties \nDifferential scanning calorimetry (DSC) is used to determine the thermal properties of polyanhydrides. Glass transition temperature, melting temperature, and heat of fusion can all be determined by DSC. Crystallinity of a polyanhydride can be determined using DSC, Small angle X-ray scattering (SAXS), Nuclear magnetic resonance (NMR), and X-ray diffraction.\n\nDegradation \n Comparison of bulk and surface erosion mechanisms.\nThe erosion and degradation of a polymer describe how the polymer physically loses mass (degrades). The two common erosion mechanisms are surface and bulk erosion. Polyanhydrides are surface eroding polymers. Surface eroding polymers do not allow water to penetrate into the material. They erode layer by layer, like a lollipop. The hydrophobic backbone with hydrolytically labile anhydride linkages allows hydrolytic degradation to be controlled by manipulating the polymer composition. This manipulation can occur by adding a hydrophilic group to the polyanhydride to make a copolymer. Polyanhydride copolymers with hydrophilic groups exhibit bulk eroding characteristics. Bulk eroding polymers take in water like a sponge (throughout the material) and erode inside and on the surface of the polymer. \nDrug release from bulk eroding polymers is difficult to characterize because the primary mode of release from these polymers is diffusion. Unlike surface eroding polymers, bulk eroding polymers show a very weak relationship between the rate of polymer degradation and the rate of drug release. Therefore, the development of surface eroding polyanhydrides incorporated into the bulk eroding polymers is of increased importance.\n\nBiocompatibility \nBiocompatibility and toxicity of a polymeric material is evaluated by examining systemic toxic responses, local tissue responses, carcinogenic and mutagenic responses, and allergic responses to the material's degradation products. Animal studies are conducted to test the polymer\u2019s effect on each of these negative responses. Polyanhydrides and their degradation products have not been found to cause significant harmful responses and are considered to be biocompatible.\n\nReferences \nDomb, A., Amselem, S., Langer, R., and Manair, M. \u201cChapter 3: Polyanhydrides as Carriers of Drugs.\u201d Biomedical Polymers Designed \u2013to \u2013Degrade Systems. Hanser Publishers: Munich, Vienna, NY, 1994.\nKumar, N., Langer, R., and Domb, A. \u201cPolyanhydrides: an overview.\u201d Advanced Drug Delivery Reviews, 2002.\n\u201cPolyanhydride Synthesis Techniques.\u201d Wyatt Technology Corp. http:\/\/www.lightscattering.com\/literature\/polyanhydride.pdf[permanent dead link ] \nTamada, J. and Langer, R. \u201cThe development of polyanhydrides for drug delivery applications.\u201d Journal of Biomaterials Science, Polymer Ed. Vol. 3, No. 4, pp. 315–353, 1992.\nTorres, M. P.; Determan, A. S.; Malapragada, S. K.; Narasimhan, B. \u201cPolyanhydrides.\u201d Encyclopedia of Chemical Processing. 2006.\nB.M. Vogel, S.K. Mallapragada, and B. Narasimhan, \u201cRapid Synthesis of Polyanhydrides By Microwave Polymerization\u201d, Macromolecular Rapid Communications 25, 330-333, 2004.\nB.M. Vogel, S.K. Mallapragada, \u201cSynthesis of Novel Biodegradable Polyanhydrides Containing Aromatic and Glycol Functionality for Tailoring of Hydrophilicity in Controlled Drug Delivery Devices\u201d, Biomaterials, 26, 721-728, 2004.\nB.M. Vogel, Naomi Eidelman, S.K. Mallapragada and B. Narasimhan, \u201cParallel Synthesis and Dissolution Testing of Polyanhydride Random Copolymers\u201d, Journal of Combinatorial Chemistry, 7, 921-928, 2005.\nB.M. Vogel and S.K. Mallapragada, \u201cThe Synthesis of Polyanhydrides\u201d, in Handbook of Biodegradable Materials and their Applications, edited by S.K. Mallapragada and Balaji Narasimhan, ASP Publishers, Vol. 1, 1-19, 2005.\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polyanhydrides\">https:\/\/www.limswiki.org\/index.php\/Polyanhydrides<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 12 March 2016, at 03:00.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 687 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","97063e0cc3ba0ecf1c29ddb1aab5b704_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Polyanhydrides skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Polyanhydrides<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Polyanhydrides<\/b> are a class of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biodegradable\" class=\"mw-redirect\" title=\"Biodegradable\" rel=\"external_link\" target=\"_blank\">biodegradable<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymers<\/a> characterized by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anhydride\" class=\"mw-redirect\" title=\"Anhydride\" rel=\"external_link\" target=\"_blank\">anhydride<\/a> bonds that connect <a href=\"https:\/\/en.wikipedia.org\/wiki\/Repeat_unit\" title=\"Repeat unit\" rel=\"external_link\" target=\"_blank\">repeat units<\/a> of the polymer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Backbone_chain\" title=\"Backbone chain\" rel=\"external_link\" target=\"_blank\">backbone chain<\/a>. Their main application is in the medical device and pharmaceutical industry. <a href=\"https:\/\/en.wikipedia.org\/wiki\/In_vivo\" title=\"In vivo\" rel=\"external_link\" target=\"_blank\">In vivo<\/a>, polyanhydrides degrade into non-toxic diacid <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomers\" class=\"mw-redirect\" title=\"Monomers\" rel=\"external_link\" target=\"_blank\">monomers<\/a> that can be metabolized and eliminated from the body. Owing to their safe degradation products, polyanhydrides are considered to be biocompatible. \n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>The characteristic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anhydride\" class=\"mw-redirect\" title=\"Anhydride\" rel=\"external_link\" target=\"_blank\">anhydride<\/a> bonds in polyanhydrides are water-labile (the polymer chain breaks apart at the anhydride bond). This results in two carboxylic acid groups which are easily <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metabolized\" class=\"mw-redirect\" title=\"Metabolized\" rel=\"external_link\" target=\"_blank\">metabolized<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatible\" class=\"mw-redirect\" title=\"Biocompatible\" rel=\"external_link\" target=\"_blank\">biocompatible<\/a>. \n<a href=\"https:\/\/en.wikipedia.org\/wiki\/Biodegradable\" class=\"mw-redirect\" title=\"Biodegradable\" rel=\"external_link\" target=\"_blank\">Biodegradable<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymers\" class=\"mw-redirect\" title=\"Polymers\" rel=\"external_link\" target=\"_blank\">polymers<\/a>, such as polyanhydrides, are capable of releasing physically entrapped or encapsulated drugs by well-defined kinetics and are a growing area of medical research. Polyanhydrides have been investigated as an important material for the short-term release of drugs or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_activity\" title=\"Biological activity\" rel=\"external_link\" target=\"_blank\">bioactive<\/a> agents. The rapid degradation and limited mechanical properties of polyanhydrides render them ideal as controlled <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug_delivery\" title=\"Drug delivery\" rel=\"external_link\" target=\"_blank\">drug delivery<\/a> devices. \n<\/p><p>One example, Gliadel<a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.gliadel.com\" target=\"_blank\">[1]<\/a>, is a device in clinical use for the treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain_cancer\" class=\"mw-redirect\" title=\"Brain cancer\" rel=\"external_link\" target=\"_blank\">brain cancer<\/a>. This product is made of a polyanhydride wafer containing a chemotherapeutic agent. After removal of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cancerous\" class=\"mw-redirect\" title=\"Cancerous\" rel=\"external_link\" target=\"_blank\">cancerous<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain_tumor\" title=\"Brain tumor\" rel=\"external_link\" target=\"_blank\">brain tumor<\/a>, the wafer is inserted into the brain releasing a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemotherapy\" title=\"Chemotherapy\" rel=\"external_link\" target=\"_blank\">chemotherapy<\/a> agent at a controlled rate proportional to the degradation rate of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a>. The localized treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemotherapy\" title=\"Chemotherapy\" rel=\"external_link\" target=\"_blank\">chemotherapy<\/a> protects the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immune_system\" title=\"Immune system\" rel=\"external_link\" target=\"_blank\">immune system<\/a> from high levels of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiation\" title=\"Radiation\" rel=\"external_link\" target=\"_blank\">radiation<\/a>. \n<\/p><p>Other applications of polyanhydrides include the use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saturation_(chemistry)\" title=\"Saturation (chemistry)\" rel=\"external_link\" target=\"_blank\">unsaturated<\/a> polyanhydrides in bone replacement, as well as polyanhydride copolymers as vehicles for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vaccine\" title=\"Vaccine\" rel=\"external_link\" target=\"_blank\">vaccine<\/a> delivery.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Classes\">Classes<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:302px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Polyanhydride_structure.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Polyanhydride_structure.svg\/300px-Polyanhydride_structure.svg.png\" width=\"300\" height=\"222\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Polyanhydride_structure.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The structure of a polyanhydride molecule with <i>n<\/i> repeating units.<\/div><\/div><\/div>\n<p>There are three main classes of polyanhydrides: aliphatic, unsaturated, and aromatic. These classes are determined by examining their R groups (the chemistry of the molecule between the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anhydride\" class=\"mw-redirect\" title=\"Anhydride\" rel=\"external_link\" target=\"_blank\">anhydride<\/a> bonds). \n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Aliphatic\" class=\"mw-redirect\" title=\"Aliphatic\" rel=\"external_link\" target=\"_blank\">Aliphatic<\/a> polyanhydrides consist of R groups containing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon\" title=\"Carbon\" rel=\"external_link\" target=\"_blank\">carbon<\/a> atoms bonded in straight or branched chains. This class of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymers\" class=\"mw-redirect\" title=\"Polymers\" rel=\"external_link\" target=\"_blank\">polymers<\/a> is characterized by a crystalline structure, melting temperature range of 50\u201390 \u00b0C, and solubility in chlorinated hydrocarbons. They <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_decomposition\" title=\"Chemical decomposition\" rel=\"external_link\" target=\"_blank\">degrade<\/a> and are eliminated from the body within weeks of being introduced to the bodily environment. \n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Saturation_(chemistry)\" title=\"Saturation (chemistry)\" rel=\"external_link\" target=\"_blank\">Unsaturated<\/a> polyanhydrides consist of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organic_chemistry\" title=\"Organic chemistry\" rel=\"external_link\" target=\"_blank\">organic<\/a> R groups with one or more double bonds (or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Degrees_of_unsaturation\" class=\"mw-redirect\" title=\"Degrees of unsaturation\" rel=\"external_link\" target=\"_blank\">degrees of unsaturation<\/a>). This class of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymers\" class=\"mw-redirect\" title=\"Polymers\" rel=\"external_link\" target=\"_blank\">polymers<\/a> has a highly crystalline structure and is insoluble in common organic solvents. \n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Aromatic\" class=\"mw-redirect\" title=\"Aromatic\" rel=\"external_link\" target=\"_blank\">Aromatic<\/a> polyanhydrides consist of R groups containing a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Benzene\" title=\"Benzene\" rel=\"external_link\" target=\"_blank\">benzene<\/a> (aromatic) ring. Properties of this class include a crystalline structure, insolubility in common organic solvents, and melting points greater than 100 \u00b0C. They are very <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrophobic\" class=\"mw-redirect\" title=\"Hydrophobic\" rel=\"external_link\" target=\"_blank\">hydrophobic<\/a> and therefore degrade slowly when in the bodily environment. This slow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_decomposition\" title=\"Chemical decomposition\" rel=\"external_link\" target=\"_blank\">degradation<\/a> rate makes <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aromatic\" class=\"mw-redirect\" title=\"Aromatic\" rel=\"external_link\" target=\"_blank\">aromatic<\/a> polyanhydrides less suitable for drug delivery when used as homopolymers, but they can be copolymerized with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aliphatic\" class=\"mw-redirect\" title=\"Aliphatic\" rel=\"external_link\" target=\"_blank\">aliphatic<\/a> class to achieve the desired degradation rate.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Synthesis_and_characterization\">Synthesis and characterization<\/span><\/h2>\n<p>Polyanhydrides are synthesized using either melt condensation or solution polymerization. Depending on the synthesis method used,\nvarious characteristics of polyanhydrides can be altered to achieve the desired product. Characterization of polyanhydrides determines the structure, composition, molecular weight, and thermal properties of the molecule. These properties are determined by using various light-scattering and size-exclusion methods. \n<\/p>\n<h3><span class=\"mw-headline\" id=\"Polymerization\">Polymerization<\/span><\/h3>\n<p>Polyanhydrides can be easily prepared by using available, low cost resources. The process can be varied to achieve desirable characteristics. Traditionally, polyanhydrides have been prepared by melt condensation polymerization, which results in high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_weight\" class=\"mw-redirect\" title=\"Molecular weight\" rel=\"external_link\" target=\"_blank\">molecular weight<\/a> polymers. Melt condensation polymerization involves reacting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dicarboxylic_acid\" title=\"Dicarboxylic acid\" rel=\"external_link\" target=\"_blank\">dicarboxylic acid<\/a> monomers with excess <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetic_anhydride\" title=\"Acetic anhydride\" rel=\"external_link\" target=\"_blank\">acetic anhydride<\/a> at a high temperature and under a vacuum to form the polymers. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalysts\" class=\"mw-redirect\" title=\"Catalysts\" rel=\"external_link\" target=\"_blank\">Catalysts<\/a> may be used to achieve higher molecular weights and shorter reaction times. Generally, a one-step synthesis (method involving only one reaction) is used which does not require purification. \n<\/p><p>There are many other methods used to synthesize polyanhydrides. Some of the other methods include: microwave heating, high-throughput synthesis (synthesis of polymers in parallel), ring opening polymerization (removal of cyclic monomers), interfacial condensation (high temperature reaction of two monomers), dehydrative coupling agents (removing the water group from two carboxyl groups), and solution polymerization (reacting in a solution).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Chemical_structure_and_composition_analysis\">Chemical structure and composition analysis<\/span><\/h3>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_structure\" title=\"Chemical structure\" rel=\"external_link\" target=\"_blank\">chemical structure<\/a> and composition of polyanhydrides can be determined by H<sup>1<\/sup><a href=\"https:\/\/en.wikipedia.org\/wiki\/NMR\" class=\"mw-redirect\" title=\"NMR\" rel=\"external_link\" target=\"_blank\">NMR<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spectroscopy\" title=\"Spectroscopy\" rel=\"external_link\" target=\"_blank\">spectroscopy<\/a>. This will determine the class of polanhydride (aromatic, aliphatic, or unsaturated) as well as the structural features of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a>. For example, the analysis of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_magnetic_resonance\" title=\"Nuclear magnetic resonance\" rel=\"external_link\" target=\"_blank\">nuclear magnetic resonance<\/a>(<a href=\"https:\/\/en.wikipedia.org\/wiki\/NMR\" class=\"mw-redirect\" title=\"NMR\" rel=\"external_link\" target=\"_blank\">NMR<\/a>) peaks allows one to determine if a copolymer has a random or block-like structure. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_weight\" class=\"mw-redirect\" title=\"Molecular weight\" rel=\"external_link\" target=\"_blank\">Molecular weight<\/a> and degradation rate can also determined by <a href=\"https:\/\/en.wikipedia.org\/wiki\/NMR\" class=\"mw-redirect\" title=\"NMR\" rel=\"external_link\" target=\"_blank\">NMR<\/a>. \n<\/p>\n<h3><span class=\"mw-headline\" id=\"Molecular_weight_analysis\">Molecular weight analysis<\/span><\/h3>\n<p>Aside from using <a href=\"https:\/\/en.wikipedia.org\/wiki\/NMR\" class=\"mw-redirect\" title=\"NMR\" rel=\"external_link\" target=\"_blank\">NMR<\/a> to determine a polyanhydride\u2019s molecular weight, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gel_permeation_chromatography\" title=\"Gel permeation chromatography\" rel=\"external_link\" target=\"_blank\">gel permeation chromatography<\/a> (GPC), and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Viscosity\" title=\"Viscosity\" rel=\"external_link\" target=\"_blank\">viscosity<\/a> measurements may also be used. \n<\/p>\n<h3><span class=\"mw-headline\" id=\"Thermal_properties\">Thermal properties<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Differential_scanning_calorimetry\" title=\"Differential scanning calorimetry\" rel=\"external_link\" target=\"_blank\">Differential scanning calorimetry<\/a> (DSC) is used to determine the thermal properties of polyanhydrides. Glass transition temperature, melting temperature, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heat_of_fusion\" class=\"mw-redirect\" title=\"Heat of fusion\" rel=\"external_link\" target=\"_blank\">heat of fusion<\/a> can all be determined by DSC. Crystallinity of a polyanhydride can be determined using DSC, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Small_angle_X-ray_scattering_(SAXS)\" class=\"mw-redirect\" title=\"Small angle X-ray scattering (SAXS)\" rel=\"external_link\" target=\"_blank\">Small angle X-ray scattering (SAXS)<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_magnetic_resonance\" title=\"Nuclear magnetic resonance\" rel=\"external_link\" target=\"_blank\">Nuclear magnetic resonance<\/a> (NMR), and <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray_diffraction\" class=\"mw-redirect\" title=\"X-ray diffraction\" rel=\"external_link\" target=\"_blank\">X-ray diffraction<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Degradation\">Degradation<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:384px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bulk_vs_surface_erosion.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/f6\/Bulk_vs_surface_erosion.jpg\" width=\"382\" height=\"215\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bulk_vs_surface_erosion.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Comparison of bulk and surface erosion mechanisms.<\/div><\/div><\/div>\n<p>The erosion and degradation of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> describe how the polymer physically loses mass (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_decomposition\" title=\"Chemical decomposition\" rel=\"external_link\" target=\"_blank\">degrades<\/a>). The two common erosion mechanisms are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surface_and_bulk_erosion\" title=\"Surface and bulk erosion\" rel=\"external_link\" target=\"_blank\">surface and bulk erosion<\/a>. Polyanhydrides are surface eroding polymers. Surface eroding polymers do not allow water to penetrate into the material. They erode layer by layer, like a lollipop. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrophobic\" class=\"mw-redirect\" title=\"Hydrophobic\" rel=\"external_link\" target=\"_blank\">hydrophobic<\/a> backbone with hydrolytically labile anhydride linkages allows <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrolytic\" class=\"mw-redirect\" title=\"Hydrolytic\" rel=\"external_link\" target=\"_blank\">hydrolytic<\/a> degradation to be controlled by manipulating the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> composition. This manipulation can occur by adding a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrophilic\" class=\"mw-redirect\" title=\"Hydrophilic\" rel=\"external_link\" target=\"_blank\">hydrophilic<\/a> group to the polyanhydride to make a copolymer. Polyanhydride copolymers with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrophilic\" class=\"mw-redirect\" title=\"Hydrophilic\" rel=\"external_link\" target=\"_blank\">hydrophilic<\/a> groups exhibit bulk eroding characteristics. Bulk eroding polymers take in water like a sponge (throughout the material) and erode inside and on the surface of the polymer. \n<\/p><p>Drug release from bulk eroding <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymers\" class=\"mw-redirect\" title=\"Polymers\" rel=\"external_link\" target=\"_blank\">polymers<\/a> is difficult to characterize because the primary mode of release from these polymers is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion\" title=\"Diffusion\" rel=\"external_link\" target=\"_blank\">diffusion<\/a>. Unlike surface eroding polymers, bulk eroding polymers show a very weak relationship between the rate of polymer degradation and the rate of drug release. Therefore, the development of surface eroding polyanhydrides incorporated into the bulk eroding polymers is of increased importance.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Biocompatibility\">Biocompatibility<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">Biocompatibility<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxicity\" title=\"Toxicity\" rel=\"external_link\" target=\"_blank\">toxicity<\/a> of a polymeric material is evaluated by examining <a href=\"https:\/\/en.wiktionary.org\/wiki\/systemic\" class=\"extiw\" title=\"wikt:systemic\" rel=\"external_link\" target=\"_blank\">systemic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxic\" class=\"mw-redirect\" title=\"Toxic\" rel=\"external_link\" target=\"_blank\">toxic<\/a> responses, local <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_(biology)\" title=\"Tissue (biology)\" rel=\"external_link\" target=\"_blank\">tissue<\/a> responses, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carcinogenic\" class=\"mw-redirect\" title=\"Carcinogenic\" rel=\"external_link\" target=\"_blank\">carcinogenic<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mutagenic\" class=\"mw-redirect\" title=\"Mutagenic\" rel=\"external_link\" target=\"_blank\">mutagenic<\/a> responses, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Allergic\" class=\"mw-redirect\" title=\"Allergic\" rel=\"external_link\" target=\"_blank\">allergic<\/a> responses to the material's degradation products. Animal studies are conducted to test the polymer\u2019s effect on each of these negative responses. Polyanhydrides and their degradation products have not been found to cause significant harmful responses and are considered to be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatible\" class=\"mw-redirect\" title=\"Biocompatible\" rel=\"external_link\" target=\"_blank\">biocompatible<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<ul><li>Domb, A., Amselem, S., Langer, R., and Manair, M. \u201cChapter 3: Polyanhydrides as Carriers of Drugs.\u201d Biomedical Polymers Designed \u2013to \u2013Degrade Systems. Hanser Publishers: Munich, Vienna, NY, 1994.<\/li>\n<li>Kumar, N., Langer, R., and Domb, A. \u201cPolyanhydrides: an overview.\u201d Advanced Drug Delivery Reviews, 2002.<\/li>\n<li>\u201cPolyanhydride Synthesis Techniques.\u201d Wyatt Technology Corp. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.lightscattering.com\/literature\/polyanhydride.pdf\" target=\"_blank\">http:\/\/www.lightscattering.com\/literature\/polyanhydride.pdf<\/a><sup class=\"noprint Inline-Template\"><span style=\"white-space: nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Link_rot\" title=\"Wikipedia:Link rot\" rel=\"external_link\" target=\"_blank\"><span title=\" Dead link since March 2018\">permanent dead link<\/span><\/a><\/i>]<\/span><\/sup><\/li>\n<li>Tamada, J. and Langer, R. \u201cThe development of polyanhydrides for drug delivery applications.\u201d Journal of Biomaterials Science, Polymer Ed. Vol. 3, No. 4, pp. 315–353, 1992.<\/li>\n<li>Torres, M. P.; Determan, A. S.; Malapragada, S. K.; Narasimhan, B. \u201cPolyanhydrides.\u201d Encyclopedia of Chemical Processing. 2006.<\/li>\n<li>B.M. Vogel, S.K. Mallapragada, and B. Narasimhan, \u201cRapid Synthesis of Polyanhydrides By Microwave Polymerization\u201d, Macromolecular Rapid Communications 25, 330-333, 2004.<\/li>\n<li>B.M. Vogel, S.K. Mallapragada, \u201cSynthesis of Novel Biodegradable Polyanhydrides Containing Aromatic and Glycol Functionality for Tailoring of Hydrophilicity in Controlled Drug Delivery Devices\u201d, Biomaterials, 26, 721-728, 2004.<\/li>\n<li>B.M. Vogel, Naomi Eidelman, S.K. Mallapragada and B. Narasimhan, \u201cParallel Synthesis and Dissolution Testing of Polyanhydride Random Copolymers\u201d, Journal of Combinatorial Chemistry, 7, 921-928, 2005.<\/li>\n<li>B.M. Vogel and S.K. Mallapragada, \u201cThe Synthesis of Polyanhydrides\u201d, in Handbook of Biodegradable Materials and their Applications, edited by S.K. Mallapragada and Balaji Narasimhan, ASP Publishers, Vol. 1, 1-19, 2005.<\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1262\nCached time: 20181217044859\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.068 seconds\nReal time usage: 0.104 seconds\nPreprocessor visited node count: 224\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 1862\/2097152 bytes\nTemplate argument size: 552\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 0\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.016\/10.000 seconds\nLua memory usage: 822 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 59.909 1 Template:Dead_link\n100.00% 59.909 1 -total\n<\/p>\n<pre>66.10% 39.601 1 Template:Fix\n56.52% 33.858 2 Template:Category_handler\n 5.40% 3.233 1 Template:Fix\/category\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:9516170-1!canonical and timestamp 20181217044859 and revision id 832777566\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Polyanhydrides\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212220\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.009 seconds\nReal time usage: 0.142 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 136.257 1 - wikipedia:Polyanhydrides\n100.00% 136.257 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8427-0!*!*!*!*!*!* and timestamp 20181217212220 and revision id 24669\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polyanhydrides\">https:\/\/www.limswiki.org\/index.php\/Polyanhydrides<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","97063e0cc3ba0ecf1c29ddb1aab5b704_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Polyanhydride_structure.svg\/600px-Polyanhydride_structure.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/f6\/Bulk_vs_surface_erosion.jpg"],"97063e0cc3ba0ecf1c29ddb1aab5b704_timestamp":1545081740,"dcf48b8187f8b2f31e42d926b7bacdb8_type":"article","dcf48b8187f8b2f31e42d926b7bacdb8_title":"Poly(methyl methacrylate)","dcf48b8187f8b2f31e42d926b7bacdb8_url":"https:\/\/www.limswiki.org\/index.php\/Poly(methyl_methacrylate)","dcf48b8187f8b2f31e42d926b7bacdb8_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPoly(methyl methacrylate)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is about the transparent plastic sometimes called acrylic glass. For the glass\/plastic laminate often called \"safety glass\", see Laminated glass. For the neurotoxic designer drug PMMA, commonly sold as MDMA, see para-Methoxy-N-methylamphetamine. For other uses, see Acrylic (disambiguation).\n\nPoly(methyl methacrylate)\n\n\n\n\n\nNames\n\n\n\nIUPAC name\nPoly(methyl 2-methylpropenoate)\n\n\n\n\nOther names\nPoly(methyl methacrylate) (PMMA)\r\nmethyl methacrylate resin\r\nperspex\n\n\nIdentifiers\n\n\n\nCAS Number\n\n9011-14-7  Y \n\n\n3D model (JSmol)\n\nInteractive image \n\n\n\n\n\n\n\nChemSpider\n\nnone\n\n\n\nECHA InfoCard \n\n100.112.313\n\n\n\n\n\n\nKEGG\n\nC19504  N \n\n\n\n\n\n\n\n\n\nSMILES\nC[C](C)C(=O)OC\n\n\n\nProperties\n\n\nChemical formula\n\n(C5O2H8)n \n\n\nMolar mass\n\nvaries   \n\n\n\n\nDensity\n\n1.18 g\/cm3[1]\n\n\nMelting point\n\n 160 \u00b0C (320 \u00b0F; 433 K)[4] \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMagnetic susceptibility (χ)\n\n\u22129.06\u00d710\u22126 (SI, 22\u00b0C) [2]\n\n\n\nRefractive index (nD)\n\n1.4905 at 589.3 nm[3]\n\n\n\n\n\n\n\n\n\n\nExcept where otherwise noted, data are given for materials in their standard state (at 25 \u00b0C [77 \u00b0F], 100 kPa).\n\n\nN  verify  (what is Y N  ?)\n\n\nInfobox references\n\n\n\n\n\n\n\n Lichtenberg figure: high voltage dielectric breakdown in an acrylic polymer block\nPoly(methyl methacrylate) (PMMA), also known as acrylic or acrylic glass as well as by the trade names Crylux, Plexiglas, Acrylite, Lucite, and Perspex among several others (see below), is a transparent thermoplastic often used in sheet form as a lightweight or shatter-resistant alternative to glass. The same material can be used as a casting resin, in inks and coatings, and has many other uses.\nAlthough not a type of familiar silica-based glass, the substance, like many thermoplastics, is often technically classified as a type of glass (in that it is a non-crystalline vitreous substance) hence its occasional historical designation as acrylic glass. Chemically, it is the synthetic polymer of methyl methacrylate. The material was developed in 1928 in several different laboratories by many chemists, such as William Chalmers, Otto R\u00f6hm, and Walter Bauer, and was first brought to market in 1933 by the Rohm and Haas Company under the trademark Plexiglas.\nPMMA is an economical alternative to polycarbonate (PC) when tensile strength, flexural strength, transparency, polishability, and UV tolerance are more important than impact strength, chemical resistance and heat resistance.[5] Additionally, PMMA does not contain the potentially harmful bisphenol-A subunits found in polycarbonate. It is often preferred because of its moderate properties, easy handling and processing, and low cost. Non-modified PMMA behaves in a brittle manner when under load, especially under an impact force, and is more prone to scratching than conventional inorganic glass, but modified PMMA is sometimes able to achieve high scratch and impact resistance.\n\nContents \n\n1 History \n\n1.1 Names \n\n\n2 Synthesis \n3 Processing \n4 Handling, cutting, and joining \n5 Acrylate resin casting \n6 Properties \n\n6.1 Modification of properties \n\n\n7 Poly(methyl acrylate) \n8 Uses \n\n8.1 Transparent glass substitute \n8.2 Daylight redirection \n8.3 Medical technologies and implants \n8.4 Uses in dentistry \n8.5 Artistic and aesthetic uses \n8.6 Other uses \n\n\n9 Biodegradation \n10 See also \n11 References \n12 External links \n\n\nHistory \nThe first acrylic acid was created in 1843. Methacrylic acid, derived from acrylic acid, was formulated in 1865. The reaction between methacrylic acid and methanol results in the ester methyl methacrylate. Polymethyl methacrylate was discovered in the early 1930s by British chemists Rowland Hill and John Crawford at Imperial Chemical Industries (ICI) in England. ICI registered the product under the trademark Perspex. About the same time, chemist and industrialist Otto R\u00f6hm of Rohm and Haas AG in Germany attempted to produce safety glass by polymerizing methyl methacrylate between two layers of glass. The polymer separated from the glass as a clear plastic sheet, which R\u00f6hm gave the trademarked name Plexiglas in 1933. Both Perspex and Plexiglas were commercialized in the late 1930s. In the United States, E.I. du Pont de Nemours & Company (now DuPont Company) subsequently introduced its own product under the trademark Lucite. In 1936 ICI Acrylics (now Lucite International) began the first commercially viable production of acrylic safety glass. During World War II both Allied and Axis forces used acrylic glass for submarine periscopes and aircraft windshields, canopies, and gun turrets. Airplane pilots whose eyes were damaged by flying shards of PMMA fared much better than those injured by standard glass, demonstrating better compatibility between human tissue and PMMA than glass.[6] Civilian applications followed after the war.[7]\n\nNames \nCommon orthographic stylings include polymethyl methacrylate[8][9] and polymethylmethacrylate. The full chemical name is poly(methyl 2-methylpropenoate). (It is a common mistake to use \"an\" instead of \"en\".)\nAlthough PMMA is often called simply \"acrylic\", acrylic can also refer to other polymers or copolymers containing polyacrylonitrile. Notable trade names include Acrylite,[10] Lucite,[11] R-Cast,[12] Plexiglas,[13][14] Optix,[13] Perspex,[13] Oroglas,[15] Altuglas,[16] Cyrolite,[13] and Sumipex.\n\nSynthesis \nPMMA is routinely produced by emulsion polymerization, solution polymerization, and bulk polymerization. Generally, radical initiation is used (including living polymerization methods), but anionic polymerization of PMMA can also be performed. To produce 1 kg (2.2 lb) of PMMA, about 2 kg (4.4 lb) of petroleum is needed.[citation needed ] PMMA produced by radical polymerization (all commercial PMMA) is atactic and completely amorphous.\n\nProcessing \nThe glass transition temperature (Tg) of atactic PMMA is 105 \u00b0C (221 \u00b0F). The Tg values of commercial grades of PMMA range from 85 to 165 \u00b0C (185 to 329 \u00b0F); the range is so wide because of the vast number of commercial compositions which are copolymers with co-monomers other than methyl methacrylate. PMMA is thus an organic glass at room temperature; i.e., it is below its Tg. The forming temperature starts at the glass transition temperature and goes up from there.[17] All common molding processes may be used, including injection molding, compression molding, and extrusion. The highest quality PMMA sheets are produced by cell casting, but in this case, the polymerization and molding steps occur concurrently. The strength of the material is higher than molding grades owing to its extremely high molecular mass. Rubber toughening has been used to increase the toughness of PMMA to overcome its brittle behavior in response to applied loads.\n\n Handling, cutting, and joining \nPMMA can be joined using cyanoacrylate cement (commonly known as superglue), with heat (welding), or by using solvents such as di- or trichloromethane[18] to dissolve the plastic at the joint, which then fuses and sets, forming an almost invisible weld. Scratches may easily be removed by polishing or by heating the surface of the material.\nLaser cutting may be used to form intricate designs from PMMA sheets. PMMA vaporizes to gaseous compounds (including its monomers) upon laser cutting, so a very clean cut is made, and cutting is performed very easily. However, the pulsed lasercutting introduces high internal stresses along the cut edge, which on exposure to solvents produce undesirable \"stress-crazing\" at the cut edge and several millimetres deep. Even ammonium-based glass-cleaner and almost everything short of soap-and-water produces similar undesirable crazing, sometimes over the entire surface of the cut parts, at great distances from the stressed edge.[19] Annealing the PMMA sheet\/parts is therefore an obligatory post-processing step when intending to chemically bond lasercut parts together.\nIn the majority of applications, it will not shatter. Rather, it breaks into large dull pieces. Since PMMA is softer and more easily scratched than glass, scratch-resistant coatings are often added to PMMA sheets to protect it (as well as possible other functions).\n\nAcrylate resin casting \nSee also: Amber\n Illustrative and secure bromine chemical sample used for teaching. The glass sample vial of the corrosive and poisonous liquid has been cast into an acrylic plastic cube\nMethyl methacrylate \"synthetic resin\" for casting (simply the bulk liquid chemical) may be used in conjunction with a polymerization catalyst such as MEKP, to produce hardened transparent PMMA in any shape, from a mold. Objects like insects or coins, or even dangerous chemicals in breakable quartz ampules, may be embedded in such \"cast\" blocks, for display and safe handling.\n\nProperties \n Skeletal structure of methyl methacrylate, the constituent monomer of PMMA\n Pieces of perspex from German plane which had been shot down, 2007, photo by Collection of Auckland Museum T\u0101maki Paenga Hira, 2007.10.2.\nPMMA is a strong, tough, and lightweight material. It has a density of 1.17\u20131.20 g\/cm3,[1][20] which is less than half that of glass.[1] It also has good impact strength, higher than both glass and polystyrene; however, PMMA's impact strength is still significantly lower than polycarbonate and some engineered polymers. PMMA ignites at 460 \u00b0C (860 \u00b0F) and burns, forming carbon dioxide, water, carbon monoxide and low-molecular-weight compounds, including formaldehyde.[21]\nPMMA transmits up to 92% of visible light (3 mm thickness), and gives a reflection of about 4% from each of its surfaces due to its refractive index (1.4905 at 589.3 nm).[3] It filters ultraviolet (UV) light at wavelengths below about 300 nm (similar to ordinary window glass). Some manufacturers[22] add coatings or additives to PMMA to improve absorption in the 300\u2013400 nm range. PMMA passes infrared light of up to 2,800 nm and blocks IR of longer wavelengths up to 25,000 nm. Colored PMMA varieties allow specific IR wavelengths to pass while blocking visible light (for remote control or heat sensor applications, for example).\nPMMA swells and dissolves in many organic solvents; it also has poor resistance to many other chemicals due to its easily hydrolyzed ester groups. Nevertheless, its environmental stability is superior to most other plastics such as polystyrene and polyethylene, and PMMA is therefore often the material of choice for outdoor applications.[23]\nPMMA has a maximum water absorption ratio of 0.3\u20130.4% by weight.[20] Tensile strength decreases with increased water absorption.[24] Its coefficient of thermal expansion is relatively high at (5\u201310)\u00d710\u22125 \u00b0C\u22121.[25]\n\nModification of properties \nPure poly(methyl methacrylate) homopolymer is rarely sold as an end product, since it is not optimized for most applications. Rather, modified formulations with varying amounts of other comonomers, additives, and fillers are created for uses where specific properties are required. For example,\n\nA small amount of acrylate comonomers are routinely used in PMMA grades destined for heat processing, since this stabilizes the polymer to depolymerization (\"unzipping\") during processing.\nComonomers such as butyl acrylate are often added to improve impact strength.\nComonomers such as methacrylic acid can be added to increase the glass transition temperature of the polymer for higher temperature use such as in lighting applications.\nPlasticizers may be added to improve processing properties, lower the glass transition temperature, or improve impact properties.\nDyes may be added to give color for decorative applications, or to protect against (or filter) UV light.\nFillers may be added to improve cost-effectiveness.\n Poly(methyl acrylate) \nMain article: Poly(methyl acrylate)\nThe polymer of methyl acrylate, PMA or poly(methyl acrylate), is similar to poly(methyl methacrylate), except for the lack of methyl groups on the backbone carbon chain.[26] PMA is a soft white rubbery material that is softer than PMMA because its long polymer chains are thinner and smoother and can more easily slide past each other.\n\nUses \nThis section contains embedded lists that may be poorly defined, unverified or indiscriminate. Please help to clean it up to meet Wikipedia's quality standards. Where appropriate, incorporate items into the main body of the article. (February 2010)\nBeing transparent and durable, PMMA is a versatile material and has been used in a wide range of fields and applications such as rear-lights and instrument clusters for vehicles, appliances, and lenses for glasses. PMMA in the form of sheets affords to shatter resistant panels for building windows, skylights, bulletproof security barriers, signs & displays, sanitary ware (bathtubs), LCD screens, furniture and many other applications. It is also used for coating polymers based on MMA provides outstanding stability against environmental conditions with reduced emission of VOC. Methacrylate polymers are used extensively in medical and dental applications where purity and stability are critical to performance.[citation needed ]\n\nTransparent glass substitute \n Close-up of pressure sphere of Bathyscaphe Trieste, with a single conical window of PMMA (Plexiglas) set into sphere hull. The very small black circle (smaller than the man's head) is the inner side of the plastic \"window,\" and is only a few inches in diameter. The larger circular clear black area represents the larger outer-side of the thick one-piece plastic cone \"window.\"\n 10-meter (33-foot) deep Monterey Bay Aquarium tank has acrylic windows up to 33 centimeters (13 inches) thick to withstand the water pressure\nPMMA is commonly used for constructing residential and commercial aquariums. Designers started building large aquariums when poly(methyl methacrylate) could be used. It is less often used in other building types due to incidents such as the Summerland disaster.\nPMMA is used for viewing ports and even complete pressure hulls of submersibles, such as the Alicia submarine's viewing sphere and the window of the bathyscaphe Trieste.\nPMMA is used in the lenses of exterior lights of automobiles.[27]\nSpectator protection in ice hockey rinks is made from PMMA.\nHistorically, PMMA was an important improvement in the design of aircraft windows, making possible such designs as the bombardier's transparent nose compartment in the Boeing B-17 Flying Fortress. Modern aircraft transparencies often use stretched acrylic plies.\nPolice vehicles for riot control often have the regular glass replaced with PMMA to protect the occupants from thrown objects.\nPMMA is an important material in the making of certain lighthouse lenses.[28]\nPMMA was used for the roofing of the compound in the Olympic Park for the 1972 Summer Olympics in Munich. It enabled a light and translucent construction of the structure.[29]\nPMMA (under the brand name \"Lucite\") was used for the ceiling of the Houston Astrodome.\nDaylight redirection \nMain article: Anidolic lighting\nLaser cut acrylic panels have been used to redirect sunlight into a light pipe or tubular skylight and, from there, to spread it into a room.[30] Their developers Veronica Garcia Hansen, Ken Yeang, and Ian Edmonds were awarded the Far East Economic Review Innovation Award in bronze for this technology in 2003.[31][32]\nAttenuation being quite strong for distances over one meter (more than 90% intensity loss for a 3000 K source[33]), acrylic broadband light guides are then dedicated mostly to decorative uses.\nPairs of acrylic sheets with a layer of microreplicated prisms between the sheets can have reflective and refractive properties that let them redirect part of incoming sunlight in dependence on its angle of incidence. Such panels act as miniature light shelves. Such panels have been commercialized for purposes of daylighting, to be used as a window or a canopy such that sunlight descending from the sky is directed to the ceiling or into the room rather than to the floor. This can lead to a higher illumination of the back part of a room, in particular when combined with a white ceiling, while having a slight impact on the view to the outside compared to normal glazing.[34][35]\nMedical technologies and implants \nPMMA has a good degree of compatibility with human tissue, and it is used in the manufacture of rigid intraocular lenses which are implanted in the eye when the original lens has been removed in the treatment of cataracts. This compatibility was discovered by the English ophthalmologist Sir Harold Ridley in WWII RAF pilots, whose eyes had been riddled with PMMA splinters coming from the side windows of their Supermarine Spitfire fighters \u2013 the plastic scarcely caused any rejection, compared to glass splinters coming from aircraft such as the Hawker Hurricane.[36] Ridley had a lens manufactured by the Rayner company (Brighton & Hove, East Sussex) made from Perspex polymerised by ICI. On 29 November 1949 at St Thomas' Hospital, London, Ridley implanted the first intraocular lens at St Thomas's Hospital in London.[37]\nIn particular, acrylic-type contact lenses are useful for cataract surgery in patients that have recurrent ocular inflammation (uveitis), as acrylic material induces less inflammation. \n\nEyeglass lenses are commonly made from PMMA.\nHistorically, hard contact lenses were frequently made of this material. Soft contact lenses are often made of a related polymer, where acrylate monomers containing one or more hydroxyl groups make them hydrophilic.\nIn orthopedic surgery, PMMA bone cement is used to affix implants and to remodel lost bone. It is supplied as a powder with liquid methyl methacrylate (MMA). Although PMMA is biologically compatible, MMA is considered to be an irritant and a possible carcinogen. PMMA has also been linked to cardiopulmonary events in the operating room due to hypotension.[38] Bone cement acts like a grout and not so much like a glue in arthroplasty. Although sticky, it does not bond to either the bone or the implant, it primarily fills the spaces between the prosthesis and the bone preventing motion. A disadvantage of this bone cement is that it heats up to 82.5 \u00b0C (180.5 \u00b0F) while setting that may cause thermal necrosis of neighboring tissue. A careful balance of initiators and monomers is needed to reduce the rate of polymerization, and thus the heat generated.\nIn cosmetic surgery, tiny PMMA microspheres suspended in some biological fluid are injected as a soft tissue filler under the skin to reduce wrinkles or scars permanently.[39] PMMA as a soft tissue filler was widely used in the beginning of the century to restore volume in patients with HIV-related facial wasting. PMMA is used illegally to shape muscles by some bodybuilders.\nPlombage is an outdated treatment of tuberculosis where the pleural space around an infected lung was filled with PMMA balls, in order to compress and collapse the affected lung.\nEmerging biotechnology and Biomedical research uses PMMA to create microfluidic lab-on-a-chip devices, which require 100 micrometre-wide geometries for routing liquids. These small geometries are amenable to using PMMA in a biochip fabrication process and offers moderate biocompatibility.\nBioprocess chromatography columns use cast acrylic tubes as an alternative to glass and stainless steel. These are pressure rated and satisfy stringent requirements of materials for biocompatibility, toxicity and extractables.\nUses in dentistry \nDue to its aforementioned biocompatibility, Poly(methyl methacrylate) is a commonly used material in modern dentistry, particularly in the fabrication of dental prosthetics, artificial teeth, and orthodontic appliances.\n\nAcrylic Prosthetic Construction: Pre-polymerized, powdered PMMA spheres are mixed with a Methyl Methacrylate liquid monomer, Benzoyl Peroxide (initiator), and NN-Dimethyl-P-Toluidine (accelerator), and placed under heat and pressure to produce a hardened polymerized PMMA structure. Through the use of injection molding techniques, wax based designs with artificial teeth set in predetermined positions built on gypsum stone models of patients' mouths can be converted into functional prosthetics used to replace missing dentition. PMMA polymer and methyl methacrylate monomer mix is then injected into a flask containing a gypsum mold of the previously designed prosthesis, and placed under heat to initiate polymerization process. Pressure is used during the curing process to minimize polymerization shrinkage, ensuring an accurate fit of the prosthesis. Though other methods of polymerizing PMMA for prosthetic fabrication exist, such as chemical and microwave resin activation, the previously described heat-activated resin polymerization technique is the most commonly used due to its cost effectiveness and minimal polymerization shrinkage.\nArtificial Teeth: While denture teeth can be made of several different materials, PMMA is a material of choice for the manufacturing of artificial teeth used in dental prosthetics. Mechanical properties of the material allow for heightened control of aesthetics, easy surface adjustments, decreased risk of fracture when in function in the oral cavity, and minimal wear against opposing teeth. Additionally, since the bases of dental prosthetics are often constructed using PMMA, adherence of PMMA denture teeth to PMMA denture bases is unparalleled, leading to the construction of a strong and durable prosthetic.[40]\nArtistic and aesthetic uses \n Lexus Perspex car sculpture.\n Plexiglas art by Manfred Kielnhofer\n Kawai acrylic grand piano\nAcrylic paint essentially consists of PMMA suspended in water; however since PMMA is hydrophobic, a substance with both hydrophobic and hydrophilic groups needs to be added to facilitate the suspension.\nModern furniture makers, especially in the 1960s and 1970s, seeking to give their products a space age aesthetic, incorporated Lucite and other PMMA products into their designs, especially office chairs. Many other products (for example, guitars) are sometimes made with acrylic glass to make the commonly opaque objects translucent.\nPerspex has been used as a surface to paint on, for example by Salvador Dal\u00ed.\nDiasec is a process which uses acrylic glass as a substitute for normal glass in picture frames. This is done for its relatively low cost, light weight, shatter-resistance, aesthetics and because it can be ordered in larger sizes than standard picture framing glass.\nAs early as 1939, Los Angeles-based Dutch sculptor Jan De Swart experimented with samples of Lucite sent to him by DuPont; De Swart created tools to work the Lucite for sculpture and mixed chemicals to bring about certain effects of color and refraction[41]\nFrom approximately the 1960s onward, sculptors and glass artists such as Jan Kub\u00ed\u010dek and Leroy Lamis began using acrylics, especially taking advantage of the material's flexibility, light weight, cost and its capacity to refract and filter light.\nIn the 1950s and 1960s, Lucite was an extremely popular material for jewelry, with several companies specialized in creating high-quality pieces from this material. Lucite beads and ornaments are still sold by jewelry suppliers.\nAcrylic Sheets are produced in dozens of standard colors,[42] most commonly sold using color numbers developed by Rohm & Haas in the 1950s.\nOther uses \nPMMA, in the commercial form Tecnovit 7200 is used vastly in the medical field. It is used for plastic histology, electron micropsy, as well as many more uses.\nPMMA has been used to create ultra-white opaque membranes that are flexible and switch appearance to transparent when wet.[43]\nAcrylic is used in tanning beds as the transparent surface that separates the occupant from the tanning bulbs while tanning. The type of acrylic used in tanning beds is most often formulated from a special type of polymethyl methacrylate, a compound that allows the passage of ultraviolet rays\nSheets of PMMA are commonly used in the sign industry to make flat cut out letters in thicknesses typically varying from 3 to 25 millimeters (0.1 to 1.0 in). These letters may be used alone to represent a company's name and\/or logo, or they may be a component of illuminated channel letters. Acrylic is also used extensively throughout the sign industry as a component of wall signs where it may be a backplate, painted on the surface or the backside, a faceplate with additional raised lettering or even photographic images printed directly to it, or a spacer to separate sign components.\nPMMA was used in Laserdisc optical media.[44] (CDs and DVDs use both acrylic and polycarbonate for impact resistance.)\nIt is used as a light guide for the backlights in TFT-LCDs.[citation needed ]\nPlastic optical fiber used for short distance communication is made from PMMA, and perfluorinated PMMA, clad with fluorinated PMMA, in situations where its flexibility and cheaper installation costs outweigh its poor heat tolerance and higher attenuation over glass fiber.\nPMMA, in a purified form, is used as the matrix in laser dye-doped organic solid-state gain media for tunable solid state dye lasers.[45]\nIn semiconductor research and industry, PMMA aids as a resist in the electron beam lithography process. A solution consisting of the polymer in a solvent is used to spin coat silicon and other semiconducting and semi-insulating wafers with a thin film. Patterns on this can be made by an electron beam (using an electron microscope), deep UV light (shorter wavelength than the standard photolithography process), or X-rays. Exposure to these creates chain scission or (de-cross-linking) within the PMMA, allowing for the selective removal of exposed areas by a chemical developer, making it a positive photoresist. PMMA's advantage is that it allows for extremely high resolution patterns to be made. Smooth PMMA surface can be easily nanostructured by treatment in oxygen radio-frequency plasma[46] and nanostructured PMMA surface can be easily smoothed by vacuum ultraviolet (VUV) irradiation.[46]\nPMMA is used as a shield to stop beta radiation emitted from radioisotopes.\nSmall strips of PMMA are used as dosimeter devices during the Gamma Irradiation process. The optical properties of PMMA change as the gamma dose increases, and can be measured with a spectrophotometer.\nA blacklight-reactive tattoo ink using PMMA microcapsules has been developed.[47]\nPMMA can be used as a dispersant for ceramic powders to stabilize colloidal suspensions in non-aqueous media.[citation needed ] Due to its high viscosity upon dissolution, it can also be used as binder material for solution deposition processes, e.g. printing of solar cells.[48]\nIn the 1960s, luthier Dan Armstrong developed a line of electric guitars and basses whose bodies were made completely of acrylic. These instruments were marketed under the Ampeg brand. Ibanez[49] and B.C. Rich have also made acrylic guitars.\nLudwig-Musser makes a line of acrylic drums called Vistalites, well known as being used by Led Zeppelin drummer John Bonham.\nArtificial nails in the \"acrylic\" type often include PMMA powder.[50]\nSome modern briar, and occasionally meerschaum, tobacco pipes sport stems made of Lucite.\nPMMA technology is utilized in roofing and waterproofing applications. By incorporating a polyester fleece sandwiched between two layers of catalyst-activated PMMA resin, a fully reinforced liquid membrane is created in situ.\nPMMA is a widely used material to create deal toys and financial tombstones.\n\n\t\t\n\t\t\t\n\t\t\t\nHigh heel shoes made of Lucite\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nAn electric bass guitar made from poly(methyl methacrylate)\n\n\t\t\t\n\t\t\n\nBiodegradation \n A Futuro house in Warrington, New Zealand\nThe Futuro house was made of fibreglass-reinforced polyester plastic, polyester-polyurethane, and poly(methylmethacrylate); one of them was found to be degrading by cyanobacteria and Archaea.[51][52]\n\n\nSee also \nLexan\nOrganic laser\nOrganic photonics\nReferences \n\n\n^ a b c Polymethylmethacrylate (PMMA, Acrylic) Archived 2015-04-02 at the Wayback Machine.. Makeitfrom.com. Retrieved 2015-03-23. \n\n^ Wapler, M. C.; Leupold, J.; Dragonu, I.; von Elverfeldt, D.; Zaitsev, M.; Wallrabe, U. 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CS1 maint: Archived copy as title (link) \n\n^ Reed Business Information (13 June 1974). \"Misused materials stoked Sumerland fire\". 62 (902). IPC Magazines: 684. ISSN 0262-4079. Archived from the original on 21 April 2016. \n\n^ David K. Platt (1 January 2003). Engineering and High Performance Plastics Market Report: A Rapra Market Report. Smithers Rapra. p. 170. ISBN 978-1-85957-380-8. Archived from the original on 21 April 2016. \n\n^ Ashby, Michael F. (2005). Materials Selection in Mechanical Design (3rd ed.). Elsevier. p. 519. ISBN 978-0-7506-6168-3. \n\n^ \"Working with Plexiglas&\u00ae\" Archived 2015-02-21 at the Wayback Machine.. science-projects.com. \n\n^ Andersen, Hans J. \"Tensions in acrylics when laser cutting\". Archived from the original on 8 December 2015. Retrieved 23 December 2014 . \n\n^ a b DATA TABLE FOR: Polymers: Commodity Polymers: PMMA Archived 2007-12-13 at the Wayback Machine.. Matbase.com. Retrieved 2012-05-09. \n\n^ Zeng, W. R.; Li, S. F.; Chow, W. K. (2002). \"Preliminary Studies on Burning Behavior of Polymethylmethacrylate (PMMA)\". Journal of Fire Sciences. 20 (4): 297\u2013317. doi:10.1177\/073490402762574749. hdl:10397\/31946. INIST:14365060. \n\n^ Altuglas International Plexiglas UF-3 UF-4 and UF-5 sheets Archived 2006-11-17 at the Wayback Machine.. Plexiglas.com. Retrieved 2012-05-09. \n\n^ Myer Ezrin Plastics Failure Guide: Cause and Prevention Archived 2016-04-21 at the Wayback Machine., Hanser Verlag, 1996 ISBN 1-56990-184-8, p. 168 \n\n^ Ishiyama, Chiemi; Yamamoto, Yoshito; Higo, Yakichi (2005). Buchheit, T.; Minor, A.; Spolenak, R.; et al., eds. \"Effects of Humidity History on the Tensile Deformation Behaviour of Poly(methyl \u2013methacrylate) (PMMA) Films\". MRS Proceedings. 875: O12.7. doi:10.1557\/PROC-875-O12.7. \n\n^ \"Tangram Technology Ltd. \u2013 Polymer Data File \u2013 PMMA\". Archived from the original on 2010-04-21. \n\n^ Polymethyl acrylate and polyethyl acrylate, Encyclop\u00e6dia Britannica Archived 2007-04-28 at the Wayback Machine.. Encyclop\u00e6dia Britannica. Retrieved 2012-05-09. \n\n^ Kutz, Myer (2002). Handbook of Materials Selection. John Wiley & Sons. p. 341. ISBN 978-0-471-35924-1. \n\n^ Terry Pepper, Seeing the Light, Illumination Archived 2009-01-23 at the Wayback Machine.. Terrypepper.com. Retrieved 2012-05-09. \n\n^ Deplazes, Andrea, ed. (2013). Constructing Architecture \u2013 Materials Processes Structures, A Handbook. Birkh\u00e4user. ISBN 978-3038214526. \n\n^ Yeang, Ken. Light Pipes: An Innovative Design Device for Bringing Natural Daylight and Illumination into Buildings with Deep Floor Plan Archived 2009-03-05 at the Wayback Machine., Nomination for the Far East Economic Review Asian Innovation Awards 2003 \n\n^ Lighting up your workplace \u2013 Queensland student pipes light to your office cubicle Archived 2009-01-05 at the Wayback Machine., May 9, 2005 \n\n^ Kenneth Yeang Archived 2008-09-25 at the Wayback Machine., World Cities Summit 2008, June 23\u201325, 2008, Singapore \n\n^ Gerchikov, Victor; Mossman, Michele; Whitehead, Lorne (2005). \"Modeling Attenuation versus Length in Practical Light Guides\". LEUKOS. 1 (4): 47\u201359. doi:10.1582\/LEUKOS.01.04.003 (inactive 2018-09-23). \n\n^ How Serraglaze works Archived 2009-03-05 at the Wayback Machine.. Bendinglight.co.uk. Retrieved 2012-05-09. \n\n^ Glaze of light Archived 2009-01-10 at the Wayback Machine., Building Design Online, June 8, 2007 \n\n^ Robert A. Meyers, \"Molecular biology and biotechnology: a comprehensive desk reference\", Wiley-VCH, 1995, p. 722 ISBN 1-56081-925-1 \n\n^ Apple, David J (2006). Sir Harold Ridely and His Fight for Sight: He Changed the World So That We May Better See It. Thorofare NJ USA: Slack. ISBN 978-1-55642-786-2. \n\n^ Kaufmann, Timothy J.; Jensen, Mary E.; Ford, Gabriele; Gill, Lena L.; Marx, William F.; Kallmes, David F. (2002-04-01). \"Cardiovascular Effects of Polymethylmethacrylate Use in Percutaneous Vertebroplasty\". American Journal of Neuroradiology. 23 (4): 601\u20134. PMID 11950651. \n\n^ \"Filling in Wrinkles Safely\". U.S. Food and Drug Administration. February 28, 2015. Archived from the original on 21 November 2015. Retrieved 8 December 2015 . \n\n^ Prosthodontic treatment for edentulous patients : complete dentures and implant-supported prostheses. Zarb, George A. (George Albert), 1938- (13th ed.). St. Louis, Mo.: Elsevier Mosby. 2013. ISBN 9780323078443. OCLC 773020864. \n\n^ de Swart, Ursula. My Life with Jan. Collection of Jock de Swart, Durango, CO \n\n^ Plexiglas \u00ae Color Numbers Archived 2016-05-18 at the Portuguese Web Archive. professionalplastics.com \n\n^ Syurik, Julia; Jacucci, Gianni; Onelli, Olimpia D.; Holscher, Hendrik; Vignolini, Silvia (22 February 2018). \"Bio-inspired Highly Scattering Networks via Polymer Phase Separation\". Advanced Functional Materials. 28 (24): 1706901. doi:10.1002\/adfm.201706901. \n\n^ Goodman, Robert L. (2002-11-19). How Electronic Things Work... And What to do When They Don't. McGraw Hill Professional. ISBN 9780071429245. \n\n^ Duarte, F. J. (Ed.), Tunable Laser Applications (CRC, New York, 2009) Chapters 3 and 4. \n\n^ a b Lapshin, R. V.; Alekhin, A. P.; Kirilenko, A. G.; Odintsov, S. L.; Krotkov, V. A. (2010). \"Vacuum ultraviolet smoothing of nanometer-scale asperities of Poly(methyl methacrylate) surface\". Journal of Surface Investigation. X-ray, Synchrotron and Neutron Techniques. 4 (1): 1\u201311. doi:10.1134\/S1027451010010015. \n\n^ \u2013 Blacklight Tattoo Ink \u2013 Blacklight Tattoo Ink FAQ Archived 2012-01-04 at the Wayback Machine.. Crazychameleonbodyartsupply.com. Retrieved 2012-05-09. \n\n^ Uhl, Alexander R.; Romanyuk, Yaroslav E.; Tiwari, Ayodhya N. (2011). \"Thin film Cu(In,Ga)Se2 solar cells processed from solution pastes with polymethyl methacrylate binder\". Thin Solid Films. 519 (21): 7259\u201363. Bibcode:2011TSF...519.7259U. doi:10.1016\/j.tsf.2011.01.136. \n\n^ JS2K-PLT Archived 2007-09-28 at the Wayback Machine.. Ibanezregister.com. Retrieved 2012-05-09. \n\n^ Symington, Jan (2006). \"Salon management\". Australian nail technology. Croydon, Victoria, Australia: Tertiary Press. p. 11. ISBN 978-0864585981. \n\n^ Cappitelli, Francesca; Principi, Pamela; Sorlini, Claudia (2006). \"Biodeterioration of modern materials in contemporary collections: Can biotechnology help?\". Trends in Biotechnology. 24 (8): 350\u20134. doi:10.1016\/j.tibtech.2006.06.001. PMID 16782219. \n\n^ Rinaldi, Andrea (2006). \"Saving a fragile legacy. Biotechnology and microbiology are increasingly used to preserve and restore the world's cultural heritage\". EMBO Reports. 7 (11): 1075\u20139. doi:10.1038\/sj.embor.7400844. PMC 1679785 . PMID 17077862. \n\n\nExternal links \nPerspex Technical Properties https:\/\/www.theplasticshop.co.uk\/plastic_technical_data_sheets\/perspex_technical_properties_data_sheet.pdfvtePlasticsChemical types\nAcrylonitrile butadiene styrene (ABS)\nCross-linked polyethylene (PEX, XLPE)\nEthylene vinyl acetate (EVA)\nPoly(methyl methacrylate) (PMMA)\nPolyacrylic acid (PAA)\nPolyamide (PA)\nPolybutylene (PB)\nPolybutylene terephthalate (PBT)\nPolycarbonate (PC)\nPolyetheretherketone (PEEK)\nPolyester (PEs)\nPolyethylene (PE)\nPolyethylene terephthalate (PET, PETE)\nPolyimide (PI)\nPolylactic acid (PLA)\nPolyoxymethylene (POM)\nPolyphenyl ether (PPE)\nPolypropylene (PP)\nPolystyrene (PS)\nPolysulfone (PES)\nPolytetrafluoroethylene (PTFE)\nPolyurethane (PU)\nPolyvinyl chloride (PVC)\nPolyvinylidene chloride (PVDC)\nStyrene maleic anhydride (SMA)\nStyrene-acrylonitrile (SAN)\nMechanical types\nThermoplastic\nDuroplast\nCorrugated plastic\nPolymeric foam\nHigh performance plastics\nAdditives\nPolymer additive\nColorants\nPlasticizer\nStabilizer for polymers\nBiodegradable additives\nProducts\nPlastic industry\nCommodity plastics\nEngineering plastics\nHigh-performance plastics\nPlastic film\nPlastic bottle\nPlastic bag\nPlastic shopping bag\nPlastic cutlery\nBlister pack\nFoam food container\nConstruction\nGeosynthetics\nCategory:Plastics applications\nEnvironment and healthvteHealth issues of plastics and polyhalogenated compounds (PHCs)Plasticizers: Phthalates\nDIBP\nDBP\nBBP (BBzP)\nDIHP\nDEHP (DOP)\nDIDP\nDINP\nMiscellaneous plasticizers\nOrganophosphates\nAdipates (DEHA\nDOA)\nMonomers\nBisphenol A (BPA, in Polycarbonates)\nVinyl chloride (in PVC)\nMiscellaneous additives incl. PHCs\nPBDEs\nPCBs\nOrganotins\nPFCs\nPerfluorooctanoic acid\nHealth issues\nTeratogen\nCarcinogen\nEndocrine disruptor\nDiabetes\nObesity\nObesogen\nPolymer fume fever\nPollution\nPlastic pollution\nGreat Pacific garbage patch\nPersistent organic pollutant\nDioxins\nList of environmental health hazards\nRegulations\nCalifornia Proposition 65\nEuropean REACH regulation\nJapan Toxic Substances Law\nToxic Substances Control Act\nWaste\nPlastic pollution\nGreat Pacific garbage patch\nPersistent organic pollutant\nDioxins\nList of environmental health hazards\nPlastic recycling\nBiodegradable plastic\nIdentification codes\nAuthority control \nGND: 4211340-4 \nNDL: 00560147 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Poly(methyl_methacrylate)\">https:\/\/www.limswiki.org\/index.php\/Poly(methyl_methacrylate)<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 16:47.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,137 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","dcf48b8187f8b2f31e42d926b7bacdb8_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Poly_methyl_methacrylate skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Poly(methyl methacrylate)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">This article is about the transparent plastic sometimes called acrylic glass. For the glass\/plastic laminate often called \"safety glass\", see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laminated_glass\" title=\"Laminated glass\" rel=\"external_link\" target=\"_blank\">Laminated glass<\/a>. For the neurotoxic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Designer_drug\" title=\"Designer drug\" rel=\"external_link\" target=\"_blank\">designer drug<\/a> PMMA, commonly sold as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methylenedioxymethamphetamine\" class=\"mw-redirect\" title=\"Methylenedioxymethamphetamine\" rel=\"external_link\" target=\"_blank\">MDMA<\/a>, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Para-Methoxy-N-methylamphetamine\" title=\"Para-Methoxy-N-methylamphetamine\" rel=\"external_link\" target=\"_blank\">para-Methoxy-N-methylamphetamine<\/a>. For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acrylic_(disambiguation)\" class=\"mw-redirect mw-disambig\" title=\"Acrylic (disambiguation)\" rel=\"external_link\" target=\"_blank\">Acrylic (disambiguation)<\/a>.<\/div>\n\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Lichtenberg_figure_in_block_of_Plexiglas.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/55\/Lichtenberg_figure_in_block_of_Plexiglas.jpg\/220px-Lichtenberg_figure_in_block_of_Plexiglas.jpg\" width=\"220\" height=\"200\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Lichtenberg_figure_in_block_of_Plexiglas.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lichtenberg_figure\" title=\"Lichtenberg figure\" rel=\"external_link\" target=\"_blank\">Lichtenberg figure<\/a>: high voltage dielectric breakdown in an acrylic polymer block<\/div><\/div><\/div>\n<p><b>Poly(methyl methacrylate)<\/b> (<b>PMMA<\/b>), also known as <b>acrylic<\/b> or <b>acrylic glass<\/b> as well as by the trade names <b>Crylux<\/b>, <b>Plexiglas<\/b>, <b>Acrylite<\/b>, <b>Lucite<\/b>, and <b>Perspex<\/b> among several others (see below), is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transparency_(optics)\" class=\"mw-redirect\" title=\"Transparency (optics)\" rel=\"external_link\" target=\"_blank\">transparent<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoplastic\" title=\"Thermoplastic\" rel=\"external_link\" target=\"_blank\">thermoplastic<\/a> often used in sheet form as a lightweight or shatter-resistant alternative to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soda-lime_glass\" class=\"mw-redirect\" title=\"Soda-lime glass\" rel=\"external_link\" target=\"_blank\">glass<\/a>. The same material can be used as a casting resin, in inks and coatings, and has many other uses.\n<\/p><p>Although not a type of familiar <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silica\" class=\"mw-redirect\" title=\"Silica\" rel=\"external_link\" target=\"_blank\">silica<\/a>-based glass, the substance, like many thermoplastics, is often technically classified as a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass\" title=\"Glass\" rel=\"external_link\" target=\"_blank\">glass<\/a> (in that it is a non-crystalline vitreous substance) hence its occasional historical designation as <i>acrylic glass<\/i>. Chemically, it is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_synthetic_polymers\" title=\"List of synthetic polymers\" rel=\"external_link\" target=\"_blank\">synthetic polymer<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methyl_methacrylate\" title=\"Methyl methacrylate\" rel=\"external_link\" target=\"_blank\">methyl methacrylate<\/a>. The material was developed in 1928 in several different laboratories by many chemists, such as William Chalmers, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otto_R%C3%B6hm\" title=\"Otto R\u00f6hm\" rel=\"external_link\" target=\"_blank\">Otto R\u00f6hm<\/a>, and Walter Bauer, and was first brought to market in 1933 by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rohm_and_Haas\" title=\"Rohm and Haas\" rel=\"external_link\" target=\"_blank\">Rohm and Haas Company<\/a> under the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trademark\" title=\"Trademark\" rel=\"external_link\" target=\"_blank\">trademark<\/a> Plexiglas.\n<\/p><p>PMMA is an economical alternative to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polycarbonate\" title=\"Polycarbonate\" rel=\"external_link\" target=\"_blank\">polycarbonate<\/a> (PC) when <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tensile_strength\" class=\"mw-redirect\" title=\"Tensile strength\" rel=\"external_link\" target=\"_blank\">tensile strength<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flexural_strength\" title=\"Flexural strength\" rel=\"external_link\" target=\"_blank\">flexural strength<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transparency_and_translucency\" title=\"Transparency and translucency\" rel=\"external_link\" target=\"_blank\">transparency<\/a>, polishability, and UV tolerance are more important than <a href=\"https:\/\/en.wikipedia.org\/wiki\/Impact_strength\" class=\"mw-redirect\" title=\"Impact strength\" rel=\"external_link\" target=\"_blank\">impact strength<\/a>, chemical resistance and heat resistance.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Additionally, PMMA does not contain the potentially harmful <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bisphenol-A\" class=\"mw-redirect\" title=\"Bisphenol-A\" rel=\"external_link\" target=\"_blank\">bisphenol-A<\/a> subunits found in polycarbonate. It is often preferred because of its moderate properties, easy handling and processing, and low cost. Non-modified PMMA behaves in a brittle manner when under load, especially under an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Impact_(mechanics)\" title=\"Impact (mechanics)\" rel=\"external_link\" target=\"_blank\">impact force<\/a>, and is more prone to scratching than conventional inorganic glass, but modified PMMA is sometimes able to achieve high scratch and impact resistance.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The first acrylic acid was created in 1843. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methacrylic_acid\" title=\"Methacrylic acid\" rel=\"external_link\" target=\"_blank\">Methacrylic acid<\/a>, derived from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acrylic_acid\" title=\"Acrylic acid\" rel=\"external_link\" target=\"_blank\">acrylic acid<\/a>, was formulated in 1865. The reaction between methacrylic acid and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methanol\" title=\"Methanol\" rel=\"external_link\" target=\"_blank\">methanol<\/a> results in the ester methyl methacrylate. Polymethyl methacrylate was discovered in the early 1930s by British chemists Rowland Hill and John Crawford at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Imperial_Chemical_Industries\" title=\"Imperial Chemical Industries\" rel=\"external_link\" target=\"_blank\">Imperial Chemical Industries<\/a> (ICI) in England. ICI registered the product under the trademark Perspex. About the same time, chemist and industrialist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otto_R%C3%B6hm\" title=\"Otto R\u00f6hm\" rel=\"external_link\" target=\"_blank\">Otto R\u00f6hm<\/a> of Rohm and Haas AG in Germany attempted to produce safety glass by polymerizing methyl methacrylate between two layers of glass. The polymer separated from the glass as a clear plastic sheet, which R\u00f6hm gave the trademarked name Plexiglas in 1933. Both Perspex and Plexiglas were commercialized in the late 1930s. In the United States, E.I. du Pont de Nemours & Company (now DuPont Company) subsequently introduced its own product under the trademark Lucite. In 1936 ICI Acrylics (now Lucite International) began the first commercially viable production of acrylic safety glass. During World War II both Allied and Axis forces used acrylic glass for submarine periscopes and aircraft windshields, canopies, and gun turrets. Airplane pilots whose eyes were damaged by flying shards of PMMA fared much better than those injured by standard glass, demonstrating better compatibility between human tissue and PMMA than glass.<sup id=\"rdp-ebb-cite_ref-Schwarcz2012_6-0\" class=\"reference\"><a href=\"#cite_note-Schwarcz2012-6\" rel=\"external_link\">[6]<\/a><\/sup> Civilian applications followed after the war.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Names\">Names<\/span><\/h3>\n<p>Common orthographic stylings include <i>polymethyl methacrylate<\/i><sup id=\"rdp-ebb-cite_ref-Dorlands_8-0\" class=\"reference\"><a href=\"#cite_note-Dorlands-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-MW_Collegiate_9-0\" class=\"reference\"><a href=\"#cite_note-MW_Collegiate-9\" rel=\"external_link\">[9]<\/a><\/sup> and <i>polymethylmethacrylate<\/i>. The full chemical name is poly(methyl 2-methylprop<b>en<\/b>oate). (It is a common mistake to use \"an\" instead of \"en\".)\n<\/p><p>Although PMMA is often called simply \"acrylic\", <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Acrylate_polymer\" title=\"Acrylate polymer\" rel=\"external_link\" target=\"_blank\">acrylic<\/a><\/i> can also refer to other polymers or copolymers containing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyacrylonitrile\" title=\"Polyacrylonitrile\" rel=\"external_link\" target=\"_blank\">polyacrylonitrile<\/a>. Notable trade names include Acrylite,<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> Lucite,<sup id=\"rdp-ebb-cite_ref-tess_lucite_11-0\" class=\"reference\"><a href=\"#cite_note-tess_lucite-11\" rel=\"external_link\">[11]<\/a><\/sup> R-Cast,<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> Plexiglas,<sup id=\"rdp-ebb-cite_ref-HarperPetrie2003_13-0\" class=\"reference\"><a href=\"#cite_note-HarperPetrie2003-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> Optix,<sup id=\"rdp-ebb-cite_ref-HarperPetrie2003_13-1\" class=\"reference\"><a href=\"#cite_note-HarperPetrie2003-13\" rel=\"external_link\">[13]<\/a><\/sup> Perspex,<sup id=\"rdp-ebb-cite_ref-HarperPetrie2003_13-2\" class=\"reference\"><a href=\"#cite_note-HarperPetrie2003-13\" rel=\"external_link\">[13]<\/a><\/sup> Oroglas,<sup id=\"rdp-ebb-cite_ref-Information1974_15-0\" class=\"reference\"><a href=\"#cite_note-Information1974-15\" rel=\"external_link\">[15]<\/a><\/sup> Altuglas,<sup id=\"rdp-ebb-cite_ref-Platt2003_16-0\" class=\"reference\"><a href=\"#cite_note-Platt2003-16\" rel=\"external_link\">[16]<\/a><\/sup> Cyrolite,<sup id=\"rdp-ebb-cite_ref-HarperPetrie2003_13-3\" class=\"reference\"><a href=\"#cite_note-HarperPetrie2003-13\" rel=\"external_link\">[13]<\/a><\/sup> and Sumipex.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Synthesis\">Synthesis<\/span><\/h2>\n<p>PMMA is routinely produced by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Emulsion_polymerization\" title=\"Emulsion polymerization\" rel=\"external_link\" target=\"_blank\">emulsion polymerization<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solution_polymerization\" title=\"Solution polymerization\" rel=\"external_link\" target=\"_blank\">solution polymerization<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bulk_polymerization\" title=\"Bulk polymerization\" rel=\"external_link\" target=\"_blank\">bulk polymerization<\/a>. Generally, radical initiation is used (including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Living_polymerization\" title=\"Living polymerization\" rel=\"external_link\" target=\"_blank\">living polymerization<\/a> methods), but anionic polymerization of PMMA can also be performed. To produce 1 kg (2.2 lb) of PMMA, about 2 kg (4.4 lb) of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Petroleum\" title=\"Petroleum\" rel=\"external_link\" target=\"_blank\">petroleum<\/a> is needed.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"Since the C and H are preserved, and oxygen is added, it should be less than 1 (May 2016)\">citation needed<\/span><\/a><\/i>]<\/sup> PMMA produced by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radical_polymerization\" title=\"Radical polymerization\" rel=\"external_link\" target=\"_blank\">radical polymerization<\/a> (all commercial PMMA) is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atactic\" class=\"mw-redirect\" title=\"Atactic\" rel=\"external_link\" target=\"_blank\">atactic<\/a> and completely amorphous.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Processing\">Processing<\/span><\/h2>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass_transition_temperature\" class=\"mw-redirect\" title=\"Glass transition temperature\" rel=\"external_link\" target=\"_blank\">glass transition temperature<\/a> (<i>T<sub>g<\/sub><\/i>) of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tacticity\" title=\"Tacticity\" rel=\"external_link\" target=\"_blank\">atactic<\/a> PMMA is 105 \u00b0C (221 \u00b0F). The <i>T<sub>g<\/sub><\/i> values of commercial grades of PMMA range from 85 to 165 \u00b0C (185 to 329 \u00b0F); the range is so wide because of the vast number of commercial compositions which are copolymers with co-monomers other than methyl methacrylate. PMMA is thus an organic glass at room temperature; i.e., it is below its <i>T<sub>g<\/sub><\/i>. The forming temperature starts at the glass transition temperature and goes up from there.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> All common molding processes may be used, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Injection_molding\" class=\"mw-redirect\" title=\"Injection molding\" rel=\"external_link\" target=\"_blank\">injection molding<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Compression_molding\" title=\"Compression molding\" rel=\"external_link\" target=\"_blank\">compression molding<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Extrusion\" title=\"Extrusion\" rel=\"external_link\" target=\"_blank\">extrusion<\/a>. The highest quality PMMA sheets are produced by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cell_casting\" title=\"Cell casting\" rel=\"external_link\" target=\"_blank\">cell casting<\/a>, but in this case, the polymerization and molding steps occur concurrently. The strength of the material is higher than molding grades owing to its extremely high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_mass\" title=\"Molecular mass\" rel=\"external_link\" target=\"_blank\">molecular mass<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rubber_toughening\" title=\"Rubber toughening\" rel=\"external_link\" target=\"_blank\">Rubber toughening<\/a> has been used to increase the toughness of PMMA to overcome its brittle behavior in response to applied loads.\n<\/p>\n<h2><span id=\"rdp-ebb-Handling.2C_cutting.2C_and_joining\"><\/span><span class=\"mw-headline\" id=\"Handling,_cutting,_and_joining\">Handling, cutting, and joining<\/span><\/h2>\n<p>PMMA can be joined using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyanoacrylate\" title=\"Cyanoacrylate\" rel=\"external_link\" target=\"_blank\">cyanoacrylate<\/a> cement (commonly known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superglue\" class=\"mw-redirect\" title=\"Superglue\" rel=\"external_link\" target=\"_blank\">superglue<\/a>), with heat (welding), or by using solvents such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dichloromethane\" title=\"Dichloromethane\" rel=\"external_link\" target=\"_blank\">di-<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chloroform\" title=\"Chloroform\" rel=\"external_link\" target=\"_blank\">trichloromethane<\/a><sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> to dissolve the plastic at the joint, which then fuses and sets, forming an almost invisible <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solvent_welding\" class=\"mw-redirect\" title=\"Solvent welding\" rel=\"external_link\" target=\"_blank\">weld<\/a>. Scratches may easily be removed by polishing or by heating the surface of the material.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Laser_cutting\" title=\"Laser cutting\" rel=\"external_link\" target=\"_blank\">Laser cutting<\/a> may be used to form intricate designs from PMMA sheets. PMMA vaporizes to gaseous compounds (including its monomers) upon laser cutting, so a very clean cut is made, and cutting is performed very easily. However, the pulsed lasercutting introduces high internal stresses along the cut edge, which on exposure to solvents produce undesirable \"stress-crazing\" at the cut edge and several millimetres deep. Even ammonium-based glass-cleaner and almost everything short of soap-and-water produces similar undesirable crazing, sometimes over the entire surface of the cut parts, at great distances from the stressed edge.<sup id=\"rdp-ebb-cite_ref-hjsandersen_19-0\" class=\"reference\"><a href=\"#cite_note-hjsandersen-19\" rel=\"external_link\">[19]<\/a><\/sup> Annealing the PMMA sheet\/parts is therefore an obligatory post-processing step when intending to chemically bond lasercut parts together.\n<\/p><p>In the majority of applications, it will not shatter. Rather, it breaks into large dull pieces. Since PMMA is softer and more easily scratched than glass, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anti-scratch_coating\" title=\"Anti-scratch coating\" rel=\"external_link\" target=\"_blank\">scratch-resistant coatings<\/a> are often added to PMMA sheets to protect it (as well as possible other functions).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Acrylate_resin_casting\">Acrylate resin casting<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amber\" title=\"Amber\" rel=\"external_link\" target=\"_blank\">Amber<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bromine_vial_in_acrylic_cube.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/35\/Bromine_vial_in_acrylic_cube.jpg\/220px-Bromine_vial_in_acrylic_cube.jpg\" width=\"220\" height=\"218\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bromine_vial_in_acrylic_cube.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Illustrative and secure <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bromine\" title=\"Bromine\" rel=\"external_link\" target=\"_blank\">bromine<\/a> chemical sample used for teaching. The glass sample vial of the corrosive and poisonous liquid has been cast into an acrylic plastic cube<\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Methyl_methacrylate\" title=\"Methyl methacrylate\" rel=\"external_link\" target=\"_blank\">Methyl methacrylate<\/a> \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Synthetic_resin\" title=\"Synthetic resin\" rel=\"external_link\" target=\"_blank\">synthetic resin<\/a>\" for casting (simply the bulk liquid chemical) may be used in conjunction with a polymerization catalyst such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/MEKP\" class=\"mw-redirect\" title=\"MEKP\" rel=\"external_link\" target=\"_blank\">MEKP<\/a>, to produce hardened transparent PMMA in any shape, from a mold. Objects like insects or coins, or even dangerous chemicals in breakable quartz ampules, may be embedded in such \"cast\" blocks, for display and safe handling.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Properties\">Properties<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:102px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Methyl-methacrylate-skeletal.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/ce\/Methyl-methacrylate-skeletal.png\/100px-Methyl-methacrylate-skeletal.png\" width=\"100\" height=\"80\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Methyl-methacrylate-skeletal.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Skeletal structure of methyl methacrylate, the constituent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomer<\/a> of PMMA<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Perspex_pieces_(AM_2007.10.2-2).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d1\/Perspex_pieces_%28AM_2007.10.2-2%29.jpg\/220px-Perspex_pieces_%28AM_2007.10.2-2%29.jpg\" width=\"220\" height=\"200\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Perspex_pieces_(AM_2007.10.2-2).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Pieces of perspex from German plane which had been shot down, 2007, photo by Collection of Auckland Museum T\u0101maki Paenga Hira, 2007.10.2.<\/div><\/div><\/div>\n<p>PMMA is a strong, tough, and lightweight material. It has a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Density\" title=\"Density\" rel=\"external_link\" target=\"_blank\">density<\/a> of 1.17\u20131.20 g\/cm<sup>3<\/sup>,<sup id=\"rdp-ebb-cite_ref-p1_1-1\" class=\"reference\"><a href=\"#cite_note-p1-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-p2_20-0\" class=\"reference\"><a href=\"#cite_note-p2-20\" rel=\"external_link\">[20]<\/a><\/sup> which is less than half that of glass.<sup id=\"rdp-ebb-cite_ref-p1_1-2\" class=\"reference\"><a href=\"#cite_note-p1-1\" rel=\"external_link\">[1]<\/a><\/sup> It also has good impact strength, higher than both glass and polystyrene; however, PMMA's impact strength is still significantly lower than polycarbonate and some engineered polymers. PMMA ignites at 460 \u00b0C (860 \u00b0F) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Combustion\" title=\"Combustion\" rel=\"external_link\" target=\"_blank\">burns<\/a>, forming <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_dioxide\" title=\"Carbon dioxide\" rel=\"external_link\" target=\"_blank\">carbon dioxide<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Water\" title=\"Water\" rel=\"external_link\" target=\"_blank\">water<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_monoxide\" title=\"Carbon monoxide\" rel=\"external_link\" target=\"_blank\">carbon monoxide<\/a> and low-molecular-weight compounds, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Formaldehyde\" title=\"Formaldehyde\" rel=\"external_link\" target=\"_blank\">formaldehyde<\/a>.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p><p>PMMA <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transmittance\" title=\"Transmittance\" rel=\"external_link\" target=\"_blank\">transmits<\/a> up to 92% of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visible_light\" class=\"mw-redirect\" title=\"Visible light\" rel=\"external_link\" target=\"_blank\">visible light<\/a> (3 mm thickness), and gives a reflection of about 4% from each of its surfaces due to its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refractive_index\" title=\"Refractive index\" rel=\"external_link\" target=\"_blank\">refractive index<\/a> (1.4905 at 589.3 nm).<sup id=\"rdp-ebb-cite_ref-refr_3-1\" class=\"reference\"><a href=\"#cite_note-refr-3\" rel=\"external_link\">[3]<\/a><\/sup> It filters <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultraviolet\" title=\"Ultraviolet\" rel=\"external_link\" target=\"_blank\">ultraviolet<\/a> (UV) light at wavelengths below about 300 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nanometre\" title=\"Nanometre\" rel=\"external_link\" target=\"_blank\">nm<\/a> (similar to ordinary window glass). Some manufacturers<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> add coatings or additives to PMMA to improve absorption in the 300\u2013400 nm range. PMMA passes <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infrared\" title=\"Infrared\" rel=\"external_link\" target=\"_blank\">infrared<\/a> light of up to 2,800 nm and blocks IR of longer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wavelength\" title=\"Wavelength\" rel=\"external_link\" target=\"_blank\">wavelengths<\/a> up to 25,000 nm. Colored PMMA varieties allow specific IR wavelengths to pass while blocking <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visible_spectrum\" title=\"Visible spectrum\" rel=\"external_link\" target=\"_blank\">visible light<\/a> (for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_control\" title=\"Remote control\" rel=\"external_link\" target=\"_blank\">remote control<\/a> or heat sensor applications, for example).\n<\/p><p>PMMA swells and dissolves in many organic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solvent\" title=\"Solvent\" rel=\"external_link\" target=\"_blank\">solvents<\/a>; it also has poor resistance to many other chemicals due to its easily <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrolysis\" title=\"Hydrolysis\" rel=\"external_link\" target=\"_blank\">hydrolyzed<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ester\" title=\"Ester\" rel=\"external_link\" target=\"_blank\">ester<\/a> groups. Nevertheless, its environmental stability is superior to most other plastics such as polystyrene and polyethylene, and PMMA is therefore often the material of choice for outdoor applications.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p><p>PMMA has a maximum water absorption ratio of 0.3\u20130.4% by weight.<sup id=\"rdp-ebb-cite_ref-p2_20-1\" class=\"reference\"><a href=\"#cite_note-p2-20\" rel=\"external_link\">[20]<\/a><\/sup> Tensile strength decreases with increased water absorption.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> Its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coefficient_of_thermal_expansion\" class=\"mw-redirect\" title=\"Coefficient of thermal expansion\" rel=\"external_link\" target=\"_blank\">coefficient of thermal expansion<\/a> is relatively high at (5\u201310)\u00d710<sup>\u22125<\/sup> \u00b0C<sup>\u22121<\/sup>.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Modification_of_properties\">Modification of properties<\/span><\/h3>\n<p>Pure poly(methyl methacrylate) homopolymer is rarely sold as an end product, since it is not optimized for most applications. Rather, modified formulations with varying amounts of other comonomers, additives, and fillers are created for uses where specific properties are required. For example,\n<\/p>\n<ul><li>A small amount of acrylate comonomers are routinely used in PMMA grades destined for heat processing, since this stabilizes the polymer to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Depolymerization\" title=\"Depolymerization\" rel=\"external_link\" target=\"_blank\">depolymerization<\/a> (\"unzipping\") during processing.<\/li>\n<li>Comonomers such as butyl acrylate are often added to improve impact strength.<\/li>\n<li>Comonomers such as methacrylic acid can be added to increase the glass transition temperature of the polymer for higher temperature use such as in lighting applications.<\/li>\n<li>Plasticizers may be added to improve processing properties, lower the glass transition temperature, or improve impact properties.<\/li>\n<li>Dyes may be added to give color for decorative applications, or to protect against (or filter) UV light.<\/li>\n<li>Fillers may be added to improve cost-effectiveness.<\/li><\/ul>\n<h2><span id=\"rdp-ebb-Poly.28methyl_acrylate.29\"><\/span><span class=\"mw-headline\" id=\"Poly(methyl_acrylate)\">Poly(methyl acrylate)<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Poly(methyl_acrylate)\" title=\"Poly(methyl acrylate)\" rel=\"external_link\" target=\"_blank\">Poly(methyl acrylate)<\/a><\/div>\n<p>The polymer of methyl acrylate, PMA or poly(methyl acrylate), is similar to poly(methyl methacrylate), except for the lack of methyl groups on the backbone carbon chain.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> PMA is a soft white rubbery material that is softer than PMMA because its long polymer chains are thinner and smoother and can more easily slide past each other.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Uses\">Uses<\/span><\/h2>\n\n<p>Being transparent and durable, PMMA is a versatile material and has been used in a wide range of fields and applications such as rear-lights and instrument clusters for vehicles, appliances, and lenses for glasses. PMMA in the form of sheets affords to shatter resistant panels for building windows, skylights, bulletproof security barriers, signs & displays, sanitary ware (bathtubs), LCD screens, furniture and many other applications. It is also used for coating polymers based on MMA provides outstanding stability against environmental conditions with reduced emission of VOC. Methacrylate polymers are used extensively in medical and dental applications where purity and stability are critical to performance.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Transparent_glass_substitute\">Transparent glass substitute<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bathyscaphe_Trieste_sphere.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/Bathyscaphe_Trieste_sphere.jpg\/220px-Bathyscaphe_Trieste_sphere.jpg\" width=\"220\" height=\"274\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bathyscaphe_Trieste_sphere.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Close-up of pressure sphere of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bathyscaphe_Trieste\" title=\"Bathyscaphe Trieste\" rel=\"external_link\" target=\"_blank\">Bathyscaphe Trieste<\/a>, with a single conical window of PMMA (Plexiglas) set into sphere hull. The very small black circle (smaller than the man's head) is the inner side of the plastic \"window,\" and is only a few inches in diameter. The larger circular clear black area represents the larger outer-side of the thick one-piece plastic cone \"window.\"<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:KelpAquarium.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/84\/KelpAquarium.jpg\/220px-KelpAquarium.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:KelpAquarium.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>10-meter (33-foot) deep <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monterey_Bay_Aquarium\" title=\"Monterey Bay Aquarium\" rel=\"external_link\" target=\"_blank\">Monterey Bay Aquarium<\/a> tank has acrylic windows up to 33 centimeters (13 inches) thick to withstand the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluid_statics#Hydrostatic_pressure\" class=\"mw-redirect\" title=\"Fluid statics\" rel=\"external_link\" target=\"_blank\">water pressure<\/a><\/div><\/div><\/div>\n<ul><li>PMMA is commonly used for constructing residential and commercial <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aquarium\" title=\"Aquarium\" rel=\"external_link\" target=\"_blank\">aquariums<\/a>. Designers started building large aquariums when poly(methyl methacrylate) could be used. It is less often used in other building types due to incidents such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Summerland_disaster\" title=\"Summerland disaster\" rel=\"external_link\" target=\"_blank\">Summerland disaster<\/a>.<\/li>\n<li>PMMA is used for viewing ports and even complete pressure hulls of submersibles, such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alicia_(submarine)\" title=\"Alicia (submarine)\" rel=\"external_link\" target=\"_blank\">Alicia submarine<\/a>'s viewing sphere and the window of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bathyscaphe_Trieste\" title=\"Bathyscaphe Trieste\" rel=\"external_link\" target=\"_blank\">bathyscaphe Trieste<\/a>.<\/li>\n<li>PMMA is used in the lenses of exterior lights of automobiles.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup><\/li>\n<li>Spectator protection in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ice_hockey\" title=\"Ice hockey\" rel=\"external_link\" target=\"_blank\">ice hockey<\/a> rinks is made from PMMA.<\/li>\n<li>Historically, PMMA was an important improvement in the design of aircraft windows, making possible such designs as the bombardier's transparent nose compartment in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boeing_B-17_Flying_Fortress\" title=\"Boeing B-17 Flying Fortress\" rel=\"external_link\" target=\"_blank\">Boeing B-17 Flying Fortress<\/a>. Modern aircraft transparencies often use stretched acrylic plies.<\/li>\n<li>Police vehicles for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Riot_control\" title=\"Riot control\" rel=\"external_link\" target=\"_blank\">riot control<\/a> often have the regular glass replaced with PMMA to protect the occupants from thrown objects.<\/li>\n<li>PMMA is an important material in the making of certain lighthouse lenses.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup><\/li>\n<li>PMMA was used for the roofing of the compound in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Olympiapark,_Munich\" class=\"mw-redirect\" title=\"Olympiapark, Munich\" rel=\"external_link\" target=\"_blank\">Olympic Park<\/a> for the <a href=\"https:\/\/en.wikipedia.org\/wiki\/1972_Summer_Olympics\" title=\"1972 Summer Olympics\" rel=\"external_link\" target=\"_blank\">1972 Summer Olympics<\/a> in Munich. It enabled a light and translucent construction of the structure.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup><\/li>\n<li>PMMA (under the brand name \"Lucite\") was used for the ceiling of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reliant_Astrodome\" class=\"mw-redirect\" title=\"Reliant Astrodome\" rel=\"external_link\" target=\"_blank\">Houston Astrodome<\/a>.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Daylight_redirection\">Daylight redirection<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anidolic_lighting\" title=\"Anidolic lighting\" rel=\"external_link\" target=\"_blank\">Anidolic lighting<\/a><\/div>\n<ul><li>Laser cut acrylic panels have been used to redirect sunlight into a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Light_tube#Light_tube_with_reflective_material\" title=\"Light tube\" rel=\"external_link\" target=\"_blank\">light pipe<\/a> or tubular skylight and, from there, to spread it into a room.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup> Their developers Veronica Garcia Hansen, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ken_Yeang\" title=\"Ken Yeang\" rel=\"external_link\" target=\"_blank\">Ken Yeang<\/a>, and Ian Edmonds were awarded the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Far_Eastern_Economic_Review#Awards_presented_by_FEER\" title=\"Far Eastern Economic Review\" rel=\"external_link\" target=\"_blank\">Far East Economic Review Innovation Award<\/a> in bronze for this technology in 2003.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup><\/li>\n<li>Attenuation being quite strong for distances over one meter (more than 90% intensity loss for a 3000 K source<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup>), acrylic broadband light guides are then dedicated mostly to decorative uses.<\/li>\n<li>Pairs of acrylic sheets with a layer of microreplicated prisms between the sheets can have reflective and refractive properties that let them redirect part of incoming sunlight in dependence on its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angle_of_incidence_(optics)\" title=\"Angle of incidence (optics)\" rel=\"external_link\" target=\"_blank\">angle of incidence<\/a>. Such panels act as miniature <a href=\"https:\/\/en.wikipedia.org\/wiki\/Architectural_light_shelf\" title=\"Architectural light shelf\" rel=\"external_link\" target=\"_blank\">light shelves<\/a>. Such panels have been commercialized for purposes of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Daylighting\" title=\"Daylighting\" rel=\"external_link\" target=\"_blank\">daylighting<\/a>, to be used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Window\" title=\"Window\" rel=\"external_link\" target=\"_blank\">window<\/a> or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Canopy_(building)\" title=\"Canopy (building)\" rel=\"external_link\" target=\"_blank\">canopy<\/a> such that sunlight descending from the sky is directed to the ceiling or into the room rather than to the floor. This can lead to a higher illumination of the back part of a room, in particular when combined with a white ceiling, while having a slight impact on the view to the outside compared to normal glazing.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Medical_technologies_and_implants\">Medical technologies and implants<\/span><\/h3>\n<ul><li>PMMA has a good degree of compatibility with human <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_(biology)\" title=\"Tissue (biology)\" rel=\"external_link\" target=\"_blank\">tissue<\/a>, and it is used in the manufacture of rigid <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intraocular_lens\" title=\"Intraocular lens\" rel=\"external_link\" target=\"_blank\">intraocular lenses<\/a> which are implanted in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_eye\" title=\"Human eye\" rel=\"external_link\" target=\"_blank\">eye<\/a> when the original lens has been removed in the treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cataract\" title=\"Cataract\" rel=\"external_link\" target=\"_blank\">cataracts<\/a>. This compatibility was discovered by the English ophthalmologist Sir <a href=\"https:\/\/en.wikipedia.org\/wiki\/Harold_Ridley_(ophthalmologist)\" title=\"Harold Ridley (ophthalmologist)\" rel=\"external_link\" target=\"_blank\">Harold Ridley<\/a> in WWII RAF pilots, whose eyes had been riddled with PMMA splinters coming from the side windows of their Supermarine <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spitfire\" class=\"mw-redirect\" title=\"Spitfire\" rel=\"external_link\" target=\"_blank\">Spitfire<\/a> fighters \u2013 the plastic scarcely caused any rejection, compared to glass splinters coming from aircraft such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hawker_Hurricane\" title=\"Hawker Hurricane\" rel=\"external_link\" target=\"_blank\">Hawker Hurricane<\/a>.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup> Ridley had a lens manufactured by the Rayner company (Brighton & Hove, East Sussex) made from Perspex polymerised by ICI. On 29 November 1949 at St Thomas' Hospital, London, Ridley implanted the first intraocular lens at St Thomas's Hospital in London.<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup><\/li><\/ul>\n<p>In particular, acrylic-type contact lenses are useful for cataract surgery in patients that have recurrent ocular inflammation (uveitis), as acrylic material induces less inflammation. \n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Glasses\" title=\"Glasses\" rel=\"external_link\" target=\"_blank\">Eyeglass<\/a> lenses are commonly made from PMMA.<\/li>\n<li>Historically, hard <a href=\"https:\/\/en.wikipedia.org\/wiki\/Contact_lens\" title=\"Contact lens\" rel=\"external_link\" target=\"_blank\">contact lenses<\/a> were frequently made of this material. Soft contact lenses are often made of a related polymer, where acrylate monomers containing one or more <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxyl\" class=\"mw-redirect\" title=\"Hydroxyl\" rel=\"external_link\" target=\"_blank\">hydroxyl groups<\/a> make them <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrophile\" title=\"Hydrophile\" rel=\"external_link\" target=\"_blank\">hydrophilic<\/a>.<\/li>\n<li>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedic_surgery\" title=\"Orthopedic surgery\" rel=\"external_link\" target=\"_blank\">orthopedic surgery<\/a>, PMMA <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_cement\" title=\"Bone cement\" rel=\"external_link\" target=\"_blank\">bone cement<\/a> is used to affix implants and to remodel lost bone. It is supplied as a powder with liquid methyl methacrylate (MMA). Although PMMA is biologically compatible, MMA is considered to be an irritant and a possible <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carcinogen\" title=\"Carcinogen\" rel=\"external_link\" target=\"_blank\">carcinogen<\/a>. PMMA has also been linked to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiopulmonary_resuscitation\" title=\"Cardiopulmonary resuscitation\" rel=\"external_link\" target=\"_blank\">cardiopulmonary<\/a> events in the operating room due to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypotension\" title=\"Hypotension\" rel=\"external_link\" target=\"_blank\">hypotension<\/a>.<sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup> Bone cement acts like a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grout\" title=\"Grout\" rel=\"external_link\" target=\"_blank\">grout<\/a> and not so much like a glue in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroplasty\" title=\"Arthroplasty\" rel=\"external_link\" target=\"_blank\">arthroplasty<\/a>. Although sticky, it does not bond to either the bone or the implant, it primarily fills the spaces between the prosthesis and the bone preventing motion. A disadvantage of this bone cement is that it heats up to 82.5 \u00b0C (180.5 \u00b0F) while setting that may cause thermal necrosis of neighboring tissue. A careful balance of initiators and monomers is needed to reduce the rate of polymerization, and thus the heat generated.<\/li>\n<li>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">cosmetic surgery<\/a>, tiny PMMA microspheres suspended in some biological fluid are injected as a soft tissue filler under the skin to reduce wrinkles or scars permanently.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup> PMMA as a soft tissue filler was widely used in the beginning of the century to restore volume in patients with HIV-related facial wasting. PMMA is used illegally to shape muscles by some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bodybuilding\" title=\"Bodybuilding\" rel=\"external_link\" target=\"_blank\">bodybuilders<\/a>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Plombage\" title=\"Plombage\" rel=\"external_link\" target=\"_blank\">Plombage<\/a> is an outdated treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tuberculosis\" title=\"Tuberculosis\" rel=\"external_link\" target=\"_blank\">tuberculosis<\/a> where the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pleural\" class=\"mw-redirect\" title=\"Pleural\" rel=\"external_link\" target=\"_blank\">pleural<\/a> space around an infected <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lung\" title=\"Lung\" rel=\"external_link\" target=\"_blank\">lung<\/a> was filled with PMMA balls, in order to compress and collapse the affected lung.<\/li>\n<li>Emerging biotechnology and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_research\" title=\"Medical research\" rel=\"external_link\" target=\"_blank\">Biomedical research<\/a> uses PMMA to create <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microfluidics\" title=\"Microfluidics\" rel=\"external_link\" target=\"_blank\">microfluidic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lab-on-a-chip\" title=\"Lab-on-a-chip\" rel=\"external_link\" target=\"_blank\">lab-on-a-chip<\/a> devices, which require 100 micrometre-wide geometries for routing liquids. These small geometries are amenable to using PMMA in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biochip\" title=\"Biochip\" rel=\"external_link\" target=\"_blank\">biochip<\/a> fabrication process and offers moderate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatibility<\/a>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioprocess\" title=\"Bioprocess\" rel=\"external_link\" target=\"_blank\">Bioprocess<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromatography\" title=\"Chromatography\" rel=\"external_link\" target=\"_blank\">chromatography<\/a> columns use cast acrylic tubes as an alternative to glass and stainless steel. These are pressure rated and satisfy stringent requirements of materials for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatibility<\/a>, toxicity and extractables.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Uses_in_dentistry\">Uses in dentistry<\/span><\/h3>\n<p>Due to its aforementioned biocompatibility, Poly(methyl methacrylate) is a commonly used material in modern dentistry, particularly in the fabrication of dental prosthetics, artificial teeth, and orthodontic appliances.\n<\/p>\n<ul><li><b>Acrylic Prosthetic<\/b> <b>Construction<\/b>: Pre-polymerized, powdered PMMA spheres are mixed with a Methyl Methacrylate liquid monomer, Benzoyl Peroxide (initiator), and NN-Dimethyl-P-Toluidine (accelerator), and placed under heat and pressure to produce a hardened polymerized PMMA structure. Through the use of injection molding techniques, wax based designs with artificial teeth set in predetermined positions built on gypsum stone models of patients' mouths can be converted into functional prosthetics used to replace missing dentition. PMMA polymer and methyl methacrylate monomer mix is then injected into a flask containing a gypsum mold of the previously designed prosthesis, and placed under heat to initiate polymerization process. Pressure is used during the curing process to minimize polymerization shrinkage, ensuring an accurate fit of the prosthesis. Though other methods of polymerizing PMMA for prosthetic fabrication exist, such as chemical and microwave resin activation, the previously described heat-activated resin polymerization technique is the most commonly used due to its cost effectiveness and minimal polymerization shrinkage.<\/li>\n<li><b>Artificial<\/b> <b>Teeth<\/b>: While denture teeth can be made of several different materials, PMMA is a material of choice for the manufacturing of artificial teeth used in dental prosthetics. Mechanical properties of the material allow for heightened control of aesthetics, easy surface adjustments, decreased risk of fracture when in function in the oral cavity, and minimal wear against opposing teeth. Additionally, since the bases of dental prosthetics are often constructed using PMMA, adherence of PMMA denture teeth to PMMA denture bases is unparalleled, leading to the construction of a strong and durable prosthetic.<sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Artistic_and_aesthetic_uses\">Artistic and aesthetic uses<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Lexus_LF-A_Crystallised_Wind.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fa\/Lexus_LF-A_Crystallised_Wind.jpg\/220px-Lexus_LF-A_Crystallised_Wind.jpg\" width=\"220\" height=\"124\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Lexus_LF-A_Crystallised_Wind.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lexus_LFA#Sculpture_models\" title=\"Lexus LFA\" rel=\"external_link\" target=\"_blank\">Lexus<\/a> Perspex car sculpture.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Maylan-interior-design-neue-wiener-werkstaette-interlux-roehm-_evonik-_indeustries-contemporary-light-art-sedan-chair-seats-manfred-kielnhofer-illumination-auchtion.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4d\/Maylan-interior-design-neue-wiener-werkstaette-interlux-roehm-_evonik-_indeustries-contemporary-light-art-sedan-chair-seats-manfred-kielnhofer-illumination-auchtion.jpg\/220px-thumbnail.jpg\" width=\"220\" height=\"160\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Maylan-interior-design-neue-wiener-werkstaette-interlux-roehm-_evonik-_indeustries-contemporary-light-art-sedan-chair-seats-manfred-kielnhofer-illumination-auchtion.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Plexiglas art by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manfred_Kielnhofer\" title=\"Manfred Kielnhofer\" rel=\"external_link\" target=\"_blank\">Manfred Kielnhofer<\/a><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kawai_CR-40A.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c7\/Kawai_CR-40A.jpg\/170px-Kawai_CR-40A.jpg\" width=\"170\" height=\"227\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kawai_CR-40A.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Kawai_(company)\" class=\"mw-redirect\" title=\"Kawai (company)\" rel=\"external_link\" target=\"_blank\">Kawai<\/a> acrylic grand piano<\/div><\/div><\/div>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Acrylic_paint\" title=\"Acrylic paint\" rel=\"external_link\" target=\"_blank\">Acrylic paint<\/a> essentially consists of PMMA suspended in water; however since PMMA is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrophobe\" title=\"Hydrophobe\" rel=\"external_link\" target=\"_blank\">hydrophobic<\/a>, a substance with both hydrophobic and hydrophilic groups needs to be added to facilitate the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Suspension_(chemistry)\" title=\"Suspension (chemistry)\" rel=\"external_link\" target=\"_blank\">suspension<\/a>.<\/li>\n<li>Modern <a href=\"https:\/\/en.wikipedia.org\/wiki\/Furniture\" title=\"Furniture\" rel=\"external_link\" target=\"_blank\">furniture<\/a> makers, especially in the 1960s and 1970s, seeking to give their products a space age aesthetic, incorporated Lucite and other PMMA products into their designs, especially office chairs. Many other products (for example, guitars) are sometimes made with acrylic glass to make the commonly opaque objects translucent.<\/li>\n<li>Perspex has been used as a surface to paint on, for example by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Salvador_Dal%C3%AD\" title=\"Salvador Dal\u00ed\" rel=\"external_link\" target=\"_blank\">Salvador Dal\u00ed<\/a>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Diasec\" title=\"Diasec\" rel=\"external_link\" target=\"_blank\">Diasec<\/a> is a process which uses acrylic glass as a substitute for normal glass in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Picture_frame\" title=\"Picture frame\" rel=\"external_link\" target=\"_blank\">picture frames<\/a>. This is done for its relatively low cost, light weight, shatter-resistance, aesthetics and because it can be ordered in larger sizes than standard <a href=\"https:\/\/en.wikipedia.org\/wiki\/Picture_framing_glass\" title=\"Picture framing glass\" rel=\"external_link\" target=\"_blank\">picture framing glass<\/a>.<\/li>\n<li>As early as 1939, Los Angeles-based Dutch sculptor experimented with samples of Lucite sent to him by DuPont; De Swart created tools to work the Lucite for sculpture and mixed chemicals to bring about certain effects of color and refraction<sup id=\"rdp-ebb-cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\" rel=\"external_link\">[41]<\/a><\/sup><\/li>\n<li>From approximately the 1960s onward, sculptors and glass artists such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jan_Kub%C3%AD%C4%8Dek\" title=\"Jan Kub\u00ed\u010dek\" rel=\"external_link\" target=\"_blank\">Jan Kub\u00ed\u010dek<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Leroy_Lamis\" title=\"Leroy Lamis\" rel=\"external_link\" target=\"_blank\">Leroy Lamis<\/a> began using acrylics, especially taking advantage of the material's flexibility, light weight, cost and its capacity to refract and filter light.<\/li>\n<li>In the 1950s and 1960s, Lucite was an extremely popular material for jewelry, with several companies specialized in creating high-quality pieces from this material. Lucite beads and ornaments are still sold by jewelry suppliers.<\/li>\n<li>Acrylic Sheets are produced in dozens of standard colors,<sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup> most commonly sold using color numbers developed by Rohm & Haas in the 1950s.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Other_uses\">Other uses<\/span><\/h3>\n<ul><li>PMMA, in the commercial form Tecnovit 7200 is used vastly in the medical field. It is used for plastic histology, electron micropsy, as well as many more uses.<\/li>\n<li>PMMA has been used to create ultra-white opaque membranes that are flexible and switch appearance to transparent when wet.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup><\/li>\n<li>Acrylic is used in tanning beds as the transparent surface that separates the occupant from the tanning bulbs while tanning. The type of acrylic used in tanning beds is most often formulated from a special type of polymethyl methacrylate, a compound that allows the passage of ultraviolet rays<\/li>\n<li>Sheets of PMMA are commonly used in the sign industry to make flat cut out letters in thicknesses typically varying from 3 to 25 millimeters (0.1 to 1.0 in). These letters may be used alone to represent a company's name and\/or logo, or they may be a component of illuminated channel letters. Acrylic is also used extensively throughout the sign industry as a component of wall signs where it may be a backplate, painted on the surface or the backside, a faceplate with additional raised lettering or even photographic images printed directly to it, or a spacer to separate sign components.<\/li>\n<li>PMMA was used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laserdisc\" class=\"mw-redirect\" title=\"Laserdisc\" rel=\"external_link\" target=\"_blank\">Laserdisc<\/a> optical media.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Compact_Disc\" class=\"mw-redirect\" title=\"Compact Disc\" rel=\"external_link\" target=\"_blank\">CDs<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/DVD\" title=\"DVD\" rel=\"external_link\" target=\"_blank\">DVDs<\/a> use both acrylic and polycarbonate for impact resistance.)<\/li>\n<li>It is used as a light guide for the backlights in <a href=\"https:\/\/en.wikipedia.org\/wiki\/TFT_LCD\" class=\"mw-redirect\" title=\"TFT LCD\" rel=\"external_link\" target=\"_blank\">TFT-LCDs<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2013)\">citation needed<\/span><\/a><\/i>]<\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_optical_fiber\" title=\"Plastic optical fiber\" rel=\"external_link\" target=\"_blank\">Plastic optical fiber<\/a> used for short distance communication is made from PMMA, and perfluorinated PMMA, clad with fluorinated PMMA, in situations where its flexibility and cheaper installation costs outweigh its poor heat tolerance and higher attenuation over glass fiber.<\/li>\n<li>PMMA, in a purified form, is used as the matrix in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laser_dye\" title=\"Laser dye\" rel=\"external_link\" target=\"_blank\">laser dye<\/a>-doped organic solid-state gain media for tunable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solid_state_dye_lasers\" class=\"mw-redirect\" title=\"Solid state dye lasers\" rel=\"external_link\" target=\"_blank\">solid state dye lasers<\/a>.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup><\/li>\n<li>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semiconductor\" title=\"Semiconductor\" rel=\"external_link\" target=\"_blank\">semiconductor<\/a> research and industry, PMMA aids as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Resist_(semiconductor_fabrication)\" title=\"Resist (semiconductor fabrication)\" rel=\"external_link\" target=\"_blank\">resist<\/a> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electron_beam_lithography\" class=\"mw-redirect\" title=\"Electron beam lithography\" rel=\"external_link\" target=\"_blank\">electron beam lithography<\/a> process. A solution consisting of the polymer in a solvent is used to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin_coating\" title=\"Spin coating\" rel=\"external_link\" target=\"_blank\">spin coat<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon\" title=\"Silicon\" rel=\"external_link\" target=\"_blank\">silicon<\/a> and other semiconducting and semi-insulating wafers with a thin film. Patterns on this can be made by an electron beam (using an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electron_microscope\" title=\"Electron microscope\" rel=\"external_link\" target=\"_blank\">electron microscope<\/a>), deep UV light (shorter wavelength than the standard <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photolithography\" title=\"Photolithography\" rel=\"external_link\" target=\"_blank\">photolithography<\/a> process), or <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray\" title=\"X-ray\" rel=\"external_link\" target=\"_blank\">X-rays<\/a>. Exposure to these creates chain scission or (de-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Cross-link\" title=\"Cross-link\" rel=\"external_link\" target=\"_blank\">cross-linking<\/a>) within the PMMA, allowing for the selective removal of exposed areas by a chemical developer, making it a positive photoresist. PMMA's advantage is that it allows for extremely high resolution patterns to be made. Smooth PMMA surface can be easily nanostructured by treatment in oxygen <sup id=\"rdp-ebb-cite_ref-vacuum2010_46-0\" class=\"reference\"><a href=\"#cite_note-vacuum2010-46\" rel=\"external_link\">[46]<\/a><\/sup> and nanostructured PMMA surface can be easily smoothed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vacuum_ultraviolet\" class=\"mw-redirect\" title=\"Vacuum ultraviolet\" rel=\"external_link\" target=\"_blank\">vacuum ultraviolet<\/a> (VUV) irradiation.<sup id=\"rdp-ebb-cite_ref-vacuum2010_46-1\" class=\"reference\"><a href=\"#cite_note-vacuum2010-46\" rel=\"external_link\">[46]<\/a><\/sup><\/li>\n<li>PMMA is used as a shield to stop beta radiation emitted from radioisotopes.<\/li>\n<li>Small strips of PMMA are used as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dosimeter\" title=\"Dosimeter\" rel=\"external_link\" target=\"_blank\">dosimeter<\/a> devices during the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gamma_ray\" title=\"Gamma ray\" rel=\"external_link\" target=\"_blank\">Gamma<\/a> Irradiation process. The optical properties of PMMA change as the gamma dose increases, and can be measured with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spectrophotometry\" title=\"Spectrophotometry\" rel=\"external_link\" target=\"_blank\">spectrophotometer<\/a>.<\/li>\n<li>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Black_light\" class=\"mw-redirect\" title=\"Black light\" rel=\"external_link\" target=\"_blank\">blacklight<\/a>-reactive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tattoo\" title=\"Tattoo\" rel=\"external_link\" target=\"_blank\">tattoo<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ink\" title=\"Ink\" rel=\"external_link\" target=\"_blank\">ink<\/a> using PMMA <a href=\"https:\/\/en.wikipedia.org\/wiki\/Micro-encapsulation\" title=\"Micro-encapsulation\" rel=\"external_link\" target=\"_blank\">microcapsules<\/a> has been developed.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup><\/li>\n<li>PMMA can be used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dispersant\" title=\"Dispersant\" rel=\"external_link\" target=\"_blank\">dispersant<\/a> for ceramic powders to stabilize colloidal suspensions in non-aqueous media.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2013)\">citation needed<\/span><\/a><\/i>]<\/sup> Due to its high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Viscosity\" title=\"Viscosity\" rel=\"external_link\" target=\"_blank\">viscosity<\/a> upon dissolution, it can also be used as binder material for solution deposition processes, e.g. printing of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solar_cells\" class=\"mw-redirect\" title=\"Solar cells\" rel=\"external_link\" target=\"_blank\">solar cells<\/a>.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup><\/li>\n<li>In the 1960s, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Luthier\" title=\"Luthier\" rel=\"external_link\" target=\"_blank\">luthier<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dan_Armstrong\" title=\"Dan Armstrong\" rel=\"external_link\" target=\"_blank\">Dan Armstrong<\/a> developed a line of electric guitars and basses whose bodies were made completely of acrylic. These instruments were marketed under the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ampeg\" title=\"Ampeg\" rel=\"external_link\" target=\"_blank\">Ampeg<\/a> brand. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ibanez\" title=\"Ibanez\" rel=\"external_link\" target=\"_blank\">Ibanez<\/a><sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/B.C._Rich\" title=\"B.C. Rich\" rel=\"external_link\" target=\"_blank\">B.C. Rich<\/a> have also made acrylic guitars.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ludwig-Musser\" class=\"mw-redirect\" title=\"Ludwig-Musser\" rel=\"external_link\" target=\"_blank\">Ludwig-Musser<\/a> makes a line of acrylic drums called Vistalites, well known as being used by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Led_Zeppelin\" title=\"Led Zeppelin\" rel=\"external_link\" target=\"_blank\">Led Zeppelin<\/a> drummer <a href=\"https:\/\/en.wikipedia.org\/wiki\/John_Bonham\" title=\"John Bonham\" rel=\"external_link\" target=\"_blank\">John Bonham<\/a>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_nails\" title=\"Artificial nails\" rel=\"external_link\" target=\"_blank\">Artificial nails<\/a> in the \"acrylic\" type often include PMMA powder.<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup><\/li>\n<li>Some modern briar, and occasionally meerschaum, tobacco pipes sport stems made of Lucite.<\/li>\n<li>PMMA technology is utilized in roofing and waterproofing applications. By incorporating a polyester fleece sandwiched between two layers of catalyst-activated PMMA resin, a fully reinforced liquid membrane is created <i>in situ<\/i>.<\/li>\n<li>PMMA is a widely used material to create <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deal_toys\" class=\"mw-redirect\" title=\"Deal toys\" rel=\"external_link\" target=\"_blank\">deal toys<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tombstone_(financial_industry)\" title=\"Tombstone (financial industry)\" rel=\"external_link\" target=\"_blank\">financial tombstones<\/a>.<\/li><\/ul>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 235px\"><div style=\"width: 235px\">\n\t\t\t<div class=\"thumb\" style=\"width: 230px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Acrylic_Heels.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/15\/Acrylic_Heels.jpg\/135px-Acrylic_Heels.jpg\" width=\"135\" height=\"200\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/High-heeled_footwear\" class=\"mw-redirect\" title=\"High-heeled footwear\" rel=\"external_link\" target=\"_blank\">High heel<\/a> shoes made of Lucite\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 235px\"><div style=\"width: 235px\">\n\t\t\t<div class=\"thumb\" style=\"width: 230px;\"><div style=\"margin:48.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Basscat_Bass.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0e\/Basscat_Bass.jpg\/200px-Basscat_Bass.jpg\" width=\"200\" height=\"133\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>An electric <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bass_guitar\" title=\"Bass guitar\" rel=\"external_link\" target=\"_blank\">bass guitar<\/a> made from poly(methyl methacrylate)\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h2><span class=\"mw-headline\" id=\"Biodegradation\">Biodegradation<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Futuro_house_Warrington.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b6\/Futuro_house_Warrington.JPG\/170px-Futuro_house_Warrington.JPG\" width=\"170\" height=\"227\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Futuro_house_Warrington.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Futuro\" title=\"Futuro\" rel=\"external_link\" target=\"_blank\">Futuro<\/a> house in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Warrington,_New_Zealand\" title=\"Warrington, New Zealand\" rel=\"external_link\" target=\"_blank\">Warrington, New Zealand<\/a><\/div><\/div><\/div>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Futuro\" title=\"Futuro\" rel=\"external_link\" target=\"_blank\">Futuro<\/a> house was made of fibreglass-reinforced polyester plastic, polyester-polyurethane, and poly(methylmethacrylate); one of them was found to be degrading by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyanobacteria\" title=\"Cyanobacteria\" rel=\"external_link\" target=\"_blank\">cyanobacteria<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Archaea\" title=\"Archaea\" rel=\"external_link\" target=\"_blank\">Archaea<\/a>.<sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup>\n<\/p>\n<div style=\"clear:both;\"><\/div>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lexan\" class=\"mw-redirect\" title=\"Lexan\" rel=\"external_link\" target=\"_blank\">Lexan<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Organic_laser\" title=\"Organic laser\" rel=\"external_link\" target=\"_blank\">Organic laser<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Organic_photonics\" title=\"Organic photonics\" rel=\"external_link\" target=\"_blank\">Organic photonics<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 35em; -webkit-column-width: 35em; column-width: 35em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-p1-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-p1_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-p1_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-p1_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.makeitfrom.com\/material-properties\/Polymethylmethacrylate-PMMA-Acrylic\" target=\"_blank\">Polymethylmethacrylate (PMMA, Acrylic)<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150402124133\/http:\/\/www.makeitfrom.com\/material-properties\/Polymethylmethacrylate-PMMA-Acrylic\" target=\"_blank\">Archived<\/a> 2015-04-02 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Makeitfrom.com. Retrieved 2015-03-23.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wapler, M. C.; Leupold, J.; Dragonu, I.; von Elverfeldt, D.; Zaitsev, M.; Wallrabe, U. (2014). \"Magnetic properties of materials for MR engineering, micro-MR and beyond\". <i>JMR<\/i>. <b>242<\/b> (2014): 233\u2013242. <a href=\"https:\/\/en.wikipedia.org\/wiki\/ArXiv\" title=\"ArXiv\" rel=\"external_link\" target=\"_blank\">arXiv<\/a>:<span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/arxiv.org\/abs\/1403.4760\" target=\"_blank\">1403.4760<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2014JMagR.242..233W\" target=\"_blank\">2014JMagR.242..233W<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jmr.2014.02.005\" target=\"_blank\">10.1016\/j.jmr.2014.02.005<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24705364\" target=\"_blank\">24705364<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JMR&rft.atitle=Magnetic+properties+of+materials+for+MR+engineering%2C+micro-MR+and+beyond&rft.volume=242&rft.issue=2014&rft.pages=233-242&rft.date=2014&rft_id=info%3Aarxiv%2F1403.4760&rft_id=info%3Apmid%2F24705364&rft_id=info%3Adoi%2F10.1016%2Fj.jmr.2014.02.005&rft_id=info%3Abibcode%2F2014JMagR.242..233W&rft.aulast=Wapler&rft.aufirst=M.+C.&rft.au=Leupold%2C+J.&rft.au=Dragonu%2C+I.&rft.au=von+Elverfeldt%2C+D.&rft.au=Zaitsev%2C+M.&rft.au=Wallrabe%2C+U.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-refr-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-refr_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-refr_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/refractiveindex.info\/?shelf=organic&book=poly%28methyl_methacrylate%29&page=Szczurowski\" target=\"_blank\">Refractive index and related constants \u2013 Poly(methyl methacrylate) (PMMA, Acrylic glass)<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20141106114447\/http:\/\/refractiveindex.info\/?shelf=organic&book=poly%28methyl_methacrylate%29&page=Szczurowski\" target=\"_blank\">Archived<\/a> 2014-11-06 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Refractiveindex.info. Retrieved 2014-10-27.<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Smith, William F.; Hashemi, Javad (2006). <i>Foundations of Materials Science and Engineering<\/i> (4th ed.). McGraw-Hill. p. 509. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-07-295358-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Foundations+of+Materials+Science+and+Engineering&rft.pages=509&rft.edition=4th&rft.pub=McGraw-Hill&rft.date=2006&rft.isbn=978-0-07-295358-9&rft.aulast=Smith&rft.aufirst=William+F.&rft.au=Hashemi%2C+Javad&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Hydrosight. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hydrosight.com\/acrylic-vs-polycarbonate-a-quantitative-and-qualitative-comparison\/\" target=\"_blank\">\"Acrylic vs. Polycarbonate: A quantitative and qualitative comparison\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170119194950\/http:\/\/www.hydrosight.com\/acrylic-vs-polycarbonate-a-quantitative-and-qualitative-comparison\/\" target=\"_blank\">Archived<\/a> from the original on 2017-01-19.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Acrylic+vs.+Polycarbonate%3A+A+quantitative+and+qualitative+comparison&rft.au=Hydrosight&rft_id=http%3A%2F%2Fwww.hydrosight.com%2Facrylic-vs-polycarbonate-a-quantitative-and-qualitative-comparison%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Schwarcz2012-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Schwarcz2012_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFSchwarcz,_Joe2012\" class=\"citation\">Schwarcz, Joe (6 November 2012), <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=Ar_wkXGvB8UC&pg=PT226\" target=\"_blank\"><i>The Right Chemistry: 108 Enlightening, Nutritious, Health-Conscious and Occasionally Bizarre Inquiries into the Science of Daily Life<\/i><\/a>, Doubleday Canada, p. 226, <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-385-67160-6, <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160420210611\/https:\/\/books.google.com\/books?id=Ar_wkXGvB8UC&pg=PT226\" target=\"_blank\">archived<\/a> from the original on 20 April 2016<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Right+Chemistry%3A+108+Enlightening%2C+Nutritious%2C+Health-Conscious+and+Occasionally+Bizarre+Inquiries+into+the+Science+of+Daily+Life&rft.pages=226&rft.pub=Doubleday+Canada&rft.date=2012-11-06&rft.isbn=978-0-385-67160-6&rft.au=Schwarcz%2C+Joe&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DAr_wkXGvB8UC%26pg%3DPT226&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.britannica.com\/science\/polymethyl-methacrylate\" target=\"_blank\">\"Archived copy\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20171031004312\/https:\/\/www.britannica.com\/science\/polymethyl-methacrylate\" target=\"_blank\">Archived<\/a> from the original on 2017-10-31<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-05-22<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Archived+copy&rft_id=https%3A%2F%2Fwww.britannica.com%2Fscience%2Fpolymethyl-methacrylate&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Archived copy as title (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Archived_copy_as_title\" title=\"Category:CS1 maint: Archived copy as title\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Dorlands-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Dorlands_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation\"><span class=\"cs1-lock-subscription\" title=\"Paid subscription required\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.dorlandsonline.com\/dorland\/definition?id=100085009&searchterm=polymethyl%20methacrylate\" target=\"_blank\">\"polymethyl methacrylate\"<\/a><\/span>, <i>Dorland's Illustrated Medical Dictionary<\/i>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elsevier\" title=\"Elsevier\" rel=\"external_link\" target=\"_blank\">Elsevier<\/a><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Dorland%27s+Illustrated+Medical+Dictionary&rft.atitle=polymethyl+methacrylate&rft_id=https%3A%2F%2Fwww.dorlandsonline.com%2Fdorland%2Fdefinition%3Fid%3D100085009%26searchterm%3Dpolymethyl%2520methacrylate&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-MW_Collegiate-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MW_Collegiate_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.merriam-webster.com\/dictionary\/polymethyl+methacrylate\" target=\"_blank\">\"Polymethyl methacrylate\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Merriam-Webster\" title=\"Merriam-Webster\" rel=\"external_link\" target=\"_blank\">Merriam-Webster Dictionary<\/a><\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Merriam-Webster+Dictionary&rft.atitle=Polymethyl+methacrylate&rft_id=https%3A%2F%2Fwww.merriam-webster.com%2Fdictionary%2Fpolymethyl%2Bmethacrylate&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">. Acrylite.co <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.acrylite.co\/\" target=\"_blank\">https:\/\/www.acrylite.co\/<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131007020020\/http:\/\/www.acrylite.net\/product\/acrylite\/en\/about\/acrylite-brand\/pages\/default.aspx\" target=\"_blank\">Archived<\/a> from the original on 2013-10-07<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-11-15<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.pub=Acrylite.co&rft_id=https%3A%2F%2Fwww.acrylite.co%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span> <span class=\"cs1-visible-error error citation-comment\">Missing or empty <code class=\"cs1-code\">|title=<\/code> (<a href=\"#citation_missing_title\" title=\"Help:CS1 errors\" rel=\"external_link\">help<\/a>)<\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-tess_lucite-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-tess_lucite_11-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/tmsearch.uspto.gov\" target=\"_blank\">\"Trademark Electronic Search System\"<\/a>. <i>TESS<\/i>. US Patent and Trademark Office. p. Search for Registration Number 0350093<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">29 June<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=TESS&rft.atitle=Trademark+Electronic+Search+System&rft.pages=Search+for+Registration+Number+0350093&rft_id=http%3A%2F%2Ftmsearch.uspto.gov&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150924022614\/http:\/\/www.reynoldspolymer.com\/A-Brief-History-of-Reynolds-Polymer-Technology\" target=\"_blank\">\"R-Cast\u00ae a Brief History\"<\/a>. Reynoldspolymer.com. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.reynoldspolymer.com\/A-Brief-History-of-Reynolds-Polymer-Technology\" target=\"_blank\">the original<\/a> on 2015-09-24.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=R-Cast%C2%AE+a+Brief+History&rft.pub=Reynoldspolymer.com&rft_id=http%3A%2F%2Fwww.reynoldspolymer.com%2FA-Brief-History-of-Reynolds-Polymer-Technology&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-HarperPetrie2003-13\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-HarperPetrie2003_13-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HarperPetrie2003_13-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HarperPetrie2003_13-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HarperPetrie2003_13-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Charles A. Harper; Edward M. Petrie (10 October 2003). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=oe5YJmRmxQMC&pg=PA9\" target=\"_blank\"><i>Plastics Materials and Processes: A Concise Encyclopedia<\/i><\/a>. John Wiley & Sons. p. 9. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-471-45920-0. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160420235832\/https:\/\/books.google.com\/books?id=oe5YJmRmxQMC&pg=PA9\" target=\"_blank\">Archived<\/a> from the original on 20 April 2016.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Plastics+Materials+and+Processes%3A+A+Concise+Encyclopedia&rft.pages=9&rft.pub=John+Wiley+%26+Sons&rft.date=2003-10-10&rft.isbn=978-0-471-45920-0&rft.au=Charles+A.+Harper&rft.au=Edward+M.+Petrie&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Doe5YJmRmxQMC%26pg%3DPA9&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.wipo.int\/branddb\/en\/\" target=\"_blank\">\"Archived copy\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130121162152\/http:\/\/wipo.int\/branddb\/en\/\" target=\"_blank\">Archived<\/a> from the original on 2013-01-21<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-01-25<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Archived+copy&rft_id=http%3A%2F%2Fwww.wipo.int%2Fbranddb%2Fen%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Archived copy as title (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Archived_copy_as_title\" title=\"Category:CS1 maint: Archived copy as title\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Information1974-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Information1974_15-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Reed Business Information (13 June 1974). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=9fCPtxShxY8C&pg=PA684\" target=\"_blank\">\"Misused materials stoked Sumerland fire\"<\/a>. <b>62<\/b> (902). IPC Magazines: 684. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0262-4079\" target=\"_blank\">0262-4079<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160421165319\/https:\/\/books.google.com\/books?id=9fCPtxShxY8C&pg=PA684\" target=\"_blank\">Archived<\/a> from the original on 21 April 2016.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Misused+materials+stoked+Sumerland+fire&rft.volume=62&rft.issue=902&rft.pages=684&rft.date=1974-06-13&rft.issn=0262-4079&rft.au=Reed+Business+Information&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D9fCPtxShxY8C%26pg%3DPA684&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Platt2003-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Platt2003_16-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">David K. Platt (1 January 2003). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=ajVlFikzvA8C&pg=PA170\" target=\"_blank\"><i>Engineering and High Performance Plastics Market Report: A Rapra Market Report<\/i><\/a>. Smithers Rapra. p. 170. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-85957-380-8. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160421171832\/https:\/\/books.google.com\/books?id=ajVlFikzvA8C&pg=PA170\" target=\"_blank\">Archived<\/a> from the original on 21 April 2016.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Engineering+and+High+Performance+Plastics+Market+Report%3A+A+Rapra+Market+Report&rft.pages=170&rft.pub=Smithers+Rapra&rft.date=2003-01-01&rft.isbn=978-1-85957-380-8&rft.au=David+K.+Platt&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DajVlFikzvA8C%26pg%3DPA170&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Michael_F._Ashby\" title=\"Michael F. Ashby\" rel=\"external_link\" target=\"_blank\">Ashby, Michael F.<\/a> (2005). <i>Materials Selection in Mechanical Design<\/i> (3rd ed.). Elsevier. p. 519. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-7506-6168-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Materials+Selection+in+Mechanical+Design&rft.pages=519&rft.edition=3rd&rft.pub=Elsevier&rft.date=2005&rft.isbn=978-0-7506-6168-3&rft.aulast=Ashby&rft.aufirst=Michael+F.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.science-projects.com\/Plastics\/PlexiglasWork.htm\" target=\"_blank\">\"Working with Plexiglas<sup>&\u00ae<\/sup>\"<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150221110921\/http:\/\/www.science-projects.com\/Plastics\/PlexiglasWork.htm\" target=\"_blank\">Archived<\/a> 2015-02-21 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. <i>science-projects.com<\/i>.<\/span>\n<\/li>\n<li id=\"cite_note-hjsandersen-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-hjsandersen_19-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Andersen, Hans J. <a rel=\"external_link\" class=\"external text\" href=\"#lblTensions\">\"Tensions in acrylics when laser cutting\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"#lblTensions\">Archived<\/a> from the original on 8 December 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">23 December<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Tensions+in+acrylics+when+laser+cutting&rft.aulast=Andersen&rft.aufirst=Hans+J&rft_id=http%3A%2F%2Fwww.support.induflex.dk%2FPlast_Laserskaering_acryl.aspx%3FLang%3Den-GB%23lblTensions&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-p2-20\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-p2_20-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-p2_20-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.matbase.com\/material\/polymers\/commodity\/pmma\/properties\" target=\"_blank\">DATA TABLE FOR: Polymers: Commodity Polymers: PMMA<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20071213163116\/http:\/\/www.matbase.com\/material\/polymers\/commodity\/pmma\/properties\" target=\"_blank\">Archived<\/a> 2007-12-13 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Matbase.com. Retrieved 2012-05-09.<\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zeng, W. R.; Li, S. F.; Chow, W. K. (2002). \"Preliminary Studies on Burning Behavior of Polymethylmethacrylate (PMMA)\". <i>Journal of Fire Sciences<\/i>. <b>20<\/b> (4): 297\u2013317. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F073490402762574749\" target=\"_blank\">10.1177\/073490402762574749<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Handle_System\" title=\"Handle System\" rel=\"external_link\" target=\"_blank\">hdl<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/hdl.handle.net\/10397%2F31946\" target=\"_blank\">10397\/31946<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Institut_de_l%27information_scientifique_et_technique\" title=\"Institut de l'information scientifique et technique\" rel=\"external_link\" target=\"_blank\">INIST<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/cat.inist.fr\/?aModele=afficheN&cpsidt=14365060\" target=\"_blank\">14365060<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Fire+Sciences&rft.atitle=Preliminary+Studies+on+Burning+Behavior+of+Polymethylmethacrylate+%28PMMA%29&rft.volume=20&rft.issue=4&rft.pages=297-317&rft.date=2002&rft_id=info%3Ahdl%2F10397%2F31946&rft_id=info%3Adoi%2F10.1177%2F073490402762574749&rft.aulast=Zeng&rft.aufirst=W.+R.&rft.au=Li%2C+S.+F.&rft.au=Chow%2C+W.+K.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"#9\">Altuglas International Plexiglas UF-3 UF-4 and UF-5 sheets<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20061117051151\/http:\/\/www.plexiglas.com\/acrylicsheet\/acrylicsheetfamily\" target=\"_blank\">Archived<\/a> 2006-11-17 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Plexiglas.com. Retrieved 2012-05-09.<\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Myer Ezrin <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=baWyaC3w3hcC&pg=PA168\" target=\"_blank\"><i>Plastics Failure Guide: Cause and Prevention<\/i><\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160421165428\/https:\/\/books.google.com\/books?id=baWyaC3w3hcC&pg=PA168\" target=\"_blank\">Archived<\/a> 2016-04-21 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>., Hanser Verlag, 1996 <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-56990-184-8, p. 168<\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ishiyama, Chiemi; Yamamoto, Yoshito; Higo, Yakichi (2005). Buchheit, T.; Minor, A.; Spolenak, R.; et al., eds. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/journals.cambridge.org\/article_S1946427400117178\" target=\"_blank\">\"Effects of Humidity History on the Tensile Deformation Behaviour of Poly(methyl \u2013methacrylate) (PMMA) Films\"<\/a>. <i>MRS Proceedings<\/i>. <b>875<\/b>: O12.7. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1557%2FPROC-875-O12.7\" target=\"_blank\">10.1557\/PROC-875-O12.7<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=MRS+Proceedings&rft.atitle=Effects+of+Humidity+History+on+the+Tensile+Deformation+Behaviour+of+Poly%28methyl+%E2%80%93methacrylate%29+%28PMMA%29+Films&rft.volume=875&rft.pages=O12.7&rft.date=2005&rft_id=info%3Adoi%2F10.1557%2FPROC-875-O12.7&rft.aulast=Ishiyama&rft.aufirst=Chiemi&rft.au=Yamamoto%2C+Yoshito&rft.au=Higo%2C+Yakichi&rft_id=http%3A%2F%2Fjournals.cambridge.org%2Farticle_S1946427400117178&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.tangram.co.uk\/TI-Polymer-PMMA.html\" target=\"_blank\">\"Tangram Technology Ltd. \u2013 Polymer Data File \u2013 PMMA\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100421184714\/http:\/\/www.tangram.co.uk\/TI-Polymer-PMMA.html\" target=\"_blank\">Archived<\/a> from the original on 2010-04-21.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Tangram+Technology+Ltd.+%E2%80%93+Polymer+Data+File+%E2%80%93+PMMA&rft_id=http%3A%2F%2Fwww.tangram.co.uk%2FTI-Polymer-PMMA.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.britannica.com\/eb\/article-76445\/major-industrial-polymers\" target=\"_blank\">Polymethyl acrylate and polyethyl acrylate, Encyclop\u00e6dia Britannica<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070428171931\/http:\/\/www.britannica.com\/eb\/article-76445\/major-industrial-polymers\" target=\"_blank\">Archived<\/a> 2007-04-28 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. <i>Encyclop\u00e6dia Britannica<\/i>. Retrieved 2012-05-09.<\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Kutz, Myer (2002). <i>Handbook of Materials Selection<\/i>. John Wiley & Sons. p. 341. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-471-35924-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Handbook+of+Materials+Selection&rft.pages=341&rft.pub=John+Wiley+%26+Sons&rft.date=2002&rft.isbn=978-0-471-35924-1&rft.au=Kutz%2C+Myer&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.terrypepper.com\/lights\/closeups\/illumination\/index.htm\" target=\"_blank\">Terry Pepper, Seeing the Light, Illumination<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090123055321\/http:\/\/www.terrypepper.com\/lights\/closeups\/illumination\/index.htm\" target=\"_blank\">Archived<\/a> 2009-01-23 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Terrypepper.com. Retrieved 2012-05-09.<\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Deplazes, Andrea, ed. (2013). <i>Constructing Architecture \u2013 Materials Processes Structures, A Handbook<\/i>. Birkh\u00e4user. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3038214526.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Constructing+Architecture+%E2%80%93+Materials+Processes+Structures%2C+A+Handbook&rft.pub=Birkh%C3%A4user&rft.date=2013&rft.isbn=978-3038214526&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Yeang, Ken. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.trhamzahyeang.com\/features\/img\/Light%20pipe%20paper.pdf\" target=\"_blank\">Light Pipes: An Innovative Design Device for Bringing Natural Daylight and Illumination into Buildings with Deep Floor Plan<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090305001322\/http:\/\/www.trhamzahyeang.com\/features\/img\/Light%20pipe%20paper.pdf\" target=\"_blank\">Archived<\/a> 2009-03-05 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>., Nomination for the Far East Economic Review Asian Innovation Awards 2003<\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.scienceinpublic.com\/freshinnovators\/2005\/Veronica\/veronicagarciahansen.htm\" target=\"_blank\"><i>Lighting up your workplace \u2013 Queensland student pipes light to your office cubicle<\/i><\/a><i> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090105210012\/http:\/\/www.scienceinpublic.com\/freshinnovators\/2005\/Veronica\/veronicagarciahansen.htm\" target=\"_blank\">Archived<\/a> 2009-01-05 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>., May 9, 2005<\/i><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"#kenneth01\">Kenneth Yeang<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080925033953\/http:\/\/www.worldcities.com.sg\/speaker3.htm\" target=\"_blank\">Archived<\/a> 2008-09-25 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>., World Cities Summit 2008, June 23\u201325, 2008, Singapore<\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gerchikov, Victor; Mossman, Michele; Whitehead, Lorne (2005). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.tandfonline.com\/doi\/abs\/10.1582\/LEUKOS.01.04.003\" target=\"_blank\">\"Modeling Attenuation versus Length in Practical Light Guides\"<\/a>. <i>LEUKOS<\/i>. <b>1<\/b> (4): 47\u201359. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1582%2FLEUKOS.01.04.003\" target=\"_blank\">10.1582\/LEUKOS.01.04.003<\/a> (inactive 2018-09-23).<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=LEUKOS&rft.atitle=Modeling+Attenuation+versus+Length+in+Practical+Light+Guides&rft.volume=1&rft.issue=4&rft.pages=47-59&rft.date=2005&rft_id=info%3Adoi%2F10.1582%2FLEUKOS.01.04.003&rft.aulast=Gerchikov&rft.aufirst=Victor&rft.au=Mossman%2C+Michele&rft.au=Whitehead%2C+Lorne&rft_id=http%3A%2F%2Fwww.tandfonline.com%2Fdoi%2Fabs%2F10.1582%2FLEUKOS.01.04.003&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bendinglight.co.uk\/assets\/pdf_downloads\/How_Serraglaze_Works.pdf\" target=\"_blank\">How Serraglaze works<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090305001319\/http:\/\/www.bendinglight.co.uk\/assets\/pdf_downloads\/How_Serraglaze_Works.pdf\" target=\"_blank\">Archived<\/a> 2009-03-05 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Bendinglight.co.uk. Retrieved 2012-05-09.<\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bdonline.co.uk\/story.asp?sectioncode=453&storycode=3088579&c=1\" target=\"_blank\">Glaze of light<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090110100911\/http:\/\/www.bdonline.co.uk\/story.asp?sectioncode=453&storycode=3088579&c=1\" target=\"_blank\">Archived<\/a> 2009-01-10 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>., Building Design Online, June 8, 2007<\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Robert A. Meyers, \"Molecular biology and biotechnology: a comprehensive desk reference\", Wiley-VCH, 1995, p. 722 <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-56081-925-1<\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Apple, David J (2006). <i>Sir Harold Ridely and His Fight for Sight: He Changed the World So That We May Better See It<\/i>. Thorofare NJ USA: Slack. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-55642-786-2.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Sir+Harold+Ridely+and+His+Fight+for+Sight%3A+He+Changed+the+World+So+That+We+May+Better+See+It&rft.place=Thorofare+NJ+USA&rft.pub=Slack&rft.date=2006&rft.isbn=978-1-55642-786-2&rft.aulast=Apple&rft.aufirst=David+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-38\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-38\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kaufmann, Timothy J.; Jensen, Mary E.; Ford, Gabriele; Gill, Lena L.; Marx, William F.; Kallmes, David F. (2002-04-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ajnr.org\/cgi\/pmidlookup?view=long&pmid=11950651\" target=\"_blank\">\"Cardiovascular Effects of Polymethylmethacrylate Use in Percutaneous Vertebroplasty\"<\/a>. <i>American Journal of Neuroradiology<\/i>. <b>23<\/b> (4): 601\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11950651\" target=\"_blank\">11950651<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Neuroradiology&rft.atitle=Cardiovascular+Effects+of+Polymethylmethacrylate+Use+in+Percutaneous+Vertebroplasty&rft.volume=23&rft.issue=4&rft.pages=601-4&rft.date=2002-04-01&rft_id=info%3Apmid%2F11950651&rft.aulast=Kaufmann&rft.aufirst=Timothy+J.&rft.au=Jensen%2C+Mary+E.&rft.au=Ford%2C+Gabriele&rft.au=Gill%2C+Lena+L.&rft.au=Marx%2C+William+F.&rft.au=Kallmes%2C+David+F.&rft_id=http%3A%2F%2Fwww.ajnr.org%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D11950651&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-39\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-39\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/ForConsumers\/ConsumerUpdates\/ucm049349.htm\" target=\"_blank\">\"Filling in Wrinkles Safely\"<\/a>. U.S. Food and Drug Administration. February 28, 2015. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20151121160450\/http:\/\/www.fda.gov\/ForConsumers\/ConsumerUpdates\/ucm049349.htm\" target=\"_blank\">Archived<\/a> from the original on 21 November 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">8 December<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Filling+in+Wrinkles+Safely&rft.pub=U.S.+Food+and+Drug+Administration&rft.date=2015-02-28&rft_id=http%3A%2F%2Fwww.fda.gov%2FForConsumers%2FConsumerUpdates%2Fucm049349.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-40\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-40\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><i>Prosthodontic treatment for edentulous patients : complete dentures and implant-supported prostheses<\/i>. Zarb, George A. (George Albert), 1938- (13th ed.). St. Louis, Mo.: Elsevier Mosby. 2013. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780323078443. <a href=\"https:\/\/en.wikipedia.org\/wiki\/OCLC\" title=\"OCLC\" rel=\"external_link\" target=\"_blank\">OCLC<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/oclc\/773020864\" target=\"_blank\">773020864<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Prosthodontic+treatment+for+edentulous+patients+%3A+complete+dentures+and+implant-supported+prostheses&rft.place=St.+Louis%2C+Mo.&rft.edition=13th&rft.pub=Elsevier+Mosby&rft.date=2013&rft_id=info%3Aoclcnum%2F773020864&rft.isbn=9780323078443&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-41\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-41\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">de Swart, Ursula. My Life with Jan. Collection of Jock de Swart, Durango, CO<\/span>\n<\/li>\n<li id=\"cite_note-42\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-42\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.professionalplastics.com\/professionalplastics\/content\/PlexiglassColorChart.pdf\" target=\"_blank\">Plexiglas \u00ae Color Numbers<\/a> <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/arquivo.pt\/wayback\/20160518084847\/http:\/\/www.professionalplastics.com\/professionalplastics\/content\/PlexiglassColorChart.pdf\" target=\"_blank\">Archived<\/a> 2016-05-18 at the Portuguese Web Archive. professionalplastics.com<\/span>\n<\/li>\n<li id=\"cite_note-43\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-43\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Syurik, Julia; Jacucci, Gianni; Onelli, Olimpia D.; Holscher, Hendrik; Vignolini, Silvia (22 February 2018). \"Bio-inspired Highly Scattering Networks via Polymer Phase Separation\". <i>Advanced Functional Materials<\/i>. <b>28<\/b> (24): 1706901. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fadfm.201706901\" target=\"_blank\">10.1002\/adfm.201706901<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Advanced+Functional+Materials&rft.atitle=Bio-inspired+Highly+Scattering+Networks+via+Polymer+Phase+Separation&rft.volume=28&rft.issue=24&rft.pages=1706901&rft.date=2018-02-22&rft_id=info%3Adoi%2F10.1002%2Fadfm.201706901&rft.aulast=Syurik&rft.aufirst=Julia&rft.au=Jacucci%2C+Gianni&rft.au=Onelli%2C+Olimpia+D.&rft.au=Holscher%2C+Hendrik&rft.au=Vignolini%2C+Silvia&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-44\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-44\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Goodman, Robert L. (2002-11-19). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=oIcRDQAAQBAJ&q=PMMA+Laserdisc&dq=PMMA+Laserdisc\" target=\"_blank\"><i>How Electronic Things Work... And What to do When They Don't<\/i><\/a>. McGraw Hill Professional. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780071429245.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=How+Electronic+Things+Work...+And+What+to+do+When+They+Don%27t&rft.pub=McGraw+Hill+Professional&rft.date=2002-11-19&rft.isbn=9780071429245&rft.aulast=Goodman&rft.aufirst=Robert+L.&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3DoIcRDQAAQBAJ%26q%3DPMMA%2BLaserdisc%26dq%3DPMMA%2BLaserdisc&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-45\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-45\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/F._J._Duarte\" title=\"F. J. Duarte\" rel=\"external_link\" target=\"_blank\">Duarte, F. J.<\/a> (Ed.), <i>Tunable Laser Applications<\/i> (CRC, New York, 2009) Chapters 3 and 4.<\/span>\n<\/li>\n<li id=\"cite_note-vacuum2010-46\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-vacuum2010_46-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-vacuum2010_46-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lapshin, R. V.; Alekhin, A. P.; Kirilenko, A. G.; Odintsov, S. L.; Krotkov, V. A. (2010). \"Vacuum ultraviolet smoothing of nanometer-scale asperities of Poly(methyl methacrylate) surface\". <i>Journal of Surface Investigation. X-ray, Synchrotron and Neutron Techniques<\/i>. <b>4<\/b> (1): 1\u201311. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1134%2FS1027451010010015\" target=\"_blank\">10.1134\/S1027451010010015<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Surface+Investigation.+X-ray%2C+Synchrotron+and+Neutron+Techniques&rft.atitle=Vacuum+ultraviolet+smoothing+of+nanometer-scale+asperities+of+Poly%28methyl+methacrylate%29+surface&rft.volume=4&rft.issue=1&rft.pages=1-11&rft.date=2010&rft_id=info%3Adoi%2F10.1134%2FS1027451010010015&rft.aulast=Lapshin&rft.aufirst=R.+V.&rft.au=Alekhin%2C+A.+P.&rft.au=Kirilenko%2C+A.+G.&rft.au=Odintsov%2C+S.+L.&rft.au=Krotkov%2C+V.+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-47\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-47\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.crazychameleonbodyartsupply.com\/crazy-chameleon-blacklight-tattoo-ink-faq-main.htm\" target=\"_blank\">\u2013 Blacklight Tattoo Ink \u2013 Blacklight Tattoo Ink FAQ<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120104204812\/http:\/\/www.crazychameleonbodyartsupply.com\/crazy-chameleon-blacklight-tattoo-ink-faq-main.htm\" target=\"_blank\">Archived<\/a> 2012-01-04 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Crazychameleonbodyartsupply.com. Retrieved 2012-05-09.<\/span>\n<\/li>\n<li id=\"cite_note-48\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-48\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Uhl, Alexander R.; Romanyuk, Yaroslav E.; Tiwari, Ayodhya N. (2011). \"Thin film Cu(In,Ga)Se<sub>2<\/sub> solar cells processed from solution pastes with polymethyl methacrylate binder\". <i>Thin Solid Films<\/i>. <b>519<\/b> (21): 7259\u201363. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2011TSF...519.7259U\" target=\"_blank\">2011TSF...519.7259U<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.tsf.2011.01.136\" target=\"_blank\">10.1016\/j.tsf.2011.01.136<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Thin+Solid+Films&rft.atitle=Thin+film+Cu%28In%2CGa%29Se%3Csub%3E2%3C%2Fsub%3E+solar+cells+processed+from+solution+pastes+with+polymethyl+methacrylate+binder&rft.volume=519&rft.issue=21&rft.pages=7259-63&rft.date=2011&rft_id=info%3Adoi%2F10.1016%2Fj.tsf.2011.01.136&rft_id=info%3Abibcode%2F2011TSF...519.7259U&rft.aulast=Uhl&rft.aufirst=Alexander+R.&rft.au=Romanyuk%2C+Yaroslav+E.&rft.au=Tiwari%2C+Ayodhya+N.&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-49\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-49\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ibanezregister.com\/Gallery\/js\/gal-js2k.htm\" target=\"_blank\">JS2K-PLT<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070928120415\/http:\/\/www.ibanezregister.com\/Gallery\/js\/gal-js2k.htm\" target=\"_blank\">Archived<\/a> 2007-09-28 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Ibanezregister.com. Retrieved 2012-05-09.<\/span>\n<\/li>\n<li id=\"cite_note-50\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-50\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Symington, Jan (2006). \"Salon management\". <i>Australian nail technology<\/i>. Croydon, Victoria, Australia: Tertiary Press. p. 11. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0864585981.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Salon+management&rft.btitle=Australian+nail+technology&rft.place=Croydon%2C+Victoria%2C+Australia&rft.pages=11&rft.pub=Tertiary+Press&rft.date=2006&rft.isbn=978-0864585981&rft.aulast=Symington&rft.aufirst=Jan&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-51\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-51\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cappitelli, Francesca; Principi, Pamela; Sorlini, Claudia (2006). \"Biodeterioration of modern materials in contemporary collections: Can biotechnology help?\". <i>Trends in Biotechnology<\/i>. <b>24<\/b> (8): 350\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.tibtech.2006.06.001\" target=\"_blank\">10.1016\/j.tibtech.2006.06.001<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16782219\" target=\"_blank\">16782219<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Trends+in+Biotechnology&rft.atitle=Biodeterioration+of+modern+materials+in+contemporary+collections%3A+Can+biotechnology+help%3F&rft.volume=24&rft.issue=8&rft.pages=350-4&rft.date=2006&rft_id=info%3Adoi%2F10.1016%2Fj.tibtech.2006.06.001&rft_id=info%3Apmid%2F16782219&rft.aulast=Cappitelli&rft.aufirst=Francesca&rft.au=Principi%2C+Pamela&rft.au=Sorlini%2C+Claudia&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-52\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-52\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rinaldi, Andrea (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1679785\" target=\"_blank\">\"Saving a fragile legacy. Biotechnology and microbiology are increasingly used to preserve and restore the world's cultural heritage\"<\/a>. <i>EMBO Reports<\/i>. <b>7<\/b> (11): 1075\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fsj.embor.7400844\" target=\"_blank\">10.1038\/sj.embor.7400844<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1679785\" target=\"_blank\">1679785<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17077862\" target=\"_blank\">17077862<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=EMBO+Reports&rft.atitle=Saving+a+fragile+legacy.+Biotechnology+and+microbiology+are+increasingly+used+to+preserve+and+restore+the+world%27s+cultural+heritage&rft.volume=7&rft.issue=11&rft.pages=1075-9&rft.date=2006&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1679785&rft_id=info%3Apmid%2F17077862&rft_id=info%3Adoi%2F10.1038%2Fsj.embor.7400844&rft.aulast=Rinaldi&rft.aufirst=Andrea&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1679785&rfr_id=info%3Asid%2Fen.wikipedia.org%3APoly%28methyl+methacrylate%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2><p>\nPerspex Technical Properties <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.theplasticshop.co.uk\/plastic_technical_data_sheets\/perspex_technical_properties_data_sheet.pdf\" target=\"_blank\">https:\/\/www.theplasticshop.co.uk\/plastic_technical_data_sheets\/perspex_technical_properties_data_sheet.pdf<\/a><\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1255\nCached time: 20181217110839\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 1.080 seconds\nReal time usage: 1.398 seconds\nPreprocessor visited node count: 7139\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 170288\/2097152 bytes\nTemplate argument size: 12969\/2097152 bytes\nHighest expansion depth: 22\/40\nExpensive parser function count: 16\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 110882\/5000000 bytes\nNumber of Wikibase entities loaded: 8\/400\nLua time usage: 0.529\/10.000 seconds\nLua memory usage: 11.29 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1191.944 1 -total\n<\/p>\n<pre>39.12% 466.241 1 Template:Reflist\n38.57% 459.702 1 Template:Chembox\n22.03% 262.529 1 Template:Chembox_Identifiers\n14.86% 177.064 11 Template:Cite_journal\n13.10% 156.138 3 Template:Chembox_headerbar\n12.90% 153.703 13 Template:Trim\n 7.87% 93.847 10 Template:Main_other\n 7.80% 93.015 1 Template:Chembox_Properties\n 7.07% 84.321 4 Template:Citation_needed\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:173283-1!canonical and timestamp 20181217110837 and revision id 873357311\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Poly%28methyl_methacrylate%29\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212219\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.024 seconds\nReal time usage: 0.187 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 176.809 1 - wikipedia:Poly(methyl_methacrylate)\n100.00% 176.809 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8289-0!*!*!*!*!*!* and timestamp 20181217212219 and revision id 24501\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Poly(methyl_methacrylate)\">https:\/\/www.limswiki.org\/index.php\/Poly(methyl_methacrylate)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","dcf48b8187f8b2f31e42d926b7bacdb8_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c2\/PMMA_repeating_unit.svg\/200px-PMMA_repeating_unit.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/55\/Lichtenberg_figure_in_block_of_Plexiglas.jpg\/440px-Lichtenberg_figure_in_block_of_Plexiglas.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/35\/Bromine_vial_in_acrylic_cube.jpg\/440px-Bromine_vial_in_acrylic_cube.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/ce\/Methyl-methacrylate-skeletal.png\/200px-Methyl-methacrylate-skeletal.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d1\/Perspex_pieces_%28AM_2007.10.2-2%29.jpg\/440px-Perspex_pieces_%28AM_2007.10.2-2%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/Bathyscaphe_Trieste_sphere.jpg\/440px-Bathyscaphe_Trieste_sphere.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/84\/KelpAquarium.jpg\/440px-KelpAquarium.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fa\/Lexus_LF-A_Crystallised_Wind.jpg\/440px-Lexus_LF-A_Crystallised_Wind.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4d\/Maylan-interior-design-neue-wiener-werkstaette-interlux-roehm-_evonik-_indeustries-contemporary-light-art-sedan-chair-seats-manfred-kielnhofer-illumination-auchtion.jpg\/440px-thumbnail.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c7\/Kawai_CR-40A.jpg\/340px-Kawai_CR-40A.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/15\/Acrylic_Heels.jpg\/270px-Acrylic_Heels.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0e\/Basscat_Bass.jpg\/400px-Basscat_Bass.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b6\/Futuro_house_Warrington.JPG\/340px-Futuro_house_Warrington.JPG"],"dcf48b8187f8b2f31e42d926b7bacdb8_timestamp":1545081739,"ba658ca741e7c54681acc81bb997f786_type":"article","ba658ca741e7c54681acc81bb997f786_title":"Oxinium","ba658ca741e7c54681acc81bb997f786_url":"https:\/\/www.limswiki.org\/index.php\/Oxinium","ba658ca741e7c54681acc81bb997f786_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tOxinium\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (February 2016) (Learn how and when to remove this template message)\nThis article is missing information about historic events related to the product since 2005 . Please expand the article to include this information. Further details may exist on the talk page. (February 2016)\nOxinium is the brand name of a material used for replacement joints manufactured by the reconstructive orthopedic surgery division of medical devices company Smith & Nephew. It consists of a zirconium alloy metal substrate that transitions into a ceramic zirconium oxide outer surface.\nThe ceramic surface is extremely abrasion resistant compared to traditional metal implant materials such as cobalt chromium. It also has a lower coefficient of friction against ultra-high molecular weight polyethylene (UHMWPE), the typical counterface material used in total joint replacements. These two factors likely contribute to the significantly lower UHMWPE wear rates observed in simulator testing. Reducing UHMWPE wear is thought to decrease the risk of implant failure due to osteolysis. All-ceramic materials can have a similar effect on reducing wear, but are brittle and difficult to manufacture. The metal substrate of Oxinium implants makes components easier to manufacture and gives them greater toughness (a combination of strength and ductility). In essence, this technology combines the abrasion resistance and low friction of a ceramic with the workability and toughness of a metal.[citation needed ]\nThis combination of properties led to Oxinium technology being the first ever implant-related technology to win the prestigious ASM International Engineering Materials Achievement Award (EMAA) in 2005.[citation needed ]\nCurrent competitive reduced-wear options in total hip arthroplasty (THA) are ceramic-on-ceramic, metal-on-metal, and metal-on-cross-linked polyethylene. The only competitive reduced-wear option for total knee arthroplasty (TKA) is metal-on-cross-linked polyethylene.\nIn September 2003, Smith & Nephew recalled its Macrotextured Oxinium Profix and Genesis II knee implants because of reports that 30 people receiving the implants without bone cement had to undergo a replacement surgery after they became loose.[1]\n\nReferences \n\n^ Knee implant recall hits Smith & Nephew, The Guardian, [September 18, 2003] \n\n\nExternal links \nSmith & Nephew Corporate Website.\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Oxinium\">https:\/\/www.limswiki.org\/index.php\/Oxinium<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 2 March 2016, at 20:43.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 779 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","ba658ca741e7c54681acc81bb997f786_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Oxinium skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Oxinium<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p><b>Oxinium<\/b> is the brand name of a material used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Replacement_joint\" class=\"mw-redirect\" title=\"Replacement joint\" rel=\"external_link\" target=\"_blank\">replacement joints<\/a> manufactured by the reconstructive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedic_surgery\" title=\"Orthopedic surgery\" rel=\"external_link\" target=\"_blank\">orthopedic surgery<\/a> division of medical devices company <a href=\"https:\/\/en.wikipedia.org\/wiki\/Smith_%26_Nephew\" title=\"Smith & Nephew\" rel=\"external_link\" target=\"_blank\">Smith & Nephew<\/a>. It consists of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zirconium\" title=\"Zirconium\" rel=\"external_link\" target=\"_blank\">zirconium<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alloy\" title=\"Alloy\" rel=\"external_link\" target=\"_blank\">alloy<\/a> metal substrate that transitions into a ceramic zirconium oxide outer surface.\n<\/p><p>The ceramic surface is extremely abrasion resistant compared to traditional metal implant materials such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vitallium\" title=\"Vitallium\" rel=\"external_link\" target=\"_blank\">cobalt chromium<\/a>. It also has a lower coefficient of friction against ultra-high molecular weight polyethylene (<a href=\"https:\/\/en.wikipedia.org\/wiki\/UHMWPE\" class=\"mw-redirect\" title=\"UHMWPE\" rel=\"external_link\" target=\"_blank\">UHMWPE<\/a>), the typical counterface material used in total joint replacements. These two factors likely contribute to the significantly lower UHMWPE wear rates observed in simulator testing. Reducing UHMWPE wear is thought to decrease the risk of implant failure due to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteolysis\" title=\"Osteolysis\" rel=\"external_link\" target=\"_blank\">osteolysis<\/a>. All-ceramic materials can have a similar effect on reducing wear, but are brittle and difficult to manufacture. The metal substrate of Oxinium implants makes components easier to manufacture and gives them greater toughness (a combination of strength and ductility). In essence, this technology combines the abrasion resistance and low friction of a ceramic with the workability and toughness of a metal.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (September 2012)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>This combination of properties led to Oxinium technology being the first ever implant-related technology to win the prestigious <a href=\"https:\/\/en.wikipedia.org\/wiki\/ASM_International_(society)\" title=\"ASM International (society)\" rel=\"external_link\" target=\"_blank\">ASM International<\/a> Engineering Materials Achievement Award (EMAA) in 2005.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (September 2012)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Current competitive reduced-wear options in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">total hip arthroplasty<\/a> (THA) are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic\" title=\"Ceramic\" rel=\"external_link\" target=\"_blank\">ceramic<\/a>-on-ceramic, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal\" title=\"Metal\" rel=\"external_link\" target=\"_blank\">metal<\/a>-on-metal, and metal-on-cross-linked <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a>. The only competitive reduced-wear option for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee_replacement\" title=\"Knee replacement\" rel=\"external_link\" target=\"_blank\">total knee arthroplasty<\/a> (TKA) is metal-on-cross-linked polyethylene.\n<\/p><p>In September 2003, Smith & Nephew recalled its Macrotextured Oxinium Profix and Genesis II knee implants because of reports that 30 people receiving the implants without bone cement had to undergo a replacement surgery after they became loose.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/business.guardian.co.uk\/story\/0,3604,1044180,00.html\" target=\"_blank\">Knee implant recall hits Smith & Nephew<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Guardian\" title=\"The Guardian\" rel=\"external_link\" target=\"_blank\">The Guardian<\/a>, [September 18, 2003]<\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.smith-nephew.com\" target=\"_blank\">Smith & Nephew Corporate Website<\/a>.<\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1240\nCached time: 20181204233036\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.088 seconds\nReal time usage: 0.134 seconds\nPreprocessor visited node count: 400\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 10018\/2097152 bytes\nTemplate argument size: 1080\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 478\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.043\/10.000 seconds\nLua memory usage: 1.58 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 111.714 1 -total\n<\/p>\n<pre>55.86% 62.405 1 Template:Refimprove\n39.86% 44.526 2 Template:Ambox\n37.95% 42.394 2 Template:Fact\n31.67% 35.376 2 Template:Fix\n16.15% 18.037 2 Template:Delink\n11.33% 12.660 4 Template:Category_handler\n 5.95% 6.645 1 Template:Missing_information\n 4.07% 4.542 2 Template:Fix\/category\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:3270504-1!canonical and timestamp 20181204233036 and revision id 811273751\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Oxinium\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212219\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.164 seconds\nReal time usage: 0.255 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 248.612 1 - wikipedia:Oxinium\n100.00% 248.612 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8047-0!*!*!*!*!*!* and timestamp 20181217212219 and revision id 24397\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Oxinium\">https:\/\/www.limswiki.org\/index.php\/Oxinium<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","ba658ca741e7c54681acc81bb997f786_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/6c\/Wiki_letter_w.svg\/88px-Wiki_letter_w.svg.png"],"ba658ca741e7c54681acc81bb997f786_timestamp":1545081739,"45e6b93ac87f5e1649b08b4fa3224f90_type":"article","45e6b93ac87f5e1649b08b4fa3224f90_title":"Nickel titanium","45e6b93ac87f5e1649b08b4fa3224f90_url":"https:\/\/www.limswiki.org\/index.php\/Nickel_titanium","45e6b93ac87f5e1649b08b4fa3224f90_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tNickel titanium\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tNickel titanium, also known as Nitinol (part of shape memory alloy), is a metal alloy of nickel and titanium, where the two elements are present in roughly equal atomic percentages e.g. Nitinol 55, Nitinol 60.\n\nNickel TitaniumMaterial propertiesDensity6.45 g\/cm3 (0.233 lb\/cu in)Electrical resistivity (austenite)82\u00d7 10\u22126  \u03a9\u00b7cm(martensite)76\u00d7 10\u22126  \u03a9\u00b7cmThermal conductivity (austenite)0.18 W\/cm\u00b7K(martensite)0.086 W\/cm\u00b7KCoefficient of thermal expansion (austenite)11\u00d7 10\u22126 \/\u00b0C(martensite)6.6\u00d7 10\u22126 \/\u00b0CMagnetic permeability< 1.002Magnetic susceptibility (austenite)3.7\u00d7 10\u22126  emu\/g(martensite)2.4\u00d7 10\u22126  emu\/gElastic modulus (austenite)75\u201383 GPa(martensite)28\u201340 GPaYield strength (austenite)195\u2013690 MPa(martensite)70\u2013140 MPaPoisson's ratio0.33Nitinol properties are particular to the precise composition of the alloy and its processing. These specifications are typical for commercially available shape memory nitinol alloys.vte\nNitinol alloys exhibit two closely related and unique properties: shape memory effect (SME) and superelasticity (SE; also called pseudoelasticity, PE). Shape memory is the ability of nitinol to undergo deformation at one temperature, then recover its original, undeformed shape upon heating above its \"transformation temperature\". Superelasticity occurs at a narrow temperature range just above its transformation temperature; in this case, no heating is necessary to cause the undeformed shape to recover, and the material exhibits enormous elasticity, some 10-30 times that of ordinary metal.\n\nContents \n\n1 History \n2 Mechanism \n3 Manufacturing process \n4 Challenges \n5 Applications \n\n5.1 Thermal and electrical actuators \n5.2 Biocompatible and biomedical applications \n5.3 Damping systems in structural engineering \n5.4 Other applications and prototypes \n\n\n6 References \n7 Further reading \n8 External links \n\n\nHistory \nThe word Nitinol is derived from its composition and its place of discovery: (Nickel Titanium-Naval Ordnance Laboratory). William J. Buehler[1] along with Frederick Wang,[2] discovered its properties during research at the Naval Ordnance Laboratory in 1959.[3][4] Buehler was attempting to make a better missile nose cone, which could resist fatigue, heat and the force of impact. Having found that a 1:1 alloy of nickel and titanium could do the job, in 1961 he presented a sample at a laboratory management meeting. The sample, folded up like an accordion, was passed around and flexed by the participants. One of them applied heat from his pipe lighter to the sample and, to everyone's surprise, the accordion-shaped strip stretched and took its previous shape.[5]\nWhile the potential applications for nitinol were realized immediately, practical efforts to commercialize the alloy did not take place until a decade later. This delay was largely because of the extraordinary difficulty of melting, processing and machining the alloy. Even these efforts encountered financial challenges that were not readily overcome until the 1980s, when these practical difficulties finally began to be resolved.\nThe discovery of the shape-memory effect in general dates back to 1932, when Swedish chemist Arne \u00d6lander[6] first observed the property in gold-cadmium alloys. The same effect was observed in Cu-Zn (brass) in the early 1950s.[7]\n\nMechanism \n 3D view of austenite and martensite structures of the NiTi compound.\nNitinol's unusual properties are derived from a reversible solid-state phase transformation known as a martensitic transformation, between two different martensite crystal phases, requiring 10,000\u201320,000 psi (69\u2013138 MPa) of mechanical stress.\nAt high temperatures, nitinol assumes an interpenetrating simple cubic structure referred to as austenite (also known as the parent phase). At low temperatures, nitinol spontaneously transforms to a more complicated monoclinic crystal structure known as martensite (daughter phase).[8] There are four transition temperatures associated to the austenite-to-martensite and martensite-to-austenite transformations. Starting from full austenite, martensite begins to form as the alloy is cooled to the so-called martensite start temperature, or Ms, and the temperature at which the transformation is complete is called the martensite finish temperature, or Mf. When the alloy is fully martensite and is subjected to heating, austenite starts to form at the austenite start temperature, As, and finishes at the austenite finish temperature, Af.[9]\n\n Thermal hysteresis of nitinol's phase transformationThe cooling\/heating cycle shows thermal hysteresis. The hysteresis width depends on the precise nitinol composition and processing. Its typical value is a temperature range spanning about 20-50 K (20-50 \u00b0C; 36-90 \u00b0F) but it can be reduced or amplified by alloying[10] and processing.[11]\nCrucial to nitinol properties are two key aspects of this phase transformation. First is that the transformation is \"reversible\", meaning that heating above the transformation temperature will revert the crystal structure to the simpler austenite phase. The second key point is that the transformation in both directions is instantaneous.\n\nMartensite's crystal structure (known as a monoclinic, or B19' structure) has the unique ability to undergo limited deformation in some ways without breaking atomic bonds. This type of deformation is known as twinning, which consists of the rearrangement of atomic planes without causing slip, or permanent deformation. It is able to undergo about 6\u20138% strain in this manner. When martensite is reverted to austenite by heating, the original austenitic structure is restored, regardless of whether the martensite phase was deformed. Thus the name \"shape memory\" refers to the fact that the shape of the high temperature austenite phase is \"remembered,\" even though the alloy is severely deformed at a lower temperature.[12] 2D view of nitinol's crystalline structure during cooling\/heating cycle\nA great deal of pressure can be produced by preventing the reversion of deformed martensite to austenite \u2014 from 35,000 psi to, in many cases, more than 100,000 psi (689 MPa). One of the reasons that nitinol works so hard to return to its original shape is that it is not just an ordinary metal alloy, but what is known as an intermetallic compound. In an ordinary alloy, the constituents are randomly positioned in the crystal lattice; in an ordered intermetallic compound, the atoms (in this case, nickel and titanium) have very specific locations in the lattice.[13] The fact that nitinol is an intermetallic is largely responsible for the complexity in fabricating devices made from the alloy.[why? ]\n\n The effect of nitinol composition on the Ms temperature.\nThe scenario described above (cooling austenite to form martensite, deforming the martensite, then heating to revert to austenite, thus returning the original, undeformed shape) is known as the thermal shape memory effect. To fix the original \"parent shape,\" the alloy must be held in position and heated to about 500 \u00b0C (932 \u00b0F). This process is usually called shape setting.[14] A second effect, called superelasticity or pseudoelasticity, is also observed in nitinol. This effect is the direct result of the fact that martensite can be formed by applying a stress as well as by cooling. Thus in a certain temperature range, one can apply a stress to austenite, causing martensite to form while at the same time changing shape. In this case, as soon as the stress is removed, the nitinol will spontaneously return to its original shape. In this mode of use, nitinol behaves like a super spring, possessing an elastic range 10\u201330 times greater than that of a normal spring material. There are, however, constraints: the effect is only observed about 0-40 K (0-40 \u00b0C; 0-72 \u00b0F) above the Af temperature. This upper limit is referred to as Md,[15] which corresponds to the highest temperature in which it is still possible to stress-induce the formation of martensite. Below Md, martensite formation under load allows superelasticity due to twinning. Above Md, since martensite is no longer formed, the only response to stress is slip of the austenitic microstructure, and thus permanent deformation.\nNitinol is typically composed of approximately 50 to 51% nickel by atomic percent (55 to 56% weight percent).[13][16] Making small changes in the composition can change the transition temperature of the alloy significantly. Transformation temperatures in nitinol can be controlled to some extent, where Af temperature ranges from about \u221220 \u00b0C to +110 \u00b0C. Thus, it is common practice to refer to a nitinol formulation as \"superelastic\" or \"austenitic\" if Af is lower than a reference temperature, while as \"shape memory\" or \"martensitic\" if higher. The reference temperature is usually defined as the room temperature or the human body temperature (37 \u00b0C; 98 \u00b0F).\nOne often-encountered effect regarding nitinol is the so-called R-phase. The R-phase is another martensitic phase that competes with the martensite phase mentioned above. Because it does not offer the large memory effects of the martensite phase, it is usually of non practical use.\n\nManufacturing process \nNitinol is exceedingly difficult to make, due to the exceptionally tight compositional control required, and the tremendous reactivity of titanium. Every atom of titanium that combines with oxygen or carbon is an atom that is robbed from the NiTi lattice, thus shifting the composition and making the transformation temperature that much lower. There are two primary melting methods used today:\n\nVacuum arc remelting (VAR)\nThis is done by striking an electrical arc between the raw material and a water-cooled copper strike plate. Melting is done in a high vacuum, and the mold itself is water-cooled copper.\nVacuum induction melting (VIM)\nThis is done by using alternating magnetic fields to heat the raw materials in a crucible (generally carbon). This is also done in a high vacuum.\nWhile both methods have advantages, it has been demonstrated that an industrial state-of-the-art VIM melted material has smaller inclusions than an industrial state-of-the-art VAR one, leading to a higher fatigue resistance.[17] Other research report that VAR employing extreme high-purity raw materials may lead to a reduced number of inclusions and thus to an improved fatigue behavior.[18] Other methods are also used on a boutique scale, including plasma arc melting, induction skull melting, and e-beam melting. Physical vapour deposition is also used on a laboratory scale.\nHot working of nitinol is relatively easy, but cold working is difficult because the enormous elasticity of the alloy increases die or roll contact, leading to tremendous frictional resistance and tool wear. For similar reasons, machining is extremely difficult\u2014to make things worse, the thermal conductivity of nitinol is poor, so heat is difficult to remove. Grinding (abrasive cutting), Electrical discharge machining (EDM) and laser cutting are all relatively easy.\nHeat treating nitinol is delicate and critical. It is a knowledge intensive process to fine-tune the transformation temperatures. Aging time and temperature controls the precipitation of various Ni-rich phases, and thus controls how much nickel resides in the NiTi lattice; by depleting the matrix of nickel, aging increases the transformation temperature. The combination of heat treatment and cold working is essential in controlling the properties of nitinol products.[19]\n\nChallenges \nFatigue failures of nitinol devices are a constant subject of discussion. Because it is the material of choice for applications requiring enormous flexibility and motion (e.g., peripheral stents, heart valves, smart thermomechanical actuators and electromechanical microactuators), it is necessarily exposed to much greater fatigue strains compared to other metals. While the strain-controlled fatigue performance of nitinol is superior to all other known metals, fatigue failures have been observed in the most demanding applications. There is a great deal of effort underway trying to better understand and define the durability limits of nitinol.\nNitinol is half nickel, and thus there has been a great deal of concern in the medical industry regarding the release of nickel, a known allergen and possible carcinogen.[19] (Nickel is also present in substantial amounts in stainless steel and cobalt-chrome alloys.) When properly treated (via electropolishing and\/or passivation), nitinol forms a very stable protective TiO2 layer that acts as a very effective and self-healing barrier against ion exchange. It has been repeatedly shown that nitinol releases nickel at a slower pace than stainless steel, for example. With that said, very early medical devices were made without electropolishing, and corrosion was observed. Today's nitinol vascular self-expandable metallic stents, for example, show no evidence of corrosion or nickel release, and the outcomes in patients with and without nickel allergies are indistinguishable.\nThere are constant and long-running discussions regarding inclusions in nitinol, both TiC and Ti2NiOx. As in all other metals and alloys, inclusions can be found in Nitinol. The size, distribution and type of inclusions can be controlled to some extent. Theoretically, smaller, rounder and few inclusions should lead to increased fatigue durability. In literature, some early works report to have failed to show measurable differences,[20][21] while novel studies demonstrate a dependence of fatigue resistance on the typical inclusion size in an alloy.[17][18][22][23][24]\nNitinol is difficult to weld, both to itself and other materials. Laser welding nitinol to itself is a relatively routine process. More recently, strong joints between NiTi wires and stainless steel wires have been made using nickel filler.[25] Laser[26] and Tungsten Inert Gas (TIG)[27] welds have been made between NiTi tubes and stainless steel tubes . More research is ongoing into other processes and other metals to which nitinol can be welded.\nActuation frequency of nitinol is dependent on the heat management, especially during the cooling phase. Numerous methods are used to increase the cooling performance, such as forced air,[28] flowing liquids,[29] thermoelectric modules (i.e. Peltier or semiconductor heat pumps),[30] heat sinks,[31] conductive materials[32] and higher surface-to-volume ratio[33] (improvements up to 3.3 Hz with very thin wires[34] and up to 100 Hz with thinfilm nitinol[35]). The fastest nitinol actuation recorded was carried by a high voltage capacitor discharge which heated an SMA wire in a manner of microseconds, and resulted in a complete phase transformation (and high velocities) in a few milliseconds.[36]\nRecent advances have shown that processing of nitinol can expand thermomechanical capabilities, allowing for multiple shape memories to be embedded within a monolithic structure.[37][38] Research on multi-memory technology is on-going and promises to deliver enhanced shape memory devices in the near future[39]\n,[40] and the application of new materials and material structures, such hybrid shape memory materials (SMMs) and shape memory composites (SMCs).[41]\n\n<\/p>\nApplications \nThere are four commonly used types of applications for nitinol:\nFree recovery\n\nNitinol is deformed at a low temperature, and heated to recover its original shape through the Shape Memory effect.\nConstrained recovery\n\nAs for free recovery, except that recovery is rigidly prevented and thus a stress is generated.\nWork production\n\nHere the alloy is allowed to recover, but to do so it must act against a force (thus doing work).\nSuperelasticity\n\nNitinol acts as a super spring through the Superelastic effect.\n\nIn 1989 a survey was conducted in the United States and Canada that involved seven organizations. The survey focused on predicting the future technology, market, and applications of SMAs. The companies predicted the following uses of nitinol in a decreasing order of importance: (1) Couplings, (2) Biomedical and medical, (3) Toys, demonstration, novelty items, (4) Actuators, (5) Heat Engines, (6) Sensors, (7) Cryogenically activated die and bubble memory sockets, and finally (8) lifting devices.[42]\nToday, nitinol finds application in the listed industrial applications:\n\nThermal and electrical actuators \nNitinol can be used to replace conventional actuators (solenoids, servo motors, etc.), such as in the Stiquito, a simple hexapod robot.\nNitinol springs are used in thermal valves for fluidics, where the material both acts as a temperature sensor and an actuator.\nIt is used as autofocus actuator in action cameras and as an Optical Image Stabilizer in mobile phones.[43]\nIt is used in pneumatic valves for comfort seating and has become an industry standard.\nThe 2014 Chevrolet Corvette incorporates nitinol actuators, which replaced heavier motorized actuators to open and close the hatch vent that releases air from the trunk, making it easier to close.\nBiocompatible and biomedical applications \nMain article: Nitinol biocompatibility\nNitinol is highly biocompatible and has properties suitable for use in orthopedic implants. Due to Nitinol's unique properties it has seen a large demand for use in less invasive medical devices. Nitinol tubing is commonly used in catheters, stents, and superelastic needles.\nIn colorectal surgery [1], the material is used in devices for reconnecting the intestine after removing the pathology.\nNitinol is used for devices developed by Franz Freudenthal to treat Patent ductus arteriosus, blocking a blood vessel that bypasses the lungs and has failed to close after birth in an infant.[44]\nIn dentistry, the material is used in orthodontics for brackets and wires connecting the teeth. Once the SMA wire is placed in the mouth its temperature rises to ambient body temperature. This causes the nitinol to contract back to its original shape, applying a constant force to move the teeth. These SMA wires do not need to be retightened as often as other wires because they can contract as the teeth move unlike conventional stainless steel wires. Additionally, nitinol can be used in endodontics, where nitinol files are used to clean and shape the root canals during the root canal procedure. Because of the high fatigue tolerance and flexibility of nitinol, it greatly decreases the possibility of an endodontic file breaking inside the tooth during root canal treatment, thus improving safety for the patient.\nAnother significant application of nitinol in medicine is in stents: a collapsed stent can be inserted into an artery or vein, where body temperature warms the stent and the stent returns to its original expanded shape following removal of a constraining sheath; the stent then helps support the artery or vein to improve blood flow. It is also used as a replacement for sutures - nitinol wire can be woven through two structures then allowed to transform into its preformed shape, which should hold the structures in place.\nSimilarly, collapsible structures composed of braided, microscopically-thin nitinol filaments can be used in neurovascular interventions such as stroke thrombolysis, embolization, and intracranial angioplasty.[45]\nA more recent application of nitinol wire is in female contraception, specifically in intrauterine devices.\nDamping systems in structural engineering \nSuperelastic Nitinol finds a variety of applications in civil structures such as bridges and buildings. One such application is Intelligent Reinforced Concrete (IRC), which incorporates Ni-Ti wires embedded within the concrete. These wires can sense cracks and contract to heal macro-sized cracks.[46]\nAnother application is active tuning of structural natural frequency using Nitinol wires to dampen vibrations.\nOther applications and prototypes \nDemonstration model heat engines have been built which use nitinol wire to produce mechanical energy from hot and cold heat sources.[47] A prototype commercial engine developed in the 1970s by engineer Ridgway Banks at Lawrence Berkeley National Laboratory, was named the Banks Engine.[48][49][50][51][52]\nNitinol is also popular in extremely resilient glasses frames.[53] It is also used in some mechanical watch springs.\nBoeing engineers successfully flight-tested SMA-actuated morphing chevrons on the Boeing 777-300ER Quiet Technology Demonstrator 2.[54]\nIt can be used as a temperature control system; as it changes shape, it can activate a switch or a variable resistor to control the temperature.\nIt has been used in cell-phone technology as a retractable antenna, or microphone boom, due to its highly flexible and mechanical memory nature.\nIt is used to made certain surgical implants, such as the SmartToe.\nIt is used in some novelty products, such as self-bending spoons which can be used by amateur and stage magicians to demonstrate \"psychic\" powers or as a practical joke, as the spoon will bend itself when used to stir tea, coffee, or any other warm liquid.\nIt can also be used as wires which are used to locate and mark breast tumours so that the following surgery can be more exact.\nDue to the high damping capacity of Superelastic nitinol, it is also used as a golf club insert.[55]\nNickel titanium can be used to make the underwires for underwire bras.[56][57][58]\nIt is used in some actuation-bending devices, such as those developed by Finnish technology company Modti Inc.\nReferences \n\n\n^ Buehler, W. J.; Gilfrich, J. W.; Wiley, R. C. (1963). \"Effects of Low-Temperature Phase Changes on the Mechanical Properties of Alloys Near Composition TiNi\". Journal of Applied Physics. 34 (5): 1475\u20131477. doi:10.1063\/1.1729603. \n\n^ Wang, F. E.; Buehler, W. J.; Pickart, S. J. (1965). \"Crystal Structure and a Unique Martensitic Transition of TiNi\". Journal of Applied Physics. 36 (10): 3232\u20133239. doi:10.1063\/1.1702955. \n\n^ \"The Alloy That Remembers\", Time, 1968-09-13 \n\n^ Kauffman, G. B.; Mayo, I. (1997). \"The Story of Nitinol: The Serendipitous Discovery of the Memory Metal and Its Applications\". The Chemical Educator. 2 (2): 1\u201321. doi:10.1007\/s00897970111a. \n\n^ Withers, Neil. \"Nitinol\". Chemistry World. Royal Society of Chemistry. Retrieved 29 January 2018 . \n\n^ \u00d6lander, A. (1932). \"An Electrochemical Investigation of Solid Cadmium-Gold Alloys\". Journal of the American Chemical Society. 54 (10): 3819\u20133833. doi:10.1021\/ja01349a004. \n\n^ Hornbogen, E.; Wassermann, G. (1956). \"\u00dcber den Einflu\u03b2 von Spannungen und das Auftreten von Umwandlungsplastizit\u00e4t bei \u03b21-\u03b2-Umwandlung des Messings\". Zeitschrift f\u00fcr Metallkunde. 47: 427\u2013433. \n\n^ Otsuka, K.; Ren, X. (2005). \"Physical Metallurgy of Ti-Ni-based Shape Memory Alloys\". Progress in Materials Science. 50 (5): 511\u2013678. doi:10.1016\/j.pmatsci.2004.10.001. \n\n^ \"Nitinol facts\". Nitinol.com. 2013. \n\n^ Chluba, Christoph; Ge, Wenwei; Miranda, Rodrigo Lima de; Strobel, Julian; Kienle, Lorenz; Quandt, Eckhard; Wuttig, Manfred (2015-05-29). \"Ultralow-fatigue shape memory alloy films\". Science. 348 (6238): 1004\u20131007. Bibcode:2015Sci...348.1004C. doi:10.1126\/science.1261164. ISSN 0036-8075. PMID 26023135. \n\n^ Spini, Tatiana Sobottka; Valarelli, Fabr\u00edcio Pinelli; Can\u00e7ado, Rodrigo Hermont; Freitas, Karina Maria Salvatore de; Villarinho, Denis Jardim; Spini, Tatiana Sobottka; Valarelli, Fabr\u00edcio Pinelli; Can\u00e7ado, Rodrigo Hermont; Freitas, Karina Maria Salvatore de (2014-04-01). \"Transition temperature range of thermally activated nickel-titanium archwires\". Journal of Applied Oral Science. 22 (2): 109\u2013117. doi:10.1590\/1678-775720130133. ISSN 1678-7757. PMC 3956402 . PMID 24676581. \n\n^ Funakubo, Hiroyasu (1984), Shape memory alloys, University of Tokyo, pp. 7, 176 . \n\n^ a b \"Nitinol SM495 Wire\" (PDF) . 2013. Archived from the original (properties, PDF) on 2011-07-14. \n\n^ \"Fabrication & Heat Treatment of Nitinol\". memry.com. 2011-01-26. Retrieved 2017-03-28 . \n\n^ R Meling, Torstein; \u00d8degaard, Jan (August 1998). \"The effect of temperature on the elastic responses to longitudinal torsion of rectangular nickel titanium archwires\". The Angle Orthodontist. 68 (4): 357\u2013368. doi:10.1043\/0003-3219(1998)068<0357:TEOTOT>2.3.CO;2. PMID 9709837. \n\n^ \"Nitinol SE508 Wire\" (PDF) . 2013. Archived from the original (properties, PDF) on 2011-07-14. \n\n^ a b Urbano, Marco; Coda, Alberto; Beretta, Stefano; Cadelli, Andrea; Sczerzenie, Frank (2013-09-01). \"The Effect of Inclusions on Fatigue Properties for Nitinol\". Fatigue and Fracture Metallic Medical Materials and Devices: 18\u201334. doi:10.1520\/STP155920120189. \n\n^ a b Robertson, Scott W.; Launey, Maximilien; Shelley, Oren; Ong, Ich; Vien, Lot; Senthilnathan, Karthike; Saffari, Payman; Schlegel, Scott; Pelton, Alan R. (2015-11-01). \"A statistical approach to understand the role of inclusions on the fatigue resistance of superelastic Nitinol wire and tubing\". Journal of the Mechanical Behavior of Biomedical Materials. 51: 119\u2013131. doi:10.1016\/j.jmbbm.2015.07.003. ISSN 1878-0180. PMID 26241890. \n\n^ a b Pelton, A.; Russell, S.; DiCello, J. (2003). \"The Physical Metallurgy of Nitinol for Medical Applications\". JOM. 55 (5): 33\u201337. doi:10.1007\/s11837-003-0243-3. \n\n^ Morgan, N.; Wick, A.; DiCello, J.; Graham, R. (2006). \"Carbon and Oxygen Levels in Nitinol Alloys and the Implications for Medical Device Manufacture and Durability\". SMST-2006 Proceedings of the International Conference on Shape Memory and Superelastic Technologies (PDF) . ASM International. pp. 821\u2013828. doi:10.1361\/cp2006smst821. ISBN 978-0-87170-862-5. LCCN 2009499204. \n\n^ Miyazaki, S.; Sugaya, Y.; Otsuka, K. (1989). \"Mechanism of Fatigue Crack Nucleation in Ti-Ni Alloys\". Shape memory materials : May 31-June 3, 1988, Sunshine City, Ikebukuro, Tokyo, Japan. Proceedings of the MRS International Meeting on Advanced Materials. 9. Materials Research Society. pp. 257\u2013262. ISBN 1-55899-038-0. LCCN 90174266. \n\n^ \"The Influence of Microcleanliness on the Fatigue Performance of Nitinol - Conference Proceedings - ASM International\". www.asminternational.org. Retrieved 2017-04-05 . \n\n^ \"Academic paper (PDF): Smartflex NiTi Wires for Shape Memory Actuators\". ResearchGate. Retrieved 2017-04-05 . \n\n^ Rahim, M.; Frenzel, J.; Frotscher, M.; Pfetzing-Micklich, J.; Steegm\u00fcller, R.; Wohlschl\u00f6gel, M.; Mughrabi, H.; Eggeler, G. (2013-06-01). \"Impurity levels and fatigue lives of pseudoelastic NiTi shape memory alloys\". Acta Materialia. 61 (10): 3667\u20133686. doi:10.1016\/j.actamat.2013.02.054. \n\n^ US patent 6875949, Hall, P. C., \"Method of Welding Titanium and Titanium Based Alloys to Ferrous Metals\"   \n\n^ Hahnlen, Ryan; Fox, Gordon (October 29, 2012). \"Fusion welding of nickel\u2013titanium and 304 stainless steel tubes: Part I: laser welding\". Journal of Intelligent Material Systems and Structures. 24 (8). \n\n^ Fox, Gordon; Hahnlen, Ryan (October 29, 2012). \"Fusion welding of nickel\u2013titanium and 304 stainless steel tubes: Part II: tungsten inert gas welding\". Journal of Intelligent Material Systems and Structures. 24 (8). \n\n^ Tadesse Y, Thayer N, Priya S (2010). \"Tailoring the response time of shape memory alloy wires through active cooling and pre-stress\". Journal of Intelligent Material Systems and Structures. 21: 19\u201340. doi:10.1177\/1045389x09352814. \n\n^ Wellman PS, Peine WJ, Favalora G, Howe RD (1997). \"Mechanical Design and Control of a High-Bandwidth Shape Memory Alloy Tactile Display\". International Symposium on Experimental Robotics. \n\n^ Romano R, Tannuri EA (2009). \"Modeling, control and experimental validation of a novel actuator based on shape memory alloys\". Mechatronics. 19: 1169\u20131177. doi:10.1016\/j.mechatronics.2009.03.007. \n\n^ Russell RA, Gorbet RB (1995). \"Improving the response of SMA actuators\". Robotics and Automation. 3: 2299\u2013304. \n\n^ Chee Siong L, Yokoi H, Arai T (2005). \"Improving heat sinking in ambient environment for the shape memory alloy (SMA)\". Intelligent Robots and Systems: 3560\u20133565. \n\n^ An L, Huang WM, Fu YQ, Guo NQ (2008). \"A note on size effect in actuating NiTi shape memory alloys by electrical current\". Materials & Design. 29: 1432\u20131437. doi:10.1016\/j.matdes.2007.09.001. \n\n^ https:\/\/www.saesgetters.com\/sites\/default\/files\/SMARTFLEX%20Products%20DATASHEETS_Layout%201.pdf \n\n^ Winzek B; Schmitz S; Rumpf H; Sterzl T; Ralf Hassdorf; Thienhaus S (2004). \"Recent developments in shape memory thin film technology\". Materials Science and Engineering: A. 378: 40\u201346. doi:10.1016\/j.msea.2003.09.105. \n\n^ Vollach, Shahaf, and D. Shilo. \"The mechanical response of shape memory alloys under a rapid heating pulse.\" Experimental Mechanics 50.6 (2010): 803-811. \n\n^ Khan, M. I.; Zhou Y. N. (2011), Methods and Systems for Processing Materials, Including Shape Memory Materials, WO Patent WO\/2011\/014,962 \n\n^ Daly, M.; Pequegnat, A.; Zhou, Y.; Khan, M. I. (2012), \"Enhanced thermomechanical functionality of a laser processed hybrid NiTi\u2013NiTiCu shape memory alloy\", Smart Materials and Structures, 21 (4): 045018, Bibcode:2012SMaS...21d5018D, doi:10.1088\/0964-1726\/21\/4\/045018 \n\n^ Daly, M.; Pequegnat, A.; Zhou, Y. N.; Khan, M. I. (2012), \"Fabrication of a novel laser-processed NiTi shape memory microgripper with enhanced thermomechanical functionality\", Journal of Intelligent Material Systems and Structures, 24 (8): 984\u2013990, doi:10.1177\/1045389X12444492 \n\n^ Pequegnat, A.; Daly, M.; Wang, J.; Zhou, Y.; Khan, M. I. (2012), \"Dynamic actuation of a novel laser-processed NiTi linear actuator\", Smart Materials and Structures, 21 (9): 094004, Bibcode:2012SMaS...21i4004P, doi:10.1088\/0964-1726\/21\/9\/094004 \n\n^ Tao T, Liang YC, Taya M (2006). \"Bio-inspired actuating system for swimming using shape memory alloy composites\". Int J Automat Comput. 3page=366-373. \n\n^ Miller, R. K.; Walker, T. (1989). Survey on Shape Memory Alloys. Survey Reports. 89. Future Technology Surveys. p. 17. ISBN 9781558651005. OCLC 38076438. \n\n^ Actuator Solutions (2015-12-18), SMA AF \/ OIS Mechanism, retrieved 2017-04-05 \n\n^ Alejandra Martins (2014-10-02). \"The inventions of the Bolivian doctor who saved thousands of children\". BBC Mundo. Retrieved 2015-03-30 . \n\n^ Smith, Keith. \"Nitinol Micro-Braids for Neurovascular Interventions\". US BioDesign. \n\n^ Shape Memory Alloy Engineering (PDF) . 2014. pp. 369\u2013401. ISBN 9781322158457. \n\n^ \"Nitinol Heat Engine Kit\". Images Scientific Instruments. 2007. Retrieved 2011 . Check date values in: |accessdate= (help) \n\n^ Banks, R. (1975). \"The Banks Engine\". Die Naturwissenschaften. 62 (7): 305\u2013308. Bibcode:1975NW.....62..305B. doi:10.1007\/BF00608890. \n\n^ Vimeo posting of \"The Individualist\", documentary on Ridgway Banks \n\n^ \"Single wire nitinol engine\", Ridgway M. Banks, US Patent \n\n^ \"Metals that Remember\", Popular Science, January 1988 \n\n^ \"Engine Uses No Fuel\", Milwaukee Journal, December 5, 1973 \n\n^ Hero Khan (2013-11-01), Nitinol Glasses, retrieved 2017-04-05 \n\n^ \"Boeing Frontiers Online\". www.boeing.com. Retrieved 2017-04-05 . \n\n^ \"Memory Golf Clubs\". spinoff.nasa.gov. Retrieved 2017-04-05 . \n\n^ Brady, G. S.; Clauser, H. R.; Vaccari, J. A. (2002). Materials Handbook (15th ed.). McGraw-Hill Professional. p. 633. ISBN 978-0-07-136076-0. Retrieved 2009-05-09 . \n\n^ Sang, D.; Ellis, P.; Ryan, L.; Taylor, J.; McMonagle, D.; Petheram, L.; Godding, P. (2005). Scientifica. Nelson Thornes. p. 80. ISBN 0-7487-7996-5. Retrieved 2009-05-09 . \n\n^ Jones, G.; Falvo, M. R.; Taylor, A. R.; Broadwell, B. P. (2007). \"Nanomaterials: Memory Wire\". Nanoscale Science. NSTA Press. p. 109. ISBN 1-933531-05-3. Retrieved 2009-05-09 . \n\n\nFurther reading \nH.R. Chen, ed., Shape Memory Alloys: Manufacture, Properties and Applications, Nova Science Publishers, Inc., 2010, ISBN 978-1-60741-789-7.\nY.Y. Chu & L.C. Zhao, eds., Shape Memory Materials and Its [sic] Applications, Trans Tech Publications Ltd., 2002, ISBN 0-87849-896-6.\nD.C. Lagoudas, ed., Shape Memory Alloys, Springer Science+Business Media LLC, 2008, ISBN 978-0-387-47684-1.\nK. \u014ctsuka & C.M. Wayman, eds., Shape Memory Materials, Cambridge University Press, 1998, ISBN 0-521-44487-X\nSai V. Raj, Low Temperature Creep of Hot-extruded Near-stoichiometric NiTi Shape Memory Alloy, National Aeronautics and Space Administration, Glenn Research Center, 2013.\nGerald Julien, Nitinol Technologies, Inc Edgewood, Wa. Us patent\" 6422010 Manufacturing of Nitinol Parts & Forms\nA process of making parts and forms of Type 60 Nitinol having a shape memory effect, comprising: selecting a Type 60 Nitinol. Inventor G, Julien CEO of Nitinol Technologies, Inc. (Washington State)\n\nExternal links \n\n\n\nWikimedia Commons has media related to Nickel titanium.\nSociety of Shape Memory and Superelastic Technologies\nNitinol Resource Library\nPhysical properties of nitinol\nNitinol Technical Resource Library\nLiterature on Nitinol Wire\nNitinol-Tubing\nScience Digest articles - Miracle Metal 1982 - PDF\n\nhttp:\/\/www.colorsproject.com\/nitinol_articles_science_digest_1982_sanders.pdf\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Nickel_titanium\">https:\/\/www.limswiki.org\/index.php\/Nickel_titanium<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","45e6b93ac87f5e1649b08b4fa3224f90_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Nickel_titanium skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Nickel titanium<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Nickel titanium<\/b>, also known as <b>Nitinol<\/b> (part of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shape_memory_alloy\" class=\"mw-redirect\" title=\"Shape memory alloy\" rel=\"external_link\" target=\"_blank\">shape memory alloy<\/a>), is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal\" title=\"Metal\" rel=\"external_link\" target=\"_blank\">metal<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alloy\" title=\"Alloy\" rel=\"external_link\" target=\"_blank\">alloy<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nickel\" title=\"Nickel\" rel=\"external_link\" target=\"_blank\">nickel<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a>, where the two elements are present in roughly equal atomic percentages e.g. Nitinol 55, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nitinol_60\" title=\"Nitinol 60\" rel=\"external_link\" target=\"_blank\">Nitinol 60<\/a>.\n<\/p>\n\n<p>Nitinol alloys exhibit two closely related and unique properties: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shape_memory\" class=\"mw-redirect\" title=\"Shape memory\" rel=\"external_link\" target=\"_blank\">shape memory<\/a> effect (SME) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superelasticity\" class=\"mw-redirect\" title=\"Superelasticity\" rel=\"external_link\" target=\"_blank\">superelasticity<\/a> (SE; also called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pseudoelasticity\" title=\"Pseudoelasticity\" rel=\"external_link\" target=\"_blank\">pseudoelasticity<\/a>, PE). Shape memory is the ability of nitinol to undergo <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deformation_(engineering)\" title=\"Deformation (engineering)\" rel=\"external_link\" target=\"_blank\">deformation<\/a> at one temperature, then recover its original, undeformed shape upon heating above its \"transformation temperature\". Superelasticity occurs at a narrow temperature range just above its transformation temperature; in this case, no heating is necessary to cause the undeformed shape to recover, and the material exhibits enormous elasticity, some 10-30 times that of ordinary metal.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The word Nitinol is derived from its composition and its place of discovery: (<i>Ni<\/i>ckel <i>Ti<\/i>tanium-<i>N<\/i>aval <i>O<\/i>rdnance <i>L<\/i>aboratory). <sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> along with ,<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> discovered its properties during research at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Naval_Ordnance_Laboratory\" title=\"Naval Ordnance Laboratory\" rel=\"external_link\" target=\"_blank\">Naval Ordnance Laboratory<\/a> in 1959.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Buehler was attempting to make a better missile nose cone, which could resist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fatigue_(material)\" title=\"Fatigue (material)\" rel=\"external_link\" target=\"_blank\">fatigue<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heat\" title=\"Heat\" rel=\"external_link\" target=\"_blank\">heat<\/a> and the force of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Impact_(mechanics)\" title=\"Impact (mechanics)\" rel=\"external_link\" target=\"_blank\">impact<\/a>. Having found that a 1:1 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alloy\" title=\"Alloy\" rel=\"external_link\" target=\"_blank\">alloy<\/a> of nickel and titanium could do the job, in 1961 he presented a sample at a laboratory management meeting. The sample, folded up like an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Accordion\" title=\"Accordion\" rel=\"external_link\" target=\"_blank\">accordion<\/a>, was passed around and flexed by the participants. One of them applied heat from his pipe lighter to the sample and, to everyone's surprise, the accordion-shaped strip stretched and took its previous shape.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>While the potential applications for nitinol were realized immediately, practical efforts to commercialize the alloy did not take place until a decade later. This delay was largely because of the extraordinary difficulty of melting, processing and machining the alloy. Even these efforts encountered financial challenges that were not readily overcome until the 1980s, when these practical difficulties finally began to be resolved.\n<\/p><p>The discovery of the shape-memory effect in general dates back to 1932, when Swedish chemist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arne_%C3%96lander\" title=\"Arne \u00d6lander\" rel=\"external_link\" target=\"_blank\">Arne \u00d6lander<\/a><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> first observed the property in gold-cadmium alloys. The same effect was observed in Cu-Zn (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Brass\" title=\"Brass\" rel=\"external_link\" target=\"_blank\">brass<\/a>) in the early 1950s.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Mechanism\">Mechanism<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Nitinol_Austenite_and_martensite.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/eb\/Nitinol_Austenite_and_martensite.jpg\/220px-Nitinol_Austenite_and_martensite.jpg\" width=\"220\" height=\"106\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Nitinol_Austenite_and_martensite.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>3D view of austenite and martensite structures of the NiTi compound.<\/div><\/div><\/div>\n<p>Nitinol's unusual properties are derived from a reversible solid-state phase transformation known as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Martensitic_transformation\" class=\"mw-redirect\" title=\"Martensitic transformation\" rel=\"external_link\" target=\"_blank\">martensitic transformation<\/a>, between two different martensite crystal phases, requiring 10,000\u201320,000 psi (69\u2013138 MPa) of mechanical stress.\n<\/p><p>At high temperatures, nitinol assumes an interpenetrating simple cubic structure referred to as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Austenite\" title=\"Austenite\" rel=\"external_link\" target=\"_blank\">austenite<\/a> (also known as the parent phase). At low temperatures, nitinol spontaneously transforms to a more complicated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monoclinic_crystal_structure\" class=\"mw-redirect\" title=\"Monoclinic crystal structure\" rel=\"external_link\" target=\"_blank\">monoclinic crystal structure<\/a> known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Martensite\" title=\"Martensite\" rel=\"external_link\" target=\"_blank\">martensite<\/a> (daughter phase).<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> There are four transition temperatures associated to the austenite-to-martensite and martensite-to-austenite transformations. Starting from full austenite, martensite begins to form as the alloy is cooled to the so-called <i>martensite start temperature<\/i>, or M<sub>s<\/sub>, and the temperature at which the transformation is complete is called the <i>martensite finish temperature<\/i>, or M<sub>f<\/sub>. When the alloy is fully martensite and is subjected to heating, austenite starts to form at the <i>austenite start temperature<\/i>, A<sub>s<\/sub>, and finishes at the <i>austenite finish temperature<\/i>, A<sub>f<\/sub>.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Nitinol_transformation_hysterisis.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Nitinol_transformation_hysterisis.svg\/220px-Nitinol_transformation_hysterisis.svg.png\" width=\"220\" height=\"234\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Nitinol_transformation_hysterisis.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Thermal hysteresis of nitinol's phase transformation<\/div><\/div><\/div><p>The cooling\/heating cycle shows thermal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hysteresis\" title=\"Hysteresis\" rel=\"external_link\" target=\"_blank\">hysteresis<\/a>. The hysteresis width depends on the precise nitinol composition and processing. Its typical value is a temperature range spanning about 20-50 K (20-50 \u00b0C; 36-90 \u00b0F) but it can be reduced or amplified by alloying<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> and processing.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>Crucial to nitinol properties are two key aspects of this phase transformation. First is that the transformation is \"reversible\", meaning that heating above the transformation temperature will revert the crystal structure to the simpler austenite phase. The second key point is that the transformation in both directions is instantaneous.\n<\/p><p>\nMartensite's crystal structure (known as a monoclinic, or B19' structure) has the unique ability to undergo limited deformation in some ways without breaking atomic bonds. This type of deformation is known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystal_twinning\" title=\"Crystal twinning\" rel=\"external_link\" target=\"_blank\">twinning<\/a>, which consists of the rearrangement of atomic planes without causing slip, or permanent deformation. It is able to undergo about 6\u20138% strain in this manner. When martensite is reverted to austenite by heating, the original austenitic structure is restored, regardless of whether the martensite phase was deformed. Thus the name \"shape memory\" refers to the fact that the shape of the high temperature austenite phase is \"remembered,\" even though the alloy is severely deformed at a lower temperature.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> <\/p><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:NiTi_structure_transformation.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/60\/NiTi_structure_transformation.jpg\/220px-NiTi_structure_transformation.jpg\" width=\"220\" height=\"174\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:NiTi_structure_transformation.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>2D view of nitinol's crystalline structure during cooling\/heating cycle<\/div><\/div><\/div>\n<p>A great deal of pressure can be produced by preventing the reversion of deformed martensite to austenite \u2014 from 35,000 psi to, in many cases, more than 100,000 psi (689 MPa). One of the reasons that nitinol works so hard to return to its original shape is that it is not just an ordinary metal alloy, but what is known as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intermetallic_compound\" class=\"mw-redirect\" title=\"Intermetallic compound\" rel=\"external_link\" target=\"_blank\">intermetallic compound<\/a>. In an ordinary alloy, the constituents are randomly positioned in the crystal lattice; in an ordered intermetallic compound, the atoms (in this case, nickel and titanium) have very specific locations in the lattice.<sup id=\"rdp-ebb-cite_ref-nitinol.com_13-0\" class=\"reference\"><a href=\"#cite_note-nitinol.com-13\" rel=\"external_link\">[13]<\/a><\/sup> The fact that nitinol is an intermetallic is largely responsible for the complexity in fabricating devices made from the alloy.<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Please_clarify\" title=\"Wikipedia:Please clarify\" rel=\"external_link\" target=\"_blank\"><span title=\"The reason for this is unclear. (January 2017)\">why?<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Nitinol_Ms_vs_Ni_content.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0f\/Nitinol_Ms_vs_Ni_content.jpg\/220px-Nitinol_Ms_vs_Ni_content.jpg\" width=\"220\" height=\"292\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Nitinol_Ms_vs_Ni_content.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The effect of nitinol composition on the M<sub>s<\/sub> temperature.<\/div><\/div><\/div>\n<p>The scenario described above (cooling austenite to form martensite, deforming the martensite, then heating to revert to austenite, thus returning the original, undeformed shape) is known as the thermal shape memory effect. To fix the original \"parent shape,\" the alloy must be held in position and heated to about 500 \u00b0C (932 \u00b0F). This process is usually called <i>shape setting<\/i>.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> A second effect, called superelasticity or pseudoelasticity, is also observed in nitinol. This effect is the direct result of the fact that martensite can be formed by applying a stress as well as by cooling. Thus in a certain temperature range, one can apply a stress to austenite, causing martensite to form while at the same time changing shape. In this case, as soon as the stress is removed, the nitinol will spontaneously return to its original shape. In this mode of use, nitinol behaves like a super spring, possessing an elastic range 10\u201330 times greater than that of a normal spring material. There are, however, constraints: the effect is only observed about 0-40 K (0-40 \u00b0C; 0-72 \u00b0F) above the A<sub>f<\/sub> temperature. This upper limit is referred to as M<sub>d<\/sub>,<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> which corresponds to the highest temperature in which it is still possible to stress-induce the formation of martensite. Below M<sub>d<\/sub>, martensite formation under load allows superelasticity due to twinning. Above M<sub>d<\/sub>, since martensite is no longer formed, the only response to stress is slip of the austenitic microstructure, and thus permanent deformation.\n<\/p><p>Nitinol is typically composed of approximately 50 to 51% nickel by atomic percent (55 to 56% weight percent).<sup id=\"rdp-ebb-cite_ref-nitinol.com_13-1\" class=\"reference\"><a href=\"#cite_note-nitinol.com-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> Making small changes in the composition can change the transition temperature of the alloy significantly. Transformation temperatures in nitinol can be controlled to some extent, where A<sub>f<\/sub> temperature ranges from about \u221220 \u00b0C to +110 \u00b0C. Thus, it is common practice to refer to a nitinol formulation as \"superelastic\" or \"austenitic\" if A<sub>f<\/sub> is lower than a reference temperature, while as \"shape memory\" or \"martensitic\" if higher. The reference temperature is usually defined as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Room_temperature\" title=\"Room temperature\" rel=\"external_link\" target=\"_blank\">room temperature<\/a> or the human body temperature (37 \u00b0C; 98 \u00b0F).\n<\/p><p>One often-encountered effect regarding nitinol is the so-called <a href=\"https:\/\/en.wikipedia.org\/wiki\/R-Phase\" title=\"R-Phase\" rel=\"external_link\" target=\"_blank\">R-phase<\/a>. The R-phase is another martensitic phase that competes with the martensite phase mentioned above. Because it does not offer the large memory effects of the martensite phase, it is usually of non practical use.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Manufacturing_process\">Manufacturing process<\/span><\/h2>\n<p>Nitinol is exceedingly difficult to make, due to the exceptionally tight compositional control required, and the tremendous reactivity of titanium. Every atom of titanium that combines with oxygen or carbon is an atom that is robbed from the NiTi lattice, thus shifting the composition and making the transformation temperature that much lower. There are two primary melting methods used today:\n<\/p>\n<dl><dt><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vacuum_arc_remelting\" title=\"Vacuum arc remelting\" rel=\"external_link\" target=\"_blank\">Vacuum arc remelting<\/a> (VAR)<\/dt>\n<dd>This is done by striking an electrical arc between the raw material and a water-cooled copper strike plate. Melting is done in a high vacuum, and the mold itself is water-cooled copper.<\/dd>\n<dt><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vacuum_induction_melting\" title=\"Vacuum induction melting\" rel=\"external_link\" target=\"_blank\">Vacuum induction melting<\/a> (VIM)<\/dt>\n<dd>This is done by using alternating magnetic fields to heat the raw materials in a crucible (generally carbon). This is also done in a high vacuum.<\/dd><\/dl>\n<p>While both methods have advantages, it has been demonstrated that an industrial state-of-the-art VIM melted material has smaller inclusions than an industrial state-of-the-art VAR one, leading to a higher fatigue resistance.<sup id=\"rdp-ebb-cite_ref-:0_17-0\" class=\"reference\"><a href=\"#cite_note-:0-17\" rel=\"external_link\">[17]<\/a><\/sup> Other research report that VAR employing extreme high-purity raw materials may lead to a reduced number of inclusions and thus to an improved fatigue behavior.<sup id=\"rdp-ebb-cite_ref-:1_18-0\" class=\"reference\"><a href=\"#cite_note-:1-18\" rel=\"external_link\">[18]<\/a><\/sup> Other methods are also used on a boutique scale, including plasma arc melting, induction skull melting, and e-beam melting. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_vapour_deposition\" class=\"mw-redirect\" title=\"Physical vapour deposition\" rel=\"external_link\" target=\"_blank\">Physical vapour deposition<\/a> is also used on a laboratory scale.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hot_working\" title=\"Hot working\" rel=\"external_link\" target=\"_blank\">Hot working<\/a> of nitinol is relatively easy, but <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cold_working\" class=\"mw-redirect\" title=\"Cold working\" rel=\"external_link\" target=\"_blank\">cold working<\/a> is difficult because the enormous elasticity of the alloy increases die or roll contact, leading to tremendous frictional resistance and tool wear. For similar reasons, machining is extremely difficult\u2014to make things worse, the thermal conductivity of nitinol is poor, so heat is difficult to remove. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grinding_(abrasive_cutting)\" title=\"Grinding (abrasive cutting)\" rel=\"external_link\" target=\"_blank\">Grinding (abrasive cutting)<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical_discharge_machining\" title=\"Electrical discharge machining\" rel=\"external_link\" target=\"_blank\">Electrical discharge machining<\/a> (EDM) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laser_cutting\" title=\"Laser cutting\" rel=\"external_link\" target=\"_blank\">laser cutting<\/a> are all relatively easy.\n<\/p><p>Heat treating nitinol is delicate and critical. It is a knowledge intensive process to fine-tune the transformation temperatures. Aging time and temperature controls the precipitation of various Ni-rich phases, and thus controls how much nickel resides in the NiTi lattice; by depleting the matrix of nickel, aging increases the transformation temperature. The combination of heat treatment and cold working is essential in controlling the properties of nitinol products.<sup id=\"rdp-ebb-cite_ref-Pelton_19-0\" class=\"reference\"><a href=\"#cite_note-Pelton-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Challenges\">Challenges<\/span><\/h2>\n<p>Fatigue failures of nitinol devices are a constant subject of discussion. Because it is the material of choice for applications requiring enormous flexibility and motion (e.g., peripheral stents, heart valves, smart thermomechanical actuators and electromechanical microactuators), it is necessarily exposed to much greater fatigue strains compared to other metals. While the strain-controlled fatigue performance of nitinol is superior to all other known metals, fatigue failures have been observed in the most demanding applications. There is a great deal of effort underway trying to better understand and define the durability limits of nitinol.\n<\/p><p>Nitinol is half nickel, and thus there has been a great deal of concern in the medical industry regarding the release of nickel, a known allergen and possible carcinogen.<sup id=\"rdp-ebb-cite_ref-Pelton_19-1\" class=\"reference\"><a href=\"#cite_note-Pelton-19\" rel=\"external_link\">[19]<\/a><\/sup> (Nickel is also present in substantial amounts in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a> and cobalt-chrome alloys.) When properly treated (via <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electropolishing\" title=\"Electropolishing\" rel=\"external_link\" target=\"_blank\">electropolishing<\/a> and\/or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Passivation_(chemistry)\" title=\"Passivation (chemistry)\" rel=\"external_link\" target=\"_blank\">passivation<\/a>), nitinol forms a very stable protective TiO<sub>2<\/sub> layer that acts as a very effective and self-healing barrier against ion exchange. It has been repeatedly shown that nitinol releases nickel at a slower pace than stainless steel, for example. With that said, very early medical devices were made without electropolishing, and corrosion was observed. Today's nitinol vascular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Self-expandable_metallic_stent\" title=\"Self-expandable metallic stent\" rel=\"external_link\" target=\"_blank\">self-expandable metallic stents<\/a>, for example, show no evidence of corrosion or nickel release, and the outcomes in patients with and without nickel allergies are indistinguishable.\n<\/p><p>There are constant and long-running discussions regarding inclusions in nitinol, both TiC and Ti<sub>2<\/sub>NiO<sub>x<\/sub>. As in all other metals and alloys, inclusions can be found in Nitinol. The size, distribution and type of inclusions can be controlled to some extent. Theoretically, smaller, rounder and few inclusions should lead to increased fatigue durability. In literature, some early works report to have failed to show measurable differences,<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> while novel studies demonstrate a dependence of fatigue resistance on the typical inclusion size in an alloy.<sup id=\"rdp-ebb-cite_ref-:0_17-1\" class=\"reference\"><a href=\"#cite_note-:0-17\" rel=\"external_link\">[17]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-:1_18-1\" class=\"reference\"><a href=\"#cite_note-:1-18\" rel=\"external_link\">[18]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p><p>Nitinol is difficult to weld, both to itself and other materials. Laser welding nitinol to itself is a relatively routine process. More recently, strong joints between NiTi wires and stainless steel wires have been made using nickel filler.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> Laser<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> and Tungsten Inert Gas (TIG)<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> welds have been made between NiTi tubes and stainless steel tubes . More research is ongoing into other processes and other metals to which nitinol can be welded.\n<\/p><p>Actuation frequency of nitinol is dependent on the heat management, especially during the cooling phase. Numerous methods are used to increase the cooling performance, such as forced air,<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> flowing liquids,<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> thermoelectric modules (i.e. Peltier or semiconductor heat pumps),<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup> heat sinks,<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> conductive materials<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> and higher surface-to-volume ratio<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup> (improvements up to 3.3 Hz with very thin wires<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup> and up to 100 Hz with thinfilm nitinol<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup>). The fastest nitinol actuation recorded was carried by a high voltage capacitor discharge which heated an SMA wire in a manner of microseconds, and resulted in a complete phase transformation (and high velocities) in a few milliseconds.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup>\n<\/p><p>Recent advances have shown that processing of nitinol can expand thermomechanical capabilities, allowing for multiple shape memories to be embedded within a monolithic structure.<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup> Research on multi-memory technology is on-going and promises to deliver enhanced shape memory devices in the near future<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup>\n<p>,<sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup> and the application of new materials and material structures, such hybrid shape memory materials (SMMs) and shape memory composites (SMCs).<sup id=\"rdp-ebb-cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/p>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>There are four commonly used types of applications for nitinol:\n<\/p><p><b>Free recovery<\/b>\n<\/p>\n<dl><dd>Nitinol is deformed at a low temperature, and heated to recover its original shape through the Shape Memory effect.<\/dd><\/dl>\n<p><b>Constrained recovery<\/b>\n<\/p>\n<dl><dd>As for free recovery, except that recovery is rigidly prevented and thus a stress is generated.<\/dd><\/dl>\n<p><b>Work production<\/b>\n<\/p>\n<dl><dd>Here the alloy is allowed to recover, but to do so it must act against a force (thus doing work).<\/dd><\/dl>\n<p><b>Superelasticity<\/b>\n<\/p>\n<dl><dd>Nitinol acts as a super spring through the Superelastic effect.<\/dd>\n<dd><\/dd><\/dl>\n<p>In 1989 a survey was conducted in the United States and Canada that involved seven organizations. The survey focused on predicting the future technology, market, and applications of SMAs. The companies predicted the following uses of nitinol in a decreasing order of importance: (1) Couplings, (2) Biomedical and medical, (3) Toys, demonstration, novelty items, (4) Actuators, (5) Heat Engines, (6) Sensors, (7) Cryogenically activated die and bubble memory sockets, and finally (8) lifting devices.<sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup>\n<\/p><p>Today, nitinol finds application in the listed industrial applications:\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Thermal_and_electrical_actuators\">Thermal and electrical actuators<\/span><\/h3>\n<ul><li>Nitinol can be used to replace conventional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Actuator\" title=\"Actuator\" rel=\"external_link\" target=\"_blank\">actuators<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Solenoid\" title=\"Solenoid\" rel=\"external_link\" target=\"_blank\">solenoids<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Servo_motor\" class=\"mw-redirect\" title=\"Servo motor\" rel=\"external_link\" target=\"_blank\">servo motors<\/a>, etc.), such as in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stiquito\" title=\"Stiquito\" rel=\"external_link\" target=\"_blank\">Stiquito<\/a>, a simple <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hexapod_(robotics)\" title=\"Hexapod (robotics)\" rel=\"external_link\" target=\"_blank\">hexapod<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robot\" title=\"Robot\" rel=\"external_link\" target=\"_blank\">robot<\/a>.<\/li>\n<li>Nitinol springs are used in thermal valves for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluidics\" title=\"Fluidics\" rel=\"external_link\" target=\"_blank\">fluidics<\/a>, where the material both acts as a temperature sensor and an actuator.<\/li>\n<li>It is used as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autofocus\" title=\"Autofocus\" rel=\"external_link\" target=\"_blank\">autofocus<\/a> actuator in action cameras and as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Image_stabilization\" title=\"Image stabilization\" rel=\"external_link\" target=\"_blank\">Optical Image Stabilizer<\/a> in mobile phones.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup><\/li>\n<li>It is used in pneumatic valves for comfort seating and has become an industry standard.<\/li>\n<li>The 2014 Chevrolet Corvette incorporates nitinol actuators, which replaced heavier motorized actuators to open and close the hatch vent that releases air from the trunk, making it easier to close.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Biocompatible_and_biomedical_applications\">Biocompatible and biomedical applications<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nitinol_biocompatibility\" title=\"Nitinol biocompatibility\" rel=\"external_link\" target=\"_blank\">Nitinol biocompatibility<\/a><\/div>\n<ul><li>Nitinol is highly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatible<\/a> and has properties suitable for use in orthopedic implants. Due to Nitinol's unique properties it has seen a large demand for use in less invasive medical devices. Nitinol tubing is commonly used in catheters, stents, and superelastic needles.<\/li>\n<li>In colorectal surgery <a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.nitisurgical.com\/patient_education.htm\" target=\"_blank\">[1]<\/a>, the material is used in devices for reconnecting the intestine after removing the pathology.<\/li>\n<li>Nitinol is used for devices developed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Franz_Freudenthal\" title=\"Franz Freudenthal\" rel=\"external_link\" target=\"_blank\">Franz Freudenthal<\/a> to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patent_ductus_arteriosus\" title=\"Patent ductus arteriosus\" rel=\"external_link\" target=\"_blank\">Patent ductus arteriosus<\/a>, blocking a blood vessel that bypasses the lungs and has failed to close after birth in an infant.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup><\/li>\n<li>In dentistry, the material is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthodontics\" title=\"Orthodontics\" rel=\"external_link\" target=\"_blank\">orthodontics<\/a> for brackets and wires connecting the teeth. Once the SMA wire is placed in the mouth its temperature rises to ambient body temperature. This causes the nitinol to contract back to its original shape, applying a constant force to move the teeth. These SMA wires do not need to be retightened as often as other wires because they can contract as the teeth move unlike conventional stainless steel wires. Additionally, nitinol can be used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endodontics\" title=\"Endodontics\" rel=\"external_link\" target=\"_blank\">endodontics<\/a>, where nitinol files are used to clean and shape the root canals during the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Root_canal\" title=\"Root canal\" rel=\"external_link\" target=\"_blank\">root canal<\/a> procedure. Because of the high fatigue tolerance and flexibility of nitinol, it greatly decreases the possibility of an endodontic file breaking inside the tooth during root canal treatment, thus improving safety for the patient.<\/li>\n<li>Another significant application of nitinol in medicine is in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stents<\/a>: a collapsed stent can be inserted into an artery or vein, where body temperature warms the stent and the stent returns to its original expanded shape following removal of a constraining sheath; the stent then helps support the artery or vein to improve blood flow. It is also used as a replacement for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" title=\"Surgical suture\" rel=\"external_link\" target=\"_blank\">sutures<\/a> - nitinol wire can be woven through two structures then allowed to transform into its preformed shape, which should hold the structures in place.<\/li>\n<li>Similarly, collapsible structures composed of braided, microscopically-thin nitinol filaments can be used in neurovascular interventions such as stroke thrombolysis, embolization, and intracranial angioplasty.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup><\/li>\n<li>A more recent application of nitinol wire is in female contraception, specifically in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intrauterine_device\" title=\"Intrauterine device\" rel=\"external_link\" target=\"_blank\">intrauterine devices<\/a>.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Damping_systems_in_structural_engineering\">Damping systems in structural engineering<\/span><\/h3>\n<ul><li>Superelastic Nitinol finds a variety of applications in civil structures such as bridges and buildings. One such application is Intelligent Reinforced Concrete (IRC), which incorporates Ni-Ti wires embedded within the concrete. These wires can sense cracks and contract to heal macro-sized cracks.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup><\/li>\n<li>Another application is active tuning of structural natural frequency using Nitinol wires to dampen vibrations.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Other_applications_and_prototypes\">Other applications and prototypes<\/span><\/h3>\n<ul><li>Demonstration model <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heat_engine\" title=\"Heat engine\" rel=\"external_link\" target=\"_blank\">heat engines<\/a> have been built which use nitinol wire to produce mechanical energy from hot and cold heat sources.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup> A prototype commercial engine developed in the 1970s by engineer Ridgway Banks at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lawrence_Berkeley_National_Laboratory\" title=\"Lawrence Berkeley National Laboratory\" rel=\"external_link\" target=\"_blank\">Lawrence Berkeley National Laboratory<\/a>, was named the Banks Engine.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup><\/li>\n<li>Nitinol is also popular in extremely resilient glasses frames.<sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup> It is also used in some mechanical watch springs.<\/li>\n<li>Boeing engineers successfully flight-tested SMA-actuated morphing chevrons on the Boeing 777-300ER <a href=\"https:\/\/en.wikipedia.org\/wiki\/EcoDemonstrator\" title=\"EcoDemonstrator\" rel=\"external_link\" target=\"_blank\">Quiet Technology Demonstrator 2<\/a>.<sup id=\"rdp-ebb-cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\" rel=\"external_link\">[54]<\/a><\/sup><\/li>\n<li>It can be used as a temperature control system; as it changes shape, it can activate a switch or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Variable_resistor\" class=\"mw-redirect\" title=\"Variable resistor\" rel=\"external_link\" target=\"_blank\">variable resistor<\/a> to control the temperature.<\/li>\n<li>It has been used in cell-phone technology as a retractable antenna, or microphone boom, due to its highly flexible and mechanical memory nature.<\/li>\n<li>It is used to made certain surgical implants, such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/SmartToe\" class=\"mw-redirect\" title=\"SmartToe\" rel=\"external_link\" target=\"_blank\">SmartToe<\/a>.<\/li>\n<li>It is used in some novelty products, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spoon_bending\" title=\"Spoon bending\" rel=\"external_link\" target=\"_blank\">self-bending spoons<\/a> which can be used by amateur and stage magicians to demonstrate \"psychic\" powers or as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Practical_joke\" title=\"Practical joke\" rel=\"external_link\" target=\"_blank\">practical joke<\/a>, as the spoon will bend itself when used to stir tea, coffee, or any other warm liquid.<\/li>\n<li>It can also be used as wires which are used to locate and mark breast tumours so that the following surgery can be more exact.<\/li>\n<li>Due to the high damping capacity of Superelastic nitinol, it is also used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Golf_club_(equipment)\" class=\"mw-redirect\" title=\"Golf club (equipment)\" rel=\"external_link\" target=\"_blank\">golf club<\/a> insert.<sup id=\"rdp-ebb-cite_ref-55\" class=\"reference\"><a href=\"#cite_note-55\" rel=\"external_link\">[55]<\/a><\/sup><\/li>\n<li>Nickel titanium can be used to make the underwires for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Underwire_bra\" title=\"Underwire bra\" rel=\"external_link\" target=\"_blank\">underwire bras<\/a>.<sup id=\"rdp-ebb-cite_ref-Brady_56-0\" class=\"reference\"><a href=\"#cite_note-Brady-56\" rel=\"external_link\">[56]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Sang_57-0\" class=\"reference\"><a href=\"#cite_note-Sang-57\" rel=\"external_link\">[57]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-GailJones_58-0\" class=\"reference\"><a href=\"#cite_note-GailJones-58\" rel=\"external_link\">[58]<\/a><\/sup><\/li>\n<li>It is used in some actuation-bending devices, such as those developed by Finnish technology company <a href=\"https:\/\/en.wikipedia.org\/wiki\/Modti_inc.\" title=\"Modti inc.\" rel=\"external_link\" target=\"_blank\">Modti Inc<\/a>.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Buehler, W. J.; Gilfrich, J. W.; Wiley, R. C. (1963). \"Effects of Low-Temperature Phase Changes on the Mechanical Properties of Alloys Near Composition TiNi\". <i>Journal of Applied Physics<\/i>. <b>34<\/b> (5): 1475\u20131477. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1063%2F1.1729603\" target=\"_blank\">10.1063\/1.1729603<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Applied+Physics&rft.atitle=Effects+of+Low-Temperature+Phase+Changes+on+the+Mechanical+Properties+of+Alloys+Near+Composition+TiNi&rft.volume=34&rft.issue=5&rft.pages=1475-1477&rft.date=1963&rft_id=info%3Adoi%2F10.1063%2F1.1729603&rft.au=Buehler%2C+W.+J.&rft.au=Gilfrich%2C+J.+W.&rft.au=Wiley%2C+R.+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wang, F. E.; Buehler, W. J.; Pickart, S. J. 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Royal Society of Chemistry<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">29 January<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Chemistry+World&rft.atitle=Nitinol&rft.aulast=Withers&rft.aufirst=Neil&rft_id=https%3A%2F%2Fwww.chemistryworld.com%2Fpodcasts%2Fnitinol%2F6710.article&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">\u00d6lander, A. 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Nitinol.com. 2013.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Nitinol+facts&rft.pub=Nitinol.com&rft.date=2013&rft_id=http%3A%2F%2Fwww.nitinol.com%2Fnitinol-university%2Fnitinol-facts%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chluba, Christoph; Ge, Wenwei; Miranda, Rodrigo Lima de; Strobel, Julian; Kienle, Lorenz; Quandt, Eckhard; Wuttig, Manfred (2015-05-29). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/science.sciencemag.org\/content\/348\/6238\/1004\" target=\"_blank\">\"Ultralow-fatigue shape memory alloy films\"<\/a>. <i>Science<\/i>. <b>348<\/b> (6238): 1004\u20131007. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2015Sci...348.1004C\" target=\"_blank\">2015Sci...348.1004C<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1126%2Fscience.1261164\" target=\"_blank\">10.1126\/science.1261164<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0036-8075\" target=\"_blank\">0036-8075<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26023135\" target=\"_blank\">26023135<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Science&rft.atitle=Ultralow-fatigue+shape+memory+alloy+films&rft.volume=348&rft.issue=6238&rft.pages=1004-1007&rft.date=2015-05-29&rft_id=info%3Adoi%2F10.1126%2Fscience.1261164&rft.issn=0036-8075&rft_id=info%3Apmid%2F26023135&rft_id=info%3Abibcode%2F2015Sci...348.1004C&rft.aulast=Chluba&rft.aufirst=Christoph&rft.au=Ge%2C+Wenwei&rft.au=Miranda%2C+Rodrigo+Lima+de&rft.au=Strobel%2C+Julian&rft.au=Kienle%2C+Lorenz&rft.au=Quandt%2C+Eckhard&rft.au=Wuttig%2C+Manfred&rft_id=http%3A%2F%2Fscience.sciencemag.org%2Fcontent%2F348%2F6238%2F1004&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Spini, Tatiana Sobottka; Valarelli, Fabr\u00edcio Pinelli; Can\u00e7ado, Rodrigo Hermont; Freitas, Karina Maria Salvatore de; Villarinho, Denis Jardim; Spini, Tatiana Sobottka; Valarelli, Fabr\u00edcio Pinelli; Can\u00e7ado, Rodrigo Hermont; Freitas, Karina Maria Salvatore de (2014-04-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.scielo.br\/scielo.php?script=sci_abstract&pid=S1678-77572014000200109&lng=en&nrm=iso&tlng=en\" target=\"_blank\">\"Transition temperature range of thermally activated nickel-titanium archwires\"<\/a>. <i>Journal of Applied Oral Science<\/i>. <b>22<\/b> (2): 109\u2013117. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1590%2F1678-775720130133\" target=\"_blank\">10.1590\/1678-775720130133<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1678-7757\" target=\"_blank\">1678-7757<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3956402\" target=\"_blank\">3956402<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24676581\" target=\"_blank\">24676581<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Applied+Oral+Science&rft.atitle=Transition+temperature+range+of+thermally+activated+nickel-titanium+archwires&rft.volume=22&rft.issue=2&rft.pages=109-117&rft.date=2014-04-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3956402&rft.issn=1678-7757&rft_id=info%3Apmid%2F24676581&rft_id=info%3Adoi%2F10.1590%2F1678-775720130133&rft.aulast=Spini&rft.aufirst=Tatiana+Sobottka&rft.au=Valarelli%2C+Fabr%C3%ADcio+Pinelli&rft.au=Can%C3%A7ado%2C+Rodrigo+Hermont&rft.au=Freitas%2C+Karina+Maria+Salvatore+de&rft.au=Villarinho%2C+Denis+Jardim&rft.au=Spini%2C+Tatiana+Sobottka&rft.au=Valarelli%2C+Fabr%C3%ADcio+Pinelli&rft.au=Can%C3%A7ado%2C+Rodrigo+Hermont&rft.au=Freitas%2C+Karina+Maria+Salvatore+de&rft_id=http%3A%2F%2Fwww.scielo.br%2Fscielo.php%3Fscript%3Dsci_abstract%26pid%3DS1678-77572014000200109%26lng%3Den%26nrm%3Diso%26tlng%3Den&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFFunakubo1984\" class=\"citation\">Funakubo, Hiroyasu (1984), <i>Shape memory alloys<\/i>, University of Tokyo, pp. 7, 176<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Shape+memory+alloys&rft.pages=7%2C+176&rft.pub=University+of+Tokyo&rft.date=1984&rft.aulast=Funakubo&rft.aufirst=Hiroyasu&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>.<\/span>\n<\/li>\n<li id=\"cite_note-nitinol.com-13\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-nitinol.com_13-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-nitinol.com_13-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110714184605\/http:\/\/www.nitinol.com\/media\/files\/material-properties-pdfs\/sm495_wire_data%20%5BConverted%5D_v2.pdf\" target=\"_blank\">\"Nitinol SM495 Wire\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. 2013. 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Retrieved <span class=\"nowrap\">2017-03-28<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=memry.com&rft.atitle=Fabrication+%26+Heat+Treatment+of+Nitinol&rft.date=2011-01-26&rft_id=http%3A%2F%2Fmemry.com%2Fnitinol-iq%2Fnitinol-fundamentals%2Ffabrication-heat-treatment&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">R Meling, Torstein; \u00d8degaard, Jan (August 1998). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.angle.org\/doi\/10.1043\/0003-3219(1998)068%3C0357:TEOTOT%3E2.3.CO;2?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed&code=angf-site\" target=\"_blank\">\"The effect of temperature on the elastic responses to longitudinal torsion of rectangular nickel titanium archwires\"<\/a>. <i>The Angle Orthodontist<\/i>. <b>68<\/b> (4): 357\u2013368. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1043%2F0003-3219%281998%29068%3C0357%3ATEOTOT%3E2.3.CO%3B2\" target=\"_blank\">10.1043\/0003-3219(1998)068<0357:TEOTOT>2.3.CO;2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9709837\" target=\"_blank\">9709837<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Angle+Orthodontist&rft.atitle=The+effect+of+temperature+on+the+elastic+responses+to+longitudinal+torsion+of+rectangular+nickel+titanium+archwires&rft.volume=68&rft.issue=4&rft.pages=357-368&rft.date=1998-08&rft_id=info%3Adoi%2F10.1043%2F0003-3219%281998%29068%3C0357%3ATEOTOT%3E2.3.CO%3B2&rft_id=info%3Apmid%2F9709837&rft.aulast=R+Meling&rft.aufirst=Torstein&rft.au=%C3%98degaard%2C+Jan&rft_id=http%3A%2F%2Fwww.angle.org%2Fdoi%2F10.1043%2F0003-3219%281998%29068%253C0357%3ATEOTOT%253E2.3.CO%3B2%3Furl_ver%3DZ39.88-2003%26rfr_id%3Dori%3Arid%3Acrossref.org%26rfr_dat%3Dcr_pub%253dpubmed%26code%3Dangf-site&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110714184648\/http:\/\/www.nitinol.com\/media\/files\/material-properties-pdfs\/se508_wire_data%20%5BConverted%5D_v2.pdf\" target=\"_blank\">\"Nitinol SE508 Wire\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. 2013. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nitinol.com\/media\/files\/material-properties-pdfs\/se508_wire_data%20%5BConverted%5D_v2.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(properties, PDF)<\/span> on 2011-07-14.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Nitinol+SE508+Wire&rft.date=2013&rft_id=http%3A%2F%2Fwww.nitinol.com%2Fmedia%2Ffiles%2Fmaterial-properties-pdfs%2Fse508_wire_data%2520%255BConverted%255D_v2.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:0-17\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_17-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_17-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Urbano, Marco; Coda, Alberto; Beretta, Stefano; Cadelli, Andrea; Sczerzenie, Frank (2013-09-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.astm.org\/DIGITAL_LIBRARY\/STP\/PAGES\/STP155920120189.htm\" target=\"_blank\">\"The Effect of Inclusions on Fatigue Properties for Nitinol\"<\/a>. <i>Fatigue and Fracture Metallic Medical Materials and Devices<\/i>: 18\u201334. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1520%2FSTP155920120189\" target=\"_blank\">10.1520\/STP155920120189<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Fatigue+and+Fracture+Metallic+Medical+Materials+and+Devices&rft.atitle=The+Effect+of+Inclusions+on+Fatigue+Properties+for+Nitinol&rft.pages=18-34&rft.date=2013-09-01&rft_id=info%3Adoi%2F10.1520%2FSTP155920120189&rft.aulast=Urbano&rft.aufirst=Marco&rft.au=Coda%2C+Alberto&rft.au=Beretta%2C+Stefano&rft.au=Cadelli%2C+Andrea&rft.au=Sczerzenie%2C+Frank&rft_id=https%3A%2F%2Fwww.astm.org%2FDIGITAL_LIBRARY%2FSTP%2FPAGES%2FSTP155920120189.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:1-18\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:1_18-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_18-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Robertson, Scott W.; Launey, Maximilien; Shelley, Oren; Ong, Ich; Vien, Lot; Senthilnathan, Karthike; Saffari, Payman; Schlegel, Scott; Pelton, Alan R. (2015-11-01). \"A statistical approach to understand the role of inclusions on the fatigue resistance of superelastic Nitinol wire and tubing\". <i>Journal of the Mechanical Behavior of Biomedical Materials<\/i>. <b>51<\/b>: 119\u2013131. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jmbbm.2015.07.003\" target=\"_blank\">10.1016\/j.jmbbm.2015.07.003<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1878-0180\" target=\"_blank\">1878-0180<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26241890\" target=\"_blank\">26241890<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+Mechanical+Behavior+of+Biomedical+Materials&rft.atitle=A+statistical+approach+to+understand+the+role+of+inclusions+on+the+fatigue+resistance+of+superelastic+Nitinol+wire+and+tubing&rft.volume=51&rft.pages=119-131&rft.date=2015-11-01&rft.issn=1878-0180&rft_id=info%3Apmid%2F26241890&rft_id=info%3Adoi%2F10.1016%2Fj.jmbbm.2015.07.003&rft.aulast=Robertson&rft.aufirst=Scott+W.&rft.au=Launey%2C+Maximilien&rft.au=Shelley%2C+Oren&rft.au=Ong%2C+Ich&rft.au=Vien%2C+Lot&rft.au=Senthilnathan%2C+Karthike&rft.au=Saffari%2C+Payman&rft.au=Schlegel%2C+Scott&rft.au=Pelton%2C+Alan+R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Pelton-19\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Pelton_19-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Pelton_19-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pelton, A.; Russell, S.; DiCello, J. (2003). <a rel=\"external_link\" class=\"external text\" href=\"#page-1\">\"The Physical Metallurgy of Nitinol for Medical Applications\"<\/a>. <i>JOM<\/i>. <b>55<\/b> (5): 33\u201337. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11837-003-0243-3\" target=\"_blank\">10.1007\/s11837-003-0243-3<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JOM&rft.atitle=The+Physical+Metallurgy+of+Nitinol+for+Medical+Applications&rft.volume=55&rft.issue=5&rft.pages=33-37&rft.date=2003&rft_id=info%3Adoi%2F10.1007%2Fs11837-003-0243-3&rft.au=Pelton%2C+A.&rft.au=Russell%2C+S.&rft.au=DiCello%2C+J.&rft_id=https%3A%2F%2Flink.springer.com%2Farticle%2F10.1007%252Fs11837-003-0243-3%23page-1&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Morgan, N.; Wick, A.; DiCello, J.; Graham, R. (2006). \"Carbon and Oxygen Levels in Nitinol Alloys and the Implications for Medical Device Manufacture and Durability\". <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nitinol.com\/media\/reference-library\/151_Morgan_Wick_DiCello_Graham_2008.pdf\" target=\"_blank\"><i>SMST-2006 Proceedings of the International Conference on Shape Memory and Superelastic Technologies<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. ASM International. pp. 821\u2013828. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1361%2Fcp2006smst821\" target=\"_blank\">10.1361\/cp2006smst821<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-87170-862-5. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Library_of_Congress_Control_Number\" title=\"Library of Congress Control Number\" rel=\"external_link\" target=\"_blank\">LCCN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/lccn.loc.gov\/2009499204\" target=\"_blank\">2009499204<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Carbon+and+Oxygen+Levels+in+Nitinol+Alloys+and+the+Implications+for+Medical+Device+Manufacture+and+Durability&rft.btitle=SMST-2006+Proceedings+of+the+International+Conference+on+Shape+Memory+and+Superelastic+Technologies&rft.pages=821-828&rft.pub=ASM+International&rft.date=2006&rft_id=info%3Alccn%2F2009499204&rft_id=info%3Adoi%2F10.1361%2Fcp2006smst821&rft.isbn=978-0-87170-862-5&rft.au=Morgan%2C+N.&rft.au=Wick%2C+A.&rft.au=DiCello%2C+J.&rft.au=Graham%2C+R.&rft_id=http%3A%2F%2Fwww.nitinol.com%2Fmedia%2Freference-library%2F151_Morgan_Wick_DiCello_Graham_2008.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Miyazaki, S.; Sugaya, Y.; Otsuka, K. (1989). \"Mechanism of Fatigue Crack Nucleation in Ti-Ni Alloys\". <i>Shape memory materials : May 31-June 3, 1988, Sunshine City, Ikebukuro, Tokyo, Japan<\/i>. Proceedings of the MRS International Meeting on Advanced Materials. <b>9<\/b>. Materials Research Society. pp. 257\u2013262. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-55899-038-0. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Library_of_Congress_Control_Number\" title=\"Library of Congress Control Number\" rel=\"external_link\" target=\"_blank\">LCCN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/lccn.loc.gov\/90174266\" target=\"_blank\">90174266<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Mechanism+of+Fatigue+Crack+Nucleation+in+Ti-Ni+Alloys&rft.btitle=Shape+memory+materials+%3A+May+31-June+3%2C+1988%2C+Sunshine+City%2C+Ikebukuro%2C+Tokyo%2C+Japan&rft.series=Proceedings+of+the+MRS+International+Meeting+on+Advanced+Materials&rft.pages=257-262&rft.pub=Materials+Research+Society&rft.date=1989&rft_id=info%3Alccn%2F90174266&rft.isbn=1-55899-038-0&rft.au=Miyazaki%2C+S.&rft.au=Sugaya%2C+Y.&rft.au=Otsuka%2C+K.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.asminternational.org\/conferences\/resources\/conference-proceedings?p_p_auth=JbQd1FjJ&p_p_id=101&p_p_lifecycle=0&p_p_state=maximized&_101_struts_action=\/asset_publisher\/view_content&_101_assetEntryId=5918779&_101_type=content&_101_groupId=10192&_101_urlTitle=the-influence-of-microcleanliness-on-the-fatigue-performance-of-nitinol\" target=\"_blank\">\"The Influence of Microcleanliness on the Fatigue Performance of Nitinol - Conference Proceedings - ASM International\"<\/a>. <i>www.asminternational.org<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-04-05<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.asminternational.org&rft.atitle=The+Influence+of+Microcleanliness+on+the+Fatigue+Performance+of+Nitinol+-+Conference+Proceedings+-+ASM+International&rft_id=http%3A%2F%2Fwww.asminternational.org%2Fconferences%2Fresources%2Fconference-proceedings%3Fp_p_auth%3DJbQd1FjJ%26p_p_id%3D101%26p_p_lifecycle%3D0%26p_p_state%3Dmaximized%26_101_struts_action%3D%2Fasset_publisher%2Fview_content%26_101_assetEntryId%3D5918779%26_101_type%3Dcontent%26_101_groupId%3D10192%26_101_urlTitle%3Dthe-influence-of-microcleanliness-on-the-fatigue-performance-of-nitinol&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.researchgate.net\/publication\/225396994_Smartflex_NiTi_Wires_for_Shape_Memory_Actuators\" target=\"_blank\">\"Academic paper (PDF): Smartflex NiTi Wires for Shape Memory Actuators\"<\/a>. <i>ResearchGate<\/i><span class=\"reference-accessdate\">. 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(2012), \"Dynamic actuation of a novel laser-processed NiTi linear actuator\", <i>Smart Materials and Structures<\/i>, <b>21<\/b> (9): 094004, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2012SMaS...21i4004P\" target=\"_blank\">2012SMaS...21i4004P<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1088%2F0964-1726%2F21%2F9%2F094004\" target=\"_blank\">10.1088\/0964-1726\/21\/9\/094004<\/a><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Smart+Materials+and+Structures&rft.atitle=Dynamic+actuation+of+a+novel+laser-processed+NiTi+linear+actuator&rft.volume=21&rft.issue=9&rft.pages=094004&rft.date=2012&rft_id=info%3Adoi%2F10.1088%2F0964-1726%2F21%2F9%2F094004&rft_id=info%3Abibcode%2F2012SMaS...21i4004P&rft.au=Pequegnat%2C+A.&rft.au=Daly%2C+M.&rft.au=Wang%2C+J.&rft.au=Zhou%2C+Y.&rft.au=Khan%2C+M.+I.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-41\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-41\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tao T, Liang YC, Taya M (2006). \"Bio-inspired actuating system for swimming using shape memory alloy composites\". <i>Int J Automat Comput<\/i>. 3page=366-373.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Int+J+Automat+Comput&rft.atitle=Bio-inspired+actuating+system+for+swimming+using+shape+memory+alloy+composites&rft.volume=3page%3D366-373&rft.date=2006&rft.aulast=Tao&rft.aufirst=T&rft.au=Liang%2C+YC&rft.au=Taya%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-42\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-42\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Miller, R. 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Future Technology Surveys. p. 17. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781558651005. <a href=\"https:\/\/en.wikipedia.org\/wiki\/OCLC\" title=\"OCLC\" rel=\"external_link\" target=\"_blank\">OCLC<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/oclc\/38076438\" target=\"_blank\">38076438<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Survey+on+Shape+Memory+Alloys&rft.series=Survey+Reports&rft.pages=17&rft.pub=Future+Technology+Surveys&rft.date=1989&rft_id=info%3Aoclcnum%2F38076438&rft.isbn=9781558651005&rft.au=Miller%2C+R.+K.&rft.au=Walker%2C+T.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-43\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-43\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFActuator_Solutions2015\" class=\"citation\">Actuator Solutions (2015-12-18), <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=orlrmErs9cU\" target=\"_blank\"><i>SMA AF \/ OIS Mechanism<\/i><\/a><span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">2017-04-05<\/span><\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=SMA+AF+%2F+OIS+Mechanism&rft.date=2015-12-18&rft.au=Actuator+Solutions&rft_id=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DorlrmErs9cU&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-44\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-44\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFAlejandra_Martins2014\" class=\"citation journal\">Alejandra Martins (2014-10-02). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bbc.co.uk\/mundo\/noticias\/2014\/10\/141002_medico_boliviano_corazon_am\" target=\"_blank\">\"The inventions of the Bolivian doctor who saved thousands of children\"<\/a>. <i>BBC Mundo<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-03-30<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BBC+Mundo&rft.atitle=The+inventions+of+the+Bolivian+doctor+who+saved+thousands+of+children&rft.date=2014-10-02&rft.au=Alejandra+Martins&rft_id=http%3A%2F%2Fwww.bbc.co.uk%2Fmundo%2Fnoticias%2F2014%2F10%2F141002_medico_boliviano_corazon_am&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-45\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-45\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Smith, Keith. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.usbiodesign.com\/biomedical-textile-specialties\/neurovascular\" target=\"_blank\">\"Nitinol Micro-Braids for Neurovascular Interventions\"<\/a>. <i>US BioDesign<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=US+BioDesign&rft.atitle=Nitinol+Micro-Braids+for+Neurovascular+Interventions&rft.aulast=Smith&rft.aufirst=Keith&rft_id=http%3A%2F%2Fwww.usbiodesign.com%2Fbiomedical-textile-specialties%2Fneurovascular&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-46\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-46\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www-2.unipv.it\/compmech\/publications\/2014_3b.pdf\" target=\"_blank\"><i>Shape Memory Alloy Engineering<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. 2014. pp. 369\u2013401. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781322158457.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Shape+Memory+Alloy+Engineering&rft.pages=369-401&rft.date=2014&rft.isbn=9781322158457&rft_id=http%3A%2F%2Fwww-2.unipv.it%2Fcompmech%2Fpublications%2F2014_3b.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-47\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-47\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.imagesco.com\/nitinol\/heat-engine.html\" target=\"_blank\">\"Nitinol Heat Engine Kit\"<\/a>. Images Scientific Instruments. 2007<span class=\"reference-accessdate\">. Retrieved 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Nitinol+Heat+Engine+Kit&rft.pub=Images+Scientific+Instruments&rft.date=2007&rft_id=http%3A%2F%2Fwww.imagesco.com%2Fnitinol%2Fheat-engine.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span> <span class=\"cs1-visible-error error citation-comment\">Check date values in: <code class=\"cs1-code\">|accessdate=<\/code> (<a href=\"#bad_date\" title=\"Help:CS1 errors\" rel=\"external_link\">help<\/a>)<\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-48\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-48\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Banks, R. (1975). \"The Banks Engine\". <i>Die Naturwissenschaften<\/i>. <b>62<\/b> (7): 305\u2013308. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/1975NW.....62..305B\" target=\"_blank\">1975NW.....62..305B<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2FBF00608890\" target=\"_blank\">10.1007\/BF00608890<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Die+Naturwissenschaften&rft.atitle=The+Banks+Engine&rft.volume=62&rft.issue=7&rft.pages=305-308&rft.date=1975&rft_id=info%3Adoi%2F10.1007%2FBF00608890&rft_id=info%3Abibcode%2F1975NW.....62..305B&rft.au=Banks%2C+R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-49\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-49\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/vimeo.com\/45924783\" target=\"_blank\">Vimeo posting of \"The Individualist\", documentary on Ridgway Banks<\/a><\/span>\n<\/li>\n<li id=\"cite_note-50\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-50\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.google.com\/patents\/US4450686\" target=\"_blank\">\"Single wire nitinol engine\", Ridgway M. Banks, US Patent<\/a><\/span>\n<\/li>\n<li id=\"cite_note-51\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-51\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=%22ridgway%20banks%22%20nitinol&f=false\">\"Metals that Remember\", <i>Popular Science<\/i>, January 1988<\/a><\/span>\n<\/li>\n<li id=\"cite_note-52\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-52\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/news.google.com\/newspapers?nid=1499&dat=19731205&id=KU41AAAAIBAJ&sjid=hn4EAAAAIBAJ&pg=6746,4624661\" target=\"_blank\">\"Engine Uses No Fuel\", <i>Milwaukee Journal<\/i>, December 5, 1973<\/a><\/span>\n<\/li>\n<li id=\"cite_note-53\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-53\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFHero_Khan2013\" class=\"citation\">Hero Khan (2013-11-01), <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=XPrg8EZlD1E\" target=\"_blank\"><i>Nitinol Glasses<\/i><\/a><span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">2017-04-05<\/span><\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Nitinol+Glasses&rft.date=2013-11-01&rft.au=Hero+Khan&rft_id=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DXPrg8EZlD1E&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-54\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-54\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.boeing.com\/news\/frontiers\/archive\/2006\/march\/i_tt.html\" target=\"_blank\">\"Boeing Frontiers Online\"<\/a>. <i>www.boeing.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-04-05<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.boeing.com&rft.atitle=Boeing+Frontiers+Online&rft_id=http%3A%2F%2Fwww.boeing.com%2Fnews%2Ffrontiers%2Farchive%2F2006%2Fmarch%2Fi_tt.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-55\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-55\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/spinoff.nasa.gov\/spinoff1997\/ch8.html\" target=\"_blank\">\"Memory Golf Clubs\"<\/a>. <i>spinoff.nasa.gov<\/i><span class=\"reference-accessdate\">. 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Retrieved <span class=\"nowrap\">2009-05-09<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Scientifica&rft.pages=80&rft.pub=Nelson+Thornes&rft.date=2005&rft.isbn=0-7487-7996-5&rft.au=Sang%2C+D.&rft.au=Ellis%2C+P.&rft.au=Ryan%2C+L.&rft.au=Taylor%2C+J.&rft.au=McMonagle%2C+D.&rft.au=Petheram%2C+L.&rft.au=Godding%2C+P.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D_iLwLRjoxQIC%26pg%3DPA80%26dq%3D%2522nickel%2Bunderwire%2522&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-GailJones-58\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-GailJones_58-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Jones, G.; Falvo, M. R.; Taylor, A. R.; Broadwell, B. P. (2007). \"Nanomaterials: Memory Wire\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=pVWw-ZcEaDIC&pg=PT92&dq=%22nickel+underwire%22\" target=\"_blank\"><i>Nanoscale Science<\/i><\/a>. NSTA Press. p. 109. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-933531-05-3<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2009-05-09<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Nanomaterials%3A+Memory+Wire&rft.btitle=Nanoscale+Science&rft.pages=109&rft.pub=NSTA+Press&rft.date=2007&rft.isbn=1-933531-05-3&rft.au=Jones%2C+G.&rft.au=Falvo%2C+M.+R.&rft.au=Taylor%2C+A.+R.&rft.au=Broadwell%2C+B.+P.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DpVWw-ZcEaDIC%26pg%3DPT92%26dq%3D%2522nickel%2Bunderwire%2522&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANickel+titanium\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li>H.R. Chen, ed., <i>Shape Memory Alloys: Manufacture, Properties and Applications<\/i>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nova_Science_Publishers,_Inc.\" class=\"mw-redirect\" title=\"Nova Science Publishers, Inc.\" rel=\"external_link\" target=\"_blank\">Nova Science Publishers, Inc.<\/a>, 2010, <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-60741-789-7.<\/li>\n<li>Y.Y. Chu & L.C. Zhao, eds., <i>Shape Memory Materials and Its [sic] Applications<\/i>, Trans Tech Publications Ltd., 2002, <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-87849-896-6.<\/li>\n<li>D.C. Lagoudas, ed., <i>Shape Memory Alloys<\/i>, Springer Science+Business Media LLC, 2008, <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-387-47684-1.<\/li>\n<li>K. \u014ctsuka & C.M. Wayman, eds., <i>Shape Memory Materials<\/i>, Cambridge University Press, 1998, <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-521-44487-X<\/li>\n<li>Sai V. Raj, <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/purl.fdlp.gov\/GPO\/gpo40560\" target=\"_blank\"><i>Low Temperature Creep of Hot-extruded Near-stoichiometric NiTi Shape Memory Alloy<\/i><\/a><i>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Aeronautics_and_Space_Administration\" class=\"mw-redirect\" title=\"National Aeronautics and Space Administration\" rel=\"external_link\" target=\"_blank\">National Aeronautics and Space Administration<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glenn_Research_Center\" title=\"Glenn Research Center\" rel=\"external_link\" target=\"_blank\">Glenn Research Center<\/a>, 2013.<\/i><\/li>\n<li>Gerald Julien, Nitinol Technologies, Inc Edgewood, Wa. Us patent\" 6422010 Manufacturing of Nitinol Parts & Forms<\/li><\/ul>\n<p>A process of making parts and forms of Type 60 Nitinol having a shape memory effect, comprising: selecting a Type 60 Nitinol. Inventor G, Julien CEO of Nitinol Technologies, Inc. (Washington State)\n<\/p>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/asmcommunity.asminternational.org\/portal\/site\/smst\/\" target=\"_blank\">Society of Shape Memory and Superelastic Technologies<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.memry.com\/resources\/index.php\" target=\"_blank\">Nitinol Resource Library<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.tinialloy.com\/pdf\/introductiontosma.pdf\" target=\"_blank\">Physical properties of nitinol<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/jmmedical.com\/resources.html\" target=\"_blank\">Nitinol Technical Resource Library<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fwmetals.com\/resources.php#whitepapers\" target=\"_blank\">Literature on Nitinol Wire<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/jmmedical.com\/nitinol\/56\/Tubing.html\" target=\"_blank\">Nitinol-Tubing<\/a><\/li><\/ul>\n<p>Science Digest articles - Miracle Metal 1982 - PDF\n<\/p>\n<ul><li><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.colorsproject.com\/nitinol_articles_science_digest_1982_sanders.pdf\" target=\"_blank\">http:\/\/www.colorsproject.com\/nitinol_articles_science_digest_1982_sanders.pdf<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1327\nCached time: 20181217110740\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.796 seconds\nReal time usage: 0.988 seconds\nPreprocessor visited node count: 4450\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 117093\/2097152 bytes\nTemplate argument size: 2339\/2097152 bytes\nHighest expansion depth: 14\/40\nExpensive parser function count: 7\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 152412\/5000000 bytes\nNumber of Wikibase entities loaded: 6\/400\nLua time usage: 0.507\/10.000 seconds\nLua memory usage: 8.41 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 894.457 1 -total\n<\/p>\n<pre>56.96% 509.489 1 Template:Reflist\n29.90% 267.457 25 Template:Cite_journal\n16.45% 147.097 1 Template:Infobox\n 9.57% 85.636 1 Template:Commons_category\n 7.07% 63.216 7 Template:Cite_book\n 6.87% 61.491 6 Template:E\n 5.98% 53.449 1 Template:Why\n 5.58% 49.893 4 Template:Convert\n 5.50% 49.154 8 Template:Citation\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:8305325-1!canonical and timestamp 20181217110739 and revision id 874126040\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nickel_titanium\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212218\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.185 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 177.240 1 - wikipedia:Nickel_titanium\n100.00% 177.240 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8212-0!*!*!*!*!*!* and timestamp 20181217212218 and revision id 24362\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Nickel_titanium\">https:\/\/www.limswiki.org\/index.php\/Nickel_titanium<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","45e6b93ac87f5e1649b08b4fa3224f90_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/e\/eb\/Nitinol_Austenite_and_martensite.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Nitinol_transformation_hysterisis.svg\/440px-Nitinol_transformation_hysterisis.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/60\/NiTi_structure_transformation.jpg\/440px-NiTi_structure_transformation.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0f\/Nitinol_Ms_vs_Ni_content.jpg\/440px-Nitinol_Ms_vs_Ni_content.jpg"],"45e6b93ac87f5e1649b08b4fa3224f90_timestamp":1545081738,"b228670943896b75bcfeaddb00c811c5_type":"article","b228670943896b75bcfeaddb00c811c5_title":"Metals in medicine","b228670943896b75bcfeaddb00c811c5_url":"https:\/\/www.limswiki.org\/index.php\/Metals_in_medicine","b228670943896b75bcfeaddb00c811c5_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMetals in medicine\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tMetals in medicine are used in organic systems for diagnostic and treatment purposes. Inorganic elements are also essential for organic life as cofactors in enzymes called metalloproteins. When metals are scarce or high quantities, equilibrium is set out of balance and must be returned to its natural state via interventional and natural methods.\n\nContents \n\n1 Toxic metals \n2 Metal anemia \n3 Metals in diagnosis \n4 Metals in treatment \n5 See also \n6 References \n\n\nToxic metals \nMetals can be toxic in high quantities. Either ingestion or faulty metabolic pathways can lead to metal poisoning. Sources of toxic metals include cadmium from tobacco, arsenic from agriculture and mercury from volcanoes and forest fires. Nature, in the form of trees and plants, is able to trap many toxins and can bring abnormally high levels back into equilibrium. Toxic metal poisoning is usually treated with some type of chelating agent.[1][2] Heavy metal poisoning, e.g., Hg, Cd, Pb, are particularly pernicious.\nExamples of specific types of toxic metals include:\n\nCopper: copper toxicity usually presents itself as a side effect of low levels of the protein ceruloplasmin, which normally is involved in copper storage. This is referred to as Wilson\u2019s disease. Wilson's disease is an autosomal recessive genetic disorder whose mutation causes the ATPase that transports copper into bile and ultimately incorporates it into ceruloplasmin to malfunction.\nPlutonium: ever since the nuclear age, plutonium poisoning is a potential danger, especially among nuclear reactor employees; inhalation of Pu dust is particularly dangerous due to its intense alpha particle emission. There have been very few cases of plutonium poisoning.\nMercury: mercury is usually ingested from agricultural sources or other environmental sources. Mercury poisoning can lead to neurological disease and kidney failure if left untreated.\nIron: iron toxicity, iron poisoning, or iron overload is well known. Iron does test only very weakly positive for the Ames test for cancer, however, since it is such a strong catalyst and essential for the production of ATP and consequently DNA production, any excess soluble iron is toxic especially over time. Too much iron deposited in tissues or high levels in the blood stream has been successfully linked to a vast majority of human diseases from Alzheimer's to Malaria. In Botany, iron is a severe problem for the irrigation of plants like rice, maize, or wheat in Sub-Saharan Africa whose subterranean water contains excessive amounts of iron which then poisons these crops.\nLead and cadmium: lead and cadmium poisoning can lead to gastrointestinal, kidney, and neurological dysfunction. The use of unleaded paints and gas has successfully decreased the number of cases of lead heavy metal poisoning.\nNickel, chromium, and cadmium: via metal-DNA interactions, these metals can be carcinogenic.[2]\nNickel: allergies to nickel, particularly from skin to metal contact via jewelry, are common.\nZinc, cadmium, magnesium, chromium: metal fume fever can be caused by ingestion of the fumes of these metals and leads to fume like symptoms.\nMetal anemia \nHumans need a certain amount of certain metals to function normally. Most metals are used as cofactors or prosthetics in enzymes, catalyzing specific reactions and serving essential roles. The essential metals for humans are: Sodium, Potassium, Magnesium, Copper, Vanadium, Chromium, Manganese, Iron, Cobalt, Nickel, Zinc, Molybdenum, and Cadmium. Anemia symptoms are caused by lack of a certain essential metal. Anemia can be associated with malnourishment or faulty metabolic processes, usually caused by a genetic defect.[2]\nExamples of specific types of metal anemia include:\n\nIron: common simple anemia (iron deficiency), results in the loss of functional heme proteins (hemoglobin, myoglobin, etc.), which are responsible for oxygen transport or utilization of oxygen. Pernicious anemia comes from a lack of vitamin B-12 (which contains a cobalt complex called cobalamin), which then in turn interferes with the function of red blood cells.\nZinc: Zinc anemia is mostly due to diet can result in growth retardation.\nCopper: Copper anemia in infants results from infants with a poor diet and can cause heart disease.[2]\nMetals in diagnosis \nMetal ions are often used for diagnostic medical imaging. Metal complexes can be used either for radioisotope imaging (from their emitted radiation) or as contrast agents, for example, in magnetic resonance imaging (MRI). Such imaging can be enhanced by manipulation of the ligands in a complex to create specificity so that the complex will be taken up by a certain cell or organ type.[2][3]\n\n Figure 1. Structure of Bleomycin A2\nExamples of metals used for diagnosis include:\n\nTechnetium. 99mTc is the most commonly used radioisotope agent for imaging purposes. It has a short half-life, emits only gamma ray photons, and does not emit beta or alpha particles (which are more damaging to surrounding cells), and thus is particularly suitable as an imaging radioisotope.\nGadolinium(III), Iron(III), Manganese(II): For MRI imaging paramagnetic metals are needed for contrast imaging. Gadolinium(III), Iron(III), and Manganese(II) are all paramagnetic metals that are able to alter the tissue relaxation times and produce a contrast image.\nCobalt(III): 57Cobalt(III) is used with the compound bleomycin (BLM) (Figure 1), which is an antibiotic, to selectively be taken up by tumor cells. The use of cobalt results in the best blood-to-tumor distribution ratio, but its half-life is too long to be conducive for imaging purposes. A solution has been proposed to attach an EDTA moiety to the terminal thiazole ring of bleomycin, radiolabeled so that the entire complex can then be traceable. This system could provide tumor locations accurately, leading to earlier detection and more non-invasive procedures in the future.[2]\nMetals in treatment \nMetals have been used in treatments since ancient times. The Ebers Papyrus from 1500BC is the first written account of the use of metals for treatment and describes the use of Copper to reduce inflammation and the use of iron to treat anemia. Sodium vanadate has been used since the early 20th century to treat rheumatoid arthritis. Recently metals have been used to treat cancer, by specifically attacking cancer cells and interacting directly with DNA. The positive charge on most metals can interact with the negative charge of the phosphate backbone of DNA. Some drugs developed that include metals interact directly with other metals already present in protein active sites, while other drugs can use metals to interact with amino acids with the highest reduction potential.[3]\n\n Figure 2. Structure of Cisplatin, a platinum coordination complex.\nExamples of Metals used in treatment include:\n\nPlatinum: Platinum based compounds have been shown to specifically effect head and neck tumors. These coordination complexes are thought to act to cross-link DNA in tumor cells (Figure 2).\nGold: Gold salt complexes have been used to treat rheumatoid arthritis (Figure 3). The gold salts are believed to interact with albumin and eventually be taken up by immune cells, triggering anti-mitochondrial effects and eventually cell apoptosis. This is an indirect treatment of arthritis, mitigating the immune response.\nLithium: Li2CO3 can be used to treat prophylaxis of manic-depression behavior.\nZinc: Zinc can be used topically to heal wounds. Zn2+ can be used to treat the herpes virus.\nSilver: Silver has been used to prevent infection at the burn site for burn wound patients.\nPlatinum, Titanium, Vanadium, Iron: cis DDP (cis-diaminedichoroplatinum), titanium, vanadium, and iron have been shown to react with DNA specifically in tumor cells to treat patients with cancer.\nGold, Silver, Copper: Phosphine ligand compounds containing gold, silver, and copper have anti-cancer properties.[2]\nLanthanum: Lanthanum Carbonate often used under the trade-name Fosrenol is used as a phosphate binder in patients suffering from Chronic Kidney disease.\nBismuth: Bismuth subsalicylate is used as an antacid.\n Figure 3. Structure of Sodium aurothiomalate, a gold salt complex.\n Figure 4. Structure of bismuth subsalicylate.\nSee also \nTitanium biocompatibility\nBiometal\nReferences \n\n\n^ Nash, Robert A. \u201cMetals in Medicine.\u201d Alternative Therapies II.4 (2005):18-25. \n\n^ a b c d e f g Lippard, Stephen J. \u201cMetals in Medicine.\u201d Bioinorganic Chemistry. Mill City: University Science Books, 1994. 505-583. \n\n^ a b Dabrowiak, James C. \u201cMetals in Medicine.\u201d Inorganic Chemica Acta. (2012). Preface. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Metals_in_medicine\">https:\/\/www.limswiki.org\/index.php\/Metals_in_medicine<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 1 March 2016, at 17:24.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 606 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","b228670943896b75bcfeaddb00c811c5_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Metals_in_medicine skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Metals in medicine<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Metals in medicine<\/b> are used in organic systems for diagnostic and treatment purposes. Inorganic elements are also essential for organic life as cofactors in enzymes called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metalloprotein\" title=\"Metalloprotein\" rel=\"external_link\" target=\"_blank\">metalloproteins<\/a>. When metals are scarce or high quantities, equilibrium is set out of balance and must be returned to its natural state via interventional and natural methods.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Toxic_metals\">Toxic metals<\/span><\/h2>\n<p>Metals can be toxic in high quantities. Either ingestion or faulty metabolic pathways can lead to metal poisoning. Sources of toxic metals include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cadmium\" title=\"Cadmium\" rel=\"external_link\" target=\"_blank\">cadmium<\/a> from tobacco, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arsenic\" title=\"Arsenic\" rel=\"external_link\" target=\"_blank\">arsenic<\/a> from agriculture and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercury_(element)\" title=\"Mercury (element)\" rel=\"external_link\" target=\"_blank\">mercury<\/a> from volcanoes and forest fires. Nature, in the form of trees and plants, is able to trap many toxins and can bring abnormally high levels back into equilibrium. Toxic metal poisoning is usually treated with some type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chelating_agent\" class=\"mw-redirect\" title=\"Chelating agent\" rel=\"external_link\" target=\"_blank\">chelating agent<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-L_2-0\" class=\"reference\"><a href=\"#cite_note-L-2\" rel=\"external_link\">[2]<\/a><\/sup> Heavy metal poisoning, e.g., Hg, Cd, Pb, are particularly pernicious.\n<\/p><p>Examples of specific types of toxic metals include:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Copper\" title=\"Copper\" rel=\"external_link\" target=\"_blank\">Copper<\/a>: copper toxicity usually presents itself as a side effect of low levels of the protein <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceruloplasmin\" title=\"Ceruloplasmin\" rel=\"external_link\" target=\"_blank\">ceruloplasmin<\/a>, which normally is involved in copper storage. This is referred to as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wilson%E2%80%99s_disease\" class=\"mw-redirect\" title=\"Wilson\u2019s disease\" rel=\"external_link\" target=\"_blank\">Wilson\u2019s disease<\/a>. Wilson's disease is an autosomal recessive genetic disorder whose mutation causes the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ATPase\" title=\"ATPase\" rel=\"external_link\" target=\"_blank\">ATPase<\/a> that transports copper into bile and ultimately incorporates it into ceruloplasmin to malfunction.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Plutonium\" title=\"Plutonium\" rel=\"external_link\" target=\"_blank\">Plutonium<\/a>: ever since the nuclear age, plutonium poisoning is a potential danger, especially among nuclear reactor employees; inhalation of Pu dust is particularly dangerous due to its intense alpha particle emission. There have been very few cases of plutonium poisoning.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercury_(element)\" title=\"Mercury (element)\" rel=\"external_link\" target=\"_blank\">Mercury<\/a>: mercury is usually ingested from agricultural sources or other environmental sources. Mercury poisoning can lead to neurological disease and kidney failure if left untreated.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron\" title=\"Iron\" rel=\"external_link\" target=\"_blank\">Iron<\/a>: iron toxicity, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron_poisoning\" title=\"Iron poisoning\" rel=\"external_link\" target=\"_blank\">iron poisoning<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron_overload\" title=\"Iron overload\" rel=\"external_link\" target=\"_blank\">iron overload<\/a> is well known. Iron does test only very weakly positive for the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ames_test\" title=\"Ames test\" rel=\"external_link\" target=\"_blank\">Ames test<\/a> for cancer, however, since it is such a strong catalyst and essential for the production of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adenosine_triphosphate\" title=\"Adenosine triphosphate\" rel=\"external_link\" target=\"_blank\">ATP<\/a> and consequently DNA production, any excess soluble iron is toxic especially over time. Too much iron deposited in tissues or high levels in the blood stream has been successfully linked to a vast majority of human diseases from Alzheimer's to Malaria. In Botany, iron is a severe problem for the irrigation of plants like rice, maize, or wheat in Sub-Saharan Africa whose subterranean water contains excessive amounts of iron which then poisons these crops.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lead\" title=\"Lead\" rel=\"external_link\" target=\"_blank\">Lead<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cadmium\" title=\"Cadmium\" rel=\"external_link\" target=\"_blank\">cadmium<\/a>: lead and cadmium poisoning can lead to gastrointestinal, kidney, and neurological dysfunction. The use of unleaded paints and gas has successfully decreased the number of cases of lead heavy metal poisoning.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nickel\" title=\"Nickel\" rel=\"external_link\" target=\"_blank\">Nickel<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium\" title=\"Chromium\" rel=\"external_link\" target=\"_blank\">chromium<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cadmium\" title=\"Cadmium\" rel=\"external_link\" target=\"_blank\">cadmium<\/a>: via metal-DNA interactions, these metals can be carcinogenic.<sup id=\"rdp-ebb-cite_ref-L_2-1\" class=\"reference\"><a href=\"#cite_note-L-2\" rel=\"external_link\">[2]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nickel\" title=\"Nickel\" rel=\"external_link\" target=\"_blank\">Nickel<\/a>: allergies to nickel, particularly from skin to metal contact via jewelry, are common.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Zinc\" title=\"Zinc\" rel=\"external_link\" target=\"_blank\">Zinc<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cadmium\" title=\"Cadmium\" rel=\"external_link\" target=\"_blank\">cadmium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium\" title=\"Magnesium\" rel=\"external_link\" target=\"_blank\">magnesium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium\" title=\"Chromium\" rel=\"external_link\" target=\"_blank\">chromium<\/a>: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal_fume_fever\" title=\"Metal fume fever\" rel=\"external_link\" target=\"_blank\">metal fume fever<\/a> can be caused by ingestion of the fumes of these metals and leads to fume like symptoms.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Metal_anemia\">Metal anemia<\/span><\/h2>\n<p>Humans need a certain amount of certain metals to function normally. Most metals are used as cofactors or prosthetics in enzymes, catalyzing specific reactions and serving essential roles. The essential metals for humans are: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium\" title=\"Sodium\" rel=\"external_link\" target=\"_blank\">Sodium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Potassium\" title=\"Potassium\" rel=\"external_link\" target=\"_blank\">Potassium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium\" title=\"Magnesium\" rel=\"external_link\" target=\"_blank\">Magnesium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copper\" title=\"Copper\" rel=\"external_link\" target=\"_blank\">Copper<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vanadium\" title=\"Vanadium\" rel=\"external_link\" target=\"_blank\">Vanadium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium\" title=\"Chromium\" rel=\"external_link\" target=\"_blank\">Chromium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manganese\" title=\"Manganese\" rel=\"external_link\" target=\"_blank\">Manganese<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron\" title=\"Iron\" rel=\"external_link\" target=\"_blank\">Iron<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cobalt\" title=\"Cobalt\" rel=\"external_link\" target=\"_blank\">Cobalt<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nickel\" title=\"Nickel\" rel=\"external_link\" target=\"_blank\">Nickel<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zinc\" title=\"Zinc\" rel=\"external_link\" target=\"_blank\">Zinc<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molybdenum\" title=\"Molybdenum\" rel=\"external_link\" target=\"_blank\">Molybdenum<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cadmium\" title=\"Cadmium\" rel=\"external_link\" target=\"_blank\">Cadmium<\/a>. Anemia symptoms are caused by lack of a certain essential metal. Anemia can be associated with malnourishment or faulty metabolic processes, usually caused by a genetic defect.<sup id=\"rdp-ebb-cite_ref-L_2-2\" class=\"reference\"><a href=\"#cite_note-L-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Examples of specific types of metal anemia include:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron\" title=\"Iron\" rel=\"external_link\" target=\"_blank\">Iron<\/a>: common simple anemia (iron deficiency), results in the loss of functional heme proteins (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemoglobin\" title=\"Hemoglobin\" rel=\"external_link\" target=\"_blank\">hemoglobin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myoglobin\" title=\"Myoglobin\" rel=\"external_link\" target=\"_blank\">myoglobin<\/a>, etc.), which are responsible for oxygen transport or utilization of oxygen. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pernicious_anemia\" class=\"mw-redirect\" title=\"Pernicious anemia\" rel=\"external_link\" target=\"_blank\">Pernicious anemia<\/a> comes from a lack of vitamin B-12 (which contains a cobalt complex called cobalamin), which then in turn interferes with the function of red blood cells.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Zinc\" title=\"Zinc\" rel=\"external_link\" target=\"_blank\">Zinc<\/a>: Zinc anemia is mostly due to diet can result in growth retardation.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Copper\" title=\"Copper\" rel=\"external_link\" target=\"_blank\">Copper<\/a>: Copper anemia in infants results from infants with a poor diet and can cause heart disease.<sup id=\"rdp-ebb-cite_ref-L_2-3\" class=\"reference\"><a href=\"#cite_note-L-2\" rel=\"external_link\">[2]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Metals_in_diagnosis\">Metals in diagnosis<\/span><\/h2>\n<p>Metal ions are often used for diagnostic medical imaging. Metal complexes can be used either for radioisotope imaging (from their emitted radiation) or as contrast agents, for example, in magnetic resonance imaging (MRI). Such imaging can be enhanced by manipulation of the ligands in a complex to create specificity so that the complex will be taken up by a certain cell or organ type.<sup id=\"rdp-ebb-cite_ref-L_2-4\" class=\"reference\"><a href=\"#cite_note-L-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-D_3-0\" class=\"reference\"><a href=\"#cite_note-D-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bleomycin_A2.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/69\/Bleomycin_A2.svg\/220px-Bleomycin_A2.svg.png\" width=\"220\" height=\"118\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bleomycin_A2.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Figure 1. Structure of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bleomycin\" title=\"Bleomycin\" rel=\"external_link\" target=\"_blank\">Bleomycin<\/a> A2<\/div><\/div><\/div>\n<p>Examples of metals used for diagnosis include:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Technetium\" title=\"Technetium\" rel=\"external_link\" target=\"_blank\">Technetium<\/a>. <sup>99m<\/sup>Tc is the most commonly used radioisotope agent for imaging purposes. It has a short half-life, emits only gamma ray photons, and does not emit beta or alpha particles (which are more damaging to surrounding cells), and thus is particularly suitable as an imaging radioisotope.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gadolinium\" title=\"Gadolinium\" rel=\"external_link\" target=\"_blank\">Gadolinium<\/a>(III), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron\" title=\"Iron\" rel=\"external_link\" target=\"_blank\">Iron<\/a>(III), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manganese\" title=\"Manganese\" rel=\"external_link\" target=\"_blank\">Manganese<\/a>(II): For MRI imaging paramagnetic metals are needed for contrast imaging. Gadolinium(III), Iron(III), and Manganese(II) are all paramagnetic metals that are able to alter the tissue relaxation times and produce a contrast image.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cobalt\" title=\"Cobalt\" rel=\"external_link\" target=\"_blank\">Cobalt<\/a>(III): <sup>57<\/sup>Cobalt(III) is used with the compound <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bleomycin\" title=\"Bleomycin\" rel=\"external_link\" target=\"_blank\">bleomycin<\/a> (BLM) (Figure 1), which is an antibiotic, to selectively be taken up by tumor cells. The use of cobalt results in the best blood-to-tumor distribution ratio, but its half-life is too long to be conducive for imaging purposes. A solution has been proposed to attach an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylenediaminetetraacetic_acid\" title=\"Ethylenediaminetetraacetic acid\" rel=\"external_link\" target=\"_blank\">EDTA<\/a> moiety to the terminal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thiazole\" title=\"Thiazole\" rel=\"external_link\" target=\"_blank\">thiazole<\/a> ring of bleomycin, radiolabeled so that the entire complex can then be traceable. This system could provide tumor locations accurately, leading to earlier detection and more non-invasive procedures in the future.<sup id=\"rdp-ebb-cite_ref-L_2-5\" class=\"reference\"><a href=\"#cite_note-L-2\" rel=\"external_link\">[2]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Metals_in_treatment\">Metals in treatment<\/span><\/h2>\n<p>Metals have been used in treatments since ancient times. The Ebers Papyrus from 1500BC is the first written account of the use of metals for treatment and describes the use of Copper to reduce inflammation and the use of iron to treat anemia. Sodium vanadate has been used since the early 20th century to treat rheumatoid arthritis. Recently metals have been used to treat cancer, by specifically attacking cancer cells and interacting directly with DNA. The positive charge on most metals can interact with the negative charge of the phosphate backbone of DNA. Some drugs developed that include metals interact directly with other metals already present in protein active sites, while other drugs can use metals to interact with amino acids with the highest reduction potential.<sup id=\"rdp-ebb-cite_ref-D_3-1\" class=\"reference\"><a href=\"#cite_note-D-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cisplatin-stereo.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/80\/Cisplatin-stereo.svg\/220px-Cisplatin-stereo.svg.png\" width=\"220\" height=\"133\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cisplatin-stereo.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Figure 2. Structure of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cisplatin\" title=\"Cisplatin\" rel=\"external_link\" target=\"_blank\">Cisplatin<\/a>, a platinum coordination complex.<\/div><\/div><\/div>\n<p>Examples of Metals used in treatment include:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Platinum\" title=\"Platinum\" rel=\"external_link\" target=\"_blank\">Platinum<\/a>: Platinum based compounds have been shown to specifically effect head and neck tumors. These coordination complexes are thought to act to cross-link DNA in tumor cells (Figure 2).<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gold\" title=\"Gold\" rel=\"external_link\" target=\"_blank\">Gold<\/a>: Gold salt complexes have been used to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\" title=\"Rheumatoid arthritis\" rel=\"external_link\" target=\"_blank\">rheumatoid arthritis<\/a> (Figure 3). The gold salts are believed to interact with albumin and eventually be taken up by immune cells, triggering anti-mitochondrial effects and eventually cell apoptosis. This is an indirect treatment of arthritis, mitigating the immune response.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithium\" title=\"Lithium\" rel=\"external_link\" target=\"_blank\">Lithium<\/a>: Li<sub>2<\/sub>CO<sub>3<\/sub> can be used to treat prophylaxis of manic-depression behavior.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Zinc\" title=\"Zinc\" rel=\"external_link\" target=\"_blank\">Zinc<\/a>: Zinc can be used topically to heal wounds. Zn<sup>2+<\/sup> can be used to treat the herpes virus.<\/li>\n<li>Silver: Silver has been used to prevent infection at the burn site for burn wound patients.<\/li>\n<li>Platinum, Titanium, Vanadium, Iron: cis DDP (cis-diaminedichoroplatinum), titanium, vanadium, and iron have been shown to react with DNA specifically in tumor cells to treat patients with cancer.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gold\" title=\"Gold\" rel=\"external_link\" target=\"_blank\">Gold<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silver\" title=\"Silver\" rel=\"external_link\" target=\"_blank\">Silver<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copper\" title=\"Copper\" rel=\"external_link\" target=\"_blank\">Copper<\/a>: Phosphine ligand compounds containing gold, silver, and copper have anti-cancer properties.<sup id=\"rdp-ebb-cite_ref-L_2-6\" class=\"reference\"><a href=\"#cite_note-L-2\" rel=\"external_link\">[2]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lanthanum\" title=\"Lanthanum\" rel=\"external_link\" target=\"_blank\">Lanthanum<\/a>: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lanthanum_carbonate\" title=\"Lanthanum carbonate\" rel=\"external_link\" target=\"_blank\">Lanthanum Carbonate<\/a> often used under the trade-name Fosrenol is used as a phosphate binder in patients suffering from Chronic Kidney disease.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bismuth\" title=\"Bismuth\" rel=\"external_link\" target=\"_blank\">Bismuth<\/a>: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bismuth_subsalicylate\" title=\"Bismuth subsalicylate\" rel=\"external_link\" target=\"_blank\">Bismuth subsalicylate<\/a> is used as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antacid\" title=\"Antacid\" rel=\"external_link\" target=\"_blank\">antacid<\/a>.<\/li><\/ul>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sodium_aurothiomalate.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/30\/Sodium_aurothiomalate.svg\/220px-Sodium_aurothiomalate.svg.png\" width=\"220\" height=\"150\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sodium_aurothiomalate.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Figure 3. Structure of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_aurothiomalate\" title=\"Sodium aurothiomalate\" rel=\"external_link\" target=\"_blank\">Sodium aurothiomalate<\/a>, a gold salt complex.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bismuth_subsalicylate.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cb\/Bismuth_subsalicylate.png\/220px-Bismuth_subsalicylate.png\" width=\"220\" height=\"151\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bismuth_subsalicylate.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Figure 4. Structure of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bismuth_subsalicylate\" title=\"Bismuth subsalicylate\" rel=\"external_link\" target=\"_blank\">bismuth subsalicylate<\/a>.<\/div><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_biocompatibility\" title=\"Titanium biocompatibility\" rel=\"external_link\" target=\"_blank\">Titanium biocompatibility<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biometal_(biology)\" title=\"Biometal (biology)\" rel=\"external_link\" target=\"_blank\">Biometal<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Nash, Robert A. \u201cMetals in Medicine.\u201d Alternative Therapies II.4 (2005):18-25.<\/span>\n<\/li>\n<li id=\"cite_note-L-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-L_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-L_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-L_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-L_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-L_2-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-L_2-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-L_2-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Lippard, Stephen J. \u201cMetals in Medicine.\u201d Bioinorganic Chemistry. Mill City: University Science Books, 1994. 505-583.<\/span>\n<\/li>\n<li id=\"cite_note-D-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-D_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-D_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Dabrowiak, James C. \u201cMetals in Medicine.\u201d Inorganic Chemica Acta. (2012). Preface.<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1257\nCached time: 20181217004912\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.060 seconds\nReal time usage: 0.071 seconds\nPreprocessor visited node count: 225\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 338\/2097152 bytes\nTemplate argument size: 82\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 2102\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.004\/10.000 seconds\nLua memory usage: 521 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 27.898 1 Template:Reflist\n100.00% 27.898 1 -total\n<\/p>\n<pre> 8.91% 2.486 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:37435596-1!canonical and timestamp 20181217004912 and revision id 775280388\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Metals_in_medicine\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212218\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.008 seconds\nReal time usage: 0.139 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 133.920 1 - wikipedia:Metals_in_medicine\n100.00% 133.920 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8207-0!*!*!*!*!*!* and timestamp 20181217212218 and revision id 24357\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Metals_in_medicine\">https:\/\/www.limswiki.org\/index.php\/Metals_in_medicine<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","b228670943896b75bcfeaddb00c811c5_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/69\/Bleomycin_A2.svg\/440px-Bleomycin_A2.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/80\/Cisplatin-stereo.svg\/440px-Cisplatin-stereo.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/30\/Sodium_aurothiomalate.svg\/440px-Sodium_aurothiomalate.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/c\/cb\/Bismuth_subsalicylate.png"],"b228670943896b75bcfeaddb00c811c5_timestamp":1545081738,"7421bd0ccd10ef9c987559cc110bd0ff_type":"article","7421bd0ccd10ef9c987559cc110bd0ff_title":"Metal foam","7421bd0ccd10ef9c987559cc110bd0ff_url":"https:\/\/www.limswiki.org\/index.php\/Metal_foam","7421bd0ccd10ef9c987559cc110bd0ff_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMetal foam\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Foamed aluminium\n Regular foamed aluminium\nA metal foam is a cellular structure consisting of a solid metal (frequently aluminium) with gas-filled pores comprising a large portion of the volume. The pores can be sealed (closed-cell foam) or interconnected (open-cell foam). The defining characteristic of metal foams is a high porosity: typically only 5\u201325% of the volume is the base metal, making these ultralight materials. The strength of the material is due to the square-cube law.\nMetallic foams typically retain some physical properties of their base material. Foam made from non-flammable metal remains non-flammable and can generally be recycled as the base material. Its coefficient of thermal expansion is similar while thermal conductivity is likely reduced.[1]\n\nContents \n\n1 Open-cell \n\n1.1 Manufacturing \n\n\n2 Closed-cell \n\n2.1 Manufacturing \n\n\n3 Composites \n4 Stochastic and regular foams \n\n4.1 Stochastic \n4.2 Regular \n\n\n5 Regular foams gallery \n6 Applications \n\n6.1 Design \n\n6.1.1 Design gallery \n\n\n6.2 Mechanical \n\n6.2.1 Orthopedics \n6.2.2 Automotive \n6.2.3 Energy absorption \n\n\n6.3 Thermal \n\n\n7 See also \n8 References \n9 External links \n\n\n\nOpen-cell \n Open-cell metal foam\n CFD (numerical simulation) of fluid flow and heat transfer on an open cell metal foam\nOpen celled metal foam, also called metal sponge,[2] can be used in heat exchangers (compact electronics cooling, cryogen tanks, PCM heat exchangers), energy absorption, flow diffusion, and lightweight optics. The high cost of the material generally limits its use to advanced technology, aerospace, and manufacturing.\nFine-scale open-cell foams, with cells smaller than can be seen unaided, are used as high-temperature filters in the chemical industry.\nMetallic foams are used in compact heat exchangers to increase heat transfer at the cost of reduced pressure.[3][4][5][clarification needed ] However, their use permits substantial reduction in physical size and fabrication costs. Most models of these materials use idealized and periodic structures or averaged macroscopic properties.\nMetal sponge has very large surface area per unit weight and catalysts are often formed into metal sponge, such as palladium black, platinum sponge, and spongy nickel. Metals such as osmium and palladium hydride are metaphorically called \"metal sponges\", but this term is in reference to their property of binding to hydrogen, rather than the physical structure.[6]\n\nManufacturing \nOpen cell foams are manufactured by foundry or powder metallurgy. In the powder method, \"space holders\" are used; as their name suggests, they occupy the pore spaces and channels. In casting processes, foam is cast with an open-celled polyurethane foam skeleton.\n\nClosed-cell \nClosed-cell metal foam was first reported in 1926 by Meller in a French patent where foaming of light metals, either by inert gas injection or by blowing agent, was suggested.[7] Two patents on sponge-like metal were issued to Benjamin Sosnik in 1948 and 1951 who applied mercury vapor to blow liquid aluminium.[8][9]\nClosed-cell metal foams were developed in 1956 by John C. Elliott at Bjorksten Research Laboratories. Although the first prototypes were available in the 1950s, commercial production began in the 1990s by Shinko Wire company in Japan. Closed-cell metal foams are primarily used as an impact-absorbing material, similarly to the polymer foams in a bicycle helmet but for higher impact loads. Unlike many polymer foams, metal foams remain deformed after impact and can therefore only be deformed once. They are light (typically 10\u201325% of the density of an identical non-porous alloy; commonly those of aluminium) and stiff and are frequently proposed as a lightweight structural material. However, they have not been widely used for this purpose.\nClosed-cell foams retain the fire resistance and recycling potential of other metallic foams, but add the property of flotation in water.\n\nManufacturing \nFoams are commonly made by injecting a gas or mixing a foaming agent into molten metal.[10] Melts can be foamed by creating gas bubbles in the material. Normally, bubbles in molten metal are highly buoyant in the high-density liquid and rise quickly to the surface. This rise can be slowed by increasing the viscosity of the molten metal by adding ceramic powders or alloying elements to form stabilizing particles in the melt, or by other means. Metallic melts can be foamed in one of three ways:\n\nby injecting gas into the liquid metal from an external source;\nby causing gas formation in the liquid by admixing gas-releasing blowing agents with the molten metal;\nby causing the precipitation of gas that was previously dissolved in the molten metal.\nTo stabilize the molten metal bubbles, high temperature foaming agents (nano- or micrometer- sized solid particles) are required. The size of the pores, or cells, is usually 1 to 8 mm. When foaming or blowing agents are used, they are mixed with the powdered metal before it is melted. This is the so-called \"powder route\" of foaming, and it is probably the most established (from an industrial standpoint). After metal (e.g. aluminium) powders and foaming agent (e.g.TiH2) have been mixed, they are compressed into a compact, solid precursor, which can be available in the form of a billet, a sheet, or a wire. Production of precursors can be done by a combination of materials forming processes, such as powder pressing,[11] extrusion (direct[12] or conform[13]) and flat rolling.[14]\n\nComposites \nComposite metal foam (CMF) is formed from hollow beads of one metal within a solid matrix of another, such as steel within aluminium, show 5 to 6 times greater strength to density ratio and more than 7 times greater energy absorption than previous metal foams.[15]\nA less than one inch thick plate has enough resistance to turn a 7.62 x 63 mm standard-issue M2 armor piercing bullet to dust. The test plate outperformed a solid metal plate of similar thickness, while weighing far less. Other potential applications include nuclear waste (shielding X-rays, gamma rays and neutron radiation) transfer and thermal insulation for space vehicle atmospheric re-entry, with twice the resistance to fire and heat as the plain metals.[16]\nCMF can replace rolled steel armor with the same protection for one-third the weight. It can block fragments and the shock waves that are responsible for brain injuries. Stainless steel CMF can block blast pressure and fragmentation at 5,000 feet per second from high explosive incendiary (HEI) rounds that detonate 18 inches from the shield. Steel CMF plates (9.5 mm or 16.75 mm thick) were placed 18 inches from the strikeplate held up against the wave of blast pressure and against the copper and steel fragments created by a 23\u00d7152 mm HEI round (as in anti-aircraft weapons) as well as a 2.3mm aluminum strikeplate.[17]\n\nStochastic and regular foams \nStochastic \nA foam is said to be stochastic when the porosity distribution is random. Most foams are stochastic because of the method of manufacture:\n\nFoaming of liquid or solid (powder) metal .\nVapor deposition (CVD on a random matrix )\nDirect or indirect random casting of a mold containing beads or matrix.\nRegular \n Manufacturing process of a regular metal foam by direct molding, CTIF process[18][19][20]\nA foam is said to be regular when the structure is ordered. Direct molding is one technology that produces regular foams[18][19] with open pores. In the alternate, regular metal foams can be produced by additive processes such as selective laser melting (SLM).\nPlates can be used as casting cores. The shape is customized for each application. This manufacturing method allows for \"perfect\" foam, so-called because it satisfies Plateau's laws and has conducting pores of the shape of a truncated octahedron Kelvin cell (body-centered cubic structure).\n\n Kelvin cell (Similar to the Weaire\u2013Phelan structure)\nRegular foams gallery \n\n\t\t\n\t\t\t\n\t\t\t\nHeat sink with copper foam\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nCrash box including Aluminium foam\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nAluminium foam with big porosity\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nAluminium foam with aluminium sheet\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nHeader - steel metal foam\n\n\t\t\t\n\t\t\n\nApplications \nDesign \nMetal foam can be used in product or architectural composition.\n\nDesign gallery \n\n\t\t\n\t\t\t\n\t\t\t\nmachined metal foam\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nDesign heatsink with regular foam[21]\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\ncoffee table with large pored aluminium\n\n\t\t\t\n\t\t\n\nMechanical \nOrthopedics \nMain article: Osseointegration \u00a7 Advances in materials engineering: metal foams\nFoam metal has been used in experimental animal prosthetics. In this application, a hole is drilled into the bone and the metal foam inserted, letting the bone grow into the metal for a permanent junction. For orthopedic applications, tantalum or titanium foams are common for their tensile strength, corrosion resistance and biocompatibility.\nThe back legs of Siberian Husky named Triumph received foam metal prostheses. Mammalian studies showed that porous metals, such as titanium foam, may allow vascularization within the porous area.[22]\nOrthopedic device manufacturers use foam construction or metal foam coatings[23] to achieve desired levels of osseointegration.[24][25][26]\n\nAutomotive \nThe primary functions of metallic foams in vehicles are to increase sound damping, reduce weight, increase energy absorption in case of crashes, and (in military applications) to combat the concussive force of IEDs. As an example, foam filled tubes could be used as anti-intrusion bars.[27] Because of their low density (0.4\u20130.9 g\/cm3), aluminium and aluminium alloy foams are under particular consideration. These foams are stiff, fire resistant, nontoxic, recyclable, energy absorbent, less thermally conductive, less magnetically permeable, and more efficiently sound dampening, especially when compared to hollow parts. Metallic foams in hollow car parts decrease weakness points usually associated with car crashes and vibration. These foams are inexpensive to cast with powder metallurgy, compared to casting other hollow parts.\nCompared to polymer foams in vehicles, metallic foams are stiffer, stronger, more energy absorbent, and resistant to fire and the weather adversities of UV light, humidity, and temperature variation. However, they are heavier, more expensive, and non-insulating.[28]\nMetal foam technology has been applied to automotive exhaust gas.[29] Compared to traditional catalytic converters that use cordierite ceramic as substrate, metal foam substrate offers better heat transfer and exhibits excellent mass-transport properties (high turbulence) and may reduce the quantity of platinum catalyst required.[30]\n\nEnergy absorption \n Aluminium crash graph\nMetal foams are used for stiffening a structure without increasing its mass.[31] For this application, metal foams are generally closed pore and made of aluminium. Foam panels are glued to the aluminium plate to obtain a resistant composite sandwich locally (in the sheet thickness) and rigid along the length depending on the foam's thickness.\nThe advantage of metal foams is that the reaction is constant, regardless of the direction of the force. Foams have a plateau of stress after deformation that is constant for as much as 80% of the crushing.[32]\n\nThermal \n Heat conduction in regular metal foam structure\n Heat transfer in regular metal foam structure\nTian et al.[33] listed several criteria to assess a foam in a heat exchanger. The comparison of thermal-performance metal foams with materials conventionally used in the intensification of exchange (fins, coupled surfaces, bead bed) first shows that the pressure losses caused by foams are much more important than with conventional fins, yet are significantly lower than those of beads. The exchange coefficients are close to beds and ball and well above the blades.[34][35]\nFoams offer other thermophysical and mechanical features:\n\nVery low mass (density 5\u201325% of the bulk solid depending the manufacturing method)\nLarge exchange surface (250\u201310000 m2\/m3)\nRelatively high permeability\nRelatively high effective thermal conductivities (5\u201330 W\/(mK))\nGood resistance to thermal shocks, high pressures, high temperatures, moisture, wear and thermal cycling\nGood absorption of mechanical shock and sound\nPore size and porosity can be controlled by the manufacturer\nCommercialization of foam-based compact heat exchangers, heat sinks and shock absorbers is limited due to the high cost of foam replications. Their long-term resistance to fouling, corrosion and erosion are insufficiently characterized. From a manufacturing standpoint, the transition to foam technology requires new production and assembly techniques and heat exchanger design.\n\nSee also \nPorous medium\nCeramic foam\nNanofoam\nReticulated foam\nAluminum polymer composite\nAluminium foam sandwich\nTitanium foam\nReferences \n\n\n^ Compare Materials: Cast Aluminium and Aluminium Foam Archived 2010-04-30 at the Wayback Machine.. Makeitfrom.com. Retrieved on 2011-11-19. \n\n^ \nJohn Banhart.\n\"What are cellular metals and metal foams?\" Archived 2010-12-29 at the Wayback Machine.. \n\n^ Topin, F.; Bonnet, J. -P.; Madani, B.; Tadrist, L. (2006). \"Experimental Analysis of Multiphase Flow in Metallic foam: Flow Laws, Heat Transfer and Convective Boiling\". Advanced Engineering Materials. 8 (9): 890. doi:10.1002\/adem.200600102. \n\n^ Banhart, J. (2001). \"Manufacture, Characterization and application of cellular metals and metal foams\". Progress in materials Science. 46 (6): 559\u2013632. doi:10.1016\/S0079-6425(00)00002-5. \n\n^ DeGroot, C.T., Straatman, A.G., and Betchen, L.J. (2009). \"Modeling forced convection in finned metal foam heat sinks\". J. Electron. Packag. 131 (2): 021001. doi:10.1115\/1.3103934. CS1 maint: Multiple names: authors list (link) \n\n^ \nRalph Wolf; Khalid Mansour.\n\"The Amazing Metal Sponge: Soaking Up Hydrogen\" Archived 2015-11-16 at the Wayback Machine..\n1995. \n\n^ De Meller, M.A. French Patent 615,147 (1926). \n\n^ Sosnick, B. U.S. Patent 2,434,775 (1948). \n\n^ Sosnick, B. U.S. Patent 2,553,016 (1951). \n\n^ Banhart, John (2000). \"Manufacturing Routes for Metallic Foams\". JOM. Minerals, Metals & Materials Society. 52 (12): 22\u201327. doi:10.1007\/s11837-000-0062-8. Archived from the original on 2012-01-01. Retrieved 2012-01-20 . \n\n^ Bonaccorsi, L.; Proverbio, E. (1 September 2006). \"Powder Compaction Effect on Foaming Behavior of Uni-Axial Pressed PM Precursors\". Advanced Engineering Materials. 8 (9): 864\u2013869. doi:10.1002\/adem.200600082. \n\n^ Shiomi, M.; Imagama, S.; Osakada, K.; Matsumoto, R. (2010). \"Fabrication of aluminium foams from powder by hot extrusion and foaming\". Journal of Materials Processing Technology. 210 (9): 1203\u20131208. doi:10.1016\/j.jmatprotec.2010.03.006. \n\n^ Dunand, [editors] Louis Philippe Lefebvre, John Banhart, David C. (2008). MetFoam 2007 : porous metals and metallic foams : proceedings of the fifth International Conference on Porous Metals and Metallic Foams, September 5\u20137, 2007, Montreal Canada. Lancaster, Pa.: DEStech Publications Inc. pp. 7\u201310. ISBN 1932078282. CS1 maint: Extra text: authors list (link) \n\n^ Strano, M.; Pourhassan, R.; Mussi, V. (2013). \"The effect of cold rolling on the foaming efficiency of aluminium precursors\". Journal of Manufacturing Processes. 15 (2): 227. doi:10.1016\/j.jmapro.2012.12.006. \n\n^ Urweb:High Performance Composite Metal Foam Archived 2013-12-12 at the Wayback Machine.. . Retrieved on 2013-12-10. \n\n^ MICU, ALEXANDRU (April 6, 2016). \"Composite metal foam better at stopping bullets than solid plates\". ZME Science. Archived from the original on April 10, 2016. Retrieved 2016-04-09 . \n\n^ Wang, Brian (2018-04-24). \"Composite metal foams provide armor protection for one third the weight and make super car bumpers | NextBigFuture.com\". NextBigFuture.com. Retrieved 2018-05-24 . \n\n^ a b Recherche sur la production de pi\u00e8ces de fonderie en mousse m\u00e9tallique \u2013 Recherche en fonderie : les mousses m\u00e9talliques Archived 2013-10-29 at the Wayback Machine.. Ctif.com. Retrieved on 2013-12-03. \n\n^ a b ALVEOTEC \u2013 Innovation Archived 2014-07-30 at the Wayback Machine.. Alveotec.fr\/en. Retrieved on 2013-12-03. \n\n^ \"ALVEOTEC - Actualit\u00e9s - video : making process of aluminium foam\". Archived from the original on 2014-07-30. \n\n^ ALVEOTEC - Actualit\u00e9s - LOUPI Lighing launches his new metal foam heatsink for lighting application_66.html Archived 2014-07-30 at the Wayback Machine.. Alveotec.fr. Retrieved on 2013-12-03. \n\n^ Osseointegration with Titanium Foam in Rabbit Femur Archived 2016-04-18 at the Wayback Machine., YouTube \n\n^ Titanium coatings on Orthopedic Devices Archived 2016-03-13 at the Wayback Machine.. Youtube \n\n^ Biomet Orthopedics, Regenerex\u00ae Porous Titanium Construct Archived 2011-09-28 at the Wayback Machine. \n\n^ Zimmer Orthopedics, Trabeluar Metal Technology Archived 2011-07-18 at the Wayback Machine. \n\n^ Zimmer CSTiTM (Cancellous-Structured Titanium TM) Porous Coating Archived 2011-07-18 at the Wayback Machine. \n\n^ Strano, Matteo (2011). \"A New FEM Approach for Simulation of Metal Foam Filled Tubes\". Journal of Manufacturing Science and Engineering. 133 (6): 061003. doi:10.1115\/1.4005354. \n\n^ New Concept for Design of Lightweight Automotive Components Archived 2012-03-24 at the Wayback Machine.. (PDF) . Retrieved on 2013-12-03. \n\n^ Alantum Innovations in Alloy Foam: Home Archived 2010-02-17 at the Wayback Machine.. Alantum.com. Retrieved on 2011-11-19. \n\n^ Development of Metal Foam Based Aftertreatment on a Diesel Passenger Car \u2013 Virtual Conference Center[permanent dead link ] . Vcc-sae.org. Retrieved on 2011-11-19. \n\n^ Banhart, John; Dunand, David C. (2008). MetFoam 2007: Porous Metals and Metallic Foams : Proceedings of the Fifth International Conference on Porous Metals and Metallic Foams, September 5-7, 2007, Montreal Canada. DEStech Publications, Inc. ISBN 9781932078282. \n\n^ ALVEOTEC \u2013 Actualit\u00e9s \u2013 Examples of metal foam applications. Archived 2014-07-30 at the Wayback Machine. Alveotec.fr. Retrieved on 2013-12-03. \n\n^ Tian, J.; Kim, T.; Lu, T. J.; Hodson, H. P.; Queheillalt, D. T.; Sypeck, D. J.; Wadley, H. N. G. (2004). \"The effects of topology upon fluid-flow and heat-transfer within cellular copper structures\" (PDF) . International Journal of Heat and Mass Transfer. 47 (14\u201316): 3171. doi:10.1016\/j.ijheatmasstransfer.2004.02.010. Archived (PDF) from the original on 2016-03-03. \n\n^ Miscevic, M. (1997). Etude de l'intensification des transferts thermiques par des structures poreuses: Application aux \u00e9changeurs compacts et au refroidissement diphasique. IUSTI. Marseille., Universit\u00e9 de Provence \n\n^ Catillon, S., C. Louis, et al. (2005). Utilisation de mousses m\u00e9talliques dans un r\u00e9formeur catalytique du m\u00e9thanol pour la production de H2. GECAT, La Rochelle. \n\n\nExternal links \nVideo : Aluminium regular foam: Crash box test\nVideo : How regular foams are made\nNASA Fact sheet FS-2003-09-117-MSFC \u2014 Viscous Liquid Foam and Bulk Metallic Glass (Foam)\nHow to Make an Aluminium Metal Foam on YouTube\nFischer, S. F.; Thielen, M.; Wei\u00df, P.; Seidel, R.; Speck, T.; B\u00fchrig-Polaczek, A.; B\u00fcnck, M. (2013). \"Production and properties of a precision-cast bio-inspired composite\". Journal of Materials Science. 49: 43. doi:10.1007\/s10853-013-7878-4. \nBullet destruction video on YouTube\nAuthority control \nGND: 4402720-5 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Metal_foam\">https:\/\/www.limswiki.org\/index.php\/Metal_foam<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 19:17.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,108 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","7421bd0ccd10ef9c987559cc110bd0ff_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Metal_foam skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Metal foam<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Aluminium_foam.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fc\/Aluminium_foam.jpg\/220px-Aluminium_foam.jpg\" width=\"220\" height=\"293\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Aluminium_foam.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Foamed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium\" title=\"Aluminium\" rel=\"external_link\" target=\"_blank\">aluminium<\/a><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Alv%C3%A9oles_4.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/Alv%C3%A9oles_4.jpg\/220px-Alv%C3%A9oles_4.jpg\" width=\"220\" height=\"238\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Alv%C3%A9oles_4.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Regular foamed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium\" title=\"Aluminium\" rel=\"external_link\" target=\"_blank\">aluminium<\/a><\/div><\/div><\/div>\n<p>A <b>metal foam<\/b> is a cellular structure consisting of a solid <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal\" title=\"Metal\" rel=\"external_link\" target=\"_blank\">metal<\/a> (frequently <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium\" title=\"Aluminium\" rel=\"external_link\" target=\"_blank\">aluminium<\/a>) with gas-filled <a href=\"https:\/\/en.wikipedia.org\/wiki\/Porosity\" title=\"Porosity\" rel=\"external_link\" target=\"_blank\">pores<\/a> comprising a large portion of the volume. The pores can be sealed (closed-cell <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foam\" title=\"Foam\" rel=\"external_link\" target=\"_blank\">foam<\/a>) or interconnected (open-cell foam). The defining characteristic of metal foams is a high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Porosity\" title=\"Porosity\" rel=\"external_link\" target=\"_blank\">porosity<\/a>: typically only 5\u201325% of the volume is the base metal, making these <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultralight_material\" title=\"Ultralight material\" rel=\"external_link\" target=\"_blank\">ultralight materials<\/a>. The strength of the material is due to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Square-cube_law\" class=\"mw-redirect\" title=\"Square-cube law\" rel=\"external_link\" target=\"_blank\">square-cube law<\/a>.\n<\/p><p>Metallic foams typically retain some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_property\" title=\"Physical property\" rel=\"external_link\" target=\"_blank\">physical properties<\/a> of their base material. Foam made from non-flammable metal remains non-flammable and can generally be recycled as the base material. Its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coefficient_of_thermal_expansion\" class=\"mw-redirect\" title=\"Coefficient of thermal expansion\" rel=\"external_link\" target=\"_blank\">coefficient of thermal expansion<\/a> is similar while <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_conductivity\" title=\"Thermal conductivity\" rel=\"external_link\" target=\"_blank\">thermal conductivity<\/a> is likely reduced.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<div class=\"toclimit-3\">\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Open-cell\">Open-cell<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Metal_Foam_in_Scanning_Electron_Microscope,_magnification_10x.GIF\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/af\/Metal_Foam_in_Scanning_Electron_Microscope%2C_magnification_10x.GIF\/220px-Metal_Foam_in_Scanning_Electron_Microscope%2C_magnification_10x.GIF\" width=\"220\" height=\"176\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Metal_Foam_in_Scanning_Electron_Microscope,_magnification_10x.GIF\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Open-cell metal foam<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Numerical_simulation_on_an_open_cell_metal_foam._Velocity_and_temperature_fields.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/54\/Numerical_simulation_on_an_open_cell_metal_foam._Velocity_and_temperature_fields.gif\/220px-Numerical_simulation_on_an_open_cell_metal_foam._Velocity_and_temperature_fields.gif\" width=\"220\" height=\"228\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Numerical_simulation_on_an_open_cell_metal_foam._Velocity_and_temperature_fields.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>CFD (numerical simulation) of fluid flow and heat transfer on an open cell metal foam<\/div><\/div><\/div>\n<p>Open celled metal foam, also called metal sponge,<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> can be used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heat_exchanger\" title=\"Heat exchanger\" rel=\"external_link\" target=\"_blank\">heat exchangers<\/a> (compact <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer_cooling\" title=\"Computer cooling\" rel=\"external_link\" target=\"_blank\">electronics cooling<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cryogenics\" title=\"Cryogenics\" rel=\"external_link\" target=\"_blank\">cryogen tanks<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phase_change_material\" class=\"mw-redirect\" title=\"Phase change material\" rel=\"external_link\" target=\"_blank\">PCM<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heat_exchanger\" title=\"Heat exchanger\" rel=\"external_link\" target=\"_blank\">heat exchangers<\/a>), energy absorption, flow diffusion, and . The high cost of the material generally limits its use to advanced technology, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aerospace\" title=\"Aerospace\" rel=\"external_link\" target=\"_blank\">aerospace<\/a>, and manufacturing.\n<\/p><p>Fine-scale open-cell foams, with cells smaller than can be seen unaided, are used as high-temperature <a href=\"https:\/\/en.wikipedia.org\/wiki\/Filter_(chemistry)\" class=\"mw-redirect\" title=\"Filter (chemistry)\" rel=\"external_link\" target=\"_blank\">filters<\/a> in the chemical industry.\n<\/p><p>Metallic foams are used in compact heat exchangers to increase heat transfer at the cost of reduced pressure.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><sup class=\"noprint Inline-Template\" style=\"margin-left:0.1em; white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Please_clarify\" title=\"Wikipedia:Please clarify\" rel=\"external_link\" target=\"_blank\"><span title=\"This has no meaning: "to increase heat transfer at the cost of reduced pressure" (July 2016)\">clarification needed<\/span><\/a><\/i>]<\/sup> However, their use permits substantial reduction in physical size and fabrication costs. Most models of these materials use idealized and periodic structures or averaged macroscopic properties.\n<\/p><p>Metal sponge has very large surface area per unit weight and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalyst\" class=\"mw-redirect\" title=\"Catalyst\" rel=\"external_link\" target=\"_blank\">catalysts<\/a> are often formed into metal sponge, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Palladium_black\" title=\"Palladium black\" rel=\"external_link\" target=\"_blank\">palladium black<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Platinum_black#Platinum_metal_sponge\" title=\"Platinum black\" rel=\"external_link\" target=\"_blank\">platinum sponge<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spongy_nickel\" class=\"mw-redirect\" title=\"Spongy nickel\" rel=\"external_link\" target=\"_blank\">spongy nickel<\/a>. Metals such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osmium\" title=\"Osmium\" rel=\"external_link\" target=\"_blank\">osmium<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Palladium_hydride\" title=\"Palladium hydride\" rel=\"external_link\" target=\"_blank\">palladium hydride<\/a> are metaphorically called \"metal sponges\", but this term is in reference to their property of binding to hydrogen, rather than the physical structure.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Manufacturing\">Manufacturing<\/span><\/h3>\n<p>Open cell foams are manufactured by foundry or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Powder_metallurgy\" title=\"Powder metallurgy\" rel=\"external_link\" target=\"_blank\">powder metallurgy<\/a>. In the powder method, \"space holders\" are used; as their name suggests, they occupy the pore spaces and channels. In casting processes, foam is cast with an open-celled <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyurethane\" title=\"Polyurethane\" rel=\"external_link\" target=\"_blank\">polyurethane<\/a> foam skeleton.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Closed-cell\">Closed-cell<\/span><\/h2>\n<p>Closed-cell metal foam was first reported in 1926 by Meller in a French patent where foaming of light metals, either by inert gas injection or by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blowing_agent\" title=\"Blowing agent\" rel=\"external_link\" target=\"_blank\">blowing agent<\/a>, was suggested.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> Two patents on sponge-like metal were issued to Benjamin Sosnik in 1948 and 1951 who applied <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercury_(element)\" title=\"Mercury (element)\" rel=\"external_link\" target=\"_blank\">mercury<\/a> vapor to blow liquid aluminium.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>Closed-cell metal foams were developed in 1956 by John C. Elliott at Bjorksten Research Laboratories. Although the first prototypes were available in the 1950s, commercial production began in the 1990s by Shinko Wire company in Japan. Closed-cell metal foams are primarily used as an impact-absorbing material, similarly to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> foams in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bicycle_helmet\" title=\"Bicycle helmet\" rel=\"external_link\" target=\"_blank\">bicycle helmet<\/a> but for higher impact loads. Unlike many polymer foams, metal foams remain deformed after impact and can therefore only be deformed once. They are light (typically 10\u201325% of the density of an identical non-porous alloy; commonly those of aluminium) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stiffness\" title=\"Stiffness\" rel=\"external_link\" target=\"_blank\">stiff<\/a> and are frequently proposed as a lightweight structural material. However, they have not been widely used for this purpose.\n<\/p><p>Closed-cell foams retain the fire resistance and recycling potential of other metallic foams, but add the property of flotation in water.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Manufacturing_2\">Manufacturing<\/span><\/h3>\n<p>Foams are commonly made by injecting a gas or mixing a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foaming_agent\" title=\"Foaming agent\" rel=\"external_link\" target=\"_blank\">foaming agent<\/a> into <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molten\" class=\"mw-redirect\" title=\"Molten\" rel=\"external_link\" target=\"_blank\">molten<\/a> metal.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> Melts can be foamed by creating gas bubbles in the material. Normally, bubbles in molten metal are highly buoyant in the high-density liquid and rise quickly to the surface. This rise can be slowed by increasing the viscosity of the molten metal by adding ceramic powders or alloying elements to form stabilizing particles in the melt, or by other means. Metallic melts can be foamed in one of three ways:\n<\/p>\n<ul><li>by injecting gas into the liquid metal from an external source;<\/li>\n<li>by causing gas formation in the liquid by admixing gas-releasing blowing agents with the molten metal;<\/li>\n<li>by causing the precipitation of gas that was previously dissolved in the molten metal.<\/li><\/ul>\n<p>To stabilize the molten metal bubbles, high temperature foaming agents (nano- or micrometer- sized solid particles) are required. The size of the <a href=\"https:\/\/en.wiktionary.org\/wiki\/Pore\" class=\"extiw\" title=\"wiktionary:Pore\" rel=\"external_link\" target=\"_blank\">pores<\/a>, or cells, is usually 1 to 8 mm. When foaming or blowing agents are used, they are mixed with the powdered metal before it is melted. This is the so-called \"powder route\" of foaming, and it is probably the most established (from an industrial standpoint). After metal (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium\" title=\"Aluminium\" rel=\"external_link\" target=\"_blank\">aluminium<\/a>) powders and foaming agent (e.g.<a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_hydride\" title=\"Titanium hydride\" rel=\"external_link\" target=\"_blank\">TiH<sub>2<\/sub><\/a>) have been mixed, they are compressed into a compact, solid precursor, which can be available in the form of a billet, a sheet, or a wire. Production of precursors can be done by a combination of materials forming processes, such as powder pressing,<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Extrusion\" title=\"Extrusion\" rel=\"external_link\" target=\"_blank\">extrusion<\/a> (direct<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> or conform<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>) and flat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rolling_(metalworking)\" title=\"Rolling (metalworking)\" rel=\"external_link\" target=\"_blank\">rolling<\/a>.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Composites\">Composites<\/span><\/h2>\n<p>Composite metal foam (CMF) is formed from hollow beads of one metal within a solid matrix of another, such as steel within aluminium, show 5 to 6 times greater strength to density ratio and more than 7 times greater energy absorption than previous metal foams.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p>A less than one inch thick plate has enough resistance to turn a 7.62 x 63 mm standard-issue M2 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Armor-piercing_shell\" title=\"Armor-piercing shell\" rel=\"external_link\" target=\"_blank\">armor piercing bullet<\/a> to dust. The test plate outperformed a solid metal plate of similar thickness, while weighing far less. Other potential applications include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radioactive_waste\" title=\"Radioactive waste\" rel=\"external_link\" target=\"_blank\">nuclear waste<\/a> (shielding <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray\" title=\"X-ray\" rel=\"external_link\" target=\"_blank\">X-rays<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gamma_rays\" class=\"mw-redirect\" title=\"Gamma rays\" rel=\"external_link\" target=\"_blank\">gamma rays<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neutron\" title=\"Neutron\" rel=\"external_link\" target=\"_blank\">neutron<\/a> radiation) transfer and thermal insulation for space vehicle atmospheric re-entry, with twice the resistance to fire and heat as the plain metals.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>CMF can replace rolled steel armor with the same protection for one-third the weight. It can block fragments and the shock waves that are responsible for brain injuries. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">Stainless steel<\/a> CMF can block blast pressure and fragmentation at 5,000 feet per second from <a href=\"https:\/\/en.wikipedia.org\/wiki\/High-explosive_incendiary\" title=\"High-explosive incendiary\" rel=\"external_link\" target=\"_blank\">high explosive incendiary<\/a> (HEI) rounds that detonate 18 inches from the shield. Steel CMF plates (9.5 mm or 16.75 mm thick) were placed 18 inches from the strikeplate held up against the wave of blast pressure and against the copper and steel fragments created by a 23\u00d7152 mm HEI round (as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anti-aircraft_warfare\" title=\"Anti-aircraft warfare\" rel=\"external_link\" target=\"_blank\">anti-aircraft weapons<\/a>) as well as a 2.3mm aluminum strikeplate.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Stochastic_and_regular_foams\">Stochastic and regular foams<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Stochastic\">Stochastic<\/span><\/h3>\n<p>A foam is said to be stochastic when the porosity distribution is random. Most foams are stochastic because of the method of manufacture:\n<\/p>\n<ul><li>Foaming of liquid or solid (powder) metal .<\/li>\n<li>Vapor deposition (CVD on a random matrix )<\/li>\n<li>Direct or indirect random casting of a mold containing beads or matrix.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Regular\">Regular<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Fabrication_des_mousses_fonderie.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f3\/Fabrication_des_mousses_fonderie.jpg\/220px-Fabrication_des_mousses_fonderie.jpg\" width=\"220\" height=\"101\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Fabrication_des_mousses_fonderie.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Manufacturing process of a regular metal foam by direct molding, CTIF process<sup id=\"rdp-ebb-cite_ref-autogenerated1_18-0\" class=\"reference\"><a href=\"#cite_note-autogenerated1-18\" rel=\"external_link\">[18]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-alveotec1_19-0\" class=\"reference\"><a href=\"#cite_note-alveotec1-19\" rel=\"external_link\">[19]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup><\/div><\/div><\/div>\n<p>A foam is said to be regular when the structure is ordered. Direct molding is one technology that produces regular foams<sup id=\"rdp-ebb-cite_ref-autogenerated1_18-1\" class=\"reference\"><a href=\"#cite_note-autogenerated1-18\" rel=\"external_link\">[18]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-alveotec1_19-1\" class=\"reference\"><a href=\"#cite_note-alveotec1-19\" rel=\"external_link\">[19]<\/a><\/sup> with open pores. In the alternate, regular metal foams can be produced by additive processes such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Selective_laser_melting\" title=\"Selective laser melting\" rel=\"external_link\" target=\"_blank\">selective laser melting<\/a> (SLM).\n<\/p><p>Plates can be used as casting cores. The shape is customized for each application. This manufacturing method allows for \"perfect\" foam, so-called because it satisfies <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plateau%27s_laws\" title=\"Plateau's laws\" rel=\"external_link\" target=\"_blank\">Plateau's laws<\/a> and has conducting pores of the shape of a truncated octahedron Kelvin cell (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Body-centered_cubic\" class=\"mw-redirect\" title=\"Body-centered cubic\" rel=\"external_link\" target=\"_blank\">body-centered cubic<\/a> structure).\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Truncatedoctahedron.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7c\/Truncatedoctahedron.gif\/220px-Truncatedoctahedron.gif\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Truncatedoctahedron.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Kelvin cell (Similar to the Weaire\u2013Phelan structure)<\/div><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Regular_foams_gallery\">Regular foams gallery<\/span><\/h2>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:17.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Heat_sink_copper_foam.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a0\/Heat_sink_copper_foam.jpg\/120px-Heat_sink_copper_foam.jpg\" width=\"120\" height=\"115\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Heat sink with copper foam\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Metal_foam_-Crash_box_1.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/Metal_foam_-Crash_box_1.JPG\/120px-Metal_foam_-Crash_box_1.JPG\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Crash box including Aluminium foam\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Metal_foam_-_big_porosity.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/Metal_foam_-_big_porosity.jpg\/103px-Metal_foam_-_big_porosity.jpg\" width=\"103\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Aluminium foam with big porosity\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Aluminium_foam_with_aluminium_sheet.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Aluminium_foam_with_aluminium_sheet.jpg\/120px-Aluminium_foam_with_aluminium_sheet.jpg\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Aluminium foam with aluminium sheet\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Header_-_steel_metal_foam.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/01\/Header_-_steel_metal_foam.jpg\/115px-Header_-_steel_metal_foam.jpg\" width=\"115\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Header - steel metal foam\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Design\">Design<\/span><\/h3>\n<p>Metal foam can be used in product or architectural composition.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Design_gallery\">Design gallery<\/span><\/h4>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Aluminium_composition.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/28\/Aluminium_composition.png\/87px-Aluminium_composition.png\" width=\"87\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>machined metal foam\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:19.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Design_heatsink.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3a\/Design_heatsink.JPG\/120px-Design_heatsink.JPG\" width=\"120\" height=\"111\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Design heatsink with regular foam<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:33px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Metal_foam_Coffee_table.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/03\/Metal_foam_Coffee_table.jpg\/120px-Metal_foam_Coffee_table.jpg\" width=\"120\" height=\"84\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>coffee table with large pored aluminium\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h3><span class=\"mw-headline\" id=\"Mechanical\">Mechanical<\/span><\/h3>\n<h4><span class=\"mw-headline\" id=\"Orthopedics\">Orthopedics<\/span><\/h4>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseointegration#Advances_in_materials_engineering:_metal_foams\" title=\"Osseointegration\" rel=\"external_link\" target=\"_blank\">Osseointegration \u00a7 Advances in materials engineering: metal foams<\/a><\/div>\n<p>Foam metal has been used in experimental animal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthetics<\/a>. In this application, a hole is drilled into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> and the metal foam inserted, letting the bone grow into the metal for a permanent junction. For orthopedic applications, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalum\" title=\"Tantalum\" rel=\"external_link\" target=\"_blank\">tantalum<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a> foams are common for their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tensile_strength\" class=\"mw-redirect\" title=\"Tensile strength\" rel=\"external_link\" target=\"_blank\">tensile strength<\/a>, corrosion resistance and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatibility<\/a>.\n<\/p><p>The back legs of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Siberian_Husky\" title=\"Siberian Husky\" rel=\"external_link\" target=\"_blank\">Siberian Husky<\/a> named Triumph received foam metal prostheses. Mammalian studies showed that porous metals, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a> foam, may allow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular\" class=\"mw-redirect\" title=\"Vascular\" rel=\"external_link\" target=\"_blank\">vascular<\/a>ization within the porous area.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p><p>Orthopedic device manufacturers use foam construction or metal foam coatings<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> to achieve desired levels of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseointegration\" title=\"Osseointegration\" rel=\"external_link\" target=\"_blank\">osseointegration<\/a>.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Automotive\">Automotive<\/span><\/h4>\n<p>The primary functions of metallic foams in vehicles are to increase <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sound_damping\" class=\"mw-redirect\" title=\"Sound damping\" rel=\"external_link\" target=\"_blank\">sound damping<\/a>, reduce weight, increase energy absorption in case of crashes, and (in military applications) to combat the concussive force of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Improvised_explosive_device\" title=\"Improvised explosive device\" rel=\"external_link\" target=\"_blank\">IEDs<\/a>. As an example, foam filled tubes could be used as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anti-intrusion_bar\" title=\"Anti-intrusion bar\" rel=\"external_link\" target=\"_blank\">anti-intrusion bars<\/a>.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> Because of their low density (0.4\u20130.9 g\/cm<sup>3<\/sup>), aluminium and aluminium alloy foams are under particular consideration. These foams are stiff, fire resistant, nontoxic, recyclable, energy absorbent, less thermally conductive, less magnetically permeable, and more efficiently sound dampening, especially when compared to hollow parts. Metallic foams in hollow car parts decrease weakness points usually associated with car crashes and vibration. These foams are inexpensive to cast with powder metallurgy, compared to casting other hollow parts.\n<\/p><p>Compared to polymer foams in vehicles, metallic foams are stiffer, stronger, more energy absorbent, and resistant to fire and the weather adversities of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultraviolet\" title=\"Ultraviolet\" rel=\"external_link\" target=\"_blank\">UV<\/a> light, humidity, and temperature variation. However, they are heavier, more expensive, and non-insulating.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/p><p>Metal foam technology has been applied to automotive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Exhaust_gas\" title=\"Exhaust gas\" rel=\"external_link\" target=\"_blank\">exhaust gas<\/a>.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> Compared to traditional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalytic_converter\" title=\"Catalytic converter\" rel=\"external_link\" target=\"_blank\">catalytic converter<\/a>s that use <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cordierite\" title=\"Cordierite\" rel=\"external_link\" target=\"_blank\">cordierite<\/a> ceramic as substrate, metal foam substrate offers better heat transfer and exhibits excellent mass-transport properties (high turbulence) and may reduce the quantity of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Platinum\" title=\"Platinum\" rel=\"external_link\" target=\"_blank\">platinum<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalyst\" class=\"mw-redirect\" title=\"Catalyst\" rel=\"external_link\" target=\"_blank\">catalyst<\/a> required.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Energy_absorption\">Energy absorption<\/span><\/h4>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Aluminium_crash_-_regular_foam.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/36\/Aluminium_crash_-_regular_foam.png\/220px-Aluminium_crash_-_regular_foam.png\" width=\"220\" height=\"154\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Aluminium_crash_-_regular_foam.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Aluminium crash graph<\/div><\/div><\/div>\n<p>Metal foams are used for stiffening a structure without increasing its mass.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> For this application, metal foams are generally closed pore and made of aluminium. Foam panels are glued to the aluminium plate to obtain a resistant composite sandwich locally (in the sheet thickness) and rigid along the length depending on the foam's thickness.\n<\/p><p>The advantage of metal foams is that the reaction is constant, regardless of the direction of the force. Foams have a plateau of stress after deformation that is constant for as much as 80% of the crushing.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Thermal\">Thermal<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mousse_aluminium_-_conduction_thermique.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/ca\/Mousse_aluminium_-_conduction_thermique.png\/220px-Mousse_aluminium_-_conduction_thermique.png\" width=\"220\" height=\"190\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mousse_aluminium_-_conduction_thermique.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Heat conduction in regular metal foam structure<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mousse_aluminium_-_transfert_thermique.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/50\/Mousse_aluminium_-_transfert_thermique.png\/220px-Mousse_aluminium_-_transfert_thermique.png\" width=\"220\" height=\"202\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mousse_aluminium_-_transfert_thermique.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Heat transfer in regular metal foam structure<\/div><\/div><\/div>\n<p>Tian et al.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup> listed several criteria to assess a foam in a heat exchanger. The comparison of thermal-performance metal foams with materials conventionally used in the intensification of exchange (fins, coupled surfaces, bead bed) first shows that the pressure losses caused by foams are much more important than with conventional fins, yet are significantly lower than those of beads. The exchange coefficients are close to beds and ball and well above the blades.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup>\n<\/p><p>Foams offer other thermophysical and mechanical features:\n<\/p>\n<ul><li>Very low mass (density 5\u201325% of the bulk solid depending the manufacturing method)<\/li>\n<li>Large exchange surface (250\u201310000 m<sup>2<\/sup>\/m<sup>3<\/sup>)<\/li>\n<li>Relatively high permeability<\/li>\n<li>Relatively high effective thermal conductivities (5\u201330 W\/(mK))<\/li>\n<li>Good resistance to thermal shocks, high pressures, high temperatures, moisture, wear and thermal cycling<\/li>\n<li>Good absorption of mechanical shock and sound<\/li>\n<li>Pore size and porosity can be controlled by the manufacturer<\/li><\/ul>\n<p>Commercialization of foam-based compact heat exchangers, heat sinks and shock absorbers is limited due to the high cost of foam replications. Their long-term resistance to fouling, corrosion and erosion are insufficiently characterized. From a manufacturing standpoint, the transition to foam technology requires new production and assembly techniques and heat exchanger design.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Porous_medium\" title=\"Porous medium\" rel=\"external_link\" target=\"_blank\">Porous medium<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_foam\" title=\"Ceramic foam\" rel=\"external_link\" target=\"_blank\">Ceramic foam<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nanofoam\" title=\"Nanofoam\" rel=\"external_link\" target=\"_blank\">Nanofoam<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Reticulated_foam\" title=\"Reticulated foam\" rel=\"external_link\" target=\"_blank\">Reticulated foam<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminum_polymer_composite\" title=\"Aluminum polymer composite\" rel=\"external_link\" target=\"_blank\">Aluminum polymer composite<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium_foam_sandwich\" title=\"Aluminium foam sandwich\" rel=\"external_link\" target=\"_blank\">Aluminium foam sandwich<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_foam\" title=\"Titanium foam\" rel=\"external_link\" target=\"_blank\">Titanium foam<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.makeitfrom.com\/compare\/?left=Cast_Alum&right=Alum_Foam\" target=\"_blank\">Compare Materials: Cast Aluminium and Aluminium Foam<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100430185427\/http:\/\/www.makeitfrom.com\/compare\/?left=Cast_Alum\" target=\"_blank\">Archived<\/a> 2010-04-30 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Makeitfrom.com. Retrieved on 2011-11-19.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\nJohn Banhart.\n<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.metalfoam.net\/\" target=\"_blank\">\"What are cellular metals and metal foams?\"<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20101229165208\/http:\/\/metalfoam.net\/\" target=\"_blank\">Archived<\/a> 2010-12-29 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>..<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Topin, F.; Bonnet, J. -P.; Madani, B.; Tadrist, L. (2006). \"Experimental Analysis of Multiphase Flow in Metallic foam: Flow Laws, Heat Transfer and Convective Boiling\". <i>Advanced Engineering Materials<\/i>. <b>8<\/b> (9): 890. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fadem.200600102\" target=\"_blank\">10.1002\/adem.200600102<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Advanced+Engineering+Materials&rft.atitle=Experimental+Analysis+of+Multiphase+Flow+in+Metallic+foam%3A+Flow+Laws%2C+Heat+Transfer+and+Convective+Boiling&rft.volume=8&rft.issue=9&rft.pages=890&rft.date=2006&rft_id=info%3Adoi%2F10.1002%2Fadem.200600102&rft.aulast=Topin&rft.aufirst=F.&rft.au=Bonnet%2C+J.+-P.&rft.au=Madani%2C+B.&rft.au=Tadrist%2C+L.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMetal+foam\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Banhart, J. (2001). \"Manufacture, Characterization and application of cellular metals and metal foams\". <i>Progress in materials Science<\/i>. <b>46<\/b> (6): 559\u2013632. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0079-6425%2800%2900002-5\" target=\"_blank\">10.1016\/S0079-6425(00)00002-5<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Progress+in+materials+Science&rft.atitle=Manufacture%2C+Characterization+and+application+of+cellular+metals+and+metal+foams&rft.volume=46&rft.issue=6&rft.pages=559-632&rft.date=2001&rft_id=info%3Adoi%2F10.1016%2FS0079-6425%2800%2900002-5&rft.au=Banhart%2C+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMetal+foam\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">DeGroot, C.T., Straatman, A.G., and Betchen, L.J. (2009). \"Modeling forced convection in finned metal foam heat sinks\". <i>J. Electron. Packag<\/i>. <b>131<\/b> (2): 021001. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1115%2F1.3103934\" target=\"_blank\">10.1115\/1.3103934<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J.+Electron.+Packag.&rft.atitle=Modeling+forced+convection+in+finned+metal+foam+heat+sinks&rft.volume=131&rft.issue=2&rft.pages=021001&rft.date=2009&rft_id=info%3Adoi%2F10.1115%2F1.3103934&rft.au=DeGroot%2C+C.T.%2C+Straatman%2C+A.G.%2C+and+Betchen%2C+L.J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMetal+foam\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\nRalph Wolf; Khalid Mansour.\n<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.psc.edu\/science\/Wolf\/Wolf.html\" target=\"_blank\">\"The Amazing Metal Sponge: Soaking Up Hydrogen\"<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20151116143530\/http:\/\/www.psc.edu\/science\/Wolf\/Wolf.html\" target=\"_blank\">Archived<\/a> 2015-11-16 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>..\n1995.<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">De Meller, M.A. French Patent 615,147 (1926).<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Sosnick, B. <span><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.google.com\/patents\/US2434775\" target=\"_blank\">U.S. Patent 2,434,775<\/a><\/span> (1948).<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Sosnick, B. <span><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.google.com\/patents\/US2553016\" target=\"_blank\">U.S. Patent 2,553,016<\/a><\/span> (1951).<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Banhart, John (2000). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.tms.org\/pubs\/journals\/JOM\/0012\/Banhart-0012.html\" target=\"_blank\">\"Manufacturing Routes for Metallic Foams\"<\/a>. <i>JOM<\/i>. Minerals, Metals & Materials Society. <b>52<\/b> (12): 22\u201327. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11837-000-0062-8\" target=\"_blank\">10.1007\/s11837-000-0062-8<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120101225041\/http:\/\/www.tms.org\/pubs\/journals\/JOM\/0012\/Banhart-0012.html\" target=\"_blank\">Archived<\/a> from the original on 2012-01-01<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2012-01-20<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JOM&rft.atitle=Manufacturing+Routes+for+Metallic+Foams&rft.volume=52&rft.issue=12&rft.pages=22-27&rft.date=2000&rft_id=info%3Adoi%2F10.1007%2Fs11837-000-0062-8&rft.aulast=Banhart&rft.aufirst=John&rft_id=http%3A%2F%2Fwww.tms.org%2Fpubs%2Fjournals%2FJOM%2F0012%2FBanhart-0012.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMetal+foam\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bonaccorsi, L.; Proverbio, E. (1 September 2006). \"Powder Compaction Effect on Foaming Behavior of Uni-Axial Pressed PM Precursors\". <i>Advanced Engineering Materials<\/i>. <b>8<\/b> (9): 864\u2013869. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fadem.200600082\" target=\"_blank\">10.1002\/adem.200600082<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Advanced+Engineering+Materials&rft.atitle=Powder+Compaction+Effect+on+Foaming+Behavior+of+Uni-Axial+Pressed+PM+Precursors&rft.volume=8&rft.issue=9&rft.pages=864-869&rft.date=2006-09-01&rft_id=info%3Adoi%2F10.1002%2Fadem.200600082&rft.aulast=Bonaccorsi&rft.aufirst=L.&rft.au=Proverbio%2C+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMetal+foam\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Shiomi, M.; Imagama, S.; Osakada, K.; Matsumoto, R. (2010). \"Fabrication of aluminium foams from powder by hot extrusion and foaming\". <i>Journal of Materials Processing Technology<\/i>. <b>210<\/b> (9): 1203\u20131208. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jmatprotec.2010.03.006\" target=\"_blank\">10.1016\/j.jmatprotec.2010.03.006<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Materials+Processing+Technology&rft.atitle=Fabrication+of+aluminium+foams+from+powder+by+hot+extrusion+and+foaming&rft.volume=210&rft.issue=9&rft.pages=1203-1208&rft.date=2010&rft_id=info%3Adoi%2F10.1016%2Fj.jmatprotec.2010.03.006&rft.aulast=Shiomi&rft.aufirst=M.&rft.au=Imagama%2C+S.&rft.au=Osakada%2C+K.&rft.au=Matsumoto%2C+R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMetal+foam\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Dunand, [editors] Louis Philippe Lefebvre, John Banhart, David C. (2008). <i>MetFoam 2007 : porous metals and metallic foams : proceedings of the fifth International Conference on Porous Metals and Metallic Foams, September 5\u20137, 2007, Montreal Canada<\/i>. Lancaster, Pa.: DEStech Publications Inc. pp. 7\u201310. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1932078282.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=MetFoam+2007+%3A+porous+metals+and+metallic+foams+%3A+proceedings+of+the+fifth+International+Conference+on+Porous+Metals+and+Metallic+Foams%2C+September+5%E2%80%937%2C+2007%2C+Montreal+Canada&rft.place=Lancaster%2C+Pa.&rft.pages=7-10&rft.pub=DEStech+Publications+Inc.&rft.date=2008&rft.isbn=1932078282&rft.aulast=Dunand&rft.aufirst=%5Beditors%5D+Louis+Philippe+Lefebvre%2C+John+Banhart%2C+David+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMetal+foam\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Extra text: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Extra_text:_authors_list\" title=\"Category:CS1 maint: Extra text: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Strano, M.; Pourhassan, R.; Mussi, V. (2013). \"The effect of cold rolling on the foaming efficiency of aluminium precursors\". <i>Journal of Manufacturing Processes<\/i>. <b>15<\/b> (2): 227. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jmapro.2012.12.006\" target=\"_blank\">10.1016\/j.jmapro.2012.12.006<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Manufacturing+Processes&rft.atitle=The+effect+of+cold+rolling+on+the+foaming+efficiency+of+aluminium+precursors&rft.volume=15&rft.issue=2&rft.pages=227&rft.date=2013&rft_id=info%3Adoi%2F10.1016%2Fj.jmapro.2012.12.006&rft.aulast=Strano&rft.aufirst=M.&rft.au=Pourhassan%2C+R.&rft.au=Mussi%2C+V.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMetal+foam\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.urweb.tv\/material\/highPerformanceComposite\/highPerformanceComposite.html\" target=\"_blank\">Urweb:High Performance Composite Metal Foam<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131212185129\/http:\/\/www.urweb.tv\/material\/highPerformanceComposite\/highPerformanceComposite.html\" target=\"_blank\">Archived<\/a> 2013-12-12 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. . Retrieved on 2013-12-10.<\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">MICU, ALEXANDRU (April 6, 2016). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.zmescience.com\/research\/metal-foam-composite-bullet-54063\/\" target=\"_blank\">\"Composite metal foam better at stopping bullets than solid plates\"<\/a>. <i>ZME Science<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160410034452\/http:\/\/www.zmescience.com\/research\/metal-foam-composite-bullet-54063\/\" target=\"_blank\">Archived<\/a> from the original on April 10, 2016<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-04-09<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=ZME+Science&rft.atitle=Composite+metal+foam+better+at+stopping+bullets+than+solid+plates&rft.date=2016-04-06&rft.aulast=MICU&rft.aufirst=ALEXANDRU&rft_id=http%3A%2F%2Fwww.zmescience.com%2Fresearch%2Fmetal-foam-composite-bullet-54063%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMetal+foam\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Wang, Brian (2018-04-24). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nextbigfuture.com\/2018\/04\/composite-metal-foams-provide-armor-protection-for-one-third-the-weight-and-make-super-car-bumpers.html\" target=\"_blank\">\"Composite metal foams provide armor protection for one third the weight and make super car bumpers | NextBigFuture.com\"<\/a>. <i>NextBigFuture.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-05-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=NextBigFuture.com&rft.atitle=Composite+metal+foams+provide+armor+protection+for+one+third+the+weight+and+make+super+car+bumpers+%7C+NextBigFuture.com&rft.date=2018-04-24&rft.aulast=Wang&rft.aufirst=Brian&rft_id=https%3A%2F%2Fwww.nextbigfuture.com%2F2018%2F04%2Fcomposite-metal-foams-provide-armor-protection-for-one-third-the-weight-and-make-super-car-bumpers.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMetal+foam\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-autogenerated1-18\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-autogenerated1_18-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-autogenerated1_18-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ctif.com\/recherche-en-fonderie-mousses-metalliques.aspx\" target=\"_blank\">Recherche sur la production de pi\u00e8ces de fonderie en mousse m\u00e9tallique \u2013 Recherche en fonderie : les mousses m\u00e9talliques<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131029212125\/http:\/\/www.ctif.com\/recherche-en-fonderie-mousses-metalliques.aspx\" target=\"_blank\">Archived<\/a> 2013-10-29 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Ctif.com. Retrieved on 2013-12-03.<\/span>\n<\/li>\n<li id=\"cite_note-alveotec1-19\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-alveotec1_19-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-alveotec1_19-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.alveotec.fr\/en\/innovation.html\" target=\"_blank\">ALVEOTEC \u2013 Innovation<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140730035036\/http:\/\/www.alveotec.fr\/en\/innovation.html\" target=\"_blank\">Archived<\/a> 2014-07-30 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Alveotec.fr\/en. Retrieved on 2013-12-03.<\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.alveotec.fr\/fr\/nos-actualites\/video-making-process-of-aluminium-foam_96.html\" target=\"_blank\">\"ALVEOTEC - Actualit\u00e9s - video : making process of aluminium foam\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140730040546\/http:\/\/www.alveotec.fr\/fr\/nos-actualites\/video-making-process-of-aluminium-foam_96.html\" target=\"_blank\">Archived<\/a> from the original on 2014-07-30.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=ALVEOTEC+-+Actualit%C3%A9s+-+video+%3A+making+process+of+aluminium+foam&rft_id=http%3A%2F%2Fwww.alveotec.fr%2Ffr%2Fnos-actualites%2Fvideo-making-process-of-aluminium-foam_96.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMetal+foam\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.alveotec.fr\/en\/our-news\/loupi-launch-his-new-metal-foam-heatsink-for-lighting-application_66.html\" target=\"_blank\">ALVEOTEC - Actualit\u00e9s - LOUPI Lighing launches his new metal foam heatsink for lighting application_66.html<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140730035034\/http:\/\/www.alveotec.fr\/en\/our-news\/loupi-launch-his-new-metal-foam-heatsink-for-lighting-application_66.html\" target=\"_blank\">Archived<\/a> 2014-07-30 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Alveotec.fr. Retrieved on 2013-12-03.<\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=hdscnna5r1Q\" target=\"_blank\">Osseointegration with Titanium Foam in Rabbit Femur<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160418190743\/https:\/\/www.youtube.com\/watch?v=hdscnna5r1Q\" target=\"_blank\">Archived<\/a> 2016-04-18 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>., YouTube<\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=Vj79YKYb5FQ\" target=\"_blank\">Titanium coatings on Orthopedic Devices<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160313150307\/https:\/\/www.youtube.com\/watch?v=Vj79YKYb5FQ\" target=\"_blank\">Archived<\/a> 2016-03-13 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Youtube<\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Biomet Orthopedics, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.biomet.com\/orthopedics\/productDetail.cfm?category=2&product=231\" target=\"_blank\">Regenerex\u00ae Porous Titanium Construct<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110928032751\/http:\/\/www.biomet.com\/orthopedics\/productDetail.cfm?category=2&product=231\" target=\"_blank\">Archived<\/a> 2011-09-28 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Zimmer Orthopedics, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.zimmer.com\/ctl?template=CP&op=global&action=1&id=33\" target=\"_blank\">Trabeluar Metal Technology<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110718154614\/http:\/\/www.zimmer.com\/ctl?template=CP&op=global&action=1&id=33\" target=\"_blank\">Archived<\/a> 2011-07-18 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Zimmer <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.zimmer.com\/ctl?op=global&action=1&id=7876&template=MP\" target=\"_blank\">CSTiTM (Cancellous-Structured Titanium TM) Porous Coating<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110718155127\/http:\/\/www.zimmer.com\/ctl?op=global&action=1&id=7876&template=MP\" target=\"_blank\">Archived<\/a> 2011-07-18 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Strano, Matteo (2011). \"A New FEM Approach for Simulation of Metal Foam Filled Tubes\". <i>Journal of Manufacturing Science and Engineering<\/i>. <b>133<\/b> (6): 061003. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1115%2F1.4005354\" target=\"_blank\">10.1115\/1.4005354<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Manufacturing+Science+and+Engineering&rft.atitle=A+New+FEM+Approach+for+Simulation+of+Metal+Foam+Filled+Tubes&rft.volume=133&rft.issue=6&rft.pages=061003&rft.date=2011&rft_id=info%3Adoi%2F10.1115%2F1.4005354&rft.aulast=Strano&rft.aufirst=Matteo&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMetal+foam\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.metalfoam.net\/Papers-conference\/2001%20Bratislava_New%20concept_.pdf\" target=\"_blank\">New Concept for Design of Lightweight Automotive Components<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120324011613\/http:\/\/www.metalfoam.net\/Papers-conference\/2001%20Bratislava_New%20concept_.pdf\" target=\"_blank\">Archived<\/a> 2012-03-24 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. (PDF) . Retrieved on 2013-12-03.<\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.alantum.com\/en\/gastreatment.html\" target=\"_blank\">Alantum Innovations in Alloy Foam: Home<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100217041329\/http:\/\/www.alantum.com\/en\/gastreatment.html\" target=\"_blank\">Archived<\/a> 2010-02-17 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Alantum.com. Retrieved on 2011-11-19.<\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/vcc-sae.org\/abstracts\/1703-development-metal-foam-based-aftertreatment-diesel-passenger-car\" target=\"_blank\">Development of Metal Foam Based Aftertreatment on a Diesel Passenger Car \u2013 Virtual Conference Center<\/a><sup class=\"noprint Inline-Template\"><span style=\"white-space: nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Link_rot\" title=\"Wikipedia:Link rot\" rel=\"external_link\" target=\"_blank\"><span title=\" Dead link since November 2017\">permanent dead link<\/span><\/a><\/i>]<\/span><\/sup>. Vcc-sae.org. Retrieved on 2011-11-19.<\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Banhart, John; Dunand, David C. (2008). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=Metal%20foams%20stiffen%20a%20structure%20without%20increasing%20its%20mass.&f=false\"><i>MetFoam 2007: Porous Metals and Metallic Foams : Proceedings of the Fifth International Conference on Porous Metals and Metallic Foams, September 5-7, 2007, Montreal Canada<\/i><\/a>. DEStech Publications, Inc. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781932078282.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=MetFoam+2007%3A+Porous+Metals+and+Metallic+Foams+%3A+Proceedings+of+the+Fifth+International+Conference+on+Porous+Metals+and+Metallic+Foams%2C+September+5-7%2C+2007%2C+Montreal+Canada&rft.pub=DEStech+Publications%2C+Inc&rft.date=2008&rft.isbn=9781932078282&rft.aulast=Banhart&rft.aufirst=John&rft.au=Dunand%2C+David+C.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DyeUM3eEF4jMC%26pg%3DPA3%26dq%3DMetal%2Bfoams%2Bstiffen%2Ba%2Bstructure%2Bwithout%2Bincreasing%2Bits%2Bmass.%26hl%3Den%26sa%3DX%26ved%3D0ahUKEwjnqKS3mqTXAhUT_mMKHaJbD9oQ6AEIJjAA%23v%3Donepage%26q%3DMetal%2520foams%2520stiffen%2520a%2520structure%2520without%2520increasing%2520its%2520mass.%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMetal+foam\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.alveotec.fr\/en\/our-news\/examples-of-metal-foam-applications_55.html\" target=\"_blank\">ALVEOTEC \u2013 Actualit\u00e9s \u2013 Examples of metal foam applications.<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140730040541\/http:\/\/www.alveotec.fr\/en\/our-news\/examples-of-metal-foam-applications_55.html\" target=\"_blank\">Archived<\/a> 2014-07-30 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>. Alveotec.fr. Retrieved on 2013-12-03.<\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tian, J.; Kim, T.; Lu, T. J.; Hodson, H. P.; Queheillalt, D. T.; Sypeck, D. J.; Wadley, H. N. G. (2004). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.virginia.edu\/ms\/research\/wadley\/Documents\/Publications\/The%20effects%20of%20topology%20upon%20fluid-flow%20and%20heat-transfer.pdf\" target=\"_blank\">\"The effects of topology upon fluid-flow and heat-transfer within cellular copper structures\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>International Journal of Heat and Mass Transfer<\/i>. <b>47<\/b> (14\u201316): 3171. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ijheatmasstransfer.2004.02.010\" target=\"_blank\">10.1016\/j.ijheatmasstransfer.2004.02.010<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160303215125\/http:\/\/www.virginia.edu\/ms\/research\/wadley\/Documents\/Publications\/The%20effects%20of%20topology%20upon%20fluid-flow%20and%20heat-transfer.pdf\" target=\"_blank\">Archived<\/a> <span class=\"cs1-format\">(PDF)<\/span> from the original on 2016-03-03.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Heat+and+Mass+Transfer&rft.atitle=The+effects+of+topology+upon+fluid-flow+and+heat-transfer+within+cellular+copper+structures&rft.volume=47&rft.issue=14%E2%80%9316&rft.pages=3171&rft.date=2004&rft_id=info%3Adoi%2F10.1016%2Fj.ijheatmasstransfer.2004.02.010&rft.aulast=Tian&rft.aufirst=J.&rft.au=Kim%2C+T.&rft.au=Lu%2C+T.+J.&rft.au=Hodson%2C+H.+P.&rft.au=Queheillalt%2C+D.+T.&rft.au=Sypeck%2C+D.+J.&rft.au=Wadley%2C+H.+N.+G.&rft_id=http%3A%2F%2Fwww.virginia.edu%2Fms%2Fresearch%2Fwadley%2FDocuments%2FPublications%2FThe%2520effects%2520of%2520topology%2520upon%2520fluid-flow%2520and%2520heat-transfer.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMetal+foam\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Miscevic, M. (1997). Etude de l'intensification des transferts thermiques par des structures poreuses: Application aux \u00e9changeurs compacts et au refroidissement diphasique. IUSTI. Marseille., Universit\u00e9 de Provence<\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Catillon, S., C. Louis, et al. (2005). Utilisation de mousses m\u00e9talliques dans un r\u00e9formeur catalytique du m\u00e9thanol pour la production de H2. GECAT, La Rochelle.<\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.alveotec.fr\/fr\/nos-actualites\/video-utilisation-de-mousse-dans-l-absorption-d-energie-en-crash_95.html\" target=\"_blank\">Video : Aluminium regular foam: Crash box test<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.alveotec.fr\/fr\/nos-actualites\/video-making-process-of-aluminium-foam_96.html\" target=\"_blank\">Video : How regular foams are made<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nasa.gov\/centers\/marshall\/news\/background\/facts\/foam.html\" target=\"_blank\">NASA Fact sheet FS-2003-09-117-MSFC \u2014 Viscous Liquid Foam and Bulk Metallic Glass (Foam)<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=8FHTK2LZNTY\" target=\"_blank\"><span class=\"plainlinks\">How to Make an Aluminium Metal Foam<\/span><\/a> on <a href=\"https:\/\/en.wikipedia.org\/wiki\/YouTube\" title=\"YouTube\" rel=\"external_link\" target=\"_blank\">YouTube<\/a><\/li>\n<li><cite class=\"citation journal\">Fischer, S. F.; Thielen, M.; Wei\u00df, P.; Seidel, R.; Speck, T.; B\u00fchrig-Polaczek, A.; B\u00fcnck, M. (2013). \"Production and properties of a precision-cast bio-inspired composite\". <i>Journal of Materials Science<\/i>. <b>49<\/b>: 43. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs10853-013-7878-4\" target=\"_blank\">10.1007\/s10853-013-7878-4<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Materials+Science&rft.atitle=Production+and+properties+of+a+precision-cast+bio-inspired+composite&rft.volume=49&rft.pages=43&rft.date=2013&rft_id=info%3Adoi%2F10.1007%2Fs10853-013-7878-4&rft.aulast=Fischer&rft.aufirst=S.+F.&rft.au=Thielen%2C+M.&rft.au=Wei%C3%9F%2C+P.&rft.au=Seidel%2C+R.&rft.au=Speck%2C+T.&rft.au=B%C3%BChrig-Polaczek%2C+A.&rft.au=B%C3%BCnck%2C+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMetal+foam\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=UCokzuZa68EyFqg5OPUnreLA\" target=\"_blank\"><span class=\"plainlinks\">Bullet destruction video<\/span><\/a> on <a href=\"https:\/\/en.wikipedia.org\/wiki\/YouTube\" title=\"YouTube\" rel=\"external_link\" target=\"_blank\">YouTube<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1274\nCached time: 20181211195349\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.412 seconds\nReal time usage: 0.563 seconds\nPreprocessor visited node count: 1871\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 47082\/2097152 bytes\nTemplate argument size: 1604\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 61556\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.181\/10.000 seconds\nLua memory usage: 5.09 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 467.332 1 -total\n<\/p>\n<pre>47.49% 221.952 1 Template:Reflist\n26.62% 124.385 10 Template:Cite_journal\n18.08% 84.503 1 Template:Clarify\n13.93% 65.121 1 Template:Fix-span\n 8.32% 38.904 4 Template:Category_handler\n 8.21% 38.354 1 Template:Authority_control\n 5.58% 26.093 2 Template:Youtube\n 5.42% 25.350 15 Template:Webarchive\n 4.91% 22.940 1 Template:Replace\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2324595-1!canonical and timestamp 20181211195349 and revision id 872801989\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Metal_foam\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212217\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.020 seconds\nReal time usage: 0.159 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 151.389 1 - wikipedia:Metal_foam\n100.00% 151.389 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8318-0!*!*!*!*!*!* and timestamp 20181217212217 and revision id 24543\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Metal_foam\">https:\/\/www.limswiki.org\/index.php\/Metal_foam<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","7421bd0ccd10ef9c987559cc110bd0ff_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fc\/Aluminium_foam.jpg\/440px-Aluminium_foam.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/Alv%C3%A9oles_4.jpg\/440px-Alv%C3%A9oles_4.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/af\/Metal_Foam_in_Scanning_Electron_Microscope%2C_magnification_10x.GIF\/440px-Metal_Foam_in_Scanning_Electron_Microscope%2C_magnification_10x.GIF","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/5\/54\/Numerical_simulation_on_an_open_cell_metal_foam._Velocity_and_temperature_fields.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f3\/Fabrication_des_mousses_fonderie.jpg\/440px-Fabrication_des_mousses_fonderie.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/7\/7c\/Truncatedoctahedron.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a0\/Heat_sink_copper_foam.jpg\/240px-Heat_sink_copper_foam.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/Metal_foam_-Crash_box_1.JPG\/240px-Metal_foam_-Crash_box_1.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/Metal_foam_-_big_porosity.jpg\/206px-Metal_foam_-_big_porosity.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Aluminium_foam_with_aluminium_sheet.jpg\/240px-Aluminium_foam_with_aluminium_sheet.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/01\/Header_-_steel_metal_foam.jpg\/230px-Header_-_steel_metal_foam.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/28\/Aluminium_composition.png\/174px-Aluminium_composition.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3a\/Design_heatsink.JPG\/240px-Design_heatsink.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/03\/Metal_foam_Coffee_table.jpg\/240px-Metal_foam_Coffee_table.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/36\/Aluminium_crash_-_regular_foam.png\/440px-Aluminium_crash_-_regular_foam.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/ca\/Mousse_aluminium_-_conduction_thermique.png\/440px-Mousse_aluminium_-_conduction_thermique.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/50\/Mousse_aluminium_-_transfert_thermique.png\/440px-Mousse_aluminium_-_transfert_thermique.png"],"7421bd0ccd10ef9c987559cc110bd0ff_timestamp":1545081737,"6a3e317da061c2f39ab56a73452dea10_type":"article","6a3e317da061c2f39ab56a73452dea10_title":"Hydroxylapatite","6a3e317da061c2f39ab56a73452dea10_url":"https:\/\/www.limswiki.org\/index.php\/Hydroxylapatite","6a3e317da061c2f39ab56a73452dea10_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tHydroxylapatite\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tHydroxyapatiteHydroxylapatite crystals on matrixGeneralCategoryPhosphate mineral \r\nApatite groupFormula\r\n(repeating unit) Ca5(PO4)3(OH)Strunz classification8.BN.05Crystal systemHexagonalCrystal classDipyramidal (6\/m) \r\nH-M Symbol (6\/m)Space groupP63\/mUnit cella = 9.41 \u00c5, c = 6.88 \u00c5; Z = 2IdentificationFormula mass502.31 g\/molColorColorless, white, gray, yellow, yellowish greenCrystal habitAs tabular crystals and as stalagmites, nodules, in crystalline to massive crustsCleavagePoor on {0001} and {10<span style=\"text-decoration:overline;\">1<\/span>0}FractureConchoidalTenacityBrittleMohs scale hardness 5LusterVitreous to subresinous, earthyStreakWhiteDiaphaneityTransparent to translucentSpecific gravity3.14\u20133.21 (measured), 3.16 (calculated)Optical propertiesUniaxial (-)Refractive indexn\u03c9 = 1.651 n\u03b5 = 1.644Birefringence\u03b4 = 0.007References[1][2][3]\n Nanoscale coating of Ca-HAp, image taken with scanning probe microscope\nHydroxyapatite, also called hydroxylapatite (HA), is a naturally occurring mineral form of calcium apatite with the formula Ca5(PO4)3(OH), but it is usually written Ca10(PO4)6(OH)2 to denote that the crystal unit cell comprises two entities. Hydroxyapatite is the hydroxyl endmember of the complex apatite group. The OH\u2212 ion can be replaced by fluoride, chloride or carbonate, producing fluorapatite or chlorapatite. It crystallizes in the hexagonal crystal system. Pure hydroxyapatite powder is white. Naturally occurring apatites can, however, also have brown, yellow, or green colorations, comparable to the discolorations of dental fluorosis.\nUp to 50% by volume and 70% by weight of human bone is a modified form of hydroxyapatite, known as bone mineral.[4] Carbonated calcium-deficient hydroxyapatite is the main mineral of which dental enamel and dentin are composed. Hydroxyapatite crystals are also found in the small calcifications, within the pineal gland and other structures, known as corpora arenacea or 'brain sand'.[5]\n\nContents \n\n1 Chemical synthesis \n2 Calcium deficient hydroxyapatite \n3 Biological function \n4 Medical uses \n\n4.1 Supplement \n\n\n5 Chromatography \n6 Use in archaeology \n7 See also \n8 References \n9 External links \n\n\nChemical synthesis \nHydroxyapatite can be synthesized via several methods, such as wet chemical deposition, biomimetic deposition, sol-gel route (wet-chemical precipitation) or electrodeposition.[6] Yagai and Aoki proposed the hydroxyapatite nanocrystal suspension can be prepared by a wet chemical precipitation reaction following the reaction equation below:[7]\n10 Ca(OH)2 + 6 H3PO4 \u2192 Ca10(PO4)6(OH)2 + 18 H2O\nSeveral studies have shown that hydroxyapatite synthesis via the wet-chemical route can be improved by high-power ultrasound. The ultrasonically assisted synthesis (sono-synthesis) of hydroxyapatite is a successful technique for the production of nanostructured hydroxyapatite to high quality standards. The ultrasonic route allows the production of nano-crystalline hydroxyapatite as well as modified particles, e.g. core-shell nanospheres and composites.[8]\n\nCalcium deficient hydroxyapatite \nCalcium deficient (non-stochiometric) hydroxyapatite, Ca10\u2212x(PO4)6\u2212x(HPO4)x(OH)2\u2212x (where x is between 0 and 1) has a Ca\/P ratio between 1.67 and 1.5. The Ca\/P ratio is often used in the discussion of calcium phosphate phases.[9] Stoichiometric apatite Ca10(PO4)6(OH)2 has a Ca\/P ratio of 10:6 normally expressed as 1.67. The non-stoichiometric phases have the hydroxyapatite structure with cation vacancies (Ca2+) and anion (OH\u2013) vacancies. The sites occupied solely by phosphate anions in stochiometric hydroxyapatite, are occupied by phosphate or hydrogen phosphate, HPO42\u2013, anions.[9] \nPreparation of these calcium deficient phases can be prepared by precipitation from a mixture of calcium nitrate and diammonium phosphate with the desired Ca\/P ratio, for example to make a sample with a Ca\/P ratio of 1.6:[10]\n\n9.6 Ca(NO3)2 + 6 (NH4)2HPO4 \u2192 Ca9.6(PO4)5.6(HPO4)0.4(OH)1.6\nSintering these non-stoichiometric phases forms a solid phase which is an intimate mixture of tricalcium phosphate and hydroxyapatite, termed biphasic calcium phosphate:[11]\n\nCa10\u2212x(PO4)6\u2212x(HPO4)x(OH)2\u2212x \u2192 (1\u2212x) Ca10(PO4)6(OH)2 + 3x Ca3(PO4)2\nBiological function \n A 3D visualization of half of a hydroxyapatite unit cell, from x-ray crystallography\nThe clubbing appendages of the Odontodactylus scyllarus (peacock mantis shrimp) are made of an extremely dense form of the mineral which has a higher specific strength and toughness than any synthetic composite material; these properties have led to its investigation for potential synthesis and engineering use.[12] Their dactyl appendages have excellent impact resistance due to the impact region being composed of mainly crystalline hydroxyapatite, which offers significant hardness. A periodic layer underneath the impact layer composed of hydroxyapatite with lower calcium and phosphorus content (thus resulting in a much lower modulus) inhibits crack growth by forcing new cracks to change directions. This periodic layer also reduces the energy transferred across both layers due to the large difference in modulus, even reflecting some of the incident energy.[13] \nHydroxyapatite is present in bone and teeth; bone is made primarily of HA crystals interspersed in a collagen matrix -- 65 to 70% of the mass of bone is HA. Similarly HA is 70 to 80% of the mass of dentin and enamel in teeth. In enamel, the matrix for HA is formed by amelogenins and enamelins instead of collagen.[14]\nHydroxylapatite deposits in tendons around joints results in the medical condition calcific tendinitis.[15]\n\nMedical uses \n Flexible hydrogel-HA composite, which has a mineral-to-organic matrix ratio approximating that of human bone.\nHA is increasingly used to make bone grafting materials as well as dental prosthetics and repair. Some implants, e.g. hip replacements, dental implants and bone conduction implants, are coated with HA.[14]. As the native dissolution rate of hydroxyapatite in-vivo, around 10 wt% per year, is significantly lower than the growth rate of newly formed bone tissue, in its use as a bone replacement material, ways are being sought to enhance its solubility rate and thus promote better bioactivity.[16]\n\nSupplement \nMicrocrystalline hydroxyapatite (MH) is marketed as a \"bone-building\" supplement with superior absorption in comparison to calcium.[17] It is a second-generation calcium supplement derived from bovine bone.[17] In the 1980s, bone meal calcium supplements were found to be contaminated with heavy metals,[17] and although the manufacturers claim their MH is free from contaminants, people are advised to avoid it because its effect in the body has not been well-tested.[17]\n\nChromatography \nThe mechanism of hydroxyapatite (HA) chromatography is complicated and has been described as \"mixed-mode\" ion exchange. It involves nonspecific interactions between positively charged calcium ions and negatively charged phosphate ions on the stationary phase HA resin with protein negatively charged carboxyl groups and positively charged amino groups. It may be difficult to predict the effectiveness of HA chromatography based on physical and chemical properties of the desired protein to be purified. For elution, a buffer with increasing phosphate concentration is typically used for application.\n\nUse in archaeology \nIn archaeology, hydroxyapatite from human and animal remains can be analysed to reconstruct ancient diets, migrations and palaeoclimate. The mineral fractions of bone and teeth act as a reservoir of trace elements, including carbon, oxygen and strontium. Stable isotope analysis of human and faunal hydroxyapatite can be used to indicate whether a diet was predominantly terrestrial or marine in nature (carbon, strontium);[18] the geographical origin and migratory habits of an animal or human (oxygen, strontium)[19] and to reconstruct past temperatures and climate shifts (oxygen).[20] Post-depositional alteration of bone can contribute to the degradation of bone collagen, the protein required for stable isotope analysis.[21]\n\n Needle-like hydroxyapatite crystals on stainless steel. Scanning electron microscope picture from University of Tartu.\n Hydroxyapatite\nSee also \nArchaeological science\nBiomaterials: Mechanical Properties\nCalcium hydroxyphosphate\nReferences \n\n\n^ Hydroxylapatite. Mindat \n\n^ Hydroxylapatite. Webmineral \n\n^ Anthony, John W.; Bideaux, Richard A.; Bladh, Kenneth W.; Nichols, Monte C., eds. (2000). \"Hydroxylapatite\". Handbook of Mineralogy (PDF) . IV (Arsenates, Phosphates, Vanadates). Chantilly, VA, US: Mineralogical Society of America. ISBN 978-0962209734. \n\n^ \nJunqueira, Luiz Carlos; Jos\u00e9 Carneiro (2003). Foltin, Janet; Lebowitz, Harriet; Boyle, Peter J., eds. Basic Histology, Text & Atlas (10th ed.). McGraw-Hill Companies. p. 144. ISBN 978-0-07-137829-1. Inorganic matter represents about 50% of the dry weight of bone ... crystals show imperfections and are not identical to the hydroxyapatite found in the rock minerals \n\n^ Angervall, Lennart; Berger, Sven; R\u00f6ckert, Hans (2009). \"A Microradiographic and X-Ray Crystallographic Study of Calcium in the Pineal Body and in Intracranial Tumours\". Acta Pathologica Microbiologica Scandinavica. 44 (2): 113\u2013119. doi:10.1111\/j.1699-0463.1958.tb01060.x. \n\n^ Ferraz, M. P.; Monteiro, F. J.; Manuel, C. M. (2004). \"Hydroxyapatite nanoparticles: A review of preparation methodologies\". Journal of applied biomaterials & biomechanics : JABB. 2 (2): 74\u201380. PMID 20803440. \n\n^ Bouyer, E.; Gitzhofer, F.; Boulos, M. I. (2000). \"Morphological study of hydroxyapatite nanocrystal suspension\". Journal of Materials Science: Materials in Medicine. 11 (8): 523\u201331. doi:10.1023\/A:1008918110156. PMID 15348004. \n\n^ Sono-Synthesis of Nano-Hydroxyapatite. hielscher.com \n\n^ a b Rey, C.; Combes, C.; Drouet, C.; Grossin, D. (2011). \"1.111 \u2013 Bioactive Ceramics: Physical Chemistry\". In Ducheyne, Paul. Comprehensive Biomaterials. 1. Elsevier. pp. 187\u2013281. doi:10.1016\/B978-0-08-055294-1.00178-1. ISBN 978-0-08-055294-1. \n\n^ Raynaud, S.; Champion, E.; Bernache-Assollant, D.; Thomas, P. (2002). \"Calcium phosphate apatites with variable Ca\/P atomic ratio I. Synthesis, characterisation and thermal stability of powders\". Biomaterials. 23 (4): 1065\u201372. doi:10.1016\/S0142-9612(01)00218-6. PMID 11791909. \n\n^ Valletregi, M. (1997). \"Synthesis and characterisation of calcium deficient apatite\". Solid State Ionics. 101\u2013103: 1279\u20131285. doi:10.1016\/S0167-2738(97)00213-0. \n\n^ Weaver, J. C.; Milliron, G. W.; Miserez, A.; Evans-Lutterodt, K.; Herrera, S.; Gallana, I.; Mershon, W. J.; Swanson, B.; Zavattieri, P.; Dimasi, E.; Kisailus, D. (2012). \"The Stomatopod Dactyl Club: A Formidable Damage-Tolerant Biological Hammer\". Science. 336 (6086): 1275\u201380. Bibcode:2012Sci...336.1275W. doi:10.1126\/science.1218764. PMID 22679090. \n\n^ Tanner, K. E. (2012). \"Small but Extremely Tough\". Science. 336 (6086): 1237\u20138. Bibcode:2012Sci...336.1237T. doi:10.1126\/science.1222642. PMID 22679085. \n\n^ a b Habibah, TU; Salisbury, HG (January 2018). \"Biomaterials, Hydroxyapatite\". PMID 30020686. \n\n^ Carcia, CR; Scibek, JS (March 2013). \"Causation and management of calcific tendonitis and periarthritis\". Current Opinion in Rheumatology. 25 (2): 204\u20139. doi:10.1097\/bor.0b013e32835d4e85. PMID 23370373. \n\n^ Zhu, H.; et al. (2018). \"Nanostructural insights into the dissolution behavior of Sr-doped hydroxyapatite\". Journal of the European Ceramic Society. 38 (16): 5554\u20135562. doi:10.1016\/j.jeurceramsoc.2018.07.056. CS1 maint: Explicit use of et al. (link) \n\n^ a b c d Straub, D.A. (2007). \"Calcium Supplementation in Clinical Practice: A Review of Forms, Doses, and Indications\". NCP- Nutrition in Clinical Practice. 22 (3): 286\u201396. doi:10.1177\/0115426507022003286. PMID 17507729. \n\n^ Richards, M. P.; Schulting, R. J.; Hedges, R. E. M. (2003). \"Archaeology: Sharp shift in diet at onset of Neolithic\" (PDF) . Nature. 425 (6956): 366. Bibcode:2003Natur.425..366R. doi:10.1038\/425366a. PMID 14508478. \n\n^ Britton, K.; Grimes, V.; Dau, J.; Richards, M. P. (2009). \"Reconstructing faunal migrations using intra-tooth sampling and strontium and oxygen isotope analyses: A case study of modern caribou (Rangifer tarandus granti)\". Journal of Archaeological Science. 36 (5): 1163\u20131172. doi:10.1016\/j.jas.2009.01.003. \n\n^ Daniel Bryant, J.; Luz, B.; Froelich, P. N. (1994). \"Oxygen isotopic composition of fossil horse tooth phosphate as a record of continental paleoclimate\". Palaeogeography, Palaeoclimatology, Palaeoecology. 107 (3\u20134): 303\u2013316. Bibcode:1994PPP...107..303D. doi:10.1016\/0031-0182(94)90102-3. \n\n^ Van Klinken, G. J. (1999). \"Bone Collagen Quality Indicators for Palaeodietary and Radiocarbon Measurements\". Journal of Archaeological Science. 26 (6): 687\u2013695. doi:10.1006\/jasc.1998.0385. \n\n\nExternal links \n Media related to Apatit-(CaOH) (Hydroxyapatite) at Wikimedia Commons\n\nvtePhosphate mineralsCrystalline\nBeraunite\nBrazilianite\nEosphorite\nFluorapatite\nHydroxyapatite\nLithiophilite\nMetatorbernite\nMonazite\nStruvite\nTaranakite\nVariscite\nWavellite\nXenotime\nCryptocrystalline\nTurquoise\nWhitlockite\nAmorphous\nSantabarbaraite\nScorodite\nCobalt phosphate\n\nAuthority control \nLCCN: sh85063508 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Hydroxylapatite\">https:\/\/www.limswiki.org\/index.php\/Hydroxylapatite<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","6a3e317da061c2f39ab56a73452dea10_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Hydroxylapatite skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Hydroxylapatite<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Nanoscale_coating_of_Ca-HAp.PNG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4f\/Nanoscale_coating_of_Ca-HAp.PNG\/220px-Nanoscale_coating_of_Ca-HAp.PNG\" width=\"220\" height=\"138\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Nanoscale_coating_of_Ca-HAp.PNG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Nanoscale coating of Ca-HAp, image taken with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scanning_probe_microscopy\" title=\"Scanning probe microscopy\" rel=\"external_link\" target=\"_blank\">scanning probe microscope<\/a><\/div><\/div><\/div>\n<p><b>Hydroxyapatite<\/b>, also called <b>hydroxylapatite<\/b> (<b>HA<\/b>), is a naturally occurring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mineral\" title=\"Mineral\" rel=\"external_link\" target=\"_blank\">mineral<\/a> form of calcium <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apatite\" title=\"Apatite\" rel=\"external_link\" target=\"_blank\">apatite<\/a> with the formula Ca<sub>5<\/sub>(PO<sub>4<\/sub>)<sub>3<\/sub>(OH), but it is usually written Ca<sub>10<\/sub>(PO<sub>4<\/sub>)<sub>6<\/sub>(OH)<sub>2<\/sub> to denote that the crystal unit cell comprises two entities. Hydroxyapatite is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxyl\" class=\"mw-redirect\" title=\"Hydroxyl\" rel=\"external_link\" target=\"_blank\">hydroxyl<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endmember_(mineralogy)\" class=\"mw-redirect\" title=\"Endmember (mineralogy)\" rel=\"external_link\" target=\"_blank\">endmember<\/a> of the complex <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apatite\" title=\"Apatite\" rel=\"external_link\" target=\"_blank\">apatite group<\/a>. The OH<sup>\u2212<\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ion\" title=\"Ion\" rel=\"external_link\" target=\"_blank\">ion<\/a> can be replaced by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorine\" title=\"Fluorine\" rel=\"external_link\" target=\"_blank\">fluoride<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chlorine\" title=\"Chlorine\" rel=\"external_link\" target=\"_blank\">chloride<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbonate\" title=\"Carbonate\" rel=\"external_link\" target=\"_blank\">carbonate<\/a>, producing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorapatite\" title=\"Fluorapatite\" rel=\"external_link\" target=\"_blank\">fluorapatite<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chlorapatite\" class=\"mw-redirect\" title=\"Chlorapatite\" rel=\"external_link\" target=\"_blank\">chlorapatite<\/a>. It crystallizes in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hexagonal_(crystal_system)\" class=\"mw-redirect\" title=\"Hexagonal (crystal system)\" rel=\"external_link\" target=\"_blank\">hexagonal<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystal_system\" title=\"Crystal system\" rel=\"external_link\" target=\"_blank\">crystal system<\/a>. Pure hydroxyapatite powder is white. Naturally occurring apatites can, however, also have brown, yellow, or green colorations, comparable to the discolorations of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_fluorosis\" title=\"Dental fluorosis\" rel=\"external_link\" target=\"_blank\">dental fluorosis<\/a>.\n<\/p><p>Up to 50% by volume and 70% by weight of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_bone\" class=\"mw-redirect\" title=\"Human bone\" rel=\"external_link\" target=\"_blank\">human bone<\/a> is a modified form of hydroxyapatite, known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_mineral\" title=\"Bone mineral\" rel=\"external_link\" target=\"_blank\">bone mineral<\/a>.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Carbonated calcium-deficient hydroxyapatite is the main mineral of which <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_enamel\" class=\"mw-redirect\" title=\"Dental enamel\" rel=\"external_link\" target=\"_blank\">dental enamel<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dentin\" title=\"Dentin\" rel=\"external_link\" target=\"_blank\">dentin<\/a> are composed. Hydroxyapatite crystals are also found in the small calcifications, within the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pineal_gland\" title=\"Pineal gland\" rel=\"external_link\" target=\"_blank\">pineal gland<\/a> and other structures, known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corpora_arenacea\" title=\"Corpora arenacea\" rel=\"external_link\" target=\"_blank\">corpora arenacea<\/a> or 'brain sand'.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Chemical_synthesis\">Chemical synthesis<\/span><\/h2>\n<p>Hydroxyapatite can be synthesized via several methods, such as wet chemical deposition, biomimetic deposition, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sol-gel\" class=\"mw-redirect\" title=\"Sol-gel\" rel=\"external_link\" target=\"_blank\">sol-gel<\/a> route (wet-chemical precipitation) or electrodeposition.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> Yagai and Aoki proposed the hydroxyapatite nanocrystal suspension can be prepared by a wet chemical precipitation reaction following the reaction equation below:<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>10 Ca(OH)<sub>2<\/sub> + 6 H<sub>3<\/sub>PO<sub>4<\/sub> \u2192 Ca<sub>10<\/sub>(PO<sub>4<\/sub>)<sub>6<\/sub>(OH)<sub>2<\/sub> + 18 H<sub>2<\/sub>O\n<\/p><p>Several studies have shown that hydroxyapatite synthesis via the wet-chemical route can be improved by high-power ultrasound. The ultrasonically assisted synthesis (sono-synthesis) of hydroxyapatite is a successful technique for the production of nanostructured hydroxyapatite to high quality standards. The ultrasonic route allows the production of nano-crystalline hydroxyapatite as well as modified particles, e.g. core-shell nanospheres and composites.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Calcium_deficient_hydroxyapatite\">Calcium deficient hydroxyapatite<\/span><\/h2>\n<p>Calcium deficient (non-stochiometric) hydroxyapatite, Ca<sub>10\u2212x<\/sub>(PO<sub>4<\/sub>)<sub>6\u2212x<\/sub>(HPO<sub>4<\/sub>)<sub>x<\/sub>(OH)<sub>2\u2212x<\/sub> (where x is between 0 and 1) has a Ca\/P ratio between 1.67 and 1.5. The Ca\/P ratio is often used in the discussion of calcium phosphate phases.<sup id=\"rdp-ebb-cite_ref-Bioactive_9-0\" class=\"reference\"><a href=\"#cite_note-Bioactive-9\" rel=\"external_link\">[9]<\/a><\/sup> Stoichiometric apatite Ca<sub>10<\/sub>(PO<sub>4<\/sub>)<sub>6<\/sub>(OH)<sub>2<\/sub> has a Ca\/P ratio of 10:6 normally expressed as 1.67. The non-stoichiometric phases have the hydroxyapatite structure with cation vacancies (Ca<sup>2+<\/sup>) and anion (OH<sup>\u2013<\/sup>) vacancies. The sites occupied solely by phosphate anions in stochiometric hydroxyapatite, are occupied by phosphate or hydrogen phosphate, HPO<sub>4<\/sub><sup>2\u2013<\/sup>, anions.<sup id=\"rdp-ebb-cite_ref-Bioactive_9-1\" class=\"reference\"><a href=\"#cite_note-Bioactive-9\" rel=\"external_link\">[9]<\/a><\/sup> \nPreparation of these calcium deficient phases can be prepared by precipitation from a mixture of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_nitrate\" title=\"Calcium nitrate\" rel=\"external_link\" target=\"_blank\">calcium nitrate<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diammonium_phosphate\" title=\"Diammonium phosphate\" rel=\"external_link\" target=\"_blank\">diammonium phosphate<\/a> with the desired Ca\/P ratio, for example to make a sample with a Ca\/P ratio of 1.6:<sup id=\"rdp-ebb-cite_ref-ChampionI_10-0\" class=\"reference\"><a href=\"#cite_note-ChampionI-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<dl><dd>9.6 Ca(NO<sub>3<\/sub>)<sub>2<\/sub> + 6 (NH<sub>4<\/sub>)<sub>2<\/sub>HPO<sub>4<\/sub> \u2192 Ca<sub>9.6<\/sub>(PO<sub>4<\/sub>)<sub>5.6<\/sub>(HPO<sub>4<\/sub>)<sub>0.4<\/sub>(OH)<sub>1.6<\/sub><\/dd><\/dl>\n<p>Sintering these non-stoichiometric phases forms a solid phase which is an intimate mixture of tricalcium phosphate and hydroxyapatite, termed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tricalcium_phosphate\" title=\"Tricalcium phosphate\" rel=\"external_link\" target=\"_blank\">biphasic calcium phosphate<\/a>:<sup id=\"rdp-ebb-cite_ref-ValletRegi1997_11-0\" class=\"reference\"><a href=\"#cite_note-ValletRegi1997-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<dl><dd>Ca<sub>10\u2212x<\/sub>(PO<sub>4<\/sub>)<sub>6\u2212x<\/sub>(HPO<sub>4<\/sub>)<sub>x<\/sub>(OH)<sub>2\u2212x<\/sub> \u2192 (1\u2212x) Ca<sub>10<\/sub>(PO<sub>4<\/sub>)<sub>6<\/sub>(OH)<sub>2<\/sub> + 3x Ca<sub>3<\/sub>(PO<sub>4<\/sub>)<sub>2<\/sub><\/dd><\/dl>\n<h2><span class=\"mw-headline\" id=\"Biological_function\">Biological function<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hydroxyapatite3.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ea\/Hydroxyapatite3.png\/220px-Hydroxyapatite3.png\" width=\"220\" height=\"111\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hydroxyapatite3.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A 3D visualization of half of a hydroxyapatite unit cell, from x-ray crystallography<\/div><\/div><\/div>\n<p>The clubbing appendages of the <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Odontodactylus_scyllarus\" title=\"Odontodactylus scyllarus\" rel=\"external_link\" target=\"_blank\">Odontodactylus scyllarus<\/a><\/i> (peacock mantis shrimp) are made of an extremely dense form of the mineral which has a higher specific strength and toughness than any synthetic composite material; these properties have led to its investigation for potential synthesis and engineering use.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> Their dactyl appendages have excellent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Impact_resistance\" class=\"mw-redirect\" title=\"Impact resistance\" rel=\"external_link\" target=\"_blank\">impact resistance<\/a> due to the impact region being composed of mainly crystalline hydroxyapatite, which offers significant hardness. A periodic layer underneath the impact layer composed of hydroxyapatite with lower calcium and phosphorus content (thus resulting in a much lower modulus) inhibits crack growth by forcing new cracks to change directions. This periodic layer also reduces the energy transferred across both layers due to the large difference in modulus, even reflecting some of the incident energy.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> \n<\/p><p>Hydroxyapatite is present in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Teeth\" class=\"mw-redirect\" title=\"Teeth\" rel=\"external_link\" target=\"_blank\">teeth<\/a>; bone is made primarily of HA crystals interspersed in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Collagen\" title=\"Collagen\" rel=\"external_link\" target=\"_blank\">collagen<\/a> matrix -- 65 to 70% of the mass of bone is HA. Similarly HA is 70 to 80% of the mass of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dentin\" title=\"Dentin\" rel=\"external_link\" target=\"_blank\">dentin<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tooth_enamel\" title=\"Tooth enamel\" rel=\"external_link\" target=\"_blank\">enamel<\/a> in teeth. In enamel, the matrix for HA is formed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amelogenin\" title=\"Amelogenin\" rel=\"external_link\" target=\"_blank\">amelogenins<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Enamelin\" title=\"Enamelin\" rel=\"external_link\" target=\"_blank\">enamelins<\/a> instead of collagen.<sup id=\"rdp-ebb-cite_ref-statpearls2018_14-0\" class=\"reference\"><a href=\"#cite_note-statpearls2018-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>Hydroxylapatite deposits in tendons around joints results in the medical condition <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcific_tendinitis\" title=\"Calcific tendinitis\" rel=\"external_link\" target=\"_blank\">calcific tendinitis<\/a>.<sup id=\"rdp-ebb-cite_ref-Car2013_15-0\" class=\"reference\"><a href=\"#cite_note-Car2013-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:122px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hydrogel-HA.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6e\/Hydrogel-HA.jpg\/120px-Hydrogel-HA.jpg\" width=\"120\" height=\"187\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hydrogel-HA.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Flexible hydrogel-HA composite, which has a mineral-to-organic matrix ratio approximating that of human bone.<\/div><\/div><\/div>\n<p>HA is increasingly used to make <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_grafting\" title=\"Bone grafting\" rel=\"external_link\" target=\"_blank\">bone grafting<\/a> materials as well as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_prosthesis\" title=\"Dental prosthesis\" rel=\"external_link\" target=\"_blank\">dental prosthetics and repair<\/a>. Some implants, e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">hip replacements<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implants\" class=\"mw-redirect\" title=\"Dental implants\" rel=\"external_link\" target=\"_blank\">dental implants<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_anchored_hearing_aid#DermaLock_technology\" class=\"mw-redirect\" title=\"Bone anchored hearing aid\" rel=\"external_link\" target=\"_blank\">bone conduction implants<\/a>, are coated with HA.<sup id=\"rdp-ebb-cite_ref-statpearls2018_14-1\" class=\"reference\"><a href=\"#cite_note-statpearls2018-14\" rel=\"external_link\">[14]<\/a><\/sup>. As the native dissolution rate of hydroxyapatite in-vivo, around 10 wt% per year, is significantly lower than the growth rate of newly formed bone tissue, in its use as a bone replacement material, ways are being sought to enhance its solubility rate and thus promote better bioactivity.<sup id=\"rdp-ebb-cite_ref-\u201cSDHA\u201d_16-0\" class=\"reference\"><a href=\"#cite_note-\u201cSDHA\u201d-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Supplement\">Supplement<\/span><\/h3>\n<p>Microcrystalline hydroxyapatite (MH) is marketed as a \"bone-building\" supplement with superior absorption in comparison to calcium.<sup id=\"rdp-ebb-cite_ref-Straub2007_17-0\" class=\"reference\"><a href=\"#cite_note-Straub2007-17\" rel=\"external_link\">[17]<\/a><\/sup> It is a second-generation calcium supplement derived from bovine bone.<sup id=\"rdp-ebb-cite_ref-Straub2007_17-1\" class=\"reference\"><a href=\"#cite_note-Straub2007-17\" rel=\"external_link\">[17]<\/a><\/sup> In the 1980s, bone meal calcium supplements were found to be contaminated with heavy metals,<sup id=\"rdp-ebb-cite_ref-Straub2007_17-2\" class=\"reference\"><a href=\"#cite_note-Straub2007-17\" rel=\"external_link\">[17]<\/a><\/sup> and although the manufacturers claim their MH is free from contaminants, people are advised to avoid it because its effect in the body has not been well-tested.<sup id=\"rdp-ebb-cite_ref-Straub2007_17-3\" class=\"reference\"><a href=\"#cite_note-Straub2007-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Chromatography\">Chromatography<\/span><\/h2>\n<p>The mechanism of hydroxyapatite (HA) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromatography\" title=\"Chromatography\" rel=\"external_link\" target=\"_blank\">chromatography<\/a> is complicated and has been described as \"mixed-mode\" ion exchange. It involves nonspecific interactions between positively charged calcium ions and negatively charged phosphate ions on the stationary phase HA resin with protein negatively charged carboxyl groups and positively charged amino groups. It may be difficult to predict the effectiveness of HA chromatography based on physical and chemical properties of the desired protein to be purified. For elution, a buffer with increasing phosphate concentration is typically used for application.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Use_in_archaeology\">Use in archaeology<\/span><\/h2>\n<p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Archaeology\" title=\"Archaeology\" rel=\"external_link\" target=\"_blank\">archaeology<\/a>, hydroxyapatite from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Faunal_assemblage\" title=\"Faunal assemblage\" rel=\"external_link\" target=\"_blank\">human and animal remains<\/a> can be analysed to reconstruct ancient <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diet_(nutrition)\" title=\"Diet (nutrition)\" rel=\"external_link\" target=\"_blank\">diets<\/a>, migrations and palaeoclimate. The mineral fractions of bone and teeth act as a reservoir of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Micronutrients\" class=\"mw-redirect\" title=\"Micronutrients\" rel=\"external_link\" target=\"_blank\">trace elements<\/a>, including carbon, oxygen and strontium. Stable isotope analysis of human and faunal hydroxyapatite can be used to indicate whether a diet was predominantly terrestrial or marine in nature (carbon, strontium);<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> the geographical origin and migratory habits of an animal or human (oxygen, strontium)<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> and to reconstruct past temperatures and climate shifts (oxygen).<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> Post-depositional alteration of bone can contribute to the degradation of bone collagen, the protein required for stable isotope analysis.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:H%C3%BCdroks%C3%BCapatiidi_kristallid.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/aa\/H%C3%BCdroks%C3%BCapatiidi_kristallid.JPG\/220px-H%C3%BCdroks%C3%BCapatiidi_kristallid.JPG\" width=\"220\" height=\"187\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:H%C3%BCdroks%C3%BCapatiidi_kristallid.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Needle-like hydroxyapatite crystals on stainless steel. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scanning_electron_microscope\" title=\"Scanning electron microscope\" rel=\"external_link\" target=\"_blank\">Scanning electron microscope<\/a> picture from <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Tartu\" title=\"University of Tartu\" rel=\"external_link\" target=\"_blank\">University of Tartu<\/a>.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hydroxylapatite-338779.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Hydroxylapatite-338779.jpg\/250px-Hydroxylapatite-338779.jpg\" width=\"250\" height=\"235\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hydroxylapatite-338779.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Hydroxyapatite<\/div><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Archaeological_science\" title=\"Archaeological science\" rel=\"external_link\" target=\"_blank\">Archaeological science<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterials:_Mechanical_Properties\" class=\"mw-redirect\" title=\"Biomaterials: Mechanical Properties\" rel=\"external_link\" target=\"_blank\">Biomaterials: Mechanical Properties<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_hydroxyphosphate\" title=\"Calcium hydroxyphosphate\" rel=\"external_link\" target=\"_blank\">Calcium hydroxyphosphate<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mindat.org\/min-1992.html\" target=\"_blank\">Hydroxylapatite<\/a>. Mindat<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.webmineral.com\/data\/Hydroxylapatite.shtml\" target=\"_blank\">Hydroxylapatite<\/a>. Webmineral<\/span>\n<\/li>\n<li id=\"cite_note-HB-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-HB_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Anthony, John W.; Bideaux, Richard A.; Bladh, Kenneth W.; Nichols, Monte C., eds. (2000). \"Hydroxylapatite\". <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.handbookofmineralogy.org\/pdfs\/hydroxylapatite.pdf\" target=\"_blank\"><i>Handbook of Mineralogy<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. IV (Arsenates, Phosphates, Vanadates). Chantilly, VA, US: Mineralogical Society of America. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0962209734.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Hydroxylapatite&rft.btitle=Handbook+of+Mineralogy&rft.place=Chantilly%2C+VA%2C+US&rft.pub=Mineralogical+Society+of+America&rft.date=2000&rft.isbn=978-0962209734&rft_id=http%3A%2F%2Fwww.handbookofmineralogy.org%2Fpdfs%2Fhydroxylapatite.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHydroxyapatite\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\n<cite class=\"citation book\">Junqueira, Luiz Carlos; Jos\u00e9 Carneiro (2003). Foltin, Janet; Lebowitz, Harriet; Boyle, Peter J., eds. <i>Basic Histology, Text & Atlas<\/i> (10th ed.). McGraw-Hill Companies. p. 144. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-07-137829-1. <q>Inorganic matter represents about 50% of the dry weight of bone ... crystals show imperfections and are not identical to the hydroxyapatite found in the rock minerals<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Basic+Histology%2C+Text+%26+Atlas&rft.pages=144&rft.edition=10th&rft.pub=McGraw-Hill+Companies&rft.date=2003&rft.isbn=978-0-07-137829-1&rft.aulast=Junqueira&rft.aufirst=Luiz+Carlos&rft.au=Jos%C3%A9+Carneiro&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHydroxyapatite\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Angervall, Lennart; Berger, Sven; R\u00f6ckert, Hans (2009). \"A Microradiographic and X-Ray Crystallographic Study of Calcium in the Pineal Body and in Intracranial Tumours\". <i>Acta Pathologica Microbiologica Scandinavica<\/i>. <b>44<\/b> (2): 113\u2013119. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1699-0463.1958.tb01060.x\" target=\"_blank\">10.1111\/j.1699-0463.1958.tb01060.x<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Pathologica+Microbiologica+Scandinavica&rft.atitle=A+Microradiographic+and+X-Ray+Crystallographic+Study+of+Calcium+in+the+Pineal+Body+and+in+Intracranial+Tumours&rft.volume=44&rft.issue=2&rft.pages=113-119&rft.date=2009&rft_id=info%3Adoi%2F10.1111%2Fj.1699-0463.1958.tb01060.x&rft.aulast=Angervall&rft.aufirst=Lennart&rft.au=Berger%2C+Sven&rft.au=R%C3%B6ckert%2C+Hans&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHydroxyapatite\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ferraz, M. P.; Monteiro, F. J.; Manuel, C. M. (2004). \"Hydroxyapatite nanoparticles: A review of preparation methodologies\". <i>Journal of applied biomaterials & biomechanics : JABB<\/i>. <b>2<\/b> (2): 74\u201380. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20803440\" target=\"_blank\">20803440<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+applied+biomaterials+%26+biomechanics+%3A+JABB&rft.atitle=Hydroxyapatite+nanoparticles%3A+A+review+of+preparation+methodologies&rft.volume=2&rft.issue=2&rft.pages=74-80&rft.date=2004&rft_id=info%3Apmid%2F20803440&rft.aulast=Ferraz&rft.aufirst=M.+P.&rft.au=Monteiro%2C+F.+J.&rft.au=Manuel%2C+C.+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHydroxyapatite\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bouyer, E.; Gitzhofer, F.; Boulos, M. I. (2000). \"Morphological study of hydroxyapatite nanocrystal suspension\". <i>Journal of Materials Science: Materials in Medicine<\/i>. <b>11<\/b> (8): 523\u201331. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1023%2FA%3A1008918110156\" target=\"_blank\">10.1023\/A:1008918110156<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15348004\" target=\"_blank\">15348004<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Materials+Science%3A+Materials+in+Medicine&rft.atitle=Morphological+study+of+hydroxyapatite+nanocrystal+suspension&rft.volume=11&rft.issue=8&rft.pages=523-31&rft.date=2000&rft_id=info%3Adoi%2F10.1023%2FA%3A1008918110156&rft_id=info%3Apmid%2F15348004&rft.aulast=Bouyer&rft.aufirst=E.&rft.au=Gitzhofer%2C+F.&rft.au=Boulos%2C+M.+I.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHydroxyapatite\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hielscher.com\/sono-synthesis-of-nano-hydroxyapatite.htm\" target=\"_blank\">Sono-Synthesis of Nano-Hydroxyapatite<\/a>. hielscher.com<\/span>\n<\/li>\n<li id=\"cite_note-Bioactive-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Bioactive_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Bioactive_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Rey, C.; Combes, C.; Drouet, C.; Grossin, D. (2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/B9780080552941000234\" target=\"_blank\">\"1.111 \u2013 Bioactive Ceramics: Physical Chemistry\"<\/a>. In Ducheyne, Paul. <i>Comprehensive Biomaterials<\/i>. <b>1<\/b>. 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N. (1994). \"Oxygen isotopic composition of fossil horse tooth phosphate as a record of continental paleoclimate\". <i>Palaeogeography, Palaeoclimatology, Palaeoecology<\/i>. <b>107<\/b> (3\u20134): 303\u2013316. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/1994PPP...107..303D\" target=\"_blank\">1994PPP...107..303D<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0031-0182%2894%2990102-3\" target=\"_blank\">10.1016\/0031-0182(94)90102-3<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Palaeogeography%2C+Palaeoclimatology%2C+Palaeoecology&rft.atitle=Oxygen+isotopic+composition+of+fossil+horse+tooth+phosphate+as+a+record+of+continental+paleoclimate&rft.volume=107&rft.issue=3%E2%80%934&rft.pages=303-316&rft.date=1994&rft_id=info%3Adoi%2F10.1016%2F0031-0182%2894%2990102-3&rft_id=info%3Abibcode%2F1994PPP...107..303D&rft.aulast=Daniel+Bryant&rft.aufirst=J.&rft.au=Luz%2C+B.&rft.au=Froelich%2C+P.+N.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHydroxyapatite\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Van Klinken, G. J. (1999). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.researchgate.net\/publication\/248579377_Bone_Collagen_Quality_Indicators_for_Palaeodietary_and_Radiocarbon_Measurements\" target=\"_blank\">\"Bone Collagen Quality Indicators for Palaeodietary and Radiocarbon Measurements\"<\/a>. <i>Journal of Archaeological Science<\/i>. <b>26<\/b> (6): 687\u2013695. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1006%2Fjasc.1998.0385\" target=\"_blank\">10.1006\/jasc.1998.0385<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Archaeological+Science&rft.atitle=Bone+Collagen+Quality+Indicators+for+Palaeodietary+and+Radiocarbon+Measurements&rft.volume=26&rft.issue=6&rft.pages=687-695&rft.date=1999&rft_id=info%3Adoi%2F10.1006%2Fjasc.1998.0385&rft.aulast=Van+Klinken&rft.aufirst=G.+J.&rft_id=https%3A%2F%2Fwww.researchgate.net%2Fpublication%2F248579377_Bone_Collagen_Quality_Indicators_for_Palaeodietary_and_Radiocarbon_Measurements&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHydroxyapatite\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Commons-logo.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/12px-Commons-logo.svg.png\" width=\"12\" height=\"16\" class=\"noviewer\" \/><\/a> Media related to <a href=\"https:\/\/commons.wikimedia.org\/wiki\/Category:Apatite-(CaOH)\" class=\"extiw\" title=\"commons:Category:Apatite-(CaOH)\" rel=\"external_link\" target=\"_blank\">Apatit-(CaOH) (Hydroxyapatite)<\/a> at Wikimedia Commons\n<\/p>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1251\nCached time: 20181212230353\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.464 seconds\nReal time usage: 0.582 seconds\nPreprocessor visited node count: 1804\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 57811\/2097152 bytes\nTemplate argument size: 1894\/2097152 bytes\nHighest expansion depth: 8\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 55742\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.257\/10.000 seconds\nLua memory usage: 4.17 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 482.188 1 -total\n<\/p>\n<pre>53.28% 256.932 1 Template:Reflist\n29.07% 140.155 15 Template:Cite_journal\n16.87% 81.322 3 Template:Cite_book\n16.72% 80.640 1 Template:Infobox_mineral\n13.63% 65.735 1 Template:Infobox\n13.25% 63.911 1 Template:Commonscat-inline\n 9.92% 47.847 1 Template:Authority_control\n 3.84% 18.508 1 Template:Phosphate_minerals\n 3.23% 15.556 1 Template:Navbox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1966606-1!canonical and timestamp 20181212230353 and revision id 873364760\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxylapatite\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212217\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.167 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 160.481 1 - wikipedia:Hydroxylapatite\n100.00% 160.481 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8024-0!*!*!*!*!*!* and timestamp 20181217212216 and revision id 24135\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Hydroxylapatite\">https:\/\/www.limswiki.org\/index.php\/Hydroxylapatite<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","6a3e317da061c2f39ab56a73452dea10_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/ff\/Mineraly.sk_-_hydroxylapatit.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4f\/Nanoscale_coating_of_Ca-HAp.PNG\/440px-Nanoscale_coating_of_Ca-HAp.PNG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ea\/Hydroxyapatite3.png\/440px-Hydroxyapatite3.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/6\/6e\/Hydrogel-HA.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/aa\/H%C3%BCdroks%C3%BCapatiidi_kristallid.JPG\/440px-H%C3%BCdroks%C3%BCapatiidi_kristallid.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/f8\/Hydroxylapatite-338779.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/24px-Commons-logo.svg.png"],"6a3e317da061c2f39ab56a73452dea10_timestamp":1545081736,"a7440e4ccf9932b6f0b014cc2d083229_type":"article","a7440e4ccf9932b6f0b014cc2d083229_title":"Fluorosilicate glass","a7440e4ccf9932b6f0b014cc2d083229_url":"https:\/\/www.limswiki.org\/index.php\/Fluorosilicate_glass","a7440e4ccf9932b6f0b014cc2d083229_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tFluorosilicate glass\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFluorosilicate glass (FSG) is a glass material composed primarily of fluorine, silicon and oxygen. It has a number of uses in industry and manufacturing, especially in semiconductor fabrication where it forms an insulating dielectric. The related fluorosilicate glass-ceramics have good mechanical and chemical properties.\n\nContents \n\n1 Semiconductor fabrication \n2 Fluorosilicate glass-ceramics \n3 See also \n4 References \n\n\nSemiconductor fabrication \nFluorosilicate glass has a low-k dielectric and is used in between copper metal layers during silicon integrated circuit fabrication process. It is widely used by semiconductor foundries on geometries sub 0.25\u03bc.\nFluorosilicate glass is effectively a fluorine-containing silicon dioxide (k=3.5, while k of undoped silicon dioxide is 3.9).[1]\nFluorosilicate glass is used by IBM.[2] Intel started using Cu metal layers and FSG on its 1.2 GHz Pentium processor at 130 nm CMOS. TSMC (Taiwan Semiconductor Manufacturing Company) brought in FSG and copper together in the Altera APEX.\n\nFluorosilicate glass-ceramics \nFluorosilicate glass-ceramics are crystalline or semi-crystalline solids formed by careful cooling of molten fluorosilicate glass. They have good mechanical properties.\nPotassium fluororichterite based materials are composed from tiny interlocked rod-shaped amphibole crystals; they have good resistance to chemicals and can be used in microwave ovens. Richterite glass-ceramics are used for high-performance tableware.\nFluorosilicate glass-ceramics with sheet structure, derived from mica, are strong and machinable. They find a number of uses and can be used in high vacuum and as dielectrics and precision ceramic components. A number of mica and mica-fluoroapatite glass-ceramics were studied as biomaterials.[3]\n\nSee also \nFluoride glass\nGlass\nSilicate\nReferences \n\n\n^ Committee, E.D.F.A.S.D.R. (2004). Microelectronics Failure Analysis: Desk Reference. ASM International. ISBN 9780871708045. Retrieved 2015-04-13 . \n\n^ Soltis, F.G. (2001). Fortress Rochester: The Inside Story of the IBM ISeries. NEWS\/400 Books. p. 54. ISBN 9781583040836. Retrieved 2015-04-13 . \n\n^ Martin, J.W. (2006). Concise Encyclopedia of the Structure of Materials. Elsevier Science. p. 203. ISBN 9780080524634. Retrieved 2015-04-13 . \n\n\nvteGlass science topicsBasics\nGlass\nGlass transition\nSupercooling\nFormulation\nAgInSbTe\nBioglass\nBorophosphosilicate glass\nBorosilicate glass\nCeramic glaze\nChalcogenide glass\nCobalt glass\nCranberry glass\nCrown glass\nFlint glass\nFluorosilicate glass\nFused quartz\nGeSbTe\nGold ruby glass\nLead glass\nMilk glass\nPhosphosilicate glass\nPhotochromic lens glass\nSilicate glass\nSoda\u2013lime glass\nSodium hexametaphosphate\nSoluble glass\nTellurite glass\nThoriated glass\nUltra low expansion glass\nUranium glass\nVitreous enamel\nWood's glass\nZBLAN\nGlass-ceramics\nBioactive glass\nCorningWare\nGlass-ceramic-to-metal seals\nMacor\nZerodur\nPreparation\nAnnealing\nChemical vapor deposition\nGlass batch calculation\nGlass forming\nGlass melting\nGlass modeling\nIon implantation\nLiquidus temperature\nSol-gel technique\nViscosity\nVitrification\nOptics\nAchromat\nDispersion\nGradient-index optics\nHydrogen darkening\nOptical amplifier\nOptical fiber\nOptical lens design\nPhotochromic lens\nPhotosensitive glass\nRefraction\nTransparent materials\nSurface\r\nmodification\nAnti-reflective coating\nChemically strengthened glass\nCorrosion\nDealkalization\nDNA microarray\nHydrogen darkening\nInsulated glazing\nPorous glass\nSelf-cleaning glass\nSol-gel technique\nTempered glass\nDiverse\r\ntopics\nGlass-coated wire\nSafety glass\nGlass databases\nGlass electrode\nGlass fiber reinforced concrete\nGlass ionomer cement\nGlass microspheres\nGlass-reinforced plastic\nGlass-to-metal seal\nPorous glass\nPrince Rupert's drops\nRadioactive waste vitrification\nWindshield\nGlass fiber\n\n\r\n\n\nThis glass material related article is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Fluorosilicate_glass\">https:\/\/www.limswiki.org\/index.php\/Fluorosilicate_glass<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 29 February 2016, at 22:31.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 695 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","a7440e4ccf9932b6f0b014cc2d083229_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Fluorosilicate_glass skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Fluorosilicate glass<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Fluorosilicate glass<\/b> (<b>FSG<\/b>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass\" title=\"Glass\" rel=\"external_link\" target=\"_blank\">glass<\/a> material composed primarily of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorine\" title=\"Fluorine\" rel=\"external_link\" target=\"_blank\">fluorine<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon\" title=\"Silicon\" rel=\"external_link\" target=\"_blank\">silicon<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen\" title=\"Oxygen\" rel=\"external_link\" target=\"_blank\">oxygen<\/a>. It has a number of uses in industry and manufacturing, especially in semiconductor fabrication where it forms an insulating <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dielectric\" title=\"Dielectric\" rel=\"external_link\" target=\"_blank\">dielectric<\/a>. The related fluorosilicate glass-ceramics have good mechanical and chemical properties.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Semiconductor_fabrication\">Semiconductor fabrication<\/span><\/h2>\n<p>Fluorosilicate glass has a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Low-k_dielectric\" class=\"mw-redirect\" title=\"Low-k dielectric\" rel=\"external_link\" target=\"_blank\">low-k dielectric<\/a> and is used in between <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copper_interconnect\" title=\"Copper interconnect\" rel=\"external_link\" target=\"_blank\">copper metal layers<\/a> during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon\" title=\"Silicon\" rel=\"external_link\" target=\"_blank\">silicon<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Integrated_circuit\" title=\"Integrated circuit\" rel=\"external_link\" target=\"_blank\">integrated circuit<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semiconductor_device_fabrication\" title=\"Semiconductor device fabrication\" rel=\"external_link\" target=\"_blank\">fabrication<\/a> process. It is widely used by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semiconductor_fabrication_plant\" title=\"Semiconductor fabrication plant\" rel=\"external_link\" target=\"_blank\">semiconductor foundries<\/a> on geometries sub 0.25\u03bc.\nFluorosilicate glass is effectively a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorine\" title=\"Fluorine\" rel=\"external_link\" target=\"_blank\">fluorine<\/a>-containing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_dioxide\" title=\"Silicon dioxide\" rel=\"external_link\" target=\"_blank\">silicon dioxide<\/a> (k=3.5, while k of undoped silicon dioxide is 3.9).<sup id=\"rdp-ebb-cite_ref-google_1-0\" class=\"reference\"><a href=\"#cite_note-google-1\" rel=\"external_link\">[1]<\/a><\/sup>\nFluorosilicate glass is used by <a href=\"https:\/\/en.wikipedia.org\/wiki\/IBM\" title=\"IBM\" rel=\"external_link\" target=\"_blank\">IBM<\/a>.<sup id=\"rdp-ebb-cite_ref-google2_2-0\" class=\"reference\"><a href=\"#cite_note-google2-2\" rel=\"external_link\">[2]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intel\" title=\"Intel\" rel=\"external_link\" target=\"_blank\">Intel<\/a> started using Cu metal layers and FSG on its 1.2 GHz <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pentium_(brand)\" class=\"mw-redirect\" title=\"Pentium (brand)\" rel=\"external_link\" target=\"_blank\">Pentium<\/a> processor at 130 nm <a href=\"https:\/\/en.wikipedia.org\/wiki\/CMOS\" title=\"CMOS\" rel=\"external_link\" target=\"_blank\">CMOS<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/TSMC\" title=\"TSMC\" rel=\"external_link\" target=\"_blank\">TSMC<\/a> (Taiwan Semiconductor Manufacturing Company) brought in FSG and copper together in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Altera\" title=\"Altera\" rel=\"external_link\" target=\"_blank\">Altera<\/a> APEX.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Fluorosilicate_glass-ceramics\">Fluorosilicate glass-ceramics<\/span><\/h2>\n<p>Fluorosilicate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass-ceramic\" title=\"Glass-ceramic\" rel=\"external_link\" target=\"_blank\">glass-ceramics<\/a> are crystalline or semi-crystalline solids formed by careful cooling of molten fluorosilicate glass. They have good mechanical properties.\n<\/p><p>Potassium fluororichterite based materials are composed from tiny interlocked rod-shaped <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amphibole\" title=\"Amphibole\" rel=\"external_link\" target=\"_blank\">amphibole<\/a> crystals; they have good resistance to chemicals and can be used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microwave_oven\" title=\"Microwave oven\" rel=\"external_link\" target=\"_blank\">microwave ovens<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Richterite\" title=\"Richterite\" rel=\"external_link\" target=\"_blank\">Richterite<\/a> glass-ceramics are used for high-performance <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tableware\" title=\"Tableware\" rel=\"external_link\" target=\"_blank\">tableware<\/a>.\n<\/p><p>Fluorosilicate glass-ceramics with sheet structure, derived from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mica\" title=\"Mica\" rel=\"external_link\" target=\"_blank\">mica<\/a>, are strong and machinable. They find a number of uses and can be used in high vacuum and as dielectrics and precision ceramic components. A number of mica and mica-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroapatite\" class=\"mw-redirect\" title=\"Fluoroapatite\" rel=\"external_link\" target=\"_blank\">fluoroapatite<\/a> glass-ceramics were studied as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterial\" title=\"Biomaterial\" rel=\"external_link\" target=\"_blank\">biomaterials<\/a>.<sup id=\"rdp-ebb-cite_ref-google3_3-0\" class=\"reference\"><a href=\"#cite_note-google3-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoride_glass\" title=\"Fluoride glass\" rel=\"external_link\" target=\"_blank\">Fluoride glass<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass\" title=\"Glass\" rel=\"external_link\" target=\"_blank\">Glass<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicate\" title=\"Silicate\" rel=\"external_link\" target=\"_blank\">Silicate<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-google-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-google_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Committee, E.D.F.A.S.D.R. (2004). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=MyVHpqi1SXwC\" target=\"_blank\"><i>Microelectronics Failure Analysis: Desk Reference<\/i><\/a>. ASM International. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780871708045<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-04-13<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Microelectronics+Failure+Analysis%3A+Desk+Reference&rft.pub=ASM+International&rft.date=2004&rft.isbn=9780871708045&rft.au=Committee%2C+E.D.F.A.S.D.R.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DMyVHpqi1SXwC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFluorosilicate+glass\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-google2-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-google2_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Soltis, F.G. (2001). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=ypJmzqt7JdUC\" target=\"_blank\"><i>Fortress Rochester: The Inside Story of the IBM ISeries<\/i><\/a>. NEWS\/400 Books. p. 54. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781583040836<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-04-13<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Fortress+Rochester%3A+The+Inside+Story+of+the+IBM+ISeries&rft.pages=54&rft.pub=NEWS%2F400+Books&rft.date=2001&rft.isbn=9781583040836&rft.au=Soltis%2C+F.G.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DypJmzqt7JdUC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFluorosilicate+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-google3-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-google3_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Martin, J.W. (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=xv420pEC2qMC\" target=\"_blank\"><i>Concise Encyclopedia of the Structure of Materials<\/i><\/a>. Elsevier Science. p. 203. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780080524634<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-04-13<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Concise+Encyclopedia+of+the+Structure+of+Materials&rft.pages=203&rft.pub=Elsevier+Science&rft.date=2006&rft.isbn=9780080524634&rft.au=Martin%2C+J.W.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Dxv420pEC2qMC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFluorosilicate+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n<p><br \/>\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1322\nCached time: 20181211174714\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.152 seconds\nReal time usage: 0.218 seconds\nPreprocessor visited node count: 328\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 23379\/2097152 bytes\nTemplate argument size: 84\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 8402\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.072\/10.000 seconds\nLua memory usage: 2.43 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 169.086 1 -total\n<\/p>\n<pre>72.99% 123.420 1 Template:Reflist\n63.50% 107.372 3 Template:Cite_book\n13.92% 23.532 1 Template:Glass-material-stub\n12.98% 21.949 1 Template:Glass_science\n 9.12% 15.425 1 Template:Asbox\n 8.63% 14.593 1 Template:Navbox\n 1.55% 2.624 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:4649290-1!canonical and timestamp 20181211174714 and revision id 846225842\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorosilicate_glass\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212216\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.130 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 123.052 1 - wikipedia:Fluorosilicate_glass\n100.00% 123.052 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8193-0!*!*!*!*!*!* and timestamp 20181217212216 and revision id 24339\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Fluorosilicate_glass\">https:\/\/www.limswiki.org\/index.php\/Fluorosilicate_glass<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","a7440e4ccf9932b6f0b014cc2d083229_images":[],"a7440e4ccf9932b6f0b014cc2d083229_timestamp":1545081736,"6b865b25b13ebc2fbacc2fbeb6111784_type":"article","6b865b25b13ebc2fbacc2fbeb6111784_title":"Elastin","6b865b25b13ebc2fbacc2fbeb6111784_url":"https:\/\/www.limswiki.org\/index.php\/Elastin","6b865b25b13ebc2fbacc2fbeb6111784_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tElastin\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tELNIdentifiersAliases ELN , SVAS, WBS, WS, elastin, ADCL1External IDsOMIM: 130160 GeneCards: ELN Gene location (Human)Chr.Chromosome 7 (human)[1] Band7q11.23 Start74,027,789 bp[1] End74,069,907 bp[1] Gene ontologyMolecular function\u2022 extracellular matrix structural constituent\r\n\u2022 protein binding\r\n Cellular component\u2022 proteinaceous extracellular matrix\r\n\u2022 extracellular region\r\n\u2022 elastic fiber\r\n\u2022 extracellular matrix\r\n\u2022 collagen-containing extracellular matrix\r\n Biological process\u2022 animal organ morphogenesis\r\n\u2022 cell proliferation\r\n\u2022 extracellular matrix disassembly\r\n\u2022 extracellular matrix organization\r\n\u2022 blood circulation\r\n\u2022 respiratory gaseous exchange\r\n Sources:Amigo \/ QuickGOOrthologsSpeciesHumanMouseEntrez 2006 n\/aEnsembl ENSG00000049540 n\/aUniProt P15502 n\/aRefSeq (mRNA)NM_000501\r\nNM_001081752\r\nNM_001081753\r\nNM_001081754\r\nNM_001081755\r\nNM_001278912\r\nNM_001278913\r\nNM_001278914\r\nNM_001278915\r\nNM_001278916\r\nNM_001278917\r\nNM_001278918\r\nNM_001278939 n\/a RefSeq (protein)NP_000492\r\nNP_001075221\r\nNP_001075222\r\nNP_001075223\r\nNP_001075224\r\nNP_001265841\r\nNP_001265842\r\nNP_001265843\r\nNP_001265844\r\nNP_001265845\r\nNP_001265846\r\nNP_001265847\r\nNP_001265868 n\/a Location (UCSC)Chr 7: 74.03 \u2013 74.07 Mb n\/a PubMed search[2] n\/a WikidataView\/Edit Human\nElastin is a highly elastic protein in connective tissue and allows many tissues in the body to resume their shape after stretching or contracting. Elastin helps skin to return to its original position when it is poked or pinched. Elastin is also an important load-bearing tissue in the bodies of vertebrates and used in places where mechanical energy is required to be stored. In humans, elastin is encoded by the ELN gene.[3]\n\nContents \n\n1 Function \n2 Clinical significance \n3 Composition \n\n3.1 Tissue distribution \n\n\n4 Biosynthesis \n\n4.1 Tropoelastin precursors \n4.2 Aggregation \n4.3 Crosslinking \n\n\n5 Molecular biology \n6 See also \n7 References \n8 Further reading \n9 External links \n\n\nFunction \nThe ELN gene encodes a protein that is one of the two components of elastic fibers. The encoded protein is rich in hydrophobic amino acids such as glycine and proline, which form mobile hydrophobic regions bounded by crosslinks between lysine residues.[4] Multiple transcript variants encoding different isoforms have been found for this gene.[4] Elastin's soluble precursor is tropoelastin.[5] The characterization of disorder is consistent with an entropy-driven mechanism of elastic recoil. It is concluded that conformational disorder is a constitutive feature of elastin structure and function.[6]\n\nClinical significance \nDeletions and mutations in this gene are associated with supravalvular aortic stenosis (SVAS) and the autosomal dominant cutis laxa.[4] Other associated defects in elastin include Marfan syndrome, emphysema caused by \u03b11-antitrypsin deficiency, atherosclerosis, Buschke-Ollendorff syndrome, Menkes syndrome, pseudoxanthoma elasticum, and Williams syndrome.[7]\n\nComposition \n Stretched elastin isolated from bovine aorta\nIn the body, elastin is usually associated with other proteins in connective tissues. Elastic fiber in the body is a mixture of amorphous elastin and fibrous fibrillin. Both components are primarily made of smaller amino acids such as glycine, valine, alanine, and proline.[7][8] The total elastin ranges from 58 to 75% of the weight of the dry defatted artery in normal canine arteries.[9] Comparison between fresh and digested tissues shows that, at 35% strain, a minimum of 48% of the arterial load is carried by elastin, and a minimum of 43% of the change in stiffness of arterial tissue is due to the change in elastin stiffness.[10]\n\nTissue distribution \nElastin serves an important function in arteries as a medium for pressure wave propagation to help blood flow and is particularly abundant in large elastic blood vessels such as the aorta. Elastin is also very important in the lungs, elastic ligaments, elastic cartilage, the skin, and the bladder. It is present in all vertebrates above the jawless fish.[11]\n\nBiosynthesis \nTropoelastin precursors \nElastin is made by linking together many small soluble precursor tropoelastin protein molecules (50-70 kDa), to make the final massive insoluble, durable complex. The unlinked tropoelastin molecules are not normally available in the cell, since they become crosslinked into elastin fibres immediately after their synthesis by the cell and during their export into the extracellular matrix.\nEach tropoelastin consists of a string of 36 small domains, each weighing about 2 kDa in a random coil conformation. The protein consists of alternating hydrophobic and hydrophilic domains, which are encoded by separate exons, so that the domain structure of tropoelastin reflects the exon organization of the gene. The hydrophilic domains contain Lys-Ala (KA) and Lys-Pro (KP) motifs that are involved in crosslinking during the formation of mature elastin. In the KA domains, lysine residues occur as pairs or triplets separated by two or three alanine residues (e.g. AAAKAAKAA) whereas in KP domains the lysine residues are separated mainly by proline residues (e.g. KPLKP).\n\nAggregation \nTropoelastin aggregates at physiological temperature due to interactions between hydrophobic domains in a process called coacervation. This process is reversible and thermodynamically controlled and does not require protein cleavage. The coacervate is made insoluble by irreversible crosslinking.\n\nCrosslinking \nTo make mature elastin fibres, the tropoelastin molecules are cross-linked via their lysine residues with desmosine and isodesmosine cross-linking molecules. The enzyme that performs the crosslinking is lysyl oxidase, using an in vivo Chichibabin pyridine synthesis reaction.[12]\n\nMolecular biology \n Domain structure of human tropoelastin\nIn mammals, the genome only contains one gene for tropoelastin, called ELN. The human ELN gene is a 45 kb segment on chromosome 7, and has 34 exons interrupted by almost 700 introns, with the first exon being a signal peptide assigning its extracellular localization. The large number of introns suggests that genetic recombination may contribute to the instability of the gene, leading to diseases such as SVAS. The expression of tropoelastin mRNA is highly regulated under at least eight different transcription start sites.\nTissue specific variants of elastin are produced by alternative splicing of the tropoelastin gene. There are at least 11 known human tropoelastin isoforms. these isoforms are under developmental regulation, however there are minimal differences among tissues at the same developmental stage.[7]\n\nSee also \nElastic fibers\nElastin receptor\nCutis laxa\nWilliams syndrome\nReferences \n\n\n^ a b c GRCh38: Ensembl release 89: ENSG00000049540 - Ensembl, May 2017 \n\n^ \"Human PubMed Reference:\". \n\n^ Curran, Mark E.; Atkinson, Donald L.; Ewart, Amanda K.; Morris, Colleen A.; Leppert, Mark F.; Keating, Mark T. (9 April 1993). \"The elastin gene is disrupted by a translocation associated with supravalvular aortic stenosis\". Cell. 73 (1): 159\u2013168. doi:10.1016\/0092-8674(93)90168-P. Retrieved 26 February 2015 . \n\n^ a b c \"Entrez Gene: elastin\". \n\n^ \"Elastin (ELN)\". Retrieved 31 October 2011 . \n\n^ Muiznieks LD, Weiss AS, Keeley FW (Apr 2010). \"Structural disorder and dynamics of elastin\". Biochemistry and Cell Biology. 88 (2): 239\u201350. doi:10.1139\/o09-161. PMID 20453927. \n\n^ a b c Vrhovski, Bernadette; Weiss, Anthony S. (15 November 1998). \"Biochemistry of tropoelastin\". European Journal of Biochemistry. 258 (1): 1\u201318. doi:10.1046\/j.1432-1327.1998.2580001.x. Retrieved 26 February 2015 . \n\n^ Kielty CM, Sherratt MJ, Shuttleworth CA (Jul 2002). \"Elastic fibres\". Journal of Cell Science. 115 (Pt 14): 2817\u201328. PMID 12082143. \n\n^ Fischer GM, Llaurado JG (Aug 1966). \"Collagen and elastin content in canine arteries selected from functionally different vascular beds\". Circulation Research. 19 (2): 394\u2013399. doi:10.1161\/01.res.19.2.394. PMID 5914851. \n\n^ Lammers SR, Kao PH, Qi HJ, Hunter K, Lanning C, Albietz J, Hofmeister S, Mecham R, Stenmark KR, Shandas R (Oct 2008). \"Changes in the structure-function relationship of elastin and its impact on the proximal pulmonary arterial mechanics of hypertensive calves\". American Journal of Physiology. Heart and Circulatory Physiology. 295 (4): H1451-9. doi:10.1152\/ajpheart.00127.2008. PMC 2593497 . PMID 18660454. \n\n^ Sage EH, Gray WR (1977). \"Evolution of elastin structure\". Advances in Experimental Medicine and Biology. 79: 291\u2013312. doi:10.1007\/978-1-4684-9093-0_27. PMID 868643. \n\n^ Umeda H, Takeuchi M, Suyama K (Apr 2001). \"Two new elastin cross-links having pyridine skeleton. Implication of ammonia in elastin cross-linking in vivo\". The Journal of Biological Chemistry. 276 (16): 12579\u201312587. doi:10.1074\/jbc.M009744200. PMID 11278561. \n\n\nFurther reading \n\nJan SL, Chan SC, Fu YC, Lin SJ (Jun 2009). \"Elastin gene study of infants with isolated congenital ductus arteriosus aneurysm\". Acta Cardiologica. 64 (3): 363\u20139. doi:10.2143\/ac.64.3.2038023. PMID 19593948. \nKeeley FW, Bellingham CM, Woodhouse KA (Feb 2002). \"Elastin as a self-organizing biomaterial: use of recombinantly expressed human elastin polypeptides as a model for investigations of structure and self-assembly of elastin\". Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences. 357 (1418): 185\u20139. doi:10.1098\/rstb.2001.1027. PMC 1692930 . PMID 11911775. \nChoudhury R, McGovern A, Ridley C, Cain SA, Baldwin A, Wang MC, Guo C, Mironov A, Drymoussi Z, Trump D, Shuttleworth A, Baldock C, Kielty CM (Sep 2009). \"Differential regulation of elastic fiber formation by fibulin-4 and -5\". The Journal of Biological Chemistry. 284 (36): 24553\u201367. doi:10.1074\/jbc.M109.019364. PMC 2782046 . PMID 19570982. \nHubmacher D, Cirulis JT, Miao M, Keeley FW, Reinhardt DP (Jan 2010). \"Functional consequences of homocysteinylation of the elastic fiber proteins fibrillin-1 and tropoelastin\". The Journal of Biological Chemistry. 285 (2): 1188\u201398. doi:10.1074\/jbc.M109.021246. PMC 2801247 . PMID 19889633. \nCoolen NA, Schouten KC, Middelkoop E, Ulrich MM (Jan 2010). \"Comparison between human fetal and adult skin\". Archives of Dermatological Research. 302 (1): 47\u201355. doi:10.1007\/s00403-009-0989-8. PMC 2799629 . PMID 19701759. \nMcGeachie M, Ramoni RL, Mychaleckyj JC, Furie KL, Dreyfuss JM, Liu Y, Herrington D, Guo X, Lima JA, Post W, Rotter JI, Rich S, Sale M, Ramoni MF (Dec 2009). \"Integrative predictive model of coronary artery calcification in atherosclerosis\". Circulation. 120 (24): 2448\u201354. doi:10.1161\/CIRCULATIONAHA.109.865501. PMC 2810344 . PMID 19948975. \nYoshida T, Kato K, Yokoi K, Oguri M, Watanabe S, Metoki N, Yoshida H, Satoh K, Aoyagi Y, Nishigaki Y, Nozawa Y, Yamada Y (Aug 2009). \"Association of genetic variants with chronic kidney disease in individuals with different lipid profiles\". International Journal of Molecular Medicine. 24 (2): 233\u201346. doi:10.3892\/ijmm_00000226. PMID 19578796. \nAkima T, Nakanishi K, Suzuki K, Katayama M, Ohsuzu F, Kawai T (Nov 2009). \"Soluble elastin decreases in the progress of atheroma formation in human aorta\". Circulation Journal. 73 (11): 2154\u201362. doi:10.1253\/circj.cj-09-0104. PMID 19755752. \nChen Q, Zhang T, Roshetsky JF, Ouyang Z, Essers J, Fan C, Wang Q, Hinek A, Plow EF, Dicorleto PE (Oct 2009). \"Fibulin-4 regulates expression of the tropoelastin gene and consequent elastic-fibre formation by human fibroblasts\". The Biochemical Journal. 423 (1): 79\u201389. doi:10.1042\/BJ20090993. PMC 3024593 . PMID 19627254. \nTintar D, Samouillan V, Dandurand J, Lacabanne C, Pepe A, Bochicchio B, Tamburro AM (Nov 2009). \"Human tropoelastin sequence: dynamics of polypeptide coded by exon 6 in solution\". Biopolymers. 91 (11): 943\u201352. doi:10.1002\/bip.21282. PMID 19603496. \nDyksterhuis LB, Weiss AS (Jun 2010). \"Homology models for domains 21-23 of human tropoelastin shed light on lysine crosslinking\". Biochemical and Biophysical Research Communications. 396 (4): 870\u20133. doi:10.1016\/j.bbrc.2010.05.013. PMID 20457133. \nRomero R, Velez Edwards DR, Kusanovic JP, Hassan SS, Mazaki-Tovi S, Vaisbuch E, Kim CJ, Chaiworapongsa T, Pearce BD, Friel LA, Bartlett J, Anant MK, Salisbury BA, Vovis GF, Lee MS, Gomez R, Behnke E, Oyarzun E, Tromp G, Williams SM, Menon R (May 2010). \"Identification of fetal and maternal single nucleotide polymorphisms in candidate genes that predispose to spontaneous preterm labor with intact membranes\". American Journal of Obstetrics and Gynecology. 202 (5): 431.e1\u201334. doi:10.1016\/j.ajog.2010.03.026. PMC 3604889 . PMID 20452482. \nFan BJ, Figuieredo Sena DR, Pasquale LR, Grosskreutz CL, Rhee DJ, Chen TC, Delbono EA, Haines JL, Wiggs JL (Sep 2010). \"Lack of association of polymorphisms in elastin with pseudoexfoliation syndrome and glaucoma\". Journal of Glaucoma. 19 (7): 432\u2013436. doi:10.1097\/IJG.0b013e3181c4b0fe. PMID 20051886. \nBertram C, Hass R (Oct 2009). \"Cellular senescence of human mammary epithelial cells (HMEC) is associated with an altered MMP-7\/HB-EGF signaling and increased formation of elastin-like structures\". Mechanisms of Ageing and Development. 130 (10): 657\u201369. doi:10.1016\/j.mad.2009.08.001. PMID 19682489. \nRoberts KE, Kawut SM, Krowka MJ, Brown RS, Trotter JF, Shah V, Peter I, Tighiouart H, Mitra N, Handorf E, Knowles JA, Zacks S, Fallon MB (Jul 2010). \"Genetic risk factors for hepatopulmonary syndrome in patients with advanced liver disease\". Gastroenterology. 139 (1): 130\u20139.e24. doi:10.1053\/j.gastro.2010.03.044. PMC 2908261 . PMID 20346360. \nRosenbloom J (Dec 1984). \"Elastin: relation of protein and gene structure to disease\". Laboratory Investigation. 51 (6): 605\u201323. PMID 6150137. \nBax DV, Rodgers UR, Bilek MM, Weiss AS (Oct 2009). \"Cell adhesion to tropoelastin is mediated via the C-terminal GRKRK motif and integrin alphaVbeta3\". The Journal of Biological Chemistry. 284 (42): 28616\u201323. doi:10.1074\/jbc.M109.017525. PMC 2781405 . PMID 19617625. \nRodriguez-Revenga L, Iranzo P, Badenas C, Puig S, Carri\u00f3 A, Mil\u00e0 M (Sep 2004). \"A novel elastin gene mutation resulting in an autosomal dominant form of cutis laxa\". Archives of Dermatology. 140 (9): 1135\u20139. doi:10.1001\/archderm.140.9.1135. PMID 15381555. \nMicale L, Turturo MG, Fusco C, Augello B, Jurado LA, Izzi C, Digilio MC, Milani D, Lapi E, Zelante L, Merla G (Mar 2010). \"Identification and characterization of seven novel mutations of elastin gene in a cohort of patients affected by supravalvular aortic stenosis\". European Journal of Human Genetics. 18 (3): 317\u201323. doi:10.1038\/ejhg.2009.181. PMC 2987220 . PMID 19844261. \nTzaphlidou M (2004). \"The role of collagen and elastin in aged skin: an image processing approach\". Micron. 35 (3): 173\u20137. doi:10.1016\/j.micron.2003.11.003. PMID 15036271. \n\nExternal links \nElastin at the US National Library of Medicine Medical Subject Headings (MeSH)\nHistology image: 21402loa \u2013 Histology Learning System at Boston University\nGeneReviews\/NIH\/NCBI\/UW entry on Williams or Williams-Beuren Syndrome\nThe Elastin Protein\nMicrofibril \nThis article incorporates text from the United States National Library of Medicine, which is in the public domain.\n\nvteProtein: scleroproteinsExtracellular matrixCollagenFibril forming\ntype I\nCOL1A1\nCOL1A2\ntype II (COL2A1)\ntype III\ntype V\nCOL5A1\nCOL5A2\nCOL5A3\nCOL24A1\nCOL26A1\nOther\nFACIT: type IX\nCOL9A1\nCOL9A2\nCOL9A3\ntype XII (COL12A1)\nCOL14A1\nCOL16A1\nCOL19A1\nCOL20A1\nCOL21A1\nCOL22A1\nbasement membrane: type IV\nCOL4A1\nCOL4A2\nCOL4A3\nCOL4A4\nCOL4A5\nCOL4A6\nmultiplexin: COL15A1\ntype XVIII\nCOL18A1\nEndostatin\ntransmembrane: COL13A1\nCOL17A1\nCOL23A1\nCOL25A1\nother: type VI\nCOL6A1\nCOL6A2\nCOL6A3\nCOL6A5\ntype VII (COL7A1)\ntype VIII\nCOL8A1\nCOL8A2\ntype X (COL10A1)\ntype XI\nCOL11A1\nCOL11A2\nCOL27A1\nCOL28A1\nEnzymes\nProlyl hydroxylase\/Lysyl hydroxylase\nCartilage associated protein\/Leprecan\nADAMTS2\nProcollagen peptidase\nLysyl oxidase\nLaminin\nalpha\nLAMA1\nLAMA2\nLAMA3\nLAMA4\nLAMA5\nbeta\nLAMB1\nLAMB2\nLAMB3\nLAMB4\ngamma\nLAMC1\nLAMC2\nLAMC3\nOther\nALCAM\nElastin\nTropoelastin\nVitronectin\nFRAS1\nFREM2\nDecorin\nFAM20C\nECM1\nMatrix gla protein\nTectorin\nTECTA\nTECTB\nOther\nKeratin\/Cytokeratin\nGelatin\nReticulin\nCartilage oligomeric matrix protein\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Elastin\">https:\/\/www.limswiki.org\/index.php\/Elastin<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","6b865b25b13ebc2fbacc2fbeb6111784_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Elastin skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Elastin<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Elastin<\/b> is a highly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elasticity_(physics)\" title=\"Elasticity (physics)\" rel=\"external_link\" target=\"_blank\">elastic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Protein\" title=\"Protein\" rel=\"external_link\" target=\"_blank\">protein<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Connective_tissue\" title=\"Connective tissue\" rel=\"external_link\" target=\"_blank\">connective tissue<\/a> and allows many tissues in the body to resume their shape after stretching or contracting. Elastin helps skin to return to its original position when it is poked or pinched. Elastin is also an important load-bearing tissue in the bodies of vertebrates and used in places where mechanical energy is required to be stored. In humans, elastin is encoded by the <i>ELN<\/i> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gene\" title=\"Gene\" rel=\"external_link\" target=\"_blank\">gene<\/a>.<sup id=\"rdp-ebb-cite_ref-pmid8096434_3-0\" class=\"reference\"><a href=\"#cite_note-pmid8096434-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Function\">Function<\/span><\/h2>\n<p>The <i>ELN<\/i> gene encodes a protein that is one of the two components of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastic_fibers\" class=\"mw-redirect\" title=\"Elastic fibers\" rel=\"external_link\" target=\"_blank\">elastic fibers<\/a>. The encoded protein is rich in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrophobic\" class=\"mw-redirect\" title=\"Hydrophobic\" rel=\"external_link\" target=\"_blank\">hydrophobic<\/a> amino acids such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glycine\" title=\"Glycine\" rel=\"external_link\" target=\"_blank\">glycine<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proline\" title=\"Proline\" rel=\"external_link\" target=\"_blank\">proline<\/a>, which form mobile hydrophobic regions bounded by crosslinks between <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lysine\" title=\"Lysine\" rel=\"external_link\" target=\"_blank\">lysine<\/a> residues.<sup id=\"rdp-ebb-cite_ref-entrez_4-0\" class=\"reference\"><a href=\"#cite_note-entrez-4\" rel=\"external_link\">[4]<\/a><\/sup> Multiple transcript variants encoding different isoforms have been found for this gene.<sup id=\"rdp-ebb-cite_ref-entrez_4-1\" class=\"reference\"><a href=\"#cite_note-entrez-4\" rel=\"external_link\">[4]<\/a><\/sup> Elastin's soluble precursor is tropoelastin.<sup id=\"rdp-ebb-cite_ref-Elastin_(ELN)_5-0\" class=\"reference\"><a href=\"#cite_note-Elastin_(ELN)-5\" rel=\"external_link\">[5]<\/a><\/sup> The characterization of disorder is consistent with an entropy-driven mechanism of elastic recoil. It is concluded that conformational disorder is a constitutive feature of elastin structure and function.<sup id=\"rdp-ebb-cite_ref-pmid20453927_6-0\" class=\"reference\"><a href=\"#cite_note-pmid20453927-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Clinical_significance\">Clinical significance<\/span><\/h2>\n<p>Deletions and mutations in this gene are associated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aortic_valve_stenosis\" class=\"mw-redirect\" title=\"Aortic valve stenosis\" rel=\"external_link\" target=\"_blank\">supravalvular aortic stenosis<\/a> (SVAS) and the autosomal dominant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cutis_laxa\" title=\"Cutis laxa\" rel=\"external_link\" target=\"_blank\">cutis laxa<\/a>.<sup id=\"rdp-ebb-cite_ref-entrez_4-2\" class=\"reference\"><a href=\"#cite_note-entrez-4\" rel=\"external_link\">[4]<\/a><\/sup> Other associated defects in elastin include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Marfan_syndrome\" title=\"Marfan syndrome\" rel=\"external_link\" target=\"_blank\">Marfan syndrome<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Emphysema\" class=\"mw-redirect\" title=\"Emphysema\" rel=\"external_link\" target=\"_blank\">emphysema<\/a> caused by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alpha_1-antitrypsin\" class=\"mw-redirect\" title=\"Alpha 1-antitrypsin\" rel=\"external_link\" target=\"_blank\">\u03b1<sub>1<\/sub>-antitrypsin<\/a> deficiency, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atherosclerosis\" title=\"Atherosclerosis\" rel=\"external_link\" target=\"_blank\">atherosclerosis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Buschke-Ollendorff_syndrome\" class=\"mw-redirect\" title=\"Buschke-Ollendorff syndrome\" rel=\"external_link\" target=\"_blank\">Buschke-Ollendorff syndrome<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Menkes_syndrome\" class=\"mw-redirect\" title=\"Menkes syndrome\" rel=\"external_link\" target=\"_blank\">Menkes syndrome<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pseudoxanthoma_elasticum\" title=\"Pseudoxanthoma elasticum\" rel=\"external_link\" target=\"_blank\">pseudoxanthoma elasticum<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Williams_syndrome\" title=\"Williams syndrome\" rel=\"external_link\" target=\"_blank\">Williams syndrome<\/a>.<sup id=\"rdp-ebb-cite_ref-vrhovski1998_7-0\" class=\"reference\"><a href=\"#cite_note-vrhovski1998-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Composition\">Composition<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Elastin_bovine.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/be\/Elastin_bovine.png\/220px-Elastin_bovine.png\" width=\"220\" height=\"158\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Elastin_bovine.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Stretched elastin isolated from bovine aorta<\/div><\/div><\/div>\n<p>In the body, elastin is usually associated with other proteins in connective tissues. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastic_fiber\" title=\"Elastic fiber\" rel=\"external_link\" target=\"_blank\">Elastic fiber<\/a> in the body is a mixture of amorphous elastin and fibrous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibrillin\" title=\"Fibrillin\" rel=\"external_link\" target=\"_blank\">fibrillin<\/a>. Both components are primarily made of smaller <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amino_acid\" title=\"Amino acid\" rel=\"external_link\" target=\"_blank\">amino acids<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glycine\" title=\"Glycine\" rel=\"external_link\" target=\"_blank\">glycine<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Valine\" title=\"Valine\" rel=\"external_link\" target=\"_blank\">valine<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alanine\" title=\"Alanine\" rel=\"external_link\" target=\"_blank\">alanine<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proline\" title=\"Proline\" rel=\"external_link\" target=\"_blank\">proline<\/a>.<sup id=\"rdp-ebb-cite_ref-vrhovski1998_7-1\" class=\"reference\"><a href=\"#cite_note-vrhovski1998-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid12082143_8-0\" class=\"reference\"><a href=\"#cite_note-pmid12082143-8\" rel=\"external_link\">[8]<\/a><\/sup> The total elastin ranges from 58 to 75% of the weight of the dry defatted artery in normal canine arteries.<sup id=\"rdp-ebb-cite_ref-pmid5914851_9-0\" class=\"reference\"><a href=\"#cite_note-pmid5914851-9\" rel=\"external_link\">[9]<\/a><\/sup> Comparison between fresh and digested tissues shows that, at 35% strain, a minimum of 48% of the arterial load is carried by elastin, and a minimum of 43% of the change in stiffness of arterial tissue is due to the change in elastin stiffness.<sup id=\"rdp-ebb-cite_ref-pmid18660454_10-0\" class=\"reference\"><a href=\"#cite_note-pmid18660454-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Tissue_distribution\">Tissue distribution<\/span><\/h3>\n<p>Elastin serves an important function in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arteries\" class=\"mw-redirect\" title=\"Arteries\" rel=\"external_link\" target=\"_blank\">arteries<\/a> as a medium for pressure wave propagation to help <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_flow\" class=\"mw-redirect\" title=\"Blood flow\" rel=\"external_link\" target=\"_blank\">blood flow<\/a> and is particularly abundant in large elastic blood vessels such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aorta\" title=\"Aorta\" rel=\"external_link\" target=\"_blank\">aorta<\/a>. Elastin is also very important in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lung\" title=\"Lung\" rel=\"external_link\" target=\"_blank\">lungs<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ligament\" title=\"Ligament\" rel=\"external_link\" target=\"_blank\">elastic ligaments<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastic_cartilage\" title=\"Elastic cartilage\" rel=\"external_link\" target=\"_blank\">elastic cartilage<\/a>, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin\" title=\"Skin\" rel=\"external_link\" target=\"_blank\">skin<\/a>, and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinary_bladder\" title=\"Urinary bladder\" rel=\"external_link\" target=\"_blank\">bladder<\/a>. It is present in all <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertebrates\" class=\"mw-redirect\" title=\"Vertebrates\" rel=\"external_link\" target=\"_blank\">vertebrates<\/a> above the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Agnatha\" title=\"Agnatha\" rel=\"external_link\" target=\"_blank\">jawless fish<\/a>.<sup id=\"rdp-ebb-cite_ref-pmid8686432_11-0\" class=\"reference\"><a href=\"#cite_note-pmid8686432-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Biosynthesis\">Biosynthesis<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Tropoelastin_precursors\">Tropoelastin precursors<\/span><\/h3>\n<p>Elastin is made by linking together many small <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soluble\" class=\"mw-redirect\" title=\"Soluble\" rel=\"external_link\" target=\"_blank\">soluble<\/a> precursor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tropoelastin\" class=\"mw-redirect\" title=\"Tropoelastin\" rel=\"external_link\" target=\"_blank\">tropoelastin<\/a> protein molecules (50-70 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atomic_mass_unit\" title=\"Atomic mass unit\" rel=\"external_link\" target=\"_blank\">kDa<\/a>), to make the final massive insoluble, durable complex. The unlinked tropoelastin molecules are not normally available in the cell, since they become crosslinked into elastin fibres immediately after their synthesis by the cell and during their export into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Extracellular_matrix\" title=\"Extracellular matrix\" rel=\"external_link\" target=\"_blank\">extracellular matrix<\/a>.\n<\/p><p>Each tropoelastin consists of a string of 36 small <a href=\"https:\/\/en.wikipedia.org\/wiki\/Protein_domain\" title=\"Protein domain\" rel=\"external_link\" target=\"_blank\">domains<\/a>, each weighing about 2 kDa in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Random_coil\" title=\"Random coil\" rel=\"external_link\" target=\"_blank\">random coil conformation<\/a>. The protein consists of alternating <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrophobic\" class=\"mw-redirect\" title=\"Hydrophobic\" rel=\"external_link\" target=\"_blank\">hydrophobic<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrophilic\" class=\"mw-redirect\" title=\"Hydrophilic\" rel=\"external_link\" target=\"_blank\">hydrophilic<\/a> domains, which are encoded by separate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Exon\" title=\"Exon\" rel=\"external_link\" target=\"_blank\">exons<\/a>, so that the domain structure of tropoelastin reflects the exon organization of the gene. The hydrophilic domains contain Lys-Ala (KA) and Lys-Pro (KP) motifs that are involved in crosslinking during the formation of mature elastin. In the KA domains, lysine residues occur as pairs or triplets separated by two or three alanine residues (e.g. AAAKAAKAA) whereas in KP domains the lysine residues are separated mainly by proline residues (e.g. KPLKP).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Aggregation\">Aggregation<\/span><\/h3>\n<p>Tropoelastin aggregates at physiological temperature due to interactions between hydrophobic domains in a process called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coacervation\" class=\"mw-redirect\" title=\"Coacervation\" rel=\"external_link\" target=\"_blank\">coacervation<\/a>. This process is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reversible_reaction\" title=\"Reversible reaction\" rel=\"external_link\" target=\"_blank\">reversible<\/a> and thermodynamically controlled and does not require <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proteolysis\" title=\"Proteolysis\" rel=\"external_link\" target=\"_blank\">protein cleavage<\/a>. The coacervate is made insoluble by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reversible_reaction\" title=\"Reversible reaction\" rel=\"external_link\" target=\"_blank\">irreversible<\/a> crosslinking.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Crosslinking\">Crosslinking<\/span><\/h3>\n<p>To make mature elastin fibres, the tropoelastin molecules are cross-linked via their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lysine\" title=\"Lysine\" rel=\"external_link\" target=\"_blank\">lysine<\/a> residues with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Desmosine\" title=\"Desmosine\" rel=\"external_link\" target=\"_blank\">desmosine<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isodesmosine\" title=\"Isodesmosine\" rel=\"external_link\" target=\"_blank\">isodesmosine<\/a> cross-linking molecules. The enzyme that performs the crosslinking is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lysyl_oxidase\" title=\"Lysyl oxidase\" rel=\"external_link\" target=\"_blank\">lysyl oxidase<\/a>, using an <i>in vivo<\/i> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chichibabin_pyridine_synthesis\" title=\"Chichibabin pyridine synthesis\" rel=\"external_link\" target=\"_blank\">Chichibabin pyridine synthesis<\/a> reaction.<sup id=\"rdp-ebb-cite_ref-:0_12-0\" class=\"reference\"><a href=\"#cite_note-:0-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Molecular_biology\">Molecular biology<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:352px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Domain_structure_human_tropoelastin_(EN).png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cb\/Domain_structure_human_tropoelastin_%28EN%29.png\/350px-Domain_structure_human_tropoelastin_%28EN%29.png\" width=\"350\" height=\"117\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Domain_structure_human_tropoelastin_(EN).png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Domain structure of human tropoelastin<\/div><\/div><\/div>\n<p>In mammals, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Genome\" title=\"Genome\" rel=\"external_link\" target=\"_blank\">genome<\/a> only contains one gene for tropoelastin, called <i>ELN<\/i>. The human <i>ELN<\/i> gene is a 45 kb segment on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromosome_7\" title=\"Chromosome 7\" rel=\"external_link\" target=\"_blank\">chromosome 7<\/a>, and has 34 exons interrupted by almost 700 introns, with the first exon being a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Signal_peptide\" title=\"Signal peptide\" rel=\"external_link\" target=\"_blank\">signal peptide<\/a> assigning its extracellular localization. The large number of introns suggests that <a href=\"https:\/\/en.wikipedia.org\/wiki\/Genetic_recombination\" title=\"Genetic recombination\" rel=\"external_link\" target=\"_blank\">genetic recombination<\/a> may contribute to the instability of the gene, leading to diseases such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Supravalvular_aortic_stenosis\" title=\"Supravalvular aortic stenosis\" rel=\"external_link\" target=\"_blank\">SVAS<\/a>. The expression of tropoelastin mRNA is highly regulated under at least eight different <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcription_(genetics)\" class=\"mw-redirect\" title=\"Transcription (genetics)\" rel=\"external_link\" target=\"_blank\">transcription start sites<\/a>.\n<\/p><p>Tissue specific variants of elastin are produced by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alternative_splicing\" title=\"Alternative splicing\" rel=\"external_link\" target=\"_blank\">alternative splicing<\/a> of the tropoelastin gene. There are at least 11 known human tropoelastin isoforms. these isoforms are under developmental regulation, however there are minimal differences among tissues at the same developmental stage.<sup id=\"rdp-ebb-cite_ref-vrhovski1998_7-2\" class=\"reference\"><a href=\"#cite_note-vrhovski1998-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastic_fibers\" class=\"mw-redirect\" title=\"Elastic fibers\" rel=\"external_link\" target=\"_blank\">Elastic fibers<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastin_receptor\" class=\"mw-redirect\" title=\"Elastin receptor\" rel=\"external_link\" target=\"_blank\">Elastin receptor<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cutis_laxa\" title=\"Cutis laxa\" rel=\"external_link\" target=\"_blank\">Cutis laxa<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Williams_syndrome\" title=\"Williams syndrome\" rel=\"external_link\" target=\"_blank\">Williams syndrome<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 33em; -webkit-column-width: 33em; column-width: 33em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-refGRCh38Ensembl-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-refGRCh38Ensembl_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-refGRCh38Ensembl_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-refGRCh38Ensembl_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/May2017.archive.ensembl.org\/Homo_sapiens\/Gene\/Summary?db=core;g=ENSG00000049540\" target=\"_blank\">GRCh38: Ensembl release 89: ENSG00000049540<\/a> - <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ensembl_genome_database_project\" title=\"Ensembl genome database project\" rel=\"external_link\" target=\"_blank\">Ensembl<\/a>, May 2017<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/sites\/entrez?db=gene&cmd=Link&LinkName=gene_pubmed&from_uid=2006\" target=\"_blank\">\"Human PubMed Reference:\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Human+PubMed+Reference%3A&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fsites%2Fentrez%3Fdb%3Dgene%26cmd%3DLink%26LinkName%3Dgene_pubmed%26from_uid%3D2006&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-pmid8096434-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid8096434_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Curran, Mark E.; Atkinson, Donald L.; Ewart, Amanda K.; Morris, Colleen A.; Leppert, Mark F.; Keating, Mark T. (9 April 1993). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/009286749390168P\" target=\"_blank\">\"The elastin gene is disrupted by a translocation associated with supravalvular aortic stenosis\"<\/a>. <i>Cell<\/i>. <b>73<\/b> (1): 159\u2013168. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0092-8674%2893%2990168-P\" target=\"_blank\">10.1016\/0092-8674(93)90168-P<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 February<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cell&rft.atitle=The+elastin+gene+is+disrupted+by+a+translocation+associated+with+supravalvular+aortic+stenosis&rft.volume=73&rft.issue=1&rft.pages=159-168&rft.date=1993-04-09&rft_id=info%3Adoi%2F10.1016%2F0092-8674%2893%2990168-P&rft.aulast=Curran&rft.aufirst=Mark+E.&rft.au=Atkinson%2C+Donald+L.&rft.au=Ewart%2C+Amanda+K.&rft.au=Morris%2C+Colleen+A.&rft.au=Leppert%2C+Mark+F.&rft.au=Keating%2C+Mark+T.&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2F009286749390168P&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-entrez-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-entrez_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-entrez_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-entrez_4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/sites\/entrez?Db=gene&Cmd=ShowDetailView&TermToSearch=2006\" target=\"_blank\">\"Entrez Gene: elastin\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Entrez+Gene%3A+elastin&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fsites%2Fentrez%3FDb%3Dgene%26Cmd%3DShowDetailView%26TermToSearch%3D2006&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Elastin_(ELN)-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Elastin_(ELN)_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/wiki.medpedia.com\/Elastin_%28ELN%29\" target=\"_blank\">\"Elastin (ELN)\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">31 October<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Elastin+%28ELN%29&rft_id=http%3A%2F%2Fwiki.medpedia.com%2FElastin_%2528ELN%2529&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid20453927-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid20453927_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Muiznieks LD, Weiss AS, Keeley FW (Apr 2010). \"Structural disorder and dynamics of elastin\". <i>Biochemistry and Cell Biology<\/i>. <b>88<\/b> (2): 239\u201350. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1139%2Fo09-161\" target=\"_blank\">10.1139\/o09-161<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20453927\" target=\"_blank\">20453927<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biochemistry+and+Cell+Biology&rft.atitle=Structural+disorder+and+dynamics+of+elastin&rft.volume=88&rft.issue=2&rft.pages=239-50&rft.date=2010-04&rft_id=info%3Adoi%2F10.1139%2Fo09-161&rft_id=info%3Apmid%2F20453927&rft.aulast=Muiznieks&rft.aufirst=LD&rft.au=Weiss%2C+AS&rft.au=Keeley%2C+FW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-vrhovski1998-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-vrhovski1998_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-vrhovski1998_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-vrhovski1998_7-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vrhovski, Bernadette; Weiss, Anthony S. (15 November 1998). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1046\/j.1432-1327.1998.2580001.x\/abstract\" target=\"_blank\">\"Biochemistry of tropoelastin\"<\/a>. <i>European Journal of Biochemistry<\/i>. <b>258<\/b> (1): 1\u201318. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1046%2Fj.1432-1327.1998.2580001.x\" target=\"_blank\">10.1046\/j.1432-1327.1998.2580001.x<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 February<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Journal+of+Biochemistry&rft.atitle=Biochemistry+of+tropoelastin&rft.volume=258&rft.issue=1&rft.pages=1-18&rft.date=1998-11-15&rft_id=info%3Adoi%2F10.1046%2Fj.1432-1327.1998.2580001.x&rft.aulast=Vrhovski&rft.aufirst=Bernadette&rft.au=Weiss%2C+Anthony+S.&rft_id=http%3A%2F%2Fonlinelibrary.wiley.com%2Fdoi%2F10.1046%2Fj.1432-1327.1998.2580001.x%2Fabstract&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid12082143-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid12082143_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kielty CM, Sherratt MJ, Shuttleworth CA (Jul 2002). \"Elastic fibres\". <i>Journal of Cell Science<\/i>. <b>115<\/b> (Pt 14): 2817\u201328. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12082143\" target=\"_blank\">12082143<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Cell+Science&rft.atitle=Elastic+fibres&rft.volume=115&rft.issue=Pt+14&rft.pages=2817-28&rft.date=2002-07&rft_id=info%3Apmid%2F12082143&rft.aulast=Kielty&rft.aufirst=CM&rft.au=Sherratt%2C+MJ&rft.au=Shuttleworth%2C+CA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid5914851-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid5914851_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Fischer GM, Llaurado JG (Aug 1966). \"Collagen and elastin content in canine arteries selected from functionally different vascular beds\". <i>Circulation Research<\/i>. <b>19<\/b> (2): 394\u2013399. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1161%2F01.res.19.2.394\" target=\"_blank\">10.1161\/01.res.19.2.394<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/5914851\" target=\"_blank\">5914851<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Circulation+Research&rft.atitle=Collagen+and+elastin+content+in+canine+arteries+selected+from+functionally+different+vascular+beds&rft.volume=19&rft.issue=2&rft.pages=394-399&rft.date=1966-08&rft_id=info%3Adoi%2F10.1161%2F01.res.19.2.394&rft_id=info%3Apmid%2F5914851&rft.aulast=Fischer&rft.aufirst=GM&rft.au=Llaurado%2C+JG&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid18660454-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid18660454_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lammers SR, Kao PH, Qi HJ, Hunter K, Lanning C, Albietz J, Hofmeister S, Mecham R, Stenmark KR, Shandas R (Oct 2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2593497\" target=\"_blank\">\"Changes in the structure-function relationship of elastin and its impact on the proximal pulmonary arterial mechanics of hypertensive calves\"<\/a>. <i>American Journal of Physiology. Heart and Circulatory Physiology<\/i>. <b>295<\/b> (4): H1451-9. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1152%2Fajpheart.00127.2008\" target=\"_blank\">10.1152\/ajpheart.00127.2008<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2593497\" target=\"_blank\">2593497<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18660454\" target=\"_blank\">18660454<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Physiology.+Heart+and+Circulatory+Physiology&rft.atitle=Changes+in+the+structure-function+relationship+of+elastin+and+its+impact+on+the+proximal+pulmonary+arterial+mechanics+of+hypertensive+calves&rft.volume=295&rft.issue=4&rft.pages=H1451-9.&rft.date=2008-10&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2593497&rft_id=info%3Apmid%2F18660454&rft_id=info%3Adoi%2F10.1152%2Fajpheart.00127.2008&rft.aulast=Lammers&rft.aufirst=SR&rft.au=Kao%2C+PH&rft.au=Qi%2C+HJ&rft.au=Hunter%2C+K&rft.au=Lanning%2C+C&rft.au=Albietz%2C+J&rft.au=Hofmeister%2C+S&rft.au=Mecham%2C+R&rft.au=Stenmark%2C+KR&rft.au=Shandas%2C+R&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2593497&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid8686432-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid8686432_11-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sage EH, Gray WR (1977). \"Evolution of elastin structure\". <i>Advances in Experimental Medicine and Biology<\/i>. <b>79<\/b>: 291\u2013312. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2F978-1-4684-9093-0_27\" target=\"_blank\">10.1007\/978-1-4684-9093-0_27<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/868643\" target=\"_blank\">868643<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Advances+in+Experimental+Medicine+and+Biology&rft.atitle=Evolution+of+elastin+structure&rft.volume=79&rft.pages=291-312&rft.date=1977&rft_id=info%3Adoi%2F10.1007%2F978-1-4684-9093-0_27&rft_id=info%3Apmid%2F868643&rft.aulast=Sage&rft.aufirst=EH&rft.au=Gray%2C+WR&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:0-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-:0_12-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Umeda H, Takeuchi M, Suyama K (Apr 2001). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jbc.org\/content\/276\/16\/12579.abstract\" target=\"_blank\">\"Two new elastin cross-links having pyridine skeleton. Implication of ammonia in elastin cross-linking in vivo\"<\/a>. <i>The Journal of Biological Chemistry<\/i>. <b>276<\/b> (16): 12579\u201312587. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1074%2Fjbc.M009744200\" target=\"_blank\">10.1074\/jbc.M009744200<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11278561\" target=\"_blank\">11278561<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Biological+Chemistry&rft.atitle=Two+new+elastin+cross-links+having+pyridine+skeleton.+Implication+of+ammonia+in+elastin+cross-linking+in+vivo&rft.volume=276&rft.issue=16&rft.pages=12579-12587&rft.date=2001-04&rft_id=info%3Adoi%2F10.1074%2Fjbc.M009744200&rft_id=info%3Apmid%2F11278561&rft.aulast=Umeda&rft.aufirst=H&rft.au=Takeuchi%2C+M&rft.au=Suyama%2C+K&rft_id=http%3A%2F%2Fwww.jbc.org%2Fcontent%2F276%2F16%2F12579.abstract&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<div class=\"refbegin columns references-column-width\" style=\"-moz-column-width: 33em; -webkit-column-width: 33em; column-width: 33em;\">\n<ul><li><cite class=\"citation journal\">Jan SL, Chan SC, Fu YC, Lin SJ (Jun 2009). \"Elastin gene study of infants with isolated congenital ductus arteriosus aneurysm\". <i>Acta Cardiologica<\/i>. <b>64<\/b> (3): 363\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2143%2Fac.64.3.2038023\" target=\"_blank\">10.2143\/ac.64.3.2038023<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19593948\" target=\"_blank\">19593948<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Cardiologica&rft.atitle=Elastin+gene+study+of+infants+with+isolated+congenital+ductus+arteriosus+aneurysm&rft.volume=64&rft.issue=3&rft.pages=363-9&rft.date=2009-06&rft_id=info%3Adoi%2F10.2143%2Fac.64.3.2038023&rft_id=info%3Apmid%2F19593948&rft.aulast=Jan&rft.aufirst=SL&rft.au=Chan%2C+SC&rft.au=Fu%2C+YC&rft.au=Lin%2C+SJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Keeley FW, Bellingham CM, Woodhouse KA (Feb 2002). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1692930\" target=\"_blank\">\"Elastin as a self-organizing biomaterial: use of recombinantly expressed human elastin polypeptides as a model for investigations of structure and self-assembly of elastin\"<\/a>. <i>Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences<\/i>. <b>357<\/b> (1418): 185\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1098%2Frstb.2001.1027\" target=\"_blank\">10.1098\/rstb.2001.1027<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1692930\" target=\"_blank\">1692930<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11911775\" target=\"_blank\">11911775<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Philosophical+Transactions+of+the+Royal+Society+of+London.+Series+B%2C+Biological+Sciences&rft.atitle=Elastin+as+a+self-organizing+biomaterial%3A+use+of+recombinantly+expressed+human+elastin+polypeptides+as+a+model+for+investigations+of+structure+and+self-assembly+of+elastin&rft.volume=357&rft.issue=1418&rft.pages=185-9&rft.date=2002-02&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1692930&rft_id=info%3Apmid%2F11911775&rft_id=info%3Adoi%2F10.1098%2Frstb.2001.1027&rft.aulast=Keeley&rft.aufirst=FW&rft.au=Bellingham%2C+CM&rft.au=Woodhouse%2C+KA&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1692930&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Choudhury R, McGovern A, Ridley C, Cain SA, Baldwin A, Wang MC, Guo C, Mironov A, Drymoussi Z, Trump D, Shuttleworth A, Baldock C, Kielty CM (Sep 2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2782046\" target=\"_blank\">\"Differential regulation of elastic fiber formation by fibulin-4 and -5\"<\/a>. <i>The Journal of Biological Chemistry<\/i>. <b>284<\/b> (36): 24553\u201367. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1074%2Fjbc.M109.019364\" target=\"_blank\">10.1074\/jbc.M109.019364<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2782046\" target=\"_blank\">2782046<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19570982\" target=\"_blank\">19570982<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Biological+Chemistry&rft.atitle=Differential+regulation+of+elastic+fiber+formation+by+fibulin-4+and+-5&rft.volume=284&rft.issue=36&rft.pages=24553-67&rft.date=2009-09&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2782046&rft_id=info%3Apmid%2F19570982&rft_id=info%3Adoi%2F10.1074%2Fjbc.M109.019364&rft.aulast=Choudhury&rft.aufirst=R&rft.au=McGovern%2C+A&rft.au=Ridley%2C+C&rft.au=Cain%2C+SA&rft.au=Baldwin%2C+A&rft.au=Wang%2C+MC&rft.au=Guo%2C+C&rft.au=Mironov%2C+A&rft.au=Drymoussi%2C+Z&rft.au=Trump%2C+D&rft.au=Shuttleworth%2C+A&rft.au=Baldock%2C+C&rft.au=Kielty%2C+CM&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2782046&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Hubmacher D, Cirulis JT, Miao M, Keeley FW, Reinhardt DP (Jan 2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2801247\" target=\"_blank\">\"Functional consequences of homocysteinylation of the elastic fiber proteins fibrillin-1 and tropoelastin\"<\/a>. <i>The Journal of Biological Chemistry<\/i>. <b>285<\/b> (2): 1188\u201398. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1074%2Fjbc.M109.021246\" target=\"_blank\">10.1074\/jbc.M109.021246<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2801247\" target=\"_blank\">2801247<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19889633\" target=\"_blank\">19889633<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Biological+Chemistry&rft.atitle=Functional+consequences+of+homocysteinylation+of+the+elastic+fiber+proteins+fibrillin-1+and+tropoelastin&rft.volume=285&rft.issue=2&rft.pages=1188-98&rft.date=2010-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2801247&rft_id=info%3Apmid%2F19889633&rft_id=info%3Adoi%2F10.1074%2Fjbc.M109.021246&rft.aulast=Hubmacher&rft.aufirst=D&rft.au=Cirulis%2C+JT&rft.au=Miao%2C+M&rft.au=Keeley%2C+FW&rft.au=Reinhardt%2C+DP&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2801247&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Coolen NA, Schouten KC, Middelkoop E, Ulrich MM (Jan 2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2799629\" target=\"_blank\">\"Comparison between human fetal and adult skin\"<\/a>. <i>Archives of Dermatological Research<\/i>. <b>302<\/b> (1): 47\u201355. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00403-009-0989-8\" target=\"_blank\">10.1007\/s00403-009-0989-8<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2799629\" target=\"_blank\">2799629<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19701759\" target=\"_blank\">19701759<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+of+Dermatological+Research&rft.atitle=Comparison+between+human+fetal+and+adult+skin&rft.volume=302&rft.issue=1&rft.pages=47-55&rft.date=2010-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2799629&rft_id=info%3Apmid%2F19701759&rft_id=info%3Adoi%2F10.1007%2Fs00403-009-0989-8&rft.aulast=Coolen&rft.aufirst=NA&rft.au=Schouten%2C+KC&rft.au=Middelkoop%2C+E&rft.au=Ulrich%2C+MM&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2799629&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">McGeachie M, Ramoni RL, Mychaleckyj JC, Furie KL, Dreyfuss JM, Liu Y, Herrington D, Guo X, Lima JA, Post W, Rotter JI, Rich S, Sale M, Ramoni MF (Dec 2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2810344\" target=\"_blank\">\"Integrative predictive model of coronary artery calcification in atherosclerosis\"<\/a>. <i>Circulation<\/i>. <b>120<\/b> (24): 2448\u201354. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1161%2FCIRCULATIONAHA.109.865501\" target=\"_blank\">10.1161\/CIRCULATIONAHA.109.865501<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2810344\" target=\"_blank\">2810344<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19948975\" target=\"_blank\">19948975<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Circulation&rft.atitle=Integrative+predictive+model+of+coronary+artery+calcification+in+atherosclerosis&rft.volume=120&rft.issue=24&rft.pages=2448-54&rft.date=2009-12&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2810344&rft_id=info%3Apmid%2F19948975&rft_id=info%3Adoi%2F10.1161%2FCIRCULATIONAHA.109.865501&rft.aulast=McGeachie&rft.aufirst=M&rft.au=Ramoni%2C+RL&rft.au=Mychaleckyj%2C+JC&rft.au=Furie%2C+KL&rft.au=Dreyfuss%2C+JM&rft.au=Liu%2C+Y&rft.au=Herrington%2C+D&rft.au=Guo%2C+X&rft.au=Lima%2C+JA&rft.au=Post%2C+W&rft.au=Rotter%2C+JI&rft.au=Rich%2C+S&rft.au=Sale%2C+M&rft.au=Ramoni%2C+MF&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2810344&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Yoshida T, Kato K, Yokoi K, Oguri M, Watanabe S, Metoki N, Yoshida H, Satoh K, Aoyagi Y, Nishigaki Y, Nozawa Y, Yamada Y (Aug 2009). \"Association of genetic variants with chronic kidney disease in individuals with different lipid profiles\". <i>International Journal of Molecular Medicine<\/i>. <b>24<\/b> (2): 233\u201346. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3892%2Fijmm_00000226\" target=\"_blank\">10.3892\/ijmm_00000226<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19578796\" target=\"_blank\">19578796<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Molecular+Medicine&rft.atitle=Association+of+genetic+variants+with+chronic+kidney+disease+in+individuals+with+different+lipid+profiles&rft.volume=24&rft.issue=2&rft.pages=233-46&rft.date=2009-08&rft_id=info%3Adoi%2F10.3892%2Fijmm_00000226&rft_id=info%3Apmid%2F19578796&rft.aulast=Yoshida&rft.aufirst=T&rft.au=Kato%2C+K&rft.au=Yokoi%2C+K&rft.au=Oguri%2C+M&rft.au=Watanabe%2C+S&rft.au=Metoki%2C+N&rft.au=Yoshida%2C+H&rft.au=Satoh%2C+K&rft.au=Aoyagi%2C+Y&rft.au=Nishigaki%2C+Y&rft.au=Nozawa%2C+Y&rft.au=Yamada%2C+Y&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Akima T, Nakanishi K, Suzuki K, Katayama M, Ohsuzu F, Kawai T (Nov 2009). \"Soluble elastin decreases in the progress of atheroma formation in human aorta\". <i>Circulation Journal<\/i>. <b>73<\/b> (11): 2154\u201362. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1253%2Fcircj.cj-09-0104\" target=\"_blank\">10.1253\/circj.cj-09-0104<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19755752\" target=\"_blank\">19755752<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Circulation+Journal&rft.atitle=Soluble+elastin+decreases+in+the+progress+of+atheroma+formation+in+human+aorta&rft.volume=73&rft.issue=11&rft.pages=2154-62&rft.date=2009-11&rft_id=info%3Adoi%2F10.1253%2Fcircj.cj-09-0104&rft_id=info%3Apmid%2F19755752&rft.aulast=Akima&rft.aufirst=T&rft.au=Nakanishi%2C+K&rft.au=Suzuki%2C+K&rft.au=Katayama%2C+M&rft.au=Ohsuzu%2C+F&rft.au=Kawai%2C+T&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Chen Q, Zhang T, Roshetsky JF, Ouyang Z, Essers J, Fan C, Wang Q, Hinek A, Plow EF, Dicorleto PE (Oct 2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3024593\" target=\"_blank\">\"Fibulin-4 regulates expression of the tropoelastin gene and consequent elastic-fibre formation by human fibroblasts\"<\/a>. <i>The Biochemical Journal<\/i>. <b>423<\/b> (1): 79\u201389. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1042%2FBJ20090993\" target=\"_blank\">10.1042\/BJ20090993<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3024593\" target=\"_blank\">3024593<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19627254\" target=\"_blank\">19627254<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Biochemical+Journal&rft.atitle=Fibulin-4+regulates+expression+of+the+tropoelastin+gene+and+consequent+elastic-fibre+formation+by+human+fibroblasts&rft.volume=423&rft.issue=1&rft.pages=79-89&rft.date=2009-10&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3024593&rft_id=info%3Apmid%2F19627254&rft_id=info%3Adoi%2F10.1042%2FBJ20090993&rft.aulast=Chen&rft.aufirst=Q&rft.au=Zhang%2C+T&rft.au=Roshetsky%2C+JF&rft.au=Ouyang%2C+Z&rft.au=Essers%2C+J&rft.au=Fan%2C+C&rft.au=Wang%2C+Q&rft.au=Hinek%2C+A&rft.au=Plow%2C+EF&rft.au=Dicorleto%2C+PE&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3024593&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Tintar D, Samouillan V, Dandurand J, Lacabanne C, Pepe A, Bochicchio B, Tamburro AM (Nov 2009). \"Human tropoelastin sequence: dynamics of polypeptide coded by exon 6 in solution\". <i>Biopolymers<\/i>. <b>91<\/b> (11): 943\u201352. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fbip.21282\" target=\"_blank\">10.1002\/bip.21282<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19603496\" target=\"_blank\">19603496<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biopolymers&rft.atitle=Human+tropoelastin+sequence%3A+dynamics+of+polypeptide+coded+by+exon+6+in+solution&rft.volume=91&rft.issue=11&rft.pages=943-52&rft.date=2009-11&rft_id=info%3Adoi%2F10.1002%2Fbip.21282&rft_id=info%3Apmid%2F19603496&rft.aulast=Tintar&rft.aufirst=D&rft.au=Samouillan%2C+V&rft.au=Dandurand%2C+J&rft.au=Lacabanne%2C+C&rft.au=Pepe%2C+A&rft.au=Bochicchio%2C+B&rft.au=Tamburro%2C+AM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Dyksterhuis LB, Weiss AS (Jun 2010). \"Homology models for domains 21-23 of human tropoelastin shed light on lysine crosslinking\". <i>Biochemical and Biophysical Research Communications<\/i>. <b>396<\/b> (4): 870\u20133. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.bbrc.2010.05.013\" target=\"_blank\">10.1016\/j.bbrc.2010.05.013<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20457133\" target=\"_blank\">20457133<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biochemical+and+Biophysical+Research+Communications&rft.atitle=Homology+models+for+domains+21-23+of+human+tropoelastin+shed+light+on+lysine+crosslinking&rft.volume=396&rft.issue=4&rft.pages=870-3&rft.date=2010-06&rft_id=info%3Adoi%2F10.1016%2Fj.bbrc.2010.05.013&rft_id=info%3Apmid%2F20457133&rft.aulast=Dyksterhuis&rft.aufirst=LB&rft.au=Weiss%2C+AS&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Romero R, Velez Edwards DR, Kusanovic JP, Hassan SS, Mazaki-Tovi S, Vaisbuch E, Kim CJ, Chaiworapongsa T, Pearce BD, Friel LA, Bartlett J, Anant MK, Salisbury BA, Vovis GF, Lee MS, Gomez R, Behnke E, Oyarzun E, Tromp G, Williams SM, Menon R (May 2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3604889\" target=\"_blank\">\"Identification of fetal and maternal single nucleotide polymorphisms in candidate genes that predispose to spontaneous preterm labor with intact membranes\"<\/a>. <i>American Journal of Obstetrics and Gynecology<\/i>. <b>202<\/b> (5): 431.e1\u201334. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ajog.2010.03.026\" target=\"_blank\">10.1016\/j.ajog.2010.03.026<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3604889\" target=\"_blank\">3604889<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20452482\" target=\"_blank\">20452482<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Obstetrics+and+Gynecology&rft.atitle=Identification+of+fetal+and+maternal+single+nucleotide+polymorphisms+in+candidate+genes+that+predispose+to+spontaneous+preterm+labor+with+intact+membranes&rft.volume=202&rft.issue=5&rft.pages=431.e1-34&rft.date=2010-05&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3604889&rft_id=info%3Apmid%2F20452482&rft_id=info%3Adoi%2F10.1016%2Fj.ajog.2010.03.026&rft.aulast=Romero&rft.aufirst=R&rft.au=Velez+Edwards%2C+DR&rft.au=Kusanovic%2C+JP&rft.au=Hassan%2C+SS&rft.au=Mazaki-Tovi%2C+S&rft.au=Vaisbuch%2C+E&rft.au=Kim%2C+CJ&rft.au=Chaiworapongsa%2C+T&rft.au=Pearce%2C+BD&rft.au=Friel%2C+LA&rft.au=Bartlett%2C+J&rft.au=Anant%2C+MK&rft.au=Salisbury%2C+BA&rft.au=Vovis%2C+GF&rft.au=Lee%2C+MS&rft.au=Gomez%2C+R&rft.au=Behnke%2C+E&rft.au=Oyarzun%2C+E&rft.au=Tromp%2C+G&rft.au=Williams%2C+SM&rft.au=Menon%2C+R&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3604889&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Fan BJ, Figuieredo Sena DR, Pasquale LR, Grosskreutz CL, Rhee DJ, Chen TC, Delbono EA, Haines JL, Wiggs JL (Sep 2010). \"Lack of association of polymorphisms in elastin with pseudoexfoliation syndrome and glaucoma\". <i>Journal of Glaucoma<\/i>. <b>19<\/b> (7): 432\u2013436. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FIJG.0b013e3181c4b0fe\" target=\"_blank\">10.1097\/IJG.0b013e3181c4b0fe<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20051886\" target=\"_blank\">20051886<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Glaucoma&rft.atitle=Lack+of+association+of+polymorphisms+in+elastin+with+pseudoexfoliation+syndrome+and+glaucoma&rft.volume=19&rft.issue=7&rft.pages=432-436&rft.date=2010-09&rft_id=info%3Adoi%2F10.1097%2FIJG.0b013e3181c4b0fe&rft_id=info%3Apmid%2F20051886&rft.aulast=Fan&rft.aufirst=BJ&rft.au=Figuieredo+Sena%2C+DR&rft.au=Pasquale%2C+LR&rft.au=Grosskreutz%2C+CL&rft.au=Rhee%2C+DJ&rft.au=Chen%2C+TC&rft.au=Delbono%2C+EA&rft.au=Haines%2C+JL&rft.au=Wiggs%2C+JL&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Bertram C, Hass R (Oct 2009). \"Cellular senescence of human mammary epithelial cells (HMEC) is associated with an altered MMP-7\/HB-EGF signaling and increased formation of elastin-like structures\". <i>Mechanisms of Ageing and Development<\/i>. <b>130<\/b> (10): 657\u201369. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.mad.2009.08.001\" target=\"_blank\">10.1016\/j.mad.2009.08.001<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19682489\" target=\"_blank\">19682489<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Mechanisms+of+Ageing+and+Development&rft.atitle=Cellular+senescence+of+human+mammary+epithelial+cells+%28HMEC%29+is+associated+with+an+altered+MMP-7%2FHB-EGF+signaling+and+increased+formation+of+elastin-like+structures&rft.volume=130&rft.issue=10&rft.pages=657-69&rft.date=2009-10&rft_id=info%3Adoi%2F10.1016%2Fj.mad.2009.08.001&rft_id=info%3Apmid%2F19682489&rft.aulast=Bertram&rft.aufirst=C&rft.au=Hass%2C+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Roberts KE, Kawut SM, Krowka MJ, Brown RS, Trotter JF, Shah V, Peter I, Tighiouart H, Mitra N, Handorf E, Knowles JA, Zacks S, Fallon MB (Jul 2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2908261\" target=\"_blank\">\"Genetic risk factors for hepatopulmonary syndrome in patients with advanced liver disease\"<\/a>. <i>Gastroenterology<\/i>. <b>139<\/b> (1): 130\u20139.e24. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1053%2Fj.gastro.2010.03.044\" target=\"_blank\">10.1053\/j.gastro.2010.03.044<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2908261\" target=\"_blank\">2908261<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20346360\" target=\"_blank\">20346360<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gastroenterology&rft.atitle=Genetic+risk+factors+for+hepatopulmonary+syndrome+in+patients+with+advanced+liver+disease&rft.volume=139&rft.issue=1&rft.pages=130-9.e24&rft.date=2010-07&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2908261&rft_id=info%3Apmid%2F20346360&rft_id=info%3Adoi%2F10.1053%2Fj.gastro.2010.03.044&rft.aulast=Roberts&rft.aufirst=KE&rft.au=Kawut%2C+SM&rft.au=Krowka%2C+MJ&rft.au=Brown%2C+RS&rft.au=Trotter%2C+JF&rft.au=Shah%2C+V&rft.au=Peter%2C+I&rft.au=Tighiouart%2C+H&rft.au=Mitra%2C+N&rft.au=Handorf%2C+E&rft.au=Knowles%2C+JA&rft.au=Zacks%2C+S&rft.au=Fallon%2C+MB&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2908261&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Rosenbloom J (Dec 1984). \"Elastin: relation of protein and gene structure to disease\". <i>Laboratory Investigation<\/i>. <b>51<\/b> (6): 605\u201323. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6150137\" target=\"_blank\">6150137<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Laboratory+Investigation&rft.atitle=Elastin%3A+relation+of+protein+and+gene+structure+to+disease&rft.volume=51&rft.issue=6&rft.pages=605-23&rft.date=1984-12&rft_id=info%3Apmid%2F6150137&rft.aulast=Rosenbloom&rft.aufirst=J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Bax DV, Rodgers UR, Bilek MM, Weiss AS (Oct 2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2781405\" target=\"_blank\">\"Cell adhesion to tropoelastin is mediated via the C-terminal GRKRK motif and integrin alphaVbeta3\"<\/a>. <i>The Journal of Biological Chemistry<\/i>. <b>284<\/b> (42): 28616\u201323. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1074%2Fjbc.M109.017525\" target=\"_blank\">10.1074\/jbc.M109.017525<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2781405\" target=\"_blank\">2781405<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19617625\" target=\"_blank\">19617625<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Biological+Chemistry&rft.atitle=Cell+adhesion+to+tropoelastin+is+mediated+via+the+C-terminal+GRKRK+motif+and+integrin+alphaVbeta3&rft.volume=284&rft.issue=42&rft.pages=28616-23&rft.date=2009-10&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2781405&rft_id=info%3Apmid%2F19617625&rft_id=info%3Adoi%2F10.1074%2Fjbc.M109.017525&rft.aulast=Bax&rft.aufirst=DV&rft.au=Rodgers%2C+UR&rft.au=Bilek%2C+MM&rft.au=Weiss%2C+AS&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2781405&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Rodriguez-Revenga L, Iranzo P, Badenas C, Puig S, Carri\u00f3 A, Mil\u00e0 M (Sep 2004). \"A novel elastin gene mutation resulting in an autosomal dominant form of cutis laxa\". <i>Archives of Dermatology<\/i>. <b>140<\/b> (9): 1135\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Farchderm.140.9.1135\" target=\"_blank\">10.1001\/archderm.140.9.1135<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15381555\" target=\"_blank\">15381555<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+of+Dermatology&rft.atitle=A+novel+elastin+gene+mutation+resulting+in+an+autosomal+dominant+form+of+cutis+laxa&rft.volume=140&rft.issue=9&rft.pages=1135-9&rft.date=2004-09&rft_id=info%3Adoi%2F10.1001%2Farchderm.140.9.1135&rft_id=info%3Apmid%2F15381555&rft.aulast=Rodriguez-Revenga&rft.aufirst=L&rft.au=Iranzo%2C+P&rft.au=Badenas%2C+C&rft.au=Puig%2C+S&rft.au=Carri%C3%B3%2C+A&rft.au=Mil%C3%A0%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Micale L, Turturo MG, Fusco C, Augello B, Jurado LA, Izzi C, Digilio MC, Milani D, Lapi E, Zelante L, Merla G (Mar 2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2987220\" target=\"_blank\">\"Identification and characterization of seven novel mutations of elastin gene in a cohort of patients affected by supravalvular aortic stenosis\"<\/a>. <i>European Journal of Human Genetics<\/i>. <b>18<\/b> (3): 317\u201323. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fejhg.2009.181\" target=\"_blank\">10.1038\/ejhg.2009.181<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2987220\" target=\"_blank\">2987220<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19844261\" target=\"_blank\">19844261<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Journal+of+Human+Genetics&rft.atitle=Identification+and+characterization+of+seven+novel+mutations+of+elastin+gene+in+a+cohort+of+patients+affected+by+supravalvular+aortic+stenosis&rft.volume=18&rft.issue=3&rft.pages=317-23&rft.date=2010-03&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2987220&rft_id=info%3Apmid%2F19844261&rft_id=info%3Adoi%2F10.1038%2Fejhg.2009.181&rft.aulast=Micale&rft.aufirst=L&rft.au=Turturo%2C+MG&rft.au=Fusco%2C+C&rft.au=Augello%2C+B&rft.au=Jurado%2C+LA&rft.au=Izzi%2C+C&rft.au=Digilio%2C+MC&rft.au=Milani%2C+D&rft.au=Lapi%2C+E&rft.au=Zelante%2C+L&rft.au=Merla%2C+G&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2987220&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Tzaphlidou M (2004). \"The role of collagen and elastin in aged skin: an image processing approach\". <i>Micron<\/i>. <b>35<\/b> (3): 173\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.micron.2003.11.003\" target=\"_blank\">10.1016\/j.micron.2003.11.003<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15036271\" target=\"_blank\">15036271<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Micron&rft.atitle=The+role+of+collagen+and+elastin+in+aged+skin%3A+an+image+processing+approach&rft.volume=35&rft.issue=3&rft.pages=173-7&rft.date=2004&rft_id=info%3Adoi%2F10.1016%2Fj.micron.2003.11.003&rft_id=info%3Apmid%2F15036271&rft.aulast=Tzaphlidou&rft.aufirst=M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AElastin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/meshb.nlm.nih.gov\/record\/ui?name=Elastin\" target=\"_blank\">Elastin<\/a> at the US National Library of Medicine <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_Subject_Headings\" title=\"Medical Subject Headings\" rel=\"external_link\" target=\"_blank\">Medical Subject Headings<\/a> (MeSH)<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bu.edu\/histology\/p\/21402loa.htm\" target=\"_blank\">Histology image: 21402loa<\/a> \u2013 Histology Learning System at Boston University<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/bookshelf\/br.fcgi?book=gene&part=williams\" target=\"_blank\">GeneReviews\/NIH\/NCBI\/UW entry on Williams or Williams-Beuren Syndrome<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/macromoleculeinsights.com\/elastin.php\" target=\"_blank\">The Elastin Protein<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/jcs.biologists.org\/cgi\/content\/full\/115\/14\/2817\/FIG2\" target=\"_blank\">Microfibril <\/a><\/li><\/ul>\n<p><i>This article incorporates text from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_National_Library_of_Medicine\" title=\"United States National Library of Medicine\" rel=\"external_link\" target=\"_blank\">United States National Library of Medicine<\/a>, which is in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Public_domain\" title=\"Public domain\" rel=\"external_link\" target=\"_blank\">public domain<\/a>.<\/i>\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1274\nCached time: 20181214151857\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.768 seconds\nReal time usage: 0.882 seconds\nPreprocessor visited node count: 1606\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 129214\/2097152 bytes\nTemplate argument size: 165\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 20\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 64650\/5000000 bytes\nNumber of Wikibase entities loaded: 21\/400\nLua time usage: 0.551\/10.000 seconds\nLua memory usage: 6.23 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 726.425 1 -total\n<\/p>\n<pre>43.51% 316.048 1 Template:Infobox_gene\n39.60% 287.695 28 Template:Cite_journal\n14.02% 101.871 1 Template:Reflist\n 3.49% 25.367 1 Template:Authority_control\n 3.00% 21.772 3 Template:Navbox\n 2.61% 18.938 1 Template:Fibrous_proteins\n 2.10% 15.277 1 Template:Refbegin\n 1.31% 9.497 1 Template:MeshName\n 0.91% 6.642 2 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:740501-1!canonical and timestamp 20181214151857 and revision id 866153192\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Elastin\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212216\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.161 seconds\nReal time usage: 0.280 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 268.214 1 - wikipedia:Elastin\n100.00% 268.214 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8288-0!*!*!*!*!*!* and timestamp 20181217212215 and revision id 24500\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Elastin\">https:\/\/www.limswiki.org\/index.php\/Elastin<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","6b865b25b13ebc2fbacc2fbeb6111784_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/99\/Ideogram_human_chromosome_7.svg\/600px-Ideogram_human_chromosome_7.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b5\/Human_chromosome_7_ideogram.svg\/600px-Human_chromosome_7_ideogram.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d8\/HSR_1996_II_3.5e.svg\/28px-HSR_1996_II_3.5e.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/6\/6a\/Red_rectangle_2x18.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/be\/Elastin_bovine.png\/440px-Elastin_bovine.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cb\/Domain_structure_human_tropoelastin_%28EN%29.png\/700px-Domain_structure_human_tropoelastin_%28EN%29.png"],"6b865b25b13ebc2fbacc2fbeb6111784_timestamp":1545081735,"409d395c1f0988d33ed4b66dafd5686a_type":"article","409d395c1f0988d33ed4b66dafd5686a_title":"Copolyester","409d395c1f0988d33ed4b66dafd5686a_url":"https:\/\/www.limswiki.org\/index.php\/Copolyester","409d395c1f0988d33ed4b66dafd5686a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCopolyester\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tCopolyester forms when modifications are made to polyesters, which are combinations of diacids and diols. For example, by introducing other diacids, such as isophthalic acid (IPA), or other diols, such as cyclohexane dimethanol (CHDM) to the polyester polyethylene terephthalate (PET), the material becomes a copolyester due to its comonomer content.[1]\nCopolyesters retain their strength, clarity, and other mechanical properties even when exposed to a variety of chemicals that typically affect other materials, such as polycarbonates. This, plus their versatility and flexibility, allows manufacturers to use them effectively in the design of both high-volume, low-cost parts as well as critical, more expensive component parts.\n\nContents \n\n1 Applications \n2 Manufacturers \n3 See also \n4 References \n\n\nApplications \nCopolyesters offer versatility to meet a wide variety of applications.[1]\nCopolyester resins have proved to be effective in packaging applications, due to their toughness, versatility and chemical resistance. They are also frequently used in the manufacture and packaging of consumer goods and materials. Markets that rely on copolyesters include medical packaging, home appliances, consumer goods (pens, toys, sporting goods, etc.), and cosmetics, among others.[2][3][4][5][6]\nTable of Common Copolyester and Components \n\n\n\n\nPolyester \/ Copolyester\n\nDiacid (s)\n\nDiol (s)\n\nProperties\n\n\nPET\n\nTerephthalic acid (TPA)\n\nEthylene glycol (EG)\n\n\n\n\nPCTG\n\nTPA\n\nCyclohexanedimethanol (CHDM)+EG\n\n\n\n\nPCTA\n\nTPA + isophthalic acid (IPA)\n\nCHDM\n\n\n\n\nPETG\n\nTPA\n\nCHDM+EG\n\n\n\n\nPCT\n\nTPA\n\nCHDM\n\n\n\nManufacturers \nThe main global manufacturers and suppliers of Copolyester resins are as follows (The brand names are in parenthesis):\n\nEastman Chemical Company \u2013 (Eastar, Provista, Tritan)[7]\nBostik Findley \u2013 (Vitel)\nToyobo \u2013 (Vylon)\nEvonik \u2013 (Dynacoll S)\nSKChemical \u2013 (Skygreen, Ecozen, Skybon)\nHenkel \u2013 (Petaflex)\nCovestro (formerly Bayer MaterialScience AG) \u2013 (Vivak\/ PETg)\nMacroocean \u2013 (Marcoa, Marnex)[8]\nSee also \nPolyester\nReferences \n\n\n^ a b Copolyester \u2013 A Versatile Choice for Medical Applications Thijs Jaarsma. 2004. Business Briefing: Medical Device Manufacturing & Technology. \n\n^ Eastman - EASTAR copolyester - Introduction \n\n^ Eastman - EASTAR copolyester - Product List \n\n^ \"Archived copy\". Archived from the original on 2011-03-16. Retrieved 2011-03-22 . CS1 maint: Archived copy as title (link) \n\n^ http:\/\/www.dynapol.com\/product\/dynapol\/en\/products-services\/dynapol-types\/dynapol-series\/pages\/default.asp \n\n^ John Scheirs, Timothy E. Long (2003). Modern Polyesters: Chemistry and Technology of Polyesters and Copolyesters. Chichester, England: Wiley. ISBN 0-471-49856-4. \n\n^ Eastman\u2122 product list for all Polymers Archived 2014-01-16 at the Wayback Machine. \n\n^ Macroocean\u2122 product list \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Copolyester\">https:\/\/www.limswiki.org\/index.php\/Copolyester<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 12 March 2016, at 02:58.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 584 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","409d395c1f0988d33ed4b66dafd5686a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Copolyester skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Copolyester<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Copolyester<\/b> forms when modifications are made to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyesters\" class=\"mw-redirect\" title=\"Polyesters\" rel=\"external_link\" target=\"_blank\">polyesters<\/a>, which are combinations of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diacid\" class=\"mw-redirect\" title=\"Diacid\" rel=\"external_link\" target=\"_blank\">diacids<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diol\" title=\"Diol\" rel=\"external_link\" target=\"_blank\">diols<\/a>. For example, by introducing other diacids, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isophthalic_acid\" title=\"Isophthalic acid\" rel=\"external_link\" target=\"_blank\">isophthalic acid<\/a> (IPA), or other diols, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyclohexane_dimethanol\" class=\"mw-redirect\" title=\"Cyclohexane dimethanol\" rel=\"external_link\" target=\"_blank\">cyclohexane dimethanol<\/a> (CHDM) to the polyester <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene_terephthalate\" title=\"Polyethylene terephthalate\" rel=\"external_link\" target=\"_blank\">polyethylene terephthalate<\/a> (PET), the material becomes a copolyester due to its comonomer content.<sup id=\"rdp-ebb-cite_ref-Jaarsma_1-0\" class=\"reference\"><a href=\"#cite_note-Jaarsma-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Copolyesters retain their strength, clarity, and other mechanical properties even when exposed to a variety of chemicals that typically affect other materials, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polycarbonate\" title=\"Polycarbonate\" rel=\"external_link\" target=\"_blank\">polycarbonates<\/a>. This, plus their versatility and flexibility, allows manufacturers to use them effectively in the design of both high-volume, low-cost parts as well as critical, more expensive component parts.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>Copolyesters offer versatility to meet a wide variety of applications.<sup id=\"rdp-ebb-cite_ref-Jaarsma_1-1\" class=\"reference\"><a href=\"#cite_note-Jaarsma-1\" rel=\"external_link\">[1]<\/a><\/sup>\nCopolyester resins have proved to be effective in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Packaging\" class=\"mw-redirect\" title=\"Packaging\" rel=\"external_link\" target=\"_blank\">packaging<\/a> applications, due to their toughness, versatility and chemical resistance. They are also frequently used in the manufacture and packaging of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Consumer_goods\" class=\"mw-redirect\" title=\"Consumer goods\" rel=\"external_link\" target=\"_blank\">consumer goods<\/a> and materials. Markets that rely on copolyesters include medical packaging, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Home_appliances\" class=\"mw-redirect\" title=\"Home appliances\" rel=\"external_link\" target=\"_blank\">home appliances<\/a>, consumer goods (pens, toys, sporting goods, etc.), and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cosmetics\" title=\"Cosmetics\" rel=\"external_link\" target=\"_blank\">cosmetics<\/a>, among others.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p><b>Table of Common Copolyester and Components <\/b>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Manufacturers\">Manufacturers<\/span><\/h2>\n<p>The main global manufacturers and suppliers of Copolyester resins are as follows (The brand names are in parenthesis):\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Eastman_Chemical_Company\" title=\"Eastman Chemical Company\" rel=\"external_link\" target=\"_blank\">Eastman Chemical Company<\/a> \u2013 (Eastar, Provista, Tritan)<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bostik\" title=\"Bostik\" rel=\"external_link\" target=\"_blank\">Bostik<\/a> Findley \u2013 (Vitel)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Toyobo\" title=\"Toyobo\" rel=\"external_link\" target=\"_blank\">Toyobo<\/a> \u2013 (Vylon)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Evonik\" class=\"mw-redirect\" title=\"Evonik\" rel=\"external_link\" target=\"_blank\">Evonik<\/a> \u2013 (Dynacoll S)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/SK_Group\" title=\"SK Group\" rel=\"external_link\" target=\"_blank\">SKChemical<\/a> \u2013 (Skygreen, Ecozen, Skybon)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Henkel\" title=\"Henkel\" rel=\"external_link\" target=\"_blank\">Henkel<\/a> \u2013 (Petaflex)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Covestro\" title=\"Covestro\" rel=\"external_link\" target=\"_blank\">Covestro<\/a> (formerly Bayer MaterialScience AG) \u2013 (Vivak\/ PETg)<\/li>\n<li>Macroocean \u2013 (Marcoa, Marnex)<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyester\" title=\"Polyester\" rel=\"external_link\" target=\"_blank\">Polyester<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-Jaarsma-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Jaarsma_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Jaarsma_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><i>Copolyester \u2013 A Versatile Choice for Medical Applications<\/i> Thijs Jaarsma. 2004. Business Briefing: Medical Device Manufacturing & Technology.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20071016145742\/http:\/\/eastman.com\/Brands\/Eastar\/Introduction\/\" target=\"_blank\">Eastman - EASTAR copolyester - Introduction<\/a><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20071016145758\/http:\/\/eastman.com\/Brands\/Eastar\/Products\/\" target=\"_blank\">Eastman - EASTAR copolyester - Product List<\/a><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110316160118\/http:\/\/www.bostik-us.com\/our-brands\/vitel\/default.html\" target=\"_blank\">\"Archived copy\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bostik-us.com\/our-brands\/vitel\/default.html\" target=\"_blank\">the original<\/a> on 2011-03-16<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2011-03-22<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Archived+copy&rft_id=http%3A%2F%2Fwww.bostik-us.com%2Four-brands%2Fvitel%2Fdefault.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACopolyester\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Archived copy as title (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Archived_copy_as_title\" title=\"Category:CS1 maint: Archived copy as title\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.dynapol.com\/product\/dynapol\/en\/products-services\/dynapol-types\/dynapol-series\/pages\/default.asp\" target=\"_blank\">http:\/\/www.dynapol.com\/product\/dynapol\/en\/products-services\/dynapol-types\/dynapol-series\/pages\/default.asp<\/a><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">John Scheirs, Timothy E. Long (2003). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=chdm&f=false\"><i>Modern Polyesters: Chemistry and Technology of Polyesters and Copolyesters<\/i><\/a>. Chichester, England: Wiley. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-471-49856-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Modern+Polyesters%3A+Chemistry+and+Technology+of+Polyesters+and+Copolyesters&rft.place=Chichester%2C+England&rft.pub=Wiley&rft.date=2003&rft.isbn=0-471-49856-4&rft.aulast=John+Scheirs&rft.aufirst=Timothy+E.+Long&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fhl%3Den%26lr%3D%26id%3DZgxgZ5vfxTkC%26oi%3Dfnd%26pg%3DPR5%26dq%3Dcopolyester%2Bglycol%2Bdiacid%26ots%3DDqJJDyncFn%26sig%3DU1JPIcYS_6zI4Ku76uCRTx3TUYg%23v%3Donepage%26q%3Dchdm%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACopolyester\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.eastman.com\/products\/pages\/polymers.aspx\" target=\"_blank\">Eastman\u2122 product list for all Polymers<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140116180516\/http:\/\/www.eastman.com\/products\/pages\/polymers.aspx\" target=\"_blank\">Archived<\/a> 2014-01-16 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.macroocean.com\/productsandservices.html\" target=\"_blank\">Macroocean\u2122 product list<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1269\nCached time: 20181207050113\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.124 seconds\nReal time usage: 0.166 seconds\nPreprocessor visited node count: 246\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 4711\/2097152 bytes\nTemplate argument size: 75\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 8612\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.067\/10.000 seconds\nLua memory usage: 1.77 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 137.312 1 Template:Reflist\n100.00% 137.312 1 -total\n<\/p>\n<pre>67.25% 92.348 1 Template:Cite_web\n13.44% 18.454 1 Template:Webarchive\n 5.47% 7.518 1 Template:Cite_book\n 1.58% 2.175 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:16878758-1!canonical and timestamp 20181207050112 and revision id 826643009\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Copolyester\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212215\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.048 seconds\nReal time usage: 0.177 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 171.560 1 - wikipedia:Copolyester\n100.00% 171.560 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8426-0!*!*!*!*!*!* and timestamp 20181217212215 and revision id 24668\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Copolyester\">https:\/\/www.limswiki.org\/index.php\/Copolyester<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","409d395c1f0988d33ed4b66dafd5686a_images":[],"409d395c1f0988d33ed4b66dafd5686a_timestamp":1545081735,"bc7dd428c20404c491b1764921094845_type":"article","bc7dd428c20404c491b1764921094845_title":"Cobalt-chrome","bc7dd428c20404c491b1764921094845_url":"https:\/\/www.limswiki.org\/index.php\/Cobalt-chrome","bc7dd428c20404c491b1764921094845_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCobalt-chrome\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Cobalt-chrome disc with dental bridges and crowns manufactured using WorkNC Dental\nCobalt-chrome or cobalt-chromium (CoCr) is a metal alloy of cobalt and chromium. Cobalt-chrome has a very high specific strength and is commonly used in gas turbines, dental implants, and orthopedic implants.[1]\n\nContents \n\n1 History \n2 Synthesis \n3 Properties \n4 Common types \n5 Structure \n6 Uses \n\n6.1 Medical implants \n6.2 Dental prosthetics \n6.3 Industry \n\n\n7 Hazards \n8 See also \n9 References \n\n\nHistory \nCo-Cr alloy was first discovered by Elwood Haynes in the early 1900s by fusing cobalt and chromium. The alloy was first discovered with many other elements such as tungsten and molybdenum in it. Haynes reported his alloy was capable of resisting oxidation and corrosive fumes and exhibited no visible sign of tarnish even when subjecting the alloy to boiling nitric acid.[2] Under the name Stellite\u2122, Co-Cr alloy has been used in various fields where high wear-resistance was needed including aerospace industry,[3] cutlery, bearings, blades, etc. \nCo-Cr alloy started receiving more attention as its biomedical application was found. In the 20th century, the alloy was first used in medical tool manufacturing,[4] and in 1960, the first Co-Cr prosthetic heart valve was implanted, which happened to last over 30 years showing its high wear-resistance.[5] Recently, due to excellent resistant properties, biocompatibility, high melting points, and incredible strength at high temperatures, Co-Cr alloy is used for the manufacture of many artificial joints including hips and knees, dental partial bridge work, gas turbines, and many others.[4]\n\nSynthesis \nThe common Co-Cr alloy production requires the extraction of cobalt and chromium from cobalt oxide and chromium oxide ores. Both of the ores need to go through reduction process to obtain pure metals. Chromium usually goes through aluminothermic reduction technique, and pure cobalt can be achieved through many different ways depending on the characteristics of the specific ore. Pure metals are then fused together under vacuum either by electric arc or by induction melting.[4] Due to the chemical reactivity of metals at high temperature, the process requires vacuum conditions or inert atmosphere to prevent oxygen uptake by the metal. ASTM F75, a Co-Cr-Mo alloy, is produced in an inert argon atmosphere by ejecting molten metals through a small nozzle that is immediately cooled to produce a fine powder of the alloy.[3]\nHowever, synthesis of Co-Cr alloy through the method mentioned above is very expensive and difficult. Recently, in 2010, scientists at the University of Cambridge have produced the alloy through a novel electrochemical, solid-state reduction technique known as the FFC Cambridge Process which involves the reduction of an oxide precursor cathode in a molten chloride electrolyte.[4]\n\nProperties \nCo-Cr alloys show high resistance to corrosion due to the spontaneous formation of a protective passive film composed of mostly Cr2O3, and minor amounts of cobalt and other metal oxides on the surface.[6] As its wide application in biomedical industry indicates, Co-Cr alloys are well known for their biocompatibility. Biocompatibility also depends on the film and how this oxidized surface interacts with physiological environment.[7] Good mechanical properties that are similar to stainless steel are a result of a multiphase structure and precipitation of carbides, which increase the hardness of Co-Cr alloys tremendously. The hardness of Co-Cr alloys varies ranging 550-800 MPa, and tensile strength varies ranging 145-270 MPa.[8] Moreover, tensile and fatigue strength increases radically as they are heat-treated.[9] However, Co-Cr alloys tend to have low ductility, which can cause component fracture. This is a concern as the alloys are commonly used in hip replacements.[10] In order to overcome the low ductility, nickel, carbon, and\/or nitrogen are added. These elements stabilize the \u03b3 phase, which has better mechanical properties compared to other phases of Co-Cr alloys.[11]\n\nCommon types \nThere are several Co-Cr alloys that are commonly produced and used in various fields. F75 and F799 are Co-Cr-Mo alloys with very similar composition yet slightly different production processes, F90 is a Co-Cr-W-Ni alloy, and F562 is a Co-Ni-Cr-Mo-Ti alloy.[3]\n\nStructure \nDepending on the percent composition of cobalt or chromium and the temperature, Co-Cr alloys show different structures. The \u03c3 phase, where the alloy contains approximately 60-75% cobalt, tends to be brittle and subject to a fracture. FCC crystal structure is found in the \u03b3 phase, and the \u03b3 phase shows improved strength and ductility compared to the \u03c3 phase. FCC crystal structure is commonly found in cobalt rich alloys, while chromium rich alloys tend to have BCC crystal structure. The \u03b3 phase Co-Cr alloy can be converted into the \u03b5 phase at high pressures, which shows a HCP crystal structure.[11]\n\nUses \nMedical implants \nCo-Cr alloys are most commonly used to make artificial joints including knee and hip joints due to high wear-resistance and biocompatibility.[4] Co-Cr alloys tend to be corrosion resistant, which reduces complication with the surrounding tissues when implanted, and chemically inert that they minimize the possibility of irritation, allergic reaction, and immune response.[12] Co-Cr alloy has also been widely used in the manufacture of stent and other surgical implants as Co-Cr alloy demonstrates excellent biocompatibility with blood and soft tissues as well.[13] The alloy composition used in orthopedic implants is described in industry standard ASTM-F75: cobalt with 27 to 30% chromium, 5 to 7% molybdenum, and limits on other important elements such as manganese and silicon, less than 1%, iron, less than 0.75%, nickel, less than 0.5%, and carbon, nitrogen, tungsten, phosphorus, sulfur, boron etc.[1] \nBesides cobalt-chromium-molybdenum (CoCrMo), cobalt-nickel-chromium-molybdenum (CoNiCrMo) is also used for implants.[14] The possible toxicity of released Ni ions from CoNiCr alloys and also their limited frictional properties are a matter of concern in using these alloys as articulating components. Thus, CoCrMo is usually the dominant alloy for total joint arthroplasty.[14]\n\nDental prosthetics \n A Co-Cr partial denture.\nCo-Cr alloy dentures and cast partial dentures have been commonly manufactured since 1929 due to lower cost and lower density compared to gold alloys; however, Co-Cr alloys tend to exhibit a higher modulus of elasticity and cyclic fatigue resistance, which are significant factors for dental prosthesis.[15] The alloy is a commonly used as a metal framework for dental partials. A well known brand for this purpose is Vitallium.\n\nIndustry \nDue to mechanical properties such as high corrosion and wear resistance, Co-Cr alloys (eg. Stellites) are used in making wind turbines, engine components, and many other industrial\/mechanical components where high wear-resistance is needed.[3] \nCo-Cr alloy is also very commonly used in fashion industry to make jewellery, especially wedding bands.\n\nHazards \nMetals released from Co-Cr alloy tools and prosthetics may cause allergic reactions and skin eczema.[16] Prosthetics or any medical equipment with high nickel mass percentage Co-Cr alloy should be avoided due to low biocompatibility, as nickel is the most common metal sensitizer in the human body.[11]\n\nSee also \nAlacrite\nReferences \n\n\n^ a b ARCAM ASTM F75 CoCr Alloy Archived 2011-07-07 at the Wayback Machine. \n\n^ Haynes, E. Metal alloy. US patent no. 873745; 1907. \n\n^ a b c d Ratner, B. D.; Hoffman, A. S.; Schoen, F. J.; Lemons, J. E. Biomaterial Science, 2nd ed.; Academic Press, 1996. \n\n^ a b c d e Hyslop, D. J. S.; Abdelkader, A. M.; Cox, A.; Fray, D. J. Electrochemical Synthesis of a Biomedically Important Co-Cr Alloy. Acta Materialia. 2010, 58, 3124-3130. \n\n^ Tarzia, V.; Bottio, T.; Testolin, L.; Gerosa, G. Extended (31 years) durability of a Starr-Edwards Prothesis in Mitral Positioin. Interactive CardioVasc Thorac Surg. 2007, 6, 570-571. \n\n^ Bettini, E.; Leygraf, C.; Pan, J. Nature of Current Increaase for a CoCrMo\nAlloy: \u201cTranspassive\u201d Dissolution vs. Water Oxidation. Int. J. Electrochem. Sci. 2013,\n8, 11791-11804. \n\n^ Zimmermann, J.; Ciacchi, L. C. Origins of the Selective Cr Oxidation in CoCr Alloy Surfaces. J. Pjus. Chem. Lett. 2010, 1, 2343-2348. \n\n^ Carek, A.; Babic, J. Z.; Schauperl, Z.; Tomislav, B. Mechanical Properties of Co-Cr Alloys for Metal Base Framework. Int. J. Prosthodont. Restor. Dent. 2011, 1, 13-19. \n\n^ Devine, T. M.; Wulff, J. Cast vs. Wrought Cobalt-Chromium Surgical Implant Alloys. J. Biomed. Mater. Res. 1975, 9, 151-167. \n\n^ Longquan, S.; Northwood, D.; Cao, Z. The Properties of a Wrought Biomedical Cobalt-Chromium Alloy. J. Mat. Sci. 1994, 29, 1233-1238. \n\n^ a b c Lee, S.; Nomura, N.; Chiba, A. Significant Improvement in Mechanical Properties of Biomedical Co-Cr-Mo Alloys with Combination of N Addition and Cr-Enrichment. Materials Transactions. 2008, 2, 260-264. \n\n^ Hermawan, H.; Ramdan, D.; Djuansjah, J. R. P.; Metals for Biomedical Applications. Biomedical Engineering \u2013 From Theory to\nApplications. 2011, 410-430. \n\n^ Kereiakes, D. J.; Cox, D. A.; Hermiller, J. B.; Midei, M. G.; Usefulness of a Cobalt Chromium Coronary Stent Alloy. The Amer. J. Cardi. 2003, 92, 463-466. \n\n^ a b Biomimetic Porous Titanium Scaffolds for Orthopedic and Dental Applications, Alireza Nouri, Peter D. Hodgson and Cui\u2019e Wen (Institute for Technology Research and Innovation, Deakin University, Australia) \n\n^ Cheng, H.; Xu, M.; Zhang, H.; Wu, W.; Zheng, M.; Li, X. Cyclic Fatigue Properties of Cobalt-Chromium Alloy Clasps for Partial Removable Dental Protheses. J. Prosthetic Dent. 2010, 104, 389-396. \n\n^ Kettelarij, J. A.; Liden, C.; Axen, E.; Julander, A. Cobalt, Nickel, and Chromium Release\nfrom Dental Tools and Alloys. Contact Dermititis. 2014, 70, 3-10. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Cobalt-chrome\">https:\/\/www.limswiki.org\/index.php\/Cobalt-chrome<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 11 March 2016, at 19:48.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 913 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","bc7dd428c20404c491b1764921094845_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Cobalt-chrome skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Cobalt-chrome<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:302px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Disc_with_dental_implants_made_with_WorkNC.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/14\/Disc_with_dental_implants_made_with_WorkNC.jpg\/300px-Disc_with_dental_implants_made_with_WorkNC.jpg\" width=\"300\" height=\"201\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Disc_with_dental_implants_made_with_WorkNC.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><b>Cobalt-chrome<\/b> disc with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bridge_(dentistry)\" title=\"Bridge (dentistry)\" rel=\"external_link\" target=\"_blank\">dental bridges<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crown_(dentistry)\" title=\"Crown (dentistry)\" rel=\"external_link\" target=\"_blank\">crowns<\/a> manufactured using <a href=\"https:\/\/en.wikipedia.org\/wiki\/WorkNC_Dental\" class=\"mw-redirect\" title=\"WorkNC Dental\" rel=\"external_link\" target=\"_blank\">WorkNC Dental<\/a><\/div><\/div><\/div>\n<p><b>Cobalt-chrome<\/b> or <b>cobalt-chromium<\/b> (<b>CoCr<\/b>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal\" title=\"Metal\" rel=\"external_link\" target=\"_blank\">metal<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alloy\" title=\"Alloy\" rel=\"external_link\" target=\"_blank\">alloy<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cobalt\" title=\"Cobalt\" rel=\"external_link\" target=\"_blank\">cobalt<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium\" title=\"Chromium\" rel=\"external_link\" target=\"_blank\">chromium<\/a>. Cobalt-chrome has a very high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Specific_strength\" title=\"Specific strength\" rel=\"external_link\" target=\"_blank\">specific strength<\/a> and is commonly used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gas_turbine\" title=\"Gas turbine\" rel=\"external_link\" target=\"_blank\">gas turbines<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">dental implants<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedic_surgery\" title=\"Orthopedic surgery\" rel=\"external_link\" target=\"_blank\">orthopedic implants<\/a>.<sup id=\"rdp-ebb-cite_ref-arcam_1-0\" class=\"reference\"><a href=\"#cite_note-arcam-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Co-Cr alloy was first discovered by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elwood_Haynes\" title=\"Elwood Haynes\" rel=\"external_link\" target=\"_blank\">Elwood Haynes<\/a> in the early 1900s by fusing cobalt and chromium. The alloy was first discovered with many other elements such as tungsten and molybdenum in it. Haynes reported his alloy was capable of resisting oxidation and corrosive fumes and exhibited no visible sign of tarnish even when subjecting the alloy to boiling nitric acid.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> Under the name <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stellite\" title=\"Stellite\" rel=\"external_link\" target=\"_blank\">Stellite<\/a>\u2122, Co-Cr alloy has been used in various fields where high wear-resistance was needed including aerospace industry,<sup id=\"rdp-ebb-cite_ref-:1_3-0\" class=\"reference\"><a href=\"#cite_note-:1-3\" rel=\"external_link\">[3]<\/a><\/sup> cutlery, bearings, blades, etc. \n<\/p><p>Co-Cr alloy started receiving more attention as its biomedical application was found. In the 20th century, the alloy was first used in medical tool manufacturing,<sup id=\"rdp-ebb-cite_ref-:0_4-0\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup> and in 1960, the first Co-Cr prosthetic heart valve was implanted, which happened to last over 30 years showing its high wear-resistance.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Recently, due to excellent resistant properties, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatibility<\/a>, high melting points, and incredible strength at high temperatures, Co-Cr alloy is used for the manufacture of many artificial joints including hips and knees, dental partial bridge work, gas turbines, and many others.<sup id=\"rdp-ebb-cite_ref-:0_4-1\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Synthesis\">Synthesis<\/span><\/h2>\n<p>The common Co-Cr alloy production requires the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cobalt_extraction_techniques\" class=\"mw-redirect\" title=\"Cobalt extraction techniques\" rel=\"external_link\" target=\"_blank\">extraction of cobalt<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium\" title=\"Chromium\" rel=\"external_link\" target=\"_blank\">chromium<\/a> from cobalt oxide and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium_oxide\" title=\"Chromium oxide\" rel=\"external_link\" target=\"_blank\">chromium oxide<\/a> ores. Both of the ores need to go through reduction process to obtain pure metals. Chromium usually goes through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminothermic_reaction\" title=\"Aluminothermic reaction\" rel=\"external_link\" target=\"_blank\">aluminothermic reduction technique<\/a>, and pure cobalt can be achieved through many different ways depending on the characteristics of the specific ore. Pure metals are then fused together under vacuum either by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electric_arc\" title=\"Electric arc\" rel=\"external_link\" target=\"_blank\">electric arc<\/a> or by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vacuum_induction_melting\" title=\"Vacuum induction melting\" rel=\"external_link\" target=\"_blank\">induction melting<\/a>.<sup id=\"rdp-ebb-cite_ref-:0_4-2\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup> Due to the chemical reactivity of metals at high temperature, the process requires vacuum conditions or inert atmosphere to prevent oxygen uptake by the metal. ASTM F75, a Co-Cr-Mo alloy, is produced in an inert argon atmosphere by ejecting molten metals through a small nozzle that is immediately cooled to produce a fine powder of the alloy.<sup id=\"rdp-ebb-cite_ref-:1_3-1\" class=\"reference\"><a href=\"#cite_note-:1-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>However, synthesis of Co-Cr alloy through the method mentioned above is very expensive and difficult. Recently, in 2010, scientists at the University of Cambridge have produced the alloy through a novel electrochemical, solid-state reduction technique known as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/FFC_Cambridge_Process\" class=\"mw-redirect\" title=\"FFC Cambridge Process\" rel=\"external_link\" target=\"_blank\">FFC Cambridge Process<\/a> which involves the reduction of an oxide precursor cathode in a molten chloride electrolyte.<sup id=\"rdp-ebb-cite_ref-:0_4-3\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Properties\">Properties<\/span><\/h2>\n<p>Co-Cr alloys show high resistance to corrosion due to the spontaneous formation of a protective passive film composed of mostly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium(III)_oxide\" title=\"Chromium(III) oxide\" rel=\"external_link\" target=\"_blank\">Cr<sub>2<\/sub>O<sub>3<\/sub><\/a>, and minor amounts of cobalt and other metal oxides on the surface.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> As its wide application in biomedical industry indicates, Co-Cr alloys are well known for their biocompatibility. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">Biocompatibility<\/a> also depends on the film and how this oxidized surface interacts with physiological environment.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> Good mechanical properties that are similar to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a> are a result of a multiphase structure and precipitation of carbides, which increase the hardness of Co-Cr alloys tremendously. The hardness of Co-Cr alloys varies ranging 550-800 MPa, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tensile_strength\" class=\"mw-redirect\" title=\"Tensile strength\" rel=\"external_link\" target=\"_blank\">tensile strength<\/a> varies ranging 145-270 MPa.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> Moreover, tensile and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fatigue_(material)\" title=\"Fatigue (material)\" rel=\"external_link\" target=\"_blank\">fatigue<\/a> strength increases radically as they are heat-treated.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> However, Co-Cr alloys tend to have low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ductility\" title=\"Ductility\" rel=\"external_link\" target=\"_blank\">ductility<\/a>, which can cause component fracture. This is a concern as the alloys are commonly used in hip replacements.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> In order to overcome the low ductility, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nickel\" title=\"Nickel\" rel=\"external_link\" target=\"_blank\">nickel<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon\" title=\"Carbon\" rel=\"external_link\" target=\"_blank\">carbon<\/a>, and\/or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nitrogen\" title=\"Nitrogen\" rel=\"external_link\" target=\"_blank\">nitrogen<\/a> are added. These elements stabilize the \u03b3 phase, which has better mechanical properties compared to other phases of Co-Cr alloys.<sup id=\"rdp-ebb-cite_ref-:2_11-0\" class=\"reference\"><a href=\"#cite_note-:2-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Common_types\">Common types<\/span><\/h2>\n<p>There are several Co-Cr alloys that are commonly produced and used in various fields. F75 and F799 are Co-Cr-Mo alloys with very similar composition yet slightly different production processes, F90 is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alacrite\" title=\"Alacrite\" rel=\"external_link\" target=\"_blank\">Co-Cr-W-Ni alloy<\/a>, and F562 is a Co-Ni-Cr-Mo-Ti alloy.<sup id=\"rdp-ebb-cite_ref-:1_3-2\" class=\"reference\"><a href=\"#cite_note-:1-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Structure\">Structure<\/span><\/h2>\n<p>Depending on the percent composition of cobalt or chromium and the temperature, Co-Cr alloys show different structures. The \u03c3 phase, where the alloy contains approximately 60-75% cobalt, tends to be brittle and subject to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fracture\" title=\"Fracture\" rel=\"external_link\" target=\"_blank\">fracture<\/a>. FCC crystal structure is found in the \u03b3 phase, and the \u03b3 phase shows improved strength and ductility compared to the \u03c3 phase. FCC crystal structure is commonly found in cobalt rich alloys, while chromium rich alloys tend to have BCC crystal structure. The \u03b3 phase Co-Cr alloy can be converted into the \u03b5 phase at high pressures, which shows a HCP crystal structure.<sup id=\"rdp-ebb-cite_ref-:2_11-1\" class=\"reference\"><a href=\"#cite_note-:2-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Uses\">Uses<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Medical_implants\">Medical implants<\/span><\/h3>\n<p>Co-Cr alloys are most commonly used to make artificial joints including knee and hip joints due to high wear-resistance and biocompatibility.<sup id=\"rdp-ebb-cite_ref-:0_4-4\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup> Co-Cr alloys tend to be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corrosion\" title=\"Corrosion\" rel=\"external_link\" target=\"_blank\">corrosion<\/a> resistant, which reduces complication with the surrounding tissues when implanted, and chemically inert that they minimize the possibility of irritation, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Allergic_reaction\" class=\"mw-redirect\" title=\"Allergic reaction\" rel=\"external_link\" target=\"_blank\">allergic reaction<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immune_response\" title=\"Immune response\" rel=\"external_link\" target=\"_blank\">immune response<\/a>.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> Co-Cr alloy has also been widely used in the manufacture of stent and other surgical implants as Co-Cr alloy demonstrates excellent biocompatibility with blood and soft tissues as well.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> The alloy composition used in orthopedic implants is described in industry standard <a href=\"https:\/\/en.wikipedia.org\/wiki\/ASTM\" class=\"mw-redirect\" title=\"ASTM\" rel=\"external_link\" target=\"_blank\">ASTM<\/a>-F75: cobalt with 27 to 30% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium\" title=\"Chromium\" rel=\"external_link\" target=\"_blank\">chromium<\/a>, 5 to 7% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molybdenum\" title=\"Molybdenum\" rel=\"external_link\" target=\"_blank\">molybdenum<\/a>, and limits on other important elements such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manganese\" title=\"Manganese\" rel=\"external_link\" target=\"_blank\">manganese<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon\" title=\"Silicon\" rel=\"external_link\" target=\"_blank\">silicon<\/a>, less than 1%, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron\" title=\"Iron\" rel=\"external_link\" target=\"_blank\">iron<\/a>, less than 0.75%, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nickel\" title=\"Nickel\" rel=\"external_link\" target=\"_blank\">nickel<\/a>, less than 0.5%, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon\" title=\"Carbon\" rel=\"external_link\" target=\"_blank\">carbon<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nitrogen\" title=\"Nitrogen\" rel=\"external_link\" target=\"_blank\">nitrogen<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tungsten\" title=\"Tungsten\" rel=\"external_link\" target=\"_blank\">tungsten<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphorus\" title=\"Phosphorus\" rel=\"external_link\" target=\"_blank\">phosphorus<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sulfur\" title=\"Sulfur\" rel=\"external_link\" target=\"_blank\">sulfur<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boron\" title=\"Boron\" rel=\"external_link\" target=\"_blank\">boron<\/a> etc.<sup id=\"rdp-ebb-cite_ref-arcam_1-1\" class=\"reference\"><a href=\"#cite_note-arcam-1\" rel=\"external_link\">[1]<\/a><\/sup> \n<\/p><p>Besides cobalt-chromium-molybdenum (CoCrMo), cobalt-nickel-chromium-molybdenum (CoNiCrMo) is also used for implants.<sup id=\"rdp-ebb-cite_ref-intech_14-0\" class=\"reference\"><a href=\"#cite_note-intech-14\" rel=\"external_link\">[14]<\/a><\/sup> The possible toxicity of released Ni ions from CoNiCr alloys and also their limited frictional properties are a matter of concern in using these alloys as articulating components. Thus, CoCrMo is usually the dominant alloy for total joint <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroplasty\" title=\"Arthroplasty\" rel=\"external_link\" target=\"_blank\">arthroplasty<\/a>.<sup id=\"rdp-ebb-cite_ref-intech_14-1\" class=\"reference\"><a href=\"#cite_note-intech-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Dental_prosthetics\">Dental prosthetics<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Denture_example_2.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/78\/Denture_example_2.jpg\/220px-Denture_example_2.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Denture_example_2.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A Co-Cr partial denture.<\/div><\/div><\/div>\n<p>Co-Cr alloy <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dentures\" title=\"Dentures\" rel=\"external_link\" target=\"_blank\">dentures<\/a> and cast <a href=\"https:\/\/en.wikipedia.org\/wiki\/Partial_dentures\" class=\"mw-redirect\" title=\"Partial dentures\" rel=\"external_link\" target=\"_blank\">partial dentures<\/a> have been commonly manufactured since 1929 due to lower cost and lower density compared to gold alloys; however, Co-Cr alloys tend to exhibit a higher <a href=\"https:\/\/en.wikipedia.org\/wiki\/Modulus_of_elasticity\" class=\"mw-redirect\" title=\"Modulus of elasticity\" rel=\"external_link\" target=\"_blank\">modulus of elasticity<\/a> and cyclic fatigue resistance, which are significant factors for dental prosthesis.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> The alloy is a commonly used as a metal framework for dental partials. A well known brand for this purpose is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vitallium\" title=\"Vitallium\" rel=\"external_link\" target=\"_blank\">Vitallium<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Industry\">Industry<\/span><\/h3>\n<p>Due to mechanical properties such as high corrosion and wear resistance, Co-Cr alloys (eg. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stellite\" title=\"Stellite\" rel=\"external_link\" target=\"_blank\">Stellites<\/a>) are used in making wind turbines, engine components, and many other industrial\/mechanical components where high wear-resistance is needed.<sup id=\"rdp-ebb-cite_ref-:1_3-3\" class=\"reference\"><a href=\"#cite_note-:1-3\" rel=\"external_link\">[3]<\/a><\/sup> \n<\/p><p>Co-Cr alloy is also very commonly used in fashion industry to make jewellery, especially wedding bands.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Hazards\">Hazards<\/span><\/h2>\n<p>Metals released from Co-Cr alloy tools and prosthetics may cause allergic reactions and skin <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eczema\" class=\"mw-redirect\" title=\"Eczema\" rel=\"external_link\" target=\"_blank\">eczema<\/a>.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> Prosthetics or any medical equipment with high nickel mass percentage Co-Cr alloy should be avoided due to low biocompatibility, as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nickel\" title=\"Nickel\" rel=\"external_link\" target=\"_blank\">nickel<\/a> is the most common metal sensitizer in the human body.<sup id=\"rdp-ebb-cite_ref-:2_11-2\" class=\"reference\"><a href=\"#cite_note-:2-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Alacrite\" title=\"Alacrite\" rel=\"external_link\" target=\"_blank\">Alacrite<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 35em; -webkit-column-width: 35em; column-width: 35em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-arcam-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-arcam_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-arcam_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.arcam.com\/CommonResources\/Files\/www.arcam.com\/Documents\/EBM%20Materials\/Arcam-ASTM-F75-Cobalt-Chrome.pdf\" target=\"_blank\">ARCAM ASTM F75 CoCr Alloy<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110707155747\/http:\/\/www.arcam.com\/CommonResources\/Files\/www.arcam.com\/Documents\/EBM%20Materials\/Arcam-ASTM-F75-Cobalt-Chrome.pdf\" target=\"_blank\">Archived<\/a> 2011-07-07 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Haynes, E. Metal alloy. US patent no. 873745; 1907.<\/span>\n<\/li>\n<li id=\"cite_note-:1-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:1_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_3-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Ratner, B. D.; Hoffman, A. S.; Schoen, F. J.; Lemons, J. E. <i>Biomaterial Science, <\/i>2nd ed.; Academic Press, 1996.<\/span>\n<\/li>\n<li id=\"cite_note-:0-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Hyslop, D. J. S.; Abdelkader, A. M.; Cox, A.; Fray, D. J. Electrochemical Synthesis of a Biomedically Important Co-Cr Alloy. <i>Acta Materialia<\/i>. <b>2010, <\/b><i>58, <\/i>3124-3130.<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Tarzia, V.; Bottio, T.; Testolin, L.; Gerosa, G. Extended (31 years) durability of a Starr-Edwards Prothesis in Mitral Positioin. <i>Interactive CardioVasc Thorac Surg. <\/i><b>2007, <\/b><i>6, <\/i>570-571. <b> <\/b><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Bettini, E.; Leygraf, C.; Pan, J. Nature of Current Increaase for a CoCrMo\nAlloy: \u201cTranspassive\u201d Dissolution vs. Water Oxidation. <i>Int. J. Electrochem. Sci. <\/i><b>2013,<\/b>\n<b><i>8, <\/i>11791-11804.<\/b><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Zimmermann, J.; Ciacchi, L. C. Origins of the Selective Cr Oxidation in CoCr Alloy Surfaces. <i>J. Pjus. Chem. Lett. <\/i><b>2010, <\/b><i>1, <\/i>2343-2348.<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Carek, A.; Babic, J. Z.; Schauperl, Z.; Tomislav, B. Mechanical Properties of Co-Cr Alloys for Metal Base Framework. <i>Int. J. Prosthodont. Restor. Dent. <\/i><b>2011, <\/b><i>1, <\/i>13-19.<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Devine, T. M.; Wulff, J. Cast vs. Wrought Cobalt-Chromium Surgical Implant Alloys. <i>J. Biomed. Mater. Res. <\/i><b>1975, <\/b><i>9, <\/i>151-167.<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Longquan, S.; Northwood, D.; Cao, Z. The Properties of a Wrought Biomedical Cobalt-Chromium Alloy. <i>J. Mat. Sci. <\/i><b>1994, <\/b><i>29, <\/i>1233-1238.<\/span>\n<\/li>\n<li id=\"cite_note-:2-11\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:2_11-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:2_11-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:2_11-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Lee, S.; Nomura, N.; Chiba, A. Significant Improvement in Mechanical Properties of Biomedical Co-Cr-Mo Alloys with Combination of N Addition and Cr-Enrichment. <i>Materials Transactions. <\/i><b>2008, <\/b><i>2, <\/i>260-264.<\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Hermawan, H.; Ramdan, D.; Djuansjah, J. R. P.; Metals for Biomedical Applications. <i>Biomedical Engineering \u2013 From Theory to<\/i>\nApplications<i>. <b>2011, <\/b>410-430.<\/i><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Kereiakes, D. J.; Cox, D. A.; Hermiller, J. B.; Midei, M. G.; Usefulness of a Cobalt Chromium Coronary Stent Alloy. <i>The Amer. J. Cardi. <\/i><b>2003, <\/b><i>92, <\/i>463-466.<i> <\/i><\/span>\n<\/li>\n<li id=\"cite_note-intech-14\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-intech_14-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-intech_14-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.intechopen.com\/source\/pdfs\/10040\/InTech-Biomimetic_porous_titanium_scaffolds_for_orthopedic_and_dental_applications.pdf\" target=\"_blank\">Biomimetic Porous Titanium Scaffolds for Orthopedic and Dental Applications<\/a>, Alireza Nouri, Peter D. Hodgson and Cui\u2019e Wen (Institute for Technology Research and Innovation, Deakin University, Australia)<\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Cheng, H.; Xu, M.; Zhang, H.; Wu, W.; Zheng, M.; Li, X. Cyclic Fatigue Properties of Cobalt-Chromium Alloy Clasps for Partial Removable Dental Protheses. <i>J. Prosthetic Dent. <\/i><b>2010, <\/b><i>104, <\/i>389-396.<\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Kettelarij, J. A.; Liden, C.; Axen, E.; Julander, A. Cobalt, Nickel, and Chromium Release\nfrom Dental Tools and Alloys. <i>Contact Dermititis. <\/i><b>2014, <\/b><i>70, <\/i>3-10.<\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1324\nCached time: 20181207061816\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.116 seconds\nReal time usage: 0.136 seconds\nPreprocessor visited node count: 401\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 1181\/2097152 bytes\nTemplate argument size: 105\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 8681\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.011\/10.000 seconds\nLua memory usage: 780 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 62.066 1 Template:Reflist\n100.00% 62.066 1 -total\n<\/p>\n<pre>51.94% 32.239 1 Template:Webarchive\n 5.63% 3.493 1 Template:Main_other\n 3.98% 2.468 1 Template:Column-width\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:29453694-1!canonical and timestamp 20181207061816 and revision id 841888614\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cobalt-chrome\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212214\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.053 seconds\nReal time usage: 0.191 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 185.125 1 - wikipedia:Cobalt-chrome\n100.00% 185.125 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8390-0!*!*!*!*!*!* and timestamp 20181217212214 and revision id 24624\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Cobalt-chrome\">https:\/\/www.limswiki.org\/index.php\/Cobalt-chrome<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","bc7dd428c20404c491b1764921094845_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/14\/Disc_with_dental_implants_made_with_WorkNC.jpg\/600px-Disc_with_dental_implants_made_with_WorkNC.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/78\/Denture_example_2.jpg\/440px-Denture_example_2.jpg"],"bc7dd428c20404c491b1764921094845_timestamp":1545081734,"a5eaf6574cad0e6921d65c5f2248e0fe_type":"article","a5eaf6574cad0e6921d65c5f2248e0fe_title":"Ceramic materials","a5eaf6574cad0e6921d65c5f2248e0fe_url":"https:\/\/www.limswiki.org\/index.php\/Ceramic_materials","a5eaf6574cad0e6921d65c5f2248e0fe_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCeramic materials\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is about the material properties of ceramics. For other uses, see Ceramic (disambiguation).\n A Ming Dynasty porcelain vase dated to 1403\u20131424\n A selection of silicon nitride components.\n Fire test furnace insulated with firebrick and ceramic fibre insulation.\n Mid-16th century ceramic tilework on the Dome of the Rock, Jerusalem\n Spherical Hanging Ornament, 1575\u20131585, Ottoman period. Brooklyn Museum.\n Fixed partial porcelain denture, or \"bridge\"\nA ceramic is a solid material comprising an inorganic compound of metal, non-metal or metalloid atoms primarily held in ionic and covalent bonds. Common examples are earthenware, porcelain, and brick.\nThe crystallinity of ceramic materials ranges from highly oriented to semi-crystalline, vitrified, and often completely amorphous (e.g., glasses). Most often, fired ceramics are either vitrified or semi-vitrified as is the case with earthenware, stoneware, and porcelain. Varying crystallinity and electron consumption in the ionic and covalent bonds cause most ceramic materials to be good thermal and electrical insulators (extensively researched in ceramic engineering). With such a large range of possible options for the composition\/structure of a ceramic (e.g. nearly all of the elements, nearly all types of bonding, and all levels of crystallinity), the breadth of the subject is vast, and identifiable attributes (e.g. hardness, toughness, electrical conductivity, etc.) are hard to specify for the group as a whole. General properties such as high melting temperature, high hardness, poor conductivity, high moduli of elasticity, chemical resistance and low ductility are the norm,[1] with known exceptions to each of these rules (e.g. piezoelectric ceramics, glass transition temperature, superconductive ceramics, etc.). Many composites, such as fiberglass and carbon fiber, while containing ceramic materials, are not considered to be part of the ceramic family.[2]\nThe earliest ceramics made by humans were pottery objects (i.e. pots or vessels) or figurines made from clay, either by itself or mixed with other materials like silica, hardened, sintered, in fire. Later ceramics were glazed and fired to create smooth, colored surfaces, decreasing porosity through the use of glassy, amorphous ceramic coatings on top of the crystalline ceramic substrates.[3] Ceramics now include domestic, industrial and building products, as well as a wide range of ceramic art. In the 20th century, new ceramic materials were developed for use in advanced ceramic engineering, such as in semiconductors.\nThe word \"ceramic\" comes from the Greek word \u03ba\u03b5\u03c1\u03b1\u03bc\u03b9\u03ba\u03cc\u03c2 (keramikos), \"of pottery\" or \"for pottery\",[4] from \u03ba\u03ad\u03c1\u03b1\u03bc\u03bf\u03c2 (keramos), \"potter's clay, tile, pottery\".[5] The earliest known mention of the root \"ceram-\" is the Mycenaean Greek ke-ra-me-we, \"workers of ceramics\", written in Linear B syllabic script.[6] The word \"ceramic\" may be used as an adjective to describe a material, product or process, or it may be used as a noun, either singular, or, more commonly, as the plural noun \"ceramics\".[7]\n\nContents \n\n1 Types of ceramic material \n\n1.1 Crystalline ceramics \n1.2 Noncrystalline ceramics \n\n\n2 Properties of ceramics \n\n2.1 Mechanical properties \n2.2 Electrical properties \n\n2.2.1 Semiconductors \n2.2.2 Superconductivity \n2.2.3 Ferroelectricity and supersets \n2.2.4 Positive thermal coefficient \n\n\n2.3 Optical properties \n\n\n3 Examples \n4 Ceramic products \n\n4.1 By usage \n4.2 Ceramics made with clay \n4.3 Classification of ceramics \n\n\n5 Applications \n6 Ceramics in archaeology \n7 See also \n8 References \n9 Further reading \n10 External links \n\n\nTypes of ceramic material \nThis section does not cite any sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (February 2016) (Learn how and when to remove this template message)\n A low magnification SEM micrograph of an advanced ceramic material. The properties of ceramics make fracturing an important inspection method.\nA ceramic material is an inorganic, non-metallic, often crystalline oxide, nitride or carbide material. Some elements, such as carbon or silicon, may be considered ceramics. Ceramic materials are brittle, hard, strong in compression, weak in shearing and tension. They withstand chemical erosion that occurs in other materials subjected to acidic or caustic environments. Ceramics generally can withstand very high temperatures, such as temperatures that range from 1,000 \u00b0C to 1,600 \u00b0C (1,800 \u00b0F to 3,000 \u00b0F). Glass is often not considered a ceramic because of its amorphous (noncrystalline) character. However, glassmaking involves several steps of the ceramic process and its mechanical properties are similar to ceramic materials.\nTraditional ceramic raw materials include clay minerals such as kaolinite, whereas more recent materials include aluminium oxide, more commonly known as alumina. The modern ceramic materials, which are classified as advanced ceramics, include silicon carbide and tungsten carbide. Both are valued for their abrasion resistance, and hence find use in applications such as the wear plates of crushing equipment in mining operations. Advanced ceramics are also used in the medicine, electrical, electronics industries and body armor.\n\nCrystalline ceramics \nCrystalline ceramic materials are not amenable to a great range of processing. Methods for dealing with them tend to fall into one of two categories \u2013 either make the ceramic in the desired shape, by reaction in situ, or by \"forming\" powders into the desired shape, and then sintering to form a solid body. Ceramic forming techniques include shaping by hand (sometimes including a rotation process called \"throwing\"), slip casting, tape casting (used for making very thin ceramic capacitors, e.g.), injection molding, dry pressing, and other variations. Details of these processes are described in the two books listed below.[which? ] A few methods use a hybrid between the two approaches.\n\nNoncrystalline ceramics \nNoncrystalline ceramics, being glass, tend to be formed from melts. The glass is shaped when either fully molten, by casting, or when in a state of toffee-like viscosity, by methods such as blowing into a mold. If later heat treatments cause this glass to become partly crystalline, the resulting material is known as a glass-ceramic, widely used as cook-top and also as a glass composite material for nuclear waste disposal.\n\nProperties of ceramics \nThe physical properties of any ceramic substance are a direct result of its crystalline structure and chemical composition. Solid-state chemistry reveals the fundamental connection between microstructure and properties such as localized density variations, grain size distribution, type of porosity and second-phase content, which can all be correlated with ceramic properties such as mechanical strength \u03c3 by the Hall-Petch equation, hardness, toughness, dielectric constant, and the optical properties exhibited by transparent materials.\nPhysical properties of chemical compounds which provide evidence of chemical composition include odor, colour, volume, density (mass \/ volume), melting point, boiling point, heat capacity, physical form at room temperature (solid, liquid or gas), hardness, porosity, and index of refraction.\nCeramography is the art and science of preparation, examination and evaluation of ceramic microstructures. Evaluation and characterization of ceramic microstructures is often implemented on similar spatial scales to that used commonly in the emerging field of nanotechnology: from tens of angstroms (A) to tens of micrometers (\u00b5m). This is typically somewhere between the minimum wavelength of visible light and the resolution limit of the naked eye.\nThe microstructure includes most grains, secondary phases, grain boundaries, pores, micro-cracks, structural defects and hardness microindentions. Most bulk mechanical, optical, thermal, electrical and magnetic properties are significantly affected by the observed microstructure. The fabrication method and process conditions are generally indicated by the microstructure. The root cause of many ceramic failures is evident in the cleaved and polished microstructure. Physical properties which constitute the field of materials science and engineering include the following:\n\nMechanical properties \n Cutting disks made of silicon carbide\n The Porsche Carrera GT's carbon-ceramic (silicon carbide) disc brake\nMechanical properties are important in structural and building materials as well as textile fabrics. They include many properties used to describe the strength of materials such as: elasticity \/ plasticity, tensile strength, compressive strength, shear strength, fracture toughness & ductility (low in brittle materials), and indentation hardness.\nIn modern materials science, fracture mechanics is an important tool in improving the mechanical performance of materials and components. It applies the physics of stress and strain, in particular the theories of elasticity and plasticity, to the microscopic crystallographic defects found in real materials in order to predict the macroscopic mechanical failure of bodies. Fractography is widely used with fracture mechanics to understand the causes of failures and also verify the theoretical failure predictions with real life failures.\nCeramic materials are usually ionic or covalent bonded materials, and can be crystalline or amorphous. A material held together by either type of bond will tend to fracture before any plastic deformation takes place, which results in poor toughness in these materials. Additionally, because these materials tend to be porous, the pores and other microscopic imperfections act as stress concentrators, decreasing the toughness further, and reducing the tensile strength. These combine to give catastrophic failures, as opposed to the normally much more gentle failure modes of metals.\nThese materials do show plastic deformation. However, due to the rigid structure of the crystalline materials, there are very few available slip systems for dislocations to move, and so they deform very slowly. With the non-crystalline (glassy) materials, viscous flow is the dominant source of plastic deformation, and is also very slow. It is therefore neglected in many applications of ceramic materials.\nTo overcome the brittle behaviour, ceramic material development has introduced the class of ceramic matrix composite materials, in which ceramic fibers are embedded and with specific coatings are forming fiber bridges across any crack. This mechanism substantially increases the fracture toughness of such ceramics. The ceramic disc brakes are, for example using a ceramic matrix composite material manufactured with a specific process.\n\nElectrical properties \nSemiconductors \nSome ceramics are semiconductors. Most of these are transition metal oxides that are II-VI semiconductors, such as zinc oxide.\nWhile there are prospects of mass-producing blue LEDs from zinc oxide, ceramicists are most interested in the electrical properties that show grain boundary effects.\nOne of the most widely used of these is the varistor. These are devices that exhibit the property that resistance drops sharply at a certain threshold voltage. Once the voltage across the device reaches the threshold, there is a breakdown of the electrical structure in the vicinity of the grain boundaries, which results in its electrical resistance dropping from several megohms down to a few hundred ohms. The major advantage of these is that they can dissipate a lot of energy, and they self-reset \u2013 after the voltage across the device drops below the threshold, its resistance returns to being high.\nThis makes them ideal for surge-protection applications; as there is control over the threshold voltage and energy tolerance, they find use in all sorts of applications. The best demonstration of their ability can be found in electrical substations, where they are employed to protect the infrastructure from lightning strikes. They have rapid response, are low maintenance, and do not appreciably degrade from use, making them virtually ideal devices for this application.\nSemiconducting ceramics are also employed as gas sensors. When various gases are passed over a polycrystalline ceramic, its electrical resistance changes. With tuning to the possible gas mixtures, very inexpensive devices can be produced.\n\nSuperconductivity \n The Meissner effect demonstrated by levitating a magnet above a cuprate superconductor, which is cooled by liquid nitrogen\nUnder some conditions, such as extremely low temperature, some ceramics exhibit high-temperature superconductivity. The exact reason for this is not known, but there are two major families of superconducting ceramics.\n\nFerroelectricity and supersets \nPiezoelectricity, a link between electrical and mechanical response, is exhibited by a large number of ceramic materials, including the quartz used to measure time in watches and other electronics. Such devices use both properties of piezoelectrics, using electricity to produce a mechanical motion (powering the device) and then using this mechanical motion to produce electricity (generating a signal). The unit of time measured is the natural interval required for electricity to be converted into mechanical energy and back again.\nThe piezoelectric effect is generally stronger in materials that also exhibit pyroelectricity, and all pyroelectric materials are also piezoelectric. These materials can be used to inter convert between thermal, mechanical, or electrical energy; for instance, after synthesis in a furnace, a pyroelectric crystal allowed to cool under no applied stress generally builds up a static charge of thousands of volts. Such materials are used in motion sensors, where the tiny rise in temperature from a warm body entering the room is enough to produce a measurable voltage in the crystal.\nIn turn, pyroelectricity is seen most strongly in materials which also display the ferroelectric effect, in which a stable electric dipole can be oriented or reversed by applying an electrostatic field. Pyroelectricity is also a necessary consequence of ferroelectricity. This can be used to store information in ferroelectric capacitors, elements of ferroelectric RAM.\nThe most common such materials are lead zirconate titanate and barium titanate. Aside from the uses mentioned above, their strong piezoelectric response is exploited in the design of high-frequency loudspeakers, transducers for sonar, and actuators for atomic force and scanning tunneling microscopes.\n\nPositive thermal coefficient \n Silicon nitride rocket thruster. Left: Mounted in test stand. Right: Being tested with H2\/O2 propellants\nIncreases in temperature can cause grain boundaries to suddenly become insulating in some semiconducting ceramic materials, mostly mixtures of heavy metal titanates. The critical transition temperature can be adjusted over a wide range by variations in chemistry. In such materials, current will pass through the material until joule heating brings it to the transition temperature, at which point the circuit will be broken and current flow will cease. Such ceramics are used as self-controlled heating elements in, for example, the rear-window defrost circuits of automobiles.\nAt the transition temperature, the material's dielectric response becomes theoretically infinite. While a lack of temperature control would rule out any practical use of the material near its critical temperature, the dielectric effect remains exceptionally strong even at much higher temperatures. Titanates with critical temperatures far below room temperature have become synonymous with \"ceramic\" in the context of ceramic capacitors for just this reason.\n\nOptical properties \n Cermax xenon arc lamp with synthetic sapphire output window\nOptically transparent materials focus on the response of a material to incoming lightwaves of a range of wavelengths. Frequency selective optical filters can be utilized to alter or enhance the brightness and contrast of a digital image. Guided lightwave transmission via frequency selective waveguides involves the emerging field of fiber optics and the ability of certain glassy compositions as a transmission medium for a range of frequencies simultaneously (multi-mode optical fiber) with little or no interference between competing wavelengths or frequencies. This resonant mode of energy and data transmission via electromagnetic (light) wave propagation, though low powered, is virtually lossless. Optical waveguides are used as components in Integrated optical circuits (e.g. light-emitting diodes, LEDs) or as the transmission medium in local and long haul optical communication systems. Also of value to the emerging materials scientist is the sensitivity of materials to radiation in the thermal infrared (IR) portion of the electromagnetic spectrum. This heat-seeking ability is responsible for such diverse optical phenomena as Night-vision and IR luminescence.\nThus, there is an increasing need in the military sector for high-strength, robust materials which have the capability to transmit light (electromagnetic waves) in the visible (0.4 \u2013 0.7 micrometers) and mid-infrared (1 \u2013 5 micrometers) regions of the spectrum. These materials are needed for applications requiring transparent armor, including next-generation high-speed missiles and pods, as well as protection against improvised explosive devices (IED).\nIn the 1960s, scientists at General Electric (GE) discovered that under the right manufacturing conditions, some ceramics, especially aluminium oxide (alumina), could be made translucent. These translucent materials were transparent enough to be used for containing the electrical plasma generated in high-pressure sodium street lamps. During the past two decades, additional types of transparent ceramics have been developed for applications such as nose cones for heat-seeking missiles, windows for fighter aircraft, and scintillation counters for computed tomography scanners.\nIn the early 1970s, Thomas Soules pioneered computer modeling of light transmission through translucent ceramic alumina. His model showed that microscopic pores in ceramic, mainly trapped at the junctions of microcrystalline grains, caused light to scatter and prevented true transparency. The volume fraction of these microscopic pores had to be less than 1% for high-quality optical transmission.\nThis is basically a particle size effect. Opacity results from the incoherent scattering of light at surfaces and interfaces. In addition to pores, most of the interfaces in a typical metal or ceramic object are in the form of grain boundaries which separate tiny regions of crystalline order. When the size of the scattering center (or grain boundary) is reduced below the size of the wavelength of the light being scattered, the scattering no longer occurs to any significant extent.\nIn the formation of polycrystalline materials (metals and ceramics) the size of the crystalline grains is determined largely by the size of the crystalline particles present in the raw material during formation (or pressing) of the object. Moreover, the size of the grain boundaries scales directly with particle size. Thus a reduction of the original particle size below the wavelength of visible light (~ 0.5 micrometers for shortwave violet) eliminates any light scattering, resulting in a transparent material.\nRecently[when? ], Japanese scientists have developed techniques to produce ceramic parts that rival the transparency of traditional crystals (grown from a single seed) and exceed the fracture toughness of a single crystal.[citation needed ] In particular, scientists at the Japanese firm Konoshima Ltd., a producer of ceramic construction materials and industrial chemicals, have been looking for markets for their transparent ceramics.\nLivermore researchers realized that these ceramics might greatly benefit high-powered lasers used in the National Ignition Facility (NIF) Programs Directorate. In particular, a Livermore research team began to acquire advanced transparent ceramics from Konoshima to determine if they could meet the optical requirements needed for Livermore\u2019s Solid-State Heat Capacity Laser (SSHCL).[citation needed ] Livermore researchers have also been testing applications of these materials for applications such as advanced drivers for laser-driven fusion power plants.\n\nExamples \n Porcelain high-voltage insulator\n Silicon carbide is used for inner plates of ballistic vests\n Ceramic BN crucible\nA composite material of ceramic and metal is known as cermet.\nOther ceramic materials, generally requiring greater purity in their make-up than those above, include forms of several chemical compounds, including:\n\nBarium titanate (often mixed with strontium titanate) displays ferroelectricity, meaning that its mechanical, electrical, and thermal responses are coupled to one another and also history-dependent. It is widely used in electromechanical transducers, ceramic capacitors, and data storage elements. Grain boundary conditions can create PTC effects in heating elements.\nBismuth strontium calcium copper oxide, a high-temperature superconductor\nBoron oxide is used in body armour.\nBoron nitride is structurally isoelectronic to carbon and takes on similar physical forms: a graphite-like one used as a lubricant, and a diamond-like one used as an abrasive.\nEarthenware used for domestic ware such as plates and mugs.\nFerrite is used in the magnetic cores of electrical transformers and magnetic core memory.\nLead zirconate titanate (PZT) was developed at the United States National Bureau of Standards in 1954. PZT is used as an ultrasonic transducer, as its piezoelectric properties greatly exceed those of Rochelle salt.[8]\nMagnesium diboride (MgB2) is an unconventional superconductor.\nPorcelain is used for a wide range of household and industrial products.\nSialon (Silicon Aluminium Oxynitride) has high strength; resistance to thermal shock, chemical and wear resistance, and low density. These ceramics are used in non-ferrous molten metal handling, weld pins and the chemical industry.\nSilicon carbide (SiC) is used as a susceptor in microwave furnaces, a commonly used abrasive, and as a refractory material.\nSilicon nitride (Si3N4) is used as an abrasive powder.\nSteatite (magnesium silicates) is used as an electrical insulator.\nTitanium carbide Used in space shuttle re-entry shields and scratchproof watches.\nUranium oxide (UO2), used as fuel in nuclear reactors.\nYttrium barium copper oxide (YBa2Cu3O7\u2212x), another high temperature superconductor.\nZinc oxide (ZnO), which is a semiconductor, and used in the construction of varistors.\nZirconium dioxide (zirconia), which in pure form undergoes many phase changes between room temperature and practical sintering temperatures, can be chemically \"stabilized\" in several different forms. Its high oxygen ion conductivity recommends it for use in fuel cells and automotive oxygen sensors. In another variant, metastable structures can impart transformation toughening for mechanical applications; most ceramic knife blades are made of this material.\nPartially stabilised zirconia (PSZ) is much less brittle than other ceramics and is used for metal forming tools, valves and liners, abrasive slurries, kitchen knives and bearings subject to severe abrasion.[9]\n Kitchen knife with a ceramic blade\nCeramic products \nBy usage \nFor convenience, ceramic products are usually divided into four main types; these are shown below with some examples:\n\nStructural, including bricks, pipes, floor and roof tiles\nRefractories, such as kiln linings, gas fire radiants, steel and glass making crucibles\nWhitewares, including tableware, cookware, wall tiles, pottery products and sanitary ware[10]\nTechnical, also known as engineering, advanced, special, and fine ceramics. Such items include:\ngas burner nozzles\nballistic protection, vehicle armour\nnuclear fuel uranium oxide pellets\nbiomedical implants\ncoatings of jet engine turbine blades\nceramic disk brake\nmissile nose cones\nbearing (mechanical)\ntiles used in the Space Shuttle program\nCeramics made with clay \nMain article: Pottery\nFrequently, the raw materials of modern ceramics do not include clays.[11]\nThose that do are classified as follows:\n\nEarthenware, fired at lower temperatures than other types\nStoneware, vitreous or semi-vitreous\nPorcelain, which contains a high content of kaolin\nBone china\nClassification of ceramics \nCeramics can also be classified into three distinct material categories: \n\nOxides: alumina, beryllia, ceria, zirconia\nNon-oxides: carbide, boride, nitride, silicide\nComposite materials: particulate reinforced, fiber reinforced, combinations of oxides and nonoxides.\nEach one of these classes can be developed into unique material properties because ceramics tend to be crystalline.\n\nApplications \nKnife blades: the blade of a ceramic knife will stay sharp for much longer than that of a steel knife, although it is more brittle and can snap.\nCarbon-ceramic brake disks for vehicles are resistant to brake fade at high temperatures.\nAdvanced composite ceramic and metal matrices have been designed for most modern armoured fighting vehicles because they offer superior penetrating resistance against shaped charges (such as HEAT rounds) and kinetic energy penetrators.\nCeramics such as alumina and boron carbide have been used in ballistic armored vests to repel high-velocity rifle fire. Such plates are known commonly as small arms protective inserts, or SAPIs. Similar material is used to protect the cockpits of some military airplanes, because of the low weight of the material.\nCeramics can be used in place of steel for ball bearings. Their higher hardness means they are much less susceptible to wear and typically last for triple the lifetime of a steel part. They also deform less under load, meaning they have less contact with the bearing retainer walls and can roll faster. In very high speed applications, heat from friction during rolling can cause problems for metal bearings, which are reduced by the use of ceramics. Ceramics are also more chemically resistant and can be used in wet environments where steel bearings would rust. In some cases, their electricity-insulating properties may also be valuable in bearings. Two drawbacks to ceramic bearings are a significantly higher cost and susceptibility to damage under shock loads.\nIn the early 1980s, Toyota researched production of an adiabatic engine using ceramic components in the hot gas area. The ceramics would have allowed temperatures of over 3000 \u00b0F (1650 \u00b0C). The expected advantages would have been lighter materials and a smaller cooling system (or no need for one at all), leading to a major weight reduction. The expected increase of fuel efficiency of the engine (caused by the higher temperature, as shown by Carnot's theorem) could not be verified experimentally; it was found that the heat transfer on the hot ceramic cylinder walls was higher than the transfer to a cooler metal wall as the cooler gas film on the metal surface works as a thermal insulator. Thus, despite all of these desirable properties, such engines have not succeeded in production because of costs for the ceramic components and the limited advantages. (Small imperfections in the ceramic material with its low fracture toughness lead to cracks, which can lead to potentially dangerous equipment failure.) Such engines are possible in laboratory settings, but mass production is not feasible with current technology.[citation needed ]\nWork is being done in developing ceramic parts for gas turbine engines. Currently, even blades made of advanced metal alloys used in the engines' hot section require cooling and careful limiting of operating temperatures. Turbine engines made with ceramics could operate more efficiently, giving aircraft greater range and payload for a set amount of fuel.\nRecent advances have been made in ceramics which include bioceramics, such as dental implants and synthetic bones. Hydroxyapatite, the natural mineral component of bone, has been made synthetically from a number of biological and chemical sources and can be formed into ceramic materials. Orthopedic implants coated with these materials bond readily to bone and other tissues in the body without rejection or inflammatory reactions so are of great interest for gene delivery and tissue engineering scaffolds. Most hydroxyapatite ceramics are very porous and lack mechanical strength, and are used to coat metal orthopedic devices to aid in forming a bond to bone or as bone fillers. They are also used as fillers for orthopedic plastic screws to aid in reducing the inflammation and increase absorption of these plastic materials. Work is being done to make strong, fully dense nanocrystalline hydroxyapatite ceramic materials for orthopedic weight bearing devices, replacing foreign metal and plastic orthopedic materials with a synthetic, but naturally occurring, bone mineral. Ultimately, these ceramic materials may be used as bone replacements or with the incorporation of protein collagens, synthetic bones.\nDurable actinide-containing ceramic materials have many applications such as in nuclear fuels for burning excess Pu and in chemically-inert sources of alpha irradiation for power supply of unmanned space vehicles or to produce electricity for microelectronic devices. Both use and disposal of radioactive actinides require their immobilisation in a durable host material. Nuclear waste long-lived radionuclides such as actinides are immobilised using chemically-durable crystalline materials based on polycrystalline ceramics and large single crystals.[12]\nHigh-tech ceramic is used in watchmaking for producing watch cases. The material is valued by watchmakers for its light weight, scratch resistance, durability and smooth touch. IWC is one of the brands that initiated the use of ceramic in watchmaking.[13]\nCeramics in archaeology \nCeramic artifacts have an important role in archaeology for understanding the culture, technology and behavior of peoples of the past. They are among the most common artifacts to be found at an archaeological site, generally in the form of small fragments of broken pottery called sherds. Processing of collected sherds can be consistent with two main types of analysis: technical and traditional.\nTraditional analysis involves sorting ceramic artifacts, sherds and larger fragments into specific types based on style, composition, manufacturing and morphology. By creating these typologies it is possible to distinguish between different cultural styles, the purpose of the ceramic and technological state of the people among other conclusions. In addition, by looking at stylistic changes of ceramics over time is it possible to separate (seriate) the ceramics into distinct diagnostic groups (assemblages). A comparison of ceramic artifacts with known dated assemblages allows for a chronological assignment of these pieces.[14]\nThe technical approach to ceramic analysis involves a finer examination of the composition of ceramic artifacts and sherds to determine the source of the material and through this the possible manufacturing site. Key criteria are the composition of the clay and the temper used in the manufacture of the article under study: temper is a material added to the clay during the initial production stage, and it is used to aid the subsequent drying process. Types of temper include shell pieces, granite fragments and ground sherd pieces called 'grog'. Temper is usually identified by microscopic examination of the temper material. Clay identification is determined by a process of refiring the ceramic, and assigning a color to it using Munsell Soil Color notation. By estimating both the clay and temper compositions, and locating a region where both are known to occur, an assignment of the material source can be made. From the source assignment of the artifact further investigations can be made into the site of manufacture.\n\nSee also \nCeramic chemistry\nCeramic engineering\nCeramic nanoparticle\nCeramic matrix composite\nCeramic art\nReferences \n\n\n^ Black, J. T.; Kohser, R. A. (2012). DeGarmo's materials and processes in manufacturing. Wiley. p. 226. ISBN 978-0-470-92467-9. \n\n^ Carter, C. B.; Norton, M. G. (2007). Ceramic materials: Science and engineering. Springer. pp. 3 & 4. ISBN 978-0-387-46271-4. \n\n^ Carter, C. B.; Norton, M. G. (2007). Ceramic materials: Science and engineering. Springer. pp. 20 & 21. ISBN 978-0-387-46271-4. \n\n^ \u03ba\u03b5\u03c1\u03b1\u03bc\u03b9\u03ba\u03cc\u03c2, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus Digital Library \n\n^ \u03ba\u03ad\u03c1\u03b1\u03bc\u03bf\u03c2, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus Digital Library \n\n^ Palaeolexicon, Word study tool of ancient languages \n\n^ \"ceramic\". Oxford English Dictionary (3rd ed.). Oxford University Press. September 2005.  (Subscription or UK public library membership required.) \n\n^ Wachtman, John B., Jr. (ed.) (1999) Ceramic Innovations in the 20th century, The American Ceramic Society. ISBN 978-1-57498-093-6. \n\n^ Garvie, R. C.; Hannink, R. H.; Pascoe, R. T. (1975). \"Ceramic steel?\". Nature. 258 (5537): 703\u2013704. Bibcode:1975Natur.258..703G. doi:10.1038\/258703a0. \n\n^ \"Whiteware Pottery\". Encyclop\u00e6dia Britannica. Retrieved 30 June 2015 . \n\n^ Geiger, Greg. Introduction To Ceramics, American Ceramic Society \n\n^ B.E. Burakov, M.I Ojovan, W.E. Lee. Crystalline Materials for Actinide Immobilisation, Imperial College Press, London, 198 pp. (2010).\nhttp:\/\/www.worldscientific.com\/worldscibooks\/10.1142\/p652. \n\n^ \"Watch Case Materials Explained: Ceramic | aBlogtoWatch\". aBlogtoWatch. 18 April 2012. \n\n^ Mississippi Valley Archaeological Center, Ceramic Analysis Archived June 3, 2012, at the Wayback Machine., Retrieved 04-11-12 \n\n\nFurther reading \nGuy, John (1986). Guy, John, ed. Oriental trade ceramics in South-East Asia, ninth to sixteenth centuries: with a catalogue of Chinese, Vietnamese and Thai wares in Australian collections (illustrated, revised ed.). Oxford University Press. Retrieved 24 April 2014 . \nExternal links \n\n Ceramicat Wikipedia's sister projects \n \n \n Media from Wikimedia Commons \n Quotations from Wikiquote \n \n \n\nDolni Vestonice Venus- Oldest known Ceramic statuette of a nude female figure dated to 29 000 \u2013 25 000 BP (Gravettian industry. Czech Republic\nThe Gardiner Museum \u2013 The only museum in Canada entirely devoted to ceramics\nIntroduction, Scientific Principles, Properties and Processing of Ceramics\nAdvanced Ceramics \u2013 The Evolution, Classification, Properties, Production, Firing, Finishing and Design of Advanced Ceramics\nCerame-Unie, aisbl \u2013 The European Ceramic Industry Association\nAuthority control \nBNF: cb11935435f (data) \nGND: 4030270-2 \nHDS: 47274 \nNARA: 10641915 \nNDL: 00570816 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Ceramic_materials\">https:\/\/www.limswiki.org\/index.php\/Ceramic_materials<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 11 March 2016, at 19:46.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,613 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","a5eaf6574cad0e6921d65c5f2248e0fe_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Ceramic_materials skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Ceramic materials<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">This article is about the material properties of ceramics. For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_(disambiguation)\" class=\"mw-disambig\" title=\"Ceramic (disambiguation)\" rel=\"external_link\" target=\"_blank\">Ceramic (disambiguation)<\/a>.<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Blue_and_white_vase_Jingdezhen_Ming_Yongle_1403_1424.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4f\/Blue_and_white_vase_Jingdezhen_Ming_Yongle_1403_1424.jpg\/220px-Blue_and_white_vase_Jingdezhen_Ming_Yongle_1403_1424.jpg\" width=\"220\" height=\"292\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Blue_and_white_vase_Jingdezhen_Ming_Yongle_1403_1424.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ming_Dynasty\" class=\"mw-redirect\" title=\"Ming Dynasty\" rel=\"external_link\" target=\"_blank\">Ming Dynasty<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Porcelain\" title=\"Porcelain\" rel=\"external_link\" target=\"_blank\">porcelain<\/a> vase dated to 1403\u20131424<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Si3N4bearings.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/64\/Si3N4bearings.jpg\/220px-Si3N4bearings.jpg\" width=\"220\" height=\"189\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Si3N4bearings.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A selection of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_nitride\" title=\"Silicon nitride\" rel=\"external_link\" target=\"_blank\">silicon nitride<\/a> components.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Firebrick_electric_furnace_ceramic_fibre_gasket.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/85\/Firebrick_electric_furnace_ceramic_fibre_gasket.jpg\/220px-Firebrick_electric_furnace_ceramic_fibre_gasket.jpg\" width=\"220\" height=\"339\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Firebrick_electric_furnace_ceramic_fibre_gasket.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fire_test\" title=\"Fire test\" rel=\"external_link\" target=\"_blank\">Fire test<\/a> furnace insulated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fire_brick\" title=\"Fire brick\" rel=\"external_link\" target=\"_blank\">firebrick<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/High_temperature_insulation_wool\" class=\"mw-redirect\" title=\"High temperature insulation wool\" rel=\"external_link\" target=\"_blank\">ceramic fibre<\/a> insulation.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Israel-2013-Jerusalem-Temple_Mount-Dome_of_the_Rock-Detail_01.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/20\/Israel-2013-Jerusalem-Temple_Mount-Dome_of_the_Rock-Detail_01.jpg\/220px-Israel-2013-Jerusalem-Temple_Mount-Dome_of_the_Rock-Detail_01.jpg\" width=\"220\" height=\"152\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Israel-2013-Jerusalem-Temple_Mount-Dome_of_the_Rock-Detail_01.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Mid-16th century ceramic tilework on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dome_of_the_Rock\" title=\"Dome of the Rock\" rel=\"external_link\" target=\"_blank\">Dome of the Rock<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jerusalem\" title=\"Jerusalem\" rel=\"external_link\" target=\"_blank\">Jerusalem<\/a><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Spherical_Hanging_Ornament,_1575-1585.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/eb\/Spherical_Hanging_Ornament%2C_1575-1585.jpg\/220px-Spherical_Hanging_Ornament%2C_1575-1585.jpg\" width=\"220\" height=\"210\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Spherical_Hanging_Ornament,_1575-1585.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><i>Spherical Hanging Ornament<\/i>, 1575\u20131585, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ottoman_Empire\" title=\"Ottoman Empire\" rel=\"external_link\" target=\"_blank\">Ottoman<\/a> period. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brooklyn_Museum\" title=\"Brooklyn Museum\" rel=\"external_link\" target=\"_blank\">Brooklyn Museum<\/a>.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bridge_from_dental_porcelain.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2c\/Bridge_from_dental_porcelain.jpg\/220px-Bridge_from_dental_porcelain.jpg\" width=\"220\" height=\"135\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bridge_from_dental_porcelain.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Fixed partial porcelain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Denture\" class=\"mw-redirect\" title=\"Denture\" rel=\"external_link\" target=\"_blank\">denture<\/a>, or \"bridge\"<\/div><\/div><\/div>\n<p>A <b>ceramic<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solid\" title=\"Solid\" rel=\"external_link\" target=\"_blank\">solid<\/a> material comprising an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inorganic_compound\" title=\"Inorganic compound\" rel=\"external_link\" target=\"_blank\">inorganic compound<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal\" title=\"Metal\" rel=\"external_link\" target=\"_blank\">metal<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nonmetal\" title=\"Nonmetal\" rel=\"external_link\" target=\"_blank\">non-metal<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metalloid\" title=\"Metalloid\" rel=\"external_link\" target=\"_blank\">metalloid<\/a> atoms primarily held in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ionic_bonding\" title=\"Ionic bonding\" rel=\"external_link\" target=\"_blank\">ionic<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Covalent_bond\" title=\"Covalent bond\" rel=\"external_link\" target=\"_blank\">covalent<\/a> bonds. Common examples are earthenware, porcelain, and brick.\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystallinity\" title=\"Crystallinity\" rel=\"external_link\" target=\"_blank\">crystallinity<\/a> of ceramic materials ranges from highly oriented to semi-crystalline, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vitrification\" title=\"Vitrification\" rel=\"external_link\" target=\"_blank\">vitrified<\/a>, and often completely <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amorphous\" class=\"mw-redirect\" title=\"Amorphous\" rel=\"external_link\" target=\"_blank\">amorphous<\/a> (e.g., <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass\" title=\"Glass\" rel=\"external_link\" target=\"_blank\">glasses<\/a>). Most often, fired ceramics are either vitrified or semi-vitrified as is the case with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Earthenware\" title=\"Earthenware\" rel=\"external_link\" target=\"_blank\">earthenware<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stoneware\" title=\"Stoneware\" rel=\"external_link\" target=\"_blank\">stoneware<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Porcelain\" title=\"Porcelain\" rel=\"external_link\" target=\"_blank\">porcelain<\/a>. Varying crystallinity and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electron\" title=\"Electron\" rel=\"external_link\" target=\"_blank\">electron<\/a> consumption in the ionic and covalent bonds cause most ceramic materials to be good thermal and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulator_(electricity)\" title=\"Insulator (electricity)\" rel=\"external_link\" target=\"_blank\">electrical insulators<\/a> (extensively researched in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_engineering\" title=\"Ceramic engineering\" rel=\"external_link\" target=\"_blank\">ceramic engineering<\/a>). With such a large range of possible options for the composition\/structure of a ceramic (e.g. nearly all of the elements, nearly all types of bonding, and all levels of crystallinity), the breadth of the subject is vast, and identifiable attributes (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hardness\" title=\"Hardness\" rel=\"external_link\" target=\"_blank\">hardness<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toughness\" title=\"Toughness\" rel=\"external_link\" target=\"_blank\">toughness<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical_resistivity_and_conductivity\" title=\"Electrical resistivity and conductivity\" rel=\"external_link\" target=\"_blank\">electrical conductivity<\/a>, etc.) are hard to specify for the group as a whole. General properties such as high melting temperature, high hardness, poor conductivity, high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastic_modulus\" title=\"Elastic modulus\" rel=\"external_link\" target=\"_blank\">moduli of elasticity<\/a>, chemical resistance and low ductility are the norm,<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> with known exceptions to each of these rules (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Piezoelectricity\" title=\"Piezoelectricity\" rel=\"external_link\" target=\"_blank\">piezoelectric ceramics<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass_transition\" title=\"Glass transition\" rel=\"external_link\" target=\"_blank\">glass transition<\/a> temperature, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superconductivity\" title=\"Superconductivity\" rel=\"external_link\" target=\"_blank\">superconductive ceramics<\/a>, etc.). Many composites, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiberglass\" title=\"Fiberglass\" rel=\"external_link\" target=\"_blank\">fiberglass<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon-fiber-reinforced_polymer\" class=\"mw-redirect\" title=\"Carbon-fiber-reinforced polymer\" rel=\"external_link\" target=\"_blank\">carbon fiber<\/a>, while containing ceramic materials, are not considered to be part of the ceramic family.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>The earliest ceramics made by humans were <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pottery\" title=\"Pottery\" rel=\"external_link\" target=\"_blank\">pottery<\/a> objects (i.e. <i>pots<\/i> or <i>vessels<\/i>) or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Figurine\" title=\"Figurine\" rel=\"external_link\" target=\"_blank\">figurines<\/a> made from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clay\" title=\"Clay\" rel=\"external_link\" target=\"_blank\">clay<\/a>, either by itself or mixed with other materials like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_dioxide\" title=\"Silicon dioxide\" rel=\"external_link\" target=\"_blank\">silica<\/a>, hardened, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sintering\" title=\"Sintering\" rel=\"external_link\" target=\"_blank\">sintered<\/a>, in fire. Later ceramics were <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glazing_(ceramics)\" class=\"mw-redirect\" title=\"Glazing (ceramics)\" rel=\"external_link\" target=\"_blank\">glazed<\/a> and fired to create smooth, colored surfaces, decreasing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Porosity\" title=\"Porosity\" rel=\"external_link\" target=\"_blank\">porosity<\/a> through the use of glassy, amorphous ceramic coatings on top of the crystalline ceramic substrates.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> Ceramics now include domestic, industrial and building products, as well as a wide range of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_art\" title=\"Ceramic art\" rel=\"external_link\" target=\"_blank\">ceramic art<\/a>. In the 20th century, new <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_materials\" class=\"mw-redirect\" title=\"Ceramic materials\" rel=\"external_link\" target=\"_blank\">ceramic materials<\/a> were developed for use in advanced ceramic engineering, such as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semiconductor\" title=\"Semiconductor\" rel=\"external_link\" target=\"_blank\">semiconductors<\/a>.\n<\/p><p>The word \"<i><a href=\"https:\/\/en.wiktionary.org\/wiki\/ceramic\" class=\"extiw\" title=\"wikt:ceramic\" rel=\"external_link\" target=\"_blank\">ceramic<\/a><\/i>\" comes from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greek_language\" title=\"Greek language\" rel=\"external_link\" target=\"_blank\">Greek<\/a> word \u03ba\u03b5\u03c1\u03b1\u03bc\u03b9\u03ba\u03cc\u03c2 (<i>keramikos<\/i>), \"of pottery\" or \"for pottery\",<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> from <a href=\"https:\/\/en.wiktionary.org\/wiki\/%CE%BA%CE%AD%CF%81%CE%B1%CE%BC%CE%BF%CF%82\" class=\"extiw\" title=\"wikt:\u03ba\u03ad\u03c1\u03b1\u03bc\u03bf\u03c2\" rel=\"external_link\" target=\"_blank\">\u03ba\u03ad\u03c1\u03b1\u03bc\u03bf\u03c2<\/a> (<i>keramos<\/i>), \"potter's clay, tile, pottery\".<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> The earliest known mention of the root \"ceram-\" is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mycenaean_Greek\" title=\"Mycenaean Greek\" rel=\"external_link\" target=\"_blank\">Mycenaean Greek<\/a> <i>ke-ra-me-we<\/i>, \"workers of ceramics\", written in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Linear_B\" title=\"Linear B\" rel=\"external_link\" target=\"_blank\">Linear B<\/a> syllabic script.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> The word \"ceramic\" may be used as an adjective to describe a material, product or process, or it may be used as a noun, either singular, or, more commonly, as the plural noun \"ceramics\".<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types_of_ceramic_material\">Types of ceramic material<\/span><\/h2>\n\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ceramic_fractured_SEM.TIF\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ab\/Ceramic_fractured_SEM.TIF\/lossy-page1-220px-Ceramic_fractured_SEM.TIF.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ceramic_fractured_SEM.TIF\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A low magnification <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scanning_Electron_Microscope\" class=\"mw-redirect\" title=\"Scanning Electron Microscope\" rel=\"external_link\" target=\"_blank\">SEM micrograph<\/a> of an advanced ceramic material. The properties of ceramics make fracturing an important inspection method.<\/div><\/div><\/div>\n<p>A ceramic material is an inorganic, non-metallic, often crystalline oxide, nitride or carbide material. Some elements, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon\" title=\"Carbon\" rel=\"external_link\" target=\"_blank\">carbon<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon\" title=\"Silicon\" rel=\"external_link\" target=\"_blank\">silicon<\/a>, may be considered ceramics. Ceramic materials are brittle, hard, strong in compression, weak in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shear_stress\" title=\"Shear stress\" rel=\"external_link\" target=\"_blank\">shearing<\/a> and tension. They withstand chemical erosion that occurs in other materials subjected to acidic or caustic environments. Ceramics generally can withstand very high temperatures, such as temperatures that range from 1,000 \u00b0C to 1,600 \u00b0C (1,800 \u00b0F to 3,000 \u00b0F). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass\" title=\"Glass\" rel=\"external_link\" target=\"_blank\">Glass<\/a> is often not considered a ceramic because of its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amorphous\" class=\"mw-redirect\" title=\"Amorphous\" rel=\"external_link\" target=\"_blank\">amorphous<\/a> (noncrystalline) character. However, glassmaking involves several steps of the ceramic process and its mechanical properties are similar to ceramic materials.\n<\/p><p>Traditional ceramic raw materials include clay minerals such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kaolinite\" title=\"Kaolinite\" rel=\"external_link\" target=\"_blank\">kaolinite<\/a>, whereas more recent materials include aluminium oxide, more commonly known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alumina\" class=\"mw-redirect\" title=\"Alumina\" rel=\"external_link\" target=\"_blank\">alumina<\/a>. The modern ceramic materials, which are classified as advanced ceramics, include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_carbide\" title=\"Silicon carbide\" rel=\"external_link\" target=\"_blank\">silicon carbide<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tungsten_carbide\" title=\"Tungsten carbide\" rel=\"external_link\" target=\"_blank\">tungsten carbide<\/a>. Both are valued for their abrasion resistance, and hence find use in applications such as the wear plates of crushing equipment in mining operations. Advanced ceramics are also used in the medicine, electrical, electronics industries and body armor.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Crystalline_ceramics\">Crystalline ceramics<\/span><\/h3>\n<p>Crystalline ceramic materials are not amenable to a great range of processing. Methods for dealing with them tend to fall into one of two categories \u2013 either make the ceramic in the desired shape, by reaction <i>in situ<\/i>, or by \"forming\" powders into the desired shape, and then <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sintering\" title=\"Sintering\" rel=\"external_link\" target=\"_blank\">sintering<\/a> to form a solid body. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_forming_techniques\" title=\"Ceramic forming techniques\" rel=\"external_link\" target=\"_blank\">Ceramic forming techniques<\/a> include shaping by hand (sometimes including a rotation process called \"throwing\"), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Slipcasting\" title=\"Slipcasting\" rel=\"external_link\" target=\"_blank\">slip casting<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tape_casting\" title=\"Tape casting\" rel=\"external_link\" target=\"_blank\">tape casting<\/a> (used for making very thin ceramic capacitors, e.g.), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Injection_molding\" class=\"mw-redirect\" title=\"Injection molding\" rel=\"external_link\" target=\"_blank\">injection molding<\/a>, dry pressing, and other variations. Details of these processes are described in the two books listed below.<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Avoid_weasel_words\" class=\"mw-redirect\" title=\"Wikipedia:Avoid weasel words\" rel=\"external_link\" target=\"_blank\"><span title=\"The material near this tag possibly uses too vague attribution or weasel words. (December 2012)\">which?<\/span><\/a><\/i>]<\/sup> A few methods use a hybrid between the two approaches.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Noncrystalline_ceramics\">Noncrystalline ceramics<\/span><\/h3>\n<p>Noncrystalline ceramics, being glass, tend to be formed from melts. The glass is shaped when either fully molten, by casting, or when in a state of toffee-like viscosity, by methods such as blowing into a mold. If later heat treatments cause this glass to become partly crystalline, the resulting material is known as a glass-ceramic, widely used as cook-top and also as a glass composite material for nuclear waste disposal.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Properties_of_ceramics\">Properties of ceramics<\/span><\/h2>\n<p>The physical properties of any ceramic substance are a direct result of its crystalline structure and chemical composition. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solid-state_chemistry\" title=\"Solid-state chemistry\" rel=\"external_link\" target=\"_blank\">Solid-state chemistry<\/a> reveals the fundamental connection between microstructure and properties such as localized density variations, grain size distribution, type of porosity and second-phase content, which can all be correlated with ceramic properties such as mechanical strength \u03c3 by the Hall-Petch equation, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hardness\" title=\"Hardness\" rel=\"external_link\" target=\"_blank\">hardness<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toughness\" title=\"Toughness\" rel=\"external_link\" target=\"_blank\">toughness<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dielectric_constant\" class=\"mw-redirect\" title=\"Dielectric constant\" rel=\"external_link\" target=\"_blank\">dielectric constant<\/a>, and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical\" class=\"mw-redirect\" title=\"Optical\" rel=\"external_link\" target=\"_blank\">optical<\/a> properties exhibited by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transparent_materials\" class=\"mw-redirect\" title=\"Transparent materials\" rel=\"external_link\" target=\"_blank\">transparent materials<\/a>.\n<\/p><p>Physical properties of chemical compounds which provide evidence of chemical composition include odor, colour, volume, density (mass \/ volume), melting point, boiling point, heat capacity, physical form at room temperature (solid, liquid or gas), hardness, porosity, and index of refraction.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramography\" title=\"Ceramography\" rel=\"external_link\" target=\"_blank\">Ceramography<\/a> is the art and science of preparation, examination and evaluation of ceramic microstructures. Evaluation and characterization of ceramic microstructures is often implemented on similar spatial scales to that used commonly in the emerging field of nanotechnology: from tens of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angstrom\" class=\"mw-redirect\" title=\"Angstrom\" rel=\"external_link\" target=\"_blank\">angstroms<\/a> (A) to tens of micrometers (\u00b5m). This is typically somewhere between the minimum wavelength of visible light and the resolution limit of the naked eye.\n<\/p><p>The microstructure includes most grains, secondary phases, grain boundaries, pores, micro-cracks, structural defects and hardness microindentions. Most bulk mechanical, optical, thermal, electrical and magnetic properties are significantly affected by the observed microstructure. The fabrication method and process conditions are generally indicated by the microstructure. The root cause of many ceramic failures is evident in the cleaved and polished microstructure. Physical properties which constitute the field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Materials_science\" title=\"Materials science\" rel=\"external_link\" target=\"_blank\">materials science<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Engineering\" title=\"Engineering\" rel=\"external_link\" target=\"_blank\">engineering<\/a> include the following:\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Mechanical_properties\">Mechanical properties<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ultra-thin_separated_(Carborundum)_disk.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0b\/Ultra-thin_separated_%28Carborundum%29_disk.jpg\/220px-Ultra-thin_separated_%28Carborundum%29_disk.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ultra-thin_separated_(Carborundum)_disk.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Cutting disks made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_carbide\" title=\"Silicon carbide\" rel=\"external_link\" target=\"_blank\">silicon carbide<\/a><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PCCB_Brake_Carrera_GT.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/PCCB_Brake_Carrera_GT.jpg\/220px-PCCB_Brake_Carrera_GT.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PCCB_Brake_Carrera_GT.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The Porsche Carrera GT's carbon-ceramic (silicon carbide) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disc_brake\" title=\"Disc brake\" rel=\"external_link\" target=\"_blank\">disc brake<\/a><\/div><\/div><\/div>\n<p>Mechanical properties are important in structural and building materials as well as textile fabrics. They include many properties used to describe the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Strength_of_materials\" title=\"Strength of materials\" rel=\"external_link\" target=\"_blank\">strength of materials<\/a> such as: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elasticity_(physics)\" title=\"Elasticity (physics)\" rel=\"external_link\" target=\"_blank\">elasticity<\/a> \/ <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plasticity_(physics)\" title=\"Plasticity (physics)\" rel=\"external_link\" target=\"_blank\">plasticity<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tensile_strength\" class=\"mw-redirect\" title=\"Tensile strength\" rel=\"external_link\" target=\"_blank\">tensile strength<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Compressive_strength\" title=\"Compressive strength\" rel=\"external_link\" target=\"_blank\">compressive strength<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shear_strength\" title=\"Shear strength\" rel=\"external_link\" target=\"_blank\">shear strength<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fracture_toughness\" title=\"Fracture toughness\" rel=\"external_link\" target=\"_blank\">fracture toughness<\/a> & <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ductility\" title=\"Ductility\" rel=\"external_link\" target=\"_blank\">ductility<\/a> (low in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brittle\" class=\"mw-redirect\" title=\"Brittle\" rel=\"external_link\" target=\"_blank\">brittle<\/a> materials), and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Indentation_hardness\" title=\"Indentation hardness\" rel=\"external_link\" target=\"_blank\">indentation hardness<\/a>.\n<\/p><p>In modern <a href=\"https:\/\/en.wikipedia.org\/wiki\/Materials_science\" title=\"Materials science\" rel=\"external_link\" target=\"_blank\">materials science<\/a>, fracture mechanics is an important tool in improving the mechanical performance of materials and components. It applies the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physics\" title=\"Physics\" rel=\"external_link\" target=\"_blank\">physics<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stress_(mechanics)\" title=\"Stress (mechanics)\" rel=\"external_link\" target=\"_blank\">stress<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deformation_(mechanics)\" title=\"Deformation (mechanics)\" rel=\"external_link\" target=\"_blank\">strain<\/a>, in particular the theories of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elasticity_(physics)\" title=\"Elasticity (physics)\" rel=\"external_link\" target=\"_blank\">elasticity<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plasticity_(physics)\" title=\"Plasticity (physics)\" rel=\"external_link\" target=\"_blank\">plasticity<\/a>, to the microscopic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystallographic_defects\" class=\"mw-redirect\" title=\"Crystallographic defects\" rel=\"external_link\" target=\"_blank\">crystallographic defects<\/a> found in real materials in order to predict the macroscopic mechanical failure of bodies. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fractography\" title=\"Fractography\" rel=\"external_link\" target=\"_blank\">Fractography<\/a> is widely used with fracture mechanics to understand the causes of failures and also verify the theoretical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Failure\" title=\"Failure\" rel=\"external_link\" target=\"_blank\">failure<\/a> predictions with real life failures.\n<\/p><p>Ceramic materials are usually <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ionic_bond\" class=\"mw-redirect\" title=\"Ionic bond\" rel=\"external_link\" target=\"_blank\">ionic<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Covalent\" class=\"mw-redirect\" title=\"Covalent\" rel=\"external_link\" target=\"_blank\">covalent<\/a> bonded materials, and can be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystal\" title=\"Crystal\" rel=\"external_link\" target=\"_blank\">crystalline<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amorphous_solid\" title=\"Amorphous solid\" rel=\"external_link\" target=\"_blank\">amorphous<\/a>. A material held together by either type of bond will tend to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fracture#Brittle_fracture\" title=\"Fracture\" rel=\"external_link\" target=\"_blank\">fracture<\/a> before any <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_deformation\" class=\"mw-redirect\" title=\"Plastic deformation\" rel=\"external_link\" target=\"_blank\">plastic deformation<\/a> takes place, which results in poor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toughness\" title=\"Toughness\" rel=\"external_link\" target=\"_blank\">toughness<\/a> in these materials. Additionally, because these materials tend to be porous, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Porosity\" title=\"Porosity\" rel=\"external_link\" target=\"_blank\">pores<\/a> and other microscopic imperfections act as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stress_concentration\" title=\"Stress concentration\" rel=\"external_link\" target=\"_blank\">stress concentrators<\/a>, decreasing the toughness further, and reducing the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tensile_strength\" class=\"mw-redirect\" title=\"Tensile strength\" rel=\"external_link\" target=\"_blank\">tensile strength<\/a>. These combine to give <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catastrophic_failure\" title=\"Catastrophic failure\" rel=\"external_link\" target=\"_blank\">catastrophic failures<\/a>, as opposed to the normally much more gentle <a href=\"https:\/\/en.wikipedia.org\/wiki\/Failure_mode\" class=\"mw-redirect\" title=\"Failure mode\" rel=\"external_link\" target=\"_blank\">failure modes<\/a> of metals.\n<\/p><p>These materials do show <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plasticity_(physics)\" title=\"Plasticity (physics)\" rel=\"external_link\" target=\"_blank\">plastic deformation<\/a>. However, due to the rigid structure of the crystalline materials, there are very few available for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dislocation\" title=\"Dislocation\" rel=\"external_link\" target=\"_blank\">dislocations<\/a> to move, and so they deform very slowly. With the non-crystalline (glassy) materials, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Viscosity\" title=\"Viscosity\" rel=\"external_link\" target=\"_blank\">viscous<\/a> flow is the dominant source of plastic deformation, and is also very slow. It is therefore neglected in many applications of ceramic materials.\n<\/p><p>To overcome the brittle behaviour, ceramic material development has introduced the class of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_matrix_composite\" title=\"Ceramic matrix composite\" rel=\"external_link\" target=\"_blank\">ceramic matrix composite<\/a> materials, in which ceramic fibers are embedded and with specific coatings are forming fiber bridges across any crack. This mechanism substantially increases the fracture toughness of such ceramics. The ceramic disc brakes are, for example using a ceramic matrix composite material manufactured with a specific process.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Electrical_properties\">Electrical properties<\/span><\/h3>\n<h4><span class=\"mw-headline\" id=\"Semiconductors\">Semiconductors<\/span><\/h4>\n<p>Some ceramics are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semiconductor\" title=\"Semiconductor\" rel=\"external_link\" target=\"_blank\">semiconductors<\/a>. Most of these are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transition_metal_oxides\" class=\"mw-redirect\" title=\"Transition metal oxides\" rel=\"external_link\" target=\"_blank\">transition metal oxides<\/a> that are II-VI semiconductors, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zinc_oxide\" title=\"Zinc oxide\" rel=\"external_link\" target=\"_blank\">zinc oxide<\/a>.\n<\/p><p>While there are prospects of mass-producing blue <a href=\"https:\/\/en.wikipedia.org\/wiki\/LED\" class=\"mw-redirect\" title=\"LED\" rel=\"external_link\" target=\"_blank\">LEDs<\/a> from zinc oxide, ceramicists are most interested in the electrical properties that show <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grain_boundary\" title=\"Grain boundary\" rel=\"external_link\" target=\"_blank\">grain boundary<\/a> effects.\n<\/p><p>One of the most widely used of these is the varistor. These are devices that exhibit the property that resistance drops sharply at a certain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Threshold_voltage\" title=\"Threshold voltage\" rel=\"external_link\" target=\"_blank\">threshold voltage<\/a>. Once the voltage across the device reaches the threshold, there is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical_breakdown\" title=\"Electrical breakdown\" rel=\"external_link\" target=\"_blank\">breakdown<\/a> of the electrical structure in the vicinity of the grain boundaries, which results in its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical_resistance\" class=\"mw-redirect\" title=\"Electrical resistance\" rel=\"external_link\" target=\"_blank\">electrical resistance<\/a> dropping from several megohms down to a few hundred <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ohm_(unit)\" class=\"mw-redirect\" title=\"Ohm (unit)\" rel=\"external_link\" target=\"_blank\">ohms<\/a>. The major advantage of these is that they can dissipate a lot of energy, and they self-reset \u2013 after the voltage across the device drops below the threshold, its resistance returns to being high.\n<\/p><p>This makes them ideal for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surge_protector\" title=\"Surge protector\" rel=\"external_link\" target=\"_blank\">surge-protection<\/a> applications; as there is control over the threshold voltage and energy tolerance, they find use in all sorts of applications. The best demonstration of their ability can be found in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical_substation\" title=\"Electrical substation\" rel=\"external_link\" target=\"_blank\">electrical substations<\/a>, where they are employed to protect the infrastructure from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lightning\" title=\"Lightning\" rel=\"external_link\" target=\"_blank\">lightning<\/a> strikes. They have rapid response, are low maintenance, and do not appreciably degrade from use, making them virtually ideal devices for this application.\n<\/p><p>Semiconducting ceramics are also employed as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gas_sensor\" class=\"mw-redirect\" title=\"Gas sensor\" rel=\"external_link\" target=\"_blank\">gas sensors<\/a>. When various gases are passed over a polycrystalline ceramic, its electrical resistance changes. With tuning to the possible gas mixtures, very inexpensive devices can be produced.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Superconductivity\">Superconductivity<\/span><\/h4>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Magnet_4.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7d\/Magnet_4.jpg\/220px-Magnet_4.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Magnet_4.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Meissner_effect\" title=\"Meissner effect\" rel=\"external_link\" target=\"_blank\">Meissner effect<\/a> demonstrated by levitating a magnet above a cuprate superconductor, which is cooled by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liquid_nitrogen\" title=\"Liquid nitrogen\" rel=\"external_link\" target=\"_blank\">liquid nitrogen<\/a><\/div><\/div><\/div>\n<p>Under some conditions, such as extremely low temperature, some ceramics exhibit <a href=\"https:\/\/en.wikipedia.org\/wiki\/High-temperature_superconductivity\" title=\"High-temperature superconductivity\" rel=\"external_link\" target=\"_blank\">high-temperature superconductivity<\/a>. The exact reason for this is not known, but there are two major families of superconducting ceramics.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Ferroelectricity_and_supersets\">Ferroelectricity and supersets<\/span><\/h4>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Piezoelectricity\" title=\"Piezoelectricity\" rel=\"external_link\" target=\"_blank\">Piezoelectricity<\/a>, a link between electrical and mechanical response, is exhibited by a large number of ceramic materials, including the quartz used to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystal_oscillator\" title=\"Crystal oscillator\" rel=\"external_link\" target=\"_blank\">measure time<\/a> in watches and other electronics. Such devices use both properties of piezoelectrics, using electricity to produce a mechanical motion (powering the device) and then using this mechanical motion to produce electricity (generating a signal). The unit of time measured is the natural interval required for electricity to be converted into mechanical energy and back again.\n<\/p><p>The piezoelectric effect is generally stronger in materials that also exhibit <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyroelectricity\" title=\"Pyroelectricity\" rel=\"external_link\" target=\"_blank\">pyroelectricity<\/a>, and all pyroelectric materials are also piezoelectric. These materials can be used to inter convert between thermal, mechanical, or electrical energy; for instance, after synthesis in a furnace, a pyroelectric crystal allowed to cool under no applied stress generally builds up a static charge of thousands of volts. Such materials are used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Motion_sensor\" class=\"mw-redirect\" title=\"Motion sensor\" rel=\"external_link\" target=\"_blank\">motion sensors<\/a>, where the tiny rise in temperature from a warm body entering the room is enough to produce a measurable voltage in the crystal.\n<\/p><p>In turn, pyroelectricity is seen most strongly in materials which also display the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferroelectric_effect\" class=\"mw-redirect\" title=\"Ferroelectric effect\" rel=\"external_link\" target=\"_blank\">ferroelectric effect<\/a>, in which a stable electric dipole can be oriented or reversed by applying an electrostatic field. Pyroelectricity is also a necessary consequence of ferroelectricity. This can be used to store information in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferroelectric_capacitor\" title=\"Ferroelectric capacitor\" rel=\"external_link\" target=\"_blank\">ferroelectric capacitors<\/a>, elements of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferroelectric_RAM\" title=\"Ferroelectric RAM\" rel=\"external_link\" target=\"_blank\">ferroelectric RAM<\/a>.\n<\/p><p>The most common such materials are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lead_zirconate_titanate\" title=\"Lead zirconate titanate\" rel=\"external_link\" target=\"_blank\">lead zirconate titanate<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Barium_titanate\" title=\"Barium titanate\" rel=\"external_link\" target=\"_blank\">barium titanate<\/a>. Aside from the uses mentioned above, their strong piezoelectric response is exploited in the design of high-frequency <a href=\"https:\/\/en.wikipedia.org\/wiki\/Loudspeaker\" title=\"Loudspeaker\" rel=\"external_link\" target=\"_blank\">loudspeakers<\/a>, transducers for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sonar\" title=\"Sonar\" rel=\"external_link\" target=\"_blank\">sonar<\/a>, and actuators for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atomic_force_microscope\" class=\"mw-redirect\" title=\"Atomic force microscope\" rel=\"external_link\" target=\"_blank\">atomic force<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scanning_tunneling_microscope\" title=\"Scanning tunneling microscope\" rel=\"external_link\" target=\"_blank\">scanning tunneling microscopes<\/a>.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Positive_thermal_coefficient\">Positive thermal coefficient<\/span><\/h4>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Si3N4thruster.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a1\/Si3N4thruster.jpg\/220px-Si3N4thruster.jpg\" width=\"220\" height=\"58\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Si3N4thruster.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Silicon nitride rocket thruster. Left: Mounted in test stand. Right: Being tested with H<sub>2<\/sub>\/O<sub>2<\/sub> propellants<\/div><\/div><\/div>\n<p>Increases in temperature can cause grain boundaries to suddenly become insulating in some semiconducting ceramic materials, mostly mixtures of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heavy_metals\" title=\"Heavy metals\" rel=\"external_link\" target=\"_blank\">heavy metal<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanate\" title=\"Titanate\" rel=\"external_link\" target=\"_blank\">titanates<\/a>. The critical transition temperature can be adjusted over a wide range by variations in chemistry. In such materials, current will pass through the material until <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joule_heating\" title=\"Joule heating\" rel=\"external_link\" target=\"_blank\">joule heating<\/a> brings it to the transition temperature, at which point the circuit will be broken and current flow will cease. Such ceramics are used as self-controlled heating elements in, for example, the rear-window defrost circuits of automobiles.\n<\/p><p>At the transition temperature, the material's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dielectric\" title=\"Dielectric\" rel=\"external_link\" target=\"_blank\">dielectric<\/a> response becomes theoretically infinite. While a lack of temperature control would rule out any practical use of the material near its critical temperature, the dielectric effect remains exceptionally strong even at much higher temperatures. Titanates with critical temperatures far below room temperature have become synonymous with \"ceramic\" in the context of ceramic capacitors for just this reason.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Optical_properties\">Optical properties<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:152px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cermax.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0b\/Cermax.jpg\/150px-Cermax.jpg\" width=\"150\" height=\"131\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cermax.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Cermax xenon arc lamp with synthetic sapphire output window<\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Optics\" title=\"Optics\" rel=\"external_link\" target=\"_blank\">Optically transparent materials<\/a> focus on the response of a material to incoming lightwaves of a range of wavelengths. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_filter\" title=\"Optical filter\" rel=\"external_link\" target=\"_blank\">Frequency selective optical filters<\/a> can be utilized to alter or enhance the brightness and contrast of a digital image. Guided lightwave transmission via frequency selective <a href=\"https:\/\/en.wikipedia.org\/wiki\/Waveguides\" class=\"mw-redirect\" title=\"Waveguides\" rel=\"external_link\" target=\"_blank\">waveguides<\/a> involves the emerging field of fiber <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optics\" title=\"Optics\" rel=\"external_link\" target=\"_blank\">optics<\/a> and the ability of certain glassy compositions as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transmission_medium\" title=\"Transmission medium\" rel=\"external_link\" target=\"_blank\">transmission medium<\/a> for a range of frequencies simultaneously (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Multi-mode_optical_fiber\" title=\"Multi-mode optical fiber\" rel=\"external_link\" target=\"_blank\">multi-mode optical fiber<\/a>) with little or no <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adjacent-channel_interference\" title=\"Adjacent-channel interference\" rel=\"external_link\" target=\"_blank\">interference<\/a> between competing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wavelengths\" class=\"mw-redirect\" title=\"Wavelengths\" rel=\"external_link\" target=\"_blank\">wavelengths<\/a> or frequencies. This <a href=\"https:\/\/en.wikipedia.org\/wiki\/Resonant\" class=\"mw-redirect\" title=\"Resonant\" rel=\"external_link\" target=\"_blank\">resonant<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Normal_mode\" title=\"Normal mode\" rel=\"external_link\" target=\"_blank\">mode<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Energy\" title=\"Energy\" rel=\"external_link\" target=\"_blank\">energy<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Data_transmission\" title=\"Data transmission\" rel=\"external_link\" target=\"_blank\">data transmission<\/a> via electromagnetic (light) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wave_propagation\" title=\"Wave propagation\" rel=\"external_link\" target=\"_blank\">wave propagation<\/a>, though low powered, is virtually lossless. Optical waveguides are used as components in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Integrated_optical_circuit\" class=\"mw-redirect\" title=\"Integrated optical circuit\" rel=\"external_link\" target=\"_blank\">Integrated optical circuits<\/a> (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Light-emitting_diodes\" class=\"mw-redirect\" title=\"Light-emitting diodes\" rel=\"external_link\" target=\"_blank\">light-emitting diodes<\/a>, LEDs) or as the transmission medium in local and long haul <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_communication\" title=\"Optical communication\" rel=\"external_link\" target=\"_blank\">optical communication<\/a> systems. Also of value to the emerging materials scientist is the sensitivity of materials to radiation in the thermal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infrared\" title=\"Infrared\" rel=\"external_link\" target=\"_blank\">infrared<\/a> (IR) portion of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electromagnetic_spectrum\" title=\"Electromagnetic spectrum\" rel=\"external_link\" target=\"_blank\">electromagnetic spectrum<\/a>. This heat-seeking ability is responsible for such diverse optical phenomena as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Night-vision\" class=\"mw-redirect\" title=\"Night-vision\" rel=\"external_link\" target=\"_blank\">Night-vision<\/a> and IR <a href=\"https:\/\/en.wikipedia.org\/wiki\/Luminescence\" title=\"Luminescence\" rel=\"external_link\" target=\"_blank\">luminescence<\/a>.\n<\/p><p>Thus, there is an increasing need in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Military\" title=\"Military\" rel=\"external_link\" target=\"_blank\">military<\/a> sector for high-strength, robust materials which have the capability to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transmit\" class=\"mw-redirect\" title=\"Transmit\" rel=\"external_link\" target=\"_blank\">transmit<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Light\" title=\"Light\" rel=\"external_link\" target=\"_blank\">light<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Electromagnetic_waves\" class=\"mw-redirect\" title=\"Electromagnetic waves\" rel=\"external_link\" target=\"_blank\">electromagnetic waves<\/a>) in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visible_spectrum\" title=\"Visible spectrum\" rel=\"external_link\" target=\"_blank\">visible<\/a> (0.4 \u2013 0.7 micrometers) and mid-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Infrared\" title=\"Infrared\" rel=\"external_link\" target=\"_blank\">infrared<\/a> (1 \u2013 5 micrometers) regions of the spectrum. These materials are needed for applications requiring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transparency_and_translucency\" title=\"Transparency and translucency\" rel=\"external_link\" target=\"_blank\">transparent<\/a> armor, including next-generation high-speed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Missile\" title=\"Missile\" rel=\"external_link\" target=\"_blank\">missiles<\/a> and pods, as well as protection against improvised explosive devices (IED).\n<\/p><p>In the 1960s, scientists at General Electric (GE) discovered that under the right manufacturing conditions, some ceramics, especially <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium_oxide\" title=\"Aluminium oxide\" rel=\"external_link\" target=\"_blank\">aluminium oxide<\/a> (alumina), could be made <a href=\"https:\/\/en.wikipedia.org\/wiki\/Translucent\" class=\"mw-redirect\" title=\"Translucent\" rel=\"external_link\" target=\"_blank\">translucent<\/a>. These translucent materials were transparent enough to be used for containing the electrical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plasma_(physics)\" title=\"Plasma (physics)\" rel=\"external_link\" target=\"_blank\">plasma<\/a> generated in high-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Pressure\" title=\"Pressure\" rel=\"external_link\" target=\"_blank\">pressure<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium\" title=\"Sodium\" rel=\"external_link\" target=\"_blank\">sodium<\/a> street lamps. During the past two decades, additional types of transparent ceramics have been developed for applications such as nose cones for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heat-seeking\" class=\"mw-redirect\" title=\"Heat-seeking\" rel=\"external_link\" target=\"_blank\">heat-seeking<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Missiles\" class=\"mw-redirect\" title=\"Missiles\" rel=\"external_link\" target=\"_blank\">missiles<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Window\" title=\"Window\" rel=\"external_link\" target=\"_blank\">windows<\/a> for fighter <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aircraft\" title=\"Aircraft\" rel=\"external_link\" target=\"_blank\">aircraft<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scintillation_counter\" title=\"Scintillation counter\" rel=\"external_link\" target=\"_blank\">scintillation counters<\/a> for computed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tomography\" title=\"Tomography\" rel=\"external_link\" target=\"_blank\">tomography<\/a> scanners.\n<\/p><p>In the early 1970s, Thomas Soules pioneered computer modeling of light transmission through translucent ceramic alumina. His model showed that microscopic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Porosity\" title=\"Porosity\" rel=\"external_link\" target=\"_blank\">pores<\/a> in ceramic, mainly trapped at the junctions of microcrystalline <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystallite\" title=\"Crystallite\" rel=\"external_link\" target=\"_blank\">grains<\/a>, caused light to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scattering\" title=\"Scattering\" rel=\"external_link\" target=\"_blank\">scatter<\/a> and prevented true transparency. The volume fraction of these microscopic pores had to be less than 1% for high-quality optical transmission.\n<\/p><p>This is basically a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Particle_size_(grain_size)\" class=\"mw-redirect\" title=\"Particle size (grain size)\" rel=\"external_link\" target=\"_blank\">particle size<\/a> effect. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Opacity_(optics)\" title=\"Opacity (optics)\" rel=\"external_link\" target=\"_blank\">Opacity<\/a> results from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Incoherent_scattering\" class=\"mw-redirect\" title=\"Incoherent scattering\" rel=\"external_link\" target=\"_blank\">incoherent scattering<\/a> of light at surfaces and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interface_(chemistry)\" class=\"mw-redirect\" title=\"Interface (chemistry)\" rel=\"external_link\" target=\"_blank\">interfaces<\/a>. In addition to pores, most of the interfaces in a typical metal or ceramic object are in the form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grain_boundaries\" class=\"mw-redirect\" title=\"Grain boundaries\" rel=\"external_link\" target=\"_blank\">grain boundaries<\/a> which separate tiny regions of crystalline order. When the size of the scattering center (or grain boundary) is reduced below the size of the wavelength of the light being scattered, the scattering no longer occurs to any significant extent.\n<\/p><p>In the formation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polycrystalline\" class=\"mw-redirect\" title=\"Polycrystalline\" rel=\"external_link\" target=\"_blank\">polycrystalline<\/a> materials (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Metals\" class=\"mw-redirect\" title=\"Metals\" rel=\"external_link\" target=\"_blank\">metals<\/a> and ceramics) the size of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystalline\" class=\"mw-redirect\" title=\"Crystalline\" rel=\"external_link\" target=\"_blank\">crystalline<\/a> grains is determined largely by the size of the crystalline <a href=\"https:\/\/en.wiktionary.org\/wiki\/Particles\" class=\"extiw\" title=\"wiktionary:Particles\" rel=\"external_link\" target=\"_blank\">particles<\/a> present in the raw material during formation (or pressing) of the object. Moreover, the size of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grain_boundaries\" class=\"mw-redirect\" title=\"Grain boundaries\" rel=\"external_link\" target=\"_blank\">grain boundaries<\/a> scales directly with particle size. Thus a reduction of the original particle size below the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wavelength\" title=\"Wavelength\" rel=\"external_link\" target=\"_blank\">wavelength<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visible_light\" class=\"mw-redirect\" title=\"Visible light\" rel=\"external_link\" target=\"_blank\">visible light<\/a> (~ 0.5 micrometers for shortwave violet) eliminates any light <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scattering\" title=\"Scattering\" rel=\"external_link\" target=\"_blank\">scattering<\/a>, resulting in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transparency_and_translucency\" title=\"Transparency and translucency\" rel=\"external_link\" target=\"_blank\">transparent<\/a> material.\n<\/p><p>Recently<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Dates_and_numbers#Chronological_items\" title=\"Wikipedia:Manual of Style\/Dates and numbers\" rel=\"external_link\" target=\"_blank\"><span title=\"The time period mentioned near this tag is ambiguous. (March 2011)\">when?<\/span><\/a><\/i>]<\/sup>, Japanese scientists have developed techniques to produce ceramic parts that rival the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transparency_and_translucency\" title=\"Transparency and translucency\" rel=\"external_link\" target=\"_blank\">transparency<\/a> of traditional crystals (grown from a single seed) and exceed the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fracture_toughness\" title=\"Fracture toughness\" rel=\"external_link\" target=\"_blank\">fracture toughness<\/a> of a single crystal.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2011)\">citation needed<\/span><\/a><\/i>]<\/sup> In particular, scientists at the Japanese firm Konoshima Ltd., a producer of ceramic construction materials and industrial chemicals, have been looking for markets for their transparent ceramics.\n<\/p><p>Livermore researchers realized that these ceramics might greatly benefit high-powered <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lasers\" class=\"mw-redirect\" title=\"Lasers\" rel=\"external_link\" target=\"_blank\">lasers<\/a> used in the National Ignition Facility (NIF) Programs Directorate. In particular, a Livermore research team began to acquire advanced transparent ceramics from Konoshima to determine if they could meet the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical\" class=\"mw-redirect\" title=\"Optical\" rel=\"external_link\" target=\"_blank\">optical<\/a> requirements needed for Livermore\u2019s Solid-State Heat Capacity Laser (SSHCL).<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2011)\">citation needed<\/span><\/a><\/i>]<\/sup> Livermore researchers have also been testing applications of these materials for applications such as advanced drivers for laser-driven <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_fusion\" title=\"Nuclear fusion\" rel=\"external_link\" target=\"_blank\">fusion<\/a> power plants.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Examples\">Examples<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Insulator.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e8\/Insulator.jpg\/170px-Insulator.jpg\" width=\"170\" height=\"227\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Insulator.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Porcelain high-voltage insulator<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bodyarmor.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1b\/Bodyarmor.jpg\/170px-Bodyarmor.jpg\" width=\"170\" height=\"155\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bodyarmor.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Silicon carbide is used for inner plates of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ballistic_vest\" class=\"mw-redirect\" title=\"Ballistic vest\" rel=\"external_link\" target=\"_blank\">ballistic vests<\/a><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:72px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:BNcrucible.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/1\/19\/BNcrucible.jpg\" width=\"70\" height=\"85\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:BNcrucible.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Ceramic BN crucible<\/div><\/div><\/div>\n<p>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Composite_material\" title=\"Composite material\" rel=\"external_link\" target=\"_blank\">composite material<\/a> of ceramic and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal\" title=\"Metal\" rel=\"external_link\" target=\"_blank\">metal<\/a> is known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cermet\" title=\"Cermet\" rel=\"external_link\" target=\"_blank\">cermet<\/a>.\n<\/p><p>Other ceramic materials, generally requiring greater purity in their make-up than those above, include forms of several chemical compounds, including:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Barium_titanate\" title=\"Barium titanate\" rel=\"external_link\" target=\"_blank\">Barium titanate<\/a> (often mixed with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Strontium_titanate\" title=\"Strontium titanate\" rel=\"external_link\" target=\"_blank\">strontium titanate<\/a>) displays <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferroelectricity\" title=\"Ferroelectricity\" rel=\"external_link\" target=\"_blank\">ferroelectricity<\/a>, meaning that its mechanical, electrical, and thermal responses are coupled to one another and also history-dependent. It is widely used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electromechanics\" title=\"Electromechanics\" rel=\"external_link\" target=\"_blank\">electromechanical<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transducer\" title=\"Transducer\" rel=\"external_link\" target=\"_blank\">transducers<\/a>, ceramic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capacitor\" title=\"Capacitor\" rel=\"external_link\" target=\"_blank\">capacitors<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferroelectric_RAM\" title=\"Ferroelectric RAM\" rel=\"external_link\" target=\"_blank\">data storage<\/a> elements. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystallite\" title=\"Crystallite\" rel=\"external_link\" target=\"_blank\">Grain boundary<\/a> conditions can create <a href=\"https:\/\/en.wikipedia.org\/wiki\/Positive_temperature_coefficient\" class=\"mw-redirect\" title=\"Positive temperature coefficient\" rel=\"external_link\" target=\"_blank\">PTC<\/a> effects in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heating_element\" title=\"Heating element\" rel=\"external_link\" target=\"_blank\">heating elements<\/a>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bismuth_strontium_calcium_copper_oxide\" title=\"Bismuth strontium calcium copper oxide\" rel=\"external_link\" target=\"_blank\">Bismuth strontium calcium copper oxide<\/a>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/High-temperature_superconductor\" class=\"mw-redirect\" title=\"High-temperature superconductor\" rel=\"external_link\" target=\"_blank\">high-temperature superconductor<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Boron_oxide\" title=\"Boron oxide\" rel=\"external_link\" target=\"_blank\">Boron oxide<\/a> is used in body armour.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Boron_nitride\" title=\"Boron nitride\" rel=\"external_link\" target=\"_blank\">Boron nitride<\/a> is structurally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isoelectronic\" class=\"mw-redirect\" title=\"Isoelectronic\" rel=\"external_link\" target=\"_blank\">isoelectronic<\/a> to carbon and takes on similar physical forms: a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Graphite\" title=\"Graphite\" rel=\"external_link\" target=\"_blank\">graphite<\/a>-like one used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lubricant\" title=\"Lubricant\" rel=\"external_link\" target=\"_blank\">lubricant<\/a>, and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diamond\" title=\"Diamond\" rel=\"external_link\" target=\"_blank\">diamond<\/a>-like one used as an abrasive.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Earthenware\" title=\"Earthenware\" rel=\"external_link\" target=\"_blank\">Earthenware<\/a> used for domestic ware such as plates and mugs.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferrite_(magnet)\" title=\"Ferrite (magnet)\" rel=\"external_link\" target=\"_blank\">Ferrite<\/a> is used in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_core\" title=\"Magnetic core\" rel=\"external_link\" target=\"_blank\">magnetic cores<\/a> of electrical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transformer\" title=\"Transformer\" rel=\"external_link\" target=\"_blank\">transformers<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_core_memory\" class=\"mw-redirect\" title=\"Magnetic core memory\" rel=\"external_link\" target=\"_blank\">magnetic core memory<\/a>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lead_zirconate_titanate\" title=\"Lead zirconate titanate\" rel=\"external_link\" target=\"_blank\">Lead zirconate titanate<\/a> (PZT) was developed at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Institute_of_Standards_and_Technology\" title=\"National Institute of Standards and Technology\" rel=\"external_link\" target=\"_blank\">National Bureau of Standards<\/a> in 1954. PZT is used as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasonic_sensor\" class=\"mw-redirect\" title=\"Ultrasonic sensor\" rel=\"external_link\" target=\"_blank\">ultrasonic transducer<\/a>, as its piezoelectric properties greatly exceed those of Rochelle salt.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium_diboride\" title=\"Magnesium diboride\" rel=\"external_link\" target=\"_blank\">Magnesium diboride<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium\" title=\"Magnesium\" rel=\"external_link\" target=\"_blank\">Mg<\/a>B<sub>2<\/sub>) is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Unconventional_superconductor\" title=\"Unconventional superconductor\" rel=\"external_link\" target=\"_blank\">unconventional superconductor<\/a>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Porcelain\" title=\"Porcelain\" rel=\"external_link\" target=\"_blank\">Porcelain<\/a> is used for a wide range of household and industrial products.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sialon\" title=\"Sialon\" rel=\"external_link\" target=\"_blank\">Sialon<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_Aluminium_Oxynitride\" class=\"mw-redirect\" title=\"Silicon Aluminium Oxynitride\" rel=\"external_link\" target=\"_blank\">Silicon Aluminium Oxynitride<\/a>) has high strength; resistance to thermal shock, chemical and wear resistance, and low density. These ceramics are used in non-ferrous molten metal handling, weld pins and the chemical industry.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_carbide\" title=\"Silicon carbide\" rel=\"external_link\" target=\"_blank\">Silicon carbide<\/a> (SiC) is used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Susceptor\" title=\"Susceptor\" rel=\"external_link\" target=\"_blank\">susceptor<\/a> in microwave furnaces, a commonly used abrasive, and as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refraction_(metallurgy)\" title=\"Refraction (metallurgy)\" rel=\"external_link\" target=\"_blank\">refractory<\/a> material.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_nitride\" title=\"Silicon nitride\" rel=\"external_link\" target=\"_blank\">Silicon nitride<\/a> (Si<sub>3<\/sub><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nitrogen\" title=\"Nitrogen\" rel=\"external_link\" target=\"_blank\">N<\/a><sub>4<\/sub>) is used as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abrasive\" title=\"Abrasive\" rel=\"external_link\" target=\"_blank\">abrasive<\/a> powder.<\/li>\n<li>Steatite (magnesium silicates) is used as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical_insulator\" class=\"mw-redirect\" title=\"Electrical insulator\" rel=\"external_link\" target=\"_blank\">electrical insulator<\/a>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_carbide\" title=\"Titanium carbide\" rel=\"external_link\" target=\"_blank\">Titanium carbide<\/a> Used in space shuttle re-entry shields and scratchproof watches.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Uranium_oxide\" title=\"Uranium oxide\" rel=\"external_link\" target=\"_blank\">Uranium oxide<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Uranium\" title=\"Uranium\" rel=\"external_link\" target=\"_blank\">U<\/a>O<sub>2<\/sub>), used as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_fuel\" title=\"Nuclear fuel\" rel=\"external_link\" target=\"_blank\">fuel<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_reactor\" title=\"Nuclear reactor\" rel=\"external_link\" target=\"_blank\">nuclear reactors<\/a>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Yttrium_barium_copper_oxide\" title=\"Yttrium barium copper oxide\" rel=\"external_link\" target=\"_blank\">Yttrium barium copper oxide<\/a> (Y<a href=\"https:\/\/en.wikipedia.org\/wiki\/Barium\" title=\"Barium\" rel=\"external_link\" target=\"_blank\">Ba<\/a><sub>2<\/sub><a href=\"https:\/\/en.wikipedia.org\/wiki\/Copper\" title=\"Copper\" rel=\"external_link\" target=\"_blank\">Cu<\/a><sub>3<\/sub><a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen\" title=\"Oxygen\" rel=\"external_link\" target=\"_blank\">O<\/a><sub>7\u2212x<\/sub>), another high temperature <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superconductivity\" title=\"Superconductivity\" rel=\"external_link\" target=\"_blank\">superconductor<\/a>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Zinc_oxide\" title=\"Zinc oxide\" rel=\"external_link\" target=\"_blank\">Zinc oxide<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Zinc\" title=\"Zinc\" rel=\"external_link\" target=\"_blank\">Zn<\/a>O), which is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semiconductor\" title=\"Semiconductor\" rel=\"external_link\" target=\"_blank\">semiconductor<\/a>, and used in the construction of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Varistor\" title=\"Varistor\" rel=\"external_link\" target=\"_blank\">varistors<\/a>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Zirconium_dioxide\" title=\"Zirconium dioxide\" rel=\"external_link\" target=\"_blank\">Zirconium dioxide<\/a> (zirconia), which in pure form undergoes many <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phase_transition\" title=\"Phase transition\" rel=\"external_link\" target=\"_blank\">phase changes<\/a> between room temperature and practical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sintering\" title=\"Sintering\" rel=\"external_link\" target=\"_blank\">sintering<\/a> temperatures, can be chemically \"stabilized\" in several different forms. Its high oxygen <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ion_conductivity\" class=\"mw-redirect\" title=\"Ion conductivity\" rel=\"external_link\" target=\"_blank\">ion conductivity<\/a> recommends it for use in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fuel_cell\" title=\"Fuel cell\" rel=\"external_link\" target=\"_blank\">fuel cells<\/a> and automotive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen_sensor\" title=\"Oxygen sensor\" rel=\"external_link\" target=\"_blank\">oxygen sensors<\/a>. In another variant, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metastable\" class=\"mw-redirect\" title=\"Metastable\" rel=\"external_link\" target=\"_blank\">metastable<\/a> structures can impart <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fracture_toughness\" title=\"Fracture toughness\" rel=\"external_link\" target=\"_blank\">transformation toughening<\/a> for mechanical applications; most <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_knife\" title=\"Ceramic knife\" rel=\"external_link\" target=\"_blank\">ceramic knife<\/a> blades are made of this material.<\/li>\n<li>Partially stabilised zirconia (PSZ) is much less brittle than other ceramics and is used for metal forming tools, valves and liners, abrasive slurries, kitchen knives and bearings subject to severe abrasion.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li><\/ul>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CeramicKnife1.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b6\/CeramicKnife1.jpg\/220px-CeramicKnife1.jpg\" width=\"220\" height=\"58\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CeramicKnife1.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Kitchen knife with a ceramic blade<\/div><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Ceramic_products\">Ceramic products<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"By_usage\">By usage<\/span><\/h3>\n<p>For convenience, ceramic products are usually divided into four main types; these are shown below with some examples:\n<\/p>\n<ul><li>Structural, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brick\" title=\"Brick\" rel=\"external_link\" target=\"_blank\">bricks<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pipe_(material)\" class=\"mw-redirect\" title=\"Pipe (material)\" rel=\"external_link\" target=\"_blank\">pipes<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flooring\" title=\"Flooring\" rel=\"external_link\" target=\"_blank\">floor<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Roof_tile\" class=\"mw-redirect\" title=\"Roof tile\" rel=\"external_link\" target=\"_blank\">roof tiles<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Refractory\" title=\"Refractory\" rel=\"external_link\" target=\"_blank\">Refractories<\/a>, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kiln\" title=\"Kiln\" rel=\"external_link\" target=\"_blank\">kiln<\/a> linings, gas fire radiants, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Steel\" title=\"Steel\" rel=\"external_link\" target=\"_blank\">steel<\/a> and glass making crucibles<\/li>\n<li>Whitewares, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tableware\" title=\"Tableware\" rel=\"external_link\" target=\"_blank\">tableware<\/a>, cookware, wall tiles, pottery products and sanitary ware<sup id=\"rdp-ebb-cite_ref-whiteware_10-0\" class=\"reference\"><a href=\"#cite_note-whiteware-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li>Technical, also known as engineering, advanced, special, and fine ceramics. Such items include:\n<ul><li>gas burner <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nozzle\" title=\"Nozzle\" rel=\"external_link\" target=\"_blank\">nozzles<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ballistic_vest\" class=\"mw-redirect\" title=\"Ballistic vest\" rel=\"external_link\" target=\"_blank\">ballistic protection<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vehicle_armour\" title=\"Vehicle armour\" rel=\"external_link\" target=\"_blank\">vehicle armour<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_fuel\" title=\"Nuclear fuel\" rel=\"external_link\" target=\"_blank\">nuclear fuel<\/a> uranium oxide pellets<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">biomedical implants<\/a><\/li>\n<li>coatings of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jet_engine\" title=\"Jet engine\" rel=\"external_link\" target=\"_blank\">jet engine<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Turbine\" title=\"Turbine\" rel=\"external_link\" target=\"_blank\">turbine<\/a> blades<\/li>\n<li>ceramic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disk_brake\" class=\"mw-redirect\" title=\"Disk brake\" rel=\"external_link\" target=\"_blank\">disk brake<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Missile\" title=\"Missile\" rel=\"external_link\" target=\"_blank\">missile<\/a> nose cones<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bearing_(mechanical)\" title=\"Bearing (mechanical)\" rel=\"external_link\" target=\"_blank\">bearing (mechanical)<\/a><\/li>\n<li>tiles used in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Space_Shuttle_program\" title=\"Space Shuttle program\" rel=\"external_link\" target=\"_blank\">Space Shuttle program<\/a><\/li><\/ul><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Ceramics_made_with_clay\">Ceramics made with clay<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pottery\" title=\"Pottery\" rel=\"external_link\" target=\"_blank\">Pottery<\/a><\/div>\n<p>Frequently, the raw materials of modern ceramics do not include clays.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\nThose that do are classified as follows:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Earthenware\" title=\"Earthenware\" rel=\"external_link\" target=\"_blank\">Earthenware<\/a>, fired at lower temperatures than other types<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Stoneware\" title=\"Stoneware\" rel=\"external_link\" target=\"_blank\">Stoneware<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vitrification#In_ceramics\" title=\"Vitrification\" rel=\"external_link\" target=\"_blank\">vitreous<\/a> or semi-vitreous<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Porcelain\" title=\"Porcelain\" rel=\"external_link\" target=\"_blank\">Porcelain<\/a>, which contains a high content of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kaolin\" class=\"mw-redirect\" title=\"Kaolin\" rel=\"external_link\" target=\"_blank\">kaolin<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_china\" title=\"Bone china\" rel=\"external_link\" target=\"_blank\">Bone china<\/a><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Classification_of_ceramics\">Classification of ceramics<\/span><\/h3>\n<p>Ceramics can also be classified into three distinct material categories: \n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxide\" title=\"Oxide\" rel=\"external_link\" target=\"_blank\">Oxides<\/a>: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alumina\" class=\"mw-redirect\" title=\"Alumina\" rel=\"external_link\" target=\"_blank\">alumina<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Beryllia\" class=\"mw-redirect\" title=\"Beryllia\" rel=\"external_link\" target=\"_blank\">beryllia<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceria\" class=\"mw-redirect\" title=\"Ceria\" rel=\"external_link\" target=\"_blank\">ceria<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zirconia\" class=\"mw-redirect\" title=\"Zirconia\" rel=\"external_link\" target=\"_blank\">zirconia<\/a><\/li>\n<li>Non-oxides: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbide\" title=\"Carbide\" rel=\"external_link\" target=\"_blank\">carbide<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boride\" title=\"Boride\" rel=\"external_link\" target=\"_blank\">boride<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nitride\" title=\"Nitride\" rel=\"external_link\" target=\"_blank\">nitride<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicide\" title=\"Silicide\" rel=\"external_link\" target=\"_blank\">silicide<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Composite_material\" title=\"Composite material\" rel=\"external_link\" target=\"_blank\">Composite materials<\/a>: particulate reinforced, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_matrix_composite\" title=\"Ceramic matrix composite\" rel=\"external_link\" target=\"_blank\">fiber reinforced<\/a>, combinations of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxide\" title=\"Oxide\" rel=\"external_link\" target=\"_blank\">oxides<\/a> and nonoxides.<\/li><\/ul>\n<p>Each one of these classes can be developed into unique material properties because ceramics tend to be crystalline.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<ul><li>Knife blades: the blade of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_knife\" title=\"Ceramic knife\" rel=\"external_link\" target=\"_blank\">ceramic knife<\/a> will stay sharp for much longer than that of a steel knife, although it is more brittle and can snap.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Disk_brake\" class=\"mw-redirect\" title=\"Disk brake\" rel=\"external_link\" target=\"_blank\">Carbon-ceramic brake disks<\/a> for vehicles are resistant to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brake_fade\" title=\"Brake fade\" rel=\"external_link\" target=\"_blank\">brake fade<\/a> at high temperatures.<\/li>\n<li>Advanced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Composite_armour\" title=\"Composite armour\" rel=\"external_link\" target=\"_blank\">composite ceramic and metal matrices<\/a> have been designed for most modern <a href=\"https:\/\/en.wikipedia.org\/wiki\/Armoured_fighting_vehicles\" class=\"mw-redirect\" title=\"Armoured fighting vehicles\" rel=\"external_link\" target=\"_blank\">armoured fighting vehicles<\/a> because they offer superior penetrating resistance against <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shaped_charge\" title=\"Shaped charge\" rel=\"external_link\" target=\"_blank\">shaped charges<\/a> (such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/High_explosive_anti-tank\" class=\"mw-redirect\" title=\"High explosive anti-tank\" rel=\"external_link\" target=\"_blank\">HEAT<\/a> rounds) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kinetic_energy_penetrator\" title=\"Kinetic energy penetrator\" rel=\"external_link\" target=\"_blank\">kinetic energy penetrators<\/a>.<\/li>\n<li>Ceramics such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alumina\" class=\"mw-redirect\" title=\"Alumina\" rel=\"external_link\" target=\"_blank\">alumina<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boron_carbide\" title=\"Boron carbide\" rel=\"external_link\" target=\"_blank\">boron carbide<\/a> have been used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bulletproof_vest\" title=\"Bulletproof vest\" rel=\"external_link\" target=\"_blank\">ballistic armored vests<\/a> to repel high-velocity <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rifle\" title=\"Rifle\" rel=\"external_link\" target=\"_blank\">rifle<\/a> fire. Such plates are known commonly as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Small_Arms_Protective_Insert\" title=\"Small Arms Protective Insert\" rel=\"external_link\" target=\"_blank\">small arms protective inserts<\/a>, or SAPIs. Similar material is used to protect the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cockpit_(aviation)\" class=\"mw-redirect\" title=\"Cockpit (aviation)\" rel=\"external_link\" target=\"_blank\">cockpits<\/a> of some military airplanes, because of the low weight of the material.<\/li>\n<li>Ceramics can be used in place of steel for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ball_bearing\" title=\"Ball bearing\" rel=\"external_link\" target=\"_blank\">ball bearings<\/a>. Their higher hardness means they are much less susceptible to wear and typically last for triple the lifetime of a steel part. They also deform less under load, meaning they have less contact with the bearing retainer walls and can roll faster. In very high speed applications, heat from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Friction\" title=\"Friction\" rel=\"external_link\" target=\"_blank\">friction<\/a> during rolling can cause problems for metal bearings, which are reduced by the use of ceramics. Ceramics are also more chemically resistant and can be used in wet environments where steel bearings would rust. In some cases, their electricity-insulating properties may also be valuable in bearings. Two drawbacks to ceramic bearings are a significantly higher cost and susceptibility to damage under shock loads.<\/li>\n<li>In the early 1980s, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toyota\" title=\"Toyota\" rel=\"external_link\" target=\"_blank\">Toyota<\/a> researched production of an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adiabatic\" class=\"mw-redirect\" title=\"Adiabatic\" rel=\"external_link\" target=\"_blank\">adiabatic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Internal_combustion_engine\" title=\"Internal combustion engine\" rel=\"external_link\" target=\"_blank\">engine<\/a> using ceramic components in the hot gas area. The ceramics would have allowed temperatures of over 3000 \u00b0F (1650 \u00b0C). The expected advantages would have been lighter materials and a smaller cooling system (or no need for one at all), leading to a major weight reduction. The expected increase of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fuel_efficiency\" title=\"Fuel efficiency\" rel=\"external_link\" target=\"_blank\">fuel efficiency<\/a> of the engine (caused by the higher temperature, as shown by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carnot_heat_engine\" title=\"Carnot heat engine\" rel=\"external_link\" target=\"_blank\">Carnot's<\/a> theorem) could not be verified experimentally; it was found that the heat transfer on the hot ceramic cylinder walls was higher than the transfer to a cooler metal wall as the cooler gas film on the metal surface works as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_insulator\" class=\"mw-redirect\" title=\"Thermal insulator\" rel=\"external_link\" target=\"_blank\">thermal insulator<\/a>. Thus, despite all of these desirable properties, such engines have not succeeded in production because of costs for the ceramic components and the limited advantages. (Small imperfections in the ceramic material with its low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fracture_toughness\" title=\"Fracture toughness\" rel=\"external_link\" target=\"_blank\">fracture toughness<\/a> lead to cracks, which can lead to potentially dangerous equipment failure.) Such engines are possible in laboratory settings, but mass production is not feasible with current technology.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"Where are any other references to Toyota's work? (July 2009)\">citation needed<\/span><\/a><\/i>]<\/sup><\/li>\n<li>Work is being done in developing ceramic parts for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gas_turbine\" title=\"Gas turbine\" rel=\"external_link\" target=\"_blank\">gas turbine<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heat_engine\" title=\"Heat engine\" rel=\"external_link\" target=\"_blank\">engines<\/a>. Currently, even blades made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superalloy\" title=\"Superalloy\" rel=\"external_link\" target=\"_blank\">advanced metal alloys<\/a> used in the engines' hot section require cooling and careful limiting of operating temperatures. Turbine engines made with ceramics could operate more efficiently, giving aircraft greater range and payload for a set amount of fuel.<\/li>\n<li>Recent advances have been made in ceramics which include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioceramic\" title=\"Bioceramic\" rel=\"external_link\" target=\"_blank\">bioceramics<\/a>, such as dental implants and synthetic bones. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxyapatite\" title=\"Hydroxyapatite\" rel=\"external_link\" target=\"_blank\">Hydroxyapatite<\/a>, the natural mineral component of bone, has been made synthetically from a number of biological and chemical sources and can be formed into ceramic materials. Orthopedic implants coated with these materials bond readily to bone and other tissues in the body without rejection or inflammatory reactions so are of great interest for gene delivery and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_engineering\" title=\"Tissue engineering\" rel=\"external_link\" target=\"_blank\">tissue engineering<\/a> scaffolds. Most hydroxyapatite ceramics are very porous and lack mechanical strength, and are used to coat metal orthopedic devices to aid in forming a bond to bone or as bone fillers. They are also used as fillers for orthopedic plastic screws to aid in reducing the inflammation and increase absorption of these plastic materials. Work is being done to make strong, fully dense nanocrystalline hydroxyapatite ceramic materials for orthopedic weight bearing devices, replacing foreign metal and plastic orthopedic materials with a synthetic, but naturally occurring, bone mineral. Ultimately, these ceramic materials may be used as bone replacements or with the incorporation of protein <a href=\"https:\/\/en.wikipedia.org\/wiki\/Collagen\" title=\"Collagen\" rel=\"external_link\" target=\"_blank\">collagens<\/a>, synthetic bones.<\/li>\n<li>Durable actinide-containing ceramic materials have many applications such as in nuclear fuels for burning excess Pu and in chemically-inert sources of alpha irradiation for power supply of unmanned space vehicles or to produce electricity for microelectronic devices. Both use and disposal of radioactive actinides require their immobilisation in a durable host material. Nuclear waste long-lived radionuclides such as actinides are immobilised using chemically-durable crystalline materials based on polycrystalline ceramics and large single crystals.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><\/li><\/ul>\n<ul><li>High-tech ceramic is used in watchmaking for producing watch cases. The material is valued by watchmakers for its light weight, scratch resistance, durability and smooth touch. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Watch_Company\" title=\"International Watch Company\" rel=\"external_link\" target=\"_blank\">IWC<\/a> is one of the brands that initiated the use of ceramic in watchmaking.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Ceramics_in_archaeology\">Ceramics in archaeology<\/span><\/h2>\n<p>Ceramic artifacts have an important role in archaeology for understanding the culture, technology and behavior of peoples of the past. They are among the most common artifacts to be found at an archaeological site, generally in the form of small fragments of broken pottery called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sherd\" title=\"Sherd\" rel=\"external_link\" target=\"_blank\">sherds<\/a>. Processing of collected sherds can be consistent with two main types of analysis: technical and traditional.\n<\/p><p>Traditional analysis involves sorting ceramic artifacts, sherds and larger fragments into specific types based on style, composition, manufacturing and morphology. By creating these typologies it is possible to distinguish between different cultural styles, the purpose of the ceramic and technological state of the people among other conclusions. In addition, by looking at stylistic changes of ceramics over time is it possible to separate (seriate) the ceramics into distinct diagnostic groups (assemblages). A comparison of ceramic artifacts with known dated assemblages allows for a chronological assignment of these pieces.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>The technical approach to ceramic analysis involves a finer examination of the composition of ceramic artifacts and sherds to determine the source of the material and through this the possible manufacturing site. Key criteria are the composition of the clay and the temper used in the manufacture of the article under study: temper is a material added to the clay during the initial production stage, and it is used to aid the subsequent drying process. Types of temper include shell pieces, granite fragments and ground sherd pieces called 'grog'. Temper is usually identified by microscopic examination of the temper material. Clay identification is determined by a process of refiring the ceramic, and assigning a color to it using Munsell Soil Color notation. By estimating both the clay and temper compositions, and locating a region where both are known to occur, an assignment of the material source can be made. From the source assignment of the artifact further investigations can be made into the site of manufacture.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_chemistry\" title=\"Ceramic chemistry\" rel=\"external_link\" target=\"_blank\">Ceramic chemistry<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_engineering\" title=\"Ceramic engineering\" rel=\"external_link\" target=\"_blank\">Ceramic engineering<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_nanoparticle\" title=\"Ceramic nanoparticle\" rel=\"external_link\" target=\"_blank\">Ceramic nanoparticle<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_matrix_composite\" title=\"Ceramic matrix composite\" rel=\"external_link\" target=\"_blank\">Ceramic matrix composite<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_art\" title=\"Ceramic art\" rel=\"external_link\" target=\"_blank\">Ceramic art<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Black, J. T.; Kohser, R. A. (2012). <i>DeGarmo's materials and processes in manufacturing<\/i>. Wiley. p. 226. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-470-92467-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=DeGarmo%27s+materials+and+processes+in+manufacturing&rft.pages=226&rft.pub=Wiley&rft.date=2012&rft.isbn=978-0-470-92467-9&rft.au=Black%2C+J.+T.&rft.au=Kohser%2C+R.+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACeramic\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Carter, C. B.; Norton, M. G. (2007). <i>Ceramic materials: Science and engineering<\/i>. Springer. pp. 3 & 4. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-387-46271-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Ceramic+materials%3A+Science+and+engineering&rft.pages=3+%26+4&rft.pub=Springer&rft.date=2007&rft.isbn=978-0-387-46271-4&rft.au=Carter%2C+C.+B.&rft.au=Norton%2C+M.+G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACeramic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Carter, C. B.; Norton, M. G. (2007). <i>Ceramic materials: Science and engineering<\/i>. Springer. pp. 20 & 21. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-387-46271-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Ceramic+materials%3A+Science+and+engineering&rft.pages=20+%26+21&rft.pub=Springer&rft.date=2007&rft.isbn=978-0-387-46271-4&rft.au=Carter%2C+C.+B.&rft.au=Norton%2C+M.+G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACeramic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.perseus.tufts.edu\/hopper\/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dkeramiko%2Fs\" target=\"_blank\">\u03ba\u03b5\u03c1\u03b1\u03bc\u03b9\u03ba\u03cc\u03c2<\/a>, Henry George Liddell, Robert Scott, <i>A Greek-English Lexicon<\/i>, on Perseus Digital Library<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.perseus.tufts.edu\/hopper\/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dke%2Framos\" target=\"_blank\">\u03ba\u03ad\u03c1\u03b1\u03bc\u03bf\u03c2<\/a>, Henry George Liddell, Robert Scott, <i>A Greek-English Lexicon<\/i>, on Perseus Digital Library<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.palaeolexicon.com\/default.aspx?static=12&wid=383\" target=\"_blank\">Palaeolexicon<\/a>, Word study tool of ancient languages<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFReference-OED-ceramic\" class=\"citation\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/oed.com\/search?searchType=dictionary&q=ceramic\" target=\"_blank\">\"ceramic\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxford_English_Dictionary\" title=\"Oxford English Dictionary\" rel=\"external_link\" target=\"_blank\">Oxford English Dictionary<\/a><\/i> (3rd ed.). Oxford University Press. September 2005.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=ceramic&rft.btitle=Oxford+English+Dictionary&rft.edition=3rd&rft.pub=Oxford+University+Press&rft.date=2005-09&rft_id=http%3A%2F%2Foed.com%2Fsearch%3FsearchType%3Ddictionary%26q%3Dceramic&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACeramic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> <span style=\"font-size:0.95em; font-size:90%; color:#555\">(Subscription or <a rel=\"external_link\" class=\"external text\" href=\"#public\">UK public library membership<\/a> required.)<\/span><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Wachtman, John B., Jr. (ed.) (1999) <i>Ceramic Innovations in the 20th century<\/i>, The American Ceramic Society. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-57498-093-6.<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Garvie, R. C.; Hannink, R. H.; Pascoe, R. T. (1975). \"Ceramic steel?\". <i>Nature<\/i>. <b>258<\/b> (5537): 703\u2013704. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/1975Natur.258..703G\" target=\"_blank\">1975Natur.258..703G<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2F258703a0\" target=\"_blank\">10.1038\/258703a0<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature&rft.atitle=Ceramic+steel%3F&rft.volume=258&rft.issue=5537&rft.pages=703-704&rft.date=1975&rft_id=info%3Adoi%2F10.1038%2F258703a0&rft_id=info%3Abibcode%2F1975Natur.258..703G&rft.aulast=Garvie&rft.aufirst=R.+C.&rft.au=Hannink%2C+R.+H.&rft.au=Pascoe%2C+R.+T.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACeramic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-whiteware-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-whiteware_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.britannica.com\/art\/whiteware\" target=\"_blank\">\"Whiteware Pottery\"<\/a>. <i>Encyclop\u00e6dia Britannica<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">30 June<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Encyclop%C3%A6dia+Britannica&rft.atitle=Whiteware+Pottery&rft_id=http%3A%2F%2Fwww.britannica.com%2Fart%2Fwhiteware&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACeramic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Geiger, Greg. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060815173829\/http:\/\/www.newi.ac.uk\/buckleyc\/ceramics.htm\" target=\"_blank\">Introduction To Ceramics<\/a>, American Ceramic Society<\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">B.E. Burakov, M.I Ojovan, W.E. Lee. Crystalline Materials for Actinide Immobilisation, Imperial College Press, London, 198 pp. (2010).\n<a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.worldscientific.com\/worldscibooks\/10.1142\/p652\" target=\"_blank\">http:\/\/www.worldscientific.com\/worldscibooks\/10.1142\/p652<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ablogtowatch.com\/watch-case-materials-explained-ceramic\/\" target=\"_blank\">\"Watch Case Materials Explained: Ceramic | aBlogtoWatch\"<\/a>. <i>aBlogtoWatch<\/i>. 18 April 2012.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=aBlogtoWatch&rft.atitle=Watch+Case+Materials+Explained%3A+Ceramic+%7C+aBlogtoWatch&rft.date=2012-04-18&rft_id=http%3A%2F%2Fwww.ablogtowatch.com%2Fwatch-case-materials-explained-ceramic%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACeramic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Mississippi Valley Archaeological Center, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.uwlax.edu\/mvac\/processarch\/processarch\/lab_ceramic.html\" target=\"_blank\">Ceramic Analysis<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120603053406\/http:\/\/www.uwlax.edu\/mvac\/processarch\/processarch\/lab_ceramic.html\" target=\"_blank\">Archived<\/a> June 3, 2012, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>., Retrieved 04-11-12<\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite id=\"rdp-ebb-CITEREFGuy1986\" class=\"citation book\">Guy, John (1986). Guy, John, ed. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=GxrrAAAAMAAJ\" target=\"_blank\"><i>Oriental trade ceramics in South-East Asia, ninth to sixteenth centuries: with a catalogue of Chinese, Vietnamese and Thai wares in Australian collections<\/i><\/a> (illustrated, revised ed.). Oxford University Press<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">24 April<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Oriental+trade+ceramics+in+South-East+Asia%2C+ninth+to+sixteenth+centuries%3A+with+a+catalogue+of+Chinese%2C+Vietnamese+and+Thai+wares+in+Australian+collections&rft.edition=illustrated%2C+revised&rft.pub=Oxford+University+Press&rft.date=1986&rft.aulast=Guy&rft.aufirst=John&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DGxrrAAAAMAAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACeramic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/donsmaps.com\/dolnivenus.html\" target=\"_blank\">Dolni Vestonice Venus<\/a>- Oldest known Ceramic statuette of a nude female figure dated to 29 000 \u2013 25 000 BP (Gravettian industry. Czech Republic<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080412091856\/http:\/\/www.gardinermuseum.on.ca\/default_noflash.aspx\" target=\"_blank\">The Gardiner Museum<\/a> \u2013 The only museum in Canada entirely devoted to ceramics<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/matse1.mse.uiuc.edu\/ceramics\/ceramics.html\" target=\"_blank\">Introduction, Scientific Principles, Properties and Processing of Ceramics<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.azom.com\/details.asp?ArticleID=2123\" target=\"_blank\">Advanced Ceramics<\/a> \u2013 The Evolution, Classification, Properties, Production, Firing, Finishing and Design of Advanced Ceramics<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/cerameunie.eu\/\" target=\"_blank\">Cerame-Unie, aisbl<\/a> \u2013 The European Ceramic Industry Association<\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1329\nCached time: 20181217064853\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.472 seconds\nReal time usage: 0.612 seconds\nPreprocessor visited node count: 2007\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 38292\/2097152 bytes\nTemplate argument size: 3165\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 12\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 24457\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.225\/10.000 seconds\nLua memory usage: 4.74 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 471.841 1 -total\n<\/p>\n<pre>48.54% 229.039 1 Template:Reflist\n17.75% 83.752 4 Template:Cite_book\n14.47% 68.295 5 Template:Fix\n 9.48% 44.720 1 Template:Unreferenced_section\n 9.08% 42.866 1 Template:Cite_journal\n 8.80% 41.511 1 Template:About\n 8.40% 39.637 1 Template:Authority_control\n 8.10% 38.199 1 Template:Unreferenced\n 7.74% 36.544 5 Template:Delink\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:6458-1!canonical and timestamp 20181217064852 and revision id 873946924\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_materials\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212214\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.179 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 171.794 1 - wikipedia:Ceramic_materials\n100.00% 171.794 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8389-0!*!*!*!*!*!* and timestamp 20181217212214 and revision id 24623\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Ceramic_materials\">https:\/\/www.limswiki.org\/index.php\/Ceramic_materials<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","a5eaf6574cad0e6921d65c5f2248e0fe_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4f\/Blue_and_white_vase_Jingdezhen_Ming_Yongle_1403_1424.jpg\/440px-Blue_and_white_vase_Jingdezhen_Ming_Yongle_1403_1424.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/64\/Si3N4bearings.jpg\/440px-Si3N4bearings.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/85\/Firebrick_electric_furnace_ceramic_fibre_gasket.jpg\/440px-Firebrick_electric_furnace_ceramic_fibre_gasket.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/20\/Israel-2013-Jerusalem-Temple_Mount-Dome_of_the_Rock-Detail_01.jpg\/440px-Israel-2013-Jerusalem-Temple_Mount-Dome_of_the_Rock-Detail_01.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/eb\/Spherical_Hanging_Ornament%2C_1575-1585.jpg\/440px-Spherical_Hanging_Ornament%2C_1575-1585.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2c\/Bridge_from_dental_porcelain.jpg\/440px-Bridge_from_dental_porcelain.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ab\/Ceramic_fractured_SEM.TIF\/lossy-page1-440px-Ceramic_fractured_SEM.TIF.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0b\/Ultra-thin_separated_%28Carborundum%29_disk.jpg\/440px-Ultra-thin_separated_%28Carborundum%29_disk.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/PCCB_Brake_Carrera_GT.jpg\/440px-PCCB_Brake_Carrera_GT.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7d\/Magnet_4.jpg\/440px-Magnet_4.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a1\/Si3N4thruster.jpg\/440px-Si3N4thruster.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0b\/Cermax.jpg\/300px-Cermax.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e8\/Insulator.jpg\/340px-Insulator.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1b\/Bodyarmor.jpg\/340px-Bodyarmor.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/1\/19\/BNcrucible.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b6\/CeramicKnife1.jpg\/440px-CeramicKnife1.jpg"],"a5eaf6574cad0e6921d65c5f2248e0fe_timestamp":1545081734,"ad3e131c6031fddd4da24326304bd5a5_type":"article","ad3e131c6031fddd4da24326304bd5a5_title":"Calcium phosphate","ad3e131c6031fddd4da24326304bd5a5_url":"https:\/\/www.limswiki.org\/index.php\/Calcium_phosphate","ad3e131c6031fddd4da24326304bd5a5_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCalcium phosphate\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor the function of calcium phosphate in organisms, see Calcium metabolism.\nCalcium phosphate is a family of materials and minerals containing calcium ions (Ca2+) together with inorganic phosphate anions. Some so-called calcium phosphates contain oxide and hydroxide as well. They are white solids of nutritious value.[1]\n\nContents \n\n1 Orthophosphates, di- and monohydrogen phosphates \n2 Di- and polyphosphates \n3 Hydroxy- and oxo-phosphates \n4 Overview \n5 References \n\n\n Orthophosphates, di- and monohydrogen phosphates \nThese materials contain Ca2+ combined with PO43\u2212,H2PO4\u2212 , and\/or HPO42\u2212:\n\nMonocalcium phosphate, E341 (CAS# 7758-23-8 for anhydrous; CAS#10031-30-8 for monohydrate: Ca(H2PO4)2 and Ca(H2PO4)2(H2O)\nDicalcium phosphate (dibasic calcium phosphate), E341(ii) (CAS# 7757-93-9): CaHPO4 (mineral: monetite) and a dihydrate CaHPO4(H2O)2 (mineral: brushite)\nTricalcium phosphate (tribasic calcium phosphate or tricalcic phosphate, sometimes referred to as calcium phosphate or calcium orthophosphate, whitlockite), E341(iii) (CAS#7758-87-4): Ca3(PO4)2\nOctacalcium phosphate (CAS# 13767-12-9): Ca8H2(PO4)6.5H2O\nAmorphous calcium phosphate, a glassy precipitate of variable composition that may be present in biological systems.\nDi- and polyphosphates \nThese materials contain Ca2+ combined with the polyphosphates, such as P2O74\u2212 and triphosphate [P3O10]5\u2212:\n\nDicalcium diphosphate (CAS#7790-76-3]: Ca2P2O7\nCalcium triphosphate (CAS# 26158-70-3): Ca5(P3O10)2\nHydroxy- and oxo-phosphates \nThese materials contain other anions in addition to phosphate:\n\nHydroxyapatite Ca5(PO4)3(OH)\nApatite Ca10(PO4)6(OH, F, Cl, Br)2\nTetracalcium phosphate (CAS#1306-01-0): Ca4(PO4)2O\nOverview \nCalcium phosphates are found in many living organisms, e.g., bone mineral and tooth enamel. In milk, it exists in a colloidal form in micelles bound to casein protein with magnesium, zinc, and citrate - collectively referred to as colloidal calcium phosphate (CCP).[2] Various calcium phosphate minerals are used in the production of phosphoric acid and fertilizers. Overuse of certain forms of calcium phosphate can lead to nutrient-containing surface runoff and subsequent adverse effects upon receiving waters such as algal blooms and eutrophication.\n\nReferences \n\n\n^ Klaus Schr\u00f6dter; Gerhard Bettermann; Thomas Staffel; Friedrich Wahl; Thomas Klein; Thomas Hofmann (2008). Phosphoric Acid and Phosphates. Ullmann\u2019s Encyclopedia of Industrial Chemistry. Weinheim: Wiley-VCH. doi:10.1002\/14356007.a19_465.pub3. \n\n^ A. Y. Tamime, ed. (2006). Brined cheeses - The Society of Dairy Technology (SDT). Wiley-Blackwell. ISBN 978-1-4051-2460-7. \n\n\nvteCalcium compounds\nCaAl2O4\nCaB6\nCaBr2\nCa(BrO3)2\nCaC2\nCaCN2\nCa(CN)2\nCaCO3\nCaC2O4\nCaCl2\nCa(ClO)2\nCa(ClO3)2\nCaCrO4\nCaF2\nCaH2\nCa(HCO3)2\nCaH2S2O6\nCaI2\nCa(IO3)2\nCa(MnO4)2\nCaN6\nCa(NO3)2\nCaO\nCaO2\nCa(OH)2\nCaP\nCaS\nCaSO3\nCaSO4\nCaSe\nCaSi\nCaSi2\nCaTiO3\nCa2P2O7\nCa2SiO4\nCa3Al2O6\nCa3(AsO4)2\nCa3(BO3)2\nCa3(C6H5O7)2\nCa3N2\nCa3P2\nCa4(PO4)2O\nCa3(PO4)2\nCa(H2PO4)2\nCaHPO4\nC36H70CaO4\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Calcium_phosphate\">https:\/\/www.limswiki.org\/index.php\/Calcium_phosphate<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 11 March 2016, at 19:44.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 405 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","ad3e131c6031fddd4da24326304bd5a5_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Calcium_phosphate skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Calcium phosphate<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For the function of calcium phosphate in organisms, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_metabolism\" title=\"Calcium metabolism\" rel=\"external_link\" target=\"_blank\">Calcium metabolism<\/a>.<\/div>\n<p><b>Calcium phosphate<\/b> is a family of materials and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mineral\" title=\"Mineral\" rel=\"external_link\" target=\"_blank\">minerals<\/a> containing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium\" title=\"Calcium\" rel=\"external_link\" target=\"_blank\">calcium<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ion\" title=\"Ion\" rel=\"external_link\" target=\"_blank\">ions<\/a> (Ca<sup>2+<\/sup>) together with inorganic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphate\" title=\"Phosphate\" rel=\"external_link\" target=\"_blank\">phosphate<\/a> anions. Some so-called calcium phosphates contain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxide\" title=\"Oxide\" rel=\"external_link\" target=\"_blank\">oxide<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxide\" title=\"Hydroxide\" rel=\"external_link\" target=\"_blank\">hydroxide<\/a> as well. They are white solids of nutritious value.<sup id=\"rdp-ebb-cite_ref-Ullmann_1-0\" class=\"reference\"><a href=\"#cite_note-Ullmann-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span id=\"rdp-ebb-Orthophosphates.2C_di-_and_monohydrogen_phosphates\"><\/span><span class=\"mw-headline\" id=\"Orthophosphates,_di-_and_monohydrogen_phosphates\">Orthophosphates, di- and monohydrogen phosphates<\/span><\/h2>\n<p>These materials contain Ca<sup>2+<\/sup> combined with PO<sub>4<\/sub><sup>3\u2212<\/sup>,H<sub>2<\/sub>PO<sub>4<\/sub><sup>\u2212<\/sup> , and\/or HPO<sub>4<\/sub><sup>2\u2212<\/sup>:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Monocalcium_phosphate\" title=\"Monocalcium phosphate\" rel=\"external_link\" target=\"_blank\">Monocalcium phosphate<\/a>, E341 (CAS# 7758-23-8 for anhydrous; CAS#10031-30-8 for monohydrate: Ca(H<sub>2<\/sub>PO<sub>4<\/sub>)<sub>2<\/sub> and Ca(H<sub>2<\/sub>PO<sub>4<\/sub>)<sub>2<\/sub>(H<sub>2<\/sub>O)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dicalcium_phosphate\" title=\"Dicalcium phosphate\" rel=\"external_link\" target=\"_blank\">Dicalcium phosphate<\/a> (dibasic calcium phosphate), E341(ii) (CAS# 7757-93-9): CaHPO<sub>4<\/sub> (mineral: ) and a dihydrate CaHPO<sub>4<\/sub>(H<sub>2<\/sub>O)<sub>2<\/sub> (mineral: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brushite\" title=\"Brushite\" rel=\"external_link\" target=\"_blank\">brushite<\/a>)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tricalcium_phosphate\" title=\"Tricalcium phosphate\" rel=\"external_link\" target=\"_blank\">Tricalcium phosphate<\/a> (tribasic calcium phosphate or tricalcic phosphate, sometimes referred to as calcium phosphate or calcium orthophosphate, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Whitlockite\" title=\"Whitlockite\" rel=\"external_link\" target=\"_blank\">whitlockite<\/a>), E341(iii) (CAS#7758-87-4): Ca<sub>3<\/sub>(PO<sub>4<\/sub>)<sub>2<\/sub><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Octacalcium_phosphate\" title=\"Octacalcium phosphate\" rel=\"external_link\" target=\"_blank\">Octacalcium phosphate<\/a> (CAS# 13767-12-9): Ca<sub>8<\/sub>H<sub>2<\/sub>(PO<sub>4<\/sub>)<sub>6<\/sub><sup>.<\/sup>5H<sub>2<\/sub>O<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Amorphous_calcium_phosphate\" title=\"Amorphous calcium phosphate\" rel=\"external_link\" target=\"_blank\">Amorphous calcium phosphate<\/a>, a glassy precipitate of variable composition that may be present in biological systems.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Di-_and_polyphosphates\">Di- and polyphosphates<\/span><\/h2>\n<p>These materials contain Ca<sup>2+<\/sup> combined with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyphosphate\" title=\"Polyphosphate\" rel=\"external_link\" target=\"_blank\">polyphosphates<\/a>, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyrophosphate\" title=\"Pyrophosphate\" rel=\"external_link\" target=\"_blank\">P<sub>2<\/sub>O<sub>7<\/sub><sup>4\u2212<\/sup><\/a> and triphosphate [P<sub>3<\/sub>O<sub>10<\/sub>]<sup>5\u2212<\/sup>:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dicalcium_diphosphate\" class=\"mw-redirect\" title=\"Dicalcium diphosphate\" rel=\"external_link\" target=\"_blank\">Dicalcium diphosphate<\/a> (CAS#7790-76-3]: Ca<sub>2<\/sub>P<sub>2<\/sub>O<sub>7<\/sub><\/li>\n<li> (CAS# 26158-70-3): Ca<sub>5<\/sub>(P<sub>3<\/sub>O<sub>10<\/sub>)<sub>2<\/sub><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Hydroxy-_and_oxo-phosphates\">Hydroxy- and oxo-phosphates<\/span><\/h2>\n<p>These materials contain other anions in addition to phosphate:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxyapatite\" title=\"Hydroxyapatite\" rel=\"external_link\" target=\"_blank\">Hydroxyapatite<\/a> Ca<sub>5<\/sub>(PO<sub>4<\/sub>)<sub>3<\/sub>(OH)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Apatite\" title=\"Apatite\" rel=\"external_link\" target=\"_blank\">Apatite<\/a> Ca<sub>10<\/sub>(PO<sub>4<\/sub>)<sub>6<\/sub>(OH, F, Cl, Br)<sub>2<\/sub><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tetracalcium_phosphate\" title=\"Tetracalcium phosphate\" rel=\"external_link\" target=\"_blank\">Tetracalcium phosphate<\/a> (CAS#1306-01-0): Ca<sub>4<\/sub>(PO<sub>4<\/sub>)<sub>2<\/sub>O<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Overview\">Overview<\/span><\/h2>\n<p>Calcium phosphates are found in many living organisms, e.g., <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_mineral\" title=\"Bone mineral\" rel=\"external_link\" target=\"_blank\">bone mineral<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tooth_enamel\" title=\"Tooth enamel\" rel=\"external_link\" target=\"_blank\">tooth enamel<\/a>. In milk, it exists in a colloidal form in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Micelles\" class=\"mw-redirect\" title=\"Micelles\" rel=\"external_link\" target=\"_blank\">micelles<\/a> bound to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Casein\" title=\"Casein\" rel=\"external_link\" target=\"_blank\">casein<\/a> protein with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium\" title=\"Magnesium\" rel=\"external_link\" target=\"_blank\">magnesium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zinc\" title=\"Zinc\" rel=\"external_link\" target=\"_blank\">zinc<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Citrate\" class=\"mw-redirect\" title=\"Citrate\" rel=\"external_link\" target=\"_blank\">citrate<\/a> - collectively referred to as colloidal calcium phosphate (CCP).<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> Various calcium phosphate minerals are used in the production of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphoric_acid\" title=\"Phosphoric acid\" rel=\"external_link\" target=\"_blank\">phosphoric acid<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fertilizer\" title=\"Fertilizer\" rel=\"external_link\" target=\"_blank\">fertilizers<\/a>. Overuse of certain forms of calcium phosphate can lead to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nutrient\" title=\"Nutrient\" rel=\"external_link\" target=\"_blank\">nutrient<\/a>-containing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surface_runoff\" title=\"Surface runoff\" rel=\"external_link\" target=\"_blank\">surface runoff<\/a> and subsequent adverse effects upon receiving waters such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Algal_bloom\" title=\"Algal bloom\" rel=\"external_link\" target=\"_blank\">algal blooms<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eutrophication\" title=\"Eutrophication\" rel=\"external_link\" target=\"_blank\">eutrophication<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-Ullmann-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Ullmann_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Klaus Schr\u00f6dter; Gerhard Bettermann; Thomas Staffel; Friedrich Wahl; Thomas Klein; Thomas Hofmann (2008). <i>Phosphoric Acid and Phosphates<\/i>. Ullmann\u2019s Encyclopedia of Industrial Chemistry. Weinheim: Wiley-VCH. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14356007.a19_465.pub3\" target=\"_blank\">10.1002\/14356007.a19_465.pub3<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Phosphoric+Acid+and+Phosphates&rft.place=Weinheim&rft.series=Ullmann%E2%80%99s+Encyclopedia+of+Industrial+Chemistry&rft.pub=Wiley-VCH&rft.date=2008&rft_id=info%3Adoi%2F10.1002%2F14356007.a19_465.pub3&rft.au=Klaus+Schr%C3%B6dter&rft.au=Gerhard+Bettermann&rft.au=Thomas+Staffel&rft.au=Friedrich+Wahl&rft.au=Thomas+Klein&rft.au=Thomas+Hofmann&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalcium+phosphate\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">A. Y. Tamime, ed. (2006). <i>Brined cheeses - The Society of Dairy Technology (SDT)<\/i>. Wiley-Blackwell. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-4051-2460-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Brined+cheeses+-+The+Society+of+Dairy+Technology+%28SDT%29&rft.pub=Wiley-Blackwell&rft.date=2006&rft.isbn=978-1-4051-2460-7&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalcium+phosphate\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1331\nCached time: 20181207012012\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.156 seconds\nReal time usage: 0.209 seconds\nPreprocessor visited node count: 230\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 14313\/2097152 bytes\nTemplate argument size: 81\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 5346\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.093\/10.000 seconds\nLua memory usage: 2.05 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 171.386 1 -total\n<\/p>\n<pre>72.51% 124.266 1 Template:Reflist\n64.39% 110.356 2 Template:Cite_book\n17.15% 29.389 1 Template:For\n 9.11% 15.613 1 Template:Calcium_compounds\n 7.33% 12.557 1 Template:Navbox\n 1.60% 2.745 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:807003-1!canonical and timestamp 20181207012012 and revision id 872356414\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_phosphate\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212213\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.152 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 146.516 1 - wikipedia:Calcium_phosphate\n100.00% 146.516 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8388-0!*!*!*!*!*!* and timestamp 20181217212213 and revision id 24622\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Calcium_phosphate\">https:\/\/www.limswiki.org\/index.php\/Calcium_phosphate<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","ad3e131c6031fddd4da24326304bd5a5_images":[],"ad3e131c6031fddd4da24326304bd5a5_timestamp":1545081733,"8478ad5f9a28e06b9a61e65f3ded06f9_type":"article","8478ad5f9a28e06b9a61e65f3ded06f9_title":"Borosilicate glass","8478ad5f9a28e06b9a61e65f3ded06f9_url":"https:\/\/www.limswiki.org\/index.php\/Borosilicate_glass","8478ad5f9a28e06b9a61e65f3ded06f9_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tBorosilicate glass\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Guitar slide made of borosilicate glass\nBorosilicate glass is a type of glass with silica and boron trioxide as the main glass-forming constituents. Borosilicate glasses are known for having very low coefficients of thermal expansion (~3 \u00d7 10\u22126 K\u22121 at 20 \u00b0C), making them resistant to thermal shock, more so than any other common glass. Such glass is less subject to thermal stress and is commonly used for the construction of reagent bottles. Borosilicate glass is sold under such trade names as Borcam, Borosil, DURAN, Suprax, Simax, BSA 60, BSC 51 (By NIPRO), Heatex, Endural, Schott, Refmex, Kimble, MG(India) and some (but not all) items sold under the trade name Pyrex.\n\nContents \n\n1 History \n2 Manufacturing process \n3 Physical characteristics \n\n3.1 Glass families \n\n3.1.1 Non-alkaline-earth borosilicate glass (borosilicate glass 3.3) \n3.1.2 Alkaline-earth-containing borosilicate glasses \n3.1.3 High-borate borosilicate glasses \n\n\n\n\n4 Usage \n\n4.1 Health and science \n4.2 Electronics \n4.3 Cookware \n4.4 Lighting \n4.5 Optics \n4.6 Rapid prototyping \n4.7 Other \n\n\n5 Trade names \n6 Borosilicate nanoparticles \n7 In lampworking \n\n7.1 Beadmaking \n\n\n8 References \n\n\nHistory \nBorosilicate glass was first developed by the German glassmaker Otto Schott in the late 19th century. Otto Schott was also the founder of today's Schott AG, which has sold borosilicate glass later under the brand name DURAN. As part of an equity carve-out in 2005, the DURAN Group was founded and the manufacture of Duran was transferred to it. After Corning Glass Works introduced Pyrex in 1915, the name became a synonym for borosilicate glass in the English-speaking world. However, borosilicate glass is the name of a glass family with various members tailored to completely different purposes. Most common today is borosilicate 3.3 glass such as Duran, International Cookware's Pyrex, NIPRO BSA 60, and BSC 51.\nThe European manufacturer of Pyrex, International Cookware, still uses borosilicate glass in its Pyrex glass kitchen products,[1] but the U.S. manufacturer of Pyrex kitchenware now uses tempered soda-lime glass.[2] Thus Pyrex can refer to either soda-lime glass or borosilicate glass when discussing kitchen glassware, while Pyrex, Bomex, Duran, TGI and Simax all refer to borosilicate glass when discussing laboratory glassware. The real difference is the trademark and the company that owns the Pyrex name. The original Corning ware made of borosilicate glass was trademarked in capital letters (PYREX). When the kitchenware division was sold, the trademark was changed to lowercase (pyrex) and switched to low thermal-expansion soda-lime glass. The scientific division of Pyrex has always used borosilicate glass[3].[citation needed ]\nIn addition to quartz, sodium carbonate, and aluminium oxide traditionally used in glassmaking, boron is used in the manufacture of borosilicate glass. The composition of low-expansion borosilicate glass, such as those laboratory glasses mentioned above, is approximately 80% silica, 13% boric oxide, 4% sodium oxide and 2\u20133% aluminium oxide. Though more difficult to make than traditional glass due to the high melting temperature required, it is economical to produce. Its superior durability, chemical and heat resistance finds use in chemical laboratory equipment, cookware, lighting, and in certain kinds of windows.\n\nManufacturing process \nBorosilicate glass is created by combining together and melting boric oxide, silica sand, soda ash,[4] and alumina. Since borosilicate glass melts at a higher temperature than ordinary silicate glass, some new techniques were required for industrial production. The manufacturing process depends on the product geometry and can be differentiated between different methods like floating, tube drawing, or moulding.\n\nPhysical characteristics \nThe common type of borosilicate glass used for laboratory glassware has a very low thermal expansion coefficient (3.3 \u00d7 10\u22126 K\u22121),[5] about one-third that of ordinary soda-lime glass. This reduces material stresses caused by temperature gradients, which makes borosilicate a more suitable type of glass for certain applications (see below). Fused quartzware is even better in this respect (having one-fifteenth the thermal expansion of soda-lime glass); however, the difficulty of working with fused quartz makes quartzware much more expensive, and borosilicate glass is a low-cost compromise. While more resistant to thermal shock than other types of glass, borosilicate glass can still crack or shatter when subjected to rapid or uneven temperature variations.\nAmong the characteristic properties of this glass family are:\n\nDifferent borosilicate glasses cover a wide range of different thermal expansions, enabling direct seals with various metals and alloys like molybdenum glass with a CTE of 4,6, tungsten with a CTE around 4,0 and Kovar with a CTE around 5,0 because of the matched CTE with the sealing partner\nAllowing high maximum temperatures of typically about 500 \u00b0C (932 \u00b0F)\nShowing an extremely high chemical resistance in corrosive environments. Norm tests for example for acid resistance create extreme conditions and reveal very low impacts on glass\nThe softening point (temperature at which viscosity is approximately 107.6 poise) of type 7740 Pyrex is 820 \u00b0C (1,510 \u00b0F).[6]\nBorosilicate glass is less dense (about 2.23 g\/cm3) than typical soda-lime glass due to the low atomic mass of boron. Its mean specific heat capacity at constant pressure (20\u2013100 \u00b0C) is 0.83 J\/(g\u22c5K), roughly one fifth of water's.[7]\nThe temperature differential that borosilicate glass can withstand before fracturing is about 165 \u00b0C (329 \u00b0F). This compares well with soda lime glass, which can withstand only a 37 \u00b0C (99 \u00b0F) change in temperature and is why typical kitchenware made from traditional soda-lime glass will shatter if a vessel containing boiling water is placed on ice, but Pyrex or other borosilicate laboratory glass will not.[8]\nOptically, borosilicate glasses are crown glasses with low dispersion (Abbe numbers around 65) and relatively low refractive indices (1.51\u20131.54 across the visible range).\n\nGlass families \nFor the purposes of classification, borosilicate glass can be roughly arranged in the following groups, according to their oxide composition (in mass fractions). Characteristic of borosilicate glasses is the presence of substantial amounts of silica (SiO2) and boric oxide (B2O3, >8%) as glass network formers. The amount of boric oxide affects the glass properties in a particular way. Apart from the highly resistant varieties (B2O3 up to a maximum of 13%), there are others that \u2013 due to the different way in which the boric oxide is incorporated into the structural network \u2013 have only low chemical resistance (B2O3 content over 15%). Hence we differentiate between the following subtypes.\n\n Non-alkaline-earth borosilicate glass (borosilicate glass 3.3) \nThe B2O3 content for borosilicate glass is typically 12\u201313% and the SiO2 content over 80%. High chemical durability and low thermal expansion (3.3 \u00d7 10\u22126 K\u22121) \u2013 the lowest of all commercial glasses for large-scale technical applications \u2013 make this a multitalented glass material. High-grade borosilicate flat glasses are used in a wide variety of industries, mainly for technical applications that require either good thermal resistance, excellent chemical durability, or high light transmission in combination with a pristine surface quality. Other typical applications for different forms of borosilicate glass include glass tubing, glass piping, glass containers, etc. especially for the chemical industry.\n\nAlkaline-earth-containing borosilicate glasses \nIn addition to about 75% SiO2 and 8\u201312% B2O3, these glasses contain up to 5% alkaline earths and alumina (Al2O3). This is a subtype of slightly softer glasses, which have thermal expansions in the range (4.0\u20135.0) \u00d7 10\u22126 K\u22121.\n\nHigh-borate borosilicate glasses \nGlasses containing 15\u201325% B2O3, 65\u201370% SiO2, and smaller amounts of alkalis and Al2O3 as additional components have low softening points and low thermal expansion. Sealability to metals in the expansion range of tungsten and molybdenum and high electrical insulation are their most important features. The increased B2O3 content reduces the chemical resistance; in this respect, high-borate borosilicate glasses differ widely from non-alkaline-earth and alkaline-earth borosilicate glasses. Among these are also borosilicate glasses that transmit UV light down to 180 nm, which combine the best of the borosilicate glass and the quartz world.[9]\n\nUsage \nBorosilicate glass has a wide variety of uses ranging from cookware to lab equipment, as well as a component of high-quality products such as implantable medical devices and devices used in space exploration\n\nHealth and science \n Borosilicate beakers\nVirtually all modern laboratory glassware is made of borosilicate glass. It is widely used in this application due to its chemical and thermal resistance and good optical clarity, but the glass can react with sodium hydride upon heating to produce sodium borohydride, a common laboratory reducing agent. Fused quartz is also found in some laboratory equipment when its higher melting point and transmission of UV are required (e.g. for tube furnace liners and UV cuvettes), but the cost and difficulty of working with quartz make it excessive for the majority of laboratory equipment.\nAdditionally, borosilicate tubing is used as the feedstock for the production of parenteral drug packaging, such as vials and pre-filled syringes, as well as ampoules and dental cartridges. The chemical resistance of borosilicate glass minimizes the migration of sodium ions from the glass matrix, thus making it well suited for injectable-drug applications. This type of glass is typically referred to as USP \/ EP JP Type I.\nBorosilicate is widely used in implantable medical devices such as prosthetic eyes, artificial hip joints, bone cements, dental composite materials (white fillings)[10] and even in breast implants.\nMany implantable devices benefit from the unique advantages of borosilicate glass encapsulation. Applications include veterinary tracking devices, neurostimulators for the treatment of epilepsy, implantable drug pumps, cochlear implants, and physiological sensors.[11]\n\nElectronics \nDuring the mid-twentieth century, borosilicate glass tubing was used to pipe coolants (often distilled water) through high-power vacuum-tube\u2013based electronic equipment, such as commercial broadcast transmitters.\nBorosilicate glasses also have an application in the semiconductor industry in the development of microelectromechanical systems (MEMS), as part of stacks of etched silicon wafers bonded to the etched borosilicate glass.\n\nCookware \n Arc International bakeware\nGlass cookware is another common usage. Borosilicate glass is used for measuring cups, featuring screen printed markings providing graduated measurements. Borosilicate glass is sometimes used for high-quality beverage glassware. Borosilicate glass is thin and durable, microwave- and dishwasher-safe.\n\nLighting \nMany high-quality flashlights use borosilicate glass for the lens. This increases light transmittance through the lens compared to plastics and lower-quality glass.\nSeveral types of high-intensity discharge (HID) lamps, such as mercury-vapor and metal-halide lamps, use borosilicate glass as the outer envelope material.\nNew lampworking techniques led to artistic applications such as contemporary glass marbles. The modern studio glass movement has responded to color. Borosilicate is commonly used in the glassblowing form of lampworking and the artists create a range of products such as jewelry, kitchenware, sculpture, as well as for artistic glass smoking pipes.\nLighting manufacturers use borosilicate glass in their refractors.\nOrganic light-emitting diode (for display and lighting purposes) also uses borosilicate glass (BK7). The thicknesses of the BK7 glass substrates are usually less than 1 millimeter for the OLED fabrication. Due to its optical and mechanical characteristics in relation with cost, BK7 is a common substrate in OLEDs. However, depending on the application, soda-lime glass substrates of similar thicknesses are also used in OLED fabrication.\n\nOptics \nMost astronomical reflecting telescope use glass mirror components made of borosilicate glass because of its low coefficient of thermal expansion. This makes very precise optical surfaces possible that change very little with temperature, and matched glass mirror components that \"track\" across temperature changes and retain the optical system's characteristics.\nThe optical glass most often used for making instrument lenses is Schott BK-7 (or the equivalent from other makers), a very finely made borosilicate crown glass.[12]\nIt is also designated as 517642 glass after its 1.517 refractive index and 64.2 Abbe number. Other less costly borosilicate glasses, such as Schott B270 or the equivalent, are used to make \"crown-glass\" eyeglass lenses. Ordinary lower-cost borosilicate glass, like that used to make kitchenware and even reflecting telescope mirrors, cannot be used for high-quality lenses because of the striations and inclusions common to lower grades of this type of glass. The maximal working temperature is 268 \u00b0C (514 \u00b0F). While it transitions to a liquid starting at 288 \u00b0C (550 \u00b0F) (just before it turns red-hot), it is not workable until it reaches over 538 \u00b0C (1,000 \u00b0F). That means that in order to industrially produce this glass, oxygen\/fuel torches must be used. Glassblowers borrowed technology and techniques from welders.\n\n<\/p>\nRapid prototyping \nBorosilicate glass has become the material of choice for fused deposition modeling (FDM), or fused filament fabrication (FFF), build plates. Its low coefficient of expansion makes borosilicate glass, when used in combination with resistance-heating plates and pads, an ideal material for the heated build platform onto which plastic materials are extruded one layer at a time. The initial layer of build must be placed onto a substantially flat, heated surface to minimize shrinkage of some build materials (ABS, polycarbonate, polyamide, etc.) due to cooling after deposition. The build plate will cycle from room temperature to between 100 \u00b0C and 130 \u00b0C for each prototype that is built. The temperature, along with various coatings (Kapton tape, painter tape, hair spray, glue stick, ABS+acetone slurry, etc.), ensure that the first layer may be adhered to and remain adhered to the plate, without warping, as the first and subsequent layers cool following extrusion. Subsequently, following the build, the heating elements and plate are allowed to cool. The resulting residual stress formed when the plastic contracts as it cools, while the glass remains relatively dimensionally unchanged due to the low coefficient of thermal expansion, provides a convenient aid in removing the otherwise mechanically bonded plastic from the build plate. In some cases the parts self-separate as the developed stresses overcome the adhesive bond of the build material to the coating material and underlying plate.\n\nOther \nAquarium heaters are sometimes made of borosilicate glass. Due to its high heat resistance, it can tolerate the significant temperature difference between the water and the nichrome heating element.\nSpecialty glass smoking pipes for cannabis and tobacco are made from borosilicate glass. The high heat resistance makes the pipes more durable. Some Harm Reduction organizations also give out borosilicate pipes intended for smoking crack cocaine, as the heat resistance prevents the glass from cracking, causing cuts and burns that can spread Hepatitis C.[13]\nMost premanufactured glass guitar slides are also made of borosilicate glass.\nBorosilicate is also a material of choice for evacuated-tube solar thermal technology, because of its high strength and heat resistance.\nThe thermal insulation tiles on the Space Shuttle were coated with a borosilicate glass.[14]\nBorosilicate glasses are used for immobilisation and disposal of radioactive wastes. In most countries high-level radioactive waste has been incorporated into alkali borosilicate or phosphate vitreous waste forms for many years, and vitrification is an established technology.[15] Vitrification is a particularly attractive immobilization route because of the high chemical durability of the vitrified glass product. This characteristic has been used by industry for centuries.[citation needed ] The chemical resistance of glass can allow it to remain in a corrosive environment for many thousands and even millions of years.\nBorosilicate glass tubing is used in specialty TIG welding torch nozzles in place of standard alumina nozzles. This allows a clear view of the arc in situations where visibility is limited.\n\nTrade names \nBorosilicate glass is offered in slightly different compositions under different trade names:\n\nBorofloat of Schott AG, a borosilicate glass, which is produced to flat glass in a float process.\nBK7 of Schott, a borosilicate glass with a high level of purity. Main use in lens and mirrors for laser, cameras and telescopes.\nDuran of DURAN Group, similar to Pyrex, Simax or Jenaer Glas.\nFiolax of Schott, mainly used for containers for pharmaceutical applications.\nIlmabor of TGI [de] (2014 insolvency), mainly used for containers and equipment in laboratories and medicine.\nJenaer Glas of Zwiesel Kristallglas, formerly Schott AG. Mainly used for kitchenware.\nPyrex of Arc International Cookware, formerly Corning. Mainly used for kitchenware\nRasotherm of VEB Jenaer Glaswerk Schott & Genossen, for technical glass\nSimax of Kavalierglass a.s.\nWillow Glass is an alkali free, thin and flexible borosilicate glass of Corning\nBorosilicate nanoparticles \nIt was initially thought that borosilicate glass could not be formed into nanoparticles, since an unstable boron oxide precursor prevented successful forming of these shapes. However, in 2008 a team of researchers from the Swiss Federal Institute of Technology at Lausanne were successful in forming borosilicate nanoparticles of 100 to 500 nanometers in diameter. The researchers formed a gel of tetraethylorthosilicate and trimethoxyboroxine. When this gel is exposed to water under proper conditions, a dynamic reaction ensues which results in the nanoparticles.[16]\n\nIn lampworking \nBorosilicate (or \"boro\", as it is often called) is used extensively in the glassblowing process lampworking; the glassworker uses a burner torch to melt and form glass, using a variety of metal and graphite tools to shape it. Borosilicate is referred to as \"hard glass\" and has a higher melting point (approximately 3,000 \u00b0F \/ 1648 \u00b0C) than \"soft glass\", which is preferred for glassblowing by beadmakers. Raw glass used in lampworking comes in glass rods for solid work and glass tubes for hollow work tubes and vessels\/containers. Lampworking is used to make complex and custom scientific apparatus; most major universities have a lampworking shop to manufacture and repair their glassware. For this kind of \"scientific glassblowing\", the specifications must be exact and the glassblower must be highly skilled and able to work with precision. Lampworking is also done as art, and common items made include goblets, paper weights, pipes, pendants, compositions and figurines.\nIn 1968, English metallurgist John Burton brought his hobby of hand-mixing metallic oxides into borosilicate glass to Los Angeles. Burton began a glass workshop at Pepperdine College, with instructor Margaret Youd. A few of the students in the classes, including Suellen Fowler, discovered that a specific combination of oxides made a glass that would shift from amber to purples and blues, depending on the heat and flame atmosphere. Fowler shared this combination with Paul Trautman, who formulated the first small-batch colored borosilicate recipes. He then founded Northstar Glassworks in the mid-1980s, the first factory devoted solely to producing colored borosilicate glass rods and tubes for use by artists in the flame. Trautman also developed the techniques and technology to make the small-batch colored boro that is used by a number of similar companies.[17] \n\nBeadmaking \nIn recent years, with the resurgence of lampworking as a technique to make handmade glass beads, borosilicate has become a popular material in many glass artists' studios. Borosilicate for beadmaking comes in thin, pencil-like rods. Glass Alchemy, Trautman Art Glass, and Northstar are popular manufacturers, although there are other brands available. The metals used to color borosilicate glass, particularly silver, often create strikingly beautiful and unpredictable results when melted in an oxygen-gas torch flame. Because it is more shock-resistant and stronger than soft glass, borosilicate is particularly suited for pipe making, as well as sculpting figures and creating large beads. The tools used for making glass beads from borosilicate glass are the same as those used for making glass beads from soft glass.\n\nReferences \n\n\n^ Pyrex History Archived September 22, 2008, at the Wayback Machine. \n\n^ \"Exploding Pyrex\". Retrieved 2009-10-27 . \n\n^ \"Archived copy\" (PDF) . Archived (PDF) from the original on 2015-11-23. Retrieved 2017-12-04 . CS1 maint: Archived copy as title (link) \n\n^ Spinosa, E. D.; Hooie, D. T.; Bennett, R. B. (1979). Summary Report on Emissions from the Glass Manufacturing Industry. Environmental Protection Agency, Office of Research and Development, [Office of Energy, Minerals, and Industry], Industrial Environmental Research Laboratory. \n\n^ \"Borosilicato\". refmexgl.com. Archived from the original on 2012-06-30. Retrieved 2012-11-02 . \n\n^ Weissler, G. L. (1979). Vacuum Physics and Technology (2 ed.). Academic Press. p. 315. ISBN 978-0-12-475914-5. \n\n^ \"Borosilikatglas BOROFLOAT\u00ae - Thermische Produkteigenschaften\". www.schott.com. Schott AG. Retrieved 31 August 2018 . \n\n^ Brandt, R. C.; Martens, R. I. (September 2012), \"Shattering Glass Cookware\", American Ceramics Society Bulletin, American Ceramics Society, archived from the original on 2015-03-10 \n\n^ \"Archived copy\" (PDF) . Archived (PDF) from the original on 2017-08-24. Retrieved 2017-08-24 . CS1 maint: Archived copy as title (link) \n\n^ R Wananuruksawong et al 2011 IOP Conf. Ser.: Mater. Sci. Eng. 18 192010 doi:10.1088\/1757-899X\/18\/19\/192010 Fabrication of Silicon Nitride Dental Core Ceramics with Borosilicate Veneering material \n\n^ http:\/\/medicaldesign.com\/materials\/encapsulating-smaller-and-smarter-implantables-glass-act \n\n^ \"Bor-crown glass from SCHOTT\". Archived from the original on 2017-07-05. \n\n^ \"Safer Crack Cocaine Smoking Equipment Distribution: Comprehensive Best Practice Guidelines\". www.catie.ca. Retrieved 2018-05-14 . \n\n^ \"SPACE SHUTTLE ORBITER SYSTEMS THERMAL PROTECTION SYSTEM\". Archived from the original on 2009-07-15. Retrieved 2009-07-15 . \n\n^ M. I. Ojovan and W.E. Lee. An Introduction to Nuclear Waste Immobilisation, Elsevier, Amsterdam, 315 p. (2005) \n\n^ Chemical & Engineering News Vol. 86 No. 37, 15 September 2008, \"Making Borosilicate nanoparticles is now possible\", p. 35 \n\n^ Robert Mickelsen, \"Art Glass Lampworking History\" Online Glass Museum, http:\/\/www.theglassmuseum.com\/lampwork.html \n\n\n\n\n\nLook up Borosilicate glass in Wiktionary, the free dictionary.\n\n\n\nWikimedia Commons has media related to Borosilicate glass.\nvteBoron compounds\nBAs\nBBr3\nBCl3\nBF\nBF3\nBI3\nBN\nB(NO3)3\nB(OH)3\nBP\nBPO4\nB2F4\nB2Cl4\nB2H6\nBH3NH3\nB2O\nB2O3\nB2S3\nB4C\nB6O\nB5H9\nB5H11\nB6H10\nB6H12\nB10H14\n\nvteGlass science topicsBasics\nGlass\nGlass transition\nSupercooling\nFormulation\nAgInSbTe\nBioglass\nBorophosphosilicate glass\nBorosilicate glass\nCeramic glaze\nChalcogenide glass\nCobalt glass\nCranberry glass\nCrown glass\nFlint glass\nFluorosilicate glass\nFused quartz\nGeSbTe\nGold ruby glass\nLead glass\nMilk glass\nPhosphosilicate glass\nPhotochromic lens glass\nSilicate glass\nSoda\u2013lime glass\nSodium hexametaphosphate\nSoluble glass\nTellurite glass\nThoriated glass\nUltra low expansion glass\nUranium glass\nVitreous enamel\nWood's glass\nZBLAN\nGlass-ceramics\nBioactive glass\nCorningWare\nGlass-ceramic-to-metal seals\nMacor\nZerodur\nPreparation\nAnnealing\nChemical vapor deposition\nGlass batch calculation\nGlass forming\nGlass melting\nGlass modeling\nIon implantation\nLiquidus temperature\nSol-gel technique\nViscosity\nVitrification\nOptics\nAchromat\nDispersion\nGradient-index optics\nHydrogen darkening\nOptical amplifier\nOptical fiber\nOptical lens design\nPhotochromic lens\nPhotosensitive glass\nRefraction\nTransparent materials\nSurface\r\nmodification\nAnti-reflective coating\nChemically strengthened glass\nCorrosion\nDealkalization\nDNA microarray\nHydrogen darkening\nInsulated glazing\nPorous glass\nSelf-cleaning glass\nSol-gel technique\nTempered glass\nDiverse\r\ntopics\nGlass-coated wire\nSafety glass\nGlass databases\nGlass electrode\nGlass fiber reinforced concrete\nGlass ionomer cement\nGlass microspheres\nGlass-reinforced plastic\nGlass-to-metal seal\nPorous glass\nPrince Rupert's drops\nRadioactive waste vitrification\nWindshield\nGlass fiber\n\nvteGlass makers and brandsContemporary\r\n companies\nAnchor Hocking\nArc International\nArdagh Group\nArmashield\nAsahi\nAurora Glass Foundry\nAventas group\nBaccarat\nBerengo Studio\nBlenko Glass Company\nBodum\nBormioli Rocco\nBorosil\nCaithness Glass\nCox & Barnard\nCorning\nDartington Crystal\nDaum\nDuralex\nEdinburgh Crystal\nFanavid\nFenton Art Glass Company\nFirozabad glass industry\nFlabeg\nFranz Mayer\nFuyao\nGlava\nGlaverbel\nGuardian Industries\nHadeland\nHardman & Co.\nHeaton, Butler and Bayne\nHolmegaard Glassworks\nHolophane\nHoya\nKingdom of Crystal\nKokomo Opalescent Glass Works\nKosta Glasbruk\nLibbey-Owens-Ford\nLiuli Gongfang\nIittala\nLuoyang\nJohns Manville\nMats Jonasson M\u00e5ler\u00e5s\nMoser Glass\nMosser Glass\nNippon Sheet Glass\nOhara\nOrrefors\nOsram\nOwens Corning\nOwens-Illinois\nPauly & C. - Compagnia Venezia Murano\nPhu Phong\nPilkington\nPPG Industries\nPreciosa\nRiedel\nRona\nRoyal Leerdam Crystal\nSaint-Gobain\nSaint-Louis\nSchott\nSterlite Optical Technologies\nSteuben\nSwarovski\nTyrone Crystal\nVal Saint Lambert\nVerrerie of Brehat\nWaterford\nWatts & Co.\nWorld Kitchen\nXinyi Glass\nZwiesel\nHistoric\r\n companies\nBakewell Glass\nBelmont Glass Company\nBoston and Sandwich Glass Company\nBrockway Glass\nCarr Lowrey Glass Company\nCambridge Glass\nChance Brothers\nClayton and Bell\nDugan Glass Company\nDuncan & Miller\nDunbar Glass\nFostoria Glass Company\nGeneral Glass Industries\nGus Crystal\nAlexander Gibbs\nGr\u00f6nvik glasbruk\nHartford City Glass Company\nHazel-Atlas\nHeisey\nHemingray Glass Company\nJ. H. Hobbs, Brockunier and Company\nIndiana Glass Company\nKnox Glass Bottle Company\nLavers, Barraud and Westlake\nManufacture royale de glaces de miroirs\nMillersburg Glass Company\nMorris & Co.\nNachtmann\nNorthwood Glass Company\nNovelty Glass Company\nOld Dominion Glass Company\nJames Powell and Sons\nRavenhead Glass\nThe Root Glass Company\nSeneca Glass Company\nShrigley and Hunt\nSneath Glass Company\nVenini & C.\nWard and Hughes\nWestmoreland Glass Company\nWheaton Industries \nWhitall Tatum Company\nWhite Glass Company\nWorshipful Company\nGlassmakers\nJohn Adams\nRichard M. Atwater\nFrederick Carder\nIrving Wightman Colburn\nHenry Crimmel\nFriedrich\nHenry Clay Fry\nA. H. Heisey\nEdward D. Libbey\nDante Marioni\nAntonio Neri\nMichael Joseph Owens\nAlastair Pilkington\nFlavio Poli\nSalviati\nOtto Schott\nHenry William Stiegel\nS. Donald Stookey\nLino Tagliapietra\nW. E. S. Turner\nTomasz Urbanowicz\nPaolo Venini\nJohn M. Whitall\nTrademarks\r\n and brands\nActiv\nBohemian glass\nBomex\nDuran\nEndural\nBurmese glass\nChevron bead\nCorelle\nCorningWare\nCranberry glass\nCristallo\nDragontrail\nFavrile\nFire-King\nForest glass\nGorilla Glass\nMacor\nMillefiori\nMurano glass\nOpaline glass\nPeking glass\nPyrex\nRona\nRavenhead Glass\nSatsuma Kiriko cut glass\nTiffany glass\nVisions\nVitrite\nVitrolite\nVycor\nWaterford Crystal\nWood's glass\nZerodur\nRelated\r\n articles\nList of defunct glassmaking companies\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Borosilicate_glass\">https:\/\/www.limswiki.org\/index.php\/Borosilicate_glass<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","8478ad5f9a28e06b9a61e65f3ded06f9_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Borosilicate_glass skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Borosilicate glass<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:GlassGuitarSlide.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2e\/GlassGuitarSlide.jpg\/220px-GlassGuitarSlide.jpg\" width=\"220\" height=\"146\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:GlassGuitarSlide.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Slide_(guitar_technique)\" class=\"mw-redirect\" title=\"Slide (guitar technique)\" rel=\"external_link\" target=\"_blank\">Guitar slide<\/a> made of borosilicate glass<\/div><\/div><\/div>\n<p><b>Borosilicate glass<\/b> is a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass\" title=\"Glass\" rel=\"external_link\" target=\"_blank\">glass<\/a> with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_dioxide\" title=\"Silicon dioxide\" rel=\"external_link\" target=\"_blank\">silica<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boron_trioxide\" title=\"Boron trioxide\" rel=\"external_link\" target=\"_blank\">boron trioxide<\/a> as the main glass-forming constituents. Borosilicate glasses are known for having very low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coefficient_of_thermal_expansion\" class=\"mw-redirect\" title=\"Coefficient of thermal expansion\" rel=\"external_link\" target=\"_blank\">coefficients of thermal expansion<\/a> (~3 \u00d7 10<sup>\u22126<\/sup> K<sup>\u22121<\/sup> at 20 \u00b0C), making them resistant to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_shock\" title=\"Thermal shock\" rel=\"external_link\" target=\"_blank\">thermal shock<\/a>, more so than any other common glass. Such glass is less subject to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_stress\" title=\"Thermal stress\" rel=\"external_link\" target=\"_blank\">thermal stress<\/a> and is commonly used for the construction of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reagent_bottle\" title=\"Reagent bottle\" rel=\"external_link\" target=\"_blank\">reagent bottles<\/a>. Borosilicate glass is sold under such trade names as , <a href=\"https:\/\/en.wikipedia.org\/wiki\/Borosil\" title=\"Borosil\" rel=\"external_link\" target=\"_blank\">Borosil<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Duran_(glass)\" title=\"Duran (glass)\" rel=\"external_link\" target=\"_blank\">DURAN<\/a>, Suprax, Simax, BSA 60, BSC 51 (By NIPRO), Heatex, Endural, <a href=\"https:\/\/en.wikipedia.org\/wiki\/SCHOTT-Rohrglas_GmbH\" title=\"SCHOTT-Rohrglas GmbH\" rel=\"external_link\" target=\"_blank\">Schott<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refmex_GL_Glass\" title=\"Refmex GL Glass\" rel=\"external_link\" target=\"_blank\">Refmex<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kimble_Chase\" title=\"Kimble Chase\" rel=\"external_link\" target=\"_blank\">Kimble<\/a>, MG(India) and some (but not all) items sold under the trade name <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyrex\" title=\"Pyrex\" rel=\"external_link\" target=\"_blank\">Pyrex<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Borosilicate glass was first developed by the German glassmaker <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otto_Schott\" title=\"Otto Schott\" rel=\"external_link\" target=\"_blank\">Otto Schott<\/a> in the late 19th century. Otto Schott was also the founder of today's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Schott_AG\" title=\"Schott AG\" rel=\"external_link\" target=\"_blank\">Schott AG<\/a>, which has sold borosilicate glass later under the brand name <a href=\"https:\/\/en.wikipedia.org\/wiki\/Duran_(glass)\" title=\"Duran (glass)\" rel=\"external_link\" target=\"_blank\">DURAN<\/a>. As part of an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Equity_carve-out\" title=\"Equity carve-out\" rel=\"external_link\" target=\"_blank\">equity carve-out<\/a> in 2005, the DURAN Group was founded and the manufacture of Duran was transferred to it. After <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corning_Incorporated\" class=\"mw-redirect\" title=\"Corning Incorporated\" rel=\"external_link\" target=\"_blank\">Corning Glass Works<\/a> introduced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyrex\" title=\"Pyrex\" rel=\"external_link\" target=\"_blank\">Pyrex<\/a> in 1915, the name became a synonym for borosilicate glass in the English-speaking world. However, borosilicate glass is the name of a glass family with various members tailored to completely different purposes. Most common today is borosilicate 3.3 glass such as Duran, International Cookware's Pyrex, NIPRO BSA 60, and BSC 51.\n<\/p><p>The European manufacturer of Pyrex, International Cookware, still uses borosilicate glass in its Pyrex glass kitchen products,<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> but the U.S. manufacturer of Pyrex kitchenware now uses tempered <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soda-lime_glass\" class=\"mw-redirect\" title=\"Soda-lime glass\" rel=\"external_link\" target=\"_blank\">soda-lime glass<\/a>.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> Thus Pyrex can refer to either soda-lime glass or borosilicate glass when discussing kitchen glassware, while Pyrex, Bomex, Duran, TGI and Simax all refer to borosilicate glass when discussing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laboratory_glassware\" title=\"Laboratory glassware\" rel=\"external_link\" target=\"_blank\">laboratory glassware<\/a>. The real difference is the trademark and the company that owns the Pyrex name. The original Corning ware made of borosilicate glass was trademarked in capital letters (PYREX). When the kitchenware division was sold, the trademark was changed to lowercase (pyrex) and switched to low thermal-expansion soda-lime glass. The scientific division of Pyrex has always used borosilicate glass<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2015)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>In addition to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quartz\" title=\"Quartz\" rel=\"external_link\" target=\"_blank\">quartz<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_carbonate\" title=\"Sodium carbonate\" rel=\"external_link\" target=\"_blank\">sodium carbonate<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium_oxide\" title=\"Aluminium oxide\" rel=\"external_link\" target=\"_blank\">aluminium oxide<\/a> traditionally used in glassmaking, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boron\" title=\"Boron\" rel=\"external_link\" target=\"_blank\">boron<\/a> is used in the manufacture of borosilicate glass. The composition of low-expansion borosilicate glass, such as those laboratory glasses mentioned above, is approximately 80% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_dioxide\" title=\"Silicon dioxide\" rel=\"external_link\" target=\"_blank\">silica<\/a>, 13% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boric_oxide\" class=\"mw-redirect\" title=\"Boric oxide\" rel=\"external_link\" target=\"_blank\">boric oxide<\/a>, 4% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_oxide\" title=\"Sodium oxide\" rel=\"external_link\" target=\"_blank\">sodium oxide<\/a> and 2\u20133% aluminium oxide. Though more difficult to make than traditional glass due to the high melting temperature required, it is economical to produce. Its superior durability, chemical and heat resistance finds use in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemistry\" title=\"Chemistry\" rel=\"external_link\" target=\"_blank\">chemical<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laboratory\" title=\"Laboratory\" rel=\"external_link\" target=\"_blank\">laboratory<\/a> equipment, cookware, lighting, and in certain kinds of windows.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Manufacturing_process\">Manufacturing process<\/span><\/h2>\n<p>Borosilicate glass is created by combining together and melting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boron_trioxide\" title=\"Boron trioxide\" rel=\"external_link\" target=\"_blank\">boric oxide<\/a>, silica sand, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_carbonate\" title=\"Sodium carbonate\" rel=\"external_link\" target=\"_blank\">soda ash<\/a>,<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> and alumina. Since borosilicate glass melts at a higher temperature than ordinary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicate_glass\" class=\"mw-redirect\" title=\"Silicate glass\" rel=\"external_link\" target=\"_blank\">silicate glass<\/a>, some new techniques were required for industrial production. The manufacturing process depends on the product geometry and can be differentiated between different methods like floating, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass_tube\" title=\"Glass tube\" rel=\"external_link\" target=\"_blank\">tube drawing<\/a>, or moulding.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Physical_characteristics\">Physical characteristics<\/span><\/h2>\n<p>The common type of borosilicate glass used for laboratory glassware has a very low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_expansion\" title=\"Thermal expansion\" rel=\"external_link\" target=\"_blank\">thermal expansion<\/a> coefficient (3.3 \u00d7 10<sup>\u22126<\/sup> K<sup>\u22121<\/sup>),<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> about one-third that of ordinary soda-lime glass. This reduces material stresses caused by temperature gradients, which makes borosilicate a more suitable type of glass for certain <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/medium.com\/@kpkrish012\/application-of-borosilicate-glass-7f1cd1e1efb\" target=\"_blank\">applications<\/a> (see below). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fused_quartz\" title=\"Fused quartz\" rel=\"external_link\" target=\"_blank\">Fused quartzware<\/a> is even better in this respect (having one-fifteenth the thermal expansion of soda-lime glass); however, the difficulty of working with fused quartz makes quartzware much more expensive, and borosilicate glass is a low-cost compromise. While more resistant to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_shock\" title=\"Thermal shock\" rel=\"external_link\" target=\"_blank\">thermal shock<\/a> than other types of glass, borosilicate glass can still crack or shatter when subjected to rapid or uneven temperature variations.\n<\/p><p>Among the characteristic properties of this glass family are:\n<\/p>\n<ul><li>Different borosilicate glasses cover a wide range of different thermal expansions, enabling direct seals with various metals and alloys like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molybdenum\" title=\"Molybdenum\" rel=\"external_link\" target=\"_blank\">molybdenum<\/a> glass with a CTE of 4,6, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tungsten\" title=\"Tungsten\" rel=\"external_link\" target=\"_blank\">tungsten<\/a> with a CTE around 4,0 and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kovar\" title=\"Kovar\" rel=\"external_link\" target=\"_blank\">Kovar<\/a> with a CTE around 5,0 because of the matched CTE with the sealing partner<\/li>\n<li>Allowing high maximum temperatures of typically about 500 \u00b0C (932 \u00b0F)<\/li>\n<li>Showing an extremely high chemical resistance in corrosive environments. Norm tests for example for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corrosion\" title=\"Corrosion\" rel=\"external_link\" target=\"_blank\">acid resistance<\/a> create extreme conditions and reveal very low impacts on glass<\/li><\/ul>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Softening_point\" title=\"Softening point\" rel=\"external_link\" target=\"_blank\">softening point<\/a> (temperature at which <a href=\"https:\/\/en.wikipedia.org\/wiki\/Viscosity\" title=\"Viscosity\" rel=\"external_link\" target=\"_blank\">viscosity<\/a> is approximately 10<sup>7.6<\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Poise_(unit)\" title=\"Poise (unit)\" rel=\"external_link\" target=\"_blank\">poise<\/a>) of type 7740 Pyrex is 820 \u00b0C (1,510 \u00b0F).<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>Borosilicate glass is less <a href=\"https:\/\/en.wikipedia.org\/wiki\/Density\" title=\"Density\" rel=\"external_link\" target=\"_blank\">dense<\/a> (about 2.23 g\/cm<sup>3<\/sup>) than typical soda-lime glass due to the low atomic mass of boron. Its mean specific heat capacity at constant pressure (20\u2013100 \u00b0C) is 0.83 J\/(g\u22c5K), roughly one fifth of water's.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>The temperature differential that borosilicate glass can withstand before fracturing is about 165 \u00b0C (329 \u00b0F). This compares well with soda lime glass, which can withstand only a 37 \u00b0C (99 \u00b0F) change in temperature and is why typical kitchenware made from traditional soda-lime glass will shatter if a vessel containing boiling water is placed on ice, but Pyrex or other borosilicate laboratory glass will not.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>Optically, borosilicate glasses are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crown_glass_(optics)\" title=\"Crown glass (optics)\" rel=\"external_link\" target=\"_blank\">crown glasses<\/a> with low dispersion (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Abbe_number\" title=\"Abbe number\" rel=\"external_link\" target=\"_blank\">Abbe numbers<\/a> around 65) and relatively low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refractive_index\" title=\"Refractive index\" rel=\"external_link\" target=\"_blank\">refractive indices<\/a> (1.51\u20131.54 across the visible range).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Glass_families\">Glass families<\/span><\/h3>\n<p>For the purposes of classification, borosilicate glass can be roughly arranged in the following groups, according to their oxide composition (in mass fractions). Characteristic of borosilicate glasses is the presence of substantial amounts of silica (SiO<sub>2<\/sub>) and boric oxide (B<sub>2<\/sub>O<sub>3<\/sub>, >8%) as glass network formers. The amount of boric oxide affects the glass properties in a particular way. Apart from the highly resistant varieties (B<sub>2<\/sub>O<sub>3<\/sub> up to a maximum of 13%), there are others that \u2013 due to the different way in which the boric oxide is incorporated into the structural network \u2013 have only low chemical resistance (B<sub>2<\/sub>O<sub>3<\/sub> content over 15%). Hence we differentiate between the following subtypes.\n<\/p>\n<h4><span id=\"rdp-ebb-Non-alkaline-earth_borosilicate_glass_.28borosilicate_glass_3.3.29\"><\/span><span class=\"mw-headline\" id=\"Non-alkaline-earth_borosilicate_glass_(borosilicate_glass_3.3)\">Non-alkaline-earth borosilicate glass (borosilicate glass 3.3)<\/span><\/h4>\n<p>The B<sub>2<\/sub>O<sub>3<\/sub> content for borosilicate glass is typically 12\u201313% and the SiO<sub>2<\/sub> content over 80%. High chemical durability and low thermal expansion (3.3 \u00d7 10<sup>\u22126<\/sup> K<sup>\u22121<\/sup>) \u2013 the lowest of all commercial glasses for large-scale technical applications \u2013 make this a multitalented glass material. High-grade borosilicate flat glasses are used in a wide variety of industries, mainly for technical applications that require either good thermal resistance, excellent chemical durability, or high light transmission in combination with a pristine surface quality. Other typical applications for different forms of borosilicate glass include glass tubing, glass <a class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Piping\" rel=\"external_link\" target=\"_blank\">piping<\/a>, glass containers, etc. especially for the chemical industry.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Alkaline-earth-containing_borosilicate_glasses\">Alkaline-earth-containing borosilicate glasses<\/span><\/h4>\n<p>In addition to about 75% SiO<sub>2<\/sub> and 8\u201312% B<sub>2<\/sub>O<sub>3<\/sub>, these glasses contain up to 5% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alkaline_earths\" class=\"mw-redirect\" title=\"Alkaline earths\" rel=\"external_link\" target=\"_blank\">alkaline earths<\/a> and alumina (Al<sub>2<\/sub>O<sub>3<\/sub>). This is a subtype of slightly softer glasses, which have thermal expansions in the range (4.0\u20135.0) \u00d7 10<sup>\u22126<\/sup> K<sup>\u22121<\/sup>.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"High-borate_borosilicate_glasses\">High-borate borosilicate glasses<\/span><\/h4>\n<p>Glasses containing 15\u201325% B<sub>2<\/sub>O<sub>3<\/sub>, 65\u201370% SiO<sub>2<\/sub>, and smaller amounts of alkalis and Al<sub>2<\/sub>O<sub>3<\/sub> as additional components have low softening points and low thermal expansion. Sealability to metals in the expansion range of tungsten and molybdenum and high electrical insulation are their most important features. The increased B<sub>2<\/sub>O<sub>3<\/sub> content reduces the chemical resistance; in this respect, high-borate borosilicate glasses differ widely from non-alkaline-earth and alkaline-earth borosilicate glasses. Among these are also borosilicate glasses that transmit UV light down to 180 nm, which combine the best of the borosilicate glass and the quartz world.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Usage\">Usage<\/span><\/h2>\n<p>Borosilicate glass has a wide variety of uses ranging from cookware to lab equipment, as well as a component of high-quality products such as implantable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_devices\" class=\"mw-redirect\" title=\"Medical devices\" rel=\"external_link\" target=\"_blank\">medical devices<\/a> and devices used in space exploration\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Health_and_science\">Health and science<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Beakers.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/12\/Beakers.jpg\/220px-Beakers.jpg\" width=\"220\" height=\"217\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Beakers.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Borosilicate beakers<\/div><\/div><\/div>\n<p>Virtually all modern laboratory glassware is made of borosilicate glass. It is widely used in this application due to its chemical and thermal resistance and good optical clarity, but the glass can react with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_hydride\" title=\"Sodium hydride\" rel=\"external_link\" target=\"_blank\">sodium hydride<\/a> upon heating to produce <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_borohydride\" title=\"Sodium borohydride\" rel=\"external_link\" target=\"_blank\">sodium borohydride<\/a>, a common laboratory reducing agent. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fused_quartz\" title=\"Fused quartz\" rel=\"external_link\" target=\"_blank\">Fused quartz<\/a> is also found in some laboratory equipment when its higher melting point and transmission of UV are required (e.g. for tube furnace liners and UV cuvettes), but the cost and difficulty of working with quartz make it excessive for the majority of laboratory equipment.\n<\/p><p>Additionally, borosilicate tubing is used as the feedstock for the production of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parenteral\" class=\"mw-redirect\" title=\"Parenteral\" rel=\"external_link\" target=\"_blank\">parenteral<\/a> drug packaging, such as vials and pre-filled <a href=\"https:\/\/en.wikipedia.org\/wiki\/Syringe\" title=\"Syringe\" rel=\"external_link\" target=\"_blank\">syringes<\/a>, as well as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ampoule\" title=\"Ampoule\" rel=\"external_link\" target=\"_blank\">ampoules<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_syringe\" class=\"mw-redirect\" title=\"Dental syringe\" rel=\"external_link\" target=\"_blank\">dental cartridges<\/a>. The chemical resistance of borosilicate glass minimizes the migration of sodium ions from the glass matrix, thus making it well suited for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug_injection\" title=\"Drug injection\" rel=\"external_link\" target=\"_blank\">injectable-drug<\/a> applications. This type of glass is typically referred to as USP \/ EP JP Type I.\n<\/p><p>Borosilicate is widely used in implantable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_devices\" class=\"mw-redirect\" title=\"Medical devices\" rel=\"external_link\" target=\"_blank\">medical devices<\/a> such as prosthetic eyes, artificial hip joints, bone cements, dental composite materials (white fillings)<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> and even in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_implants\" class=\"mw-redirect\" title=\"Breast implants\" rel=\"external_link\" target=\"_blank\">breast implants<\/a>.\n<\/p><p>Many implantable devices benefit from the unique advantages of borosilicate glass encapsulation. Applications include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microchip_implant_(animal)\" title=\"Microchip implant (animal)\" rel=\"external_link\" target=\"_blank\">veterinary tracking devices<\/a>, neurostimulators for the treatment of epilepsy, implantable drug pumps, cochlear implants, and physiological sensors.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Electronics\">Electronics<\/span><\/h3>\n<p>During the mid-twentieth century, borosilicate glass tubing was used to pipe coolants (often <a href=\"https:\/\/en.wikipedia.org\/wiki\/Distilled_water\" title=\"Distilled water\" rel=\"external_link\" target=\"_blank\">distilled water<\/a>) through high-power <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vacuum-tube\" class=\"mw-redirect\" title=\"Vacuum-tube\" rel=\"external_link\" target=\"_blank\">vacuum-tube<\/a>\u2013based electronic equipment, such as commercial broadcast transmitters.\n<\/p><p>Borosilicate glasses also have an application in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semiconductor_industry\" title=\"Semiconductor industry\" rel=\"external_link\" target=\"_blank\">semiconductor industry<\/a> in the development of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microelectromechanical_systems\" title=\"Microelectromechanical systems\" rel=\"external_link\" target=\"_blank\">microelectromechanical systems<\/a> (MEMS), as part of stacks of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Etching_(microfabrication)\" title=\"Etching (microfabrication)\" rel=\"external_link\" target=\"_blank\">etched<\/a> silicon <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wafer_(electronics)\" title=\"Wafer (electronics)\" rel=\"external_link\" target=\"_blank\">wafers<\/a> bonded to the etched borosilicate glass.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Cookware\">Cookware<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Arcopal.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6f\/Arcopal.JPG\/220px-Arcopal.JPG\" width=\"220\" height=\"181\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Arcopal.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arc_International\" title=\"Arc International\" rel=\"external_link\" target=\"_blank\">Arc International<\/a> bakeware<\/div><\/div><\/div>\n<p>Glass cookware is another common usage. Borosilicate glass is used for measuring cups, featuring screen printed markings providing graduated measurements. Borosilicate glass is sometimes used for high-quality beverage glassware. Borosilicate glass is thin and durable, microwave- and dishwasher-safe.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Lighting\">Lighting<\/span><\/h3>\n<p>Many high-quality flashlights use borosilicate glass for the lens. This increases light transmittance through the lens compared to plastics and lower-quality glass.\n<\/p><p>Several types of <a href=\"https:\/\/en.wikipedia.org\/wiki\/High-intensity_discharge_lamp\" title=\"High-intensity discharge lamp\" rel=\"external_link\" target=\"_blank\">high-intensity discharge<\/a> (HID) lamps, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercury-vapor_lamp\" title=\"Mercury-vapor lamp\" rel=\"external_link\" target=\"_blank\">mercury-vapor<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal-halide_lamp\" title=\"Metal-halide lamp\" rel=\"external_link\" target=\"_blank\">metal-halide lamps<\/a>, use borosilicate glass as the outer envelope material.\n<\/p><p>New <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lampworking\" title=\"Lampworking\" rel=\"external_link\" target=\"_blank\">lampworking<\/a> techniques led to artistic applications such as contemporary glass <a href=\"https:\/\/en.wikipedia.org\/wiki\/Marble_(toy)\" title=\"Marble (toy)\" rel=\"external_link\" target=\"_blank\">marbles<\/a>. The modern <a href=\"https:\/\/en.wikipedia.org\/wiki\/Studio_glass\" title=\"Studio glass\" rel=\"external_link\" target=\"_blank\">studio glass<\/a> movement has responded to color. Borosilicate is commonly used in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glassblowing\" title=\"Glassblowing\" rel=\"external_link\" target=\"_blank\">glassblowing<\/a> form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lampworking\" title=\"Lampworking\" rel=\"external_link\" target=\"_blank\">lampworking<\/a> and the artists create a range of products such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jewelry\" class=\"mw-redirect\" title=\"Jewelry\" rel=\"external_link\" target=\"_blank\">jewelry<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kitchenware\" title=\"Kitchenware\" rel=\"external_link\" target=\"_blank\">kitchenware<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sculpture\" title=\"Sculpture\" rel=\"external_link\" target=\"_blank\">sculpture<\/a>, as well as for artistic glass smoking pipes.\n<\/p><p>Lighting manufacturers use borosilicate glass in their refractors.\n<\/p><p>Organic light-emitting diode (for display and lighting purposes) also uses borosilicate glass (BK7). The thicknesses of the BK7 glass substrates are usually less than 1 millimeter for the <a href=\"https:\/\/en.wikipedia.org\/wiki\/OLED\" title=\"OLED\" rel=\"external_link\" target=\"_blank\">OLED<\/a> fabrication. Due to its optical and mechanical characteristics in relation with cost, BK7 is a common substrate in OLEDs. However, depending on the application, soda-lime glass substrates of similar thicknesses are also used in OLED fabrication.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Optics\">Optics<\/span><\/h3>\n<p>Most astronomical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reflecting_telescope\" title=\"Reflecting telescope\" rel=\"external_link\" target=\"_blank\">reflecting telescope<\/a> use glass mirror components made of borosilicate glass because of its low coefficient of thermal expansion. This makes very precise optical surfaces possible that change very little with temperature, and matched glass mirror components that \"track\" across temperature changes and retain the optical system's characteristics.\n<\/p><p>The optical glass most often used for making instrument <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lens_(optics)\" title=\"Lens (optics)\" rel=\"external_link\" target=\"_blank\">lenses<\/a> is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Schott_AG\" title=\"Schott AG\" rel=\"external_link\" target=\"_blank\">Schott<\/a> BK-7 (or the equivalent from other makers), a very finely made borosilicate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crown_glass_(optics)\" title=\"Crown glass (optics)\" rel=\"external_link\" target=\"_blank\">crown glass<\/a>.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<p>It is also designated as 517642 glass after its 1.517 refractive index and 64.2 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abbe_number\" title=\"Abbe number\" rel=\"external_link\" target=\"_blank\">Abbe number<\/a>. Other less costly borosilicate glasses, such as Schott B270 or the equivalent, are used to make \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Crown_glass_(optics)\" title=\"Crown glass (optics)\" rel=\"external_link\" target=\"_blank\">crown-glass<\/a>\" eyeglass lenses. Ordinary lower-cost borosilicate glass, like that used to make kitchenware and even reflecting telescope mirrors, cannot be used for high-quality lenses because of the striations and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inclusion_(mineral)\" title=\"Inclusion (mineral)\" rel=\"external_link\" target=\"_blank\">inclusions<\/a> common to lower grades of this type of glass. The maximal working temperature is 268 \u00b0C (514 \u00b0F). While it transitions to a liquid starting at 288 \u00b0C (550 \u00b0F) (just before it turns red-hot), it is not workable until it reaches over 538 \u00b0C (1,000 \u00b0F). That means that in order to industrially produce this glass, oxygen\/fuel torches must be used. Glassblowers borrowed technology and techniques from welders.\n<\/p>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Rapid_prototyping\">Rapid prototyping<\/span><\/h3>\n<p>Borosilicate glass has become the material of choice for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fused_deposition_modeling\" class=\"mw-redirect\" title=\"Fused deposition modeling\" rel=\"external_link\" target=\"_blank\">fused deposition modeling<\/a> (FDM), or fused filament fabrication (FFF), build plates. Its low coefficient of expansion makes borosilicate glass, when used in combination with resistance-heating plates and pads, an ideal material for the heated build platform onto which plastic materials are extruded one layer at a time. The initial layer of build must be placed onto a substantially flat, heated surface to minimize shrinkage of some build materials (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Acrylonitrile_butadiene_styrene\" title=\"Acrylonitrile butadiene styrene\" rel=\"external_link\" target=\"_blank\">ABS<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polycarbonate\" title=\"Polycarbonate\" rel=\"external_link\" target=\"_blank\">polycarbonate<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyamide\" title=\"Polyamide\" rel=\"external_link\" target=\"_blank\">polyamide<\/a>, etc.) due to cooling after deposition. The build plate will cycle from room temperature to between 100 \u00b0C and 130 \u00b0C for each prototype that is built. The temperature, along with various coatings (Kapton tape, painter tape, hair spray, glue stick, ABS+acetone slurry, etc.), ensure that the first layer may be adhered to and remain adhered to the plate, without warping, as the first and subsequent layers cool following extrusion. Subsequently, following the build, the heating elements and plate are allowed to cool. The resulting residual stress formed when the plastic contracts as it cools, while the glass remains relatively dimensionally unchanged due to the low coefficient of thermal expansion, provides a convenient aid in removing the otherwise mechanically bonded plastic from the build plate. In some cases the parts self-separate as the developed stresses overcome the adhesive bond of the build material to the coating material and underlying plate.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Other\">Other<\/span><\/h3>\n<p>Aquarium heaters are sometimes made of borosilicate glass. Due to its high heat resistance, it can tolerate the significant temperature difference between the water and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nichrome\" title=\"Nichrome\" rel=\"external_link\" target=\"_blank\">nichrome<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heating_element\" title=\"Heating element\" rel=\"external_link\" target=\"_blank\">heating element<\/a>.\n<\/p><p>Specialty glass <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pipe_smoking\" title=\"Pipe smoking\" rel=\"external_link\" target=\"_blank\">smoking pipes<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cannabis_pipe\" class=\"mw-redirect\" title=\"Cannabis pipe\" rel=\"external_link\" target=\"_blank\">cannabis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Smoking_pipe_(tobacco)\" class=\"mw-redirect\" title=\"Smoking pipe (tobacco)\" rel=\"external_link\" target=\"_blank\">tobacco<\/a> are made from borosilicate glass. The high heat resistance makes the pipes more durable. Some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Harm_reduction\" title=\"Harm reduction\" rel=\"external_link\" target=\"_blank\">Harm Reduction<\/a> organizations also give out borosilicate pipes intended for smoking <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crack_cocaine\" title=\"Crack cocaine\" rel=\"external_link\" target=\"_blank\">crack cocaine<\/a>, as the heat resistance prevents the glass from cracking, causing cuts and burns that can spread Hepatitis C.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p><p>Most premanufactured glass <a href=\"https:\/\/en.wikipedia.org\/wiki\/Slide_guitar\" title=\"Slide guitar\" rel=\"external_link\" target=\"_blank\">guitar slides<\/a> are also made of borosilicate glass.\n<\/p><p>Borosilicate is also a material of choice for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solar_thermal_collector#Evacuated_tube_collectors\" title=\"Solar thermal collector\" rel=\"external_link\" target=\"_blank\">evacuated-tube solar thermal technology<\/a>, because of its high strength and heat resistance.\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Space_Shuttle_thermal_protection_system\" title=\"Space Shuttle thermal protection system\" rel=\"external_link\" target=\"_blank\">thermal insulation tiles<\/a> on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Space_Shuttle\" title=\"Space Shuttle\" rel=\"external_link\" target=\"_blank\">Space Shuttle<\/a> were coated with a borosilicate glass.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>Borosilicate glasses are used for immobilisation and disposal of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radioactive_waste\" title=\"Radioactive waste\" rel=\"external_link\" target=\"_blank\">radioactive wastes<\/a>. In most countries <a href=\"https:\/\/en.wikipedia.org\/wiki\/High-level_radioactive_waste_management\" title=\"High-level radioactive waste management\" rel=\"external_link\" target=\"_blank\">high-level radioactive waste<\/a> has been incorporated into alkali borosilicate or phosphate vitreous waste forms for many years, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radioactive_waste#Vitrification\" title=\"Radioactive waste\" rel=\"external_link\" target=\"_blank\">vitrification<\/a> is an established technology.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> Vitrification is a particularly attractive immobilization route because of the high chemical durability of the vitrified glass product. This characteristic has been used by industry for centuries.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2010)\">citation needed<\/span><\/a><\/i>]<\/sup> The chemical resistance of glass can allow it to remain in a corrosive environment for many thousands and even millions of years.\n<\/p><p>Borosilicate glass tubing is used in specialty <a href=\"https:\/\/en.wikipedia.org\/wiki\/TIG_welding\" class=\"mw-redirect\" title=\"TIG welding\" rel=\"external_link\" target=\"_blank\">TIG welding<\/a> torch nozzles in place of standard <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alumina\" class=\"mw-redirect\" title=\"Alumina\" rel=\"external_link\" target=\"_blank\">alumina<\/a> nozzles. This allows a clear view of the arc in situations where visibility is limited.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Trade_names\">Trade names<\/span><\/h2>\n<p>Borosilicate glass is offered in slightly different compositions under different trade names:\n<\/p>\n<ul><li>Borofloat of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Schott_AG\" title=\"Schott AG\" rel=\"external_link\" target=\"_blank\">Schott AG<\/a>, a borosilicate glass, which is produced to flat glass in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Float_glass\" title=\"Float glass\" rel=\"external_link\" target=\"_blank\">float process<\/a>.<\/li>\n<li>BK7 of Schott, a borosilicate glass with a high level of purity. Main use in lens and mirrors for laser, cameras and telescopes.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Duran_(glass)\" title=\"Duran (glass)\" rel=\"external_link\" target=\"_blank\">Duran<\/a> of , similar to Pyrex, Simax or Jenaer Glas.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiolax\" class=\"mw-redirect\" title=\"Fiolax\" rel=\"external_link\" target=\"_blank\">Fiolax<\/a> of Schott, mainly used for containers for pharmaceutical applications.<\/li>\n<li> of <span class=\"noprint\" style=\"font-size:85%; font-style: normal;\"> [<a href=\"https:\/\/de.wikipedia.org\/wiki\/Technische_Glaswerke_Ilmenau\" class=\"extiw\" title=\"de:Technische Glaswerke Ilmenau\" rel=\"external_link\" target=\"_blank\">de<\/a>]<\/span> (2014 insolvency), mainly used for containers and equipment in laboratories and medicine.<\/li>\n<li> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zwiesel_Kristallglas\" title=\"Zwiesel Kristallglas\" rel=\"external_link\" target=\"_blank\">Zwiesel Kristallglas<\/a>, formerly Schott AG. Mainly used for kitchenware.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pyrex\" title=\"Pyrex\" rel=\"external_link\" target=\"_blank\">Pyrex<\/a> of , formerly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corning_Inc.\" title=\"Corning Inc.\" rel=\"external_link\" target=\"_blank\">Corning<\/a>. Mainly used for kitchenware<\/li>\n<li> of VEB Jenaer Glaswerk Schott & Genossen, for technical glass<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Simax\" class=\"mw-redirect\" title=\"Simax\" rel=\"external_link\" target=\"_blank\">Simax<\/a> of Kavalierglass a.s.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Willow_Glass\" class=\"mw-redirect\" title=\"Willow Glass\" rel=\"external_link\" target=\"_blank\">Willow Glass<\/a> is an alkali free, thin and flexible borosilicate glass of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corning_Inc.\" title=\"Corning Inc.\" rel=\"external_link\" target=\"_blank\">Corning<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Borosilicate_nanoparticles\">Borosilicate nanoparticles<\/span><\/h2>\n<p>It was initially thought that borosilicate glass could not be formed into <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nanoparticle\" title=\"Nanoparticle\" rel=\"external_link\" target=\"_blank\">nanoparticles<\/a>, since an unstable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boron_oxide\" title=\"Boron oxide\" rel=\"external_link\" target=\"_blank\">boron oxide<\/a> precursor prevented successful forming of these shapes. However, in 2008 a team of researchers from the Swiss <a href=\"https:\/\/en.wikipedia.org\/wiki\/%C3%89cole_Polytechnique_F%C3%A9d%C3%A9rale_de_Lausanne\" title=\"\u00c9cole Polytechnique F\u00e9d\u00e9rale de Lausanne\" rel=\"external_link\" target=\"_blank\">Federal Institute of Technology<\/a> at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lausanne\" title=\"Lausanne\" rel=\"external_link\" target=\"_blank\">Lausanne<\/a> were successful in forming borosilicate nanoparticles of 100 to 500 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nanometer\" class=\"mw-redirect\" title=\"Nanometer\" rel=\"external_link\" target=\"_blank\">nanometers<\/a> in diameter. The researchers formed a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gel\" title=\"Gel\" rel=\"external_link\" target=\"_blank\">gel<\/a> of tetraethylorthosilicate and trimethoxyboroxine. When this gel is exposed to water under proper conditions, a dynamic reaction ensues which results in the nanoparticles.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"In_lampworking\">In lampworking<\/span><\/h2>\n<p>Borosilicate (or \"boro\", as it is often called) is used extensively in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glassblowing\" title=\"Glassblowing\" rel=\"external_link\" target=\"_blank\">glassblowing<\/a> process <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lampworking\" title=\"Lampworking\" rel=\"external_link\" target=\"_blank\">lampworking<\/a>; the glassworker uses a burner torch to melt and form glass, using a variety of metal and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Graphite\" title=\"Graphite\" rel=\"external_link\" target=\"_blank\">graphite<\/a> tools to shape it. Borosilicate is referred to as \"hard glass\" and has a higher melting point (approximately 3,000 \u00b0F \/ 1648 \u00b0C) than \"soft glass\", which is preferred for glassblowing by beadmakers. Raw glass used in lampworking comes in glass rods for solid work and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass_tubes\" class=\"mw-redirect\" title=\"Glass tubes\" rel=\"external_link\" target=\"_blank\">glass tubes<\/a> for hollow work tubes and vessels\/containers. Lampworking is used to make complex and custom scientific apparatus; most major universities have a lampworking shop to manufacture and repair their glassware. For this kind of \"scientific glassblowing\", the specifications must be exact and the glassblower must be highly skilled and able to work with precision. Lampworking is also done as art, and common items made include goblets, paper weights, pipes, pendants, compositions and figurines.\n<\/p><p>In 1968, English metallurgist John Burton brought his hobby of hand-mixing metallic oxides into borosilicate glass to Los Angeles. Burton began a glass workshop at Pepperdine College, with instructor Margaret Youd. A few of the students in the classes, including Suellen Fowler, discovered that a specific combination of oxides made a glass that would shift from amber to purples and blues, depending on the heat and flame atmosphere. Fowler shared this combination with Paul Trautman, who formulated the first small-batch colored borosilicate recipes. He then founded Northstar Glassworks in the mid-1980s, the first factory devoted solely to producing colored borosilicate glass rods and tubes for use by artists in the flame. Trautman also developed the techniques and technology to make the small-batch colored boro that is used by a number of similar companies.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> \n<\/p>\n<h3><span class=\"mw-headline\" id=\"Beadmaking\">Beadmaking<\/span><\/h3>\n<p>In recent years, with the resurgence of lampworking as a technique to make handmade glass beads, borosilicate has become a popular material in many glass artists' studios. Borosilicate for beadmaking comes in thin, pencil-like rods. Glass Alchemy, Trautman Art Glass, and Northstar are popular manufacturers, although there are other brands available. The metals used to color borosilicate glass, particularly silver, often create strikingly beautiful and unpredictable results when melted in an oxygen-gas torch flame. Because it is more shock-resistant and stronger than soft glass, borosilicate is particularly suited for pipe making, as well as sculpting figures and creating large beads. The tools used for making glass beads from borosilicate glass are the same as those used for making glass beads from soft glass.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.arc-international-cookware.com\/en\/aboutus\/pyrex-history.php\" target=\"_blank\">Pyrex History<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080922015443\/http:\/\/www.arc-international-cookware.com\/en\/aboutus\/pyrex-history.php\" target=\"_blank\">Archived<\/a> September 22, 2008, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.snopes.com\/food\/warnings\/pyrex.asp\" target=\"_blank\">\"Exploding Pyrex\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2009-10-27<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Exploding+Pyrex&rft_id=http%3A%2F%2Fwww.snopes.com%2Ffood%2Fwarnings%2Fpyrex.asp&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABorosilicate+glass\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.scilabware.com\/uploads\/PDFs\/2010\/Technical_information_Glassware.pdf\" target=\"_blank\">\"Archived copy\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20151123034105\/http:\/\/www.scilabware.com\/uploads\/pdfs\/2010\/technical_information_glassware.pdf\" target=\"_blank\">Archived<\/a> <span class=\"cs1-format\">(PDF)<\/span> from the original on 2015-11-23<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-12-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Archived+copy&rft_id=http%3A%2F%2Fwww.scilabware.com%2Fuploads%2FPDFs%2F2010%2FTechnical_information_Glassware.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABorosilicate+glass\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Archived copy as title (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Archived_copy_as_title\" title=\"Category:CS1 maint: Archived copy as title\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Spinosa, E. D.; Hooie, D. T.; Bennett, R. B. (1979). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=Borosilicate%20glass%20is%20created%20by%20combining%20together%20and%20melting%20boric%20oxide,%20silica%20sand,%20soda%20ash,%20and%20alumina&f=false\"><i>Summary Report on Emissions from the Glass Manufacturing Industry<\/i><\/a>. Environmental Protection Agency, Office of Research and Development, [Office of Energy, Minerals, and Industry], Industrial Environmental Research Laboratory.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Summary+Report+on+Emissions+from+the+Glass+Manufacturing+Industry&rft.pub=Environmental+Protection+Agency%2C+Office+of+Research+and+Development%2C+%5BOffice+of+Energy%2C+Minerals%2C+and+Industry%5D%2C+Industrial+Environmental+Research+Laboratory&rft.date=1979&rft.aulast=Spinosa&rft.aufirst=E.+D.&rft.au=Hooie%2C+D.+T.&rft.au=Bennett%2C+R.+B.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Dqh5u_jNtydsC%26pg%3DPA14%26dq%3DBorosilicate%2Bglass%2Bis%2Bcreated%2Bby%2Bcombining%2Btogether%2Band%2Bmelting%2Bboric%2Boxide%2C%2Bsilica%2Bsand%2C%2Bsoda%2Bash%2C%2Band%2Balumina%26hl%3Den%26sa%3DX%26ved%3D0ahUKEwjY7Ky649fXAhVPImMKHUZYD8sQ6AEIKDAA%23v%3Donepage%26q%3DBorosilicate%2520glass%2520is%2520created%2520by%2520combining%2520together%2520and%2520melting%2520boric%2520oxide%2C%2520silica%2520sand%2C%2520soda%2520ash%2C%2520and%2520alumina%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABorosilicate+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.refmexgl.com\/index.php\/catalogo\/detalle\/producto\/9\" target=\"_blank\">\"Borosilicato\"<\/a>. <i>refmexgl.com<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120630160930\/http:\/\/www.refmexgl.com\/index.php\/catalogo\/detalle\/producto\/9\" target=\"_blank\">Archived<\/a> from the original on 2012-06-30<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2012-11-02<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=refmexgl.com&rft.atitle=Borosilicato&rft_id=http%3A%2F%2Fwww.refmexgl.com%2Findex.php%2Fcatalogo%2Fdetalle%2Fproducto%2F9&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABorosilicate+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Weissler, G. L. (1979). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=tfLWfAx1ZWQC\" target=\"_blank\"><i>Vacuum Physics and Technology<\/i><\/a> (2 ed.). Academic Press. p. 315. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-12-475914-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Vacuum+Physics+and+Technology&rft.pages=315&rft.edition=2&rft.pub=Academic+Press&rft.date=1979&rft.isbn=978-0-12-475914-5&rft.aulast=Weissler&rft.aufirst=G.+L.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DtfLWfAx1ZWQC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABorosilicate+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.schott.com\/borofloat\/english\/attribute\/thermic\/index.html\" target=\"_blank\">\"Borosilikatglas BOROFLOAT\u00ae - Thermische Produkteigenschaften\"<\/a>. <i>www.schott.com<\/i>. Schott AG<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">31 August<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.schott.com&rft.atitle=Borosilikatglas+BOROFLOAT%C2%AE+-+Thermische+Produkteigenschaften&rft_id=https%3A%2F%2Fwww.schott.com%2Fborofloat%2Fenglish%2Fattribute%2Fthermic%2Findex.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABorosilicate+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFBrandtMartens2012\" class=\"citation\">Brandt, R. C.; Martens, R. I. (September 2012), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ceramics.org\/ceramic-tech-today\/hells-kitchen-thermal-stress-and-glass-cookware-that-shatters\" target=\"_blank\">\"Shattering Glass Cookware\"<\/a>, <i>American Ceramics Society Bulletin<\/i>, American Ceramics Society, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/archive.wikiwix.com\/cache\/20150310160424\/http:\/\/ceramics.org\/ceramic-tech-today\/hells-kitchen-thermal-stress-and-glass-cookware-that-shatters\" target=\"_blank\">archived<\/a> from the original on 2015-03-10<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Ceramics+Society+Bulletin&rft.atitle=Shattering+Glass+Cookware&rft.date=2012-09&rft.aulast=Brandt&rft.aufirst=R.+C.&rft.au=Martens%2C+R.+I.&rft_id=http%3A%2F%2Fceramics.org%2Fceramic-tech-today%2Fhells-kitchen-thermal-stress-and-glass-cookware-that-shatters&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABorosilicate+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.schott.com\/d\/tubing\/c3fb6f14-beae-4571-82bb-a989308ffe2a\/1.1\/schott-brochure-technical-glasses_english.pdf\" target=\"_blank\">\"Archived copy\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170824175254\/http:\/\/www.schott.com\/d\/tubing\/c3fb6f14-beae-4571-82bb-a989308ffe2a\/1.1\/schott-brochure-technical-glasses_english.pdf\" target=\"_blank\">Archived<\/a> <span class=\"cs1-format\">(PDF)<\/span> from the original on 2017-08-24<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-08-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Archived+copy&rft_id=http%3A%2F%2Fwww.schott.com%2Fd%2Ftubing%2Fc3fb6f14-beae-4571-82bb-a989308ffe2a%2F1.1%2Fschott-brochure-technical-glasses_english.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABorosilicate+glass\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Archived copy as title (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Archived_copy_as_title\" title=\"Category:CS1 maint: Archived copy as title\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">R Wananuruksawong et al 2011 IOP Conf. Ser.: Mater. Sci. Eng. 18 192010 doi:10.1088\/1757-899X\/18\/19\/192010 Fabrication of Silicon Nitride Dental Core Ceramics with Borosilicate Veneering material<\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/medicaldesign.com\/materials\/encapsulating-smaller-and-smarter-implantables-glass-act\" target=\"_blank\">http:\/\/medicaldesign.com\/materials\/encapsulating-smaller-and-smarter-implantables-glass-act<\/a><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.pgo-online.com\/intl\/katalog\/BK7.html\" target=\"_blank\">\"Bor-crown glass from SCHOTT\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170705165919\/https:\/\/www.pgo-online.com\/intl\/katalog\/BK7.html\" target=\"_blank\">Archived<\/a> from the original on 2017-07-05.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Bor-crown+glass+from+SCHOTT&rft_id=https%3A%2F%2Fwww.pgo-online.com%2Fintl%2Fkatalog%2FBK7.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABorosilicate+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.catie.ca\/en\/pif\/fall-2014\/safer-crack-cocaine-smoking-equipment-distribution-comprehensive-best-practice-guideli\" target=\"_blank\">\"Safer Crack Cocaine Smoking Equipment Distribution: Comprehensive Best Practice Guidelines\"<\/a>. <i>www.catie.ca<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-05-14<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.catie.ca&rft.atitle=Safer+Crack+Cocaine+Smoking+Equipment+Distribution%3A+Comprehensive+Best+Practice+Guidelines&rft_id=http%3A%2F%2Fwww.catie.ca%2Fen%2Fpif%2Ffall-2014%2Fsafer-crack-cocaine-smoking-equipment-distribution-comprehensive-best-practice-guideli&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABorosilicate+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/science.ksc.nasa.gov\/shuttle\/technology\/sts-newsref\/sts_sys.html\" target=\"_blank\">\"SPACE SHUTTLE ORBITER SYSTEMS THERMAL PROTECTION SYSTEM\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090715235829\/http:\/\/science.ksc.nasa.gov\/shuttle\/technology\/sts-newsref\/sts_sys.html\" target=\"_blank\">Archived<\/a> from the original on 2009-07-15<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2009-07-15<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=SPACE+SHUTTLE+ORBITER+SYSTEMS+THERMAL+PROTECTION+SYSTEM&rft_id=http%3A%2F%2Fscience.ksc.nasa.gov%2Fshuttle%2Ftechnology%2Fsts-newsref%2Fsts_sys.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABorosilicate+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">M. I. Ojovan and W.E. Lee. An Introduction to Nuclear Waste Immobilisation, Elsevier, Amsterdam, 315 p. (2005)<\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_%26_Engineering_News\" title=\"Chemical & Engineering News\" rel=\"external_link\" target=\"_blank\">Chemical & Engineering News<\/a><\/i> Vol. 86 No. 37, 15 September 2008, \"Making Borosilicate nanoparticles is now possible\", p. 35<\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Robert Mickelsen, \"Art Glass Lampworking History\" Online Glass Museum, <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.theglassmuseum.com\/lampwork.html\" target=\"_blank\">http:\/\/www.theglassmuseum.com\/lampwork.html<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1322\nCached time: 20181207010031\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.412 seconds\nReal time usage: 0.556 seconds\nPreprocessor visited node count: 1515\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 74851\/2097152 bytes\nTemplate argument size: 1562\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 33138\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.179\/10.000 seconds\nLua memory usage: 6.7 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 404.443 1 -total\n<\/p>\n<pre>38.26% 154.742 1 Template:Reflist\n23.24% 93.987 8 Template:Cite_web\n21.28% 86.062 2 Template:Citation_needed\n16.02% 64.812 2 Template:Fix\n11.57% 46.798 1 Template:Commons_category\n10.56% 42.690 7 Template:Convert\n10.13% 40.988 4 Template:Category_handler\n 5.79% 23.423 3 Template:Navbox\n 4.70% 19.013 1 Template:Ill\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1452308-1!canonical and timestamp 20181207010031 and revision id 872255782\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Borosilicate_glass\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212213\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.166 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 158.279 1 - wikipedia:Borosilicate_glass\n100.00% 158.279 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8287-0!*!*!*!*!*!* and timestamp 20181217212212 and revision id 24499\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Borosilicate_glass\">https:\/\/www.limswiki.org\/index.php\/Borosilicate_glass<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","8478ad5f9a28e06b9a61e65f3ded06f9_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2e\/GlassGuitarSlide.jpg\/440px-GlassGuitarSlide.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/12\/Beakers.jpg\/440px-Beakers.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6f\/Arcopal.JPG\/440px-Arcopal.JPG"],"8478ad5f9a28e06b9a61e65f3ded06f9_timestamp":1545081732,"586066a272d44cda0be5711d9e55266c_type":"article","586066a272d44cda0be5711d9e55266c_title":"Bone cement","586066a272d44cda0be5711d9e55266c_url":"https:\/\/www.limswiki.org\/index.php\/Bone_cement","586066a272d44cda0be5711d9e55266c_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tBone cement\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (August 2014) (Learn how and when to remove this template message)\nIUPAC definition\nSynthetic, self-curing organic or inorganic material used\r\nto fill up a cavity or to create a mechanical fixation.\nNote 1: In situ self-curing can be the source of released reagents\r\nthat can cause local and\/or systemic toxicity as in the case of the\r\nmonomer released from methacrylics-based bone cement used in \r\northopedic surgery.\n\nNote 2: In dentistry, polymer-based cements are also used as fillers\r\nof cavities. They are generally cured photochemically using UV radiation\r\nin contrast to bone cements.[1]\n\nBone cements have been used very successfully to anchor artificial joints (hip joints, knee joints, shoulder and elbow joints) for more than half a century. Artificial joints (referred to as prostheses) are anchored with bone cement. The bone cement fills the free space between the prosthesis and the bone and plays the important role of an elastic zone. This is necessary because the human hip is acted on by approximately 10-12 times the body weight and therefore the bone cement must absorb the forces acting on the hips to ensure that the artificial implant remains in place over the long term.\nBone cement chemically is nothing more than Plexiglas (i.e. polymethyl methacrylate or PMMA). PMMA was used clinically for the first time in the 1940s in plastic surgery to close gaps in the skull. Comprehensive clinical tests of the compatibility of bone cements with the body were conducted before their use in surgery. The excellent tissue compatibility of PMMA allowed bone cements to be used for anchorage of head prostheses in the 1950s.\nToday several million procedures of this type are conducted every year all over the world and more than half of them routinely use bone cements - and the proportion is increasing. Bone cement is considered a reliable anchorage material with its ease of use in clinical practice and particularly because of its proven long survival rate with cemented-in prostheses. Hip and knee registers for artificial joint replacements such as those in Sweden and Norway[2] clearly demonstrate the advantages of cemented-in anchorage. A similar register for endoprosthesis was introduced in Germany in 2010.[3]\n\nContents \n\n1 Composition \n2 Important information for the use of bone cement \n3 Revisions \n4 See also \n5 References \n6 External links \n\n\nComposition \nBone cements are provided as two-component materials. Bone cements consist of a powder (i.e., pre-polymerized PMMA and or PMMA or MMA co-polymer beads and or amorphous powder, radio-opacifer, initiator) and a liquid (MMA monomer, stabilizer, inhibitor). The two components are mixed and a free radical polymerization occurs of the monomer when the initiator is mixed with the accelerator. The bone cement viscosity changes over time from a runny liquid into a dough like state that can be safely applied and then finally hardens into solid hardened material.[4] The set time can be tailored to help the physician safely apply the bone cement into the bone bed to either anchor metal or plastic prosthetic device to bone or used alone in the spine to treat osteoporotic compression fractures.\nDuring the exothermic free-radical polymerization process, the cement heats up. This polymerization heat reaches temperatures of around 82-86 \u00b0C in the body. This temperature is higher than the critical level for protein denaturation in the body. The cause of the low polymerization temperature in the body is the relatively thin cement coating, which should not exceed 5 mm, and the temperature dissipation via the large prosthesis surface and the flow of blood.\nThe individual components of the bone cement are also known in the area of dental filler materials. Acrylate-based plastics are also used in these applications. While the individual components are not always perfectly safe as pharmaceutical additives and active substances per se, as bone cement the individual substances are either converted or fully enclosed in the cement matrix during the polymerization phase from the increase in viscosity to curing. From current knowledge, cured bone cement can now be classified as safe, as originally demonstrated during the early studies on compatibility with the body conducted in the 1950s.\nMore recently bone cement has been use in the spine in either vertebroplasty or kyphoplasty procedures. The composition of these types of cement is mostly based on calcium phosphate and more recently magnesium phosphate. A novel biodegradable, non-exothermic, self-setting orthopedic cement composition based on amorphous magnesium phosphate (AMP) was developed. The occurrence of undesirable exothermic reactions was avoided through using AMP as the solid precursor [5]\n\nImportant information for the use of bone cement \nWhat is referred to as bone cement implantation syndrome (BCIS) is described in the literature.[6] For a long time it was believed that the incompletely converted monomer released from bone cement was the cause of circulation reactions and embolism. However, it is now known that this monomer (residual monomer) is metabolized by the respiratory chain and split into carbon dioxide and water and excreted. Embolisms can always occur during anchorage of artificial joints when material is inserted into the previously cleared femoral canal. The result is intramedullary pressure increase, potentially driving fat into the circulation.\nIf the patient is known to have any allergies to constituents of the bone cement, according to current knowledge bone cement should not be used to anchor the prosthesis. Anchorage without cement - cement-free implant placement - is the alternative.\nNew bone cement formulations require characterization according to ASTM F451.[7] This standard describes the test methods to assess cure rate, residual monomer, mechanical strength, benzoyl peroxide concentration, and heat evolution during cure.\n\nRevisions \nRevision is the replacement of a prosthesis. This means that a prosthesis previously implanted in the body is removed and replaced by a new prosthesis. Compared to the initial operation revisions are often more complex and more difficult, because every revision involves the loss of healthy bone substance. Revision operations are also more expensive for a satisfactory result. The most important goal is therefore to avoid revisions by using a good surgical procedure and using products with good (long-term) results.\nUnfortunately, it is not always possible to avoid revisions.[2][4] There can also be different reasons for revisions and there is a distinction between septic or aseptic revision.[8] If it is necessary to replace an implant without confirmation of an infection\u2014for example, aseptic\u2014the cement is not necessarily removed completely. However, if the implant has loosened for septic reasons, the cement must be fully removed to clear an infection. In the current state of knowledge it is easier to remove cement than to release a well-anchored cement-free prosthesis from the bone site. Ultimately it is important for the stability of the revised prosthesis to detect possible loosening of the initial implant early to be able to retain as much healthy bone as possible.\nA prosthesis fixed with bone cement offers very high primary stability combined with fast remobilization of patients. The cemented-in prosthesis can be fully loaded very soon after the operation because the PMMA gets most of its strength within 24 hours.[8] The necessary rehabilitation is comparatively simple for patients who have had a cemented-in prosthesis implanted. The joints can be loaded again very soon after the operation, but the use of crutches is still required for a reasonable period for safety reasons.\nBone cement has proven particularly useful because specific active substances, e.g. antibiotics, can be added to the powder component. The active substances are released locally after implant placement of the new joint, i.e. in the immediate vicinity of the new prosthesis and have been confirmed to reduce the danger of infection. The antibiotics act against bacteria precisely at the site where they are required in the open wound without subjecting the body in general to unnecessarily high antibiotic levels. This makes bone cement a modern drug delivery system that delivers the required drugs directly to the surgical site. The important factor is not how much active substance is in the cement matrix but how much of the active substance is actually released locally. Too much active substance in the bone cement would actually be detrimental, because the mechanical stability of the fixed prosthesis is weakened by a high proportion of active substance in the cement. The local active substance levels of industrially manufactured bone cements that are formed by the use of bone cements that contain active substances are approximate (assuming that there is no incompatibility) and are significantly below the clinical routine dosages for systemic single injections.\n\nSee also \nOsteoplasty \u2013 use of bone cement to reduce pain\nReferences \n\n\n^ \"Terminology for biorelated polymers and applications (IUPAC Recommendations 2012)\" (PDF) . Pure and Applied Chemistry. 84 (2): 377\u2013410. 2012. doi:10.1351\/PAC-REC-10-12-04. \n\n^ a b \"Is there still a place for the cemented titanium femoral stem? 10,108 cases from the Norwegian Arthroplasty Register\". Acta Orthopaedica. 83 (1): 1\u20136. 2012. doi:10.3109\/17453674.2011.645194. PMC 3278649 . PMID 22206445. \n\n^ \"Wir \u00fcber uns\". Endoprothesenregister Deutschland. EPRD Deutsche Endoprothesenregister GmbH. Archived from the original on 2016-02-25. Retrieved 22 February 2016 . \n\n^ a b \"The effect of the type of cement on early revision of Charnley total hip prostheses. A review of eight thousand five hundred and seventy-nine primary arthroplasties from the Norwegian Arthroplasty Register\". The Journal of Bone and Joint Surgery. 77 (10): 1543\u20131550. 1995. PMID 7593063. \n\n^ Evaluation of amorphous magnesium phosphate (AMP) based non-exothermic orthopedic cements, Biomed. Mater. 11 (2016) 055010, https:\/\/dx.doi.org\/10.1088\/1748-6041\/11\/5\/055010. \n\n^ Br. J. Anaesth. (2009) 102 (1): 12-22.\ndoi: 10.1093\/bja\/aen328 \n\n^ ASTM F451: Standard Specification for Acrylic Bone Cement \n\n^ a b \"Experimental investigation of the effect of surface roughness on bone-cement-implant shear bond strength\". Journal of the Mechanical Behavior of Biomedical Materials. 28: 254\u2013262. 2013. doi:10.1016\/j.jmbbm.2013.08.005. PMID 24004958. \n\n\nExternal links \nApplication note describing how to measure residual monomer in bone cement\nA presentation on the rheology of bone cement\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Bone_cement\">https:\/\/www.limswiki.org\/index.php\/Bone_cement<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 22:18.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 697 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","586066a272d44cda0be5711d9e55266c_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Bone_cement skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Bone cement<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"quotebox pullquote floatright\" style=\";\">\n<div class=\"quotebox-title\" style=\"\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Union_of_Pure_and_Applied_Chemistry\" title=\"International Union of Pure and Applied Chemistry\" rel=\"external_link\" target=\"_blank\">IUPAC<\/a> definition<\/div>\n<div class=\"quotebox-quote left-aligned\" style=\"\">Synthetic, self-curing organic or inorganic material used<br \/>to fill up a cavity or to create a mechanical fixation.\n<p>Note 1: In situ self-curing can be the source of released reagents<br \/>that can cause local and\/or systemic toxicity as in the case of the<br \/>monomer released from methacrylics-based bone cement used in <br \/>orthopedic surgery.\n<\/p>\nNote 2: In dentistry, polymer-based cements are also used as fillers<br \/>of cavities. They are generally cured photochemically using UV radiation<br \/>in contrast to bone cements.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><\/div>\n<\/div>\n<p><b>Bone cements<\/b> have been used very successfully to anchor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_joint\" class=\"mw-redirect\" title=\"Artificial joint\" rel=\"external_link\" target=\"_blank\">artificial joints<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_joint\" class=\"mw-redirect\" title=\"Hip joint\" rel=\"external_link\" target=\"_blank\">hip joints<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee_joint\" class=\"mw-redirect\" title=\"Knee joint\" rel=\"external_link\" target=\"_blank\">knee joints<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shoulder_joint\" title=\"Shoulder joint\" rel=\"external_link\" target=\"_blank\">shoulder<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elbow_joint\" class=\"mw-redirect\" title=\"Elbow joint\" rel=\"external_link\" target=\"_blank\">elbow joints<\/a>) for more than half a century. Artificial joints (referred to as prostheses) are anchored with bone cement. The bone cement fills the free space between the prosthesis and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> and plays the important role of an elastic zone. This is necessary because the human hip is acted on by approximately 10-12 times the body weight and therefore the bone cement must absorb the forces acting on the hips to ensure that the artificial implant remains in place over the long term.\n<\/p><p>Bone cement chemically is nothing more than Plexiglas (i.e. polymethyl methacrylate or PMMA). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Poly(methyl_methacrylate)\" title=\"Poly(methyl methacrylate)\" rel=\"external_link\" target=\"_blank\">PMMA<\/a> was used clinically for the first time in the 1940s in plastic surgery to close gaps in the skull. Comprehensive clinical tests of the compatibility of bone cements with the body were conducted before their use in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a>. The excellent tissue compatibility of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Poly(methyl_methacrylate)\" title=\"Poly(methyl methacrylate)\" rel=\"external_link\" target=\"_blank\">PMMA<\/a> allowed bone cements to be used for anchorage of head prostheses in the 1950s.\n<\/p><p>Today several million procedures of this type are conducted every year all over the world and more than half of them routinely use bone cements - and the proportion is increasing. Bone cement is considered a reliable anchorage material with its ease of use in clinical practice and particularly because of its proven long survival rate with cemented-in prostheses. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip\" title=\"Hip\" rel=\"external_link\" target=\"_blank\">Hip<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee\" title=\"Knee\" rel=\"external_link\" target=\"_blank\">knee<\/a> registers for artificial joint replacements such as those in Sweden and Norway<sup id=\"rdp-ebb-cite_ref-norwegian_2012_2-0\" class=\"reference\"><a href=\"#cite_note-norwegian_2012-2\" rel=\"external_link\">[2]<\/a><\/sup> clearly demonstrate the advantages of cemented-in anchorage. A similar register for endoprosthesis was introduced in Germany in 2010.<sup id=\"rdp-ebb-cite_ref-EPRDWasIst_3-0\" class=\"reference\"><a href=\"#cite_note-EPRDWasIst-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Composition\">Composition<\/span><\/h2>\n<p>Bone cements are provided as two-component materials. Bone cements consist of a powder (i.e., pre-polymerized PMMA and or PMMA or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methyl_methacrylate\" title=\"Methyl methacrylate\" rel=\"external_link\" target=\"_blank\">MMA<\/a> co-polymer beads and or amorphous powder, radio-opacifer, initiator) and a liquid (MMA monomer, stabilizer, inhibitor). The two components are mixed and a free <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radical_polymerization\" title=\"Radical polymerization\" rel=\"external_link\" target=\"_blank\">radical polymerization<\/a> occurs of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomer<\/a> when the initiator is mixed with the accelerator. The bone cement <a href=\"https:\/\/en.wikipedia.org\/wiki\/Viscosity\" title=\"Viscosity\" rel=\"external_link\" target=\"_blank\">viscosity<\/a> changes over time from a runny liquid into a dough like state that can be safely applied and then finally hardens into solid hardened material.<sup id=\"rdp-ebb-cite_ref-norwegian_1995_4-0\" class=\"reference\"><a href=\"#cite_note-norwegian_1995-4\" rel=\"external_link\">[4]<\/a><\/sup> The set time can be tailored to help the physician safely apply the bone cement into the bone bed to either anchor metal or plastic prosthetic device to bone or used alone in the spine to treat osteoporotic compression fractures.\n<\/p><p>During the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Exothermic_reaction\" title=\"Exothermic reaction\" rel=\"external_link\" target=\"_blank\">exothermic<\/a> free-radical polymerization process, the cement heats up. This polymerization heat reaches temperatures of around 82-86 \u00b0C in the body. This temperature is higher than the critical level for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Protein\" title=\"Protein\" rel=\"external_link\" target=\"_blank\">protein<\/a> denaturation in the body. The cause of the low polymerization temperature in the body is the relatively thin cement coating, which should not exceed 5 mm, and the temperature dissipation via the large prosthesis surface and the flow of blood.\n<\/p><p>The individual components of the bone cement are also known in the area of dental filler materials. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acrylate\" title=\"Acrylate\" rel=\"external_link\" target=\"_blank\">Acrylate<\/a>-based plastics are also used in these applications. While the individual components are not always perfectly safe as pharmaceutical additives and active substances per se, as bone cement the individual substances are either converted or fully enclosed in the cement matrix during the polymerization phase from the increase in viscosity to curing. From current knowledge, cured bone cement can now be classified as safe, as originally demonstrated during the early studies on compatibility with the body conducted in the 1950s.\n<\/p><p>More recently bone cement has been use in the spine in either <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertebroplasty\" class=\"mw-redirect\" title=\"Vertebroplasty\" rel=\"external_link\" target=\"_blank\">vertebroplasty<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kyphoplasty\" class=\"mw-redirect\" title=\"Kyphoplasty\" rel=\"external_link\" target=\"_blank\">kyphoplasty<\/a> procedures. The composition of these types of cement is mostly based on calcium phosphate and more recently magnesium phosphate. A novel biodegradable, non-exothermic, self-setting orthopedic cement composition based on amorphous magnesium phosphate (AMP) was developed. The occurrence of undesirable exothermic reactions was avoided through using AMP as the solid precursor <sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Important_information_for_the_use_of_bone_cement\">Important information for the use of bone cement<\/span><\/h2>\n<p>What is referred to as bone cement implantation syndrome (BCIS) is described in the literature.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> For a long time it was believed that the incompletely converted monomer released from bone cement was the cause of circulation reactions and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Embolism\" title=\"Embolism\" rel=\"external_link\" target=\"_blank\">embolism<\/a>. However, it is now known that this monomer (residual monomer) is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metabolism\" title=\"Metabolism\" rel=\"external_link\" target=\"_blank\">metabolized<\/a> by the respiratory chain and split into <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_dioxide\" title=\"Carbon dioxide\" rel=\"external_link\" target=\"_blank\">carbon dioxide<\/a> and water and excreted. Embolisms can always occur during anchorage of artificial joints when material is inserted into the previously cleared femoral canal. The result is intramedullary pressure increase, potentially driving fat into the circulation.\n<\/p><p>If the patient is known to have any allergies to constituents of the bone cement, according to current knowledge bone cement should not be used to anchor the prosthesis. Anchorage without cement - cement-free implant placement - is the alternative.\n<\/p><p>New bone cement formulations require characterization according to ASTM F451.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> This standard describes the test methods to assess cure rate, residual monomer, mechanical strength, benzoyl peroxide concentration, and heat evolution during cure.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Revisions\">Revisions<\/span><\/h2>\n<p>Revision is the replacement of a prosthesis. This means that a prosthesis previously implanted in the body is removed and replaced by a new prosthesis. Compared to the initial operation revisions are often more complex and more difficult, because every revision involves the loss of healthy bone substance. Revision operations are also more expensive for a satisfactory result. The most important goal is therefore to avoid revisions by using a good surgical procedure and using products with good (long-term) results.\n<\/p><p>Unfortunately, it is not always possible to avoid revisions.<sup id=\"rdp-ebb-cite_ref-norwegian_2012_2-1\" class=\"reference\"><a href=\"#cite_note-norwegian_2012-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-norwegian_1995_4-1\" class=\"reference\"><a href=\"#cite_note-norwegian_1995-4\" rel=\"external_link\">[4]<\/a><\/sup> There can also be different reasons for revisions and there is a distinction between septic or aseptic revision.<sup id=\"rdp-ebb-cite_ref-experimental_cement_strength_8-0\" class=\"reference\"><a href=\"#cite_note-experimental_cement_strength-8\" rel=\"external_link\">[8]<\/a><\/sup> If it is necessary to replace an implant without confirmation of an infection\u2014for example, aseptic\u2014the cement is not necessarily removed completely. However, if the implant has loosened for septic reasons, the cement must be fully removed to clear an infection. In the current state of knowledge it is easier to remove cement than to release a well-anchored cement-free prosthesis from the bone site. Ultimately it is important for the stability of the revised prosthesis to detect possible loosening of the initial implant early to be able to retain as much healthy bone as possible.\n<\/p><p>A prosthesis fixed with bone cement offers very high primary stability combined with fast remobilization of patients. The cemented-in prosthesis can be fully loaded very soon after the operation because the PMMA gets most of its strength within 24 hours.<sup id=\"rdp-ebb-cite_ref-experimental_cement_strength_8-1\" class=\"reference\"><a href=\"#cite_note-experimental_cement_strength-8\" rel=\"external_link\">[8]<\/a><\/sup> The necessary rehabilitation is comparatively simple for patients who have had a cemented-in prosthesis implanted. The joints can be loaded again very soon after the operation, but the use of crutches is still required for a reasonable period for safety reasons.\n<\/p><p>Bone cement has proven particularly useful because specific active substances, e.g. antibiotics, can be added to the powder component. The active substances are released locally after implant placement of the new joint, i.e. in the immediate vicinity of the new prosthesis and have been confirmed to reduce the danger of infection. The antibiotics act against bacteria precisely at the site where they are required in the open wound without subjecting the body in general to unnecessarily high antibiotic levels. This makes bone cement a modern drug delivery system that delivers the required drugs directly to the surgical site. The important factor is not how much active substance is in the cement matrix but how much of the active substance is actually released locally. Too much active substance in the bone cement would actually be detrimental, because the mechanical stability of the fixed prosthesis is weakened by a high proportion of active substance in the cement. The local active substance levels of industrially manufactured bone cements that are formed by the use of bone cements that contain active substances are approximate (assuming that there is no incompatibility) and are significantly below the clinical routine dosages for systemic single injections.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoplasty\" title=\"Osteoplasty\" rel=\"external_link\" target=\"_blank\">Osteoplasty<\/a> \u2013 use of bone cement to reduce pain<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 33em; -webkit-column-width: 33em; column-width: 33em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pac.iupac.org\/publications\/pac\/pdf\/2012\/pdf\/8402x0377.pdf\" target=\"_blank\">\"Terminology for biorelated polymers and applications (IUPAC Recommendations 2012)\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pure_and_Applied_Chemistry\" title=\"Pure and Applied Chemistry\" rel=\"external_link\" target=\"_blank\">Pure and Applied Chemistry<\/a><\/i>. <b>84<\/b> (2): 377\u2013410. 2012. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1351%2FPAC-REC-10-12-04\" target=\"_blank\">10.1351\/PAC-REC-10-12-04<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pure+and+Applied+Chemistry&rft.atitle=Terminology+for+biorelated+polymers+and+applications+%28IUPAC+Recommendations+2012%29&rft.volume=84&rft.issue=2&rft.pages=377-410&rft.date=2012&rft_id=info%3Adoi%2F10.1351%2FPAC-REC-10-12-04&rft_id=http%3A%2F%2Fpac.iupac.org%2Fpublications%2Fpac%2Fpdf%2F2012%2Fpdf%2F8402x0377.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABone+cement\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-norwegian_2012-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-norwegian_2012_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-norwegian_2012_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3278649\" target=\"_blank\">\"Is there still a place for the cemented titanium femoral stem? 10,108 cases from the Norwegian Arthroplasty Register\"<\/a>. <i><\/i>. <b>83<\/b> (1): 1\u20136. 2012. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3109%2F17453674.2011.645194\" target=\"_blank\">10.3109\/17453674.2011.645194<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3278649\" target=\"_blank\">3278649<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22206445\" target=\"_blank\">22206445<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Orthopaedica&rft.atitle=Is+there+still+a+place+for+the+cemented+titanium+femoral+stem%3F+10%2C108+cases+from+the+Norwegian+Arthroplasty+Register&rft.volume=83&rft.issue=1&rft.pages=1-6&rft.date=2012&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3278649&rft_id=info%3Apmid%2F22206445&rft_id=info%3Adoi%2F10.3109%2F17453674.2011.645194&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3278649&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABone+cement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-EPRDWasIst-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-EPRDWasIst_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160225233324\/http:\/\/www.eprd.de\/wir-ueber-uns\/\" target=\"_blank\">\"Wir \u00fcber uns\"<\/a>. <i>Endoprothesenregister Deutschland<\/i>. EPRD Deutsche Endoprothesenregister GmbH. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.eprd.de\/wir-ueber-uns\/\" target=\"_blank\">the original<\/a> on 2016-02-25<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">22 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Endoprothesenregister+Deutschland&rft.atitle=Wir+%C3%BCber+uns&rft_id=http%3A%2F%2Fwww.eprd.de%2Fwir-ueber-uns%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABone+cement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-norwegian_1995-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-norwegian_1995_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-norwegian_1995_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">\"The effect of the type of cement on early revision of Charnley total hip prostheses. A review of eight thousand five hundred and seventy-nine primary arthroplasties from the Norwegian Arthroplasty Register\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Journal_of_Bone_and_Joint_Surgery\" title=\"The Journal of Bone and Joint Surgery\" rel=\"external_link\" target=\"_blank\">The Journal of Bone and Joint Surgery<\/a><\/i>. <b>77<\/b> (10): 1543\u20131550. 1995. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7593063\" target=\"_blank\">7593063<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Bone+and+Joint+Surgery&rft.atitle=The+effect+of+the+type+of+cement+on+early+revision+of+Charnley+total+hip+prostheses.+A+review+of+eight+thousand+five+hundred+and+seventy-nine+primary+arthroplasties+from+the+Norwegian+Arthroplasty+Register&rft.volume=77&rft.issue=10&rft.pages=1543-1550&rft.date=1995&rft_id=info%3Apmid%2F7593063&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABone+cement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"> Evaluation of amorphous magnesium phosphate (AMP) based non-exothermic orthopedic cements, Biomed. Mater. 11 (2016) 055010, <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/dx.doi.org\/10.1088\/1748-6041\/11\/5\/055010\" target=\"_blank\">https:\/\/dx.doi.org\/10.1088\/1748-6041\/11\/5\/055010<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Br. J. Anaesth. (2009) 102 (1): 12-22.\ndoi: 10.1093\/bja\/aen328<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.astm.org\/Standards\/F451.htm\" target=\"_blank\">ASTM F451: Standard Specification for Acrylic Bone Cement<\/a><\/span>\n<\/li>\n<li id=\"cite_note-experimental_cement_strength-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-experimental_cement_strength_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-experimental_cement_strength_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">\"Experimental investigation of the effect of surface roughness on bone-cement-implant shear bond strength\". <i><\/i>. <b>28<\/b>: 254\u2013262. 2013. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jmbbm.2013.08.005\" target=\"_blank\">10.1016\/j.jmbbm.2013.08.005<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24004958\" target=\"_blank\">24004958<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+Mechanical+Behavior+of+Biomedical+Materials&rft.atitle=Experimental+investigation+of+the+effect+of+surface+roughness+on+bone-cement-implant+shear+bond+strength&rft.volume=28&rft.pages=254-262&rft.date=2013&rft_id=info%3Adoi%2F10.1016%2Fj.jmbbm.2013.08.005&rft_id=info%3Apmid%2F24004958&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABone+cement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.campoly.com\/index.php\/download_file\/view\/574\/108\/\" target=\"_blank\">Application note describing how to measure residual monomer in bone cement<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.campoly.com\/index.php\/download_file\/view\/298\/191\/\" target=\"_blank\">A presentation on the rheology of bone cement<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1268\nCached time: 20181129234856\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.248 seconds\nReal time usage: 1.135 seconds\nPreprocessor visited node count: 478\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 15384\/2097152 bytes\nTemplate argument size: 816\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 17753\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.138\/10.000 seconds\nLua memory usage: 2.83 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1105.997 1 -total\n<\/p>\n<pre>59.46% 657.652 1 Template:Reflist\n36.14% 399.715 1 Template:Refimprove\n34.57% 382.396 1 Template:Ambox\n27.20% 300.784 4 Template:Cite_journal\n14.87% 164.484 1 Template:Cite_web\n 3.62% 40.063 1 Template:Quote_box\n 0.38% 4.235 1 Template:Main_other\n 0.31% 3.459 1 Template:Column-width\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:6216692-1!canonical and timestamp 20181129234855 and revision id 868058916\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_cement\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212212\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.016 seconds\nReal time usage: 0.108 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 98.567 1 - wikipedia:Bone_cement\n100.00% 98.567 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:7995-0!*!*!*!*!*!* and timestamp 20181217212212 and revision id 24107\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Bone_cement\">https:\/\/www.limswiki.org\/index.php\/Bone_cement<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","586066a272d44cda0be5711d9e55266c_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png"],"586066a272d44cda0be5711d9e55266c_timestamp":1545081732,"fd852efea96060534722ee2be083c720_type":"article","fd852efea96060534722ee2be083c720_title":"Bioresorbable metal","fd852efea96060534722ee2be083c720_url":"https:\/\/www.limswiki.org\/index.php\/Bioresorbable_metal","fd852efea96060534722ee2be083c720_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tBioresorbable metal\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is an orphan, as no other articles link to it. Please introduce links to this page from related articles ; try the Find link tool for suggestions. (December 2017)\nBioresorbable (also called biodegradable or bioabsorbable) metals are metals or their alloys that degrade safely within the body.[1] The primary metals in this category are magnesium-based[2] and iron-based alloys,[3] although recently zinc has also been investigated.[4] Currently, the primary uses of bioresorbable metals are as stents for blood vessels (for example bioresorbable stents) and other internal ducts.\n\nContents \n\n1 Background \n\n1.1 Driving force for development \n\n\n2 Potential applications \n\n2.1 Corrosion Product Toxicity \n\n\n3 Potential bioresorbable metal candidates \n\n3.1 Magnesium \n3.2 Iron \n3.3 Zinc \n3.4 Biodegradable bulk metallic glasses \n\n\n4 References \n\n\nBackground \nAlthough bioabsorbable polymers and other materials have come into widespread use in recent years, degradable metals have not yet had the same success in the medical industry.\n\nDriving force for development \nThe driving force behind the development of bioresorbable metals is primarily due to their ability to provide metal-like mechanical properties while degrading safely in the body.[1] This is especially relevant in orthopaedic applications, where although many surgeries only require implants to provide temporary support (allowing the surrounding tissue to heal), the majority of current bio-metals are permanent (e.g. stainless steel, titanium). Degradation of the implant means that intervention or secondary surgery will not be necessary to remove the material at the end of its functional life, providing significant savings in both cost and time for the patient and health care system. In addition, the corrosion products of current bio-metals (which will still corrode in the body to some degree) can generally not be considered biocompatible.\n\nPotential applications \nThere are a number of applications for biodegradable metals, including cardiovascular implants (i.e. stents) and orthopedics. It is in this latter category where these materials offer the greatest potential. Bioresorbable metals are able to withstand loads that would destroy any currently available polymers, and offer much greater plasticity than bioceramics, which are brittle and prone to fracture. A well-designed implant could provide the exact mechanical support needed for different areas (through alloying and metal working), and load would be transferred to the surrounding tissue over time, letting it heal and reducing the effects of stress shielding.[5] A summary of the primary benefits and drawbacks of magnesium biomaterials has been provided by Kirkland.[6] This is a significant problem as the majority of tests performed in the research community are a mix of other standards from both the biomedical and the engineering (e.g. corrosion) communities, often making comparison between results difficult.\n\nCorrosion Product Toxicity \nEven though all elements in a bioresorbable metal may themselves be considered biocompatible, the morphology and elemental makeup (or combination of elements) of the degradation products may cause adverse reactions in the body. In addition, the rapid evolution of hydrogen gas that is concomitant with Mg-alloy degradation may cause addition problems in vivo.[7] It is therefore crucial to intricately understand the corrosion of each implant and the products that are release, in light of their toxicity and the likelihood of inflammation. The majority of studies in the literature have focused on elements that are known to be biocompatible or abundant in the body, such as calcium[8][9] and zinc.[10]\n\nPotential bioresorbable metal candidates \nAlthough all metals will degrade and eventually disappear inside the body through the processes of corrosion and wear, true bioresorbable metals must have an appreciable degradation rate to allow the implant to be absorbed in a practical amount of time in reference to their application. Also, any degradation product would have to be safely metabolized or excreted by the body to avoid toxicity and inflammation.\n\nMagnesium \nPerhaps the most widely investigated material in this category, magnesium was originally investigated as a potential biomaterial in 1878 when it was used by physician Edward C. Huse in wire form as a ligature to stop bleeding.[11] Development continued into the 1920s, after which Mg-based biomaterials fell out of general investigation due to their poor performance (likely due to impurities in the alloys drastically increasing corrosion). It was not until the late 1990s that interest started to pick up again, spurred by the availability of ultra-high purity Mg, which significantly increases its longevity inside the body.\nCurrently, most research on Mg is focused on reducing and controlling the rate of degradation, with many alloys corroding too rapidly (in vitro) for any practical application.[5][12]\n\nIron \nThe majority of iron-based alloy research has been focused on cardiovascular applications, such as stents.[13] However this area receives much less interest in the research community than Mg-based alloys.[citation needed ]\n\nZinc \nTo date little work has been published on the use of a primarily zinc-based biomaterial, with corrosion rates found to be very low and zinc within a tolerable toxicity range [4][5]\n\nBiodegradable bulk metallic glasses \nAlthough strictly speaking a side-category, a related, relatively new area of interest has been the investigation of bioabsorbable metallic glass, with a group at UNSW currently investigating these novel materials.[14]\n\nReferences \n\n\n^ a b Kirkland, N; Birbilis N (2013). Magnesium Biomaterials: Design, Testing and Best Practice. New York: Springer. ISBN 978-3-319-02123-2. Retrieved 26 November 2013 . \n\n^ Kirkland, N. T. (2012). \"Magnesium biomaterials: Past, present and future\". Corrosion Engineering, Science and Technology. 47 (5): 322\u2013328. doi:10.1179\/1743278212Y.0000000034. \n\n^ Peuster, M.; Wohlsein, P.; Br\u00fcgmann, M.; Ehlerding, M.; Seidler, K.; Fink, C.; Brauer, H.; Fischer, A.; Hausdorf, G. (2001). \"A novel approach to temporary stenting: Degradable cardiovascular stents produced from corrodible metal---results 6-18 months after implantation into New Zealand white rabbits\". Heart. 86 (5): 563\u2013569. doi:10.1136\/heart.86.5.563. PMC 1729971 . PMID 11602554. \n\n^ a b Vojt\u011bch, D.; Kub\u00e1sek, J.; \u0160er\u00e1k, J.; Nov\u00e1k, P. (2011). \"Mechanical and corrosion properties of newly developed biodegradable Zn-based alloys for bone fixation\". Acta Biomaterialia. 7 (9): 3515\u20133522. doi:10.1016\/j.actbio.2011.05.008. PMID 21621017. \n\n^ a b c Ibrahim, H.; Esfahani, S. N.; Poorganji, B.; Dean, D.; Elahinia, M. (January 2017). \"Resorbable bone fixation alloys, forming, and post-fabrication treatments\". Materials Science and Engineering: C. 70 (1). doi:10.1016\/j.msec.2016.09.069. \n\n^ Witte, F.; Fischer, J.; Nellesen, J.; Crostack, H. A.; Kaese, V.; Pisch, A.; Beckmann, F.; Windhagen, H. (2006). \"In vitro and in vivo corrosion measurements of magnesium alloys\". Biomaterials. 27 (7): 1013\u20131018. doi:10.1016\/j.biomaterials.2005.07.037. PMID 16122786. \n\n^ Kuhlmann, J.; Bartsch, I.; Willbold, E.; Schuchardt, S.; Holz, O.; Hort, N.; H\u00f6che, D.; Heineman, W. R.; Witte, F. (2012). \"Fast escape of hydrogen from gas cavities around corroding magnesium implants\". Acta Biomaterialia. 9 (10): 8714. doi:10.1016\/j.actbio.2012.10.008. \n\n^ Kirkland, N. T.; Birbilis, N.; Walker, J.; Woodfield, T.; Dias, G. J.; Staiger, M. P. (2010). \"In-vitro dissolution of magnesium-calcium binary alloys: Clarifying the unique role of calcium additions in bioresorbable magnesium implant alloys\". Journal of Biomedical Materials Research Part B: Applied Biomaterials. 95B: 91. doi:10.1002\/jbm.b.31687. \n\n^ Cao, J. D.; Martens, P.; Laws, K. J.; Boughton, P.; Ferry, M. (2013). \"Quantitativein vitroassessment of Mg65Zn30Ca5degradation and its effect on cell viability\". Journal of Biomedical Materials Research Part B: Applied Biomaterials. 101B: 43. doi:10.1002\/jbm.b.32811. \n\n^ Brar, H. S.; Platt, M. O.; Sarntinoranont, M.; Martin, P. I.; Manuel, M. V. (2009). \"Magnesium as a biodegradable and bioabsorbable material for medical implants\". JOM. 61 (9): 31. doi:10.1007\/s11837-009-0129-0. \n\n^ Huse, Edward C. (1878). \"A New Ligature?\". Chicago Medical Journal and Examiner. 37: 171\u2013172. \n\n^ Kirkland, N. T.; Lespagnol, J.; Birbilis, N.; Staiger, M. P. (2010). \"A survey of bio-corrosion rates of magnesium alloys\". Corrosion Science. 52 (2): 287. doi:10.1016\/j.corsci.2009.09.033. \n\n^ Moravej, M.; Mantovani, D. (2011). \"Biodegradable Metals for Cardiovascular Stent Application: Interests and New Opportunities\". International Journal of Molecular Sciences. 12 (12): 4250. doi:10.3390\/ijms12074250. \n\n^ University of New South Wales (2010). \"BMGs for Electronic, Biomedical and Aerospace Applications\". Archived from the original on 5 January 2013. Retrieved 7 January 2013 . \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Bioresorbable_metal\">https:\/\/www.limswiki.org\/index.php\/Bioresorbable_metal<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 29 February 2016, at 21:54.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,043 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","fd852efea96060534722ee2be083c720_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Bioresorbable_metal skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Bioresorbable metal<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Bioresorbable<\/b> (also called <b>biodegradable<\/b> or <b>bioabsorbable<\/b>) <b>metals<\/b> are metals or their alloys that degrade safely within the body.<sup id=\"rdp-ebb-cite_ref-kirklandbook_1-0\" class=\"reference\"><a href=\"#cite_note-kirklandbook-1\" rel=\"external_link\">[1]<\/a><\/sup> The primary metals in this category are magnesium-based<sup id=\"rdp-ebb-cite_ref-kirkland1_2-0\" class=\"reference\"><a href=\"#cite_note-kirkland1-2\" rel=\"external_link\">[2]<\/a><\/sup> and iron-based alloys,<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> although recently zinc has also been investigated.<sup id=\"rdp-ebb-cite_ref-vojtech_4-0\" class=\"reference\"><a href=\"#cite_note-vojtech-4\" rel=\"external_link\">[4]<\/a><\/sup> Currently, the primary uses of bioresorbable metals are as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stents<\/a> for blood vessels (for example <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioresorbable_stent\" title=\"Bioresorbable stent\" rel=\"external_link\" target=\"_blank\">bioresorbable stents<\/a>) and other internal ducts.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Background\">Background<\/span><\/h2>\n<p>Although bioabsorbable polymers and other materials have come into widespread use in recent years, degradable metals have not yet had the same success in the medical industry.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Driving_force_for_development\">Driving force for development<\/span><\/h3>\n<p>The driving force behind the development of bioresorbable metals is primarily due to their ability to provide metal-like mechanical properties while degrading safely in the body.<sup id=\"rdp-ebb-cite_ref-kirklandbook_1-1\" class=\"reference\"><a href=\"#cite_note-kirklandbook-1\" rel=\"external_link\">[1]<\/a><\/sup> This is especially relevant in orthopaedic applications, where although many surgeries only require implants to provide temporary support (allowing the surrounding tissue to heal), the majority of current bio-metals are permanent (e.g. stainless steel, titanium). Degradation of the implant means that intervention or secondary surgery will not be necessary to remove the material at the end of its functional life, providing significant savings in both cost and time for the patient and health care system. In addition, the corrosion products of current bio-metals (which will still corrode in the body to some degree) can generally not be considered biocompatible.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Potential_applications\">Potential applications<\/span><\/h2>\n<p>There are a number of applications for biodegradable metals, including cardiovascular implants (i.e. stents) and orthopedics. It is in this latter category where these materials offer the greatest potential. Bioresorbable metals are able to withstand loads that would destroy any currently available polymers, and offer much greater plasticity than bioceramics, which are brittle and prone to fracture. A well-designed implant could provide the exact mechanical support needed for different areas (through alloying and metal working), and load would be transferred to the surrounding tissue over time, letting it heal and reducing the effects of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stress_shielding\" title=\"Stress shielding\" rel=\"external_link\" target=\"_blank\">stress shielding<\/a>.<sup id=\"rdp-ebb-cite_ref-:0_5-0\" class=\"reference\"><a href=\"#cite_note-:0-5\" rel=\"external_link\">[5]<\/a><\/sup> A summary of the primary benefits and drawbacks of magnesium biomaterials has been provided by Kirkland.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> This is a significant problem as the majority of tests performed in the research community are a mix of other standards from both the biomedical and the engineering (e.g. corrosion) communities, often making comparison between results difficult.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Corrosion_Product_Toxicity\">Corrosion Product Toxicity<\/span><\/h3>\n<p>Even though all elements in a bioresorbable metal may themselves be considered biocompatible, the morphology and elemental makeup (or combination of elements) of the degradation products may cause adverse reactions in the body. In addition, the rapid evolution of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrogen_gas\" class=\"mw-redirect\" title=\"Hydrogen gas\" rel=\"external_link\" target=\"_blank\">hydrogen gas<\/a> that is concomitant with Mg-alloy degradation may cause addition problems <a href=\"https:\/\/en.wikipedia.org\/wiki\/In_vivo\" title=\"In vivo\" rel=\"external_link\" target=\"_blank\">in vivo<\/a>.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> It is therefore crucial to intricately understand the corrosion of each implant and the products that are release, in light of their toxicity and the likelihood of inflammation. The majority of studies in the literature have focused on elements that are known to be biocompatible or abundant in the body, such as calcium<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> and zinc.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Potential_bioresorbable_metal_candidates\">Potential bioresorbable metal candidates<\/span><\/h2>\n<p>Although all metals will degrade and eventually disappear inside the body through the processes of corrosion and wear, true bioresorbable metals must have an appreciable degradation rate to allow the implant to be absorbed in a practical amount of time in reference to their application. Also, any degradation product would have to be safely metabolized or excreted by the body to avoid toxicity and inflammation.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Magnesium\">Magnesium<\/span><\/h3>\n<p>Perhaps the most widely investigated material in this category, magnesium was originally investigated as a potential biomaterial in 1878 when it was used by physician Edward C. Huse in wire form as a ligature to stop bleeding.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> Development continued into the 1920s, after which Mg-based biomaterials fell out of general investigation due to their poor performance (likely due to impurities in the alloys drastically increasing corrosion). It was not until the late 1990s that interest started to pick up again, spurred by the availability of ultra-high purity Mg, which significantly increases its longevity inside the body.\n<\/p><p>Currently, most research on Mg is focused on reducing and controlling the rate of degradation, with many alloys corroding too rapidly (in vitro) for any practical application.<sup id=\"rdp-ebb-cite_ref-:0_5-1\" class=\"reference\"><a href=\"#cite_note-:0-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Iron\">Iron<\/span><\/h3>\n<p>The majority of iron-based alloy research has been focused on cardiovascular applications, such as stents.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> However this area receives much less interest in the research community than Mg-based alloys.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Zinc\">Zinc<\/span><\/h3>\n<p>To date little work has been published on the use of a primarily zinc-based biomaterial, with corrosion rates found to be very low and zinc within a tolerable toxicity range <sup id=\"rdp-ebb-cite_ref-vojtech_4-1\" class=\"reference\"><a href=\"#cite_note-vojtech-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-:0_5-2\" class=\"reference\"><a href=\"#cite_note-:0-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Biodegradable_bulk_metallic_glasses\">Biodegradable bulk metallic glasses<\/span><\/h3>\n<p>Although strictly speaking a side-category, a related, relatively new area of interest has been the investigation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioabsorbable_metallic_glass\" title=\"Bioabsorbable metallic glass\" rel=\"external_link\" target=\"_blank\">bioabsorbable metallic glass<\/a>, with a group at UNSW currently investigating these novel materials.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-kirklandbook-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-kirklandbook_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-kirklandbook_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Kirkland, N; Birbilis N (2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.springer.com\/materials\/biomaterials\/book\/978-3-319-02122-5\" target=\"_blank\"><i>Magnesium Biomaterials: Design, Testing and Best Practice<\/i><\/a>. New York: Springer. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-319-02123-2<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 November<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Magnesium+Biomaterials%3A+Design%2C+Testing+and+Best+Practice&rft.place=New+York&rft.pub=Springer&rft.date=2013&rft.isbn=978-3-319-02123-2&rft.aulast=Kirkland&rft.aufirst=N&rft.au=Birbilis+N&rft_id=https%3A%2F%2Fwww.springer.com%2Fmaterials%2Fbiomaterials%2Fbook%2F978-3-319-02122-5&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioresorbable+metal\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-kirkland1-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-kirkland1_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kirkland, N. T. (2012). \"Magnesium biomaterials: Past, present and future\". <i>Corrosion Engineering, Science and Technology<\/i>. <b>47<\/b> (5): 322\u2013328. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1179%2F1743278212Y.0000000034\" target=\"_blank\">10.1179\/1743278212Y.0000000034<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Corrosion+Engineering%2C+Science+and+Technology&rft.atitle=Magnesium+biomaterials%3A+Past%2C+present+and+future&rft.volume=47&rft.issue=5&rft.pages=322-328&rft.date=2012&rft_id=info%3Adoi%2F10.1179%2F1743278212Y.0000000034&rft.aulast=Kirkland&rft.aufirst=N.+T.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioresorbable+metal\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Peuster, M.; Wohlsein, P.; Br\u00fcgmann, M.; Ehlerding, M.; Seidler, K.; Fink, C.; Brauer, H.; Fischer, A.; Hausdorf, G. (2001). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1729971\" target=\"_blank\">\"A novel approach to temporary stenting: Degradable cardiovascular stents produced from corrodible metal---results 6-18 months after implantation into New Zealand white rabbits\"<\/a>. <i>Heart<\/i>. <b>86<\/b> (5): 563\u2013569. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fheart.86.5.563\" target=\"_blank\">10.1136\/heart.86.5.563<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1729971\" target=\"_blank\">1729971<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11602554\" target=\"_blank\">11602554<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Heart&rft.atitle=A+novel+approach+to+temporary+stenting%3A+Degradable+cardiovascular+stents+produced+from+corrodible+metal---results+6-18+months+after+implantation+into+New+Zealand+white+rabbits&rft.volume=86&rft.issue=5&rft.pages=563-569&rft.date=2001&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1729971&rft_id=info%3Apmid%2F11602554&rft_id=info%3Adoi%2F10.1136%2Fheart.86.5.563&rft.aulast=Peuster&rft.aufirst=M.&rft.au=Wohlsein%2C+P.&rft.au=Br%C3%BCgmann%2C+M.&rft.au=Ehlerding%2C+M.&rft.au=Seidler%2C+K.&rft.au=Fink%2C+C.&rft.au=Brauer%2C+H.&rft.au=Fischer%2C+A.&rft.au=Hausdorf%2C+G.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1729971&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioresorbable+metal\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-vojtech-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-vojtech_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-vojtech_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vojt\u011bch, D.; Kub\u00e1sek, J.; \u0160er\u00e1k, J.; Nov\u00e1k, P. (2011). \"Mechanical and corrosion properties of newly developed biodegradable Zn-based alloys for bone fixation\". <i>Acta Biomaterialia<\/i>. <b>7<\/b> (9): 3515\u20133522. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.actbio.2011.05.008\" target=\"_blank\">10.1016\/j.actbio.2011.05.008<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21621017\" target=\"_blank\">21621017<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Biomaterialia&rft.atitle=Mechanical+and+corrosion+properties+of+newly+developed+biodegradable+Zn-based+alloys+for+bone+fixation&rft.volume=7&rft.issue=9&rft.pages=3515-3522&rft.date=2011&rft_id=info%3Adoi%2F10.1016%2Fj.actbio.2011.05.008&rft_id=info%3Apmid%2F21621017&rft.aulast=Vojt%C4%9Bch&rft.aufirst=D.&rft.au=Kub%C3%A1sek%2C+J.&rft.au=%C5%A0er%C3%A1k%2C+J.&rft.au=Nov%C3%A1k%2C+P.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioresorbable+metal\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:0-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_5-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ibrahim, H.; Esfahani, S. N.; Poorganji, B.; Dean, D.; Elahinia, M. (January 2017). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S092849311631534X\" target=\"_blank\">\"Resorbable bone fixation alloys, forming, and post-fabrication treatments\"<\/a>. <i>Materials Science and Engineering: C<\/i>. <b>70<\/b> (1). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.msec.2016.09.069\" target=\"_blank\">10.1016\/j.msec.2016.09.069<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Materials+Science+and+Engineering%3A+C&rft.atitle=Resorbable+bone+fixation+alloys%2C+forming%2C+and+post-fabrication+treatments&rft.volume=70&rft.issue=1&rft.date=2017-01&rft_id=info%3Adoi%2F10.1016%2Fj.msec.2016.09.069&rft.aulast=Ibrahim&rft.aufirst=H.&rft.au=Esfahani%2C+S.+N.&rft.au=Poorganji%2C+B.&rft.au=Dean%2C+D.&rft.au=Elahinia%2C+M.&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS092849311631534X&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioresorbable+metal\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Witte, F.; Fischer, J.; Nellesen, J.; Crostack, H. A.; Kaese, V.; Pisch, A.; Beckmann, F.; Windhagen, H. (2006). \"In vitro and in vivo corrosion measurements of magnesium alloys\". <i>Biomaterials<\/i>. <b>27<\/b> (7): 1013\u20131018. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.biomaterials.2005.07.037\" target=\"_blank\">10.1016\/j.biomaterials.2005.07.037<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16122786\" target=\"_blank\">16122786<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biomaterials&rft.atitle=In+vitro+and+in+vivo+corrosion+measurements+of+magnesium+alloys&rft.volume=27&rft.issue=7&rft.pages=1013-1018&rft.date=2006&rft_id=info%3Adoi%2F10.1016%2Fj.biomaterials.2005.07.037&rft_id=info%3Apmid%2F16122786&rft.aulast=Witte&rft.aufirst=F.&rft.au=Fischer%2C+J.&rft.au=Nellesen%2C+J.&rft.au=Crostack%2C+H.+A.&rft.au=Kaese%2C+V.&rft.au=Pisch%2C+A.&rft.au=Beckmann%2C+F.&rft.au=Windhagen%2C+H.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioresorbable+metal\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kuhlmann, J.; Bartsch, I.; Willbold, E.; Schuchardt, S.; Holz, O.; Hort, N.; H\u00f6che, D.; Heineman, W. R.; Witte, F. (2012). \"Fast escape of hydrogen from gas cavities around corroding magnesium implants\". <i>Acta Biomaterialia<\/i>. <b>9<\/b> (10): 8714. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.actbio.2012.10.008\" target=\"_blank\">10.1016\/j.actbio.2012.10.008<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Biomaterialia&rft.atitle=Fast+escape+of+hydrogen+from+gas+cavities+around+corroding+magnesium+implants&rft.volume=9&rft.issue=10&rft.pages=8714&rft.date=2012&rft_id=info%3Adoi%2F10.1016%2Fj.actbio.2012.10.008&rft.aulast=Kuhlmann&rft.aufirst=J.&rft.au=Bartsch%2C+I.&rft.au=Willbold%2C+E.&rft.au=Schuchardt%2C+S.&rft.au=Holz%2C+O.&rft.au=Hort%2C+N.&rft.au=H%C3%B6che%2C+D.&rft.au=Heineman%2C+W.+R.&rft.au=Witte%2C+F.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioresorbable+metal\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kirkland, N. T.; Birbilis, N.; Walker, J.; Woodfield, T.; Dias, G. J.; Staiger, M. P. (2010). \"In-vitro dissolution of magnesium-calcium binary alloys: Clarifying the unique role of calcium additions in bioresorbable magnesium implant alloys\". <i>Journal of Biomedical Materials Research Part B: Applied Biomaterials<\/i>. <b>95B<\/b>: 91. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fjbm.b.31687\" target=\"_blank\">10.1002\/jbm.b.31687<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Biomedical+Materials+Research+Part+B%3A+Applied+Biomaterials&rft.atitle=In-vitro+dissolution+of+magnesium-calcium+binary+alloys%3A+Clarifying+the+unique+role+of+calcium+additions+in+bioresorbable+magnesium+implant+alloys&rft.volume=95B&rft.pages=91&rft.date=2010&rft_id=info%3Adoi%2F10.1002%2Fjbm.b.31687&rft.aulast=Kirkland&rft.aufirst=N.+T.&rft.au=Birbilis%2C+N.&rft.au=Walker%2C+J.&rft.au=Woodfield%2C+T.&rft.au=Dias%2C+G.+J.&rft.au=Staiger%2C+M.+P.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioresorbable+metal\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cao, J. D.; Martens, P.; Laws, K. J.; Boughton, P.; Ferry, M. (2013). \"Quantitativein vitroassessment of Mg65Zn30Ca5degradation and its effect on cell viability\". <i>Journal of Biomedical Materials Research Part B: Applied Biomaterials<\/i>. <b>101B<\/b>: 43. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fjbm.b.32811\" target=\"_blank\">10.1002\/jbm.b.32811<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Biomedical+Materials+Research+Part+B%3A+Applied+Biomaterials&rft.atitle=Quantitativein+vitroassessment+of+Mg65Zn30Ca5degradation+and+its+effect+on+cell+viability&rft.volume=101B&rft.pages=43&rft.date=2013&rft_id=info%3Adoi%2F10.1002%2Fjbm.b.32811&rft.aulast=Cao&rft.aufirst=J.+D.&rft.au=Martens%2C+P.&rft.au=Laws%2C+K.+J.&rft.au=Boughton%2C+P.&rft.au=Ferry%2C+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioresorbable+metal\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brar, H. S.; Platt, M. O.; Sarntinoranont, M.; Martin, P. I.; Manuel, M. V. (2009). \"Magnesium as a biodegradable and bioabsorbable material for medical implants\". <i>JOM<\/i>. <b>61<\/b> (9): 31. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11837-009-0129-0\" target=\"_blank\">10.1007\/s11837-009-0129-0<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JOM&rft.atitle=Magnesium+as+a+biodegradable+and+bioabsorbable+material+for+medical+implants&rft.volume=61&rft.issue=9&rft.pages=31&rft.date=2009&rft_id=info%3Adoi%2F10.1007%2Fs11837-009-0129-0&rft.aulast=Brar&rft.aufirst=H.+S.&rft.au=Platt%2C+M.+O.&rft.au=Sarntinoranont%2C+M.&rft.au=Martin%2C+P.+I.&rft.au=Manuel%2C+M.+V.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioresorbable+metal\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Huse, Edward C. (1878). \"A New Ligature?\". <i>Chicago Medical Journal and Examiner<\/i>. <b>37<\/b>: 171\u2013172.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Chicago+Medical+Journal+and+Examiner&rft.atitle=A+New+Ligature%3F&rft.volume=37&rft.pages=171-172&rft.date=1878&rft.aulast=Huse&rft.aufirst=Edward+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioresorbable+metal\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kirkland, N. T.; Lespagnol, J.; Birbilis, N.; Staiger, M. P. (2010). \"A survey of bio-corrosion rates of magnesium alloys\". <i>Corrosion Science<\/i>. <b>52<\/b> (2): 287. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.corsci.2009.09.033\" target=\"_blank\">10.1016\/j.corsci.2009.09.033<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Corrosion+Science&rft.atitle=A+survey+of+bio-corrosion+rates+of+magnesium+alloys&rft.volume=52&rft.issue=2&rft.pages=287&rft.date=2010&rft_id=info%3Adoi%2F10.1016%2Fj.corsci.2009.09.033&rft.aulast=Kirkland&rft.aufirst=N.+T.&rft.au=Lespagnol%2C+J.&rft.au=Birbilis%2C+N.&rft.au=Staiger%2C+M.+P.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioresorbable+metal\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Moravej, M.; Mantovani, D. (2011). \"Biodegradable Metals for Cardiovascular Stent Application: Interests and New Opportunities\". <i>International Journal of Molecular Sciences<\/i>. <b>12<\/b> (12): 4250. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3390%2Fijms12074250\" target=\"_blank\">10.3390\/ijms12074250<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Molecular+Sciences&rft.atitle=Biodegradable+Metals+for+Cardiovascular+Stent+Application%3A+Interests+and+New+Opportunities&rft.volume=12&rft.issue=12&rft.pages=4250&rft.date=2011&rft_id=info%3Adoi%2F10.3390%2Fijms12074250&rft.aulast=Moravej&rft.aufirst=M.&rft.au=Mantovani%2C+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioresorbable+metal\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">University of New South Wales (2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130105044106\/http:\/\/www.materials.unsw.edu.au\/research\/bulk-metallic-glasses-for-biomedical-electronics-aerospace-and-advanced-structural-applications\" target=\"_blank\">\"BMGs for Electronic, Biomedical and Aerospace Applications\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.materials.unsw.edu.au\/research\/bulk-metallic-glasses-for-biomedical-electronics-aerospace-and-advanced-structural-applications\" target=\"_blank\">the original<\/a> on 5 January 2013<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">7 January<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=BMGs+for+Electronic%2C+Biomedical+and+Aerospace+Applications&rft.date=2010&rft.au=University+of+New+South+Wales&rft_id=http%3A%2F%2Fwww.materials.unsw.edu.au%2Fresearch%2Fbulk-metallic-glasses-for-biomedical-electronics-aerospace-and-advanced-structural-applications&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioresorbable+metal\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1250\nCached time: 20181217014855\nCache expiry: 86400\nDynamic content: true\nCPU time usage: 0.312 seconds\nReal time usage: 0.389 seconds\nPreprocessor visited node count: 1111\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 36575\/2097152 bytes\nTemplate argument size: 1537\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 41552\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.199\/10.000 seconds\nLua memory usage: 4.74 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 354.009 1 -total\n<\/p>\n<pre>66.02% 233.725 1 Template:Reflist\n33.14% 117.335 12 Template:Cite_journal\n21.91% 77.573 1 Template:Cite_book\n20.92% 74.064 1 Template:Orphan\n15.37% 54.416 1 Template:Draft_other\n14.40% 50.982 1 Template:Ambox\n 9.42% 33.337 1 Template:Citation_needed\n 8.46% 29.959 1 Template:Fix\n 4.23% 14.980 1 Template:Delink\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:39058868-1!canonical and timestamp 20181217014855 and revision id 852654685\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bioresorbable_metal\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212212\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.009 seconds\nReal time usage: 0.156 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 149.435 1 - wikipedia:Bioresorbable_metal\n100.00% 149.435 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8187-0!*!*!*!*!*!* and timestamp 20181217212212 and revision id 24333\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Bioresorbable_metal\">https:\/\/www.limswiki.org\/index.php\/Bioresorbable_metal<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","fd852efea96060534722ee2be083c720_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/6c\/Wiki_letter_w.svg\/80px-Wiki_letter_w.svg.png"],"fd852efea96060534722ee2be083c720_timestamp":1545081732,"4c739aecba54acdad1b847edb7137a8c_type":"article","4c739aecba54acdad1b847edb7137a8c_title":"Biopolymer","4c739aecba54acdad1b847edb7137a8c_url":"https:\/\/www.limswiki.org\/index.php\/Biopolymer","4c739aecba54acdad1b847edb7137a8c_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tBiopolymer\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\"Biopolymers\" redirects here. For the scientific journal, see Biopolymers (journal).\n In the structure of DNA is a pair of biopolymers, polynucleotides, forming the double helix\nBiopolymers are polymers produced by living organisms; in other words, they are polymeric biomolecules. Biopolymers contain monomeric units that are covalently bonded to form larger structures. There are three main classes of biopolymers, classified according to the monomeric units used and the structure of the biopolymer formed: polynucleotides (RNA and DNA), which are long polymers composed of 13 or more nucleotide monomers; polypeptides, which are short polymers of amino acids; and polysaccharides, which are often linear bonded polymeric carbohydrate structures.[1][2][3][4]\nOther examples of biopolymers include rubber, suberin, melanin and lignin.\n\n\nIUPAC definition\nSubstance composed of one type of biomacromolecules.\nNote 1: Modified from the definition given in ref.[5] in order\r\nto avoid confusion between polymer and macromolecule in\r\nthe fields of proteins, polysaccharides, polynucleotides, and bacterial\r\naliphatic polyesters.\n\nNote 2: The use of the term \u201cbiomacromolecule\u201d is recommended\r\nwhen molecular characteristics are considered.[6]\n\nCellulose is the most common organic compound and biopolymer on Earth. About 33 percent of all plant matter is cellulose. The cellulose content of cotton is 90 percent, for wood it is 50 percent.[7]\n\nContents \n\n1 Vs synthetic polymers \n2 Conventions and nomenclature \n\n2.1 Polypeptides \n2.2 Nucleic acids \n2.3 Sugars \n\n\n3 Structural characterization \n4 As materials \n\n4.1 Environmental impacts \n\n\n5 See also \n6 References \n7 External links \n\n\nVs synthetic polymers \nA major defining difference between biopolymers and synthetic polymers can be found in their structures. All polymers are made of repetitive units called monomers. Biopolymers often have a well-defined structure, though this is not a defining characteristic (example: lignocellulose): \nThe exact chemical composition and the sequence in which these units are arranged is called the primary structure, in the case of proteins. Many biopolymers spontaneously fold into characteristic compact shapes (see also \"protein folding\" as well as secondary structure and tertiary structure), which determine their biological functions and depend in a complicated way on their primary structures. Structural biology is the study of the structural properties of the biopolymers.\nIn contrast, most synthetic polymers have much simpler and more random (or stochastic) structures. This fact leads to a molecular mass distribution that is missing in biopolymers.\nIn fact, as their synthesis is controlled by a template-directed process in most in vivo systems, all biopolymers of a type (say one specific protein) are all alike: they all contain the similar sequences and numbers of monomers and thus all have the same mass. This phenomenon is called monodispersity in contrast to the polydispersity encountered in synthetic polymers. As a result, biopolymers have a polydispersity index of 1.[8]\n\nConventions and nomenclature \nPolypeptides \nThe convention for a polypeptide is to list its constituent amino acid residues as they occur from the amino terminus to the carboxylic acid terminus. The amino acid residues are always joined by peptide bonds. Protein, though used colloquially to refer to any polypeptide, refers to larger or fully functional forms and can consist of several polypeptide chains as well as single chains. Proteins can also be modified to include non-peptide components, such as saccharide chains and lipids.\n\nNucleic acids \nThe convention for a nucleic acid sequence is to list the nucleotides as they occur from the 5' end to the 3' end of the polymer chain, where 5' and 3' refer to the numbering of carbons around the ribose ring which participate in forming the phosphate diester linkages of the chain. Such a sequence is called the primary structure of the biopolymer.\n\nSugars \nSugar-based biopolymers are often difficult with regards to convention. Sugar polymers can be linear or branched and are typically joined with glycosidic bonds. The exact placement of the linkage can vary, and the orientation of the linking functional groups is also important, resulting in \u03b1- and \u03b2-glycosidic bonds with numbering definitive of the linking carbons' location in the ring. In addition, many saccharide units can undergo various chemical modifications, such as amination, and can even form parts of other molecules, such as glycoproteins.\n\nStructural characterization \nThere are a number of biophysical techniques for determining sequence information. Protein sequence can be determined by Edman degradation, in which the N-terminal residues are hydrolyzed from the chain one at a time, derivatized, and then identified. Mass spectrometer techniques can also be used. Nucleic acid sequence can be determined using gel electrophoresis and capillary electrophoresis. Lastly, mechanical properties of these biopolymers can often be measured using optical tweezers or atomic-force microscopy. Dual polarization interferometry can be used to measure the conformational changes or self-assembly of these materials when stimulated by pH, temperature, ionic strength or other binding partners.\n\nAs materials \nSome biopolymers- such as PLA, naturally occurring zein, and poly-3-hydroxybutyrate can be used as plastics, replacing the need for polystyrene or polyethylene based plastics.\nSome plastics are now referred to as being 'degradable', 'oxy-degradable' or 'UV-degradable'. This means that they break down when exposed to light or air, but these plastics are still primarily (as much as 98 per cent) oil-based and are not currently certified as 'biodegradable' under the European Union directive on Packaging and Packaging Waste (94\/62\/EC). Biopolymers will break down, and some are suitable for domestic composting.[9]\nBiopolymers (also called renewable polymers) are produced from biomass for use in the packaging industry. Biomass comes from crops such as sugar beet, potatoes or wheat: when used to produce biopolymers, these are classified as non food crops. These can be converted in the following pathways:\nSugar beet > Glyconic acid > Polyglyconic acid\nStarch > (fermentation) > Lactic acid > Polylactic acid (PLA)\nBiomass > (fermentation) > Bioethanol > Ethene > Polyethylene\nMany types of packaging can be made from biopolymers: food trays, blown starch pellets for shipping fragile goods, thin films for wrapping.\n\nEnvironmental impacts \nBiopolymers can be sustainable, carbon neutral and are always renewable, because they are made from plant materials which can be grown indefinitely. These plant materials come from agricultural non food crops. Therefore, the use of biopolymers would create a sustainable industry. In contrast, the feedstocks for polymers derived from petrochemicals will eventually deplete. In addition, biopolymers have the potential to cut carbon emissions and reduce CO2 quantities in the atmosphere: this is because the CO2 released when they degrade can be reabsorbed by crops grown to replace them: this makes them close to carbon neutral.\nBiopolymers are biodegradable, and some are also compostable. Some biopolymers are biodegradable: they are broken down into CO2 and water by microorganisms. Some of these biodegradable biopolymers are compostable: they can be put into an industrial composting process and will break down by 90% within six months. Biopolymers that do this can be marked with a 'compostable' symbol, under European Standard EN 13432 (2000). Packaging marked with this symbol can be put into industrial composting processes and will break down within six months or less. An example of a compostable polymer is PLA film under 20\u03bcm thick: films which are thicker than that do not qualify as compostable, even though they are \"biodegradable\".[10] In Europe there is a home composting standard and associated logo that enables consumers to identify and dispose of packaging in their compost heap.[9]\n\nSee also \nBiomaterials\nBioplastic\nBiopolymers & Cell (journal)\nCondensation polymers\nCondensed tannins\nDNA sequence\nFood microbiology \u00a7 Microbial biopolymers\nMelanin\nNon food crops\nPhosphoramidite\nPolymer chemistry\nSequence-controlled polymers\nSequencing\nSmall molecules\nWorm-like chain\nReferences \n\n\n^ \nMohanty, A.K., et al., Natural Fibers, Biopolymers, and Biocomposites (CRC Press, 2005) \n\n^ \nChandra, R., and Rustgi, R., \"Biodegradable Polymers\", Progress in Polymer Science, Vol. 23, p. 1273 (1998) \n\n^ \nMeyers, M.A., et al., \"Biological Materials: Structure & Mechanical Properties\", Progress in Materials Science, Vol. 53, p. 1 (2008) \n\n^ \nKumar, A., et al., \"Smart Polymers: Physical Forms & Bioengineering Applications\", Progress in Polymer Science, Vol. 32, p.1205 (2007) \n\n^ Alan D. MacNaught, Andrew R. Wilkinson, ed. (1997). Compendium of Chemical Terminology: IUPAC Recommendations (the \"Gold Book\") (2nd ed.). Blackwell Science. ISBN 0865426848. \n\n^ \"Terminology for biorelated polymers and applications (IUPAC Recommendations 2012)\" (PDF) . Pure and Applied Chemistry. 84 (2): 377\u2013410. 2012. doi:10.1351\/PAC-REC-10-12-04. \n\n^ \nKlemm, D., Heublein, B., Fink, H., and Bohn, A., \"Cellulose: \nFascinating Biopolymer \/ Sustainable Raw Material\", Ang. Chemie (Intl. Edn.) Vol. 44, p. 3358 (2004) \n\n^ \nStupp, S.I and Braun, P.V., \"Role of Proteins in Microstructural Control: Biomaterials, Ceramics & Semiconductors\", Science, Vol. 277, p. 1242 (1997) \n\n^ a b NNFCC Renewable Polymers Factsheet: Bioplastics \n\n^ NNFCC Newsletter \u2013 Issue 5. Biopolymers: A Renewable Resource for the Plastics Industry \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Biopolymers.\nNNFCC: The UK's National Centre for Biorenewable Energy, Fuels and Materials\nBioplastics Magazine\nBiopolymer group\nBio-Polym Blog\nWhat\u2019s Stopping Bioplastic?\nAuthority control \nNDL: 00570451 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Biopolymer\">https:\/\/www.limswiki.org\/index.php\/Biopolymer<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 22:13.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,310 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","4c739aecba54acdad1b847edb7137a8c_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Biopolymer skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Biopolymer<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">\"Biopolymers\" redirects here. For the scientific journal, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biopolymers_(journal)\" title=\"Biopolymers (journal)\" rel=\"external_link\" target=\"_blank\">Biopolymers (journal)<\/a>.<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:183px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ADN_animation.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/8\/81\/ADN_animation.gif\" width=\"181\" height=\"313\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ADN_animation.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>In the structure of <a href=\"https:\/\/en.wikipedia.org\/wiki\/DNA\" title=\"DNA\" rel=\"external_link\" target=\"_blank\">DNA<\/a> is a pair of <b>biopolymers<\/b>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polynucleotide\" title=\"Polynucleotide\" rel=\"external_link\" target=\"_blank\">polynucleotides<\/a>, forming the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Double_helix\" class=\"mw-redirect\" title=\"Double helix\" rel=\"external_link\" target=\"_blank\">double helix<\/a><\/div><\/div><\/div>\n<p><b>Biopolymers<\/b> are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymers<\/a> produced by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organism\" title=\"Organism\" rel=\"external_link\" target=\"_blank\">living organisms<\/a>; in other words, they are polymeric <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomolecule\" title=\"Biomolecule\" rel=\"external_link\" target=\"_blank\">biomolecules<\/a>. Biopolymers contain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomeric<\/a> units that are covalently bonded to form larger structures. There are three main classes of biopolymers, classified according to the monomeric units used and the structure of the biopolymer formed: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polynucleotide\" title=\"Polynucleotide\" rel=\"external_link\" target=\"_blank\">polynucleotides<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/RNA\" title=\"RNA\" rel=\"external_link\" target=\"_blank\">RNA<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/DNA\" title=\"DNA\" rel=\"external_link\" target=\"_blank\">DNA<\/a>), which are long polymers composed of 13 or more <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nucleotide\" title=\"Nucleotide\" rel=\"external_link\" target=\"_blank\">nucleotide<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomers<\/a>; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polypeptides\" class=\"mw-redirect\" title=\"Polypeptides\" rel=\"external_link\" target=\"_blank\">polypeptides<\/a>, which are short polymers of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amino_acid\" title=\"Amino acid\" rel=\"external_link\" target=\"_blank\">amino acids<\/a>; and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polysaccharides\" class=\"mw-redirect\" title=\"Polysaccharides\" rel=\"external_link\" target=\"_blank\">polysaccharides<\/a>, which are often linear bonded polymeric <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbohydrate\" title=\"Carbohydrate\" rel=\"external_link\" target=\"_blank\">carbohydrate<\/a> structures.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\nOther examples of biopolymers include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rubber\" class=\"mw-redirect\" title=\"Rubber\" rel=\"external_link\" target=\"_blank\">rubber<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Suberin\" title=\"Suberin\" rel=\"external_link\" target=\"_blank\">suberin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Melanin\" title=\"Melanin\" rel=\"external_link\" target=\"_blank\">melanin<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lignin\" title=\"Lignin\" rel=\"external_link\" target=\"_blank\">lignin<\/a>.\n<\/p>\n<div class=\"quotebox pullquote floatright\" style=\";\">\n<div class=\"quotebox-title\" style=\"\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Union_of_Pure_and_Applied_Chemistry\" title=\"International Union of Pure and Applied Chemistry\" rel=\"external_link\" target=\"_blank\">IUPAC<\/a> definition<\/div>\n<div class=\"quotebox-quote left-aligned\" style=\"\">Substance composed of one type of <i>biomacromolecules<\/i>.\n<p><i>Note 1<\/i>: Modified from the definition given in ref.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> in order<br \/>to avoid confusion between <i>polymer<\/i> and <i>macromolecule<\/i> in<br \/>the fields of proteins, polysaccharides, polynucleotides, and bacterial<br \/>aliphatic polyesters.\n<\/p>\n<i>Note 2<\/i>: The use of the term \u201cbiomacromolecule\u201d is recommended<br \/>when molecular characteristics are considered.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><\/div>\n<\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cellulose\" title=\"Cellulose\" rel=\"external_link\" target=\"_blank\">Cellulose<\/a> is the most common organic compound and biopolymer on Earth. About 33 percent of all plant matter is cellulose. The cellulose content of cotton is 90 percent, for wood it is 50 percent.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Vs_synthetic_polymers\">Vs synthetic polymers<\/span><\/h2>\n<p>A major defining difference between <b>biopolymers<\/b> and <b>synthetic<\/b> polymers can be found in their structures. All polymers are made of repetitive units called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomers<\/a>. Biopolymers often have a well-defined structure, though this is not a defining characteristic (example: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lignocellulose\" class=\"mw-redirect\" title=\"Lignocellulose\" rel=\"external_link\" target=\"_blank\">lignocellulose<\/a>): \nThe exact chemical composition and the sequence in which these units are arranged is called the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Primary_structure\" class=\"mw-redirect\" title=\"Primary structure\" rel=\"external_link\" target=\"_blank\">primary structure<\/a>, in the case of proteins. Many biopolymers spontaneously fold into characteristic compact shapes (see also \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Protein_folding\" title=\"Protein folding\" rel=\"external_link\" target=\"_blank\">protein folding<\/a>\" as well as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Secondary_structure\" class=\"mw-redirect\" title=\"Secondary structure\" rel=\"external_link\" target=\"_blank\">secondary structure<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tertiary_structure\" class=\"mw-redirect\" title=\"Tertiary structure\" rel=\"external_link\" target=\"_blank\">tertiary structure<\/a>), which determine their biological functions and depend in a complicated way on their primary structures. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Structural_biology\" title=\"Structural biology\" rel=\"external_link\" target=\"_blank\">Structural biology<\/a> is the study of the structural properties of the biopolymers.\nIn contrast, most <b>synthetic polymers<\/b> have much simpler and more random (or stochastic) structures. This fact leads to a molecular mass distribution that is missing in biopolymers.\nIn fact, as their synthesis is controlled by a template-directed process in most <i>in vivo<\/i> systems, all biopolymers of a type (say one specific protein) are all alike: they all contain the similar sequences and numbers of monomers and thus all have the same mass. This phenomenon is called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monodispersity\" class=\"mw-redirect\" title=\"Monodispersity\" rel=\"external_link\" target=\"_blank\">monodispersity<\/a> in contrast to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polydispersity\" class=\"mw-redirect\" title=\"Polydispersity\" rel=\"external_link\" target=\"_blank\">polydispersity<\/a> encountered in synthetic polymers. As a result, biopolymers have a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polydispersity_index\" class=\"mw-redirect\" title=\"Polydispersity index\" rel=\"external_link\" target=\"_blank\">polydispersity index<\/a> of 1.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Conventions_and_nomenclature\">Conventions and nomenclature<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Polypeptides\">Polypeptides<\/span><\/h3>\n<p>The convention for a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polypeptide\" class=\"mw-redirect\" title=\"Polypeptide\" rel=\"external_link\" target=\"_blank\">polypeptide<\/a> is to list its constituent amino acid residues as they occur from the amino terminus to the carboxylic acid terminus. The amino acid residues are always joined by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peptide_bond\" title=\"Peptide bond\" rel=\"external_link\" target=\"_blank\">peptide bonds<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Protein\" title=\"Protein\" rel=\"external_link\" target=\"_blank\">Protein<\/a>, though used colloquially to refer to any polypeptide, refers to larger or fully functional forms and can consist of several polypeptide chains as well as single chains. Proteins can also be modified to include non-peptide components, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saccharide\" class=\"mw-redirect\" title=\"Saccharide\" rel=\"external_link\" target=\"_blank\">saccharide<\/a> chains and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lipid\" title=\"Lipid\" rel=\"external_link\" target=\"_blank\">lipids<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Nucleic_acids\">Nucleic acids<\/span><\/h3>\n<p>The convention for a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nucleic_acid\" title=\"Nucleic acid\" rel=\"external_link\" target=\"_blank\">nucleic acid<\/a> sequence is to list the nucleotides as they occur from the 5' end to the 3' end of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer_chain\" class=\"mw-redirect\" title=\"Polymer chain\" rel=\"external_link\" target=\"_blank\">polymer chain<\/a>, where 5' and 3' refer to the numbering of carbons around the ribose ring which participate in forming the phosphate diester linkages of the chain. Such a sequence is called the primary structure of the biopolymer.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Sugars\">Sugars<\/span><\/h3>\n<p>Sugar-based biopolymers are often difficult with regards to convention. Sugar polymers can be linear or branched and are typically joined with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glycosidic_bond\" title=\"Glycosidic bond\" rel=\"external_link\" target=\"_blank\">glycosidic bonds<\/a>. The exact placement of the linkage can vary, and the orientation of the linking functional groups is also important, resulting in \u03b1- and \u03b2-glycosidic bonds with numbering definitive of the linking carbons' location in the ring. In addition, many saccharide units can undergo various chemical modifications, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amination\" title=\"Amination\" rel=\"external_link\" target=\"_blank\">amination<\/a>, and can even form parts of other molecules, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glycoprotein\" title=\"Glycoprotein\" rel=\"external_link\" target=\"_blank\">glycoproteins<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Structural_characterization\">Structural characterization<\/span><\/h2>\n<p>There are a number of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biophysics\" title=\"Biophysics\" rel=\"external_link\" target=\"_blank\">biophysical<\/a> techniques for determining sequence information. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peptide_sequence\" class=\"mw-redirect\" title=\"Peptide sequence\" rel=\"external_link\" target=\"_blank\">Protein sequence<\/a> can be determined by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Edman_degradation\" title=\"Edman degradation\" rel=\"external_link\" target=\"_blank\">Edman degradation<\/a>, in which the N-terminal residues are hydrolyzed from the chain one at a time, derivatized, and then identified. Mass <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spectrometer\" title=\"Spectrometer\" rel=\"external_link\" target=\"_blank\">spectrometer<\/a> techniques can also be used. Nucleic acid sequence can be determined using gel <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrophoresis\" title=\"Electrophoresis\" rel=\"external_link\" target=\"_blank\">electrophoresis<\/a> and capillary electrophoresis. Lastly, mechanical properties of these biopolymers can often be measured using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_tweezers\" title=\"Optical tweezers\" rel=\"external_link\" target=\"_blank\">optical tweezers<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atomic-force_microscopy\" class=\"mw-redirect\" title=\"Atomic-force microscopy\" rel=\"external_link\" target=\"_blank\">atomic-force microscopy<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dual_polarization_interferometry\" class=\"mw-redirect\" title=\"Dual polarization interferometry\" rel=\"external_link\" target=\"_blank\">Dual polarization interferometry<\/a> can be used to measure the conformational changes or self-assembly of these materials when stimulated by pH, temperature, ionic strength or other binding partners.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"As_materials\">As materials<\/span><\/h2>\n<p>Some biopolymers- such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polylactic_acid\" title=\"Polylactic acid\" rel=\"external_link\" target=\"_blank\">PLA<\/a>, naturally occurring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zein\" title=\"Zein\" rel=\"external_link\" target=\"_blank\">zein<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Poly-3-hydroxybutyrate\" class=\"mw-redirect\" title=\"Poly-3-hydroxybutyrate\" rel=\"external_link\" target=\"_blank\">poly-3-hydroxybutyrate<\/a> can be used as plastics, replacing the need for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polystyrene\" title=\"Polystyrene\" rel=\"external_link\" target=\"_blank\">polystyrene<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a> based plastics.\n<\/p><p>Some plastics are now referred to as being 'degradable', 'oxy-degradable' or 'UV-degradable'. This means that they break down when exposed to light or air, but these plastics are still primarily (as much as 98 per cent) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oil\" title=\"Oil\" rel=\"external_link\" target=\"_blank\">oil<\/a>-based and are not currently certified as 'biodegradable' under the <a href=\"https:\/\/en.wikipedia.org\/wiki\/European_Union_directive\" class=\"mw-redirect\" title=\"European Union directive\" rel=\"external_link\" target=\"_blank\">European Union directive<\/a> on Packaging and Packaging Waste (94\/62\/EC). Biopolymers will break down, and some are suitable for domestic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Composting\" class=\"mw-redirect\" title=\"Composting\" rel=\"external_link\" target=\"_blank\">composting<\/a>.<sup id=\"rdp-ebb-cite_ref-nnfcc_9-0\" class=\"reference\"><a href=\"#cite_note-nnfcc-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>Biopolymers (also called renewable polymers) are produced from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomass\" title=\"Biomass\" rel=\"external_link\" target=\"_blank\">biomass<\/a> for use in the packaging industry. Biomass comes from crops such as sugar beet, potatoes or wheat: when used to produce biopolymers, these are classified as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Non_food_crops\" class=\"mw-redirect\" title=\"Non food crops\" rel=\"external_link\" target=\"_blank\">non food crops<\/a>. These can be converted in the following pathways:\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sugar_beet\" title=\"Sugar beet\" rel=\"external_link\" target=\"_blank\">Sugar beet<\/a> > Glyconic acid > Polyglyconic acid\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Starch\" title=\"Starch\" rel=\"external_link\" target=\"_blank\">Starch<\/a> > (fermentation) > <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lactic_acid\" title=\"Lactic acid\" rel=\"external_link\" target=\"_blank\">Lactic acid<\/a> > <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polylactic_acid\" title=\"Polylactic acid\" rel=\"external_link\" target=\"_blank\">Polylactic acid<\/a> (PLA)\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomass\" title=\"Biomass\" rel=\"external_link\" target=\"_blank\">Biomass<\/a> > (fermentation) > <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioethanol\" class=\"mw-redirect\" title=\"Bioethanol\" rel=\"external_link\" target=\"_blank\">Bioethanol<\/a> > <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethene\" class=\"mw-redirect\" title=\"Ethene\" rel=\"external_link\" target=\"_blank\">Ethene<\/a> > <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">Polyethylene<\/a>\n<\/p><p>Many types of packaging can be made from biopolymers: food trays, blown starch pellets for shipping fragile goods, thin films for wrapping.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Environmental_impacts\">Environmental impacts<\/span><\/h3>\n<p>Biopolymers can be sustainable, carbon neutral and are always <a href=\"https:\/\/en.wikipedia.org\/wiki\/Renewable\" class=\"mw-redirect\" title=\"Renewable\" rel=\"external_link\" target=\"_blank\">renewable<\/a>, because they are made from plant materials which can be grown indefinitely. These plant materials come from agricultural <a href=\"https:\/\/en.wikipedia.org\/wiki\/Non_food_crops\" class=\"mw-redirect\" title=\"Non food crops\" rel=\"external_link\" target=\"_blank\">non food crops<\/a>. Therefore, the use of biopolymers would create a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sustainable\" class=\"mw-redirect\" title=\"Sustainable\" rel=\"external_link\" target=\"_blank\">sustainable<\/a> industry. In contrast, the feedstocks for polymers derived from petrochemicals will eventually deplete. In addition, biopolymers have the potential to cut <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_emissions\" class=\"mw-redirect\" title=\"Carbon emissions\" rel=\"external_link\" target=\"_blank\">carbon emissions<\/a> and reduce CO<sub>2<\/sub> quantities in the atmosphere: this is because the CO<sub>2<\/sub> released when they degrade can be reabsorbed by crops grown to replace them: this makes them close to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_neutral\" class=\"mw-redirect\" title=\"Carbon neutral\" rel=\"external_link\" target=\"_blank\">carbon neutral<\/a>.\n<\/p><p>Biopolymers are biodegradable, and some are also compostable. Some biopolymers are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biodegradable\" class=\"mw-redirect\" title=\"Biodegradable\" rel=\"external_link\" target=\"_blank\">biodegradable<\/a>: they are broken down into CO<sub>2<\/sub> and water by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microorganisms\" class=\"mw-redirect\" title=\"Microorganisms\" rel=\"external_link\" target=\"_blank\">microorganisms<\/a>. Some of these biodegradable biopolymers are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Compostable\" class=\"mw-redirect\" title=\"Compostable\" rel=\"external_link\" target=\"_blank\">compostable<\/a>: they can be put into an industrial composting process and will break down by 90% within six months. Biopolymers that do this can be marked with a 'compostable' symbol, under European Standard EN 13432 (2000). Packaging marked with this symbol can be put into industrial composting processes and will break down within six months or less. An example of a compostable polymer is PLA film under 20\u03bcm thick: films which are thicker than that do not qualify as compostable, even though they are \"biodegradable\".<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> In Europe there is a home composting standard and associated logo that enables consumers to identify and dispose of packaging in their compost heap.<sup id=\"rdp-ebb-cite_ref-nnfcc_9-1\" class=\"reference\"><a href=\"#cite_note-nnfcc-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterial\" title=\"Biomaterial\" rel=\"external_link\" target=\"_blank\">Biomaterials<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioplastic\" title=\"Bioplastic\" rel=\"external_link\" target=\"_blank\">Bioplastic<\/a><\/li>\n<li><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biopolymers_%26_Cell\" title=\"Biopolymers & Cell\" rel=\"external_link\" target=\"_blank\">Biopolymers & Cell<\/a><\/i> (journal)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Condensation_polymer\" title=\"Condensation polymer\" rel=\"external_link\" target=\"_blank\">Condensation polymers<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Condensed_tannin\" title=\"Condensed tannin\" rel=\"external_link\" target=\"_blank\">Condensed tannins<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/DNA_sequence\" class=\"mw-redirect\" title=\"DNA sequence\" rel=\"external_link\" target=\"_blank\">DNA sequence<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_microbiology#Microbial_biopolymers\" title=\"Food microbiology\" rel=\"external_link\" target=\"_blank\">Food microbiology \u00a7 Microbial biopolymers<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Melanin\" title=\"Melanin\" rel=\"external_link\" target=\"_blank\">Melanin<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Non_food_crops\" class=\"mw-redirect\" title=\"Non food crops\" rel=\"external_link\" target=\"_blank\">Non food crops<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphoramidite\" title=\"Phosphoramidite\" rel=\"external_link\" target=\"_blank\">Phosphoramidite<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer_chemistry\" title=\"Polymer chemistry\" rel=\"external_link\" target=\"_blank\">Polymer chemistry<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sequence-controlled_polymer\" title=\"Sequence-controlled polymer\" rel=\"external_link\" target=\"_blank\">Sequence-controlled polymers<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sequencing\" title=\"Sequencing\" rel=\"external_link\" target=\"_blank\">Sequencing<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Small_molecule\" title=\"Small molecule\" rel=\"external_link\" target=\"_blank\">Small molecules<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Worm-like_chain\" title=\"Worm-like chain\" rel=\"external_link\" target=\"_blank\">Worm-like chain<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\nMohanty, A.K., et al., <b>Natural Fibers, Biopolymers, and Biocomposites<\/b> (CRC Press, 2005)<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\nChandra, R., and Rustgi, R., \"Biodegradable Polymers\", Progress in Polymer Science, Vol. 23, p. 1273 (1998)<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\nMeyers, M.A., et al., \"Biological Materials: Structure & Mechanical Properties\", Progress in Materials Science, Vol. 53, p. 1 (2008)<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\nKumar, A., et al., \"Smart Polymers: Physical Forms & Bioengineering Applications\", Progress in Polymer Science, Vol. 32, p.1205 (2007)<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Alan D. MacNaught, Andrew R. Wilkinson, ed. (1997). <i>Compendium of Chemical Terminology: IUPAC Recommendations (the \"Gold Book\")<\/i> (2nd ed.). Blackwell Science. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0865426848.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Compendium+of+Chemical+Terminology%3A+IUPAC+Recommendations+%28the+%22Gold+Book%22%29&rft.edition=2nd&rft.pub=Blackwell+Science&rft.date=1997&rft.isbn=0865426848&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiopolymer\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pac.iupac.org\/publications\/pac\/pdf\/2012\/pdf\/8402x0377.pdf\" target=\"_blank\">\"Terminology for biorelated polymers and applications (IUPAC Recommendations 2012)\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pure_and_Applied_Chemistry\" title=\"Pure and Applied Chemistry\" rel=\"external_link\" target=\"_blank\">Pure and Applied Chemistry<\/a><\/i>. <b>84<\/b> (2): 377\u2013410. 2012. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1351%2FPAC-REC-10-12-04\" target=\"_blank\">10.1351\/PAC-REC-10-12-04<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pure+and+Applied+Chemistry&rft.atitle=Terminology+for+biorelated+polymers+and+applications+%28IUPAC+Recommendations+2012%29&rft.volume=84&rft.issue=2&rft.pages=377-410&rft.date=2012&rft_id=info%3Adoi%2F10.1351%2FPAC-REC-10-12-04&rft_id=http%3A%2F%2Fpac.iupac.org%2Fpublications%2Fpac%2Fpdf%2F2012%2Fpdf%2F8402x0377.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiopolymer\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\nKlemm, D., Heublein, B., Fink, H., and Bohn, A., \"Cellulose: \nFascinating Biopolymer \/ Sustainable Raw Material\", Ang. Chemie (Intl. Edn.) Vol. 44, p. 3358 (2004) <\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\nStupp, S.I and Braun, P.V., \"Role of Proteins in Microstructural Control: Biomaterials, Ceramics & Semiconductors\", Science, Vol. 277, p. 1242 (1997)<\/span>\n<\/li>\n<li id=\"cite_note-nnfcc-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-nnfcc_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-nnfcc_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nnfcc.co.uk\/publications\/nnfcc-renewable-polymers-factsheet-bioplastics\" target=\"_blank\">NNFCC Renewable Polymers Factsheet: Bioplastics<\/a><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nnfcc.co.uk\/publications\/nnfcc-newsletter-issue-5-biopolymers-a-renewable-resource-for-the-plastics-industry\" target=\"_blank\">NNFCC Newsletter \u2013 Issue 5. Biopolymers: A Renewable Resource for the Plastics Industry<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nnfcc.co.uk\/\" target=\"_blank\">NNFCC: The UK's National Centre for Biorenewable Energy, Fuels and Materials<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bioplasticsmagazine.com\/\" target=\"_blank\">Bioplastics Magazine<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.biopolymer.net\/\" target=\"_blank\">Biopolymer group<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20081023075853\/http:\/\/biopol.free.fr\/\" target=\"_blank\">Bio-Polym Blog<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/archive.is\/20121209011537\/http:\/\/boldlygo.org\/blog\/whats-stopping-bioplastic\/\" target=\"_blank\">What\u2019s Stopping Bioplastic?<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1327\nCached time: 20181211215900\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.236 seconds\nReal time usage: 0.341 seconds\nPreprocessor visited node count: 562\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 9849\/2097152 bytes\nTemplate argument size: 887\/2097152 bytes\nHighest expansion depth: 9\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 9960\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.113\/10.000 seconds\nLua memory usage: 3.31 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 286.684 1 -total\n<\/p>\n<pre>36.54% 104.755 1 Template:Reflist\n22.31% 63.949 1 Template:Cite_book\n21.61% 61.940 1 Template:Commonscat\n14.22% 40.766 1 Template:Authority_control\n12.23% 35.071 1 Template:Redirect\n10.69% 30.653 1 Template:Quote_box\n 8.29% 23.768 1 Template:Cite_journal\n 4.85% 13.902 1 Template:Commons\n 3.97% 11.388 1 Template:Sister_project\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:3974-1!canonical and timestamp 20181211215859 and revision id 869418344\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Biopolymer\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212211\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.009 seconds\nReal time usage: 0.156 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 150.738 1 - wikipedia:Biopolymer\n100.00% 150.738 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:7992-0!*!*!*!*!*!* and timestamp 20181217212211 and revision id 24104\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Biopolymer\">https:\/\/www.limswiki.org\/index.php\/Biopolymer<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","4c739aecba54acdad1b847edb7137a8c_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/8\/81\/ADN_animation.gif"],"4c739aecba54acdad1b847edb7137a8c_timestamp":1545081731,"0cc9f2383870a14c79fd048150e60480_type":"article","0cc9f2383870a14c79fd048150e60480_title":"Bioglass","0cc9f2383870a14c79fd048150e60480_url":"https:\/\/www.limswiki.org\/index.php\/Bioglass","0cc9f2383870a14c79fd048150e60480_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tBioglass\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Molecular structure of Bioglass\nBioglass 45S5, commonly referred to by its commercial name Bioglass, is a glass specifically composed of 45 wt% SiO2, 24.5 wt% CaO, 24.5 wt% Na2O, and 6.0 wt% P2O5.[1]  Glasses are non-crystalline amorphous solids that are commonly composed of silica-based materials with other minor additives.  Compared to soda-lime glass (commonly used, as in windows or bottles), Bioglass 45S5 contains less silica and higher amounts of calcium and phosphorus.  The 45S5 name signifies glass with 45 weight % of SiO2 and 5:1 molar ratio of calcium to phosphorus.  This high ratio of calcium to phosphorus promotes formation of apatite crystals; calcium and silica ions can act as crystallization nuclei.[2]  Lower Ca:P ratios do not bond to bone.[3]  Bioglass 45S5's specific composition is optimal in biomedical applications because of its similar composition to that of hydroxyapatite, the mineral component of bone. This similarity provides Bioglass' ability to be integrated with living bone.\n\nThis composition of bioactive glass is comparatively soft in comparison to other glasses. It can be machined, preferably with diamond tools, or ground to powder. Bioglass has to be stored in a dry environment, as it readily absorbs moisture and reacts with it.[3] The morphology of bioglass using SEM, sintered at 900\u00b0CBioglass 45S5 is the first formulation of an artificial material that was found to chemically bond with bone. One of its main medical advantages is its biocompatibility, seen in its ability to avoid an immune reaction and fibrous encapsulation. Its primary application is the repair of bone injuries or defects too large to be regenerated by the natural process.[3]\nThe first successful surgical use of Bioglass 45S5 was in replacement of ossicles in the middle ear, as a treatment of conductive hearing loss. Other uses include cones for implantation into the jaw following a tooth extraction. Composite materials made of Bioglass 45S5 and patient's own bone can be used for bone reconstruction.[2] Further research is being conducted for the development of new processing techniques to allow for more applications of Bioglass.\n\nContents \n\n1 History \n2 Applications \n3 Mechanism of action \n4 Manufacturing \n5 Shortcomings \n6 Methods of improvement \n7 See also \n8 References \n\n\nHistory \nBioglass is important to the field of biomaterials as one of the first completely synthetic materials that seamlessly bonds to bone. It was developed by Larry L. Hench in the late 1960s. The idea for the material came to him during a bus ride in 1967. While working as an assistant professor at the University of Florida, Dr. Hench decided to attend the U.S. Army Materials Research Conference held in Sagamore, New York, where he planned to talk about radiation resistant electronic materials. He began discussing his research with a fellow traveller on the bus, Colonel Klinker, who had recently returned to the United States after serving as an Army medical supply officer in Vietnam.[4]\nAfter listening to Dr. Hench's description of his research, the Colonel asked, \u201cIf you can make a material that will survive exposure to high energy radiation can you make a material that will survive exposure to the human body?\u201d[4] Klinker then went on to describe the amputations that he had witnessed in Vietnam, which resulted from the body's rejection of metal and plastic implants. Hench realized that there was a need for a novel material that could form a living bond with tissues in the body.[4]\nWhen Hench returned to Florida after the conference, he submitted a proposal to the U.S. Army Medical Research and Design Command. He received funding in 1968, and in November 1969 Hench began to synthesize small rectangles of what he called 45S5 glass. Ted Greenlee, Assistant Professor of Orthopaedic Surgery at the University of Florida, implanted them in rat femurs at the VA Hospital in Gainesville. Six weeks later, Greenlee called Hench asking, \"Larry, what are those samples you gave me? They will not come out of the bone. I have pulled on them, I have pushed on them, I have cracked the bone and they are still bonded in place.\"[4]\nWith this first successful experiment, Bioglass was born and the first compositions studied. Hench published his first paper on the subject in 1971 in the Journal of Biomedical Materials Research, and his lab continued to work on the project for the next 10 years with continued funding from the U.S. Army. By 2006, there were over 500 papers published on the topic of bioactive glasses from different laboratories and institutions around the world.[4] The first successful surgical use of Bioglass 45S5 was in replacement of ossicles in middle ear as a treatment of conductive hearing loss, and the material continues to be used in bone reconstruction applications today.[1]\n\nApplications \nBioactive glass offers good osteoconductivity and bioactivity, it can deliver cells and is biodegradable. This makes it an excellent candidate to be used in tissue engineering applications. Although this material is known to be brittle, it is still used extensively to enhance the growth of bone since new forms of bioactive glasses are based on borate and borosilicate compositions. Bioglass can also be doped with varying quantities of elements like copper, zinc, or strontium which can allow the growth and formation of healthy bone. The formation of neocartilage can also be induced with bioactive glass by using an in vitro culture of chondrocyte-seeded hydrogels and can serve as a subchondral substrate for tissue-engineered osteochondral constructs.[1]\nThe borate-based bioactive glass has controllable degradation rates in order to match the rate at which actual bone is formed. Bone formation has been shown to enhance when using this type of material. When implanted into rabbit femurs, the 45S5 bioactive glass showed that it could induce bone proliferation at a much quicker rate than synthetic hydroxyapatite (HA). 45S5 glass can also be osteoconductive and osteoinductive because it allows for new bone growth along the bone-implant interface as well as within the bone-implant interface. Studies have been conducted to determine the process by which it can induce bone formation. It was shown that 45S5 glass degrades and releases sodium ions, as well as soluble silica, the combination of all these ions is said to produce new bone. Borate bioglass has proven that it can support cell proliferation and differentiation in vitro and in vivo. It also has shown that it is suitable to be used as a substrate for drug release when treating bone infection. However, there has been a concern as to whether or not the release of boron into a solution as borate ions will be toxic to the body. It has been shown that in static cell culture conditions, borate glasses were toxic to cells, but not in dynamic culture conditions.[5]\nAnother area in which bioactive glass has been investigated to use is enamel reconstruction, which has proven to be a difficult task in the field of dentistry. Enamel is made up of a very organized hierarchical microstructure of carbonated hydroxyapatite nanocrystals. It has been reported that Bioglass 45S5-phosphoric acid paste can be used to form an interaction layer that can obstruct dentinal tubule orifices and can therefore be useful in the treatment of dentin hypersensitivity lesions.[6] This material in an aqueous environment could have an antibacterial property that is advantageous in periodontal surgical procedures. In a study done with 45S5 Bioglass, control biofilms of S. sanguis were grown on inactive glass particulates and the biofilm grown on the Bioglass was significantly lower than those that were on the inactive glass. It was concluded that Bioglass can reduce surface bacterial formation, which could benefit post-surgical periodontal wound healing. The most effective antibacterial bioactive glass is S53P4, which has exhibited a growth-inhibitory effect on the pathogens that was tested on it. Bioactive glasses that are sol-gel derived, such as CaPSiO and CaPSiO II, have also exhibited antibacterial property. Studies done with S. epidermidis and E. coli cultured with bioactive glass have shown that the 45S5 bioactive glass have a very high antibacterial resistance. It was also observed in the experiment that there were needle-like bioglass debris which could have ruptured the cell walls of the bacteria and rendered them inactive.[7]\nBioactive glass has even been applied to medical devices to help restore the hearing to a deaf patient using Bioglass 45S5 in 1984. The patient went deaf due to at ear infection that degraded two of the three bones in her middle ear. An implant was designed to replace the damaged bone and carry sound from the eardrum to the cochlea, restoring the patient's hearing. Before this material was available, plastics and metals would be used because they did not produce a reaction in the body, however they eventually failed because tissue would grow around them after implantation. A prosthesis made up of Bioglass 45S5 was made to fit the patient and most of the prosthesis that were made were able to maintain functionality after 10 years.[8] The Endosseous Ridge Maintenance Implant made of Bioglass 45S5 was another device that could be inserted into tooth extraction sites that would repair tooth roots and allow for a stable ridge for dentures.[6]\nThis material has also been used in jaw and orthopedics applications, in this way it dissolves and can stimulate the natural bone to repair itself. GlaxoSmithKline is using this material as an active ingredient in toothpaste  under the commercial name NovaMin, which can help repair tiny holes and decrease tooth sensitivity.[6] Currently, bioactive glass is still be researched and has yet to reach its full capacity of use .\n\nMechanism of action \n The integration of Bioglass with bone. The reaction with surrounding physiological fluid at the surface of Bioglass is shown in first two steps, and the formation of new bone is shown in the last two stages.\nWhen implanted, Bioglass 45S5 reacts with the surrounding physiological fluid, causing the formation of a hydroxyl carbonated apatite (HCA) layer at the material surface. The HCA layer has a similar composition to hydroxyapatite, the mineral phase of bone, a quality which allows for strong interaction and integration with bone. The process by which this reaction occurs can be separated into 12 steps. The first 5 steps are related to the Bioglass response to the environment within the body, and occur rapidly at the material surface over several hours.[9] Reaction steps 6-10 detail the reaction of the body to the integration of the biomaterial, and the process of integration with bone. These stages occur over the scale of several weeks or months.[10] The steps are separated as follows:[9][10]\n1. Alkali ions (ex. Na+ and Ca2+) on the glass surface rapidly exchange with hydrogen ions or hydronium from surrounding bodily fluids. The reaction below shows this process, which causes hydrolysis of silica groups. As this occurs, the pH of the solution increases.\nSi\u23afO\u23afNa+ + H+ + OH\u2212 \u2192 Si\u23afOH+ + Na+ (aq) + OH\u2212\n2. Due to an increase in the hydroxyl (OH\u2212) concentration at the surface (a result of step 1), a dissolution of the silica glass network occurs, seen by the breaking of Si\u23afO\u23afSi bonds. Soluble silica is transformed to the form of Si(OH)4 and silanols (Si\u23afOH) creation occurs at the material surface. The reaction occurring in this stage is shown below:\nSi\u23afO\u23afSi + H2O\u2192 Si\u23afOH + OH\u23afSi\n3. The silanol groups at the material surface condense and re-polymerize to form a silica-gel layer at the surface of Bioglass. As a result of the first steps, the surface contains very little alkali content. The condensation reaction is shown below:\nSi\u23afOH + Si\u23afOH \u2192 Si\u23afO\u23afSi\n4. Amorphous Ca2+ and PO43\u2212 gather at the silica-rich layer (created in step 3) from both the surrounding bodily fluid and the bulk of the Bioglass. This creates a layer composed primarily of CaO\u23afP2O5 on top of the silica layer.\n5. The CaO\u23afP2O5 film created in step 4 incorporates OH\u2212 and CO32\u2212 from the bodily solution, causing it to crystallize. This layer is called a mixed carbonated hydroxyl apatite (HCA).\n6. Growth factors adsorb to the surface of Bioglass due to its structural and chemical similarities to hydroxyapatite.\n7. Adsorbed growth factors cause the activation of M2 macrophages. M2 macrophages tend to promote wound healing and the initiate the migration of progenitor cells to an injury site. In contrast, M1 macrophages become activated when a non-biocompatible material is implanted, triggering an inflammatory response.[11]\n8. Triggered by M2 macrophage activation, mesenchymal stem cells and osteoprogenitor cells migrate to the Bioglass surface and attach to the HCA layer.\n9. Stem cells and osteoprogenitor cells at the HCA surface differentiate to become osteogenic cells typically present in bone tissue, particularly osteoblasts.\n10. The attached and differentiated osteoblasts generate and deposit extracellular matrix (ECM) components, primarily type I collagen, the main protein component of bone.\n11. The collagen ECM becomes mineralized as normally occurs in native bone. Nanoscale hydroxyapatite crystals form a layered structure with the deposited collagen at the surface of the implant.\n12. Following these reactions, bone growth continues as the newly recruited cells continue to function and facilitate tissue growth and repair. The Bioglass implant continues to degrade and be converted to new ECM material.\n\nManufacturing \nThere are three main manufacturing techniques that are used for the synthesis of Bioglass. The first is melt quench synthesis, which is the conventional glass-making technology used by Larry Hench when he first manufactured the material in 1969. This method includes melting a mixture of oxides such as SiO2, Na2O, CaO and P2O5 at high temperatures generally above 1100-1300 \u00b0C.[12] Platinum or platinum alloy crucibles to are used avoid contamination, which would interfere with the product's chemical reactivity in organism. Annealing is a crucial step in forming bulk parts, due to high thermal expansion of the material. Heat treatment of Bioglass reduces the volatile alkali metal oxide content and precipitates apatite crystals in the glass matrix. However, the scaffolds that result from melt quench techniques are much less porous compared to other manufacturing methods, which may lead to defects in tissue integration when implanted in vivo.[13]\nThe second method is sol-gel synthesis of Bioglass. This process is carried out at much lower temperatures than the traditional melting methods. It involves the creation of a solution (sol), which is composed of metal-organic and metal salt precursors. A gel is then formed through hydrolysis and condensation reactions, and it undergoes thermal treatment for drying, oxide formation, and organic removal. Because of the lower fabrication temperatures used in this method, there is a greater level of control on the composition and homogeneity of the product. In addition, sol-gel bioglasses have much higher porosity, which leads to a greater surface area and degree of integration in the body.[12]\nThe third method is microwave synthesis of Bioglass, which has been gaining attention in recent years. Microwave synthesis is a rapid and low-cost powder synthesis method in which precursors are dissolved in water, transferred to an ultrasonic bath, and irradiated. The resulting amorphous powder is then filtered, dried  at 80 \u00b0C, and calcined at 700 \u00b0C.[14]\n\nShortcomings \nA setback to using Bioglass 45S5 is that it is difficult to process into porous 3D scaffolds. These porous scaffolds are usually prepared by sintering glass particles that are already formed into the 3D geometry and allowing them to bond to the particles into a strong glass phase made up of a network of pores. Since this particular type of bioglass cannot fully sinter by viscous flow above its Tg, and its Tg is close to the onset of crystallization, it is hard to sinter this material into a dense network.[1]\n45S5 glass also has a slow degradation and rate of conversion to an HA-like material. This setback makes it more difficult for the degradation rate of the scaffold to coincide with the rate of tissue formation. Another limitation is that the biological environment can be easily influenced by its degradation. Increases in the sodium and calcium ions and changing pH is due to its degradation. However, the roles of these ions and their toxicity to the body have not been fully researched.[1]\n\nMethods of improvement \nSeveral studies have investigated methods to improve the mechanical strength and toughness of Bioglass 45S5. These include creating polymer-glass composites, which combine the bioactivity of Bioglass with the relative flexibility and wear resistance of different polymers. Another solution is coating a metallic implant with Bioglass, which takes advantage of the mechanical strength of the implant's bulk material while retaining bioactive effects at the surface. Some of the most notable modifications have used various forms of carbon to improve the properties of 45S5 glass.[15]\nFor example, Touri et al. developed a method to incorporate carbon nanotubes (CNTs) into the structure without interfering with the material's bioactive properties. CNTs were chosen because of their large aspect ratio and high strength. By synthesizing Bioglass 45S5 on a CNT scaffold, the researchers were able to create a composite that more than doubled the compressive strength and the elastic modulus when compared to the pure glass.[16]\nAnother study carried out by Li et al. looked into different properties, such as the fracture toughness and wear resistance of Bioglass 45S5. The authors loaded graphene nanoplatelets (GNP) into the glass structure through a spark plasma sintering method. Graphene was chosen because of its high specific surface area and strength, as well as its cytocompatibility and lack of interference with Bioglass 45S5's bioactivity. The composites that were created in this experiment achieved a fracture toughness of more than double the control. In addition, the tribological properties of the material were greatly improved.[15]\n\nSee also \nBioactive glass\nMechanical properties of biomaterials\nSynthesis of bioglass\nReferences \n\n\n^ a b c d e Rahaman, M. \"Bioactive glass in tissue engineering\". Acta Biomaterialia. 7: 2355\u20132373. doi:10.1016\/j.actbio.2011.03.016. PMC 3085647 . \n\n^ a b Chen, Q.; Thompson, I.; Boccaccini, A. (2006). \"45S5 Bioglass\u00ae-derived glass\u2013ceramic scaffolds for bone tissue engineering\". Biomaterials. 27: 2414\u20132425. doi:10.1016\/j.biomaterials.2005.11.025. \n\n^ a b c Jones, J.R. (2013). \"Review of bioactive glass: From Hench to hybrids\". Acta Biomaterialia. 9: 4457\u20134486. doi:10.1016\/j.actbio.2012.08.023. \n\n^ a b c d e Hench, L.L. (December 2006). \"The story of Bioglass\". Journal of Materials Science in Medicine. 17: 967\u201378. doi:10.1007\/s10856-006-0432-z. \n\n^ Krishnan, Vidya; Lakshmi, T (2013-04-01). \"Bioglass: A novel biocompatible innovation\". Journal of Advanced Pharmaceutical Technology & Research. 4 (2). doi:10.4103\/2231-4040.111523. PMC 3696226 . PMID 23833747. \n\n^ a b c Bakry, A.S. \"Evaluation of new treatment for incipient enamel demineralization using 45S5 bioglass\". Dental Materials. 30: 341\u2013320. \n\n^ Hu, S. \"Study on antibacterial effect of 45S5 Bioglass\". Journal of Materials Science: Materials in Medicine. 20: 281\u2013286. doi:10.1007\/s10856-008-3564-5. \n\n^ Jones, J.R. \"Review of bioactive glass: From Hench to hybrids\". Acta Biomaterialia. 9: 4457\u20134486. doi:10.1016\/j.actbio.2012.08.023. \n\n^ a b Rabiee, S.M.; Nazparvar, N.; Azizian, M.; Vashaee, D.; Tayebi, L. (July 2015). \"Effect of ion substitution on properties of bioactive glasses: A review\". Ceramics International. 41: 7241\u20137251. doi:10.1016\/j.ceramint.2015.02.140. \n\n^ a b Hench, L. L. (July 1998). \"Bioceramics\". Journal of the American Ceramic Society. 81: 1705\u20131728. doi:10.1111\/j.1151-2916.1998.tb02540.x. \n\n^ Roszer, T. \"Understanding the Mysterious M2 Macrophage through Activation Markers and Effector Mechanisms\". Mediators of Inflammation. \n\n^ a b Deliomanli, Aylin M.; Yildirim, Mehmet (2016). \"Sol-gel synthesis of 13-93 bioactive glass powders containing therapeutic agents\" (PDF) . Journal of the Australian Ceramic Society. 52[2]: 9\u201319. \n\n^ Hench, L.L.; Paschall, H.A. (1973). \"DIrect chemical bond of bioactive glass-ceramic materials to bone and muscle\". Journal of Biomedical Materials Research. 7 (3): 25\u201342. doi:10.1002\/jbm.820070304. PMID 4123968. \n\n^ Sarkar, Swapan Kumar; Lee, Byong Taek (2011). \"Synthesis of Bioactive Glass by Microwave Energy Irradiation and its In-Vitro Biocompatibility\". Bioceramics Development and Applications. 1: 1\u20133. doi:10.4303\/bda\/D110155. \n\n^ a b Li, Z. (January 2017). \"Mechanical, tribological and biological properties of novel 45S5 Bioglass\u00ae composites reinforced with in situ reduced graphene oxide\". Journal of Mechanical Behavior of Biomedical Materials. 65: 77\u201389. doi:10.1016\/j.jmbbm.2016.08.007. \n\n^ Touri, R (September 2013). \"The Use of Carbon Nanotubes to Reinforce 45S5 Bioglass-Based Scaffolds for Tissue Engineering\". BioMed Research International. 2013. doi:10.1155\/2013\/465086. \n\n\nvteGlass science topicsBasics\nGlass\nGlass transition\nSupercooling\nFormulation\nAgInSbTe\nBioglass\nBorophosphosilicate glass\nBorosilicate glass\nCeramic glaze\nChalcogenide glass\nCobalt glass\nCranberry glass\nCrown glass\nFlint glass\nFluorosilicate glass\nFused quartz\nGeSbTe\nGold ruby glass\nLead glass\nMilk glass\nPhosphosilicate glass\nPhotochromic lens glass\nSilicate glass\nSoda\u2013lime glass\nSodium hexametaphosphate\nSoluble glass\nTellurite glass\nThoriated glass\nUltra low expansion glass\nUranium glass\nVitreous enamel\nWood's glass\nZBLAN\nGlass-ceramics\nBioactive glass\nCorningWare\nGlass-ceramic-to-metal seals\nMacor\nZerodur\nPreparation\nAnnealing\nChemical vapor deposition\nGlass batch calculation\nGlass forming\nGlass melting\nGlass modeling\nIon implantation\nLiquidus temperature\nSol-gel technique\nViscosity\nVitrification\nOptics\nAchromat\nDispersion\nGradient-index optics\nHydrogen darkening\nOptical amplifier\nOptical fiber\nOptical lens design\nPhotochromic lens\nPhotosensitive glass\nRefraction\nTransparent materials\nSurface\r\nmodification\nAnti-reflective coating\nChemically strengthened glass\nCorrosion\nDealkalization\nDNA microarray\nHydrogen darkening\nInsulated glazing\nPorous glass\nSelf-cleaning glass\nSol-gel technique\nTempered glass\nDiverse\r\ntopics\nGlass-coated wire\nSafety glass\nGlass databases\nGlass electrode\nGlass fiber reinforced concrete\nGlass ionomer cement\nGlass microspheres\nGlass-reinforced plastic\nGlass-to-metal seal\nPorous glass\nPrince Rupert's drops\nRadioactive waste vitrification\nWindshield\nGlass fiber\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Bioglass\">https:\/\/www.limswiki.org\/index.php\/Bioglass<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 22:06.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 529 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","0cc9f2383870a14c79fd048150e60480_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Bioglass skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Bioglass<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:B007852m-f9.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/93\/B007852m-f9.gif\/220px-B007852m-f9.gif\" width=\"220\" height=\"172\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:B007852m-f9.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Molecular structure of Bioglass<\/div><\/div><\/div>\n<p><b>Bioglass 45S5<\/b>, commonly referred to by its commercial name <b>Bioglass<\/b>, is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass\" title=\"Glass\" rel=\"external_link\" target=\"_blank\">glass<\/a> specifically composed of 45 wt% SiO<sub>2<\/sub>, 24.5 wt% CaO, 24.5 wt% Na<sub>2<\/sub>O, and 6.0 wt% P<sub>2<\/sub>O<sub>5<\/sub>.<sup id=\"rdp-ebb-cite_ref-:3_1-0\" class=\"reference\"><a href=\"#cite_note-:3-1\" rel=\"external_link\">[1]<\/a><\/sup>  Glasses are non-crystalline amorphous solids that are commonly composed of silica-based materials with other minor additives.  Compared to soda-lime glass (commonly used, as in windows or bottles), Bioglass 45S5 contains less silica and higher amounts of calcium and phosphorus.  The 45S5 name signifies glass with 45 weight % of SiO<sub>2<\/sub> and 5:1 molar ratio of calcium to phosphorus.  This high ratio of calcium to phosphorus promotes formation of apatite crystals; calcium and silica ions can act as crystallization nuclei.<sup id=\"rdp-ebb-cite_ref-:7_2-0\" class=\"reference\"><a href=\"#cite_note-:7-2\" rel=\"external_link\">[2]<\/a><\/sup>  Lower Ca:P ratios do not bond to bone.<sup id=\"rdp-ebb-cite_ref-:4_3-0\" class=\"reference\"><a href=\"#cite_note-:4-3\" rel=\"external_link\">[3]<\/a><\/sup>  Bioglass 45S5's specific composition is optimal in biomedical applications because of its similar composition to that of hydroxyapatite, the mineral component of bone. This similarity provides Bioglass' ability to be integrated with living bone.\n<\/p><p>\nThis composition of bioactive glass is comparatively soft in comparison to other glasses. It can be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Machined\" class=\"mw-redirect\" title=\"Machined\" rel=\"external_link\" target=\"_blank\">machined<\/a>, preferably with diamond tools, or ground to powder. Bioglass has to be stored in a dry environment, as it readily absorbs moisture and reacts with it.<sup id=\"rdp-ebb-cite_ref-:4_3-1\" class=\"reference\"><a href=\"#cite_note-:4-3\" rel=\"external_link\">[3]<\/a><\/sup> <\/p><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MorphologyofBioglass.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/57\/MorphologyofBioglass.png\/220px-MorphologyofBioglass.png\" width=\"220\" height=\"111\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MorphologyofBioglass.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The morphology of bioglass using SEM, sintered at 900\u00b0C<\/div><\/div><\/div><p>Bioglass 45S5 is the first formulation of an artificial material that was found to chemically bond with bone. One of its main medical advantages is its biocompatibility, seen in its ability to avoid an immune reaction and fibrous encapsulation. Its primary application is the repair of bone injuries or defects too large to be regenerated by the natural process.<sup id=\"rdp-ebb-cite_ref-:4_3-2\" class=\"reference\"><a href=\"#cite_note-:4-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>The first successful surgical use of Bioglass 45S5 was in replacement of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ossicles\" title=\"Ossicles\" rel=\"external_link\" target=\"_blank\">ossicles<\/a> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Middle_ear\" title=\"Middle ear\" rel=\"external_link\" target=\"_blank\">middle ear<\/a>, as a treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Conductive_hearing_loss\" title=\"Conductive hearing loss\" rel=\"external_link\" target=\"_blank\">conductive hearing loss<\/a>. Other uses include cones for implantation into the jaw following a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tooth_extraction\" class=\"mw-redirect\" title=\"Tooth extraction\" rel=\"external_link\" target=\"_blank\">tooth extraction<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Composite_material\" title=\"Composite material\" rel=\"external_link\" target=\"_blank\">Composite materials<\/a> made of Bioglass 45S5 and patient's own bone can be used for bone reconstruction.<sup id=\"rdp-ebb-cite_ref-:7_2-1\" class=\"reference\"><a href=\"#cite_note-:7-2\" rel=\"external_link\">[2]<\/a><\/sup> Further research is being conducted for the development of new processing techniques to allow for more applications of Bioglass.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Bioglass is important to the field of biomaterials as one of the first completely synthetic materials that seamlessly bonds to bone. It was developed by Larry L. Hench in the late 1960s. The idea for the material came to him during a bus ride in 1967. While working as an assistant professor at the University of Florida, Dr. Hench decided to attend the U.S. Army Materials Research Conference held in Sagamore, New York, where he planned to talk about radiation resistant electronic materials. He began discussing his research with a fellow traveller on the bus, Colonel Klinker, who had recently returned to the United States after serving as an Army medical supply officer in Vietnam.<sup id=\"rdp-ebb-cite_ref-:8_4-0\" class=\"reference\"><a href=\"#cite_note-:8-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>After listening to Dr. Hench's description of his research, the Colonel asked, \u201cIf you can make a material that will survive exposure to high energy radiation can you make a material that will survive exposure to the human body?\u201d<sup id=\"rdp-ebb-cite_ref-:8_4-1\" class=\"reference\"><a href=\"#cite_note-:8-4\" rel=\"external_link\">[4]<\/a><\/sup> Klinker then went on to describe the amputations that he had witnessed in Vietnam, which resulted from the body's rejection of metal and plastic implants. Hench realized that there was a need for a novel material that could form a living bond with tissues in the body.<sup id=\"rdp-ebb-cite_ref-:8_4-2\" class=\"reference\"><a href=\"#cite_note-:8-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>When Hench returned to Florida after the conference, he submitted a proposal to the U.S. Army Medical Research and Design Command. He received funding in 1968, and in November 1969 Hench began to synthesize small rectangles of what he called 45S5 glass. Ted Greenlee, Assistant Professor of Orthopaedic Surgery at the University of Florida, implanted them in rat femurs at the VA Hospital in Gainesville. Six weeks later, Greenlee called Hench asking, \"Larry, what are those samples you gave me? They will not come out of the bone. I have pulled on them, I have pushed on them, I have cracked the bone and they are still bonded in place.\"<sup id=\"rdp-ebb-cite_ref-:8_4-3\" class=\"reference\"><a href=\"#cite_note-:8-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>With this first successful experiment, Bioglass was born and the first compositions studied. Hench published his first paper on the subject in 1971 in the Journal of Biomedical Materials Research, and his lab continued to work on the project for the next 10 years with continued funding from the U.S. Army. By 2006, there were over 500 papers published on the topic of bioactive glasses from different laboratories and institutions around the world.<sup id=\"rdp-ebb-cite_ref-:8_4-4\" class=\"reference\"><a href=\"#cite_note-:8-4\" rel=\"external_link\">[4]<\/a><\/sup> The first successful surgical use of Bioglass 45S5 was in replacement of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ossicles\" title=\"Ossicles\" rel=\"external_link\" target=\"_blank\">ossicles<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Middle_ear\" title=\"Middle ear\" rel=\"external_link\" target=\"_blank\">middle ear<\/a> as a treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Conductive_hearing_loss\" title=\"Conductive hearing loss\" rel=\"external_link\" target=\"_blank\">conductive hearing loss<\/a>, and the material continues to be used in bone reconstruction applications today.<sup id=\"rdp-ebb-cite_ref-:3_1-1\" class=\"reference\"><a href=\"#cite_note-:3-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>Bioactive glass offers good osteoconductivity and bioactivity, it can deliver cells and is biodegradable. This makes it an excellent candidate to be used in tissue engineering applications. Although this material is known to be brittle, it is still used extensively to enhance the growth of bone since new forms of bioactive glasses are based on borate and borosilicate compositions. Bioglass can also be doped with varying quantities of elements like copper, zinc, or strontium which can allow the growth and formation of healthy bone. The formation of neocartilage can also be induced with bioactive glass by using an in vitro culture of chondrocyte-seeded hydrogels and can serve as a subchondral substrate for tissue-engineered osteochondral constructs.<sup id=\"rdp-ebb-cite_ref-:3_1-2\" class=\"reference\"><a href=\"#cite_note-:3-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>The borate-based bioactive glass has controllable degradation rates in order to match the rate at which actual bone is formed. Bone formation has been shown to enhance when using this type of material. When implanted into rabbit femurs, the 45S5 bioactive glass showed that it could induce bone proliferation at a much quicker rate than synthetic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxylapatite\" class=\"mw-redirect\" title=\"Hydroxylapatite\" rel=\"external_link\" target=\"_blank\">hydroxyapatite<\/a> (HA). 45S5 glass can also be osteoconductive and osteoinductive because it allows for new bone growth along the bone-implant interface as well as within the bone-implant interface. Studies have been conducted to determine the process by which it can induce bone formation. It was shown that 45S5 glass degrades and releases sodium ions, as well as soluble silica, the combination of all these ions is said to produce new bone. Borate bioglass has proven that it can support cell proliferation and differentiation in vitro and in vivo. It also has shown that it is suitable to be used as a substrate for drug release when treating bone infection. However, there has been a concern as to whether or not the release of boron into a solution as borate ions will be toxic to the body. It has been shown that in static cell culture conditions, borate glasses were toxic to cells, but not in dynamic culture conditions.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>Another area in which bioactive glass has been investigated to use is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tooth_enamel\" title=\"Tooth enamel\" rel=\"external_link\" target=\"_blank\">enamel<\/a> reconstruction, which has proven to be a difficult task in the field of dentistry. Enamel is made up of a very organized hierarchical microstructure of carbonated hydroxyapatite nanocrystals. It has been reported that Bioglass 45S5-phosphoric acid paste can be used to form an interaction layer that can obstruct dentinal tubule orifices and can therefore be useful in the treatment of dentin hypersensitivity lesions.<sup id=\"rdp-ebb-cite_ref-:2_6-0\" class=\"reference\"><a href=\"#cite_note-:2-6\" rel=\"external_link\">[6]<\/a><\/sup> This material in an aqueous environment could have an antibacterial property that is advantageous in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Periodontal_pathology\" class=\"mw-redirect\" title=\"Periodontal pathology\" rel=\"external_link\" target=\"_blank\">periodontal<\/a> surgical procedures. In a study done with 45S5 Bioglass, control <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biofilm\" title=\"Biofilm\" rel=\"external_link\" target=\"_blank\">biofilms<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Streptococcus_sanguinis\" title=\"Streptococcus sanguinis\" rel=\"external_link\" target=\"_blank\">S. sanguis<\/a> were grown on inactive glass particulates and the biofilm grown on the Bioglass was significantly lower than those that were on the inactive glass. It was concluded that Bioglass can reduce surface bacterial formation, which could benefit post-surgical periodontal wound healing. The most effective antibacterial bioactive glass is S53P4, which has exhibited a growth-inhibitory effect on the pathogens that was tested on it. Bioactive glasses that are sol-gel derived, such as CaPSiO and CaPSiO II, have also exhibited antibacterial property. Studies done with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Staphylococcus_epidermidis\" title=\"Staphylococcus epidermidis\" rel=\"external_link\" target=\"_blank\">S. epidermidis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Escherichia_coli\" title=\"Escherichia coli\" rel=\"external_link\" target=\"_blank\">E. coli<\/a> cultured with bioactive glass have shown that the 45S5 bioactive glass have a very high antibacterial resistance. It was also observed in the experiment that there were needle-like bioglass debris which could have ruptured the cell walls of the bacteria and rendered them inactive.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>Bioactive glass has even been applied to medical devices to help restore the hearing to a deaf patient using Bioglass 45S5 in 1984. The patient went deaf due to at ear infection that degraded two of the three bones in her middle ear. An implant was designed to replace the damaged bone and carry sound from the eardrum to the cochlea, restoring the patient's hearing. Before this material was available, plastics and metals would be used because they did not produce a reaction in the body, however they eventually failed because tissue would grow around them after implantation. A prosthesis made up of Bioglass 45S5 was made to fit the patient and most of the prosthesis that were made were able to maintain functionality after 10 years.<sup id=\"rdp-ebb-cite_ref-:9_8-0\" class=\"reference\"><a href=\"#cite_note-:9-8\" rel=\"external_link\">[8]<\/a><\/sup> The Endosseous Ridge Maintenance Implant made of Bioglass 45S5 was another device that could be inserted into tooth extraction sites that would repair tooth roots and allow for a stable ridge for dentures.<sup id=\"rdp-ebb-cite_ref-:2_6-1\" class=\"reference\"><a href=\"#cite_note-:2-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>This material has also been used in jaw and orthopedics applications, in this way it dissolves and can stimulate the natural bone to repair itself. GlaxoSmithKline is using this material as an active ingredient in toothpaste  under the commercial name NovaMin, which can help repair tiny holes and decrease tooth sensitivity.<sup id=\"rdp-ebb-cite_ref-:2_6-2\" class=\"reference\"><a href=\"#cite_note-:2-6\" rel=\"external_link\">[6]<\/a><\/sup> Currently, bioactive glass is still be researched and has yet to reach its full capacity of use .\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Mechanism_of_action\">Mechanism of action<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:383px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bioglass_Surface_Reaction.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/86\/Bioglass_Surface_Reaction.jpg\/381px-Bioglass_Surface_Reaction.jpg\" width=\"381\" height=\"183\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bioglass_Surface_Reaction.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The integration of Bioglass with bone. The reaction with surrounding physiological fluid at the surface of Bioglass is shown in first two steps, and the formation of new bone is shown in the last two stages.<\/div><\/div><\/div>\n<p>When implanted, Bioglass 45S5 reacts with the surrounding physiological fluid, causing the formation of a hydroxyl carbonated apatite (HCA) layer at the material surface. The HCA layer has a similar composition to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxylapatite\" class=\"mw-redirect\" title=\"Hydroxylapatite\" rel=\"external_link\" target=\"_blank\">hydroxyapatite<\/a>, the mineral phase of bone, a quality which allows for strong interaction and integration with bone. The process by which this reaction occurs can be separated into 12 steps. The first 5 steps are related to the Bioglass response to the environment within the body, and occur rapidly at the material surface over several hours.<sup id=\"rdp-ebb-cite_ref-:0_9-0\" class=\"reference\"><a href=\"#cite_note-:0-9\" rel=\"external_link\">[9]<\/a><\/sup> Reaction steps 6-10 detail the reaction of the body to the integration of the biomaterial, and the process of integration with bone. These stages occur over the scale of several weeks or months.<sup id=\"rdp-ebb-cite_ref-:1_10-0\" class=\"reference\"><a href=\"#cite_note-:1-10\" rel=\"external_link\">[10]<\/a><\/sup> The steps are separated as follows:<sup id=\"rdp-ebb-cite_ref-:0_9-1\" class=\"reference\"><a href=\"#cite_note-:0-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-:1_10-1\" class=\"reference\"><a href=\"#cite_note-:1-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>1. Alkali ions (ex. Na<sup>+<\/sup> and Ca<sup>2+<\/sup>) on the glass surface rapidly exchange with hydrogen ions or hydronium from surrounding bodily fluids. The reaction below shows this process, which causes hydrolysis of silica groups. As this occurs, the pH of the solution increases.\n<\/p><p>Si\u23afO\u23afNa<sup>+<\/sup> + H<sup>+<\/sup> + OH<sup>\u2212<\/sup> \u2192 Si\u23afOH<sup>+<\/sup> + Na<sup>+<\/sup> (aq) + OH<sup>\u2212<\/sup>\n<\/p><p>2. Due to an increase in the hydroxyl (OH<sup>\u2212<\/sup>) concentration at the surface (a result of step 1), a dissolution of the silica glass network occurs, seen by the breaking of Si\u23afO\u23afSi bonds. Soluble silica is transformed to the form of Si(OH)<sub>4<\/sub> and silanols (Si\u23afOH) creation occurs at the material surface. The reaction occurring in this stage is shown below:\n<\/p><p>Si\u23afO\u23afSi + H<sub>2<\/sub>O\u2192 Si\u23afOH + OH\u23afSi\n<\/p><p>3. The silanol groups at the material surface condense and re-polymerize to form a silica-gel layer at the surface of Bioglass. As a result of the first steps, the surface contains very little alkali content. The condensation reaction is shown below:\n<\/p><p>Si\u23afOH + Si\u23afOH \u2192 Si\u23afO\u23afSi\n<\/p><p>4. Amorphous Ca<sup>2+<\/sup> and PO<sub>4<\/sub><sup>3\u2212<\/sup> gather at the silica-rich layer (created in step 3) from both the surrounding bodily fluid and the bulk of the Bioglass. This creates a layer composed primarily of CaO\u23afP<sub>2<\/sub>O<sub>5<\/sub> on top of the silica layer.\n<\/p><p>5. The CaO\u23afP<sub>2<\/sub>O<sub>5<\/sub> film created in step 4 incorporates OH<sup>\u2212<\/sup> and CO<sub>3<\/sub><sup>2\u2212<\/sup> from the bodily solution, causing it to crystallize. This layer is called a mixed carbonated hydroxyl apatite (HCA).\n<\/p><p>6. Growth factors adsorb to the surface of Bioglass due to its structural and chemical similarities to hydroxyapatite.\n<\/p><p>7. Adsorbed growth factors cause the activation of M2 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Macrophage\" title=\"Macrophage\" rel=\"external_link\" target=\"_blank\">macrophages<\/a>. M2 macrophages tend to promote wound healing and the initiate the migration of progenitor cells to an injury site. In contrast, M1 macrophages become activated when a non-biocompatible material is implanted, triggering an inflammatory response.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>8. Triggered by M2 macrophage activation, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mesenchymal_stem_cell\" title=\"Mesenchymal stem cell\" rel=\"external_link\" target=\"_blank\">mesenchymal stem cells<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteochondroprogenitor_cell\" title=\"Osteochondroprogenitor cell\" rel=\"external_link\" target=\"_blank\">osteoprogenitor cells<\/a> migrate to the Bioglass surface and attach to the HCA layer.\n<\/p><p>9. Stem cells and osteoprogenitor cells at the HCA surface differentiate to become osteogenic cells typically present in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_tissue\" class=\"mw-redirect\" title=\"Bone tissue\" rel=\"external_link\" target=\"_blank\">bone tissue<\/a>, particularly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoblast\" title=\"Osteoblast\" rel=\"external_link\" target=\"_blank\">osteoblasts<\/a>.\n<\/p><p>10. The attached and differentiated osteoblasts generate and deposit <a href=\"https:\/\/en.wikipedia.org\/wiki\/Extracellular_matrix\" title=\"Extracellular matrix\" rel=\"external_link\" target=\"_blank\">extracellular matrix<\/a> (ECM) components, primarily <a href=\"https:\/\/en.wikipedia.org\/wiki\/Type_I_collagen\" title=\"Type I collagen\" rel=\"external_link\" target=\"_blank\">type I collagen<\/a>, the main protein component of bone.\n<\/p><p>11. The collagen ECM becomes <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoblast#Mineralization_of_bone\" title=\"Osteoblast\" rel=\"external_link\" target=\"_blank\">mineralized<\/a> as normally occurs in native bone. Nanoscale hydroxyapatite crystals form a layered structure with the deposited collagen at the surface of the implant.\n<\/p><p>12. Following these reactions, bone growth continues as the newly recruited cells continue to function and facilitate tissue growth and repair. The Bioglass implant continues to degrade and be converted to new ECM material.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Manufacturing\">Manufacturing<\/span><\/h2>\n<p>There are three main manufacturing techniques that are used for the synthesis of Bioglass. The first is melt quench synthesis, which is the conventional glass-making technology used by Larry Hench when he first manufactured the material in 1969. This method includes melting a mixture of oxides such as SiO<sub>2<\/sub>, Na<sub>2<\/sub>O, CaO and P<sub>2<\/sub>O<sub>5<\/sub> at high temperatures generally above 1100-1300 \u00b0C.<sup id=\"rdp-ebb-cite_ref-:5_12-0\" class=\"reference\"><a href=\"#cite_note-:5-12\" rel=\"external_link\">[12]<\/a><\/sup> Platinum or platinum alloy <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crucible\" title=\"Crucible\" rel=\"external_link\" target=\"_blank\">crucibles<\/a> to are used avoid contamination, which would interfere with the product's chemical reactivity in organism. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Annealing_(glass)\" title=\"Annealing (glass)\" rel=\"external_link\" target=\"_blank\">Annealing<\/a> is a crucial step in forming bulk parts, due to high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_expansion\" title=\"Thermal expansion\" rel=\"external_link\" target=\"_blank\">thermal expansion<\/a> of the material. Heat treatment of Bioglass reduces the volatile alkali metal oxide content and precipitates apatite crystals in the glass matrix. However, the scaffolds that result from melt quench techniques are much less porous compared to other manufacturing methods, which may lead to defects in tissue integration when implanted in vivo.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p><p>The second method is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sol-gel\" class=\"mw-redirect\" title=\"Sol-gel\" rel=\"external_link\" target=\"_blank\">sol-gel<\/a> synthesis of Bioglass. This process is carried out at much lower temperatures than the traditional melting methods. It involves the creation of a solution (sol), which is composed of metal-organic and metal salt precursors. A gel is then formed through hydrolysis and condensation reactions, and it undergoes thermal treatment for drying, oxide formation, and organic removal. Because of the lower fabrication temperatures used in this method, there is a greater level of control on the composition and homogeneity of the product. In addition, sol-gel bioglasses have much higher porosity, which leads to a greater surface area and degree of integration in the body.<sup id=\"rdp-ebb-cite_ref-:5_12-1\" class=\"reference\"><a href=\"#cite_note-:5-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p>The third method is microwave synthesis of Bioglass, which has been gaining attention in recent years. Microwave synthesis is a rapid and low-cost powder synthesis method in which precursors are dissolved in water, transferred to an ultrasonic bath, and irradiated. The resulting amorphous powder is then filtered, dried  at 80 \u00b0C, and calcined at 700 \u00b0C.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Shortcomings\">Shortcomings<\/span><\/h2>\n<p>A setback to using Bioglass 45S5 is that it is difficult to process into porous 3D scaffolds. These porous scaffolds are usually prepared by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sintering\" title=\"Sintering\" rel=\"external_link\" target=\"_blank\">sintering<\/a> glass particles that are already formed into the 3D geometry and allowing them to bond to the particles into a strong glass phase made up of a network of pores. Since this particular type of bioglass cannot fully sinter by viscous flow above its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass_transition_temperature\" class=\"mw-redirect\" title=\"Glass transition temperature\" rel=\"external_link\" target=\"_blank\">Tg<\/a>, and its Tg is close to the onset of crystallization, it is hard to sinter this material into a dense network.<sup id=\"rdp-ebb-cite_ref-:3_1-3\" class=\"reference\"><a href=\"#cite_note-:3-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>45S5 glass also has a slow degradation and rate of conversion to an HA-like material. This setback makes it more difficult for the degradation rate of the scaffold to coincide with the rate of tissue formation. Another limitation is that the biological environment can be easily influenced by its degradation. Increases in the sodium and calcium ions and changing pH is due to its degradation. However, the roles of these ions and their toxicity to the body have not been fully researched.<sup id=\"rdp-ebb-cite_ref-:3_1-4\" class=\"reference\"><a href=\"#cite_note-:3-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Methods_of_improvement\">Methods of improvement<\/span><\/h2>\n<p>Several studies have investigated methods to improve the mechanical strength and toughness of Bioglass 45S5. These include creating polymer-glass <a href=\"https:\/\/en.wikipedia.org\/wiki\/Composite_material\" title=\"Composite material\" rel=\"external_link\" target=\"_blank\">composites<\/a>, which combine the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioactivity\" class=\"mw-redirect\" title=\"Bioactivity\" rel=\"external_link\" target=\"_blank\">bioactivity<\/a> of Bioglass with the relative flexibility and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wear_resistance\" class=\"mw-redirect\" title=\"Wear resistance\" rel=\"external_link\" target=\"_blank\">wear resistance<\/a> of different polymers. Another solution is coating a metallic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implant<\/a> with Bioglass, which takes advantage of the mechanical strength of the implant's bulk material while retaining bioactive effects at the surface. Some of the most notable modifications have used various forms of carbon to improve the properties of 45S5 glass.<sup id=\"rdp-ebb-cite_ref-:6_15-0\" class=\"reference\"><a href=\"#cite_note-:6-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p>For example, Touri et al. developed a method to incorporate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_nanotube\" title=\"Carbon nanotube\" rel=\"external_link\" target=\"_blank\">carbon nanotubes<\/a> (CNTs) into the structure without interfering with the material's bioactive properties. CNTs were chosen because of their large aspect ratio and high strength. By synthesizing Bioglass 45S5 on a CNT scaffold, the researchers were able to create a composite that more than doubled the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Compressive_strength\" title=\"Compressive strength\" rel=\"external_link\" target=\"_blank\">compressive strength<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastic_modulus\" title=\"Elastic modulus\" rel=\"external_link\" target=\"_blank\">elastic modulus<\/a> when compared to the pure glass.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>Another study carried out by Li et al. looked into different properties, such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fracture_toughness\" title=\"Fracture toughness\" rel=\"external_link\" target=\"_blank\">fracture toughness<\/a> and wear resistance of Bioglass 45S5. The authors loaded <a href=\"https:\/\/en.wikipedia.org\/wiki\/Graphene\" title=\"Graphene\" rel=\"external_link\" target=\"_blank\">graphene<\/a> nanoplatelets (GNP) into the glass structure through a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spark_plasma_sintering\" title=\"Spark plasma sintering\" rel=\"external_link\" target=\"_blank\">spark plasma sintering<\/a> method. Graphene was chosen because of its high specific surface area and strength, as well as its cytocompatibility and lack of interference with Bioglass 45S5's bioactivity. The composites that were created in this experiment achieved a fracture toughness of more than double the control. In addition, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tribological\" class=\"mw-redirect\" title=\"Tribological\" rel=\"external_link\" target=\"_blank\">tribological<\/a> properties of the material were greatly improved.<sup id=\"rdp-ebb-cite_ref-:6_15-1\" class=\"reference\"><a href=\"#cite_note-:6-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioactive_glass\" title=\"Bioactive glass\" rel=\"external_link\" target=\"_blank\">Bioactive glass<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mechanical_properties_of_biomaterials\" title=\"Mechanical properties of biomaterials\" rel=\"external_link\" target=\"_blank\">Mechanical properties of biomaterials<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Synthesis_of_bioglass\" title=\"Synthesis of bioglass\" rel=\"external_link\" target=\"_blank\">Synthesis of bioglass<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-:3-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:3_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rahaman, M. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3085647\" target=\"_blank\">\"Bioactive glass in tissue engineering\"<\/a>. <i>Acta Biomaterialia<\/i>. <b>7<\/b>: 2355\u20132373. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.actbio.2011.03.016\" target=\"_blank\">10.1016\/j.actbio.2011.03.016<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3085647\" target=\"_blank\">3085647<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Biomaterialia&rft.atitle=Bioactive+glass+in+tissue+engineering&rft.volume=7&rft.pages=2355-2373&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3085647&rft_id=info%3Adoi%2F10.1016%2Fj.actbio.2011.03.016&rft.aulast=Rahaman&rft.aufirst=M&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3085647&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioglass\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-:7-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:7_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:7_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chen, Q.; Thompson, I.; Boccaccini, A. (2006). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0142961205010422\" target=\"_blank\">\"45S5 Bioglass\u00ae-derived glass\u2013ceramic scaffolds for bone tissue engineering\"<\/a>. <i>Biomaterials<\/i>. <b>27<\/b>: 2414\u20132425. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.biomaterials.2005.11.025\" target=\"_blank\">10.1016\/j.biomaterials.2005.11.025<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biomaterials&rft.atitle=45S5+Bioglass%C2%AE-derived+glass%E2%80%93ceramic+scaffolds+for+bone+tissue+engineering&rft.volume=27&rft.pages=2414-2425&rft.date=2006&rft_id=info%3Adoi%2F10.1016%2Fj.biomaterials.2005.11.025&rft.aulast=Chen&rft.aufirst=Q.&rft.au=Thompson%2C+I.&rft.au=Boccaccini%2C+A.&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS0142961205010422&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioglass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:4-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:4_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:4_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:4_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jones, J.R. (2013). \"Review of bioactive glass: From Hench to hybrids\". <i>Acta Biomaterialia<\/i>. <b>9<\/b>: 4457\u20134486. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.actbio.2012.08.023\" target=\"_blank\">10.1016\/j.actbio.2012.08.023<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Biomaterialia&rft.atitle=Review+of+bioactive+glass%3A+From+Hench+to+hybrids&rft.volume=9&rft.pages=4457-4486&rft.date=2013&rft_id=info%3Adoi%2F10.1016%2Fj.actbio.2012.08.023&rft.aulast=Jones&rft.aufirst=J.R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioglass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:8-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:8_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:8_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:8_4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:8_4-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:8_4-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hench, L.L. 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Materials+Science+in+Medicine&rft.atitle=The+story+of+Bioglass&rft.volume=17&rft.pages=967-78&rft.date=2006-12&rft_id=info%3Adoi%2F10.1007%2Fs10856-006-0432-z&rft.aulast=Hench&rft.aufirst=L.L.&rft_id=https%3A%2F%2Fwww.researchgate.net%2Fpublication%2F6675044_The_Story_of_BioglassR&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioglass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Krishnan, Vidya; Lakshmi, T (2013-04-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.japtr.org\/text.asp?2013\/4\/2\/78\/111523\" target=\"_blank\">\"Bioglass: A novel biocompatible innovation\"<\/a>. <i>Journal of Advanced Pharmaceutical Technology & Research<\/i>. <b>4<\/b> (2). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4103%2F2231-4040.111523\" target=\"_blank\">10.4103\/2231-4040.111523<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3696226\" target=\"_blank\">3696226<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" 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rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:2_6-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bakry, A.S. \"Evaluation of new treatment for incipient enamel demineralization using 45S5 bioglass\". <i>Dental Materials<\/i>. <b>30<\/b>: 341\u2013320.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Dental+Materials&rft.atitle=Evaluation+of+new+treatment+for+incipient+enamel+demineralization+using+45S5+bioglass&rft.volume=30&rft.pages=341-320&rft.aulast=Bakry&rft.aufirst=A.S&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioglass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hu, S. \"Study on antibacterial effect of 45S5 Bioglass\". <i>Journal of Materials Science: Materials in Medicine<\/i>. <b>20<\/b>: 281\u2013286. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs10856-008-3564-5\" target=\"_blank\">10.1007\/s10856-008-3564-5<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Materials+Science%3A+Materials+in+Medicine&rft.atitle=Study+on+antibacterial+effect+of+45S5+Bioglass&rft.volume=20&rft.pages=281-286&rft_id=info%3Adoi%2F10.1007%2Fs10856-008-3564-5&rft.aulast=Hu&rft.aufirst=S&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioglass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:9-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-:9_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jones, J.R. \"Review of bioactive glass: From Hench to hybrids\". <i>Acta Biomaterialia<\/i>. <b>9<\/b>: 4457\u20134486. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.actbio.2012.08.023\" target=\"_blank\">10.1016\/j.actbio.2012.08.023<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Biomaterialia&rft.atitle=Review+of+bioactive+glass%3A+From+Hench+to+hybrids&rft.volume=9&rft.pages=4457-4486&rft_id=info%3Adoi%2F10.1016%2Fj.actbio.2012.08.023&rft.aulast=Jones&rft.aufirst=J.R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioglass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:0-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rabiee, S.M.; Nazparvar, N.; Azizian, M.; Vashaee, D.; Tayebi, L. (July 2015). \"Effect of ion substitution on properties of bioactive glasses: A review\". <i>Ceramics International<\/i>. <b>41<\/b>: 7241\u20137251. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ceramint.2015.02.140\" target=\"_blank\">10.1016\/j.ceramint.2015.02.140<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ceramics+International&rft.atitle=Effect+of+ion+substitution+on+properties+of+bioactive+glasses%3A+A+review&rft.volume=41&rft.pages=7241-7251&rft.date=2015-07&rft_id=info%3Adoi%2F10.1016%2Fj.ceramint.2015.02.140&rft.au=Rabiee%2C+S.M.&rft.au=Nazparvar%2C+N.&rft.au=Azizian%2C+M.&rft.au=Vashaee%2C+D.&rft.au=Tayebi%2C+L.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioglass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:1-10\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:1_10-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_10-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hench, L. L. (July 1998). \"Bioceramics\". <i>Journal of the American Ceramic Society<\/i>. <b>81<\/b>: 1705\u20131728. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1151-2916.1998.tb02540.x\" target=\"_blank\">10.1111\/j.1151-2916.1998.tb02540.x<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+American+Ceramic+Society&rft.atitle=Bioceramics&rft.volume=81&rft.pages=1705-1728&rft.date=1998-07&rft_id=info%3Adoi%2F10.1111%2Fj.1151-2916.1998.tb02540.x&rft.aulast=Hench&rft.aufirst=L.+L.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioglass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Roszer, T. \"Understanding the Mysterious M2 Macrophage through Activation Markers and Effector Mechanisms\". <i>Mediators of Inflammation<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Mediators+of+Inflammation&rft.atitle=Understanding+the+Mysterious+M2+Macrophage+through+Activation+Markers+and+Effector+Mechanisms&rft.aulast=Roszer&rft.aufirst=T.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioglass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:5-12\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:5_12-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:5_12-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Deliomanli, Aylin M.; Yildirim, Mehmet (2016). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/austceram.com\/wp-content\/uploads\/2016\/06\/2-JACS-52-2-Aylin-9-19.pdf\" target=\"_blank\">\"Sol-gel synthesis of 13-93 bioactive glass powders containing therapeutic agents\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Journal of the Australian Ceramic Society<\/i>. 52[2]: 9\u201319.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+Australian+Ceramic+Society&rft.atitle=Sol-gel+synthesis+of+13-93+bioactive+glass+powders+containing+therapeutic+agents&rft.volume=52%5B2%5D&rft.pages=9-19&rft.date=2016&rft.aulast=Deliomanli&rft.aufirst=Aylin+M.&rft.au=Yildirim%2C+Mehmet&rft_id=https%3A%2F%2Faustceram.com%2Fwp-content%2Fuploads%2F2016%2F06%2F2-JACS-52-2-Aylin-9-19.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioglass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hench, L.L.; Paschall, H.A. (1973). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jbm.820070304\/abstract\" target=\"_blank\">\"DIrect chemical bond of bioactive glass-ceramic materials to bone and muscle\"<\/a>. <i>Journal of Biomedical Materials Research<\/i>. <b>7<\/b> (3): 25\u201342. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fjbm.820070304\" target=\"_blank\">10.1002\/jbm.820070304<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/4123968\" target=\"_blank\">4123968<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Biomedical+Materials+Research&rft.atitle=DIrect+chemical+bond+of+bioactive+glass-ceramic+materials+to+bone+and+muscle&rft.volume=7&rft.issue=3&rft.pages=25-42&rft.date=1973&rft_id=info%3Adoi%2F10.1002%2Fjbm.820070304&rft_id=info%3Apmid%2F4123968&rft.aulast=Hench&rft.aufirst=L.L.&rft.au=Paschall%2C+H.A.&rft_id=http%3A%2F%2Fonlinelibrary.wiley.com%2Fdoi%2F10.1002%2Fjbm.820070304%2Fabstract&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioglass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sarkar, Swapan Kumar; Lee, Byong Taek (2011). \"Synthesis of Bioactive Glass by Microwave Energy Irradiation and its In-Vitro Biocompatibility\". <i>Bioceramics Development and Applications<\/i>. <b>1<\/b>: 1\u20133. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4303%2Fbda%2FD110155\" target=\"_blank\">10.4303\/bda\/D110155<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Bioceramics+Development+and+Applications&rft.atitle=Synthesis+of+Bioactive+Glass+by+Microwave+Energy+Irradiation+and+its+In-Vitro+Biocompatibility&rft.volume=1&rft.pages=1-3&rft.date=2011&rft_id=info%3Adoi%2F10.4303%2Fbda%2FD110155&rft.aulast=Sarkar&rft.aufirst=Swapan+Kumar&rft.au=Lee%2C+Byong+Taek&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioglass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:6-15\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:6_15-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:6_15-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Li, Z. (January 2017). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S1751616116302648\" target=\"_blank\">\"Mechanical, tribological and biological properties of novel 45S5 Bioglass\u00ae composites reinforced with in situ reduced graphene oxide\"<\/a>. <i>Journal of Mechanical Behavior of Biomedical Materials<\/i>. <b>65<\/b>: 77\u201389. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jmbbm.2016.08.007\" target=\"_blank\">10.1016\/j.jmbbm.2016.08.007<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Mechanical+Behavior+of+Biomedical+Materials&rft.atitle=Mechanical%2C+tribological+and+biological+properties+of+novel+45S5+Bioglass%C2%AE+composites+reinforced+with+in+situ+reduced+graphene+oxide&rft.volume=65&rft.pages=77-89&rft.date=2017-01&rft_id=info%3Adoi%2F10.1016%2Fj.jmbbm.2016.08.007&rft.aulast=Li&rft.aufirst=Z.&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS1751616116302648&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioglass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Touri, R (September 2013). \"The Use of Carbon Nanotubes to Reinforce 45S5 Bioglass-Based Scaffolds for Tissue Engineering\". <i>BioMed Research International<\/i>. <b>2013<\/b>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1155%2F2013%2F465086\" target=\"_blank\">10.1155\/2013\/465086<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BioMed+Research+International&rft.atitle=The+Use+of+Carbon+Nanotubes+to+Reinforce+45S5+Bioglass-Based+Scaffolds+for+Tissue+Engineering&rft.volume=2013&rft.date=2013-09&rft_id=info%3Adoi%2F10.1155%2F2013%2F465086&rft.aulast=Touri&rft.aufirst=R&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioglass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1272\nCached time: 20181213084232\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.280 seconds\nReal time usage: 0.326 seconds\nPreprocessor visited node count: 986\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 43727\/2097152 bytes\nTemplate argument size: 104\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 46645\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.131\/10.000 seconds\nLua memory usage: 3.16 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 222.614 1 -total\n<\/p>\n<pre>91.23% 203.081 1 Template:Reflist\n71.81% 159.864 16 Template:Cite_journal\n 8.72% 19.416 1 Template:Glass_science\n 7.12% 15.852 1 Template:Navbox\n 1.54% 3.431 1 Template:Main_other\n 0.90% 1.995 1 Template:Column-width\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2161298-1!canonical and timestamp 20181213084232 and revision id 873368919\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bioglass\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212211\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.167 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 159.204 1 - wikipedia:Bioglass\n100.00% 159.204 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:7989-0!*!*!*!*!*!* and timestamp 20181217212211 and revision id 24101\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Bioglass\">https:\/\/www.limswiki.org\/index.php\/Bioglass<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","0cc9f2383870a14c79fd048150e60480_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/9\/93\/B007852m-f9.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/57\/MorphologyofBioglass.png\/440px-MorphologyofBioglass.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/8\/86\/Bioglass_Surface_Reaction.jpg"],"0cc9f2383870a14c79fd048150e60480_timestamp":1545081730,"0b500bd5164615c395077300cc77d867_type":"article","0b500bd5164615c395077300cc77d867_title":"Bioceramic","0b500bd5164615c395077300cc77d867_url":"https:\/\/www.limswiki.org\/index.php\/Bioceramic","0b500bd5164615c395077300cc77d867_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tBioceramic\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t A porous bioceramic granule of an orthobiologic calcium composition manufactured by Cam Bioceramics\nBioceramics and bioglasses are ceramic materials that are biocompatible.[1] Bioceramics are an important subset of biomaterials.[2][3] Bioceramics range in biocompatibility from the ceramic oxides, which are inert in the body, to the other extreme of resorbable materials, which are eventually replaced by the body after they have assisted repair. Bioceramics are used in many types of medical procedures. Bioceramics are typically used as rigid materials in surgical implants, though some bioceramics are flexible. The ceramic materials used are not the same as porcelain type ceramic materials. Rather, bioceramics are closely related to either the body's own materials or are extremely durable metal oxides.\n\nContents \n\n1 History \n2 Applications \n\n2.1 Mechanical properties and composition \n2.2 Multipurpose \n2.3 Specific use \n\n\n3 Biocompatibility \n4 Processing \n5 Commercial Usage \n6 Future trends \n7 See also \n8 References \n\n\nHistory \nPrior to 1925, the materials used in implant surgery were primarily relatively pure metals. The success of these materials was surprising considering the relatively primitive surgical techniques. The 1930s marked the beginning of the era of better surgical techniques as well as the first use of alloys such as vitallium.\nIn 1969, L. L. Hench and others discovered that various kinds of glasses and ceramics could bond to living bone[4][5] Hench was inspired by the idea on his way to a conference on materials. He was seated next to a colonel who had just returned from the Vietnam War. The colonel shared that after an injury the bodies of soldiers would often reject the implant. Hench was intrigued and began to investigate materials that would be biocompatible. The final product was a new material which he called bioglass. This work inspired a new field called bioceramics.[6] With the discovery of bioglass, interest in bioceramics grew rapidly.\nOn April 26, 1988, the first international symposium on bioceramics was held in Kyoto, Japan.[7]\n\nApplications \n A titanium hip prosthesis, with a ceramic head and polyethylene acetabular cup\nCeramics are now commonly used in the medical fields as dental and bone implants.[8][9] Surgical cermets are used regularly. Joint replacements are commonly coated with bioceramic materials to reduce wear and inflammatory response. Other examples of medical uses for bioceramics are in pacemakers, kidney dialysis machines, and respirators.[6] The global demand on medical ceramics and ceramic components was about U.S. $9.8 billion in 2010. It was forecast to have an annual growth of 6 to 7 percent in the following years, with world market value predicted to increase to U.S. $15.3 billion by 2015 and reach U.S. $18.5 billion by 2018.[10]\n\nMechanical properties and composition \nBioceramics are meant to be used in extracorporeal circulation systems (dialysis for example) or engineered bioreactors; however, they're most common as implants.[11] Ceramics show numerous applications as biomaterials due to their physico-chemical properties. They have the advantage of being inert in the human body, and their hardness and resistance to abrasion makes them useful for bones and teeth replacement. Some ceramics also have excellent resistance to friction, making them useful as replacement materials for malfunctioning joints. Properties such as appearance and electrical insulation are also a concern for specific biomedical applications.\nSome bioceramics incorporate alumina (Al2O3) as their lifespan is longer than that of the patient's. The material can be used in inner ear ossicles, ocular prostheses, electrical insulation for pacemakers, catheter orifices and in numerous prototypes of implantable systems such as cardiac pumps.[12]\nAluminosilicates are commonly used in dental prostheses, pure or in ceramic-polymer composites. The ceramic-polymer composites are a potential way to filling of cavities replacing amalgams suspected to have toxic effects. The aluminosilicates also have a glassy structure. Contrary to artificial teeth in resin, the colour of tooth ceramic remains stable[11][13] Zirconia doped with yttrium oxide has been proposed as a substitute for alumina for osteoarticular prostheses. The main advantages are a greater failure strength, and a good resistance to fatigue.\nVitreous carbon is also used as it is light, resistant to wear, and compatible with blood. It is mostly used in cardiac valve replacement. Diamond can be used for the same application, but in coating form.[12]\nCalcium phosphate-based ceramics constitute, at present, the preferred bone substitute in orthopaedic and maxillofacial surgery.[11] They are similar to the mineral phase of the bone in structure and\/or chemical composition. The material is typically porous, which provide a good bone-implant interface due to the increase of surface area that encourages cell colonisation and revascularisation. Additionally, it has lower mechanical strength compared to bone, making highly porous implants very delicate. Since Young's modulus of ceramics is generally much higher than that of the bone tissue, the implant can cause mechanical stresses at the bone interface.[11] Calcium phosphates usually found in bioceramics include hydroxyapatite (HAP) Ca10(PO4)6(OH)2; tricalcium phosphate \u03b2 (\u03b2 TCP): Ca3 (PO4)2; and mixtures of HAP and \u03b2 TCP.\nTable 1: Bioceramics Applications[12]\n\n\n\n\nDevices\nFunction\nBiomaterial\n\n\nArtificial total hip, knee, shoulder, elbow, wrist\nReconstruct arthritic or fractured joints\nHigh-density alumina, metal bioglass coatings\n\n\nBone plates, screws, wires\nRepair fractures\nBioglass-metal fibre composite, Polysulphone-carbon fibre composite\n\n\nIntramedullary nails\nAlign fractures\nBioglass-metal fibre composite, Polysulphone-carbon fibre composite\n\n\nHarrington rods\nCorrect chronic spinal curvature\nBioglass-metal fibre composite, Polysulphone-carbon fibre composite\n\n\nPermanently implanted artificial limbs\nReplace missing extremities\nBioglass-metal fibre composite, Polysulphone-carbon fibre composite\n\n\nVertebrae Spacers and extensors\nCorrect congenital deformity\nAl2O3\n\n\nSpinal fusion\nImmobilise vertebrae to protect spinal cord\nBioglass\n\n\nAlveolar bone replacements, mandibular reconstruction\nRestore the alveolar ridge to improve denture fit\nPolytetra fluro ethylene (PTFE) - carbon composite, Porous Al2O3, Bioglass, dense-apatite\n\n\nEnd osseous tooth replacement implants\nReplace diseased, damaged or loosened teeth\nAl2O3, Bioglass, dense hydroxyapatite, vitreous carbon\n\n\nOrthodontic anchors\nProvide posts for stress application required to change deformities\nBioglass-coated Al2O3, Bioglass coated vitallium\n\nTable 2: Mechanical Properties of Ceramic Biomaterials[12]\n\n\n\n\nMaterial\nYoung\u2019s Modulus (GPa)\nCompressiveStrength (MPa)\nBond strength (GPa)\nHardness\nDensity (g\/cm3)\n\n\nInert Al2O3\n380\n4000\n300-400\n2000-3000(HV)\n>3.9\n\n\nZrO2 (PS)\n150-200\n2000\n200-500\n1000-3000(HV)\n\u22486.0\n\n\nGraphite\n20-25\n138\nNA\nNA\n1.5-1.9\n\n\n(LTI)Pyrolitic Carbon\n17-28\n900\n270-500\nNA\n1.7-2.2\n\n\nVitreous Carbon\n24-31\n172\n70-207\n150-200(DPH)\n1.4-1.6\n\n\nBioactive HAP\n73-117\n600\n120\n350\n3.1\n\n\nBioglass\n\u224875\n1000\n50\nNA\n2.5\n\n\nAW Glass Ceramic\n118\n1080\n215\n680\n2.8\n\n\nBone\n3-30\n130-180\n60-160\nNA\nNA\n\nMultipurpose \nA number of implanted ceramics have not actually been designed for specific biomedical applications. However, they manage to find their way into different implantable systems because of their properties and their good biocompatibility. Among these ceramics, we can cite silicon carbide, titanium nitrides and carbides, and boron nitride. TiN has been suggested as the friction surface in hip prostheses. While cell culture tests show a good biocompatibility, the analysis of implants shows significant wear, related to a delaminating of the TiN layer. Silicon carbide is another modern-day ceramic which seems to provide good biocompatibility and can be used in bone implants.[11]\n\nSpecific use \nIn addition to being used for their traditional properties, bioactive ceramics have seen specific use for due to their biological activity. Calcium phosphates, oxides, and hydroxides are common examples. Other natural materials \u2014 generally of animal origin \u2014 such as bioglass and other composites feature a combination of mineral-organic composite materials such as HAP, alumina, or titanium dioxide with the biocompatible polymers (polymethylmethacrylate): PMMA, poly(L-lactic) acid: PLLA, poly(ethylene). Composites can be differentiated as bioresorbable or non-bioresorbable, with the latter being the result of the combination of a non-bioresorbable calcium phosphate (HAP) with a non-bioresorbable polymer (PMMA, PE). These materials may become more widespread in the future, on account of the many combination possibilities and their aptitude at combining a biological activity with mechanical properties similar to those of the bone.[12]\n\nBiocompatibility \nBioceramics' properties of being anticorrosive, biocompatible, and aesthetic make them quite suitable for medical usage. Zirconia ceramic has bioinertness and noncytotoxicity. Carbon is another alternative with similar mechanical properties to bone, and it also features blood compatibility, no tissue reaction, and non-toxicity to cells. None of the three bioinert ceramics exhibit bonding with the bone. However, bioactivity of bioinert ceramics can be achieved by forming composites with bioactive ceramics. Bioglass and glass ceramics are nontoxic and chemically bond to bone. Glass ceramics elicit osteoinductive properties, while calcium phosphate ceramics also exhibit non-toxicity to tissues and bioresorption. The ceramic particulate reinforcement has led to the choice of more materials for implant applications that include ceramic\/ceramic, ceramic\/polymer, and ceramic\/metal composites. Among these composites ceramic\/polymer composites have been found to release toxic elements into the surrounding tissues. Metals face corrosion related problems, and ceramic coatings on metallic implants degrade over time during lengthy applications. Ceramic\/ceramic composites enjoy superiority due to similarity to bone minerals, exhibiting biocompatibility and a readiness to be shaped. The biological activity of bioceramics has to be considered under various in vitro and in vivo studies. Performance needs must be considered in accordance with the particular site of implantation.[12]\n\nProcessing \nTechnically, ceramics are composed of raw materials such as powders and natural or synthetic chemical additives, favoring either compaction (hot, cold or isostatic), setting (hydraulic or chemical), or accelerating sintering processes. According to the formulation and shaping process used, bioceramics can vary in density and porosity as cements, ceramic depositions, or ceramic composites.[11]\nA developing material processing technique based on the biomimetic processes aims to imitate natural and biological processes and offer the possibility of making bioceramics at ambient temperature rather than through conventional or hydrothermal processes [GRO 96]. The prospect of using these relatively low processing temperatures opens up possibilities for mineral organic combinations with improved biological properties through the addition of proteins and biologically active molecules (growth factors, antibiotics, anti-tumor agents, etc.). However, these materials have poor mechanical properties which can be improved, partially, by combining them with bonding proteins.[11]\n\nCommercial Usage \nCommon bioactive materials available commercially for clinical use include 45S5 bioactive glass, A\/W bioactive glass ceramic, dense synthetic HA, and bioactive composites such as a polyethylene\u2013HA mixture. All these materials form an interfacial bond with adjacent tissue.[13]\nHigh-purity alumina bioceramics are currently commercially available from various producers. U.K. manufacturer Morgan Advanced Ceramics (MAC) began manufacturing orthopaedic devices in 1985 and quickly became a recognised supplier of ceramic femoral heads for hip replacements. MAC Bioceramics has the longest clinical history for alumina ceramic materials, manufacturing HIP Vitox\u00ae alumina since 1985.[14] Some calcium-deficient phosphates with an apatite structure were thus commercialised as \"tricalcium phosphate\" even though they did not exhibit the expected crystalline structure of tricalcium phosphate.[14]\nCurrently, numerous commercial products described as HA are available in various physical forms (e.g. granules, specially designed blocks for specific applications). HA\/polymer composite (HA\/polyethyelene, HAPEXTM) is also commercially available for ear implants, abrasives, and plasma-sprayed coating for orthopedic and dental implants.[14]\n\nFuture trends \nBioceramics have been proposed as a possible treatment for cancer. Two methods of treatment have been proposed: hyperthermia and radiotherapy. Hyperthermia treatment involves implanting a bioceramic material that contains a ferrite or other magnetic material.[15] The area is then exposed to an alternating magnetic field, which causes the implant and surrounding area to heat up. Alternatively, the bioceramic materials can be doped with \u03b2-emitting materials and implanted into the cancerous area.[2]\nOther trends include engineering bioceramics for specific tasks. Ongoing research involves the chemistry, composition, and micro- and nanostructures of the materials to improve their biocompatibility.[16][17][18]\n\nSee also \nCeramic-impregnated fabrics\nReferences \n\n\n^ P. Ducheyne, G. W. Hastings (editors) (1984) CRC metal and ceramic biomaterials vol 1 ISBN 0-8493-6261-X \n\n^ a b J. F. Shackelford (editor)(1999) MSF bioceramics applications of ceramic and glass materials in medicine ISBN 0-87849-822-2 \n\n^ H. Oonishi, H. Aoki, K. Sawai (editors) (1988) Bioceramics vol. 1 ISBN 0-912791-82-9 \n\n^ Hench, Larry L. (1991). \"Bioceramics: From Concept to Clinic\" (PDF) . Journal of the American Ceramic Society. 74 (7): 1487. doi:10.1111\/j.1151-2916.1991.tb07132.x. \n\n^ T. Yamamuro, L. L. Hench, J. Wilson (editors) (1990) CRC Handbook of bioactive ceramics vol II ISBN 0-8493-3242-7 \n\n^ a b Kassinger, Ruth. Ceramics: From Magic Pots to Man-Made Bones. Brookfield, CT: Twenty-First Century Books, 2003, ISBN 978-0761325857 \n\n^ Oonishi, H.; Aoki, H. (1989). Sawai, K., ed. Bioceramics: Proceedings of 1st International Bioceramic Symposium. Ishiyaku Euroamerica. p. 443. ISBN 978-0912791821. Retrieved 17 February 2016 . \n\n^ D. Muster (editor) (1992) Biomaterials hard tissue repair and replacement ISBN 0-444-88350-9 \n\n^ Kinnari, Teemu J.; Esteban, Jaime; Gomez-Barrena, Enrique; Zamora, Nieves; Fernandez-Roblas, Ricardo; Nieto, Alejandra; Doadrio, Juan C.; L\u00f3pez-Noriega, Adolfo; Ruiz-Hern\u00e1ndez, Eduardo; Arcos, Daniel; Vallet-Reg\u00ed, Mar\u00eda (2008). \"Bacterial adherence to SiO2-based multifunctional bioceramics\". Journal of Biomedical Materials Research Part A. doi:10.1002\/jbm.a.31943. \n\n^ Market Report: World Medical Ceramics Market. Acmite Market Intelligence. 2011. \n\n^ a b c d e f g Boch, Philippe, Niepce, Jean-Claude. (2010) Ceramic Materials: Processes, Properties and Applications. doi: 10.1002\/9780470612415.ch12 \n\n^ a b c d e f Thamaraiselvi, T. V., and S. Rajeswari. \u201cBiological evaluation of bioceramic materials-a review.\u201d Carbon 24.31 (2004): 172. \n\n^ a b Hench LL. Bioceramics: From concept to clinic. J Amer CeramSoc 1991;74(7):1487\u2013510. \n\n^ a b c Kokubo, T. Bioceramics and Their Clinical Applications, Woodhead Publishing Limited, Cambridge, England, 2008 ISBN 978-1-84569-204-9 \n\n^ John, \u0141ukasz; Janeta, Mateusz; Szafert, S\u0142awomir. \"Designing of macroporous magnetic bioscaffold based on functionalized methacrylate network covered by hydroxyapatites and doped with nano-MgFe 2 O 4 for potential cancer hyperthermia therapy\". Materials Science and Engineering: C. 78: 901\u2013911. doi:10.1016\/j.msec.2017.04.133. \n\n^ Chai, Chou; Leong, Kam W (2007). \"Biomaterials Approach to Expand and Direct Differentiation of Stem Cells\". Molecular Therapy. 15 (3): 467\u201380. doi:10.1038\/sj.mt.6300084. PMC 2365728 . PMID 17264853. \n\n^ Zhu, Xiaolong; Chen, Jun; Scheideler, Lutz; Altebaeumer, Thomas; Geis-Gerstorfer, Juergen; Kern, Dieter (2004). \"Cellular Reactions of Osteoblasts to Micron- and Submicron-Scale Porous Structures of Titanium Surfaces\". Cells Tissues Organs. 178 (1): 13\u201322. doi:10.1159\/000081089. PMID 15550756. \n\n^ Hao, L; Lawrence, J; Chian, KS (2005). \"Osteoblast cell adhesion on a laser modified zirconia based bioceramic\". Journal of Materials Science: Materials in Medicine. 16 (8): 719\u201326. doi:10.1007\/s10856-005-2608-3. PMID 15965741. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Bioceramic\">https:\/\/www.limswiki.org\/index.php\/Bioceramic<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent 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class=\"firstHeading\" lang=\"en\">Bioceramic<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:302px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cam_Bioceramics_Large_Porous_Granule.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/69\/Cam_Bioceramics_Large_Porous_Granule.png\/300px-Cam_Bioceramics_Large_Porous_Granule.png\" width=\"300\" height=\"292\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cam_Bioceramics_Large_Porous_Granule.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A porous bioceramic granule of an orthobiologic calcium composition manufactured by Cam Bioceramics<\/div><\/div><\/div>\n<p><b>Bioceramics<\/b> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioglass\" title=\"Bioglass\" rel=\"external_link\" target=\"_blank\">bioglasses<\/a> are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic\" title=\"Ceramic\" rel=\"external_link\" target=\"_blank\">ceramic<\/a> materials that are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatible<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> Bioceramics are an important subset of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterials\" class=\"mw-redirect\" title=\"Biomaterials\" rel=\"external_link\" target=\"_blank\">biomaterials<\/a>.<sup id=\"rdp-ebb-cite_ref-Shackelford_2-0\" class=\"reference\"><a href=\"#cite_note-Shackelford-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> Bioceramics range in biocompatibility from the ceramic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxides\" class=\"mw-redirect\" title=\"Oxides\" rel=\"external_link\" target=\"_blank\">oxides<\/a>, which are inert in the body, to the other extreme of resorbable materials, which are eventually replaced by the body after they have assisted repair. Bioceramics are used in many types of medical procedures. Bioceramics are typically used as rigid materials in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">surgical implants<\/a>, though some bioceramics are flexible. The ceramic materials used are not the same as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Porcelain\" title=\"Porcelain\" rel=\"external_link\" target=\"_blank\">porcelain<\/a> type ceramic materials. Rather, bioceramics are closely related to either the body's own materials or are extremely durable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mixed_metal_oxide\" class=\"mw-redirect\" title=\"Mixed metal oxide\" rel=\"external_link\" target=\"_blank\">metal oxides<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Prior to 1925, the materials used in implant surgery were primarily relatively pure metals. The success of these materials was surprising considering the relatively primitive surgical techniques. The 1930s marked the beginning of the era of better surgical techniques as well as the first use of alloys such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vitallium\" title=\"Vitallium\" rel=\"external_link\" target=\"_blank\">vitallium<\/a>.\n<\/p><p>In 1969, L. L. Hench and others discovered that various kinds of glasses and ceramics could bond to living bone<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Hench was inspired by the idea on his way to a conference on materials. He was seated next to a colonel who had just returned from the Vietnam War. The colonel shared that after an injury the bodies of soldiers would often reject the implant. Hench was intrigued and began to investigate materials that would be biocompatible. The final product was a new material which he called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioglass\" title=\"Bioglass\" rel=\"external_link\" target=\"_blank\">bioglass<\/a>. This work inspired a new field called bioceramics.<sup id=\"rdp-ebb-cite_ref-Kassinger_6-0\" class=\"reference\"><a href=\"#cite_note-Kassinger-6\" rel=\"external_link\">[6]<\/a><\/sup> With the discovery of bioglass, interest in bioceramics grew rapidly.\n<\/p><p>On April 26, 1988, the first international symposium on bioceramics was held in Kyoto, Japan.<sup id=\"rdp-ebb-cite_ref-OonishiBio89_7-0\" class=\"reference\"><a href=\"#cite_note-OonishiBio89-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0a\/Hip_prosthesis.jpg\/220px-Hip_prosthesis.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A titanium hip prosthesis, with a ceramic head and polyethylene acetabular cup<\/div><\/div><\/div>\n<p>Ceramics are now commonly used in the medical fields as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">dental<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implants<\/a>.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> Surgical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cermet#Bioceramics\" title=\"Cermet\" rel=\"external_link\" target=\"_blank\">cermets<\/a> are used regularly. Joint replacements are commonly coated with bioceramic materials to reduce wear and inflammatory response. Other examples of medical uses for bioceramics are in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pacemaker\" class=\"mw-redirect\" title=\"Pacemaker\" rel=\"external_link\" target=\"_blank\">pacemakers<\/a>, kidney dialysis machines, and respirators.<sup id=\"rdp-ebb-cite_ref-Kassinger_6-1\" class=\"reference\"><a href=\"#cite_note-Kassinger-6\" rel=\"external_link\">[6]<\/a><\/sup> The global demand on medical ceramics and ceramic components was about U.S. $9.8 billion in 2010. It was forecast to have an annual growth of 6 to 7 percent in the following years, with world market value predicted to increase to U.S. $15.3 billion by 2015 and reach U.S. $18.5 billion by 2018.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Mechanical_properties_and_composition\">Mechanical properties and composition<\/span><\/h3>\n<p>Bioceramics are meant to be used in extracorporeal circulation systems (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Dialysis\" title=\"Dialysis\" rel=\"external_link\" target=\"_blank\">dialysis<\/a> for example) or engineered bioreactors; however, they're most common as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implants<\/a>.<sup id=\"rdp-ebb-cite_ref-Boch_11-0\" class=\"reference\"><a href=\"#cite_note-Boch-11\" rel=\"external_link\">[11]<\/a><\/sup> Ceramics show numerous applications as biomaterials due to their physico-chemical properties. They have the advantage of being inert in the human body, and their hardness and resistance to abrasion makes them useful for bones and teeth replacement. Some ceramics also have excellent resistance to friction, making them useful as replacement materials for malfunctioning <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joints\" class=\"mw-redirect\" title=\"Joints\" rel=\"external_link\" target=\"_blank\">joints<\/a>. Properties such as appearance and electrical insulation are also a concern for specific biomedical applications.\n<\/p><p>Some bioceramics incorporate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium_oxide\" title=\"Aluminium oxide\" rel=\"external_link\" target=\"_blank\">alumina<\/a> (Al<sub>2<\/sub>O<sub>3<\/sub>) as their lifespan is longer than that of the patient's. The material can be used in inner <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ear_ossicles\" class=\"mw-redirect\" title=\"Ear ossicles\" rel=\"external_link\" target=\"_blank\">ear ossicles<\/a>, ocular prostheses, electrical insulation for pacemakers, catheter orifices and in numerous prototypes of implantable systems such as cardiac pumps.<sup id=\"rdp-ebb-cite_ref-Thamaraiselvi_12-0\" class=\"reference\"><a href=\"#cite_note-Thamaraiselvi-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminosilicate\" title=\"Aluminosilicate\" rel=\"external_link\" target=\"_blank\">Aluminosilicates<\/a> are commonly used in dental prostheses, pure or in ceramic-polymer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_composite\" title=\"Dental composite\" rel=\"external_link\" target=\"_blank\">composites<\/a>. The ceramic-polymer composites are a potential way to filling of cavities replacing amalgams suspected to have toxic effects. The aluminosilicates also have a glassy structure. Contrary to artificial teeth in resin, the colour of tooth ceramic remains stable<sup id=\"rdp-ebb-cite_ref-Boch_11-1\" class=\"reference\"><a href=\"#cite_note-Boch-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Hench_13-0\" class=\"reference\"><a href=\"#cite_note-Hench-13\" rel=\"external_link\">[13]<\/a><\/sup> Zirconia doped with yttrium oxide has been proposed as a substitute for alumina for osteoarticular prostheses. The main advantages are a greater failure strength, and a good resistance to fatigue.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vitreous_carbon\" class=\"mw-redirect\" title=\"Vitreous carbon\" rel=\"external_link\" target=\"_blank\">Vitreous carbon<\/a> is also used as it is light, resistant to wear, and compatible with blood. It is mostly used in cardiac valve replacement. Diamond can be used for the same application, but in coating form.<sup id=\"rdp-ebb-cite_ref-Thamaraiselvi_12-1\" class=\"reference\"><a href=\"#cite_note-Thamaraiselvi-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_phosphate\" title=\"Calcium phosphate\" rel=\"external_link\" target=\"_blank\">Calcium phosphate<\/a>-based ceramics constitute, at present, the preferred bone substitute in orthopaedic and maxillofacial surgery.<sup id=\"rdp-ebb-cite_ref-Boch_11-2\" class=\"reference\"><a href=\"#cite_note-Boch-11\" rel=\"external_link\">[11]<\/a><\/sup> They are similar to the mineral phase of the bone in structure and\/or chemical composition. The material is typically porous, which provide a good bone-implant interface due to the increase of surface area that encourages cell colonisation and revascularisation. Additionally, it has lower mechanical strength compared to bone, making highly porous implants very delicate. Since <a href=\"https:\/\/en.wikipedia.org\/wiki\/Young%27s_modulus\" title=\"Young's modulus\" rel=\"external_link\" target=\"_blank\">Young's modulus<\/a> of ceramics is generally much higher than that of the bone tissue, the implant can cause mechanical stresses at the bone interface.<sup id=\"rdp-ebb-cite_ref-Boch_11-3\" class=\"reference\"><a href=\"#cite_note-Boch-11\" rel=\"external_link\">[11]<\/a><\/sup> Calcium phosphates usually found in bioceramics include hydroxyapatite (HAP) Ca<sub>10<\/sub>(PO<sub>4<\/sub>)<sub>6<\/sub>(OH)<sub>2<\/sub>; tricalcium phosphate \u03b2 (\u03b2 TCP): Ca<sub>3<\/sub> (PO<sub>4<\/sub>)<sub>2<\/sub>; and mixtures of HAP and \u03b2 TCP.\n<\/p><p><b>Table 1: Bioceramics Applications<\/b><sup id=\"rdp-ebb-cite_ref-Thamaraiselvi_12-2\" class=\"reference\"><a href=\"#cite_note-Thamaraiselvi-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Devices<\/th>\n<th>Function<\/th>\n<th>Biomaterial\n<\/th><\/tr>\n<tr>\n<td>Artificial total hip, knee, shoulder, elbow, wrist<\/td>\n<td>Reconstruct arthritic or fractured joints<\/td>\n<td>High-density alumina, metal bioglass coatings\n<\/td><\/tr>\n<tr>\n<td>Bone plates, screws, wires<\/td>\n<td>Repair fractures<\/td>\n<td>Bioglass-metal fibre composite, Polysulphone-carbon fibre composite\n<\/td><\/tr>\n<tr>\n<td>Intramedullary nails<\/td>\n<td>Align fractures<\/td>\n<td>Bioglass-metal fibre composite, Polysulphone-carbon fibre composite\n<\/td><\/tr>\n<tr>\n<td>Harrington rods<\/td>\n<td>Correct chronic spinal curvature<\/td>\n<td>Bioglass-metal fibre composite, Polysulphone-carbon fibre composite\n<\/td><\/tr>\n<tr>\n<td>Permanently implanted artificial limbs<\/td>\n<td>Replace missing extremities<\/td>\n<td>Bioglass-metal fibre composite, Polysulphone-carbon fibre composite\n<\/td><\/tr>\n<tr>\n<td>Vertebrae Spacers and extensors<\/td>\n<td>Correct congenital deformity<\/td>\n<td>Al<sub>2<\/sub>O<sub>3<\/sub>\n<\/td><\/tr>\n<tr>\n<td>Spinal fusion<\/td>\n<td>Immobilise vertebrae to protect spinal cord<\/td>\n<td>Bioglass\n<\/td><\/tr>\n<tr>\n<td>Alveolar bone replacements, mandibular reconstruction<\/td>\n<td>Restore the alveolar ridge to improve denture fit<\/td>\n<td>Polytetra fluro ethylene (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Polytetrafluoroethylene\" title=\"Polytetrafluoroethylene\" rel=\"external_link\" target=\"_blank\">PTFE<\/a>) - carbon composite, Porous Al<sub>2<\/sub>O<sub>3<\/sub>, Bioglass, dense-apatite\n<\/td><\/tr>\n<tr>\n<td>End osseous tooth replacement implants<\/td>\n<td>Replace diseased, damaged or loosened teeth<\/td>\n<td>Al<sub>2<\/sub>O<sub>3<\/sub>, Bioglass, dense hydroxyapatite, vitreous carbon\n<\/td><\/tr>\n<tr>\n<td>Orthodontic anchors<\/td>\n<td>Provide posts for stress application required to change deformities<\/td>\n<td>Bioglass-coated Al<sub>2<\/sub>O<sub>3<\/sub>, Bioglass coated vitallium\n<\/td><\/tr><\/tbody><\/table>\n<p><b>Table 2: Mechanical Properties of Ceramic Biomaterials<\/b><sup id=\"rdp-ebb-cite_ref-Thamaraiselvi_12-3\" class=\"reference\"><a href=\"#cite_note-Thamaraiselvi-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Material<\/th>\n<th>Young\u2019s Modulus (GPa)<\/th>\n<th>CompressiveStrength (MPa)<\/th>\n<th>Bond strength (GPa)<\/th>\n<th>Hardness<\/th>\n<th>Density (g\/cm<sup>3<\/sup>)\n<\/th><\/tr>\n<tr>\n<td>Inert Al<sub>2<\/sub>O<sub>3<\/sub><\/td>\n<td>380<\/td>\n<td>4000<\/td>\n<td>300-400<\/td>\n<td>2000-3000(HV)<\/td>\n<td>>3.9\n<\/td><\/tr>\n<tr>\n<td>ZrO<sub>2<\/sub> (PS)<\/td>\n<td>150-200<\/td>\n<td>2000<\/td>\n<td>200-500<\/td>\n<td>1000-3000(HV)<\/td>\n<td>\u22486.0\n<\/td><\/tr>\n<tr>\n<td>Graphite<\/td>\n<td>20-25<\/td>\n<td>138<\/td>\n<td>NA<\/td>\n<td>NA<\/td>\n<td>1.5-1.9\n<\/td><\/tr>\n<tr>\n<td>(LTI)Pyrolitic Carbon<\/td>\n<td>17-28<\/td>\n<td>900<\/td>\n<td>270-500<\/td>\n<td>NA<\/td>\n<td>1.7-2.2\n<\/td><\/tr>\n<tr>\n<td>Vitreous Carbon<\/td>\n<td>24-31<\/td>\n<td>172<\/td>\n<td>70-207<\/td>\n<td>150-200(DPH)<\/td>\n<td>1.4-1.6\n<\/td><\/tr>\n<tr>\n<td>Bioactive HAP<\/td>\n<td>73-117<\/td>\n<td>600<\/td>\n<td>120<\/td>\n<td>350<\/td>\n<td>3.1\n<\/td><\/tr>\n<tr>\n<td>Bioglass<\/td>\n<td>\u224875<\/td>\n<td>1000<\/td>\n<td>50<\/td>\n<td>NA<\/td>\n<td>2.5\n<\/td><\/tr>\n<tr>\n<td>AW Glass Ceramic<\/td>\n<td>118<\/td>\n<td>1080<\/td>\n<td>215<\/td>\n<td>680<\/td>\n<td>2.8\n<\/td><\/tr>\n<tr>\n<td>Bone<\/td>\n<td>3-30<\/td>\n<td>130-180<\/td>\n<td>60-160<\/td>\n<td>NA<\/td>\n<td>NA\n<\/td><\/tr><\/tbody><\/table>\n<h3><span class=\"mw-headline\" id=\"Multipurpose\">Multipurpose<\/span><\/h3>\n<p>A number of implanted ceramics have not actually been designed for specific biomedical applications. However, they manage to find their way into different implantable systems because of their properties and their good biocompatibility. Among these ceramics, we can cite <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_carbide\" title=\"Silicon carbide\" rel=\"external_link\" target=\"_blank\">silicon carbide<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbides\" class=\"mw-redirect\" title=\"Carbides\" rel=\"external_link\" target=\"_blank\">carbides<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boron_nitride\" title=\"Boron nitride\" rel=\"external_link\" target=\"_blank\">boron nitride<\/a>. TiN has been suggested as the friction surface in hip prostheses. While cell culture tests show a good biocompatibility, the analysis of implants shows significant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wear\" title=\"Wear\" rel=\"external_link\" target=\"_blank\">wear<\/a>, related to a delaminating of the TiN layer. Silicon carbide is another modern-day ceramic which seems to provide good biocompatibility and can be used in bone implants.<sup id=\"rdp-ebb-cite_ref-Boch_11-4\" class=\"reference\"><a href=\"#cite_note-Boch-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Specific_use\">Specific use<\/span><\/h3>\n<p>In addition to being used for their traditional properties, bioactive ceramics have seen specific use for due to their biological activity. Calcium phosphates, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxides\" class=\"mw-redirect\" title=\"Oxides\" rel=\"external_link\" target=\"_blank\">oxides<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxides\" class=\"mw-redirect\" title=\"Hydroxides\" rel=\"external_link\" target=\"_blank\">hydroxides<\/a> are common examples. Other natural materials \u2014 generally of animal origin \u2014 such as bioglass and other composites feature a combination of mineral-organic composite materials such as HAP, alumina, or titanium dioxide with the biocompatible polymers (polymethylmethacrylate): PMMA, poly(L-lactic) acid: PLLA, poly(ethylene). Composites can be differentiated as bioresorbable or non-bioresorbable, with the latter being the result of the combination of a non-bioresorbable calcium phosphate (HAP) with a non-bioresorbable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> (PMMA, PE). These materials may become more widespread in the future, on account of the many combination possibilities and their aptitude at combining a biological activity with mechanical properties similar to those of the bone.<sup id=\"rdp-ebb-cite_ref-Thamaraiselvi_12-4\" class=\"reference\"><a href=\"#cite_note-Thamaraiselvi-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Biocompatibility\">Biocompatibility<\/span><\/h2>\n<p>Bioceramics' properties of being anticorrosive, biocompatible, and aesthetic make them quite suitable for medical usage. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zirconia\" class=\"mw-redirect\" title=\"Zirconia\" rel=\"external_link\" target=\"_blank\">Zirconia<\/a> ceramic has bioinertness and noncytotoxicity. Carbon is another alternative with similar mechanical properties to bone, and it also features blood compatibility, no tissue reaction, and non-toxicity to cells. None of the three bioinert ceramics exhibit bonding with the bone. However, bioactivity of bioinert ceramics can be achieved by forming composites with bioactive ceramics. Bioglass and glass ceramics are nontoxic and chemically bond to bone. Glass ceramics elicit osteoinductive properties, while calcium phosphate ceramics also exhibit non-toxicity to tissues and bioresorption. The ceramic particulate reinforcement has led to the choice of more materials for implant applications that include ceramic\/ceramic, ceramic\/polymer, and ceramic\/metal composites. Among these composites ceramic\/polymer composites have been found to release toxic elements into the surrounding tissues. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metals\" class=\"mw-redirect\" title=\"Metals\" rel=\"external_link\" target=\"_blank\">Metals<\/a> face corrosion related problems, and ceramic coatings on metallic implants degrade over time during lengthy applications. Ceramic\/ceramic composites enjoy superiority due to similarity to bone minerals, exhibiting biocompatibility and a readiness to be shaped. The biological activity of bioceramics has to be considered under various <i>in vitro<\/i> and <i>in vivo<\/i> studies. Performance needs must be considered in accordance with the particular site of implantation.<sup id=\"rdp-ebb-cite_ref-Thamaraiselvi_12-5\" class=\"reference\"><a href=\"#cite_note-Thamaraiselvi-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Processing\">Processing<\/span><\/h2>\n<p>Technically, ceramics are composed of raw materials such as powders and natural or synthetic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_additives\" class=\"mw-redirect\" title=\"Chemical additives\" rel=\"external_link\" target=\"_blank\">chemical additives<\/a>, favoring either compaction (hot, cold or isostatic), setting (hydraulic or chemical), or accelerating <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sintering\" title=\"Sintering\" rel=\"external_link\" target=\"_blank\">sintering<\/a> processes. According to the formulation and shaping process used, bioceramics can vary in density and porosity as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cements\" class=\"mw-redirect\" title=\"Cements\" rel=\"external_link\" target=\"_blank\">cements<\/a>, ceramic depositions, or ceramic composites.<sup id=\"rdp-ebb-cite_ref-Boch_11-5\" class=\"reference\"><a href=\"#cite_note-Boch-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>A developing material processing technique based on the biomimetic processes aims to imitate natural and biological processes and offer the possibility of making bioceramics at ambient temperature rather than through conventional or hydrothermal processes [GRO 96]. The prospect of using these relatively low processing temperatures opens up possibilities for mineral organic combinations with improved biological properties through the addition of proteins and biologically active molecules (growth factors, antibiotics, anti-tumor agents, etc.). However, these materials have poor mechanical properties which can be improved, partially, by combining them with bonding proteins.<sup id=\"rdp-ebb-cite_ref-Boch_11-6\" class=\"reference\"><a href=\"#cite_note-Boch-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Commercial_Usage\">Commercial Usage<\/span><\/h2>\n<p>Common bioactive materials available commercially for clinical use include 45S5 bioactive glass, A\/W bioactive glass ceramic, dense synthetic HA, and bioactive composites such as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a>\u2013HA mixture. All these materials form an interfacial bond with adjacent tissue.<sup id=\"rdp-ebb-cite_ref-Hench_13-1\" class=\"reference\"><a href=\"#cite_note-Hench-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p><p>High-purity alumina bioceramics are currently commercially available from various producers. U.K. manufacturer Morgan Advanced Ceramics (MAC) began manufacturing orthopaedic devices in 1985 and quickly became a recognised supplier of ceramic femoral heads for hip replacements. MAC Bioceramics has the longest clinical history for alumina ceramic materials, manufacturing HIP Vitox\u00ae alumina since 1985.<sup id=\"rdp-ebb-cite_ref-Kokubo_14-0\" class=\"reference\"><a href=\"#cite_note-Kokubo-14\" rel=\"external_link\">[14]<\/a><\/sup> Some calcium-deficient phosphates with an apatite structure were thus commercialised as \"tricalcium phosphate\" even though they did not exhibit the expected crystalline structure of tricalcium phosphate.<sup id=\"rdp-ebb-cite_ref-Kokubo_14-1\" class=\"reference\"><a href=\"#cite_note-Kokubo-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>Currently, numerous commercial products described as HA are available in various physical forms (e.g. granules, specially designed blocks for specific applications). HA\/polymer composite (HA\/polyethyelene, HAPEXTM) is also commercially available for ear implants, abrasives, and plasma-sprayed coating for orthopedic and dental implants.<sup id=\"rdp-ebb-cite_ref-Kokubo_14-2\" class=\"reference\"><a href=\"#cite_note-Kokubo-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Future_trends\">Future trends<\/span><\/h2>\n<p>Bioceramics have been proposed as a possible treatment for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cancer\" title=\"Cancer\" rel=\"external_link\" target=\"_blank\">cancer<\/a>. Two methods of treatment have been proposed: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperthermia\" title=\"Hyperthermia\" rel=\"external_link\" target=\"_blank\">hyperthermia<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiotherapy\" class=\"mw-redirect\" title=\"Radiotherapy\" rel=\"external_link\" target=\"_blank\">radiotherapy<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperthermia_treatment\" class=\"mw-redirect\" title=\"Hyperthermia treatment\" rel=\"external_link\" target=\"_blank\">Hyperthermia treatment<\/a> involves implanting a bioceramic material that contains a ferrite or other magnetic material.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> The area is then exposed to an alternating magnetic field, which causes the implant and surrounding area to heat up. Alternatively, the bioceramic materials can be doped with \u03b2-emitting materials and implanted into the cancerous area.<sup id=\"rdp-ebb-cite_ref-Shackelford_2-1\" class=\"reference\"><a href=\"#cite_note-Shackelford-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Other trends include engineering bioceramics for specific tasks. Ongoing research involves the chemistry, composition, and micro- and nanostructures of the materials to improve their biocompatibility.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic-impregnated_fabrics\" class=\"mw-redirect\" title=\"Ceramic-impregnated fabrics\" rel=\"external_link\" target=\"_blank\">Ceramic-impregnated fabrics<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 35em; -webkit-column-width: 35em; column-width: 35em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">P. Ducheyne, G. W. Hastings (editors) (1984) <i>CRC metal and ceramic biomaterials<\/i> vol 1 <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-8493-6261-X<\/span>\n<\/li>\n<li id=\"cite_note-Shackelford-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Shackelford_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Shackelford_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">J. F. Shackelford (editor)(1999) <i>MSF bioceramics applications of ceramic and glass materials in medicine<\/i> <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-87849-822-2<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">H. Oonishi, H. Aoki, K. Sawai (editors) (1988) <i>Bioceramics<\/i> vol. 1 <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-912791-82-9<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hench, Larry L. (1991). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ualberta.ca\/~hanifi\/Bioceramics%20-%20Hench.pdf\" target=\"_blank\">\"Bioceramics: From Concept to Clinic\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Journal of the American Ceramic Society<\/i>. <b>74<\/b> (7): 1487. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1151-2916.1991.tb07132.x\" target=\"_blank\">10.1111\/j.1151-2916.1991.tb07132.x<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+American+Ceramic+Society&rft.atitle=Bioceramics%3A+From+Concept+to+Clinic&rft.volume=74&rft.issue=7&rft.pages=1487&rft.date=1991&rft_id=info%3Adoi%2F10.1111%2Fj.1151-2916.1991.tb07132.x&rft.aulast=Hench&rft.aufirst=Larry+L.&rft_id=https%3A%2F%2Fwww.ualberta.ca%2F~hanifi%2FBioceramics%2520-%2520Hench.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioceramic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">T. Yamamuro, L. L. Hench, J. Wilson (editors) (1990) <i>CRC Handbook of bioactive ceramics<\/i> vol II <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-8493-3242-7<\/span>\n<\/li>\n<li id=\"cite_note-Kassinger-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Kassinger_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kassinger_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Kassinger, Ruth. <i>Ceramics: From Magic Pots to Man-Made Bones<\/i>. Brookfield, CT: Twenty-First Century Books, 2003, <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0761325857<\/span>\n<\/li>\n<li id=\"cite_note-OonishiBio89-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-OonishiBio89_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Oonishi, H.; Aoki, H. (1989). Sawai, K., ed. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books\/about\/Bioceramics.html?id=mivfMQEACAAJ\" target=\"_blank\"><i>Bioceramics: Proceedings of 1st International Bioceramic Symposium<\/i><\/a>. Ishiyaku Euroamerica. p. 443. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0912791821<span class=\"reference-accessdate\">. 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Muster (editor) (1992) <i>Biomaterials hard tissue repair and replacement<\/i> <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-444-88350-9<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kinnari, Teemu J.; Esteban, Jaime; Gomez-Barrena, Enrique; Zamora, Nieves; Fernandez-Roblas, Ricardo; Nieto, Alejandra; Doadrio, Juan C.; L\u00f3pez-Noriega, Adolfo; Ruiz-Hern\u00e1ndez, Eduardo; Arcos, Daniel; Vallet-Reg\u00ed, Mar\u00eda (2008). \"Bacterial adherence to SiO<sub>2<\/sub>-based multifunctional bioceramics\". <i>Journal of Biomedical Materials Research Part A<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fjbm.a.31943\" target=\"_blank\">10.1002\/jbm.a.31943<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Biomedical+Materials+Research+Part+A&rft.atitle=Bacterial+adherence+to+SiO%3Csub%3E2%3C%2Fsub%3E-based+multifunctional+bioceramics&rft.date=2008&rft_id=info%3Adoi%2F10.1002%2Fjbm.a.31943&rft.aulast=Kinnari&rft.aufirst=Teemu+J.&rft.au=Esteban%2C+Jaime&rft.au=Gomez-Barrena%2C+Enrique&rft.au=Zamora%2C+Nieves&rft.au=Fernandez-Roblas%2C+Ricardo&rft.au=Nieto%2C+Alejandra&rft.au=Doadrio%2C+Juan+C.&rft.au=L%C3%B3pez-Noriega%2C+Adolfo&rft.au=Ruiz-Hern%C3%A1ndez%2C+Eduardo&rft.au=Arcos%2C+Daniel&rft.au=Vallet-Reg%C3%AD%2C+Mar%C3%ADa&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioceramic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.acmite.com\/market-reports\/materials\/world-medical-ceramics-market.html\" target=\"_blank\"><i>Market Report: World Medical Ceramics Market<\/i><\/a>. Acmite Market Intelligence. 2011.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Market+Report%3A+World+Medical+Ceramics+Market&rft.pub=Acmite+Market+Intelligence&rft.date=2011&rft_id=http%3A%2F%2Fwww.acmite.com%2Fmarket-reports%2Fmaterials%2Fworld-medical-ceramics-market.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioceramic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Boch-11\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Boch_11-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Boch_11-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Boch_11-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Boch_11-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Boch_11-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Boch_11-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Boch_11-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Boch, Philippe, Niepce, Jean-Claude. (2010) Ceramic Materials: Processes, Properties and Applications. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F9780470612415.ch12\" target=\"_blank\"> 10.1002\/9780470612415.ch12<\/a><\/span>\n<\/li>\n<li id=\"cite_note-Thamaraiselvi-12\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Thamaraiselvi_12-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Thamaraiselvi_12-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Thamaraiselvi_12-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Thamaraiselvi_12-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Thamaraiselvi_12-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Thamaraiselvi_12-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Thamaraiselvi, T. V., and S. Rajeswari. \u201cBiological evaluation of bioceramic materials-a review.\u201d Carbon 24.31 (2004): 172.<\/span>\n<\/li>\n<li id=\"cite_note-Hench-13\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Hench_13-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Hench_13-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Hench LL. Bioceramics: From concept to clinic. J Amer CeramSoc 1991;74(7):1487\u2013510.<\/span>\n<\/li>\n<li id=\"cite_note-Kokubo-14\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Kokubo_14-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kokubo_14-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kokubo_14-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Kokubo, T. Bioceramics and Their Clinical Applications, Woodhead Publishing Limited, Cambridge, England, 2008 <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-84569-204-9<\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">John, \u0141ukasz; Janeta, Mateusz; Szafert, S\u0142awomir. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016\/j.msec.2017.04.133\" target=\"_blank\">\"Designing of macroporous magnetic bioscaffold based on functionalized methacrylate network covered by hydroxyapatites and doped with nano-MgFe 2 O 4 for potential cancer hyperthermia therapy\"<\/a>. <i>Materials Science and 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Materials+Science+and+Engineering%3A+C&rft.atitle=Designing+of+macroporous+magnetic+bioscaffold+based+on+functionalized+methacrylate+network+covered+by+hydroxyapatites+and+doped+with+nano-MgFe+2+O+4++for+potential+cancer+hyperthermia+therapy&rft.volume=78&rft.pages=901-911&rft_id=info%3Adoi%2F10.1016%2Fj.msec.2017.04.133&rft.aulast=John&rft.aufirst=%C5%81ukasz&rft.au=Janeta%2C+Mateusz&rft.au=Szafert%2C+S%C5%82awomir&rft_id=https%3A%2F%2Fdoi.org%2F10.1016%2Fj.msec.2017.04.133&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioceramic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chai, Chou; Leong, Kam W (2007). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2365728\" target=\"_blank\">\"Biomaterials Approach to Expand and Direct Differentiation of Stem Cells\"<\/a>. <i>Molecular Therapy<\/i>. <b>15<\/b> (3): 467\u201380. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fsj.mt.6300084\" target=\"_blank\">10.1038\/sj.mt.6300084<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2365728\" target=\"_blank\">2365728<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17264853\" target=\"_blank\">17264853<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Molecular+Therapy&rft.atitle=Biomaterials+Approach+to+Expand+and+Direct+Differentiation+of+Stem+Cells&rft.volume=15&rft.issue=3&rft.pages=467-80&rft.date=2007&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2365728&rft_id=info%3Apmid%2F17264853&rft_id=info%3Adoi%2F10.1038%2Fsj.mt.6300084&rft.aulast=Chai&rft.aufirst=Chou&rft.au=Leong%2C+Kam+W&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2365728&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioceramic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zhu, Xiaolong; Chen, Jun; Scheideler, Lutz; Altebaeumer, Thomas; Geis-Gerstorfer, Juergen; Kern, Dieter (2004). \"Cellular Reactions of Osteoblasts to Micron- and Submicron-Scale Porous Structures of Titanium Surfaces\". <i>Cells Tissues Organs<\/i>. <b>178<\/b> (1): 13\u201322. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000081089\" target=\"_blank\">10.1159\/000081089<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" 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class=\"citation journal\">Hao, L; Lawrence, J; Chian, KS (2005). \"Osteoblast cell adhesion on a laser modified zirconia based bioceramic\". <i>Journal of Materials Science: Materials in Medicine<\/i>. <b>16<\/b> (8): 719\u201326. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs10856-005-2608-3\" target=\"_blank\">10.1007\/s10856-005-2608-3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15965741\" target=\"_blank\">15965741<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Materials+Science%3A+Materials+in+Medicine&rft.atitle=Osteoblast+cell+adhesion+on+a+laser+modified+zirconia+based+bioceramic&rft.volume=16&rft.issue=8&rft.pages=719-26&rft.date=2005&rft_id=info%3Adoi%2F10.1007%2Fs10856-005-2608-3&rft_id=info%3Apmid%2F15965741&rft.aulast=Hao&rft.aufirst=L&rft.au=Lawrence%2C+J&rft.au=Chian%2C+KS&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioceramic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1241\nCached time: 20181217110819\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.288 seconds\nReal time usage: 0.369 seconds\nPreprocessor visited node count: 1986\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 24655\/2097152 bytes\nTemplate argument size: 1784\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 42381\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.114\/10.000 seconds\nLua memory usage: 3.57 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 286.015 1 -total\n100.00% 286.015 1 Template:Reflist\n<\/p>\n<pre>41.80% 119.564 6 Template:Cite_journal\n38.88% 111.197 7 Template:ISBN\n23.46% 67.093 7 Template:Catalog_lookup_link\n 5.31% 15.188 7 Template:Error-small\n 4.54% 12.986 2 Template:Cite_book\n 4.15% 11.862 21 Template:Yesno-no\n 3.62% 10.359 1 Template:Doi\n 2.49% 7.133 21 Template:Yesno\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:22183423-1!canonical and timestamp 20181217110818 and revision id 819423168\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bioceramic\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212210\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.177 seconds\nReal time usage: 0.272 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 262.732 1 - wikipedia:Bioceramic\n100.00% 262.732 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:7988-0!*!*!*!*!*!* and timestamp 20181217212210 and revision id 24100\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Bioceramic\">https:\/\/www.limswiki.org\/index.php\/Bioceramic<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","0b500bd5164615c395077300cc77d867_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/69\/Cam_Bioceramics_Large_Porous_Granule.png\/600px-Cam_Bioceramics_Large_Porous_Granule.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0a\/Hip_prosthesis.jpg\/440px-Hip_prosthesis.jpg"],"0b500bd5164615c395077300cc77d867_timestamp":1545081730,"1cd99f544b11b79a9e3d99e90b7848ec_type":"article","1cd99f544b11b79a9e3d99e90b7848ec_title":"Bioactive glass","1cd99f544b11b79a9e3d99e90b7848ec_url":"https:\/\/www.limswiki.org\/index.php\/Bioactive_glass","1cd99f544b11b79a9e3d99e90b7848ec_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tBioactive glass\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tBioactive glasses are a group of surface reactive glass-ceramic biomaterials and include the original bioactive glass, bioglass. The biocompatibility and bioactivity of these glasses has led them to be investigated extensively for use as implant device in the human body to repair and replace diseased or damaged bones.\n\nContents \n\n1 Medical uses \n2 Structure \n\n2.1 Compositions \n\n\n3 Mechanism of activity \n4 History \n5 Composition \n\n5.1 Bioglass 8625 \n5.2 Bioglass 45S5 \n\n\n6 See also \n7 References \n\n\nMedical uses \nThere is tentative evidence that bioactive glass may also be useful in long bone infections.[1] Support from randomized controlled trials; however, is still not available as of 2015.[2]\n\nStructure \nSolid state NMR spectroscopy has been very useful in elucidating the structure of amorphous solids. Bioactive glasses have been studied by 29Si and 31P solid state MAS NMR spectroscopy. The chemical shift from MAS NMR is indicative of the type of chemical species present in the glass. The 29Si MAS NMR spectroscopy showed that Bioglass 45S5 was a Q2 type-structure with a small amount of Q3 ; i.e., silicate chains with a few crosslinks. The 31P MAS NMR revealed predominately Q0 species; i.e., PO43\u2212; subsequent MAS NMR spectroscopy measurements have shown that Si-O-P bonds are below detectable levels [3]\n\nCompositions \nThere have been many variations on the original composition which was Food and Drug Administration (FDA) approved and termed Bioglass. This composition is known as 45S5. Other compositions are in the list below.\n\n45S5: 45  wt% SiO2, 24.5 wt% CaO, 24.5 wt% Na2O and 6.0  wt% P2O5. Bioglass\n58S: 60 wt% SiO2, 36 wt% CaO and 4 wt% P2O5.\n70S30C: 70 wt% SiO2, 30 wt% CaO.\nS53P4: 53 wt% SiO2, 23 wt% Na2O, 20 wt% CaO and 4 wt% P2O5. (S53P4 is the only bacterial growth inhibiting bioactive glass).\nMechanism of activity \nThe underlying mechanisms that enable bioactive glasses to act as materials for bone repair have been investigated since the first work of Hench et al. at the University of Florida. Early attention was paid to changes in the bioactive glass surface. Five inorganic reaction stages are commonly thought to occur when a bioactive glass is immersed in a physiological environment:\n1) Ion exchange in which modifier cations (mostly Na+) in the glass exchange with hydronium ions in the external solution.\n2) Hydrolysis in which Si-O-Si bridges are broken, forming Si-OH silanol groups, and the glass network is disrupted.\n3) Condensation of silanols in which the disrupted glass network changes its morphology to form a gel-like surface layer, depleted in sodium and calcium ions.\n4) Precipitation in which an amorphous calcium phosphate layer is deposited on the gel.\n5) Mineralization in which the calcium phosphate layer gradually transforms into crystalline hydroxyapatite, that mimics the mineral phase naturally contained with vertebrate bones.\nLater, it was discovered that the morphology of the gel surface layer was a key component in determining the bioactive response. This was supported by studies on bioactive glasses derived from sol-gel processing. Such glasses could contain significantly higher concentrations of SiO2 than traditional melt-derived bioactive glasses and still maintain bioactivity (i.e., the ability to form a mineralized hydroxyapatite layer on the surface). The inherent porosity of the sol-gel-derived material was cited as a possible explanation for why bioactivity was retained, and often enhanced with respect to the melt-derived glass.\nSubsequent advances in DNA microarray technology enabled an entirely new perspective on the mechanisms of bioactivity in bioactive glasses. Previously, it was known that a complex interplay existed between bioactive glasses and the molecular biology of the implant host, but the available tools did not provide a sufficient quantity of information to develop a holistic picture. Using DNA microarrays, researchers are now able to identify entire classes of genes that are regulated by the dissolution products of bioactive glasses, resulting in the so-called \"genetic theory\" of bioactive glasses. The first microarray studies on bioactive glasses demonstrated that genes associated with osteoblast growth and differentiation, maintenance of extracellular matrix, and promotion of cell-cell and cell-matrix adhesion were up-regulated by conditioned cell culture media containing the dissolution products of bioactive glass.\n\nHistory \nLarry Hench and colleagues at the University of Florida first developed these materials in the late 1960s and they have been further developed by his research team at the Imperial College London and other researchers worldwide.\n\nComposition \nBioglass 8625 \nBioglass 8625, also called Schott 8625, is a soda-lime glass used for encapsulation of implanted devices. The most common use of Bioglass 8625 is in the housings of RFID transponders for use in human and animal microchip implants. It is patented and manufactured by Schott AG.[4] Bioglass 8625 is also used for some piercings.\nBioglass 8625 does not bond to tissue or bone, it is held in place by fibrous tissue encapsulation. After implantation, a calcium-rich layer forms on the interface between the glass and the tissue. Without additional antimigration coating it is subject to migration in the tissue. The antimigration coating is a material that bonds to both the glass and the tissue. Parylene, usually parylene type C, is often used as such material.[5]\nBioglass 8625 has a significant content of iron, which provides infrared light absorption and allows sealing by a light source, e.g. a Nd:YAG laser or a mercury-vapor lamp.[4] The content of Fe2O3 yields high absorption with maximum at 1100 nm, and gives the glass a green tint. The use of infrared radiation instead of flame or contact heating helps preventing contamination of the device.[6]\nAfter implantation, the glass reacts with the environment in two phases, in the span of about two weeks. In the first phase, alkali metal ions are leached from the glass and replaced with hydrogen ions; small amount of calcium ions also diffuses from the material. During the second phase, the Si-O-Si bonds in the silica matrix undergo hydrolysis, yielding a gel-like surface layer rich on Si-O-H groups. A calcium phosphate-rich passivation layer gradually forms over the surface of the glass, preventing further leaching.\nIt is used in microchips for tracking of many kinds of animals, and recently in some human implants. The U.S. Food and Drug Administration (FDA) approved use of Bioglass 8625 in humans in 1994.\n\nBioglass 45S5 \nBioglass 45S5, one of the most important formulations, is composed of SiO2, Na2O, CaO and P2O5. Professor Larry Hench developed Bioglass at the University of Florida in the late 1960s. He was challenged by a MASH army officer to develop a material to help regenerate bone, as many Vietnam war veterans suffered badly from bone damage, such that most of them injured in this way lost their limbs.\nThe composition was originally selected because of being roughly eutectic.[7]\nThe 45S5 name signifies glass with 45 wt.% of SiO2 and 5:1 molar ratio of Calcium to Phosphorus. Lower Ca\/P ratios do not bond to bone.[8]\nThe key composition features of Bioglass is that it contains less than 60 mol% SiO2, high Na2O and CaO contents, high CaO\/P2O5 ratio, which makes Bioglass highly reactive to aqueous medium and bioactive.\nHigh bioactivity is the main advantage of Bioglass, while its disadvantages includes mechanical weakness, low fracture resistance due to amorphous 2-dimensional glass network. The bending strength of most Bioglass is in the range of 40\u201360 MPa, which is not enough for load-bearing application. Its Young's modulus is 30\u201335 GPa, very close to that of cortical bone, which can be an advantage. Bioglass implants can be used in non-load-bearing applications, for buried implants loaded slightly or compressively. Bioglass can be also used as a bioactive component in composite materials or as powder. Sometimes, Bioglass can be converted into an artificial cocaine. This has no known side-effects.[7]\nThe first successful surgical use of Bioglass 45S5 was in replacement of ossicles in middle ear, as a treatment of conductive hearing loss. The advantage of 45S5 is in no tendency to form fibrous tissue. Other uses are in cones for implantation into the jaw following a tooth extraction. Composite materials made of Bioglass 45S5 and patient's own bone can be used for bone reconstruction.[7]\nBioglass is comparatively soft in comparison to other glasses. It can be machined, preferably with diamond tools, or ground to powder. Bioglass has to be stored in a dry environment, as it readily absorbs moisture and reacts with it.[8]\nBioglass 45S5 is manufactured by conventional glass-making technology, using platinum or platinum alloy crucibles to avoid contamination. Contaminants would interfere with the chemical reactivity in organism. Annealing is a crucial step in forming bulk parts, due to high thermal expansion of the material.\nHeat treatment of Bioglass reduces the volatile alkali metal oxide content and precipitates apatite crystals in the glass matrix. The resulting glass\u2013ceramic material, named Ceravital, has higher mechanical strength and lower bioactivity.[9]\n\nSee also \nPorous medium\nCeramic foam\nNanofoam\nMetal foam\nOsseointegration\nReferences \n\n\n^ Aur\u00e9gan, JC; B\u00e9gu\u00e9, T (December 2015). \"Bioactive glass for long bone infection: a systematic review\". Injury. 46 Suppl 8: S3\u20137. doi:10.1016\/s0020-1383(15)30048-6. PMID 26747915. \n\n^ van Gestel, NA; Geurts, J; Hulsen, DJ; van Rietbergen, B; Hofmann, S; Arts, JJ (2015). \"Clinical Applications of S53P4 Bioactive Glass in Bone Healing and Osteomyelitic Treatment: A Literature Review\". BioMed Research International. 2015: 684826. doi:10.1155\/2015\/684826. PMC 4609389 . PMID 26504821. \n\n^ Pedone, A; Charpentier T; Malavasi G; Menziani M C (2010). \"New Insights into the Atomic Structure of 45S5 Bioglass by Means of Solid-State NMR Spectroscopy and Accurate First-Principles Simulations\". Chem. Mater. 22 (19): 5644\u20135652. doi:10.1021\/cm102089c. \n\n^ a b Transponder Glass \n\n^ Thevissen, PW; Poelman, G; De Cooman, M; Puers, R; Willems, G (2006). \"Implantation of an RFID-tag into human molars to reduce hard forensic identification labor. Part I: working principle\" (PDF) . Forensic Science International. 159 Suppl 1: S33\u20139. doi:10.1016\/j.forsciint.2006.02.029. PMID 16563681. \n\n^ SCHOTT Electronic Packaging \n\n^ a b c The chemistry of medical and dental materials by John W. Nicholson, p. 92, Royal Society of Chemistry, 2002 ISBN 0-85404-572-4 \n\n^ a b Biomaterials and tissue engineering by Donglu Shi p. 27, Springer, 2004 ISBN 3-540-22203-0 \n\n^ Engineering materials for biomedical applications by Swee Hin Teoh, p. 6-21, World Scientific, 2004 ISBN 981-256-061-0 \n\n\nvteGlass science topicsBasics\nGlass\nGlass transition\nSupercooling\nFormulation\nAgInSbTe\nBioglass\nBorophosphosilicate glass\nBorosilicate glass\nCeramic glaze\nChalcogenide glass\nCobalt glass\nCranberry glass\nCrown glass\nFlint glass\nFluorosilicate glass\nFused quartz\nGeSbTe\nGold ruby glass\nLead glass\nMilk glass\nPhosphosilicate glass\nPhotochromic lens glass\nSilicate glass\nSoda\u2013lime glass\nSodium hexametaphosphate\nSoluble glass\nTellurite glass\nThoriated glass\nUltra low expansion glass\nUranium glass\nVitreous enamel\nWood's glass\nZBLAN\nGlass-ceramics\nBioactive glass\nCorningWare\nGlass-ceramic-to-metal seals\nMacor\nZerodur\nPreparation\nAnnealing\nChemical vapor deposition\nGlass batch calculation\nGlass forming\nGlass melting\nGlass modeling\nIon implantation\nLiquidus temperature\nSol-gel technique\nViscosity\nVitrification\nOptics\nAchromat\nDispersion\nGradient-index optics\nHydrogen darkening\nOptical amplifier\nOptical fiber\nOptical lens design\nPhotochromic lens\nPhotosensitive glass\nRefraction\nTransparent materials\nSurface\r\nmodification\nAnti-reflective coating\nChemically strengthened glass\nCorrosion\nDealkalization\nDNA microarray\nHydrogen darkening\nInsulated glazing\nPorous glass\nSelf-cleaning glass\nSol-gel technique\nTempered glass\nDiverse\r\ntopics\nGlass-coated wire\nSafety glass\nGlass databases\nGlass electrode\nGlass fiber reinforced concrete\nGlass ionomer cement\nGlass microspheres\nGlass-reinforced plastic\nGlass-to-metal seal\nPorous glass\nPrince Rupert's drops\nRadioactive waste vitrification\nWindshield\nGlass fiber\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Bioactive_glass\">https:\/\/www.limswiki.org\/index.php\/Bioactive_glass<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 21:48.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 708 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","1cd99f544b11b79a9e3d99e90b7848ec_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Bioactive_glass skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Bioactive glass<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Bioactive glasses<\/b> are a group of surface reactive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass-ceramic\" title=\"Glass-ceramic\" rel=\"external_link\" target=\"_blank\">glass-ceramic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterial\" title=\"Biomaterial\" rel=\"external_link\" target=\"_blank\">biomaterials<\/a> and include the original bioactive glass, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioglass\" title=\"Bioglass\" rel=\"external_link\" target=\"_blank\">bioglass<\/a>. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatibility<\/a> and bioactivity of these <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass\" title=\"Glass\" rel=\"external_link\" target=\"_blank\">glasses<\/a> has led them to be investigated extensively for use as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implant<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">device<\/a> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_body\" title=\"Human body\" rel=\"external_link\" target=\"_blank\">human body<\/a> to repair and replace <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disease\" title=\"Disease\" rel=\"external_link\" target=\"_blank\">diseased<\/a> or damaged <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bones<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<p>There is tentative evidence that bioactive glass may also be useful in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteomyelitis\" title=\"Osteomyelitis\" rel=\"external_link\" target=\"_blank\">long bone infections<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> Support from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Randomized_controlled_trials\" class=\"mw-redirect\" title=\"Randomized controlled trials\" rel=\"external_link\" target=\"_blank\">randomized controlled trials<\/a>; however, is still not available as of 2015.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Structure\">Structure<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Solid-state_nuclear_magnetic_resonance\" title=\"Solid-state nuclear magnetic resonance\" rel=\"external_link\" target=\"_blank\">Solid state NMR spectroscopy<\/a> has been very useful in elucidating the structure of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amorphous_solids\" class=\"mw-redirect\" title=\"Amorphous solids\" rel=\"external_link\" target=\"_blank\">amorphous solids<\/a>. Bioactive glasses have been studied by <sup>29<\/sup>Si and <sup>31<\/sup>P solid state <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magic_angle_spinning\" title=\"Magic angle spinning\" rel=\"external_link\" target=\"_blank\">MAS<\/a> NMR spectroscopy. The chemical shift from MAS NMR is indicative of the type of chemical species present in the glass. The <sup>29<\/sup>Si MAS NMR spectroscopy showed that Bioglass 45S5 was a Q2 type-structure with a small amount of Q3 ; i.e., <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicate\" title=\"Silicate\" rel=\"external_link\" target=\"_blank\">silicate<\/a> chains with a few crosslinks. The <sup>31<\/sup>P MAS NMR revealed predominately Q0 species; i.e., PO<sub>4<\/sub><sup>3\u2212<\/sup>; subsequent MAS NMR spectroscopy measurements have shown that Si-O-P bonds are below detectable levels <sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Compositions\">Compositions<\/span><\/h3>\n<p>There have been many variations on the original composition which was <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> (FDA) approved and termed Bioglass. This composition is known as 45S5. Other compositions are in the list below.\n<\/p>\n<ul><li>45S5: 45  wt% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_dioxide\" title=\"Silicon dioxide\" rel=\"external_link\" target=\"_blank\">SiO<sub>2<\/sub><\/a>, 24.5 wt% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_oxide\" title=\"Calcium oxide\" rel=\"external_link\" target=\"_blank\">CaO<\/a>, 24.5 wt% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_oxide\" title=\"Sodium oxide\" rel=\"external_link\" target=\"_blank\">Na<sub>2<\/sub>O<\/a> and 6.0  wt% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphorus_pentoxide\" title=\"Phosphorus pentoxide\" rel=\"external_link\" target=\"_blank\">P<sub>2<\/sub>O<sub>5<\/sub><\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioglass\" title=\"Bioglass\" rel=\"external_link\" target=\"_blank\">Bioglass<\/a><\/li>\n<li>58S: 60 wt% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_dioxide\" title=\"Silicon dioxide\" rel=\"external_link\" target=\"_blank\">SiO<sub>2<\/sub><\/a>, 36 wt% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_oxide\" title=\"Calcium oxide\" rel=\"external_link\" target=\"_blank\">CaO<\/a> and 4 wt% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphorus_pentoxide\" title=\"Phosphorus pentoxide\" rel=\"external_link\" target=\"_blank\">P<sub>2<\/sub>O<sub>5<\/sub><\/a>.<\/li>\n<li>70S30C: 70 wt% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_dioxide\" title=\"Silicon dioxide\" rel=\"external_link\" target=\"_blank\">SiO<sub>2<\/sub><\/a>, 30 wt% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_oxide\" title=\"Calcium oxide\" rel=\"external_link\" target=\"_blank\">CaO<\/a>.<\/li>\n<li>S53P4: 53 wt% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_dioxide\" title=\"Silicon dioxide\" rel=\"external_link\" target=\"_blank\">SiO<sub>2<\/sub><\/a>, 23 wt% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_oxide\" title=\"Sodium oxide\" rel=\"external_link\" target=\"_blank\">Na<sub>2<\/sub>O<\/a>, 20 wt% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium_oxide\" title=\"Calcium oxide\" rel=\"external_link\" target=\"_blank\">CaO<\/a> and 4 wt% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphorus_pentoxide\" title=\"Phosphorus pentoxide\" rel=\"external_link\" target=\"_blank\">P<sub>2<\/sub>O<sub>5<\/sub><\/a>. (S53P4 is the only bacterial growth inhibiting bioactive glass).<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Mechanism_of_activity\">Mechanism of activity<\/span><\/h2>\n<p>The underlying mechanisms that enable bioactive glasses to act as materials for bone repair have been investigated since the first work of Hench et al. at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Florida\" title=\"University of Florida\" rel=\"external_link\" target=\"_blank\">University of Florida<\/a>. Early attention was paid to changes in the bioactive glass surface. Five inorganic reaction stages are commonly thought to occur when a bioactive glass is immersed in a physiological environment:\n<\/p><p>1) Ion exchange in which modifier cations (mostly Na<sup>+<\/sup>) in the glass exchange with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydronium\" title=\"Hydronium\" rel=\"external_link\" target=\"_blank\">hydronium<\/a> ions in the external solution.\n<\/p><p>2) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrolysis\" title=\"Hydrolysis\" rel=\"external_link\" target=\"_blank\">Hydrolysis<\/a> in which Si-O-Si bridges are broken, forming Si-OH silanol groups, and the glass network is disrupted.\n<\/p><p>3) Condensation of silanols in which the disrupted glass network changes its morphology to form a gel-like surface layer, depleted in sodium and calcium ions.\n<\/p><p>4) Precipitation in which an amorphous calcium phosphate layer is deposited on the gel.\n<\/p><p>5) Mineralization in which the calcium phosphate layer gradually transforms into crystalline hydroxyapatite, that mimics the mineral phase naturally contained with vertebrate bones.\n<\/p><p>Later, it was discovered that the morphology of the gel surface layer was a key component in determining the bioactive response. This was supported by studies on bioactive glasses derived from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sol-gel\" class=\"mw-redirect\" title=\"Sol-gel\" rel=\"external_link\" target=\"_blank\">sol-gel<\/a> processing. Such glasses could contain significantly higher concentrations of SiO<sub>2<\/sub> than traditional melt-derived bioactive glasses and still maintain bioactivity (i.e., the ability to form a mineralized hydroxyapatite layer on the surface). The inherent porosity of the sol-gel-derived material was cited as a possible explanation for why bioactivity was retained, and often enhanced with respect to the melt-derived glass.\n<\/p><p>Subsequent advances in <a href=\"https:\/\/en.wikipedia.org\/wiki\/DNA_microarray\" title=\"DNA microarray\" rel=\"external_link\" target=\"_blank\">DNA microarray<\/a> technology enabled an entirely new perspective on the mechanisms of bioactivity in bioactive glasses. Previously, it was known that a complex interplay existed between bioactive glasses and the molecular biology of the implant host, but the available tools did not provide a sufficient quantity of information to develop a holistic picture. Using DNA microarrays, researchers are now able to identify entire classes of genes that are regulated by the dissolution products of bioactive glasses, resulting in the so-called \"genetic theory\" of bioactive glasses. The first microarray studies on bioactive glasses demonstrated that genes associated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoblast\" title=\"Osteoblast\" rel=\"external_link\" target=\"_blank\">osteoblast<\/a> growth and differentiation, maintenance of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Extracellular_matrix\" title=\"Extracellular matrix\" rel=\"external_link\" target=\"_blank\">extracellular matrix<\/a>, and promotion of cell-cell and cell-matrix adhesion were up-regulated by conditioned cell culture media containing the dissolution products of bioactive glass.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Larry Hench and colleagues at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Florida\" title=\"University of Florida\" rel=\"external_link\" target=\"_blank\">University of Florida<\/a> first developed these materials in the late 1960s and they have been further developed by his research team at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Imperial_College_London\" title=\"Imperial College London\" rel=\"external_link\" target=\"_blank\">Imperial College London<\/a> and other researchers worldwide.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Composition\">Composition<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Bioglass_8625\">Bioglass 8625<\/span><\/h3>\n<p>Bioglass 8625, also called Schott 8625, is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soda-lime_glass\" class=\"mw-redirect\" title=\"Soda-lime glass\" rel=\"external_link\" target=\"_blank\">soda-lime glass<\/a> used for encapsulation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implanted devices<\/a>. The most common use of Bioglass 8625 is in the housings of <a href=\"https:\/\/en.wikipedia.org\/wiki\/RFID\" class=\"mw-redirect\" title=\"RFID\" rel=\"external_link\" target=\"_blank\">RFID<\/a> transponders for use in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microchip_implant_(human)\" title=\"Microchip implant (human)\" rel=\"external_link\" target=\"_blank\">human<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microchip_implant_(animal)\" title=\"Microchip implant (animal)\" rel=\"external_link\" target=\"_blank\">animal<\/a> microchip implants. It is patented and manufactured by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Schott_AG\" title=\"Schott AG\" rel=\"external_link\" target=\"_blank\">Schott AG<\/a>.<sup id=\"rdp-ebb-cite_ref-schott_4-0\" class=\"reference\"><a href=\"#cite_note-schott-4\" rel=\"external_link\">[4]<\/a><\/sup> Bioglass 8625 is also used for some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Piercing\" class=\"mw-redirect\" title=\"Piercing\" rel=\"external_link\" target=\"_blank\">piercings<\/a>.\n<\/p><p>Bioglass 8625 does not bond to tissue or bone, it is held in place by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibrous_tissue\" class=\"mw-redirect\" title=\"Fibrous tissue\" rel=\"external_link\" target=\"_blank\">fibrous tissue<\/a> encapsulation. After implantation, a calcium-rich layer forms on the interface between the glass and the tissue. Without additional antimigration coating it is subject to migration in the tissue. The antimigration coating is a material that bonds to both the glass and the tissue. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parylene\" title=\"Parylene\" rel=\"external_link\" target=\"_blank\">Parylene<\/a>, usually parylene type C, is often used as such material.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>Bioglass 8625 has a significant content of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron\" title=\"Iron\" rel=\"external_link\" target=\"_blank\">iron<\/a>, which provides infrared light absorption and allows sealing by a light source, e.g. a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neodymium_laser\" class=\"mw-redirect\" title=\"Neodymium laser\" rel=\"external_link\" target=\"_blank\">Nd:YAG laser<\/a> or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercury-vapor_lamp\" title=\"Mercury-vapor lamp\" rel=\"external_link\" target=\"_blank\">mercury-vapor lamp<\/a>.<sup id=\"rdp-ebb-cite_ref-schott_4-1\" class=\"reference\"><a href=\"#cite_note-schott-4\" rel=\"external_link\">[4]<\/a><\/sup> The content of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron(III)_oxide\" title=\"Iron(III) oxide\" rel=\"external_link\" target=\"_blank\">Fe<sub>2<\/sub>O<sub>3<\/sub><\/a> yields high absorption with maximum at 1100 nm, and gives the glass a green tint. The use of infrared radiation instead of flame or contact heating helps preventing contamination of the device.<sup id=\"rdp-ebb-cite_ref-schott2_6-0\" class=\"reference\"><a href=\"#cite_note-schott2-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>After implantation, the glass reacts with the environment in two phases, in the span of about two weeks. In the first phase, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alkali_metal\" title=\"Alkali metal\" rel=\"external_link\" target=\"_blank\">alkali metal<\/a> ions are leached from the glass and replaced with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydron_(chemistry)\" title=\"Hydron (chemistry)\" rel=\"external_link\" target=\"_blank\">hydrogen ions<\/a>; small amount of calcium ions also diffuses from the material. During the second phase, the Si-O-Si bonds in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silica\" class=\"mw-redirect\" title=\"Silica\" rel=\"external_link\" target=\"_blank\">silica<\/a> matrix undergo <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrolysis\" title=\"Hydrolysis\" rel=\"external_link\" target=\"_blank\">hydrolysis<\/a>, yielding a gel-like surface layer rich on Si-O-H groups. A calcium phosphate-rich <a href=\"https:\/\/en.wikipedia.org\/wiki\/Passivation_(chemistry)\" title=\"Passivation (chemistry)\" rel=\"external_link\" target=\"_blank\">passivation layer<\/a> gradually forms over the surface of the glass, preventing further leaching.\n<\/p><p>It is used in microchips for tracking of many kinds of animals, and recently in some human implants. The U.S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> (FDA) approved use of Bioglass 8625 in humans in 1994.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Bioglass_45S5\">Bioglass 45S5<\/span><\/h3>\n<p>Bioglass 45S5, one of the most important formulations, is composed of SiO<sub>2<\/sub>, Na<sub>2<\/sub>O, CaO and P<sub>2<\/sub>O<sub>5<\/sub>. Professor Larry Hench developed Bioglass at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Florida\" title=\"University of Florida\" rel=\"external_link\" target=\"_blank\">University of Florida<\/a> in the late 1960s. He was challenged by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mobile_Army_Surgical_Hospital\" class=\"mw-redirect\" title=\"Mobile Army Surgical Hospital\" rel=\"external_link\" target=\"_blank\">MASH<\/a> army officer to develop a material to help regenerate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a>, as many <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vietnam_war\" class=\"mw-redirect\" title=\"Vietnam war\" rel=\"external_link\" target=\"_blank\">Vietnam war<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Veteran\" title=\"Veteran\" rel=\"external_link\" target=\"_blank\">veterans<\/a> suffered badly from bone damage, such that most of them injured in this way lost their limbs.\n<\/p><p>The composition was originally selected because of being roughly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eutectic\" class=\"mw-redirect\" title=\"Eutectic\" rel=\"external_link\" target=\"_blank\">eutectic<\/a>.<sup id=\"rdp-ebb-cite_ref-chemdent_7-0\" class=\"reference\"><a href=\"#cite_note-chemdent-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>The 45S5 name signifies glass with 45 wt.% of SiO<sub>2<\/sub> and 5:1 molar ratio of Calcium to Phosphorus. Lower Ca\/P ratios do not bond to bone.<sup id=\"rdp-ebb-cite_ref-biomat_8-0\" class=\"reference\"><a href=\"#cite_note-biomat-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>The key composition features of Bioglass is that it contains less than 60 mol% SiO<sub>2<\/sub>, high Na<sub>2<\/sub>O and CaO contents, high CaO\/P<sub>2<\/sub>O<sub>5<\/sub> ratio, which makes Bioglass highly reactive to aqueous medium and bioactive.\n<\/p><p>High bioactivity is the main advantage of Bioglass, while its disadvantages includes mechanical weakness, low fracture resistance due to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amorphous\" class=\"mw-redirect\" title=\"Amorphous\" rel=\"external_link\" target=\"_blank\">amorphous<\/a> 2-dimensional glass network. The bending strength of most Bioglass is in the range of 40\u201360 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Megapascal\" class=\"mw-redirect\" title=\"Megapascal\" rel=\"external_link\" target=\"_blank\">MPa<\/a>, which is not enough for load-bearing application. Its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Young%27s_modulus\" title=\"Young's modulus\" rel=\"external_link\" target=\"_blank\">Young's modulus<\/a> is 30\u201335 GPa, very close to that of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cortical_bone\" class=\"mw-redirect\" title=\"Cortical bone\" rel=\"external_link\" target=\"_blank\">cortical bone<\/a>, which can be an advantage. Bioglass implants can be used in non-load-bearing applications, for buried implants loaded slightly or compressively. Bioglass can be also used as a bioactive component in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Composite_material\" title=\"Composite material\" rel=\"external_link\" target=\"_blank\">composite materials<\/a> or as powder. Sometimes, Bioglass can be converted into an artificial cocaine. This has no known side-effects.<sup id=\"rdp-ebb-cite_ref-chemdent_7-1\" class=\"reference\"><a href=\"#cite_note-chemdent-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>The first successful surgical use of Bioglass 45S5 was in replacement of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ossicles\" title=\"Ossicles\" rel=\"external_link\" target=\"_blank\">ossicles<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Middle_ear\" title=\"Middle ear\" rel=\"external_link\" target=\"_blank\">middle ear<\/a>, as a treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Conductive_hearing_loss\" title=\"Conductive hearing loss\" rel=\"external_link\" target=\"_blank\">conductive hearing loss<\/a>. The advantage of 45S5 is in no tendency to form fibrous tissue. Other uses are in cones for implantation into the jaw following a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tooth_extraction\" class=\"mw-redirect\" title=\"Tooth extraction\" rel=\"external_link\" target=\"_blank\">tooth extraction<\/a>. Composite materials made of Bioglass 45S5 and patient's own bone can be used for bone reconstruction.<sup id=\"rdp-ebb-cite_ref-chemdent_7-2\" class=\"reference\"><a href=\"#cite_note-chemdent-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>Bioglass is comparatively soft in comparison to other glasses. It can be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Machined\" class=\"mw-redirect\" title=\"Machined\" rel=\"external_link\" target=\"_blank\">machined<\/a>, preferably with diamond tools, or ground to powder. Bioglass has to be stored in a dry environment, as it readily absorbs moisture and reacts with it.<sup id=\"rdp-ebb-cite_ref-biomat_8-1\" class=\"reference\"><a href=\"#cite_note-biomat-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>Bioglass 45S5 is manufactured by conventional glass-making technology, using platinum or platinum alloy <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crucible\" title=\"Crucible\" rel=\"external_link\" target=\"_blank\">crucibles<\/a> to avoid contamination. Contaminants would interfere with the chemical reactivity in organism. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Annealing_(glass)\" title=\"Annealing (glass)\" rel=\"external_link\" target=\"_blank\">Annealing<\/a> is a crucial step in forming bulk parts, due to high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_expansion\" title=\"Thermal expansion\" rel=\"external_link\" target=\"_blank\">thermal expansion<\/a> of the material.\n<\/p><p>Heat treatment of Bioglass reduces the volatile alkali metal oxide content and precipitates apatite crystals in the glass matrix. The resulting glass\u2013ceramic material, named Ceravital, has higher mechanical strength and lower bioactivity.<sup id=\"rdp-ebb-cite_ref-engmat_9-0\" class=\"reference\"><a href=\"#cite_note-engmat-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Porous_medium\" title=\"Porous medium\" rel=\"external_link\" target=\"_blank\">Porous medium<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_foam\" title=\"Ceramic foam\" rel=\"external_link\" target=\"_blank\">Ceramic foam<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nanofoam\" title=\"Nanofoam\" rel=\"external_link\" target=\"_blank\">Nanofoam<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal_foam\" title=\"Metal foam\" rel=\"external_link\" target=\"_blank\">Metal foam<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseointegration\" title=\"Osseointegration\" rel=\"external_link\" target=\"_blank\">Osseointegration<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Aur\u00e9gan, JC; B\u00e9gu\u00e9, T (December 2015). \"Bioactive glass for long bone infection: a systematic review\". <i>Injury<\/i>. 46 Suppl 8: S3\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fs0020-1383%2815%2930048-6\" target=\"_blank\">10.1016\/s0020-1383(15)30048-6<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26747915\" target=\"_blank\">26747915<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Injury&rft.atitle=Bioactive+glass+for+long+bone+infection%3A+a+systematic+review.&rft.volume=46+Suppl+8&rft.pages=S3-7&rft.date=2015-12&rft_id=info%3Adoi%2F10.1016%2Fs0020-1383%2815%2930048-6&rft_id=info%3Apmid%2F26747915&rft.aulast=Aur%C3%A9gan&rft.aufirst=JC&rft.au=B%C3%A9gu%C3%A9%2C+T&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioactive+glass\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">van Gestel, NA; Geurts, J; Hulsen, DJ; van Rietbergen, B; Hofmann, S; Arts, JJ (2015). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4609389\" target=\"_blank\">\"Clinical Applications of S53P4 Bioactive Glass in Bone Healing and Osteomyelitic Treatment: A Literature Review\"<\/a>. <i>BioMed Research International<\/i>. <b>2015<\/b>: 684826. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1155%2F2015%2F684826\" target=\"_blank\">10.1155\/2015\/684826<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4609389\" target=\"_blank\">4609389<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26504821\" target=\"_blank\">26504821<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BioMed+Research+International&rft.atitle=Clinical+Applications+of+S53P4+Bioactive+Glass+in+Bone+Healing+and+Osteomyelitic+Treatment%3A+A+Literature+Review.&rft.volume=2015&rft.pages=684826&rft.date=2015&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4609389&rft_id=info%3Apmid%2F26504821&rft_id=info%3Adoi%2F10.1155%2F2015%2F684826&rft.aulast=van+Gestel&rft.aufirst=NA&rft.au=Geurts%2C+J&rft.au=Hulsen%2C+DJ&rft.au=van+Rietbergen%2C+B&rft.au=Hofmann%2C+S&rft.au=Arts%2C+JJ&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4609389&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioactive+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pedone, A; Charpentier T; Malavasi G; Menziani M C (2010). \"New Insights into the Atomic Structure of 45S5 Bioglass by Means of Solid-State NMR Spectroscopy and Accurate First-Principles Simulations\". <i>Chem. Mater<\/i>. <b>22<\/b> (19): 5644\u20135652. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1021%2Fcm102089c\" target=\"_blank\">10.1021\/cm102089c<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Chem.+Mater.&rft.atitle=New+Insights+into+the+Atomic+Structure+of+45S5+Bioglass+by+Means+of+Solid-State+NMR+Spectroscopy+and+Accurate+First-Principles+Simulations&rft.volume=22&rft.issue=19&rft.pages=5644-5652&rft.date=2010&rft_id=info%3Adoi%2F10.1021%2Fcm102089c&rft.aulast=Pedone&rft.aufirst=A&rft.au=Charpentier+T&rft.au=Malavasi+G&rft.au=Menziani+M+C&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioactive+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-schott-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-schott_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-schott_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.schott.com\/epackaging\/english\/glass\/transponder.html\" target=\"_blank\">Transponder Glass<\/a><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Thevissen, PW; Poelman, G; De Cooman, M; Puers, R; Willems, G (2006). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.kuleuven.be\/fortand\/MFO\/articles\/06_RFID_01.pdf\" target=\"_blank\">\"Implantation of an RFID-tag into human molars to reduce hard forensic identification labor. Part I: working principle\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Forensic Science International<\/i>. 159 Suppl 1: S33\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.forsciint.2006.02.029\" target=\"_blank\">10.1016\/j.forsciint.2006.02.029<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16563681\" target=\"_blank\">16563681<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Forensic+Science+International&rft.atitle=Implantation+of+an+RFID-tag+into+human+molars+to+reduce+hard+forensic+identification+labor.+Part+I%3A+working+principle&rft.volume=159+Suppl+1&rft.pages=S33-9&rft.date=2006&rft_id=info%3Adoi%2F10.1016%2Fj.forsciint.2006.02.029&rft_id=info%3Apmid%2F16563681&rft.aulast=Thevissen&rft.aufirst=PW&rft.au=Poelman%2C+G&rft.au=De+Cooman%2C+M&rft.au=Puers%2C+R&rft.au=Willems%2C+G&rft_id=http%3A%2F%2Fwww.kuleuven.be%2Ffortand%2FMFO%2Farticles%2F06_RFID_01.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioactive+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-schott2-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-schott2_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.schott.com\/epackaging\/english\/download\/ep_brochure_2009_engl.pdf\" target=\"_blank\">SCHOTT Electronic Packaging<\/a><\/span>\n<\/li>\n<li id=\"cite_note-chemdent-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-chemdent_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-chemdent_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-chemdent_7-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><i><a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=bioglass&f=false\">The chemistry of medical and dental materials<\/a><\/i> by John W. Nicholson, p. 92, Royal Society of Chemistry, 2002 <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-85404-572-4<\/span>\n<\/li>\n<li id=\"cite_note-biomat-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-biomat_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-biomat_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><i><a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=bioglass&f=false\">Biomaterials and tissue engineering<\/a><\/i> by Donglu Shi p. 27, Springer, 2004 <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 3-540-22203-0<\/span>\n<\/li>\n<li id=\"cite_note-engmat-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-engmat_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i><a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=bioglass&f=false\">Engineering materials for biomedical applications<\/a><\/i> by Swee Hin Teoh, p. 6-21, World Scientific, 2004 <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 981-256-061-0<\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1323\nCached time: 20181217110818\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.288 seconds\nReal time usage: 0.353 seconds\nPreprocessor visited node count: 1071\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 28473\/2097152 bytes\nTemplate argument size: 723\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 21032\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.143\/10.000 seconds\nLua memory usage: 2.61 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 269.026 1 -total\n<\/p>\n<pre>95.01% 255.606 1 Template:Reflist\n63.54% 170.945 4 Template:Cite_journal\n22.38% 60.221 3 Template:ISBN\n 9.78% 26.300 3 Template:Catalog_lookup_link\n 4.96% 13.352 1 Template:Glass_science\n 4.43% 11.926 3 Template:Error-small\n 3.97% 10.669 1 Template:Navbox\n 3.26% 8.761 9 Template:Yesno-no\n 2.03% 5.450 9 Template:Yesno\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2238741-1!canonical and timestamp 20181217110818 and revision id 853813005\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bioactive_glass\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212210\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.045 seconds\nReal time usage: 0.179 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 172.835 1 - wikipedia:Bioactive_glass\n100.00% 172.835 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:7987-0!*!*!*!*!*!* and timestamp 20181217212209 and revision id 24099\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Bioactive_glass\">https:\/\/www.limswiki.org\/index.php\/Bioactive_glass<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","1cd99f544b11b79a9e3d99e90b7848ec_images":[],"1cd99f544b11b79a9e3d99e90b7848ec_timestamp":1545081729,"54f8fb996ec840d445d91d7c30b7ddb0_type":"article","54f8fb996ec840d445d91d7c30b7ddb0_title":"Bioabsorbable metallic glass","54f8fb996ec840d445d91d7c30b7ddb0_url":"https:\/\/www.limswiki.org\/index.php\/Bioabsorbable_metallic_glass","54f8fb996ec840d445d91d7c30b7ddb0_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tBioabsorbable metallic glass\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tBioresorbable (or bioabsorbable) metallic glass is a type of amorphous metal, which is based on the Mg-Zn-Ca ternary system.[1] Containing only elements which already exist inside the human body, namely Mg, Zn and Ca, these amorphous alloys are a special type of biodegradable metal.[2]\n\nContents \n\n1 History \n2 Properties \n3 Recent developments \n4 See also \n5 References \n6 External links \n\n\nHistory \nThe first reported metallic glass was an alloy (Au75Si25) produced at Caltech by W. Klement (Jr.), Willens and Duwez in 1960.[3] This and other early glass-forming alloys had to be cooled extremely rapidly (in the order of one mega-kelvin per second, 106 K\/s) to avoid crystallization. An important consequence of this was that metallic glasses could only be produced in a limited number of forms (typically ribbons, foils, or wires) in which one or more dimensions were small so that heat could be extracted quickly enough to achieve the necessary cooling rates. As a result, metallic glass specimens (with a few exceptions) were limited to thicknesses of less than one hundred micrometers.\nMg-Zn-Ca based metallic glasses are a relatively new group of amorphous metals, possessing commercial and technical advantages over early compositions. Gu and co-workers produced the first Mg-Zn-Ca BMG in 2005, reporting high glass forming ability, high strength and most importantly exceptional plasticity. This lanthanide-free, Mg-based glass attracted immediate interest due to its low density and cost, and particularly because of its uncharacteristically high ductility. This property was unexpected for such compositions, as the constituent elements are found to be of relatively low Poisson ratio, and hence contribute little to the inherent plasticity of the glass. This unlikely asset was seized upon by Li in 2008, who made use of the Poisson ratio principle and increased Mg content at the expense of Zn to further enhance plasticity. Further improvements were achieved by incremental addition of Ca to the Mg72Zn28 binary composition, producing numerous ternary alloys along the 350 \u00b0C isotherm of the Mg-Zn-Ca system.\nTernary Ca-Mg-Zn bulk metallic glasses were also discovered in 2005.[4] Similar to the Mg-Zn-Ca, these two amorphous alloys are both bioresorbable metallic glasses and are based on the same Mg-Zn-Ca ternary system.[1] The elements are displayed in order of decreasing atomic concentration. Hence, the distinction between these two metallic glasses lies in their most dominant element, namely Ca and Mg. These Ca-based bulk glassy alloys had compositions of Ca55Mg15+XZn30\u2212X, Ca60Mg10+YZn30\u2212Y, and Ca55+ZMg25\u2212ZZn20, where X = 0, 5 and 10; Y = 0, 5, 7.5, 10, and 15; and Z = 0, 5, 7.5, 10, and 15. Critical casting thicknesses of up to 10 mm were achieved.[4]\n\nProperties \nUnlike traditional steel or titanium, this material dissolves in organisms at a rate of roughly 1 millimeter per month and is replaced with bone tissue. This speed can be adjusted by varying the content of zinc.[5]\nAmorphous Ca65Zn20Mg15 alloy exhibits extremely poor corrosion resistance. Wang et al.[6] reported that the said amorphous alloy completely disintegrated after no more than 3 hours exposure in biocorrosion environment. In static distilled water at room temperature, Dahlman et al.[7] also reported destructive corrosion reactions of the same material, decomposing into a multiphase powder.\nCa-BMGs with higher Zn contents as reported by Cao et al.[8] showed an elastic modulus in the range of 35\u201346 GPa, and a hardness of 0.7\u20131.4 GPa.\n\nRecent developments \nMetallic glasses based on the Mg-Zn-Ca ternary alloy system only consist of the elements which already exist inside the human body. As such, it is being explored as a potential bioresorbable biomaterial for use in orthopaedic applications.[6][8][9][10][11]\n\nSee also \nBioresorbable stents\nMaterials science\nReferences \n\n\n^ a b Mg-Zn-Ca ternary system \n\n^ Ibrahim, H.; Esfahani, S. N.; Poorganji, B.; Dean, D.; Elahinia, M. (January 2017). \"Resorbable bone fixation alloys, forming, and post-fabrication treatments\". Materials Science and Engineering: C. 70 (1). doi:10.1016\/j.msec.2016.09.069. \n\n^ Klement, W.; Willens, R. H.; Duwez, POL (1960). \"Non-crystalline structure in solidified gold-silicon Alloys\". Nature. 187 (4740): 869\u2013870. doi:10.1038\/187869b0. \n\n^ a b Senkov, O.N.; Scott, J.M. (2005). \"Glass forming ability and thermal stability of ternary Ca-Mg-Zn bulk metallic glasses\". Journal of Non-Crystalline Solids. 351 (37\u201339): 3087\u20133094. doi:10.1016\/j.jnoncrysol.2005.07.022. \n\n^ \"Fixing bones with dissolvable glass\". PhysicsWorld. Oct 1, 2009. \n\n^ a b Wang, Y.B.; et al. (2011). \"Biodegradable CaMgZn bulk metallic glass for potential skeletal application\". Acta Biomaterialia. 7: 3196\u20133208. doi:10.1016\/j.actbio.2011.04.027. \n\n^ Dahlman, J.; Senkov, O.N.; Scott, J.M.; Miracle, D.B. (2007). \"Corrosion properties of Ca based bulk metallic glasses\" (PDF) . Materials Transactions. 48 (7): 1850\u20131854. doi:10.2320\/matertrans.mj200732. \n\n^ a b Cao, J.D.; et al. (2012). \"Ca\u2013Mg\u2013Zn bulk metallic glasses as bioresorbable metals\". Acta Biomaterialia. 8 (6): 2375\u20132383. doi:10.1016\/j.actbio.2012.03.009. \n\n^ Mills, Georgie. \"Mending broken bones with glass\". Australia Unlimited. Retrieved 22 April 2013 . \n\n^ \"BMGs for Electronic, Biomedical and Aerospace Applications\". University of New South Wales. Apr 28, 2010. Archived from the original on 2013-01-05. \n\n^ Kirkland, N.T. (2012). \"Magnesium biomaterials: Past, present and future\". Corrosion Engineering, Science and Technology. 47 (5): 322\u2013328. doi:10.1179\/1743278212Y.0000000034. \n\n\nExternal links \nBioabsorbable metallic glasses\n\"New materials for bone repair become nutrients, not poison\"\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Bioabsorbable_metallic_glass\">https:\/\/www.limswiki.org\/index.php\/Bioabsorbable_metallic_glass<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal 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version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 29 February 2016, at 20:37.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 526 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","54f8fb996ec840d445d91d7c30b7ddb0_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Bioabsorbable_metallic_glass skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Bioabsorbable metallic glass<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Bioresorbable<\/b> (or <b>bioabsorbable<\/b>) <b>metallic glass<\/b> is a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amorphous_metal\" title=\"Amorphous metal\" rel=\"external_link\" target=\"_blank\">amorphous metal<\/a>, which is based on the <i>Mg-Zn-Ca ternary system<\/i>.<sup id=\"rdp-ebb-cite_ref-Google_1-0\" class=\"reference\"><a href=\"#cite_note-Google-1\" rel=\"external_link\">[1]<\/a><\/sup> Containing only <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_element\" title=\"Chemical element\" rel=\"external_link\" target=\"_blank\">elements<\/a> which already exist inside the human body, namely <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium\" title=\"Magnesium\" rel=\"external_link\" target=\"_blank\">Mg<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zinc\" title=\"Zinc\" rel=\"external_link\" target=\"_blank\">Zn<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium\" title=\"Calcium\" rel=\"external_link\" target=\"_blank\">Ca<\/a>, these <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amorphous_alloy\" class=\"mw-redirect\" title=\"Amorphous alloy\" rel=\"external_link\" target=\"_blank\">amorphous alloys<\/a> are a special type of .<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The first reported <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metallic_glass\" class=\"mw-redirect\" title=\"Metallic glass\" rel=\"external_link\" target=\"_blank\">metallic glass<\/a> was an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alloy\" title=\"Alloy\" rel=\"external_link\" target=\"_blank\">alloy<\/a> (Au<sub>75<\/sub>Si<sub>25<\/sub>) produced at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Caltech\" class=\"mw-redirect\" title=\"Caltech\" rel=\"external_link\" target=\"_blank\">Caltech<\/a> by W. Klement (Jr.), Willens and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pol_Duwez\" title=\"Pol Duwez\" rel=\"external_link\" target=\"_blank\">Duwez<\/a> in 1960.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> This and other early glass-forming alloys had to be cooled extremely rapidly (in the order of one <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mega-\" title=\"Mega-\" rel=\"external_link\" target=\"_blank\">mega-<\/a><a href=\"https:\/\/en.wikipedia.org\/wiki\/Kelvin\" title=\"Kelvin\" rel=\"external_link\" target=\"_blank\">kelvin<\/a> per second, 10<sup>6<\/sup> K\/s) to avoid <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystallization\" title=\"Crystallization\" rel=\"external_link\" target=\"_blank\">crystallization<\/a>. An important consequence of this was that metallic glasses could only be produced in a limited number of forms (typically ribbons, foils, or wires) in which one or more dimensions were small so that heat could be extracted quickly enough to achieve the necessary cooling rates. As a result, metallic glass specimens (with a few exceptions) were limited to thicknesses of less than one hundred <a href=\"https:\/\/en.wikipedia.org\/wiki\/Micrometre\" title=\"Micrometre\" rel=\"external_link\" target=\"_blank\">micrometers<\/a>.\n<\/p><p>Mg-Zn-Ca based metallic glasses are a relatively new group of amorphous metals, possessing commercial and technical advantages over early compositions. Gu and co-workers produced the first Mg-Zn-Ca BMG in 2005, reporting high glass forming ability, high strength and most importantly exceptional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plasticity_(physics)\" title=\"Plasticity (physics)\" rel=\"external_link\" target=\"_blank\">plasticity<\/a>. This <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lanthanide\" title=\"Lanthanide\" rel=\"external_link\" target=\"_blank\">lanthanide<\/a>-free, Mg-based glass attracted immediate interest due to its low density and cost, and particularly because of its uncharacteristically high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ductility\" title=\"Ductility\" rel=\"external_link\" target=\"_blank\">ductility<\/a>. This property was unexpected for such compositions, as the constituent elements are found to be of relatively low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Poisson_ratio\" class=\"mw-redirect\" title=\"Poisson ratio\" rel=\"external_link\" target=\"_blank\">Poisson ratio<\/a>, and hence contribute little to the inherent plasticity of the glass. This unlikely asset was seized upon by Li in 2008, who made use of the Poisson ratio principle and increased Mg content at the expense of Zn to further enhance plasticity. Further improvements were achieved by incremental addition of Ca to the Mg72Zn28 binary composition, producing numerous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ternary_alloy\" class=\"mw-redirect\" title=\"Ternary alloy\" rel=\"external_link\" target=\"_blank\">ternary alloys<\/a> along the 350 \u00b0C <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isothermal_process\" title=\"Isothermal process\" rel=\"external_link\" target=\"_blank\">isotherm<\/a> of the Mg-Zn-Ca system.\n<\/p><p>Ternary Ca-Mg-Zn bulk metallic glasses were also discovered in 2005.<sup id=\"rdp-ebb-cite_ref-senkov_4-0\" class=\"reference\"><a href=\"#cite_note-senkov-4\" rel=\"external_link\">[4]<\/a><\/sup> Similar to the Mg-Zn-Ca, these two <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amorphous_alloy\" class=\"mw-redirect\" title=\"Amorphous alloy\" rel=\"external_link\" target=\"_blank\">amorphous alloys<\/a> are both bioresorbable metallic glasses and are based on the same <i>Mg-Zn-Ca ternary system<\/i>.<sup id=\"rdp-ebb-cite_ref-Google_1-1\" class=\"reference\"><a href=\"#cite_note-Google-1\" rel=\"external_link\">[1]<\/a><\/sup> The elements are displayed in order of decreasing atomic concentration. Hence, the distinction between these two <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metallic_glass\" class=\"mw-redirect\" title=\"Metallic glass\" rel=\"external_link\" target=\"_blank\">metallic glasses<\/a> lies in their most dominant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_element\" title=\"Chemical element\" rel=\"external_link\" target=\"_blank\">element<\/a>, namely <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium\" title=\"Calcium\" rel=\"external_link\" target=\"_blank\">Ca<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium\" title=\"Magnesium\" rel=\"external_link\" target=\"_blank\">Mg<\/a>. These Ca-based bulk glassy alloys had compositions of Ca<sub>55<\/sub>Mg<sub>15+X<\/sub>Zn<sub>30\u2212X<\/sub>, Ca<sub>60<\/sub>Mg<sub>10+Y<\/sub>Zn<sub>30\u2212Y<\/sub>, and Ca<sub>55+Z<\/sub>Mg<sub>25\u2212Z<\/sub>Zn<sub>20<\/sub>, where X = 0, 5 and 10; Y = 0, 5, 7.5, 10, and 15; and Z = 0, 5, 7.5, 10, and 15. Critical casting thicknesses of up to 10 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Millimetre\" title=\"Millimetre\" rel=\"external_link\" target=\"_blank\">mm<\/a> were achieved.<sup id=\"rdp-ebb-cite_ref-senkov_4-1\" class=\"reference\"><a href=\"#cite_note-senkov-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Properties\">Properties<\/span><\/h2>\n<p>Unlike traditional steel or titanium, this material dissolves in organisms at a rate of roughly 1 millimeter per month and is replaced with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_tissue\" class=\"mw-redirect\" title=\"Bone tissue\" rel=\"external_link\" target=\"_blank\">bone tissue<\/a>. This speed can be adjusted by varying the content of zinc.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>Amorphous Ca<sub>65<\/sub>Zn<sub>20<\/sub>Mg<sub>15<\/sub> alloy exhibits extremely poor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corrosion_resistance\" class=\"mw-redirect\" title=\"Corrosion resistance\" rel=\"external_link\" target=\"_blank\">corrosion resistance<\/a>. Wang <i>et al.<\/i><sup id=\"rdp-ebb-cite_ref-wang_6-0\" class=\"reference\"><a href=\"#cite_note-wang-6\" rel=\"external_link\">[6]<\/a><\/sup> reported that the said amorphous alloy completely disintegrated after no more than 3 hours exposure in biocorrosion environment. In static distilled water at room temperature, Dahlman <i>et al.<\/i><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> also reported destructive corrosion reactions of the same material, decomposing into a multiphase powder.\n<\/p><p>Ca-BMGs with higher <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zinc\" title=\"Zinc\" rel=\"external_link\" target=\"_blank\">Zn<\/a> contents as reported by Cao <i>et al.<\/i><sup id=\"rdp-ebb-cite_ref-cao_8-0\" class=\"reference\"><a href=\"#cite_note-cao-8\" rel=\"external_link\">[8]<\/a><\/sup> showed an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastic_modulus\" title=\"Elastic modulus\" rel=\"external_link\" target=\"_blank\">elastic modulus<\/a> in the range of 35\u201346 <a href=\"https:\/\/en.wikipedia.org\/wiki\/GPa\" class=\"mw-redirect\" title=\"GPa\" rel=\"external_link\" target=\"_blank\">GPa<\/a>, and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hardness\" title=\"Hardness\" rel=\"external_link\" target=\"_blank\">hardness<\/a> of 0.7\u20131.4 <a href=\"https:\/\/en.wikipedia.org\/wiki\/GPa\" class=\"mw-redirect\" title=\"GPa\" rel=\"external_link\" target=\"_blank\">GPa<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Recent_developments\">Recent developments<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Metallic_glass\" class=\"mw-redirect\" title=\"Metallic glass\" rel=\"external_link\" target=\"_blank\">Metallic glasses<\/a> based on the Mg-Zn-Ca ternary alloy system only consist of the elements which already exist inside the human body. As such, it is being explored as a potential bioresorbable biomaterial for use in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopaedic\" class=\"mw-redirect\" title=\"Orthopaedic\" rel=\"external_link\" target=\"_blank\">orthopaedic<\/a> applications.<sup id=\"rdp-ebb-cite_ref-wang_6-1\" class=\"reference\"><a href=\"#cite_note-wang-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-cao_8-1\" class=\"reference\"><a href=\"#cite_note-cao-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioresorbable_stent\" title=\"Bioresorbable stent\" rel=\"external_link\" target=\"_blank\">Bioresorbable stents<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Materials_science\" title=\"Materials science\" rel=\"external_link\" target=\"_blank\">Materials science<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-Google-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Google_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Google_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/sites.google.com\/site\/unswbmg\/documents\/MgZnCa.jpg\" target=\"_blank\">Mg-Zn-Ca ternary system<\/a><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ibrahim, H.; Esfahani, S. N.; Poorganji, B.; Dean, D.; Elahinia, M. (January 2017). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S092849311631534X\" target=\"_blank\">\"Resorbable bone fixation alloys, forming, and post-fabrication treatments\"<\/a>. <i>Materials Science and Engineering: C<\/i>. <b>70<\/b> (1). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.msec.2016.09.069\" target=\"_blank\">10.1016\/j.msec.2016.09.069<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Materials+Science+and+Engineering%3A+C&rft.atitle=Resorbable+bone+fixation+alloys%2C+forming%2C+and+post-fabrication+treatments&rft.volume=70&rft.issue=1&rft.date=2017-01&rft_id=info%3Adoi%2F10.1016%2Fj.msec.2016.09.069&rft.aulast=Ibrahim&rft.aufirst=H.&rft.au=Esfahani%2C+S.+N.&rft.au=Poorganji%2C+B.&rft.au=Dean%2C+D.&rft.au=Elahinia%2C+M.&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS092849311631534X&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioabsorbable+metallic+glass\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Klement, W.; Willens, R. H.; Duwez, POL (1960). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nature.com\/nature\/journal\/v187\/n4740\/abs\/187869b0.html\" target=\"_blank\">\"Non-crystalline structure in solidified gold-silicon Alloys\"<\/a>. <i>Nature<\/i>. <b>187<\/b> (4740): 869\u2013870. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2F187869b0\" target=\"_blank\">10.1038\/187869b0<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature&rft.atitle=Non-crystalline+structure+in+solidified+gold-silicon+Alloys&rft.volume=187&rft.issue=4740&rft.pages=869-870&rft.date=1960&rft_id=info%3Adoi%2F10.1038%2F187869b0&rft.aulast=Klement&rft.aufirst=W.&rft.au=Willens%2C+R.+H.&rft.au=Duwez%2C+POL&rft_id=http%3A%2F%2Fwww.nature.com%2Fnature%2Fjournal%2Fv187%2Fn4740%2Fabs%2F187869b0.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioabsorbable+metallic+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-senkov-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-senkov_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-senkov_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Senkov, O.N.; Scott, J.M. 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(2007). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.jim.or.jp\/journal\/e\/pdf3\/48\/07\/1850.pdf\" target=\"_blank\">\"Corrosion properties of Ca based bulk metallic glasses\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Materials Transactions<\/i>. <b>48<\/b> (7): 1850\u20131854. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2320%2Fmatertrans.mj200732\" target=\"_blank\">10.2320\/matertrans.mj200732<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Materials+Transactions&rft.atitle=Corrosion+properties+of+Ca+based+bulk+metallic+glasses&rft.volume=48&rft.issue=7&rft.pages=1850-1854&rft.date=2007&rft_id=info%3Adoi%2F10.2320%2Fmatertrans.mj200732&rft.aulast=Dahlman&rft.aufirst=J.&rft.au=Senkov%2C+O.N.&rft.au=Scott%2C+J.M.&rft.au=Miracle%2C+D.B.&rft_id=https%3A%2F%2Fwww.jim.or.jp%2Fjournal%2Fe%2Fpdf3%2F48%2F07%2F1850.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioabsorbable+metallic+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-cao-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-cao_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-cao_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cao, J.D.; et al. (2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S1742706112000955\" target=\"_blank\">\"Ca\u2013Mg\u2013Zn bulk metallic glasses as bioresorbable metals\"<\/a>. <i>Acta Biomaterialia<\/i>. <b>8<\/b> (6): 2375\u20132383. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.actbio.2012.03.009\" target=\"_blank\">10.1016\/j.actbio.2012.03.009<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Biomaterialia&rft.atitle=Ca%E2%80%93Mg%E2%80%93Zn+bulk+metallic+glasses+as+bioresorbable+metals&rft.volume=8&rft.issue=6&rft.pages=2375-2383&rft.date=2012&rft_id=info%3Adoi%2F10.1016%2Fj.actbio.2012.03.009&rft.aulast=Cao&rft.aufirst=J.D.&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS1742706112000955&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioabsorbable+metallic+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Mills, Georgie. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.australiaunlimited.com\/science\/mending-broken-bones-glass\" target=\"_blank\">\"Mending broken bones with glass\"<\/a>. <i>Australia Unlimited<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">22 April<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Australia+Unlimited&rft.atitle=Mending+broken+bones+with+glass&rft.aulast=Mills&rft.aufirst=Georgie&rft_id=http%3A%2F%2Fwww.australiaunlimited.com%2Fscience%2Fmending-broken-bones-glass&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioabsorbable+metallic+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130105044106\/http:\/\/www.materials.unsw.edu.au\/research\/bulk-metallic-glasses-for-biomedical-electronics-aerospace-and-advanced-structural-applications\" target=\"_blank\">\"BMGs for Electronic, Biomedical and Aerospace Applications\"<\/a>. University of New South Wales. Apr 28, 2010. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.materials.unsw.edu.au\/research\/bulk-metallic-glasses-for-biomedical-electronics-aerospace-and-advanced-structural-applications\" target=\"_blank\">the original<\/a> on 2013-01-05.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=BMGs+for+Electronic%2C+Biomedical+and+Aerospace+Applications&rft.date=2010-04-28&rft_id=http%3A%2F%2Fwww.materials.unsw.edu.au%2Fresearch%2Fbulk-metallic-glasses-for-biomedical-electronics-aerospace-and-advanced-structural-applications&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioabsorbable+metallic+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kirkland, N.T. (2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ingentaconnect.com\/content\/maney\/cest\/2012\/00000047\/00000005\/art00002\" target=\"_blank\">\"Magnesium biomaterials: Past, present and future\"<\/a>. <i>Corrosion Engineering, Science and Technology<\/i>. <b>47<\/b> (5): 322\u2013328. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1179%2F1743278212Y.0000000034\" target=\"_blank\">10.1179\/1743278212Y.0000000034<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Corrosion+Engineering%2C+Science+and+Technology&rft.atitle=Magnesium+biomaterials%3A+Past%2C+present+and+future&rft.volume=47&rft.issue=5&rft.pages=322-328&rft.date=2012&rft_id=info%3Adoi%2F10.1179%2F1743278212Y.0000000034&rft.aulast=Kirkland&rft.aufirst=N.T.&rft_id=http%3A%2F%2Fwww.ingentaconnect.com%2Fcontent%2Fmaney%2Fcest%2F2012%2F00000047%2F00000005%2Fart00002&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABioabsorbable+metallic+glass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/sites.google.com\/site\/unswbmg\/\" target=\"_blank\"><i>Bioabsorbable metallic glasses<\/i><\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.abc.net.au\/radionational\/programs\/scienceshow\/new-materials-for-bone-repair-become-nutrients2c-not-poison\/3709958\" target=\"_blank\">\"New materials for bone repair become nutrients, not poison\"<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1244\nCached time: 20181126114240\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.200 seconds\nReal time usage: 0.237 seconds\nPreprocessor visited node count: 582\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 18838\/2097152 bytes\nTemplate argument size: 92\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 29436\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.123\/10.000 seconds\nLua memory usage: 3.15 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 195.635 1 Template:Reflist\n100.00% 195.635 1 -total\n<\/p>\n<pre>76.87% 150.378 7 Template:Cite_journal\n 9.48% 18.550 3 Template:Cite_news\n 1.74% 3.412 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:31382667-1!canonical and timestamp 20181126114240 and revision id 804613606\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bioabsorbable_metallic_glass\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212209\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.052 seconds\nReal time usage: 0.192 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 185.813 1 - wikipedia:Bioabsorbable_metallic_glass\n100.00% 185.813 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8183-0!*!*!*!*!*!* and timestamp 20181217212209 and revision id 24329\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Bioabsorbable_metallic_glass\">https:\/\/www.limswiki.org\/index.php\/Bioabsorbable_metallic_glass<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","54f8fb996ec840d445d91d7c30b7ddb0_images":[],"54f8fb996ec840d445d91d7c30b7ddb0_timestamp":1545081729,"b52fd310a75c0ad51d3c8adcc8f559d9_type":"article","b52fd310a75c0ad51d3c8adcc8f559d9_title":"Aluminium oxide","b52fd310a75c0ad51d3c8adcc8f559d9_url":"https:\/\/www.limswiki.org\/index.php\/Aluminium_oxide","b52fd310a75c0ad51d3c8adcc8f559d9_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tAluminium oxide\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is about aluminium(III) oxide, Al2O3. For other uses, see Aluminium oxide (compounds).\n\nAluminium oxide\r\n(Aluminum oxide)\n\n\n\n\n\n\n\n\n\n\n\nIdentifiers\n\n\n\nCAS Number\n\n1344-28-1  Y \n\n\n3D model (JSmol)\n\nInteractive image Interactive image \n\n\n\n\n\n\n\nChemSpider\n\n8164808  Y \n\n\n\nECHA InfoCard \n\n100.014.265\n\n\n\n\n\n\n\n\nPubChem CID\n\n9989226 \n\n\nRTECS number\n\nBD120000\n\n\nUNII\n\nLMI26O6933  Y \n\n\n\n\nInChI\nInChI=1S\/2Al.3O\/q2*+3;3*-2 Y Key: PNEYBMLMFCGWSK-UHFFFAOYSA-N Y InChI=1\/2Al.3O\/q2*+3;3*-2Key: PNEYBMLMFCGWSK-UHFFFAOYAC\n\n\n\n\nSMILES\n[Al+3].[Al+3].[O-2].[O-2].[O-2][O-2].[O-2].[O-2].[Al+3].[Al+3]\n\n\n\nProperties\n\n\nChemical formula\n\nAl 2O 3\n\n\nMolar mass\n\n101.96 g\u00b7mol\u22121  \n\n\nAppearance\n\nwhite solid\n\n\nOdor\n\nodorless\n\n\nDensity\n\n3.987g\/cm3\n\n\nMelting point\n\n 2,072 \u00b0C (3,762 \u00b0F; 2,345 K)[3] \n\n\nBoiling point\n\n 2,977 \u00b0C (5,391 \u00b0F; 3,250 K)[4] \n\n\n\n\nSolubility in water\n\ninsoluble\n\n\n\nSolubility\n\ninsoluble in diethyl ether \r\n practically insoluble in ethanol\n\n\n\n\n\n\n\n\nlog P\n\n0.31860[1]\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nMagnetic susceptibility (χ)\n\n\u221237.0\u00d710\u22126 cm3\/mol\n\n\nThermal conductivity\n\n30 W\u00b7m\u22121\u00b7K\u22121[2]\n\n\nRefractive index (nD)\n\nn\u03c9=1.768\u20131.772 \r\nn\u03b5=1.760\u20131.763 \r\n Birefringence 0.008\n\n\nStructure\n\n\nCrystal structure\n\nTrigonal, hR30, space group = R3 c, No. 167\n\n\n\n\nLattice constant\n\na = 478.5 pm, c = 1299.1 pm\n\n\n\n\nCoordination geometry\n\noctahedral\n\n\n\nThermochemistry\n\n\n\nStd molar\r\nentropy (So298)\n\n50.92 J\u00b7mol\u22121\u00b7K\u22121[5]\n\n\nStd enthalpy of\r\nformation (\u0394fHo298)\n\n\u22121675.7 kJ\/mol[5]\n\n\nPharmacology\n\n\n\nATC code\n\nD10AX04 (WHO ) \n\n\nHazards\n\n\n\nSafety data sheet\n\nSee: data page\n\n\n\n\n\n\nEU classification (DSD) (outdated) \n\nNot listed.\n\n\n\n\n\n\nNFPA 704\n\n\n\n0 \n1 \n0 \n\n\nFlash point\n\nNon-flammable  \n\n\n\n\n\n\nUS health exposure limits (NIOSH):\n\n\n\n\n\nPEL (Permissible)\n\nOSHA 15 mg\/m3 (Total Dust)\r\nOSHA 5 mg\/m3 (Respirable Fraction)\r\nACGIH\/TLV 10 mg\/m3\n\n\n\n\n\nREL (Recommended)\n\nnone[6]\n\n\n\n\n\nIDLH (Immediate danger)\n\nN.D.[6]\n\n\n\n\nRelated compounds\n\n\nOther anions\n\naluminium hydroxide\n\n\nOther cations\n\nboron trioxide\r\ngallium oxide\r\nindium oxide\r\nthallium oxide\n\n\n\nSupplementary data page\n\n\n\n\nStructure and\r\nproperties\n\nRefractive index (n),\r\nDielectric constant (\u03b5r), etc.\n\n\nThermodynamic\r\ndata\n\nPhase behaviour\r\nsolid–liquid–gas\n\n\nSpectral data\n\nUV, IR, NMR, MS\n\n\nExcept where otherwise noted, data are given for materials in their standard state (at 25 \u00b0C [77 \u00b0F], 100 kPa).\n\n\nY  verify  (what is Y N  ?)\n\n\nInfobox references\n\n\n\n\n\n\n\nAluminium oxide (IUPAC name) or aluminum oxide (American English) is a chemical compound of aluminium and oxygen with the chemical formula Al2O3. It is the most commonly occurring of several aluminium oxides, and specifically identified as aluminium(III) oxide. It is commonly called alumina (regardless of whether the element is spelled aluminum or aluminium), and may also be called aloxide, aloxite, or alundum depending on particular forms or applications. It occurs naturally in its crystalline polymorphic phase \u03b1-Al2O3 as the mineral corundum, varieties of which form the precious gemstones ruby and sapphire. Al2O3 is significant in its use to produce aluminium metal, as an abrasive owing to its hardness, and as a refractory material owing to its high melting point.[7]\n\nContents \n\n1 Natural occurrence \n2 Properties \n\n2.1 Amphoteric nature \n\n\n3 Structure \n4 Production \n5 Applications \n6 See also \n7 References \n8 External links \n\n\nNatural occurrence \nCorundum is the most common naturally occurring crystalline form of aluminium oxide.[8] Rubies and sapphires are gem-quality forms of corundum, which owe their characteristic colors to trace impurities. Rubies are given their characteristic deep red color and their laser qualities by traces of chromium. Sapphires come in different colors given by various other impurities, such as iron and titanium.\n\nProperties \n Aluminium oxide in its powdered form.\nAl2O3 is an electrical insulator but has a relatively high thermal conductivity (30 Wm\u22121K\u22121 )[2] for a ceramic material. Aluminium oxide is insoluble in water. In its most commonly occurring crystalline form, called corundum or \u03b1-aluminium oxide, its hardness makes it suitable for use as an abrasive and as a component in cutting tools.[7]\nAluminium oxide is responsible for the resistance of metallic aluminium to weathering. Metallic aluminium is very reactive with atmospheric oxygen, and a thin passivation layer of aluminium oxide (4 nm thickness) forms on any exposed aluminium surface.[9] This layer protects the metal from further oxidation. The thickness and properties of this oxide layer can be enhanced using a process called anodising. A number of alloys, such as aluminium bronzes, exploit this property by including a proportion of aluminium in the alloy to enhance corrosion resistance. The aluminium oxide generated by anodising is typically amorphous, but discharge assisted oxidation processes such as plasma electrolytic oxidation result in a significant proportion of crystalline aluminium oxide in the coating, enhancing its hardness.\nAluminium oxide was taken off the United States Environmental Protection Agency's chemicals lists in 1988. Aluminium oxide is on the EPA's Toxics Release Inventory list if it is a fibrous form.[10]\n\nAmphoteric nature \nAluminium oxide is an amphoteric substance, meaning it can react with both acids and bases, such as hydrofluoric acid and sodium hydroxide, acting as an acid with a base and a base with an acid, neutralising the other and producing a salt.\n\nAl2O3 + 6 HF \u2192 2 AlF3 + 3 H2O\nAl2O3 + 2 NaOH + 3 H2O \u2192 2 NaAl(OH)4 (sodium aluminate)\nStructure \n Corundum from Brazil, size about 2\u00d73 cm.\nThe most common form of crystalline aluminium oxide is known as corundum, which is the thermodynamically stable form.[11] The oxygen ions form a nearly hexagonal close-packed structure with the aluminium ions filling two-thirds of the octahedral interstices. Each Al3+ center is octahedral. In terms of its crystallography, corundum adopts a trigonal Bravais lattice with a space group of R-3c (number 167 in the International Tables). The primitive cell contains two formula units of aluminium oxide.\nAluminium oxide also exists in other phases, including the cubic \u03b3 and \u03b7 phases, the monoclinic \u03b8 phase, the hexagonal \u03c7 phase, the orthorhombic \u03ba phase and the \u03b4 phase that can be tetragonal or orthorhombic.[11][12] Each has a unique crystal structure and properties. Cubic \u03b3-Al2O3 has important technical applications. The so-called \u03b2-Al2O3 proved to be NaAl11O17.[13]\nMolten aluminium oxide near the melting temperature is roughly 2\/3 tetrahedral (i.e. 2\/3 of the Al are surrounded by 4 oxygen neighbors), and 1\/3 5-coordinated, very little (<5%) octahedral Al-O is present.[14] Around 80% of the oxygen atoms are shared among three or more Al-O polyhedra, and the majority of inter-polyhedral connections are corner-sharing, with the remaining 10\u201320% being edge-sharing.[14] The breakdown of octahedra upon melting is accompanied by a relatively large volume increase (~20%), the density of the liquid close to its melting point is 2.93 g\/cm3.[15]\n\nProduction \nAluminium hydroxide minerals are the main component of bauxite, the principal ore of aluminium. A mixture of the minerals comprise bauxite ore, including gibbsite (Al(OH)3), boehmite (\u03b3-AlO(OH)), and diaspore (\u03b1-AlO(OH)), along with impurities of iron oxides and hydroxides, quartz and clay minerals.[16] Bauxites are found in laterites. Bauxite is purified by the Bayer process:\n\nAl2O3 + H2O + NaOH \u2192 NaAl(OH)4\nAl(OH)3 + NaOH \u2192 NaAl(OH)4\nExcept for SiO2, the other components of bauxite do not dissolve in base. Upon filtering the basic mixture, Fe2O3 is removed. When the Bayer liquor is cooled, Al(OH)3 precipitates, leaving the silicates in solution.\n\nNaAl(OH)4 \u2192 NaOH + Al(OH)3\nThe solid Al(OH)3 Gibbsite is then calcined (heated to over 1100 \u00b0C) to give aluminium oxide:[7]\n\n2 Al(OH)3 \u2192 Al2O3 + 3 H2O\nThe product aluminium oxide tends to be multi-phase, i.e., consisting of several phases of aluminium oxide rather than solely corundum.[12] The production process can therefore be optimized to produce a tailored product. The type of phases present affects, for example, the solubility and pore structure of the aluminium oxide product which, in turn, affects the cost of aluminium production and pollution control.[12]\nFor its application as an electrical insulator in integrated circuits, where the conformal growth of a thin film is a prerequisite and the preferred growth mode is atomic layer deposition, Al2O3 films can be prepared by the chemical exchange between trimethylaluminum Al(CH3)3 and H2O:[17]\n\n2 Al(CH3)3 + 3 H2O \u2192 Al2O3 + 6 CH4\nH2O in the above reaction can be replaced by ozone (O3) as the active oxidant and the following reaction then takes place:[18][19]\n\n2 Al(CH3)3 + O3 \u2192 Al2O3 + 3 C2H6\nThe Al2O3 films prepared using O3 show 10\u2013100 times lower leakage current density compared with those prepared by H2O.\nKnown as alundum (in fused form) or aloxite[20] in the mining, ceramic, and materials science communities, aluminium oxide finds wide use. Annual world production of aluminium oxide in 2015 was approximately 115 million tonnes, over 90% of which is used in the manufacture of aluminium metal.[7] The major uses of speciality aluminium oxides are in refractories, ceramics, polishing and abrasive applications. Large tonnages of aluminium hydroxide, from which alumina is derived, are used in the manufacture of zeolites, coating titania pigments, and as a fire retardant\/smoke suppressant.\n\nApplications \nThis section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (August 2018) (Learn how and when to remove this template message)\nOver 90% of the aluminium oxide, normally termed Smelter Grade Alumina (SGA), produced is consumed for the production of aluminium, usually by the Hall\u2013H\u00e9roult process. The remainder, normally called speciality alumina is used in a wide variety of applications which reflect its inertness, temperature resistance and electrical resistance.[21]\n\nFiller:\nBeing fairly chemically inert and white, aluminium oxide is a favored filler for plastics. Aluminium oxide is a common ingredient in sunscreen and is sometimes also present in cosmetics such as blush, lipstick, and nail polish.\n\nGlass:\nMany formulations of glass have aluminium oxide as an ingredient.[22]\n\nCatalysis:\nAluminium oxide catalyses a variety of reactions that are useful industrially. In its largest scale application, aluminium oxide is the catalyst in the Claus process for converting hydrogen sulfide waste gases into elemental sulfur in refineries. It is also useful for dehydration of alcohols to alkenes.\nAluminium oxide serves as a catalyst support for many industrial catalysts, such as those used in hydrodesulfurization and some Ziegler-Natta polymerizations.\n\nPurification:\nAluminium oxide is widely used to remove water from gas streams.[23]\n\nAbrasive:\nAluminium oxide is used for its hardness and strength. It is widely used as an abrasive, including as a much less expensive substitute for industrial diamond. Many types of sandpaper use aluminium oxide crystals. In addition, its low heat retention and low specific heat make it widely used in grinding operations, particularly cutoff tools. As the powdery abrasive mineral aloxite, it is a major component, along with silica, of the cue tip \"chalk\" used in billiards. Aluminium oxide powder is used in some CD\/DVD polishing and scratch-repair kits. Its polishing qualities are also behind its use in toothpaste.\n\nPaint:\nMain article: Alumina effect pigment\nAluminium oxide flakes are used in paint for reflective decorative effects, such as in the automotive or cosmetic industries.\n\nComposite fiber:\nAluminium oxide has been used in a few experimental and commercial fiber materials for high-performance applications (e.g., Fiber FP, Nextel 610, Nextel 720).[24] Alumina nanofibers in particular have become a research field of interest.\n\nPersonal armor:\nSome body armors utilize alumina ceramic plates, usually in combination with aramid or UHMWPE backing to achieve effectiveness against even most rifle threats. Alumina ceramic armor is readily available to most civilians in jurisdictions where it is legal, but is not considered military grade.[25]\n\nAbrasion protection:\nAluminium oxide can be grown as a coating on aluminium by anodizing or by plasma electrolytic oxidation (see the \"Properties\" above). Both the hardness and abrasion-resistant characteristics of the coating originate from the high strength of aluminium oxide, yet the porous coating layer produced with conventional direct current anodizing procedures is within a 60-70 Rockwell hardness C range [26] which is comparable only to hardened carbon steel alloys, but considerably inferior to the hardness of natural and synthetic corundum. Instead, with plasma electrolytic oxidation, the coating is porous only on the surface oxide layer while the lower oxide layers are much more compact than with standard DC anodizing procedures and present a higher crystallinity due to the oxide layers being remelted and densified to obtain \u03b1-Al2O3 clusters[27] with much higher coating hardness values circa 2000 Vickers hardness.\n\n Aluminium oxide output in 2005Alumina is used to manufacture tiles which are attached inside pulverized fuel lines and flue gas ducting on coal fired power stations to protect high wear areas. They are not suitable for areas with high impact forces as these tiles are brittle and susceptible to breakage.\nOther:\nIn lighting, transparent aluminium oxide is used in some sodium vapor lamps.[28] Aluminium oxide is also used in preparation of coating suspensions in compact fluorescent lamps.\nIn chemistry laboratories, aluminium oxide is a medium for chromatography, available in basic (pH 9.5), acidic (pH 4.5 when in water) and neutral formulations.\nHealth and medical applications include it as a material in hip replacements[7] and birth control pills.[29]\nIt is used as a dosimeter for radiation protection and therapy applications for its optically stimulated luminescence properties.[citation needed ]\nAluminium oxide is an electrical insulator used as a substrate (silicon on sapphire) for integrated circuits but also as a tunnel barrier for the fabrication of superconducting devices such as single electron transistors and superconducting quantum interference devices (SQUIDs).\nAluminum oxide being a dielectric with relatively large band gap is used as an insulating barrier in capacitors.[30]\nInsulation for high-temperature furnaces is often manufactured from aluminium oxide. Sometimes the insulation has varying percentages of silica depending on the temperature rating of the material. The insulation can be made in blanket, board, brick and loose fiber forms for various application requirements.\nSmall pieces of aluminium oxide are often used as boiling chips in chemistry.\nIt is also used to make spark plug insulators.[31]\nUsing a plasma spray process and mixed with titania, it is coated onto the braking surface of some bicycle rims to provide abrasion and wear resistance.[citation needed ]\nMost ceramic eyes on fishing rods are circular rings made from aluminium oxide.[citation needed ]\n\nSee also \nAluminium oxide nanoparticle\nCharged Aerosol Release Experiment (CARE)\nList of alumina refineries\nMicro-Pulling-Down\nTransparent alumina\nBauxite tailings\nReferences \n\n\n^ \"Aluminum oxide_msds\". \n\n^ a b Material Properties Data: Alumina (Aluminum Oxide) Archived 2010-04-01 at the Wayback Machine.. Makeitfrom.com. Retrieved on 2013-04-17. \n\n^ Patnaik, P. (2002). Handbook of Inorganic Chemicals. McGraw-Hill. ISBN 0-07-049439-8. \n\n^ Raymond C. Rowe; Paul J. Sheskey; Marian E. Quinn (2009). \"Adipic acid\". Handbook of Pharmaceutical Excipients. Pharmaceutical Press. pp. 11\u201312. ISBN 978-0-85369-792-3. \n\n^ a b Zumdahl, Steven S. (2009). Chemical Principles 6th Ed. Houghton Mifflin Company. ISBN 0-618-94690-X. \n\n^ a b \"NIOSH Pocket Guide to Chemical Hazards #0021\". National Institute for Occupational Safety and Health (NIOSH). \n\n^ a b c d e \"Alumina (Aluminium Oxide) \u2013 The Different Types of Commercially Available Grades\". The A to Z of Materials. Archived from the original on 10 October 2007. Retrieved 27 October 2007 . \n\n^ Elam, J. W. (October 2010). Atomic Layer Deposition Applications 6. The Electrochemical Society. ISBN 9781566778213. \n\n^ Campbell, Timothy; Kalia, Rajiv; Nakano, Aiichiro; Vashishta, Priya; Ogata, Shuji; Rodgers, Stephen (1999). \"Dynamics of Oxidation of Aluminium Nanoclusters using Variable Charge Molecular-Dynamics Simulations on Parallel Computers\" (PDF) . Physical Review Letters. 82 (24): 4866. Bibcode:1999PhRvL..82.4866C. doi:10.1103\/PhysRevLett.82.4866. Archived (PDF) from the original on 2010-07-01. \n\n^ \"EPCRA Section 313 Chemical List For Reporting Year 2006\" (PDF) . US EPA. Archived from the original (PDF) on 2008-05-22. Retrieved 2008-09-30 . \n\n^ a b I. Levin; D. Brandon (1998). \"Metastable Alumina Polymorphs: Crystal Structures and Transition Sequences\". Journal of the American Ceramic Society. 81 (8): 1995\u20132012. doi:10.1111\/j.1151-2916.1998.tb02581.x. Archived from the original on 2014-11-29. \n\n^ a b c Paglia, G. (2004). \"Determination of the Structure of \u03b3-Alumina using Empirical and First Principles Calculations Combined with Supporting Experiments\" (free download) . Curtin University of Technology, Perth. Retrieved 2009-05-05 . \n\n^ Wiberg, E.; Holleman, A. F. (2001). Inorganic Chemistry. Elsevier. ISBN 0-12-352651-5. \n\n^ a b Skinner, L.B.; et al. (2013). \"Joint diffraction and modeling approach to the structure of liquid alumina\". Phys. Rev. B. 87 (2): 024201. Bibcode:2013PhRvB..87b4201S. doi:10.1103\/PhysRevB.87.024201. Archived from the original on 2013-02-24. \n\n^ Paradis, P.-F.; et al. (2004). \"Non-Contact Thermophysical Property Measurements of Liquid and Undercooled Alumina\". Jap. J. Appl. Phys. 43 (4): 1496\u20131500. Bibcode:2004JaJAP..43.1496P. doi:10.1143\/JJAP.43.1496. \n\n^ \"Bauxite and Alumina Statistics and Information\". USGS. Archived from the original on 6 May 2009. Retrieved 2009-05-05 . \n\n^ Higashi GS, Fleming (1989). \"Sequential surface chemical reaction limited growth of high quality Al2O3 dielectrics\". Appl. Phys. Lett. 55 (19): 1963\u201365. Bibcode:1989ApPhL..55.1963H. doi:10.1063\/1.102337. \n\n^ Kim JB; Kwon DR; Chakrabarti K; Lee Chongmu; Oh KY; Lee JH (2002). \"Improvement in Al2O3 dielectric behavior by using ozone as an oxidant for the atomic layer deposition technique\". J. Appl. Phys. 92 (11): 6739\u201342. Bibcode:2002JAP....92.6739K. doi:10.1063\/1.1515951. \n\n^ Kim, Jaebum; Chakrabarti, Kuntal; Lee, Jinho; Oh, Ki-Young; Lee, Chongmu (2003). \"Effects of ozone as an oxygen source on the properties of the Al2O3 thin films prepared by atomic layer deposition\". Mater Chem Phys. 78 (3): 733\u201338. doi:10.1016\/S0254-0584(02)00375-9. \n\n^ \"Aloxite\". ChemIndustry.com database. Archived from the original on 25 June 2007. Retrieved 24 February 2007 . \n\n^ Evans, K. A. (1993). \"Properties and uses of aluminium oxides and aluminium hydroxides\". In Downs, A. J. The Chemistry of Aluminium, Indium and Gallium. Blackie Academic. ISBN 075140103X. \n\n^ Akers, Michael J. (2016-04-19). Sterile Drug Products: Formulation, Packaging, Manufacturing and Quality. CRC Press. ISBN 9781420020564. \n\n^ Hudson, L. Keith; Misra, Chanakya; Perrotta, Anthony J.; Wefers, Karl and Williams, F. S. (2002) \"Aluminum Oxide\" in Ullmann's Encyclopedia of Industrial Chemistry, Wiley-VCH, Weinheim. doi:10.1002\/14356007.a01_557. \n\n^ Mallick, P.K. (2008). Fiber-reinforced composites materials, manufacturing, and design (3rd ed., [expanded and rev. ed.] ed.). Boca Raton, FL: CRC Press. pp. Ch.2.1.7. ISBN 0-8493-4205-8. \n\n^ \"Ballistic Resistance of Body Armor\" (PDF) . US Department of Justice. NIJ. Retrieved 31 August 2018 . \n\n^ Osborn, Joseph H. (2014). \"understanding and specifying anodizing: what a manufacturer needs to know\". OMW Corporation. Archived from the original on 2016-11-20. Retrieved 2018-06-02 . \n\n^ Li, Q; Liang, J; Wang, Q. \"Modern Surface Engineering Treatments, chapter 4 Plasma Oxidation Coatings on Lightweight Metals\" (PDF) . INTECH 2013. Archived (PDF) from the original on 2016-03-04. \n\n^ \"GE Innovation Timeline 1957\u20131970\". Archived from the original on 16 February 2009. Retrieved 2009-01-12 . \n\n^ \"DailyMed - JUNEL FE 1\/20- norethindrone acetate and ethinyl estradiol, and ferrous fumarate\". dailymed.nlm.nih.gov. Archived from the original on 2017-03-13. Retrieved 2017-03-13 . \n\n^ Belkin, A.; et., al. (2017). \"Recovery of Alumina Nanocapacitors after High Voltage Breakdown\". Sci. Rep. Bibcode:2017NatSR...7..932B. doi:10.1038\/s41598-017-01007-9. \n\n^ Farndon, John (2001). Aluminum. Marshall Cavendish. ISBN 9780761409472. Archived from the original on 2017-12-04. \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Aluminium oxide.\nCDC - NIOSH Pocket Guide to Chemical Hazards\nvteAluminium compoundsAl(I)\nAlBr\nAlCl\nAlF\nAlI\nAl2O\nAl(II)\nAlB2\nAlB12\nAlO\nAl(III)\nAlAs\nAl(BH4)3\nAlBr3\nAlCl3\nAlF3\nAlH3\nAlI3\nAlN\nAl(NO3)3\nAl2(CO3)3\nAl(OH)3\nAl(OH)2OAc\nAl(OH)(OAc)2\nAl(OAc)3\nAl2SO4(OAc)4\nAlP\nAlPO4\nAlSb\n Al(C5H7O2)3\nAl(MnO4)3\nAl2(MoO4)3\nAl2O3\nAl2S3\nAl2(SO4)3\nAl2Se3\nAl2Te3\nAl2SiO5\nAl4C3\nAlOHO\nAl(OH)2CO2C17H5\nNaAlH2(OC2H4OCH3)2\nLiAlH2(OC2H4OCH3)2Alums\n(NH4)Al(SO4)2\nKAl(SO4)2\nNaAl(SO4)2\nOrganoaluminium(III) compounds\n(Al(CH3)3)2\n(Al(C2H5)3)2\nAl(CH2CH(CH3)2)3\nAl(C2H5)2Cl\nAl(C2H5)2CN\nAl(CH2CH(CH3)2)2H\nAl(C2H5)2Cl2C2H5Cl\nTi(C5H5)2CH2ClAl(CH3)2\n\n\nvteOxidesMixed oxidation states\nAntimony tetroxide (Sb2O4)\nCobalt(II,III) oxide (Co3O4)\nEuropium(II,III) oxide (Eu3O4)\nIron(II,III) oxide (Fe3O4)\nLead(II,IV) oxide (Pb3O4)\nManganese(II,III) oxide (Mn3O4)\nSilver(I,III) oxide (Ag2O2)\nTriuranium octoxide (U3O8)\nCarbon suboxide (C3O2)\nMellitic anhydride (C12O9)\nPraseodymium(III,IV) oxide (Pr6O11)\nTerbium(III,IV) oxide (Tb4O7)\n+1 oxidation state\nCopper(I) oxide (Cu2O)\nDicarbon monoxide (C2O)\nDichlorine monoxide (Cl2O)\nGallium(I) oxide (Ga2O)\nLithium oxide (Li2O)\nPotassium oxide (K2O)\nRubidium oxide (Rb2O)\nSilver oxide (Ag2O)\nThallium(I) oxide (Tl2O)\nSodium oxide (Na2O)\nWater (hydrogen oxide) (H2O)\n+2 oxidation state\nAluminium(II) oxide (AlO)\nBarium oxide (BaO)\nBeryllium oxide (BeO)\nCadmium oxide (CdO)\nCalcium oxide (CaO)\nCarbon monoxide (CO)\nChromium(II) oxide (CrO)\nCobalt(II) oxide (CoO)\nCopper(II) oxide (CuO)\nEuropium(II) oxide (EuO)\nGermanium monoxide (GeO))\nIron(II) oxide (FeO)\nLead(II) oxide (PbO)\nMagnesium oxide (MgO)\nManganese(II) oxide (MnO)\nMercury(II) oxide (HgO)\nNickel(II) oxide (NiO)\nNitric oxide (NO)\nPalladium(II) oxide (PdO)\nSilicon monoxide (SiO)\nStrontium oxide (SrO)\nSulfur monoxide (SO)\nDisulfur dioxide (S2O2)\nThorium monoxide (ThO)\nTin(II) oxide (SnO)\nTitanium(II) oxide (TiO)\nVanadium(II) oxide (VO)\nZinc oxide (ZnO)\n+3 oxidation state\nAluminium oxide (Al2O3)\nAntimony trioxide (Sb2O3)\nArsenic trioxide (As2O3)\nBismuth(III) oxide (Bi2O3)\nBoron trioxide (B2O3)\nCerium(III) oxide (Ce2O3)\nDibromine trioxide (Br2O3)\nChromium(III) oxide (Cr2O3)\nDinitrogen trioxide (N2O3)\nDysprosium(III) oxide (Dy2O3)\nErbium(III) oxide (Er2O3)\nEuropium(III) oxide (Eu2O3)\nGadolinium(III) oxide (Gd2O3)\nGallium(III) oxide (Ga2O3)\nHolmium(III) oxide (Ho2O3)\nIndium(III) oxide (In2O3)\nIron(III) oxide (Fe2O3)\nLanthanum oxide (La2O3)\nLutetium(III) oxide (Lu2O3)\nManganese(III) oxide (Mn2O3)\nNeodymium(III) oxide (Nd2O3)\nNickel(III) oxide (Ni2O3)\nPhosphorus trioxide (P4O6)\nPraseodymium(III) oxide (Pr2O3)\nPromethium(III) oxide (Pm2O3)\nRhodium(III) oxide (Rh2O3)\nSamarium(III) oxide (Sm2O3)\nScandium oxide (Sc2O3)\nTerbium(III) oxide (Tb2O3)\nThallium(III) oxide (Tl2O3)\nThulium(III) oxide (Tm2O3)\nTitanium(III) oxide (Ti2O3)\nTungsten(III) oxide (W2O3)\nVanadium(III) oxide (V2O3)\nYtterbium(III) oxide (Yb2O3)\nYttrium(III) oxide (Y2O3)\n+4 oxidation state\nAmericium dioxide (AmO2)\nCarbon dioxide (CO2)\nCarbon trioxide (CO3)\nCerium(IV) oxide (CeO2)\nChlorine dioxide (ClO2)\nChromium(IV) oxide (CrO2)\nDinitrogen tetroxide (N2O4)\nGermanium dioxide (GeO2)\nHafnium(IV) oxide (HfO2)\nLead dioxide (PbO2)\nManganese dioxide (MnO2)\nNeptunium(IV) oxide (NpO2)\nNitrogen dioxide (NO2)\nOsmium dioxide (OsO2)\nPlutonium(IV) oxide (PuO2)\nPraseodymium(IV) oxide (PrO2)\nProtactinium(IV) oxide (PaO2)\nRhodium(IV) oxide (RhO2)\nRuthenium(IV) oxide (RuO2)\nSelenium dioxide (SeO2)\nSilicon dioxide (SiO2)\nSulfur dioxide (SO2)\nTellurium dioxide (TeO2)\nTerbium(IV) oxide (TbO2)\nThorium dioxide (ThO2)\nTin dioxide (SnO2)\nTitanium dioxide (TiO2)\nTungsten(IV) oxide (WO2)\nUranium dioxide (UO2)\nVanadium(IV) oxide (VO2)\nZirconium dioxide (ZrO2)\n+5 oxidation state\nAntimony pentoxide (Sb2O5)\nArsenic pentoxide (As2O5)\nDinitrogen pentoxide (N2O5)\nNiobium pentoxide (Nb2O5)\nPhosphorus pentoxide (P2O5)\nProtactinium(V) oxide (Pa2O5)\nTantalum pentoxide (Ta2O5)\nVanadium(V) oxide (V2O5)\n+6 oxidation state\nChromium trioxide (CrO3)\nMolybdenum trioxide (MoO3)\nRhenium trioxide (ReO3)\nSelenium trioxide (SeO3)\nSulfur trioxide (SO3)\nTellurium trioxide (TeO3)\nTungsten trioxide (WO3)\nUranium trioxide (UO3)\nXenon trioxide (XeO3)\nIridium trioxide (IrO3)\n+7 oxidation state\nDichlorine heptoxide (Cl2O7)\nManganese heptoxide (Mn2O7)\nRhenium(VII) oxide (Re2O7)\nTechnetium(VII) oxide (Tc2O7)\n+8 oxidation state\nOsmium tetroxide (OsO4)\nRuthenium tetroxide (RuO4)\nXenon tetroxide (XeO4)\nIridium tetroxide (IrO4)\nHassium tetroxide (HsO4)\nRelated\nOxocarbon\nSuboxide\nOxyanion\nOzonide\nPeroxide\nSuperoxide\nOxides are sorted by oxidation state.\nCategory:Oxides\nvteOxygen compounds\nAgO\nAl2O3\nAmO2\nAm2O3\nAs2O3\nAs2O5\nAu2O3\nB2O3\nBaO\nBeO\nBi2O3\nBiO2\nBi2O5\nBrO2\nBr2O3\nBr2O5\nCO\nCO2\nC2O3\nCaO\nCaO2\nCdO\nCeO2\nCe3O4\nCe2O3\nClO2\nCl2O\nCl2O3\nCl2O4\nCl2O6\nCl2O7\nCoO\nCo2O3\nCo3O4\nCrO3\nCr2O3\nCr2O5\nCr5O12\nCsO2\nCs2O3\nCuO\nD2O\nDy2O3\nEr2O3\nEu2O3\nOF\r\n2 \nO\r\n2 F\r\n2 \nO\r\n3 F\r\n2 \nO\r\n4 F\r\n2 \nFeO\nFe2O3\nFe3O4\nGa2O\nGa2O3\nGeO\nGeO2\nH2O\nH218O\nH2O2\nHfO2\nHgO\nHg2O\nHo2O3\nI2O4\nI2O5\nI2O6\nI4O9\nIn2O3\nIrO2\nKO2\nK2O2\nLa2O3\nLi2O\nLi2O2\nLu2O3\nMgO\nMg2O3\nMnO\nMnO2\nMn2O3\nMn2O7\nMoO2\nMoO3\nMo2O3\nNO\nNO2\nN2O\nN2O3\nN2O4\nN2O5\nNaO2\nNa2O\nNa2O2\nNbO\nNbO2\nNd2O3\nChemical formulas\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Aluminium_oxide\">https:\/\/www.limswiki.org\/index.php\/Aluminium_oxide<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 11 March 2016, at 19:43.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,187 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","b52fd310a75c0ad51d3c8adcc8f559d9_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Aluminium_oxide skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Aluminium oxide<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">This article is about aluminium(III) oxide, Al<sub>2<\/sub>O<sub>3<\/sub>. For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium_oxide_(compounds)\" class=\"mw-redirect\" title=\"Aluminium oxide (compounds)\" rel=\"external_link\" target=\"_blank\">Aluminium oxide (compounds)<\/a>.<\/div>\n\n<p><b>Aluminium oxide<\/b> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/IUPAC\" class=\"mw-redirect\" title=\"IUPAC\" rel=\"external_link\" target=\"_blank\">IUPAC<\/a> name) or <b>aluminum oxide<\/b> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/American_English\" title=\"American English\" rel=\"external_link\" target=\"_blank\">American English<\/a>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_compound\" title=\"Chemical compound\" rel=\"external_link\" target=\"_blank\">chemical compound<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium\" title=\"Aluminium\" rel=\"external_link\" target=\"_blank\">aluminium<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen\" title=\"Oxygen\" rel=\"external_link\" target=\"_blank\">oxygen<\/a> with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_formula\" title=\"Chemical formula\" rel=\"external_link\" target=\"_blank\">chemical formula<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium\" title=\"Aluminium\" rel=\"external_link\" target=\"_blank\">Al<\/a><sub>2<\/sub><a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen\" title=\"Oxygen\" rel=\"external_link\" target=\"_blank\">O<\/a><sub>3<\/sub>. It is the most commonly occurring of several <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium_oxide_(compounds)\" class=\"mw-redirect\" title=\"Aluminium oxide (compounds)\" rel=\"external_link\" target=\"_blank\">aluminium oxides<\/a>, and specifically identified as <b>aluminium(III) oxide<\/b>. It is commonly called <b>alumina<\/b> (regardless of whether the element is spelled aluminum or aluminium), and may also be called <b>aloxide<\/b>, <b>aloxite<\/b>, or <b>alundum<\/b> depending on particular forms or applications. It occurs naturally in its crystalline <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymorphism_(materials_science)\" title=\"Polymorphism (materials science)\" rel=\"external_link\" target=\"_blank\">polymorphic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phase_(matter)\" title=\"Phase (matter)\" rel=\"external_link\" target=\"_blank\">phase<\/a> \u03b1-Al<sub>2<\/sub>O<sub>3<\/sub> as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mineral\" title=\"Mineral\" rel=\"external_link\" target=\"_blank\">mineral<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corundum\" title=\"Corundum\" rel=\"external_link\" target=\"_blank\">corundum<\/a>, varieties of which form the precious <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gemstone\" title=\"Gemstone\" rel=\"external_link\" target=\"_blank\">gemstones<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ruby\" title=\"Ruby\" rel=\"external_link\" target=\"_blank\">ruby<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sapphire\" title=\"Sapphire\" rel=\"external_link\" target=\"_blank\">sapphire<\/a>. Al<sub>2<\/sub>O<sub>3<\/sub> is significant in its use to produce aluminium metal, as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abrasive\" title=\"Abrasive\" rel=\"external_link\" target=\"_blank\">abrasive<\/a> owing to its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hardness\" title=\"Hardness\" rel=\"external_link\" target=\"_blank\">hardness<\/a>, and as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refractory\" title=\"Refractory\" rel=\"external_link\" target=\"_blank\">refractory<\/a> material owing to its high melting point.<sup id=\"rdp-ebb-cite_ref-azom_7-0\" class=\"reference\"><a href=\"#cite_note-azom-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Natural_occurrence\">Natural occurrence<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Corundum\" title=\"Corundum\" rel=\"external_link\" target=\"_blank\">Corundum<\/a> is the most common naturally occurring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystallinity\" title=\"Crystallinity\" rel=\"external_link\" target=\"_blank\">crystalline<\/a> form of aluminium oxide.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ruby\" title=\"Ruby\" rel=\"external_link\" target=\"_blank\">Rubies<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sapphire\" title=\"Sapphire\" rel=\"external_link\" target=\"_blank\">sapphires<\/a> are gem-quality forms of corundum, which owe their characteristic colors to trace impurities. Rubies are given their characteristic deep red color and their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laser\" title=\"Laser\" rel=\"external_link\" target=\"_blank\">laser<\/a> qualities by traces of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium\" title=\"Chromium\" rel=\"external_link\" target=\"_blank\">chromium<\/a>. Sapphires come in different colors given by various other impurities, such as iron and titanium.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Properties\">Properties<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Oxid_hlinit%C3%BD.PNG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Aluminium oxide in its powdered form.\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a2\/Oxid_hlinit%C3%BD.PNG\/220px-Oxid_hlinit%C3%BD.PNG\" width=\"220\" height=\"85\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Oxid_hlinit%C3%BD.PNG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Aluminium oxide in its powdered form.<\/div><\/div><\/div>\n<p>Al<sub>2<\/sub>O<sub>3<\/sub> is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulator_(electricity)\" title=\"Insulator (electricity)\" rel=\"external_link\" target=\"_blank\">electrical insulator<\/a> but has a relatively high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermal_conductivity\" title=\"Thermal conductivity\" rel=\"external_link\" target=\"_blank\">thermal conductivity<\/a> (<span class=\"nowrap\">30 Wm<sup>\u22121<\/sup>K<sup>\u22121<\/sup><\/span>)<sup id=\"rdp-ebb-cite_ref-properties_2-1\" class=\"reference\"><a href=\"#cite_note-properties-2\" rel=\"external_link\">[2]<\/a><\/sup> for a ceramic material. Aluminium oxide is insoluble in water. In its most commonly occurring crystalline form, called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corundum\" title=\"Corundum\" rel=\"external_link\" target=\"_blank\">corundum<\/a> or \u03b1-aluminium oxide, its hardness makes it suitable for use as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abrasive\" title=\"Abrasive\" rel=\"external_link\" target=\"_blank\">abrasive<\/a> and as a component in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cutting_tools\" class=\"mw-redirect\" title=\"Cutting tools\" rel=\"external_link\" target=\"_blank\">cutting tools<\/a>.<sup id=\"rdp-ebb-cite_ref-azom_7-1\" class=\"reference\"><a href=\"#cite_note-azom-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>Aluminium oxide is responsible for the resistance of metallic aluminium to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Weathering\" title=\"Weathering\" rel=\"external_link\" target=\"_blank\">weathering<\/a>. Metallic aluminium is very reactive with atmospheric oxygen, and a thin <a href=\"https:\/\/en.wikipedia.org\/wiki\/Passivation_(chemistry)\" title=\"Passivation (chemistry)\" rel=\"external_link\" target=\"_blank\">passivation layer<\/a> of aluminium oxide (4 nm thickness) forms on any exposed aluminium surface.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> This layer protects the metal from further oxidation. The thickness and properties of this oxide layer can be enhanced using a process called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anodising\" class=\"mw-redirect\" title=\"Anodising\" rel=\"external_link\" target=\"_blank\">anodising<\/a>. A number of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alloys\" class=\"mw-redirect\" title=\"Alloys\" rel=\"external_link\" target=\"_blank\">alloys<\/a>, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium_bronze\" title=\"Aluminium bronze\" rel=\"external_link\" target=\"_blank\">aluminium bronzes<\/a>, exploit this property by including a proportion of aluminium in the alloy to enhance corrosion resistance. The aluminium oxide generated by anodising is typically <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amorphous\" class=\"mw-redirect\" title=\"Amorphous\" rel=\"external_link\" target=\"_blank\">amorphous<\/a>, but discharge assisted oxidation processes such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plasma_electrolytic_oxidation\" title=\"Plasma electrolytic oxidation\" rel=\"external_link\" target=\"_blank\">plasma electrolytic oxidation<\/a> result in a significant proportion of crystalline aluminium oxide in the coating, enhancing its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hardness\" title=\"Hardness\" rel=\"external_link\" target=\"_blank\">hardness<\/a>.\n<\/p><p>Aluminium oxide was taken off the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Environmental_Protection_Agency\" title=\"United States Environmental Protection Agency\" rel=\"external_link\" target=\"_blank\">United States Environmental Protection Agency<\/a>'s chemicals lists in 1988. Aluminium oxide is on the EPA's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxics_Release_Inventory\" title=\"Toxics Release Inventory\" rel=\"external_link\" target=\"_blank\">Toxics Release Inventory<\/a> list if it is a fibrous form.<sup id=\"rdp-ebb-cite_ref-TRI_10-0\" class=\"reference\"><a href=\"#cite_note-TRI-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Amphoteric_nature\">Amphoteric nature<\/span><\/h3>\n<p>Aluminium oxide is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amphoteric\" class=\"mw-redirect\" title=\"Amphoteric\" rel=\"external_link\" target=\"_blank\">amphoteric<\/a> substance, meaning it can react with both <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acids\" class=\"mw-redirect\" title=\"Acids\" rel=\"external_link\" target=\"_blank\">acids<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Base_(chemistry)\" title=\"Base (chemistry)\" rel=\"external_link\" target=\"_blank\">bases<\/a>, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrofluoric_acid\" title=\"Hydrofluoric acid\" rel=\"external_link\" target=\"_blank\">hydrofluoric acid<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_hydroxide\" title=\"Sodium hydroxide\" rel=\"external_link\" target=\"_blank\">sodium hydroxide<\/a>, acting as an acid with a base and a base with an acid, neutralising the other and producing a salt.\n<\/p>\n<dl><dd>Al<sub>2<\/sub>O<sub>3<\/sub> + 6 HF \u2192 2 AlF<sub>3<\/sub> + 3 H<sub>2<\/sub>O<\/dd>\n<dd>Al<sub>2<\/sub>O<sub>3<\/sub> + 2 NaOH + 3 H<sub>2<\/sub>O \u2192 2 NaAl(OH)<sub>4<\/sub> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_aluminate\" title=\"Sodium aluminate\" rel=\"external_link\" target=\"_blank\">sodium aluminate<\/a>)<\/dd><\/dl>\n<h2><span class=\"mw-headline\" id=\"Structure\">Structure<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:182px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Corindon_azulEZ.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1e\/Corindon_azulEZ.jpg\/180px-Corindon_azulEZ.jpg\" width=\"180\" height=\"150\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Corindon_azulEZ.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Corundum from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brazil\" title=\"Brazil\" rel=\"external_link\" target=\"_blank\">Brazil<\/a>, size about 2\u00d73 cm.<\/div><\/div><\/div>\n<p>The most common form of crystalline aluminium oxide is known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corundum\" title=\"Corundum\" rel=\"external_link\" target=\"_blank\">corundum<\/a>, which is the thermodynamically stable form.<sup id=\"rdp-ebb-cite_ref-Levin_11-0\" class=\"reference\"><a href=\"#cite_note-Levin-11\" rel=\"external_link\">[11]<\/a><\/sup> The oxygen ions form a nearly hexagonal close-packed structure with the aluminium ions filling two-thirds of the octahedral interstices. Each Al<sup>3+<\/sup> center is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Octahedral_molecular_geometry\" title=\"Octahedral molecular geometry\" rel=\"external_link\" target=\"_blank\">octahedral<\/a>. In terms of its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystallography\" title=\"Crystallography\" rel=\"external_link\" target=\"_blank\">crystallography<\/a>, corundum adopts a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trigonal\" class=\"mw-redirect\" title=\"Trigonal\" rel=\"external_link\" target=\"_blank\">trigonal<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bravais_lattice\" title=\"Bravais lattice\" rel=\"external_link\" target=\"_blank\">Bravais lattice<\/a> with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Space_group\" title=\"Space group\" rel=\"external_link\" target=\"_blank\">space group<\/a> of R-3c (number 167 in the International Tables). The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Primitive_cell\" title=\"Primitive cell\" rel=\"external_link\" target=\"_blank\">primitive cell<\/a> contains two formula units of aluminium oxide.\n<\/p><p>Aluminium oxide also exists in other phases, including the cubic \u03b3 and \u03b7 phases, the monoclinic \u03b8 phase, the hexagonal \u03c7 phase, the orthorhombic \u03ba phase and the \u03b4 phase that can be tetragonal or orthorhombic.<sup id=\"rdp-ebb-cite_ref-Levin_11-1\" class=\"reference\"><a href=\"#cite_note-Levin-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Paglia_12-0\" class=\"reference\"><a href=\"#cite_note-Paglia-12\" rel=\"external_link\">[12]<\/a><\/sup> Each has a unique crystal structure and properties. Cubic \u03b3-Al<sub>2<\/sub>O<sub>3<\/sub> has important technical applications. The so-called \u03b2-Al<sub>2<\/sub>O<sub>3<\/sub> proved to be NaAl<sub>11<\/sub>O<sub>17<\/sub>.<sup id=\"rdp-ebb-cite_ref-Wiberg&Holleman_13-0\" class=\"reference\"><a href=\"#cite_note-Wiberg&Holleman-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p><p>Molten aluminium oxide near the melting temperature is roughly 2\/3 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tetrahedral\" class=\"mw-redirect\" title=\"Tetrahedral\" rel=\"external_link\" target=\"_blank\">tetrahedral<\/a> (i.e. 2\/3 of the Al are surrounded by 4 oxygen neighbors), and 1\/3 5-coordinated, very little (<5%) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Octahedral\" class=\"mw-redirect\" title=\"Octahedral\" rel=\"external_link\" target=\"_blank\">octahedral<\/a> Al-O is present.<sup id=\"rdp-ebb-cite_ref-Skinner2013_14-0\" class=\"reference\"><a href=\"#cite_note-Skinner2013-14\" rel=\"external_link\">[14]<\/a><\/sup> Around 80% of the oxygen atoms are shared among three or more Al-O polyhedra, and the majority of inter-polyhedral connections are corner-sharing, with the remaining 10\u201320% being edge-sharing.<sup id=\"rdp-ebb-cite_ref-Skinner2013_14-1\" class=\"reference\"><a href=\"#cite_note-Skinner2013-14\" rel=\"external_link\">[14]<\/a><\/sup> The breakdown of octahedra upon melting is accompanied by a relatively large volume increase (~20%), the density of the liquid close to its melting point is 2.93 g\/cm<sup>3<\/sup>.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Production\">Production<\/span><\/h2>\n<p>Aluminium <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxide\" title=\"Hydroxide\" rel=\"external_link\" target=\"_blank\">hydroxide<\/a> minerals are the main component of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bauxite\" title=\"Bauxite\" rel=\"external_link\" target=\"_blank\">bauxite<\/a>, the principal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ore\" title=\"Ore\" rel=\"external_link\" target=\"_blank\">ore<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium\" title=\"Aluminium\" rel=\"external_link\" target=\"_blank\">aluminium<\/a>. A mixture of the minerals comprise bauxite ore, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gibbsite\" title=\"Gibbsite\" rel=\"external_link\" target=\"_blank\">gibbsite<\/a> (Al(OH)<sub>3<\/sub>), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boehmite\" title=\"Boehmite\" rel=\"external_link\" target=\"_blank\">boehmite<\/a> (\u03b3-AlO(OH)), and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diaspore\" title=\"Diaspore\" rel=\"external_link\" target=\"_blank\">diaspore<\/a> (\u03b1-AlO(OH)), along with impurities of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron_oxide\" title=\"Iron oxide\" rel=\"external_link\" target=\"_blank\">iron oxides<\/a> and hydroxides, quartz and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clay_minerals\" title=\"Clay minerals\" rel=\"external_link\" target=\"_blank\">clay minerals<\/a>.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> Bauxites are found in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laterite\" title=\"Laterite\" rel=\"external_link\" target=\"_blank\">laterites<\/a>. Bauxite is purified by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bayer_process\" title=\"Bayer process\" rel=\"external_link\" target=\"_blank\">Bayer process<\/a>:\n<\/p>\n<dl><dd>Al<sub>2<\/sub>O<sub>3<\/sub> + H<sub>2<\/sub>O + NaOH \u2192 NaAl(OH)<sub>4<\/sub><\/dd>\n<dd>Al(OH)<sub>3<\/sub> + NaOH \u2192 NaAl(OH)<sub>4<\/sub><\/dd><\/dl>\n<p>Except for SiO<sub>2<\/sub>, the other components of bauxite do not dissolve in base. Upon filtering the basic mixture, Fe<sub>2<\/sub>O<sub>3<\/sub> is removed. When the Bayer liquor is cooled, Al(OH)<sub>3<\/sub> precipitates, leaving the silicates in solution.\n<\/p>\n<dl><dd>NaAl(OH)<sub>4<\/sub> \u2192 NaOH + Al(OH)<sub>3<\/sub><\/dd><\/dl>\n<p>The solid Al(OH)<sub>3<\/sub> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gibbsite\" title=\"Gibbsite\" rel=\"external_link\" target=\"_blank\">Gibbsite<\/a> is then <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcined\" class=\"mw-redirect\" title=\"Calcined\" rel=\"external_link\" target=\"_blank\">calcined<\/a> (heated to over 1100 \u00b0C) to give aluminium oxide:<sup id=\"rdp-ebb-cite_ref-azom_7-2\" class=\"reference\"><a href=\"#cite_note-azom-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<dl><dd>2 Al(OH)<sub>3<\/sub> \u2192 Al<sub>2<\/sub>O<sub>3<\/sub> + 3 H<sub>2<\/sub>O<\/dd><\/dl>\n<p>The product aluminium oxide tends to be multi-phase, i.e., consisting of several phases of aluminium oxide rather than solely <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corundum\" title=\"Corundum\" rel=\"external_link\" target=\"_blank\">corundum<\/a>.<sup id=\"rdp-ebb-cite_ref-Paglia_12-1\" class=\"reference\"><a href=\"#cite_note-Paglia-12\" rel=\"external_link\">[12]<\/a><\/sup> The production process can therefore be optimized to produce a tailored product. The type of phases present affects, for example, the solubility and pore structure of the aluminium oxide product which, in turn, affects the cost of aluminium production and pollution control.<sup id=\"rdp-ebb-cite_ref-Paglia_12-2\" class=\"reference\"><a href=\"#cite_note-Paglia-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p>For its application as an electrical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulator_(electricity)\" title=\"Insulator (electricity)\" rel=\"external_link\" target=\"_blank\">insulator<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Integrated_circuits\" class=\"mw-redirect\" title=\"Integrated circuits\" rel=\"external_link\" target=\"_blank\">integrated circuits<\/a>, where the conformal growth of a thin film is a prerequisite and the preferred growth mode is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atomic_layer_deposition\" title=\"Atomic layer deposition\" rel=\"external_link\" target=\"_blank\">atomic layer deposition<\/a>, Al<sub>2<\/sub>O<sub>3<\/sub> films can be prepared by the chemical exchange between trimethylaluminum Al(CH<sub>3<\/sub>)<sub>3<\/sub> and H<sub>2<\/sub>O:<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<dl><dd>2 Al(CH<sub>3<\/sub>)<sub>3<\/sub> + 3 H<sub>2<\/sub>O \u2192 Al<sub>2<\/sub>O<sub>3<\/sub> + 6 CH<sub>4<\/sub><\/dd><\/dl>\n<p>H<sub>2<\/sub>O in the above reaction can be replaced by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ozone\" title=\"Ozone\" rel=\"external_link\" target=\"_blank\">ozone<\/a> (O<sub>3<\/sub>) as the active oxidant and the following reaction then takes place:<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<dl><dd>2 Al(CH<sub>3<\/sub>)<sub>3<\/sub> + O<sub>3<\/sub> \u2192 Al<sub>2<\/sub>O<sub>3<\/sub> + 3 C<sub>2<\/sub>H<sub>6<\/sub><\/dd><\/dl>\n<p>The Al<sub>2<\/sub>O<sub>3<\/sub> films prepared using O<sub>3<\/sub> show 10\u2013100 times lower leakage current density compared with those prepared by H<sub>2<\/sub>O.\n<\/p><p>Known as alundum (in fused form) or aloxite<sup id=\"rdp-ebb-cite_ref-CI14835_20-0\" class=\"reference\"><a href=\"#cite_note-CI14835-20\" rel=\"external_link\">[20]<\/a><\/sup> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mining\" title=\"Mining\" rel=\"external_link\" target=\"_blank\">mining<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic\" title=\"Ceramic\" rel=\"external_link\" target=\"_blank\">ceramic<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Materials_science\" title=\"Materials science\" rel=\"external_link\" target=\"_blank\">materials science<\/a> communities, aluminium oxide finds wide use. Annual world production of aluminium oxide in 2015 was approximately 115 million <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tonne\" title=\"Tonne\" rel=\"external_link\" target=\"_blank\">tonnes<\/a>, over 90% of which is used in the manufacture of aluminium metal.<sup id=\"rdp-ebb-cite_ref-azom_7-3\" class=\"reference\"><a href=\"#cite_note-azom-7\" rel=\"external_link\">[7]<\/a><\/sup> The major uses of speciality aluminium oxides are in refractories, ceramics, polishing and abrasive applications. Large tonnages of aluminium hydroxide, from which alumina is derived, are used in the manufacture of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zeolites\" class=\"mw-redirect\" title=\"Zeolites\" rel=\"external_link\" target=\"_blank\">zeolites<\/a>, coating <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_dioxide\" title=\"Titanium dioxide\" rel=\"external_link\" target=\"_blank\">titania<\/a> pigments, and as a fire retardant\/smoke suppressant.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n\n<p>Over 90% of the aluminium oxide, normally termed Smelter Grade Alumina (SGA), produced is consumed for the production of aluminium, usually by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hall%E2%80%93H%C3%A9roult_process\" title=\"Hall\u2013H\u00e9roult process\" rel=\"external_link\" target=\"_blank\">Hall\u2013H\u00e9roult process<\/a>. The remainder, normally called speciality alumina is used in a wide variety of applications which reflect its inertness, temperature resistance and electrical resistance.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<ul><li>Filler:<\/li><\/ul>\n<p>Being fairly chemically inert and white, aluminium oxide is a favored filler for plastics. Aluminium oxide is a common ingredient in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sunscreen\" title=\"Sunscreen\" rel=\"external_link\" target=\"_blank\">sunscreen<\/a> and is sometimes also present in cosmetics such as blush, lipstick, and nail polish.\n<\/p>\n<ul><li>Glass:<\/li><\/ul>\n<p>Many formulations of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass\" title=\"Glass\" rel=\"external_link\" target=\"_blank\">glass<\/a> have aluminium oxide as an ingredient.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<ul><li>Catalysis:<\/li><\/ul>\n<p>Aluminium oxide catalyses a variety of reactions that are useful industrially. In its largest scale application, aluminium oxide is the catalyst in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Claus_process\" title=\"Claus process\" rel=\"external_link\" target=\"_blank\">Claus process<\/a> for converting hydrogen sulfide waste gases into elemental sulfur in refineries. It is also useful for dehydration of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alcohol\" title=\"Alcohol\" rel=\"external_link\" target=\"_blank\">alcohols<\/a> to alkenes.\n<\/p><p>Aluminium oxide serves as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalyst_support\" title=\"Catalyst support\" rel=\"external_link\" target=\"_blank\">catalyst support<\/a> for many industrial catalysts, such as those used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrodesulfurization\" title=\"Hydrodesulfurization\" rel=\"external_link\" target=\"_blank\">hydrodesulfurization<\/a> and some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ziegler-Natta\" class=\"mw-redirect\" title=\"Ziegler-Natta\" rel=\"external_link\" target=\"_blank\">Ziegler-Natta<\/a> polymerizations.\n<\/p>\n<ul><li>Purification:<\/li><\/ul>\n<p>Aluminium oxide is widely used to remove water from gas streams.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p>\n<ul><li>Abrasive:<\/li><\/ul>\n<p>Aluminium oxide is used for its hardness and strength. It is widely used as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abrasive\" title=\"Abrasive\" rel=\"external_link\" target=\"_blank\">abrasive<\/a>, including as a much less expensive substitute for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Industrial_diamond\" class=\"mw-redirect\" title=\"Industrial diamond\" rel=\"external_link\" target=\"_blank\">industrial diamond<\/a>. Many types of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sandpaper\" title=\"Sandpaper\" rel=\"external_link\" target=\"_blank\">sandpaper<\/a> use aluminium oxide crystals. In addition, its low heat retention and low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Specific_heat\" class=\"mw-redirect\" title=\"Specific heat\" rel=\"external_link\" target=\"_blank\">specific heat<\/a> make it widely used in grinding operations, particularly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metalworking\" title=\"Metalworking\" rel=\"external_link\" target=\"_blank\">cutoff<\/a> tools. As the powdery abrasive mineral <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aloxite\" class=\"mw-redirect\" title=\"Aloxite\" rel=\"external_link\" target=\"_blank\">aloxite<\/a>, it is a major component, along with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silica\" class=\"mw-redirect\" title=\"Silica\" rel=\"external_link\" target=\"_blank\">silica<\/a>, of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cue_stick\" title=\"Cue stick\" rel=\"external_link\" target=\"_blank\">cue tip<\/a> \"chalk\" used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cue_sports\" title=\"Cue sports\" rel=\"external_link\" target=\"_blank\">billiards<\/a>. Aluminium oxide powder is used in some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Compact_disc\" title=\"Compact disc\" rel=\"external_link\" target=\"_blank\">CD<\/a>\/<a href=\"https:\/\/en.wikipedia.org\/wiki\/DVD\" title=\"DVD\" rel=\"external_link\" target=\"_blank\">DVD<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polishing\" title=\"Polishing\" rel=\"external_link\" target=\"_blank\">polishing<\/a> and scratch-repair kits. Its polishing qualities are also behind its use in toothpaste.\n<\/p>\n<ul><li>Paint:<\/li><\/ul>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alumina_effect_pigment\" title=\"Alumina effect pigment\" rel=\"external_link\" target=\"_blank\">Alumina effect pigment<\/a><\/div>\n<p>Aluminium oxide flakes are used in paint for reflective decorative effects, such as in the automotive or cosmetic industries.\n<\/p>\n<ul><li>Composite fiber:<\/li><\/ul>\n<p>Aluminium oxide has been used in a few experimental and commercial fiber materials for high-performance applications (e.g., Fiber FP, Nextel 610, Nextel 720).<sup id=\"rdp-ebb-cite_ref-mallick_24-0\" class=\"reference\"><a href=\"#cite_note-mallick-24\" rel=\"external_link\">[24]<\/a><\/sup> Alumina <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nanofibers\" class=\"mw-redirect\" title=\"Nanofibers\" rel=\"external_link\" target=\"_blank\">nanofibers<\/a> in particular have become a research field of interest.\n<\/p>\n<ul><li>Personal armor:<\/li><\/ul>\n<p>Some body armors utilize alumina ceramic plates, usually in combination with aramid or UHMWPE backing to achieve effectiveness against even most rifle threats. Alumina ceramic armor is readily available to most civilians in jurisdictions where it is legal, but is not considered military grade.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p>\n<ul><li>Abrasion protection:<\/li><\/ul>\n<p>Aluminium oxide can be grown as a coating on aluminium by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anodizing\" title=\"Anodizing\" rel=\"external_link\" target=\"_blank\">anodizing<\/a> or by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plasma_electrolytic_oxidation\" title=\"Plasma electrolytic oxidation\" rel=\"external_link\" target=\"_blank\">plasma electrolytic oxidation<\/a> (see the \"Properties\" above). Both the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hardness\" title=\"Hardness\" rel=\"external_link\" target=\"_blank\">hardness<\/a> and abrasion-resistant characteristics of the coating originate from the high strength of aluminium oxide, yet the porous coating layer produced with conventional direct current anodizing procedures is within a 60-70 Rockwell hardness C range <sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> which is comparable only to hardened carbon steel alloys, but considerably inferior to the hardness of natural and synthetic corundum. Instead, with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plasma_electrolytic_oxidation\" title=\"Plasma electrolytic oxidation\" rel=\"external_link\" target=\"_blank\">plasma electrolytic oxidation<\/a>, the coating is porous only on the surface oxide layer while the lower oxide layers are much more compact than with standard DC anodizing procedures and present a higher crystallinity due to the oxide layers being remelted and densified to obtain \u03b1-Al2O3 clusters<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> with much higher coating hardness values circa 2000 Vickers hardness.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:2005alumina.PNG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/db\/2005alumina.PNG\/220px-2005alumina.PNG\" width=\"220\" height=\"96\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:2005alumina.PNG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Aluminium oxide output in 2005<\/div><\/div><\/div><p>Alumina is used to manufacture tiles which are attached inside pulverized fuel lines and flue gas ducting on coal fired power stations to protect high wear areas. They are not suitable for areas with high impact forces as these tiles are brittle and susceptible to breakage.\n<\/p><ul><li>Other:<\/li><\/ul>\n<p>In lighting, transparent aluminium oxide is used in some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_vapor_lamp\" class=\"mw-redirect\" title=\"Sodium vapor lamp\" rel=\"external_link\" target=\"_blank\">sodium vapor lamps<\/a>.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> Aluminium oxide is also used in preparation of coating suspensions in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Compact_fluorescent_lamp\" title=\"Compact fluorescent lamp\" rel=\"external_link\" target=\"_blank\">compact fluorescent lamps<\/a>.\n<\/p><p>In chemistry laboratories, aluminium oxide is a medium for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromatography\" title=\"Chromatography\" rel=\"external_link\" target=\"_blank\">chromatography<\/a>, available in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Base_(chemistry)\" title=\"Base (chemistry)\" rel=\"external_link\" target=\"_blank\">basic<\/a> (pH 9.5), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acid\" title=\"Acid\" rel=\"external_link\" target=\"_blank\">acidic<\/a> (pH 4.5 when in water) and neutral formulations.\n<\/p><p>Health and medical applications include it as a material in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">hip replacements<\/a><sup id=\"rdp-ebb-cite_ref-azom_7-4\" class=\"reference\"><a href=\"#cite_note-azom-7\" rel=\"external_link\">[7]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oral_contraceptive_pill\" title=\"Oral contraceptive pill\" rel=\"external_link\" target=\"_blank\">birth control pills<\/a>.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p><p>It is used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dosimeter\" title=\"Dosimeter\" rel=\"external_link\" target=\"_blank\">dosimeter<\/a> for radiation protection and therapy applications for its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optically_stimulated_luminescence\" title=\"Optically stimulated luminescence\" rel=\"external_link\" target=\"_blank\">optically stimulated luminescence<\/a> properties.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2014)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Aluminium oxide is an electrical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulator_(electricity)\" title=\"Insulator (electricity)\" rel=\"external_link\" target=\"_blank\">insulator<\/a> used as a substrate (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon_on_sapphire\" title=\"Silicon on sapphire\" rel=\"external_link\" target=\"_blank\">silicon on sapphire<\/a>) for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Integrated_circuits\" class=\"mw-redirect\" title=\"Integrated circuits\" rel=\"external_link\" target=\"_blank\">integrated circuits<\/a> but also as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quantum_tunneling\" class=\"mw-redirect\" title=\"Quantum tunneling\" rel=\"external_link\" target=\"_blank\">tunnel barrier<\/a> for the fabrication of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superconducting\" class=\"mw-redirect\" title=\"Superconducting\" rel=\"external_link\" target=\"_blank\">superconducting<\/a> devices such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Single_electron_transistor\" class=\"mw-redirect\" title=\"Single electron transistor\" rel=\"external_link\" target=\"_blank\">single electron transistors<\/a> and superconducting quantum interference devices (<a href=\"https:\/\/en.wikipedia.org\/wiki\/SQUID\" title=\"SQUID\" rel=\"external_link\" target=\"_blank\">SQUIDs<\/a>).\n<\/p><p>Aluminum oxide being a dielectric with relatively large band gap is used as an insulating barrier in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capacitors\" class=\"mw-redirect\" title=\"Capacitors\" rel=\"external_link\" target=\"_blank\">capacitors<\/a>.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p><p>Insulation for high-temperature furnaces is often manufactured from aluminium oxide. Sometimes the insulation has varying percentages of silica depending on the temperature rating of the material. The insulation can be made in blanket, board, brick and loose fiber forms for various application requirements.\n<\/p><p>Small pieces of aluminium oxide are often used as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boiling_chips\" class=\"mw-redirect\" title=\"Boiling chips\" rel=\"external_link\" target=\"_blank\">boiling chips<\/a> in chemistry.\n<\/p><p>It is also used to make <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spark_plug\" title=\"Spark plug\" rel=\"external_link\" target=\"_blank\">spark plug<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulator_(electricity)\" title=\"Insulator (electricity)\" rel=\"external_link\" target=\"_blank\">insulators<\/a>.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup>\n<\/p><p>Using a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plasma_spraying\" class=\"mw-redirect\" title=\"Plasma spraying\" rel=\"external_link\" target=\"_blank\">plasma spray<\/a> process and mixed with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_dioxide\" title=\"Titanium dioxide\" rel=\"external_link\" target=\"_blank\">titania<\/a>, it is coated onto the braking surface of some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bicycle\" title=\"Bicycle\" rel=\"external_link\" target=\"_blank\">bicycle<\/a> rims to provide abrasion and wear resistance.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2011)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Most ceramic eyes on fishing rods are circular rings made from aluminium oxide.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2014)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium_oxide_nanoparticle\" title=\"Aluminium oxide nanoparticle\" rel=\"external_link\" target=\"_blank\">Aluminium oxide nanoparticle<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Charged_Aerosol_Release_Experiment\" title=\"Charged Aerosol Release Experiment\" rel=\"external_link\" target=\"_blank\">Charged Aerosol Release Experiment<\/a> (CARE)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_alumina_refineries\" title=\"List of alumina refineries\" rel=\"external_link\" target=\"_blank\">List of alumina refineries<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Micro-Pulling-Down\" class=\"mw-redirect\" title=\"Micro-Pulling-Down\" rel=\"external_link\" target=\"_blank\">Micro-Pulling-Down<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Transparent_alumina\" class=\"mw-redirect\" title=\"Transparent alumina\" rel=\"external_link\" target=\"_blank\">Transparent alumina<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bauxite_tailings\" title=\"Bauxite tailings\" rel=\"external_link\" target=\"_blank\">Bauxite tailings<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-chemsrc-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-chemsrc_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.chemsrc.com\/en\/cas\/1344-28-1_177878.html\" target=\"_blank\">\"Aluminum oxide_msds\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Aluminum+oxide_msds&rft_id=https%3A%2F%2Fwww.chemsrc.com%2Fen%2Fcas%2F1344-28-1_177878.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-properties-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-properties_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-properties_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.makeitfrom.com\/data\/?material=Alumina\" target=\"_blank\">Material Properties Data: Alumina (Aluminum Oxide)<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100401131344\/http:\/\/www.makeitfrom.com\/data\/?material=Alumina\" target=\"_blank\">Archived<\/a> 2010-04-01 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Makeitfrom.com. Retrieved on 2013-04-17.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Patnaik, P. (2002). <i>Handbook of Inorganic Chemicals<\/i>. McGraw-Hill. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-07-049439-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Handbook+of+Inorganic+Chemicals&rft.pub=McGraw-Hill&rft.date=2002&rft.isbn=0-07-049439-8&rft.au=Patnaik%2C+P.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Raymond C. Rowe; Paul J. Sheskey; Marian E. Quinn (2009). \"Adipic acid\". <i>Handbook of Pharmaceutical Excipients<\/i>. Pharmaceutical Press. pp. 11\u201312. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-85369-792-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Adipic+acid&rft.btitle=Handbook+of+Pharmaceutical+Excipients&rft.pages=11-12&rft.pub=Pharmaceutical+Press&rft.date=2009&rft.isbn=978-0-85369-792-3&rft.au=Raymond+C.+Rowe&rft.au=Paul+J.+Sheskey&rft.au=Marian+E.+Quinn&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-b1-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-b1_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-b1_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Zumdahl, Steven S. (2009). <i>Chemical Principles 6th Ed<\/i>. Houghton Mifflin Company. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-618-94690-X.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Chemical+Principles+6th+Ed.&rft.pub=Houghton+Mifflin+Company&rft.date=2009&rft.isbn=0-618-94690-X&rft.au=Zumdahl%2C+Steven+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-NIOSH-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-NIOSH_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-NIOSH_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cdc.gov\/niosh\/npg\/npgd0021.html\" target=\"_blank\">\"NIOSH Pocket Guide to Chemical Hazards #0021\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Institute_for_Occupational_Safety_and_Health\" title=\"National Institute for Occupational Safety and Health\" rel=\"external_link\" target=\"_blank\">National Institute for Occupational Safety and Health<\/a> (NIOSH).<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=NIOSH+Pocket+Guide+to+Chemical+Hazards+%230021&rft.pub=National+Institute+for+Occupational+Safety+and+Health+%28NIOSH%29&rft_id=https%3A%2F%2Fwww.cdc.gov%2Fniosh%2Fnpg%2Fnpgd0021.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-azom-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-azom_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-azom_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-azom_7-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-azom_7-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-azom_7-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20071010063029\/http:\/\/www.azom.com\/details.asp?ArticleID=1389\" target=\"_blank\">\"Alumina (Aluminium Oxide) \u2013 The Different Types of Commercially Available Grades\"<\/a>. The A to Z of Materials. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.azom.com\/details.asp?ArticleID=1389\" target=\"_blank\">the original<\/a> on 10 October 2007<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">27 October<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Alumina+%28Aluminium+Oxide%29+%E2%80%93+The+Different+Types+of+Commercially+Available+Grades&rft.pub=The+A+to+Z+of+Materials&rft_id=http%3A%2F%2Fwww.azom.com%2Fdetails.asp%3FArticleID%3D1389&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Elam, J. W. (October 2010). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=Corundum%20is%20the%20most%20common%20naturally%20occurring%20crystalline%20form%20of%20aluminium%20oxide.&f=false\"><i>Atomic Layer Deposition Applications 6<\/i><\/a>. The Electrochemical Society. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781566778213.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Atomic+Layer+Deposition+Applications+6&rft.pub=The+Electrochemical+Society&rft.date=2010-10&rft.isbn=9781566778213&rft.aulast=Elam&rft.aufirst=J.+W.&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3D9WyXTae58DgC%26pg%3DPA46%26dq%3DCorundum%2Bis%2Bthe%2Bmost%2Bcommon%2Bnaturally%2Boccurring%2Bcrystalline%2Bform%2Bof%2Baluminium%2Boxide.%23v%3Donepage%26q%3DCorundum%2520is%2520the%2520most%2520common%2520naturally%2520occurring%2520crystalline%2520form%2520of%2520aluminium%2520oxide.%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Campbell, Timothy; Kalia, Rajiv; Nakano, Aiichiro; Vashishta, Priya; Ogata, Shuji; Rodgers, Stephen (1999). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/cacs.usc.edu\/papers\/Campbell-nAloxid-PRL99.pdf\" target=\"_blank\">\"Dynamics of Oxidation of Aluminium Nanoclusters using Variable Charge Molecular-Dynamics Simulations on Parallel Computers\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Physical Review Letters<\/i>. <b>82<\/b> (24): 4866. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/1999PhRvL..82.4866C\" target=\"_blank\">1999PhRvL..82.4866C<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1103%2FPhysRevLett.82.4866\" target=\"_blank\">10.1103\/PhysRevLett.82.4866<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100701230226\/http:\/\/cacs.usc.edu\/papers\/Campbell-nAloxid-PRL99.pdf\" target=\"_blank\">Archived<\/a> <span class=\"cs1-format\">(PDF)<\/span> from the original on 2010-07-01.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Physical+Review+Letters&rft.atitle=Dynamics+of+Oxidation+of+Aluminium+Nanoclusters+using+Variable+Charge+Molecular-Dynamics+Simulations+on+Parallel+Computers&rft.volume=82&rft.issue=24&rft.pages=4866&rft.date=1999&rft_id=info%3Adoi%2F10.1103%2FPhysRevLett.82.4866&rft_id=info%3Abibcode%2F1999PhRvL..82.4866C&rft.au=Campbell%2C+Timothy&rft.au=Kalia%2C+Rajiv&rft.au=Nakano%2C+Aiichiro&rft.au=Vashishta%2C+Priya&rft.au=Ogata%2C+Shuji&rft.au=Rodgers%2C+Stephen&rft_id=http%3A%2F%2Fcacs.usc.edu%2Fpapers%2FCampbell-nAloxid-PRL99.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-TRI-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-TRI_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/wayback.archive-it.org\/all\/20080522232533\/http:\/\/www.epa.gov\/tri\/chemical\/chemical%20lists\/RY2006ChemicalList.pdf\" target=\"_blank\">\"EPCRA Section 313 Chemical List For Reporting Year 2006\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. 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Phys<\/i>. <b>92<\/b> (11): 6739\u201342. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2002JAP....92.6739K\" target=\"_blank\">2002JAP....92.6739K<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1063%2F1.1515951\" target=\"_blank\">10.1063\/1.1515951<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J.+Appl.+Phys.&rft.atitle=Improvement+in+Al%3Csub%3E2%3C%2Fsub%3EO%3Csub%3E3%3C%2Fsub%3E+dielectric+behavior+by+using+ozone+as+an+oxidant+for+the+atomic+layer+deposition+technique&rft.volume=92&rft.issue=11&rft.pages=6739-42&rft.date=2002&rft_id=info%3Adoi%2F10.1063%2F1.1515951&rft_id=info%3Abibcode%2F2002JAP....92.6739K&rft.au=Kim+JB&rft.au=Kwon+DR&rft.au=Chakrabarti+K&rft.au=Lee+Chongmu&rft.au=Oh+KY&rft.au=Lee+JH&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kim, Jaebum; Chakrabarti, Kuntal; Lee, Jinho; Oh, Ki-Young; Lee, Chongmu (2003). \"Effects of ozone as an oxygen source on the properties of the Al<sub>2<\/sub>O<sub>3<\/sub> thin films prepared by atomic layer deposition\". <i>Mater Chem Phys<\/i>. <b>78<\/b> (3): 733\u201338. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0254-0584%2802%2900375-9\" target=\"_blank\">10.1016\/S0254-0584(02)00375-9<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Mater+Chem+Phys&rft.atitle=Effects+of+ozone+as+an+oxygen+source+on+the+properties+of+the+Al%3Csub%3E2%3C%2Fsub%3EO%3Csub%3E3%3C%2Fsub%3E+thin+films+prepared+by+atomic+layer+deposition&rft.volume=78&rft.issue=3&rft.pages=733-38&rft.date=2003&rft_id=info%3Adoi%2F10.1016%2FS0254-0584%2802%2900375-9&rft.au=Kim%2C+Jaebum&rft.au=Chakrabarti%2C+Kuntal&rft.au=Lee%2C+Jinho&rft.au=Oh%2C+Ki-Young&rft.au=Lee%2C+Chongmu&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-CI14835-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-CI14835_20-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.chemindustry.com\/chemicals\/14835.html\" target=\"_blank\">\"Aloxite\"<\/a>. ChemIndustry.com database. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070625100844\/http:\/\/www.chemindustry.com\/chemicals\/14835.html\" target=\"_blank\">Archived<\/a> from the original on 25 June 2007<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">24 February<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Aloxite&rft_id=http%3A%2F%2Fwww.chemindustry.com%2Fchemicals%2F14835.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Evans, K. A. (1993). \"Properties and uses of aluminium oxides and aluminium hydroxides\". In Downs, A. J. <i>The Chemistry of Aluminium, Indium and Gallium<\/i>. Blackie Academic. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 075140103X.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Properties+and+uses+of+aluminium+oxides+and+aluminium+hydroxides&rft.btitle=The+Chemistry+of+Aluminium%2C+Indium+and+Gallium&rft.pub=Blackie+Academic&rft.date=1993&rft.isbn=075140103X&rft.aulast=Evans&rft.aufirst=K.+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Akers, Michael J. (2016-04-19). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=some%20glass%20contain%20aluminum%20oxide&f=false\"><i>Sterile Drug Products: Formulation, Packaging, Manufacturing and Quality<\/i><\/a>. CRC Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781420020564.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Sterile+Drug+Products%3A+Formulation%2C+Packaging%2C+Manufacturing+and+Quality&rft.pub=CRC+Press&rft.date=2016-04-19&rft.isbn=9781420020564&rft.aulast=Akers&rft.aufirst=Michael+J.&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3DC2_LBQAAQBAJ%26pg%3DPA73%26dq%3Dsome%2Bglass%2Bcontain%2Baluminum%2Boxide%23v%3Donepage%26q%3Dsome%2520glass%2520contain%2520aluminum%2520oxide%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Hudson, L. Keith; Misra, Chanakya; Perrotta, Anthony J.; Wefers, Karl and Williams, F. S. (2002) \"Aluminum Oxide\" in <i>Ullmann's Encyclopedia of Industrial Chemistry<\/i>, Wiley-VCH, Weinheim. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14356007.a01_557\" target=\"_blank\">10.1002\/14356007.a01_557<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-mallick-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-mallick_24-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Mallick, P.K. (2008). <i>Fiber-reinforced composites materials, manufacturing, and design<\/i> (3rd ed., [expanded and rev. ed.] ed.). Boca Raton, FL: CRC Press. pp. Ch.2.1.7. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-8493-4205-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Fiber-reinforced+composites+materials%2C+manufacturing%2C+and+design&rft.place=Boca+Raton%2C+FL&rft.pages=Ch.2.1.7&rft.edition=3rd+ed.%2C+%5Bexpanded+and+rev.+ed.%5D&rft.pub=CRC+Press&rft.date=2008&rft.isbn=0-8493-4205-8&rft.aulast=Mallick&rft.aufirst=P.K.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncjrs.gov\/pdffiles1\/nij\/223054.pdf\" target=\"_blank\">\"Ballistic Resistance of Body Armor\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>US Department of Justice<\/i>. NIJ<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">31 August<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=US+Department+of+Justice&rft.atitle=Ballistic+Resistance+of+Body+Armor&rft_id=https%3A%2F%2Fwww.ncjrs.gov%2Fpdffiles1%2Fnij%2F223054.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Osborn, Joseph H. (2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20161120010024\/http:\/\/www.omwcorp.com\/understandingano\/anoindex.html\" target=\"_blank\">\"understanding and specifying anodizing: what a manufacturer needs to know\"<\/a>. <i>OMW Corporation<\/i>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.omwcorp.com\/understandingano\/anoindex.html\" target=\"_blank\">the original<\/a> on 2016-11-20<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-06-02<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=OMW+Corporation&rft.atitle=understanding+and+specifying+anodizing%3A+what+a+manufacturer+needs+to+know&rft.date=2014&rft.aulast=Osborn&rft.aufirst=Joseph+H.&rft_id=http%3A%2F%2Fwww.omwcorp.com%2Funderstandingano%2Fanoindex.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Li, Q; Liang, J; Wang, Q. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/cdn.intechopen.com\/pdfs-wm\/44294.pdf\" target=\"_blank\">\"Modern Surface Engineering Treatments, chapter 4 <i>Plasma Oxidation Coatings on Lightweight Metals<\/i>\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>INTECH 2013<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160304114502\/http:\/\/cdn.intechopen.com\/pdfs-wm\/44294.pdf\" target=\"_blank\">Archived<\/a> <span class=\"cs1-format\">(PDF)<\/span> from the original on 2016-03-04.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=INTECH+2013&rft.atitle=Modern+Surface+Engineering+Treatments%2C+chapter+4+Plasma+Oxidation+Coatings+on+Lightweight+Metals&rft.aulast=Li&rft.aufirst=Q&rft.au=Liang%2C+J&rft.au=Wang%2C+Q&rft_id=http%3A%2F%2Fcdn.intechopen.com%2Fpdfs-wm%2F44294.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ge.com\/innovation\/timeline\/eras\/science_and_research.html\" target=\"_blank\">\"GE Innovation Timeline 1957\u20131970\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090216233917\/http:\/\/www.ge.com\/innovation\/timeline\/eras\/science_and_research.html\" target=\"_blank\">Archived<\/a> from the original on 16 February 2009<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2009-01-12<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=GE+Innovation+Timeline+1957%E2%80%931970&rft_id=http%3A%2F%2Fwww.ge.com%2Finnovation%2Ftimeline%2Feras%2Fscience_and_research.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=75bb0024-8f1a-4036-9acd-006ea430f3b7\" target=\"_blank\">\"DailyMed - JUNEL FE 1\/20- norethindrone acetate and ethinyl estradiol, and ferrous fumarate\"<\/a>. <i>dailymed.nlm.nih.gov<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170313130132\/https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=75bb0024-8f1a-4036-9acd-006ea430f3b7\" target=\"_blank\">Archived<\/a> from the original on 2017-03-13<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-03-13<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=dailymed.nlm.nih.gov&rft.atitle=DailyMed+-+JUNEL+FE+1%2F20-+norethindrone+acetate+and+ethinyl+estradiol%2C+and+ferrous+fumarate&rft_id=https%3A%2F%2Fdailymed.nlm.nih.gov%2Fdailymed%2FdrugInfo.cfm%3Fsetid%3D75bb0024-8f1a-4036-9acd-006ea430f3b7%23&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Belkin, A.; et., al. (2017). \"Recovery of Alumina Nanocapacitors after High Voltage Breakdown\". <i>Sci. Rep<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2017NatSR...7..932B\" target=\"_blank\">2017NatSR...7..932B<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fs41598-017-01007-9\" target=\"_blank\">10.1038\/s41598-017-01007-9<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Sci.+Rep.&rft.atitle=Recovery+of+Alumina+Nanocapacitors+after+High+Voltage+Breakdown&rft.date=2017&rft_id=info%3Adoi%2F10.1038%2Fs41598-017-01007-9&rft_id=info%3Abibcode%2F2017NatSR...7..932B&rft.aulast=Belkin&rft.aufirst=A.&rft.au=et.%2C+al.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Farndon, John (2001). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=Aluminum%20oxide%20is%20also%20used%20to%20make%20spark%20plug%20insulators&f=false\"><i>Aluminum<\/i><\/a>. Marshall Cavendish. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780761409472. <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=Aluminum%20oxide%20is%20also%20used%20to%20make%20spark%20plug%20insulators&f=false\">Archived<\/a> from the original on 2017-12-04.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Aluminum&rft.pub=Marshall+Cavendish&rft.date=2001&rft.isbn=9780761409472&rft.aulast=Farndon&rft.aufirst=John&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DTYBh3fBQrVwC%26pg%3DPA19%26dq%3DAluminum%2Boxide%2Bis%2Balso%2Bused%2Bto%2Bmake%2Bspark%2Bplug%2Binsulators%26hl%3Den%26sa%3DX%26ved%3D0ahUKEwjztcjU2bfXAhVny1QKHawqBYIQ6AEIKDAA%23v%3Donepage%26q%3DAluminum%2520oxide%2520is%2520also%2520used%2520to%2520make%2520spark%2520plug%2520insulators%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAluminium+oxide\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cdc.gov\/niosh\/npg\/npgd0021.html\" target=\"_blank\">CDC - NIOSH Pocket Guide to Chemical Hazards<\/a><\/li><\/ul>\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1262\nCached time: 20181215053216\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 1.252 seconds\nReal time usage: 1.631 seconds\nPreprocessor visited node count: 10315\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 284435\/2097152 bytes\nTemplate argument size: 33011\/2097152 bytes\nHighest expansion depth: 21\/40\nExpensive parser function count: 6\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 86192\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.512\/10.000 seconds\nLua memory usage: 9.68 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1328.098 1 -total\n<\/p>\n<pre>50.94% 676.483 1 Template:Chembox\n25.95% 344.669 1 Template:Chembox_Identifiers\n25.42% 337.658 1 Template:Reflist\n15.75% 209.221 8 Template:Chembox_headerbar\n15.60% 207.208 25 Template:Trim\n11.85% 157.317 1 Template:Chembox_Properties\n 9.23% 122.607 11 Template:Main_other\n 8.89% 118.008 10 Template:Cite_web\n 8.22% 109.153 1 Template:Chembox_parametercheck\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:141888-1!canonical and timestamp 20181215053214 and revision id 870135785\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium_oxide\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212208\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.052 seconds\nReal time usage: 0.224 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 213.711 1 - wikipedia:Aluminium_oxide\n100.00% 213.711 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8387-0!*!*!*!*!*!* and timestamp 20181217212208 and revision id 24621\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Aluminium_oxide\">https:\/\/www.limswiki.org\/index.php\/Aluminium_oxide<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","b52fd310a75c0ad51d3c8adcc8f559d9_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cc\/Corundum-3D-balls.png\/500px-Corundum-3D-balls.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c9\/Aluminium_oxide2.jpg\/440px-Aluminium_oxide2.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a2\/Oxid_hlinit%C3%BD.PNG\/440px-Oxid_hlinit%C3%BD.PNG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1e\/Corindon_azulEZ.jpg\/360px-Corindon_azulEZ.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/db\/2005alumina.PNG\/440px-2005alumina.PNG"],"b52fd310a75c0ad51d3c8adcc8f559d9_timestamp":1545081728,"593f3194d9b04f9bdab3fe6b5f1ad41e_type":"article","593f3194d9b04f9bdab3fe6b5f1ad41e_title":"Alacrite","593f3194d9b04f9bdab3fe6b5f1ad41e_url":"https:\/\/www.limswiki.org\/index.php\/Alacrite","593f3194d9b04f9bdab3fe6b5f1ad41e_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tAlacrite\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tAlacrite (also known as L-605, Cobalt L-605, Haynes 25, and occasionally F90[1][2][3]) is a family of cobalt-based alloys. The alloy exhibits useful mechanical properties and is oxidation- and sulfidation-resistant.[2]\nOne member of the family, XSH Alacrite,[4] is described as \"a non-magnetic, stainless super-alloy whose high surface hardness enables one to achieve a mirror quality polish.\"[5] Originally developed for manufacturing aircraft components,[6] L-605 has also been used in aerospace components and turbine engines as well as drug-eluting and other kinds of stents due to its biocompatibility.[2] The Institut National de M\u00e9trologie in France has also used the material as a kilogram mass standard.[5][6]\n\nComposition and standardization \nL-605 is composed primarily of cobalt (Co), with a specified mixture of chromium (Cr), tungsten (W), nickel (Ni), iron (Fe) and carbon (C), as well as small amounts of manganese (Mn), silicon (Si), and phosphorus (P). The tungsten and nickel improve the alloy's machinability,[3] while chromium contributes to its solid-solution strengthening.[2] The following tolerances must be met to be considered an L-605 alloy:[1][2][4][6]\n\n\n\n\n\n\n\nTolerances for L-605 composition\n\n\nCo\n\nCr\n\nW\n\nNi\n\nFe\n\nC\n\nMn\n\nSi\n\nP\n\n\nBalance\n\n19\u201321\n\n14\u201316\n\n9\u201311\n\n< 3\n\n0.05\u20130.15\n\n1\u20132\n\n< 1\n\n< 0.4\n\n\n\nWhen used for implantable medical devices, the ASTM F90-09 and ISO 5832-5:2005 specifications dictate how L-605 is manufactured and tested.[2][3][7][8]\n\nReferences \n\n\n^ a b \"Nickel Alloy L-605, Cobalt\u00ae L-605, Haynes\u00ae 25\". Continental Steel & Tube Company. Retrieved 11 March 2016 . \n\n^ a b c d e f Poncin, P.; Gruez, B.; Missillier, P.; Comte-Gaz, P.; Proft, J.L. (2006). \"L605 Precipitates and Their Effects on Stent Applications\". In Venugopalan, R.; Wu, M. Medical Device Materials III - Proceedings of the Materials & Processes for Medical Devices Conference. ASTM International. pp. 85\u201392. ISBN 9781615031153. Retrieved 11 March 2016 . \n\n^ a b c Brunski, J.B. (2009). \"3.2.9 Metals\". In Academic Press. Biomedical Engineering Desk Reference. Elsevier. pp. 230\u2013247. ISBN 9780123746474. Retrieved 11 March 2016 . \n\n^ a b Meury, P.A.; Molins, R.; Gosset, A. (June 2005). \"D\u00e9finition d'un nouvel alliage m\u00e9tallique pour la r\u00e9alisation d'\u00e9talons de masse secondaires\" (PDF) . Actes du 12e congr\u00e8s international de m\u00e9trologie. Laboratoire national de m\u00e9trologie et d\u2019essais. Archived from the original (PDF) on 8 March 2014. Retrieved 11 March 2016 . \n\n^ a b \"BNM-INM\/CNAM - M.G.A.\" L'Institut National de M\u00e9trologie. Archived from the original on 30 March 2012. Retrieved 11 March 2016 . \n\n^ a b c Jones, F.E.; Schoonover, R.M. (2002). \"Chapter 3: Contamination of Mass Standards\". Handbook of Mass Measurement. CRC Press. pp. 23\u201336. ISBN 9781420038453. Retrieved 11 March 2016 . \n\n^ \"ASTM F90-09: Standard Specification for Wrought Cobalt-20Chromium-15Tungsten-10Nickel Alloy for Surgical Implant Applications (UNS R30605)\". ASTM.org. ASTM International. Retrieved 11 March 2016 . \n\n^ \"ISO 5832-5:2005: Implants for surgery -- Metallic materials -- Part 5: Wrought cobalt-chromium-tungsten-nickel alloy\". ISO.org. International Organization for Standardization. 11 March 2016. \n\n\n\r\n\n\nThis alloy-related article is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Alacrite\">https:\/\/www.limswiki.org\/index.php\/Alacrite<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 11 March 2016, at 19:39.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 469 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","593f3194d9b04f9bdab3fe6b5f1ad41e_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Alacrite skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Alacrite<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Alacrite<\/b> (also known as <b>L-605<\/b>, <b>Cobalt L-605<\/b>, <b>Haynes 25<\/b>, and occasionally <b>F90<\/b><sup id=\"rdp-ebb-cite_ref-ContSteelL605_1-0\" class=\"reference\"><a href=\"#cite_note-ContSteelL605-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-PoncinL605_06_2-0\" class=\"reference\"><a href=\"#cite_note-PoncinL605_06-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-BrunskiMetals09_3-0\" class=\"reference\"><a href=\"#cite_note-BrunskiMetals09-3\" rel=\"external_link\">[3]<\/a><\/sup>) is a family of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cobalt\" title=\"Cobalt\" rel=\"external_link\" target=\"_blank\">cobalt<\/a>-based <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alloy\" title=\"Alloy\" rel=\"external_link\" target=\"_blank\">alloys<\/a>. The alloy exhibits useful mechanical properties and is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Redox\" title=\"Redox\" rel=\"external_link\" target=\"_blank\">oxidation-<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sulfidation\" title=\"Sulfidation\" rel=\"external_link\" target=\"_blank\">sulfidation<\/a>-resistant.<sup id=\"rdp-ebb-cite_ref-PoncinL605_06_2-1\" class=\"reference\"><a href=\"#cite_note-PoncinL605_06-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>One member of the family, XSH Alacrite,<sup id=\"rdp-ebb-cite_ref-MeuryDef05_4-0\" class=\"reference\"><a href=\"#cite_note-MeuryDef05-4\" rel=\"external_link\">[4]<\/a><\/sup> is described as \"a non-magnetic, stainless super-alloy whose high surface hardness enables one to achieve a mirror quality polish.\"<sup id=\"rdp-ebb-cite_ref-INM_MGAArch_12_5-0\" class=\"reference\"><a href=\"#cite_note-INM_MGAArch_12-5\" rel=\"external_link\">[5]<\/a><\/sup> Originally developed for manufacturing aircraft components,<sup id=\"rdp-ebb-cite_ref-JonesHand02_6-0\" class=\"reference\"><a href=\"#cite_note-JonesHand02-6\" rel=\"external_link\">[6]<\/a><\/sup> L-605 has also been used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aerospace\" title=\"Aerospace\" rel=\"external_link\" target=\"_blank\">aerospace<\/a> components and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gas_turbine\" title=\"Gas turbine\" rel=\"external_link\" target=\"_blank\">turbine engines<\/a> as well as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug-eluting_stents\" class=\"mw-redirect\" title=\"Drug-eluting stents\" rel=\"external_link\" target=\"_blank\">drug-eluting<\/a> and other kinds of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stents<\/a> due to its <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatibility<\/a>.<sup id=\"rdp-ebb-cite_ref-PoncinL605_06_2-2\" class=\"reference\"><a href=\"#cite_note-PoncinL605_06-2\" rel=\"external_link\">[2]<\/a><\/sup> The Institut National de M\u00e9trologie in <a href=\"https:\/\/en.wikipedia.org\/wiki\/France\" title=\"France\" rel=\"external_link\" target=\"_blank\">France<\/a> has also used the material as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kilogram\" title=\"Kilogram\" rel=\"external_link\" target=\"_blank\">kilogram<\/a> mass standard.<sup id=\"rdp-ebb-cite_ref-INM_MGAArch_12_5-1\" class=\"reference\"><a href=\"#cite_note-INM_MGAArch_12-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-JonesHand02_6-1\" class=\"reference\"><a href=\"#cite_note-JonesHand02-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Composition_and_standardization\">Composition and standardization<\/span><\/h2>\n<p>L-605 is composed primarily of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cobalt\" title=\"Cobalt\" rel=\"external_link\" target=\"_blank\">cobalt<\/a> (Co), with a specified mixture of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium\" title=\"Chromium\" rel=\"external_link\" target=\"_blank\">chromium<\/a> (Cr), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tungsten\" title=\"Tungsten\" rel=\"external_link\" target=\"_blank\">tungsten<\/a> (W), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nickel\" title=\"Nickel\" rel=\"external_link\" target=\"_blank\">nickel<\/a> (Ni), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron\" title=\"Iron\" rel=\"external_link\" target=\"_blank\">iron<\/a> (Fe) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon\" title=\"Carbon\" rel=\"external_link\" target=\"_blank\">carbon<\/a> (C), as well as small amounts of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manganese\" title=\"Manganese\" rel=\"external_link\" target=\"_blank\">manganese<\/a> (Mn), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicon\" title=\"Silicon\" rel=\"external_link\" target=\"_blank\">silicon<\/a> (Si), and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphorus\" title=\"Phosphorus\" rel=\"external_link\" target=\"_blank\">phosphorus<\/a> (P). The tungsten and nickel improve the alloy's machinability,<sup id=\"rdp-ebb-cite_ref-BrunskiMetals09_3-1\" class=\"reference\"><a href=\"#cite_note-BrunskiMetals09-3\" rel=\"external_link\">[3]<\/a><\/sup> while chromium contributes to its solid-solution strengthening.<sup id=\"rdp-ebb-cite_ref-PoncinL605_06_2-3\" class=\"reference\"><a href=\"#cite_note-PoncinL605_06-2\" rel=\"external_link\">[2]<\/a><\/sup> The following tolerances must be met to be considered an L-605 alloy:<sup id=\"rdp-ebb-cite_ref-ContSteelL605_1-1\" class=\"reference\"><a href=\"#cite_note-ContSteelL605-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-PoncinL605_06_2-4\" class=\"reference\"><a href=\"#cite_note-PoncinL605_06-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-MeuryDef05_4-1\" class=\"reference\"><a href=\"#cite_note-MeuryDef05-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-JonesHand02_6-2\" class=\"reference\"><a href=\"#cite_note-JonesHand02-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<table style=\"\">\n<tbody><tr>\n<td style=\"vertical-align:top;\">\n<table class=\"wikitable\" border=\"1\" cellpadding=\"5\" cellspacing=\"0\" style=\"\">\n\n<tbody><tr>\n<td style=\"background-color:white; padding-left:10px; padding-right:10px;\" colspan=\"9\">Tolerances for L-605 composition\n<\/td><\/tr>\n<tr>\n<th style=\"padding-left:10px; padding-right:10px;\">Co\n<\/th>\n<th style=\"padding-left:10px; padding-right:10px;\">Cr\n<\/th>\n<th style=\"padding-left:10px; padding-right:10px;\">W\n<\/th>\n<th style=\"padding-left:10px; padding-right:10px;\">Ni\n<\/th>\n<th style=\"padding-left:10px; padding-right:10px;\">Fe\n<\/th>\n<th style=\"padding-left:10px; padding-right:10px;\">C\n<\/th>\n<th style=\"padding-left:10px; padding-right:10px;\">Mn\n<\/th>\n<th style=\"padding-left:10px; padding-right:10px;\">Si\n<\/th>\n<th style=\"padding-left:10px; padding-right:10px;\">P\n<\/th><\/tr>\n<tr>\n<td style=\"background-color:white; padding-left:10px; padding-right:10px;\">Balance\n<\/td>\n<td style=\"background-color:white; padding-left:10px; padding-right:10px;\">19\u201321\n<\/td>\n<td style=\"background-color:white; padding-left:10px; padding-right:10px;\">14\u201316\n<\/td>\n<td style=\"background-color:white; padding-left:10px; padding-right:10px;\">9\u201311\n<\/td>\n<td style=\"background-color:white; padding-left:10px; padding-right:10px;\">< 3\n<\/td>\n<td style=\"background-color:white; padding-left:10px; padding-right:10px;\">0.05\u20130.15\n<\/td>\n<td style=\"background-color:white; padding-left:10px; padding-right:10px;\">1\u20132\n<\/td>\n<td style=\"background-color:white; padding-left:10px; padding-right:10px;\">< 1\n<\/td>\n<td style=\"background-color:white; padding-left:10px; padding-right:10px;\">< 0.4\n<\/td><\/tr>\n<\/tbody><\/table>\n<\/td><\/tr><\/tbody><\/table>\n<p>When used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implantable<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical devices<\/a>, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ASTM_International\" title=\"ASTM International\" rel=\"external_link\" target=\"_blank\">ASTM<\/a> F90-09 and <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Organization_for_Standardization\" title=\"International Organization for Standardization\" rel=\"external_link\" target=\"_blank\">ISO<\/a> 5832-5:2005 specifications dictate how L-605 is manufactured and tested.<sup id=\"rdp-ebb-cite_ref-PoncinL605_06_2-5\" class=\"reference\"><a href=\"#cite_note-PoncinL605_06-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-BrunskiMetals09_3-2\" class=\"reference\"><a href=\"#cite_note-BrunskiMetals09-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-ASTMF90-09_7-0\" class=\"reference\"><a href=\"#cite_note-ASTMF90-09-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-ISO_5832_8-0\" class=\"reference\"><a href=\"#cite_note-ISO_5832-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-ContSteelL605-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ContSteelL605_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ContSteelL605_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/continentalsteel.com\/nickel-alloys\/grades\/l-605-cobalt-l-605-haynes-25\/\" target=\"_blank\">\"Nickel Alloy L-605, Cobalt\u00ae L-605, Haynes\u00ae 25\"<\/a>. Continental Steel & Tube Company<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Nickel+Alloy+L-605%2C+Cobalt%C2%AE+L-605%2C+Haynes%C2%AE+25&rft.pub=Continental+Steel+%26+Tube+Company&rft_id=http%3A%2F%2Fcontinentalsteel.com%2Fnickel-alloys%2Fgrades%2Fl-605-cobalt-l-605-haynes-25%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAlacrite\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-PoncinL605_06-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-PoncinL605_06_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-PoncinL605_06_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-PoncinL605_06_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-PoncinL605_06_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-PoncinL605_06_2-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-PoncinL605_06_2-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Poncin, P.; Gruez, B.; Missillier, P.; Comte-Gaz, P.; Proft, J.L. (2006). \"L605 Precipitates and Their Effects on Stent Applications\". In Venugopalan, R.; Wu, M. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=edtoQUe2VxgC&pg=PA85\" target=\"_blank\"><i>Medical Device Materials III - Proceedings of the Materials & Processes for Medical Devices Conference<\/i><\/a>. ASTM International. pp. 85\u201392. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781615031153<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=L605+Precipitates+and+Their+Effects+on+Stent+Applications&rft.btitle=Medical+Device+Materials+III+-+Proceedings+of+the+Materials+%26+Processes+for+Medical+Devices+Conference&rft.pages=85-92&rft.pub=ASTM+International&rft.date=2006&rft.isbn=9781615031153&rft.au=Poncin%2C+P.&rft.au=Gruez%2C+B.&rft.au=Missillier%2C+P.&rft.au=Comte-Gaz%2C+P.&rft.au=Proft%2C+J.L.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DedtoQUe2VxgC%26pg%3DPA85&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAlacrite\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-BrunskiMetals09-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-BrunskiMetals09_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-BrunskiMetals09_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-BrunskiMetals09_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Brunski, J.B. (2009). \"3.2.9 Metals\". In Academic Press. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=b8uWIVbd1WgC&pg=PA239\" target=\"_blank\"><i>Biomedical Engineering Desk Reference<\/i><\/a>. Elsevier. pp. 230\u2013247. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780123746474<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=3.2.9+Metals&rft.btitle=Biomedical+Engineering+Desk+Reference&rft.pages=230-247&rft.pub=Elsevier&rft.date=2009&rft.isbn=9780123746474&rft.au=Brunski%2C+J.B.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Db8uWIVbd1WgC%26pg%3DPA239&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAlacrite\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-MeuryDef05-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-MeuryDef05_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-MeuryDef05_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Meury, P.A.; Molins, R.; Gosset, A. (June 2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140308194616\/http:\/\/www.lne.fr\/publications\/actes_12e_congres_metrologie\/definition_alliage_metallique_etalon_masse.pdf\" target=\"_blank\">\"D\u00e9finition d'un nouvel alliage m\u00e9tallique pour la r\u00e9alisation d'\u00e9talons de masse secondaires\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Actes du 12e congr\u00e8s international de m\u00e9trologie<\/i>. Laboratoire national de m\u00e9trologie et d\u2019essais. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.lne.fr\/publications\/actes_12e_congres_metrologie\/definition_alliage_metallique_etalon_masse.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 8 March 2014<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Actes+du+12e+congr%C3%A8s+international+de+m%C3%A9trologie&rft.atitle=D%C3%A9finition+d%27un+nouvel+alliage+m%C3%A9tallique+pour+la+r%C3%A9alisation+d%27%C3%A9talons+de+masse+secondaires&rft.date=2005-06&rft.au=Meury%2C+P.A.&rft.au=Molins%2C+R.&rft.au=Gosset%2C+A.&rft_id=http%3A%2F%2Fwww.lne.fr%2Fpublications%2Factes_12e_congres_metrologie%2Fdefinition_alliage_metallique_etalon_masse.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAlacrite\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-INM_MGAArch_12-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-INM_MGAArch_12_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-INM_MGAArch_12_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120330131514\/http:\/\/ww1.cnam.fr\/instituts\/inm\/english\/mga\/mga.htm\" target=\"_blank\">\"BNM-INM\/CNAM - M.G.A.\"<\/a> L'Institut National de M\u00e9trologie. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ww1.cnam.fr\/instituts\/inm\/english\/mga\/mga.htm\" target=\"_blank\">the original<\/a> on 30 March 2012<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=BNM-INM%2FCNAM+-+M.G.A.&rft.pub=L%27Institut+National+de+M%C3%A9trologie&rft_id=http%3A%2F%2Fww1.cnam.fr%2Finstituts%2Finm%2Fenglish%2Fmga%2Fmga.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAlacrite\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-JonesHand02-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-JonesHand02_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-JonesHand02_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-JonesHand02_6-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Jones, F.E.; Schoonover, R.M. (2002). \"Chapter 3: Contamination of Mass Standards\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=bVXMBQAAQBAJ&pg=PA34\" target=\"_blank\"><i>Handbook of Mass Measurement<\/i><\/a>. CRC Press. pp. 23\u201336. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781420038453<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+3%3A+Contamination+of+Mass+Standards&rft.btitle=Handbook+of+Mass+Measurement&rft.pages=23-36&rft.pub=CRC+Press&rft.date=2002&rft.isbn=9781420038453&rft.au=Jones%2C+F.E.&rft.au=Schoonover%2C+R.M.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DbVXMBQAAQBAJ%26pg%3DPA34&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAlacrite\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ASTMF90-09-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ASTMF90-09_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.astm.org\/DATABASE.CART\/HISTORICAL\/F90-09.htm\" target=\"_blank\">\"ASTM F90-09: Standard Specification for Wrought Cobalt-20Chromium-15Tungsten-10Nickel Alloy for Surgical Implant Applications (UNS R30605)\"<\/a>. <i>ASTM.org<\/i>. ASTM International<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 March<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=ASTM.org&rft.atitle=ASTM+F90-09%3A+Standard+Specification+for+Wrought+Cobalt-20Chromium-15Tungsten-10Nickel+Alloy+for+Surgical+Implant+Applications+%28UNS+R30605%29&rft_id=http%3A%2F%2Fwww.astm.org%2FDATABASE.CART%2FHISTORICAL%2FF90-09.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAlacrite\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ISO_5832-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ISO_5832_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.iso.org\/iso\/iso_catalogue\/catalogue_tc\/catalogue_detail.htm?csnumber=35169\" target=\"_blank\">\"ISO 5832-5:2005: Implants for surgery -- Metallic materials -- Part 5: Wrought cobalt-chromium-tungsten-nickel alloy\"<\/a>. <i>ISO.org<\/i>. International Organization for Standardization. 11 March 2016.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=ISO.org&rft.atitle=ISO+5832-5%3A2005%3A+Implants+for+surgery+--+Metallic+materials+--+Part+5%3A+Wrought+cobalt-chromium-tungsten-nickel+alloy&rft.date=2016-03-11&rft_id=http%3A%2F%2Fwww.iso.org%2Fiso%2Fiso_catalogue%2Fcatalogue_tc%2Fcatalogue_detail.htm%3Fcsnumber%3D35169&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAlacrite\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><br \/>\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1332\nCached time: 20181217110839\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.168 seconds\nReal time usage: 0.214 seconds\nPreprocessor visited node count: 507\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 17959\/2097152 bytes\nTemplate argument size: 72\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 25495\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.084\/10.000 seconds\nLua memory usage: 2.57 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 162.510 1 -total\n<\/p>\n<pre>88.12% 143.209 1 Template:Reflist\n60.92% 98.994 5 Template:Cite_web\n11.83% 19.219 1 Template:Alloy-stub\n11.33% 18.418 3 Template:Cite_book\n10.57% 17.176 1 Template:Asbox\n 1.51% 2.458 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:3147292-1!canonical and timestamp 20181217110839 and revision id 788097886\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Alacrite\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212208\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.153 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 146.836 1 - wikipedia:Alacrite\n100.00% 146.836 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8384-0!*!*!*!*!*!* and timestamp 20181217212208 and revision id 24618\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Alacrite\">https:\/\/www.limswiki.org\/index.php\/Alacrite<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","593f3194d9b04f9bdab3fe6b5f1ad41e_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/48\/Gussmetallschmelze.jpg\/65px-Gussmetallschmelze.jpg"],"593f3194d9b04f9bdab3fe6b5f1ad41e_timestamp":1545081728,"0b9dc8881728dd8ed2bf4d72aa197bcc_type":"article","0b9dc8881728dd8ed2bf4d72aa197bcc_title":"Abductin","0b9dc8881728dd8ed2bf4d72aa197bcc_url":"https:\/\/www.limswiki.org\/index.php\/Abductin","0b9dc8881728dd8ed2bf4d72aa197bcc_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tAbductin\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tAbductinIdentifiersOrganismArgopecten irradian SymbolN\/ARefSeq (mRNA)AF026848RefSeq (Prot)AAB94680UniProtO44354\n Abductin is found in the hinge ligament of bivalves such as Argopecten irradians and Placopecten magellanicus[1]\nAbductin is a natural elastic protein that is found in the hinge ligament of bivalve mollusks. It is unique as it is the only protein in nature with compressible elasticity. It is similar to elastin and resilin, but amino acid analysis reveals that it has high concentrations of glycine and methionine. \nAbductin is made up of three prominent amino acids, glycine, methionine, and phenylalanine, which are arranged in a repeating pentapeptide sequence throughout the molecule.[2][1]\nIt has been proposed that the protein could have uses in drug delivery or tissue engineering.[3]\n\nReferences \n\n\n^ a b Ehrlich H (2010). \"Chapter 19: Abductin\". Biological Materials Of Marine Origin, Biologically-Inspired Systems. 1. pp. 319\u2013322. \n\n^ Kelly RE, Rice RV (January 1967). \"Abductin: a rubber-like protein from the internal triangular hinge ligament of pecten\". Science. 155 (3759): 208\u201310. PMID 6015528. \n\n^ Su RS, Renner JN, Liu JC (December 2013). \"Synthesis and characterization of recombinant abductin-based proteins\". Biomacromolecules. 14 (12): 4301\u20138. doi:10.1021\/bm401162g. PMID 24147646. \n\n\nvteBivalve anatomyShell\nCallus\nHinge line\nHinge teeth\nLigament\nLira\nLunule\nNacre\nPallial line\nPallial sinus\nPeriostracum\nProdissoconch\nResilifer\nResilium\nSculpture\nUmbo \nValve\nBeak\nAnnuli\nOther hard parts\nByssus\nPearl\nSea silk\nSoft parts\nAdductor muscles\nCtenidium\nGastric shield\nMantle\nNephridium\nSiphon\nOther\nAbductin\nGlochidium\nPseudofeces\nTrochophore\nVeliger\n\nThis protein-related article is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Abductin\">https:\/\/www.limswiki.org\/index.php\/Abductin<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 16:44.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 427 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","0b9dc8881728dd8ed2bf4d72aa197bcc_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Abductin skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Abductin<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hyriidae_-_Mycetopodidae.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8a\/Hyriidae_-_Mycetopodidae.jpg\/220px-Hyriidae_-_Mycetopodidae.jpg\" width=\"220\" height=\"158\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hyriidae_-_Mycetopodidae.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Abductin is found in the hinge ligament of bivalves such as <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Argopecten_irradians\" title=\"Argopecten irradians\" rel=\"external_link\" target=\"_blank\">Argopecten irradians<\/a><\/i> and <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Placopecten_magellanicus\" title=\"Placopecten magellanicus\" rel=\"external_link\" target=\"_blank\">Placopecten magellanicus<\/a><\/i><sup id=\"rdp-ebb-cite_ref-Ehrlich_1-0\" class=\"reference\"><a href=\"#cite_note-Ehrlich-1\" rel=\"external_link\">[1]<\/a><\/sup><\/div><\/div><\/div>\n<p><b>Abductin<\/b> is a natural elastic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Protein\" title=\"Protein\" rel=\"external_link\" target=\"_blank\">protein<\/a> that is found in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ligament_(bivalve)\" title=\"Ligament (bivalve)\" rel=\"external_link\" target=\"_blank\">hinge ligament<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bivalvia\" title=\"Bivalvia\" rel=\"external_link\" target=\"_blank\">bivalve<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mollusks\" class=\"mw-redirect\" title=\"Mollusks\" rel=\"external_link\" target=\"_blank\">mollusks<\/a>. It is unique as it is the only protein in nature with compressible elasticity. It is similar to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastin\" title=\"Elastin\" rel=\"external_link\" target=\"_blank\">elastin<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Resilin\" title=\"Resilin\" rel=\"external_link\" target=\"_blank\">resilin<\/a>, but <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amino_acid\" title=\"Amino acid\" rel=\"external_link\" target=\"_blank\">amino acid<\/a> analysis reveals that it has high concentrations of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glycine\" title=\"Glycine\" rel=\"external_link\" target=\"_blank\">glycine<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methionine\" title=\"Methionine\" rel=\"external_link\" target=\"_blank\">methionine<\/a>. \n<\/p><p>Abductin is made up of three prominent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amino_acids\" class=\"mw-redirect\" title=\"Amino acids\" rel=\"external_link\" target=\"_blank\">amino acids<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glycine\" title=\"Glycine\" rel=\"external_link\" target=\"_blank\">glycine<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methionine\" title=\"Methionine\" rel=\"external_link\" target=\"_blank\">methionine<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phenylalanine\" title=\"Phenylalanine\" rel=\"external_link\" target=\"_blank\">phenylalanine<\/a>, which are arranged in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pentapeptide_repeat\" title=\"Pentapeptide repeat\" rel=\"external_link\" target=\"_blank\">repeating pentapeptide<\/a> sequence throughout the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecule\" title=\"Molecule\" rel=\"external_link\" target=\"_blank\">molecule<\/a>.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Ehrlich_1-1\" class=\"reference\"><a href=\"#cite_note-Ehrlich-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>It has been proposed that the protein could have uses in drug delivery or tissue engineering.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-Ehrlich-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Ehrlich_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ehrlich_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Ehrlich H (2010). \"Chapter 19: Abductin\". <i>Biological Materials Of Marine Origin, Biologically-Inspired Systems<\/i>. <b>1<\/b>. pp. 319\u2013322.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+19%3A+Abductin&rft.btitle=Biological+Materials+Of+Marine+Origin%2C+Biologically-Inspired+Systems&rft.pages=319-322&rft.date=2010&rft.aulast=Ehrlich&rft.aufirst=Hermann&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAbductin\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kelly RE, Rice RV (January 1967). \"Abductin: a rubber-like protein from the internal triangular hinge ligament of pecten\". <i>Science<\/i>. <b>155<\/b> (3759): 208\u201310. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6015528\" target=\"_blank\">6015528<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Science&rft.atitle=Abductin%3A+a+rubber-like+protein+from+the+internal+triangular+hinge+ligament+of+pecten&rft.volume=155&rft.issue=3759&rft.pages=208-10&rft.date=1967-01&rft_id=info%3Apmid%2F6015528&rft.aulast=Kelly&rft.aufirst=RE&rft.au=Rice%2C+RV&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAbductin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Su RS, Renner JN, Liu JC (December 2013). \"Synthesis and characterization of recombinant abductin-based proteins\". <i>Biomacromolecules<\/i>. <b>14<\/b> (12): 4301\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1021%2Fbm401162g\" target=\"_blank\">10.1021\/bm401162g<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24147646\" target=\"_blank\">24147646<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biomacromolecules&rft.atitle=Synthesis+and+characterization+of+recombinant+abductin-based+proteins&rft.volume=14&rft.issue=12&rft.pages=4301-8&rft.date=2013-12&rft_id=info%3Adoi%2F10.1021%2Fbm401162g&rft_id=info%3Apmid%2F24147646&rft.aulast=Su&rft.aufirst=RS&rft.au=Renner%2C+JN&rft.au=Liu%2C+JC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAbductin\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1274\nCached time: 20181207064529\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.188 seconds\nReal time usage: 0.249 seconds\nPreprocessor visited node count: 506\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 20694\/2097152 bytes\nTemplate argument size: 239\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 8091\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.105\/10.000 seconds\nLua memory usage: 2.5 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 212.802 1 -total\n<\/p>\n<pre>59.08% 125.728 1 Template:Reflist\n36.13% 76.877 1 Template:Cite_book\n25.67% 54.620 1 Template:Infobox_nonhuman_protein\n21.51% 45.769 1 Template:Infobox\n16.56% 35.243 2 Template:Cite_journal\n 7.05% 14.999 1 Template:Bivalve_anatomy\n 6.33% 13.460 1 Template:Protein-stub\n 5.43% 11.563 1 Template:Navbox\n 5.23% 11.135 1 Template:Asbox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:37584586-1!canonical and timestamp 20181207064529 and revision id 831441265\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Abductin\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212207\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.015 seconds\nReal time usage: 0.147 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 140.674 1 - wikipedia:Abductin\n100.00% 140.674 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8286-0!*!*!*!*!*!* and timestamp 20181217212207 and revision id 24498\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Abductin\">https:\/\/www.limswiki.org\/index.php\/Abductin<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","0b9dc8881728dd8ed2bf4d72aa197bcc_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8a\/Hyriidae_-_Mycetopodidae.jpg\/440px-Hyriidae_-_Mycetopodidae.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/60\/Myoglobin.png\/60px-Myoglobin.png"],"0b9dc8881728dd8ed2bf4d72aa197bcc_timestamp":1545081727,"648684e0deb85f1b40ca4dc75106cb6d_type":"article","648684e0deb85f1b40ca4dc75106cb6d_title":"Mechanical properties of biomaterials","648684e0deb85f1b40ca4dc75106cb6d_url":"https:\/\/www.limswiki.org\/index.php\/Mechanical_properties_of_biomaterials","648684e0deb85f1b40ca4dc75106cb6d_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMechanical properties of biomaterials\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tMaterials that are used for biomedical or clinical applications are known as biomaterials. The following article deals with fifth generation biomaterials that are used for bone structure replacement. For any material to be classified for biomedical application three requirements must be met. The first requirement is that the material must be biocompatible; it means that the organism should not treat it as a foreign object. Secondly, the material should be biodegradable (for in-graft only); the material should harmlessly degrade or dissolve in the body of the organism to allow it to resume natural functioning. Thirdly, the material should be mechanically sound; for the replacement of load bearing structures, the material should possess equivalent or greater mechanical stability to ensure high reliability of the graft.\n\nContents \n\n1 Introduction \n2 Elastic modulus \n3 Hardness \n4 Fracture strength \n5 Fracture toughness \n6 Fatigue \n7 See also \n8 References \n9 Further reading \n\n\nIntroduction \nThe biomaterial term is used for materials that can be used in biomedical and clinical applications. They are bioactive and biocompatible in nature. Currently, many types of metals and alloys (stainless steel, titanium, nickel, magnesium, Co\u2013Cr alloys, Ti alloys),[1] ceramics (zirconia, bioglass, alumina, hydroxyapatite) [1] and polymers (acrylic, nylon, silicone, polyurethane, polycaprolactone, polyanhydrides) [1] are used for load bearing application. This includes dental replacement and bone joining or replacement for medical and clinical application. Therefore their mechanical properties are very important. Mechanical properties of some biomaterials and bone are summarized in table 1.[2] Among them hydroxyapatite is most widely studied bioactive and biocompatible material. However, it has lower young\u2019s modulus and fracture toughness with brittle nature. Hence, it is required to produce a biomaterial with good mechanical properties.\n\nElastic modulus \nElastic modulus is simply defined as the ratio of stress to strain within the proportional limit. Physically, it represents the stiffness of a material within the elastic range when tensile or compressive load are applied. It is clinically important because it indicates the selected biomaterial has similar deformable properties with the material it is going to replace. These force-bearing materials require high elastic modulus with low deflection. As the elastic modulus of material increases fracture resistance decreases. It is desirable that the biomaterial elastic modulus is similar to bone. This is because if it is more than bone elastic modulus then load is born by material only; while the load is bear by bone only if it is less than bone material. The Elastic modulus of a material is generally calculated by bending test because deflection can be easily measured in this case as compared to very small elongation in compressive or tensile load. However, biomaterials (for bone replacement) are usually porous and the sizes of the samples are small. Therefore, nanoindentation test is used to determine the elastic modulus of these materials. This method has high precision and convenient for micro scale samples. Another method of elastic modulus measurement is non-destructive method. It is also clinically very good method because of its simplicity and repeatability since materials are not destroyed.[3]\n\nHardness \nHardness is one of the most important parameters for comparing properties of materials. It is used for finding the suitability of the clinical use of biomaterials. Biomaterial hardness is desirable as equal to bone hardness. If higher than the biomaterial, then it penetrates in the bone. As above said, biomaterials sample are very small therefore, micro and nano scale hardness test (Diamond Knoop and Vickers indenters) are used.[3]\n\nFracture strength \nStrength of materials is defined as the maximum stress that can be endured before fracture occurs. Strength of biomaterials (bioceramics) is an important mechanical property because they are brittle. In brittle materials like bioceramics, cracks easily propagate when the material is subject to tensile loading, unlike compressive loading. A number of methods are available for determining the tensile strength of materials, such as the bending flexural test, the biaxial flexural strength test and the weibull approach. In bioceramics, flaws influence the reliability and strength of the material during implantation and fabrication. There are a number of ways that flaws can be produced in bioceramics such as thermal sintering and heating. The importance is for bioceramics to have high reliability, rather than high strength.\n\nFracture toughness \nFracture toughness is required to alter the crack propagation in ceramics. It is helpful to evaluate the serviceability, performance and long term clinical success of biomaterials. It is reported that the high fracture toughness material improved clinical performance and reliability as compare to low fracture toughness.[4] It can be measured by many methods e.g. indentation fracture, indentation strength, single edge notched beam, single edge pre cracked beam and double cantilever beam.\n\nFatigue \nFatigue is defined as failure of a material due to repeated\/cyclic loading or unloading (tensile or compressive stresses). It is also an important parameter for biomaterial because cyclic load is applied during their serving life. In this cyclic loading condition, micro crack\/flaws may be generated at the interface of the matrix and the filler. This micro crack can initiate permanent plastic deformation which results in large crack propagation or failure. During the cyclic load several factor also contribute to microcrack generation such as frictional sliding of the mating surface, progressive wear, residual stresses at grain boundaries, stress due to shear.[3]\nTable 1: Summary of mechanical properties of cortical bone and biomaterial\n\n\n\n\n\nMaterial\nTensile strength (MPa)\nCompressive strength (MPa)\nElastic modulus (GPa)\nFracture toughness (MPa. m-1\/2)\n\n\nBioglass\n42[5]\n500[5]\n35[6]\n2[6]\n\n\nCortical Bone\n50-151[5]\n100-230[7]\n7-30[6]\n2-12[6]\n\n\nTitanium\n345[8]\n250-600[9]\n102.7[8]\n58-66[8]\n\n\nStainless steel\n465-950[1]\n1000[9]\n200[5]\n55-95[9]\n\n\nTi-Alloys\n596-1100[8]\n450-1850[9]\n55-114[8]\n40-92[8]\n\n\nAlumina\n270-500[9]\n3000-5000[9]\n380-410[6]\n5-6[6]\n\n\nHydroxyapatites\n40-300[9]\n500-1000[7]\n80-120[6]\n0.6-1[6]\n\nSee also \n\nArtificial bone\nBiomaterials\nStress\nStrain\nHooke's law\nShear modulus\nBending stiffness\nToughness\n\nReferences \n\n\n^ a b c d Katti, K. S. (2004). Biomaterials in total joint replacement. Colloids and Surfaces B: Biointerfaces, 39(3), 133-142. \n\n^ Wang, R. Z., Cui, F. Z., Lu, H. B., Wen, H. B., Ma, C. L., & Li, H. D. (1995). Synthesis of nanophase hydroxyapatite\/collagen composite. Journal of materials science letters, 14(7), 490-492. \n\n^ a b c Kokubo, T. (Ed.). (2008). Bioceramics and their clinical applications. Woodhead Pub. and Maney Pub. \n\n^ Fischer, H., & Marx, R. (2002). Fracture toughness of dental ceramics: comparison of bending and indentation method. Dental Materials, 18(1), 12-19. \n\n^ a b c d Chen, Q., Zhu, C., & Thouas, G. A. (2012). Progress and challenges in biomaterials used for bone tissue engineering: bioactive glasses and elastomeric composites. Progress in Biomaterials, 1(1), 1-22. \n\n^ a b c d e f g h Amaral, M., Lopes, M. A., Silva, R. F., & Santos, J. D. (2002). Densification route and mechanical properties of Si 3 N 4\u2013bioglass biocomposites. Biomaterials, 23(3), 857-862. \n\n^ a b Kokubo, T., Kim, H. M., & Kawashita, M. (2003). Novel bioactive materials with different mechanical properties. Biomaterials, 24(13), 2161-2175. \n\n^ a b c d e f Niinomi, M. (1998). Mechanical properties of biomedical titanium alloys.Materials Science and Engineering: A, 243(1), 231-236. \n\n^ a b c d e f g [1] \n\n\nFurther reading \nBhatia, S. K. (2010). Biomaterials for clinical applications. Springer.\nHench, L. L. (1993). An introduction to bioceramics (Vol. 1). World Scientific.\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Mechanical_properties_of_biomaterials\">https:\/\/www.limswiki.org\/index.php\/Mechanical_properties_of_biomaterials<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 1 March 2016, at 16:53.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 934 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","648684e0deb85f1b40ca4dc75106cb6d_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Mechanical_properties_of_biomaterials skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Mechanical properties of biomaterials<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>Materials that are used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical\" class=\"mw-redirect\" title=\"Biomedical\" rel=\"external_link\" target=\"_blank\">biomedical<\/a> or clinical applications are known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterials\" class=\"mw-redirect\" title=\"Biomaterials\" rel=\"external_link\" target=\"_blank\">biomaterials<\/a>. The following article deals with fifth generation biomaterials that are used for bone structure replacement. For any material to be classified for biomedical application three requirements must be met. The first requirement is that the material must be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatible\" class=\"mw-redirect\" title=\"Biocompatible\" rel=\"external_link\" target=\"_blank\">biocompatible<\/a>; it means that the organism should not treat it as a foreign object. Secondly, the material should be biodegradable (for in-graft only); the material should harmlessly degrade or dissolve in the body of the organism to allow it to resume natural functioning. Thirdly, the material should be mechanically sound; for the replacement of load bearing structures, the material should possess equivalent or greater mechanical stability to ensure high reliability of the graft.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Introduction\">Introduction<\/span><\/h2>\n<p>The biomaterial term is used for materials that can be used in biomedical and clinical applications. They are bioactive and biocompatible in nature. Currently, many types of metals and alloys (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nickel\" title=\"Nickel\" rel=\"external_link\" target=\"_blank\">nickel<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium\" title=\"Magnesium\" rel=\"external_link\" target=\"_blank\">magnesium<\/a>, Co\u2013Cr alloys, Ti alloys),<sup id=\"rdp-ebb-cite_ref-Katti_1-0\" class=\"reference\"><a href=\"#cite_note-Katti-1\" rel=\"external_link\">[1]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_materials\" class=\"mw-redirect\" title=\"Ceramic materials\" rel=\"external_link\" target=\"_blank\">ceramics<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Zirconia\" class=\"mw-redirect\" title=\"Zirconia\" rel=\"external_link\" target=\"_blank\">zirconia<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioglass\" title=\"Bioglass\" rel=\"external_link\" target=\"_blank\">bioglass<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alumina\" class=\"mw-redirect\" title=\"Alumina\" rel=\"external_link\" target=\"_blank\">alumina<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxyapatite\" title=\"Hydroxyapatite\" rel=\"external_link\" target=\"_blank\">hydroxyapatite<\/a>) <sup id=\"rdp-ebb-cite_ref-Katti_1-1\" class=\"reference\"><a href=\"#cite_note-Katti-1\" rel=\"external_link\">[1]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymers\" class=\"mw-redirect\" title=\"Polymers\" rel=\"external_link\" target=\"_blank\">polymers<\/a> (acrylic, nylon, silicone, polyurethane, polycaprolactone, polyanhydrides) <sup id=\"rdp-ebb-cite_ref-Katti_1-2\" class=\"reference\"><a href=\"#cite_note-Katti-1\" rel=\"external_link\">[1]<\/a><\/sup> are used for load bearing application. This includes dental replacement and bone joining or replacement for medical and clinical application. Therefore their mechanical properties are very important. Mechanical properties of some biomaterials and bone are summarized in table 1.<sup id=\"rdp-ebb-cite_ref-wang_2-0\" class=\"reference\"><a href=\"#cite_note-wang-2\" rel=\"external_link\">[2]<\/a><\/sup> Among them hydroxyapatite is most widely studied bioactive and biocompatible material. However, it has lower <a href=\"https:\/\/en.wikipedia.org\/wiki\/Young%E2%80%99s_modulus\" class=\"mw-redirect\" title=\"Young\u2019s modulus\" rel=\"external_link\" target=\"_blank\">young\u2019s modulus<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fracture_toughness\" title=\"Fracture toughness\" rel=\"external_link\" target=\"_blank\">fracture toughness<\/a> with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brittle\" class=\"mw-redirect\" title=\"Brittle\" rel=\"external_link\" target=\"_blank\">brittle<\/a> nature. Hence, it is required to produce a biomaterial with good mechanical properties.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Elastic_modulus\">Elastic modulus<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Elastic_modulus\" title=\"Elastic modulus\" rel=\"external_link\" target=\"_blank\">Elastic modulus<\/a> is simply defined as the ratio of stress to strain within the proportional limit. Physically, it represents the stiffness of a material within the elastic range when tensile or compressive load are applied. It is clinically important because it indicates the selected biomaterial has similar deformable properties with the material it is going to replace. These force-bearing materials require high elastic modulus with low deflection. As the elastic modulus of material increases fracture resistance decreases. It is desirable that the biomaterial elastic modulus is similar to bone. This is because if it is more than bone elastic modulus then load is born by material only; while the load is bear by bone only if it is less than bone material. The Elastic modulus of a material is generally calculated by bending test because deflection can be easily measured in this case as compared to very small elongation in compressive or tensile load. However, biomaterials (for bone replacement) are usually porous and the sizes of the samples are small. Therefore, nanoindentation test is used to determine the elastic modulus of these materials. This method has high precision and convenient for micro scale samples. Another method of elastic modulus measurement is non-destructive method. It is also clinically very good method because of its simplicity and repeatability since materials are not destroyed.<sup id=\"rdp-ebb-cite_ref-kokubo_3-0\" class=\"reference\"><a href=\"#cite_note-kokubo-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Hardness\">Hardness<\/span><\/h2>\n<p>Hardness is one of the most important parameters for comparing properties of materials. It is used for finding the suitability of the clinical use of biomaterials. Biomaterial hardness is desirable as equal to bone hardness. If higher than the biomaterial, then it penetrates in the bone. As above said, biomaterials sample are very small therefore, micro and nano scale hardness test (Diamond Knoop and Vickers indenters) are used.<sup id=\"rdp-ebb-cite_ref-kokubo_3-1\" class=\"reference\"><a href=\"#cite_note-kokubo-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Fracture_strength\">Fracture strength<\/span><\/h2>\n<p>Strength of materials is defined as the maximum stress that can be endured before fracture occurs. Strength of biomaterials (bioceramics) is an important mechanical property because they are brittle. In brittle materials like bioceramics, cracks easily propagate when the material is subject to tensile loading, unlike compressive loading. A number of methods are available for determining the tensile strength of materials, such as the bending flexural test, the biaxial <a href=\"https:\/\/en.wikipedia.org\/wiki\/Flexural_strength\" title=\"Flexural strength\" rel=\"external_link\" target=\"_blank\">flexural strength<\/a> test and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Weibull\" title=\"Weibull\" rel=\"external_link\" target=\"_blank\">weibull<\/a> approach. In bioceramics, flaws influence the reliability and strength of the material during implantation and fabrication. There are a number of ways that flaws can be produced in bioceramics such as thermal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sintering\" title=\"Sintering\" rel=\"external_link\" target=\"_blank\">sintering<\/a> and heating. The importance is for bioceramics to have high reliability, rather than high strength.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Fracture_toughness\">Fracture toughness<\/span><\/h2>\n<p>Fracture toughness is required to alter the crack propagation in ceramics. It is helpful to evaluate the serviceability, performance and long term clinical success of biomaterials. It is reported that the high fracture toughness material improved clinical performance and reliability as compare to low fracture toughness.<sup id=\"rdp-ebb-cite_ref-fischer_4-0\" class=\"reference\"><a href=\"#cite_note-fischer-4\" rel=\"external_link\">[4]<\/a><\/sup> It can be measured by many methods e.g. indentation fracture, indentation strength, single edge notched beam, single edge pre cracked beam and double cantilever beam.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Fatigue\">Fatigue<\/span><\/h2>\n<p>Fatigue is defined as failure of a material due to repeated\/cyclic loading or unloading (tensile or compressive stresses). It is also an important parameter for biomaterial because cyclic load is applied during their serving life. In this cyclic loading condition, micro crack\/flaws may be generated at the interface of the matrix and the filler. This micro crack can initiate permanent plastic deformation which results in large crack propagation or failure. During the cyclic load several factor also contribute to microcrack generation such as frictional sliding of the mating surface, progressive wear, residual stresses at grain boundaries, stress due to shear.<sup id=\"rdp-ebb-cite_ref-kokubo_3-2\" class=\"reference\"><a href=\"#cite_note-kokubo-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>Table 1: Summary of mechanical properties of cortical bone and biomaterial\n<\/p>\n<table class=\"wikitable\" style=\"\">\n\n\n<tbody><tr>\n<th>Material<\/th>\n<th>Tensile strength (<i>MPa<\/i>)<\/th>\n<th>Compressive strength (<i>MPa<\/i>)<\/th>\n<th>Elastic modulus (<i>GPa<\/i>)<\/th>\n<th>Fracture toughness (<i>MPa. m<\/i><sup><i>-1\/2<\/i><\/sup>)\n<\/th><\/tr>\n<tr>\n<td>Bioglass<\/td>\n<td>42<sup id=\"rdp-ebb-cite_ref-chen_5-0\" class=\"reference\"><a href=\"#cite_note-chen-5\" rel=\"external_link\">[5]<\/a><\/sup><\/td>\n<td>500<sup id=\"rdp-ebb-cite_ref-chen_5-1\" class=\"reference\"><a href=\"#cite_note-chen-5\" rel=\"external_link\">[5]<\/a><\/sup><\/td>\n<td>35<sup id=\"rdp-ebb-cite_ref-amaral_6-0\" class=\"reference\"><a href=\"#cite_note-amaral-6\" rel=\"external_link\">[6]<\/a><\/sup><\/td>\n<td>2<sup id=\"rdp-ebb-cite_ref-amaral_6-1\" class=\"reference\"><a href=\"#cite_note-amaral-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>Cortical Bone<\/td>\n<td>50-151<sup id=\"rdp-ebb-cite_ref-chen_5-2\" class=\"reference\"><a href=\"#cite_note-chen-5\" rel=\"external_link\">[5]<\/a><\/sup><\/td>\n<td>100-230<sup id=\"rdp-ebb-cite_ref-kokubo_2003_7-0\" class=\"reference\"><a href=\"#cite_note-kokubo_2003-7\" rel=\"external_link\">[7]<\/a><\/sup><\/td>\n<td>7-30<sup id=\"rdp-ebb-cite_ref-amaral_6-2\" class=\"reference\"><a href=\"#cite_note-amaral-6\" rel=\"external_link\">[6]<\/a><\/sup><\/td>\n<td>2-12<sup id=\"rdp-ebb-cite_ref-amaral_6-3\" class=\"reference\"><a href=\"#cite_note-amaral-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>Titanium<\/td>\n<td>345<sup id=\"rdp-ebb-cite_ref-niinomi_8-0\" class=\"reference\"><a href=\"#cite_note-niinomi-8\" rel=\"external_link\">[8]<\/a><\/sup><\/td>\n<td>250-600<sup id=\"rdp-ebb-cite_ref-nptel_9-0\" class=\"reference\"><a href=\"#cite_note-nptel-9\" rel=\"external_link\">[9]<\/a><\/sup><\/td>\n<td>102.7<sup id=\"rdp-ebb-cite_ref-niinomi_8-1\" class=\"reference\"><a href=\"#cite_note-niinomi-8\" rel=\"external_link\">[8]<\/a><\/sup><\/td>\n<td>58-66<sup id=\"rdp-ebb-cite_ref-niinomi_8-2\" class=\"reference\"><a href=\"#cite_note-niinomi-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>Stainless steel<\/td>\n<td>465-950<sup id=\"rdp-ebb-cite_ref-Katti_1-3\" class=\"reference\"><a href=\"#cite_note-Katti-1\" rel=\"external_link\">[1]<\/a><\/sup><\/td>\n<td>1000<sup id=\"rdp-ebb-cite_ref-nptel_9-1\" class=\"reference\"><a href=\"#cite_note-nptel-9\" rel=\"external_link\">[9]<\/a><\/sup><\/td>\n<td>200<sup id=\"rdp-ebb-cite_ref-chen_5-3\" class=\"reference\"><a href=\"#cite_note-chen-5\" rel=\"external_link\">[5]<\/a><\/sup><\/td>\n<td>55-95<sup id=\"rdp-ebb-cite_ref-nptel_9-2\" class=\"reference\"><a href=\"#cite_note-nptel-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>Ti-Alloys<\/td>\n<td>596-1100<sup id=\"rdp-ebb-cite_ref-niinomi_8-3\" class=\"reference\"><a href=\"#cite_note-niinomi-8\" rel=\"external_link\">[8]<\/a><\/sup><\/td>\n<td>450-1850<sup id=\"rdp-ebb-cite_ref-nptel_9-3\" class=\"reference\"><a href=\"#cite_note-nptel-9\" rel=\"external_link\">[9]<\/a><\/sup><\/td>\n<td>55-114<sup id=\"rdp-ebb-cite_ref-niinomi_8-4\" class=\"reference\"><a href=\"#cite_note-niinomi-8\" rel=\"external_link\">[8]<\/a><\/sup><\/td>\n<td>40-92<sup id=\"rdp-ebb-cite_ref-niinomi_8-5\" class=\"reference\"><a href=\"#cite_note-niinomi-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>Alumina<\/td>\n<td>270-500<sup id=\"rdp-ebb-cite_ref-nptel_9-4\" class=\"reference\"><a href=\"#cite_note-nptel-9\" rel=\"external_link\">[9]<\/a><\/sup><\/td>\n<td>3000-5000<sup id=\"rdp-ebb-cite_ref-nptel_9-5\" class=\"reference\"><a href=\"#cite_note-nptel-9\" rel=\"external_link\">[9]<\/a><\/sup><\/td>\n<td>380-410<sup id=\"rdp-ebb-cite_ref-amaral_6-4\" class=\"reference\"><a href=\"#cite_note-amaral-6\" rel=\"external_link\">[6]<\/a><\/sup><\/td>\n<td>5-6<sup id=\"rdp-ebb-cite_ref-amaral_6-5\" class=\"reference\"><a href=\"#cite_note-amaral-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td>Hydroxyapatites<\/td>\n<td>40-300<sup id=\"rdp-ebb-cite_ref-nptel_9-6\" class=\"reference\"><a href=\"#cite_note-nptel-9\" rel=\"external_link\">[9]<\/a><\/sup><\/td>\n<td>500-1000<sup id=\"rdp-ebb-cite_ref-kokubo_2003_7-1\" class=\"reference\"><a href=\"#cite_note-kokubo_2003-7\" rel=\"external_link\">[7]<\/a><\/sup><\/td>\n<td>80-120<sup id=\"rdp-ebb-cite_ref-amaral_6-6\" class=\"reference\"><a href=\"#cite_note-amaral-6\" rel=\"external_link\">[6]<\/a><\/sup><\/td>\n<td>0.6-1<sup id=\"rdp-ebb-cite_ref-amaral_6-7\" class=\"reference\"><a href=\"#cite_note-amaral-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/td><\/tr><\/tbody><\/table>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 35em; -webkit-column-width: 35em; column-width: 35em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_bone\" title=\"Artificial bone\" rel=\"external_link\" target=\"_blank\">Artificial bone<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterials\" class=\"mw-redirect\" title=\"Biomaterials\" rel=\"external_link\" target=\"_blank\">Biomaterials<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Stress_(mechanics)\" title=\"Stress (mechanics)\" rel=\"external_link\" target=\"_blank\">Stress<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Deformation_(mechanics)\" title=\"Deformation (mechanics)\" rel=\"external_link\" target=\"_blank\">Strain<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hooke%27s_law\" title=\"Hooke's law\" rel=\"external_link\" target=\"_blank\">Hooke's law<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Shear_modulus\" title=\"Shear modulus\" rel=\"external_link\" target=\"_blank\">Shear modulus<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bending_stiffness\" title=\"Bending stiffness\" rel=\"external_link\" target=\"_blank\">Bending stiffness<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Toughness\" title=\"Toughness\" rel=\"external_link\" target=\"_blank\">Toughness<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-Katti-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Katti_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Katti_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Katti_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Katti_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Katti, K. S. (2004). Biomaterials in total joint replacement. Colloids and Surfaces B: Biointerfaces, 39(3), 133-142.<\/span>\n<\/li>\n<li id=\"cite_note-wang-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-wang_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Wang, R. Z., Cui, F. Z., Lu, H. B., Wen, H. B., Ma, C. L., & Li, H. D. (1995). Synthesis of nanophase hydroxyapatite\/collagen composite. Journal of materials science letters, 14(7), 490-492.<\/span>\n<\/li>\n<li id=\"cite_note-kokubo-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-kokubo_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-kokubo_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-kokubo_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Kokubo, T. (Ed.). (2008). Bioceramics and their clinical applications. Woodhead Pub. and Maney Pub.<\/span>\n<\/li>\n<li id=\"cite_note-fischer-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-fischer_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Fischer, H., & Marx, R. (2002). Fracture toughness of dental ceramics: comparison of bending and indentation method. Dental Materials, 18(1), 12-19.<\/span>\n<\/li>\n<li id=\"cite_note-chen-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-chen_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-chen_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-chen_5-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-chen_5-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Chen, Q., Zhu, C., & Thouas, G. A. (2012). Progress and challenges in biomaterials used for bone tissue engineering: bioactive glasses and elastomeric composites. Progress in Biomaterials, 1(1), 1-22.<\/span>\n<\/li>\n<li id=\"cite_note-amaral-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-amaral_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-amaral_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-amaral_6-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-amaral_6-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-amaral_6-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-amaral_6-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-amaral_6-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-amaral_6-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Amaral, M., Lopes, M. A., Silva, R. F., & Santos, J. D. (2002). Densification route and mechanical properties of Si<sub> 3<\/sub> N<sub> 4<\/sub>\u2013bioglass biocomposites. Biomaterials, 23(3), 857-862.<\/span>\n<\/li>\n<li id=\"cite_note-kokubo_2003-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-kokubo_2003_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-kokubo_2003_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Kokubo, T., Kim, H. M., & Kawashita, M. (2003). Novel bioactive materials with different mechanical properties. Biomaterials, 24(13), 2161-2175.<\/span>\n<\/li>\n<li id=\"cite_note-niinomi-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-niinomi_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-niinomi_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-niinomi_8-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-niinomi_8-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-niinomi_8-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-niinomi_8-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Niinomi, M. (1998). Mechanical properties of biomedical titanium alloys.Materials Science and Engineering: A, 243(1), 231-236.<\/span>\n<\/li>\n<li id=\"cite_note-nptel-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-nptel_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-nptel_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-nptel_9-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-nptel_9-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-nptel_9-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-nptel_9-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-nptel_9-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/nptel.iitm.ac.in\/courses\/113104009\/1\" target=\"_blank\">[1]<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li>Bhatia, S. K. (2010). Biomaterials for clinical applications. Springer.<\/li>\n<li>Hench, L. L. (1993). An introduction to bioceramics (Vol. 1). World Scientific.<\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1333\nCached time: 20181217054732\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.080 seconds\nReal time usage: 0.098 seconds\nPreprocessor visited node count: 437\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 846\/2097152 bytes\nTemplate argument size: 218\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 8138\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.003\/10.000 seconds\nLua memory usage: 585 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 41.312 1 -total\n<\/p>\n<pre>58.43% 24.140 1 Template:Col_div\n31.07% 12.837 1 Template:Reflist\n10.10% 4.173 1 Template:Colend\n 8.16% 3.370 2 Template:Main_other\n 5.21% 2.151 1 Template:Column-width\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:39117935-1!canonical and timestamp 20181217054732 and revision id 862199044\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Mechanical_properties_of_biomaterials\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212207\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.044 seconds\nReal time usage: 0.169 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 163.405 1 - wikipedia:Mechanical_properties_of_biomaterials\n100.00% 163.405 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8204-0!*!*!*!*!*!* and timestamp 20181217212207 and revision id 24354\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Mechanical_properties_of_biomaterials\">https:\/\/www.limswiki.org\/index.php\/Mechanical_properties_of_biomaterials<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","648684e0deb85f1b40ca4dc75106cb6d_images":[],"648684e0deb85f1b40ca4dc75106cb6d_timestamp":1545081727,"af680bf337e2578f3ed5d787dc411655_type":"article","af680bf337e2578f3ed5d787dc411655_title":"Biomaterial","af680bf337e2578f3ed5d787dc411655_url":"https:\/\/www.limswiki.org\/index.php\/Biomaterial","af680bf337e2578f3ed5d787dc411655_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tBiomaterial\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\"Biomaterials\" redirects here. For the journal, see Biomaterials (journal).\n A hip implant is an example of an application of biomaterials\nA biomaterial is any substance that has been engineered to interact with biological systems for a medical purpose - either a therapeutic (treat, augment, repair or replace a tissue function of the body) or a diagnostic one. As a science, biomaterials is about fifty years old. The study of biomaterials is called biomaterials science or biomaterials engineering. It has experienced steady and strong growth over its history, with many companies investing large amounts of money into the development of new products. Biomaterials science encompasses elements of medicine, biology, chemistry, tissue engineering and materials science.\nNote that a biomaterial is different from a biological material, such as bone, that is produced by a biological system. Additionally, care should be exercised in defining a biomaterial as biocompatible, since it is application-specific. A biomaterial that is biocompatible or suitable for one application may not be biocompatible in another.[1]\n\n\nIUPAC definition\nMaterial exploited in contact with living tissues, organisms, or microorganisms.[2][a][b][c]\n\nContents \n\n1 Introduction \n2 Bioactivity \n3 Self-assembly \n4 Structural hierarchy \n5 Applications \n\n5.1 Heart valves \n5.2 Skin repair \n\n\n6 Compatibility \n7 Biopolymers \n8 See also \n9 Footnotes \n10 References \n11 External links \n\n\nIntroduction \nBiomaterials can be derived either from nature or synthesized in the laboratory using a variety of chemical approaches utilizing metallic components, polymers, ceramics or composite materials. They are often used and\/or adapted for a medical application, and thus comprises whole or part of a living structure or biomedical device which performs, augments, or replaces a natural function. Such functions may be relatively passive, like being used for a heart valve, or may be bioactive with a more interactive functionality such as hydroxy-apatite coated hip implants. Biomaterials are also used every day in dental applications, surgery, and drug delivery. For example, a construct with impregnated pharmaceutical products can be placed into the body, which permits the prolonged release of a drug over an extended period of time. A biomaterial may also be an autograft, allograft or xenograft used as a transplant material.\n\nBioactivity \nThe ability of an engineered biomaterial to induce a physiological response that is supportive of the biomaterial's function and performance is known as bioactivity. Most commonly, in bioactive glasses and bioactive ceramics this term refers to the ability of implanted materials to bond well with surrounding tissue in either osseoconductive or osseoproductive roles [4]. Bone implant materials are often designed to promote bone growth while dissolving into surrounding body fluid [5]. Thus for many biomaterials good biocompatibility along with good strength and dissolution rates are desirable. Commonly, bioactivity of biomateirals is gauged by the surface biomineralisation in which a native layer of hydroxyapatite is formed at the surface.\n\nSelf-assembly \nSelf-assembly is the most common term in use in the modern scientific community to describe the spontaneous aggregation of particles (atoms, molecules, colloids, micelles, etc.) without the influence of any external forces. Large groups of such particles are known to assemble themselves into thermodynamically stable, structurally well-defined arrays, quite reminiscent of one of the 7 crystal systems found in metallurgy and mineralogy (e.g. face-centered cubic, body-centered cubic, etc.). The fundamental difference in equilibrium structure is in the spatial scale of the unit cell (or lattice parameter) in each particular case.\nMolecular self-assembly is found widely in biological systems and provides the basis of a wide variety of complex biological structures. This includes an emerging class of mechanically superior biomaterials based on microstructural features and designs found in nature. Thus, self-assembly is also emerging as a new strategy in chemical synthesis and nanotechnology. Molecular crystals, liquid crystals, colloids, micelles, emulsions, phase-separated polymers, thin films and self-assembled monolayers all represent examples of the types of highly ordered structures which are obtained using these techniques. The distinguishing feature of these methods is self-organization.[6][7][8]\n\nStructural hierarchy \nNearly all materials could be seen as hierarchically structured, especially since the changes in spatial scale bring about different mechanisms of deformation and damage. However, in biological materials this hierarchical organization is inherent to the microstructure. One of the first examples of this, in the history of structural biology, is the early X-ray scattering work on the hierarchical structure of hair and wool by Astbury and Woods.[9] In bone, for example, collagen is the building block of the organic matrix \u2014 a triple helix with diameter of 1.5 nm. These tropocollagen molecules are intercalated with the mineral phase (hydroxyapatite, a calcium phosphate) forming fibrils that curl into helicoids of alternating directions. These \"osteons\" are the basic building blocks of bones, with the volume fraction distribution between organic and mineral phase being about 60\/40.\nIn another level of complexity, the hydroxyapatite crystals are mineral platelets that have a diameter of approximately 70\u2013100 nm and thickness of 1 nm. They originally nucleate at the gaps between collagen fibrils.\nSimilarly, the hierarchy of abalone shell begins at the nanolevel, with an organic layer having a thickness of 20\u201330 nm. This layer proceeds with single crystals of aragonite (a polymorph of CaCO3) consisting of \"bricks\" with dimensions of 0.5 and finishing with layers approximately 0.3 mm (mesostructure).\nCrabs are arthropods whose carapace is made of a mineralized hard component (which exhibits brittle fracture) and a softer organic component composed primarily of chitin. The brittle component is arranged in a helical pattern. Each of these mineral \u2018rods\u2019 (1 \u03bcm diameter) contains chitin\u2013protein fibrils with approximately 60 nm diameter. These fibrils are made of 3 nm diameter canals which link the interior and exterior of the shell.\n\nApplications \nBiomaterials are used in:\n\nJoint replacements\nBone plates[10]\nIntraocular lenses (IOLs) for eye surgery\nBone cement\nArtificial ligaments and tendons\nDental implants for tooth fixation\nBlood vessel prostheses\nHeart valves\nSkin repair devices (artificial tissue)\nCochlear replacements\nContact lenses\nBreast implants\nDrug delivery mechanisms\nSustainable materials\nVascular grafts\nStents\nNerve conduits\nSurgical sutures, clips, and staples for wound closure[11][12]\nPins and screws for fracture stabilisation[13]\nSurgical mesh[14][15]\nBiomaterials must be compatible with the body, and there are often issues of biocompatibility which must be resolved before a product can be placed on the market and used in a clinical setting. Because of this, biomaterials are usually subjected to the same requirements as those undergone by new drug therapies.[16][17]\nAll manufacturing companies are also required to ensure traceability of all of their products so that if a defective product is discovered, others in the same batch may be traced.\n\nHeart valves \nIn the United States, 45% of the 250,000 valve replacement procedures performed annually involve a mechanical valve implant. The most widely used valve is a bileaflet disc heart valve, or St. Jude valve. The mechanics involve two semicircular discs moving back and forth, with both allowing the flow of blood as well as the ability to form a seal against backflow. The valve is coated with pyrolytic carbon, and secured to the surrounding tissue with a mesh of woven fabric called Dacron (du Pont's trade name for polyethylene terephthalate). The mesh allows for the body's tissue to grow while incorporating the valve.[18]\n\nSkin repair \nMain article: Tissue engineering\nMost of the time, \u2018artificial\u2019 tissue is grown from the patient\u2019s own cells. However, when the damage is so extreme that it is impossible to use the patient's own cells, artificial tissue cells are grown. The difficulty is in finding a scaffold that the cells can grow and organize on. The characteristics of the scaffold must be that it is biocompatible, cells can adhere to the scaffold, mechanically strong and biodegradable. One successful scaffold is a copolymer of lactic acid and glycolic acid.[18]\n\nCompatibility \nBiocompatibility is related to the behavior of biomaterials in various environments under various chemical and physical conditions. The term may refer to specific properties of a material without specifying where or how the material is to be used. For example, a material may elicit little or no immune response in a given organism, and may or may not able to integrate with a particular cell type or tissue. The ambiguity of the term reflects the ongoing development of insights into how biomaterials interact with the human body and eventually how those interactions determine the clinical success of a medical device (such as pacemaker or hip replacement). Modern medical devices and prostheses are often made of more than one material\u2014so it might not always be sufficient to talk about the biocompatibility of a specific material.\n[19]\n\nBiopolymers \nMain article: Biopolymer\nBiopolymers are polymers produced by living organisms. Cellulose and starch, proteins and peptides, and DNA and RNA are all examples of biopolymers, in which the monomeric units, respectively, are sugars, amino acids, and nucleotides.[20]\nCellulose is both the most common biopolymer and the most common organic compound on Earth. About 33% of all plant matter is cellulose.[21][22]\n\nSee also \nBionics\nPolymeric surface\nSurface modification of biomaterials with proteins\nSynthetic biodegradable polymer\nList of biomaterials\nFootnotes \n\n\n^ The notion of exploitation includes utility for applications and for fundamental research to understand reciprocal perturbations as well.[2] \n\n^ The definition \u201cnon-viable material used in a medical device, intended to interact with biological systems\u201d recommended in ref.[3] cannot be extended to the environmental field where people mean \u201cmaterial of natural origin\u201d.[2] \n\n^ This general term should not be confused with the terms biopolymer or biomacromolecule. The use of \u201cpolymeric biomaterial\u201d is recommended when one deals with polymer or polymer device of therapeutic or biological interest.[2] \n\n\nReferences \n\n\n^ Schmalz, G.; Arenholdt-Bindslev, D. (2008). \"Chapter 1: Basic Aspects\". Biocompatibility of Dental Materials. Berlin: Springer-Verlag. pp. 1\u201312. ISBN 9783540777823. Archived from the original on 9 December 2017. Retrieved 29 February 2016 . \n\n^ a b c d Vert, M.; Doi, Y.; Hellwich, K. H.; Hess, M.; Hodge, P.; Kubisa, P.; Rinaudo, M.; Schu\u00e9, F. O. (2012). \"Terminology for biorelated polymers and applications (IUPAC Recommendations 2012)\". Pure and Applied Chemistry. 84 (2): 377. doi:10.1351\/PAC-REC-10-12-04. \n\n^ Williams, D. F., ed. (2004). Definitions in Biomaterials, Proceedings of a Consensus Conference of the European Society for Biomaterials. Amsterdam: Elsevier. \n\n^ Cao, Wanpeng; Hench, Larry (1996). \"Bioactive Materials\". Ceramics International. 22 (6): 493\u2013507. doi:10.1016\/0272-8842(95)00126-3. \n\n^ Zhu, H.; et al. (2018). \"Nanostructural insights into the dissolution behavior of Sr-doped hydroxyapatite\". Journal of the European Ceramic Society. 38 (16): 5554\u20135562. doi:10.1016\/j.jeurceramsoc.2018.07.056. CS1 maint: Explicit use of et al. (link) \n\n^ Whitesides, G.; Mathias, J.; Seto, C. (1991). \"Molecular self-assembly and nanochemistry: A chemical strategy for the synthesis of nanostructures\". Science. 254 (5036): 1312\u20139. Bibcode:1991Sci...254.1312W. doi:10.1126\/science.1962191. PMID 1962191. \n\n^ Dabbs, D. M.; Aksay, I. A. (2000). \"Self-Assembledceramicsproduced Bycomplex-Fluidtemplation\". Annual Review of Physical Chemistry. 51: 601\u201322. Bibcode:2000ARPC...51..601D. doi:10.1146\/annurev.physchem.51.1.601. PMID 11031294. \n\n^ Ariga, K.; Hill, J. P.; Lee, M. V.; Vinu, A.; Charvet, R.; Acharya, S. (2008). \"Challenges and breakthroughs in recent research on self-assembly\". Science and Technology of Advanced Materials. 9 (1): 014109. Bibcode:2008STAdM...9a4109A. doi:10.1088\/1468-6996\/9\/1\/014109. PMC 5099804 . PMID 27877935. \n\n^ Stroud, R. M. (2006). \"Present at the flood: How structural biology came about, by Richard E. Dickerson\". Protein Science. 16 (1): 135\u2013136. doi:10.1110\/ps.062627807. PMC 2222831 . \n\n^ Ibrahim, H.; Esfahani, S. N.; Poorganji, B.; Dean, D.; Elahinia, M. (January 2017). \"Resorbable bone fixation alloys, forming, and post-fabrication treatments\". Materials Science and Engineering: C. 70 (1): 870\u2013888. doi:10.1016\/j.msec.2016.09.069. PMID 27770965. \n\n^ Pillai, C. K. S.; Sharma, C. P. (2010). \"Review Paper: Absorbable Polymeric Surgical Sutures: Chemistry, Production, Properties, Biodegradability, and Performance\". Journal of Biomaterials Applications. 25 (4): 291\u2013366. CiteSeerX 10.1.1.1013.5873 . doi:10.1177\/0885328210384890. PMID 20971780. \n\n^ Pillai CK, Sharma CP (Nov 2010). \"Review paper: absorbable polymeric surgical sutures: chemistry, production, properties, biodegradability, and performance\". J Biomater Appl. 25 (4): 291\u2013366. CiteSeerX 10.1.1.1013.5873 . doi:10.1177\/0885328210384890. PMID 20971780. \n\n^ Waris, E; Ashammakhi, N; Kaarela, O; Raatikainen, T; Vasenius, J (December 2004). \"Use of bioabsorbable osteofixation devices in the hand\". Journal of Hand Surgery (Edinburgh, Scotland). 29 (6): 590\u20138. doi:10.1016\/j.jhsb.2004.02.005. PMID 15542222. \n\n^ Deasis, F. J.; Lapin, B; Gitelis, M. E.; Ujiki, M. B. (2015). \"Current state of laparoscopic parastomal hernia repair: A meta-analysis\". World Journal of Gastroenterology. 21 (28): 8670\u20137. doi:10.3748\/wjg.v21.i28.8670. PMC 4524825 . PMID 26229409. \n\n^ Banyard, D. A.; Bourgeois, J. M.; Widgerow, A. D.; Evans, G. R. (2015). \"Regenerative biomaterials: A review\". Plastic and Reconstructive Surgery. 135 (6): 1740\u20138. doi:10.1097\/PRS.0000000000001272. PMID 26017603. \n\n^ Meyers, M. A.; Chen, P. Y.; Lin, A. Y. M.; Seki, Y. (2008). \"Biological materials: Structure and mechanical properties\". Progress in Materials Science. 53: 1\u2013206. CiteSeerX 10.1.1.466.3753 . doi:10.1016\/j.pmatsci.2007.05.002. \n\n^ Espinosa, H. D.; Rim, J. E.; Barthelat, F.; Buehler, M. J. (2009). \"Merger of structure and material in nacre and bone \u2013 Perspectives on de novo biomimetic materials\". Progress in Materials Science. 54 (8): 1059\u20131100. doi:10.1016\/j.pmatsci.2009.05.001. \n\n^ a b Brown, Theodore L.; LeMay, H. Eugene; Bursten, Bruce E. (2000). Chemistry The Central Science. Prentice-Hall, Inc. pp. 451\u2013452. ISBN 978-0-13-084090-5. \n\n^ Kammula, R. G. and Morris, G. M. (2001) \"Considerations for the Biocompatibility Evaluation of Medical Devices\" Archived 2011-07-07 at the Wayback Machine., Medical Device & Diagnostic Industry \n\n^ Buehler, M. J.; Yung, Y. C. (2009). \"Deformation and failure of protein materials in physiologically extreme conditions and disease\". Nature Materials. 8 (3): 175\u201388. Bibcode:2009NatMa...8..175B. doi:10.1038\/nmat2387. PMID 19229265. \n\n^ Stupp, S. I.; Braun, P. V. (1997). \"Molecular manipulation of microstructures: Biomaterials, ceramics, and semiconductors\". Science. 277 (5330): 1242\u20138. doi:10.1126\/science.277.5330.1242. PMID 9271562. \n\n^ Klemm, D; Heublein, B; Fink, H. P.; Bohn, A (2005). \"Cellulose: Fascinating biopolymer and sustainable raw material\". Angewandte Chemie International Edition. 44 (22): 3358\u201393. doi:10.1002\/anie.200460587. PMID 15861454. \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Biomaterials.\nJournal of Biomaterials Applications\nCREB \u2013 Biomedical Engineering Research Centre\nDepartment of Biomaterials at the Max Planck Institute of Colloids and Interfaces in Potsdam-Golm, Germany\nOpen Innovation Campus for Biomaterials\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Biomaterial\">https:\/\/www.limswiki.org\/index.php\/Biomaterial<\/a>\n\t\t\t\t\tCategory: BiomaterialsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 00:09.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 455 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","af680bf337e2578f3ed5d787dc411655_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Biomaterial skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Biomaterial<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">\"Biomaterials\" redirects here. For the journal, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterials_(journal)\" title=\"Biomaterials (journal)\" rel=\"external_link\" target=\"_blank\">Biomaterials (journal)<\/a>.<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_joint_replacement,_United_States,_1998_Wellcome_L0060175.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/47\/Hip_joint_replacement%2C_United_States%2C_1998_Wellcome_L0060175.jpg\/220px-Hip_joint_replacement%2C_United_States%2C_1998_Wellcome_L0060175.jpg\" width=\"220\" height=\"146\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_joint_replacement,_United_States,_1998_Wellcome_L0060175.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_implant\" class=\"mw-redirect\" title=\"Hip implant\" rel=\"external_link\" target=\"_blank\">hip implant<\/a> is an example of an application of biomaterials<\/div><\/div><\/div>\n<p>A <b>biomaterial<\/b> is any substance that has been engineered to interact with biological systems for a medical purpose - either a therapeutic (treat, augment, repair or replace a tissue function of the body) or a diagnostic one. As a science, <b>biomaterials<\/b> is about fifty years old. The study of biomaterials is called <b>biomaterials science<\/b> or <b>biomaterials engineering<\/b>. It has experienced steady and strong growth over its history, with many companies investing large amounts of money into the development of new products. Biomaterials science encompasses elements of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medicine<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biology\" title=\"Biology\" rel=\"external_link\" target=\"_blank\">biology<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemistry\" title=\"Chemistry\" rel=\"external_link\" target=\"_blank\">chemistry<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_engineering\" title=\"Tissue engineering\" rel=\"external_link\" target=\"_blank\">tissue engineering<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Materials_science\" title=\"Materials science\" rel=\"external_link\" target=\"_blank\">materials science<\/a>.\n<\/p><p>Note that a biomaterial is different from a biological material, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a>, that is produced by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_system\" title=\"Biological system\" rel=\"external_link\" target=\"_blank\">biological system<\/a>. Additionally, care should be exercised in defining a biomaterial as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatible<\/a>, since it is application-specific. A biomaterial that is biocompatible or suitable for one application may not be biocompatible in another.<sup id=\"rdp-ebb-cite_ref-SchmalzBio08_1-0\" class=\"reference\"><a href=\"#cite_note-SchmalzBio08-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<div class=\"quotebox pullquote floatright\" style=\";\">\n<div class=\"quotebox-title\" style=\"\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Union_of_Pure_and_Applied_Chemistry\" title=\"International Union of Pure and Applied Chemistry\" rel=\"external_link\" target=\"_blank\">IUPAC<\/a> definition<\/div>\n<div class=\"quotebox-quote left-aligned\" style=\"\"><i>Material<\/i> exploited in contact with living tissues, organisms, or microorganisms.<sup id=\"rdp-ebb-cite_ref-IUPAC_2-0\" class=\"reference\"><a href=\"#cite_note-IUPAC-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[a]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[b]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[c]<\/a><\/sup><\/div>\n<\/div>\n\n<h2><span class=\"mw-headline\" id=\"Introduction\">Introduction<\/span><\/h2>\n<p>Biomaterials can be derived either from nature or synthesized in the laboratory using a variety of chemical approaches utilizing metallic components, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymers\" class=\"mw-redirect\" title=\"Polymers\" rel=\"external_link\" target=\"_blank\">polymers<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioceramic\" title=\"Bioceramic\" rel=\"external_link\" target=\"_blank\">ceramics<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Composite_materials\" class=\"mw-redirect\" title=\"Composite materials\" rel=\"external_link\" target=\"_blank\">composite materials<\/a>. They are often used and\/or adapted for a medical application, and thus comprises whole or part of a living structure or biomedical device which performs, augments, or replaces a natural function. Such functions may be relatively passive, like being used for a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_valve\" title=\"Heart valve\" rel=\"external_link\" target=\"_blank\">heart valve<\/a>, or may be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_activity\" title=\"Biological activity\" rel=\"external_link\" target=\"_blank\">bioactive<\/a> with a more interactive functionality such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxylapatite\" class=\"mw-redirect\" title=\"Hydroxylapatite\" rel=\"external_link\" target=\"_blank\">hydroxy-apatite<\/a> coated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_implant\" class=\"mw-redirect\" title=\"Hip implant\" rel=\"external_link\" target=\"_blank\">hip implants<\/a>. Biomaterials are also used every day in dental applications, surgery, and drug delivery. For example, a construct with impregnated pharmaceutical products can be placed into the body, which permits the prolonged release of a drug over an extended period of time. A biomaterial may also be an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autograft\" class=\"mw-redirect\" title=\"Autograft\" rel=\"external_link\" target=\"_blank\">autograft<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Allograft\" class=\"mw-redirect\" title=\"Allograft\" rel=\"external_link\" target=\"_blank\">allograft<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Xenograft\" class=\"mw-redirect\" title=\"Xenograft\" rel=\"external_link\" target=\"_blank\">xenograft<\/a> used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organ_transplant\" class=\"mw-redirect\" title=\"Organ transplant\" rel=\"external_link\" target=\"_blank\">transplant<\/a> material.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Bioactivity\">Bioactivity<\/span><\/h2>\n<p>The ability of an engineered biomaterial to induce a physiological response that is supportive of the biomaterial's function and performance is known as bioactivity. Most commonly, in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioactive_glass\" title=\"Bioactive glass\" rel=\"external_link\" target=\"_blank\"> bioactive glasses<\/a> and bioactive ceramics this term refers to the ability of implanted materials to bond well with surrounding tissue in either osseoconductive or osseoproductive roles <sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[4]<\/a><\/sup>. Bone implant materials are often designed to promote bone growth while dissolving into surrounding body fluid <sup id=\"rdp-ebb-cite_ref-\u201cSDHA\u201d_8-0\" class=\"reference\"><a href=\"#cite_note-\u201cSDHA\u201d-8\" rel=\"external_link\">[5]<\/a><\/sup>. Thus for many biomaterials good biocompatibility along with good strength and dissolution rates are desirable. Commonly, bioactivity of biomateirals is gauged by the surface biomineralisation in which a native layer of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxyapatite\" title=\"Hydroxyapatite\" rel=\"external_link\" target=\"_blank\">hydroxyapatite<\/a> is formed at the surface.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Self-assembly\">Self-assembly<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Self-assembly\" title=\"Self-assembly\" rel=\"external_link\" target=\"_blank\">Self-assembly<\/a> is the most common term in use in the modern scientific community to describe the spontaneous aggregation of particles (atoms, molecules, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colloids\" class=\"mw-redirect\" title=\"Colloids\" rel=\"external_link\" target=\"_blank\">colloids<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Micelles\" class=\"mw-redirect\" title=\"Micelles\" rel=\"external_link\" target=\"_blank\">micelles<\/a>, etc.) without the influence of any external forces. Large groups of such particles are known to assemble themselves into <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermodynamic\" class=\"mw-redirect\" title=\"Thermodynamic\" rel=\"external_link\" target=\"_blank\">thermodynamically<\/a> stable, structurally well-defined arrays, quite reminiscent of one of the 7 crystal systems found in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metallurgy\" title=\"Metallurgy\" rel=\"external_link\" target=\"_blank\">metallurgy<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mineralogy\" title=\"Mineralogy\" rel=\"external_link\" target=\"_blank\">mineralogy<\/a> (e.g. face-centered cubic, body-centered cubic, etc.). The fundamental difference in equilibrium structure is in the spatial scale of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Unit_cell\" class=\"mw-redirect\" title=\"Unit cell\" rel=\"external_link\" target=\"_blank\">unit cell<\/a> (or lattice parameter) in each particular case.\n<\/p><p>Molecular self-assembly is found widely in biological systems and provides the basis of a wide variety of complex biological structures. This includes an emerging class of mechanically superior biomaterials based on microstructural features and designs found in nature. Thus, self-assembly is also emerging as a new strategy in chemical synthesis and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nanotechnology\" title=\"Nanotechnology\" rel=\"external_link\" target=\"_blank\">nanotechnology<\/a>. Molecular crystals, liquid crystals, colloids, micelles, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Emulsions\" class=\"mw-redirect\" title=\"Emulsions\" rel=\"external_link\" target=\"_blank\">emulsions<\/a>, phase-separated polymers, thin films and self-assembled monolayers all represent examples of the types of highly ordered structures which are obtained using these techniques. The distinguishing feature of these methods is self-organization.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Structural_hierarchy\">Structural hierarchy<\/span><\/h2>\n<p>Nearly all materials could be seen as hierarchically structured, especially since the changes in spatial scale bring about different mechanisms of deformation and damage. However, in biological materials this hierarchical organization is inherent to the microstructure. One of the first examples of this, in the history of structural biology, is the early <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray_scattering_techniques\" title=\"X-ray scattering techniques\" rel=\"external_link\" target=\"_blank\">X-ray scattering<\/a> work on the hierarchical structure of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hair\" title=\"Hair\" rel=\"external_link\" target=\"_blank\">hair<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wool\" title=\"Wool\" rel=\"external_link\" target=\"_blank\">wool<\/a> by Astbury and Woods.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[9]<\/a><\/sup> In bone, for example, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Collagen\" title=\"Collagen\" rel=\"external_link\" target=\"_blank\">collagen<\/a> is the building block of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Matrix_(biology)\" title=\"Matrix (biology)\" rel=\"external_link\" target=\"_blank\">organic matrix<\/a> \u2014 a triple helix with diameter of 1.5 nm. These <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tropocollagen\" class=\"mw-redirect\" title=\"Tropocollagen\" rel=\"external_link\" target=\"_blank\">tropocollagen<\/a> molecules are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intercalation_(chemistry)\" title=\"Intercalation (chemistry)\" rel=\"external_link\" target=\"_blank\">intercalated<\/a> with the mineral phase (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxyapatite\" title=\"Hydroxyapatite\" rel=\"external_link\" target=\"_blank\">hydroxyapatite<\/a>, a calcium phosphate) forming <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibril\" title=\"Fibril\" rel=\"external_link\" target=\"_blank\">fibrils<\/a> that curl into <a href=\"https:\/\/en.wikipedia.org\/wiki\/Helicoid\" title=\"Helicoid\" rel=\"external_link\" target=\"_blank\">helicoids<\/a> of alternating directions. These \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteon\" title=\"Osteon\" rel=\"external_link\" target=\"_blank\">osteons<\/a>\" are the basic building blocks of bones, with the volume fraction distribution between organic and mineral phase being about 60\/40.\n<\/p><p>In another level of complexity, the hydroxyapatite crystals are mineral platelets that have a diameter of approximately 70\u2013100 nm and thickness of 1 nm. They originally nucleate at the gaps between collagen fibrils.\n<\/p><p>Similarly, the hierarchy of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abalone\" title=\"Abalone\" rel=\"external_link\" target=\"_blank\">abalone<\/a> shell begins at the nanolevel, with an organic layer having a thickness of 20\u201330 nm. This layer proceeds with single crystals of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aragonite\" title=\"Aragonite\" rel=\"external_link\" target=\"_blank\">aragonite<\/a> (a polymorph of CaCO<sub>3<\/sub>) consisting of \"bricks\" with dimensions of 0.5 and finishing with layers approximately 0.3 mm ().\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Crab\" title=\"Crab\" rel=\"external_link\" target=\"_blank\">Crabs<\/a> are arthropods whose carapace is made of a mineralized hard component (which exhibits brittle fracture) and a softer organic component composed primarily of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chitin\" title=\"Chitin\" rel=\"external_link\" target=\"_blank\">chitin<\/a>. The brittle component is arranged in a helical pattern. Each of these mineral \u2018rods\u2019 (1 \u03bcm diameter) contains chitin\u2013protein fibrils with approximately 60 nm diameter. These fibrils are made of 3 nm diameter canals which link the interior and exterior of the shell.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>Biomaterials are used in:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacements\" class=\"mw-redirect\" title=\"Joint replacements\" rel=\"external_link\" target=\"_blank\">Joint replacements<\/a><\/li>\n<li>Bone plates<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Intraocular_lens\" title=\"Intraocular lens\" rel=\"external_link\" target=\"_blank\">Intraocular lenses<\/a> (IOLs) for eye surgery<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_cement\" title=\"Bone cement\" rel=\"external_link\" target=\"_blank\">Bone cement<\/a><\/li>\n<li>Artificial ligaments and tendons<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implants\" class=\"mw-redirect\" title=\"Dental implants\" rel=\"external_link\" target=\"_blank\">Dental implants<\/a> for tooth fixation<\/li>\n<li>Blood vessel prostheses<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_valves\" class=\"mw-redirect\" title=\"Heart valves\" rel=\"external_link\" target=\"_blank\">Heart valves<\/a><\/li>\n<li>Skin repair devices (artificial tissue)<\/li>\n<li>Cochlear replacements<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Contact_lenses\" class=\"mw-redirect\" title=\"Contact lenses\" rel=\"external_link\" target=\"_blank\">Contact lenses<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_implants\" class=\"mw-redirect\" title=\"Breast implants\" rel=\"external_link\" target=\"_blank\">Breast implants<\/a><\/li>\n<li>Drug delivery mechanisms<\/li>\n<li>Sustainable materials<\/li>\n<li>Vascular grafts<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Stents\" class=\"mw-redirect\" title=\"Stents\" rel=\"external_link\" target=\"_blank\">Stents<\/a><\/li>\n<li>Nerve conduits<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_sutures\" class=\"mw-redirect\" title=\"Surgical sutures\" rel=\"external_link\" target=\"_blank\">Surgical sutures<\/a>, clips, and staples for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wound#Closure\" title=\"Wound\" rel=\"external_link\" target=\"_blank\">wound closure<\/a><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[12]<\/a><\/sup><\/li>\n<li>Pins and screws for fracture stabilisation<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[13]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_mesh\" title=\"Surgical mesh\" rel=\"external_link\" target=\"_blank\">Surgical mesh<\/a><sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[15]<\/a><\/sup><\/li><\/ul>\n<p>Biomaterials must be compatible with the body, and there are often issues of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatibility<\/a> which must be resolved before a product can be placed on the market and used in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinic\" title=\"Clinic\" rel=\"external_link\" target=\"_blank\">clinical<\/a> setting. Because of this, biomaterials are usually subjected to the same requirements as those undergone by new <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug\" title=\"Drug\" rel=\"external_link\" target=\"_blank\">drug<\/a> therapies.<sup id=\"rdp-ebb-cite_ref-Meyers08_19-0\" class=\"reference\"><a href=\"#cite_note-Meyers08-19\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Espinosa09_20-0\" class=\"reference\"><a href=\"#cite_note-Espinosa09-20\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p><p>All manufacturing companies are also required to ensure traceability of all of their products so that if a defective product is discovered, others in the same batch may be traced.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Heart_valves\">Heart valves<\/span><\/h3>\n<p>In the United States, 45% of the 250,000 valve replacement procedures performed annually involve a mechanical valve implant. The most widely used valve is a bileaflet disc heart valve, or St. Jude valve. The mechanics involve two semicircular discs moving back and forth, with both allowing the flow of blood as well as the ability to form a seal against backflow. The valve is coated with pyrolytic carbon, and secured to the surrounding tissue with a mesh of woven fabric called Dacron (du Pont's trade name for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene_terephthalate\" title=\"Polyethylene terephthalate\" rel=\"external_link\" target=\"_blank\">polyethylene terephthalate<\/a>). The mesh allows for the body's tissue to grow while incorporating the valve.<sup id=\"rdp-ebb-cite_ref-Chemistry_Textbook_21-0\" class=\"reference\"><a href=\"#cite_note-Chemistry_Textbook-21\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Skin_repair\">Skin repair<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_engineering\" title=\"Tissue engineering\" rel=\"external_link\" target=\"_blank\">Tissue engineering<\/a><\/div>\n<p>Most of the time, \u2018artificial\u2019 tissue is grown from the patient\u2019s own cells. However, when the damage is so extreme that it is impossible to use the patient's own cells, artificial tissue cells are grown. The difficulty is in finding a scaffold that the cells can grow and organize on. The characteristics of the scaffold must be that it is biocompatible, cells can adhere to the scaffold, mechanically strong and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biodegradable\" class=\"mw-redirect\" title=\"Biodegradable\" rel=\"external_link\" target=\"_blank\">biodegradable<\/a>. One successful scaffold is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copolymer\" title=\"Copolymer\" rel=\"external_link\" target=\"_blank\">copolymer<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lactic_acid\" title=\"Lactic acid\" rel=\"external_link\" target=\"_blank\">lactic acid<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glycolic_acid\" title=\"Glycolic acid\" rel=\"external_link\" target=\"_blank\">glycolic acid<\/a>.<sup id=\"rdp-ebb-cite_ref-Chemistry_Textbook_21-1\" class=\"reference\"><a href=\"#cite_note-Chemistry_Textbook-21\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Compatibility\">Compatibility<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">Biocompatibility<\/a> is related to the behavior of biomaterials in various environments under various chemical and physical conditions. The term may refer to specific properties of a material without specifying where or how the material is to be used. For example, a material may elicit little or no <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immune_response\" title=\"Immune response\" rel=\"external_link\" target=\"_blank\">immune response<\/a> in a given organism, and may or may not able to integrate with a particular cell type or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_(biology)\" title=\"Tissue (biology)\" rel=\"external_link\" target=\"_blank\">tissue<\/a>. The ambiguity of the term reflects the ongoing development of insights into how biomaterials interact with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_body\" title=\"Human body\" rel=\"external_link\" target=\"_blank\">human body<\/a> and eventually how those interactions determine the clinical success of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> (such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pacemaker\" class=\"mw-redirect\" title=\"Pacemaker\" rel=\"external_link\" target=\"_blank\">pacemaker<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">hip replacement<\/a>). Modern medical devices and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostheses\" class=\"mw-redirect\" title=\"Prostheses\" rel=\"external_link\" target=\"_blank\">prostheses<\/a> are often made of more than one material\u2014so it might not always be sufficient to talk about the biocompatibility of a specific material.\n<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Biopolymers\">Biopolymers<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biopolymer\" title=\"Biopolymer\" rel=\"external_link\" target=\"_blank\">Biopolymer<\/a><\/div>\n<p><b>Biopolymers<\/b> are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymers<\/a> produced by living organisms. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cellulose\" title=\"Cellulose\" rel=\"external_link\" target=\"_blank\">Cellulose<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Starch\" title=\"Starch\" rel=\"external_link\" target=\"_blank\">starch<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Protein\" title=\"Protein\" rel=\"external_link\" target=\"_blank\">proteins<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peptide\" title=\"Peptide\" rel=\"external_link\" target=\"_blank\">peptides<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/DNA\" title=\"DNA\" rel=\"external_link\" target=\"_blank\">DNA<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/RNA\" title=\"RNA\" rel=\"external_link\" target=\"_blank\">RNA<\/a> are all examples of biopolymers, in which the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monomer\" title=\"Monomer\" rel=\"external_link\" target=\"_blank\">monomeric<\/a> units, respectively, are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sugar\" title=\"Sugar\" rel=\"external_link\" target=\"_blank\">sugars<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amino_acid\" title=\"Amino acid\" rel=\"external_link\" target=\"_blank\">amino acids<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nucleotide\" title=\"Nucleotide\" rel=\"external_link\" target=\"_blank\">nucleotides<\/a>.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[20]<\/a><\/sup>\nCellulose is both the most common biopolymer and the most common organic compound on Earth. About 33% of all plant matter is cellulose.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[21]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bionics\" title=\"Bionics\" rel=\"external_link\" target=\"_blank\">Bionics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymeric_surface\" title=\"Polymeric surface\" rel=\"external_link\" target=\"_blank\">Polymeric surface<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Surface_modification_of_biomaterials_with_proteins\" title=\"Surface modification of biomaterials with proteins\" rel=\"external_link\" target=\"_blank\">Surface modification of biomaterials with proteins<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Synthetic_biodegradable_polymer\" title=\"Synthetic biodegradable polymer\" rel=\"external_link\" target=\"_blank\">Synthetic biodegradable polymer<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:Biomaterials\" title=\"Category:Biomaterials\" rel=\"external_link\" target=\"_blank\">List of biomaterials<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Footnotes\">Footnotes<\/span><\/h2>\n<dl><dt><div class=\"reflist\" style=\"list-style-type: lower-alpha;\"><\/div><\/dt><\/dl>\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">The notion of exploitation includes utility for applications and for fundamental research to understand reciprocal perturbations as well.<sup id=\"rdp-ebb-cite_ref-IUPAC_2-1\" class=\"reference\"><a href=\"#cite_note-IUPAC-2\" rel=\"external_link\">[2]<\/a><\/sup><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">The definition \u201cnon-viable material used in a medical device, intended to interact with biological systems\u201d recommended in ref.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[3]<\/a><\/sup> cannot be extended to the environmental field where people mean \u201cmaterial of natural origin\u201d.<sup id=\"rdp-ebb-cite_ref-IUPAC_2-2\" class=\"reference\"><a href=\"#cite_note-IUPAC-2\" rel=\"external_link\">[2]<\/a><\/sup><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">This general term should not be confused with the terms <i>biopolymer<\/i> or <i>biomacromolecule<\/i>. The use of \u201cpolymeric biomaterial\u201d is recommended when one deals with <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a><\/i> or polymer device of therapeutic or biological interest.<sup id=\"rdp-ebb-cite_ref-IUPAC_2-3\" class=\"reference\"><a href=\"#cite_note-IUPAC-2\" rel=\"external_link\">[2]<\/a><\/sup><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-SchmalzBio08-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SchmalzBio08_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Schmalz, G.; Arenholdt-Bindslev, D. (2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=mrreTHuo54wC&pg=PA1\" target=\"_blank\">\"Chapter 1: Basic Aspects\"<\/a>. <i>Biocompatibility of Dental Materials<\/i>. Berlin: Springer-Verlag. pp. 1\u201312. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9783540777823. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20171209201948\/https:\/\/books.google.com\/books?id=mrreTHuo54wC&pg=PA1\" target=\"_blank\">Archived<\/a> from the original on 9 December 2017<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">29 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+1%3A+Basic+Aspects&rft.btitle=Biocompatibility+of+Dental+Materials&rft.place=Berlin&rft.pages=1-12&rft.pub=Springer-Verlag&rft.date=2008&rft.isbn=9783540777823&rft.au=Schmalz%2C+G.&rft.au=Arenholdt-Bindslev%2C+D.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DmrreTHuo54wC%26pg%3DPA1&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiomaterial\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-IUPAC-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-IUPAC_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-IUPAC_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-IUPAC_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-IUPAC_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vert, M.; Doi, Y.; Hellwich, K. H.; Hess, M.; Hodge, P.; Kubisa, P.; Rinaudo, M.; Schu\u00e9, F. O. (2012). \"Terminology for biorelated polymers and applications (IUPAC Recommendations 2012)\". <i>Pure and Applied Chemistry<\/i>. <b>84<\/b> (2): 377. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1351%2FPAC-REC-10-12-04\" target=\"_blank\">10.1351\/PAC-REC-10-12-04<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pure+and+Applied+Chemistry&rft.atitle=Terminology+for+biorelated+polymers+and+applications+%28IUPAC+Recommendations+2012%29&rft.volume=84&rft.issue=2&rft.pages=377&rft.date=2012&rft_id=info%3Adoi%2F10.1351%2FPAC-REC-10-12-04&rft.aulast=Vert&rft.aufirst=M.&rft.au=Doi%2C+Y.&rft.au=Hellwich%2C+K.+H.&rft.au=Hess%2C+M.&rft.au=Hodge%2C+P.&rft.au=Kubisa%2C+P.&rft.au=Rinaudo%2C+M.&rft.au=Schu%C3%A9%2C+F.+O.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiomaterial\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Williams, D. F., ed. (2004). <i>Definitions in Biomaterials, Proceedings of a Consensus Conference of the European Society for Biomaterials<\/i>. Amsterdam: Elsevier.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Definitions+in+Biomaterials%2C+Proceedings+of+a+Consensus+Conference+of+the+European+Society+for+Biomaterials&rft.place=Amsterdam&rft.pub=Elsevier&rft.date=2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiomaterial\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cao, Wanpeng; Hench, Larry (1996). \"Bioactive Materials\". <i>Ceramics International<\/i>. <b>22<\/b> (6): 493\u2013507. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0272-8842%2895%2900126-3\" target=\"_blank\">10.1016\/0272-8842(95)00126-3<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ceramics+International&rft.atitle=Bioactive+Materials&rft.volume=22&rft.issue=6&rft.pages=493-507&rft.date=1996&rft_id=info%3Adoi%2F10.1016%2F0272-8842%2895%2900126-3&rft.aulast=Cao&rft.aufirst=Wanpeng&rft.au=Hench%2C+Larry&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiomaterial\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> <\/span>\n<\/li>\n<li id=\"cite_note-\u201cSDHA\u201d-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-\u201cSDHA\u201d_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zhu, H.; et al. (2018). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0955221918304837\" target=\"_blank\">\"Nanostructural insights into the dissolution behavior of Sr-doped hydroxyapatite\"<\/a>. <i>Journal of the European Ceramic Society<\/i>. <b>38<\/b> (16): 5554\u20135562. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jeurceramsoc.2018.07.056\" target=\"_blank\">10.1016\/j.jeurceramsoc.2018.07.056<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+European+Ceramic+Society&rft.atitle=Nanostructural+insights+into+the+dissolution+behavior+of+Sr-doped+hydroxyapatite&rft.volume=38&rft.issue=16&rft.pages=5554-5562&rft.date=2018&rft_id=info%3Adoi%2F10.1016%2Fj.jeurceramsoc.2018.07.056&rft.aulast=Zhu&rft.aufirst=H.&rft_id=https%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS0955221918304837&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiomaterial\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Explicit use of et al. 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G. and Morris, G. M. (2001) <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mddionline.com\/article\/considerations-biocompatibility-evaluation-medical-devices\" target=\"_blank\">\"Considerations for the Biocompatibility Evaluation of Medical Devices\"<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110707065835\/http:\/\/www.mddionline.com\/article\/considerations-biocompatibility-evaluation-medical-devices\" target=\"_blank\">Archived<\/a> 2011-07-07 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>., <i>Medical Device & Diagnostic Industry<\/i><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Buehler, M. J.; Yung, Y. C. 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(1997). \"Molecular manipulation of microstructures: Biomaterials, ceramics, and semiconductors\". <i>Science<\/i>. <b>277<\/b> (5330): 1242\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1126%2Fscience.277.5330.1242\" target=\"_blank\">10.1126\/science.277.5330.1242<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9271562\" target=\"_blank\">9271562<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Science&rft.atitle=Molecular+manipulation+of+microstructures%3A+Biomaterials%2C+ceramics%2C+and+semiconductors&rft.volume=277&rft.issue=5330&rft.pages=1242-8&rft.date=1997&rft_id=info%3Adoi%2F10.1126%2Fscience.277.5330.1242&rft_id=info%3Apmid%2F9271562&rft.aulast=Stupp&rft.aufirst=S.+I.&rft.au=Braun%2C+P.+V.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiomaterial\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Klemm, D; Heublein, B; Fink, H. P.; Bohn, A (2005). \"Cellulose: Fascinating biopolymer and sustainable raw material\". <i>Angewandte Chemie International Edition<\/i>. <b>44<\/b> (22): 3358\u201393. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fanie.200460587\" target=\"_blank\">10.1002\/anie.200460587<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15861454\" target=\"_blank\">15861454<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Angewandte+Chemie+International+Edition&rft.atitle=Cellulose%3A+Fascinating+biopolymer+and+sustainable+raw+material&rft.volume=44&rft.issue=22&rft.pages=3358-93&rft.date=2005&rft_id=info%3Adoi%2F10.1002%2Fanie.200460587&rft_id=info%3Apmid%2F15861454&rft.aulast=Klemm&rft.aufirst=D&rft.au=Heublein%2C+B&rft.au=Fink%2C+H.+P.&rft.au=Bohn%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiomaterial\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/jba.sagepub.com\/\" target=\"_blank\">Journal of Biomaterials Applications<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.creb.upc.edu\/\" target=\"_blank\">CREB \u2013 Biomedical Engineering Research Centre<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mpikg.mpg.de\/biomaterials\" target=\"_blank\">Department of Biomaterials at the Max Planck Institute of Colloids and Interfaces in Potsdam-Golm, Germany<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.chemelot.com\/\" target=\"_blank\">Open Innovation Campus for Biomaterials<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1271\nCached time: 20181214191015\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.492 seconds\nReal time usage: 0.597 seconds\nPreprocessor visited node count: 1645\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 50574\/2097152 bytes\nTemplate argument size: 1503\/2097152 bytes\nHighest expansion depth: 9\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 67368\/5000000 bytes\nNumber of Wikibase entities loaded: 5\/400\nLua time usage: 0.263\/10.000 seconds\nLua memory usage: 4.33 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 510.537 1 -total\n<\/p>\n<pre>61.84% 315.719 2 Template:Reflist\n31.18% 159.182 18 Template:Cite_journal\n18.18% 92.832 3 Template:Cite_book\n16.60% 84.759 1 Template:Commonscat\n 9.26% 47.270 1 Template:Quote_box\n 6.66% 34.014 1 Template:Redirect\n 3.79% 19.374 1 Template:Commons\n 3.32% 16.931 1 Template:Notelist\n 3.04% 15.526 1 Template:Sister_project\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:6259941-1!canonical and timestamp 20181214191014 and revision id 871433500\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterial\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212206\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.017 seconds\nReal time usage: 0.178 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 170.726 1 - wikipedia:Biomaterial\n100.00% 170.726 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8061-0!*!*!*!*!*!* and timestamp 20181217212206 and revision id 24173\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Biomaterial\">https:\/\/www.limswiki.org\/index.php\/Biomaterial<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","af680bf337e2578f3ed5d787dc411655_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/47\/Hip_joint_replacement%2C_United_States%2C_1998_Wellcome_L0060175.jpg\/440px-Hip_joint_replacement%2C_United_States%2C_1998_Wellcome_L0060175.jpg"],"af680bf337e2578f3ed5d787dc411655_timestamp":1545081726,"85e8956efae5e7c5dac4ee8e5806283f_type":"article","85e8956efae5e7c5dac4ee8e5806283f_title":"Wade-Dahl-Till valve","85e8956efae5e7c5dac4ee8e5806283f_url":"https:\/\/www.limswiki.org\/index.php\/Wade-Dahl-Till_valve","85e8956efae5e7c5dac4ee8e5806283f_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tWade-Dahl-Till valve\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Illustration of valve, from patent application\nThe Wade-Dahl-Till (WDT) valve is a cerebral shunt developed in 1962 by hydraulic engineer Stanley Wade, author Roald Dahl, and neurosurgeon Kenneth Till.[1][2]\nIn 1960, Dahl's son Theo developed hydrocephalus after being struck by a car. A standard Holter shunt was installed to drain excess fluid from his brain. However, the shunt jammed too often, causing pain and blindness, risking brain damage and requiring emergency surgery.[1] Till, neurosurgeon at London's Great Ormond Street Hospital for children, determined that debris accumulated in the hydrocephalic ventricles could clog the slits in the Holter valves, especially with patients such as Theo who had bad bleeding in the brain and brain damage. \nDahl knew Wade to be an expert in precision hydraulic engineering, from their shared hobby of flying model aircraft. (In addition to building his own model aircraft engines, Wade ran a factory at High Wycombe for producing precision hydraulic pumps.)[3] With Dahl coordinating the efforts of the neurosurgeon and the hydraulic engineer, the team developed a new mechanism using two metal discs, each in a restrictive housing at the end of a short silicone rubber tube. Fluid moving under pressure from below pushed the discs against the tube to prevent retrograde flow; pressure from above moved each disc to the \"open\" position.[2] As Till reported in The Lancet, the invention was characterized by \u201clow resistance, ease of sterilisation, no reflux, robust construction, and negligible risk of blockage\u201d.[4]\nBy the time the device was perfected, Theo had healed to the point at which it was not necessary for him. However, several thousand other children around the world benefited from the WDT valve before medicine technology progressed beyond it.[1][5]\nThe co-inventors agreed never to accept any profit from the invention.\n\n<\/p>\nReferences \n\n\n^ a b c \"Roald Dahl on the death of his daughter\" (3 February 2015). The Telegraph. \n\n^ a b GB patent 1010067, Wade, Stanley Charles, \"Hydrocephalus shunt pump\", issued 17 November 1965   \n\n^ Barry Farrell (1969). Pat and Roald. Kingsport Press. \n\n^ Dr Andrew Larner. \"Tales of the Unexpected: Roald Dahl's Neurological Contributions\" (PDF) . Advances in Clinical Neuroscience and Rehabilitation. \n\n^ Stephen Michael Shearer (2006). Patricia Neal: An Unquiet Life. The University Press of Kentucky. ISBN 978-0-8131-2391-2. \n\n\nExternal links \nUS patent 3233610, \"Hydrocephalus shunt pump\", issued 1966-02-08   \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Wade-Dahl-Till_valve\">https:\/\/www.limswiki.org\/index.php\/Wade-Dahl-Till_valve<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 19:06.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 674 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","85e8956efae5e7c5dac4ee8e5806283f_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Wade-Dahl-Till_valve skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Wade-Dahl-Till valve<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Wade-Dahl-Till_valve_(from_patent_application).png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/d\/dd\/Wade-Dahl-Till_valve_%28from_patent_application%29.png\/220px-Wade-Dahl-Till_valve_%28from_patent_application%29.png\" width=\"220\" height=\"333\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Wade-Dahl-Till_valve_(from_patent_application).png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Illustration of valve, from patent application<\/div><\/div><\/div>\n<p>The <b>Wade-Dahl-Till (WDT) valve<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_shunt\" title=\"Cerebral shunt\" rel=\"external_link\" target=\"_blank\">cerebral shunt<\/a> developed in 1962 by hydraulic engineer Stanley Wade, author <a href=\"https:\/\/en.wikipedia.org\/wiki\/Roald_Dahl\" title=\"Roald Dahl\" rel=\"external_link\" target=\"_blank\">Roald Dahl<\/a>, and neurosurgeon Kenneth Till.<sup id=\"rdp-ebb-cite_ref-Olivia_1-0\" class=\"reference\"><a href=\"#cite_note-Olivia-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-GB1010067_2-0\" class=\"reference\"><a href=\"#cite_note-GB1010067-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>In 1960, Dahl's son Theo developed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrocephalus\" title=\"Hydrocephalus\" rel=\"external_link\" target=\"_blank\">hydrocephalus<\/a> after being struck by a car. A standard was installed to drain excess fluid from his brain. However, the shunt jammed too often, causing pain and blindness, risking brain damage and requiring emergency surgery.<sup id=\"rdp-ebb-cite_ref-Olivia_1-1\" class=\"reference\"><a href=\"#cite_note-Olivia-1\" rel=\"external_link\">[1]<\/a><\/sup> Till, neurosurgeon at London's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Great_Ormond_Street_Hospital\" title=\"Great Ormond Street Hospital\" rel=\"external_link\" target=\"_blank\">Great Ormond Street Hospital<\/a> for children, determined that debris accumulated in the hydrocephalic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_system\" title=\"Ventricular system\" rel=\"external_link\" target=\"_blank\">ventricles<\/a> could clog the slits in the Holter valves, especially with patients such as Theo who had bad bleeding in the brain and brain damage. \n<\/p><p>Dahl knew Wade to be an expert in precision hydraulic engineering, from their shared hobby of flying <a href=\"https:\/\/en.wikipedia.org\/wiki\/Model_aircraft\" title=\"Model aircraft\" rel=\"external_link\" target=\"_blank\">model aircraft<\/a>. (In addition to building his own model aircraft engines, Wade ran a factory at <a href=\"https:\/\/en.wikipedia.org\/wiki\/High_Wycombe\" title=\"High Wycombe\" rel=\"external_link\" target=\"_blank\">High Wycombe<\/a> for producing precision hydraulic pumps.)<sup id=\"rdp-ebb-cite_ref-farrell_3-0\" class=\"reference\"><a href=\"#cite_note-farrell-3\" rel=\"external_link\">[3]<\/a><\/sup> With Dahl coordinating the efforts of the neurosurgeon and the hydraulic engineer, the team developed a new mechanism using two metal discs, each in a restrictive housing at the end of a short silicone rubber tube. Fluid moving under pressure from below pushed the discs against the tube to prevent retrograde flow; pressure from above moved each disc to the \"open\" position.<sup id=\"rdp-ebb-cite_ref-GB1010067_2-1\" class=\"reference\"><a href=\"#cite_note-GB1010067-2\" rel=\"external_link\">[2]<\/a><\/sup> As Till reported in <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Lancet\" title=\"The Lancet\" rel=\"external_link\" target=\"_blank\">The Lancet<\/a><\/i>, the invention was characterized by \u201clow resistance, ease of sterilisation, no reflux, robust construction, and negligible risk of blockage\u201d.<sup id=\"rdp-ebb-cite_ref-larner_4-0\" class=\"reference\"><a href=\"#cite_note-larner-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>By the time the device was perfected, Theo had healed to the point at which it was not necessary for him. However, several thousand other children around the world benefited from the WDT valve before medicine technology progressed beyond it.<sup id=\"rdp-ebb-cite_ref-Olivia_1-2\" class=\"reference\"><a href=\"#cite_note-Olivia-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-shearer_5-0\" class=\"reference\"><a href=\"#cite_note-shearer-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<p>The co-inventors agreed never to accept any profit from the invention.\n<\/p>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-Olivia-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Olivia_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Olivia_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Olivia_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.telegraph.co.uk\/culture\/books\/biographyandmemoirreviews\/7930233\/Roald-Dahls-darkest-hour.html\" target=\"_blank\">\"Roald Dahl on the death of his daughter\"<\/a> (3 February 2015). The Telegraph.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Roald+Dahl+on+the+death+of+his+daughter&rft.issue=3+February+2015&rft_id=https%3A%2F%2Fwww.telegraph.co.uk%2Fculture%2Fbooks%2Fbiographyandmemoirreviews%2F7930233%2FRoald-Dahls-darkest-hour.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWade-Dahl-Till+valve\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-GB1010067-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-GB1010067_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-GB1010067_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><span class=\"citation patent\" id=\"rdp-ebb-CITEREFWade,_Stanley_Charles1965\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/worldwide.espacenet.com\/textdoc?DB=EPODOC&IDX=GB1010067\" target=\"_blank\">GB patent 1010067<\/a>, Wade, Stanley Charles, \"Hydrocephalus shunt pump\", issued 17 November 1965<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Apatent&rft.number=1010067&rft.cc=GB&rft.title=Hydrocephalus+shunt+pump&rft.inventor=Wade%2C+Stanley+Charles&rft.date=17 November 1965&rft.appldate=22 May 1963&rft.prioritydate=28 May 1962\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<li id=\"cite_note-farrell-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-farrell_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Barry Farrell (1969). <i>Pat and Roald<\/i>. Kingsport Press.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Pat+and+Roald&rft.pub=Kingsport+Press&rft.date=1969&rft.au=Barry+Farrell&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWade-Dahl-Till+valve\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-larner-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-larner_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Dr Andrew Larner. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.acnr.co.uk\/mar_apr_2008\/ACNRMA08_nerolit.pdf\" target=\"_blank\">\"Tales of the Unexpected: Roald Dahl's Neurological Contributions\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Advances in Clinical Neuroscience and Rehabilitation.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Tales+of+the+Unexpected%3A+Roald+Dahl%E2%80%99s+Neurological+Contributions&rft.pub=Advances+in+Clinical+Neuroscience+and+Rehabilitation&rft.au=Dr+Andrew+Larner&rft_id=http%3A%2F%2Fwww.acnr.co.uk%2Fmar_apr_2008%2FACNRMA08_nerolit.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWade-Dahl-Till+valve\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-shearer-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-shearer_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Stephen Michael Shearer (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/?id=8bfGYghnSEUC&pg=PA218&lpg=PA218&dq=Wade-Dahl-Till+valve\" target=\"_blank\"><i>Patricia Neal: An Unquiet Life<\/i><\/a>. The University Press of Kentucky. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-8131-2391-2.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Patricia+Neal%3A+An+Unquiet+Life&rft.pub=The+University+Press+of+Kentucky&rft.date=2006&rft.isbn=978-0-8131-2391-2&rft.au=Stephen+Michael+Shearer&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3D8bfGYghnSEUC%26pg%3DPA218%26lpg%3DPA218%26dq%3DWade-Dahl-Till%2Bvalve&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWade-Dahl-Till+valve\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<p><span class=\"citation patent\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/worldwide.espacenet.com\/textdoc?DB=EPODOC&IDX=US3233610\" target=\"_blank\">US patent 3233610<\/a>, \"Hydrocephalus shunt pump\", issued 1966-02-08<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Apatent&rft.number=3233610&rft.cc=US&rft.title=Hydrocephalus+shunt+pump&rft.date=1966-02-08&rft.appldate=1963-05-24\"><span style=\"display: none;\"> <\/span><\/span>\n<\/p>\n<p><!-- \nNewPP limit report\nParsed by mw1332\nCached time: 20181126134408\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.112 seconds\nReal time usage: 0.156 seconds\nPreprocessor visited node count: 678\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 9076\/2097152 bytes\nTemplate argument size: 1166\/2097152 bytes\nHighest expansion depth: 10\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 11645\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.057\/10.000 seconds\nLua memory usage: 1.98 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 135.406 1 -total\n<\/p>\n<pre>99.05% 134.119 1 Template:Reflist\n59.71% 80.854 1 Template:Cite_news\n12.99% 17.593 2 Template:Cite_patent\n 8.65% 11.712 2 Template:Citation\/patent\n 7.29% 9.872 2 Template:Cite_book\n 4.37% 5.918 1 Template:Cite_web\n 2.25% 3.049 1 Template:Column-width\n 2.11% 2.862 1 Template:Citation\/authors\n 2.03% 2.744 2 Template:Citation\/make_link\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:18498748-1!canonical and timestamp 20181126134408 and revision id 839632357\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wade-Dahl-Till_valve\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212206\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.159 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 152.907 1 - wikipedia:Wade-Dahl-Till_valve\n100.00% 152.907 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8091-0!*!*!*!*!*!* and timestamp 20181217212205 and revision id 24210\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Wade-Dahl-Till_valve\">https:\/\/www.limswiki.org\/index.php\/Wade-Dahl-Till_valve<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","85e8956efae5e7c5dac4ee8e5806283f_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/d\/dd\/Wade-Dahl-Till_valve_%28from_patent_application%29.png"],"85e8956efae5e7c5dac4ee8e5806283f_timestamp":1545081725,"137abfcad37e75b89c38da3cc4279638_type":"article","137abfcad37e75b89c38da3cc4279638_title":"Voice prosthesis","137abfcad37e75b89c38da3cc4279638_url":"https:\/\/www.limswiki.org\/index.php\/Voice_prosthesis","137abfcad37e75b89c38da3cc4279638_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tVoice prosthesis\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Voice prosthesis\nA voice prosthesis (plural prostheses) is an artificial device, usually made of silicone that is used in conjunction with voice therapy to help laryngectomized patients to speak. During a total laryngectomy, the entire voice box (larynx) is removed and the windpipe (trachea) and food pipe (esophagus) are separated from each other. During this operation an opening between the food pipe and the windpipe can be created (primary puncture). This opening can also be created at a later time (secondary puncture). This opening is called a tracheo-esophageal puncture (TE puncture). The voice prosthesis is placed in this opening. Then, it becomes possible to speak by occluding the stoma and blowing the air from the lungs through the inside of the voice prosthesis and through the throat, creating a voice sound, which is called tracheo-esophageal speech.\nThe back end of the prosthesis sits at the food pipe. To avoid food, drinks, or saliva from coming through the prosthesis and into the lungs, the prosthesis has a small flap at the back.\nThere are two ways of inserting the voice prosthesis: through the mouth and throat (retrograde manner) with the help of a guide wire, or directly through the tracheostoma (anterograde) manner. Nowadays, most voice prosthesis are placed anterograde, through the stoma.\n\nContents \n\n1 History \n\n1.1 Artificial larynx \n1.2 Voice prosthesis \n\n\n2 Non-indwelling and indwelling voice prostheses \n3 Design of voice prostheses \n4 Properties of voice prostheses \n\n4.1 Material \n4.2 Sizes \n\n\n5 Problem-solving voice prosthesis for strong candida accumulation \n6 Cleaning \n\n6.1 Brushing \n6.2 Flushing \n\n\n7 Leakage \n8 Device lifetime \n9 Voice quality and speaking effort \n10 Voice prosthesis and HME \n11 Annotations \n12 References \n\n\nHistory \nThere are two lines of development on behalf of giving a voice to patients being laryngectomized.\n\nArtificial larynx \nIn 1869 the first artificial voice box (larynx) was built by Czermak.[1]\nIn 1873 Theodor Billroth made a total laryngectomy (in steps) and implanted an artificial voice box.[1][2] A new development, using modern materials, took place in France by Debry.[3]\n\nVoice prosthesis \nIn 1972 the very first voice prosthesis for voice rehabilitation after total laryngectomy was described in an article in Polish by Mozolewski.[4] Since then, many efforts have taken place in this area of rehabilitation. There are several manufacturers that have voice prosthesis in their product portfolio, e.g. Adeva\u00ae, Eska\u00ae, MediTop\u00ae, Heimomed\u00ae. The internationally most widely used are devices made by InHealth and Atos Medical. In 1980, the first commercially available prosthesis was introduced by Singer and Blom:[5] the \u2018Blom-Singer\u00ae Duckbill\u2019, a 16 French diameter, non-flanged device that the patient could remove, clean and replace him- or herself (non-indwelling). The first indwelling voice prosthesis (Groningen) was described in 1984.[6] And in 1990, the first Provox\u00ae voice prosthesis, manufactured by Atos Medical, was introduced to the market,[7] followed by the Provox\u00ae2 in 1997,[8] the Provox\u00ae ActiValve\u2122 in 2003,[9] and the non-indwelling Provox\u00ae NID\u2122 in 2005.[10] \n1994, the Blom-Singer\u00ae Classic\u2122 Indwelling Voice Prostheses[11] was introduced to the market. Like the Blom-Singer\u00ae Advantage\u00ae Indwelling Voice Prosthesis it is only inserted or replaced by medical professionals, such as speech pathologists or physicians. In 2009 the third generation Provox\u00ae Vega[12] with SmartInserter\u2122[13] was introduced.[14]\n\nNon-indwelling and indwelling voice prostheses \nThe two main categories voice prosthesis can be divided into are \u2018non-indwelling\u2019 and \u2018indwelling\u2019 voice prostheses. \u2018Non-indwelling\u2019 voice prostheses can be replaced by the patients themselves,[10] whereas \u2018indwelling\u2019 prostheses have to be replaced by a medical professional. A non-indwelling voice prosthesis has a safety strap and may also have a string with a special safety medallion that is too wide to fall into the tracheostoma. It comes in different sizes and lengths and often has a noticeable color, e.g. blue or white to enhance visibility for self-replacement and maintenance. Disadvantages of the non-indwelling prosthesis are a certain amount of risk when inserting them by oneself and the devices have a shorter lifetime and need to be changed more often. In general it takes some practice to insert the prosthesis and the ability to take excellent care of the device. Indwelling devices have sturdier flanges and can only be replaced by a medical professional. The safety strap is cut off after insertion. \nThe choice between \u2018non-indwelling\u2019 and \u2018indwelling\u2019 devices is really individual, depending on physical condition, maintenance and cost and can be alternated over a period of time to find out which one is most suitable.\n\nDesign of voice prostheses \nThe general design of voice prosthesis is quite consistent, even though there are unique characteristics. A voice prosthesis has retaining flanges at each end, the \u2018tracheal flange\u2019 and \u2018esophageal flange\u2019. Those flanges can vary in size and rigidity, e.g. indwelling prostheses have larger and more rigid flanges for stability and facilitate long-term placement. The flange near the food pipe (esophageal flange) is more rigid than the tracheal flange, near the windpipe. The one-way valve can be molded in one piece with the prosthesis and is often supported by a fluoroplastic valve seat (a colored ring that is tightly secured into the shaft of the prosthesis, adding rigidity and which is radiopaque). \nAll voice prostheses have a safety strap, which is cut off in indwelling devices after the prosthesis is put in place; in non-indwelling devices the strap is not removed and is taped to the neck. A voice prosthesis has a one-way valve near the esophageal flange that enables pulmonary air to pass into the esophagus and pharynx for sound production and prevents content from the food pipe, such as liquids or saliva, from entering the trachea.\n\nProperties of voice prostheses \nMaterial \nA voice prosthesis is usually made of medical grade silicone rubber. The valve flap and valve seat may be made out of silicone, fluoroplastic, or may be treated with SilverOxide.\n\nSizes \nThe size of a voice prosthesis varies in length, depending on the thickness of the wall between the foodpipe and the windpipe and thereby the length of the TE puncture. The according length of the voice prosthesis ranges usually between 4 and 22 mm. Another parameter is the outer diameter of the shaft of the voice prosthesis, ranging from 16-22.5 French. Which outer diameter is used is decided by the clinician and\/or the patient and is most often a matter of personal preference. Studies have shown that a larger outer diameter of the voice prosthesis allows better airflow and thereby requires less effort to speak which has a positive effect on the overall voice quality.[15]\n\nProblem-solving voice prosthesis for strong candida accumulation \nThere are even special, problem-solving voice prosthesis, e.g. for laryngectomized patients with very short device life times (less than 4 to 8 weeks) of their current prosthesis. Those extremely short device life times may be caused by excessive candida growth, so that the valve of the prosthesis does not close properly anymore and content from the food pipe leaks through the voice prosthesis into the windpipe. Some of these prostheses have a magnet within the valve that strengthens the closure, others are made of silver oxide silicone to reduce biofilm formation on the valve or use two valves, in case of defect of the esophageal valve, the other valve would seal. In patients with a short device life, the use of a voice prosthesis with supporting magnets in the valve seat and valve flap has been proven to be cost effective.[16]\n\nCleaning \nIt is important to clean the voice prosthesis regularly, as the silicone material is exposed to yeast (candida) and bacteria in the food pipe, which is normally present in these areas.[17] If yeast begins growing on or in the area of the valve flap of the voice prosthesis, it may not close well enough anymore. When this happens fluid starts to leak into the windpipe when eating or drinking.\n\nBrushing \nThe inside of the voice prosthesis is usually cleaned with a brush, which removes food and mucus. It is recommended that the patient cleans the voice prosthesis regularly to keeps it open for speech and improve the device lifetime.\n\nFlushing \nIt is also possible to flush the inside of the voice prosthesis with water or air.[18] Usually this is done in combination with brushing.\n\nLeakage \nA voice prosthesis has to be replaced regularly, because after a certain time, the valve flap of the voice prosthesis does not close properly anymore, due to yeast and other natural sediments. This causes leakage of saliva or drinks, which enters the wind pipe and makes the person concerned cough. If not resolved by cleaning the voice prosthesis, this is a sign that the voice prosthesis must be changed. If that is not possible right away, there are special plugs that can block the leakage. The patient can insert this plug him-\/ herself before eating or drinking and remove it again afterwards, as speaking with the plug in place is usually not possible.\n\nDevice lifetime \nThe device lifetime can range from a couple of weeks up to two years, depending on individual circumstances.[19] The lifetime is influenced by daily food intake, especially dairy products,[20] but also radiotherapy[A 1] and GERD (Gastro Esophageal Reflux Disease) affects the voice prosthesis and its lifetime.[21]\nThe cause of the prothesis' life time end is mostly leakage, but also growing of fistulae, granulation tissue, increasing valve's opening pressure and prothesis' loss [22]\n\nVoice quality and speaking effort \nThe voice quality when speaking with a voice prosthesis is influenced by pulmonary support, airflow resistance of the voice prosthesis, and airflow resistance of the new voice source.[23] Although the voice prosthesis is only responsible for part of the total resistance \u2013 the neoglottis is responsible for the other part \u2013 favorable airflow characteristics are expected to enable the laryngectomized patient to speak with less effort.[12]\nThe voice sounds rather clear though not very loud as samples show.[24]\n\nVoice prosthesis and HME \nAn individual combination of voice prosthesis, heat and moisture exchanger after laryngectomy and attachment is important for good speech and pulmonary rehabilitation.[25]\nThe HME sometimes is combined with free-hands-switch and virus and bacteria filter.[26]\n\nAnnotations \n\n^ A Free University of Berlin study shows a different result \n\n\nReferences \n\n\n^ a b \"Prothetische Stimmrehabilitation nach totaler Kehlkopfentfernung - eine historische Abhandlung seit Billroth (1873)\" (in German). Retrieved 2017-01-08 . \n\n^ \"Tendances chirurgicales actuelles concernant la pose de l'implant phonatoire dans les laryngectomies totales, etmodalit\u00e9s de prise en charge orthophonique p. 8\" (PDF) (in French). Retrieved 2017-01-18 . \n\n^ Fr\u00e9our, Pauline (2013-10-07). \"Le premier larynx artificiel du monde est fran\u00e7ais\". Le Figaro (in French). Retrieved 2017-01-14 . \n\n^ Mozolewski, E. (1972). \"Surgical rehabilitation of voice and speech following laryngectomy\". 26(6): Otolaryngol Pol: 653\u2013661. \n\n^ Singer, MI; Blom ED. (1980). \"An endoscopic technique for restoration of voice after laryngectomy\". Ann Otol Rhinol Laryngol. 89 (6 Pt 1): 529\u2013533. PMID 7458140. \n\n^ Manni JJ, van den Broek P, de Groot MA, Berends E (1984). \"Voice rehabilitation after laryngectomy with the Groningen prosthesis\". J Otolaryngol. 13 (5): 333\u2013336. PMID 6544851. \n\n^ Hilgers, FJ; Schouwenburg PF (1990). \"A new low-resistance, self-retaining prosthesis (Provox) for voice rehabilitation after total laryngectomy\". Laryngoscope. 100 (11): 1202\u20131207. doi:10.1288\/00005537-199011000-00014. PMID 2233085. \n\n^ Hilgers, FJ; Ackerstaff AH; Balm AJ; Tan IB; Aaronson NK; Persson JO (1997). \"Development and clinical evaluation of a second-generation voice prosthesis (Provox 2), designed for anterograde and retrograde insertion\". Acta Otolaryngol. 117 (6): 889\u2013896. doi:10.3109\/00016489709114220. PMID 9442833. \n\n^ Hilgers FJ, Ackerstaff AH, Balm AJ, Van den Brekel MW, Bing Tan I, Persson JO (2003). \"A new problem-solving indwelling voice prosthesis, eliminating the need for frequent Candida- and \"underpressure\"-related replacements: Provox ActiValve\". Acta Otolaryngol. 123 (8): 972\u2013979. doi:10.1080\/00016480310015371. PMID 14606602. \n\n^ a b Hancock, K; Houghton B; As-Brooks CJ; Coman W (2005). \"First clinical experience with a new non-indwelling voice prosthesis (Provox NID) for voice rehabilitation after total laryngectomy\". Acta Otolaryngol. 125 (9): 981\u2013990. doi:10.1080\/00016480510043486. PMID 16109676. \n\n^ Kress, P; Schafer P; Schwerdtfeger FP; Roesler S (2007). \"Measurement and comparison of in vitro air-flow characteristics of the most frequently used European indwelling voice prostheses types\". 6th European Congress of oto-Rhino-Laryngology Head and Neck Surgery, June 30 - July 4, 2007, Vienna, Austria. \n\n^ a b Hilgers FJ, Ackerstaff AH, et al. (2010). \"Clinical phase I\/feasibility study of the next generation indwelling Provox voice prosthesis (Provox Vega)\". Acta Otolaryngol. 130 (4): 511\u2013519. doi:10.3109\/00016480903283766. PMID 19895334. \n\n^ Hilgers, FJ; Ackerstaff AH; Jacobi I; Balm AJ; Tan IB; Van den Brekel MW (2010). \"Prospective clinical phase II study of two new indwelling voice prostheses (Provox Vega 22.5 and 20 Fr) and a novel anterograde insertion device (Provox Smart Inserter)\". Laryngoscope. 120 (6): 1135\u20131143. doi:10.1002\/lary.20925. PMID 20513030. \n\n^ Ward, EC; Hancock K; Lawson N; van As-Brooks CJ (2011). \"Perceptual characteristics of tracheoesophageal speech production using the new indwelling Provox Vega voice prosthesis: a randomized controlled crossover trial\". Head Neck. 33 (1): 13\u201319. doi:10.1002\/hed.21389. PMID 20848411. \n\n^ Hilgers FJ, Ackerstaff AH, et al. (2010). \"Clinical phase I\/feasibility study of the next generation indwelling Provox voice prosthesis (Provox Vega)\". Acta Otolaryngol. \n\n^ Soolsma, J; Van den Brekel MW; Ackerstaff AH; Balm AJ; Tan B; Hilgers FJ (2008). \"Long-term results of Provox ActiValve, solving the problem of frequent candida- and \"underpressure\"-related voice prosthesis replacements\". Laryngoscope. 118 (2): 252\u2013257. doi:10.1097\/MLG.0b013e318159ebde. PMID 18090869. \n\n^ Van Weissenbruch R, Albers FW, et al. (1997). \"Deterioration of the Provox silicone tracheoesophageal voice prosthesis: microbial aspects and structural changes\". Acta Otolaryngol. 117 (3): 452\u2013458. doi:10.3109\/00016489709113420. PMID 9199534. \n\n^ Free, RH; Van der Mei HC; Elving GJ; Van Weissenbruch R; Albers FW; Busscher HJ (2003). \"Influence of the Provox Flush, blowing and imitated coughing on voice prosthetic biofilms in vitro\". Acta Otolaryngol. 123 (4): 547\u2013551. doi:10.1080\/0036554021000028118. PMID 12797592. \n\n^ Hilgers, FJ; Balm AJ (1993). \"Long-term results of vocal rehabilitation after total laryngectomy with the low-resistance, indwelling Provox voice prosthesis system\". Clin Otolaryngol. 18 (6): 517\u2013523. doi:10.1111\/j.1365-2273.1993.tb00627.x. PMID 8877233. \n\n^ Schwandt, LQ; van WR; Van der Mei HC; Busscher HJ; Albers FW (2005). \"Effect of dairy products on the lifetime of Provox2 voice prostheses in vitro and in vivo\". Head Neck. 27 (6): 471\u2013477. doi:10.1002\/hed.20180. PMID 15825199. \n\n^ Boscolo-Rizzo, P; Marchiori C; Gava A; Da Mosto MC (2008). \"The impact of radiotherapy and GERD on in situ lifetime of indwelling voice prostheses\". Eur Arch Otorhinolaryngol. 265 (7): 791\u2013796. doi:10.1007\/s00405-007-0536-1. PMID 18008081. \n\n^ \"r Lebensdauer von Stimmprothesen\" (PDF) (in German). FU-Berlin. Retrieved 2017-03-10 . \n\n^ Hilgers, FJ; Cornelissen MW; Balm AJ (1993). \"Aerodynamic characteristics of the Provox low-resistance indwelling voice prosthesis\". Eur Arch Otorhinolaryngol. 250 (7): 375\u2013378. doi:10.1007\/bf00180379. PMID 8286099. \n\n^ \"Speech smples\". Retrieved 2017-03-11 . \n\n^ Balle, VH; Rindso L; Thomsen JC (2000). \"Primary speech restoration at laryngectomy by insertion of voice prosthesis-10 years' experience\". Acta Otolaryngol Suppl. 543: 244\u2013245. doi:10.1080\/000164800454512. PMID 10909032. \n\n^ \"Provox Micron HME\". Retrieved 2017-03-11 . \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Voice_prosthesis\">https:\/\/www.limswiki.org\/index.php\/Voice_prosthesis<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 20:20.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,108 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","137abfcad37e75b89c38da3cc4279638_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Voice_prosthesis skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Voice prosthesis<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Voice_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ef\/Voice_prosthesis.jpg\/220px-Voice_prosthesis.jpg\" width=\"220\" height=\"242\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Voice_prosthesis.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Voice prosthesis<\/div><\/div><\/div>\n<p>A <b>voice prosthesis<\/b> (<i>plural prostheses<\/i>) is an artificial device, usually made of silicone that is used in conjunction with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Voice_therapy\" title=\"Voice therapy\" rel=\"external_link\" target=\"_blank\">voice therapy<\/a> to help <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laryngectomy\" title=\"Laryngectomy\" rel=\"external_link\" target=\"_blank\">laryngectomized<\/a> patients to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Speech\" title=\"Speech\" rel=\"external_link\" target=\"_blank\">speak<\/a>. During a total <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laryngectomy\" title=\"Laryngectomy\" rel=\"external_link\" target=\"_blank\">laryngectomy<\/a>, the entire voice box (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Larynx\" title=\"Larynx\" rel=\"external_link\" target=\"_blank\">larynx<\/a>) is removed and the windpipe (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertebrate_trachea\" class=\"mw-redirect\" title=\"Vertebrate trachea\" rel=\"external_link\" target=\"_blank\">trachea<\/a>) and food pipe (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophagus\" title=\"Esophagus\" rel=\"external_link\" target=\"_blank\">esophagus<\/a>) are separated from each other. During this operation an opening between the food pipe and the windpipe can be created (primary puncture). This opening can also be created at a later time (secondary puncture). This opening is called a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tracheo-oesophageal_puncture\" title=\"Tracheo-oesophageal puncture\" rel=\"external_link\" target=\"_blank\">tracheo-esophageal puncture<\/a> (TE puncture). The voice prosthesis is placed in this opening. Then, it becomes possible to speak by occluding the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stoma_(medicine)\" title=\"Stoma (medicine)\" rel=\"external_link\" target=\"_blank\">stoma<\/a> and blowing the air from the lungs through the inside of the voice prosthesis and through the throat, creating a voice sound, which is called tracheo-esophageal speech.\nThe back end of the prosthesis sits at the food pipe. To avoid food, drinks, or saliva from coming through the prosthesis and into the lungs, the prosthesis has a small flap at the back.\nThere are two ways of inserting the voice prosthesis: through the mouth and throat (retrograde manner) with the help of a guide wire, or directly through the tracheostoma (anterograde) manner. Nowadays, most voice prosthesis are placed anterograde, through the stoma.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>There are two lines of development on behalf of giving a voice to patients being laryngectomized.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Artificial_larynx\">Artificial larynx<\/span><\/h3>\n<p>In 1869 the first artificial voice box (larynx) was built by Czermak.<sup id=\"rdp-ebb-cite_ref-TBL1_1-0\" class=\"reference\"><a href=\"#cite_note-TBL1-1\" rel=\"external_link\">[1]<\/a><\/sup>\nIn 1873 Theodor Billroth made a total laryngectomy (in steps) and implanted an artificial voice box.<sup id=\"rdp-ebb-cite_ref-TBL1_1-1\" class=\"reference\"><a href=\"#cite_note-TBL1-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> A new development, using modern materials, took place in France by Debry.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Voice_prosthesis\">Voice prosthesis<\/span><\/h3>\n<p>In 1972 the very first voice prosthesis for voice rehabilitation after total laryngectomy was described in an article in Polish by Mozolewski.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Since then, many efforts have taken place in this area of rehabilitation. There are several manufacturers that have voice prosthesis in their product portfolio, e.g. Adeva\u00ae, Eska\u00ae, MediTop\u00ae, Heimomed\u00ae. The internationally most widely used are devices made by InHealth and Atos Medical. In 1980, the first commercially available prosthesis was introduced by Singer and Blom:<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> the \u2018Blom-Singer\u00ae Duckbill\u2019, a 16 French diameter, non-flanged device that the patient could remove, clean and replace him- or herself (non-indwelling). The first indwelling voice prosthesis (Groningen) was described in 1984.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> And in 1990, the first Provox\u00ae voice prosthesis, manufactured by Atos Medical, was introduced to the market,<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> followed by the Provox\u00ae2 in 1997,<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> the Provox\u00ae ActiValve\u2122 in 2003,<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> and the non-indwelling Provox\u00ae NID\u2122 in 2005.<sup id=\"rdp-ebb-cite_ref-Hancock_2005_981\u2013990_10-0\" class=\"reference\"><a href=\"#cite_note-Hancock_2005_981\u2013990-10\" rel=\"external_link\">[10]<\/a><\/sup> \n1994, the Blom-Singer\u00ae Classic\u2122 Indwelling Voice Prostheses<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> was introduced to the market. Like the Blom-Singer\u00ae Advantage\u00ae Indwelling Voice Prosthesis it is only inserted or replaced by medical professionals, such as speech pathologists or physicians. In 2009 the third generation Provox\u00ae Vega<sup id=\"rdp-ebb-cite_ref-Hilgers_2010_511\u2013519_12-0\" class=\"reference\"><a href=\"#cite_note-Hilgers_2010_511\u2013519-12\" rel=\"external_link\">[12]<\/a><\/sup> with SmartInserter\u2122<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> was introduced.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Non-indwelling_and_indwelling_voice_prostheses\">Non-indwelling and indwelling voice prostheses<\/span><\/h2>\n<p>The two main categories voice prosthesis can be divided into are \u2018non-indwelling\u2019 and \u2018indwelling\u2019 voice prostheses. \u2018Non-indwelling\u2019 voice prostheses can be replaced by the patients themselves,<sup id=\"rdp-ebb-cite_ref-Hancock_2005_981\u2013990_10-1\" class=\"reference\"><a href=\"#cite_note-Hancock_2005_981\u2013990-10\" rel=\"external_link\">[10]<\/a><\/sup> whereas \u2018indwelling\u2019 prostheses have to be replaced by a medical professional. A non-indwelling voice prosthesis has a safety strap and may also have a string with a special safety medallion that is too wide to fall into the tracheostoma. It comes in different sizes and lengths and often has a noticeable color, e.g. blue or white to enhance visibility for self-replacement and maintenance. Disadvantages of the non-indwelling prosthesis are a certain amount of risk when inserting them by oneself and the devices have a shorter lifetime and need to be changed more often. In general it takes some practice to insert the prosthesis and the ability to take excellent care of the device. Indwelling devices have sturdier flanges and can only be replaced by a medical professional. The safety strap is cut off after insertion. \nThe choice between \u2018non-indwelling\u2019 and \u2018indwelling\u2019 devices is really individual, depending on physical condition, maintenance and cost and can be alternated over a period of time to find out which one is most suitable.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Design_of_voice_prostheses\">Design of voice prostheses<\/span><\/h2>\n<p>The general design of voice prosthesis is quite consistent, even though there are unique characteristics. A voice prosthesis has retaining flanges at each end, the \u2018tracheal flange\u2019 and \u2018esophageal flange\u2019. Those flanges can vary in size and rigidity, e.g. indwelling prostheses have larger and more rigid flanges for stability and facilitate long-term placement. The flange near the food pipe (esophageal flange) is more rigid than the tracheal flange, near the windpipe. The one-way valve can be molded in one piece with the prosthesis and is often supported by a fluoroplastic valve seat (a colored ring that is tightly secured into the shaft of the prosthesis, adding rigidity and which is radiopaque). \nAll voice prostheses have a safety strap, which is cut off in indwelling devices after the prosthesis is put in place; in non-indwelling devices the strap is not removed and is taped to the neck. A voice prosthesis has a one-way valve near the esophageal flange that enables pulmonary air to pass into the esophagus and pharynx for sound production and prevents content from the food pipe, such as liquids or saliva, from entering the trachea.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Properties_of_voice_prostheses\">Properties of voice prostheses<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Material\">Material<\/span><\/h3>\n<p>A voice prosthesis is usually made of medical grade silicone rubber. The valve flap and valve seat may be made out of silicone, fluoroplastic, or may be treated with SilverOxide.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Sizes\">Sizes<\/span><\/h3>\n<p>The size of a voice prosthesis varies in length, depending on the thickness of the wall between the foodpipe and the windpipe and thereby the length of the TE puncture. The according length of the voice prosthesis ranges usually between 4 and 22 mm. Another parameter is the outer diameter of the shaft of the voice prosthesis, ranging from 16-22.5 <a href=\"https:\/\/en.wikipedia.org\/wiki\/French_catheter_scale\" title=\"French catheter scale\" rel=\"external_link\" target=\"_blank\">French<\/a>. Which outer diameter is used is decided by the clinician and\/or the patient and is most often a matter of personal preference. Studies have shown that a larger outer diameter of the voice prosthesis allows better airflow and thereby requires less effort to speak which has a positive effect on the overall voice quality.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Problem-solving_voice_prosthesis_for_strong_candida_accumulation\">Problem-solving voice prosthesis for strong candida accumulation<\/span><\/h2>\n<p>There are even special, problem-solving voice prosthesis, e.g. for laryngectomized patients with very short device life times (less than 4 to 8 weeks) of their current prosthesis. Those extremely short device life times may be caused by excessive candida growth, so that the valve of the prosthesis does not close properly anymore and content from the food pipe leaks through the voice prosthesis into the windpipe. Some of these prostheses have a magnet within the valve that strengthens the closure, others are made of silver oxide silicone to reduce biofilm formation on the valve or use two valves, in case of defect of the esophageal valve, the other valve would seal. In patients with a short device life, the use of a voice prosthesis with supporting magnets in the valve seat and valve flap has been proven to be cost effective.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Cleaning\">Cleaning<\/span><\/h2>\n<p>It is important to clean the voice prosthesis regularly, as the silicone material is exposed to yeast (candida) and bacteria in the food pipe, which is normally present in these areas.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> If yeast begins growing on or in the area of the valve flap of the voice prosthesis, it may not close well enough anymore. When this happens fluid starts to leak into the windpipe when eating or drinking.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Brushing\">Brushing<\/span><\/h3>\n<p>The inside of the voice prosthesis is usually cleaned with a brush, which removes food and mucus. It is recommended that the patient cleans the voice prosthesis regularly to keeps it open for speech and improve the device lifetime.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Flushing\">Flushing<\/span><\/h3>\n<p>It is also possible to flush the inside of the voice prosthesis with water or air.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> Usually this is done in combination with brushing.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Leakage\">Leakage<\/span><\/h2>\n<p>A voice prosthesis has to be replaced regularly, because after a certain time, the valve flap of the voice prosthesis does not close properly anymore, due to yeast and other natural sediments. This causes leakage of saliva or drinks, which enters the wind pipe and makes the person concerned cough. If not resolved by cleaning the voice prosthesis, this is a sign that the voice prosthesis must be changed. If that is not possible right away, there are special plugs that can block the leakage. The patient can insert this plug him-\/ herself before eating or drinking and remove it again afterwards, as speaking with the plug in place is usually not possible.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Device_lifetime\">Device lifetime<\/span><\/h2>\n<p>The device lifetime can range from a couple of weeks up to two years, depending on individual circumstances.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> The lifetime is influenced by daily food intake, especially dairy products,<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> but also radiotherapy<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[A 1]<\/a><\/sup> and GERD (Gastro Esophageal Reflux Disease) affects the voice prosthesis and its lifetime.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[21]<\/a><\/sup>\nThe cause of the prothesis' life time end is mostly leakage, but also growing of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fistula\" title=\"Fistula\" rel=\"external_link\" target=\"_blank\">fistulae<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Granulation_tissue\" title=\"Granulation tissue\" rel=\"external_link\" target=\"_blank\">granulation tissue<\/a>, increasing valve's opening pressure and prothesis' loss <sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Voice_quality_and_speaking_effort\">Voice quality and speaking effort<\/span><\/h2>\n<p>The voice quality when speaking with a voice prosthesis is influenced by pulmonary support, airflow resistance of the voice prosthesis, and airflow resistance of the new voice source.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[23]<\/a><\/sup> Although the voice prosthesis is only responsible for part of the total resistance \u2013 the neoglottis is responsible for the other part \u2013 favorable airflow characteristics are expected to enable the laryngectomized patient to speak with less effort.<sup id=\"rdp-ebb-cite_ref-Hilgers_2010_511\u2013519_12-1\" class=\"reference\"><a href=\"#cite_note-Hilgers_2010_511\u2013519-12\" rel=\"external_link\">[12]<\/a><\/sup>\nThe voice sounds rather clear though not very loud as samples show.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Voice_prosthesis_and_HME\">Voice prosthesis and HME<\/span><\/h2>\n<p>An individual combination of voice prosthesis, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heat_and_moisture_exchanger_after_laryngectomy\" title=\"Heat and moisture exchanger after laryngectomy\" rel=\"external_link\" target=\"_blank\">heat and moisture exchanger after laryngectomy<\/a> and attachment is important for good speech and pulmonary rehabilitation.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[25]<\/a><\/sup>\nThe HME sometimes is combined with free-hands-switch and virus and bacteria filter.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Annotations\">Annotations<\/span><\/h2>\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Free_University_of_Berlin\" title=\"Free University of Berlin\" rel=\"external_link\" target=\"_blank\">Free University of Berlin<\/a> study shows a different result<\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-TBL1-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-TBL1_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-TBL1_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/oparu.uni-ulm.de\/xmlui\/handle\/123456789\/1385\" target=\"_blank\">\"Prothetische Stimmrehabilitation nach totaler Kehlkopfentfernung - eine historische Abhandlung seit Billroth (1873)\"<\/a> (in German)<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-01-08<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Prothetische+Stimmrehabilitation+nach+totaler+Kehlkopfentfernung+-+eine+historische+Abhandlung+seit+Billroth+%281873%29&rft_id=https%3A%2F%2Foparu.uni-ulm.de%2Fxmlui%2Fhandle%2F123456789%2F1385&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVoice+prosthesis\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/docnum.univ-lorraine.fr\/public\/BUMED_MORT_2013_FISSETTE_AGATHE.pdf\" target=\"_blank\">\"Tendances chirurgicales actuelles concernant la pose de l'implant phonatoire dans les laryngectomies totales, etmodalit\u00e9s de prise en charge orthophonique p. 8\"<\/a> <span class=\"cs1-format\">(PDF)<\/span> (in French)<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-01-18<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Tendances+chirurgicales+actuelles+concernant+la+pose+de+l%E2%80%99implant+phonatoire+dans+les+laryngectomies+totales%2C+etmodalit%C3%A9s+de+prise+en+charge+orthophonique+p.+8&rft_id=http%3A%2F%2Fdocnum.univ-lorraine.fr%2Fpublic%2FBUMED_MORT_2013_FISSETTE_AGATHE.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVoice+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Fr\u00e9our, Pauline (2013-10-07). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/sante.lefigaro.fr\/actualite\/2013\/10\/07\/21345-premier-larynx-artificiel-monde-est-francais\" target=\"_blank\">\"Le premier larynx artificiel du monde est fran\u00e7ais\"<\/a>. <i>Le Figaro<\/i> (in French)<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-01-14<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Le+Figaro&rft.atitle=Le+premier+larynx+artificiel+du+monde+est+fran%C3%A7ais&rft.date=2013-10-07&rft.au=Fr%C3%A9our%2C+Pauline&rft_id=http%3A%2F%2Fsante.lefigaro.fr%2Factualite%2F2013%2F10%2F07%2F21345-premier-larynx-artificiel-monde-est-francais&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVoice+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mozolewski, E. (1972). \"Surgical rehabilitation of voice and speech following laryngectomy\". 26(6): Otolaryngol Pol: 653\u2013661.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Surgical+rehabilitation+of+voice+and+speech+following+laryngectomy&rft.pages=653-661&rft.date=1972&rft.aulast=Mozolewski&rft.aufirst=E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVoice+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Singer, MI; Blom ED. (1980). \"An endoscopic technique for restoration of voice after laryngectomy\". <i>Ann Otol Rhinol Laryngol<\/i>. <b>89<\/b> (6 Pt 1): 529\u2013533. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7458140\" target=\"_blank\">7458140<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ann+Otol+Rhinol+Laryngol&rft.atitle=An+endoscopic+technique+for+restoration+of+voice+after+laryngectomy&rft.volume=89&rft.issue=6+Pt+1&rft.pages=529-533&rft.date=1980&rft_id=info%3Apmid%2F7458140&rft.aulast=Singer&rft.aufirst=MI&rft.au=Blom+ED.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVoice+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Manni JJ, van den Broek P, de Groot MA, Berends E (1984). \"Voice rehabilitation after laryngectomy with the Groningen prosthesis\". <i>J Otolaryngol<\/i>. <b>13<\/b> (5): 333\u2013336. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6544851\" target=\"_blank\">6544851<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Otolaryngol&rft.atitle=Voice+rehabilitation+after+laryngectomy+with+the+Groningen+prosthesis&rft.volume=13&rft.issue=5&rft.pages=333-336&rft.date=1984&rft_id=info%3Apmid%2F6544851&rft.aulast=Manni&rft.aufirst=JJ&rft.au=van+den+Broek%2C+P&rft.au=de+Groot%2C+MA&rft.au=Berends%2C+E&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVoice+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hilgers, FJ; Schouwenburg PF (1990). \"A new low-resistance, self-retaining prosthesis (Provox) for voice rehabilitation after total laryngectomy\". <i>Laryngoscope<\/i>. <b>100<\/b> (11): 1202\u20131207. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1288%2F00005537-199011000-00014\" target=\"_blank\">10.1288\/00005537-199011000-00014<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2233085\" target=\"_blank\">2233085<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Laryngoscope&rft.atitle=A+new+low-resistance%2C+self-retaining+prosthesis+%28Provox%29+for+voice+rehabilitation+after+total+laryngectomy&rft.volume=100&rft.issue=11&rft.pages=1202-1207&rft.date=1990&rft_id=info%3Adoi%2F10.1288%2F00005537-199011000-00014&rft_id=info%3Apmid%2F2233085&rft.aulast=Hilgers&rft.aufirst=FJ&rft.au=Schouwenburg+PF&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVoice+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hilgers, FJ; Ackerstaff AH; Balm AJ; Tan IB; Aaronson NK; Persson JO (1997). \"Development and clinical evaluation of a second-generation voice prosthesis (Provox 2), designed for anterograde and retrograde insertion\". <i>Acta Otolaryngol<\/i>. <b>117<\/b> (6): 889\u2013896. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3109%2F00016489709114220\" target=\"_blank\">10.3109\/00016489709114220<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9442833\" target=\"_blank\">9442833<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Otolaryngol&rft.atitle=Development+and+clinical+evaluation+of+a+second-generation+voice+prosthesis+%28Provox+2%29%2C+designed+for+anterograde+and+retrograde+insertion&rft.volume=117&rft.issue=6&rft.pages=889-896&rft.date=1997&rft_id=info%3Adoi%2F10.3109%2F00016489709114220&rft_id=info%3Apmid%2F9442833&rft.aulast=Hilgers&rft.aufirst=FJ&rft.au=Ackerstaff+AH&rft.au=Balm+AJ&rft.au=Tan+IB&rft.au=Aaronson+NK&rft.au=Persson+JO&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVoice+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hilgers FJ, Ackerstaff AH, Balm AJ, Van den Brekel MW, Bing Tan I, Persson JO (2003). \"A new problem-solving indwelling voice prosthesis, eliminating the need for frequent Candida- and \"underpressure\"-related replacements: Provox ActiValve\". <i>Acta Otolaryngol<\/i>. <b>123<\/b> (8): 972\u2013979. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1080%2F00016480310015371\" target=\"_blank\">10.1080\/00016480310015371<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14606602\" target=\"_blank\">14606602<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Otolaryngol&rft.atitle=A+new+problem-solving+indwelling+voice+prosthesis%2C+eliminating+the+need+for+frequent+Candida-+and+%22underpressure%22-related+replacements%3A+Provox+ActiValve&rft.volume=123&rft.issue=8&rft.pages=972-979&rft.date=2003&rft_id=info%3Adoi%2F10.1080%2F00016480310015371&rft_id=info%3Apmid%2F14606602&rft.aulast=Hilgers&rft.aufirst=FJ&rft.au=Ackerstaff%2C+AH&rft.au=Balm%2C+AJ&rft.au=Van+den+Brekel%2C+MW&rft.au=Bing+Tan%2C+I&rft.au=Persson%2C+JO&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVoice+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Hancock_2005_981\u2013990-10\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Hancock_2005_981\u2013990_10-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Hancock_2005_981\u2013990_10-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hancock, K; Houghton B; As-Brooks CJ; Coman W (2005). \"First clinical experience with a new non-indwelling voice prosthesis (Provox NID) for voice rehabilitation after total laryngectomy\". <i>Acta Otolaryngol<\/i>. <b>125<\/b> (9): 981\u2013990. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1080%2F00016480510043486\" target=\"_blank\">10.1080\/00016480510043486<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16109676\" target=\"_blank\">16109676<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Otolaryngol&rft.atitle=First+clinical+experience+with+a+new+non-indwelling+voice+prosthesis+%28Provox+NID%29+for+voice+rehabilitation+after+total+laryngectomy&rft.volume=125&rft.issue=9&rft.pages=981-990&rft.date=2005&rft_id=info%3Adoi%2F10.1080%2F00016480510043486&rft_id=info%3Apmid%2F16109676&rft.aulast=Hancock&rft.aufirst=K&rft.au=Houghton+B&rft.au=As-Brooks+CJ&rft.au=Coman+W&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVoice+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kress, P; Schafer P; Schwerdtfeger FP; Roesler S (2007). \"Measurement and comparison of in vitro air-flow characteristics of the most frequently used European indwelling voice prostheses types\". <i>6th European Congress of oto-Rhino-Laryngology Head and Neck Surgery, June 30 - July 4, 2007, Vienna, Austria<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=6th+European+Congress+of+oto-Rhino-Laryngology+Head+and+Neck+Surgery%2C+June+30+-+July+4%2C+2007%2C+Vienna%2C+Austria&rft.atitle=Measurement+and+comparison+of+in+vitro+air-flow+characteristics+of+the+most+frequently+used+European+indwelling+voice+prostheses+types&rft.date=2007&rft.aulast=Kress&rft.aufirst=P&rft.au=Schafer+P&rft.au=Schwerdtfeger+FP&rft.au=Roesler+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVoice+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Hilgers_2010_511\u2013519-12\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Hilgers_2010_511\u2013519_12-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Hilgers_2010_511\u2013519_12-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hilgers FJ, Ackerstaff AH, et al. 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FU-Berlin<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-03-10<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=r+Lebensdauer+von+Stimmprothesen&rft.pub=FU-Berlin&rft_id=http%3A%2F%2Fwww.diss.fu-berlin.de%2Fdiss%2Fservlets%2FMCRFileNodeServlet%2FFUDISS_derivate_000000001821%2F6_Diskussion.pdf%3Fhosts%3D&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVoice+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hilgers, FJ; Cornelissen MW; Balm AJ (1993). \"Aerodynamic characteristics of the Provox low-resistance indwelling voice prosthesis\". <i>Eur Arch Otorhinolaryngol<\/i>. <b>250<\/b> (7): 375\u2013378. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fbf00180379\" target=\"_blank\">10.1007\/bf00180379<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8286099\" target=\"_blank\">8286099<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Eur+Arch+Otorhinolaryngol&rft.atitle=Aerodynamic+characteristics+of+the+Provox+low-resistance+indwelling+voice+prosthesis&rft.volume=250&rft.issue=7&rft.pages=375-378&rft.date=1993&rft_id=info%3Adoi%2F10.1007%2Fbf00180379&rft_id=info%3Apmid%2F8286099&rft.aulast=Hilgers&rft.aufirst=FJ&rft.au=Cornelissen+MW&rft.au=Balm+AJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVoice+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.atosmedical.de\/?doing_wp_cron=1489222559.8730769157409667968750\" target=\"_blank\">\"Speech smples\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-03-11<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Speech+smples&rft_id=http%3A%2F%2Fwww.atosmedical.de%2F%3Fdoing_wp_cron%3D1489222559.8730769157409667968750&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVoice+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Balle, VH; Rindso L; Thomsen JC (2000). \"Primary speech restoration at laryngectomy by insertion of voice prosthesis-10 years' experience\". <i>Acta Otolaryngol Suppl<\/i>. <b>543<\/b>: 244\u2013245. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1080%2F000164800454512\" target=\"_blank\">10.1080\/000164800454512<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10909032\" target=\"_blank\">10909032<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Otolaryngol+Suppl&rft.atitle=Primary+speech+restoration+at+laryngectomy+by+insertion+of+voice+prosthesis-10+years%27+experience&rft.volume=543&rft.pages=244-245&rft.date=2000&rft_id=info%3Adoi%2F10.1080%2F000164800454512&rft_id=info%3Apmid%2F10909032&rft.aulast=Balle&rft.aufirst=VH&rft.au=Rindso+L&rft.au=Thomsen+JC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVoice+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/stimmprothese.com\/tracheostoma\/hme-filter\/provox-hme-system\/\" target=\"_blank\">\"Provox Micron HME\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-03-11<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Provox+Micron+HME&rft_id=http%3A%2F%2Fstimmprothese.com%2Ftracheostoma%2Fhme-filter%2Fprovox-hme-system%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVoice+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1319\nCached time: 20181206233623\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.328 seconds\nReal time usage: 0.368 seconds\nPreprocessor visited node count: 1282\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 49190\/2097152 bytes\nTemplate argument size: 80\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 74473\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.212\/10.000 seconds\nLua memory usage: 3.43 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 303.557 1 Template:Reflist\n100.00% 303.557 1 -total\n<\/p>\n<pre>50.31% 152.711 21 Template:Cite_journal\n36.86% 111.895 5 Template:Cite_web\n 1.16% 3.523 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:34346175-1!canonical and timestamp 20181206233622 and revision id 872360193\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Voice_prosthesis\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212205\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.050 seconds\nReal time usage: 0.200 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 193.165 1 - wikipedia:Voice_prosthesis\n100.00% 193.165 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8267-0!*!*!*!*!*!* and timestamp 20181217212205 and revision id 24478\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Voice_prosthesis\">https:\/\/www.limswiki.org\/index.php\/Voice_prosthesis<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","137abfcad37e75b89c38da3cc4279638_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ef\/Voice_prosthesis.jpg\/440px-Voice_prosthesis.jpg"],"137abfcad37e75b89c38da3cc4279638_timestamp":1545081725,"ee345c211e8182e32bd5e64c6c61308d_type":"article","ee345c211e8182e32bd5e64c6c61308d_title":"Visual prosthesis","ee345c211e8182e32bd5e64c6c61308d_url":"https:\/\/www.limswiki.org\/index.php\/Visual_prosthesis","ee345c211e8182e32bd5e64c6c61308d_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tVisual prosthesis\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor non-functional prostheses or glass eyes, see Ocular prosthesis and Craniofacial prosthesis.\n\nA visual prosthesis, often referred to as a bionic eye, is an experimental visual device intended to restore functional vision in those suffering from partial or total blindness. Many devices have been developed, usually modeled on the cochlear implant or bionic ear devices, a type of neural prosthesis in use since the mid-1980s. The idea of using electrical current (e.g., electrically stimulating the retina or the visual cortex) to provide sight dates back to the 18th century, discussed by Benjamin Franklin,[1] Tiberius Cavallo,[2] and Charles LeRoy.[3]\n\nContents \n\n1 Biological considerations \n2 Technological considerations \n3 Ongoing projects \n\n3.1 Argus retinal prosthesis \n3.2 Microsystem-based visual prosthesis (MIVP) \n3.3 Implantable miniature telescope \n3.4 T\u00fcbingen MPDA Project Alpha IMS \n3.5 Harvard\/MIT Retinal Implant \n3.6 Artificial silicon retina (ASR) \n3.7 Photovoltaic retinal prosthesis (PRIMA) \n3.8 Bionic Vision Australia \n3.9 Dobelle Eye \n3.10 Intracortical visual prosthesis \n\n\n4 See also \n5 References \n6 External links \n\n\nBiological considerations \nThe ability to give sight to a blind person via a bionic eye depends on the circumstances surrounding the loss of sight. For retinal prostheses, which are the most prevalent visual prosthetic under development (due to ease of access to the retina among other considerations), patients with vision loss due to degeneration of photoreceptors (retinitis pigmentosa, choroideremia, geographic atrophy macular degeneration) are the best candidate for treatment. Candidates for visual prosthetic implants find the procedure most successful if the optic nerve was developed prior to the onset of blindness. Persons born with blindness may lack a fully developed optical nerve, which typically develops prior to birth[4], though neuroplasticity makes it possible for the nerve, and sight, to develop after implantation.[citation needed ]\n\nTechnological considerations \nVisual prosthetics are being developed as a potentially valuable aid for individuals with visual degradation. Argus II, co-developed at the University of Southern California (USC) Eye Institute[5] and manufactured by Second Sight Medical Products Inc., is now the only such device to have received marketing approval (CE Mark in Europe in 2011). Most other efforts remain investigational; the Retina Implant AG's Alpha IMS won a CE Mark July 2013 and is a significant improvement in resolution. It is not, however, FDA-approved in the US.[6]\n\nOngoing projects \nArgus retinal prosthesis \nMain article: Argus retinal prosthesis\nMark Humayun, who joined the faculty of the Keck School of Medicine of USC Department of Ophthalmology in 2001;[7] Eugene Dejuan, now at the University of California San Francisco; engineer Howard D. Phillips; bio-electronics engineer Wentai Liu, now at University of California Los Angeles; and Robert Greenberg, now of Second Sight, were the original inventors of the active epi-retinal prosthesis[8] and demonstrated proof of principle in acute patient investigations at Johns Hopkins University in the early 1990s. In the late 1990s the company Second Sight[9] was formed by Greenberg along with medical device entrepreneur, Alfred E. Mann,[10]:35 Their first-generation implant had 16 electrodes and was implanted in six subjects by Humayun at University of Southern California between 2002 and 2004.[10]:35 [11] In 2007, the company began a trial of its second-generation, 60-electrode implant, dubbed the Argus II, in the US and in Europe.[12][13] In total 30 subjects participated in the studies spanning 10 sites in four countries. In the spring of 2011, based on the results of the clinical study which were published in 2012,[14] Argus II was approved for commercial use in Europe, and Second Sight launched the product later that same year. The Argus II was approved by the United States FDA on 14 February 2013. Three US government funding agencies (National Eye Institute, Department of Energy, and National Science Foundation) have supported the work at Second Sight, USC, UCSC, Caltech, and other research labs.[15]\n\n Microsystem-based visual prosthesis (MIVP) \nDesigned by Claude Veraart at the University of Louvain, this is a spiral cuff electrode around the optic nerve at the back of the eye. It is connected to a stimulator implanted in a small depression in the skull. The stimulator receives signals from an externally worn camera, which are translated into electrical signals that stimulate the optic nerve directly.[16]\n\nImplantable miniature telescope \nAlthough not truly an active prosthesis, an Implantable Miniature Telescope is one type of visual implant that has met with some success in the treatment of end-stage age-related macular degeneration.[17][18][19] This type of device is implanted in the eye's posterior chamber and works by increasing (by about three times) the size of the image projected onto the retina in order to overcome a centrally located scotoma or blind spot.[18][19]\nCreated by VisionCare Ophthalmic Technologies in conjunction with the CentraSight Treatment Program, the telescope is about the size of a pea and is implanted behind the iris of one eye. Images are projected onto healthy areas of the central retina, outside the degenerated macula, and is enlarged to reduce the effect the blind spot has on central vision. 2.2x or 2.7x magnification strengths make it possible to see or discern the central vision object of interest while the other eye is used for peripheral vision because the eye that has the implant will have limited peripheral vision as a side effect. Unlike a telescope which would be hand-held, the implant moves with the eye which is the main advantage. Patients using the device may however still need glasses for optimal vision and for close work. Before surgery, patients should first try out a hand-held telescope to see if they would benefit from image enlargement. One of the main drawbacks is that it cannot be used for patients who have had cataract surgery as the intraocular lens would obstruct insertion of the telescope. It also requires a large incision in the cornea to insert.[20]\n\n T\u00fcbingen MPDA Project Alpha IMS \nA Southern German team led by the University Eye Hospital in T\u00fcbingen, was formed in 1995 by Eberhart Zrenner to develop a subretinal prosthesis.\nThe chip is located behind the retina and utilizes microphotodiode arrays (MPDA) which collect incident light and transform it into electrical current stimulating the retinal ganglion cells.\nAs natural photoreceptors are far more efficient than photodiodes, visible light is not powerful enough to stimulate the MPDA. Therefore, an external power supply is used to enhance the stimulation current. The German team commenced in vivo experiments in 2000, when evoked cortical potentials were measured from Yucat\u00e1n micropigs and rabbits. At 14 months post implantation, the implant and retina surrounding it were examined and there were no noticeable changes to anatomical integrity. The implants were successful in producing evoked cortical potentials in half of the animals tested. The thresholds identified in this study were similar to those required in epiretinal stimulation.\nLater reports from this group concern the results of a clinical pilot study on 11 participants suffering from RP. Some blind patients were able to read letters, recognize unknown objects, localize a plate, a cup and cutlery.[21] Two of the patients were found to make microsaccades similar to those of healthy control participants, and the properties of the eye movements depended on the stimuli that the patients were viewing--suggesting that eye movements might be useful measures for evaluating vision restored by implants.[22][23] \nIn 2010 a new multicenter Study has been started using a fully implantable device with 1500 Electrodes Alpha IMS (produced by Retina Implant AG, Reutlingen, Germany), 10 patients included so far; first results have been presented at ARVO 2011.[citation needed ] The first UK implantations took place in March 2012 and were led by Robert MacLaren at the University of Oxford and Tim Jackson at King's College Hospital in London.[24][25] David Wong also implanted the T\u00fcbingen device in a patient in Hong Kong.[26] In all cases previously blind patients had some degree of sight restored.[citation needed ]\n\n Harvard\/MIT Retinal Implant \nJoseph Rizzo and John Wyatt at the Massachusetts Eye and Ear Infirmary and MIT began researching the feasibility of a retinal prosthesis in 1989, and performed a number of proof-of-concept epiretinal stimulation trials on blind volunteers between 1998 and 2000. They have since developed a subretinal stimulator, an array of electrodes, that is placed beneath the retina in the subretinal space and receives image signals beamed from a camera mounted on a pair of glasses. The stimulator chip decodes the picture information beamed from the camera and stimulates retinal ganglion cells accordingly. Their second generation prosthesis collects data and sends it to the implant through RF fields from transmitter coils that are mounted on the glasses. A secondary receiver coil is sutured around the iris.[27]\n\n Artificial silicon retina (ASR) \nThe brothers Alan Chow and Vincent Chow have developed a microchip containing 3500 photodiodes, which detect light and convert it into electrical impulses, which stimulate healthy retinal ganglion cells. The ASR requires no externally worn devices.[16]\nThe original Optobionics Corp. stopped operations, but Chow acquired the Optobionics name, the ASR implants and plans to reorganize a new company under the same name.[28] The ASR microchip is a 2mm in diameter silicon chip (same concept as computer chips) containing ~5,000 microscopic solar cells called \"microphotodiodes\" that each have their own stimulating electrode.[29]\n\n Photovoltaic retinal prosthesis (PRIMA) \nDaniel Palanker and his group at Stanford University have developed a photovoltaic retinal prosthesis[30] that includes a subretinal photodiode array and an infrared image projection system mounted on video goggles. Images captured by video camera are processed in a pocket PC and displayed on video goggles using pulsed near-infrared (IR, 880\u2013915 nm) light. These images are projected onto the retina via natural eye optics, and photodiodes in the subretinal implant convert light into pulsed bi-phasic electric current in each pixel.[31] Electric current flowing through the tissue between the active and return electrode in each pixel stimulates the nearby inner retinal neurons, primarily the bipolar cells, which transmit excitatory responses to the retinal ganglion cells. \nThis technology is being commercialized by Pixium Vision (PRIMA), and is being evaluated in a clinical trial (2018).\nFollowing this proof of concept, Palanker group is focusing now on developing pixels smaller than 50\u03bcm using 3-D electrodes and utilizing the effect of retinal migration into voids in the subretinal implant.\n\nBionic Vision Australia \nAn Australian team led by Professor Anthony Burkitt is developing two retinal prostheses. The Wide-View device combines novel technologies with materials that have been successfully used in other clinical implants. This approach incorporates a microchip with 98 stimulating electrodes and aims to provide increased mobility for patients to help them move safely in their environment. This implant will be placed in the suprachoroidal space. Researchers expect the first patient tests to begin with this device in 2013.\nThe Bionic Vision Australia consortium is concurrently developing the High-Acuity device, which incorporates a number of new technologies to bring together a microchip and an implant with 1024 electrodes. The device aims to provide functional central vision to assist with tasks such as face recognition and reading large print. This high-acuity implant will be inserted epiretinally. Patient tests are planned for this device in 2014 once preclinical testing has been completed.\nPatients with retinitis pigmentosa will be the first to participate in the studies, followed by age-related macular degeneration. Each prototype consists of a camera, attached to a pair of glasses which sends the signal to the implanted microchip, where it is converted into electrical impulses to stimulate the remaining healthy neurons in the retina. This information is then passed on to the optic nerve and the vision processing centres of the brain.\nThe Australian Research Council awarded Bionic Vision Australia a $42 million grant in December 2009 and the consortium was officially launched in March 2010. Bionic Vision Australia brings together a multidisciplinary team, many of whom have extensive experience developing medical devices such as the cochlear implant (or 'bionic ear').[32]\n\nDobelle Eye \nMain article: William H. Dobelle\nSimilar in function to the Harvard\/MIT device, except the stimulator chip sits in the primary visual cortex, rather than on the retina. Many subjects have been implanted with a high success rate and limited negative effects. Still in the developmental phase, upon the death of Dobelle, selling the eye for profit was ruled against[by whom? ] in favor of donating it to a publicly funded research team.[16][33]\n\nIntracortical visual prosthesis \nThe Laboratory of Neural Prosthetics at Illinois Institute Of Technology (IIT), Chicago, is developing a visual prosthetic using intracortical electrode arrays. While similar in principle to the Dobelle system, the use of intracortical electrodes allow for greatly increased spatial resolution in the stimulation signals (more electrodes per unit area). In addition, a wireless telemetry system is being developed[34] to eliminate the need for transcranial wires. Arrays of activated iridium oxide film (AIROF)-coated electrodes will be implanted in the visual cortex, located on the occipital lobe of the brain. External hardware will capture images, process them, and generate instructions which will then be transmitted to implanted circuitry via a telemetry link. The circuitry will decode the instructions and stimulate the electrodes, in turn stimulating the visual cortex. The group is developing a wearable external image capture and processing system to accompany the implanted circuitry. Studies on animals and psyphophysical studies on humans are being conducted[35] to test the feasibility of a human volunteer implant.[citation needed ]\n\nSee also \nBionic contact lens\nHuman echolocation\nReferences \n\n\n^ Dobelle WH (2000). \"Artificial vision for the blind by connecting a television camera to the visual cortex\" (PDF) . Asaio J. 46 (1): 3\u20139. doi:10.1097\/00002480-200001000-00002. PMID 10667705. Archived from the original (PDF) on 27 March 2014. Retrieved 21 July 2013 . \n\n^ Fodstad, H.; Hariz, M. (2007). \"Electricity in the treatment of nervous system disease\". In Sakas, Damianos E.; Krames, Elliot S.; Simpson, Brian A. Operative Neuromodulation. Springer. p. 11. ISBN 9783211330791. Retrieved 21 July 2013 . \n\n^ Sekirnjak C; Hottowy P; Sher A; Dabrowski W; et al. (2008). \"High-resolution electrical stimulation of primate retina for epiretinal implant design\". J Neurosci. 28 (17): 4446\u201356. doi:10.1523\/jneurosci.5138-07.2008. PMC 2681084 . PMID 18434523. Retrieved 21 July 2013 . \n\n^ Provis, Jan M; Van Driel, Diana; Billson, Frank A; Russell, Peter (1985). \"Human fetal optic nerve: Overproduction and elimination of retinal axons during development\". The Journal of Comparative Neurology. 238 (1): 92\u2013100. doi:10.1002\/cne.902380108. PMID 4044906. \n\n^ \"USC Eye Institute ophthalmologists implant first FDA-approved Argus II retinal prosthesis in western United States\". Reuters. 27 August 2014. Archived from the original on 5 January 2015. Retrieved 5 January 2015 . \n\n^ Chuang AT, Margo CE, Greenberg PB (Jul 2014). \"Retinal implants: a systematic review\". Br J Ophthalmol. 98 (7): 852\u201356. doi:10.1136\/bjophthalmol-2013-303708. PMID 24403565. \n\n^ \"Humayun faculty page at USC Keck\". Retrieved February 15, 2015 . \n\n^ U.S. Department of Energy Office of Science. \"Overview of the Artificial Retina Project\". \n\n^ \"Second Sight official website\". 2-sight.com. 2015-05-21. Retrieved 2018-06-12 . \n\n^ a b Second Sight. November 14, 2014 Second Sight Amendment No. 3 to Form S-1: Registration Statement \n\n^ Miriam Karmel (March 2012). \"Clinical Update: Retina. Retinal Prostheses: Progress and Problems\". Eyenet Magazine. \n\n^ Second Sight (9 January 2007). \"Press Release: Ending the Journey through Darkness: Innovative Technology Offers New Hope for Treating Blindness due to Retinitis Pigmentosa\" (PDF) . \n\n^ Jonathan Fildes (16 February 2007). \"Trials for bionic eye implants\". BBC. \n\n^ Humayun (April 2012). \"Interim Results from the International Trial of Second Sight's Visual Prosthesis\". Ophthalmology. \n\n^ Sifferlin, Alexandra (19 February 2013). \"FDA approves first bionic eye\". CNN. TIME. Retrieved 22 February 2013 . \n\n^ a b c James Geary (2002). The Body Electric. Phoenix. \n\n^ Chun DW; Heier JS; Raizman MB (2005). \"Visual prosthetic device for bilateral end-stage macular degeneration\". Expert Rev Med Devices. 2 (6): 657\u201365. doi:10.1586\/17434440.2.6.657. PMID 16293092. \n\n^ a b Lane SS; Kuppermann BD; Fine IH; Hamill MB; et al. (2004). \"A prospective multicenter clinical trial to evaluate the safety and effectiveness of the implantable miniature telescope\". Am J Ophthalmol. 137 (6): 993\u20131001. doi:10.1016\/j.ajo.2004.01.030. PMID 15183782. \n\n^ a b Lane SS; Kuppermann BD (2006). \"The Implantable Miniature Telescope for macular degeneration\". Current Opinion in Ophthalmology. 17 (1): 94\u201398. doi:10.1097\/01.icu.0000193067.86627.a1. PMID 16436930. \n\n^ Lipshitz, Isaac. \"Implantable Telescope Technology\". VisionCare Ophthalmic Technologies, Inc. Retrieved 20 March 2011 . \n\n^ Eberhart Zrenner; et al. (2010). \"Subretinal electronic chips allow blind patients to read letters and combine them to words\". Proceedings of the Royal Society B. 278 (1711): 1489\u201397. doi:10.1098\/rspb.2010.1747. PMC 3081743 . PMID 21047851. \n\n^ Alexander, Robert; Macknik, Stephen; Martinez-Conde, Susana (2018). \"Microsaccade Characteristics in Neurological and Ophthalmic Disease\". Frontiers in Neurology. 9 (144). doi:10.3389\/fneur.2018.00144. \n\n^ Hafed, Z; Stingl, K; Bartz-Schmidt, K; Gekeler, F; Zrenner, E. \"Oculomotor behavior of blind patients seeing with a subretinal visual implant\". Vision Research. doi:10.1016\/j.visres.2015.04.006. \n\n^ \"Blind man 'excited' at retina implant\". BBC News. 3 May 2012. Retrieved May 23, 2016 . \n\n^ Fergus Walsh (3 May 2012). \"Two blind British men have electronic retinas fitted\". BBC News. Retrieved May 23, 2016 . \n\n^ \"HKU performed the first subretinal microchip implantation in Asia Patient regained eyesight after the surgery\". HKU.hk (Press release). The University of Hong Kong. 3 May 2012. Retrieved May 23, 2016 . \n\n^ Wyatt, Jr., J.L. \"The Retinal Implant Project\" (PDF) . Research Laboratory of Electronics (RLE) at the Massachusetts Institute of Technology (MIT). Retrieved 20 March 2011 . \n\n^ \"ASR\u00ae Device\". Optobionics. Retrieved 20 March 2011 . \n\n^ \"ASR\u00ae Device\". Optobionics. Retrieved 20 March 2011 . \n\n^ Palanker Group. \"Photovoltaic Retinal Prosthesis\". \n\n^ K. Mathieson; J. Loudin; G. Goetz; P. Huie; L. Wang; T. Kamins; L. Galambos; R. Smith; J.S. Harris; A. Sher; D. Palanker (2012). \"Photovoltaic retinal prosthesis with high pixel density\". Nature Photonics. 6 (6): 391\u201397. doi:10.1038\/nphoton.2012.104. PMC 3462820 . PMID 23049619. \n\n^ \"Bionic Vision Australia's progress of the bionic eye\". Retrieved 23 July 2012 . (Subscription required (help )) . \n\n^ Simon Ings (2007). \"Chapter 10(3): Making eyes to see\". The Eye: a natural history. London: Bloomsbury. pp. 276\u201383. \n\n^ Rush, Alexander; PR Troyk (November 2012). \"A Power and Data Link for a Wireless-Implanted Neural Recording System\". Transactions on Biomedical Engineering. 59 (11): 3255\u201362. doi:10.1109\/tbme.2012.2214385. PMID 22922687. Retrieved 26 September 2013 . \n\n^ Srivastava, Nishant; PR Troyk; G Dagnelie (June 2009). \"Detection, eye-hand coordination and virtual mobility performance in simulated vision for a cortical visual prosthesis device\". Journal of Neural Engineering. 6 (3): 035008. doi:10.1088\/1741-2560\/6\/3\/035008. PMC 3902177 . 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 22:32.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 664 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","ee345c211e8182e32bd5e64c6c61308d_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Visual_prosthesis skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Visual prosthesis<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For non-functional prostheses or glass eyes, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ocular_prosthesis\" title=\"Ocular prosthesis\" rel=\"external_link\" target=\"_blank\">Ocular prosthesis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Craniofacial_prosthesis\" title=\"Craniofacial prosthesis\" rel=\"external_link\" target=\"_blank\">Craniofacial prosthesis<\/a>.<\/div>\n<p class=\"mw-empty-elt\">\n<\/p><p>A <b>visual prosthesis<\/b>, often referred to as a <b>bionic eye<\/b>, is an experimental visual device intended to restore functional vision in those suffering from partial or total <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blindness\" class=\"mw-redirect\" title=\"Blindness\" rel=\"external_link\" target=\"_blank\">blindness<\/a>. Many devices have been developed, usually modeled on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implant\" title=\"Cochlear implant\" rel=\"external_link\" target=\"_blank\">cochlear implant<\/a> or bionic ear devices, a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroprosthetics\" title=\"Neuroprosthetics\" rel=\"external_link\" target=\"_blank\">neural prosthesis<\/a> in use since the mid-1980s. The idea of using electrical current (e.g., electrically stimulating the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retina\" title=\"Retina\" rel=\"external_link\" target=\"_blank\">retina<\/a> or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_cortex\" title=\"Visual cortex\" rel=\"external_link\" target=\"_blank\">visual cortex<\/a>) to provide sight dates back to the 18th century, discussed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Benjamin_Franklin\" title=\"Benjamin Franklin\" rel=\"external_link\" target=\"_blank\">Benjamin Franklin<\/a>,<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tiberius_Cavallo\" title=\"Tiberius Cavallo\" rel=\"external_link\" target=\"_blank\">Tiberius Cavallo<\/a>,<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> and Charles LeRoy.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Biological_considerations\">Biological considerations<\/span><\/h2>\n<p>The ability to give sight to a blind person via a bionic eye depends on the circumstances surrounding the loss of sight. For retinal prostheses, which are the most prevalent visual prosthetic under development (due to ease of access to the retina among other considerations), patients with vision loss due to degeneration of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photoreceptor_cell\" title=\"Photoreceptor cell\" rel=\"external_link\" target=\"_blank\">photoreceptors<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinitis_pigmentosa\" title=\"Retinitis pigmentosa\" rel=\"external_link\" target=\"_blank\">retinitis pigmentosa<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Choroideremia\" title=\"Choroideremia\" rel=\"external_link\" target=\"_blank\">choroideremia<\/a>, geographic atrophy macular degeneration) are the best candidate for treatment. Candidates for visual prosthetic implants find the procedure most successful if the optic nerve was developed prior to the onset of blindness. Persons born with blindness may lack a fully developed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_nerve\" class=\"mw-redirect\" title=\"Optical nerve\" rel=\"external_link\" target=\"_blank\">optical nerve<\/a>, which typically develops prior to birth<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>, though <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroplasticity\" title=\"Neuroplasticity\" rel=\"external_link\" target=\"_blank\">neuroplasticity<\/a> makes it possible for the nerve, and sight, to develop after implantation.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technological_considerations\">Technological considerations<\/span><\/h2>\n<p>Visual prosthetics are being developed as a potentially valuable aid for individuals with visual <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biodegradation\" title=\"Biodegradation\" rel=\"external_link\" target=\"_blank\">degradation<\/a>. Argus II, co-developed at the University of Southern California (USC) Eye Institute<sup id=\"rdp-ebb-cite_ref-Reuters_5-0\" class=\"reference\"><a href=\"#cite_note-Reuters-5\" rel=\"external_link\">[5]<\/a><\/sup> and manufactured by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Second_Sight_Medical_Products\" class=\"mw-redirect\" title=\"Second Sight Medical Products\" rel=\"external_link\" target=\"_blank\">Second Sight Medical Products<\/a> Inc., is now the only such device to have received marketing approval (CE Mark in Europe in 2011). Most other efforts remain investigational; the Retina Implant AG's Alpha IMS won a CE Mark July 2013 and is a significant improvement in resolution. It is not, however, FDA-approved in the US.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Ongoing_projects\">Ongoing projects<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Argus_retinal_prosthesis\">Argus retinal prosthesis<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Argus_retinal_prosthesis\" title=\"Argus retinal prosthesis\" rel=\"external_link\" target=\"_blank\">Argus retinal prosthesis<\/a><\/div>\n<p>Mark Humayun, who joined the faculty of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Keck_School_of_Medicine_of_USC\" title=\"Keck School of Medicine of USC\" rel=\"external_link\" target=\"_blank\">Keck School of Medicine of USC<\/a> Department of Ophthalmology in 2001;<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> Eugene Dejuan, now at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_California_San_Francisco\" class=\"mw-redirect\" title=\"University of California San Francisco\" rel=\"external_link\" target=\"_blank\">University of California San Francisco<\/a>; engineer Howard D. Phillips; bio-electronics engineer Wentai Liu, now at <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_California_Los_Angeles\" class=\"mw-redirect\" title=\"University of California Los Angeles\" rel=\"external_link\" target=\"_blank\">University of California Los Angeles<\/a>; and Robert Greenberg, now of Second Sight, were the original inventors of the active epi-retinal prosthesis<sup id=\"rdp-ebb-cite_ref-ERP_8-0\" class=\"reference\"><a href=\"#cite_note-ERP-8\" rel=\"external_link\">[8]<\/a><\/sup> and demonstrated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proof_of_principle\" class=\"mw-redirect\" title=\"Proof of principle\" rel=\"external_link\" target=\"_blank\">proof of principle<\/a> in acute patient investigations at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Johns_Hopkins_University\" title=\"Johns Hopkins University\" rel=\"external_link\" target=\"_blank\">Johns Hopkins University<\/a> in the early 1990s. In the late 1990s the company Second Sight<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> was formed by Greenberg along with medical device entrepreneur, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alfred_E._Mann\" title=\"Alfred E. Mann\" rel=\"external_link\" target=\"_blank\">Alfred E. Mann<\/a>,<sup id=\"rdp-ebb-cite_ref-S1_10-0\" class=\"reference\"><a href=\"#cite_note-S1-10\" rel=\"external_link\">[10]<\/a><\/sup><sup class=\"reference\" style=\"white-space:nowrap;\">:<span>35<\/span><\/sup> Their first-generation implant had 16 electrodes and was implanted in six subjects by Humayun at <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Southern_California\" title=\"University of Southern California\" rel=\"external_link\" target=\"_blank\">University of Southern California<\/a> between 2002 and 2004.<sup id=\"rdp-ebb-cite_ref-S1_10-1\" class=\"reference\"><a href=\"#cite_note-S1-10\" rel=\"external_link\">[10]<\/a><\/sup><sup class=\"reference\" style=\"white-space:nowrap;\">:<span>35<\/span><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> In 2007, the company began a trial of its second-generation, 60-electrode implant, dubbed the Argus II, in the US and in Europe.<sup id=\"rdp-ebb-cite_ref-SSannounce_12-0\" class=\"reference\"><a href=\"#cite_note-SSannounce-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-BBC_13-0\" class=\"reference\"><a href=\"#cite_note-BBC-13\" rel=\"external_link\">[13]<\/a><\/sup> In total 30 subjects participated in the studies spanning 10 sites in four countries. In the spring of 2011, based on the results of the clinical study which were published in 2012,<sup id=\"rdp-ebb-cite_ref-Ophthalmology_14-0\" class=\"reference\"><a href=\"#cite_note-Ophthalmology-14\" rel=\"external_link\">[14]<\/a><\/sup> Argus II was approved for commercial use in Europe, and Second Sight launched the product later that same year. The Argus II was approved by the United States FDA on 14 February 2013. Three US government funding agencies (National Eye Institute, Department of Energy, and National Science Foundation) have supported the work at Second Sight, USC, UCSC, Caltech, and other research labs.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Microsystem-based_visual_prosthesis_.28MIVP.29\"><\/span><span class=\"mw-headline\" id=\"Microsystem-based_visual_prosthesis_(MIVP)\">Microsystem-based visual prosthesis (MIVP)<\/span><\/h3>\n<p>Designed by Claude Veraart at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Universit%C3%A9_catholique_de_Louvain\" title=\"Universit\u00e9 catholique de Louvain\" rel=\"external_link\" target=\"_blank\">University of Louvain<\/a>, this is a spiral cuff electrode around the optic nerve at the back of the eye. It is connected to a stimulator implanted in a small depression in the skull. The stimulator receives signals from an externally worn camera, which are translated into electrical signals that stimulate the optic nerve directly.<sup id=\"rdp-ebb-cite_ref-Geary_16-0\" class=\"reference\"><a href=\"#cite_note-Geary-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Implantable_miniature_telescope\">Implantable miniature telescope<\/span><\/h3>\n<p>Although not truly an active prosthesis, an Implantable Miniature Telescope is one type of visual implant that has met with some success in the treatment of end-stage <a href=\"https:\/\/en.wikipedia.org\/wiki\/Age-related_macular_degeneration\" class=\"mw-redirect\" title=\"Age-related macular degeneration\" rel=\"external_link\" target=\"_blank\">age-related macular degeneration<\/a>.<sup id=\"rdp-ebb-cite_ref-Chun_17-0\" class=\"reference\"><a href=\"#cite_note-Chun-17\" rel=\"external_link\">[17]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Lane_1_18-0\" class=\"reference\"><a href=\"#cite_note-Lane_1-18\" rel=\"external_link\">[18]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Lane_2_19-0\" class=\"reference\"><a href=\"#cite_note-Lane_2-19\" rel=\"external_link\">[19]<\/a><\/sup> This type of device is implanted in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_eye\" title=\"Human eye\" rel=\"external_link\" target=\"_blank\">eye<\/a>'s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Posterior_chamber\" class=\"mw-redirect\" title=\"Posterior chamber\" rel=\"external_link\" target=\"_blank\">posterior chamber<\/a> and works by increasing (by about three times) the size of the image projected onto the retina in order to overcome a centrally located <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scotoma\" title=\"Scotoma\" rel=\"external_link\" target=\"_blank\">scotoma<\/a> or blind spot.<sup id=\"rdp-ebb-cite_ref-Lane_1_18-1\" class=\"reference\"><a href=\"#cite_note-Lane_1-18\" rel=\"external_link\">[18]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Lane_2_19-1\" class=\"reference\"><a href=\"#cite_note-Lane_2-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p><p>Created by VisionCare Ophthalmic Technologies in conjunction with the CentraSight Treatment Program, the telescope is about the size of a pea and is implanted behind the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iris_(anatomy)\" title=\"Iris (anatomy)\" rel=\"external_link\" target=\"_blank\">iris<\/a> of one eye. Images are projected onto healthy areas of the central retina, outside the degenerated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Macula\" class=\"mw-redirect\" title=\"Macula\" rel=\"external_link\" target=\"_blank\">macula<\/a>, and is enlarged to reduce the effect the blind spot has on central vision. 2.2x or 2.7x magnification strengths make it possible to see or discern the central vision object of interest while the other eye is used for peripheral vision because the eye that has the implant will have limited peripheral vision as a side effect. Unlike a telescope which would be hand-held, the implant moves with the eye which is the main advantage. Patients using the device may however still need glasses for optimal vision and for close work. Before surgery, patients should first try out a hand-held telescope to see if they would benefit from image enlargement. One of the main drawbacks is that it cannot be used for patients who have had <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cataract_surgery\" title=\"Cataract surgery\" rel=\"external_link\" target=\"_blank\">cataract surgery<\/a> as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intraocular_lens\" title=\"Intraocular lens\" rel=\"external_link\" target=\"_blank\">intraocular lens<\/a> would obstruct insertion of the telescope. It also requires a large incision in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornea\" title=\"Cornea\" rel=\"external_link\" target=\"_blank\">cornea<\/a> to insert.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-T.C3.BCbingen_MPDA_Project_Alpha_IMS\"><\/span><span class=\"mw-headline\" id=\"T\u00fcbingen_MPDA_Project_Alpha_IMS\">T\u00fcbingen MPDA Project Alpha IMS<\/span><\/h3>\n<p>A Southern German team led by the University Eye Hospital in T\u00fcbingen, was formed in 1995 by Eberhart Zrenner to develop a subretinal prosthesis.\nThe chip is located behind the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retina\" title=\"Retina\" rel=\"external_link\" target=\"_blank\">retina<\/a> and utilizes microphotodiode arrays (MPDA) which collect incident light and transform it into electrical current stimulating the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinal_ganglion_cell\" title=\"Retinal ganglion cell\" rel=\"external_link\" target=\"_blank\">retinal ganglion cells<\/a>.\nAs natural <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photoreceptor_cell\" title=\"Photoreceptor cell\" rel=\"external_link\" target=\"_blank\">photoreceptors<\/a> are far more efficient than <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photodiode\" title=\"Photodiode\" rel=\"external_link\" target=\"_blank\">photodiodes<\/a>, visible light is not powerful enough to stimulate the MPDA. Therefore, an external power supply is used to enhance the stimulation current. The German team commenced in vivo experiments in 2000, when evoked cortical potentials were measured from Yucat\u00e1n micropigs and rabbits. At 14 months post implantation, the implant and retina surrounding it were examined and there were no noticeable changes to anatomical integrity. The implants were successful in producing evoked cortical potentials in half of the animals tested. The thresholds identified in this study were similar to those required in epiretinal stimulation.\nLater reports from this group concern the results of a clinical pilot study on 11 participants suffering from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinitis_pigmentosa\" title=\"Retinitis pigmentosa\" rel=\"external_link\" target=\"_blank\">RP<\/a>. Some blind patients were able to read letters, recognize unknown objects, localize a plate, a cup and cutlery.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> Two of the patients were found to make similar to those of healthy control participants, and the properties of the eye movements depended on the stimuli that the patients were viewing--suggesting that eye movements might be useful measures for evaluating vision restored by implants.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> \nIn 2010 a new multicenter Study has been started using a fully implantable device with 1500 Electrodes Alpha IMS (produced by Retina Implant AG, Reutlingen, Germany), 10 patients included so far; first results have been presented at ARVO 2011.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2018)\">citation needed<\/span><\/a><\/i>]<\/sup> The first UK implantations took place in March 2012 and were led by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_MacLaren\" title=\"Robert MacLaren\" rel=\"external_link\" target=\"_blank\">Robert MacLaren<\/a> at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Oxford\" title=\"University of Oxford\" rel=\"external_link\" target=\"_blank\">University of Oxford<\/a> and at <a href=\"https:\/\/en.wikipedia.org\/wiki\/King%27s_College_Hospital\" title=\"King's College Hospital\" rel=\"external_link\" target=\"_blank\">King's College Hospital<\/a> in London.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> also implanted the T\u00fcbingen device in a patient in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hong_Kong\" title=\"Hong Kong\" rel=\"external_link\" target=\"_blank\">Hong Kong<\/a>.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> In all cases previously blind patients had some degree of sight restored.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Harvard.2FMIT_Retinal_Implant\"><\/span><span class=\"mw-headline\" id=\"Harvard\/MIT_Retinal_Implant\">Harvard\/MIT Retinal Implant<\/span><\/h3>\n<p>Joseph Rizzo and John Wyatt at the Massachusetts Eye and Ear Infirmary and MIT began researching the feasibility of a retinal prosthesis in 1989, and performed a number of proof-of-concept epiretinal stimulation trials on blind volunteers between 1998 and 2000. They have since developed a subretinal stimulator, an array of electrodes, that is placed beneath the retina in the subretinal space and receives image signals beamed from a camera mounted on a pair of glasses. The stimulator chip decodes the picture information beamed from the camera and stimulates retinal ganglion cells accordingly. Their second generation prosthesis collects data and sends it to the implant through RF fields from transmitter coils that are mounted on the glasses. A secondary receiver coil is sutured around the iris.<sup id=\"rdp-ebb-cite_ref-RLE_Progress_Report_151_27-0\" class=\"reference\"><a href=\"#cite_note-RLE_Progress_Report_151-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Artificial_silicon_retina_.28ASR.29\"><\/span><span class=\"mw-headline\" id=\"Artificial_silicon_retina_(ASR)\">Artificial silicon retina (ASR)<\/span><\/h3>\n<p>The brothers Alan Chow and Vincent Chow have developed a microchip containing 3500 photodiodes, which detect light and convert it into electrical impulses, which stimulate healthy <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinal_ganglion_cell\" title=\"Retinal ganglion cell\" rel=\"external_link\" target=\"_blank\">retinal ganglion cells<\/a>. The ASR requires no externally worn devices.<sup id=\"rdp-ebb-cite_ref-Geary_16-1\" class=\"reference\"><a href=\"#cite_note-Geary-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>The original Optobionics Corp. stopped operations, but Chow acquired the Optobionics name, the ASR implants and plans to reorganize a new company under the same name.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> The ASR microchip is a 2mm in diameter silicon chip (same concept as computer chips) containing ~5,000 microscopic solar cells called \"microphotodiodes\" that each have their own stimulating electrode.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Photovoltaic_retinal_prosthesis_.28PRIMA.29\"><\/span><span class=\"mw-headline\" id=\"Photovoltaic_retinal_prosthesis_(PRIMA)\">Photovoltaic retinal prosthesis (PRIMA)<\/span><\/h3>\n<p><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/web.stanford.edu\/~palanker\/lab\/retinalpros.html\" target=\"_blank\">Daniel Palanker and his group<\/a> at Stanford University have developed a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photovoltaic_retinal_prosthesis\" title=\"Photovoltaic retinal prosthesis\" rel=\"external_link\" target=\"_blank\">photovoltaic<\/a> retinal prosthesis<sup id=\"rdp-ebb-cite_ref-Palanker_30-0\" class=\"reference\"><a href=\"#cite_note-Palanker-30\" rel=\"external_link\">[30]<\/a><\/sup> that includes a subretinal photodiode array and an infrared image projection system mounted on video goggles. Images captured by video camera are processed in a pocket PC and displayed on video goggles using pulsed near-infrared (IR, 880\u2013915 nm) light. These images are projected onto the retina via natural eye optics, and photodiodes in the subretinal implant convert light into pulsed bi-phasic electric current in each pixel.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> Electric current flowing through the tissue between the active and return electrode in each pixel stimulates the nearby inner retinal neurons, primarily the bipolar cells, which transmit excitatory responses to the retinal ganglion cells. \nThis technology is being commercialized by Pixium Vision (<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.pixium-vision.com\/en\/technology-1\/prima-vision-restoration-system\" target=\"_blank\">PRIMA<\/a>), and is being evaluated in a clinical trial (2018).\nFollowing this proof of concept, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/web.stanford.edu\/~palanker\/lab\/index.html\" target=\"_blank\">Palanker group<\/a> is focusing now on developing pixels smaller than 50\u03bcm using 3-D electrodes and utilizing the effect of retinal migration into voids in the subretinal implant.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Bionic_Vision_Australia\">Bionic Vision Australia<\/span><\/h3>\n<p>An Australian team led by Professor Anthony Burkitt is developing two retinal prostheses. The Wide-View device combines novel technologies with materials that have been successfully used in other clinical implants. This approach incorporates a microchip with 98 stimulating electrodes and aims to provide increased mobility for patients to help them move safely in their environment. This implant will be placed in the suprachoroidal space. Researchers expect the first patient tests to begin with this device in 2013.\n<\/p><p>The Bionic Vision Australia consortium is concurrently developing the High-Acuity device, which incorporates a number of new technologies to bring together a microchip and an implant with 1024 electrodes. The device aims to provide functional central vision to assist with tasks such as face recognition and reading large print. This high-acuity implant will be inserted epiretinally. Patient tests are planned for this device in 2014 once preclinical testing has been completed.\n<\/p><p>Patients with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinitis_pigmentosa\" title=\"Retinitis pigmentosa\" rel=\"external_link\" target=\"_blank\">retinitis pigmentosa<\/a> will be the first to participate in the studies, followed by age-related macular degeneration. Each prototype consists of a camera, attached to a pair of glasses which sends the signal to the implanted microchip, where it is converted into electrical impulses to stimulate the remaining healthy neurons in the retina. This information is then passed on to the optic nerve and the vision processing centres of the brain.\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Australian_Research_Council\" title=\"Australian Research Council\" rel=\"external_link\" target=\"_blank\">Australian Research Council<\/a> awarded Bionic Vision Australia a $42 million grant in December 2009 and the consortium was officially launched in March 2010. Bionic Vision Australia brings together a multidisciplinary team, many of whom have extensive experience developing medical devices such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implant\" title=\"Cochlear implant\" rel=\"external_link\" target=\"_blank\">cochlear implant<\/a> (or 'bionic ear').<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Dobelle_Eye\">Dobelle Eye<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/William_H._Dobelle\" title=\"William H. Dobelle\" rel=\"external_link\" target=\"_blank\">William H. Dobelle<\/a><\/div>\n<p>Similar in function to the Harvard\/MIT device, except the stimulator chip sits in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Primary_visual_cortex\" class=\"mw-redirect\" title=\"Primary visual cortex\" rel=\"external_link\" target=\"_blank\">primary visual cortex<\/a>, rather than on the retina. Many subjects have been implanted with a high success rate and limited negative effects. Still in the developmental phase, upon the death of Dobelle, selling the eye for profit was ruled against<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Words_to_watch#Unsupported_attributions\" title=\"Wikipedia:Manual of Style\/Words to watch\" rel=\"external_link\" target=\"_blank\"><span title=\"The material near this tag may use weasel words or too-vague attribution. (September 2018)\">by whom?<\/span><\/a><\/i>]<\/sup> in favor of donating it to a publicly funded research team.<sup id=\"rdp-ebb-cite_ref-Geary_16-2\" class=\"reference\"><a href=\"#cite_note-Geary-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Ings_33-0\" class=\"reference\"><a href=\"#cite_note-Ings-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Intracortical_visual_prosthesis\">Intracortical visual prosthesis<\/span><\/h3>\n<p>The Laboratory of Neural Prosthetics at Illinois Institute Of Technology (IIT), Chicago, is developing a visual prosthetic using intracortical electrode arrays. While similar in principle to the Dobelle system, the use of intracortical electrodes allow for greatly increased spatial resolution in the stimulation signals (more electrodes per unit area). In addition, a wireless telemetry system is being developed<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup> to eliminate the need for transcranial wires. Arrays of activated iridium oxide film (AIROF)-coated electrodes will be implanted in the visual cortex, located on the occipital lobe of the brain. External hardware will capture images, process them, and generate instructions which will then be transmitted to implanted circuitry via a telemetry link. The circuitry will decode the instructions and stimulate the electrodes, in turn stimulating the visual cortex. The group is developing a wearable external image capture and processing system to accompany the implanted circuitry. Studies on animals and psyphophysical studies on humans are being conducted<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup> to test the feasibility of a human volunteer implant.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"Almost a decade has past. Are these studies ongoing or have they completed? (September 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bionic_contact_lens\" title=\"Bionic contact lens\" rel=\"external_link\" target=\"_blank\">Bionic contact lens<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_echolocation\" title=\"Human echolocation\" rel=\"external_link\" target=\"_blank\">Human echolocation<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Dobelle WH (2000). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140327220911\/http:\/\/biomed.brown.edu\/Courses\/BI108\/2006-108websites\/group03retinalimplants\/multimedia\/article.pdf\" target=\"_blank\">\"Artificial vision for the blind by connecting a television camera to the visual cortex\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Asaio J<\/i>. <b>46<\/b> (1): 3\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00002480-200001000-00002\" target=\"_blank\">10.1097\/00002480-200001000-00002<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10667705\" target=\"_blank\">10667705<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/biomed.brown.edu\/Courses\/BI108\/2006-108websites\/group03retinalimplants\/multimedia\/article.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 27 March 2014<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">21 July<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Asaio+J&rft.atitle=Artificial+vision+for+the+blind+by+connecting+a+television+camera+to+the+visual+cortex&rft.volume=46&rft.issue=1&rft.pages=3-9&rft.date=2000&rft_id=info%3Adoi%2F10.1097%2F00002480-200001000-00002&rft_id=info%3Apmid%2F10667705&rft.au=Dobelle+WH&rft_id=http%3A%2F%2Fbiomed.brown.edu%2FCourses%2FBI108%2F2006-108websites%2Fgroup03retinalimplants%2Fmultimedia%2Farticle.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Fodstad, H.; Hariz, M. (2007). \"Electricity in the treatment of nervous system disease\". In Sakas, Damianos E.; Krames, Elliot S.; Simpson, Brian A. <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=electricity%20blindness%20Cavallo&f=false\"><i>Operative Neuromodulation<\/i><\/a>. Springer. p. 11. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9783211330791<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">21 July<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Electricity+in+the+treatment+of+nervous+system+disease&rft.btitle=Operative+Neuromodulation&rft.pages=11&rft.pub=Springer&rft.date=2007&rft.isbn=9783211330791&rft.aulast=Fodstad&rft.aufirst=H.&rft.au=Hariz%2C+M.&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3D2uJ5jYdNXKQC%26pg%3DPA11%26dq%3Delectricity%2Bblindness%2BCavallo%23v%3Donepage%26q%3Delectricity%2520blindness%2520Cavallo%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sekirnjak C; Hottowy P; Sher A; Dabrowski W; et al. (2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jneurosci.org\/content\/28\/17\/4446.full\" target=\"_blank\">\"High-resolution electrical stimulation of primate retina for epiretinal implant design\"<\/a>. <i>J Neurosci<\/i>. <b>28<\/b> (17): 4446\u201356. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1523%2Fjneurosci.5138-07.2008\" target=\"_blank\">10.1523\/jneurosci.5138-07.2008<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2681084\" target=\"_blank\">2681084<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18434523\" target=\"_blank\">18434523<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">21 July<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Neurosci&rft.atitle=High-resolution+electrical+stimulation+of+primate+retina+for+epiretinal+implant+design&rft.volume=28&rft.issue=17&rft.pages=4446-56&rft.date=2008&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2681084&rft_id=info%3Apmid%2F18434523&rft_id=info%3Adoi%2F10.1523%2Fjneurosci.5138-07.2008&rft.au=Sekirnjak+C&rft.au=Hottowy+P&rft.au=Sher+A&rft.au=Dabrowski+W&rft.au=Litke+AM&rft.au=Chichilnisky+EJ&rft_id=http%3A%2F%2Fwww.jneurosci.org%2Fcontent%2F28%2F17%2F4446.full&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Provis, Jan M; Van Driel, Diana; Billson, Frank A; Russell, Peter (1985). \"Human fetal optic nerve: Overproduction and elimination of retinal axons during development\". <i>The Journal of Comparative Neurology<\/i>. <b>238<\/b> (1): 92\u2013100. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fcne.902380108\" target=\"_blank\">10.1002\/cne.902380108<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/4044906\" target=\"_blank\">4044906<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Comparative+Neurology&rft.atitle=Human+fetal+optic+nerve%3A+Overproduction+and+elimination+of+retinal+axons+during+development&rft.volume=238&rft.issue=1&rft.pages=92-100&rft.date=1985&rft_id=info%3Adoi%2F10.1002%2Fcne.902380108&rft_id=info%3Apmid%2F4044906&rft.aulast=Provis&rft.aufirst=Jan+M&rft.au=Van+Driel%2C+Diana&rft.au=Billson%2C+Frank+A&rft.au=Russell%2C+Peter&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Reuters-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Reuters_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150105222606\/http:\/\/www.reuters.com\/article\/2014\/08\/27\/usc-eye-institute-fda-idUSnPn6JGDrT+9d+PRN20140827\" target=\"_blank\">\"USC Eye Institute ophthalmologists implant first FDA-approved Argus II retinal prosthesis in western United States\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Reuters\" title=\"Reuters\" rel=\"external_link\" target=\"_blank\">Reuters<\/a><\/i>. 27 August 2014. Archived from <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.reuters.com\/article\/2014\/08\/27\/usc-eye-institute-fda-idUSnPn6JGDrT+9d+PRN20140827\" target=\"_blank\">the original<\/a> on 5 January 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 January<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Reuters&rft.atitle=USC+Eye+Institute+ophthalmologists+implant+first+FDA-approved+Argus+II+retinal+prosthesis+in+western+United+States&rft.date=2014-08-27&rft_id=https%3A%2F%2Fwww.reuters.com%2Farticle%2F2014%2F08%2F27%2Fusc-eye-institute-fda-idUSnPn6JGDrT%2B9d%2BPRN20140827&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chuang AT, Margo CE, Greenberg PB (Jul 2014). \"Retinal implants: a systematic review\". <i>Br J Ophthalmol<\/i>. <b>98<\/b> (7): 852\u201356. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbjophthalmol-2013-303708\" target=\"_blank\">10.1136\/bjophthalmol-2013-303708<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24403565\" target=\"_blank\">24403565<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Br+J+Ophthalmol&rft.atitle=Retinal+implants%3A+a+systematic+review&rft.volume=98&rft.issue=7&rft.pages=852-56&rft.date=2014-07&rft_id=info%3Adoi%2F10.1136%2Fbjophthalmol-2013-303708&rft_id=info%3Apmid%2F24403565&rft.aulast=Chuang&rft.aufirst=AT&rft.au=Margo%2C+CE&rft.au=Greenberg%2C+PB&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.keckmedicine.org\/doctor\/mark-s-humayun\/\" target=\"_blank\">\"Humayun faculty page at USC Keck\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">February 15,<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Humayun+faculty+page+at+USC+Keck&rft_id=http%3A%2F%2Fwww.keckmedicine.org%2Fdoctor%2Fmark-s-humayun%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ERP-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ERP_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">U.S. Department of Energy Office of Science. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/artificialretina.energy.gov\/about.shtml\" target=\"_blank\">\"Overview of the Artificial Retina Project\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Overview+of+the+Artificial+Retina+Project&rft.au=U.S.+Department+of+Energy+Office+of+Science&rft_id=http%3A%2F%2Fartificialretina.energy.gov%2Fabout.shtml&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.2-sight.com\" target=\"_blank\">\"Second Sight official website\"<\/a>. 2-sight.com. 2015-05-21<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-06-12<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Second+Sight+official+website&rft.pub=2-sight.com&rft.date=2015-05-21&rft_id=http%3A%2F%2Fwww.2-sight.com&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-S1-10\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-S1_10-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-S1_10-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Second Sight. November 14, 2014 <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.sec.gov\/Archives\/edgar\/data\/1266806\/000161577414000310\/s100457_s1a.htm\" target=\"_blank\">Second Sight Amendment No. 3 to Form S-1: Registration Statement<\/a><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Miriam Karmel (March 2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.aao.org\/publications\/eyenet\/201203\/retina.cfm?RenderForPrint=1&\" target=\"_blank\">\"Clinical Update: Retina. Retinal Prostheses: Progress and Problems\"<\/a>. <i>Eyenet Magazine<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Eyenet+Magazine&rft.atitle=Clinical+Update%3A+Retina.+Retinal+Prostheses%3A+Progress+and+Problems&rft.date=2012-03&rft.au=Miriam+Karmel&rft_id=http%3A%2F%2Fwww.aao.org%2Fpublications%2Feyenet%2F201203%2Fretina.cfm%3FRenderForPrint%3D1%26&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-SSannounce-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SSannounce_12-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Second Sight (9 January 2007). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.2-sight.com\/assets\/pdfs\/20070109%20second%20sight%20release.pdf\" target=\"_blank\">\"Press Release: Ending the Journey through Darkness: Innovative Technology Offers New Hope for Treating Blindness due to Retinitis Pigmentosa\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Press+Release%3A+Ending+the+Journey+through+Darkness%3A+Innovative+Technology+Offers+New+Hope+for+Treating+Blindness+due+to+Retinitis+Pigmentosa&rft.date=2007-01-09&rft.au=Second+Sight&rft_id=http%3A%2F%2Fwww.2-sight.com%2Fassets%2Fpdfs%2F20070109%2520second%2520sight%2520release.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-BBC-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-BBC_13-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Jonathan Fildes (16 February 2007). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/news.bbc.co.uk\/1\/hi\/sci\/tech\/6368089.stm\" target=\"_blank\">\"Trials for bionic eye implants\"<\/a>. BBC.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Trials+for+bionic+eye+implants&rft.date=2007-02-16&rft.au=Jonathan+Fildes&rft_id=http%3A%2F%2Fnews.bbc.co.uk%2F1%2Fhi%2Fsci%2Ftech%2F6368089.stm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Ophthalmology-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Ophthalmology_14-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Humayun (April 2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ophsource.org\/periodicals\/ophtha\/article\/S0161-6420(11)00884-0\/abstract\" target=\"_blank\">\"Interim Results from the International Trial of Second Sight's Visual Prosthesis\"<\/a>. 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Retrieved <span class=\"nowrap\">20 March<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=ASR%C2%AE+Device&rft.pub=Optobionics&rft_id=http%3A%2F%2Foptobionics.com%2Fasrdevice.shtml&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Palanker-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Palanker_30-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Palanker Group. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.stanford.edu\/~palanker\/lab\/retinalpros.html\" target=\"_blank\">\"Photovoltaic Retinal Prosthesis\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Photovoltaic+Retinal+Prosthesis&rft.au=Palanker+Group&rft_id=http%3A%2F%2Fwww.stanford.edu%2F~palanker%2Flab%2Fretinalpros.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">K. Mathieson; J. Loudin; G. Goetz; P. Huie; L. Wang; T. Kamins; L. Galambos; R. Smith; J.S. Harris; A. Sher; D. Palanker (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.researchgate.net\/publication\/232226717_Photovoltaic_Retinal_Prosthesis_with_High_Pixel_Density\" target=\"_blank\">\"Photovoltaic retinal prosthesis with high pixel density\"<\/a>. <i>Nature Photonics<\/i>. <b>6<\/b> (6): 391\u201397. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnphoton.2012.104\" target=\"_blank\">10.1038\/nphoton.2012.104<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3462820\" target=\"_blank\">3462820<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23049619\" target=\"_blank\">23049619<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Photonics&rft.atitle=Photovoltaic+retinal+prosthesis+with+high+pixel+density&rft.volume=6&rft.issue=6&rft.pages=391-97&rft.date=2012&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3462820&rft_id=info%3Apmid%2F23049619&rft_id=info%3Adoi%2F10.1038%2Fnphoton.2012.104&rft.au=K.+Mathieson&rft.au=J.+Loudin&rft.au=G.+Goetz&rft.au=P.+Huie&rft.au=L.+Wang&rft.au=T.+Kamins&rft.au=L.+Galambos&rft.au=R.+Smith&rft.au=J.S.+Harris&rft.au=A.+Sher&rft.au=D.+Palanker&rft_id=https%3A%2F%2Fwww.researchgate.net%2Fpublication%2F232226717_Photovoltaic_Retinal_Prosthesis_with_High_Pixel_Density&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bionicvision.org.au\/eye\/progress\" target=\"_blank\">\"Bionic Vision Australia's progress of the bionic eye\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">23 July<\/span> 2012<\/span>. <span class=\"cs1-subscription\">(Subscription required (<span title=\"The site requires a paid subscription to access this page.\">help<\/span>))<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Bionic+Vision+Australia%27s+progress+of+the+bionic+eye&rft_id=http%3A%2F%2Fwww.bionicvision.org.au%2Feye%2Fprogress&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Ings-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Ings_33-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Simon Ings (2007). \"Chapter 10(3): Making eyes to see\". <i>The Eye: a natural history<\/i>. London: Bloomsbury. pp. 276\u201383.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+10%283%29%3A+Making+eyes+to+see&rft.btitle=The+Eye%3A+a+natural+history&rft.place=London&rft.pages=276-83&rft.pub=Bloomsbury&rft.date=2007&rft.au=Simon+Ings&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rush, Alexander; PR Troyk (November 2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ieeexplore.ieee.org\/xpl\/articleDetails.jsp?arnumber=6276242\" target=\"_blank\">\"A Power and Data Link for a Wireless-Implanted Neural Recording System\"<\/a>. <i>Transactions on Biomedical Engineering<\/i>. <b>59<\/b> (11): 3255\u201362. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2Ftbme.2012.2214385\" target=\"_blank\">10.1109\/tbme.2012.2214385<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22922687\" target=\"_blank\">22922687<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 September<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Transactions+on+Biomedical+Engineering&rft.atitle=A+Power+and+Data+Link+for+a+Wireless-Implanted+Neural+Recording+System&rft.volume=59&rft.issue=11&rft.pages=3255-62&rft.date=2012-11&rft_id=info%3Adoi%2F10.1109%2Ftbme.2012.2214385&rft_id=info%3Apmid%2F22922687&rft.aulast=Rush&rft.aufirst=Alexander&rft.au=PR+Troyk&rft_id=http%3A%2F%2Fieeexplore.ieee.org%2Fxpl%2FarticleDetails.jsp%3Farnumber%3D6276242&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Srivastava, Nishant; PR Troyk; G Dagnelie (June 2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3902177\" target=\"_blank\">\"Detection, eye-hand coordination and virtual mobility performance in simulated vision for a cortical visual prosthesis device\"<\/a>. <i>Journal of Neural Engineering<\/i>. <b>6<\/b> (3): 035008. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1088%2F1741-2560%2F6%2F3%2F035008\" target=\"_blank\">10.1088\/1741-2560\/6\/3\/035008<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3902177\" target=\"_blank\">3902177<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19458397\" target=\"_blank\">19458397<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Neural+Engineering&rft.atitle=Detection%2C+eye-hand+coordination+and+virtual+mobility+performance+in+simulated+vision+for+a+cortical+visual+prosthesis+device&rft.volume=6&rft.issue=3&rft.pages=035008&rft.date=2009-06&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3902177&rft_id=info%3Apmid%2F19458397&rft_id=info%3Adoi%2F10.1088%2F1741-2560%2F6%2F3%2F035008&rft.aulast=Srivastava&rft.aufirst=Nishant&rft.au=PR+Troyk&rft.au=G+Dagnelie&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3902177&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ffb.ca\/patient_resources\/factsheets\/retinal_protheses.html\" target=\"_blank\">Research Fact Sheet ~ Retinal Prostheses<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1254\nCached time: 20181126024121\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.616 seconds\nReal time usage: 0.745 seconds\nPreprocessor visited node count: 2657\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 172442\/2097152 bytes\nTemplate argument size: 2905\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 7\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 95251\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.309\/10.000 seconds\nLua memory usage: 5.3 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 560.949 1 -total\n<\/p>\n<pre>57.66% 323.454 1 Template:Reflist\n30.72% 172.340 13 Template:Cite_journal\n15.50% 86.965 5 Template:Fix\n15.13% 84.886 4 Template:Citation_needed\n11.98% 67.195 6 Template:Navbox\n11.16% 62.595 15 Template:Cite_web\n 8.33% 46.743 1 Template:Emerging_technologies\n 7.46% 41.819 9 Template:Category_handler\n 6.63% 37.210 5 Template:Delink\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:17198736-1!canonical and timestamp 20181126024121 and revision id 859247266\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_prosthesis\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212205\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.021 seconds\nReal time usage: 0.169 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 160.948 1 - wikipedia:Visual_prosthesis\n100.00% 160.948 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8285-0!*!*!*!*!*!* and timestamp 20181217212204 and revision id 24497\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Visual_prosthesis\">https:\/\/www.limswiki.org\/index.php\/Visual_prosthesis<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","ee345c211e8182e32bd5e64c6c61308d_images":[],"ee345c211e8182e32bd5e64c6c61308d_timestamp":1545081724,"93d47d1af10e3a49de14ec5386c636fc_type":"article","93d47d1af10e3a49de14ec5386c636fc_title":"Ventricular assist device","93d47d1af10e3a49de14ec5386c636fc_url":"https:\/\/www.limswiki.org\/index.php\/Ventricular_assist_device","93d47d1af10e3a49de14ec5386c636fc_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tVentricular assist device\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\n\nVentricular assist deviceA left ventricular assist device (LVAD) pumping blood from the left ventricle to the aorta, connected to an externally worn control unit and battery pack.MedlinePlus007268 [edit on Wikidata]\nA ventricular assist device (VAD) is an electromechanical device for assisting cardiac circulation, which is used either to partially or to completely replace the function of a failing heart. The function of VADs is different from that of artificial cardiac pacemakers; some are for short-term use, typically for patients recovering from myocardial infarction (heart attack) and for patients recovering from cardiac surgery; some are for long-term use (months to years to perpetuity), typically for patients suffering from advanced heart failure.\nVADs are designed to assist either the right ventricle (RVAD) or the left ventricle (LVAD), or to assist both ventricles (BiVAD). The type of ventricular assistance device applied depends upon the type of underlying heart disease, and upon the pulmonary arterial-resistance, which determines the workload of the right ventricle. The left-ventricle assistance device (LVAD) is the most common device applied to a defective heart (as it is sufficient in most cases -the right side of the heart is then often already able to make use of the heavily increased blood flow-), but when the pulmonary arterial-resistance is high, then an (additional) right-ventricle assistance device (RVAD) might be necessary to resolve the problem of cardiac circulation. If both a LVAD and a RVAD is needed a BiVAD is normally used, rather than a separate LVAD and an RVAD.\nNormally, the long-term VAD is used as a bridge to transplantation (BTT)\u2014keeping the patient alive, and in reasonably good condition, and able to await the heart transplant outside of the hospital.\nOther \"bridges\" include bridge to candidacy, bridge to decision, and bridge to recovery. \nIn some instances VAD's are also used as destination therapy (DT). In this instance, the patient shall not undergo a heart transplantion and the VAD is what the patient will use for the remainder of his life.[1][2]\n\n<\/p>VADs are distinct from artificial hearts, which are designed to assume cardiac function, and generally require the removal of the patient's heart.\n\nContents \n\n1 Design \n\n1.1 Pumps \n\n\n2 History \n3 Studies and outcomes \n\n3.1 Recent developments \n3.2 HeartMate II LVAD pivotal study \n3.3 HARPS \n3.4 REMATCH \n\n\n4 Complications and side effects \n5 List of implantable VAD devices \n6 See also \n7 References \n8 External links \n\n\nDesign \n Close-up illustration of typical left ventricular assist device (LVAD)\nPumps \nThe pumps used in VADs can be divided into two main categories\u2014pulsatile pumps,[3] that mimic the natural pulsing action of the heart, and continuous flow pumps.[4] Pulsatile VADs use positive displacement pumps.[5][6][7] In some pulsatile pumps (that use compressed air as the\/a energy source[8]), the volume occupied by blood varies during the pumping cycle. If the pump is contained inside the body then a vent tube to the outside air is required.\nContinuous-flow VADs are smaller and have proven to be more durable than pulsatile VADs.[9] They normally use either a centrifugal pump or an axial flow pump. Both types have a central rotor containing permanent magnets. Controlled electric currents running through coils contained in the pump housing apply forces to the magnets, which in turn cause the rotors to spin. In the centrifugal pumps, the rotors are shaped to accelerate the blood circumferentially and thereby cause it to move toward the outer rim of the pump, whereas in the axial flow pumps the rotors are more or less cylindrical with blades that are helical, causing the blood to be accelerated in the direction of the rotor's axis.[10]\nAn important issue with continuous flow pumps is the method used to suspend the rotor. Early versions used solid bearings; however, newer pumps, some of which are approved for use in the EU, use either magnetic levitation (\"maglev\")[11][12][13] or hydrodynamic suspension. These pumps contain only one moving part (the rotor).\n\nHistory \n 1966 DeBakey ventricular assist device.[14]\nThe first successful implantation of a left ventricular assist device was completed in 1966 by Dr. Michael E. DeBakey to a 37-year-old woman. A paracorporeal (external) circuit was able to provide mechanical support for 10 days after the surgery.[15] The first successful long-term implantation of an artificial LVAD was conducted in 1988 by Dr. William F. Bernhard of Boston Children's Hospital Medical Center and Thermedics, Inc of Woburn, MA under a National Institutes of Health (NIH) research contract which developed Heart-mate, an electronically controlled assist device. This was funded by a three-year $6.2 million contract to Thermedics and Children's Hospital, Boston MA from the National Heart and Lung and Blood Institute, a program of the NIH.[16] The early VADs emulated the heart by using a \"pulsatile\" action where blood is alternately sucked into the pump from the left ventricle then forced out into the aorta. Devices of this kind include the HeartMate IP LVAS, which was approved for use in the US by the Food and Drug Administration (FDA) in October 1994. These devices began to gain acceptance in the late 1990's as heart surgeons including Eric Rose, O. H. Frazier and Mehmet Oz began popularizing the concept that patients could live outside the hospital. Media coverage of outpatients with VADs underscored these arguments.[17]\nMore recent work has concentrated on continuous flow pumps, which can be roughly categorized as either centrifugal pumps or axial flow impeller driven pumps. These pumps have the advantage of greater simplicity resulting in smaller size and greater reliability. These devices are referred to as second generation VADs. A side effect is that the user will not have a pulse,[18]\nor that the pulse intensity will be seriously reduced.[19]\n\n<\/p>Third generation VADs suspend the impeller in the pump using either hydrodynamic or electromagnetic suspension, thus removing the need for bearings and reducing the number of moving parts to one.[citation needed ]\nAnother technology undergoing clinical trials is the use of trans cutaneous induction to power and control the device rather than using percutaneous cables. Apart from the obvious cosmetic advantage this reduces the risk of infection and the consequent need to take preventative action. A pulsatile pump using this technology has CE Mark approval and is in clinical trials for US FDA approval.[citation needed ]\nA very different approach in the early stages of development is the use of an inflatable cuff around the aorta. Inflating the cuff contracts the aorta and deflating the cuff allows the aorta to expand\u2014in effect the aorta becomes a second left ventricle. A proposed refinement is to use the patient's skeletal muscle, driven by a pacemaker, to power this device which would make it truly self-contained. However a similar operation (cardiomyoplasty) was tried in the 1990s with disappointing results. In any case, it has substantial potential advantages in avoiding the need to operate on the heart itself and in avoiding any contact between blood and the device. This approach involves a return to a pulsatile flow.[citation needed ]\nPeter Houghton was the longest surviving recipient of a VAD for permanent use. He received an experimental Jarvik 2000 LVAD in June 2000. Since then, he completed a 91-mile charity walk, published two books, lectured widely, hiked in the Swiss Alps and the American West, flew in an ultra-light aircraft, and traveled extensively around the world. He died of acute renal failure in 2007 at the age of 69.[20][21]\n\nStudies and outcomes \nRecent developments \nIn July 2009 in England, surgeons removed a donor heart that had been implanted in a toddler next to her native heart, after her native heart had recovered. This technique suggests mechanical assist device, such as an LVAD, can take some or all the work away from the native heart and allow it time to heal.[22]\nIn July 2009, 18-month follow-up results from the HeartMate II Clinical Trial concluded that continuous-flow LVAD provides effective hemodynamic support for at least 18 months in patients awaiting transplantation, with improved functional status and quality of life. (see below).[23]\nHeidelberg University Hospital reported in July 2009 that the first HeartAssist5, known as the modern version of the DeBakey VAD, was implanted there. The HeartAssist5 weighs 92 grams, is made of titanium and plastic, and serves to pump blood from the left ventricle into the aorta.[24]\nA phase 1 clinical trial is underway (as of August 2009), consisting of patients with coronary artery bypass grafting and patients in end-stage heart failure who have a left ventricular assist device. The trial involves testing a patch, called Anginera(TM) that contains cells that secrete hormone-like growth factors that stimulate other cells to grow. The patches are seeded with heart muscle cells and then implanted onto the heart with the goal of getting the muscle cells to start communicating with native tissues in a way that allows for regular contractions.[25][26]\nIn September 2009, a New Zealand news outlet, Stuff, reported that in another 18 months to two years, a new wireless device will be ready for clinical trial that will power VADs without direct contact. If successful, this may reduce the chance of infection as a result of the power cable through the skin.[27]\nThe National Institutes of Health (NIH) awarded a $2.8 million grant to develop a \"pulse-less\" total artificial heart using two VADS by Micromed, initially created by Michael DeBakey and George Noon. The grant was renewed for a second year of research in August 2009. The Total Artificial Heart was created using two HeartAssist5 VADs, whereby one VAD pumps blood throughout the body and the other circulates blood to and from the lungs.[28]\nHeartWare International announced in August 2009 that it had surpassed 50 implants of their HeartWare Ventricular Assist System in their ADVANCE Clinical Trial, an FDA-approved IDE study. The study is to assess the system as bridge-to-transplantation system for patients with end-stage heart failure. The study, Evaluation of the HeartWare LVAD System for the Treatment of Advance Heart Failure, is a multi-center study that started in May 2009.[29][30]\nOn June 27, 2014 Hannover Medical School in Hannover, Germany performed the first human implant of HeartMate III under the direction of professor Axel Haverich M.D., chief of the Cardiothoracic, Transplantation and Vascular Surgery Department and surgeon Jan Schmitto, M.D., Ph.D.[31]\nOn January 21, 2015 a study was published in Journal of American College of Cardiology suggesting that long-term use of LVAD may induce heart regeneration.[32] This may explain the bridge to recovery phenomenon first described by the Yacoub group in NEJM in 2009 (above).[citation needed ]\nHall-of-Fame Baseball Player Rod Carew had congestive heart failure and was fitted with a HeartMate II. He struggled with wearing the equipment, so he joined efforts to help supply the most helpful wear to assist the HeartMate II and HeartMate III.[33]\nThe majority of VADs on the market today are somewhat bulky. The smallest device approved by the FDA, the HeartMate II, weighs about 1 pound (0.45 kg) and measures 3 inches (7.6 cm). This has proven particularly important for women and children, for whom alternatives would have been too large.[34] As of 2017, Heartmate III has been approved by the FDA. It is smaller than its predecessor HeartMate II, and uses a full maglev impeller instead of the cup-and-ball bearing system found in HeartMate II.[35]\nOne device gained CE Mark approval for use in the EU and began clinical trials in the US (VentrAssist). As of June 2007 these pumps had been implanted in over 100 patients. In 2009, Ventracor was placed into the hands of Administrators due to financial problems and was later that year liquidated. No other companies purchased the technology, so as a result the VentrAssist device was essentially defunct. Around 30\u201350 patients worldwide remain supported on VentrAssist devices as of January 2010.[citation needed ]\nThe Heartware HVAD works similarly to the VentrAssist\u2014albeit much smaller and not requiring an abdominal pocket to be implanted into. The device has obtained CE Mark in Europe, and FDA approval in the U.S. Recently, it was shown that the Heartware HVAD can be implanted through limited access without sternotomy.[36]\nIn a small number of cases left ventricular assist devices, combined with drug therapy, have enabled the heart to recover sufficiently for the device to be able to be removed (explanted).[1][2]\n\nHeartMate II LVAD pivotal study \nA series of studies involving the use of the HeartMate II LVAD have proven useful in establishing the viability and risks of using LVADs for bridge-to-transplantation and destination therapy.\n\nThe pilot trial for the HeartMate II LVAD began in November 2003 and consisted of 46 study patients at 15 centers. Results included 11 patients supported for more than one year and three patients supported for more than two years.\nThe HeartMate II pivotal trial began in 2005 and included the evaluation of HeartMate II for two indications: Bridge to transplantation (BTT) and destination therapy (DT), or long-term, permanent support. Thoratec Corp. announced that this was the first time the FDA had approved a clinical trial to include both indications in one protocol.[37][38][39]\nA multicenter study in the United States from 2005 to 2007 with 113 patients (of which 100 reported principal outcomes) showed that significant improvements in function were prevalent after three months, and a survival rate of 68% after twelve months.[40]\nBased on one-year follow up data from the first 194 patients enrolled in the trial, the FDA approved HeartMate II for bridge-to-transplantation. The trial provided clinical evidence of improved survival rates and quality of life for a broad range of patients.[41][42]\nEighteen-month follow up data on 281 patients who had either reached the study end-point or completed 18 months of post-operative follow-up showed improved survival, less frequent adverse events and greater reliability with continuous flow LVADS compared to pulsatile flow devices. Of the 281 patients, 157 patients had undergone transplant, 58 patients were continuing with LVADs in their body and seven patients had the LVAD removed because their heart recovered; the remaining 56 had died. The results showed that the NYHA Class of heart failure the patients had been designated had significantly improved after six months of LVAD support compared to the pre-LVAD baseline. Although this trial involved bridge-to-transplant indication, the results provide early evidence that continuous flow LVADs have advantages in terms of durability and reliability for patients receiving mechanical support for destination therapy.[43]\nFollowing the FDA approval of HeartMate II LVAD for bridge-to-transplantation purposes, a post-approval (\"registry\") study was undertaken to assess the efficacy of the device in a commercial setting. The study found that the device improved outcomes, both compared to other LVAD treatments and baseline patients. Specifically, HeartMate II patients showed lower creatinine levels, 30-day survival rates were considerably higher at 96%, and 93% reached successful outcomes (transplant, cardiac recovery, or long-term LVAD).[44]\nHARPS \nThe Harefield Recovery Protocol Study (HARPS) is a clinical trial to evaluate whether advanced heart failure patients requiring VAD support can recover sufficient myocardial function to allow device removal (known as explantation). HARPS combines an LVAD (the HeartMate XVE) with conventional oral heart failure medications, followed by the novel \u03b22 agonist clenbuterol. This opens the possibility that some advanced heart failure patients may forgo heart transplantation.[45]\nTo date, 73% (11 of 15) of patients who underwent the combination therapy regimen demonstrated sufficient recovery to allow explantation and avoid heart transplantation; freedom from recurrent heart failure in surviving patients was 100% and 89% at one and four years after explantation, respectively; average ejection fraction was 64% at 59 months after explantation\u2014all patients were NYHA Class I; and no significant adverse effects were reported with clenbuterol therapy.\n\nREMATCH \nThe REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) clinical trial began in May 1998 and ran through July 2001 in 20 cardiac transplant centers around the USA. The trial was designed to compare long-term implantation of left ventricular assist devices with optimal medical management for patients with end-stage heart failure who require, but do not qualify to receive cardiac transplantation. As a result of the clinical outcomes, the device received FDA approval for both indications, in 2001 and 2003, respectively.[46]\nThe trial demonstrated an 81% improvement in two-year survival among patients receiving HeartMate XVE compared to optimal medical management. In addition, a destination therapy study following the REMATCH trial demonstrated an additional 17% improvement (61% vs. 52%) in one-year survival of patients that were implanted with a VAD (HeartMate XVE), with an implication for the appropriate selection of candidates and timing of VAD implantation.\nA test carried out in 2001 by Dr. Eric A. Rose and REMATCH study group with patients with congestive heart failure that were ineligible for a transplant showed a survival at two years of 23% for those implanted with an LVAD compared with 8% for those who were treated with drugs. The two major complications of VAD implantation were infection and mechanical failure (see below).\nAccording to a retrospective cohort study comparing patients treated with a left ventricular assist device versus inotrope therapy while awaiting heart transplantation, the group treated with LVAD had improved clinical and metabolic function at the time of transplant with better blood pressure, sodium, blood urea nitrogen, and creatinine. After transplant, 57.7% of the inotrope group had renal failure versus 16.6% in the LVAD group; 31.6% of the inotrope group had right heart failure versus 5.6% in the LVAD group; and event-free survival was 15.8% in the inotrope group versus 55.6% in the LVAD group.[47]\n\nComplications and side effects \nBleeding is the most common postoperative early complication after implantation or explantation of LVADs, necessitating reoperation in up to 60% of recipients.[48][49] The implications of massive blood transfusions are great and include infection, pulmonary insufficiency, increased costs, right heart failure, allosensitization, and viral transmission, some of which can prove fatal or preclude transplantation.[49] When bleeding occurs, it impacts the one year Kaplan-Meier mortality.[48] In addition to complexity of the patient population and the complexity of these procedures contributing to bleeding, the devices themselves may contribute to the severe coagulopathy that can ensue when these devices are implanted.[50]\nBecause the devices generally result in blood flowing over a non-biologic surface, predisposing the blood to clotting, there is need for anticoagulation measures. One device, the HeartMate XVE, is designed with a biologic surface derived from fibrin and does not require long term anticoagulation (except aspirin); unfortunately, this biologic surface may also predispose the patient to infection through selective reduction of certain types of leukocytes.[51]\nNew VAD designs which are now approved for use in the European Community and are undergoing trials for FDA approval have all but eliminated mechanical failure.[citation needed ]\nVAD-related infection can be caused by a large number of different organisms:[52]\n\nGram positive bacteria (Staphylococci, especially Staph. aureus, Enterococci)\nGram negative bacteria (Pseudomonas aeruginosa, Enterobacter species, Klebsiella species)\nFungi. especially Candida species\nTreatment of VAD-related infection is exceedingly difficult and many patients die of infection despite optimal treatment. Initial treatment should be with broad spectrum antibiotics, but every effort must be made to obtain appropriate samples for culture. A final decision regarding antibiotic therapy must be based on the results of microbiogical cultures.[citation needed ]\nOther problems include immunosuppression, clotting with resultant stroke, and bleeding secondary to anticoagulation. Some of the polyurethane components used in the devices cause the deletion of a subset of immune cells when blood comes in contact with them. This predisposes the patient to fungal and some viral infections necessitating appropriate prophylactic therapy.[53]\nConsidering the multitude of risks and lifestyle modifications associated with ventricular assist device implant,[54] it is important for prospective patients to be informed prior to decision making.[55] In addition to physician consult, various Internet-based patient directed resources are available to assist in patient education.[56][57]\n\nList of implantable VAD devices \nThis section needs to be updated. Please update this article to reflect recent events or newly available information. (April 2015)\nThis is a partial list and may never be complete\r\n\nReferenced additions are welcome\n\n\n\n\nDevice\n\nManufacturer\n\nType\n\nApproval Status as of July 2010\n\n\nHeartAssist5\n\nReliantHeart\n\nContinuous flow driven by an axial flow rotor.\n\nApproved for use in the European Union. The child version is approved by the FDA for use in children in USA. Undergoing clinical trials in USA for FDA approval.\n\n\nNovacor\n\nWorld Heart\n\nPulsatile.\n\nWas approved for use in North America, European Union and Japan. Now defunct and no longer supported by the manufacturer. (Heartware completed acquisition August 2012)\n\n\nHeartMate XVE\n\nThoratec\n\nPulsatile\n\nFDA approval for BTT in 2001 and DT in 2003. CE Mark Authorized. Rarely used anymore due to reliability concerns.\n\n\nHeartMate II\n\nThoratec\n\nRotor driven continuous axial flow, ball and cup bearings.\n\nApproved for use in North America and EU. CE Mark Authorized. FDA approval for BTT in April 2008. Recently approved by FDA in the US for Destination Therapy (as at January 2010).\n\n\nHeartMate III\n\nThoratec\n\nContinuous flow driven by a magnetically suspended axial flow rotor.\n\nPivotal trials for HeartMate III started in 2014 and supported with CarewMedicalWear. FDA approval for BTT in 2017\n\n\nIncor\n\nBerlin Heart\n\nContinuous flow driven by a magnetically suspended axial flow rotor.\n\nApproved for use in European Union. Used on humanitarian approvals on case by case basis in the US. Entered clinical trials in the US in 2009.\n\n\nExcor Pediatric\n\nBerlin Heart\n\nExternal membrane pump device designed for children.\n\nApproved for use in European Union. FDA granted Humanitarian Device Exemption for US in December 2011.\n\n\nJarvik 2000\n\nJarvik Heart\n\nContinuous flow, axial rotor supported by ceramic bearings.\n\nCurrently used in the United States as a bridge to heart transplant under an FDA-approved clinical investigation. In Europe, the Jarvik 2000 has earned CE Mark certification for both bridge-to-transplant and lifetime use. Child version currently being developed.\n\n\nMicroMed DeBakey VAD\n\nMicroMed\n\nContinuous flow driven by axial rotor supported by ceramic bearings.\n\nApproved for use in the European Union. The child version is approved by the FDA for use in children in USA. Undergoing clinical trials in USA for FDA approval.\n\n\nVentrAssist\n\nVentracor[58]\n\nContinuous flow driven by a hydrodynamically suspended centrifugal rotor.\n\nApproved for use in European Union and Australia. Company declared bankrupt while clinical trials for FDA approval were underway in 2009. Company now dissolved and intellectual property sold to Thoratec.\n\n\nMTIHeartLVAD\n\nwww.mitiheart.com\n\nContinuous flow driven by a magnetically suspended centrifugal rotor.\n\nCurrently in animal testing, recently completed successful 60 day calf implant.\n\n\nC-Pulse\n\nSunshine Heart\n\nPulsatile, driven by an inflatable cuff around the aorta.\n\nCurrently in clinical trials in the US and Australia.\n\n\nHVAD\n\nHeartWare\n\nMiniature \"third generation\" device with centrifugal blood path and hydromagnetically suspended rotor that may be placed in the pericardial space.\n\nObtained CE Mark for distribution in Europe, January 2009. Obtained FDA approval in the U.S., November 2012. Initiated US BTT trial in October 2008 (completed February 2010) and US DT trial in August 2010 (enrollment completed May 2012). FDA approval for BTT in 2012 and DT in 2017.\n\n\nMVAD\n\nHeartWare\n\nHeartWare's MVAD Pump is a development-stage miniature ventricular assist device, approximately one-third the size of HeartWare's HVAD pump.\n\nHeartWare Completed GLP Studies (September 2011).\n\n\nDuraHeart\n\nTerumo\n\nMagnetically levitated centrifugal pump.\n\nCE approved, US FDA trials underway as at January 2010.\n\n\nThoratec PVAD (Paracorporeal Ventricular Assist Device) \n\nThoratec\n\nPulsatile system includes three major components: Blood pump, cannulae and pneumatic driver (dual drive console or portable VAD driver).\n\nCE Mark Authorized. Received FDA approval for BTT in 1995 and for post-cardiotomy recovery (open heart surgery) in 1998.\n\n\nIVAD\u2014Implantable Ventricular Assist Device\n\nThoratec\n\nPulsatile system includes three major components: Blood pump, cannulae and pneumatic driver (dual drive console or portable VAD driver).\n\nCE Mark Authorized. Received FDA approval for BTT in 2004. Authorized only for internal implant, not for paracorporeal implant due to reliability issues.\n\nSee also \nIntra-aortic balloon pump\nReferences \n\n\n^ a b Birks, EJ; Tansley, PD; Hardy, J; et al. (2006). \"Left Ventricular Assist Device and Drug Therapy for the Reversal of Heart Failure\". New England Journal of Medicine. 355 (18): 1873\u20131884. doi:10.1056\/NEJMoa053063. PMID 17079761. CS1 maint: Explicit use of et al. (link) \n\n^ a b \"First VentrAssist Heart Recovery Featured on National TV\". Ventracor.com. 19 October 2006. \n\n^ Fajdek, B; Krzysztof, J (2\u20135 September 2014). \"Automatic control system for ventricular assist device\". 19th International Conference on Methods and Models in Automation and Robotics (MMAR): 874\u2013879. doi:10.1109\/MMAR.2014.6957472. \n\n^ Schulman, AR; Martens, TP; Christos, PJ; et al. (2007). \"Comparisons of infection complications between continuous flow and pulsatile flow left ventricular assist devices\". The Journal of Thoracic and Cardiovascular Surgery. 133 (3): 841\u2013842. doi:10.1016\/j.jtcvs.2006.09.083. PMID 17320612. CS1 maint: Explicit use of et al. (link) \n\n^ \"Panel A shows a first-generation pulsatile flow left ve - Open-i\". openi.nlm.nih.gov. Retrieved 23 April 2018 . \n\n^ \"404 Page not found\". ResearchGate. Retrieved 23 April 2018 . \n\n^ \"SynCardia TAH pulsatile pump components\" (PDF) . syncardia.com. Retrieved 23 April 2018 . \n\n^ \"The HeartMate XVE too has a vent line, despite being battery-powered\" (PDF) . aldmd.com. Retrieved 23 April 2018 . \n\n^ Slaughter, MS; Pagani, FD; Rogers, JG; et al. (2010). \"Clinical management of continuous-flow left ventricular assist devices in advanced heart failure\". The Journal of Heart and Lung Transplantation. 29 (4): S1\u201339. doi:10.1016\/j.healun.2010.01.011. PMID 20181499. CS1 maint: Explicit use of et al. 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Los Angeles Times. \n\n^ Pagani, FD; Miller, LW; Russell, SD; et al. (2009). \"Extended Mechanical Circulatory Support with a Continuous-Flow Rotary Left Ventricular Assist Device\". Journal of the American College of Cardiology. 54 (4): 312\u2013321. doi:10.1016\/j.jacc.2009.03.055. PMID 19608028. CS1 maint: Explicit use of et al. (link) \n\n^ \"Heidelberg Cardiac Surgeons implant world's first new DeBakey Heart Assist Device\". Insciences. 17 August 2009. Archived from the original on 18 July 2011. \n\n^ Quinn, Dale (4 August 2009). \"VA study: heart-healing patch\". Arizona Daily Star. Archived from the original on 7 August 2009. \n\n^ \"A Study of Anginera In Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery\". ClinicalTrials.gov. U.S. National Institutes of Health. 27 March 2009. Retrieved 15 September 2009 . \n\n^ Hunter, Tim (13 September 2009). \"Meet the Kiwi bionic man\". 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(2007). \"Medical Aspects of End-Stage Heart Failure: Transplantation and Device Therapies I, Abstract 1762: An Emerging Option for Women with Advanced Heart Failure: Results of the HeartMate II Continuous Flow Left Ventricular Assist Device Bridge to Transplant Trial\". Circulation. II. American Heart Association. 116: 372. Archived from the original on 8 June 2011. CS1 maint: Uses authors parameter (link) CS1 maint: Explicit use of et al. (link) \n\n^ https:\/\/www.thoratec.com\/medical-professionals\/vad-product-information\/heartmate3\/HeartMate3_PressKit-UK.pdf \n\n^ Popov, AF; Hosseini, MT; Zych, B; et al. (2012). \"HeartWare Left Ventricular Assist Device Implantation Through Bilateral Anterior Thoracotomy\". The Annals of Thoracic Surgery. 93 (2): 674\u2013676. doi:10.1016\/j.athoracsur.2011.09.055. PMID 22269746. CS1 maint: Explicit use of et al. (link) \n\n^ Benton, Susan (19 August 2008). \"HeartMate II Pivotal Clinical Trial Fact Sheet\" (PDF) . Thoratec Corporation. 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Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure\". The Annals of Thoracic Surgery. 67 (3): 723\u2013730. doi:10.1016\/S0003-4975(99)00042-9. PMID 10215217. CS1 maint: Explicit use of et al. (link) \n\n^ Rogers, JG; Butler, J; Lansman, SL; et al. (2007). \"Chronic Mechanical Circulatory Support for Inotrope-Dependent Heart Failure Patients Who Are Not Transplant Candidates\". Journal of the American College of Cardiology. 50 (8): 741\u2013747. doi:10.1016\/j.jacc.2007.03.063. PMID 17707178. CS1 maint: Explicit use of et al. (link) \n\n^ a b Schaffer, JM; Arnaoutakis, GJ; Allen, JG; et al. \"Bleeding Complications and Blood Product Utilization With Left Ventricular Assist Device Implantation\". The Annals of Thoracic Surgery. 91 (3): 740\u2013749. doi:10.1016\/j.athoracsur.2010.11.007. CS1 maint: Explicit use of et al. (link) \n\n^ a b Goldstein, Daniel J.; Robert B. Beauford (2003). \"Left ventricular assist devices and bleeding: adding insult to injury\". The Annals of Thoracic Surgery. 75: S42\u20137. doi:10.1016\/s0003-4975(03)00478-8. PMID 12820734. \n\n^ Spanier, Talia; Oz, M; Levin, H; et al. (1996). \"Activation of coagulation and fibrinolytic pathways with left ventricular assist devices\". Journal of Thoracic and Cardiovascular Surgery. 112: 1090\u20131097. doi:10.1016\/s0022-5223(96)70111-3. PMID 8873737. CS1 maint: Explicit use of et al. (link) \n\n^ Samuels, LE; Kohout, J; Casanova-Ghosh, E; et al. (2008). \"Argatroban as a Primary or Secondary Postoperative Anticoagulant in Patients Implanted with Ventricular Assist Devices\". The Annals of Thoracic Surgery. 85 (5): 1651\u20131655. doi:10.1016\/j.athoracsur.2008.01.100. PMID 18442558. CS1 maint: Explicit use of et al. (link) \n\n^ Gordon, RJ; Quagliarello, B; Lowy, FD (2006). \"Ventricular assist device-related infections\". The Lancet Infectious Diseases. 6 (7): 426\u201337. doi:10.1016\/S1473-3099(06)70522-9. PMID 16790383. CS1 maint: Uses authors parameter (link) \n\n^ Holman, WL; Rayburn, BK; McGiffin, DC; et al. (2003). \"Infection in ventricular assist devices: Prevention and treatment\". The Annals of Thoracic Surgery. 75 (6 Suppl): S48\u2013S57. doi:10.1016\/S0003-4975(03)00479-X. PMID 12820735. CS1 maint: Explicit use of et al. (link) \n\n^ Marcuccilli, L; Casida, J; Peters, RM (2013). \"Modification of self-concept in patients with a left-ventricular assist device: an initial exploration\" (PDF) . Journal of Clinical Nursing. 22 (2456\u201364): 2456\u201364. doi:10.1111\/j.1365-2702.2012.04332.x. PMID 23506318. \n\n^ Mcillvennan, CK; Allen, LA; Nowels, C; Brieke, A; Cleveland, JC; Matlock, DD (2014). \"Decision making for destination therapy left ventricular assist devices: \"there was no choice\" versus \"I thought about it an awful lot\" \". Circulation: Cardiovascular Quality and Outcomes. 7: 374\u201380. doi:10.1161\/CIRCOUTCOMES.113.000729. PMC 4081474 . PMID 24823949. \n\n^ Iacovetto, MC; Matlock, DD; Mcillvennan, CK; et al. (2014). \"Educational resources for patients considering a left ventricular assist device: a cross-sectional review of internet, print, and multimedia materials\". Circulation: Cardiovascular Quality and Outcomes. 7: 905\u201311. doi:10.1161\/CIRCOUTCOMES.114.000892. PMID 25316772. CS1 maint: Explicit use of et al. (link) \n\n^ Matlock, DD; Allen, LA; Thompson, JS; Mcilvennan, CK (31 July 2014). \"A decision aid for Left Ventricular Assist Device (LVAD) for Destination Therapy A device for patients with advanced heart failure\" (PDF) . University of Colorado School of Medicine. \n\n^ Ventracor was put into liquidation on 3 July 2009, whereby the company's assets including its intellectual property, data from clinical trials, plant and equipment and residual assets will be put up for saleBoyd, Tony (13 July 2009). \"No Heart\". Business Spectator. Retrieved 15 September 2009 . \n\n\nExternal links \nMyLVAD.com Non-branded site with information on various LVADs\nCarewMedicalWear.com Is a global supplier of LVAD Shirts for the HeartMateII and HeartMateIII\nLVADshirt.com another global supplier of LVAD shirts and accessories\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Ventricular_assist_device\">https:\/\/www.limswiki.org\/index.php\/Ventricular_assist_device<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 18:56.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 712 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","93d47d1af10e3a49de14ec5386c636fc_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Ventricular_assist_device skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Ventricular assist device<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p class=\"mw-empty-elt\">\n<\/p>\n\n<p>A <b>ventricular assist device (VAD)<\/b> is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electromechanics\" title=\"Electromechanics\" rel=\"external_link\" target=\"_blank\">electromechanical<\/a> device for assisting cardiac circulation, which is used either to partially or to completely replace the function of a failing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart\" title=\"Heart\" rel=\"external_link\" target=\"_blank\">heart<\/a>. The function of VADs is different from that of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_cardiac_pacemaker\" title=\"Artificial cardiac pacemaker\" rel=\"external_link\" target=\"_blank\">artificial cardiac pacemakers<\/a>; some are for short-term use, typically for patients recovering from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myocardial_infarction\" title=\"Myocardial infarction\" rel=\"external_link\" target=\"_blank\">myocardial infarction<\/a> (heart attack) and for patients recovering from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_surgery\" title=\"Cardiac surgery\" rel=\"external_link\" target=\"_blank\">cardiac surgery<\/a>; some are for long-term use (months to years to perpetuity), typically for patients suffering from advanced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_failure\" title=\"Heart failure\" rel=\"external_link\" target=\"_blank\">heart failure<\/a>.\n<\/p><p>VADs are designed to assist either the right <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricle_(heart)\" title=\"Ventricle (heart)\" rel=\"external_link\" target=\"_blank\">ventricle<\/a> (RVAD) or the left ventricle (LVAD), or to assist both ventricles (BiVAD). The type of ventricular assistance device applied depends upon the type of underlying <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_disease\" class=\"mw-redirect\" title=\"Heart disease\" rel=\"external_link\" target=\"_blank\">heart disease<\/a>, and upon the pulmonary arterial-resistance, which determines the workload of the right ventricle. The left-ventricle assistance device (LVAD) is the most common device applied to a defective heart (as it is sufficient in most cases -the right side of the heart is then often already able to make use of the heavily increased blood flow-), but when the pulmonary arterial-resistance is high, then an (additional) right-ventricle assistance device (RVAD) might be necessary to resolve the problem of cardiac circulation. If both a LVAD and a RVAD is needed a BiVAD is normally used, rather than a separate LVAD and an RVAD.\n<\/p><p>Normally, the long-term VAD is used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bridge_to_transplantation\" class=\"mw-redirect\" title=\"Bridge to transplantation\" rel=\"external_link\" target=\"_blank\">bridge to transplantation<\/a> (BTT)\u2014keeping the patient alive, and in reasonably good condition, and able to await the heart transplant outside of the hospital.\n<p>Other \"bridges\" include bridge to candidacy, bridge to decision, and bridge to recovery. \nIn some instances VAD's are also used as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Destination_therapy\" title=\"Destination therapy\" rel=\"external_link\" target=\"_blank\">destination therapy<\/a> (DT). In this instance, the patient shall not undergo a heart transplantion and the VAD is what the patient will use for the remainder of his life.<sup id=\"rdp-ebb-cite_ref-content.nejm.org_1-0\" class=\"reference\"><a href=\"#cite_note-content.nejm.org-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-ventracor.com_2-0\" class=\"reference\"><a href=\"#cite_note-ventracor.com-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<\/p><p>VADs are distinct from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_heart\" title=\"Artificial heart\" rel=\"external_link\" target=\"_blank\">artificial hearts<\/a>, which are designed to assume cardiac function, and generally require the removal of the patient's heart.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Design\">Design<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Blausen_0621_LVAD.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/56\/Blausen_0621_LVAD.png\/220px-Blausen_0621_LVAD.png\" width=\"220\" height=\"275\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Blausen_0621_LVAD.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Close-up illustration of typical left ventricular assist device (LVAD)<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Pumps\">Pumps<\/span><\/h3>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pump\" title=\"Pump\" rel=\"external_link\" target=\"_blank\">pumps<\/a> used in VADs can be divided into two main categories\u2014pulsatile pumps,<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> that mimic the natural pulsing action of the heart, and continuous flow pumps.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Pulsatile VADs use <a href=\"https:\/\/en.wikipedia.org\/wiki\/Positive_displacement_pump\" class=\"mw-redirect\" title=\"Positive displacement pump\" rel=\"external_link\" target=\"_blank\">positive displacement pumps<\/a>.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> In some pulsatile pumps (that use compressed air as the\/a energy source<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>), the volume occupied by blood varies during the pumping cycle. If the pump is contained inside the body then a vent tube to the outside air is required.\n<\/p><p>Continuous-flow VADs are smaller and have proven to be more durable than pulsatile VADs.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> They normally use either a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Centrifugal_pump\" title=\"Centrifugal pump\" rel=\"external_link\" target=\"_blank\">centrifugal pump<\/a> or an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Axial_flow_pump\" class=\"mw-redirect\" title=\"Axial flow pump\" rel=\"external_link\" target=\"_blank\">axial flow pump<\/a>. Both types have a central rotor containing permanent magnets. Controlled electric currents running through coils contained in the pump housing apply forces to the magnets, which in turn cause the rotors to spin. In the centrifugal pumps, the rotors are shaped to accelerate the blood circumferentially and thereby cause it to move toward the outer rim of the pump, whereas in the axial flow pumps the rotors are more or less cylindrical with blades that are helical, causing the blood to be accelerated in the direction of the rotor's axis.<sup id=\"rdp-ebb-cite_ref-fukamachi_2005_10-0\" class=\"reference\"><a href=\"#cite_note-fukamachi_2005-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>An important issue with continuous flow pumps is the method used to suspend the rotor. Early versions used solid bearings; however, newer pumps, some of which are approved for use in the EU, use either <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_levitation\" title=\"Magnetic levitation\" rel=\"external_link\" target=\"_blank\">magnetic levitation<\/a> (\"maglev\")<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluid_dynamic_bearings\" class=\"mw-redirect\" title=\"Fluid dynamic bearings\" rel=\"external_link\" target=\"_blank\">hydrodynamic suspension<\/a>. These pumps contain only one moving part (the rotor).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:122px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:1966_DeBakey_ventricular_assist_device.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d4\/1966_DeBakey_ventricular_assist_device.jpg\/120px-1966_DeBakey_ventricular_assist_device.jpg\" width=\"120\" height=\"338\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:1966_DeBakey_ventricular_assist_device.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>1966 DeBakey ventricular assist device.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><\/div><\/div><\/div>\n<p>The first successful implantation of a left ventricular assist device was completed in 1966 by Dr. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Michael_E._DeBakey\" class=\"mw-redirect\" title=\"Michael E. DeBakey\" rel=\"external_link\" target=\"_blank\">Michael E. DeBakey<\/a> to a 37-year-old woman. A paracorporeal (external) circuit was able to provide mechanical support for 10 days after the surgery.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> The first successful long-term implantation of an artificial LVAD was conducted in 1988 by Dr. <a href=\"https:\/\/en.wikipedia.org\/wiki\/William_F._Bernhard\" title=\"William F. Bernhard\" rel=\"external_link\" target=\"_blank\">William F. Bernhard<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boston_Children%27s_Hospital\" title=\"Boston Children's Hospital\" rel=\"external_link\" target=\"_blank\">Boston Children's Hospital<\/a> Medical Center and Thermedics, Inc of Woburn, MA under a National Institutes of Health (NIH) research contract which developed Heart-mate, an electronically controlled assist device. This was funded by a three-year $6.2 million contract to Thermedics and Children's Hospital, Boston MA from the National Heart and Lung and Blood Institute, a program of the NIH.<sup id=\"rdp-ebb-cite_ref-Children's_Hospital_Boston_MA_16-0\" class=\"reference\"><a href=\"#39;s_Hospital_Boston_MA-16\" rel=\"external_link\">[16]<\/a><\/sup> The early VADs emulated the heart by using a \"pulsatile\" action where blood is alternately sucked into the pump from the left ventricle then forced out into the aorta. Devices of this kind include the HeartMate IP LVAS, which was approved for use in the US by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> (FDA) in October 1994. These devices began to gain acceptance in the late 1990's as heart surgeons including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eric_Rose\" title=\"Eric Rose\" rel=\"external_link\" target=\"_blank\">Eric Rose<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/O._H._Frazier\" title=\"O. H. Frazier\" rel=\"external_link\" target=\"_blank\">O. H. Frazier<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mehmet_Oz\" title=\"Mehmet Oz\" rel=\"external_link\" target=\"_blank\">Mehmet Oz<\/a> began popularizing the concept that patients could live outside the hospital. Media coverage of outpatients with VADs underscored these arguments.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p><p>More recent work has concentrated on continuous flow pumps, which can be roughly categorized as either centrifugal pumps or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Axial_flow_pump\" class=\"mw-redirect\" title=\"Axial flow pump\" rel=\"external_link\" target=\"_blank\">axial flow<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Impeller\" title=\"Impeller\" rel=\"external_link\" target=\"_blank\">impeller<\/a> driven pumps. These pumps have the advantage of greater simplicity resulting in smaller size and greater reliability. These devices are referred to as second generation VADs. A side effect is that the user will not have a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse\" title=\"Pulse\" rel=\"external_link\" target=\"_blank\">pulse<\/a>,<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<p>or that the pulse intensity will be seriously reduced.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<\/p><p>Third generation VADs suspend the impeller in the pump using either hydrodynamic or electromagnetic suspension, thus removing the need for bearings and reducing the number of moving parts to one.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2009)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Another technology undergoing clinical trials is the use of trans cutaneous induction to power and control the device rather than using percutaneous cables. Apart from the obvious cosmetic advantage this reduces the risk of infection and the consequent need to take preventative action. A pulsatile pump using this technology has CE Mark approval and is in clinical trials for US FDA approval.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2009)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>A very different approach in the early stages of development is the use of an inflatable cuff around the aorta. Inflating the cuff contracts the aorta and deflating the cuff allows the aorta to expand\u2014in effect the aorta becomes a second left ventricle. A proposed refinement is to use the patient's skeletal muscle, driven by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pacemaker\" class=\"mw-redirect\" title=\"Pacemaker\" rel=\"external_link\" target=\"_blank\">pacemaker<\/a>, to power this device which would make it truly self-contained. However a similar operation (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiomyoplasty\" title=\"Cardiomyoplasty\" rel=\"external_link\" target=\"_blank\">cardiomyoplasty<\/a>) was tried in the 1990s with disappointing results. In any case, it has substantial potential advantages in avoiding the need to operate on the heart itself and in avoiding any contact between blood and the device. This approach involves a return to a pulsatile flow.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2009)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Peter_Houghton\" title=\"Peter Houghton\" rel=\"external_link\" target=\"_blank\">Peter Houghton<\/a> was the longest surviving recipient of a VAD for permanent use. He received an experimental Jarvik 2000 LVAD in June 2000. Since then, he completed a 91-mile charity walk, published two books, lectured widely, hiked in the Swiss Alps and the American West, flew in an ultra-light aircraft, and traveled extensively around the world. He died of acute renal failure in 2007 at the age of 69.<sup id=\"rdp-ebb-cite_ref-jarvik_houghton_20-0\" class=\"reference\"><a href=\"#cite_note-jarvik_houghton-20\" rel=\"external_link\">[20]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-texasheart_21-0\" class=\"reference\"><a href=\"#cite_note-texasheart-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Studies_and_outcomes\">Studies and outcomes<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Recent_developments\">Recent developments<\/span><\/h3>\n<ul><li>In July 2009 in England, surgeons removed a donor heart that had been implanted in a toddler next to her native heart, after her native heart had recovered. This technique suggests mechanical assist device, such as an LVAD, can take some or all the work away from the native heart and allow it time to heal.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup><\/li>\n<li>In July 2009, 18-month follow-up results from the HeartMate II Clinical Trial concluded that continuous-flow LVAD provides effective hemodynamic support for at least 18 months in patients awaiting transplantation, with improved functional status and quality of life. (see below).<sup id=\"rdp-ebb-cite_ref-jacc_jul_09_23-0\" class=\"reference\"><a href=\"#cite_note-jacc_jul_09-23\" rel=\"external_link\">[23]<\/a><\/sup><\/li>\n<li>Heidelberg University Hospital reported in July 2009 that the first HeartAssist5, known as the modern version of the DeBakey VAD, was implanted there. The HeartAssist5 weighs 92 grams, is made of titanium and plastic, and serves to pump blood from the left ventricle into the aorta.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><\/li>\n<li>A phase 1 clinical trial is underway (as of August 2009), consisting of patients with coronary artery bypass grafting and patients in end-stage heart failure who have a left ventricular assist device. The trial involves testing a patch, called Anginera(TM) that contains cells that secrete hormone-like growth factors that stimulate other cells to grow. The patches are seeded with heart muscle cells and then implanted onto the heart with the goal of getting the muscle cells to start communicating with native tissues in a way that allows for regular contractions.<sup id=\"rdp-ebb-cite_ref-az_dstar_theregen_25-0\" class=\"reference\"><a href=\"#cite_note-az_dstar_theregen-25\" rel=\"external_link\">[25]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-ctgov_anginera_26-0\" class=\"reference\"><a href=\"#cite_note-ctgov_anginera-26\" rel=\"external_link\">[26]<\/a><\/sup><\/li>\n<li>In September 2009, a New Zealand news outlet, Stuff, reported that in another 18 months to two years, a new wireless device will be ready for clinical trial that will power VADs without direct contact. If successful, this may reduce the chance of infection as a result of the power cable through the skin.<sup id=\"rdp-ebb-cite_ref-kiwi_wireless_27-0\" class=\"reference\"><a href=\"#cite_note-kiwi_wireless-27\" rel=\"external_link\">[27]<\/a><\/sup><\/li>\n<li>The National Institutes of Health (NIH) awarded a $2.8 million grant to develop a \"pulse-less\" total artificial heart using two VADS by Micromed, initially created by Michael DeBakey and George Noon. The grant was renewed for a second year of research in August 2009. The Total Artificial Heart was created using two HeartAssist5 VADs, whereby one VAD pumps blood throughout the body and the other circulates blood to and from the lungs.<sup id=\"rdp-ebb-cite_ref-debakey_noon_28-0\" class=\"reference\"><a href=\"#cite_note-debakey_noon-28\" rel=\"external_link\">[28]<\/a><\/sup><\/li>\n<li>HeartWare International announced in August 2009 that it had surpassed 50 implants of their HeartWare Ventricular Assist System in their ADVANCE Clinical Trial, an FDA-approved IDE study. The study is to assess the system as bridge-to-transplantation system for patients with end-stage heart failure. The study, Evaluation of the HeartWare LVAD System for the Treatment of Advance Heart Failure, is a multi-center study that started in May 2009.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup><\/li>\n<li>On June 27, 2014 Hannover Medical School in Hannover, Germany performed the first human implant of HeartMate III under the direction of professor Axel Haverich M.D., chief of the Cardiothoracic, Transplantation and Vascular Surgery Department and surgeon Jan Schmitto, M.D., Ph.D.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup><\/li>\n<li>On January 21, 2015 a study was published in Journal of American College of Cardiology suggesting that long-term use of LVAD may induce heart regeneration.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> This may explain the bridge to recovery phenomenon first described by the Yacoub group in NEJM in 2009 (above).<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (July 2016)\">citation needed<\/span><\/a><\/i>]<\/sup><\/li>\n<li>Hall-of-Fame Baseball Player Rod Carew had congestive heart failure and was fitted with a HeartMate II. He struggled with wearing the equipment, so he joined efforts to help supply the most helpful wear to assist the HeartMate II and HeartMate III.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup><\/li><\/ul>\n<p>The majority of VADs on the market today are somewhat bulky. The smallest device approved by the FDA, the HeartMate II, weighs about 1 pound (0.45 kg) and measures 3 inches (7.6 cm). This has proven particularly important for women and children, for whom alternatives would have been too large.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup> As of 2017, Heartmate III has been approved by the FDA. It is smaller than its predecessor HeartMate II, and uses a full maglev impeller instead of the cup-and-ball bearing system found in HeartMate II.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup>\n<\/p><p>One device gained CE Mark approval for use in the EU and began clinical trials in the US (). As of June 2007 these pumps had been implanted in over 100 patients. In 2009, Ventracor was placed into the hands of Administrators due to financial problems and was later that year liquidated. No other companies purchased the technology, so as a result the VentrAssist device was essentially defunct. Around 30\u201350 patients worldwide remain supported on VentrAssist devices as of January 2010.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>The Heartware HVAD works similarly to the VentrAssist\u2014albeit much smaller and not requiring an abdominal pocket to be implanted into. The device has obtained CE Mark in Europe, and FDA approval in the U.S. Recently, it was shown that the Heartware HVAD can be implanted through limited access without <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sternotomy\" class=\"mw-redirect\" title=\"Sternotomy\" rel=\"external_link\" target=\"_blank\">sternotomy<\/a>.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup>\n<\/p><p>In a small number of cases left ventricular assist devices, combined with drug therapy, have enabled the heart to recover sufficiently for the device to be able to be removed (<i>explanted<\/i>).<sup id=\"rdp-ebb-cite_ref-content.nejm.org_1-1\" class=\"reference\"><a href=\"#cite_note-content.nejm.org-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-ventracor.com_2-1\" class=\"reference\"><a href=\"#cite_note-ventracor.com-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"HeartMate_II_LVAD_pivotal_study\">HeartMate II LVAD pivotal study<\/span><\/h3>\n<p>A series of studies involving the use of the HeartMate II LVAD have proven useful in establishing the viability and risks of using LVADs for bridge-to-transplantation and destination therapy.\n<\/p>\n<ul><li>The pilot trial for the HeartMate II LVAD began in November 2003 and consisted of 46 study patients at 15 centers. Results included 11 patients supported for more than one year and three patients supported for more than two years.<\/li>\n<li>The HeartMate II <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pivotal_trial\" title=\"Pivotal trial\" rel=\"external_link\" target=\"_blank\">pivotal trial<\/a> began in 2005 and included the evaluation of HeartMate II for two indications: Bridge to transplantation (BTT) and destination therapy (DT), or long-term, permanent support. Thoratec Corp. announced that this was the first time the FDA had approved a clinical trial to include both indications in one protocol.<sup id=\"rdp-ebb-cite_ref-thor_hm2_piv_37-0\" class=\"reference\"><a href=\"#cite_note-thor_hm2_piv-37\" rel=\"external_link\">[37]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-crsti_hm2_piv_38-0\" class=\"reference\"><a href=\"#cite_note-crsti_hm2_piv-38\" rel=\"external_link\">[38]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-nypresb_hm2_39-0\" class=\"reference\"><a href=\"#cite_note-nypresb_hm2-39\" rel=\"external_link\">[39]<\/a><\/sup><\/li>\n<li>A multicenter study in the United States from 2005 to 2007 with 113 patients (of which 100 reported principal outcomes) showed that significant improvements in function were prevalent after three months, and a survival rate of 68% after twelve months.<sup id=\"rdp-ebb-cite_ref-njem_aug07_40-0\" class=\"reference\"><a href=\"#cite_note-njem_aug07-40\" rel=\"external_link\">[40]<\/a><\/sup><\/li>\n<li>Based on one-year follow up data from the first 194 patients enrolled in the trial, the FDA approved HeartMate II for bridge-to-transplantation. The trial provided clinical evidence of improved survival rates and quality of life for a broad range of patients.<sup id=\"rdp-ebb-cite_ref-umhs_41-0\" class=\"reference\"><a href=\"#cite_note-umhs-41\" rel=\"external_link\">[41]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-fda_heartmate_ii_42-0\" class=\"reference\"><a href=\"#cite_note-fda_heartmate_ii-42\" rel=\"external_link\">[42]<\/a><\/sup><\/li>\n<li>Eighteen-month follow up data on 281 patients who had either reached the study end-point or completed 18 months of post-operative follow-up showed improved survival, less frequent adverse events and greater reliability with continuous flow LVADS compared to pulsatile flow devices. Of the 281 patients, 157 patients had undergone transplant, 58 patients were continuing with LVADs in their body and seven patients had the LVAD removed because their heart recovered; the remaining 56 had died. The results showed that the NYHA Class of heart failure the patients had been designated had significantly improved after six months of LVAD support compared to the pre-LVAD baseline. Although this trial involved bridge-to-transplant indication, the results provide early evidence that continuous flow LVADs have advantages in terms of durability and reliability for patients receiving mechanical support for destination therapy.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup><\/li>\n<li>Following the FDA approval of HeartMate II LVAD for bridge-to-transplantation purposes, a post-approval (\"registry\") study was undertaken to assess the efficacy of the device in a commercial setting. The study found that the device improved outcomes, both compared to other LVAD treatments and baseline patients. Specifically, HeartMate II patients showed lower creatinine levels, 30-day survival rates were considerably higher at 96%, and 93% reached successful outcomes (transplant, cardiac recovery, or long-term LVAD).<sup id=\"rdp-ebb-cite_ref-JoCFAug09_44-0\" class=\"reference\"><a href=\"#cite_note-JoCFAug09-44\" rel=\"external_link\">[44]<\/a><\/sup><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"HARPS\">HARPS<\/span><\/h3>\n<p>The Harefield Recovery Protocol Study (HARPS) is a clinical trial to evaluate whether advanced heart failure patients requiring VAD support can recover sufficient myocardial function to allow device removal (known as explantation). HARPS combines an LVAD (the HeartMate XVE) with conventional oral heart failure medications, followed by the novel \u03b22 agonist clenbuterol. This opens the possibility that some advanced heart failure patients may forgo heart transplantation.<sup id=\"rdp-ebb-cite_ref-HARPS_01_45-0\" class=\"reference\"><a href=\"#cite_note-HARPS_01-45\" rel=\"external_link\">[45]<\/a><\/sup>\n<\/p><p>To date, 73% (11 of 15) of patients who underwent the combination therapy regimen demonstrated sufficient recovery to allow explantation and avoid heart transplantation; freedom from recurrent heart failure in surviving patients was 100% and 89% at one and four years after explantation, respectively; average ejection fraction was 64% at 59 months after explantation\u2014all patients were NYHA Class I; and no significant adverse effects were reported with clenbuterol therapy.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"REMATCH\">REMATCH<\/span><\/h3>\n<p>The REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) clinical trial began in May 1998 and ran through July 2001 in 20 cardiac transplant centers around the USA. The trial was designed to compare long-term implantation of left ventricular assist devices with optimal medical management for patients with end-stage heart failure who require, but do not qualify to receive cardiac transplantation. As a result of the clinical outcomes, the device received FDA approval for both indications, in 2001 and 2003, respectively.<sup id=\"rdp-ebb-cite_ref-rematch_ats_46-0\" class=\"reference\"><a href=\"#cite_note-rematch_ats-46\" rel=\"external_link\">[46]<\/a><\/sup>\n<\/p><p>The trial demonstrated an 81% improvement in two-year survival among patients receiving HeartMate XVE compared to optimal medical management. In addition, a destination therapy study following the REMATCH trial demonstrated an additional 17% improvement (61% vs. 52%) in one-year survival of patients that were implanted with a VAD (HeartMate XVE), with an implication for the appropriate selection of candidates and timing of VAD implantation.\n<\/p><p>A test carried out in 2001 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eric_Rose\" title=\"Eric Rose\" rel=\"external_link\" target=\"_blank\">Dr. Eric A. Rose<\/a> and REMATCH study group with patients with congestive heart failure that were ineligible for a transplant showed a survival at two years of 23% for those implanted with an LVAD compared with 8% for those who were treated with drugs. The two major complications of VAD implantation were infection and mechanical failure (see below).\n<\/p><p>According to a retrospective cohort study comparing patients treated with a left ventricular assist device versus inotrope therapy while awaiting heart transplantation, the group treated with LVAD had improved clinical and metabolic function at the time of transplant with better blood pressure, sodium, blood urea nitrogen, and creatinine. After transplant, 57.7% of the inotrope group had renal failure versus 16.6% in the LVAD group; 31.6% of the inotrope group had right heart failure versus 5.6% in the LVAD group; and event-free survival was 15.8% in the inotrope group versus 55.6% in the LVAD group.<sup id=\"rdp-ebb-cite_ref-intrepid_47-0\" class=\"reference\"><a href=\"#cite_note-intrepid-47\" rel=\"external_link\">[47]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Complications_and_side_effects\">Complications and side effects<\/span><\/h2>\n<p>Bleeding is the most common postoperative early complication after implantation or explantation of LVADs, necessitating reoperation in up to 60% of recipients.<sup id=\"rdp-ebb-cite_ref-Schaffer_48-0\" class=\"reference\"><a href=\"#cite_note-Schaffer-48\" rel=\"external_link\">[48]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Goldstein_49-0\" class=\"reference\"><a href=\"#cite_note-Goldstein-49\" rel=\"external_link\">[49]<\/a><\/sup> The implications of massive blood transfusions are great and include infection, pulmonary insufficiency, increased costs, right heart failure, allosensitization, and viral transmission, some of which can prove fatal or preclude transplantation.<sup id=\"rdp-ebb-cite_ref-Goldstein_49-1\" class=\"reference\"><a href=\"#cite_note-Goldstein-49\" rel=\"external_link\">[49]<\/a><\/sup> When bleeding occurs, it impacts the one year Kaplan-Meier mortality.<sup id=\"rdp-ebb-cite_ref-Schaffer_48-1\" class=\"reference\"><a href=\"#cite_note-Schaffer-48\" rel=\"external_link\">[48]<\/a><\/sup> In addition to complexity of the patient population and the complexity of these procedures contributing to bleeding, the devices themselves may contribute to the severe coagulopathy that can ensue when these devices are implanted.<sup id=\"rdp-ebb-cite_ref-Spanier_50-0\" class=\"reference\"><a href=\"#cite_note-Spanier-50\" rel=\"external_link\">[50]<\/a><\/sup>\n<\/p><p>Because the devices generally result in blood flowing over a non-biologic surface, predisposing the blood to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coagulation\" title=\"Coagulation\" rel=\"external_link\" target=\"_blank\">clotting<\/a>, there is need for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anticoagulation\" class=\"mw-redirect\" title=\"Anticoagulation\" rel=\"external_link\" target=\"_blank\">anticoagulation<\/a> measures. One device, the HeartMate XVE, is designed with a biologic surface derived from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibrin\" title=\"Fibrin\" rel=\"external_link\" target=\"_blank\">fibrin<\/a> and does not require long term anticoagulation (except aspirin); unfortunately, this biologic surface may also predispose the patient to infection through selective reduction of certain types of leukocytes.<sup id=\"rdp-ebb-cite_ref-ats_anticoag_51-0\" class=\"reference\"><a href=\"#cite_note-ats_anticoag-51\" rel=\"external_link\">[51]<\/a><\/sup>\n<\/p><p>New VAD designs which are now approved for use in the European Community and are undergoing trials for FDA approval have all but eliminated mechanical failure.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>VAD-related infection can be caused by a large number of different organisms:<sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup>\n<\/p>\n<ul><li>Gram positive bacteria (<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Staphylococci\" class=\"mw-redirect\" title=\"Staphylococci\" rel=\"external_link\" target=\"_blank\">Staphylococci<\/a><\/i>, especially <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Staphylococcus_aureus\" title=\"Staphylococcus aureus\" rel=\"external_link\" target=\"_blank\">Staph. aureus<\/a><\/i>, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Enterococci\" class=\"mw-redirect\" title=\"Enterococci\" rel=\"external_link\" target=\"_blank\">Enterococci<\/a><\/i>)<\/li>\n<li>Gram negative bacteria (<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pseudomonas_aeruginosa\" title=\"Pseudomonas aeruginosa\" rel=\"external_link\" target=\"_blank\">Pseudomonas aeruginosa<\/a><\/i>, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Enterobacter\" title=\"Enterobacter\" rel=\"external_link\" target=\"_blank\">Enterobacter<\/a><\/i> species, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Klebsiella\" title=\"Klebsiella\" rel=\"external_link\" target=\"_blank\">Klebsiella<\/a><\/i> species)<\/li>\n<li>Fungi. especially <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Candida_(fungus)\" title=\"Candida (fungus)\" rel=\"external_link\" target=\"_blank\">Candida<\/a><\/i> species<\/li><\/ul>\n<p>Treatment of VAD-related infection is exceedingly difficult and many patients die of infection despite optimal treatment. Initial treatment should be with broad spectrum antibiotics, but every effort must be made to obtain appropriate samples for culture. A final decision regarding antibiotic therapy must be based on the results of microbiogical cultures.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2009)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Other problems include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immunosuppression\" title=\"Immunosuppression\" rel=\"external_link\" target=\"_blank\">immunosuppression<\/a>, clotting with resultant stroke, and bleeding secondary to anticoagulation. Some of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyurethane\" title=\"Polyurethane\" rel=\"external_link\" target=\"_blank\">polyurethane<\/a> components used in the devices cause the deletion of a subset of <a href=\"https:\/\/en.wikipedia.org\/wiki\/White_blood_cell\" title=\"White blood cell\" rel=\"external_link\" target=\"_blank\">immune cells<\/a> when blood comes in contact with them. This predisposes the patient to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fungus\" title=\"Fungus\" rel=\"external_link\" target=\"_blank\">fungal<\/a> and some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Virus\" title=\"Virus\" rel=\"external_link\" target=\"_blank\">viral<\/a> infections necessitating appropriate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prophylaxis\" class=\"mw-redirect\" title=\"Prophylaxis\" rel=\"external_link\" target=\"_blank\">prophylactic therapy<\/a>.<sup id=\"rdp-ebb-cite_ref-holman_infection_53-0\" class=\"reference\"><a href=\"#cite_note-holman_infection-53\" rel=\"external_link\">[53]<\/a><\/sup>\n<\/p><p>Considering the multitude of risks and lifestyle modifications associated with ventricular assist device implant,<sup id=\"rdp-ebb-cite_ref-Macuccilli_54-0\" class=\"reference\"><a href=\"#cite_note-Macuccilli-54\" rel=\"external_link\">[54]<\/a><\/sup> it is important for prospective patients to be informed prior to decision making.<sup id=\"rdp-ebb-cite_ref-55\" class=\"reference\"><a href=\"#cite_note-55\" rel=\"external_link\">[55]<\/a><\/sup> In addition to physician consult, various Internet-based patient directed resources are available to assist in patient education.<sup id=\"rdp-ebb-cite_ref-Iacovetto_56-0\" class=\"reference\"><a href=\"#cite_note-Iacovetto-56\" rel=\"external_link\">[56]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Matlock_Decision_Aid_57-0\" class=\"reference\"><a href=\"#cite_note-Matlock_Decision_Aid-57\" rel=\"external_link\">[57]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"List_of_implantable_VAD_devices\">List of implantable VAD devices<\/span><\/h2>\n\n<p><i>This is a partial list and may never be complete<\/i><br \/>\n<i>Referenced additions are welcome<\/i>\n<\/p>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Device\n<\/th>\n<th>Manufacturer\n<\/th>\n<th>Type\n<\/th>\n<th>Approval Status as of July 2010\n<\/th><\/tr>\n<tr>\n<td>HeartAssist5\n<\/td>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/reliantheart.com\/heartassist5\/\" target=\"_blank\">ReliantHeart<\/a>\n<\/td>\n<td>Continuous flow driven by an axial flow rotor.\n<\/td>\n<td>Approved for use in the European Union. The child version is approved by the FDA for use in children in USA. Undergoing clinical trials in USA for FDA approval.\n<\/td><\/tr>\n<tr>\n<td>Novacor\n<\/td>\n<td><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070525194541\/http:\/\/www.worldheart.com\/index.cfm\" target=\"_blank\">World Heart<\/a>\n<\/td>\n<td>Pulsatile.\n<\/td>\n<td>Was approved for use in North America, European Union and Japan. Now defunct and no longer supported by the manufacturer. (Heartware completed acquisition August 2012)\n<\/td><\/tr>\n<tr>\n<td>HeartMate XVE\n<\/td>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.thoratec.com\/\" target=\"_blank\">Thoratec<\/a>\n<\/td>\n<td>Pulsatile\n<\/td>\n<td>FDA approval for BTT in 2001 and DT in 2003. CE Mark Authorized. Rarely used anymore due to reliability concerns.\n<\/td><\/tr>\n<tr>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/heartmateii.com\/\" target=\"_blank\">HeartMate II<\/a>\n<\/td>\n<td>Thoratec\n<\/td>\n<td>Rotor driven continuous axial flow, ball and cup bearings.\n<\/td>\n<td>Approved for use in North America and EU. CE Mark Authorized. FDA approval for BTT in April 2008. Recently approved by FDA in the US for Destination Therapy (as at January 2010).\n<\/td><\/tr>\n<tr>\n<td>HeartMate III\n<\/td>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.thoratec.com\/\" target=\"_blank\">Thoratec<\/a>\n<\/td>\n<td>Continuous flow driven by a magnetically suspended axial flow rotor.\n<\/td>\n<td>Pivotal trials for HeartMate III started in 2014 and supported with <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/carewmedicalwear.com\/\" target=\"_blank\">CarewMedicalWear<\/a>. FDA approval for BTT in 2017\n<\/td><\/tr>\n<tr>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.berlinheart.de\/index.php\/mp\/content\/products\/incor\" target=\"_blank\">Incor<\/a>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Berlinheart\" class=\"mw-redirect\" title=\"Berlinheart\" rel=\"external_link\" target=\"_blank\">Berlin Heart<\/a>\n<\/td>\n<td>Continuous flow driven by a magnetically suspended axial flow rotor.\n<\/td>\n<td>Approved for use in European Union. Used on humanitarian approvals on case by case basis in the US. Entered clinical trials in the US in 2009.\n<\/td><\/tr>\n<tr>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.berlinheart.de\/index.php\/mp\/content\/products\/excor_pediatric\" target=\"_blank\">Excor Pediatric<\/a>\n<\/td>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.berlinheart.de\/index.php\/home\/choose_region\" target=\"_blank\">Berlin Heart<\/a>\n<\/td>\n<td>External membrane pump device designed for children.\n<\/td>\n<td>Approved for use in European Union. FDA granted Humanitarian Device Exemption for US in December 2011.\n<\/td><\/tr>\n<tr>\n<td><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070930021005\/http:\/\/www.jarvikheart.com\/basic.asp?id=19\" target=\"_blank\">Jarvik 2000<\/a>\n<\/td>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jarvikheart.com\" target=\"_blank\">Jarvik Heart<\/a>\n<\/td>\n<td>Continuous flow, axial rotor supported by ceramic bearings.\n<\/td>\n<td>Currently used in the United States as a bridge to heart transplant under an FDA-approved clinical investigation. In Europe, the Jarvik 2000 has earned CE Mark certification for both bridge-to-transplant and lifetime use. Child version currently being developed.\n<\/td><\/tr>\n<tr>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.micromedcv.com\/productprofile.htm\" target=\"_blank\">MicroMed DeBakey VAD<\/a>\n<\/td>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.micromedcv.com\/\" target=\"_blank\">MicroMed<\/a>\n<\/td>\n<td>Continuous flow driven by axial rotor supported by ceramic bearings.\n<\/td>\n<td>Approved for use in the European Union. The child version is approved by the FDA for use in children in USA. Undergoing clinical trials in USA for FDA approval.\n<\/td><\/tr>\n<tr>\n<td>VentrAssist\n<\/td>\n<td>Ventracor<sup id=\"rdp-ebb-cite_ref-58\" class=\"reference\"><a href=\"#cite_note-58\" rel=\"external_link\">[58]<\/a><\/sup>\n<\/td>\n<td>Continuous flow driven by a hydrodynamically suspended centrifugal rotor.\n<\/td>\n<td>Approved for use in European Union and Australia. Company declared bankrupt while clinical trials for FDA approval were underway in 2009. Company now dissolved and intellectual property sold to Thoratec.\n<\/td><\/tr>\n<tr>\n<td>MTIHeartLVAD\n<\/td>\n<td>\n<\/td>\n<td>Continuous flow driven by a magnetically suspended centrifugal rotor.\n<\/td>\n<td>Currently in animal testing, recently completed successful 60 day calf implant.\n<\/td><\/tr>\n<tr>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sunshineheart.com\/C-Pulse\" target=\"_blank\">C-Pulse<\/a>\n<\/td>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sunshineheart.com\" target=\"_blank\">Sunshine Heart<\/a>\n<\/td>\n<td>Pulsatile, driven by an inflatable cuff around the aorta.\n<\/td>\n<td>Currently in clinical trials in the US and Australia.\n<\/td><\/tr>\n<tr>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.heartware.com\/products-technology\/pump-design\" target=\"_blank\">HVAD<\/a>\n<\/td>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.heartware.com\" target=\"_blank\">HeartWare<\/a>\n<\/td>\n<td>Miniature \"third generation\" device with centrifugal blood path and hydromagnetically suspended rotor that may be placed in the pericardial space.\n<\/td>\n<td>Obtained CE Mark for distribution in Europe, January 2009. Obtained FDA approval in the U.S., November 2012. Initiated US BTT trial in October 2008 (completed February 2010) and US DT trial in August 2010 (enrollment completed May 2012). FDA approval for BTT in 2012 and DT in 2017.\n<\/td><\/tr>\n<tr>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.heartware.com\/products-technology\/technology-pipeline\" target=\"_blank\">MVAD<\/a>\n<\/td>\n<td>HeartWare\n<\/td>\n<td>HeartWare's MVAD Pump is a development-stage miniature ventricular assist device, approximately one-third the size of HeartWare's HVAD pump.\n<\/td>\n<td>HeartWare Completed GLP Studies (September 2011).\n<\/td><\/tr>\n<tr>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/terumoheart.net\/us\/index.php\/medical-professionals\/duraheart-lvas\" target=\"_blank\">DuraHeart<\/a>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Terumo\" title=\"Terumo\" rel=\"external_link\" target=\"_blank\">Terumo<\/a>\n<\/td>\n<td>Magnetically levitated centrifugal pump.\n<\/td>\n<td>CE approved, US FDA trials underway as at January 2010.\n<\/td><\/tr>\n<tr>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.thoratec.com\/medical-professionals\/vad-product-information\/thoratec-pvad.aspx\" target=\"_blank\">Thoratec PVAD (Paracorporeal Ventricular Assist Device) <\/a>\n<\/td>\n<td>Thoratec\n<\/td>\n<td>Pulsatile system includes three major components: Blood pump, cannulae and pneumatic driver (dual drive console or portable VAD driver).\n<\/td>\n<td>CE Mark Authorized. Received FDA approval for BTT in 1995 and for post-cardiotomy recovery (open heart surgery) in 1998.\n<\/td><\/tr>\n<tr>\n<td><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.thoratec.com\/medical-professionals\/vad-product-information\/thoratec-ivad.aspx\" target=\"_blank\">IVAD\u2014Implantable Ventricular Assist Device<\/a>\n<\/td>\n<td>Thoratec\n<\/td>\n<td>Pulsatile system includes three major components: Blood pump, cannulae and pneumatic driver (dual drive console or portable VAD driver).\n<\/td>\n<td>CE Mark Authorized. Received FDA approval for BTT in 2004. Authorized only for internal implant, not for paracorporeal implant due to reliability issues.\n<\/td><\/tr><\/tbody><\/table>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Intra-aortic_balloon_pump\" title=\"Intra-aortic balloon pump\" rel=\"external_link\" target=\"_blank\">Intra-aortic balloon pump<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 32em; -webkit-column-width: 32em; column-width: 32em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-content.nejm.org-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-content.nejm.org_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-content.nejm.org_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Birks, EJ; Tansley, PD; Hardy, J; et al. (2006). \"Left Ventricular Assist Device and Drug Therapy for the Reversal of Heart Failure\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/New_England_Journal_of_Medicine\" class=\"mw-redirect\" title=\"New England Journal of Medicine\" rel=\"external_link\" target=\"_blank\">New England Journal of Medicine<\/a><\/i>. <b>355<\/b> (18): 1873\u20131884. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2FNEJMoa053063\" target=\"_blank\">10.1056\/NEJMoa053063<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17079761\" target=\"_blank\">17079761<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=New+England+Journal+of+Medicine&rft.atitle=Left+Ventricular+Assist+Device+and+Drug+Therapy+for+the+Reversal+of+Heart+Failure&rft.volume=355&rft.issue=18&rft.pages=1873-1884&rft.date=2006&rft_id=info%3Adoi%2F10.1056%2FNEJMoa053063&rft_id=info%3Apmid%2F17079761&rft.aulast=Birks&rft.aufirst=EJ&rft.au=Tansley%2C+PD&rft.au=Hardy%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Explicit use of et al. (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Explicit_use_of_et_al.\" title=\"Category:CS1 maint: Explicit use of et al.\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><\/span>\n<\/li>\n<li id=\"cite_note-ventracor.com-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ventracor.com_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ventracor.com_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080204022437\/http:\/\/www.ventracor.com\/news_item.asp?newsID=431\" target=\"_blank\">\"First VentrAssist Heart Recovery Featured on National TV\"<\/a>. <i>Ventracor.com<\/i>. 19 October 2006.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Fajdek, B; Krzysztof, J (2\u20135 September 2014). \"Automatic control system for ventricular assist device\". <i>19th International Conference on Methods and Models in Automation and Robotics (MMAR)<\/i>: 874\u2013879. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2FMMAR.2014.6957472\" target=\"_blank\">10.1109\/MMAR.2014.6957472<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=19th+International+Conference+on+Methods+and+Models+in+Automation+and+Robotics+%28MMAR%29&rft.atitle=Automatic+control+system+for+ventricular+assist+device&rft.pages=874-879&rft.date=2014-09-02%2F2014-09-05&rft_id=info%3Adoi%2F10.1109%2FMMAR.2014.6957472&rft.aulast=Fajdek&rft.aufirst=B&rft.au=Krzysztof%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Schulman, AR; Martens, TP; Christos, PJ; et al. 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(<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Explicit_use_of_et_al.\" title=\"Category:CS1 maint: Explicit use of et al.\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/openi.nlm.nih.gov\/detailedresult.php?img=PMC3303031_12471_2011_211_Fig2_HTML&req=4\" target=\"_blank\">\"Panel A shows a first-generation pulsatile flow left ve - Open-i\"<\/a>. <i>openi.nlm.nih.gov<\/i><span class=\"reference-accessdate\">. 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(<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Explicit_use_of_et_al.\" title=\"Category:CS1 maint: Explicit use of et al.\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-fukamachi_2005-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-fukamachi_2005_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Fukamachi, Kiyo; Smedira, Nicholas (August 2005). \"Smaller, Safer, Totally Implantable LVADs: Fact or Fantasy?\". <i>American College of Cardiology Current Journal Review<\/i>. <b>14<\/b> (8): 40\u201342. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.accreview.2005.06.001\" target=\"_blank\">10.1016\/j.accreview.2005.06.001<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+College+of+Cardiology+Current+Journal+Review&rft.atitle=Smaller%2C+Safer%2C+Totally+Implantable+LVADs%3A+Fact+or+Fantasy%3F&rft.volume=14&rft.issue=8&rft.pages=40-42&rft.date=2005-08&rft_id=info%3Adoi%2F10.1016%2Fj.accreview.2005.06.001&rft.aulast=Fukamachi&rft.aufirst=Kiyo&rft.au=Smedira%2C+Nicholas&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Smart, Frank. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.healio.com\/cardiology\/hf-transplantation\/news\/print\/cardiology-today\/%7B74b7c676-ca44-4c7c-9d9b-ed4f84a33e27%7D\/magnetic-levitation-heart-pump-implanted-in-first-us-patient\" target=\"_blank\">\"Magnetic levitation heart pump implanted in first U.S. patient\"<\/a>. \"Cardiology Today\". October 2008.<\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pai, CN; Shinshi, T; Asama, J; et al. (2008). \"Development of a Compact Maglev Centrifugal Blood Pump Enclosed in a Titanium Housing\". <i>Journal of Advanced Mechanical Design, Systems, and Manufacturing<\/i>. <b>2<\/b> (3): 343\u2013355. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1299%2Fjamdsm.2.343\" target=\"_blank\">10.1299\/jamdsm.2.343<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Advanced+Mechanical+Design%2C+Systems%2C+and+Manufacturing&rft.atitle=Development+of+a+Compact+Maglev+Centrifugal+Blood+Pump+Enclosed+in+a+Titanium+Housing&rft.volume=2&rft.issue=3&rft.pages=343-355&rft.date=2008&rft_id=info%3Adoi%2F10.1299%2Fjamdsm.2.343&rft.aulast=Pai&rft.aufirst=CN&rft.au=Shinshi%2C+T&rft.au=Asama%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Explicit use of et al. (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Explicit_use_of_et_al.\" title=\"Category:CS1 maint: Explicit use of et al.\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hoshi, H; Shinshi, T; Takatani, S (2006). \"Third-generation Blood Pumps with Mechanical Noncontact Magnetic Bearings\". <i>Artificial Organs<\/i>. <b>30<\/b> (5): 324\u2013338. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1525-1594.2006.00222.x\" target=\"_blank\">10.1111\/j.1525-1594.2006.00222.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16683949\" target=\"_blank\">16683949<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Artificial+Organs&rft.atitle=Third-generation+Blood+Pumps+with+Mechanical+Noncontact+Magnetic+Bearings&rft.volume=30&rft.issue=5&rft.pages=324-338&rft.date=2006&rft_id=info%3Adoi%2F10.1111%2Fj.1525-1594.2006.00222.x&rft_id=info%3Apmid%2F16683949&rft.aulast=Hoshi&rft.aufirst=H&rft.au=Shinshi%2C+T&rft.au=Takatani%2C+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.chron.com\/news\/health\/slideshow\/Dr-Denton-Cooley-and-Dr-Michael-E-DeBakey-83220\/photo-6114896.php\" target=\"_blank\">\"Dr. Denton Cooley and Dr. Michael E. 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PBS.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Electric+Heart&rft.pub=PBS&rft_id=http%3A%2F%2Fwww.pbs.org%2Fwgbh%2Fnova%2Ftranscripts%2F2617eheart.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\nDan Baum.\n<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.popsci.com\/science\/article\/2012-02\/no-pulse-how-doctors-reinvented-human-heart\" target=\"_blank\">\"No Pulse: How Doctors Reinvented the Human Heart\"<\/a>.\nPopular Science.\n2012.<\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\n<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/columbiasurgery.org\/lvad\/vad-faqs\" target=\"_blank\">\"VAD FAQs\"<\/a>.\nColumbia University Medical Center.\nquote: \"A patient who is implanted with a HeartMate II usually has a dampened pulse.\"\nViewed 2016-08-27.<\/span>\n<\/li>\n<li id=\"cite_note-jarvik_houghton-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-jarvik_houghton_20-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20101121172612\/http:\/\/www.jarvikheart.com\/basic.asp?id=63\" target=\"_blank\">\"The First Lifetime-Use Patient\"<\/a>. 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Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jarvikheart.com\/basic.asp?id=63\" target=\"_blank\">the original<\/a> on 21 November 2010.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=The+First+Lifetime-Use+Patient&rft_id=http%3A%2F%2Fwww.jarvikheart.com%2Fbasic.asp%3Fid%3D63&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-texasheart-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-texasheart_21-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080720113602\/http:\/\/texasheart.org\/AboutUs\/News\/Lucky7_device_07_06_07.cfm\" target=\"_blank\">Patient Sets World Record for Living with Heart Assist Device<\/a>. Texas Heart Institute. 6 July 2007.<\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Maugh, Thomas (14 July 2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/articles.latimes.com\/2009\/jul\/14\/science\/sci-heart14\" target=\"_blank\">\"Transplant shows heart's reparative capabilities\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Los_Angeles_Times\" title=\"Los Angeles Times\" rel=\"external_link\" target=\"_blank\">Los Angeles Times<\/a><\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Los+Angeles+Times&rft.atitle=Transplant+shows+heart%27s+reparative+capabilities&rft.date=2009-07-14&rft.aulast=Maugh&rft.aufirst=Thomas&rft_id=http%3A%2F%2Farticles.latimes.com%2F2009%2Fjul%2F14%2Fscience%2Fsci-heart14&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-jacc_jul_09-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-jacc_jul_09_23-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pagani, FD; Miller, LW; Russell, SD; et al. 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Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/insciences.org\/article.php?article_id=6496\" target=\"_blank\">the original<\/a> on 18 July 2011.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Insciences&rft.atitle=Heidelberg+Cardiac+Surgeons+implant+world%E2%80%99s+first+new+DeBakey+Heart+Assist+Device&rft.date=2009-08-17&rft_id=http%3A%2F%2Finsciences.org%2Farticle.php%3Farticle_id%3D6496&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-az_dstar_theregen-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-az_dstar_theregen_25-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Quinn, Dale (4 August 2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090807141013\/http:\/\/www.azstarnet.com\/business\/303476\" target=\"_blank\">\"VA study: heart-healing patch\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arizona_Daily_Star\" title=\"Arizona Daily Star\" rel=\"external_link\" target=\"_blank\">Arizona Daily Star<\/a><\/i>. 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Retrieved <span class=\"nowrap\">15 September<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=ClinicalTrials.gov&rft.atitle=A+Study+of+Anginera+In+Patients+Undergoing+Coronary+Artery+Bypass+Graft+%28CABG%29+Surgery&rft.date=2009-03-27&rft_id=http%3A%2F%2Fclinicaltrials.gov%2Fct2%2Fshow%2FNCT00364390&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-kiwi_wireless-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-kiwi_wireless_27-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Hunter, Tim (13 September 2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.stuff.co.nz\/manawatu-standard\/business\/2858757\/Meet-the-Kiwi-bionic-man\" target=\"_blank\">\"Meet the Kiwi bionic man\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Manawatu_Standard\" title=\"Manawatu Standard\" rel=\"external_link\" target=\"_blank\">Manawatu Standard<\/a><\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Manawatu+Standard&rft.atitle=Meet+the+Kiwi+bionic+man&rft.date=2009-09-13&rft.aulast=Hunter&rft.aufirst=Tim&rft_id=http%3A%2F%2Fwww.stuff.co.nz%2Fmanawatu-standard%2Fbusiness%2F2858757%2FMeet-the-Kiwi-bionic-man&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-debakey_noon-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-debakey_noon_28-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.businesswire.com\/portal\/site\/google\/?ndmViewId=news_view&newsId=20090806005300&newsLang=en\" target=\"_blank\">\"$2.8 Million Grant Renewed for Development of \"Pulse-Less\" Total Artificial Heart\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/BusinessWire\" class=\"mw-redirect\" title=\"BusinessWire\" rel=\"external_link\" target=\"_blank\">BusinessWire<\/a><\/i>. 6 August 2009.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BusinessWire&rft.atitle=%242.8+Million+Grant+Renewed+for+Development+of+%22Pulse-Less%22+Total+Artificial+Heart&rft.date=2009-08-06&rft_id=http%3A%2F%2Fwww.businesswire.com%2Fportal%2Fsite%2Fgoogle%2F%3FndmViewId%3Dnews_view%26newsId%3D20090806005300%26newsLang%3Den&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hopkinsmedicine.org\/heart_vascular_institute\/clinical_trials\/mechanical_circulatory_support\/heartware_lvad_system_heart_failure.html\" target=\"_blank\">\"Evaluation of the HeartWare LVAD System for the Treatment of Advanced Heart Failure\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Johns_Hopkins_Medical_Center\" class=\"mw-redirect\" title=\"Johns Hopkins Medical Center\" rel=\"external_link\" target=\"_blank\">Johns Hopkins Medical Center<\/a>. 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Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.crsti.org\/protocols\/heartmate-2.html\" target=\"_blank\">the original<\/a> on 13 July 2007.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=The+HeartMate+II+LVAS+Pivotal+Trial&rft.date=2008-08-19&rft.aulast=Dewey&rft.aufirst=Todd&rft_id=http%3A%2F%2Fwww.crsti.org%2Fprotocols%2Fheartmate-2.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-nypresb_hm2-39\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-nypresb_hm2_39-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Mager, Belinda (25 April 2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080508074333\/http:\/\/www.nyp.org\/news\/hospital\/heartmateII-organ-transplantation.html\" target=\"_blank\">\"FDA Approves HeartMate II Mechanical Heart Pump for Heart-Failure Patients Waiting for Organ Transplantation\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/NewYork%E2%80%93Presbyterian_Hospital\" title=\"NewYork\u2013Presbyterian Hospital\" rel=\"external_link\" target=\"_blank\">NewYork\u2013Presbyterian Hospital<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/nyp.org\/news\/hospital\/heartmateII-organ-transplantation.html\" target=\"_blank\">the original<\/a> on 8 May 2008.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=FDA+Approves+HeartMate+II+Mechanical+Heart+Pump+for+Heart-Failure+Patients+Waiting+for+Organ+Transplantation&rft.date=2008-04-25&rft.aulast=Mager&rft.aufirst=Belinda&rft_id=http%3A%2F%2Fnyp.org%2Fnews%2Fhospital%2FheartmateII-organ-transplantation.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-njem_aug07-40\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-njem_aug07_40-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Miller, LW; Pagani, FD; Russell, SD; et al. 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(<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Explicit_use_of_et_al.\" title=\"Category:CS1 maint: Explicit use of et al.\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Schaffer-48\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Schaffer_48-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Schaffer_48-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Schaffer, JM; Arnaoutakis, GJ; Allen, JG; et al. \"Bleeding Complications and Blood Product Utilization With Left Ventricular Assist Device Implantation\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Annals_of_Thoracic_Surgery\" title=\"The Annals of Thoracic Surgery\" rel=\"external_link\" target=\"_blank\">The Annals of Thoracic Surgery<\/a><\/i>. <b>91<\/b> (3): 740\u2013749. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.athoracsur.2010.11.007\" target=\"_blank\">10.1016\/j.athoracsur.2010.11.007<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Annals+of+Thoracic+Surgery&rft.atitle=Bleeding+Complications+and+Blood+Product+Utilization+With+Left+Ventricular+Assist+Device+Implantation&rft.volume=91&rft.issue=3&rft.pages=740-749&rft_id=info%3Adoi%2F10.1016%2Fj.athoracsur.2010.11.007&rft.aulast=Schaffer&rft.aufirst=JM&rft.au=Arnaoutakis%2C+GJ&rft.au=Allen%2C+JG&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Explicit use of et al. (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Explicit_use_of_et_al.\" title=\"Category:CS1 maint: Explicit use of et al.\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Goldstein-49\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Goldstein_49-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Goldstein_49-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Goldstein, Daniel J.; Robert B. Beauford (2003). \"Left ventricular assist devices and bleeding: adding insult to injury\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Annals_of_Thoracic_Surgery\" title=\"The Annals of Thoracic Surgery\" rel=\"external_link\" target=\"_blank\">The Annals of Thoracic Surgery<\/a><\/i>. <b>75<\/b>: S42\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fs0003-4975%2803%2900478-8\" target=\"_blank\">10.1016\/s0003-4975(03)00478-8<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12820734\" target=\"_blank\">12820734<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Annals+of+Thoracic+Surgery&rft.atitle=Left+ventricular+assist+devices+and+bleeding%3A+adding+insult+to+injury&rft.volume=75&rft.pages=S42-7&rft.date=2003&rft_id=info%3Adoi%2F10.1016%2Fs0003-4975%2803%2900478-8&rft_id=info%3Apmid%2F12820734&rft.aulast=Goldstein&rft.aufirst=Daniel+J.&rft.au=Robert+B.+Beauford&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Spanier-50\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Spanier_50-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Spanier, Talia; Oz, M; Levin, H; et al. (1996). \"Activation of coagulation and fibrinolytic pathways with left ventricular assist devices\". <i>Journal of Thoracic and Cardiovascular Surgery<\/i>. <b>112<\/b>: 1090\u20131097. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fs0022-5223%2896%2970111-3\" target=\"_blank\">10.1016\/s0022-5223(96)70111-3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8873737\" target=\"_blank\">8873737<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Thoracic+and+Cardiovascular+Surgery&rft.atitle=Activation+of+coagulation+and+fibrinolytic+pathways+with+left+ventricular+assist+devices&rft.volume=112&rft.pages=1090-1097&rft.date=1996&rft_id=info%3Adoi%2F10.1016%2Fs0022-5223%2896%2970111-3&rft_id=info%3Apmid%2F8873737&rft.aulast=Spanier&rft.aufirst=Talia&rft.au=Oz%2C+M&rft.au=Levin%2C+H&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Explicit use of et al. (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Explicit_use_of_et_al.\" title=\"Category:CS1 maint: Explicit use of et al.\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ats_anticoag-51\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ats_anticoag_51-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Samuels, LE; Kohout, J; Casanova-Ghosh, E; et al. (2008). \"Argatroban as a Primary or Secondary Postoperative Anticoagulant in Patients Implanted with Ventricular Assist Devices\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Annals_of_Thoracic_Surgery\" title=\"The Annals of Thoracic Surgery\" rel=\"external_link\" target=\"_blank\">The Annals of Thoracic Surgery<\/a><\/i>. <b>85<\/b> (5): 1651\u20131655. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.athoracsur.2008.01.100\" target=\"_blank\">10.1016\/j.athoracsur.2008.01.100<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18442558\" target=\"_blank\">18442558<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Annals+of+Thoracic+Surgery&rft.atitle=Argatroban+as+a+Primary+or+Secondary+Postoperative+Anticoagulant+in+Patients+Implanted+with+Ventricular+Assist+Devices&rft.volume=85&rft.issue=5&rft.pages=1651-1655&rft.date=2008&rft_id=info%3Adoi%2F10.1016%2Fj.athoracsur.2008.01.100&rft_id=info%3Apmid%2F18442558&rft.aulast=Samuels&rft.aufirst=LE&rft.au=Kohout%2C+J&rft.au=Casanova-Ghosh%2C+E&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Explicit use of et al. (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Explicit_use_of_et_al.\" title=\"Category:CS1 maint: Explicit use of et al.\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-52\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-52\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gordon, RJ; Quagliarello, B; Lowy, FD (2006). \"Ventricular assist device-related infections\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lancet_(journal)\" class=\"mw-redirect\" title=\"Lancet (journal)\" rel=\"external_link\" target=\"_blank\">The Lancet Infectious Diseases<\/a><\/i>. <b>6<\/b> (7): 426\u201337. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS1473-3099%2806%2970522-9\" target=\"_blank\">10.1016\/S1473-3099(06)70522-9<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16790383\" target=\"_blank\">16790383<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Lancet+Infectious+Diseases&rft.atitle=Ventricular+assist+device-related+infections&rft.volume=6&rft.issue=7&rft.pages=426-37&rft.date=2006&rft_id=info%3Adoi%2F10.1016%2FS1473-3099%2806%2970522-9&rft_id=info%3Apmid%2F16790383&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Uses authors parameter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Uses_authors_parameter\" title=\"Category:CS1 maint: Uses authors parameter\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-holman_infection-53\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-holman_infection_53-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Holman, WL; Rayburn, BK; McGiffin, DC; et al. (2003). \"Infection in ventricular assist devices: Prevention and treatment\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Annals_of_Thoracic_Surgery\" title=\"The Annals of Thoracic Surgery\" rel=\"external_link\" target=\"_blank\">The Annals of Thoracic Surgery<\/a><\/i>. <b>75<\/b> (6 Suppl): S48\u2013S57. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0003-4975%2803%2900479-X\" target=\"_blank\">10.1016\/S0003-4975(03)00479-X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12820735\" target=\"_blank\">12820735<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Annals+of+Thoracic+Surgery&rft.atitle=Infection+in+ventricular+assist+devices%3A+Prevention+and+treatment&rft.volume=75&rft.issue=6+Suppl&rft.pages=S48-S57&rft.date=2003&rft_id=info%3Adoi%2F10.1016%2FS0003-4975%2803%2900479-X&rft_id=info%3Apmid%2F12820735&rft.aulast=Holman&rft.aufirst=WL&rft.au=Rayburn%2C+BK&rft.au=McGiffin%2C+DC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Explicit use of et al. (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Explicit_use_of_et_al.\" title=\"Category:CS1 maint: Explicit use of et al.\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Macuccilli-54\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Macuccilli_54-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Marcuccilli, L; Casida, J; Peters, RM (2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/deepblue.lib.umich.edu\/bitstream\/2027.42\/99069\/1\/jocn4332.pdf\" target=\"_blank\">\"Modification of self-concept in patients with a left-ventricular assist device: an initial exploration\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Journal of Clinical Nursing<\/i>. <b>22<\/b> (2456\u201364): 2456\u201364. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1365-2702.2012.04332.x\" target=\"_blank\">10.1111\/j.1365-2702.2012.04332.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23506318\" target=\"_blank\">23506318<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Clinical+Nursing&rft.atitle=Modification+of+self-concept+in+patients+with+a+left-ventricular+assist+device%3A+an+initial+exploration.&rft.volume=22&rft.issue=2456%E2%80%9364&rft.pages=2456-64&rft.date=2013&rft_id=info%3Adoi%2F10.1111%2Fj.1365-2702.2012.04332.x&rft_id=info%3Apmid%2F23506318&rft.aulast=Marcuccilli&rft.aufirst=L&rft.au=Casida%2C+J&rft.au=Peters%2C+RM&rft_id=https%3A%2F%2Fdeepblue.lib.umich.edu%2Fbitstream%2F2027.42%2F99069%2F1%2Fjocn4332.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-55\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-55\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mcillvennan, CK; Allen, LA; Nowels, C; Brieke, A; Cleveland, JC; Matlock, DD (2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4081474\" target=\"_blank\">\"Decision making for destination therapy left ventricular assist devices: \"there was no choice\" versus \"I thought about it an awful lot<span class=\"cs1-kern-right\">\"<\/span>\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Circulation_(journal)\" title=\"Circulation (journal)\" rel=\"external_link\" target=\"_blank\">Circulation: Cardiovascular Quality and Outcomes<\/a><\/i>. <b>7<\/b>: 374\u201380. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1161%2FCIRCOUTCOMES.113.000729\" target=\"_blank\">10.1161\/CIRCOUTCOMES.113.000729<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4081474\" target=\"_blank\">4081474<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24823949\" target=\"_blank\">24823949<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Circulation%3A+Cardiovascular+Quality+and+Outcomes&rft.atitle=Decision+making+for+destination+therapy+left+ventricular+assist+devices%3A+%22there+was+no+choice%22+versus+%22I+thought+about+it+an+awful+lot%22.&rft.volume=7&rft.pages=374-80&rft.date=2014&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4081474&rft_id=info%3Apmid%2F24823949&rft_id=info%3Adoi%2F10.1161%2FCIRCOUTCOMES.113.000729&rft.aulast=Mcillvennan&rft.aufirst=CK&rft.au=Allen%2C+LA&rft.au=Nowels%2C+C&rft.au=Brieke%2C+A&rft.au=Cleveland%2C+JC&rft.au=Matlock%2C+DD&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4081474&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Iacovetto-56\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Iacovetto_56-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Iacovetto, MC; Matlock, DD; Mcillvennan, CK; et al. (2014). \"Educational resources for patients considering a left ventricular assist device: a cross-sectional review of internet, print, and multimedia materials\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Circulation_(journal)\" title=\"Circulation (journal)\" rel=\"external_link\" target=\"_blank\">Circulation: Cardiovascular Quality and Outcomes<\/a><\/i>. <b>7<\/b>: 905\u201311. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1161%2FCIRCOUTCOMES.114.000892\" target=\"_blank\">10.1161\/CIRCOUTCOMES.114.000892<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25316772\" target=\"_blank\">25316772<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Circulation%3A+Cardiovascular+Quality+and+Outcomes&rft.atitle=Educational+resources+for+patients+considering+a+left+ventricular+assist+device%3A+a+cross-sectional+review+of+internet%2C+print%2C+and+multimedia+materials.&rft.volume=7&rft.pages=905-11&rft.date=2014&rft_id=info%3Adoi%2F10.1161%2FCIRCOUTCOMES.114.000892&rft_id=info%3Apmid%2F25316772&rft.aulast=Iacovetto&rft.aufirst=MC&rft.au=Matlock%2C+DD&rft.au=Mcillvennan%2C+CK&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Explicit use of et al. (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Explicit_use_of_et_al.\" title=\"Category:CS1 maint: Explicit use of et al.\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Matlock_Decision_Aid-57\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Matlock_Decision_Aid_57-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Matlock, DD; Allen, LA; Thompson, JS; Mcilvennan, CK (31 July 2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/patientdecisionaid.org\/assets\/pdf\/lvad_ptda.pdf\" target=\"_blank\">\"A decision aid for Left Ventricular Assist Device (LVAD) for Destination Therapy A device for patients with advanced heart failure\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. University of Colorado School of Medicine.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=A+decision+aid+for+Left+Ventricular+Assist+Device+%28LVAD%29+for+Destination+Therapy+A+device+for+patients+with+advanced+heart+failure&rft.pub=University+of+Colorado+School+of+Medicine&rft.date=2014-07-31&rft.aulast=Matlock&rft.aufirst=DD&rft.au=Allen%2C+LA&rft.au=Thompson%2C+JS&rft.au=Mcilvennan%2C+CK&rft_id=https%3A%2F%2Fpatientdecisionaid.org%2Fassets%2Fpdf%2Flvad_ptda.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-58\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-58\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Ventracor was put into liquidation on 3 July 2009, whereby the company's assets including its intellectual property, data from clinical trials, plant and equipment and residual assets will be put up for sale<cite class=\"citation news\">Boyd, Tony (13 July 2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.businessspectator.com.au\/bs.nsf\/Article\/No-heart-pd20090703-TL6UR?OpenDocument&src=sph\" target=\"_blank\">\"No Heart\"<\/a>. <i>Business Spectator<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">15 September<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Business+Spectator&rft.atitle=No+Heart&rft.date=2009-07-13&rft.aulast=Boyd&rft.aufirst=Tony&rft_id=http%3A%2F%2Fwww.businessspectator.com.au%2Fbs.nsf%2FArticle%2FNo-heart-pd20090703-TL6UR%3FOpenDocument%26src%3Dsph&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVentricular+assist+device\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/mylvad.com\" target=\"_blank\">MyLVAD.com<\/a> Non-branded site with information on various LVADs<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/carewmedicalwear.com\" target=\"_blank\">CarewMedicalWear.com<\/a> Is a global supplier of LVAD Shirts for the HeartMateII and HeartMateIII<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.lvadshirt.com\" target=\"_blank\">LVADshirt.com<\/a> another global supplier of LVAD shirts and accessories<\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1327\nCached time: 20181129135720\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.704 seconds\nReal time usage: 0.811 seconds\nPreprocessor visited node count: 3640\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 124971\/2097152 bytes\nTemplate argument size: 4388\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 7\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 153302\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.429\/10.000 seconds\nLua memory usage: 8.29 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 712.000 1 -total\n<\/p>\n<pre>60.27% 429.128 1 Template:Reflist\n35.78% 254.786 28 Template:Cite_journal\n13.65% 97.154 7 Template:Citation_needed\n12.42% 88.416 7 Template:Fix\n10.66% 75.917 17 Template:Cite_news\n 7.75% 55.193 1 Template:Infobox_interventions\n 6.96% 49.582 1 Template:Infobox\n 6.64% 47.299 14 Template:Category_handler\n 5.23% 37.253 2 Template:Convert\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:3301527-1!canonical and timestamp 20181129135719 and revision id 870925255\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_assist_device\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212204\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.017 seconds\nReal time usage: 0.170 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 160.599 1 - wikipedia:Ventricular_assist_device\n100.00% 160.599 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8089-0!*!*!*!*!*!* and timestamp 20181217212204 and revision id 24208\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Ventricular_assist_device\">https:\/\/www.limswiki.org\/index.php\/Ventricular_assist_device<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","93d47d1af10e3a49de14ec5386c636fc_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2d\/Ventricular_assist_device.png\/560px-Ventricular_assist_device.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/56\/Blausen_0621_LVAD.png\/440px-Blausen_0621_LVAD.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d4\/1966_DeBakey_ventricular_assist_device.jpg\/240px-1966_DeBakey_ventricular_assist_device.jpg"],"93d47d1af10e3a49de14ec5386c636fc_timestamp":1545081724,"e1a2429a0fc4803b4a0ca02ab7bf2202_type":"article","e1a2429a0fc4803b4a0ca02ab7bf2202_title":"Vascular graft","e1a2429a0fc4803b4a0ca02ab7bf2202_url":"https:\/\/www.limswiki.org\/index.php\/Vascular_graft","e1a2429a0fc4803b4a0ca02ab7bf2202_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tVascular graft\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tA vascular bypass (or vascular graft) is a surgical procedure performed to redirect blood flow from one area to another by reconnecting blood vessels. Often, this is done to bypass around a diseased artery, from an area of normal blood flow to another relatively normal area. It is commonly performed due to inadequate blood flow (ischemia) caused by atherosclerosis, as a part of organ transplantation, or for vascular access in hemodialysis. In general, someone's own vein (autograft) is the preferred graft material (or conduit) for a vascular bypass, but other types of grafts such as polytetrafluoroethylene (Teflon), polyethylene terephthalate (Dacron), or a different person's vein (allograft) are also commonly used. Arteries can also serve as vascular grafts. A surgeon sews the graft to the source and target vessels by hand using surgical suture, creating a surgical anastomosis.\nCommon bypass sites include the heart (coronary artery bypass surgery) to treat coronary artery disease, and the legs, to treat peripheral vascular disease.\n\nContents \n\n1 Medical uses \n\n1.1 Cardiac bypass \n1.2 Leg (lower extremity) bypass \n1.3 Hemodialysis access \n1.4 Cerebral artery bypass \n\n\n2 Evaluation \n3 Contraindications \n4 Techniques \n\n4.1 Standard techniques \n4.2 ELANA \n\n\n5 Risks and complications \n6 Recovery \n7 References \n\n\nMedical uses \nCardiac bypass \nMain article: Coronary artery bypass surgery\nCardiac bypass is performed when the arteries that bring blood to the heart muscle (coronary arteries) become clogged by plaque.[1][2] Such a condition may cause chest pain from angina pectoris or a heart attack.\n\n Leg (lower extremity) bypass \nIn the legs, bypass grafting is used to treat peripheral vascular disease, acute limb ischemia, aneurysms and trauma. While there are many anatomical arrangements for vascular bypass grafts in the lower extremities depending on the location of the disease, the principle is the same: to restore blood flow to an area without normal flow. \nFor example, a femoral-popliteal bypass (\"fem-pop\") might be used if the femoral artery is occluded. A fem-pop bypass may refer to the above- or below-knee popliteal artery. Other anatomic descriptions of lower extremity bypasses include:\n\n\"fem-fem\" - femoral to femoral bypass, e.g. from right to left. Used when there is no inflow to one femoral artery (i.e., the iliac artery on the receiving side is diseased) but there is aortic flow.\n\"aorto-bifem\" - aortic to both femoral arteries. Used when there is disease at the aortic bifurcation, known as Leriche syndrome, or in both iliac arteries.\n\"ax-bifem\" - axillary artery to both femoral artery bypass. Either axillary artery can be used as the origin of the bypass. Used when patient cannot tolerate a more invasive and higher risk aorto-bifem, or when removing an infected aortic graft such as an EVAR device.\n\"fem-tib\" - femoral to one of the three tibial arteries (Anterior, Posterior or Peroneal). Used for disease of the femoral and tibial arteries, this procedure is used most frequently in people with diabetes, which tends to create disease in the tibial arteries rather than the more proximal arteries.[3]\na \"DP\" bypass - any vascular bypass where the target is the dorsalis pedis artery on the dorsum of the foot. It is used in similar situations to those described for the fem-tib bypass.\nHemodialysis access \nMain article: Vascular access\n An arteriovenous graft serving as a fistula for hemodialysis access\nA vascular bypass is often created to serve as an access point to the circulatory system for hemodialysis. Such a bypass is referred to as an arteriovenous fistula if it directly connects a vein to an artery without using synthetic material.\n\nCerebral artery bypass \nIn the skull, when blood flow is blocked or a damaged cerebral artery prevents adequate blood flow to the brain, a cerebral artery bypass may be performed to improve or restore flow to an oxygen-deprived (ischemic) area of the brain.[4]\nWhen several arteries are blocked and several bypasses are needed, the procedure is called multiple bypass. The number of bypasses needed does not always increase the risk of surgery, which depend more on the patient's overall health.\n\nEvaluation \nPrior to constructing a bypass, most surgeons will obtain or perform an imaging study to determine the severity and location of the diseased blood vessels. For cardiac and lower extremity disease, this is usually in the form of an angiogram. For hemodialysis access, this can be done with ultrasound. Occasionally, a CT angiogram will take the place of a formal angiogram.\n\nContraindications \nThe lack of an adequate venous conduit is a relative contraindication to bypass surgery, and depending on the area of disease, alternatives may be used. Medical conditions such as ischemic heart disease or chronic obstructive pulmonary disease that increase the risk of surgery are also relative contraindications. For coronary and peripheral vascular disease, lack of \"runoff\" to the distal area is also a contraindication because a vascular bypass around one diseased artery to another diseased area does not solve the vascular problem.\nIf a patient is deemed to be too high-risk to undergo a bypass, he or she may be a candidate for angioplasty or stenting of the relevant vessel.\n\nTechniques \nStandard techniques \nDogma in vascular bypass technique says to obtain proximal and distal control. This means that in a vessel with flow through it, a surgeon must be have exposure of the furthest and nearest extents of the blood vessel in which the bypass is being created, so that when the vessel is opened, blood loss is minimized. After the necessary exposure, clamps are usually used on both the proximal and distal end of the segment. Exceptions exist where there is no blood flow through the target vessel at the area of proposed entry, as is the case with an intervening occlusion.\nIf the organ perfused by an artery is sensitive to even temporary occlusion of blood flow, such as in the brain, various other measures are taken.\n\nELANA \nIn neurosurgery, excimer laser assisted non-occlusive anastomosis (ELANA) is a technique use to create a bypass without interrupting the blood supply in the recipient blood vessels. This reduces the risk of stroke or a rupture of an aneurysm.\nThe ELANA technique is a subtle modification of other methods to establish a connection between blood vessels (anastomosis) to create a bypass in or to the brain. The differences involve how the recipient artery is opened. In conventional techniques, the recipient artery is temporarily interrupted (occluded with clips) and opened using microscissors or scalpel, while in the ELANA technique blood flow is not interrupted and the opening (arteriotomy) is created with radiation from a 308 nm excimer laser delivered through a catheter inserted in the vessel that will become the bypass while blood continues to flow through the artery that receives the bypass. This difference reduces the risk of ischemia to the regions supplied by the artery receiving the bypass. The technique is most valuable in neurosurgery, as brain cells are particularly sensitive to the lack of blood supply (ischemia), including those created by older methods of bypass. Bypasses created with the help of the ELANA can be to major arteries in the brain, including extracranial to intracranial bypass, or between two arteries in the brain (intracranial to intracranial).\nSurgeons create these bypasses mainly as a step in the treatment of patients with unclippable and uncoilable giant aneurysms or tumors at the base of the skull or to treat patients at risk of stroke who can not otherwise be treated.\nThe ELANA technique has been extensively described in medical literature. It was developed starting in 1993[5] to find a way to treat patients with a bypass to a major cerebral artery without the risk of cerebral ischemia during the procedure. This technique has been reported by the general news media.[6]\n\nRisks and complications \nSeveral complications can arise after vascular bypass.[7]\nRisks of the bypass:\n\nAcute graft occlusion is the occlusion (blockage) of a vascular bypass graft shortly after the bypass is performed. Its causes, which are distinct from those of chronic graft occlusion, include technical failure (e.g. anastomotic stricture, incomplete valve lysis in non-reversed vein) and thrombosis. It is rare, but almost always requires reoperation.\nGeneral risks of surgery:\n\nHemorrhage (bleeding)\nInfection\nEmbolism\nRecovery \nImmediately following coronary artery or neurosurgical vascular bypass surgery, patients recover in an intensive care unit or coronary care unit for one to two days. Provided that recovery is normal and without complications, they can move to a less intensively monitored unit such as a step-down unit or a ward bed. Depending on the extent of the surgery, recovery from a leg bypass may start from a step-down or ward bed. Monitoring immediately after bypass surgery focuses on signs and symptoms of bleeding and graft occlusion. If bleeding is detected, treatment can range from transfusion to reoperation. Later on in the hospital course, common complications include wound infections, pneumonia, urinary tract infection, and graft occlusion.[8]\nAt discharge, patients are often prescribed oral painkillers, and should be prescribed a statin and an anti-platelet medication if not contraindicated and their bypass was performed for atherosclerosis, (e.g., peripheral vascular disease or coronary artery disease). Some patients start feeling normal after one month, while others may still experience problems several months after the procedure.[8][9]\nDuring the first twelve weeks after most bypass operations, patients are advised to avoid heavy lifting, house work, and strenuous recreation like golf, tennis, or swimming while their surgical wounds heal, particularly the sternum after coronary bypass.[8][10]\nPart of the recovery after any bypass surgery includes regular visits to a physician to monitor the patient's recovery. Normally a follow-up visit with a surgeon is scheduled for two to four weeks after surgery. The frequency of these visits gradually lessens as the patient's health improves.[8]\nFor vascular bypass operations performed for atherosclerosis, the operation does not cure the metabolic problem that led to the vascular disease. Lifestyle changes that include quitting smoking, making diet changes, and getting regular exercise are required to cure the underlying condition.[8][11]\n\nReferences \n\n\n^ \"What Is Coronary Artery Bypass Grafting\". www.nhlbi.nih.gov. National Institutes of Health \u2014 National Heart, Lung, and Blood Institute. Retrieved 11 November 2016 . \n\n^ \"Bypass Surgery, Coronary Artery\". Retrieved 8 April 2010 . \n\n^ Aboyans, V.; Lacroix, P.; Criqui, M.H. (Sep\u2013Oct 2007). \"Large and Small Vessel Atherosclerosis: Similarities and Differences\". Progress in Cardiovascular Diseases. 50 (2): 112\u2013125. doi:10.1016\/j.pcad.2007.04.001. PMID 17765473. \n\n^ \"What is Cerebral Bypass Surgery?\". mayvfieldclinic.com. Mayfield Brain and Spine. Retrieved 8 April 2010 . \n\n^ Tulleken, C.A.; Verdaasdonk, R.M.; Beck, R.J.; Mali, W.P. (November 1996). \"The Modified Excimer Laser-Assisted High-Flow Bypass Operation\". Surgical Neurology. 46 (5): 424\u2013429. doi:10.1016\/s0090-3019(96)00096-1. PMID 8874539. \n\n^ Grady, Denise (December 19, 2006). \"With Lasers and Daring, Doctors Race to Save a Young Man's Brain\". New York Times. p. F1. Retrieved 11 November 2016 . \n\n^ \"What Are the Risks of Coronary Artery Bypass Grafting?\". nhlbi.nih.gov. National Institutes of Health \u2014 National Heart, Lung, and Blood Institute. Retrieved 11 November 2016 . \n\n^ a b c d e \"What To Expect After Coronary Artery Bypass Grafting\". nhlbi.nih.gov. National Institutes of Health \u2014 National Heart, Lung, and Blood Institute. Retrieved 11 November 2016 . \n\n^ \"After Bypass Surgery Care and Results\". Retrieved 8 April 2010 . \n\n^ \"Life After Bypass Surgery\". Retrieved 8 April 2010 . \n\n^ \"Heart Bypass Surgery\". Retrieved 8 April 2010 . \n\n\nvteSurgery and other procedures involving the heart (ICD-9-CM V3 35\u201337+89.4+99.6, ICD-10-PCS 02)Surgery and ICHeart valves\r\nand septa\nValve repair\nValvulotomy\nMitral valve repair\nValvuloplasty\naortic\nmitral\nValve replacement\nAortic valve repair\nAortic valve replacement\nRoss procedure\nPercutaneous aortic valve replacement\nMitral valve replacement\nproduction of septal defect in heart \nenlargement of existing septal defect\nAtrial septostomy\nBalloon septostomy<\/dd>\ncreation of septal defect in heart\n\nBlalock\u2013Hanlon procedure<\/dd>\nshunt from heart chamber to blood vessel \natrium to pulmonary artery\nFontan procedure<\/dd>\nleft ventricle to aorta\n\nRastelli procedure<\/dd>\nright ventricle to pulmonary artery\n\nSano shunt<\/dd>\ncompound procedures \nfor transposition of great vessels\nArterial switch operation\nMustard procedure\nSenning procedure<\/dd>\nfor univentricular defect\n\nNorwood procedure\nKawashima procedure<\/dd>\nshunt from blood vessel to blood vessel \nsystemic circulation to pulmonary artery shunt\nBlalock\u2013Taussig shunt<\/dd>\nSVC to the right PA\n\nGlenn procedure<\/dd>\nCardiac vessels\nCHD \nAngioplasty\nBypass\/Coronary artery bypass\nMIDCAB\nOff-pump CAB\nTECAB<\/dd>\nCoronary stent \nBare-metal stent\nDrug-eluting stent\nBentall procedure\nValve-sparing aortic root replacement\nLeCompte maneuver\nOther\nPericardium \nPericardiocentesis\nPericardial window\nPericardiectomy\nMyocardium \nCardiomyoplasty\nDor procedure\nSeptal myectomy\nVentricular reduction\nAlcohol septal ablation\nConduction system \nMaze procedure\nCox maze and minimaze<\/dd>\nCatheter ablation\n\nCryoablation\nRadiofrequency ablation<\/dd>\nPacemaker insertion\nLeft atrial appendage occlusion\nCardiotomy\nHeart transplantation\nDiagnostic\r\ntests and\r\nprocedures\nElectrophysiology \nElectrocardiography\nVectorcardiography<\/dd>\nHolter monitor\nImplantable loop recorder\nCardiac stress test\n\nBruce protocol<\/dd>\nElectrophysiology study\nCardiac imaging \nAngiocardiography\nEchocardiography\nTTE\nTEE<\/dd>\nMyocardial perfusion imaging\nCardiovascular MRI\nVentriculography\n\nRadionuclide ventriculography<\/dd>\nCardiac catheterization\/Coronary catheterization\nCardiac CT\n\nCardiac PET\nsound \nPhonocardiogram\nFunction tests\nImpedance cardiography\nBallistocardiography\nCardiotocography\nPacing\nCardioversion\nTranscutaneous pacing\n\nvteVascular surgery ICD-9-CM V3 38\u201339, ICD-10-PCS 03\u20136Vascular and \r\nEndovascular surgeryArterial disease\nVascular bypass\nAngioplasty\nAtherectomy\nEndarterectomy\nCarotid endarterectomy\nStenting\nCarotid stenting\nVenous disease\nAmbulatory phlebectomy\nLaser surgery\nSclerotherapy\nVein stripping\nArterial and venous access\nVenous cutdown\nArteriotomy\nPhlebotomy\nAortic aneurysm \/ dissection:\nEndovascular aneurysm repair\nOpen aortic surgery\nOther\nCardiopulmonary bypass\nCardioplegia\nExtracorporeal membrane oxygenation\nVascular access\nRevascularization\nFirst rib resection\nSeldinger technique\nVascular snare\nMedical imagingAngiography\nDigital subtraction angiography\nCerebral angiography\nAortography\nFluorescein angiography\nRadionuclide angiography\nMagnetic resonance angiography\nVenography\nPortography\nImpedance phlebography\nUltrasound\nIntravascular ultrasound\nCarotid ultrasonography\nOther diagnostic\nAngioscopy\nAnkle brachial pressure index\nToe pressure\nTilt table test\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Vascular_graft\">https:\/\/www.limswiki.org\/index.php\/Vascular_graft<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical and surgical techniquesMedical devicesHidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","e1a2429a0fc4803b4a0ca02ab7bf2202_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Vascular_graft skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Vascular graft<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>A <b>vascular bypass<\/b> (or <b>vascular graft<\/b>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgical procedure<\/a> performed to redirect <a href=\"https:\/\/en.wikipedia.org\/wiki\/Circulatory_system\" title=\"Circulatory system\" rel=\"external_link\" target=\"_blank\">blood flow<\/a> from one area to another by reconnecting blood vessels. Often, this is done to bypass around a diseased artery, from an area of normal blood flow to another relatively normal area. It is commonly performed due to inadequate blood flow (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Ischemia\" title=\"Ischemia\" rel=\"external_link\" target=\"_blank\">ischemia<\/a>) caused by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atherosclerosis\" title=\"Atherosclerosis\" rel=\"external_link\" target=\"_blank\">atherosclerosis<\/a>, as a part of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organ_transplantation\" title=\"Organ transplantation\" rel=\"external_link\" target=\"_blank\">organ transplantation<\/a>, or for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular_access\" title=\"Vascular access\" rel=\"external_link\" target=\"_blank\">vascular access<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a>. In general, someone's own <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">vein<\/a> (autograft) is the preferred graft material (or conduit) for a vascular bypass, but other types of grafts such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polytetrafluoroethylene\" title=\"Polytetrafluoroethylene\" rel=\"external_link\" target=\"_blank\">polytetrafluoroethylene<\/a> (Teflon), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene_terephthalate\" title=\"Polyethylene terephthalate\" rel=\"external_link\" target=\"_blank\">polyethylene terephthalate<\/a> (Dacron), or a different person's vein (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Allotransplantation\" title=\"Allotransplantation\" rel=\"external_link\" target=\"_blank\">allograft<\/a>) are also commonly used. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">Arteries<\/a> can also serve as vascular grafts. A surgeon sews the graft to the source and target vessels by hand using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" title=\"Surgical suture\" rel=\"external_link\" target=\"_blank\">surgical suture<\/a>, creating a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_anastomosis\" title=\"Surgical anastomosis\" rel=\"external_link\" target=\"_blank\">surgical anastomosis<\/a>.\n<\/p><p>Common bypass sites include the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart\" title=\"Heart\" rel=\"external_link\" target=\"_blank\">heart<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery_bypass_surgery\" title=\"Coronary artery bypass surgery\" rel=\"external_link\" target=\"_blank\">coronary artery bypass surgery<\/a>) to treat coronary artery disease, and the legs, to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peripheral_vascular_disease\" class=\"mw-redirect\" title=\"Peripheral vascular disease\" rel=\"external_link\" target=\"_blank\">peripheral vascular disease<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Cardiac_bypass\">Cardiac bypass<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery_bypass_surgery\" title=\"Coronary artery bypass surgery\" rel=\"external_link\" target=\"_blank\">Coronary artery bypass surgery<\/a><\/div>\n<p>Cardiac bypass is performed when the arteries that bring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood\" title=\"Blood\" rel=\"external_link\" target=\"_blank\">blood<\/a> to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_muscle\" class=\"mw-redirect\" title=\"Heart muscle\" rel=\"external_link\" target=\"_blank\">heart muscle<\/a> (coronary arteries) become clogged by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atheroma\" title=\"Atheroma\" rel=\"external_link\" target=\"_blank\">plaque<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-AHA_2-0\" class=\"reference\"><a href=\"#cite_note-AHA-2\" rel=\"external_link\">[2]<\/a><\/sup> Such a condition may cause chest pain from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angina_pectoris\" class=\"mw-redirect\" title=\"Angina pectoris\" rel=\"external_link\" target=\"_blank\">angina pectoris<\/a> or a heart attack.\n<\/p>\n<h3><span id=\"rdp-ebb-Leg_.28lower_extremity.29_bypass\"><\/span><span class=\"mw-headline\" id=\"Leg_(lower_extremity)_bypass\">Leg (lower extremity) bypass<\/span><\/h3>\n<p>In the legs, bypass grafting is used to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peripheral_vascular_disease\" class=\"mw-redirect\" title=\"Peripheral vascular disease\" rel=\"external_link\" target=\"_blank\">peripheral vascular disease<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acute_limb_ischemia\" class=\"mw-redirect\" title=\"Acute limb ischemia\" rel=\"external_link\" target=\"_blank\">acute limb ischemia<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aneurysm\" title=\"Aneurysm\" rel=\"external_link\" target=\"_blank\">aneurysms<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trauma_(medicine)\" class=\"mw-redirect\" title=\"Trauma (medicine)\" rel=\"external_link\" target=\"_blank\">trauma<\/a>. While there are many anatomical arrangements for vascular bypass grafts in the lower extremities depending on the location of the disease, the principle is the same: to restore blood flow to an area without normal flow. \n<\/p><p>For example, a femoral-popliteal bypass (<b>\"fem-pop\"<\/b>) might be used if the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femoral_artery\" title=\"Femoral artery\" rel=\"external_link\" target=\"_blank\">femoral artery<\/a> is occluded. A fem-pop bypass may refer to the above- or below-knee popliteal artery. Other anatomic descriptions of lower extremity bypasses include:\n<\/p>\n<ul><li><b>\"fem-fem\"<\/b> - femoral to femoral bypass, e.g. from right to left. Used when there is no inflow to one femoral artery (i.e., the iliac artery on the receiving side is diseased) but there is aortic flow.<\/li>\n<li><b>\"aorto-bifem\"<\/b> - aortic to both femoral arteries. Used when there is disease at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aortic_bifurcation\" title=\"Aortic bifurcation\" rel=\"external_link\" target=\"_blank\">aortic bifurcation<\/a>, known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Leriche_syndrome\" class=\"mw-redirect\" title=\"Leriche syndrome\" rel=\"external_link\" target=\"_blank\">Leriche syndrome<\/a>, or in both iliac arteries.<\/li>\n<li><b>\"ax-bifem\"<\/b> - <a href=\"https:\/\/en.wikipedia.org\/wiki\/Axillary_artery\" title=\"Axillary artery\" rel=\"external_link\" target=\"_blank\">axillary artery<\/a> to both femoral artery bypass. Either axillary artery can be used as the origin of the bypass. Used when patient cannot tolerate a more invasive and higher risk aorto-bifem, or when removing an infected aortic graft such as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/EVAR\" class=\"mw-redirect\" title=\"EVAR\" rel=\"external_link\" target=\"_blank\">EVAR<\/a> device.<\/li>\n<li><b>\"fem-tib\"<\/b> - femoral to one of the three tibial arteries (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Anterior_tibial_artery\" title=\"Anterior tibial artery\" rel=\"external_link\" target=\"_blank\">Anterior<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Posterior_tibial_artery\" title=\"Posterior tibial artery\" rel=\"external_link\" target=\"_blank\">Posterior<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibular_artery\" title=\"Fibular artery\" rel=\"external_link\" target=\"_blank\">Peroneal<\/a>). Used for disease of the femoral and tibial arteries, this procedure is used most frequently in people with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetes\" class=\"mw-redirect\" title=\"Diabetes\" rel=\"external_link\" target=\"_blank\">diabetes<\/a>, which tends to create disease in the tibial arteries rather than the more <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatomical_terms_of_location#Proximal_and_distal\" title=\"Anatomical terms of location\" rel=\"external_link\" target=\"_blank\">proximal<\/a> arteries.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li>\n<li>a <b>\"DP\"<\/b> bypass - any vascular bypass where the target is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dorsalis_pedis_artery\" title=\"Dorsalis pedis artery\" rel=\"external_link\" target=\"_blank\">dorsalis pedis artery<\/a> on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dorsum_(anatomy)\" class=\"mw-redirect\" title=\"Dorsum (anatomy)\" rel=\"external_link\" target=\"_blank\">dorsum<\/a> of the foot. It is used in similar situations to those described for the fem-tib bypass.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Hemodialysis_access\">Hemodialysis access<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular_access\" title=\"Vascular access\" rel=\"external_link\" target=\"_blank\">Vascular access<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:302px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Blausen_0050_ArteriovenousGraft.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f6\/Blausen_0050_ArteriovenousGraft.png\/300px-Blausen_0050_ArteriovenousGraft.png\" width=\"300\" height=\"150\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Blausen_0050_ArteriovenousGraft.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An arteriovenous graft serving as a fistula for hemodialysis access<\/div><\/div><\/div>\n<p>A vascular bypass is often created to serve as an access point to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Circulatory_system\" title=\"Circulatory system\" rel=\"external_link\" target=\"_blank\">circulatory system<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a>. Such a bypass is referred to as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arteriovenous_fistula\" title=\"Arteriovenous fistula\" rel=\"external_link\" target=\"_blank\">arteriovenous fistula<\/a> if it directly connects a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">vein<\/a> to an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">artery<\/a> without using synthetic material.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Cerebral_artery_bypass\">Cerebral artery bypass<\/span><\/h3>\n<p>In the skull, when blood flow is blocked or a damaged <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_artery\" class=\"mw-redirect\" title=\"Cerebral artery\" rel=\"external_link\" target=\"_blank\">cerebral artery<\/a> prevents adequate blood flow to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain\" title=\"Brain\" rel=\"external_link\" target=\"_blank\">brain<\/a>, a cerebral artery bypass may be performed to improve or restore flow to an oxygen-deprived (ischemic) area of the brain.<sup id=\"rdp-ebb-cite_ref-MayField_4-0\" class=\"reference\"><a href=\"#cite_note-MayField-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>When several arteries are blocked and several bypasses are needed, the procedure is called multiple bypass. The number of bypasses needed does not always increase the risk of surgery, which depend more on the patient's overall health.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Evaluation\">Evaluation<\/span><\/h2>\n<p>Prior to constructing a bypass, most surgeons will obtain or perform an imaging study to determine the severity and location of the diseased blood vessels. For cardiac and lower extremity disease, this is usually in the form of an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angiogram\" class=\"mw-redirect\" title=\"Angiogram\" rel=\"external_link\" target=\"_blank\">angiogram<\/a>. For hemodialysis access, this can be done with ultrasound. Occasionally, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/CT_angiogram\" class=\"mw-redirect\" title=\"CT angiogram\" rel=\"external_link\" target=\"_blank\">CT angiogram<\/a> will take the place of a formal angiogram.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Contraindications\">Contraindications<\/span><\/h2>\n<p>The lack of an adequate venous conduit is a relative contraindication to bypass surgery, and depending on the area of disease, alternatives may be used. Medical conditions such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ischemic_heart_disease\" class=\"mw-redirect\" title=\"Ischemic heart disease\" rel=\"external_link\" target=\"_blank\">ischemic heart disease<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_obstructive_pulmonary_disease\" title=\"Chronic obstructive pulmonary disease\" rel=\"external_link\" target=\"_blank\">chronic obstructive pulmonary disease<\/a> that increase the risk of surgery are also relative contraindications. For coronary and peripheral vascular disease, lack of \"runoff\" to the distal area is also a contraindication because a vascular bypass around one diseased artery to another diseased area does not solve the vascular problem.\n<\/p><p>If a patient is deemed to be too high-risk to undergo a bypass, he or she may be a candidate for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angioplasty\" title=\"Angioplasty\" rel=\"external_link\" target=\"_blank\">angioplasty<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stenting<\/a> of the relevant vessel.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Techniques\">Techniques<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Standard_techniques\">Standard techniques<\/span><\/h3>\n<p>Dogma in vascular bypass technique says to obtain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatomical_terms_of_location#Proximal_and_distal\" title=\"Anatomical terms of location\" rel=\"external_link\" target=\"_blank\">proximal<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatomical_terms_of_location#Proximal_and_distal\" title=\"Anatomical terms of location\" rel=\"external_link\" target=\"_blank\">distal<\/a> control. This means that in a vessel with flow through it, a surgeon must be have exposure of the furthest and nearest extents of the blood vessel in which the bypass is being created, so that when the vessel is opened, blood loss is minimized. After the necessary exposure, clamps are usually used on both the proximal and distal end of the segment. Exceptions exist where there is no blood flow through the target vessel at the area of proposed entry, as is the case with an intervening occlusion.\n<\/p><p>If the organ perfused by an artery is sensitive to even temporary occlusion of blood flow, such as in the brain, various other measures are taken.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"ELANA\">ELANA<\/span><\/h3>\n<p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurosurgery\" title=\"Neurosurgery\" rel=\"external_link\" target=\"_blank\">neurosurgery<\/a>, excimer laser assisted non-occlusive anastomosis (ELANA) is a technique use to create a bypass without interrupting the blood supply in the recipient blood vessels. This reduces the risk of stroke or a rupture of an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aneurysm\" title=\"Aneurysm\" rel=\"external_link\" target=\"_blank\">aneurysm<\/a>.\n<\/p><p>The ELANA technique is a subtle modification of other methods to establish a connection between blood vessels (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Anastomosis\" title=\"Anastomosis\" rel=\"external_link\" target=\"_blank\">anastomosis<\/a>) to create a bypass in or to the brain. The differences involve how the recipient <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">artery<\/a> is opened. In conventional techniques, the recipient artery is temporarily interrupted (occluded with clips) and opened using microscissors or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scalpel\" title=\"Scalpel\" rel=\"external_link\" target=\"_blank\">scalpel<\/a>, while in the ELANA technique blood flow is not interrupted and the opening (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Arteriotomy\" title=\"Arteriotomy\" rel=\"external_link\" target=\"_blank\">arteriotomy<\/a>) is created with radiation from a 308 nm excimer laser delivered through a catheter inserted in the vessel that will become the bypass while blood continues to flow through the artery that receives the bypass. This difference reduces the risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ischemia\" title=\"Ischemia\" rel=\"external_link\" target=\"_blank\">ischemia<\/a> to the regions supplied by the artery receiving the bypass. The technique is most valuable in neurosurgery, as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuron\" title=\"Neuron\" rel=\"external_link\" target=\"_blank\">brain cells<\/a> are particularly sensitive to the lack of blood supply (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Ischemia\" title=\"Ischemia\" rel=\"external_link\" target=\"_blank\">ischemia<\/a>), including those created by older methods of bypass. Bypasses created with the help of the ELANA can be to major arteries in the brain, including extracranial to intracranial bypass, or between two arteries in the brain (intracranial to intracranial).\n<\/p><p>Surgeons create these bypasses mainly as a step in the treatment of patients with unclippable and uncoilable giant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aneurysms\" class=\"mw-redirect\" title=\"Aneurysms\" rel=\"external_link\" target=\"_blank\">aneurysms<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumors\" class=\"mw-redirect\" title=\"Tumors\" rel=\"external_link\" target=\"_blank\">tumors<\/a> at the base of the skull or to treat patients at risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a> who can not otherwise be treated.\n<\/p><p>The ELANA technique has been extensively described in medical literature. It was developed starting in 1993<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> to find a way to treat patients with a bypass to a major <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_artery\" class=\"mw-redirect\" title=\"Cerebral artery\" rel=\"external_link\" target=\"_blank\">cerebral artery<\/a> without the risk of cerebral ischemia during the procedure. This technique has been reported by the general news media.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Risks_and_complications\">Risks and complications<\/span><\/h2>\n<p>Several complications can arise after vascular bypass.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>Risks of the bypass:\n<\/p>\n<ul><li><b>Acute graft occlusion<\/b> is the occlusion (blockage) of a vascular bypass graft shortly after the bypass is performed. Its causes, which are distinct from those of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein_graft_failure\" title=\"Vein graft failure\" rel=\"external_link\" target=\"_blank\">chronic graft occlusion<\/a>, include technical failure (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_anastomosis\" title=\"Surgical anastomosis\" rel=\"external_link\" target=\"_blank\">anastomotic<\/a> stricture, incomplete in non-reversed vein) and thrombosis. It is rare, but almost always requires <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery#terminology\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">reoperation<\/a>.<\/li><\/ul>\n<p>General risks of surgery:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemorrhage\" class=\"mw-redirect\" title=\"Hemorrhage\" rel=\"external_link\" target=\"_blank\">Hemorrhage<\/a> (bleeding)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">Infection<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Embolism\" title=\"Embolism\" rel=\"external_link\" target=\"_blank\">Embolism<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Recovery\">Recovery<\/span><\/h2>\n<p>Immediately following coronary artery or neurosurgical vascular bypass surgery, patients recover in an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intensive_care_unit\" title=\"Intensive care unit\" rel=\"external_link\" target=\"_blank\">intensive care unit<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_care_unit\" title=\"Coronary care unit\" rel=\"external_link\" target=\"_blank\">coronary care unit<\/a> for one to two days. Provided that recovery is normal and without <a href=\"https:\/\/en.wikipedia.org\/wiki\/Complication_(medicine)\" title=\"Complication (medicine)\" rel=\"external_link\" target=\"_blank\">complications<\/a>, they can move to a less intensively monitored unit such as a or a . Depending on the extent of the surgery, recovery from a leg bypass may start from a step-down or ward bed. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monitoring_(medicine)\" title=\"Monitoring (medicine)\" rel=\"external_link\" target=\"_blank\">Monitoring<\/a> immediately after bypass surgery focuses on signs and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Symptom\" title=\"Symptom\" rel=\"external_link\" target=\"_blank\">symptoms<\/a> of bleeding and graft occlusion. If bleeding is detected, treatment can range from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_transfusion\" title=\"Blood transfusion\" rel=\"external_link\" target=\"_blank\">transfusion<\/a> to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery#terminology\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">reoperation<\/a>. Later on in the hospital course, common complications include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection#Primary_versus_opportunistic\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">wound infections<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pneumonia\" title=\"Pneumonia\" rel=\"external_link\" target=\"_blank\">pneumonia<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinary_tract_infection\" title=\"Urinary tract infection\" rel=\"external_link\" target=\"_blank\">urinary tract infection<\/a>, and graft occlusion.<sup id=\"rdp-ebb-cite_ref-NIHafter_8-0\" class=\"reference\"><a href=\"#cite_note-NIHafter-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>At discharge, patients are often prescribed oral painkillers, and should be prescribed a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Statin\" title=\"Statin\" rel=\"external_link\" target=\"_blank\">statin<\/a> and an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antiplatelet_drug\" title=\"Antiplatelet drug\" rel=\"external_link\" target=\"_blank\">anti-platelet medication<\/a> if not contraindicated and their bypass was performed for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atherosclerosis\" title=\"Atherosclerosis\" rel=\"external_link\" target=\"_blank\">atherosclerosis<\/a>, (e.g., <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peripheral_vascular_disease\" class=\"mw-redirect\" title=\"Peripheral vascular disease\" rel=\"external_link\" target=\"_blank\">peripheral vascular disease<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery_disease\" title=\"Coronary artery disease\" rel=\"external_link\" target=\"_blank\">coronary artery disease<\/a>). Some patients start feeling normal after one month, while others may still experience problems several months after the procedure.<sup id=\"rdp-ebb-cite_ref-NIHafter_8-1\" class=\"reference\"><a href=\"#cite_note-NIHafter-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-AfterBS_9-0\" class=\"reference\"><a href=\"#cite_note-AfterBS-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>During the first twelve weeks after most bypass operations, patients are advised to avoid heavy lifting, house work, and strenuous recreation like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Golf\" title=\"Golf\" rel=\"external_link\" target=\"_blank\">golf<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tennis\" title=\"Tennis\" rel=\"external_link\" target=\"_blank\">tennis<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Swimming_(sport)\" title=\"Swimming (sport)\" rel=\"external_link\" target=\"_blank\">swimming<\/a> while their surgical wounds heal, particularly the sternum after coronary bypass.<sup id=\"rdp-ebb-cite_ref-NIHafter_8-2\" class=\"reference\"><a href=\"#cite_note-NIHafter-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-ehealth_10-0\" class=\"reference\"><a href=\"#cite_note-ehealth-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>Part of the recovery after any bypass surgery includes regular visits to a physician to monitor the patient's recovery. Normally a follow-up visit with a surgeon is scheduled for two to four weeks after surgery. The frequency of these visits gradually lessens as the patient's health improves.<sup id=\"rdp-ebb-cite_ref-NIHafter_8-3\" class=\"reference\"><a href=\"#cite_note-NIHafter-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>For vascular bypass operations performed for atherosclerosis, the operation does not cure the metabolic problem that led to the vascular disease. Lifestyle changes that include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quitting_smoking\" class=\"mw-redirect\" title=\"Quitting smoking\" rel=\"external_link\" target=\"_blank\">quitting smoking<\/a>, making <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diet_(nutrition)\" title=\"Diet (nutrition)\" rel=\"external_link\" target=\"_blank\">diet<\/a> changes, and getting regular exercise are required to cure the underlying condition.<sup id=\"rdp-ebb-cite_ref-NIHafter_8-4\" class=\"reference\"><a href=\"#cite_note-NIHafter-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nhlbi.nih.gov\/health\/health-topics\/topics\/cabg\" target=\"_blank\">\"What Is Coronary Artery Bypass Grafting\"<\/a>. <i>www.nhlbi.nih.gov<\/i>. National Institutes of Health \u2014 National Heart, Lung, and Blood Institute<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 November<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.nhlbi.nih.gov&rft.atitle=What+Is+Coronary+Artery+Bypass+Grafting&rft_id=https%3A%2F%2Fwww.nhlbi.nih.gov%2Fhealth%2Fhealth-topics%2Ftopics%2Fcabg&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVascular+bypass\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-AHA-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-AHA_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.americanheart.org\/presenter.jhtml?identifier=4484\/\" target=\"_blank\">\"Bypass Surgery, Coronary Artery\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">8 April<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Bypass+Surgery%2C+Coronary+Artery&rft_id=http%3A%2F%2Fwww.americanheart.org%2Fpresenter.jhtml%3Fidentifier%3D4484%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVascular+bypass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Aboyans, V.; Lacroix, P.; Criqui, M.H. (Sep\u2013Oct 2007). \"Large and Small Vessel Atherosclerosis: Similarities and Differences\". <i>Progress in Cardiovascular Diseases<\/i>. <b>50<\/b> (2): 112\u2013125. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.pcad.2007.04.001\" target=\"_blank\">10.1016\/j.pcad.2007.04.001<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17765473\" target=\"_blank\">17765473<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Progress+in+Cardiovascular+Diseases&rft.atitle=Large+and+Small+Vessel+Atherosclerosis%3A+Similarities+and+Differences&rft.volume=50&rft.issue=2&rft.pages=112-125&rft.date=2007-09%2F2007-10&rft_id=info%3Adoi%2F10.1016%2Fj.pcad.2007.04.001&rft_id=info%3Apmid%2F17765473&rft.aulast=Aboyans&rft.aufirst=V.&rft.au=Lacroix%2C+P.&rft.au=Criqui%2C+M.H.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVascular+bypass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-MayField-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MayField_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mayfieldclinic.com\/PE-CerebralBypass.htm\" target=\"_blank\">\"What is Cerebral Bypass Surgery?\"<\/a>. <i>mayvfieldclinic.com<\/i>. Mayfield Brain and Spine<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">8 April<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=mayvfieldclinic.com&rft.atitle=What+is+Cerebral+Bypass+Surgery%3F&rft_id=http%3A%2F%2Fwww.mayfieldclinic.com%2FPE-CerebralBypass.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVascular+bypass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tulleken, C.A.; Verdaasdonk, R.M.; Beck, R.J.; Mali, W.P. (November 1996). \"The Modified Excimer Laser-Assisted High-Flow Bypass Operation\". <i>Surgical Neurology<\/i>. <b>46<\/b> (5): 424\u2013429. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fs0090-3019%2896%2900096-1\" target=\"_blank\">10.1016\/s0090-3019(96)00096-1<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8874539\" target=\"_blank\">8874539<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Surgical+Neurology&rft.atitle=The+Modified+Excimer+Laser-Assisted+High-Flow+Bypass+Operation&rft.volume=46&rft.issue=5&rft.pages=424-429&rft.date=1996-11&rft_id=info%3Adoi%2F10.1016%2Fs0090-3019%2896%2900096-1&rft_id=info%3Apmid%2F8874539&rft.aulast=Tulleken&rft.aufirst=C.A.&rft.au=Verdaasdonk%2C+R.M.&rft.au=Beck%2C+R.J.&rft.au=Mali%2C+W.P.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVascular+bypass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Grady, Denise (December 19, 2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2006\/12\/19\/health\/19brai.html\" target=\"_blank\">\"With Lasers and Daring, Doctors Race to Save a Young Man's Brain\"<\/a>. <i>New York Times<\/i>. p. F1<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 November<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=New+York+Times&rft.atitle=With+Lasers+and+Daring%2C+Doctors+Race+to+Save+a+Young+Man%E2%80%99s+Brain&rft.pages=F1&rft.date=2006-12-19&rft.aulast=Grady&rft.aufirst=Denise&rft_id=https%3A%2F%2Fwww.nytimes.com%2F2006%2F12%2F19%2Fhealth%2F19brai.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVascular+bypass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nhlbi.nih.gov\/health\/health-topics\/topics\/cabg\/risks\" target=\"_blank\">\"What Are the Risks of Coronary Artery Bypass Grafting?\"<\/a>. <i>nhlbi.nih.gov<\/i>. National Institutes of Health \u2014 National Heart, Lung, and Blood Institute<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 November<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=nhlbi.nih.gov&rft.atitle=What+Are+the+Risks+of+Coronary+Artery+Bypass+Grafting%3F&rft_id=https%3A%2F%2Fwww.nhlbi.nih.gov%2Fhealth%2Fhealth-topics%2Ftopics%2Fcabg%2Frisks&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVascular+bypass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-NIHafter-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-NIHafter_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-NIHafter_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-NIHafter_8-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-NIHafter_8-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-NIHafter_8-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nhlbi.nih.gov\/health\/health-topics\/topics\/cabg\/after\" target=\"_blank\">\"What To Expect After Coronary Artery Bypass Grafting\"<\/a>. <i>nhlbi.nih.gov<\/i>. National Institutes of Health \u2014 National Heart, Lung, and Blood Institute<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 November<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=nhlbi.nih.gov&rft.atitle=What+To+Expect+After+Coronary+Artery+Bypass+Grafting&rft_id=https%3A%2F%2Fwww.nhlbi.nih.gov%2Fhealth%2Fhealth-topics%2Ftopics%2Fcabg%2Fafter&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVascular+bypass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-AfterBS-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-AfterBS_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/afterbypasssurgery.com\/\" target=\"_blank\">\"After Bypass Surgery Care and Results\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">8 April<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=After+Bypass+Surgery+Care+and+Results&rft_id=http%3A%2F%2Fafterbypasssurgery.com%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVascular+bypass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ehealth-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ehealth_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ehealthmd.com\/library\/cardiacbypass\/CB_life.html\" target=\"_blank\">\"Life After Bypass Surgery\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">8 April<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Life+After+Bypass+Surgery&rft_id=http%3A%2F%2Fwww.ehealthmd.com%2Flibrary%2Fcardiacbypass%2FCB_life.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVascular+bypass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.medic8.com\/healthguide\/articles\/heartbypasssurgery.html\" target=\"_blank\">\"Heart Bypass Surgery\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">8 April<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Heart+Bypass+Surgery&rft_id=http%3A%2F%2Fwww.medic8.com%2Fhealthguide%2Farticles%2Fheartbypasssurgery.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVascular+bypass\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1242\nCached time: 20181205140704\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.344 seconds\nReal time usage: 0.417 seconds\nPreprocessor visited node count: 916\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 71902\/2097152 bytes\nTemplate argument size: 428\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 30946\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.129\/10.000 seconds\nLua memory usage: 3.46 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 249.936 1 -total\n<\/p>\n<pre>66.53% 166.273 1 Template:Reflist\n38.76% 96.888 8 Template:Cite_web\n22.40% 55.990 5 Template:Navbox\n13.61% 34.020 2 Template:Cite_journal\n12.15% 30.355 1 Template:Cardiac_procedures\n10.71% 26.766 2 Template:Main\n 6.97% 17.423 1 Template:Vascular_procedures\n 3.01% 7.530 1 Template:Cite_news\n 2.84% 7.089 12 Template:Nobold\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:3220889-1!canonical and timestamp 20181205140703 and revision id 817150257\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular_bypass\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212204\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.047 seconds\nReal time usage: 0.200 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 193.087 1 - wikipedia:Vascular_bypass\n100.00% 193.087 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8266-0!*!*!*!*!*!* and timestamp 20181217212203 and revision id 24477\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Vascular_graft\">https:\/\/www.limswiki.org\/index.php\/Vascular_graft<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","e1a2429a0fc4803b4a0ca02ab7bf2202_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f6\/Blausen_0050_ArteriovenousGraft.png\/600px-Blausen_0050_ArteriovenousGraft.png"],"e1a2429a0fc4803b4a0ca02ab7bf2202_timestamp":1545081723,"85403745dc8426e344d601cd17547432_type":"article","85403745dc8426e344d601cd17547432_title":"Vascular closure device","85403745dc8426e344d601cd17547432_url":"https:\/\/www.limswiki.org\/index.php\/Vascular_closure_device","85403745dc8426e344d601cd17547432_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tVascular closure device\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tVascular closure devices are medical devices used to achieve hemostasis of the small hole in the artery after a cardiovascular procedure of endovascular surgery requiring a catheterization.\nCardiovascular procedures requiring catheterization include diagnostic procedures that help diagnose diseased blood vessels and interventional procedures such as angioplasty, the placement of a stent and coronary thrombectomy.\nDuring such procedures, a small incision is made in the groin area and a hole is created in the femoral artery to gain access to the artery. This hole is referred to as the access site or puncture site. At the completion of the procedure, the hole needs to be closed.\n\nGoals \nThe main goal of a Vascular Closure Device is to provide rapid hemostasis of the artery as well as reduce access site complications.[1] VCD's also help reduce time to ambulation and time to hospital discharge.[2] In addition, VCD's are more comfortable for the patient compared to manual compression.\n\nHistory \nPrior to the development of VCD's, the main method for closing the femoral artery was manual compression. Manual compression involves up to 30 minutes of manual pressure or mechanical clamps applied directly to the patient's groin, which is very painful, followed by up to 8 hours of bed rest in the hospital recovery room.\nVascular Closure Devices were introduced in the early 1990s in an effort to reduce the time to hemostasis, enable early ambulation and improve patient comfort. Initially, devices focused on technologies involving a suture or a collagen plug.[3] These technologies are effective at closing the hole; however, they often leave an intravascular component in the artery, which can cause complications. In addition, these technologies failed to accurately address patient pain.\nMore recent methods to close the hole involve the use of novel materials that dissolve over a short period of time, such as polyethylene glycol found in the Mynx vascular closure device. These technologies incorporate a more gentle deployment of the material to the outside of the artery and avoid the use of intravascular components, leaving nothing behind in the artery and consequently improving patient comfort.[4]\n\nReferences \n\n\n^ Maureen Leahy-Patano. Sealing the Deal at the Access Site. Diagnostic and Invasive Cardiology. May\/June 2008 \n\n^ Harold L. Dauerman MD FACC, et al. Vascular Closure Devices: The Second Decade. J Am Coll Cardiol. 2007;50(17) \n\n^ Harold L. Dauerman MD FACC, et al. Vascular Closure Devices: The Second Decade. J Am Coll Cardiol. 2007;50(17) \n\n^ D. Scheinert MD, et al. The Safety and Efficacy of an Extravascular, Water-Soluble Sealant for Vascular Closure: Initial Clinical Results for Mynx. Catheterization and Cardiovascular Interventions. 70:627-633 (2007) \n\n\nHon LQ, Ganeshan A, Thomas SM, Warakaulle D, Jagdish J, Uberoi R (January 2010). \"An overview of vascular closure devices: what every radiologist should know\". Eur J Radiol. 73 (1): 181\u201390. doi:10.1016\/j.ejrad.2008.09.023. PMID 19041208. \n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Vascular_closure_device\">https:\/\/www.limswiki.org\/index.php\/Vascular_closure_device<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 12 March 2016, at 17:19.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 462 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","85403745dc8426e344d601cd17547432_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Vascular_closure_device skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Vascular closure device<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Vascular closure devices<\/b> are medical devices used to achieve <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemostasis\" title=\"Hemostasis\" rel=\"external_link\" target=\"_blank\">hemostasis<\/a> of the small hole in the artery after a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiovascular\" class=\"mw-redirect\" title=\"Cardiovascular\" rel=\"external_link\" target=\"_blank\">cardiovascular<\/a> procedure of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endovascular_surgery\" class=\"mw-redirect\" title=\"Endovascular surgery\" rel=\"external_link\" target=\"_blank\">endovascular surgery<\/a> requiring a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheterization\" class=\"mw-redirect\" title=\"Catheterization\" rel=\"external_link\" target=\"_blank\">catheterization<\/a>.\n<\/p><p>Cardiovascular procedures requiring catheterization include diagnostic procedures that help diagnose diseased blood vessels and interventional procedures such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angioplasty\" title=\"Angioplasty\" rel=\"external_link\" target=\"_blank\">angioplasty<\/a>, the placement of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stent<\/a> and coronary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thrombectomy\" title=\"Thrombectomy\" rel=\"external_link\" target=\"_blank\">thrombectomy<\/a>.\n<\/p><p>During such procedures, a small incision is made in the groin area and a hole is created in the femoral artery to gain access to the artery. This hole is referred to as the access site or puncture site. At the completion of the procedure, the hole needs to be closed.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Goals\">Goals<\/span><\/h2>\n<p>The main goal of a Vascular Closure Device is to provide rapid <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemostasis\" title=\"Hemostasis\" rel=\"external_link\" target=\"_blank\">hemostasis<\/a> of the artery as well as reduce access site complications.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> VCD's also help reduce time to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ambulation\" class=\"mw-redirect\" title=\"Ambulation\" rel=\"external_link\" target=\"_blank\">ambulation<\/a> and time to hospital discharge.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> In addition, VCD's are more comfortable for the patient compared to manual compression.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Prior to the development of VCD's, the main method for closing the femoral artery was manual compression. Manual compression involves up to 30 minutes of manual pressure or mechanical clamps applied directly to the patient's groin, which is very painful, followed by up to 8 hours of bed rest in the hospital recovery room.\n<\/p><p>Vascular Closure Devices were introduced in the early 1990s in an effort to reduce the time to hemostasis, enable early ambulation and improve patient comfort. Initially, devices focused on technologies involving a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" title=\"Surgical suture\" rel=\"external_link\" target=\"_blank\">suture<\/a> or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Collagen\" title=\"Collagen\" rel=\"external_link\" target=\"_blank\">collagen<\/a> plug.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> These technologies are effective at closing the hole; however, they often leave an intravascular component in the artery, which can cause complications. In addition, these technologies failed to accurately address patient pain.\n<\/p><p>More recent methods to close the hole involve the use of novel materials that dissolve over a short period of time, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene_glycol\" title=\"Polyethylene glycol\" rel=\"external_link\" target=\"_blank\">polyethylene glycol<\/a> found in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mynx_vascular_closure_device\" title=\"Mynx vascular closure device\" rel=\"external_link\" target=\"_blank\">Mynx vascular closure device<\/a>. These technologies incorporate a more gentle deployment of the material to the outside of the artery and avoid the use of intravascular components, leaving nothing behind in the artery and consequently improving patient comfort.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Maureen Leahy-Patano. Sealing the Deal at the Access Site. Diagnostic and Invasive Cardiology. May\/June 2008<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Harold L. Dauerman MD FACC, et al. Vascular Closure Devices: The Second Decade. J Am Coll Cardiol. 2007;50(17)<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Harold L. Dauerman MD FACC, et al. Vascular Closure Devices: The Second Decade. J Am Coll Cardiol. 2007;50(17)<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">D. Scheinert MD, et al. The Safety and Efficacy of an Extravascular, Water-Soluble Sealant for Vascular Closure: Initial Clinical Results for Mynx. Catheterization and Cardiovascular Interventions. 70:627-633 (2007)<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<ul><li><cite class=\"citation journal\">Hon LQ, Ganeshan A, Thomas SM, Warakaulle D, Jagdish J, Uberoi R (January 2010). \"An overview of vascular closure devices: what every radiologist should know\". <i>Eur J Radiol<\/i>. <b>73<\/b> (1): 181\u201390. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ejrad.2008.09.023\" target=\"_blank\">10.1016\/j.ejrad.2008.09.023<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19041208\" target=\"_blank\">19041208<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Eur+J+Radiol&rft.atitle=An+overview+of+vascular+closure+devices%3A+what+every+radiologist+should+know&rft.volume=73&rft.issue=1&rft.pages=181-90&rft.date=2010-01&rft_id=info%3Adoi%2F10.1016%2Fj.ejrad.2008.09.023&rft_id=info%3Apmid%2F19041208&rft.aulast=Hon&rft.aufirst=LQ&rft.au=Ganeshan%2C+A&rft.au=Thomas%2C+SM&rft.au=Warakaulle%2C+D&rft.au=Jagdish%2C+J&rft.au=Uberoi%2C+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVascular+closure+device\" class=\"Z3988\"><\/span><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1244\nCached time: 20181217110839\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.088 seconds\nReal time usage: 0.119 seconds\nPreprocessor visited node count: 157\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 2447\/2097152 bytes\nTemplate argument size: 87\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 3039\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.058\/10.000 seconds\nLua memory usage: 1.42 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 103.738 1 -total\n<\/p>\n<pre>79.83% 82.813 1 Template:Cite_journal\n20.11% 20.859 1 Template:Reflist\n 2.86% 2.965 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:26195628-1!canonical and timestamp 20181217110839 and revision id 722508375\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular_closure_device\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212203\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.015 seconds\nReal time usage: 0.153 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 147.695 1 - wikipedia:Vascular_closure_device\n100.00% 147.695 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8459-0!*!*!*!*!*!* and timestamp 20181217212203 and revision id 24709\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Vascular_closure_device\">https:\/\/www.limswiki.org\/index.php\/Vascular_closure_device<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","85403745dc8426e344d601cd17547432_images":[],"85403745dc8426e344d601cd17547432_timestamp":1545081723,"76697833bf71b15d31791033f77930a6_type":"article","76697833bf71b15d31791033f77930a6_title":"Vagus nerve stimulator","76697833bf71b15d31791033f77930a6_url":"https:\/\/www.limswiki.org\/index.php\/Vagus_nerve_stimulation","76697833bf71b15d31791033f77930a6_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tVagus nerve stimulation\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tVagus nerve stimulationElectrical stimulation of vagus nerve.SynonymsVagal nerve stimulation[edit on Wikidata]\nVagus nerve stimulation (VNS) is a medical treatment that involves delivering electrical impulses to the vagus nerve. It is used as an add-on treatment for certain types of intractable epilepsy and treatment-resistant depression. Frequent side effects include coughing and shortness of breath.[1] Serious side effects may include trouble talking and cardiac arrest.[1]\n\nContents \n\n1 Medical use \n2 Adverse events \n3 Mechanism of action \n4 Devices and procedures \n5 History \n6 Society and culture \n7 Research \n8 See also \n9 References \n10 Further reading \n\n\nMedical use \nVNS devices are used to treat drug-resistant epilepsy and treatment-resistant major depressive disorder (TR-MDD).[2][3][4] Specifically it is used for treatment-resistant focal epilepsy.[3] As of 2017 the efficacy of VNS for TR-MDD was unclear.[2][4]\n\nAdverse events \nFor the treatment of epilepsy generally the left vagus nerve is stimulated at mid-cervical region. The adverse effects of this stimulation include cardiac arrest,[5] bradycardia,[6] voice alteration and hoarseness, cough, shortness of breath, pain, a tingling sensation, nausea, and headache;[3] difficulty swallowing has also been reported as common,[7] as well as sleepiness.\nIn randomized controlled trials for epilepsy conducted in the United States, one-third of the subjects had some type of an increase in seizures, with 17 percent having greater than a 25 percent increase, some had 100 percent increase or more.[8]\n\nMechanism of action \nAs of 2017 little was understood about exactly how vagal nerve stimulation modulates mood and seizure control.[2]\nThe vagus is the tenth cranial nerve and arises from the medulla; it carries both afferent and efferent fibers. The afferent vagal fibers connect to the nucleus of the solitary tract which in turn projects connections to other locations in the central nervous system.[3] Proposed mechanisms include an anti-inflammatory effect,[3] as well as changes in monoamines.\n\nDevices and procedures \nThe device consists of a generator the size of a matchbox that is implanted under the skin below the person\u2019s collarbone. Lead wires from the generator are tunnelled up to the patient\u2019s neck and wrapped around the left vagus nerve at the carotid sheath, where it delivers electrical impulses to the nerve.[2]\nImplantation of the VNS device is usually done as an out-patient procedure. The procedure goes as follows: an incision is made in the upper left chest and the generator is implanted into a little \"pouch\" on the left chest under the collarbone. A second incision is made in the neck, so that the surgeon can access the vagus nerve. The surgeon then wraps the leads around the left branch of the vagus nerve, and connects the electrodes to the generator. Once successfully implanted, the generator sends electric impulses to the vagus nerve at regular intervals. The left vagus nerve is stimulated rather than the right because the right plays a role in cardiac function such that stimulating it could have negative cardiac effects.[4][9] The \"dose\" administered by the device then needs to be set, which is done via a magnetic wand; the parameters adjusted include current, frequency, pulse width, and duty cycle.[4]\n\"Wearable\" devices are being tested and developed that involve transcutaneous stimulation and do not require surgery. Electrical impulses are targeted at the aurical (ear), at points where branches of the vagus nerve have cutaneous representation; such devices had been tested in clinical trials for treatment resistant major depressive disorder as of 2017.[4][10]\n\nHistory \nIn 1997, the US Food and Drug Administration\u2019s neurological devices panel met to consider approval of an implanted vagus nerve stimulator (VNS) for epilepsy, requested by Cyberonics (which was subsequently renamed to LivaNova).[2]\nThe FDA approved an implanted VNS for TR-MDD in 2005.[4]\nIn April 2017, the FDA cleared marketing of a handheld noninvasive vagus nerve stimulator, called \"gammaCore\" and made by ElectroCore LLC, for episodic cluster headaches, under the de novo pathway.[11][12] In January 2018, the FDA cleared a new user for that device for the treatment of migraine pain in adults under a 510(k) based on the de novo clearance.[13][14]\n\nSociety and culture \nAlthough the use of VNS for TRD has been endorsed by the American Psychiatric Association, the FDA's approval of VNS for TRD remains controversial. According to Dr. A. John Rush, vice chairman for research in the Department of Psychiatry at the University of Texas Southwestern Medical Center at Dallas, results of the VNS pilot study showed that 40 percent of the treated patients displayed at least a 50 percent or greater improvement in their condition, according to the Hamilton Depression Rating Scale.[15][16] Many other studies concur that VNS is indeed efficacious in treating depression. However, these findings do not take into account improvements over time in patients without the device. In the only randomized controlled trial VNS failed to perform any better when turned on than in otherwise similar implanted patients whose device was not turned on.[17]\n\nResearch \nBecause the vagus nerve is associated with many different functions and brain regions, clinical research has been done to determine its usefulness in treating other illnesses, including various anxiety disorders,[18] obesity,[19][20] alcohol addiction,[21] chronic heart failure,[22] prevention of arrhythmias that can cause sudden cardiac death,[23] autoimmune disorders,[24][25] and several chronic pain conditions.[26]\nVNS has also been studied in small trials of people with neurodevelopmental disorders, generally who also have had epilepsy, including Landau-Kleffner syndrome, Rett syndrome, and autism spectrum disorders.[27]\nAs of 2015 VNS devices were being developed that were not implanted, but rather transmitted signals through the skin. Electrical impulses are targeted at the aurical (ear), at points where branches of the vagus nerve are close to the surface.[4][10]\nVNS is being studied as of 2018 as a treatment for migraines and fibromyalgia.[28][29]\n\nSee also \n\nCranial electrotherapy stimulation\nDeep brain stimulation\nElectrical brain stimulation\nElectrotherapy\nLow field magnetic stimulation\nTranscranial magnetic stimulation\nTranscutaneous vagus nerve stimulation\nReferences \n\n\n^ a b \"Vagus Nerve Stimulation\". Cleveland Clinic. Retrieved 19 October 2018 . \n\n^ a b c d e Edwards, CA; Kouzani, A; Lee, KH; Ross, EK (September 2017). \"Neurostimulation Devices for the Treatment of Neurologic Disorders\". Mayo Clinic Proceedings. 92 (9): 1427\u20131444. doi:10.1016\/j.mayocp.2017.05.005. PMID 28870357. \n\n^ a b c d e Panebianco, M; Rigby, A; Weston, J; Marson, AG (3 April 2015). \"Vagus nerve stimulation for partial seizures\". The Cochrane Database of Systematic Reviews (4): CD002896. doi:10.1002\/14651858.CD002896.pub2. PMID 25835947. \n\n^ a b c d e f g Carreno, FR; Frazer, A (July 2017). \"Vagal Nerve Stimulation for Treatment-Resistant Depression\". Neurotherapeutics. 14 (3): 716\u2013727. doi:10.1007\/s13311-017-0537-8. PMC 5509631 . PMID 28585221. \n\n^ Lenzer, Jeanne (2017) The Danger Within Us pg.109 ISBN 9780316343763 \n\n^ Han p, frei mg, osorio i. Probable mechanisms of action of vagus nerve stimulation in humans with epilepsy: is a window into the brain [abstract]? epilepsia 1996;37 (5suppl):83s. \n\n^ Howland, RH (June 2014). \"Vagus Nerve Stimulation\". Current Behavioral Neuroscience Reports. 1 (2): 64\u201373. doi:10.1007\/s40473-014-0010-5. PMC 4017164 . PMID 24834378. \n\n^ \"Neurological Devices Panel: Tenth Meeting transcript\" (PDF) . FDA. June 27, 1997. p. 125. Archived from the original (PDF) on August 19, 2000. \n\n^ Giordano, F; Zicca, A; Barba, C; Guerrini, R; Genitori, L (April 2017). \"Vagus nerve stimulation: Surgical technique of implantation and revision and related morbidity\". Epilepsia. 58 Suppl 1: 85\u201390. doi:10.1111\/epi.13678. PMID 28386925. \n\n^ a b Leusden, J; Sellare, R; et al. (2015). \"Transcutaneous Vagal Nerve Stimulation (tVNS): a new neuromodulation tool in healthy humans?\". Frontiers in Psychology. 6 (102): 287\u201395. doi:10.3389\/fpsyg.2015.00102. PMC 4322601 . PMID 25713547. \n\n^ Brauser, Deborah (April 18, 2017). \"FDA Approves Vagus Nerve Stimulation Device for Cluster Headache\". Medscape. \n\n^ \"GammaCore Device Classification under Section 513(f)(2)(de novo)\". FDA. Retrieved 6 June 2018 . \n\n^ Brauser, Deborah (January 29, 2018). \"FDA Clears Vagus Nerve Stimulator for Migraine Pain\". Medscape. \n\n^ \"GammaCore 510(k) Premarket Notification\". FDA. Retrieved 6 June 2018 . \n\n^ Doctor's Guide: Vagus Nerve Stimulation Successful For Depression \n\n^ Neurology Channel: Vagus Nerve Stimulation Archived October 27, 2005, at the Wayback Machine. \n\n^ FDA Summary of VNS Data \n\n^ Groves, Duncan A.; Brown, Verity J. (2005). \"Vagal nerve stimulation: A review of its applications and potential mechanisms that mediate its clinical effects\". Neuroscience & Biobehavioral Reviews. 29 (3): 493\u2013500. doi:10.1016\/j.neubiorev.2005.01.004. PMID 15820552. \n\n^ de Lartigue, G (15 October 2016). \"Role of the vagus nerve in the development and treatment of diet-induced obesity\". The Journal of Physiology. 594 (20): 5791\u20135815. doi:10.1113\/JP271538. PMC 5063945 . PMID 26959077. \n\n^ G\u00f6bel, CH; Tronnier, VM; M\u00fcnte, TF (30 June 2017). \"Brain stimulation in obesity\". International Journal of Obesity (2005). 41 (12): 1721\u20131727. doi:10.1038\/ijo.2017.150. PMID 28663570. \n\n^ Herremans SC, Baeken C (September 2012). \"The current perspective of neuromodulation techniques in the treatment of alcohol addiction: a systematic review\" (PDF) . Psychiatria Danubina. 24 (Suppl 1): S14\u201320. PMID 22945180. \n\n^ Abraham WT, Smith SA (February 2013). \"Devices in the management of advanced, chronic heart failure\". Nature Reviews. Cardiology. 10 (2): 98\u2013110. doi:10.1038\/nrcardio.2012.178. PMC 3753073 . PMID 23229137. \n\n^ Sabbah, HN (August 2011). \"Electrical vagus nerve stimulation for the treatment of chronic heart failure\". Cleveland Clinic Journal of Medicine. 78 Suppl 1: S24\u20139. doi:10.3949\/ccjm.78.s1.04. PMC 3817894 . PMID 21972326. \n\n^ Fox, Douglas (4 May 2017), Can Zapping the Vagus Nerve Jump-Start Immunity? : An experimental procedure is exposing links between nervous and immune systems, Scientific American \n\n^ Koopman, FA; van Maanen, MA; Vervoordeldonk, MJ; Tak, PP (2017). \"Balancing the autonomic nervous system to reduce inflammation in rheumatoid arthritis\". J. Intern. Med. 282(1): 64\u201375. \n\n^ Chakravarthy, K; Chaudhry, H; Williams, K; Christo, PJ (December 2015). \"Review of the Uses of Vagal Nerve Stimulation in Chronic Pain Management\". Current Pain and Headache Reports. 19 (12): 54. doi:10.1007\/s11916-015-0528-6. PMID 26493698. \n\n^ Engineer, CT; Hays, SA; Kilgard, MP (2017). \"Vagus nerve stimulation as a potential adjuvant to behavioral therapy for autism and other neurodevelopmental disorders\". Journal of Neurodevelopmental Disorders. 9: 20. doi:10.1186\/s11689-017-9203-z. PMC 5496407 . PMID 28690686. \n\n^ Johnson, RL; Wilson, CG (2018). \"A review of vagus nerve stimulation as a therapeutic intervention\". Journal of Inflammation Research. 11: 203\u2013213. doi:10.2147\/JIR.S163248. PMC 5961632 . PMID 29844694. \n\n^ Puledda, F; Goadsby, PJ (April 2017). \"An Update on Non-Pharmacological Neuromodulation for the Acute and Preventive Treatment of Migraine\". Headache. 57 (4): 685\u2013691. doi:10.1111\/head.13069. PMID 28295242. \n\n\nFurther reading \n\"Report casts doubt on VNS approval. - Free Online Library\". www.thefreelibrary.com. Retrieved 2015-12-31 . \nFeder, Barnaby J. (September 10, 2006). \"Battle Lines in Treating Depression\". 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 22:31.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 379 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","76697833bf71b15d31791033f77930a6_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Vagus_nerve_stimulation skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Vagus nerve stimulation<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Vagus nerve stimulation<\/b> (<b>VNS<\/b>) is a medical treatment that involves delivering electrical impulses to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vagus_nerve\" title=\"Vagus nerve\" rel=\"external_link\" target=\"_blank\">vagus nerve<\/a>. It is used as an add-on treatment for certain types of intractable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epilepsy\" title=\"Epilepsy\" rel=\"external_link\" target=\"_blank\">epilepsy<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Treatment-resistant_depression\" title=\"Treatment-resistant depression\" rel=\"external_link\" target=\"_blank\">treatment-resistant depression<\/a>. Frequent side effects include coughing and shortness of breath.<sup id=\"rdp-ebb-cite_ref-Cl2018_1-0\" class=\"reference\"><a href=\"#cite_note-Cl2018-1\" rel=\"external_link\">[1]<\/a><\/sup> Serious side effects may include trouble talking and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_arrest\" title=\"Cardiac arrest\" rel=\"external_link\" target=\"_blank\">cardiac arrest<\/a>.<sup id=\"rdp-ebb-cite_ref-Cl2018_1-1\" class=\"reference\"><a href=\"#cite_note-Cl2018-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_use\">Medical use<\/span><\/h2>\n<p>VNS devices are used to treat drug-resistant epilepsy and treatment-resistant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Major_depressive_disorder\" title=\"Major depressive disorder\" rel=\"external_link\" target=\"_blank\">major depressive disorder<\/a> (TR-MDD).<sup id=\"rdp-ebb-cite_ref-Edwards2017_2-0\" class=\"reference\"><a href=\"#cite_note-Edwards2017-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Cochrane2015_3-0\" class=\"reference\"><a href=\"#cite_note-Cochrane2015-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Carreno2017_4-0\" class=\"reference\"><a href=\"#cite_note-Carreno2017-4\" rel=\"external_link\">[4]<\/a><\/sup> Specifically it is used for treatment-resistant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Focal_epilepsy\" class=\"mw-redirect\" title=\"Focal epilepsy\" rel=\"external_link\" target=\"_blank\">focal epilepsy<\/a>.<sup id=\"rdp-ebb-cite_ref-Cochrane2015_3-1\" class=\"reference\"><a href=\"#cite_note-Cochrane2015-3\" rel=\"external_link\">[3]<\/a><\/sup> As of 2017 the efficacy of VNS for TR-MDD was unclear.<sup id=\"rdp-ebb-cite_ref-Edwards2017_2-1\" class=\"reference\"><a href=\"#cite_note-Edwards2017-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Carreno2017_4-1\" class=\"reference\"><a href=\"#cite_note-Carreno2017-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Adverse_events\">Adverse events<\/span><\/h2>\n<p>For the treatment of epilepsy generally the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vagus_nerve#Structure\" title=\"Vagus nerve\" rel=\"external_link\" target=\"_blank\">left vagus nerve<\/a> is stimulated at mid-cervical region. The adverse effects of this stimulation include cardiac arrest,<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> bradycardia,<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> voice alteration and hoarseness, cough, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dyspnea\" class=\"mw-redirect\" title=\"Dyspnea\" rel=\"external_link\" target=\"_blank\">shortness of breath<\/a>, pain, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paresthesias\" class=\"mw-redirect\" title=\"Paresthesias\" rel=\"external_link\" target=\"_blank\">a tingling sensation<\/a>, nausea, and headache;<sup id=\"rdp-ebb-cite_ref-Cochrane2015_3-2\" class=\"reference\"><a href=\"#cite_note-Cochrane2015-3\" rel=\"external_link\">[3]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dysphagia\" title=\"Dysphagia\" rel=\"external_link\" target=\"_blank\">difficulty swallowing<\/a> has also been reported as common,<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> as well as sleepiness.\n<\/p><p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Randomized_controlled_trial\" title=\"Randomized controlled trial\" rel=\"external_link\" target=\"_blank\">randomized controlled trials<\/a> for epilepsy conducted in the United States, one-third of the subjects had some type of an increase in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Seizures\" class=\"mw-redirect\" title=\"Seizures\" rel=\"external_link\" target=\"_blank\">seizures<\/a>, with 17 percent having greater than a 25 percent increase, some had 100 percent increase or more.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Mechanism_of_action\">Mechanism of action<\/span><\/h2>\n<p>As of 2017 little was understood about exactly how vagal nerve stimulation modulates mood and seizure control.<sup id=\"rdp-ebb-cite_ref-Edwards2017_2-2\" class=\"reference\"><a href=\"#cite_note-Edwards2017-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vagus\" class=\"mw-redirect\" title=\"Vagus\" rel=\"external_link\" target=\"_blank\">vagus<\/a> is the tenth <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cranial_nerves\" title=\"Cranial nerves\" rel=\"external_link\" target=\"_blank\">cranial nerve<\/a> and arises from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medulla_oblongata\" title=\"Medulla oblongata\" rel=\"external_link\" target=\"_blank\">medulla<\/a>; it carries both <a href=\"https:\/\/en.wikipedia.org\/wiki\/Afferent_nerve_fiber\" title=\"Afferent nerve fiber\" rel=\"external_link\" target=\"_blank\">afferent<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Efferent_nerve_fiber\" title=\"Efferent nerve fiber\" rel=\"external_link\" target=\"_blank\">efferent<\/a> fibers. The afferent vagal fibers connect to the nucleus of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solitary_tract\" title=\"Solitary tract\" rel=\"external_link\" target=\"_blank\">solitary tract<\/a> which in turn projects connections to other locations in the central nervous system.<sup id=\"rdp-ebb-cite_ref-Cochrane2015_3-3\" class=\"reference\"><a href=\"#cite_note-Cochrane2015-3\" rel=\"external_link\">[3]<\/a><\/sup> Proposed mechanisms include an anti-inflammatory effect,<sup id=\"rdp-ebb-cite_ref-Cochrane2015_3-4\" class=\"reference\"><a href=\"#cite_note-Cochrane2015-3\" rel=\"external_link\">[3]<\/a><\/sup> as well as changes in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monoamines\" class=\"mw-redirect\" title=\"Monoamines\" rel=\"external_link\" target=\"_blank\">monoamines<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Devices_and_procedures\">Devices and procedures<\/span><\/h2>\n<p>The device consists of a generator the size of a matchbox that is implanted under the skin below the person\u2019s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clavicle\" title=\"Clavicle\" rel=\"external_link\" target=\"_blank\">collarbone<\/a>. Lead wires from the generator are tunnelled up to the patient\u2019s neck and wrapped around the left vagus nerve at the carotid sheath, where it delivers electrical impulses to the nerve.<sup id=\"rdp-ebb-cite_ref-Edwards2017_2-3\" class=\"reference\"><a href=\"#cite_note-Edwards2017-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Implantation of the VNS device is usually done as an out-patient procedure. The procedure goes as follows: an incision is made in the upper left chest and the generator is implanted into a little \"pouch\" on the left chest under the collarbone. A second incision is made in the neck, so that the surgeon can access the vagus nerve. The surgeon then wraps the leads around the left branch of the vagus nerve, and connects the electrodes to the generator. Once successfully implanted, the generator sends electric impulses to the vagus nerve at regular intervals. The left vagus nerve is stimulated rather than the right because the right plays a role in cardiac function such that stimulating it could have negative cardiac effects.<sup id=\"rdp-ebb-cite_ref-Carreno2017_4-2\" class=\"reference\"><a href=\"#cite_note-Carreno2017-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> The \"dose\" administered by the device then needs to be set, which is done via a magnetic wand; the parameters adjusted include current, frequency, pulse width, and duty cycle.<sup id=\"rdp-ebb-cite_ref-Carreno2017_4-3\" class=\"reference\"><a href=\"#cite_note-Carreno2017-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>\"Wearable\" devices are being tested and developed that involve <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcutaneous_electrical_nerve_stimulation\" title=\"Transcutaneous electrical nerve stimulation\" rel=\"external_link\" target=\"_blank\">transcutaneous stimulation<\/a> and do not require surgery. Electrical impulses are targeted at the aurical (ear), at points where branches of the vagus nerve have cutaneous representation; such devices had been tested in clinical trials for treatment resistant major depressive disorder as of 2017.<sup id=\"rdp-ebb-cite_ref-Carreno2017_4-4\" class=\"reference\"><a href=\"#cite_note-Carreno2017-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-tVNS_10-0\" class=\"reference\"><a href=\"#cite_note-tVNS-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>In 1997, the US <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration\u2019<\/a>s neurological devices panel met to consider approval of an implanted vagus nerve stimulator (VNS) for epilepsy, requested by Cyberonics (which was subsequently renamed to <a href=\"https:\/\/en.wikipedia.org\/wiki\/LivaNova\" title=\"LivaNova\" rel=\"external_link\" target=\"_blank\">LivaNova<\/a>).<sup id=\"rdp-ebb-cite_ref-Edwards2017_2-4\" class=\"reference\"><a href=\"#cite_note-Edwards2017-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>The FDA approved an implanted VNS for TR-MDD in 2005.<sup id=\"rdp-ebb-cite_ref-Carreno2017_4-5\" class=\"reference\"><a href=\"#cite_note-Carreno2017-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>In April 2017, the FDA cleared marketing of a handheld noninvasive vagus nerve stimulator, called \"gammaCore\" and made by ElectroCore LLC, for episodic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cluster_headaches\" class=\"mw-redirect\" title=\"Cluster headaches\" rel=\"external_link\" target=\"_blank\">cluster headaches<\/a>, under the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Federal_Food,_Drug,_and_Cosmetic_Act#Automatic_Class_III_Designation_(De_Novo_classification)\" title=\"Federal Food, Drug, and Cosmetic Act\" rel=\"external_link\" target=\"_blank\">de novo pathway<\/a>.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> In January 2018, the FDA cleared a new user for that device for the treatment of migraine pain in adults under a <a href=\"https:\/\/en.wikipedia.org\/wiki\/510(k)\" class=\"mw-redirect\" title=\"510(k)\" rel=\"external_link\" target=\"_blank\">510(k)<\/a> based on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Federal_Food,_Drug,_and_Cosmetic_Act#Automatic_Class_III_Designation_(De_Novo_classification)\" title=\"Federal Food, Drug, and Cosmetic Act\" rel=\"external_link\" target=\"_blank\">de novo clearance<\/a>.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Society_and_culture\">Society and culture<\/span><\/h2>\n<p>Although the use of VNS for TRD has been endorsed by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Psychiatric_Association\" title=\"American Psychiatric Association\" rel=\"external_link\" target=\"_blank\">American Psychiatric Association<\/a>, the FDA's approval of VNS for TRD remains controversial. According to Dr. A. John Rush, vice chairman for research in the Department of Psychiatry at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Texas_Southwestern_Medical_Center\" title=\"University of Texas Southwestern Medical Center\" rel=\"external_link\" target=\"_blank\">University of Texas Southwestern Medical Center<\/a> at Dallas, results of the VNS pilot study showed that 40 percent of the treated patients displayed at least a 50 percent or greater improvement in their condition, according to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hamilton_Depression_Rating_Scale\" class=\"mw-redirect\" title=\"Hamilton Depression Rating Scale\" rel=\"external_link\" target=\"_blank\">Hamilton Depression Rating Scale<\/a>.<sup id=\"rdp-ebb-cite_ref-DoctorsGuide_15-0\" class=\"reference\"><a href=\"#cite_note-DoctorsGuide-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-NeurologyChannel_16-0\" class=\"reference\"><a href=\"#cite_note-NeurologyChannel-16\" rel=\"external_link\">[16]<\/a><\/sup> Many other studies concur that VNS is indeed efficacious in treating depression. However, these findings do not take into account improvements over time in patients without the device. In the only randomized controlled trial VNS failed to perform any better when turned on than in otherwise similar implanted patients whose device was not turned on.<sup id=\"rdp-ebb-cite_ref-FDA2004_17-0\" class=\"reference\"><a href=\"#cite_note-FDA2004-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Research\">Research<\/span><\/h2>\n<p>Because the vagus nerve is associated with many different functions and brain regions, clinical research has been done to determine its usefulness in treating other illnesses, including various <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anxiety_disorder\" title=\"Anxiety disorder\" rel=\"external_link\" target=\"_blank\">anxiety disorders<\/a>,<sup id=\"rdp-ebb-cite_ref-VNSreview_18-0\" class=\"reference\"><a href=\"#cite_note-VNSreview-18\" rel=\"external_link\">[18]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Obesity\" title=\"Obesity\" rel=\"external_link\" target=\"_blank\">obesity<\/a>,<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> alcohol addiction,<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> chronic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_failure\" title=\"Heart failure\" rel=\"external_link\" target=\"_blank\">heart failure<\/a>,<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> prevention of arrhythmias that can cause <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sudden_cardiac_death\" class=\"mw-redirect\" title=\"Sudden cardiac death\" rel=\"external_link\" target=\"_blank\">sudden cardiac death<\/a>,<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autoimmune_disorders\" class=\"mw-redirect\" title=\"Autoimmune disorders\" rel=\"external_link\" target=\"_blank\">autoimmune disorders<\/a>,<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> and several <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_pain\" title=\"Chronic pain\" rel=\"external_link\" target=\"_blank\">chronic pain<\/a> conditions.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p><p>VNS has also been studied in small trials of people with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurodevelopmental_disorders\" class=\"mw-redirect\" title=\"Neurodevelopmental disorders\" rel=\"external_link\" target=\"_blank\">neurodevelopmental disorders<\/a>, generally who also have had epilepsy, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Landau-Kleffner_syndrome\" class=\"mw-redirect\" title=\"Landau-Kleffner syndrome\" rel=\"external_link\" target=\"_blank\">Landau-Kleffner syndrome<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rett_syndrome\" title=\"Rett syndrome\" rel=\"external_link\" target=\"_blank\">Rett syndrome<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autism_spectrum_disorders\" class=\"mw-redirect\" title=\"Autism spectrum disorders\" rel=\"external_link\" target=\"_blank\">autism spectrum disorders<\/a>.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p><p>As of 2015 VNS devices were being developed that were not implanted, but rather transmitted signals through the skin. Electrical impulses are targeted at the aurical (ear), at points where branches of the vagus nerve are close to the surface.<sup id=\"rdp-ebb-cite_ref-Carreno2017_4-6\" class=\"reference\"><a href=\"#cite_note-Carreno2017-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-tVNS_10-1\" class=\"reference\"><a href=\"#cite_note-tVNS-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>VNS is being studied as of 2018 as a treatment for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Migraines\" class=\"mw-redirect\" title=\"Migraines\" rel=\"external_link\" target=\"_blank\">migraines<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibromyalgia\" title=\"Fibromyalgia\" rel=\"external_link\" target=\"_blank\">fibromyalgia<\/a>.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cranial_electrotherapy_stimulation\" title=\"Cranial electrotherapy stimulation\" rel=\"external_link\" target=\"_blank\">Cranial electrotherapy stimulation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Deep_brain_stimulation\" title=\"Deep brain stimulation\" rel=\"external_link\" target=\"_blank\">Deep brain stimulation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrical_brain_stimulation\" title=\"Electrical brain stimulation\" rel=\"external_link\" target=\"_blank\">Electrical brain stimulation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrotherapy\" title=\"Electrotherapy\" rel=\"external_link\" target=\"_blank\">Electrotherapy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Low_field_magnetic_stimulation\" class=\"mw-redirect\" title=\"Low field magnetic stimulation\" rel=\"external_link\" target=\"_blank\">Low field magnetic stimulation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcranial_magnetic_stimulation\" title=\"Transcranial magnetic stimulation\" rel=\"external_link\" target=\"_blank\">Transcranial magnetic stimulation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcutaneous_vagus_nerve_stimulation\" title=\"Transcutaneous vagus nerve stimulation\" rel=\"external_link\" target=\"_blank\">Transcutaneous vagus nerve stimulation<\/a><\/li><\/ul><\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-Cl2018-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Cl2018_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Cl2018_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/my.clevelandclinic.org\/health\/treatments\/17598-vagus-nerve-stimulation\" target=\"_blank\">\"Vagus Nerve Stimulation\"<\/a>. <i>Cleveland Clinic<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 October<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Cleveland+Clinic&rft.atitle=Vagus+Nerve+Stimulation&rft_id=https%3A%2F%2Fmy.clevelandclinic.org%2Fhealth%2Ftreatments%2F17598-vagus-nerve-stimulation&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Edwards2017-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Edwards2017_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Edwards2017_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Edwards2017_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Edwards2017_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Edwards2017_2-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Edwards, CA; Kouzani, A; Lee, KH; Ross, EK (September 2017). \"Neurostimulation Devices for the Treatment of Neurologic Disorders\". <i>Mayo Clinic Proceedings<\/i>. <b>92<\/b> (9): 1427\u20131444. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.mayocp.2017.05.005\" target=\"_blank\">10.1016\/j.mayocp.2017.05.005<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28870357\" target=\"_blank\">28870357<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Mayo+Clinic+Proceedings&rft.atitle=Neurostimulation+Devices+for+the+Treatment+of+Neurologic+Disorders&rft.volume=92&rft.issue=9&rft.pages=1427-1444&rft.date=2017-09&rft_id=info%3Adoi%2F10.1016%2Fj.mayocp.2017.05.005&rft_id=info%3Apmid%2F28870357&rft.aulast=Edwards&rft.aufirst=CA&rft.au=Kouzani%2C+A&rft.au=Lee%2C+KH&rft.au=Ross%2C+EK&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> <span style=\"position:relative; top: -2px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Open_access\" title=\"open access publication \u2013 free to read\" rel=\"external_link\" target=\"_blank\"><img alt=\"open access publication \u2013 free to read\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/77\/Open_Access_logo_PLoS_transparent.svg\/9px-Open_Access_logo_PLoS_transparent.svg.png\" width=\"9\" height=\"14\" \/><\/a><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Cochrane2015-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Cochrane2015_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Cochrane2015_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Cochrane2015_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Cochrane2015_3-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Cochrane2015_3-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Panebianco, M; Rigby, A; Weston, J; Marson, AG (3 April 2015). \"Vagus nerve stimulation for partial seizures\". <i>The Cochrane Database of Systematic Reviews<\/i> (4): CD002896. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD002896.pub2\" target=\"_blank\">10.1002\/14651858.CD002896.pub2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25835947\" target=\"_blank\">25835947<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Vagus+nerve+stimulation+for+partial+seizures&rft.issue=4&rft.pages=CD002896&rft.date=2015-04-03&rft_id=info%3Adoi%2F10.1002%2F14651858.CD002896.pub2&rft_id=info%3Apmid%2F25835947&rft.aulast=Panebianco&rft.aufirst=M&rft.au=Rigby%2C+A&rft.au=Weston%2C+J&rft.au=Marson%2C+AG&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> <span style=\"position:relative; top: -2px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Open_access\" title=\"open access publication \u2013 free to read\" rel=\"external_link\" target=\"_blank\"><img alt=\"open access publication \u2013 free to read\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/77\/Open_Access_logo_PLoS_transparent.svg\/9px-Open_Access_logo_PLoS_transparent.svg.png\" width=\"9\" height=\"14\" \/><\/a><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Carreno2017-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Carreno2017_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Carreno2017_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Carreno2017_4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Carreno2017_4-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Carreno2017_4-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Carreno2017_4-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Carreno2017_4-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Carreno, FR; Frazer, A (July 2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5509631\" target=\"_blank\">\"Vagal Nerve Stimulation for Treatment-Resistant Depression\"<\/a>. <i>Neurotherapeutics<\/i>. <b>14<\/b> (3): 716\u2013727. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs13311-017-0537-8\" target=\"_blank\">10.1007\/s13311-017-0537-8<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5509631\" target=\"_blank\">5509631<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28585221\" target=\"_blank\">28585221<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurotherapeutics&rft.atitle=Vagal+Nerve+Stimulation+for+Treatment-Resistant+Depression&rft.volume=14&rft.issue=3&rft.pages=716-727&rft.date=2017-07&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5509631&rft_id=info%3Apmid%2F28585221&rft_id=info%3Adoi%2F10.1007%2Fs13311-017-0537-8&rft.aulast=Carreno&rft.aufirst=FR&rft.au=Frazer%2C+A&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5509631&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Lenzer, Jeanne (2017) The Danger Within Us pg.109 <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780316343763<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Han p, frei mg, osorio i. Probable mechanisms of action of vagus nerve stimulation in humans with epilepsy: is a window into the brain [abstract]? epilepsia 1996;37 (5suppl):83s.<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Howland, RH (June 2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4017164\" target=\"_blank\">\"Vagus Nerve Stimulation\"<\/a>. <i>Current Behavioral Neuroscience Reports<\/i>. <b>1<\/b> (2): 64\u201373. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs40473-014-0010-5\" target=\"_blank\">10.1007\/s40473-014-0010-5<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4017164\" target=\"_blank\">4017164<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24834378\" target=\"_blank\">24834378<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Current+Behavioral+Neuroscience+Reports&rft.atitle=Vagus+Nerve+Stimulation&rft.volume=1&rft.issue=2&rft.pages=64-73&rft.date=2014-06&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4017164&rft_id=info%3Apmid%2F24834378&rft_id=info%3Adoi%2F10.1007%2Fs40473-014-0010-5&rft.aulast=Howland&rft.aufirst=RH&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4017164&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20000819110902\/http:\/\/www.fda.gov\/ohrms\/dockets\/AC\/97\/transcpt\/3299t1.pdf\" target=\"_blank\">\"Neurological Devices Panel: Tenth Meeting transcript\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. FDA. June 27, 1997. p. 125. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/ohrms\/dockets\/AC\/97\/transcpt\/3299t1.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on August 19, 2000.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Neurological+Devices+Panel%3A+Tenth+Meeting+transcript&rft.pages=125&rft.pub=FDA&rft.date=1997-06-27&rft_id=http%3A%2F%2Fwww.fda.gov%2Fohrms%2Fdockets%2FAC%2F97%2Ftranscpt%2F3299t1.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Giordano, F; Zicca, A; Barba, C; Guerrini, R; Genitori, L (April 2017). \"Vagus nerve stimulation: Surgical technique of implantation and revision and related morbidity\". <i>Epilepsia<\/i>. 58 Suppl 1: 85\u201390. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fepi.13678\" target=\"_blank\">10.1111\/epi.13678<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28386925\" target=\"_blank\">28386925<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Epilepsia&rft.atitle=Vagus+nerve+stimulation%3A+Surgical+technique+of+implantation+and+revision+and+related+morbidity&rft.volume=58+Suppl+1&rft.pages=85-90&rft.date=2017-04&rft_id=info%3Adoi%2F10.1111%2Fepi.13678&rft_id=info%3Apmid%2F28386925&rft.aulast=Giordano&rft.aufirst=F&rft.au=Zicca%2C+A&rft.au=Barba%2C+C&rft.au=Guerrini%2C+R&rft.au=Genitori%2C+L&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-tVNS-10\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-tVNS_10-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-tVNS_10-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Leusden, J; Sellare, R; et al. (2015). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4322601\" target=\"_blank\">\"Transcutaneous Vagal Nerve Stimulation (tVNS): a new neuromodulation tool in healthy humans?\"<\/a>. <i>Frontiers in Psychology<\/i>. <b>6<\/b> (102): 287\u201395. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3389%2Ffpsyg.2015.00102\" target=\"_blank\">10.3389\/fpsyg.2015.00102<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4322601\" target=\"_blank\">4322601<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25713547\" target=\"_blank\">25713547<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Frontiers+in+Psychology&rft.atitle=Transcutaneous+Vagal+Nerve+Stimulation+%28tVNS%29%3A+a+new+neuromodulation+tool+in+healthy+humans%3F&rft.volume=6&rft.issue=102&rft.pages=287-95&rft.date=2015&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4322601&rft_id=info%3Apmid%2F25713547&rft_id=info%3Adoi%2F10.3389%2Ffpsyg.2015.00102&rft.aulast=Leusden&rft.aufirst=J&rft.au=Sellare%2C+R&rft.au=Colzato%2C+L&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4322601&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Brauser, Deborah (April 18, 2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.medscape.com\/viewarticle\/878763\" target=\"_blank\">\"FDA Approves Vagus Nerve Stimulation Device for Cluster Headache\"<\/a>. <i>Medscape<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Medscape&rft.atitle=FDA+Approves+Vagus+Nerve+Stimulation+Device+for+Cluster+Headache&rft.date=2017-04-18&rft.aulast=Brauser&rft.aufirst=Deborah&rft_id=https%3A%2F%2Fwww.medscape.com%2Fviewarticle%2F878763&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.accessdata.fda.gov\/scripts\/cdrh\/cfdocs\/cfpmn\/denovo.cfm?ID=DEN150048\" target=\"_blank\">\"GammaCore Device Classification under Section 513(f)(2)(de novo)\"<\/a>. <i>FDA<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">6 June<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=FDA&rft.atitle=GammaCore+Device+Classification+under+Section+513%28f%29%282%29%28de+novo%29&rft_id=https%3A%2F%2Fwww.accessdata.fda.gov%2Fscripts%2Fcdrh%2Fcfdocs%2Fcfpmn%2Fdenovo.cfm%3FID%3DDEN150048&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Brauser, Deborah (January 29, 2018). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.medscape.com\/viewarticle\/891930\" target=\"_blank\">\"FDA Clears Vagus Nerve Stimulator for Migraine Pain\"<\/a>. <i>Medscape<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Medscape&rft.atitle=FDA+Clears+Vagus+Nerve+Stimulator+for+Migraine+Pain&rft.date=2018-01-29&rft.aulast=Brauser&rft.aufirst=Deborah&rft_id=https%3A%2F%2Fwww.medscape.com%2Fviewarticle%2F891930&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.accessdata.fda.gov\/scripts\/cdrh\/cfdocs\/cfPMN\/pmn.cfm?ID=K173442\" target=\"_blank\">\"GammaCore 510(k) Premarket Notification\"<\/a>. FDA<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">6 June<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=GammaCore+510%28k%29+Premarket+Notification&rft.pub=FDA&rft_id=https%3A%2F%2Fwww.accessdata.fda.gov%2Fscripts%2Fcdrh%2Fcfdocs%2FcfPMN%2Fpmn.cfm%3FID%3DK173442&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-DoctorsGuide-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-DoctorsGuide_15-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.pslgroup.com\/dg\/15131a.htm\" target=\"_blank\">Doctor's Guide: <i>Vagus Nerve Stimulation Successful For Depression<\/i><\/a><\/span>\n<\/li>\n<li id=\"cite_note-NeurologyChannel-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-NeurologyChannel_16-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.neurologychannel.com\/vagus\/\" target=\"_blank\">Neurology Channel: Vagus Nerve Stimulation<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20051027154834\/http:\/\/www.neurologychannel.com\/vagus\/\" target=\"_blank\">Archived<\/a> October 27, 2005, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-FDA2004-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FDA2004_17-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/ohrms\/dockets\/ac\/04\/briefing\/4047b1_02_Summary%20of%20Safety%20and%20Effectiveness.pdf\" target=\"_blank\">FDA Summary of VNS Data<\/a><\/span>\n<\/li>\n<li id=\"cite_note-VNSreview-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-VNSreview_18-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Groves, Duncan A.; Brown, Verity J. (2005). \"Vagal nerve stimulation: A review of its applications and potential mechanisms that mediate its clinical effects\". <i>Neuroscience & Biobehavioral Reviews<\/i>. <b>29<\/b> (3): 493\u2013500. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.neubiorev.2005.01.004\" target=\"_blank\">10.1016\/j.neubiorev.2005.01.004<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15820552\" target=\"_blank\">15820552<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuroscience+%26+Biobehavioral+Reviews&rft.atitle=Vagal+nerve+stimulation%3A+A+review+of+its+applications+and+potential+mechanisms+that+mediate+its+clinical+effects&rft.volume=29&rft.issue=3&rft.pages=493-500&rft.date=2005&rft_id=info%3Adoi%2F10.1016%2Fj.neubiorev.2005.01.004&rft_id=info%3Apmid%2F15820552&rft.aulast=Groves&rft.aufirst=Duncan+A.&rft.au=Brown%2C+Verity+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">de Lartigue, G (15 October 2016). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5063945\" target=\"_blank\">\"Role of the vagus nerve in the development and treatment of diet-induced obesity\"<\/a>. <i>The Journal of Physiology<\/i>. <b>594<\/b> (20): 5791\u20135815. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1113%2FJP271538\" target=\"_blank\">10.1113\/JP271538<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5063945\" target=\"_blank\">5063945<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26959077\" target=\"_blank\">26959077<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Physiology&rft.atitle=Role+of+the+vagus+nerve+in+the+development+and+treatment+of+diet-induced+obesity&rft.volume=594&rft.issue=20&rft.pages=5791-5815&rft.date=2016-10-15&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5063945&rft_id=info%3Apmid%2F26959077&rft_id=info%3Adoi%2F10.1113%2FJP271538&rft.aulast=de+Lartigue&rft.aufirst=G&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5063945&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">G\u00f6bel, CH; Tronnier, VM; M\u00fcnte, TF (30 June 2017). \"Brain stimulation in obesity\". <i>International Journal of Obesity (2005)<\/i>. <b>41<\/b> (12): 1721\u20131727. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fijo.2017.150\" target=\"_blank\">10.1038\/ijo.2017.150<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28663570\" target=\"_blank\">28663570<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Obesity+%282005%29&rft.atitle=Brain+stimulation+in+obesity&rft.volume=41&rft.issue=12&rft.pages=1721-1727&rft.date=2017-06-30&rft_id=info%3Adoi%2F10.1038%2Fijo.2017.150&rft_id=info%3Apmid%2F28663570&rft.aulast=G%C3%B6bel&rft.aufirst=CH&rft.au=Tronnier%2C+VM&rft.au=M%C3%BCnte%2C+TF&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Herremans SC, Baeken C (September 2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hdbp.org\/psychiatria_danubina\/pdf\/dnb_vol24%20Suppl%201_no\/dnb_vol24%20Suppl%201_no_S14.pdf\" target=\"_blank\">\"The current perspective of neuromodulation techniques in the treatment of alcohol addiction: a systematic review\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Psychiatria Danubina<\/i>. <b>24<\/b> (Suppl 1): S14\u201320. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22945180\" target=\"_blank\">22945180<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Psychiatria+Danubina&rft.atitle=The+current+perspective+of+neuromodulation+techniques+in+the+treatment+of+alcohol+addiction%3A+a+systematic+review&rft.volume=24&rft.issue=Suppl+1&rft.pages=S14-20&rft.date=2012-09&rft_id=info%3Apmid%2F22945180&rft.aulast=Herremans&rft.aufirst=SC&rft.au=Baeken%2C+C&rft_id=http%3A%2F%2Fwww.hdbp.org%2Fpsychiatria_danubina%2Fpdf%2Fdnb_vol24%2520Suppl%25201_no%2Fdnb_vol24%2520Suppl%25201_no_S14.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Abraham WT, Smith SA (February 2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3753073\" target=\"_blank\">\"Devices in the management of advanced, chronic heart failure\"<\/a>. <i>Nature Reviews. Cardiology<\/i>. <b>10<\/b> (2): 98\u2013110. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnrcardio.2012.178\" target=\"_blank\">10.1038\/nrcardio.2012.178<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3753073\" target=\"_blank\">3753073<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23229137\" target=\"_blank\">23229137<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Reviews.+Cardiology&rft.atitle=Devices+in+the+management+of+advanced%2C+chronic+heart+failure&rft.volume=10&rft.issue=2&rft.pages=98-110&rft.date=2013-02&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3753073&rft_id=info%3Apmid%2F23229137&rft_id=info%3Adoi%2F10.1038%2Fnrcardio.2012.178&rft.aulast=Abraham&rft.aufirst=WT&rft.au=Smith%2C+SA&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3753073&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sabbah, HN (August 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3817894\" target=\"_blank\">\"Electrical vagus nerve stimulation for the treatment of chronic heart failure\"<\/a>. <i>Cleveland Clinic Journal of Medicine<\/i>. 78 Suppl 1: S24\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3949%2Fccjm.78.s1.04\" target=\"_blank\">10.3949\/ccjm.78.s1.04<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3817894\" target=\"_blank\">3817894<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21972326\" target=\"_blank\">21972326<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cleveland+Clinic+Journal+of+Medicine&rft.atitle=Electrical+vagus+nerve+stimulation+for+the+treatment+of+chronic+heart+failure&rft.volume=78+Suppl+1&rft.pages=S24-9&rft.date=2011-08&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3817894&rft_id=info%3Apmid%2F21972326&rft_id=info%3Adoi%2F10.3949%2Fccjm.78.s1.04&rft.aulast=Sabbah&rft.aufirst=HN&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3817894&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFFox2017\" class=\"citation\">Fox, Douglas (4 May 2017), <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.scientificamerican.com\/article\/can-zapping-the-vagus-nerve-jump-start-immunity\/\" target=\"_blank\"><i>Can Zapping the Vagus Nerve Jump-Start Immunity? : An experimental procedure is exposing links between nervous and immune systems<\/i><\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scientific_American\" title=\"Scientific American\" rel=\"external_link\" target=\"_blank\">Scientific American<\/a><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Can+Zapping+the+Vagus+Nerve+Jump-Start+Immunity%3F+%3A+An+experimental+procedure+is+exposing+links+between+nervous+and+immune+systems&rft.pub=Scientific+American&rft.date=2017-05-04&rft.aulast=Fox&rft.aufirst=Douglas&rft_id=https%3A%2F%2Fwww.scientificamerican.com%2Farticle%2Fcan-zapping-the-vagus-nerve-jump-start-immunity%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Koopman, FA; van Maanen, MA; Vervoordeldonk, MJ; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paul-Peter_Tak\" title=\"Paul-Peter Tak\" rel=\"external_link\" target=\"_blank\">Tak<\/a>, PP (2017). \"Balancing the autonomic nervous system to reduce inflammation in rheumatoid arthritis\". <i>J. 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Med<\/i>. 282(1): 64\u201375.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J.+Intern.+Med.&rft.atitle=Balancing+the+autonomic+nervous+system+to+reduce+inflammation+in+rheumatoid+arthritis&rft.volume=282%281%29&rft.pages=64-75&rft.date=2017&rft.aulast=Koopman&rft.aufirst=FA&rft.au=van+Maanen%2C+MA&rft.au=Vervoordeldonk%2C+MJ&rft.au=Tak%2C+PP&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chakravarthy, K; Chaudhry, H; Williams, K; Christo, PJ (December 2015). \"Review of the Uses of Vagal Nerve Stimulation in Chronic Pain Management\". <i>Current Pain and Headache Reports<\/i>. <b>19<\/b> (12): 54. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11916-015-0528-6\" target=\"_blank\">10.1007\/s11916-015-0528-6<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26493698\" target=\"_blank\">26493698<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Current+Pain+and+Headache+Reports&rft.atitle=Review+of+the+Uses+of+Vagal+Nerve+Stimulation+in+Chronic+Pain+Management&rft.volume=19&rft.issue=12&rft.pages=54&rft.date=2015-12&rft_id=info%3Adoi%2F10.1007%2Fs11916-015-0528-6&rft_id=info%3Apmid%2F26493698&rft.aulast=Chakravarthy&rft.aufirst=K&rft.au=Chaudhry%2C+H&rft.au=Williams%2C+K&rft.au=Christo%2C+PJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Engineer, CT; Hays, SA; Kilgard, MP (2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5496407\" target=\"_blank\">\"Vagus nerve stimulation as a potential adjuvant to behavioral therapy for autism and other neurodevelopmental disorders\"<\/a>. <i>Journal of Neurodevelopmental Disorders<\/i>. <b>9<\/b>: 20. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2Fs11689-017-9203-z\" target=\"_blank\">10.1186\/s11689-017-9203-z<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5496407\" target=\"_blank\">5496407<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28690686\" target=\"_blank\">28690686<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Neurodevelopmental+Disorders&rft.atitle=Vagus+nerve+stimulation+as+a+potential+adjuvant+to+behavioral+therapy+for+autism+and+other+neurodevelopmental+disorders&rft.volume=9&rft.pages=20&rft.date=2017&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5496407&rft_id=info%3Apmid%2F28690686&rft_id=info%3Adoi%2F10.1186%2Fs11689-017-9203-z&rft.aulast=Engineer&rft.aufirst=CT&rft.au=Hays%2C+SA&rft.au=Kilgard%2C+MP&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5496407&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Johnson, RL; Wilson, CG (2018). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5961632\" target=\"_blank\">\"A review of vagus nerve stimulation as a therapeutic intervention\"<\/a>. <i>Journal of Inflammation Research<\/i>. <b>11<\/b>: 203\u2013213. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2147%2FJIR.S163248\" target=\"_blank\">10.2147\/JIR.S163248<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5961632\" target=\"_blank\">5961632<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29844694\" target=\"_blank\">29844694<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Inflammation+Research&rft.atitle=A+review+of+vagus+nerve+stimulation+as+a+therapeutic+intervention&rft.volume=11&rft.pages=203-213&rft.date=2018&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5961632&rft_id=info%3Apmid%2F29844694&rft_id=info%3Adoi%2F10.2147%2FJIR.S163248&rft.aulast=Johnson&rft.aufirst=RL&rft.au=Wilson%2C+CG&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5961632&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Puledda, F; Goadsby, PJ (April 2017). \"An Update on Non-Pharmacological Neuromodulation for the Acute and Preventive Treatment of Migraine\". <i>Headache<\/i>. <b>57<\/b> (4): 685\u2013691. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fhead.13069\" target=\"_blank\">10.1111\/head.13069<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28295242\" target=\"_blank\">28295242<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Headache&rft.atitle=An+Update+on+Non-Pharmacological+Neuromodulation+for+the+Acute+and+Preventive+Treatment+of+Migraine&rft.volume=57&rft.issue=4&rft.pages=685-691&rft.date=2017-04&rft_id=info%3Adoi%2F10.1111%2Fhead.13069&rft_id=info%3Apmid%2F28295242&rft.aulast=Puledda&rft.aufirst=F&rft.au=Goadsby%2C+PJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.thefreelibrary.com\/Report+casts+doubt+on+VNS+approval.-a0149222466\" target=\"_blank\">\"Report casts doubt on VNS approval. - Free Online Library\"<\/a>. <i>www.thefreelibrary.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-12-31<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.thefreelibrary.com&rft.atitle=Report+casts+doubt+on+VNS+approval.+-+Free+Online+Library&rft_id=http%3A%2F%2Fwww.thefreelibrary.com%2FReport%2Bcasts%2Bdoubt%2Bon%2BVNS%2Bapproval.-a0149222466&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation news\">Feder, Barnaby J. (September 10, 2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2006\/09\/10\/business\/yourmoney\/10cyber.html\" target=\"_blank\">\"Battle Lines in Treating Depression\"<\/a>. <i>The New York Times<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=Battle+Lines+in+Treating+Depression&rft.date=2006-09-10&rft.aulast=Feder&rft.aufirst=Barnaby+J.&rft_id=https%3A%2F%2Fwww.nytimes.com%2F2006%2F09%2F10%2Fbusiness%2Fyourmoney%2F10cyber.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1269\nCached time: 20181217110837\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.520 seconds\nReal time usage: 0.637 seconds\nPreprocessor visited node count: 2113\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 102177\/2097152 bytes\nTemplate argument size: 1587\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 81598\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.268\/10.000 seconds\nLua memory usage: 5.11 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 523.776 1 -total\n<\/p>\n<pre>62.23% 325.951 1 Template:Reflist\n25.10% 131.464 17 Template:Cite_journal\n19.07% 99.900 1 Template:Infobox_medical_intervention\n18.09% 94.755 1 Template:Infobox\n15.29% 80.103 4 Template:Cite_web\n 7.90% 41.389 7 Template:Navbox\n 7.42% 38.852 1 Template:ISBN\n 4.17% 21.825 1 Template:Psychiatry\n 3.72% 19.485 1 Template:Medicine\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2326976-1!canonical and timestamp 20181217110837 and revision id 872898990\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Vagus_nerve_stimulation\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212202\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.049 seconds\nReal time usage: 0.211 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 201.570 1 - wikipedia:Vagus_nerve_stimulation\n100.00% 201.570 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8284-0!*!*!*!*!*!* and timestamp 20181217212202 and revision id 24496\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Vagus_nerve_stimulation\">https:\/\/www.limswiki.org\/index.php\/Vagus_nerve_stimulation<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","76697833bf71b15d31791033f77930a6_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5c\/Vagus_nerve_stimulation.jpg\/560px-Vagus_nerve_stimulation.jpg"],"76697833bf71b15d31791033f77930a6_timestamp":1545081722,"9e0cf08ada8d31fed0c2a5b3c2c18a06_type":"article","9e0cf08ada8d31fed0c2a5b3c2c18a06_title":"Ureteric stent","9e0cf08ada8d31fed0c2a5b3c2c18a06_url":"https:\/\/www.limswiki.org\/index.php\/Ureteric_stent","9e0cf08ada8d31fed0c2a5b3c2c18a06_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tUreteric stent\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tUreteric stentUreteral pigtail stentSpecialtyurology[edit on Wikidata]\nA ureteral stent (pronounced you-REE-ter-ul), or ureteric stent, is a thin tube inserted into the ureter to prevent or treat obstruction of the urine flow from the kidney. The length of the stents used in adult patients varies between 24 and 30 cm. Additionally, stents come in differing diameters or gauges, to fit different size ureters. The stent is usually inserted with the aid of a cystoscope. One or both ends of the stent may be coiled to prevent it from moving out of place; this is called a JJ stent, double J stent or pig-tail stent.\n\nContents \n\n1 Stent placement \n2 Side effects and complications \n3 Removal \n4 References \n5 Further reading \n\n\nStent placement \n Three-dimensional reconstructed CT scan image of a ureteral stent in the left kidney (indicated by yellow arrow). There is a kidney stone in the pyelum of the lower pole of the kidney (higher red arrow) and one in the ureter beside the stent (lower red arrow).\nUreteral stents are used to ensure the patency of a ureter, which may be compromised, for example, by a kidney stone or a procedure. This method is sometimes used as a temporary measure, to prevent damage to a blocked kidney, until a procedure to remove the stone can be performed. Indwelling times of 12 months or longer are indicated to hold ureters open, which are compressed by tumors in the neighbourhood of the ureter or by tumors of the ureter itself. In many cases these tumors are inoperable and the stents are used to ensure drainage of urine through the ureter. If drainage is compromised for longer periods, the kidney can be damaged.\nStents may also be placed in a ureter that has been irritated or scratched during a ureteroscopy procedure that involves the removal of a stone, sometimes referred to as a 'basket grab procedure'. Stents placed for this reason are normally left in place for about a week. These stents ensure that the ureter does not spasm and collapse after the trauma of the procedure.\n\nSide effects and complications \n Abdominal X-ray showing a double J stent to relieve colics from kidney stones (red arrows). The stone obstructing the ureter is also visible (yellow arrows).\nThe main complications with ureteral stents are dislocation, infection and blockage by encrustation. Recently stents with coatings, such as heparin, were approved to reduce infection and encrustation to reduce the number of stent exchanges.[1]\nOther complications can include increased urgency and frequency of urination, blood in the urine, leakage of urine, pain in the kidney, bladder, or groin, and pain in the kidneys during, and for a short time after urination.[2] These effects are generally temporary and disappear with the removal of the stent. Drugs used for the treatment of OAB (over active bladder) are sometimes given to reduce or eliminate the increased urgency and frequency of urination caused by the presence of the stent.\nStents often have a thread, used for removal, that passes through the urethra and remains outside the body. This thread may cause irritation of the urethra. This may be increased for patients who were born with Hypospadias or other conditions that required a similar corrective surgery. Care must be taken to ensure that the thread is not caught or pulled, which may dislodge the stent.\nWhile the stent is in place, patients may carry on with most normal activities; however, the stent may cause some discomfort during strenuous physical activity. Work and other daily activities may continue as normal. Sexual activity is also possible with a stent, but stents with a thread may significantly hinder sex.[2] The stent also can rest on the prostate gland in men, and with ejaculation\/orgasm, the prostate may have movement that is discomforting to the patient, similar to severe cramping or irritation. One should approach sex differently with a stent, exercising caution.[citation needed ]\n\nRemoval \nStents with a thread may be removed in a matter of a few seconds by pulling on the thread. This is often done by a nurse, but can be done by the patient. When removing the stent, constant, steady force should be applied, to avoid starting and stopping. Something should also be placed below the patient to catch any urine that leaks during removal. Stents without a thread are removed by a doctor using a cystoscope. The stent is removed by cystoscopy, an outpatient procedure. Cystoscopy involves placement of a small flexible tube through the urethra (the hole where urine exits the body). The procedure, which usually takes only a few minutes and causes little discomfort, is performed in an outpatient clinic or ambulatory surgery center. Most patients tolerate having the stent removed using only a topical anesthetic placed in the urethra. Immediately before the procedure, sterile lubrication containing local anesthetic (lidocaine) is instilled into the urethra. Since no intravenous line is inserted and there is no anesthesia, you do not have to be accompanied by anyone else and you\ncan eat normally before and after the procedure.\nA ureteric stent may also be retrieved without the use of a cystoscope by means of a magnetic removal system. The stent inserted has a small rare earth magnet attached to its bladder end which dangles freely within the bladder. When the stent needs to be removed a small catheter with a similar magnet is inserted into the bladder and the two magnets connect and the catheter and stent can be simply removed. This eliminates the need for a costly and invasive cystoscopy in both adults and children.\n\nReferences \nJ Urol Vol 168, 2023-2023, Nov 2002\nAUA University Series, abstract PD37-11\n\n\n^ Furio Cauda, Valentina Cauda, Cristian Fiori, Barbara Onida, Edoardo Garrone, F; Cauda, V; Fiori, C; Onida, B; Garrone, E (2008), \"Heparin Coating on Ureteral Double J Stents Prevents Encrustations: An in Vivo Case Study.\", J Endourol., 22 (3): 465\u2013472, doi:10.1089\/end.2007.0218, PMID 18307380 CS1 maint: Multiple names: authors list (link) \n\n^ a b H. B. Joshi; N. Newns; F. X. Keeley Jr.; A. G. Timoney, Uretic Stent \n\n\nFurther reading \nUreteral stents- Materials; Endourology update: Mardis HK, Kroeger RM: Urological Clinics of North America, 1988, Vol. 15, No.3, 471-479.\nUreteral stents \u2013 indications, variations and complications: Saltzman B: Endourology update : Urological Clinics of North America, 1988, Vol.15, No.3, 481-491.\nSelf retained internal ureteral stents: Use and complications: Mardis HK: AUA update series, 1997, Lesson 29, Volume XVI.\nExternal urinary diversion: pathologic circumstances and available technology. Macaluso JN Jr. J Endourol. 1993 Apr;7(2):131-6. PMID 8518825\nHaving a Ureteric Stent - What to Expect and How to Manage. Authors: Mr. H. B. Joshi (Specialist Registrar in Urology, Cambridge. Formerly Research Registrar at Bristol Urological Institute), N. Newns (Staff Nurse), Mr. F. X. Keeley Jr. (Consultant Urologist), Mr. A. G. Timoney (Consultant Urologist), Bristol Urological Institute, Southmead Hospital, Westbury-on-trym, Bristol BS10 5NB\nMinimally invasive ureteric stent retrieval. W.N. Taylor. In \"Stenting the Urinary System\" 2E: Yachia, 2004, ISBN 1-84184-387-3 Martin Dunitz\nMinimally Invasive Ureteric Stent RetrievalTaylor WN, McDougall IT J UrolVol 168,2020-2013, November 2002\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Ureteric_stent\">https:\/\/www.limswiki.org\/index.php\/Ureteric_stent<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 18:37.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 522 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","9e0cf08ada8d31fed0c2a5b3c2c18a06_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Ureteric_stent skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Ureteric stent<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>A <b>ureteral stent<\/b> (pronounced you-REE-ter-ul), or <b>ureteric stent<\/b>, is a thin tube inserted into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ureter\" title=\"Ureter\" rel=\"external_link\" target=\"_blank\">ureter<\/a> to prevent or treat obstruction of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urine\" title=\"Urine\" rel=\"external_link\" target=\"_blank\">urine<\/a> flow from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney\" title=\"Kidney\" rel=\"external_link\" target=\"_blank\">kidney<\/a>. The length of the stents used in adult patients varies between 24 and 30 cm. Additionally, stents come in differing diameters or gauges, to fit different size ureters. The stent is usually inserted with the aid of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cystoscope\" class=\"mw-redirect\" title=\"Cystoscope\" rel=\"external_link\" target=\"_blank\">cystoscope<\/a>. One or both ends of the stent may be coiled to prevent it from moving out of place; this is called a <b>JJ stent<\/b>, <b>double J stent<\/b> or <b>pig-tail stent<\/b>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Stent_placement\">Stent placement<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ureterstent_double_J_3D_legend.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c4\/Ureterstent_double_J_3D_legend.jpg\/220px-Ureterstent_double_J_3D_legend.jpg\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ureterstent_double_J_3D_legend.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Three-dimensional reconstructed <a href=\"https:\/\/en.wikipedia.org\/wiki\/CT_scan\" title=\"CT scan\" rel=\"external_link\" target=\"_blank\">CT scan<\/a> image of a ureteral stent in the left kidney (indicated by yellow arrow). There is a kidney stone in the pyelum of the lower pole of the kidney (higher red arrow) and one in the ureter beside the stent (lower red arrow).<\/div><\/div><\/div>\n<p>Ureteral stents are used to ensure the patency of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ureter\" title=\"Ureter\" rel=\"external_link\" target=\"_blank\">ureter<\/a>, which may be compromised, for example, by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_stone\" class=\"mw-redirect\" title=\"Kidney stone\" rel=\"external_link\" target=\"_blank\">kidney stone<\/a> or a procedure. This method is sometimes used as a temporary measure, to prevent damage to a blocked kidney, until a procedure to remove the stone can be performed. Indwelling times of 12 months or longer are indicated to hold ureters open, which are compressed by tumors in the neighbourhood of the ureter or by tumors of the ureter itself. In many cases these tumors are inoperable and the stents are used to ensure drainage of urine through the ureter. If drainage is compromised for longer periods, the kidney can be damaged.\n<\/p><p>Stents may also be placed in a ureter that has been irritated or scratched during a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ureteroscopy\" title=\"Ureteroscopy\" rel=\"external_link\" target=\"_blank\">ureteroscopy<\/a> procedure that involves the removal of a stone, sometimes referred to as a 'basket grab procedure'. Stents placed for this reason are normally left in place for about a week. These stents ensure that the ureter does not spasm and collapse after the trauma of the procedure.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Side_effects_and_complications\">Side effects and complications<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:DoubleJ.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/DoubleJ.jpg\/220px-DoubleJ.jpg\" width=\"220\" height=\"264\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:DoubleJ.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Abdominal <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray\" title=\"X-ray\" rel=\"external_link\" target=\"_blank\">X-ray<\/a> showing a double J stent to relieve colics from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_stones\" class=\"mw-redirect\" title=\"Kidney stones\" rel=\"external_link\" target=\"_blank\">kidney stones<\/a> (red arrows). The stone obstructing the ureter is also visible (yellow arrows).<\/div><\/div><\/div>\n<p>The main complications with ureteral stents are dislocation, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a> and blockage by encrustation. Recently stents with coatings, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heparin\" title=\"Heparin\" rel=\"external_link\" target=\"_blank\">heparin<\/a>, were approved to reduce infection and encrustation to reduce the number of stent exchanges.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Other complications can include increased urgency and frequency of urination, blood in the urine, leakage of urine, pain in the kidney, bladder, or groin, and pain in the kidneys during, and for a short time after urination.<sup id=\"rdp-ebb-cite_ref-stent_2-0\" class=\"reference\"><a href=\"#cite_note-stent-2\" rel=\"external_link\">[2]<\/a><\/sup> These effects are generally temporary and disappear with the removal of the stent. Drugs used for the treatment of OAB (over active bladder) are sometimes given to reduce or eliminate the increased urgency and frequency of urination caused by the presence of the stent.\n<\/p><p>Stents often have a thread, used for removal, that passes through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urethra\" title=\"Urethra\" rel=\"external_link\" target=\"_blank\">urethra<\/a> and remains outside the body. This thread may cause irritation of the urethra. This may be increased for patients who were born with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypospadias\" title=\"Hypospadias\" rel=\"external_link\" target=\"_blank\">Hypospadias<\/a> or other conditions that required a similar corrective surgery. Care must be taken to ensure that the thread is not caught or pulled, which may dislodge the stent.\n<\/p><p>While the stent is in place, patients may carry on with most normal activities; however, the stent may cause some discomfort during strenuous physical activity. Work and other daily activities may continue as normal. Sexual activity is also possible with a stent, but stents with a thread may significantly hinder sex.<sup id=\"rdp-ebb-cite_ref-stent_2-1\" class=\"reference\"><a href=\"#cite_note-stent-2\" rel=\"external_link\">[2]<\/a><\/sup> The stent also can rest on the prostate gland in men, and with ejaculation\/orgasm, the prostate may have movement that is discomforting to the patient, similar to severe cramping or irritation. One should approach sex differently with a stent, exercising caution.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"No rationale is given for this vague advice (July 2015)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Removal\">Removal<\/span><\/h2>\n<p>Stents with a thread may be removed in a matter of a few seconds by pulling on the thread. This is often done by a nurse, but can be done by the patient. When removing the stent, constant, steady force should be applied, to avoid starting and stopping. Something should also be placed below the patient to catch any urine that leaks during removal. Stents without a thread are removed by a doctor using a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cystoscope\" class=\"mw-redirect\" title=\"Cystoscope\" rel=\"external_link\" target=\"_blank\">cystoscope<\/a>. The stent is removed by cystoscopy, an outpatient procedure. Cystoscopy involves placement of a small flexible tube through the urethra (the hole where urine exits the body). The procedure, which usually takes only a few minutes and causes little discomfort, is performed in an outpatient clinic or ambulatory surgery center. Most patients tolerate having the stent removed using only a topical anesthetic placed in the urethra. Immediately before the procedure, sterile lubrication containing local anesthetic (lidocaine) is instilled into the urethra. Since no intravenous line is inserted and there is no anesthesia, you do not have to be accompanied by anyone else and you\ncan eat normally before and after the procedure.\n<\/p><p>A ureteric stent may also be retrieved without the use of a cystoscope by means of a magnetic removal system. The stent inserted has a small rare earth magnet attached to its bladder end which dangles freely within the bladder. When the stent needs to be removed a small catheter with a similar magnet is inserted into the bladder and the two magnets connect and the catheter and stent can be simply removed. This eliminates the need for a costly and invasive cystoscopy in both adults and children.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<p>J Urol Vol 168, 2023-2023, Nov 2002\n<\/p><p>AUA University Series, abstract PD37-11\n<\/p>\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFFurio_Cauda,_Valentina_Cauda,_Cristian_Fiori,_Barbara_Onida,_Edoardo_GarroneCaudaFioriOnida2008\" class=\"citation\">Furio Cauda, Valentina Cauda, Cristian Fiori, Barbara Onida, Edoardo Garrone, F; Cauda, V; Fiori, C; Onida, B; Garrone, E (2008), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.liebertonline.com\/doi\/pdf\/10.1089\/end.2007.0218\" target=\"_blank\">\"Heparin Coating on Ureteral Double J Stents Prevents Encrustations: An in Vivo Case Study.\"<\/a>, <i>J Endourol.<\/i>, <b>22<\/b> (3): 465\u2013472, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1089%2Fend.2007.0218\" target=\"_blank\">10.1089\/end.2007.0218<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18307380\" target=\"_blank\">18307380<\/a><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Endourol.&rft.atitle=Heparin+Coating+on+Ureteral+Double+J+Stents+Prevents+Encrustations%3A+An+in+Vivo+Case+Study.&rft.volume=22&rft.issue=3&rft.pages=465-472&rft.date=2008&rft_id=info%3Adoi%2F10.1089%2Fend.2007.0218&rft_id=info%3Apmid%2F18307380&rft.aulast=Furio+Cauda%2C+Valentina+Cauda%2C+Cristian+Fiori%2C+Barbara+Onida%2C+Edoardo+Garrone&rft.aufirst=F&rft.au=Cauda%2C+V&rft.au=Fiori%2C+C&rft.au=Onida%2C+B&rft.au=Garrone%2C+E&rft_id=http%3A%2F%2Fwww.liebertonline.com%2Fdoi%2Fpdf%2F10.1089%2Fend.2007.0218&rfr_id=info%3Asid%2Fen.wikipedia.org%3AUreteric+stent\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><\/span>\n<\/li>\n<li id=\"cite_note-stent-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-stent_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-stent_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFH._B._JoshiN._NewnsF._X._Keeley_Jr.A._G._Timoney\" class=\"citation\">H. B. Joshi; N. Newns; F. X. Keeley Jr.; A. G. Timoney, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bui.ac.uk\/PatientInfo\/ureterstent.html\" target=\"_blank\"><i>Uretic Stent<\/i><\/a><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Uretic+Stent%2C&rft.au=H.+B.+Joshi&rft.au=N.+Newns&rft.au=F.+X.+Keeley+Jr.&rft.au=A.+G.+Timoney&rft_id=http%3A%2F%2Fwww.bui.ac.uk%2FPatientInfo%2Fureterstent.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AUreteric+stent\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ol><li>Ureteral stents- Materials; Endourology update: Mardis HK, Kroeger RM: Urological Clinics of North America, 1988, Vol. 15, No.3, 471-479.<\/li>\n<li>Ureteral stents \u2013 indications, variations and complications: Saltzman B: Endourology update : Urological Clinics of North America, 1988, Vol.15, No.3, 481-491.<\/li>\n<li>Self retained internal ureteral stents: Use and complications: Mardis HK: AUA update series, 1997, Lesson 29, Volume XVI.<\/li>\n<li>External urinary diversion: pathologic circumstances and available technology. Macaluso JN Jr. J Endourol. 1993 Apr;7(2):131-6. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8518825\" target=\"_blank\">8518825<\/a><\/li>\n<li>Having a Ureteric Stent - What to Expect and How to Manage. Authors: Mr. H. B. Joshi (Specialist Registrar in Urology, Cambridge. Formerly Research Registrar at Bristol Urological Institute), N. Newns (Staff Nurse), Mr. F. X. Keeley Jr. (Consultant Urologist), Mr. A. G. Timoney (Consultant Urologist), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bui.ac.uk\/PatientInfo\/ureterstent.html\" target=\"_blank\">Bristol Urological Institute, Southmead Hospital, Westbury-on-trym, Bristol BS10 5NB<\/a><\/li>\n<li>Minimally invasive ureteric stent retrieval. W.N. Taylor. In \"Stenting the Urinary System\" 2E: Yachia, 2004, <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-84184-387-3 Martin Dunitz<\/li>\n<li>Minimally Invasive Ureteric Stent RetrievalTaylor WN, McDougall IT J UrolVol 168,2020-2013, November 2002<\/li><\/ol>\n<p><!-- \nNewPP limit report\nParsed by mw1267\nCached time: 20181217110835\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.204 seconds\nReal time usage: 0.295 seconds\nPreprocessor visited node count: 736\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 11724\/2097152 bytes\nTemplate argument size: 782\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 9334\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.108\/10.000 seconds\nLua memory usage: 2.72 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 257.705 1 -total\n<\/p>\n<pre>36.03% 92.860 2 Template:Citation\n24.52% 63.177 1 Template:Infobox_medical_intervention\n23.02% 59.311 1 Template:Infobox\n20.07% 51.733 1 Template:Citation_needed\n17.95% 46.269 1 Template:Fix\n12.83% 33.066 2 Template:Category_handler\n 9.97% 25.692 1 Template:ISBN\n 6.06% 15.617 1 Template:PMID\n 5.76% 14.832 2 Template:Catalog_lookup_link\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:5798676-1!canonical and timestamp 20181217110834 and revision id 858905038\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ureteric_stent\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212202\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.016 seconds\nReal time usage: 0.152 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 145.209 1 - wikipedia:Ureteric_stent\n100.00% 145.209 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8086-0!*!*!*!*!*!* and timestamp 20181217212202 and revision id 24205\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Ureteric_stent\">https:\/\/www.limswiki.org\/index.php\/Ureteric_stent<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","9e0cf08ada8d31fed0c2a5b3c2c18a06_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/53\/Ureteral_stent.jpg\/560px-Ureteral_stent.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c4\/Ureterstent_double_J_3D_legend.jpg\/440px-Ureterstent_double_J_3D_legend.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/DoubleJ.jpg\/440px-DoubleJ.jpg"],"9e0cf08ada8d31fed0c2a5b3c2c18a06_timestamp":1545081722,"ee147bb776310ab4a9865038bcc69a57_type":"article","ee147bb776310ab4a9865038bcc69a57_title":"Tympanostomy tube","ee147bb776310ab4a9865038bcc69a57_url":"https:\/\/www.limswiki.org\/index.php\/Tympanostomy_tube","ee147bb776310ab4a9865038bcc69a57_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tTympanostomy tube\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tTympanostomy tubeThe grommet is less than 2 mm tall, smaller than a match head.SynonymsGrommet, T-tube, ear tube, pressure equalization tube, vent, PE tube, myringotomy tube[edit on Wikidata]\nTympanostomy tube, also known as a grommet or myringotomy tube, is a small tube inserted into the eardrum in order to keep the middle ear aerated for a prolonged period of time, and to prevent the accumulation of fluid in the middle ear. The operation to insert the tube involves a myringotomy and is performed under local or general anesthesia. The tube itself is made in a variety of designs. The most commonly used type is shaped like a grommet. When it is necessary to keep the middle ear ventilated for a very long period, a \"T\"-shaped tube may be used, as these \"T-tubes\" can stay in place for 2\u20134 years. Materials used to construct the tube are most often plastics such as silicone or Teflon. Stainless steel tubes exist, but are no longer in frequent use.\n\nContents \n\n1 Medical uses \n2 Procedure \n3 Outcome \n4 References \n\n\nMedical uses \n Tubes of a more permanent style, unlike those typically used in the United States. These tubes remained in place for four years until one spontaneously left the ear drum. The other was removed with tweezers after having partially disengaged from the ear drum. The removal process can cause significant pain for several minutes. \nGuidelines state that tubes are an option in:\n\nRecurrent acute otitis media: three ear infections in six months or four infections in a year.[1] The evidence for this recommendation; however, is weak.[1]\nChronic otitis media with persistent effusion for six months (one ear) or three months (both ears).[citation needed ]\nPersistent eustachian tube dysfunction[citation needed ]\nBarotrauma: Especially for prevention of recurrent episodes (e.g., after air travel, hyperbaric chamber treatment).[citation needed ]\nProcedure \nAlthough myringotomy with tube insertion can be performed under local anesthesia during a regular doctor's appointment in co-operative adults, patients requiring tube insertion are very often young children. Since damage to the ear is possible unless the patient stays quite still while being manipulated, any patient who may have difficulty lying still during the procedure typically undergoes myringotomy and tube insertion under general anesthesia.\nThe insertion of tympanostomy tubes is one of the most common surgical procedures performed on children. In the United States, it is the most common reason for a child to undergo a general anesthetic.[2]\n\nOutcome \n Ear tube\nTympanostomy tubes generally remain in the eardrum for six months to two years, with T-tubes lasting up to four years. They generally spontaneously fall out of the eardrum as the skin of the eardrum slowly migrates out towards the ear canal wall over time. The eardrum usually closes without a residual hole at the tube site but in a small number of cases a perforation can persist. There is debate among clinicians as to whether long-lasting tubes are associated with a higher incidence of adverse outcomes, such as persistent perforation, cholesteatoma, tympanosclerosis and others, as opposed to tubes designed to last for shorter durations.\nA common complication of getting a tympanostomy tube is experiencing otorrhea, which is a discharge from the ear.[3] Oral antibiotics should not be used to treat uncomplicated acute tympanostomy tube otorrhea.[3] Oral antibiotics are not a sufficient response to bacteria which cause this condition and have significant side effects including increased risk of opportunistic infection.[3] In contrast, topical antibiotic eardrops can treat this condition.[3]\n\nReferences \n\n^ a b Lieberthal, AS; Carroll, AE; Chonmaitree, T; Ganiats, TG; Hoberman, A; Jackson, MA; Joffe, MD; Miller, DT; Rosenfeld, RM; Sevilla, XD; Schwartz, RH; Thomas, PA; Tunkel, DE (March 2013). \"The diagnosis and management of acute otitis media\". Pediatrics. 131 (3): e964\u201399. doi:10.1542\/peds.2012-3488. PMID 23439909. \n\n^ Vaile L. Williamson T. Waddell A. Taylor G. Interventions for ear discharge associated with grommets (ventilation tubes) \n\n^ a b c d American Academy of Otolaryngology\u2013Head and Neck Surgery, \"Five Things Physicians and Patients Should Question\", Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Otolaryngology\u2013Head and Neck Surgery, retrieved August 1, 2013 , which cites\nRosenfeld, R. M.; Schwartz, S. R.; Pynnonen, M. A.; Tunkel, D. E.; Hussey, H. M.; Fichera, J. S.; Grimes, A. M.; Hackell, J. M.; Harrison, M. F.; Haskell, H.; Haynes, D. S.; Kim, T. W.; Lafreniere, D. C.; LeBlanc, K.; Mackey, W. L.; Netterville, J. L.; Pipan, M. E.; Raol, N. P.; Schellhase, K. G. (2013). \"Clinical Practice Guideline: Tympanostomy Tubes in Children\". Otolaryngology\u2013Head and Neck Surgery. 149 (1 Suppl): S1\u2013S35. doi:10.1177\/0194599813487302. ISSN 0194-5998. PMID 23818543. \n \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Tympanostomy_tube\">https:\/\/www.limswiki.org\/index.php\/Tympanostomy_tube<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 22:50.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 518 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","ee147bb776310ab4a9865038bcc69a57_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Tympanostomy_tube skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Tympanostomy tube<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Tympanostomy tube<\/b>, also known as a <b>grommet<\/b> or <b>myringotomy tube<\/b>, is a small tube inserted into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eardrum\" title=\"Eardrum\" rel=\"external_link\" target=\"_blank\">eardrum<\/a> in order to keep the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Middle_ear\" title=\"Middle ear\" rel=\"external_link\" target=\"_blank\">middle ear<\/a> aerated for a prolonged period of time, and to prevent the accumulation of fluid in the middle ear. The operation to insert the tube involves a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myringotomy\" title=\"Myringotomy\" rel=\"external_link\" target=\"_blank\">myringotomy<\/a> and is performed under local or <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_anesthesia\" class=\"mw-redirect\" title=\"General anesthesia\" rel=\"external_link\" target=\"_blank\">general anesthesia<\/a>. The tube itself is made in a variety of designs. The most commonly used type is shaped like a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grommet\" title=\"Grommet\" rel=\"external_link\" target=\"_blank\">grommet<\/a>. When it is necessary to keep the middle ear ventilated for a very long period, a \"T\"-shaped tube may be used, as these \"T-tubes\" can stay in place for 2\u20134 years. Materials used to construct the tube are most often <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastics\" class=\"mw-redirect\" title=\"Plastics\" rel=\"external_link\" target=\"_blank\">plastics<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Teflon\" class=\"mw-redirect\" title=\"Teflon\" rel=\"external_link\" target=\"_blank\">Teflon<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">Stainless steel<\/a> tubes exist, but are no longer in frequent use.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:210px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Typmanostomy_tubes,_permanent_style,_2006-2011_(cropped).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/8\/84\/Typmanostomy_tubes%2C_permanent_style%2C_2006-2011_%28cropped%29.jpg\" width=\"208\" height=\"244\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Typmanostomy_tubes,_permanent_style,_2006-2011_(cropped).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Tubes of a more permanent style, unlike those typically used in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a>. These tubes remained in place for four years until one spontaneously left the ear drum. The other was removed with tweezers after having partially disengaged from the ear drum. The removal process can cause significant pain for several minutes.<\/div><\/div><\/div> \n<p>Guidelines state that tubes are an option in:\n<\/p>\n<ul><li>Recurrent acute otitis media: three ear infections in six months or four infections in a year.<sup id=\"rdp-ebb-cite_ref-Peads2013_1-0\" class=\"reference\"><a href=\"#cite_note-Peads2013-1\" rel=\"external_link\">[1]<\/a><\/sup> The evidence for this recommendation; however, is weak.<sup id=\"rdp-ebb-cite_ref-Peads2013_1-1\" class=\"reference\"><a href=\"#cite_note-Peads2013-1\" rel=\"external_link\">[1]<\/a><\/sup><\/li>\n<li>Chronic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otitis_media\" title=\"Otitis media\" rel=\"external_link\" target=\"_blank\">otitis media<\/a> with persistent effusion for six months (one ear) or three months (both ears).<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2015)\">citation needed<\/span><\/a><\/i>]<\/sup><\/li>\n<li>Persistent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eustachian_tube\" title=\"Eustachian tube\" rel=\"external_link\" target=\"_blank\">eustachian tube<\/a> dysfunction<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2015)\">citation needed<\/span><\/a><\/i>]<\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Barotrauma\" title=\"Barotrauma\" rel=\"external_link\" target=\"_blank\">Barotrauma<\/a>: Especially for prevention of recurrent episodes (e.g., after air travel, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperbaric_chamber\" class=\"mw-redirect\" title=\"Hyperbaric chamber\" rel=\"external_link\" target=\"_blank\">hyperbaric chamber<\/a> treatment).<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2015)\">citation needed<\/span><\/a><\/i>]<\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Procedure\">Procedure<\/span><\/h2>\n<p>Although myringotomy with tube insertion can be performed under <a href=\"https:\/\/en.wikipedia.org\/wiki\/Local_anesthesia\" title=\"Local anesthesia\" rel=\"external_link\" target=\"_blank\">local anesthesia<\/a> during a regular doctor's appointment in co-operative adults, patients requiring tube insertion are very often young children. Since damage to the ear is possible unless the patient stays quite still while being manipulated, any patient who may have difficulty lying still during the procedure typically undergoes myringotomy and tube insertion under general anesthesia.\n<\/p><p>The insertion of tympanostomy tubes is one of the most common surgical procedures performed on children. In the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a>, it is the most common reason for a child to undergo a general anesthetic.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Outcome\">Outcome<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:122px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ear_Tube.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/96\/Ear_Tube.png\/120px-Ear_Tube.png\" width=\"120\" height=\"160\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ear_Tube.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Ear tube<\/div><\/div><\/div>\n<p>Tympanostomy tubes generally remain in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eardrum\" title=\"Eardrum\" rel=\"external_link\" target=\"_blank\">eardrum<\/a> for six months to two years, with T-tubes lasting up to four years. They generally spontaneously fall out of the eardrum as the skin of the eardrum slowly migrates out towards the ear canal wall over time. The eardrum usually closes without a residual hole at the tube site but in a small number of cases a perforation can persist. There is debate among clinicians as to whether long-lasting tubes are associated with a higher incidence of adverse outcomes, such as persistent perforation, cholesteatoma, tympanosclerosis and others, as opposed to tubes designed to last for shorter durations.\n<\/p><p>A common complication of getting a tympanostomy tube is experiencing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otitis_media#Otorrhea:_infected_drainage_from_the_middle_ear\" title=\"Otitis media\" rel=\"external_link\" target=\"_blank\">otorrhea<\/a>, which is a discharge from the ear.<sup id=\"rdp-ebb-cite_ref-AANfive_3-0\" class=\"reference\"><a href=\"#cite_note-AANfive-3\" rel=\"external_link\">[3]<\/a><\/sup> Oral antibiotics should not be used to treat uncomplicated acute tympanostomy tube otorrhea.<sup id=\"rdp-ebb-cite_ref-AANfive_3-1\" class=\"reference\"><a href=\"#cite_note-AANfive-3\" rel=\"external_link\">[3]<\/a><\/sup> Oral antibiotics are not a sufficient response to bacteria which cause this condition and have significant side effects including increased risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Opportunistic_infection\" title=\"Opportunistic infection\" rel=\"external_link\" target=\"_blank\">opportunistic infection<\/a>.<sup id=\"rdp-ebb-cite_ref-AANfive_3-2\" class=\"reference\"><a href=\"#cite_note-AANfive-3\" rel=\"external_link\">[3]<\/a><\/sup> In contrast, topical antibiotic eardrops can treat this condition.<sup id=\"rdp-ebb-cite_ref-AANfive_3-3\" class=\"reference\"><a href=\"#cite_note-AANfive-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-Peads2013-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Peads2013_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Peads2013_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lieberthal, AS; Carroll, AE; Chonmaitree, T; Ganiats, TG; Hoberman, A; Jackson, MA; Joffe, MD; Miller, DT; Rosenfeld, RM; Sevilla, XD; Schwartz, RH; Thomas, PA; Tunkel, DE (March 2013). \"The diagnosis and management of acute otitis media\". <i>Pediatrics<\/i>. <b>131<\/b> (3): e964\u201399. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1542%2Fpeds.2012-3488\" target=\"_blank\">10.1542\/peds.2012-3488<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23439909\" target=\"_blank\">23439909<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pediatrics&rft.atitle=The+diagnosis+and+management+of+acute+otitis+media.&rft.volume=131&rft.issue=3&rft.pages=e964-99&rft.date=2013-03&rft_id=info%3Adoi%2F10.1542%2Fpeds.2012-3488&rft_id=info%3Apmid%2F23439909&rft.aulast=Lieberthal&rft.aufirst=AS&rft.au=Carroll%2C+AE&rft.au=Chonmaitree%2C+T&rft.au=Ganiats%2C+TG&rft.au=Hoberman%2C+A&rft.au=Jackson%2C+MA&rft.au=Joffe%2C+MD&rft.au=Miller%2C+DT&rft.au=Rosenfeld%2C+RM&rft.au=Sevilla%2C+XD&rft.au=Schwartz%2C+RH&rft.au=Thomas%2C+PA&rft.au=Tunkel%2C+DE&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATympanostomy+tube\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Vaile L. Williamson T. Waddell A. Taylor G. <i>Interventions for ear discharge associated with grommets (ventilation tubes)<\/i><\/span>\n<\/li>\n<li id=\"cite_note-AANfive-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-AANfive_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-AANfive_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-AANfive_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-AANfive_3-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFAmerican_Academy_of_Otolaryngology\u2013Head_and_Neck_Surgery\" class=\"citation\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Academy_of_Otolaryngology%E2%80%93Head_and_Neck_Surgery\" title=\"American Academy of Otolaryngology\u2013Head and Neck Surgery\" rel=\"external_link\" target=\"_blank\">American Academy of Otolaryngology\u2013Head and Neck Surgery<\/a>, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.choosingwisely.org\/doctor-patient-lists\/american-academy-of-otolaryngology-head-and-neck-surgery-foundation\/\/\" target=\"_blank\">\"Five Things Physicians and Patients Should Question\"<\/a>, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Choosing_Wisely\" title=\"Choosing Wisely\" rel=\"external_link\" target=\"_blank\">Choosing Wisely<\/a>: an initiative of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ABIM_Foundation\" class=\"mw-redirect\" title=\"ABIM Foundation\" rel=\"external_link\" target=\"_blank\">ABIM Foundation<\/a><\/i>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Academy_of_Otolaryngology%E2%80%93Head_and_Neck_Surgery\" title=\"American Academy of Otolaryngology\u2013Head and Neck Surgery\" rel=\"external_link\" target=\"_blank\">American Academy of Otolaryngology\u2013Head and Neck Surgery<\/a><span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">August 1,<\/span> 2013<\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Choosing+Wisely%3A+an+initiative+of+the+ABIM+Foundation&rft.atitle=Five+Things+Physicians+and+Patients+Should+Question&rft.au=American+Academy+of+Otolaryngology%E2%80%93Head+and+Neck+Surgery&rft_id=http%3A%2F%2Fwww.choosingwisely.org%2Fdoctor-patient-lists%2Famerican-academy-of-otolaryngology-head-and-neck-surgery-foundation%2F%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATympanostomy+tube\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>, which cites\n<ul><li><cite class=\"citation journal\">Rosenfeld, R. M.; Schwartz, S. R.; Pynnonen, M. A.; Tunkel, D. E.; Hussey, H. M.; Fichera, J. S.; Grimes, A. M.; Hackell, J. M.; Harrison, M. F.; Haskell, H.; Haynes, D. S.; Kim, T. W.; Lafreniere, D. C.; LeBlanc, K.; Mackey, W. L.; Netterville, J. L.; Pipan, M. E.; Raol, N. P.; Schellhase, K. G. (2013). \"Clinical Practice Guideline: Tympanostomy Tubes in Children\". <i>Otolaryngology\u2013Head and Neck Surgery<\/i>. <b>149<\/b> (1 Suppl): S1\u2013S35. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F0194599813487302\" target=\"_blank\">10.1177\/0194599813487302<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0194-5998\" target=\"_blank\">0194-5998<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23818543\" target=\"_blank\">23818543<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Otolaryngology%E2%80%93Head+and+Neck+Surgery&rft.atitle=Clinical+Practice+Guideline%3A+Tympanostomy+Tubes+in+Children&rft.volume=149&rft.issue=1+Suppl&rft.pages=S1-S35&rft.date=2013&rft.issn=0194-5998&rft_id=info%3Apmid%2F23818543&rft_id=info%3Adoi%2F10.1177%2F0194599813487302&rft.aulast=Rosenfeld&rft.aufirst=R.+M.&rft.au=Schwartz%2C+S.+R.&rft.au=Pynnonen%2C+M.+A.&rft.au=Tunkel%2C+D.+E.&rft.au=Hussey%2C+H.+M.&rft.au=Fichera%2C+J.+S.&rft.au=Grimes%2C+A.+M.&rft.au=Hackell%2C+J.+M.&rft.au=Harrison%2C+M.+F.&rft.au=Haskell%2C+H.&rft.au=Haynes%2C+D.+S.&rft.au=Kim%2C+T.+W.&rft.au=Lafreniere%2C+D.+C.&rft.au=LeBlanc%2C+K.&rft.au=Mackey%2C+W.+L.&rft.au=Netterville%2C+J.+L.&rft.au=Pipan%2C+M.+E.&rft.au=Raol%2C+N.+P.&rft.au=Schellhase%2C+K.+G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATympanostomy+tube\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<\/span><\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1258\nCached time: 20181212013249\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.232 seconds\nReal time usage: 0.303 seconds\nPreprocessor visited node count: 877\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 17251\/2097152 bytes\nTemplate argument size: 1641\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 10791\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.143\/10.000 seconds\nLua memory usage: 3.05 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 270.344 1 -total\n<\/p>\n<pre>32.39% 87.558 2 Template:Cite_journal\n31.48% 85.111 3 Template:Citation_needed\n28.48% 76.997 1 Template:Infobox_medical_intervention\n27.78% 75.106 3 Template:Fix\n26.55% 71.784 1 Template:Infobox\n14.21% 38.423 6 Template:Category_handler\n11.43% 30.891 3 Template:Delink\n 3.62% 9.775 1 Template:Citation\n 2.49% 6.726 1 Template:PAGENAMEBASE\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2015316-1!canonical and timestamp 20181212013248 and revision id 862773554\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Tympanostomy_tube\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212202\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.044 seconds\nReal time usage: 0.214 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 208.154 1 - wikipedia:Tympanostomy_tube\n100.00% 208.154 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8018-0!*!*!*!*!*!* and timestamp 20181217212201 and revision id 24129\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Tympanostomy_tube\">https:\/\/www.limswiki.org\/index.php\/Tympanostomy_tube<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","ee147bb776310ab4a9865038bcc69a57_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/3\/3a\/Grommet.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/8\/84\/Typmanostomy_tubes%2C_permanent_style%2C_2006-2011_%28cropped%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/96\/Ear_Tube.png\/240px-Ear_Tube.png"],"ee147bb776310ab4a9865038bcc69a57_timestamp":1545081721,"18ca7b6afd97b2aefd0d40ff2969d686_type":"article","18ca7b6afd97b2aefd0d40ff2969d686_title":"Transjugular intrahepatic portosystemic shunt","18ca7b6afd97b2aefd0d40ff2969d686_url":"https:\/\/www.limswiki.org\/index.php\/Transjugular_intrahepatic_portosystemic_shunt","18ca7b6afd97b2aefd0d40ff2969d686_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tTransjugular intrahepatic portosystemic shunt\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tTransjugular intrahepatic portosystemic shuntFluoroscopic image of TIPS in progress. A catheter has been passed into the hepatic vein and after needle puncture, a guidewire was passed into a portal vein branch. The tract was dilated with a balloon, and contrast injected. A self-expandable metallic stent has yet to be placed over the wire.SynonymsTransjugular intrahepatic portosystemic stent shuntingICD-9-CM39.1MeSHD019168 [edit on Wikidata]\nTransjugular intrahepatic portosystemic shunt (TIPS or TIPSS) is an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein. It is used to treat portal hypertension (which is often due to liver cirrhosis) which frequently leads to intestinal bleeding, life-threatening esophageal bleeding (esophageal varices) and the buildup of fluid within the abdomen (ascites).\nAn interventional radiologist creates the shunt using an image-guided endovascular (via the blood vessels) approach, with the jugular vein as the usual entry site.\nThe procedure was first described by Josef R\u00f6sch in 1969 at Oregon Health and Science University. It was first used in a human patient by Dr. Ronald Colapinto, of the University of Toronto, in 1982, but did not become reproducibly successful until the development of endovascular stents in 1985. In 1988 the first successful TIPS was realized by M. R\u00f6ssle, G.M. Richter, G. N\u00f6ldge and J. Palmaz at the University of Freiburg.[1] The procedure has since become widely accepted as the preferred method for treating portal hypertension that is refractory to medical therapy, replacing the surgical portocaval shunt in that role.\n\nContents \n\n1 Medical uses \n2 Complications \n3 Mechanism of action \n4 Implantation \n5 See also \n6 References \n7 External links \n\n\nMedical uses \nTIPS is a life saving procedure in bleeding from esophageal or gastric varices. A randomized study showed that the survival is better if the procedure is done within 72 hours after bleeding.[2] TIPS has shown some promise for people with hepatorenal syndrome.[3] It may also help with ascites.[4]\n\nComplications \nSevere procedural complications during a TIPS procedure, including catastrophic bleeding or direct liver injury, are relatively uncommon. In the hands of an experienced physician, operative mortality is less than 1%[medical citation needed ]. On the other hand, up to 25% of patients who undergo TIPS will experience transient post-operative hepatic encephalopathy caused by increased porto-systemic passage of nitrogen from the gut.[5] In general, this can be managed with a reduction in dietary protein and medication that reduces the absorption of nitrogen.\nA less common, but more serious complication, is hepatic ischemia causing acute liver failure. While healthy livers are predominantly oxygenated by portal blood supply, long-standing portal hypertension results in compensatory hypertrophy of and increased reliance on the hepatic artery for oxygenation. Thus, in people with advanced liver disease the shunting of portal blood away from hepatocytes is usually well tolerated. However, in some cases suddenly shunting portal blood flow away from the liver may result in acute liver failure secondary to hepatic ischemia.[6] Acute hepatic dysfunction after TIPS may require emergent closure of the shunt.\nA rare but serious complication is persistent TIPS infection, also known as endotipsitis.[7]\nLastly, the TIPS may become blocked by a blood clot or in-growth of endothelial cells and no longer function. This has been significantly reduced with the use of polytetrafluoroethylene (PTFE)\u2013covered stents.[8]\n\nMechanism of action \nPortal hypertension, an important consequence of liver disease, results in the development of significant collateral circulation between the portal system and systemic venous drainage (porto-caval circulation). Portal venous congestion causes venous blood leaving the stomach and intestines to be diverted along auxiliary routes of lesser resistance in order to drain to systemic circulation. With time, the small vessels that comprise a collateral path for porto-caval circulation become engorged and dilated. These vessels are fragile and often hemorrhage into the GI tract. (See esophageal, gastric, rectal varices).\nA TIPS procedure decreases the effective vascular resistance of the liver through the creation of an alternative pathway for portal venous circulation. By creating a shunt from the portal vein to the hepatic vein, this intervention allows portal blood an alternative avenue for draining into systemic circulation. In bypassing the flow-resistant liver, the net result is a reduced pressure drop across the liver and a decreased portal venous pressure. Decreased portal venous pressure in turn lessens congestive pressures along veins in the intestine so that future bleeding is less likely to occur. The reduced pressure also makes less fluid develop, although this benefit may take weeks or months to occur.\n\nImplantation \n Steps in a TIPS procedure: A) portal hypertension has caused the coronary vein (arrow) and the umbilical vein (arrowhead) to dilate and flow in reverse. This leads to varices in the esophagus and stomach, which can bleed; B) a needle has been introduced (via the jugular vein) and is passing from the hepatic vein into the portal vein; c) the tract is dilated with a balloon; D) after placement of a stent, portal pressure is normalized and the coronary and umbilical veins no longer fill.\nTransjugular intrahepatic portosystemic shunts are typically placed by an interventional radiologist under fluoroscopic guidance.[9] Access to the liver is gained, as the name 'transjugular' suggests, via the internal jugular vein in the neck. Once access to the jugular vein is confirmed, a guidewire and introducer sheath are typically placed to facilitate the shunt's placement. This enables the interventional radiologist to gain access to the patient's hepatic vein by traveling from the superior vena cava into the inferior vena cava and finally the hepatic vein. Once the catheter is in the hepatic vein, a wedge pressure is obtained to calculate the pressure gradient in the liver. Following this, carbon dioxide is injected to locate the portal vein. Then, a special needle known as a Colapinto is advanced through the liver parenchyma to connect the hepatic vein to the large portal vein, near the center of the liver. The channel for the shunt is next created by inflating an angioplasty balloon within the liver along the tract created by the needle. The shunt is completed by placing a special mesh tube known as a stent or endograft to maintain the tract between the higher-pressure portal vein and the lower-pressure hepatic vein. After the procedure, fluoroscopic images are made to show placement. Pressure in the portal vein and inferior vena cava are often measured.\n\nSee also \nDistal splenorenal shunt procedure\nGastric antral vascular ectasia\nInterventional radiology\nPortal venous system\nReferences \n\n^ R\u00f6ssle M, Richter GM, N\u00f6ldge G, Palmaz JC, Wenz W, Gerok W (1989). \"New non-operative treatment for variceal haemorrhage\". Lancet. 2 (8655): 153. doi:10.1016\/s0140-6736(89)90201-8. PMID 2567908. \n\n^ Garc\u00eda-Pag\u00e1n, Juan Carlos; Caca, Karel; Bureau, Christophe; Laleman, Wim; Appenrodt, Beate; Luca, Angelo; Abraldes, Juan G.; Nevens, Frederik; Vinel, Jean Pierre (June 2010). \"Early use of TIPS in patients with cirrhosis and variceal bleeding\". The New England Journal of Medicine. 362 (25): 2370\u20132379. doi:10.1056\/NEJMoa0910102. ISSN 1533-4406. PMID 20573925. \n\n^ Guevara M, Rod\u00e9s J (2005). \"Hepatorenal syndrome\". Int. J. Biochem. Cell Biol. 37 (1): 22\u20136. doi:10.1016\/j.biocel.2004.06.007. PMID 15381144. \n\n^ \"Ascites - Hepatic and Biliary Disorders\". Merck Manuals Professional Edition. May 2016. Retrieved 14 December 2017 . \n\n^ Rossle M, Piotraschke J. Transjugular intrahepatic portosystemic shunt and hepatic encephalopathy. Dig Dis 1996; 14:12\u201319. \n\n^ Mayan H, Kantor R, Rimon U, Golubev N, Heyman Z, Goshen E, Shalmon B, Weiss P.: \"Fatal liver infarction after transjugular intrahepatic portosystemic shunt procedure.\" Liver, 2001;21(5):361-4. \n\n^ Mizrahi, Meir; Adar, Tomer; Shouval, Daniel; Bloom, Allan I.; Shibolet, Oren (February 2010). \"Endotipsitis-persistent infection of transjugular intrahepatic portosystemic shunt: pathogenesis, clinical features and management\". Liver International. 30 (2): 175\u2013183. doi:10.1111\/j.1478-3231.2009.02158.x. ISSN 1478-3231. PMID 19929905. \n\n^ R\u00f6ssle, Martin (November 2013). \"TIPS: 25 years later\". Journal of Hepatology. 59 (5): 1081\u20131093. doi:10.1016\/j.jhep.2013.06.014. ISSN 1600-0641. PMID 23811307. \n\n^ \"What You Need to Know about the Transjugular Intrahepatic Portosystemic Shunt (TIPS)\". Cleveland Clinic. \n\n\nExternal links \nRadiologyInfo: Transjugular Intrahepatic Portosystemic Shunt (TIPS)\nTransjugular Intrahepatic Portosystemic Shunt - eMedicine.com.\nvteVascular surgery ICD-9-CM V3 38\u201339, ICD-10-PCS 03\u20136Vascular and \r\nEndovascular surgeryArterial disease\nVascular bypass\nAngioplasty\nAtherectomy\nEndarterectomy\nCarotid endarterectomy\nStenting\nCarotid stenting\nVenous disease\nAmbulatory phlebectomy\nLaser surgery\nSclerotherapy\nVein stripping\nArterial and venous access\nVenous cutdown\nArteriotomy\nPhlebotomy\nAortic aneurysm \/ dissection:\nEndovascular aneurysm repair\nOpen aortic surgery\nOther\nCardiopulmonary bypass\nCardioplegia\nExtracorporeal membrane oxygenation\nVascular access\nRevascularization\nFirst rib resection\nSeldinger technique\nVascular snare\nMedical imagingAngiography\nDigital subtraction angiography\nCerebral angiography\nAortography\nFluorescein angiography\nRadionuclide angiography\nMagnetic resonance angiography\nVenography\nPortography\nImpedance phlebography\nUltrasound\nIntravascular ultrasound\nCarotid ultrasonography\nOther diagnostic\nAngioscopy\nAnkle brachial pressure index\nToe pressure\nTilt table test\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Transjugular_intrahepatic_portosystemic_shunt\">https:\/\/www.limswiki.org\/index.php\/Transjugular_intrahepatic_portosystemic_shunt<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal 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version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 22:00.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 544 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","18ca7b6afd97b2aefd0d40ff2969d686_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Transjugular_intrahepatic_portosystemic_shunt skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Transjugular intrahepatic portosystemic shunt<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Transjugular intrahepatic portosystemic shunt<\/b> (<b>TIPS<\/b> or <b>TIPSS<\/b>) is an artificial channel within the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liver\" title=\"Liver\" rel=\"external_link\" target=\"_blank\">liver<\/a> that establishes communication between the inflow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal_vein\" title=\"Portal vein\" rel=\"external_link\" target=\"_blank\">portal vein<\/a> and the outflow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatic_vein\" class=\"mw-redirect\" title=\"Hepatic vein\" rel=\"external_link\" target=\"_blank\">hepatic vein<\/a>. It is used to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal_hypertension\" title=\"Portal hypertension\" rel=\"external_link\" target=\"_blank\">portal hypertension<\/a> (which is often due to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liver_cirrhosis\" class=\"mw-redirect\" title=\"Liver cirrhosis\" rel=\"external_link\" target=\"_blank\">liver cirrhosis<\/a>) which frequently leads to intestinal bleeding, life-threatening esophageal bleeding (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophageal_varices\" title=\"Esophageal varices\" rel=\"external_link\" target=\"_blank\">esophageal varices<\/a>) and the buildup of fluid within the abdomen (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Ascites\" title=\"Ascites\" rel=\"external_link\" target=\"_blank\">ascites<\/a>).\n<\/p><p>An <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_radiology\" title=\"Interventional radiology\" rel=\"external_link\" target=\"_blank\">interventional radiologist<\/a> creates the shunt using an image-guided <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endovascular_surgery\" class=\"mw-redirect\" title=\"Endovascular surgery\" rel=\"external_link\" target=\"_blank\">endovascular<\/a> (via the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_vessel\" title=\"Blood vessel\" rel=\"external_link\" target=\"_blank\">blood vessels<\/a>) approach, with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jugular_vein\" title=\"Jugular vein\" rel=\"external_link\" target=\"_blank\">jugular vein<\/a> as the usual entry site.\n<\/p><p>The procedure was first described by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Josef_R%C3%B6sch\" title=\"Josef R\u00f6sch\" rel=\"external_link\" target=\"_blank\">Josef R\u00f6sch<\/a> in 1969 at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oregon_Health_and_Science_University\" class=\"mw-redirect\" title=\"Oregon Health and Science University\" rel=\"external_link\" target=\"_blank\">Oregon Health and Science University<\/a>. It was first used in a human patient by Dr. Ronald Colapinto, of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Toronto\" title=\"University of Toronto\" rel=\"external_link\" target=\"_blank\">University of Toronto<\/a>, in 1982, but did not become reproducibly successful until the development of endovascular stents in 1985. In 1988 the first successful TIPS was realized by M. R\u00f6ssle, G.M. Richter, G. N\u00f6ldge and J. Palmaz at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Freiburg\" title=\"University of Freiburg\" rel=\"external_link\" target=\"_blank\">University of Freiburg<\/a>.<sup id=\"rdp-ebb-cite_ref-pmid2567908_1-0\" class=\"reference\"><a href=\"#cite_note-pmid2567908-1\" rel=\"external_link\">[1]<\/a><\/sup> The procedure has since become widely accepted as the preferred method for treating portal hypertension that is refractory to medical therapy, replacing the surgical portocaval shunt in that role.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<p>TIPS is a life saving procedure in bleeding from esophageal or gastric varices. A randomized study showed that the survival is better if the procedure is done within 72 hours after <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bleeding\" title=\"Bleeding\" rel=\"external_link\" target=\"_blank\">bleeding<\/a>.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> TIPS has shown some promise for people with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatorenal_syndrome\" title=\"Hepatorenal syndrome\" rel=\"external_link\" target=\"_blank\">hepatorenal syndrome<\/a>.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> It may also help with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ascites\" title=\"Ascites\" rel=\"external_link\" target=\"_blank\">ascites<\/a>.<sup id=\"rdp-ebb-cite_ref-Mer2016_4-0\" class=\"reference\"><a href=\"#cite_note-Mer2016-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Complications\">Complications<\/span><\/h2>\n<p>Severe procedural complications during a TIPS procedure, including catastrophic bleeding or direct liver injury, are relatively uncommon. In the hands of an experienced physician, operative mortality is less than 1%<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Identifying_reliable_sources_(medicine)\" title=\"Wikipedia:Identifying reliable sources (medicine)\" rel=\"external_link\" target=\"_blank\"><span title=\"Material near this tag needs references to reliable medical sources. (November 2017)\">medical citation needed<\/span><\/a><\/i>]<\/sup>. On the other hand, up to 25% of patients who undergo TIPS will experience transient post-operative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatic_encephalopathy\" title=\"Hepatic encephalopathy\" rel=\"external_link\" target=\"_blank\">hepatic encephalopathy<\/a> caused by increased porto-systemic passage of nitrogen from the gut.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> In general, this can be managed with a reduction in dietary protein and medication that reduces the absorption of nitrogen.\n<\/p><p>A less common, but more serious complication, is hepatic ischemia causing acute liver failure. While healthy livers are predominantly oxygenated by portal blood supply, long-standing portal hypertension results in compensatory hypertrophy of and increased reliance on the hepatic artery for oxygenation. Thus, in people with advanced liver disease the shunting of portal blood away from hepatocytes is usually well tolerated. However, in some cases suddenly shunting portal blood flow away from the liver may result in acute liver failure secondary to hepatic ischemia.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> Acute hepatic dysfunction after TIPS may require emergent closure of the shunt.\n<\/p><p>A rare but serious complication is persistent TIPS infection, also known as endotipsitis.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>Lastly, the TIPS may become blocked by a blood clot or in-growth of endothelial cells and no longer function. This has been significantly reduced with the use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polytetrafluoroethylene\" title=\"Polytetrafluoroethylene\" rel=\"external_link\" target=\"_blank\">polytetrafluoroethylene<\/a> (PTFE)\u2013covered stents.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Mechanism_of_action\">Mechanism of action<\/span><\/h2>\n<p>Portal hypertension, an important consequence of liver disease, results in the development of significant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Collateral_circulation\" title=\"Collateral circulation\" rel=\"external_link\" target=\"_blank\">collateral circulation<\/a> between the portal system and systemic venous drainage (porto-caval circulation). Portal venous congestion causes venous blood leaving the stomach and intestines to be diverted along auxiliary routes of lesser resistance in order to drain to systemic circulation. With time, the small vessels that comprise a collateral path for porto-caval circulation become engorged and dilated. These vessels are fragile and often hemorrhage into the GI tract. (<i>See <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophageal_varices\" title=\"Esophageal varices\" rel=\"external_link\" target=\"_blank\">esophageal<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastric_varices\" title=\"Gastric varices\" rel=\"external_link\" target=\"_blank\">gastric<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rectal_varices\" class=\"mw-redirect\" title=\"Rectal varices\" rel=\"external_link\" target=\"_blank\">rectal varices<\/a><\/i>).\n<\/p><p>A TIPS procedure decreases the effective <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular_resistance\" title=\"Vascular resistance\" rel=\"external_link\" target=\"_blank\">vascular resistance<\/a> of the liver through the creation of an alternative pathway for portal venous circulation. By creating a shunt from the portal vein to the hepatic vein, this intervention allows portal blood an alternative avenue for draining into systemic circulation. In bypassing the flow-resistant liver, the net result is a reduced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pressure_drop\" title=\"Pressure drop\" rel=\"external_link\" target=\"_blank\">pressure drop<\/a> across the liver and a decreased portal venous pressure. Decreased portal venous pressure in turn lessens congestive pressures along veins in the intestine so that future bleeding is less likely to occur. The reduced pressure also makes less fluid develop, although this benefit may take weeks or months to occur.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Implantation\">Implantation<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tips_schematic.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c9\/Tips_schematic.JPG\/220px-Tips_schematic.JPG\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tips_schematic.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Steps in a TIPS procedure: A) portal hypertension has caused the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Left_gastric_vein\" title=\"Left gastric vein\" rel=\"external_link\" target=\"_blank\">coronary vein<\/a> (arrow) and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Umbilical_vein\" title=\"Umbilical vein\" rel=\"external_link\" target=\"_blank\">umbilical vein<\/a> (arrowhead) to dilate and flow in reverse. This leads to varices in the esophagus and stomach, which can bleed; B) a needle has been introduced (via the jugular vein) and is passing from the hepatic vein into the portal vein; c) the tract is dilated with a balloon; D) after placement of a stent, portal pressure is normalized and the coronary and umbilical veins no longer fill.<\/div><\/div><\/div>\n<p>Transjugular intrahepatic portosystemic shunts are typically placed by an interventional radiologist under <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroscopy\" title=\"Fluoroscopy\" rel=\"external_link\" target=\"_blank\">fluoroscopic<\/a> guidance.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> Access to the liver is gained, as the name 'transjugular' suggests, via the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jugular_vein\" title=\"Jugular vein\" rel=\"external_link\" target=\"_blank\">internal jugular vein<\/a> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neck\" title=\"Neck\" rel=\"external_link\" target=\"_blank\">neck<\/a>. Once access to the jugular vein is confirmed, a guidewire and introducer sheath are typically placed to facilitate the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shunt_(medical)\" title=\"Shunt (medical)\" rel=\"external_link\" target=\"_blank\">shunt<\/a>'s placement. This enables the interventional radiologist to gain access to the patient's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatic_vein\" class=\"mw-redirect\" title=\"Hepatic vein\" rel=\"external_link\" target=\"_blank\">hepatic vein<\/a> by traveling from the superior vena cava into the inferior vena cava and finally the hepatic vein. Once the catheter is in the hepatic vein, a wedge pressure is obtained to calculate the pressure gradient in the liver. Following this, carbon dioxide is injected to locate the portal vein. Then, a special needle known as a Colapinto is advanced through the liver parenchyma to connect the hepatic vein to the large <a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal_vein\" title=\"Portal vein\" rel=\"external_link\" target=\"_blank\">portal vein<\/a>, near the center of the liver. The channel for the shunt is next created by inflating an angioplasty balloon within the liver along the tract created by the needle. The shunt is completed by placing a special mesh tube known as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stent<\/a> or endograft to maintain the tract between the higher-pressure portal vein and the lower-pressure hepatic vein. After the procedure, fluoroscopic images are made to show placement. Pressure in the portal vein and inferior vena cava are often measured.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Distal_splenorenal_shunt_procedure\" title=\"Distal splenorenal shunt procedure\" rel=\"external_link\" target=\"_blank\">Distal splenorenal shunt procedure<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastric_antral_vascular_ectasia\" title=\"Gastric antral vascular ectasia\" rel=\"external_link\" target=\"_blank\">Gastric antral vascular ectasia<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_radiology\" title=\"Interventional radiology\" rel=\"external_link\" target=\"_blank\">Interventional radiology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal_venous_system\" title=\"Portal venous system\" rel=\"external_link\" target=\"_blank\">Portal venous system<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-pmid2567908-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid2567908_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">R\u00f6ssle M, Richter GM, N\u00f6ldge G, Palmaz JC, Wenz W, Gerok W (1989). \"New non-operative treatment for variceal haemorrhage\". <i>Lancet<\/i>. <b>2<\/b> (8655): 153. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fs0140-6736%2889%2990201-8\" target=\"_blank\">10.1016\/s0140-6736(89)90201-8<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2567908\" target=\"_blank\">2567908<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Lancet&rft.atitle=New+non-operative+treatment+for+variceal+haemorrhage&rft.volume=2&rft.issue=8655&rft.pages=153&rft.date=1989&rft_id=info%3Adoi%2F10.1016%2Fs0140-6736%2889%2990201-8&rft_id=info%3Apmid%2F2567908&rft.aulast=R%C3%B6ssle&rft.aufirst=M&rft.au=Richter%2C+GM&rft.au=N%C3%B6ldge%2C+G&rft.au=Palmaz%2C+JC&rft.au=Wenz%2C+W&rft.au=Gerok%2C+W&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATransjugular+intrahepatic+portosystemic+shunt\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Garc\u00eda-Pag\u00e1n, Juan Carlos; Caca, Karel; Bureau, Christophe; Laleman, Wim; Appenrodt, Beate; Luca, Angelo; Abraldes, Juan G.; Nevens, Frederik; Vinel, Jean Pierre (June 2010). \"Early use of TIPS in patients with cirrhosis and variceal bleeding\". <i>The New England Journal of Medicine<\/i>. <b>362<\/b> (25): 2370\u20132379. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2FNEJMoa0910102\" target=\"_blank\">10.1056\/NEJMoa0910102<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1533-4406\" target=\"_blank\">1533-4406<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20573925\" target=\"_blank\">20573925<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+England+Journal+of+Medicine&rft.atitle=Early+use+of+TIPS+in+patients+with+cirrhosis+and+variceal+bleeding&rft.volume=362&rft.issue=25&rft.pages=2370-2379&rft.date=2010-06&rft.issn=1533-4406&rft_id=info%3Apmid%2F20573925&rft_id=info%3Adoi%2F10.1056%2FNEJMoa0910102&rft.aulast=Garc%C3%ADa-Pag%C3%A1n&rft.aufirst=Juan+Carlos&rft.au=Caca%2C+Karel&rft.au=Bureau%2C+Christophe&rft.au=Laleman%2C+Wim&rft.au=Appenrodt%2C+Beate&rft.au=Luca%2C+Angelo&rft.au=Abraldes%2C+Juan+G.&rft.au=Nevens%2C+Frederik&rft.au=Vinel%2C+Jean+Pierre&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATransjugular+intrahepatic+portosystemic+shunt\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Guevara M, Rod\u00e9s J (2005). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1357272504002444\" target=\"_blank\">\"Hepatorenal syndrome\"<\/a>. <i>Int. J. Biochem. Cell Biol<\/i>. <b>37<\/b> (1): 22\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.biocel.2004.06.007\" target=\"_blank\">10.1016\/j.biocel.2004.06.007<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15381144\" target=\"_blank\">15381144<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Int.+J.+Biochem.+Cell+Biol.&rft.atitle=Hepatorenal+syndrome&rft.volume=37&rft.issue=1&rft.pages=22-6&rft.date=2005&rft_id=info%3Adoi%2F10.1016%2Fj.biocel.2004.06.007&rft_id=info%3Apmid%2F15381144&rft.aulast=Guevara&rft.aufirst=M&rft.au=Rod%C3%A9s%2C+J&rft_id=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1357272504002444&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATransjugular+intrahepatic+portosystemic+shunt\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Mer2016-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Mer2016_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.merckmanuals.com\/en-ca\/professional\/hepatic-and-biliary-disorders\/approach-to-the-patient-with-liver-disease\/ascites\" target=\"_blank\">\"Ascites - Hepatic and Biliary Disorders\"<\/a>. <i>Merck Manuals Professional Edition<\/i>. May 2016<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">14 December<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Merck+Manuals+Professional+Edition&rft.atitle=Ascites+-+Hepatic+and+Biliary+Disorders&rft.date=2016-05&rft_id=http%3A%2F%2Fwww.merckmanuals.com%2Fen-ca%2Fprofessional%2Fhepatic-and-biliary-disorders%2Fapproach-to-the-patient-with-liver-disease%2Fascites&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATransjugular+intrahepatic+portosystemic+shunt\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Rossle M, Piotraschke J. Transjugular intrahepatic portosystemic shunt and hepatic encephalopathy. Dig Dis 1996; 14:12\u201319.<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Mayan H, Kantor R, Rimon U, Golubev N, Heyman Z, Goshen E, Shalmon B, Weiss P.: \"Fatal liver infarction after transjugular intrahepatic portosystemic shunt procedure.\" Liver, 2001;21(5):361-4.<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mizrahi, Meir; Adar, Tomer; Shouval, Daniel; Bloom, Allan I.; Shibolet, Oren (February 2010). \"Endotipsitis-persistent infection of transjugular intrahepatic portosystemic shunt: pathogenesis, clinical features and management\". <i>Liver International<\/i>. <b>30<\/b> (2): 175\u2013183. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1478-3231.2009.02158.x\" target=\"_blank\">10.1111\/j.1478-3231.2009.02158.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1478-3231\" target=\"_blank\">1478-3231<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19929905\" target=\"_blank\">19929905<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Liver+International&rft.atitle=Endotipsitis-persistent+infection+of+transjugular+intrahepatic+portosystemic+shunt%3A+pathogenesis%2C+clinical+features+and+management&rft.volume=30&rft.issue=2&rft.pages=175-183&rft.date=2010-02&rft.issn=1478-3231&rft_id=info%3Apmid%2F19929905&rft_id=info%3Adoi%2F10.1111%2Fj.1478-3231.2009.02158.x&rft.aulast=Mizrahi&rft.aufirst=Meir&rft.au=Adar%2C+Tomer&rft.au=Shouval%2C+Daniel&rft.au=Bloom%2C+Allan+I.&rft.au=Shibolet%2C+Oren&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATransjugular+intrahepatic+portosystemic+shunt\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">R\u00f6ssle, Martin (November 2013). \"TIPS: 25 years later\". <i>Journal of Hepatology<\/i>. <b>59<\/b> (5): 1081\u20131093. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jhep.2013.06.014\" target=\"_blank\">10.1016\/j.jhep.2013.06.014<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1600-0641\" target=\"_blank\">1600-0641<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23811307\" target=\"_blank\">23811307<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Hepatology&rft.atitle=TIPS%3A+25+years+later&rft.volume=59&rft.issue=5&rft.pages=1081-1093&rft.date=2013-11&rft.issn=1600-0641&rft_id=info%3Apmid%2F23811307&rft_id=info%3Adoi%2F10.1016%2Fj.jhep.2013.06.014&rft.aulast=R%C3%B6ssle&rft.aufirst=Martin&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATransjugular+intrahepatic+portosystemic+shunt\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.clevelandclinic.org\/health\/health-info\/docs\/0200\/0237.asp?index=4956\" target=\"_blank\">\"What You Need to Know about the Transjugular Intrahepatic Portosystemic Shunt (TIPS)\"<\/a>. Cleveland Clinic.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=What+You+Need+to+Know+about+the+Transjugular+Intrahepatic+Portosystemic+Shunt+%28TIPS%29.&rft.pub=Cleveland+Clinic&rft_id=http%3A%2F%2Fwww.clevelandclinic.org%2Fhealth%2Fhealth-info%2Fdocs%2F0200%2F0237.asp%3Findex%3D4956&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATransjugular+intrahepatic+portosystemic+shunt\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.radiologyinfo.org\/en\/info.cfm?pg=tips\" target=\"_blank\">RadiologyInfo: Transjugular Intrahepatic Portosystemic Shunt (TIPS)<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.emedicine.com\/radio\/topic764.htm\" target=\"_blank\">Transjugular Intrahepatic Portosystemic Shunt<\/a> - eMedicine.com.<\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1262\nCached time: 20181210005953\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.272 seconds\nReal time usage: 0.352 seconds\nPreprocessor visited node count: 825\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 44399\/2097152 bytes\nTemplate argument size: 1201\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 21567\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.151\/10.000 seconds\nLua memory usage: 4.58 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 294.659 1 -total\n<\/p>\n<pre>37.92% 111.724 5 Template:Cite_journal\n27.45% 80.892 1 Template:Infobox_interventions\n24.67% 72.706 1 Template:Infobox\n17.72% 52.227 1 Template:Medical_citation_needed\n15.54% 45.795 1 Template:Fix\n10.63% 31.311 1 Template:Category_handler\n 7.50% 22.097 3 Template:Navbox\n 7.44% 21.922 1 Template:Vascular_surgery_procedures\n 3.93% 11.566 2 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2924697-1!canonical and timestamp 20181210005953 and revision id 847608285\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Transjugular_intrahepatic_portosystemic_shunt\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212201\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.151 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 144.758 1 - wikipedia:Transjugular_intrahepatic_portosystemic_shunt\n100.00% 144.758 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8322-0!*!*!*!*!*!* and timestamp 20181217212201 and revision id 24547\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Transjugular_intrahepatic_portosystemic_shunt\">https:\/\/www.limswiki.org\/index.php\/Transjugular_intrahepatic_portosystemic_shunt<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","18ca7b6afd97b2aefd0d40ff2969d686_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/8\/87\/Fluoroscopic_image_of_transjugular_intrahepatic_portosystemic_shunt_%28TIPS%29_in_progress.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c9\/Tips_schematic.JPG\/440px-Tips_schematic.JPG"],"18ca7b6afd97b2aefd0d40ff2969d686_timestamp":1545081721,"48c7ccb4d9efce1d3f1ddbad6b22dea1_type":"article","48c7ccb4d9efce1d3f1ddbad6b22dea1_title":"Transdermal implant","48c7ccb4d9efce1d3f1ddbad6b22dea1_url":"https:\/\/www.limswiki.org\/index.php\/Transdermal_implant","48c7ccb4d9efce1d3f1ddbad6b22dea1_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tTransdermal implant\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Transdermal implant\nTransdermal implants is a form of body modification used both in a medical and aesthetic context. In either case, they consist of an object placed partially below and partially above the skin, thus transdermal. The skin around it generally heals as if it were a piercing.\nIn the body piercing community, these types of modification are generally called fairly \"heavy\" due to the complexity of the procedure and the social implications. Two types of implants can be used.\n\nContents \n\n1 Procedure \n2 Microdermal implants \n\n2.1 Procedure \n2.2 Longevity \n\n\n3 See also \n4 References \n\n\nProcedure \nWhen the procedure is done using a post-like implant, an incision is made a small distance from the site. The skin is then lifted and the implant is passed through. Then, a hole is opened at the site for it to pass through, and it is moved so that the top part fills the hole. The implants used for this are generally small and not textured in any way except rounding.\nIf a more graphic implant is desired, it is generally done in two parts. First, the base is inserted the same way a single-part would be, except that the base implant is threaded. It may either stick out like a bolt, or be inward like a nut. When this is done, the top half is screwed on. This type is usually done for spikes and\/or horns.\nIn any case, the part of the implant which passes under the skin generally is somewhat large and has holes. The skin will grow into them, making it more permanent.\n\nMicrodermal implants \nThis article has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and when to remove these template messages)\n\n Some of this article's listed sources may not be reliable. Please help this article by looking for better, more reliable sources. Unreliable citations may be challenged or deleted. (April 2012) (Learn how and when to remove this template message)\nThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (June 2008) (Learn how and when to remove this template message)\nThe topic of this article may not meet Wikipedia's general notability guideline. Please help to establish notability by citing reliable secondary sources that are independent of the topic and provide significant coverage of it beyond a mere trivial mention. If notability cannot be established, the article is likely to be merged, redirected, or deleted.\r\nFind sources: \"Transdermal implant\" \u2013 news \u00b7 newspapers \u00b7 books \u00b7 scholar \u00b7 JSTOR (April 2012) (Learn how and when to remove this template message)\n \n (Learn how and when to remove this template message)\n A microdermal prior to implantation\n Healed microdermal implants\nMicrodermal implants is a form of body modification which gives the aesthetic appearance of a transdermal implant, without the complications of the much more complicated surgery associated with transdermal implants.[1] Microdermals are single point piercings which are a sort of surface piercing.[2]\nMicrodermal implants can be placed practically anywhere on the surface of the skin on the body, but are different from conventional piercings in that they are composed of two components: an anchor, which is implanted underneath the skin, with a step protruding from (or flush with) the surface of the surrounding skin, and the changeable jewellery, which is screwed into the threaded hole in the step of the anchor.\nThey should not be implanted in hands, feet, wrists, collarbones or any area where it is not flat or that is near a joint.[3]\n\nProcedure \nThe procedure is usually performed using a dermal punch or needle. When a dermal piercing is done with a punch, the pouch is made in a different way. When using a needle, the pouch is made by separating the skin. When using a dermal punch, the pouch is made by removing a bit of tissue. A microdermal punch is less painful and therefore commonly used. The process starts by identifying the point of piercing on the sterilized area that will be marked with a surgical marker. The micro dermalpunch is then used to remove skin tissues. The anchor is then placed under the skin and a piece of jewelry is placed using surgical forceps.[4]\n\nLongevity \nMicrodermal implants are a more desirable alternative to surface piercings, as they provide less scarring when removed. They are semi-permanent and can be removed with the assistance of a professional. Implants should be left alone and covered for the first 3\u20136 months as they are susceptible to outside damage (tugging, pulling and catching, which move the implant closer to the surface of the skin). Also, the body naturally rejects foreign objects, so it is crucial for the piercings to go as deep as possible. In order to combat these effects constant modification to the jewelry is being made; the latest use large holes in the anchors to encourage tissue to grow through to hold the jewelry in place.\n\nSee also \nBody modification\nBody piercing\nBody piercing materials\nSubdermal implant\nReferences \n\n\n^ BMEzine Encyclopedia[unreliable source? ] \n\n^ Living Canvas: Your Total Guide to Tattoos, Piercings, and Body Modification By Karen L Hudson \n\n^ The Art of Body Piercing By Genia Gaffaney \n\n^ Piercing Models \n\n\nvteRoutes of administration, dosage formsOralDigestive\r\ntract (enteral)Solids\nPill\nTablet\nCapsule\nPastille\nTime release technology\nOsmotic delivery system (OROS)\n\r\nLiquids\nDecoction\nElixir\nElectuary\nEmulsion\nExtended-release syrup\nEffervescent powder or tablet\nHerbal tea\nHydrogel\nMolecular encapsulation\nPowder\nSoftgel\nSolution\nSuspension\nSyrup\nSyrup Concentrate for dilution and\/or addition of carbonated water\nTincture\nBuccal (sublabial), sublingualSolids\nOrally disintegrating tablet (ODT)\nFilm\nLollipop\nSublingual drops\nLozenges\nEffervescent buccal tablet\nChewing gum\nLiquids\nMouthwash\nToothpaste\nOintment\nOral spray\nRespiratory\r\ntractSolids\nSmoking device\nDry-powder inhaler (DPI)\n\r\n0 \r\n0 Liquids\nAnaesthetic vaporizer\nVaporizer\nNebulizer\nMetered-dose inhaler (MDI)\nGas\nOxygen mask and Nasal cannula\nOxygen concentrator\nAnaesthetic machine\nRelative analgesia machine\nOphthalmic,\r\notologic, nasal\nNasal spray\nEar drops\nEye drops\nOintment\nHydrogel\nNanosphere suspension\nInsufflation\nMucoadhesive microdisc (microsphere tablet)Urogenital\nOintment\nPessary (vaginal suppository)\nVaginal ring\nVaginal douche\nIntrauterine device (IUD)\nExtra-amniotic infusion\nIntravesical infusion\nRectal (enteral)\nOintment\nSuppository\nEnema\nSolution\nHydrogel\nMurphy drip\nNutrient enemaDermal\nOintment\nTopical cream\nTopical gel\nLiniment\nPaste\nFilm\nDMSO drug solution\nElectrophoretic dermal delivery system\nHydrogel\nLiposomes\nTransfersome vesicles\nCream\nLotion\nLip balm\nMedicated shampoo\nDermal patch\nTransdermal patch\nContact (rubbed into break in the skin)\nTransdermal spray\nJet injectorInjection,\r\ninfusion\r\n(into tissue\/blood)Skin\nIntradermal\nSubcutaneous\nTransdermal implant\nOrgans\nIntracavernous\nIntravitreal\nIntra-articular injection\nTransscleral\nCentral nervous system\nIntracerebral\nIntrathecal\nEpidural\nCirculatory, musculoskeletal\nIntravenous\nIntracardiac\nIntramuscular\nIntraosseous\nIntraperitoneal\nNanocell injection\nPatient-Controlled Analgesia pump\nPIC line\n\n Category\n WikiProject\n Pharmacy portal\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Transdermal_implant\">https:\/\/www.limswiki.org\/index.php\/Transdermal_implant<\/a>\n\t\t\t\t\tCategories: Body modificationImplants (medicine)Hidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 18:32.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 560 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","48c7ccb4d9efce1d3f1ddbad6b22dea1_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Transdermal_implant skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Transdermal implant<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dermal_anchor.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/48\/Dermal_anchor.jpg\/220px-Dermal_anchor.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dermal_anchor.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Transdermal implant<\/div><\/div><\/div>\n<p><b>Transdermal implants<\/b> is a form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_modification\" title=\"Body modification\" rel=\"external_link\" target=\"_blank\">body modification<\/a> used both in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medical<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aesthetics\" title=\"Aesthetics\" rel=\"external_link\" target=\"_blank\">aesthetic<\/a> context. In either case, they consist of an object placed partially below and partially above the skin, thus <i>trans<\/i>dermal. The skin around it generally heals as if it were a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_piercing\" title=\"Body piercing\" rel=\"external_link\" target=\"_blank\">piercing<\/a>.\n<\/p><p>In the body piercing community, these types of modification are generally called fairly \"heavy\" due to the complexity of the procedure and the social implications. Two types of implants can be used.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Procedure\">Procedure<\/span><\/h2>\n<p>When the procedure is done using a post-like implant, an incision is made a small distance from the site. The skin is then lifted and the implant is passed through. Then, a hole is opened at the site for it to pass through, and it is moved so that the top part fills the hole. The implants used for this are generally small and not textured in any way except rounding.\n<\/p><p>If a more graphic implant is desired, it is generally done in two parts. First, the base is inserted the same way a single-part would be, except that the base implant is threaded. It may either stick out like a bolt, or be inward like a nut. When this is done, the top half is screwed on. This type is usually done for spikes and\/or horns.\n<\/p><p>In any case, the part of the implant which passes under the skin generally is somewhat large and has holes. The skin will grow into them, making it more permanent.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Microdermal_implants\">Microdermal implants<\/span><\/h2>\n\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dermal1.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/88\/Dermal1.jpg\/220px-Dermal1.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dermal1.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A microdermal prior to implantation<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dermal2.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/40\/Dermal2.jpg\/220px-Dermal2.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dermal2.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Healed microdermal implants<\/div><\/div><\/div>\n<p><b>Microdermal implants<\/b> is a form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_modification\" title=\"Body modification\" rel=\"external_link\" target=\"_blank\">body modification<\/a> which gives the aesthetic appearance of a transdermal implant, without the complications of the much more complicated surgery associated with transdermal implants.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> Microdermals are single point piercings which are a sort of surface piercing.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Microdermal implants can be placed practically anywhere on the surface of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin\" title=\"Skin\" rel=\"external_link\" target=\"_blank\">skin<\/a> on the body, but are different from conventional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Piercing\" class=\"mw-redirect\" title=\"Piercing\" rel=\"external_link\" target=\"_blank\">piercings<\/a> in that they are composed of two components: an anchor, which is implanted underneath the skin, with a step protruding from (or flush with) the surface of the surrounding skin, and the changeable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jewellery\" title=\"Jewellery\" rel=\"external_link\" target=\"_blank\">jewellery<\/a>, which is screwed into the threaded hole in the step of the anchor.\n<\/p><p>They should not be implanted in hands, feet, wrists, collarbones or any area where it is not flat or that is near a joint.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Procedure_2\">Procedure<\/span><\/h3>\n<p>The procedure is usually performed using a dermal punch or needle. When a dermal piercing is done with a punch, the pouch is made in a different way. When using a needle, the pouch is made by separating the skin. When using a dermal punch, the pouch is made by removing a bit of tissue. A microdermal punch is less painful and therefore commonly used. The process starts by identifying the point of piercing on the sterilized area that will be marked with a surgical marker. The micro dermalpunch is then used to remove skin tissues. The anchor is then placed under the skin and a piece of jewelry is placed using surgical forceps.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Longevity\">Longevity<\/span><\/h3>\n<p>Microdermal implants are a more desirable alternative to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surface_piercings\" class=\"mw-redirect\" title=\"Surface piercings\" rel=\"external_link\" target=\"_blank\">surface piercings<\/a>, as they provide less scarring when removed. They are semi-permanent and can be removed with the assistance of a professional. Implants should be left alone and covered for the first 3\u20136 months as they are susceptible to outside damage (tugging, pulling and catching, which move the implant closer to the surface of the skin). Also, the body naturally rejects foreign objects, so it is crucial for the piercings to go as deep as possible. In order to combat these effects constant modification to the jewelry is being made; the latest use large holes in the anchors to encourage tissue to grow through to hold the jewelry in place.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_modification\" title=\"Body modification\" rel=\"external_link\" target=\"_blank\">Body modification<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_piercing\" title=\"Body piercing\" rel=\"external_link\" target=\"_blank\">Body piercing<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_piercing_materials\" title=\"Body piercing materials\" rel=\"external_link\" target=\"_blank\">Body piercing materials<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Subdermal_implant\" title=\"Subdermal implant\" rel=\"external_link\" target=\"_blank\">Subdermal implant<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/wiki.bmezine.com\/index.php\/Microdermal\" target=\"_blank\">BMEzine Encyclopedia<\/a><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Identifying_reliable_sources\" title=\"Wikipedia:Identifying reliable sources\" rel=\"external_link\" target=\"_blank\"><span title=\"The material near this tag may rely on an unreliable source. (April 2012)\">unreliable source?<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=microdermal&f=false\">Living Canvas: Your Total Guide to Tattoos, Piercings, and Body Modification By Karen L Hudson<\/a><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=microdermal&f=false\">The Art of Body Piercing By Genia Gaffaney<\/a><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.piercingmodels.com\/microdermal-piercing\/\" target=\"_blank\">Piercing Models<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1323\nCached time: 20181216001509\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.204 seconds\nReal time usage: 0.298 seconds\nPreprocessor visited node count: 942\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 97792\/2097152 bytes\nTemplate argument size: 11892\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 1895\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.075\/10.000 seconds\nLua memory usage: 2.92 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 206.871 1 -total\n<\/p>\n<pre>81.95% 169.534 4 Template:Ambox\n57.60% 119.168 1 Template:Multiple_issues\n33.49% 69.290 6 Template:Navbox\n26.58% 54.986 1 Template:Dosage_forms\n19.93% 41.224 1 Template:Notability\n14.46% 29.906 1 Template:Reflist\n13.83% 28.601 1 Template:Find_sources_mainspace\n13.13% 27.164 1 Template:Unreliable_sources\n10.74% 22.211 1 Template:Unreliable_source?\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:630142-1!canonical and timestamp 20181216001509 and revision id 834047728\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Transdermal_implant\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212200\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.016 seconds\nReal time usage: 0.160 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 154.044 1 - wikipedia:Transdermal_implant\n100.00% 154.044 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8084-0!*!*!*!*!*!* and timestamp 20181217212200 and revision id 24203\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Transdermal_implant\">https:\/\/www.limswiki.org\/index.php\/Transdermal_implant<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","48c7ccb4d9efce1d3f1ddbad6b22dea1_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/48\/Dermal_anchor.jpg\/440px-Dermal_anchor.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a4\/Text_document_with_red_question_mark.svg\/80px-Text_document_with_red_question_mark.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/88\/Dermal1.jpg\/440px-Dermal1.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/40\/Dermal2.jpg\/440px-Dermal2.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/00\/FlattenedRoundPills.jpg\/120px-FlattenedRoundPills.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bf\/Hexaaquatitanium%28III%29-solution.jpg\/120px-Hexaaquatitanium%28III%29-solution.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b6\/Inhaler.jpg\/120px-Inhaler.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a7\/Action_photo_of_nasal_spray_on_a_black_background.jpg\/60px-Action_photo_of_nasal_spray_on_a_black_background.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/98\/Glycerin_suppositories.jpg\/60px-Glycerin_suppositories.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/SPF15SunBlock.JPG\/80px-SPF15SunBlock.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a5\/Injection_Syringe_01.jpg\/120px-Injection_Syringe_01.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5f\/Tabletten.JPG\/32px-Tabletten.JPG"],"48c7ccb4d9efce1d3f1ddbad6b22dea1_timestamp":1545081720,"9458d4002715c4ee895ca07b7b6ecbeb_type":"article","9458d4002715c4ee895ca07b7b6ecbeb_title":"Transcutaneous vagus nerve stimulator","9458d4002715c4ee895ca07b7b6ecbeb_url":"https:\/\/www.limswiki.org\/index.php\/Transcutaneous_vagus_nerve_stimulation","9458d4002715c4ee895ca07b7b6ecbeb_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tTranscutaneous vagus nerve stimulation\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs more medical references for verification or relies too heavily on primary sources. Please review the contents of the article and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. (February 2016)\nTranscutaneous vagus nerve stimulation (tVNS) is a medical treatment that involves delivering electrical impulses to the auricular branch of the vagus nerve or cervical vagus nerve. It is non-invasive and based on the rationale that there is vagus nerve distribution on the surface of the ear.\ntVNS is being studied for stroke and the treatment of depression.[1][2]\n\nReferences \n\n\n^ Cai PY, Bodhit A, Derequito R, Ansari S, Abukhalil F, Thenkabail S, Ganji S, Saravanapavan P, Shekar CC, Bidari S, Waters MF, Hedna VS (June 2014). \"Vagus nerve stimulation in ischemic stroke: old wine in a new bottle\". Front. Neurol. 5: 107. doi:10.3389\/fneur.2014.00107. PMC 4067569 . PMID 25009531. \n\n^ Shiozawa, P; Silva, ME; Carvalho, TC; Cordeiro, Q; Brunoni, AR; Fregni, F (July 2014). \"Transcutaneous vagus and trigeminal nerve stimulation for neuropsychiatric disorders: a systematic review\". Arquivos de neuro-psiquiatria. 72 (7): 542\u20137. PMID 25054988. \n\n\nvtePsychiatrySubspecialties\nAddiction psychiatry\nBiological psychiatry\nChild and adolescent psychiatry\nCognitive neuropsychiatry\nCross-cultural psychiatry\nDevelopmental disability\nDescriptive psychiatry\nEating disorders\nEmergency psychiatry\nForensic psychiatry\nGeriatric psychiatry\nImmuno-psychiatry\nLiaison psychiatry\nMilitary psychiatry\nNarcology\nNeuropsychiatry\nPalliative medicine\nPain medicine\nPsychotherapy\nSleep medicine\nOrganizations\nAmerican Academy of Child and Adolescent Psychiatry\nAmerican Board of Psychiatry and Neurology\nAmerican Neuropsychiatric Association\nAmerican Psychiatric Association\nCampaign Against Psychiatric Abuse\nChinese Society of Psychiatry\nDemocratic Psychiatry\nEuropean Psychiatric Association\nGlobal Initiative on Psychiatry\nHong Kong College of Psychiatrists\nIndependent Psychiatric Association of Russia\nIndian Psychiatric Society\nNational Institute of Mental Health\nPhiladelphia Association\nRoyal Australian and New Zealand College of Psychiatrists\nRoyal College of Psychiatrists\nWorking Commission to Investigate the Use of Psychiatry for Political Purposes\nWorld Psychiatric Association\nTaiwanese Society of Child and Adolescent Psychiatry\nRelated topics\nAnti-psychiatry\nBehavioral medicine\nClinical neuroscience\nImaging genetics\nNeuroimaging\nNeurophysiology\nPhilosophy of psychiatry\nPolitical abuse of psychiatry\nPsychiatrist\nPsychiatric epidemiology\nPsychiatric genetics\nPsychiatric survivors movement\nPsychosomatic medicine\nPsycho-oncology\nPsychopharmacology\nPsychosurgery\nPsychoanalysis\nLists\nOutline of the psychiatric survivors movement\nPsychiatrists\nNeurological disorders\nCounseling topics\nPsychotherapies\nPsychiatric medications\nby condition treated\n\n Portal\n Outline\n\nvtePhysiology of the endocrine systemRegulatory systems\nHypothalamic\u2013pituitary\u2013thyroid axis\nHypothalamic\u2013pituitary\u2013adrenal axis\nHypothalamic\u2013pituitary\u2013gonadal axis\nHypothalamic\u2013pituitary\u2013somatotropic axis\nHypothalamic\u2013pituitary\u2013prolactin axis\nHypothalamic\u2013neurohypophyseal system\nRenin\u2013angiotensin system\nMetabolism\nBlood sugar regulation\nCalcium metabolism\nFields\nNeuroendocrinology\nPediatric endocrinology\nPsychoneuroendocrinology\nReproductive endocrinology and infertility\nOther\nWolff\u2013Chaikoff effect\/Jod-Basedow effect\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Transcutaneous_vagus_nerve_stimulation\">https:\/\/www.limswiki.org\/index.php\/Transcutaneous_vagus_nerve_stimulation<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","9458d4002715c4ee895ca07b7b6ecbeb_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Transcutaneous_vagus_nerve_stimulation skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Transcutaneous vagus nerve stimulation<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Transcutaneous vagus nerve stimulation<\/b> (<b>tVNS<\/b>) is a medical treatment that involves delivering electrical impulses to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Auricular_branch_of_the_vagus_nerve\" class=\"mw-redirect\" title=\"Auricular branch of the vagus nerve\" rel=\"external_link\" target=\"_blank\">auricular branch of the vagus nerve<\/a> or cervical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vagus_nerve\" title=\"Vagus nerve\" rel=\"external_link\" target=\"_blank\">vagus nerve<\/a>. It is non-invasive and based on the rationale that there is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vagus_nerve\" title=\"Vagus nerve\" rel=\"external_link\" target=\"_blank\">vagus nerve<\/a> distribution on the surface of the ear.\n<\/p><p>tVNS is being studied for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a> and the treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Depression_(mood)\" title=\"Depression (mood)\" rel=\"external_link\" target=\"_blank\">depression<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cai PY, Bodhit A, Derequito R, Ansari S, Abukhalil F, Thenkabail S, Ganji S, Saravanapavan P, Shekar CC, Bidari S, Waters MF, Hedna VS (June 2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4067569\" target=\"_blank\">\"Vagus nerve stimulation in ischemic stroke: old wine in a new bottle\"<\/a>. <i>Front. Neurol<\/i>. <b>5<\/b>: 107. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3389%2Ffneur.2014.00107\" target=\"_blank\">10.3389\/fneur.2014.00107<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4067569\" target=\"_blank\">4067569<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25009531\" target=\"_blank\">25009531<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Front.+Neurol.&rft.atitle=Vagus+nerve+stimulation+in+ischemic+stroke%3A+old+wine+in+a+new+bottle.&rft.volume=5&rft.pages=107&rft.date=2014-06&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4067569&rft_id=info%3Apmid%2F25009531&rft_id=info%3Adoi%2F10.3389%2Ffneur.2014.00107&rft.aulast=Cai&rft.aufirst=PY&rft.au=Bodhit%2C+A&rft.au=Derequito%2C+R&rft.au=Ansari%2C+S&rft.au=Abukhalil%2C+F&rft.au=Thenkabail%2C+S&rft.au=Ganji%2C+S&rft.au=Saravanapavan%2C+P&rft.au=Shekar%2C+CC&rft.au=Bidari%2C+S&rft.au=Waters%2C+MF&rft.au=Hedna%2C+VS&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4067569&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATranscutaneous+vagus+nerve+stimulation\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Shiozawa, P; Silva, ME; Carvalho, TC; Cordeiro, Q; Brunoni, AR; Fregni, F (July 2014). \"Transcutaneous vagus and trigeminal nerve stimulation for neuropsychiatric disorders: a systematic review\". <i>Arquivos de neuro-psiquiatria<\/i>. <b>72<\/b> (7): 542\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25054988\" target=\"_blank\">25054988<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Arquivos+de+neuro-psiquiatria&rft.atitle=Transcutaneous+vagus+and+trigeminal+nerve+stimulation+for+neuropsychiatric+disorders%3A+a+systematic+review.&rft.volume=72&rft.issue=7&rft.pages=542-7&rft.date=2014-07&rft_id=info%3Apmid%2F25054988&rft.aulast=Shiozawa&rft.aufirst=P&rft.au=Silva%2C+ME&rft.au=Carvalho%2C+TC&rft.au=Cordeiro%2C+Q&rft.au=Brunoni%2C+AR&rft.au=Fregni%2C+F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATranscutaneous+vagus+nerve+stimulation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1327\nCached time: 20181207020019\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.196 seconds\nReal time usage: 0.274 seconds\nPreprocessor visited node count: 369\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 32446\/2097152 bytes\nTemplate argument size: 115\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 6518\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.116\/10.000 seconds\nLua memory usage: 2.86 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 233.286 1 -total\n<\/p>\n<pre>53.72% 125.311 1 Template:Reflist\n46.46% 108.390 2 Template:Cite_journal\n30.79% 71.833 1 Template:Medref\n19.52% 45.544 1 Template:Ambox\n11.16% 26.038 2 Template:Navbox\n10.79% 25.177 1 Template:Psychiatry\n 4.58% 10.681 2 Template:Icon\n 3.72% 8.671 1 Template:Endocrinology\n 1.34% 3.123 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:49606176-1!canonical and timestamp 20181207020019 and revision id 833657570\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Transcutaneous_Vagus_Nerve_Stimulation\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212200\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.155 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 148.895 1 - wikipedia:Transcutaneous_Vagus_Nerve_Stimulation\n100.00% 148.895 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8283-0!*!*!*!*!*!* and timestamp 20181217212200 and revision id 24495\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Transcutaneous_vagus_nerve_stimulation\">https:\/\/www.limswiki.org\/index.php\/Transcutaneous_vagus_nerve_stimulation<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","9458d4002715c4ee895ca07b7b6ecbeb_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e3\/Rod_of_Asclepius2.svg\/25px-Rod_of_Asclepius2.svg.png"],"9458d4002715c4ee895ca07b7b6ecbeb_timestamp":1545081720,"03f19c2a13dc8c6471d114f788a7587e_type":"article","03f19c2a13dc8c6471d114f788a7587e_title":"Thalamic stimulator","03f19c2a13dc8c6471d114f788a7587e_url":"https:\/\/www.limswiki.org\/index.php\/Thalamic_stimulator","03f19c2a13dc8c6471d114f788a7587e_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tThalamic stimulator\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tA thalamic stimulator is a relatively new medical device that can suppress tremors, such as those caused by Parkinson's Disease or essential tremor. It was approved for use by the Food and Drug Administration (FDA) on August 4, 1997. Installation is invasive, so it is typically only used when the tremors are incapacitating, and medication is ineffective. Typically, one or more electrodes are implanted in the brain, with subcutaneous leads to a neurostimulator, which may also be implanted. The electrodes stimulate the area of the thalamus, specifically the part of the brain that controls movement and muscle function.\nIt is notable that the presence of thalamic stimulators significantly changes ECG patterns, and prevents the use of MRI. It is sometimes regarded as a better alternative to pallidotomy or thalamotomy because it is non-permanent. For optimal installation, the patient is awake during the procedure, and talks to the surgeon to find the best placement. Once in place, the device can be activated and deactivated, for improved effectiveness during the day.\nRisks arising from the operation are infection, stroke and dysarthria.\nA fictional treatment of the device, out decades before the device itself, can be found in the novel The Terminal Man.\n\nSources \nDifferential electrocardiographic artifact from implanted thalamic stimulator\nFDA Okays Powerful Brain Implant\nWashington University implanting brain device to control tremor\nNew device offers relief for patients with tremors\nvteNeurosurgical and other procedures (ICD-9-CM V3 01\u201305+89.1, ICD-10-PCS 00\u201301)Skull\nCraniotomy\nDecompressive craniectomy\nCranioplasty\nCNSBrainthalamus and globus pallidus: \nThalamotomy\nThalamic stimulator\nPallidotomy\nventricular system: \nVentriculostomy\nSuboccipital puncture\nIntracranial pressure monitoring\ncerebrum: \nPsychosurgery\nLobotomy\nBilateral cingulotomy\nHemispherectomy\nAnterior temporal lobectomy\npituitary gland: \nHypophysectomy\nhippocampus: \nAmygdalohippocampectomy\n\nBrain biopsy\nCerebral meninges\nMeningeal biopsy\nSpinal cord and spinal canal\nSpinal cord and roots\nCordotomy\nRhizotomy\nVertebrae and intervertebral discs: see Template:Bone, cartilage, and joint procedures\nMedical imaging\nComputed tomography of the head\nCerebral angiography\nPneumoencephalography\nEchoencephalography\/Transcranial Doppler\nMagnetic resonance imaging of the brain\nBrain PET\nMyelography\nDiagnostic\nElectroencephalography\nLumbar puncture\nPolysomnography\nCPRs\nGlasgow Coma Scale\nMini\u2013mental state examination\nNational Institutes of Health Stroke Scale\nCHADS2 score\nPNSCranial and peripheral nerves\nNerve block\nVagotomy\nSympathetic nerves or ganglia\nGanglionectomy\nSympathectomy\nEndoscopic thoracic sympathectomy\nNerves (general)\nAxotomy\nNeurectomy\nNerve biopsy\nDiagnostic\nNerve conduction study\nElectromyography\nMedical imaging\nMagnetic resonance neurography\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Thalamic_stimulator\">https:\/\/www.limswiki.org\/index.php\/Thalamic_stimulator<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 22:29.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 540 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","03f19c2a13dc8c6471d114f788a7587e_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Thalamic_stimulator skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Thalamic stimulator<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>A <b>thalamic stimulator<\/b> is a relatively new medical device that can suppress <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tremor\" title=\"Tremor\" rel=\"external_link\" target=\"_blank\">tremors<\/a>, such as those caused by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parkinson%27s_Disease\" class=\"mw-redirect\" title=\"Parkinson's Disease\" rel=\"external_link\" target=\"_blank\">Parkinson's Disease<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Essential_tremor\" title=\"Essential tremor\" rel=\"external_link\" target=\"_blank\">essential tremor<\/a>. It was approved for use by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> (FDA) on August 4, 1997. Installation is invasive, so it is typically only used when the tremors are incapacitating, and medication is ineffective. Typically, one or more electrodes are implanted in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain\" title=\"Brain\" rel=\"external_link\" target=\"_blank\">brain<\/a>, with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subcutaneous_tissue\" title=\"Subcutaneous tissue\" rel=\"external_link\" target=\"_blank\">subcutaneous<\/a> leads to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurostimulator\" class=\"mw-redirect\" title=\"Neurostimulator\" rel=\"external_link\" target=\"_blank\">neurostimulator<\/a>, which may also be implanted. The electrodes stimulate the area of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thalamus\" title=\"Thalamus\" rel=\"external_link\" target=\"_blank\">thalamus<\/a>, specifically the part of the brain that controls movement and muscle function.\n<\/p><p>It is notable that the presence of thalamic stimulators significantly changes <a href=\"https:\/\/en.wikipedia.org\/wiki\/ECG\" class=\"mw-redirect\" title=\"ECG\" rel=\"external_link\" target=\"_blank\">ECG<\/a> patterns, and prevents the use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a>. It is sometimes regarded as a better alternative to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pallidotomy\" title=\"Pallidotomy\" rel=\"external_link\" target=\"_blank\">pallidotomy<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thalamotomy\" title=\"Thalamotomy\" rel=\"external_link\" target=\"_blank\">thalamotomy<\/a> because it is non-permanent. For optimal installation, the patient is awake during the procedure, and talks to the surgeon to find the best placement. Once in place, the device can be activated and deactivated, for improved effectiveness during the day.\n<\/p><p>Risks arising from the operation are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dysarthria\" title=\"Dysarthria\" rel=\"external_link\" target=\"_blank\">dysarthria<\/a>.\n<\/p><p>A fictional treatment of the device, out decades before the device itself, can be found in the novel <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Terminal_Man\" title=\"The Terminal Man\" rel=\"external_link\" target=\"_blank\">The Terminal Man<\/a><\/i>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Sources\">Sources<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/dx.doi.org\/10.1016\/j.ijcard.2003.04.061\" target=\"_blank\">Differential electrocardiographic artifact from implanted thalamic stimulator<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/19990819072954\/http:\/\/www.neurohaven.com\/parkin3.htm\" target=\"_blank\">FDA Okays Powerful Brain Implant<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20051030175519\/http:\/\/mednewsarchive.wustl.edu\/medadmin\/PAnews.nsf\/0\/2B773E4A990AE42486256B1F0074064B\" target=\"_blank\">Washington University implanting brain device to control tremor<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cnn.com\/HEALTH\/9604\/07\/tremor_treatment\/\" target=\"_blank\">New device offers relief for patients with tremors<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1241\nCached time: 20181210191648\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.064 seconds\nReal time usage: 0.079 seconds\nPreprocessor visited node count: 235\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 44071\/2097152 bytes\nTemplate argument size: 129\/2097152 bytes\nHighest expansion depth: 9\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 750\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.014\/10.000 seconds\nLua memory usage: 1,006 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n162.29% 69.105 4 Template:Navbox\n100.00% 42.581 1 Template:Neuro_procedures\n100.00% 42.581 1 -total\n<\/p>\n<pre>22.34% 9.514 5 Template:Nobold\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1726060-1!canonical and timestamp 20181210191648 and revision id 817856131\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Thalamic_stimulator\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212159\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.145 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 139.302 1 - wikipedia:Thalamic_stimulator\n100.00% 139.302 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8282-0!*!*!*!*!*!* and timestamp 20181217212159 and revision id 24494\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Thalamic_stimulator\">https:\/\/www.limswiki.org\/index.php\/Thalamic_stimulator<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","03f19c2a13dc8c6471d114f788a7587e_images":[],"03f19c2a13dc8c6471d114f788a7587e_timestamp":1545081719,"9ab5bafb9853e90fd1379483cd60862a_type":"article","9ab5bafb9853e90fd1379483cd60862a_title":"Surgical suture","9ab5bafb9853e90fd1379483cd60862a_url":"https:\/\/www.limswiki.org\/index.php\/Surgical_suture","9ab5bafb9853e90fd1379483cd60862a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurgical suture\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor other uses, see Suture.\nSurgical sutureSurgical suture on needle holder. Packaging shown above.[edit on Wikidata]\nSurgical suture is a medical device used to hold body tissues together after an injury or surgery. Application generally involves using a needle with an attached length of thread. A number of different shapes, sizes, and thread materials have been developed over its millennia of history. Surgeons, physicians, dentists, podiatrists, eye doctors, registered nurses and other trained nursing personnel, medics, and clinical pharmacists typically engage in suturing. Surgical knots are used to secure the sutures.\n\nContents \n\n1 Needles \n2 Thread \n\n2.1 Materials \n2.2 Absorbability \n2.3 Sizes \n\n\n3 Techniques \n\n3.1 Placement \n3.2 Stitching interval and spacing \n3.3 Layers \n3.4 Removal \n3.5 Expansions \n\n\n4 Tissue adhesives \n5 History \n6 See also \n7 References \n8 External links \n\n\nNeedles \nEyed or reusable needles with holes (called eyes), which are supplied separate from their suture thread, are necessary for suture. The suture must be threaded on site, as is done when sewing in a recreational setting. The advantage of this is that any thread and needle combination is possible to suit the job at hand. Swaged, or atraumatic, needles with sutures comprise a pre-packed eyeless needle attached to a specific length of suture thread. The suture manufacturer swages the suture thread to the eyeless atraumatic needle at the factory. The chief advantage of this is that the doctor or the nurse does not have to spend time threading the suture on the needle, which may be difficult for very fine needles and sutures. Also, the suture end of a swaged needle is narrower than the needle body, eliminating drag from the thread attachment site. In eyed needles, the thread protrudes from the needle body on both sides, and at best causes drag. When passing through friable tissues, the eye needle and suture combination may thus traumatise tissues more than a swaged needle, hence the designation of the latter as \"atraumatic\".\nThere are several shapes of surgical needles. These include:\n\nStraight\n1\/4 circle\n3\/8 circle\n1\/2 circle. Subtypes of this needle shape include, from larger to smaller size, CT, CT-1, CT-2 and CT-3.[1]\n5\/8 circle\ncompound curve\nhalf curved (also known as ski)\nhalf curved at both ends of a straight segment (also known as canoe)\nThe ski and canoe needle design allows curved needles to be straight enough to be used in laparoscopic surgery, where instruments are inserted into the abdominal cavity through narrow cannulas.\nNeedles may also be classified by their point geometry; examples include:\n\ntaper (needle body is round and tapers smoothly to a point)\ncutting (needle body is triangular and has a sharpened cutting edge on the inside curve)\nreverse cutting (cutting edge on the outside)\ntrocar point or tapercut (needle body is round and tapered, but ends in a small triangular cutting point)\nblunt points for sewing friable tissues\nside cutting or spatula points (flat on top and bottom with a cutting edge along the front to one side) for eye surgery\nFinally, atraumatic needles may be permanently swaged to the suture or may be designed to come off the suture with a sharp straight tug. These \"pop-offs\" are commonly used for interrupted sutures, where each suture is only passed once and then tied.\n\n\n\t\t\n\t\t\t\n\t\t\t\nEyed surgical needles which form 3\/8th of a circle, in different sizes.\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nEyed surgical needles which are semicircular, in different sizes.\n\n\t\t\t\n\t\t\n\nSutures can withstand different amounts of force based on their size; this is quantified by the U.S.P. Needle Pull Specifications.\n\nThread \nMaterials \n Micrograph of a H&E stained tissue section showing a non-absorbable multi-filament surgical suture with a surrounding foreign-body giant cell reaction\nFurther information: Suture materials comparison chart\nSuture thread is made from numerous materials. The original sutures were made from biological materials, such as catgut suture and silk. These absorbed bodily fluids and could be foci of infection. Founder of gynecology J. Marion Sims invented the use of silver wire, which is anti-bacterial, for a suture. Most modern sutures are synthetic, including the absorbables polyglycolic acid, polylactic acid, Monocryl and polydioxanone as well as the non-absorbables nylon, polyester, PVDF and polypropylene.[2] The FDA first approved triclosan-coated sutures in 2002;[3] they have been shown to reduce the chances of wound infection.[4] Sutures come in very specific sizes and may be either absorbable (naturally biodegradable in the body) or non-absorbable. Sutures must be strong enough to hold tissue securely but flexible enough to be knotted. They must be hypoallergenic and avoid the \"wick effect\" that would allow fluids and thus infection to penetrate the body along the suture tract.\n\nAbsorbability \nAll sutures are classified as either absorbable or non-absorbable depending on whether the body will naturally degrade and absorb the suture material over time. Absorbable suture materials include the original catgut as well as the newer synthetics polyglycolic acid, polylactic acid, polydioxanone, and caprolactone. \nAbsorbable (or resorbable) medical devices such as sutures are made of polymers. The polymer materials are based on one or more of five cyclic monomers: glycolide, l-lactide, p-dioxanone, trimethylene carbonate and \u03b5-caprolactone.[5]\nThey are broken down by various processes including hydrolysis (polyglycolic acid) and proteolytic enzymatic degradation. Depending on the material, the process can be from ten days to eight weeks. They are used in patients who cannot return for suture removal, or in internal body tissues.[6] In both cases, they will hold the body tissues together long enough to allow healing, but will disintegrate so that they do not leave foreign material or require further procedures. Initially, there is a foreign body reaction to the material, which is transient. After complete resorption only connective tissue will remain.[7][8][9][10] Occasionally, absorbable sutures can cause inflammation and be rejected by the body rather than absorbed.\n\n Twelve nonabsorbable sutures in a person's lower back.\nNon-absorbable sutures are made of special silk or the synthetics polypropylene, polyester or nylon. Stainless steel wires are commonly used in orthopedic surgery and for sternal closure in cardiac surgery. These may or may not have coatings to enhance their performance characteristics. Non-absorbable sutures are used either on skin wound closure, where the sutures can be removed after a few weeks, or in stressful internal environments where absorbable sutures will not suffice. Examples include the heart (with its constant pressure and movement) or the bladder (with adverse chemical conditions). Non-absorbable sutures often cause less scarring because they provoke less immune response, and thus are used where cosmetic outcome is important. They may be removed after a certain time, or left permanently.\n\nSizes \nThe examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject. You may improve this article, discuss the issue on the talk page, or create a new article, as appropriate. (December 2010) (Learn how and when to remove this template message)\nSuture sizes are defined by the United States Pharmacopeia (U.S.P.). Sutures were originally manufactured ranging in size from #1 to #6, with #1 being the smallest. A #4 suture would be roughly the diameter of a tennis racquet string. The manufacturing techniques, derived at the beginning from the production of musical strings, did not allow thinner diameters. As the procedures improved, #0 was added to the suture diameters, and later, thinner and thinner threads were manufactured, which were identified as #00 (#2-0 or #2\/0) to #000000 (#6-0 or #6\/0).\nModern sutures range from #5 (heavy braided suture for orthopedics) to #11-0 (fine monofilament suture for ophthalmics). Atraumatic needles are manufactured in all shapes for most sizes. The actual diameter of thread for a given U.S.P. size differs depending on the suture material class.\n\n\n\nUSP\r\ndesignation\nCollagen\r\ndiameter (mm)\nSynthetic absorbable\r\ndiameter (mm)\nNon-absorbable\r\ndiameter (mm)\nAmerican \r\nwire gauge\n\n\n11-0\n\n\n0.01\n\n\n\n10-0\n0.02\n0.02\n0.02\n\n\n\n9-0\n0.03\n0.03\n0.03\n\n\n\n8-0\n0.05\n0.04\n0.04\n\n\n\n7-0\n0.07\n0.05\n0.05\n\n\n\n6-0\n0.1\n0.07\n0.07\n38\u201340\n\n\n5-0\n0.15\n0.1\n0.1\n35\u201338\n\n\n4-0\n0.2\n0.15\n0.15\n32\u201334\n\n\n3-0\n0.3\n0.2\n0.2\n29\u201332\n\n\n2-0\n0.35\n0.3\n0.3\n28\n\n\n0\n0.4\n0.35\n0.35\n26\u201327\n\n\n1\n0.5\n0.4\n0.4\n25\u201326\n\n\n2\n0.6\n0.5\n0.5\n23\u201324\n\n\n3\n0.7\n0.6\n0.6\n22\n\n\n4\n0.8\n0.6\n0.6\n21\u201322\n\n\n5\n\n0.7\n0.7\n20\u201321\n\n\n6\n\n\n0.8\n19\u201320\n\n\n7\n\n\n\n18\n\n\nTechniques \nSee also: Surgical knot\n A wound before and after suture closure. The closure incorporates five simple interrupted sutures and one vertical mattress suture (center) at the apex of the wound.\n Suturing two operation wounds with eleven simple stitches by a Cuban doctor. Sara, Guinea-Bissau, 1974.\nMany different techniques exist. The most common is the simple interrupted stitch;[11] it is indeed the simplest to perform and is called \"interrupted\" because the suture thread is cut between each individual stitch. The vertical and horizontal mattress stitch are also interrupted but are more complex and specialized for everting the skin and distributing tension. The running or continuous stitch is quicker but risks failing if the suture is cut in just one place; the continuous locking stitch is in some ways a more secure version. The chest drain stitch and corner stitch are variations of the horizontal mattress.\nOther stitches or suturing techniques include:\n\nPurse-string suture, a continuous, circular inverting suture which is made to secure apposition of the edges of a surgical or traumatic wound.[12][13]\nFigure 8 stitch\nSubcuticular stitch.\nPlacement \nSutures are placed by mounting a needle with attached suture into a needle holder. The needle point is pressed into the flesh, advanced along the trajectory of the needle's curve until it emerges, and pulled through. The trailing thread is then tied into a knot, usually a square knot or surgeon's knot. Ideally, sutures bring together the wound edges, without causing indenting or blanching of the skin,[14] since the blood supply may be impeded and thus increase infection and scarring.[15][16] Ideally, sutured skin rolls slightly outward from the wound (eversion), and the depth and width of the sutured flesh is roughly equal.[15] Placement varies based on the location,\n\nStitching interval and spacing \nSkin and other soft tissue can lengthen significantly under strain. To accommodate this lengthening, continuous stitches must have an adequate amount of slack. Jenkin's rule was the first research result in this area, showing that the then-typical use of a suture-length to wound-length ratio of 2:1 increased the risk of a burst wound, and suggesting a SL:WL ratio of 4:1 or more in abdominal wounds.[16][17] A later study suggested 6:1 as the optimal ratio in abdominal closure.[18]\n\nLayers \nIn contrast to single layer suturing, two layer suturing generally involves suturing at a deeper level of a tissue followed by another layer of suturing at a more superficial level. For example, Cesarean section can be performed with single or double layer suturing of the uterine incision.[19]\n\nRemoval \nWhereas some sutures are intended to be permanent, and others in specialized cases may be kept in place for an extended period of many weeks, as a rule sutures are a short term device to allow healing of a trauma or wound.\n\nDifferent parts of the body heal at different speeds. Common time to remove stitches will vary: facial wounds 3\u20135 days; scalp wound 7\u201310 days; limbs 10\u201314 days; joints 14 days; trunk of the body 7\u201310 days.[20]\n\nRemoval of sutures is traditionally achieved by using forceps to hold the suture thread steady and pointed scalpel blades or scissors to cut. For practical reasons the two instruments (forceps and scissors) are available in a sterile kit. In certain countries (e.g. US), these kits are available in sterile disposable trays because of the high cost of cleaning and re-sterilization.\n\nExpansions \nA pledgeted suture is one that is supported by a pledget, that is, a small flat non-absorbent pad normally composed of polytetrafluoroethylene, used as buttresses under sutures when there is a possibility of sutures tearing through tissue.[21]\n\nTissue adhesives \nTopical cyanoacrylate adhesives (industrially used as super glue), have been used in combination with, or as an alternative to, sutures in wound closure. The adhesive remains liquid until exposed to water or water-containing substances\/tissue, after which it cures (polymerizes) and forms a bond to the underlying surface. The tissue adhesive has been shown to act as a barrier to microbial penetration as long as the adhesive film remains intact. Limitations of tissue adhesives include contraindications to use near the eyes and a mild learning curve on correct usage. They are also unsuitable for oozing or potentially contaminated wounds.\nIn surgical incisions it does not work as well as sutures as the wounds often break open.[22]\nCyanoacrylate is the generic name for cyanoacrylate based fast-acting glues such as methyl-2-cyanoacrylate, ethyl-2-cyanoacrylate (commonly sold under trade names like Superglue and Krazy Glue) and n-butyl-cyanoacrylate. Skin glues like Indermil and Histoacryl were the first medical grade tissue adhesives to be used, and these are composed of n-butyl cyanoacrylate. These worked well but had the disadvantage of having to be stored in the refrigerator, were exothermic so they stung the patient, and the bond was brittle. Nowadays, the longer chain polymer, 2-octyl cyanoacrylate, is the preferred medical grade glue. It is available under various trade names, such as LiquiBand, SurgiSeal, FloraSeal, and Dermabond. These have the advantages of being more flexible, making a stronger bond, and being easier to use. The longer side chain types, for example octyl and butyl forms, also reduce tissue reaction.\n\nHistory \n Sewing wound after herniotomy, 1559\n Old refillable surgical thread supplier (middle of 20th century)\nThrough many millennia, various suture materials were used, debated, and remained largely unchanged. Needles were made of bone or metals such as silver, copper, and aluminium bronze wire. Sutures were made of plant materials (flax, hemp and cotton) or animal material (hair, tendons, arteries, muscle strips and nerves, silk, and catgut).\nThe earliest reports of surgical suture date to 3000 BC in ancient Egypt, and the oldest known suture is in a mummy from 1100 BC. A detailed description of a wound suture and the suture materials used in it is by the Indian sage and physician Sushruta, written in 500 BC.[23] The Greek father of medicine, Hippocrates, described suture techniques, as did the later Roman Aulus Cornelius Celsus. The 2nd-century Roman physician Galen described gut sutures.[24] In the 10th century, the catgut suture along with the surgery needle were developed by Abulcasis[25][26]. The catgut suture was similar to that of strings for violins, guitar, and tennis racquet and it involved harvesting sheep intestines.\nJoseph Lister endorsed the routine sterilization of all suture threads. He first attempted sterilization with the 1860s \"carbolic catgut,\" and chromic catgut followed two decades later. Sterile catgut was finally achieved in 1906 with iodine treatment.\nThe next great leap came in the twentieth century. The chemical industry drove production of the first synthetic thread in the early 1930s, which exploded into production of numerous absorbable and non-absorbable synthetics. The first synthetic absorbable was based on polyvinyl alcohol in 1931. Polyesters were developed in the 1950s, and later the process of radiation sterilization was established for catgut and polyester. Polyglycolic acid was discovered in the 1960s and implemented in the 1970s. Today, most sutures are made of synthetic polymer fibers. Silk and, rarely, gut sutures are the only materials still in use from ancient times. In fact, gut sutures have been banned in Europe and Japan owing to concerns regarding Bovine Spongiform Encephalopathy. Silk suture is still used, mainly to secure surgical drains.\n\nSee also \n\nAlexis Carrel\nBarbed suture\nButterfly closure\nCheesewiring\nChitin\nCyanoacrylate\nKnots\nLigature\nList of medical topics\nSewing\nSurgical staple\nWound closure strips\n\nReferences \n\n\n^ Surgical Needle Guide from Novartis. Copyright 2005. \n\n^ \"Types of Sutures\". Dolphin Sutures. Retrieved 2014-01-07 . \n\n^ ETHICON Products (20 December 2002). \"ETHICON Receives FDA Clearance to Market VICRYL* Plus, First Ever Antibacterial Suture\". PRNewswire. Retrieved 25 January 2016 . \n\n^ Daoud, FC; Edmiston CE, Jr; Leaper, D (June 2014). \"Meta-analysis of prevention of surgical site infections following incision closure with triclosan-coated sutures: robustness to new evidence\". Surgical infections. 15 (3): 165\u201381. doi:10.1089\/sur.2013.177. PMC 4063374 . PMID 24738988. \n\n^ H\u00f6glund, Odd Viking (2012). A resorbable device for ligation of blood vessels : development, assessment of surgical procedures and clinical evaluation (PDF) . pp. 17\u201319. ISBN 978-91-576-7686-3. \n\n^ \"Suture Materials - Classification - Surgical Needles - TeachMeSurgery\". \n\n^ H\u00f6glund, Odd Viking (2012). A resorbable device for ligation of blood vessels : development, assessment of surgical procedures and clinical evaluation (PDF) . ISBN 978-91-576-7686-3. \n\n^ H\u00f6glund, Odd V; Ingman, Jessica; S\u00f6dersten, Fredrik; Hansson, Kerstin; Borg, Niklas; Lagerstedt, Anne-Sofie (2014). \"Ligation of the spermatic cord in dogs with a self-locking device of a resorbable polyglycolic based co-polymer \u2013 feasibility and long-term follow-up study\". BMC Research Notes. 7 (1): 825. doi:10.1186\/1756-0500-7-825. \n\n^ Hjort, H.; Mathisen, T.; Alves, A.; Clermont, G.; Boutrand, J. P. (5 October 2011). \"Three-year results from a preclinical implantation study of a long-term resorbable surgical mesh with time-dependent mechanical characteristics\". Hernia. 16 (2): 191\u2013197. doi:10.1007\/s10029-011-0885-y. \n\n^ Anderson, James M.; Rodriguez, Analiz; Chang, David T. (April 2008). \"Foreign body reaction to biomaterials\". Seminars in Immunology. 20 (2): 86\u2013100. doi:10.1016\/j.smim.2007.11.004. PMC 2327202 . \n\n^ Lammers, Richard L; Trott, Alexander T (2004). \"Chapter 36: Methods of Wound Closure\". In Roberts, James R; Hedges, Jerris R. Clinical Procedures in Emergency Medicine (4th ed.). Philadelphia: Saunders. p. 671. ISBN 0-7216-9760-7. \n\n^ Dorland's Medical Dictionary for Health Consumers. Copyright 2007 \n\n^ Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. \n\n^ Osterberg, B; Blomstedt, B (1979). \"Effect of suture materials on bacterial survival in infected wounds: An experimental study\". Acta Chir Scand. 145: 431. \n\n^ a b Macht, SD; Krizek, TJ (1978). \"Sutures and suturing - Current concepts\". Journal of Oral Surgery. 36: 710. \n\n^ a b Kirk, RM (1978). Basic Surgical Techniques. Edinburgh: Churchill Livingstone. \n\n^ Grossman, JA (1982). \"The repair of surface trauma\". Emergency Medicine. 14: 220. \n\n^ Varshney, S; Manek, P; Johnson, CD (September 1999). \"Six-fold suture:wound length ratio for abdominal closure\". Annals of the Royal College of Surgeons of England. 81 (5): 333\u20136. PMC 2503300 . PMID 10645176. \n\n^ Stark, M.; Chavkin, Y.; Kupfersztain, C.; Guedj, P.; Finkel, A. R. (1995). \"Evaluation of combinations of procedures in cesarean section\". International Journal of Gynecology & Obstetrics. 48 (3): 273\u20136. doi:10.1016\/0020-7292(94)02306-J. PMID 7781869. \n\n^ \"www.scribd.com\". \n\n^ \"Polytetrafluoroethylene Pledget\". \n\n^ Dumville, JC; Coulthard, P; Worthington, HV; Riley, P; Patel, N; Darcey, J; Esposito, M; van der Elst, M; van Waes, OJ (28 November 2014). \"Tissue adhesives for closure of surgical incisions\". The Cochrane Database of Systematic Reviews. 11: CD004287. doi:10.1002\/14651858.CD004287.pub4. PMID 25431843. \n\n^ Mysore, Venkataram. Acs(I) Textbook on Cutaneous and Aesthetic Surgery. Jaypee Brothers Medical Publishers Pvt. Ltd. pp. 125\u2013126. ISBN 9789350905913. Retrieved 25 January 2016 . \n\n^ Nutton, Dr Vivia (2005-07-30). Ancient Medicine. Taylor & Francis US. ISBN 9780415368483. Retrieved 21 November 2012 . \n\n^ Rooney, Anne (2009). The Story of Medicine. Arcturus Publishing. ISBN 9781848580398. \n\n^ Rakel, David; Rakel, Robert E. (2011). Textbook of Family Medicine E-Book. Elsevier Health Sciences. ISBN 1437735673. \n\n\nExternal links \n Media related to Surgical suture at Wikimedia Commons\n\nComputer modelling of sutures\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_suture\">https:\/\/www.limswiki.org\/index.php\/Surgical_suture<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 20:14.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 435 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","9ab5bafb9853e90fd1379483cd60862a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Surgical_suture skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Surgical suture<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Suture_(disambiguation)\" class=\"mw-redirect mw-disambig\" title=\"Suture (disambiguation)\" rel=\"external_link\" target=\"_blank\">Suture<\/a>.<\/div>\n\n<p><b>Surgical suture<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> used to hold <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_(biology)\" title=\"Tissue (biology)\" rel=\"external_link\" target=\"_blank\">body tissues<\/a> together after an injury or surgery. Application generally involves using a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sewing_needle\" title=\"Sewing needle\" rel=\"external_link\" target=\"_blank\">needle<\/a> with an attached length of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thread_(yarn)\" title=\"Thread (yarn)\" rel=\"external_link\" target=\"_blank\">thread<\/a>. A number of different shapes, sizes, and thread materials have been developed over its millennia of history. Surgeons, physicians, dentists, podiatrists, eye doctors, registered nurses and other trained nursing personnel, medics, and clinical pharmacists typically engage in suturing. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_knot\" title=\"Surgical knot\" rel=\"external_link\" target=\"_blank\">Surgical knots<\/a> are used to secure the sutures.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Needles\">Needles<\/span><\/h2>\n<p>Eyed or reusable needles with holes (called eyes), which are supplied separate from their suture thread, are necessary for suture. The suture must be threaded on site, as is done when sewing in a recreational setting. The advantage of this is that any thread and needle combination is possible to suit the job at hand. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Swage\" class=\"mw-redirect\" title=\"Swage\" rel=\"external_link\" target=\"_blank\">Swaged<\/a>, or atraumatic, needles with sutures comprise a pre-packed eyeless needle attached to a specific length of suture thread. The suture manufacturer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Swage\" class=\"mw-redirect\" title=\"Swage\" rel=\"external_link\" target=\"_blank\">swages<\/a> the suture thread to the eyeless atraumatic needle at the factory. The chief advantage of this is that the doctor or the nurse does not have to spend time threading the suture on the needle, which may be difficult for very fine needles and sutures. Also, the suture end of a swaged needle is narrower than the needle body, eliminating drag from the thread attachment site. In eyed needles, the thread protrudes from the needle body on both sides, and at best causes drag. When passing through friable tissues, the eye needle and suture combination may thus traumatise tissues more than a swaged needle, hence the designation of the latter as \"atraumatic\".\n<\/p><p>There are several shapes of surgical needles. These include:\n<\/p>\n<ul><li>Straight<\/li>\n<li>1\/4 circle<\/li>\n<li>3\/8 circle<\/li>\n<li>1\/2 circle. Subtypes of this needle shape include, from larger to smaller size, CT, CT-1, CT-2 and CT-3.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><\/li>\n<li>5\/8 circle<\/li>\n<li>compound curve<\/li>\n<li>half curved (also known as ski)<\/li>\n<li>half curved at both ends of a straight segment (also known as canoe)<\/li><\/ul>\n<p>The ski and canoe needle design allows curved needles to be straight enough to be used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopic_surgery\" class=\"mw-redirect\" title=\"Laparoscopic surgery\" rel=\"external_link\" target=\"_blank\">laparoscopic surgery<\/a>, where instruments are inserted into the abdominal cavity through narrow cannulas.\n<\/p><p>Needles may also be classified by their point geometry; examples include:\n<\/p>\n<ul><li>taper (needle body is round and tapers smoothly to a point)<\/li>\n<li>cutting (needle body is triangular and has a sharpened cutting edge on the inside curve)<\/li>\n<li>reverse cutting (cutting edge on the outside)<\/li>\n<li>trocar point or tapercut (needle body is round and tapered, but ends in a small triangular cutting point)<\/li>\n<li>blunt points for sewing friable tissues<\/li>\n<li>side cutting or spatula points (flat on top and bottom with a cutting edge along the front to one side) for eye surgery<\/li><\/ul>\n<p>Finally, atraumatic needles may be permanently swaged to the suture or may be designed to come off the suture with a sharp straight tug. These \"pop-offs\" are commonly used for interrupted sutures, where each suture is only passed once and then tied.\n<\/p>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:27.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HechtnaaldenB.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3a\/HechtnaaldenB.jpg\/120px-HechtnaaldenB.jpg\" width=\"120\" height=\"95\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Eyed surgical needles which form 3\/8th of a circle, in different sizes.\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:23.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HechtnaaldenG.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/28\/HechtnaaldenG.jpg\/120px-HechtnaaldenG.jpg\" width=\"120\" height=\"103\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Eyed surgical needles which are semicircular, in different sizes.\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<p>Sutures can withstand different amounts of force based on their size; this is quantified by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S.P._Needle_Pull_Specifications\" title=\"U.S.P. Needle Pull Specifications\" rel=\"external_link\" target=\"_blank\">U.S.P. Needle Pull Specifications<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Thread\">Thread<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Materials\">Materials<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Suture_micrograph.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9e\/Suture_micrograph.jpg\/220px-Suture_micrograph.jpg\" width=\"220\" height=\"164\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Suture_micrograph.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Micrograph\" title=\"Micrograph\" rel=\"external_link\" target=\"_blank\">Micrograph<\/a> of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/H%26E_stain\" title=\"H&E stain\" rel=\"external_link\" target=\"_blank\">H&E stained<\/a> tissue section showing a non-absorbable multi-filament surgical suture with a surrounding <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foreign-body_giant_cell\" title=\"Foreign-body giant cell\" rel=\"external_link\" target=\"_blank\">foreign-body giant cell<\/a> reaction<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Suture_materials_comparison_chart\" title=\"Suture materials comparison chart\" rel=\"external_link\" target=\"_blank\">Suture materials comparison chart<\/a><\/div>\n<p>Suture thread is made from numerous materials. The original sutures were made from biological materials, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut_suture\" title=\"Catgut suture\" rel=\"external_link\" target=\"_blank\">catgut suture<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silk\" title=\"Silk\" rel=\"external_link\" target=\"_blank\">silk<\/a>. These absorbed bodily fluids and could be foci of infection. Founder of gynecology <a href=\"https:\/\/en.wikipedia.org\/wiki\/J._Marion_Sims\" title=\"J. Marion Sims\" rel=\"external_link\" target=\"_blank\">J. Marion Sims<\/a> invented the use of silver wire, which is anti-bacterial, for a suture. Most modern sutures are synthetic, including the absorbables <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyglycolic_acid\" class=\"mw-redirect\" title=\"Polyglycolic acid\" rel=\"external_link\" target=\"_blank\">polyglycolic acid<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polylactic_acid\" title=\"Polylactic acid\" rel=\"external_link\" target=\"_blank\">polylactic acid<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monocryl\" title=\"Monocryl\" rel=\"external_link\" target=\"_blank\">Monocryl<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polydioxanone\" title=\"Polydioxanone\" rel=\"external_link\" target=\"_blank\">polydioxanone<\/a> as well as the non-absorbables <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nylon\" title=\"Nylon\" rel=\"external_link\" target=\"_blank\">nylon<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyester\" title=\"Polyester\" rel=\"external_link\" target=\"_blank\">polyester<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyvinylidene_fluoride\" title=\"Polyvinylidene fluoride\" rel=\"external_link\" target=\"_blank\">PVDF<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polypropylene\" title=\"Polypropylene\" rel=\"external_link\" target=\"_blank\">polypropylene<\/a>.<sup id=\"rdp-ebb-cite_ref-SutureTypes_2-0\" class=\"reference\"><a href=\"#cite_note-SutureTypes-2\" rel=\"external_link\">[2]<\/a><\/sup> The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">FDA<\/a> first approved <a href=\"https:\/\/en.wikipedia.org\/wiki\/Triclosan\" title=\"Triclosan\" rel=\"external_link\" target=\"_blank\">triclosan<\/a>-coated sutures in 2002;<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> they have been shown to reduce the chances of wound infection.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Sutures come in very specific sizes and may be either absorbable (naturally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biodegradation\" title=\"Biodegradation\" rel=\"external_link\" target=\"_blank\">biodegradable<\/a> in the body) or non-absorbable. Sutures must be strong enough to hold tissue securely but flexible enough to be knotted. They must be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypoallergenic\" title=\"Hypoallergenic\" rel=\"external_link\" target=\"_blank\">hypoallergenic<\/a> and avoid the \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Capillary_action\" title=\"Capillary action\" rel=\"external_link\" target=\"_blank\">wick<\/a> effect\" that would allow fluids and thus infection to penetrate the body along the suture tract.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Absorbability\">Absorbability<\/span><\/h3>\n<p>All sutures are classified as either absorbable or non-absorbable depending on whether the body will naturally degrade and absorb the suture material over time. <i>Absorbable<\/i> suture materials include the original <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut_suture\" title=\"Catgut suture\" rel=\"external_link\" target=\"_blank\">catgut<\/a> as well as the newer synthetics <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyglycolic_acid\" class=\"mw-redirect\" title=\"Polyglycolic acid\" rel=\"external_link\" target=\"_blank\">polyglycolic acid<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polylactic_acid\" title=\"Polylactic acid\" rel=\"external_link\" target=\"_blank\">polylactic acid<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polydioxanone\" title=\"Polydioxanone\" rel=\"external_link\" target=\"_blank\">polydioxanone<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Caprolactone\" title=\"Caprolactone\" rel=\"external_link\" target=\"_blank\">caprolactone<\/a>. \nAbsorbable (or resorbable) medical devices such as sutures are made of polymers. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer_material\" class=\"mw-redirect\" title=\"Polymer material\" rel=\"external_link\" target=\"_blank\">polymer materials<\/a> are based on one or more of five cyclic monomers: glycolide, l-lactide, p-dioxanone, trimethylene carbonate and \u03b5-caprolactone.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>They are broken down by various processes including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrolysis\" title=\"Hydrolysis\" rel=\"external_link\" target=\"_blank\">hydrolysis<\/a> (polyglycolic acid) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proteolysis\" title=\"Proteolysis\" rel=\"external_link\" target=\"_blank\">proteolytic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Enzyme\" title=\"Enzyme\" rel=\"external_link\" target=\"_blank\">enzymatic<\/a> degradation. Depending on the material, the process can be from ten days to eight weeks. They are used in patients who cannot return for suture removal, or in internal body tissues.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> In both cases, they will hold the body tissues together long enough to allow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Healing\" title=\"Healing\" rel=\"external_link\" target=\"_blank\">healing<\/a>, but will disintegrate so that they do not leave foreign material or require further procedures. Initially, there is a foreign body reaction to the material, which is transient. After complete resorption only connective tissue will remain.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> Occasionally, absorbable sutures can cause inflammation and be rejected by the body rather than absorbed.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:12_Stitches.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4e\/12_Stitches.jpg\/220px-12_Stitches.jpg\" width=\"220\" height=\"295\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:12_Stitches.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Twelve nonabsorbable sutures in a person's lower back.<\/div><\/div><\/div>\n<p><i>Non-absorbable sutures<\/i> are made of special <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silk\" title=\"Silk\" rel=\"external_link\" target=\"_blank\">silk<\/a> or the synthetics <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polypropylene\" title=\"Polypropylene\" rel=\"external_link\" target=\"_blank\">polypropylene<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyester\" title=\"Polyester\" rel=\"external_link\" target=\"_blank\">polyester<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nylon\" title=\"Nylon\" rel=\"external_link\" target=\"_blank\">nylon<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">Stainless steel<\/a> wires are commonly used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedic_surgery\" title=\"Orthopedic surgery\" rel=\"external_link\" target=\"_blank\">orthopedic surgery<\/a> and for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_sternum\" class=\"mw-redirect\" title=\"Human sternum\" rel=\"external_link\" target=\"_blank\">sternal<\/a> closure in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_surgery\" title=\"Cardiac surgery\" rel=\"external_link\" target=\"_blank\">cardiac surgery<\/a>. These may or may not have coatings to enhance their performance characteristics. Non-absorbable sutures are used either on skin wound closure, where the sutures can be removed after a few weeks, or in stressful internal environments where absorbable sutures will not suffice. Examples include the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart\" title=\"Heart\" rel=\"external_link\" target=\"_blank\">heart<\/a> (with its constant pressure and movement) or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bladder\" class=\"mw-redirect\" title=\"Bladder\" rel=\"external_link\" target=\"_blank\">bladder<\/a> (with adverse chemical conditions). Non-absorbable sutures often cause less <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scar\" title=\"Scar\" rel=\"external_link\" target=\"_blank\">scarring<\/a> because they provoke less <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immune_response\" title=\"Immune response\" rel=\"external_link\" target=\"_blank\">immune response<\/a>, and thus are used where cosmetic outcome is important. They may be removed after a certain time, or left permanently.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Sizes\">Sizes<\/span><\/h3>\n\n<p>Suture sizes are defined by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Pharmacopeia\" title=\"United States Pharmacopeia\" rel=\"external_link\" target=\"_blank\">United States Pharmacopeia<\/a> (U.S.P.). Sutures were originally manufactured ranging in size from #1 to #6, with #1 being the smallest. A #4 suture would be roughly the diameter of a tennis racquet string. The manufacturing techniques, derived at the beginning from the production of musical strings, did not allow thinner diameters. As the procedures improved, #0 was added to the suture diameters, and later, thinner and thinner threads were manufactured, which were identified as #00 (#2-0 or #2\/0) to #000000 (#6-0 or #6\/0).\n<\/p><p>Modern sutures range from #5 (heavy braided suture for orthopedics) to #11-0 (fine monofilament suture for ophthalmics). Atraumatic needles are manufactured in all shapes for most sizes. The actual diameter of thread for a given U.S.P. size differs depending on the suture material class.\n<\/p>\n<dl><dd><table class=\"wikitable\" style=\"\">\n<tbody><tr>\n<th>USP<br \/>designation<\/th>\n<th>Collagen<br \/>diameter (mm)<\/th>\n<th>Synthetic absorbable<br \/>diameter (mm)<\/th>\n<th>Non-absorbable<br \/>diameter (mm)<\/th>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_wire_gauge\" title=\"American wire gauge\" rel=\"external_link\" target=\"_blank\">American <br \/>wire gauge<\/a>\n<\/th><\/tr>\n<tr>\n<td>11-0<\/td>\n<td><\/td>\n<td><\/td>\n<td>0.01<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>10-0<\/td>\n<td>0.02<\/td>\n<td>0.02<\/td>\n<td>0.02<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>9-0<\/td>\n<td>0.03<\/td>\n<td>0.03<\/td>\n<td>0.03<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>8-0<\/td>\n<td>0.05<\/td>\n<td>0.04<\/td>\n<td>0.04<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>7-0<\/td>\n<td>0.07<\/td>\n<td>0.05<\/td>\n<td>0.05<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>6-0<\/td>\n<td>0.1<\/td>\n<td>0.07<\/td>\n<td>0.07<\/td>\n<td>38\u201340\n<\/td><\/tr>\n<tr>\n<td>5-0<\/td>\n<td>0.15<\/td>\n<td>0.1<\/td>\n<td>0.1<\/td>\n<td>35\u201338\n<\/td><\/tr>\n<tr>\n<td>4-0<\/td>\n<td>0.2<\/td>\n<td>0.15<\/td>\n<td>0.15<\/td>\n<td>32\u201334\n<\/td><\/tr>\n<tr>\n<td>3-0<\/td>\n<td>0.3<\/td>\n<td>0.2<\/td>\n<td>0.2<\/td>\n<td>29\u201332\n<\/td><\/tr>\n<tr>\n<td>2-0<\/td>\n<td>0.35<\/td>\n<td>0.3<\/td>\n<td>0.3<\/td>\n<td>28\n<\/td><\/tr>\n<tr>\n<td>0<\/td>\n<td>0.4<\/td>\n<td>0.35<\/td>\n<td>0.35<\/td>\n<td>26\u201327\n<\/td><\/tr>\n<tr>\n<td>1<\/td>\n<td>0.5<\/td>\n<td>0.4<\/td>\n<td>0.4<\/td>\n<td>25\u201326\n<\/td><\/tr>\n<tr>\n<td>2<\/td>\n<td>0.6<\/td>\n<td>0.5<\/td>\n<td>0.5<\/td>\n<td>23\u201324\n<\/td><\/tr>\n<tr>\n<td>3<\/td>\n<td>0.7<\/td>\n<td>0.6<\/td>\n<td>0.6<\/td>\n<td>22\n<\/td><\/tr>\n<tr>\n<td>4<\/td>\n<td>0.8<\/td>\n<td>0.6<\/td>\n<td>0.6<\/td>\n<td>21\u201322\n<\/td><\/tr>\n<tr>\n<td>5<\/td>\n<td><\/td>\n<td>0.7<\/td>\n<td>0.7<\/td>\n<td>20\u201321\n<\/td><\/tr>\n<tr>\n<td>6<\/td>\n<td><\/td>\n<td><\/td>\n<td>0.8<\/td>\n<td>19\u201320\n<\/td><\/tr>\n<tr>\n<td>7<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td>18\n<\/td><\/tr>\n<\/tbody><\/table><\/dd><\/dl>\n<h2><span class=\"mw-headline\" id=\"Techniques\">Techniques<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_knot\" title=\"Surgical knot\" rel=\"external_link\" target=\"_blank\">Surgical knot<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Suture,_before_and_after,_RMO.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/0\/07\/Suture%2C_before_and_after%2C_RMO.jpg\/220px-Suture%2C_before_and_after%2C_RMO.jpg\" width=\"220\" height=\"330\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Suture,_before_and_after,_RMO.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A wound before and after suture closure. The closure incorporates five <a href=\"https:\/\/en.wikipedia.org\/wiki\/Simple_interrupted_stitch\" title=\"Simple interrupted stitch\" rel=\"external_link\" target=\"_blank\">simple interrupted sutures<\/a> and one <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertical_mattress_stitch\" title=\"Vertical mattress stitch\" rel=\"external_link\" target=\"_blank\">vertical mattress suture<\/a> (center) at the apex of the wound.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara,_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/70\/ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara%2C_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif\/lossy-page1-220px-ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara%2C_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara,_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Suturing two operation wounds with eleven simple stitches by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cuban_medical_internationalism\" title=\"Cuban medical internationalism\" rel=\"external_link\" target=\"_blank\">Cuban doctor<\/a>. Sara, Guinea-Bissau, 1974.<\/div><\/div><\/div>\n<p>Many different techniques exist. The most common is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Simple_interrupted_stitch\" title=\"Simple interrupted stitch\" rel=\"external_link\" target=\"_blank\">simple interrupted stitch<\/a>;<sup id=\"rdp-ebb-cite_ref-rh_11-0\" class=\"reference\"><a href=\"#cite_note-rh-11\" rel=\"external_link\">[11]<\/a><\/sup> it is indeed the simplest to perform and is called \"interrupted\" because the suture thread is cut between each individual stitch. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertical_mattress_stitch\" title=\"Vertical mattress stitch\" rel=\"external_link\" target=\"_blank\">vertical<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Horizontal_mattress_stitch\" title=\"Horizontal mattress stitch\" rel=\"external_link\" target=\"_blank\">horizontal mattress stitch<\/a> are also interrupted but are more complex and specialized for everting the skin and distributing tension. The running or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Running_stitch\" title=\"Running stitch\" rel=\"external_link\" target=\"_blank\">continuous stitch<\/a> is quicker but risks failing if the suture is cut in just one place; the continuous locking stitch is in some ways a more secure version. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest_drain_stitch\" class=\"mw-redirect\" title=\"Chest drain stitch\" rel=\"external_link\" target=\"_blank\">chest drain stitch<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corner_stitch\" title=\"Corner stitch\" rel=\"external_link\" target=\"_blank\">corner stitch<\/a> are variations of the horizontal mattress.\n<\/p><p>Other stitches or suturing techniques include:\n<\/p>\n<ul><li><i>Purse-string suture<\/i>, a continuous, circular inverting suture which is made to secure apposition of the edges of a surgical or traumatic wound.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><\/li>\n<li>Figure 8 stitch<\/li>\n<li>Subcuticular stitch.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Placement\">Placement<\/span><\/h3>\n<p>Sutures are placed by mounting a needle with attached suture into a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Needle_holder\" title=\"Needle holder\" rel=\"external_link\" target=\"_blank\">needle holder<\/a>. The needle point is pressed into the flesh, advanced along the trajectory of the needle's curve until it emerges, and pulled through. The trailing thread is then tied into a knot, usually a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reef_knot\" title=\"Reef knot\" rel=\"external_link\" target=\"_blank\">square knot<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgeon%27s_knot\" title=\"Surgeon's knot\" rel=\"external_link\" target=\"_blank\">surgeon's knot<\/a>. Ideally, sutures bring together the wound edges, without causing indenting or blanching of the skin,<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> since the blood supply may be impeded and thus increase <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a> and scarring.<sup id=\"rdp-ebb-cite_ref-macht_15-0\" class=\"reference\"><a href=\"#cite_note-macht-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-kirk_16-0\" class=\"reference\"><a href=\"#cite_note-kirk-16\" rel=\"external_link\">[16]<\/a><\/sup> Ideally, sutured skin rolls slightly outward from the wound (eversion), and the depth and width of the sutured flesh is roughly equal.<sup id=\"rdp-ebb-cite_ref-macht_15-1\" class=\"reference\"><a href=\"#cite_note-macht-15\" rel=\"external_link\">[15]<\/a><\/sup> Placement varies based on the location,\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Stitching_interval_and_spacing\">Stitching interval and spacing<\/span><\/h3>\n<p>Skin and other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soft_tissue\" title=\"Soft tissue\" rel=\"external_link\" target=\"_blank\">soft tissue<\/a> can lengthen significantly under strain. To accommodate this lengthening, continuous stitches must have an adequate amount of slack. <b>Jenkin's rule<\/b> was the first research result in this area, showing that the then-typical use of a suture-length to wound-length ratio of 2:1 increased the risk of a burst wound, and suggesting a SL:WL ratio of 4:1 or more in abdominal wounds.<sup id=\"rdp-ebb-cite_ref-kirk_16-1\" class=\"reference\"><a href=\"#cite_note-kirk-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> A later study suggested 6:1 as the optimal ratio in abdominal closure.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Layers\">Layers<\/span><\/h3>\n<p>In contrast to <i>single layer suturing<\/i>, <i>two layer suturing<\/i> generally involves suturing at a deeper level of a tissue followed by another layer of suturing at a more superficial level. For example, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cesarean_section\" class=\"mw-redirect\" title=\"Cesarean section\" rel=\"external_link\" target=\"_blank\">Cesarean section<\/a> can be performed with single or double layer suturing of the uterine incision.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Removal\">Removal<\/span><\/h3>\n<p>Whereas some sutures are intended to be permanent, and others in specialized cases may be kept in place for an extended period of many weeks, as a rule sutures are a short term device to allow healing of a trauma or wound.\n<\/p>\n<blockquote class=\"templatequote\"><p>Different parts of the body heal at different speeds. Common time to remove stitches will vary: facial wounds 3\u20135 days; scalp wound 7\u201310 days; limbs 10\u201314 days; joints 14 days; trunk of the body 7\u201310 days.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><\/blockquote>\n<p>Removal of sutures is traditionally achieved by using forceps to hold the suture thread steady and pointed scalpel blades or scissors to cut. For practical reasons the two instruments (forceps and scissors) are available in a sterile kit. In certain countries (e.g. US), these kits are available in sterile disposable trays because of the high cost of cleaning and re-sterilization.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Expansions\">Expansions<\/span><\/h3>\n<p>A <i>pledgeted suture<\/i> is one that is supported by a <i>pledget<\/i>, that is, a small flat non-absorbent pad normally composed of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polytetrafluoroethylene\" title=\"Polytetrafluoroethylene\" rel=\"external_link\" target=\"_blank\">polytetrafluoroethylene<\/a>, used as buttresses under sutures when there is a possibility of sutures tearing through tissue.<sup id=\"rdp-ebb-cite_ref-bard_21-0\" class=\"reference\"><a href=\"#cite_note-bard-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Tissue_adhesives\">Tissue adhesives<\/span><\/h2>\n<p>Topical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyanoacrylate\" title=\"Cyanoacrylate\" rel=\"external_link\" target=\"_blank\">cyanoacrylate<\/a> adhesives (industrially used as super glue), have been used in combination with, or as an alternative to, sutures in wound closure. The adhesive remains liquid until exposed to water or water-containing substances\/tissue, after which it cures (polymerizes) and forms a bond to the underlying surface. The tissue adhesive has been shown to act as a barrier to microbial penetration as long as the adhesive film remains intact. Limitations of tissue adhesives include contraindications to use near the eyes and a mild learning curve on correct usage. They are also unsuitable for oozing or potentially contaminated wounds.\n<\/p><p>In surgical incisions it does not work as well as sutures as the wounds often break open.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p><p>Cyanoacrylate is the generic name for cyanoacrylate based fast-acting glues such as methyl-2-cyanoacrylate, ethyl-2-cyanoacrylate (commonly sold under trade names like Superglue and Krazy Glue) and n-butyl-cyanoacrylate. Skin glues like Indermil and Histoacryl were the first medical grade tissue adhesives to be used, and these are composed of n-butyl cyanoacrylate. These worked well but had the disadvantage of having to be stored in the refrigerator, were exothermic so they stung the patient, and the bond was brittle. Nowadays, the longer chain polymer, 2-octyl cyanoacrylate, is the preferred medical grade glue. It is available under various trade names, such as LiquiBand, SurgiSeal, FloraSeal, and Dermabond. These have the advantages of being more flexible, making a stronger bond, and being easier to use. The longer side chain types, for example octyl and butyl forms, also reduce tissue reaction.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:C._Stromayr;_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/57\/C._Stromayr%3B_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg\/220px-C._Stromayr%3B_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg\" width=\"220\" height=\"246\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:C._Stromayr;_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Sewing wound after <a href=\"https:\/\/en.wikipedia.org\/wiki\/Herniotomy\" class=\"mw-redirect\" title=\"Herniotomy\" rel=\"external_link\" target=\"_blank\">herniotomy<\/a>, 1559<\/div><\/div><\/div>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_thread_supplier_1.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bf\/Surgical_thread_supplier_1.jpg\/170px-Surgical_thread_supplier_1.jpg\" width=\"170\" height=\"255\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_thread_supplier_1.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Old refillable surgical thread supplier (middle of 20th century)<\/div><\/div><\/div>\n<p>Through many millennia, various suture materials were used, debated, and remained largely unchanged. Needles were made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> or metals such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silver\" title=\"Silver\" rel=\"external_link\" target=\"_blank\">silver<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copper\" title=\"Copper\" rel=\"external_link\" target=\"_blank\">copper<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium\" title=\"Aluminium\" rel=\"external_link\" target=\"_blank\">aluminium<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bronze\" title=\"Bronze\" rel=\"external_link\" target=\"_blank\">bronze<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wire\" title=\"Wire\" rel=\"external_link\" target=\"_blank\">wire<\/a>. Sutures were made of plant materials (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Flax\" title=\"Flax\" rel=\"external_link\" target=\"_blank\">flax<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemp\" title=\"Hemp\" rel=\"external_link\" target=\"_blank\">hemp<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cotton\" title=\"Cotton\" rel=\"external_link\" target=\"_blank\">cotton<\/a>) or animal material (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Hair\" title=\"Hair\" rel=\"external_link\" target=\"_blank\">hair<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tendons\" class=\"mw-redirect\" title=\"Tendons\" rel=\"external_link\" target=\"_blank\">tendons<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arteries\" class=\"mw-redirect\" title=\"Arteries\" rel=\"external_link\" target=\"_blank\">arteries<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Muscle\" title=\"Muscle\" rel=\"external_link\" target=\"_blank\">muscle<\/a> strips and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nerves\" class=\"mw-redirect\" title=\"Nerves\" rel=\"external_link\" target=\"_blank\">nerves<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silk\" title=\"Silk\" rel=\"external_link\" target=\"_blank\">silk<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut\" title=\"Catgut\" rel=\"external_link\" target=\"_blank\">catgut<\/a>).\n<\/p><p>The earliest reports of surgical suture date to 3000 BC in ancient <a href=\"https:\/\/en.wikipedia.org\/wiki\/Egypt\" title=\"Egypt\" rel=\"external_link\" target=\"_blank\">Egypt<\/a>, and the oldest known suture is in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mummy\" title=\"Mummy\" rel=\"external_link\" target=\"_blank\">mummy<\/a> from 1100 BC. A detailed description of a wound suture and the suture materials used in it is by the Indian sage and physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sushruta_Samhita\" title=\"Sushruta Samhita\" rel=\"external_link\" target=\"_blank\">Sushruta<\/a>, written in 500 BC.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> The Greek father of medicine, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hippocrates\" title=\"Hippocrates\" rel=\"external_link\" target=\"_blank\">Hippocrates<\/a>, described suture techniques, as did the later Roman <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aulus_Cornelius_Celsus\" title=\"Aulus Cornelius Celsus\" rel=\"external_link\" target=\"_blank\">Aulus Cornelius Celsus<\/a>. The 2nd-century Roman physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/Galen\" title=\"Galen\" rel=\"external_link\" target=\"_blank\">Galen<\/a> described gut sutures.<sup id=\"rdp-ebb-cite_ref-Nutton2005_24-0\" class=\"reference\"><a href=\"#cite_note-Nutton2005-24\" rel=\"external_link\">[24]<\/a><\/sup> In the 10th century, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut_suture\" title=\"Catgut suture\" rel=\"external_link\" target=\"_blank\">catgut suture<\/a> along with the surgery needle were developed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abulcasis\" class=\"mw-redirect\" title=\"Abulcasis\" rel=\"external_link\" target=\"_blank\">Abulcasis<\/a><sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup>. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut_suture\" title=\"Catgut suture\" rel=\"external_link\" target=\"_blank\">catgut suture<\/a> was similar to that of strings for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Violin\" title=\"Violin\" rel=\"external_link\" target=\"_blank\">violins<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Guitar\" title=\"Guitar\" rel=\"external_link\" target=\"_blank\">guitar<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tennis_racquet\" class=\"mw-redirect\" title=\"Tennis racquet\" rel=\"external_link\" target=\"_blank\">tennis racquet<\/a> and it involved harvesting sheep <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intestine\" class=\"mw-redirect\" title=\"Intestine\" rel=\"external_link\" target=\"_blank\">intestines<\/a>.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Joseph_Lister,_1st_Baron_Lister\" class=\"mw-redirect\" title=\"Joseph Lister, 1st Baron Lister\" rel=\"external_link\" target=\"_blank\">Joseph Lister<\/a> endorsed the routine <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">sterilization<\/a> of all suture threads. He first attempted sterilization with the 1860s \"carbolic catgut,\" and chromic catgut followed two decades later. Sterile catgut was finally achieved in 1906 with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iodine\" title=\"Iodine\" rel=\"external_link\" target=\"_blank\">iodine<\/a> treatment.\n<\/p><p>The next great leap came in the twentieth century. The chemical industry drove production of the first synthetic thread in the early 1930s, which exploded into production of numerous absorbable and non-absorbable synthetics. The first synthetic absorbable was based on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyvinyl_alcohol\" title=\"Polyvinyl alcohol\" rel=\"external_link\" target=\"_blank\">polyvinyl alcohol<\/a> in 1931. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyester\" title=\"Polyester\" rel=\"external_link\" target=\"_blank\">Polyesters<\/a> were developed in the 1950s, and later the process of radiation sterilization was established for catgut and polyester. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyglycolic_acid\" class=\"mw-redirect\" title=\"Polyglycolic acid\" rel=\"external_link\" target=\"_blank\">Polyglycolic acid<\/a> was discovered in the 1960s and implemented in the 1970s. Today, most sutures are made of synthetic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> fibers. Silk and, rarely, gut sutures are the only materials still in use from ancient times. In fact, gut sutures have been banned in Europe and Japan owing to concerns regarding <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bovine_Spongiform_Encephalopathy\" class=\"mw-redirect\" title=\"Bovine Spongiform Encephalopathy\" rel=\"external_link\" target=\"_blank\">Bovine Spongiform Encephalopathy<\/a>. Silk suture is still used, mainly to secure surgical drains.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Alexis_Carrel\" title=\"Alexis Carrel\" rel=\"external_link\" target=\"_blank\">Alexis Carrel<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Barbed_suture\" title=\"Barbed suture\" rel=\"external_link\" target=\"_blank\">Barbed suture<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Butterfly_closure\" class=\"mw-redirect\" title=\"Butterfly closure\" rel=\"external_link\" target=\"_blank\">Butterfly closure<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cheesewiring\" title=\"Cheesewiring\" rel=\"external_link\" target=\"_blank\">Cheesewiring<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Chitin\" title=\"Chitin\" rel=\"external_link\" target=\"_blank\">Chitin<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyanoacrylate\" title=\"Cyanoacrylate\" rel=\"external_link\" target=\"_blank\">Cyanoacrylate<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Knot\" title=\"Knot\" rel=\"external_link\" target=\"_blank\">Knots<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ligature_(medicine)\" title=\"Ligature (medicine)\" rel=\"external_link\" target=\"_blank\">Ligature<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_medical_topics\" class=\"mw-redirect\" title=\"List of medical topics\" rel=\"external_link\" target=\"_blank\">List of medical topics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sewing\" title=\"Sewing\" rel=\"external_link\" target=\"_blank\">Sewing<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_staple\" title=\"Surgical staple\" rel=\"external_link\" target=\"_blank\">Surgical staple<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wound_closure_strip\" title=\"Wound closure strip\" rel=\"external_link\" target=\"_blank\">Wound closure strips<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ethicon.novartis.us\/pdf\/finalNeedleDetailer.pdf\" target=\"_blank\">Surgical Needle Guide<\/a> from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Novartis\" title=\"Novartis\" rel=\"external_link\" target=\"_blank\">Novartis<\/a>. Copyright 2005.<\/span>\n<\/li>\n<li id=\"cite_note-SutureTypes-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SutureTypes_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.dolphinsutures.com\/types-of-sutures\" target=\"_blank\">\"Types of Sutures\"<\/a>. Dolphin Sutures<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2014-01-07<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Types+of+Sutures&rft.pub=Dolphin+Sutures&rft_id=http%3A%2F%2Fwww.dolphinsutures.com%2Ftypes-of-sutures&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">ETHICON Products (20 December 2002). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.prnewswire.com\/news-releases\/ethicon-receives-fda-clearance-to-market-vicryl-plus-first-ever-antibacterial-suture-77230792.html\" target=\"_blank\">\"ETHICON Receives FDA Clearance to Market VICRYL* Plus, First Ever Antibacterial Suture\"<\/a>. PRNewswire<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">25 January<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=ETHICON+Receives+FDA+Clearance+to+Market+VICRYL%2A+Plus%2C+First+Ever+Antibacterial+Suture&rft.date=2002-12-20&rft.au=ETHICON+Products&rft_id=http%3A%2F%2Fwww.prnewswire.com%2Fnews-releases%2Fethicon-receives-fda-clearance-to-market-vicryl-plus-first-ever-antibacterial-suture-77230792.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Daoud, FC; Edmiston CE, Jr; Leaper, D (June 2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4063374\" target=\"_blank\">\"Meta-analysis of prevention of surgical site infections following incision closure with triclosan-coated sutures: robustness to new evidence\"<\/a>. <i>Surgical infections<\/i>. <b>15<\/b> (3): 165\u201381. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1089%2Fsur.2013.177\" target=\"_blank\">10.1089\/sur.2013.177<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4063374\" target=\"_blank\">4063374<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24738988\" target=\"_blank\">24738988<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Surgical+infections&rft.atitle=Meta-analysis+of+prevention+of+surgical+site+infections+following+incision+closure+with+triclosan-coated+sutures%3A+robustness+to+new+evidence.&rft.volume=15&rft.issue=3&rft.pages=165-81&rft.date=2014-06&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4063374&rft_id=info%3Apmid%2F24738988&rft_id=info%3Adoi%2F10.1089%2Fsur.2013.177&rft.aulast=Daoud&rft.aufirst=FC&rft.au=Edmiston+CE%2C+Jr&rft.au=Leaper%2C+D&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4063374&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">H\u00f6glund, Odd Viking (2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pub.epsilon.slu.se\/8589\/1\/odd_v_hoglund_120210..pdf\" target=\"_blank\"><i>A resorbable device for ligation of blood vessels : development, assessment of surgical procedures and clinical evaluation<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. pp. 17\u201319. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-91-576-7686-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=A+resorbable+device+for+ligation+of+blood+vessels+%3A+development%2C+assessment+of+surgical+procedures+and+clinical+evaluation&rft.pages=17-19&rft.date=2012&rft.isbn=978-91-576-7686-3&rft.aulast=H%C3%B6glund&rft.aufirst=Odd+Viking&rft_id=http%3A%2F%2Fpub.epsilon.slu.se%2F8589%2F1%2Fodd_v_hoglund_120210..pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/teachmesurgery.com\/skills\/theatre-basics\/suture-materials\/\" target=\"_blank\">\"Suture Materials - Classification - Surgical Needles - TeachMeSurgery\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Suture+Materials+-+Classification+-+Surgical+Needles+-+TeachMeSurgery&rft_id=http%3A%2F%2Fteachmesurgery.com%2Fskills%2Ftheatre-basics%2Fsuture-materials%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">H\u00f6glund, Odd Viking (2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pub.epsilon.slu.se\/8589\/1\/odd_v_hoglund_120210..pdf\" target=\"_blank\"><i>A resorbable device for ligation of blood vessels : development, assessment of surgical procedures and clinical evaluation<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-91-576-7686-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=A+resorbable+device+for+ligation+of+blood+vessels+%3A+development%2C+assessment+of+surgical+procedures+and+clinical+evaluation&rft.date=2012&rft.isbn=978-91-576-7686-3&rft.aulast=H%C3%B6glund&rft.aufirst=Odd+Viking&rft_id=http%3A%2F%2Fpub.epsilon.slu.se%2F8589%2F1%2Fodd_v_hoglund_120210..pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">H\u00f6glund, Odd V; Ingman, Jessica; S\u00f6dersten, Fredrik; Hansson, Kerstin; Borg, Niklas; Lagerstedt, Anne-Sofie (2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bmcresnotes.biomedcentral.com\/articles\/10.1186\/1756-0500-7-825\" target=\"_blank\">\"Ligation of the spermatic cord in dogs with a self-locking device of a resorbable polyglycolic based co-polymer \u2013 feasibility and long-term follow-up study\"<\/a>. <i>BMC Research Notes<\/i>. <b>7<\/b> (1): 825. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2F1756-0500-7-825\" target=\"_blank\">10.1186\/1756-0500-7-825<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMC+Research+Notes&rft.atitle=Ligation+of+the+spermatic+cord+in+dogs+with+a+self-locking+device+of+a+resorbable+polyglycolic+based+co-polymer+%E2%80%93+feasibility+and+long-term+follow-up+study&rft.volume=7&rft.issue=1&rft.pages=825&rft.date=2014&rft_id=info%3Adoi%2F10.1186%2F1756-0500-7-825&rft.aulast=H%C3%B6glund&rft.aufirst=Odd+V&rft.au=Ingman%2C+Jessica&rft.au=S%C3%B6dersten%2C+Fredrik&rft.au=Hansson%2C+Kerstin&rft.au=Borg%2C+Niklas&rft.au=Lagerstedt%2C+Anne-Sofie&rft_id=http%3A%2F%2Fbmcresnotes.biomedcentral.com%2Farticles%2F10.1186%2F1756-0500-7-825&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hjort, H.; Mathisen, T.; Alves, A.; Clermont, G.; Boutrand, J. P. (5 October 2011). \"Three-year results from a preclinical implantation study of a long-term resorbable surgical mesh with time-dependent mechanical characteristics\". <i>Hernia<\/i>. <b>16<\/b> (2): 191\u2013197. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs10029-011-0885-y\" target=\"_blank\">10.1007\/s10029-011-0885-y<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Hernia&rft.atitle=Three-year+results+from+a+preclinical+implantation+study+of+a+long-term+resorbable+surgical+mesh+with+time-dependent+mechanical+characteristics&rft.volume=16&rft.issue=2&rft.pages=191-197&rft.date=2011-10-05&rft_id=info%3Adoi%2F10.1007%2Fs10029-011-0885-y&rft.aulast=Hjort&rft.aufirst=H.&rft.au=Mathisen%2C+T.&rft.au=Alves%2C+A.&rft.au=Clermont%2C+G.&rft.au=Boutrand%2C+J.+P.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Anderson, James M.; Rodriguez, Analiz; Chang, David T. (April 2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2327202\" target=\"_blank\">\"Foreign body reaction to biomaterials\"<\/a>. <i>Seminars in Immunology<\/i>. <b>20<\/b> (2): 86\u2013100. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.smim.2007.11.004\" target=\"_blank\">10.1016\/j.smim.2007.11.004<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2327202\" target=\"_blank\">2327202<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Seminars+in+Immunology&rft.atitle=Foreign+body+reaction+to+biomaterials&rft.volume=20&rft.issue=2&rft.pages=86-100&rft.date=2008-04&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2327202&rft_id=info%3Adoi%2F10.1016%2Fj.smim.2007.11.004&rft.aulast=Anderson&rft.aufirst=James+M.&rft.au=Rodriguez%2C+Analiz&rft.au=Chang%2C+David+T.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2327202&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-rh-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-rh_11-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Lammers, Richard L; Trott, Alexander T (2004). \"Chapter 36: Methods of Wound Closure\". In Roberts, James R; Hedges, Jerris R. <i>Clinical Procedures in Emergency Medicine<\/i> (4th ed.). Philadelphia: Saunders. p. 671. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-7216-9760-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+36%3A+Methods+of+Wound+Closure&rft.btitle=Clinical+Procedures+in+Emergency+Medicine&rft.place=Philadelphia&rft.pages=671&rft.edition=4th&rft.pub=Saunders&rft.date=2004&rft.isbn=0-7216-9760-7&rft.aulast=Lammers&rft.aufirst=Richard+L&rft.au=Trott%2C+Alexander+T&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Dorland's Medical Dictionary for Health Consumers. Copyright 2007<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Miller-Keane_Encyclopedia_%26_Dictionary_of_Medicine,_Nursing,_and_Allied_Health\" title=\"Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health\" rel=\"external_link\" target=\"_blank\">Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health<\/a>, Seventh Edition.<\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Osterberg, B; Blomstedt, B (1979). \"Effect of suture materials on bacterial survival in infected wounds: An experimental study\". <i>Acta Chir Scand<\/i>. <b>145<\/b>: 431.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Chir+Scand&rft.atitle=Effect+of+suture+materials+on+bacterial+survival+in+infected+wounds%3A+An+experimental+study&rft.volume=145&rft.pages=431&rft.date=1979&rft.aulast=Osterberg&rft.aufirst=B&rft.au=Blomstedt%2C+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-macht-15\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-macht_15-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-macht_15-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Macht, SD; Krizek, TJ (1978). \"Sutures and suturing - Current concepts\". <i>Journal of Oral Surgery<\/i>. <b>36<\/b>: 710.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Oral+Surgery&rft.atitle=Sutures+and+suturing+-+Current+concepts&rft.volume=36&rft.pages=710&rft.date=1978&rft.aulast=Macht&rft.aufirst=SD&rft.au=Krizek%2C+TJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-kirk-16\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-kirk_16-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-kirk_16-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Kirk, RM (1978). <i>Basic Surgical Techniques<\/i>. Edinburgh: Churchill Livingstone.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Basic+Surgical+Techniques&rft.place=Edinburgh&rft.pub=Churchill+Livingstone&rft.date=1978&rft.aulast=Kirk&rft.aufirst=RM&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Grossman, JA (1982). \"The repair of surface trauma\". <i>Emergency Medicine<\/i>. <b>14<\/b>: 220.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Emergency+Medicine&rft.atitle=The+repair+of+surface+trauma&rft.volume=14&rft.pages=220&rft.date=1982&rft.aulast=Grossman&rft.aufirst=JA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Varshney, S; Manek, P; Johnson, CD (September 1999). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2503300\" target=\"_blank\">\"Six-fold suture:wound length ratio for abdominal closure\"<\/a>. <i>Annals of the Royal College of Surgeons of England<\/i>. <b>81<\/b> (5): 333\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2503300\" target=\"_blank\">2503300<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10645176\" target=\"_blank\">10645176<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+the+Royal+College+of+Surgeons+of+England&rft.atitle=Six-fold+suture%3Awound+length+ratio+for+abdominal+closure.&rft.volume=81&rft.issue=5&rft.pages=333-6&rft.date=1999-09&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2503300&rft_id=info%3Apmid%2F10645176&rft.aulast=Varshney&rft.aufirst=S&rft.au=Manek%2C+P&rft.au=Johnson%2C+CD&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2503300&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stark, M.; Chavkin, Y.; Kupfersztain, C.; Guedj, P.; Finkel, A. R. (1995). \"Evaluation of combinations of procedures in cesarean section\". <i>International Journal of Gynecology & Obstetrics<\/i>. <b>48<\/b> (3): 273\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0020-7292%2894%2902306-J\" target=\"_blank\">10.1016\/0020-7292(94)02306-J<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7781869\" target=\"_blank\">7781869<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Gynecology+%26+Obstetrics&rft.atitle=Evaluation+of+combinations+of+procedures+in+cesarean+section&rft.volume=48&rft.issue=3&rft.pages=273-6&rft.date=1995&rft_id=info%3Adoi%2F10.1016%2F0020-7292%2894%2902306-J&rft_id=info%3Apmid%2F7781869&rft.aulast=Stark&rft.aufirst=M.&rft.au=Chavkin%2C+Y.&rft.au=Kupfersztain%2C+C.&rft.au=Guedj%2C+P.&rft.au=Finkel%2C+A.+R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.scribd.com\/doc\/127263916\/Bedah-Minor\" target=\"_blank\">\"www.scribd.com\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=www.scribd.com&rft_id=https%3A%2F%2Fwww.scribd.com%2Fdoc%2F127263916%2FBedah-Minor&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-bard-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-bard_21-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bardpv.com\/_vascular\/product.php?p=31\" target=\"_blank\">\"Polytetrafluoroethylene Pledget\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Polytetrafluoroethylene+Pledget&rft_id=http%3A%2F%2Fwww.bardpv.com%2F_vascular%2Fproduct.php%3Fp%3D31&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Dumville, JC; Coulthard, P; Worthington, HV; Riley, P; Patel, N; Darcey, J; Esposito, M; van der Elst, M; van Waes, OJ (28 November 2014). \"Tissue adhesives for closure of surgical incisions\". <i>The Cochrane Database of Systematic Reviews<\/i>. <b>11<\/b>: CD004287. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD004287.pub4\" target=\"_blank\">10.1002\/14651858.CD004287.pub4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25431843\" target=\"_blank\">25431843<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Tissue+adhesives+for+closure+of+surgical+incisions.&rft.volume=11&rft.pages=CD004287&rft.date=2014-11-28&rft_id=info%3Adoi%2F10.1002%2F14651858.CD004287.pub4&rft_id=info%3Apmid%2F25431843&rft.aulast=Dumville&rft.aufirst=JC&rft.au=Coulthard%2C+P&rft.au=Worthington%2C+HV&rft.au=Riley%2C+P&rft.au=Patel%2C+N&rft.au=Darcey%2C+J&rft.au=Esposito%2C+M&rft.au=van+der+Elst%2C+M&rft.au=van+Waes%2C+OJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Mysore, Venkataram. <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=sushruta&f=false\"><i>Acs(I) Textbook on Cutaneous and Aesthetic Surgery<\/i><\/a>. Jaypee Brothers Medical Publishers Pvt. Ltd. pp. 125\u2013126. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9789350905913<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">25 January<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Acs%28I%29+Textbook+on+Cutaneous+and+Aesthetic+Surgery&rft.pages=125-126&rft.pub=Jaypee+Brothers+Medical+Publishers+Pvt.+Ltd.&rft.isbn=9789350905913&rft.aulast=Mysore&rft.aufirst=Venkataram&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D47HGBAAAQBAJ%26lpg%3DPA125%26pg%3DPA126%23v%3Donepage%26q%3Dsushruta%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Nutton2005-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Nutton2005_24-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Nutton, Dr Vivia (2005-07-30). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=PREr9_rojrQC\" target=\"_blank\"><i>Ancient Medicine<\/i><\/a>. Taylor & Francis US. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780415368483<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">21 November<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Ancient+Medicine&rft.pub=Taylor+%26+Francis+US&rft.date=2005-07-30&rft.isbn=9780415368483&rft.aulast=Nutton&rft.aufirst=Dr+Vivia&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DPREr9_rojrQC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Rooney, Anne (2009). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=false\"><i>The Story of Medicine<\/i><\/a>. Arcturus Publishing. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781848580398.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Story+of+Medicine&rft.pub=Arcturus+Publishing&rft.date=2009&rft.isbn=9781848580398&rft.aulast=Rooney&rft.aufirst=Anne&rft_id=https%3A%2F%2Fbooks.google.com.sa%2Fbooks%3Fid%3DjBMEAwAAQBAJ%26pg%3DPT161%26dq%3DCatgut%2Bal-zahrawi%2BThe%2BStory%2Bof%2BMedicine%26hl%3Den%26sa%3DX%26ved%3D0ahUKEwiFg53yt_XZAhWEPRQKHTkSB1AQ6AEIMzAC%23v%3Donepage%26q%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Rakel, David; Rakel, Robert E. (2011). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=Abulcasis%20%22surgical%20needle%22&f=false\"><i>Textbook of Family Medicine E-Book<\/i><\/a>. Elsevier Health Sciences. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1437735673.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Textbook+of+Family+Medicine+E-Book&rft.pub=Elsevier+Health+Sciences&rft.date=2011&rft.isbn=1437735673&rft.aulast=Rakel&rft.aufirst=David&rft.au=Rakel%2C+Robert+E.&rft_id=https%3A%2F%2Fbooks.google.com.sa%2Fbooks%3Fid%3DB3Hr25rgpZsC%26pg%3DPA550-IA11%26dq%3DAbulcasis%2B%2522plastic%2Bsurgery%2522%26hl%3Den%26sa%3DX%26ved%3D0ahUKEwi_mJna5ffZAhWCtBQKHWJ_Cc4Q6AEILDAB%23v%3Donepage%26q%3DAbulcasis%2520%2522surgical%2520needle%2522%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Commons-logo.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/12px-Commons-logo.svg.png\" width=\"12\" height=\"16\" class=\"noviewer\" \/><\/a> Media related to <a href=\"https:\/\/commons.wikimedia.org\/wiki\/Category:Surgical_suture\" class=\"extiw\" title=\"commons:Category:Surgical suture\" rel=\"external_link\" target=\"_blank\">Surgical suture <\/a> at Wikimedia Commons\n<\/p>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.researchgate.net\/publication\/262529587_Sutured_tendon_repair_a_multi-scale_finite_element_model\" target=\"_blank\">Computer modelling of sutures<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1275\nCached time: 20181212170216\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.396 seconds\nReal time usage: 0.541 seconds\nPreprocessor visited node count: 1758\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 50735\/2097152 bytes\nTemplate argument size: 733\/2097152 bytes\nHighest expansion depth: 10\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 66925\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.197\/10.000 seconds\nLua memory usage: 5.82 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 463.253 1 -total\n<\/p>\n<pre>41.93% 194.264 1 Template:Reflist\n14.49% 67.112 4 Template:Cite_web\n14.46% 67.007 1 Template:Infobox_medical_intervention\n13.53% 62.685 1 Template:Infobox\n13.00% 60.200 10 Template:Cite_journal\n12.02% 55.704 1 Template:Commonscatinline\n10.43% 48.306 1 Template:Globalize\/US\n 9.12% 42.256 1 Template:Globalize\n 8.20% 37.983 1 Template:Ambox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:13896574-1!canonical and timestamp 20181212170216 and revision id 865977170\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212159\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.174 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 163.563 1 - wikipedia:Surgical_suture\n100.00% 163.563 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8264-0!*!*!*!*!*!* and timestamp 20181217212159 and revision id 24474\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_suture\">https:\/\/www.limswiki.org\/index.php\/Surgical_suture<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","9ab5bafb9853e90fd1379483cd60862a_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e9\/Atraumatisches_Nahtmaterial_17.JPG\/560px-Atraumatisches_Nahtmaterial_17.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3a\/HechtnaaldenB.jpg\/240px-HechtnaaldenB.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/28\/HechtnaaldenG.jpg\/240px-HechtnaaldenG.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9e\/Suture_micrograph.jpg\/440px-Suture_micrograph.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4e\/12_Stitches.jpg\/440px-12_Stitches.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/0\/07\/Suture%2C_before_and_after%2C_RMO.jpg\/440px-Suture%2C_before_and_after%2C_RMO.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/70\/ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara%2C_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif\/lossy-page1-440px-ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara%2C_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/57\/C._Stromayr%3B_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg\/440px-C._Stromayr%3B_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bf\/Surgical_thread_supplier_1.jpg\/340px-Surgical_thread_supplier_1.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/24px-Commons-logo.svg.png"],"9ab5bafb9853e90fd1379483cd60862a_timestamp":1545081719,"fa6c202bad10c3da3a2554e5a6380cac_type":"article","fa6c202bad10c3da3a2554e5a6380cac_title":"Surgical sealant film","fa6c202bad10c3da3a2554e5a6380cac_url":"https:\/\/www.limswiki.org\/index.php\/Surgical_sealant_film","fa6c202bad10c3da3a2554e5a6380cac_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurgical sealant film\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Use of a surgical sealant film to reinforce and seal gaps in the dura mater.\nA surgical sealant film is an implantable medical device used during surgery. It is a preformed flexible patch that is applied to supplement sutures and surgical staples to seal tissues and prevent leaks of fluid (including blood and cerebrospinal fluid) and air.\nThe sealant film is synthetic and incorporates absorbable polymers, including poly(lactide-co-glycolide). The polymeric components impart structural and adhesive properties with the sealing effect achieved by incorporation of a bioadhesive polymer. This forms a covalent bond to primary amines present on the tissue surfaces. In turn this results in the film rapidly becoming effective in providing a form of secondary wound closure.[1][2]\nThe film can be used for sealing the dura mater,[3][4][5] preventing blood loss in general surgery and eliminating air leaks following lung resection.\n\nReferences \n\n\n^ Cheng, L; Lau, CK; Parker, G (Oct 14, 2013). \"Use of TissuePatch\u2122 sealant film in the management of chyle leak in major neck surgery\". The British Journal of Oral & Maxillofacial Surgery. 52 (1): 87\u20139. doi:10.1016\/j.bjoms.2013.09.007. PMID 24135151. \n\n^ Cheng, LH; Hutchison, IL (October 2012). \"Thyroid surgery\". The British Journal of Oral & Maxillofacial Surgery. 50 (7): 585\u201391. doi:10.1016\/j.bjoms.2011.11.002. PMID 22192610. \n\n^ Ferroli, P; Acerbi, F; Broggi, M; Schiariti, M; Albanese, E; Tringali, G; Franzini, A; Broggi, G (Mar\u2013Apr 2013). \"A novel impermeable adhesive membrane to reinforce dural closure: a preliminary retrospective study on 119 consecutive high-risk patients\". World Neurosurgery. 79 (3\u20134): 551\u20137. doi:10.1016\/j.wneu.2011.09.022. PMID 22120260. \n\n^ von der Brelie, C; Soehle, M; Clusmann, HR (April 2012). \"Intraoperative sealing of dura mater defects with a novel, synthetic, self adhesive patch: application experience in 25 patients\". British Journal of Neurosurgery. 26 (2): 231\u20135. doi:10.3109\/02688697.2011.619597. PMID 22077588. \n\n^ Della Puppa, A; Rossetto, M; Scienza, R (October 2010). \"Use of a new absorbable sealing film for preventing postoperative cerebrospinal fluid leaks: remarks on a new approach\". British Journal of Neurosurgery. 24 (5): 609\u201311. doi:10.3109\/02688697.2010.500413. PMID 20868249. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_sealant_film\">https:\/\/www.limswiki.org\/index.php\/Surgical_sealant_film<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 20:10.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 388 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","fa6c202bad10c3da3a2554e5a6380cac_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Surgical_sealant_film skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Surgical sealant film<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Use_of_a_surgical_sealant_film,_TissuePatchDural_(Tissuemed,_Leeds,_UK)_to_reinforce_and_seal_gaps_in_the_dura_mater..JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b9\/Use_of_a_surgical_sealant_film%2C_TissuePatchDural_%28Tissuemed%2C_Leeds%2C_UK%29_to_reinforce_and_seal_gaps_in_the_dura_mater..JPG\/220px-Use_of_a_surgical_sealant_film%2C_TissuePatchDural_%28Tissuemed%2C_Leeds%2C_UK%29_to_reinforce_and_seal_gaps_in_the_dura_mater..JPG\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Use_of_a_surgical_sealant_film,_TissuePatchDural_(Tissuemed,_Leeds,_UK)_to_reinforce_and_seal_gaps_in_the_dura_mater..JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Use of a surgical sealant film to reinforce and seal gaps in the dura mater.<\/div><\/div><\/div>\n<p>A s<b>urgical sealant film<\/b> is an implantable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> used during surgery. It is a preformed flexible patch that is applied to supplement <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" title=\"Surgical suture\" rel=\"external_link\" target=\"_blank\">sutures<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_staples\" class=\"mw-redirect\" title=\"Surgical staples\" rel=\"external_link\" target=\"_blank\">surgical staples<\/a> to seal tissues and prevent leaks of fluid (including blood and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebrospinal_fluid\" title=\"Cerebrospinal fluid\" rel=\"external_link\" target=\"_blank\">cerebrospinal fluid<\/a>) and air.\n<\/p><p>The sealant film is synthetic and incorporates absorbable polymers, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Poly(lactide-co-glycolide)\" class=\"mw-redirect\" title=\"Poly(lactide-co-glycolide)\" rel=\"external_link\" target=\"_blank\">poly(lactide-co-glycolide)<\/a>. The polymeric components impart structural and adhesive properties with the sealing effect achieved by incorporation of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioadhesive\" title=\"Bioadhesive\" rel=\"external_link\" target=\"_blank\">bioadhesive<\/a> polymer. This forms a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Covalent_bond\" title=\"Covalent bond\" rel=\"external_link\" target=\"_blank\">covalent bond<\/a> to primary amines present on the tissue surfaces. In turn this results in the film rapidly becoming effective in providing a form of secondary wound closure.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>The film can be used for sealing the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dura_mater\" title=\"Dura mater\" rel=\"external_link\" target=\"_blank\">dura mater<\/a>,<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> preventing blood loss in general surgery and eliminating air leaks following lung <a href=\"https:\/\/en.wikipedia.org\/wiki\/Segmental_resection\" title=\"Segmental resection\" rel=\"external_link\" target=\"_blank\">resection<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cheng, L; Lau, CK; Parker, G (Oct 14, 2013). \"Use of TissuePatch\u2122 sealant film in the management of chyle leak in major neck surgery\". <i>The British Journal of Oral & Maxillofacial Surgery<\/i>. <b>52<\/b> (1): 87\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.bjoms.2013.09.007\" target=\"_blank\">10.1016\/j.bjoms.2013.09.007<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24135151\" target=\"_blank\">24135151<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+British+Journal+of+Oral+%26+Maxillofacial+Surgery&rft.atitle=Use+of+TissuePatch%E2%84%A2+sealant+film+in+the+management+of+chyle+leak+in+major+neck+surgery.&rft.volume=52&rft.issue=1&rft.pages=87-9&rft.date=2013-10-14&rft_id=info%3Adoi%2F10.1016%2Fj.bjoms.2013.09.007&rft_id=info%3Apmid%2F24135151&rft.aulast=Cheng&rft.aufirst=L&rft.au=Lau%2C+CK&rft.au=Parker%2C+G&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+sealant+film\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cheng, LH; Hutchison, IL (October 2012). \"Thyroid surgery\". <i>The British Journal of Oral & Maxillofacial Surgery<\/i>. <b>50<\/b> (7): 585\u201391. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.bjoms.2011.11.002\" target=\"_blank\">10.1016\/j.bjoms.2011.11.002<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22192610\" target=\"_blank\">22192610<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+British+Journal+of+Oral+%26+Maxillofacial+Surgery&rft.atitle=Thyroid+surgery.&rft.volume=50&rft.issue=7&rft.pages=585-91&rft.date=2012-10&rft_id=info%3Adoi%2F10.1016%2Fj.bjoms.2011.11.002&rft_id=info%3Apmid%2F22192610&rft.aulast=Cheng&rft.aufirst=LH&rft.au=Hutchison%2C+IL&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+sealant+film\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ferroli, P; Acerbi, F; Broggi, M; Schiariti, M; Albanese, E; Tringali, G; Franzini, A; Broggi, G (Mar\u2013Apr 2013). \"A novel impermeable adhesive membrane to reinforce dural closure: a preliminary retrospective study on 119 consecutive high-risk patients\". <i>World Neurosurgery<\/i>. <b>79<\/b> (3\u20134): 551\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.wneu.2011.09.022\" target=\"_blank\">10.1016\/j.wneu.2011.09.022<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22120260\" target=\"_blank\">22120260<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=World+Neurosurgery&rft.atitle=A+novel+impermeable+adhesive+membrane+to+reinforce+dural+closure%3A+a+preliminary+retrospective+study+on+119+consecutive+high-risk+patients.&rft.volume=79&rft.issue=3%E2%80%934&rft.pages=551-7&rft.date=2013-03%2F2013-04&rft_id=info%3Adoi%2F10.1016%2Fj.wneu.2011.09.022&rft_id=info%3Apmid%2F22120260&rft.aulast=Ferroli&rft.aufirst=P&rft.au=Acerbi%2C+F&rft.au=Broggi%2C+M&rft.au=Schiariti%2C+M&rft.au=Albanese%2C+E&rft.au=Tringali%2C+G&rft.au=Franzini%2C+A&rft.au=Broggi%2C+G&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+sealant+film\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">von der Brelie, C; Soehle, M; Clusmann, HR (April 2012). \"Intraoperative sealing of dura mater defects with a novel, synthetic, self adhesive patch: application experience in 25 patients\". <i>British Journal of Neurosurgery<\/i>. <b>26<\/b> (2): 231\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3109%2F02688697.2011.619597\" target=\"_blank\">10.3109\/02688697.2011.619597<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22077588\" target=\"_blank\">22077588<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=British+Journal+of+Neurosurgery&rft.atitle=Intraoperative+sealing+of+dura+mater+defects+with+a+novel%2C+synthetic%2C+self+adhesive+patch%3A+application+experience+in+25+patients.&rft.volume=26&rft.issue=2&rft.pages=231-5&rft.date=2012-04&rft_id=info%3Adoi%2F10.3109%2F02688697.2011.619597&rft_id=info%3Apmid%2F22077588&rft.aulast=von+der+Brelie&rft.aufirst=C&rft.au=Soehle%2C+M&rft.au=Clusmann%2C+HR&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+sealant+film\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Della Puppa, A; Rossetto, M; Scienza, R (October 2010). \"Use of a new absorbable sealing film for preventing postoperative cerebrospinal fluid leaks: remarks on a new approach\". <i>British Journal of Neurosurgery<\/i>. <b>24<\/b> (5): 609\u201311. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3109%2F02688697.2010.500413\" target=\"_blank\">10.3109\/02688697.2010.500413<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20868249\" target=\"_blank\">20868249<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=British+Journal+of+Neurosurgery&rft.atitle=Use+of+a+new+absorbable+sealing+film+for+preventing+postoperative+cerebrospinal+fluid+leaks%3A+remarks+on+a+new+approach.&rft.volume=24&rft.issue=5&rft.pages=609-11&rft.date=2010-10&rft_id=info%3Adoi%2F10.3109%2F02688697.2010.500413&rft_id=info%3Apmid%2F20868249&rft.aulast=Della+Puppa&rft.aufirst=A&rft.au=Rossetto%2C+M&rft.au=Scienza%2C+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+sealant+film\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1245\nCached time: 20181217110836\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.136 seconds\nReal time usage: 0.168 seconds\nPreprocessor visited node count: 306\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 11203\/2097152 bytes\nTemplate argument size: 85\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 15016\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.092\/10.000 seconds\nLua memory usage: 2.42 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 145.912 1 Template:Reflist\n100.00% 145.912 1 -total\n<\/p>\n<pre>87.11% 127.101 5 Template:Cite_journal\n 1.71% 2.488 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:41351219-1!canonical and timestamp 20181217110836 and revision id 862233197\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_sealant_film\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212158\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.150 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 144.741 1 - wikipedia:Surgical_sealant_film\n100.00% 144.741 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8263-0!*!*!*!*!*!* and timestamp 20181217212158 and revision id 24473\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_sealant_film\">https:\/\/www.limswiki.org\/index.php\/Surgical_sealant_film<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","fa6c202bad10c3da3a2554e5a6380cac_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b9\/Use_of_a_surgical_sealant_film%2C_TissuePatchDural_%28Tissuemed%2C_Leeds%2C_UK%29_to_reinforce_and_seal_gaps_in_the_dura_mater..JPG\/440px-Use_of_a_surgical_sealant_film%2C_TissuePatchDural_%28Tissuemed%2C_Leeds%2C_UK%29_to_reinforce_and_seal_gaps_in_the_dura_mater..JPG"],"fa6c202bad10c3da3a2554e5a6380cac_timestamp":1545081718,"ee45e10797757b6c04738eca23a81653_type":"article","ee45e10797757b6c04738eca23a81653_title":"Surgical mesh","ee45e10797757b6c04738eca23a81653_url":"https:\/\/www.limswiki.org\/index.php\/Surgical_mesh","ee45e10797757b6c04738eca23a81653_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurgical mesh\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Surgical mesh made of polypropylene, used for inguinal hernia.\nSurgical mesh is a loosely woven sheet which is used as either a permanent or temporary support for organs and other tissues during surgery. Surgical mesh is created from both inorganic and biological materials and is used in a variety of surgeries. Though hernia repair surgery is the most common application, it can also be used for reconstructive work, such as in pelvic organ prolapse.[1]\nPermanent meshes remain in the body, whereas temporary ones dissolve over time. For example, TIGR Matrix test mesh was shown in 2012 to fully dissolve after three years in a scientific trial on sheep.[2] Some types of mesh combine permanent and temporary meshes such as Vipro, which includes both re-absorbable vipryl, made from polyglycolic acid, and prolene, a non-reabsorbable polypropylene.[3]\nData of mechanical and biological behaviors of mesh in vivo may not always be concurrent within the human body due to testing in other organisms. Most published reports experiment on mice, thus creating the likelihood of possible differences when inserted into the human body. Also, most published research reports reference meshes that are currently removed from the medical device market due to complications post-surgery. Additionally, the absence of FDA-approved regulatory protocols and universal standard operating procedures leads to a variety of different testing methods from researcher to researcher. Experimentation may find differing outcomes for some meshes.\n\nContents \n\n1 Medical Uses \n\n1.1 Hernia surgery \n1.2 Pelvic surgery \n\n\n2 Regulation \n3 Biocompatibility \n\n3.1 PVDF (nanofibrous mesh) \n3.2 Reduction of inflammatory response using MSCs \n\n\n4 See also \n5 References \n\n\nMedical Uses \nThe primary function of surgical mesh is to support prolapsed organs either temporarily or permanently. It is most commonly used in hernia surgery within the abdomen, which is required when an organ protrudes through abdominal muscles. Surgical mesh may also be used for pelvic or vaginal wall reconstructions in women and is implemented to add as a growth guide for damaged tissue. Ideally, these implants should be strong enough to survive mechanical loads and actions of whichever body area they become a part of.\n\nHernia surgery \nHernia surgery is one of the most common current applications of surgical mesh. Hernias occur when organs or fatty tissue bulge through openings or debilitated areas of muscle, usually in the abdominal wall. Surgical mesh is implanted to strengthen tissue repair and minimize the rate of recurrence. The surgery can be performed laparoscopic (internally) or open with a variety of materials available for prosthesis.[4] Polypropylene (PP) is the most frequently used type of mesh, although it may be uncomfortable for the patient after implantation. Another type that is less utilized in hernia surgery is polyethylene terephthalate (PET), which faces complications in that fact that it easily degrades after some years of implantation, erasing the effects of the surgery. Polytetrafluorethylene (PTFE) is used as well, but is manufactured in the form of a foil and has difficulty integrating into surrounding tissue, therefore it loses stability.[5]\n\nPelvic surgery \nSimilar to hernia surgery, synthetic meshes may be used for organ prolapses in the pelvic region as well. Pelvic organ prolapse occurs in 50% of women above the age of 50 with a history of one or more vaginal childbirths throughout her lifetime.[6] Mesh surgery can be performed in various areas of the pelvic region, such as cystocele, rectocele, and vaginal vault or uterus. The most commonly used material, as in hernia surgery, is PP, which is considered to have acceptable biocompatibility within the region. It induces a mild inflammatory response but has a tendency to adhere to the viscera.[6]\nThe vaginal wall has three layers: tunica mucosa, muscularis, adventitia. When prolapse occurs, smooth fibers of the muscularis are compromised. Prolapse in women has also been seen to increase stiffness in the pelvis, particularly post-menopausal women.[6] Surgical mesh that is used in pelvic reconstruction must counter this stiffness, but if the modulus of elasticity is too high, it will not sufficiently support the organs. On the contrary, if the mesh is too stiff, tissue will erode and inflammatory responses will cause post-surgical complications.\nAdditionally, the mesh has enough strength to withstand basic actions and tissue behavior in physiological conditions, particularly during tissue regeneration through the mesh itself.[6] The area is subjected to a variety of loads approaching from abdominal contents, pressure from abdominal\/diaphragm muscles, and genital organs, as well as respiratory actions. For the average, reproductive-age woman, the pelvis must withstand loads of 20 N in the supine position, 25-35 N in the standing position, and 90-130 N whilst coughing.[6] Any mesh that is implanted in the pelvic area must be strong enough to withstand these loads.\n\nRegulation \nIn 2018, the United Kingdom temporarily halted vaginal mesh implants for treatment of urinary incontinence pending further investigation into the risks and available safeguards.[7] In the United States, the FDA mandated premark approval applications for mesh intended for transvaginal pelvic organ prolapse repair, with further investigation planned in 2019.[8] \n\nBiocompatibility \n Polypropylene (PP) mesh is currently used in both hernia and pelvic organ prolapses, but may not always be the most biocompatible option.\nMesh implantation will naturally generate an anti-inflammatory response to the inserted mesh, but biocompatibility ranges from how easily it is integrated to how severe the foreign body reaction is. A minimal response includes the formation of fibrosis around the prosthesis (much like in scar tissue formation); this response is generated with the best form of biocompatibility. A physical response triggers an acute inflammatory reaction, which involves the formation of giant cells and subsequently granulomas, meaning that the tissue is \u201ctolerating\u201d the mesh fairly well. Lastly, a chemical response allows for a severe inflammatory reaction during attempted tissue-mesh integration, including fibroblastic cell proliferation.[6] Ultimately, the goal for surgical mesh creation is to formulate one that has a minimal in vivo reaction to maximize comfort for the patient, avoid infection, and ensure clean integration into the body for tissue repair.\nA number of factors play into mesh biocompatibility. Mesh porosity is the ratio of pore to total area, and plays a role in the development of either bacterial infection or smooth tissue regeneration depending on pore size. Pore sizes below 10 micrometers are susceptible to infection because bacteria may enter and proliferate, while macrophages and neutrophils are too large to fit through and cannot aid in the elimination of them. With pore sizes exceeding 75 micrometers, fibroblasts, blood vessels, and collagen fibers are permitted through as part of tissue regeneration. Although there is no general consensus on the best pore size, it can be deduced that larger pores are better for development of tissue and integration in vivo.[6]\nKnowing this, the current problem with a variety of the meshes used in all types of surgeries is that they are not sufficiently biocompatible. PP proves an effective mesh for adjusting prolapsed organs, but may cause severe discomfort for the patient due to its high modulus of elasticity. This stiffens the prosthesis and results in a more pronounced inflammatory response, which complicates integration into the body with tissue ingrowth. As previously mentioned, PET too easily degrades in vivo and tissue has a difficult time integrating with PTFE. For these reasons, researchers are beginning to look for different types of surgical mesh that may be suitable for the biological environment and provide better comfort while supporting prolapsed organs.[5]\n\n PVDF (nanofibrous mesh) \nOne particular type of mesh that is under study is polyvinylidene fluoride (PVDF), or nanofibrous mesh, which has been found to be more resistant to hydrolysis and disintegration, unlike PET, and does not increase its stiffness in its age, unlike PP. It is being tested for both hernia and pelvic\/vaginal wall surgery and is produced via fiber placement layer by layer, whereas PP is constructed by a weaving-like process. This gives the nanofibrous mesh a heavyweight yet low-porosity structure, also adding greater stiffness and stress threshold when compared to PP. This is supported by the foundation of HSP 70\u2014an indicator for cell stress and protector of cell formation against damage, which is beneficial for the prosthesis and tissue formation\u2014which has been monitored and observed in a larger presence in PVDF.[5] In vitro observations of nanofibrous mesh have yielded evidence of cell migration and proliferation on the set of the mesh. Successful cell growth has been noted with long fusiform shapes and clear boundaries.[9]\nA significant advantage of using nanofibrous mesh is that it can carry far more stem cells than traditional PP mesh, which could improve cell-based therapy for pelvic organs prolapse and regeneration methods. Another important advantage of PVDF is the formation of capillaries after 12 weeks, which is essential for wound-healing. The faster neovascularization occurs, the faster tissue can be repaired and regenerated, which decreases the likelihood of suffering from exposure or extrusion of the mesh.[9]\nSome enhancements to PVDF must also be made before it can be used for human surgery. Although the modulus of elasticity is higher than that of PP, resulting stretch under identical stress is much smaller, which could cause complications such as tissue degeneration and loss of mechanical soundness. Nanofibrous mesh currently also promotes a greater foreign body reaction and inflammatory response, which is faulty for biocompatibility purposes of the mesh.[9] For these reasons, PVDF is still under consideration and experimentation for bodily implants.\n\nReduction of inflammatory response using MSCs \nInflammatory responses to mesh insertion promote tissue formation around mesh fibers and proliferation of fibroblasts, polymorphonucleocytes, and macrophages, which all aid in the integration of mesh. Failures to resolve inflammatory responses may lead to foreign body reactions and the ultimate encapsulation of the implant which negates any functional purpose that the implant was supposed to serve. Mesenchymal stem cells (MSCs) are known to reduce inflammatory responses which, when combined with surgical mesh, could prevent them from getting uncontrollable and too difficult to tame. MSCs combined with surgical meshes can be used as \u201coff the shelf\u201d products and enhance macrophage polarization in both in vivo and in vitro environments. This can encourage an anti-inflammatory response and can regulate the inflammatory reaction associated with mesh implantation.[10]\n\nSee also \nAdhesion barrier\nBiomesh\nInguinal hernia surgery meshes\nVicryl\nReferences \n\n^ \"Information on Surgical Mesh for Pelvic Organ Prolapse and Stress Urinary Incontinence\". Medical Devices Safety Communications. Food and Drug Administration. 20 November 2012. Retrieved 2 March 2013 . \n\n^ Hjort, H.; Mathisen, T.; Alves, A.; Clermont, G.; Boutrand, J.P. (2012). \"Three-year results from a preclinical implantation study of a long-term resorbable surgical mesh with time-dependent mechanical characteristics\". Hernia. 16 (2): 191\u2013197. doi:10.1007\/s10029-011-0885-y. PMC 3895198 . PMID 21972049. After 36 months, the test mesh was fully resorbed \n\n^ \"Vipro 2 mesh\". Ethicon product guide. Ethicon. Retrieved 2 March 2013 . \n\n^ Neumayer, Leigh; Giobbie-Hurder, Anita; Jonasson, Olga; Fitzgibbons, Robert Jr.; Dunlop, Dorothy; Gibbs, James; Reda, Domenic; Henderson, William (2004-04-29). \"Open Mesh versus Laparoscopic Mesh Repair of Inguinal Hernia\". New England Journal of Medicine. 350 (18): 1819\u20131827. doi:10.1056\/NEJMoa040093. ISSN 0028-4793. PMID 15107485. \n\n^ a b c Brown, Bryan N.; Londono, Ricardo; Tottey, Stephen; Zhang, Li; Kukla, Kathryn A.; Wolf, Matthew T.; Daly, Kerry A.; Reing, Janet E.; Badylak, Stephen F. (2012-03-01). \"Macrophage phenotype as a predictor of constructive remodeling following the implantation of biologically derived surgical mesh materials\". Acta Biomaterialia. 8 (3): 978\u2013987. doi:10.1016\/j.actbio.2011.11.031. PMC 4325370 . PMID 22166681. \n\n^ a b c d e f g Todros, S.; Pavan, P. G.; Natali, A. N. (2016-03-01). \"Biomechanical properties of synthetic surgical meshes for pelvic prolapse repair\". Journal of the Mechanical Behavior of Biomedical Materials. 55: 271\u2013285. doi:10.1016\/j.jmbbm.2015.10.024. \n\n^ \"Government agrees to temporarily ban vaginal mesh implants for women with urinary incontinence\". The Independent. 2018-07-10. Retrieved 2018-12-09 . \n\n^ Health, Center for Devices and Radiological. \"Urogynecologic Surgical Mesh Implants\". www.fda.gov. Retrieved 2018-12-09 . \n\n^ a b c Ding, Jing; Deng, Mou; Song, Xiao-chen; Chen, Chun; Lai, Kui-lin; Wang, Guo-shuai; Yuan, Yu-yu; Xu, Tao; Zhu, Lan (2016-08-01). \"Nanofibrous biomimetic mesh can be used for pelvic reconstructive surgery: A randomized study\". Journal of the Mechanical Behavior of Biomedical Materials. 61: 26\u201335. doi:10.1016\/j.jmbbm.2016.01.003. \n\n^ Bl\u00e1zquez, Rebeca; S\u00e1nchez-Margallo, Francisco Miguel; \u00c1lvarez, Ver\u00f3nica; Us\u00f3n, Alejandra; Casado, Javier G. (2016-02-01). \"Surgical meshes coated with mesenchymal stem cells provide an anti-inflammatory environment by a M2 macrophage polarization\". Acta Biomaterialia. 31: 221\u2013230. doi:10.1016\/j.actbio.2015.11.057. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_mesh\">https:\/\/www.limswiki.org\/index.php\/Surgical_mesh<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 18:09.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 372 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","ee45e10797757b6c04738eca23a81653_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Surgical_mesh skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Surgical mesh<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hernia_mesh_2.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8f\/Hernia_mesh_2.JPG\/220px-Hernia_mesh_2.JPG\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hernia_mesh_2.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Surgical mesh made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polypropylene\" title=\"Polypropylene\" rel=\"external_link\" target=\"_blank\">polypropylene<\/a>, used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inguinal_hernia\" title=\"Inguinal hernia\" rel=\"external_link\" target=\"_blank\">inguinal hernia<\/a>.<\/div><\/div><\/div>\n<p><b>Surgical mesh<\/b> is a loosely woven sheet which is used as either a permanent or temporary support for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organ_(anatomy)\" title=\"Organ (anatomy)\" rel=\"external_link\" target=\"_blank\">organs<\/a> and other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_(biology)\" title=\"Tissue (biology)\" rel=\"external_link\" target=\"_blank\">tissues<\/a> during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a>. Surgical mesh is created from both <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inorganic\" class=\"mw-redirect\" title=\"Inorganic\" rel=\"external_link\" target=\"_blank\">inorganic<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomesh\" title=\"Biomesh\" rel=\"external_link\" target=\"_blank\">biological materials<\/a> and is used in a variety of surgeries. Though <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hernia_repair\" title=\"Hernia repair\" rel=\"external_link\" target=\"_blank\">hernia repair<\/a> surgery is the most common application, it can also be used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">reconstructive<\/a> work, such as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pelvic_organ_prolapse\" title=\"Pelvic organ prolapse\" rel=\"external_link\" target=\"_blank\">pelvic organ prolapse<\/a>.<sup id=\"rdp-ebb-cite_ref-FDA1_1-0\" class=\"reference\"><a href=\"#cite_note-FDA1-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Permanent meshes remain in the body, whereas temporary ones dissolve over time. For example, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Novus_Scientific#TIGR.C2.AE_Matrix_Surgical_Mesh\" title=\"Novus Scientific\" rel=\"external_link\" target=\"_blank\">TIGR Matrix test mesh<\/a> was shown in 2012 to fully dissolve after three years in a scientific trial on sheep.<sup id=\"rdp-ebb-cite_ref-Hernia1_2-0\" class=\"reference\"><a href=\"#cite_note-Hernia1-2\" rel=\"external_link\">[2]<\/a><\/sup> Some types of mesh combine permanent and temporary meshes such as Vipro, which includes both re-absorbable vipryl, made from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyglycolic_acid\" class=\"mw-redirect\" title=\"Polyglycolic acid\" rel=\"external_link\" target=\"_blank\">polyglycolic acid<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prolene\" title=\"Prolene\" rel=\"external_link\" target=\"_blank\">prolene<\/a>, a non-reabsorbable polypropylene.<sup id=\"rdp-ebb-cite_ref-Ethicon1Viproproddesc_3-0\" class=\"reference\"><a href=\"#cite_note-Ethicon1Viproproddesc-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>Data of mechanical and biological behaviors of mesh <i>in vivo<\/i> may not always be concurrent within the human body due to testing in other organisms. Most published reports experiment on mice, thus creating the likelihood of possible differences when inserted into the human body. Also, most published research reports reference meshes that are currently removed from the medical device market due to complications post-surgery. Additionally, the absence of FDA-approved regulatory protocols and universal standard operating procedures leads to a variety of different testing methods from researcher to researcher. Experimentation may find differing outcomes for some meshes.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_Uses\">Medical Uses<\/span><\/h2>\n<p>The primary function of surgical mesh is to support prolapsed organs either temporarily or permanently. It is most commonly used in hernia surgery within the abdomen, which is required when an organ protrudes through abdominal muscles. Surgical mesh may also be used for pelvic or vaginal wall reconstructions in women and is implemented to add as a growth guide for damaged tissue. Ideally, these implants should be strong enough to survive mechanical loads and actions of whichever body area they become a part of.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hernia_surgery\">Hernia surgery<\/span><\/h3>\n<p>Hernia surgery is one of the most common current applications of surgical mesh. Hernias occur when organs or fatty tissue bulge through openings or debilitated areas of muscle, usually in the abdominal wall. Surgical mesh is implanted to strengthen tissue repair and minimize the rate of recurrence. The surgery can be performed laparoscopic (internally) or open with a variety of materials available for prosthesis.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Polypropylene (PP) is the most frequently used type of mesh, although it may be uncomfortable for the patient after implantation. Another type that is less utilized in hernia surgery is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene_terephthalate\" title=\"Polyethylene terephthalate\" rel=\"external_link\" target=\"_blank\">polyethylene terephthalate<\/a> (PET), which faces complications in that fact that it easily degrades after some years of implantation, erasing the effects of the surgery. Polytetrafluorethylene (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Polytetrafluoroethylene\" title=\"Polytetrafluoroethylene\" rel=\"external_link\" target=\"_blank\">PTFE<\/a>) is used as well, but is manufactured in the form of a foil and has difficulty integrating into surrounding tissue, therefore it loses stability.<sup id=\"rdp-ebb-cite_ref-:02_5-0\" class=\"reference\"><a href=\"#cite_note-:02-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Pelvic_surgery\">Pelvic surgery<\/span><\/h3>\n<p>Similar to hernia surgery, synthetic meshes may be used for organ prolapses in the pelvic region as well. Pelvic organ prolapse occurs in 50% of women above the age of 50 with a history of one or more vaginal childbirths throughout her lifetime.<sup id=\"rdp-ebb-cite_ref-:1_6-0\" class=\"reference\"><a href=\"#cite_note-:1-6\" rel=\"external_link\">[6]<\/a><\/sup> Mesh surgery can be performed in various areas of the pelvic region, such as cystocele, rectocele, and vaginal vault or uterus. The most commonly used material, as in hernia surgery, is PP, which is considered to have acceptable biocompatibility within the region. It induces a mild inflammatory response but has a tendency to adhere to the viscera.<sup id=\"rdp-ebb-cite_ref-:1_6-1\" class=\"reference\"><a href=\"#cite_note-:1-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>The vaginal wall has three layers: tunica mucosa, muscularis, adventitia. When prolapse occurs, smooth fibers of the muscularis are compromised. Prolapse in women has also been seen to increase stiffness in the pelvis, particularly post-menopausal women.<sup id=\"rdp-ebb-cite_ref-:1_6-2\" class=\"reference\"><a href=\"#cite_note-:1-6\" rel=\"external_link\">[6]<\/a><\/sup> Surgical mesh that is used in pelvic reconstruction must counter this stiffness, but if the modulus of elasticity is too high, it will not sufficiently support the organs. On the contrary, if the mesh is too stiff, tissue will erode and inflammatory responses will cause post-surgical complications.\n<\/p><p>Additionally, the mesh has enough strength to withstand basic actions and tissue behavior in physiological conditions, particularly during tissue regeneration through the mesh itself.<sup id=\"rdp-ebb-cite_ref-:1_6-3\" class=\"reference\"><a href=\"#cite_note-:1-6\" rel=\"external_link\">[6]<\/a><\/sup> The area is subjected to a variety of loads approaching from abdominal contents, pressure from abdominal\/diaphragm muscles, and genital organs, as well as respiratory actions. For the average, reproductive-age woman, the pelvis must withstand loads of 20 N in the supine position, 25-35 N in the standing position, and 90-130 N whilst coughing.<sup id=\"rdp-ebb-cite_ref-:1_6-4\" class=\"reference\"><a href=\"#cite_note-:1-6\" rel=\"external_link\">[6]<\/a><\/sup> Any mesh that is implanted in the pelvic area must be strong enough to withstand these loads.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Regulation\">Regulation<\/span><\/h2>\n<p>In 2018, the United Kingdom temporarily halted vaginal mesh implants for treatment of urinary incontinence pending further investigation into the risks and available safeguards.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> In the United States, the FDA mandated premark approval applications for mesh intended for transvaginal pelvic organ prolapse repair, with further investigation planned in 2019.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> \n<\/p>\n<h2><span class=\"mw-headline\" id=\"Biocompatibility\">Biocompatibility<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hernia_mesh_1.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/20\/Hernia_mesh_1.jpg\/220px-Hernia_mesh_1.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hernia_mesh_1.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Polypropylene (PP) mesh is currently used in both hernia and pelvic organ prolapses, but may not always be the most biocompatible option.<\/div><\/div><\/div>\n<p>Mesh implantation will naturally generate an anti-inflammatory response to the inserted mesh, but biocompatibility ranges from how easily it is integrated to how severe the foreign body reaction is. A minimal response includes the formation of fibrosis around the prosthesis (much like in scar tissue formation); this response is generated with the best form of biocompatibility. A physical response triggers an acute inflammatory reaction, which involves the formation of giant cells and subsequently granulomas, meaning that the tissue is \u201ctolerating\u201d the mesh fairly well. Lastly, a chemical response allows for a severe inflammatory reaction during attempted tissue-mesh integration, including fibroblastic cell proliferation.<sup id=\"rdp-ebb-cite_ref-:1_6-5\" class=\"reference\"><a href=\"#cite_note-:1-6\" rel=\"external_link\">[6]<\/a><\/sup> Ultimately, the goal for surgical mesh creation is to formulate one that has a minimal <i>in vivo<\/i> reaction to maximize comfort for the patient, avoid infection, and ensure clean integration into the body for tissue repair.\n<\/p><p>A number of factors play into mesh biocompatibility. Mesh porosity is the ratio of pore to total area, and plays a role in the development of either bacterial infection or smooth tissue regeneration depending on pore size. Pore sizes below 10 micrometers are susceptible to infection because bacteria may enter and proliferate, while macrophages and neutrophils are too large to fit through and cannot aid in the elimination of them. With pore sizes exceeding 75 micrometers, fibroblasts, blood vessels, and collagen fibers are permitted through as part of tissue regeneration. Although there is no general consensus on the best pore size, it can be deduced that larger pores are better for development of tissue and integration <i>in vivo<\/i>.<sup id=\"rdp-ebb-cite_ref-:1_6-6\" class=\"reference\"><a href=\"#cite_note-:1-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>Knowing this, the current problem with a variety of the meshes used in all types of surgeries is that they are not sufficiently biocompatible. PP proves an effective mesh for adjusting prolapsed organs, but may cause severe discomfort for the patient due to its high modulus of elasticity. This stiffens the prosthesis and results in a more pronounced inflammatory response, which complicates integration into the body with tissue ingrowth. As previously mentioned, PET too easily degrades <i>in vivo<\/i> and tissue has a difficult time integrating with PTFE. For these reasons, researchers are beginning to look for different types of surgical mesh that may be suitable for the biological environment and provide better comfort while supporting prolapsed organs.<sup id=\"rdp-ebb-cite_ref-:02_5-1\" class=\"reference\"><a href=\"#cite_note-:02-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-PVDF_.28nanofibrous_mesh.29\"><\/span><span class=\"mw-headline\" id=\"PVDF_(nanofibrous_mesh)\">PVDF (nanofibrous mesh)<\/span><\/h3>\n<p>One particular type of mesh that is under study is polyvinylidene fluoride (PVDF), or nanofibrous mesh, which has been found to be more resistant to hydrolysis and disintegration, unlike PET, and does not increase its stiffness in its age, unlike PP. It is being tested for both hernia and pelvic\/vaginal wall surgery and is produced via fiber placement layer by layer, whereas PP is constructed by a weaving-like process. This gives the nanofibrous mesh a heavyweight yet low-porosity structure, also adding greater stiffness and stress threshold when compared to PP. This is supported by the foundation of HSP 70\u2014an indicator for cell stress and protector of cell formation against damage, which is beneficial for the prosthesis and tissue formation\u2014which has been monitored and observed in a larger presence in PVDF.<sup id=\"rdp-ebb-cite_ref-:02_5-2\" class=\"reference\"><a href=\"#cite_note-:02-5\" rel=\"external_link\">[5]<\/a><\/sup> In vitro observations of nanofibrous mesh have yielded evidence of cell migration and proliferation on the set of the mesh. Successful cell growth has been noted with long fusiform shapes and clear boundaries.<sup id=\"rdp-ebb-cite_ref-:2_9-0\" class=\"reference\"><a href=\"#cite_note-:2-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>A significant advantage of using nanofibrous mesh is that it can carry far more stem cells than traditional PP mesh, which could improve cell-based therapy for pelvic organs prolapse and regeneration methods. Another important advantage of PVDF is the formation of capillaries after 12 weeks, which is essential for wound-healing. The faster neovascularization occurs, the faster tissue can be repaired and regenerated, which decreases the likelihood of suffering from exposure or extrusion of the mesh.<sup id=\"rdp-ebb-cite_ref-:2_9-1\" class=\"reference\"><a href=\"#cite_note-:2-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>Some enhancements to PVDF must also be made before it can be used for human surgery. Although the modulus of elasticity is higher than that of PP, resulting stretch under identical stress is much smaller, which could cause complications such as tissue degeneration and loss of mechanical soundness. Nanofibrous mesh currently also promotes a greater foreign body reaction and inflammatory response, which is faulty for biocompatibility purposes of the mesh.<sup id=\"rdp-ebb-cite_ref-:2_9-2\" class=\"reference\"><a href=\"#cite_note-:2-9\" rel=\"external_link\">[9]<\/a><\/sup> For these reasons, PVDF is still under consideration and experimentation for bodily implants.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Reduction_of_inflammatory_response_using_MSCs\">Reduction of inflammatory response using MSCs<\/span><\/h3>\n<p>Inflammatory responses to mesh insertion promote tissue formation around mesh fibers and proliferation of fibroblasts, polymorphonucleocytes, and macrophages, which all aid in the integration of mesh. Failures to resolve inflammatory responses may lead to foreign body reactions and the ultimate encapsulation of the implant which negates any functional purpose that the implant was supposed to serve. Mesenchymal stem cells (MSCs) are known to reduce inflammatory responses which, when combined with surgical mesh, could prevent them from getting uncontrollable and too difficult to tame. MSCs combined with surgical meshes can be used as \u201coff the shelf\u201d products and enhance macrophage polarization in both in vivo and in vitro environments. This can encourage an anti-inflammatory response and can regulate the inflammatory reaction associated with mesh implantation.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Adhesion_barrier\" title=\"Adhesion barrier\" rel=\"external_link\" target=\"_blank\">Adhesion barrier<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomesh\" title=\"Biomesh\" rel=\"external_link\" target=\"_blank\">Biomesh<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Inguinal_hernia_surgery#Meshes\" title=\"Inguinal hernia surgery\" rel=\"external_link\" target=\"_blank\">Inguinal hernia surgery meshes<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vicryl\" title=\"Vicryl\" rel=\"external_link\" target=\"_blank\">Vicryl<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-FDA1-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FDA1_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/Safety\/AlertsandNotices\/ucm142636.htm\" target=\"_blank\">\"Information on Surgical Mesh for Pelvic Organ Prolapse and Stress Urinary Incontinence\"<\/a>. <i>Medical Devices Safety Communications<\/i>. Food and Drug Administration. 20 November 2012<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2 March<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Medical+Devices+Safety+Communications&rft.atitle=Information+on+Surgical+Mesh+for+Pelvic+Organ+Prolapse+and+Stress+Urinary+Incontinence&rft.date=2012-11-20&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FSafety%2FAlertsandNotices%2Fucm142636.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mesh\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Hernia1-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Hernia1_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hjort, H.; Mathisen, T.; Alves, A.; Clermont, G.; Boutrand, J.P. (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3895198\" target=\"_blank\">\"Three-year results from a preclinical implantation study of a long-term resorbable surgical mesh with time-dependent mechanical characteristics\"<\/a>. <i>Hernia<\/i>. <b>16<\/b> (2): 191\u2013197. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs10029-011-0885-y\" target=\"_blank\">10.1007\/s10029-011-0885-y<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3895198\" target=\"_blank\">3895198<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21972049\" target=\"_blank\">21972049<\/a>. <q>After 36 months, the test mesh was fully resorbed<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Hernia&rft.atitle=Three-year+results+from+a+preclinical+implantation+study+of+a+long-term+resorbable+surgical+mesh+with+time-dependent+mechanical+characteristics&rft.volume=16&rft.issue=2&rft.pages=191-197&rft.date=2012&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3895198&rft_id=info%3Apmid%2F21972049&rft_id=info%3Adoi%2F10.1007%2Fs10029-011-0885-y&rft.au=Hjort%2C+H.&rft.au=Mathisen%2C+T.&rft.au=Alves%2C+A.&rft.au=Clermont%2C+G.&rft.au=Boutrand%2C+J.P.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3895198&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mesh\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Ethicon1Viproproddesc-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Ethicon1Viproproddesc_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"#hernia_solutions\">\"Vipro 2 mesh\"<\/a>. <i>Ethicon product guide<\/i>. 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Retrieved <span class=\"nowrap\">2 March<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Ethicon+product+guide&rft.atitle=Vipro+2+mesh&rft_id=http%3A%2F%2Fwww.ethiconproducts.co.uk%2Fproducts%2Fproduct-guide%23hernia_solutions&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mesh\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Neumayer, Leigh; Giobbie-Hurder, Anita; Jonasson, Olga; Fitzgibbons, Robert Jr.; Dunlop, Dorothy; Gibbs, James; Reda, Domenic; Henderson, William (2004-04-29). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/dx.doi.org\/10.1056\/NEJMoa040093\" target=\"_blank\">\"Open Mesh versus Laparoscopic Mesh Repair of Inguinal Hernia\"<\/a>. <i>New England Journal of Medicine<\/i>. <b>350<\/b> (18): 1819\u20131827. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2FNEJMoa040093\" target=\"_blank\">10.1056\/NEJMoa040093<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0028-4793\" target=\"_blank\">0028-4793<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15107485\" target=\"_blank\">15107485<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=New+England+Journal+of+Medicine&rft.atitle=Open+Mesh+versus+Laparoscopic+Mesh+Repair+of+Inguinal+Hernia&rft.volume=350&rft.issue=18&rft.pages=1819-1827&rft.date=2004-04-29&rft.issn=0028-4793&rft_id=info%3Apmid%2F15107485&rft_id=info%3Adoi%2F10.1056%2FNEJMoa040093&rft.aulast=Neumayer&rft.aufirst=Leigh&rft.au=Giobbie-Hurder%2C+Anita&rft.au=Jonasson%2C+Olga&rft.au=Fitzgibbons%2C+Robert+Jr.&rft.au=Dunlop%2C+Dorothy&rft.au=Gibbs%2C+James&rft.au=Reda%2C+Domenic&rft.au=Henderson%2C+William&rft_id=https%3A%2F%2Fdx.doi.org%2F10.1056%2FNEJMoa040093&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mesh\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:02-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:02_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:02_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:02_5-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brown, Bryan N.; Londono, Ricardo; Tottey, Stephen; Zhang, Li; Kukla, Kathryn A.; Wolf, Matthew T.; Daly, Kerry A.; Reing, Janet E.; Badylak, Stephen F. 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Retrieved <span class=\"nowrap\">2018-12-09<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=The+Independent&rft.atitle=Government+agrees+to+temporarily+ban+vaginal+mesh+implants+for+women+with+urinary+incontinence&rft.date=2018-07-10&rft_id=https%3A%2F%2Fwww.independent.co.uk%2Fnews%2Fhealth%2Fvaginal-mesh-implants-government-review-women-urinary-incontinence-health-risk-latest-a8439266.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mesh\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Health, Center for Devices and Radiological. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.fda.gov\/medicaldevices\/productsandmedicalprocedures\/implantsandprosthetics\/urogynsurgicalmesh\/\" target=\"_blank\">\"Urogynecologic Surgical Mesh Implants\"<\/a>. <i>www.fda.gov<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-12-09<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.fda.gov&rft.atitle=Urogynecologic+Surgical+Mesh+Implants&rft.aulast=Health&rft.aufirst=Center+for+Devices+and+Radiological&rft_id=https%3A%2F%2Fwww.fda.gov%2Fmedicaldevices%2Fproductsandmedicalprocedures%2Fimplantsandprosthetics%2Furogynsurgicalmesh%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mesh\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:2-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:2_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:2_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:2_9-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ding, Jing; Deng, Mou; Song, Xiao-chen; Chen, Chun; Lai, Kui-lin; Wang, Guo-shuai; Yuan, Yu-yu; Xu, Tao; Zhu, Lan (2016-08-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S1751616116000060\" target=\"_blank\">\"Nanofibrous biomimetic mesh can be used for pelvic reconstructive surgery: A randomized study\"<\/a>. <i>Journal of the Mechanical Behavior of Biomedical Materials<\/i>. <b>61<\/b>: 26\u201335. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jmbbm.2016.01.003\" target=\"_blank\">10.1016\/j.jmbbm.2016.01.003<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+Mechanical+Behavior+of+Biomedical+Materials&rft.atitle=Nanofibrous+biomimetic+mesh+can+be+used+for+pelvic+reconstructive+surgery%3A+A+randomized+study&rft.volume=61&rft.pages=26-35&rft.date=2016-08-01&rft_id=info%3Adoi%2F10.1016%2Fj.jmbbm.2016.01.003&rft.aulast=Ding&rft.aufirst=Jing&rft.au=Deng%2C+Mou&rft.au=Song%2C+Xiao-chen&rft.au=Chen%2C+Chun&rft.au=Lai%2C+Kui-lin&rft.au=Wang%2C+Guo-shuai&rft.au=Yuan%2C+Yu-yu&rft.au=Xu%2C+Tao&rft.au=Zhu%2C+Lan&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS1751616116000060&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mesh\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bl\u00e1zquez, Rebeca; S\u00e1nchez-Margallo, Francisco Miguel; \u00c1lvarez, Ver\u00f3nica; Us\u00f3n, Alejandra; Casado, Javier G. (2016-02-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S1742706115302336\" target=\"_blank\">\"Surgical meshes coated with mesenchymal stem cells provide an anti-inflammatory environment by a M2 macrophage polarization\"<\/a>. <i>Acta Biomaterialia<\/i>. <b>31<\/b>: 221\u2013230. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.actbio.2015.11.057\" target=\"_blank\">10.1016\/j.actbio.2015.11.057<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Biomaterialia&rft.atitle=Surgical+meshes+coated+with+mesenchymal+stem+cells+provide+an+anti-inflammatory+environment+by+a+M2+macrophage+polarization&rft.volume=31&rft.pages=221-230&rft.date=2016-02-01&rft_id=info%3Adoi%2F10.1016%2Fj.actbio.2015.11.057&rft.aulast=Bl%C3%A1zquez&rft.aufirst=Rebeca&rft.au=S%C3%A1nchez-Margallo%2C+Francisco+Miguel&rft.au=%C3%81lvarez%2C+Ver%C3%B3nica&rft.au=Us%C3%B3n%2C+Alejandra&rft.au=Casado%2C+Javier+G.&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS1742706115302336&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mesh\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1246\nCached time: 20181209024446\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.284 seconds\nReal time usage: 0.319 seconds\nPreprocessor visited node count: 627\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 23166\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 3\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 32582\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.179\/10.000 seconds\nLua memory usage: 3.61 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 224.437 1 -total\n<\/p>\n<pre>51.88% 116.433 6 Template:Cite_journal\n47.59% 106.818 4 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:38688920-1!canonical and timestamp 20181209024446 and revision id 872759963\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_mesh\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212158\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.015 seconds\nReal time usage: 0.167 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 160.550 1 - wikipedia:Surgical_mesh\n100.00% 160.550 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8079-0!*!*!*!*!*!* and timestamp 20181217212158 and revision id 24194\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_mesh\">https:\/\/www.limswiki.org\/index.php\/Surgical_mesh<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","ee45e10797757b6c04738eca23a81653_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8f\/Hernia_mesh_2.JPG\/440px-Hernia_mesh_2.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/20\/Hernia_mesh_1.jpg\/440px-Hernia_mesh_1.jpg"],"ee45e10797757b6c04738eca23a81653_timestamp":1545081718,"2689a937df4d5b6fdb5829738ec1d44b_type":"article","2689a937df4d5b6fdb5829738ec1d44b_title":"Subdermal implant","2689a937df4d5b6fdb5829738ec1d44b_url":"https:\/\/www.limswiki.org\/index.php\/Subdermal_implant","2689a937df4d5b6fdb5829738ec1d44b_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSubdermal implant\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Cosmetic subdermal implants on the lower arm\nA subdermal implant refers to a body modification that is placed underneath the skin, therefore allowing the body to heal over the implant and creating a raised design. Such implants fall under the broad category of body modification. Many subdermal implants are made out of silicone, either carved or mold injected. Many people who have subdermal implants use them in conjunction with other types of body modification to create a desired, dramatic effect.[1] This process is also known as a 3-D implant, or pocketing.[2]\n\nContents \n\n1 History \n2 Types \n\n2.1 Subdermal \n2.2 Transdermal \n\n\n3 Procedure \n4 Applications \n\n4.1 Genital implants \n4.2 Braille tattoo \n\n\n5 Aftercare \n6 Health risks \n7 See also \n8 Notes \n9 References \n10 External links \n\n\nHistory \nThe first subdermal implant was implanted in 1994. It is generally agreed upon that they were pioneered by Steve Haworth. In his shop, HTC Body Piercing, in Phoenix, Arizona, he first began these procedures after being asked for a bracelet. He concluded that he could put a row of beads under the woman's wrist to create the effect she desired.[1] This was followed in 1998 by the scientist Kevin Warwick who experimented with both an RFID and an electrode array implant.[3] Since then, many different artists have done many kinds of implants. Some of the well-known names in the industry include Samppa Von Cyborg, Max Yampolskiy, Russ Foxx, Brian Decker, Emilio Gonzales and Stelarc, who had a cell-cultivated ear implanted on his arm.[4]\n\nTypes \nAccording to the Church of Body Modification, there are two main types of subdermal implants: subdermal (or subcutaneous) implants and transdermal implants.[5] Magnetic subdermal implants also exist.[6]\n\n A dermal punch, used for transdermal implants, creates a large initial hole by removing a disk of skin\nSubdermal \n\u201cSubdermal implants,\u201d as defined by the Church of Body Modification, are completely buried in the Dermis. These are used for both cosmetic and medical purposes, such as the contraceptive Norplant, consisting of six levonorgestrel-releasing Silastic capsules, and is placed under the skin of the upper arm, generally a woman\u2019s arm.[7] The cosmetic variant can be molded into any shape desired; though usually made of silicone. However, Teflon variants exist as well.[1]\n\nTransdermal \nMain article: Transdermal implant\nTransdermal implants are placed partially under the skin, with the rest exposed. This is done through a process known as \"dermal punching\". First the implant is placed in between the layers of skin. It is necessary for the part of the implant that will be located under the skin to have a proper shape. This must be one with holes in it (like a figure eight) so that the body will be able to grow around it. Once the implant is placed, the part that will protrude out is exposed using a dermal punch.[5]\n\nProcedure \nTo have one of these implants installed, an incision is made down to the subcutaneous layer (subcutis) of the skin. A dermal elevator, a widely used medical instrument, separates the subcutis and the fascia, creating the pocket in which the implant will be inserted. After the implant is placed, the incision is stitched shut. Surgical tape is often applied to minimize movement while the skin fuses around the implant.[1]\nContraceptive implants in the UK and Australia are \"injected\" under the skin using a special device similar to a large syringe or ear-piercing gun, and extracted by making a tiny incision through which the implant is pulled out. Local anesthetic is usually available for the extraction, but is not required, as the cut is very small.\n\nApplications \nGenital implants \nSubdermal implants placed under the skin of the penis can provide physical stimulation for both sexual partners. The most frequent form is genital beading, using small, round implants. Short, curved rods are also used, and are called \"genital ribs\".[8][better source needed ]\n\nBraille tattoo \nKlara Jirkova, a student at the Berlin University of the Arts, raised the possibility of using subdermal implants to create \"Braille tattoos\" readable by the blind. She proposes that small implants could be grouped to form braille characters, which she says \"can be read by touch \u2013 stroke by blind people.[9] She suggests that, if located near the thumb where they could be read during a handshake, \"Braille tattoos\" could help the blind recognize whom they are greeting. She states that this will be a more meaningful form of body modification as it relates to the sense of touch instead of sight.[9]\nDespite the media attention Jirkova's proposal received, this application of subdermal implants is, at best, impractical. A \"braille tattoo\" as a form of identification between the blind would be extraneous, as the blind can easily identify others by speaking to them. Such a procedure would have a low success rate, as the implants would most likely shift during healing.[10][better source needed ] The smooth, round implants Jirkova suggests are especially prone to shifting and it is likely that a \"Braille tattoo\" would migrate to the point of being unreadable. The commonly seen \"Braille tattoo\" image is a photo manipulation from Jirkova's report, not a successfully completed modification.\nAlthough individual ball implants would present too many problems due to migration, flat premade square silicone \"character\" sheets with pre-positioned dots would solve the readability problems. These individual square sheets could be preformed and implanted with the desired effect.[original research? ]\n\nAftercare \nSubdermal implants are treated like many other body modifications in their aftercare. According to the Church of Body Modification, \"The most important part of aftercare is keeping your sutures clean and dry.\"[5] They also suggest using paper products rather than cloth to clean and cover the area, as cloth products can hold many bacteria, and that the sutures be cleaned with solutions designed for sterilizing piercings. After 10\u201312 days, the stitches can be removed. It can take up to 3 months for the desired effect to be reached. As part of the Church's philosophy, they encourage all to \"Use common sense; know your body and listen to what it needs! Take care of yourself and your modifications.\"[5] This can include seeing a doctor at the first sign of infection or for help removing sutures.\n\nHealth risks \nSubdermal implants, being similar to plastic surgery, have more risks than other kinds of body modification. Any time that the human body is opened, it must be performed in a sterile environment, in order to prevent infection. This has become a major source of controversy regarding subdermal implants.\nMany health professional are concerned for the individuals undergoing these procedures: the majority of these procedures are being performed by individuals with little to no formal medical training, and often do not take place in sterile environments.\nThe body modification industry is trying to make changes to the risky behaviors that are sometimes taken by unqualified people who are performing such implants. For example, David A. Vidra founded Health Educators, a company set up as \"education for the modification industry\".[11] It is set up to offer qualified instructors that teach sterilization and other techniques for safe procedures.\nMany medical doctors are still concerned, however. Dr. Phil Haeck states, \"This is a deviation in surgery that has no place for someone that has taken the Hippocratic Oath and wants to serve mankind.\"[1]\n\nSee also \nBody modification\nBody piercing materials\nKevin Warwick\nThe Lizardman\nThe Enigma\nMicrochip implant (human)\nNotes \n\n\n^ a b c d e Norton, Quinn (8 Mar 2006). \"Body Artists Customize Your Flesh\". Wired Magazine. Retrieved 15 Dec 2007 . \n\n^ Berry, Richard. \"Seen my knuckle-duster, anywhere?\". Herald Sun. \n\n^ Warwick, K.; Gasson, M.; Hutt, B.; Goodhew, I.; Kyberd, P.; Andrews, B.; Teddy, P.; Shad, A. (2003). \"The Application of Implant Technology for Cybernetic Systems\". Archives of Neurology. 60 (10): 1369\u201373. doi:10.1001\/archneur.60.10.1369. PMID 14568806. \n\n^ Klintron (21 May 2007). \"Third ear open\". Technoccult. Archived from the original on August 20, 2007. Retrieved 15 Dec 2007 . \n\n^ a b c d \"Implant Aftercare\". The Church of Body Modification. Archived from the original on 2007-12-10. Retrieved 15 Dec 2007 . \n\n^ Harrison,I., Warwick,K. and Ruiz,V. (2018), \"Subdermal Magnetic Implants: An Experimental Study\", Cybernetics and Systems, 49(2), 122-150. \n\n^ Sirvin, Irving; Diaz, Soledad; Holma, Pentti; Alvarez-Sanchez, Francisco; Robertson, Dale N. (1983). \"A Four-Year Clinical Study of NORPLANT Implants\". Studies in Family Planning. 14 (6\u20137): 184. JSTOR 1965499. \n\n^ BME contributors (May 3, 2006). \"Genital Ribs\". BMEzine Encyclopaedia. Retrieved August 27, 2009 . \n\n^ a b Jirkova, Klara (Summer 2007). \"Braille Tattoo\". Universit\u00e4t der K\u00fcnste Berlin. Archived from the original on 2007-10-29. Retrieved 15 Dec 2007 . \n\n^ BME contributors (September 13, 2006). \"Implant Subdermal Shifting\". BMEzine Encyclopaedia. Retrieved August 27, 2009 . \n\n^ \"Home Page\". Health Educators Inc. 9 Dec 2007. Retrieved 15 Dec 2007 . \n\n\nReferences \nHewitt, Kim (1996). Mutilating the Body: Identity in Blood and Ink. Bowling Green, Ohio: Bowling Green State University Popular Press. ISBN 978-0879727109. \nExternal links \n\n\n\nWikimedia Commons has media related to Subdermal implant.\nThe Church of Body Modification\nBody Modification Conference\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Subdermal_implant\">https:\/\/www.limswiki.org\/index.php\/Subdermal_implant<\/a>\n\t\t\t\t\tCategories: Body modificationImplants (medicine)Hidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 17:52.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,066 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","2689a937df4d5b6fdb5829738ec1d44b_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Subdermal_implant skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Subdermal implant<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bodymodificationimplantball.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/Bodymodificationimplantball.jpg\/220px-Bodymodificationimplantball.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bodymodificationimplantball.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Cosmetic subdermal implants on the lower arm<\/div><\/div><\/div>\n<p>A <b>subdermal implant<\/b> refers to a body modification that is placed underneath the skin, therefore allowing the body to heal over the implant and creating a raised design. Such implants fall under the broad category of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_modification\" title=\"Body modification\" rel=\"external_link\" target=\"_blank\">body modification<\/a>. Many subdermal implants are made out of silicone, either carved or mold injected. Many people who have subdermal implants use them in conjunction with other types of body modification to create a desired, dramatic effect.<sup id=\"rdp-ebb-cite_ref-norton_1-0\" class=\"reference\"><a href=\"#cite_note-norton-1\" rel=\"external_link\">[1]<\/a><\/sup> This process is also known as a <i>3-D implant<\/i>, or <i>pocketing<\/i>.<sup id=\"rdp-ebb-cite_ref-berry_2-0\" class=\"reference\"><a href=\"#cite_note-berry-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The first subdermal implant was implanted in 1994. It is generally agreed upon that they were pioneered by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Steve_Haworth\" title=\"Steve Haworth\" rel=\"external_link\" target=\"_blank\">Steve Haworth<\/a>. In his shop, HTC Body Piercing, in Phoenix, Arizona, he first began these procedures after being asked for a bracelet. He concluded that he could put a row of beads under the woman's wrist to create the effect she desired.<sup id=\"rdp-ebb-cite_ref-norton_1-1\" class=\"reference\"><a href=\"#cite_note-norton-1\" rel=\"external_link\">[1]<\/a><\/sup> This was followed in 1998 by the scientist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kevin_Warwick\" title=\"Kevin Warwick\" rel=\"external_link\" target=\"_blank\">Kevin Warwick<\/a> who experimented with both an <a href=\"https:\/\/en.wikipedia.org\/wiki\/RFID\" class=\"mw-redirect\" title=\"RFID\" rel=\"external_link\" target=\"_blank\">RFID<\/a> and an electrode array implant.<sup id=\"rdp-ebb-cite_ref-doi10.1001\/archneur.60.10.1369|noedit_3-0\" class=\"reference\"><a href=\"#cite_note-doi10.1001\/archneur.60.10.1369|noedit-3\" rel=\"external_link\">[3]<\/a><\/sup> Since then, many different artists have done many kinds of implants. Some of the well-known names in the industry include Samppa Von Cyborg, Max Yampolskiy, Russ Foxx, Brian Decker, Emilio Gonzales and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stelarc\" title=\"Stelarc\" rel=\"external_link\" target=\"_blank\">Stelarc<\/a>, who had a cell-cultivated ear implanted on his arm.<sup id=\"rdp-ebb-cite_ref-klintron_4-0\" class=\"reference\"><a href=\"#cite_note-klintron-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<p>According to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Church_of_Body_Modification\" title=\"Church of Body Modification\" rel=\"external_link\" target=\"_blank\">Church of Body Modification<\/a>, there are two main types of subdermal implants: subdermal (or subcutaneous) implants and transdermal implants.<sup id=\"rdp-ebb-cite_ref-church_5-0\" class=\"reference\"><a href=\"#cite_note-church-5\" rel=\"external_link\">[5]<\/a><\/sup> Magnetic subdermal implants also exist.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dermal_punch.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/74\/Dermal_punch.jpg\/220px-Dermal_punch.jpg\" width=\"220\" height=\"99\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dermal_punch.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A dermal punch, used for transdermal implants, creates a large initial hole by removing a disk of skin<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Subdermal\">Subdermal<\/span><\/h3>\n<p>\u201cSubdermal implants,\u201d as defined by the Church of Body Modification, are completely buried in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dermis\" title=\"Dermis\" rel=\"external_link\" target=\"_blank\">Dermis<\/a>. These are used for both cosmetic and medical purposes, such as the contraceptive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Norplant\" class=\"mw-redirect\" title=\"Norplant\" rel=\"external_link\" target=\"_blank\">Norplant<\/a>, consisting of six <a href=\"https:\/\/en.wikipedia.org\/wiki\/Levonorgestrel\" title=\"Levonorgestrel\" rel=\"external_link\" target=\"_blank\">levonorgestrel<\/a>-releasing Silastic capsules, and is placed under the skin of the upper arm, generally a woman\u2019s arm.<sup id=\"rdp-ebb-cite_ref-sirvin_7-0\" class=\"reference\"><a href=\"#cite_note-sirvin-7\" rel=\"external_link\">[7]<\/a><\/sup> The cosmetic variant can be molded into any shape desired; though usually made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a>. However, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Teflon\" class=\"mw-redirect\" title=\"Teflon\" rel=\"external_link\" target=\"_blank\">Teflon<\/a> variants exist as well.<sup id=\"rdp-ebb-cite_ref-norton_1-2\" class=\"reference\"><a href=\"#cite_note-norton-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Transdermal\">Transdermal<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transdermal_implant\" title=\"Transdermal implant\" rel=\"external_link\" target=\"_blank\">Transdermal implant<\/a><\/div>\n<p>Transdermal implants are placed partially under the skin, with the rest exposed. This is done through a process known as \"dermal punching\". First the implant is placed in between the layers of skin. It is necessary for the part of the implant that will be located under the skin to have a proper shape. This must be one with holes in it (like a figure eight) so that the body will be able to grow around it. Once the implant is placed, the part that will protrude out is exposed using a dermal punch.<sup id=\"rdp-ebb-cite_ref-church_5-1\" class=\"reference\"><a href=\"#cite_note-church-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Procedure\">Procedure<\/span><\/h2>\n<p>To have one of these implants installed, an incision is made down to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subcutaneous_tissue\" title=\"Subcutaneous tissue\" rel=\"external_link\" target=\"_blank\">subcutaneous layer<\/a> (subcutis) of the skin. A dermal elevator, a widely used medical instrument, separates the subcutis and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fascia\" title=\"Fascia\" rel=\"external_link\" target=\"_blank\">fascia<\/a>, creating the pocket in which the implant will be inserted. After the implant is placed, the incision is stitched shut. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_tape\" title=\"Surgical tape\" rel=\"external_link\" target=\"_blank\">Surgical tape<\/a> is often applied to minimize movement while the skin fuses around the implant.<sup id=\"rdp-ebb-cite_ref-norton_1-3\" class=\"reference\"><a href=\"#cite_note-norton-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Contraceptive implants in the UK and Australia are \"injected\" under the skin using a special device similar to a large syringe or ear-piercing gun, and extracted by making a tiny incision through which the implant is pulled out. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Local_anesthetic\" title=\"Local anesthetic\" rel=\"external_link\" target=\"_blank\">Local anesthetic<\/a> is usually available for the extraction, but is not required, as the cut is very small.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Genital_implants\">Genital implants<\/span><\/h3>\n<p>Subdermal implants placed under the skin of the penis can provide physical stimulation for both sexual partners. The most frequent form is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Genital_beading\" class=\"mw-redirect\" title=\"Genital beading\" rel=\"external_link\" target=\"_blank\">genital beading<\/a>, using small, round implants. Short, curved rods are also used, and are called \"genital ribs\".<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup class=\"noprint Inline-Template noprint noexcerpt Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:NOTRS\" class=\"mw-redirect\" title=\"Wikipedia:NOTRS\" rel=\"external_link\" target=\"_blank\"><span title=\"Source is a wiki (October 2013)\">better source needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Braille_tattoo\">Braille tattoo<\/span><\/h3>\n<p>Klara Jirkova, a student at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Berlin_University_of_the_Arts\" title=\"Berlin University of the Arts\" rel=\"external_link\" target=\"_blank\">Berlin University of the Arts<\/a>, raised the possibility of using subdermal implants to create \"Braille tattoos\" readable by the blind. She proposes that small implants could be grouped to form braille characters, which she says \"can be read by touch \u2013 stroke by blind people.<sup id=\"rdp-ebb-cite_ref-jirkova_9-0\" class=\"reference\"><a href=\"#cite_note-jirkova-9\" rel=\"external_link\">[9]<\/a><\/sup> She suggests that, if located near the thumb where they could be read during a handshake, \"Braille tattoos\" could help the blind recognize whom they are greeting. She states that this will be a more meaningful form of body modification as it relates to the sense of touch instead of sight.<sup id=\"rdp-ebb-cite_ref-jirkova_9-1\" class=\"reference\"><a href=\"#cite_note-jirkova-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>Despite the media attention Jirkova's proposal received, this application of subdermal implants is, at best, impractical. A \"braille tattoo\" as a form of identification between the blind would be extraneous, as the blind can easily identify others by speaking to them. Such a procedure would have a low success rate, as the implants would most likely shift during healing.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><sup class=\"noprint Inline-Template noprint noexcerpt Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:NOTRS\" class=\"mw-redirect\" title=\"Wikipedia:NOTRS\" rel=\"external_link\" target=\"_blank\"><span title=\"Source is a wiki (October 2013)\">better source needed<\/span><\/a><\/i>]<\/sup> The smooth, round implants Jirkova suggests are especially prone to shifting and it is likely that a \"Braille tattoo\" would migrate to the point of being unreadable. The commonly seen \"Braille tattoo\" image is a photo manipulation from Jirkova's report, not a successfully completed modification.\n<\/p><p>Although individual ball implants would present too many problems due to migration, flat premade square silicone \"character\" sheets with pre-positioned dots would solve the readability problems. These individual square sheets could be preformed and implanted with the desired effect.<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:No_original_research\" title=\"Wikipedia:No original research\" rel=\"external_link\" target=\"_blank\"><span title=\"The material near this tag possibly contains original research. (October 2013)\">original research?<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Aftercare\">Aftercare<\/span><\/h2>\n<p>Subdermal implants are treated like many other body modifications in their aftercare. According to the Church of Body Modification, \"The most important part of aftercare is keeping your sutures clean and dry.\"<sup id=\"rdp-ebb-cite_ref-church_5-2\" class=\"reference\"><a href=\"#cite_note-church-5\" rel=\"external_link\">[5]<\/a><\/sup> They also suggest using paper products rather than cloth to clean and cover the area, as cloth products can hold many bacteria, and that the sutures be cleaned with solutions designed for sterilizing piercings. After 10\u201312 days, the stitches can be removed. It can take up to 3 months for the desired effect to be reached. As part of the Church's philosophy, they encourage all to \"Use common sense; know your body and listen to what it needs! Take care of yourself and your modifications.\"<sup id=\"rdp-ebb-cite_ref-church_5-3\" class=\"reference\"><a href=\"#cite_note-church-5\" rel=\"external_link\">[5]<\/a><\/sup> This can include seeing a doctor at the first sign of infection or for help removing sutures.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Health_risks\">Health risks<\/span><\/h2>\n<p>Subdermal implants, being similar to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">plastic surgery<\/a>, have more risks than other kinds of body modification. Any time that the human body is opened, it must be performed in a sterile environment, in order to prevent infection. This has become a major source of controversy regarding subdermal implants.\n<\/p><p>Many health professional are concerned for the individuals undergoing these procedures: the majority of these procedures are being performed by individuals with little to no formal medical training, and often do not take place in sterile environments.\n<\/p><p>The body modification industry is trying to make changes to the risky behaviors that are sometimes taken by unqualified people who are performing such implants. For example, David A. Vidra founded Health Educators, a company set up as \"education for the modification industry\".<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> It is set up to offer qualified instructors that teach sterilization and other techniques for safe procedures.\n<\/p><p>Many medical doctors are still concerned, however. Dr. Phil Haeck states, \"This is a deviation in surgery that has no place for someone that has taken the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hippocratic_Oath\" title=\"Hippocratic Oath\" rel=\"external_link\" target=\"_blank\">Hippocratic Oath<\/a> and wants to serve mankind.\"<sup id=\"rdp-ebb-cite_ref-norton_1-4\" class=\"reference\"><a href=\"#cite_note-norton-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_modification\" title=\"Body modification\" rel=\"external_link\" target=\"_blank\">Body modification<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_piercing_materials\" title=\"Body piercing materials\" rel=\"external_link\" target=\"_blank\">Body piercing materials<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Kevin_Warwick\" title=\"Kevin Warwick\" rel=\"external_link\" target=\"_blank\">Kevin Warwick<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Lizardman\" title=\"The Lizardman\" rel=\"external_link\" target=\"_blank\">The Lizardman<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Enigma_(performer)\" title=\"The Enigma (performer)\" rel=\"external_link\" target=\"_blank\">The Enigma<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Microchip_implant_(human)\" title=\"Microchip implant (human)\" rel=\"external_link\" target=\"_blank\">Microchip implant (human)<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-norton-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-norton_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-norton_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-norton_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-norton_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-norton_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Norton, Quinn (8 Mar 2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.wired.com\/culture\/lifestyle\/news\/2006\/03\/70322\" target=\"_blank\">\"Body Artists Customize Your Flesh\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wired_Magazine\" class=\"mw-redirect\" title=\"Wired Magazine\" rel=\"external_link\" target=\"_blank\">Wired Magazine<\/a><\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">15 Dec<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Wired+Magazine&rft.atitle=Body+Artists+Customize+Your+Flesh&rft.date=2006-03-08&rft.au=Norton%2C+Quinn&rft_id=https%3A%2F%2Fwww.wired.com%2Fculture%2Flifestyle%2Fnews%2F2006%2F03%2F70322&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASubdermal+implant\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-berry-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-berry_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Berry, Richard. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/blogs.news.com.au\/heraldsun\/richardberry\/index.php\/heraldsun\/comments\/implants_anybody\/\" target=\"_blank\">\"Seen my knuckle-duster, anywhere?\"<\/a>. <i>Herald Sun<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Herald+Sun&rft.atitle=Seen+my+knuckle-duster%2C+anywhere%3F&rft.au=Berry%2C+Richard&rft_id=http%3A%2F%2Fblogs.news.com.au%2Fheraldsun%2Frichardberry%2Findex.php%2Fheraldsun%2Fcomments%2Fimplants_anybody%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASubdermal+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-doi10.1001\/archneur.60.10.1369|noedit-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-doi10.1001\/archneur.60.10.1369|noedit_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Warwick, K.; Gasson, M.; Hutt, B.; Goodhew, I.; Kyberd, P.; Andrews, B.; Teddy, P.; Shad, A. (2003). \"The Application of Implant Technology for Cybernetic Systems\". <i>Archives of Neurology<\/i>. <b>60<\/b> (10): 1369\u201373. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Farchneur.60.10.1369\" target=\"_blank\">10.1001\/archneur.60.10.1369<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14568806\" target=\"_blank\">14568806<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+of+Neurology&rft.atitle=The+Application+of+Implant+Technology+for+Cybernetic+Systems&rft.volume=60&rft.issue=10&rft.pages=1369-73&rft.date=2003&rft_id=info%3Adoi%2F10.1001%2Farchneur.60.10.1369&rft_id=info%3Apmid%2F14568806&rft.aulast=Warwick&rft.aufirst=K.&rft.au=Gasson%2C+M.&rft.au=Hutt%2C+B.&rft.au=Goodhew%2C+I.&rft.au=Kyberd%2C+P.&rft.au=Andrews%2C+B.&rft.au=Teddy%2C+P.&rft.au=Shad%2C+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASubdermal+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-klintron-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-klintron_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Klintron (21 May 2007). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070820102157\/http:\/\/www.technoccult.com\/archives\/category\/body-modification\/\" target=\"_blank\">\"Third ear open\"<\/a>. <i>Technoccult<\/i>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.technoccult.com\/archives\/category\/body-modification\" target=\"_blank\">the original<\/a> on August 20, 2007<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">15 Dec<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Technoccult&rft.atitle=Third+ear+open&rft.date=2007-05-21&rft.au=Klintron&rft_id=http%3A%2F%2Fwww.technoccult.com%2Farchives%2Fcategory%2Fbody-modification&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASubdermal+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-church-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-church_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-church_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-church_5-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-church_5-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20071210073917\/http:\/\/uscobm.com\/aftercare\/implant.asp?title=Implant%20aftercare\" target=\"_blank\">\"Implant Aftercare\"<\/a>. The Church of Body Modification. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.uscobm.com\/aftercare\/implant.asp?title=Implant%20aftercare\" target=\"_blank\">the original<\/a> on 2007-12-10<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">15 Dec<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Implant+Aftercare&rft.pub=The+Church+of+Body+Modification&rft_id=http%3A%2F%2Fwww.uscobm.com%2Faftercare%2Fimplant.asp%3Ftitle%3DImplant%2520aftercare&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASubdermal+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Harrison,I., Warwick,K. and Ruiz,V. (2018), \"Subdermal Magnetic Implants: An Experimental Study\", Cybernetics and Systems, 49(2), 122-150.<\/span>\n<\/li>\n<li id=\"cite_note-sirvin-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-sirvin_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sirvin, Irving; Diaz, Soledad; Holma, Pentti; Alvarez-Sanchez, Francisco; Robertson, Dale N. (1983). \"A Four-Year Clinical Study of NORPLANT Implants\". <i>Studies in Family Planning<\/i>. <b>14<\/b> (6\u20137): 184. <a href=\"https:\/\/en.wikipedia.org\/wiki\/JSTOR\" title=\"JSTOR\" rel=\"external_link\" target=\"_blank\">JSTOR<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.jstor.org\/stable\/1965499\" target=\"_blank\">1965499<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Studies+in+Family+Planning&rft.atitle=A+Four-Year+Clinical+Study+of+NORPLANT+Implants&rft.volume=14&rft.issue=6%E2%80%937&rft.pages=184&rft.date=1983&rft_id=%2F%2Fwww.jstor.org%2Fstable%2F1965499&rft.au=Sirvin%2C+Irving&rft.au=Diaz%2C+Soledad&rft.au=Holma%2C+Pentti&rft.au=Alvarez-Sanchez%2C+Francisco&rft.au=Robertson%2C+Dale+N.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASubdermal+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">BME contributors (May 3, 2006). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/wiki.bmezine.com\/index.php\/Genital_Ribs\" target=\"_blank\">\"Genital Ribs\"<\/a>. <i>BMEzine Encyclopaedia<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">August 27,<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=BMEzine+Encyclopaedia&rft.atitle=Genital+Ribs&rft.date=2006-05-03&rft.au=BME+contributors&rft_id=http%3A%2F%2Fwiki.bmezine.com%2Findex.php%2FGenital_Ribs&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASubdermal+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-jirkova-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-jirkova_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-jirkova_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Jirkova, Klara (Summer 2007). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20071029175442\/http:\/\/www.digital.udk-berlin.de\/en\/projects\/summer07\/haupt\/bodytech\/braille.html\" target=\"_blank\">\"Braille Tattoo\"<\/a>. Universit\u00e4t der K\u00fcnste Berlin. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.digital.udk-berlin.de\/en\/projects\/summer07\/haupt\/bodytech\/braille.html\" target=\"_blank\">the original<\/a> on 2007-10-29<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">15 Dec<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Braille+Tattoo&rft.pub=Universit%C3%A4t+der+K%C3%BCnste+Berlin&rft.date=2007&rft.au=Jirkova%2C+Klara&rft_id=http%3A%2F%2Fwww.digital.udk-berlin.de%2Fen%2Fprojects%2Fsummer07%2Fhaupt%2Fbodytech%2Fbraille.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASubdermal+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">BME contributors (September 13, 2006). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/wiki.bmezine.com\/index.php\/Implant_Subdermal_Shifting\" target=\"_blank\">\"Implant Subdermal Shifting\"<\/a>. <i>BMEzine Encyclopaedia<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">August 27,<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=BMEzine+Encyclopaedia&rft.atitle=Implant+Subdermal+Shifting&rft.date=2006-09-13&rft.au=BME+contributors&rft_id=http%3A%2F%2Fwiki.bmezine.com%2Findex.php%2FImplant_Subdermal_Shifting&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASubdermal+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hlthedu.com\" target=\"_blank\">\"Home Page\"<\/a>. Health Educators Inc. 9 Dec 2007<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">15 Dec<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Home+Page&rft.pub=Health+Educators+Inc&rft.date=2007-12-09&rft_id=http%3A%2F%2Fwww.hlthedu.com&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASubdermal+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<ul><li><cite class=\"citation book\">Hewitt, Kim (1996). <i>Mutilating the Body: Identity in Blood and Ink<\/i>. Bowling Green, Ohio: Bowling Green State University Popular Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0879727109.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Mutilating+the+Body%3A+Identity+in+Blood+and+Ink&rft.place=Bowling+Green%2C+Ohio&rft.pub=Bowling+Green+State+University+Popular+Press&rft.date=1996&rft.isbn=978-0879727109&rft.aulast=Hewitt&rft.aufirst=Kim&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASubdermal+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/uscobm.com\/\" target=\"_blank\">The Church of Body Modification<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ccs.mq.edu.au\/bodmod\/callforpapers.html\" target=\"_blank\">Body Modification Conference<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1251\nCached time: 20181207025354\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.260 seconds\nReal time usage: 0.368 seconds\nPreprocessor visited node count: 1083\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 25366\/2097152 bytes\nTemplate argument size: 1995\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 30119\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.151\/10.000 seconds\nLua memory usage: 4.15 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 317.741 1 -total\n<\/p>\n<pre>48.85% 155.212 1 Template:Reflist\n29.42% 93.494 8 Template:Cite_web\n17.85% 56.728 3 Template:Fix\n17.44% 55.400 2 Template:Better_source\n17.02% 54.083 1 Template:Commons_category\n11.96% 37.997 2 Template:Cite_journal\n10.65% 33.851 3 Template:Category_handler\n 7.81% 24.813 1 Template:Main\n 5.77% 18.324 3 Template:Delink\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:908714-1!canonical and timestamp 20181207025354 and revision id 841694614\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Subdermal_implant\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212157\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.139 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 133.096 1 - wikipedia:Subdermal_implant\n100.00% 133.096 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8076-0!*!*!*!*!*!* and timestamp 20181217212157 and revision id 24190\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Subdermal_implant\">https:\/\/www.limswiki.org\/index.php\/Subdermal_implant<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","2689a937df4d5b6fdb5829738ec1d44b_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/Bodymodificationimplantball.jpg\/440px-Bodymodificationimplantball.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/74\/Dermal_punch.jpg\/440px-Dermal_punch.jpg"],"2689a937df4d5b6fdb5829738ec1d44b_timestamp":1545081717,"8ecf7e3e1dde5ea95d7d06887a61f322_type":"article","8ecf7e3e1dde5ea95d7d06887a61f322_title":"Subcutaneous implantable cardioverter-defibrillator","8ecf7e3e1dde5ea95d7d06887a61f322_url":"https:\/\/www.limswiki.org\/index.php\/Subcutaneous_implantable_cardioverter-defibrillator","8ecf7e3e1dde5ea95d7d06887a61f322_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSubcutaneous implantable cardioverter-defibrillator\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tTypeImplantable cardioverter-defibrillator ManufacturerBoston ScientificWebsite(www.s-icd.eu)\nThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (March 2016) (Learn how and when to remove this template message)\nThis article reads like a review rather than an encyclopedic description of the subject. Please help improve this article to make it neutral in tone and meet Wikipedia's quality standards. (March 2016)\nThe S-ICD System is a Subcutaneous (under the skin) Implantable Cardioverter Defibrillator for people who are at risk of Sudden Cardiac Arrest. The US S-ICD Patient Information website (www.sicdsystem.com) and European S-ICD Patient Information website (www.s-icd.eu) provides more information, including pictures of patients having a Subcutaneous ICD fitted and videos of patients talking about their experience of living with a Subcutaneous ICD.\r\n\nUnlike a transvenous ICD, in which leads are fed into the heart through a vein and attached to the heart wall, the electrodes of the S-ICD are placed just under the skin and not in the heart; leaving the heart and veins untouched and intact.\nOne of the reasons the S-ICD was developed was to reduce the risk of complications associated with transvenous leads. Potential complications, such as infections in the bloodstream and the need to remove or replace the leads in the heart, are minimised or entirely eliminated with the S-ICD System.\n\nContents \n\n1 Transvenous ICD (leads in the heart) \n\n1.1 Pros \n1.2 Cons \n\n\n2 The S-ICD or Subcutaneous ICD (no lead in the heart but under the skin) \n\n2.1 Pros \n2.2 Cons \n\n\n3 Implant procedure Transvenous ICD versus Subcutaneous ICD \n4 External links \n\n\n Transvenous ICD (leads in the heart) \nPros \nThis pulse generator is smaller than the S-ICD pulse generator which may result in a less visible implanted device. This could improve the time needed to get used to the implantable device, although this is subjective.\n\nCons \nThe lead goes into the vein and heart and will grow into the heart wall over time. This may increase the chance of complications if the lead system needs to be removed or replaced, as the procedure to extract a cardiac lead can be a challenge. Because the lead needs to go into the heart it needs to be relatively thin and flexible, since it has to pass through (and remain in) the heart valve(s) and needs to flex with every heartbeat. This makes the lead more vulnerable to lead fracture (and therefore complications). Due to the position of the pulse generator under the collarbone, it can be more visible with certain clothing.\n\n The S-ICD or Subcutaneous ICD (no lead in the heart but under the skin) \nPros \nThe lead does not go into the heart which means it leaves the vein and heart completely intact. This reduces chance of complications (e.g. systemic infections). Because the lead does not go into the heart it can be thicker and more robust. This minimizes \/ reduces the chance of lead fracture. In the event the system needs to be explanted, the procedure is a relatively simple surgical procedure.\n\nCons \nThe pulse generator is larger than most transvenous ICD pulse generators. This could result in a longer time needed to get used to it, although this is subjective. Depending on the physique of a person, the S-ICD may be more visible with bare chest.\n\nImplant procedure Transvenous ICD versus Subcutaneous ICD \n\n\n\nTransvenous ICD implant procedure\nSubcutaneous ICD implant procedure\n\n\nA transvenous ICD is typically implanted in the left shoulder area, near the collarbone. Occasionally the right side is preferred for certain patients or other specific reasons.\nIn contrast to a transvenous ICD, the pulse generator is implanted on the left side of the chest next to the rib cage, just under the arm, and the lead is implanted just under the skin above the breastbone.\n\n\nUsing X-ray imaging (fluoroscopy), the leads are fed through a vein into the heart and through the heart valve(s) into the heart.\nGuided by anatomical landmarks and\/or an X-ray image, the Subcutaneous ICD electrode is tunneled under the skin. The Subcutaneous ICD delivers therapy without the need for wires implanted in the heart.\n\n\nDepending on your heart condition, 1, 2 or 3 leads will be placed in the heart. Once the leads are put in place, they are attached to the heart wall for optimal connectivity.\nThe Subcutaneous ICD leaves the heart and blood vessels untouched and intact.\n\nExternal links \nhttp:\/\/www.s-icd.eu\nhttp:\/\/www.bostonscientific.com\/en-EU\/products\/defibrillators\/s-icd-emblem.html\nhttp:\/\/www.sicdsystem.com\/en-US\/home.html\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Subcutaneous_implantable_cardioverter-defibrillator\">https:\/\/www.limswiki.org\/index.php\/Subcutaneous_implantable_cardioverter-defibrillator<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 19:55.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 479 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","8ecf7e3e1dde5ea95d7d06887a61f322_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Subcutaneous_implantable_cardioverter-defibrillator skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Subcutaneous implantable cardioverter-defibrillator<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n\n<p>The S-ICD System is a Subcutaneous (under the skin) Implantable Cardioverter <a href=\"https:\/\/en.wikipedia.org\/wiki\/Defibrillator\" class=\"mw-redirect\" title=\"Defibrillator\" rel=\"external_link\" target=\"_blank\">Defibrillator<\/a> for people who are at risk of Sudden Cardiac Arrest. The US S-ICD Patient Information website <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sicdsystem.com\/en-US\/home.html\" target=\"_blank\">(www.sicdsystem.com)<\/a> and European S-ICD Patient Information website <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.s-icd.eu\/\" target=\"_blank\">(www.s-icd.eu)<\/a> provides more information, including pictures of patients having a Subcutaneous ICD fitted and videos of patients talking about their experience of living with a Subcutaneous ICD.<br \/>\n<\/p><p>Unlike a transvenous ICD, in which leads are fed into the heart through a vein and attached to the heart wall, the electrodes of the S-ICD are placed just under the skin and not in the heart; leaving the heart and veins untouched and intact.\n<\/p><p>One of the reasons the S-ICD was developed was to reduce the risk of complications associated with transvenous leads. Potential complications, such as infections in the bloodstream and the need to remove or replace the leads in the heart, are minimised or entirely eliminated with the S-ICD System.\n<\/p>\n\n<h2><span id=\"rdp-ebb-Transvenous_ICD_.28leads_in_the_heart.29\"><\/span><span class=\"mw-headline\" id=\"Transvenous_ICD_(leads_in_the_heart)\">Transvenous ICD (leads in the heart)<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Pros\">Pros<\/span><\/h3>\n<p>This pulse generator is smaller than the S-ICD pulse generator which may result in a less visible implanted device. This could improve the time needed to get used to the implantable device, although this is subjective.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Cons\">Cons<\/span><\/h3>\n<p>The lead goes into the vein and heart and will grow into the heart wall over time. This may increase the chance of complications if the lead system needs to be removed or replaced, as the procedure to extract a cardiac lead can be a challenge. Because the lead needs to go into the heart it needs to be relatively thin and flexible, since it has to pass through (and remain in) the heart valve(s) and needs to flex with every heartbeat. This makes the lead more vulnerable to lead fracture (and therefore complications). Due to the position of the pulse generator under the collarbone, it can be more visible with certain clothing.\n<\/p>\n<h2><span id=\"rdp-ebb-The_S-ICD_or_Subcutaneous_ICD_.28no_lead_in_the_heart_but_under_the_skin.29\"><\/span><span class=\"mw-headline\" id=\"The_S-ICD_or_Subcutaneous_ICD_(no_lead_in_the_heart_but_under_the_skin)\">The S-ICD or Subcutaneous ICD (no lead in the heart but under the skin)<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Pros_2\">Pros<\/span><\/h3>\n<p>The lead does not go into the heart which means it leaves the vein and heart completely intact. This reduces chance of complications (e.g. systemic infections). Because the lead does not go into the heart it can be thicker and more robust. This minimizes \/ reduces the chance of lead fracture. In the event the system needs to be explanted, the procedure is a relatively simple surgical procedure.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Cons_2\">Cons<\/span><\/h3>\n<p>The pulse generator is larger than most transvenous ICD pulse generators. This could result in a longer time needed to get used to it, although this is subjective. Depending on the physique of a person, the S-ICD may be more visible with bare chest.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Implant_procedure_Transvenous_ICD_versus_Subcutaneous_ICD\">Implant procedure Transvenous ICD versus Subcutaneous ICD<\/span><\/h2>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Transvenous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implantable_cardioverter-defibrillator\" title=\"Implantable cardioverter-defibrillator\" rel=\"external_link\" target=\"_blank\">ICD<\/a> implant procedure<\/th>\n<th>Subcutaneous ICD implant procedure\n<\/th><\/tr>\n<tr>\n<td>A transvenous ICD is typically implanted in the left shoulder area, near the collarbone. Occasionally the right side is preferred for certain patients or other specific reasons.<\/td>\n<td>In contrast to a transvenous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implantable_cardioverter-defibrillator\" title=\"Implantable cardioverter-defibrillator\" rel=\"external_link\" target=\"_blank\">ICD<\/a>, the pulse generator is implanted on the left side of the chest next to the rib cage, just under the arm, and the lead is implanted just under the skin above the breastbone.\n<\/td><\/tr>\n<tr>\n<td>Using X-ray imaging (fluoroscopy), the leads are fed through a vein into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart\" title=\"Heart\" rel=\"external_link\" target=\"_blank\">heart<\/a> and through the heart valve(s) into the heart.<\/td>\n<td>Guided by anatomical landmarks and\/or an X-ray image, the Subcutaneous ICD electrode is tunneled under the skin. The Subcutaneous ICD delivers therapy without the need for wires implanted in the heart.\n<\/td><\/tr>\n<tr>\n<td>Depending on your heart condition, 1, 2 or 3 leads will be placed in the heart. Once the leads are put in place, they are attached to the heart wall for optimal connectivity.<\/td>\n<td>The Subcutaneous ICD leaves the heart and blood vessels untouched and intact.\n<\/td><\/tr><\/tbody><\/table>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.s-icd.eu\" target=\"_blank\">http:\/\/www.s-icd.eu<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.bostonscientific.com\/en-EU\/products\/defibrillators\/s-icd-emblem.html\" target=\"_blank\">http:\/\/www.bostonscientific.com\/en-EU\/products\/defibrillators\/s-icd-emblem.html<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.sicdsystem.com\/en-US\/home.html\" target=\"_blank\">http:\/\/www.sicdsystem.com\/en-US\/home.html<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1329\nCached time: 20181207061116\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.120 seconds\nReal time usage: 0.202 seconds\nPreprocessor visited node count: 455\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 11186\/2097152 bytes\nTemplate argument size: 337\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 0\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.067\/10.000 seconds\nLua memory usage: 2.56 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 178.329 1 -total\n<\/p>\n<pre>62.68% 111.776 1 Template:Infobox_product\n60.23% 107.408 1 Template:Infobox\n25.76% 45.934 1 Template:Refimprove\n21.93% 39.104 2 Template:Ambox\n11.49% 20.489 1 Template:Review\n 8.41% 14.991 1 Template:DMCA\n 7.10% 12.653 1 Template:Dated_maintenance_category\n 5.01% 8.934 1 Template:FULLROOTPAGENAME\n 3.49% 6.230 1 Template:Ns_has_subpages\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:47127924-1!canonical and timestamp 20181207061116 and revision id 751624804\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Subcutaneous_Implantable_Defibrillator_%28S-ICD%29\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212157\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.146 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 140.855 1 - wikipedia:Subcutaneous_Implantable_Defibrillator_(S-ICD)\n100.00% 140.855 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8262-0!*!*!*!*!*!* and timestamp 20181217212157 and revision id 24472\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Subcutaneous_implantable_cardioverter-defibrillator\">https:\/\/www.limswiki.org\/index.php\/Subcutaneous_implantable_cardioverter-defibrillator<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","8ecf7e3e1dde5ea95d7d06887a61f322_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png"],"8ecf7e3e1dde5ea95d7d06887a61f322_timestamp":1545081717,"58019a67491b49b0f7e7f687e222c2d6_type":"article","58019a67491b49b0f7e7f687e222c2d6_title":"Stent","58019a67491b49b0f7e7f687e222c2d6_url":"https:\/\/www.limswiki.org\/index.php\/Stent","58019a67491b49b0f7e7f687e222c2d6_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tStent\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is about the medical topic. For people named Stent, see Stent (surname). For other uses, see Stent (disambiguation).\nStent3D rendering of a stent in a coronary arteryMeSHD015607 MedlinePlus002303 [edit on Wikidata]\nIn medicine, a stent is a metal or plastic tube inserted into the lumen of an anatomic vessel or duct to keep the passageway open, and stenting is the placement of a stent. There is a wide variety of stents used for different purposes, from expandable coronary, vascular and biliary stents, to simple plastic stents used to allow the flow of urine between kidney and bladder. \"Stent\" is also used as a verb to describe the placement of such a device, particularly when a disease such as atherosclerosis has pathologically narrowed a structure such as an artery.\nA stent should be differentiated from a shunt. A shunt is a tube that connects two previously unconnected parts of the body to allow fluid to flow between them. Stents and shunts can be made of similar materials but perform two different tasks.[1]\n\nContents \n\n1 Stent types \n2 Etymology \n3 History \n4 See also \n5 References \n6 External links \n\n\nStent types \n\n\n\nType and description\n\nIllustration\n\n\nCoronary stents are placed during a coronary angioplasty. The most common use for coronary stents is in the coronary arteries, into which a bare-metal stent, a drug-eluting stent, a bioabsorbable stent, a dual-therapy stent (combination of both drug and bioengineered stent), or occasionally a covered stent is inserted.\n\n A coronary stent\n\n\nVascular stents are commonly placed as part of peripheral artery angioplasty. Common sites treated with peripheral artery stents include the carotid, iliac, and femoral arteries. Because of the external compression and mechanical forces subjected to these locations, flexible stent materials such as nitinol are used in a majority of peripheral stent placements.[2]\n\n Compressed and expanded peripheral artery stents\n\n\nA stent graft or covered stent is type of vascular stent with a fabric coating that creates a contained tube but is expandable like a bare metal stent. Covered stents are used in endovascular surgical procedures such as endovascular aneurysm repair. Stent grafts are also used to treat stenoses in vascular grafts and fistulas used for hemodialysis.\n\n\n\n\nUreteral stents are used to ensure the patency of a ureter, which may be compromised, for example, by a kidney stone. This method is sometimes used as a temporary measure to prevent damage to a blocked kidney until a procedure to remove the stone can be performed.\n\n Example of a ureteral stent used to alleviate hydronephrosis of the kidney\n\n\nProstatic stents are places from the bladder through the prostatic and penile urethra to allow drainage of the bladder through the penis. This is sometimes required in benign prostatic hypertrophy.\n\n Example of a stent\/catheter used in the prostate to treat an enlarged prostate and provide relief in cases of obstructed urination\n\n\nEsophageal stents are a palliative treatment for advanced esophageal cancer.\n\n Endoscopic image of a self-expanding metallic stent in an esophagus, used to palliatively treat esophageal cancer\n\n\nBiliary stents provide bile drainage from the gallbladder, pancreas, and bile ducts to the duodenum in conditions such as ascending cholangitis due to obstructing gallstones.\n\n Endoscopic image of a biliary stent seen protruding from the ampulla of Vater at the time of duodenoscopy\n\n\nGlaucoma drainage stents are recent developments and are awaiting approval in some countries. They are used to reduce intraocular pressure by providing a drainage channel.\n\n\n\n\nOther types are duodenal stents, colonic stents, and pancreatic stents, the designations referring to the location of their placement.\n\n\n\nEtymology \nAs Ariel Roguin describes in his paper \"Stent: The Man and Word Behind the Coronary Metal Prosthesis\", the current acceptable origin of the word stent is that it derives from the name of a dentist, Charles Thomas Stent, notable for his advances in the field of denture-making. He was born in Brighton, England, on October 17, 1807, was a dentist in London, and is most famous for improving and modifying the denture base of the gutta-percha, creating the Stent's compounding that made it practical as a material for dental impressions.\nThe verb form \"stenting\" was used for centuries to describe the process of stiffening garments (a usage long obsolete, per the Oxford English Dictionary) and some believe this to be the origin. According to the Merriam Webster Third New International Dictionary, the noun evolved from the Middle English verb stenten, shortened from extenten, meaning to stretch, which in turn came from Latin extentus, past participle of extendere, to stretch out. Others attribute the noun \"stent\" to Jan F. Esser, a Dutch plastic surgeon who in 1916 used the word to describe a dental impression compound invented in 1856 by the English dentist Charles Stent (1807–1885), whom Esser employed to craft a form for facial reconstruction. The full account is described in the Journal of the History of Dentistry.[3] According to the author, from the use of Stent's compound as a support for facial tissues evolved the use of a stent to hold open various bodily structures.\nThe first (self-expanding) \"stents\" used in medical practice in 1986 by Ulrich Sigwart in Lausanne were initially called \"Wallstents\" after its inventor, Hans Wallst\u00e9n.[4][5]\nJulio Palmaz et al. created a balloon-expandable stent that is currently used.[6]\n\n<\/p>\nHistory \nThe first use of a coronary stent is typically attributed to Jacques Puel and Ulrich Sigwart when they implanted a stent into a patient in Toulouse, France, in 1986.[7] It was used as a scaffold to prevent the vessel from closing and to avoid restenosis in coronary surgery\u2014a condition where scar tissue grows within the stent and interferes with vascular flow. Shortly thereafter, in 1987, Julio Palmaz (known for patenting a balloon-expandable stent [8]) and Richard Schatz implanted their similar stent into a patient in Germany. \nThough several doctors have been credited with the creation of the stent, the first FDA-approved stent was invented by Cesare Gianturco and Gary S. Roubin and approved in 1993.[9]\nTo further reduce the incidence of restenosis, the drug-eluting stent was introduced in 2003. [10]\n\nSee also \nBioresorbable stent\nBronchoscopy\nColonoscopy\nEsophagogastroduodenoscopy\nGrommet\nInterventional radiology\nReferences \n\n\n^ Health, Center for Devices and Radiological. \"Cerebral Spinal Fluid (CSF) Shunt Systems\". www.fda.gov. Retrieved 2017-09-25 . \n\n^ Vogel, T; Shindelman, L.; Nackman, G.; Graham, A. (2003). \"Efficacious Use of Nitinol Stents in the Femoral and Popliteal Arteries\". Journal of Vascular Surgery. 38 (6): 1178\u20131183. doi:10.1016\/j.jvs.2003.09.011. \n\n^ Ring, Malvin (2001). \"How a Dentist's Name Became a Synonym for a Life-saving Device: The Story of Dr. Charles Stent\". Journal of the History of Dentistry. 49 (2): 77\u201380. PMID 11484317. Retrieved 27 January 2015 . \n\n^ Rorsman, Birgitta. \"His invention saves millions of lives | Chalmers\". www.chalmers.se. Retrieved 25 July 2017 . \n\n^ C\u00e9line Bilardo. \"Hans Wallsten, inventor of the stent\". Invivo Magazine. Retrieved 28 September 2016 . \n\n^ Palmaz JC, Sibbitt RR, Reuter SR, Tio FO, Rice WJ (Jul 1985). \"Expandable intraluminal graft: a preliminary study. Work in progress\". Radiology. 156 (1): 73\u201377. doi:10.1148\/radiology.156.1.3159043. PMID 3159043. CS1 maint: Multiple names: authors list (link) \n\n^ Roguin, Ariel (2011). \"Historical Perspectives in Cardiology\". Circulation: Cardiovascular Interventions. 4: 206\u2013209. doi:10.1161\/CIRCINTERVENTIONS.110.960872. Retrieved 6 April 2015 . \n\n^ \"Guide to the Julio Palmaz Papers\". Retrieved 2018-08-24 . \n\n^ Kesselheim AS, Xu S, Avorn, J (Feb 2014). \"EClinicians' Contributions to the Development of Coronary Artery Stents: A Qualitative Study of Transformative Device Innovation\". PLoS One. 9 (2). doi:10.1371\/journal.pone.0088664. PMID 24533133. CS1 maint: Multiple names: authors list (link) \n\n^ Puranek AS, Dawson ER, Peppas NA (Jan 2013). \"Recent Advances in Drug Eluting Stents\". Int J Pharm. 441 (1\u20132). doi:10.1016\/j.ijpharm.2012.10.029. PMID 23117022. CS1 maint: Multiple names: authors list (link) \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Stent.\n\n\n\nLook up stent in Wiktionary, the free dictionary.\nCoronary Stent\nDrug-Eluting Stents \u2014 Angioplasty.Org\nCardiovascular and Interventional Radiological Society of Europe\nThe Cardiovascular Forum\nStent for Life Initiative\nAuthority control \nGND: 4562973-0 \nNDL: 01155269 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Stent\">https:\/\/www.limswiki.org\/index.php\/Stent<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 17:47.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 538 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","58019a67491b49b0f7e7f687e222c2d6_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Stent skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Stent<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">This article is about the medical topic. For people named Stent, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent_(surname)\" title=\"Stent (surname)\" rel=\"external_link\" target=\"_blank\">Stent (surname)<\/a>. For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent_(disambiguation)\" class=\"mw-disambig\" title=\"Stent (disambiguation)\" rel=\"external_link\" target=\"_blank\">Stent (disambiguation)<\/a>.<\/div>\n\n<p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medicine<\/a>, a <b>stent<\/b> is a metal or plastic tube inserted into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lumen_(anatomy)\" title=\"Lumen (anatomy)\" rel=\"external_link\" target=\"_blank\">lumen<\/a> of an anatomic vessel or duct to keep the passageway open, and <b>stenting<\/b> is the placement of a stent. There is a wide variety of stents used for different purposes, from expandable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_stent\" title=\"Coronary stent\" rel=\"external_link\" target=\"_blank\">coronary<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endovascular_surgery\" class=\"mw-redirect\" title=\"Endovascular surgery\" rel=\"external_link\" target=\"_blank\">vascular<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bile_duct\" title=\"Bile duct\" rel=\"external_link\" target=\"_blank\">biliary<\/a> stents, to simple plastic stents used to allow the flow of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urine\" title=\"Urine\" rel=\"external_link\" target=\"_blank\">urine<\/a> between <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney\" title=\"Kidney\" rel=\"external_link\" target=\"_blank\">kidney<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bladder\" class=\"mw-redirect\" title=\"Bladder\" rel=\"external_link\" target=\"_blank\">bladder<\/a>. \"Stent\" is also used as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Verb\" title=\"Verb\" rel=\"external_link\" target=\"_blank\">verb<\/a> to describe the placement of such a device, particularly when a disease such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atherosclerosis\" title=\"Atherosclerosis\" rel=\"external_link\" target=\"_blank\">atherosclerosis<\/a> has <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pathology\" title=\"Pathology\" rel=\"external_link\" target=\"_blank\">pathologically<\/a> narrowed a structure such as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">artery<\/a>.\n<\/p><p>A stent should be differentiated from a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shunt_(medical)\" title=\"Shunt (medical)\" rel=\"external_link\" target=\"_blank\">shunt<\/a>. A shunt is a tube that connects two previously unconnected parts of the body to allow fluid to flow between them. Stents and shunts can be made of similar materials but perform two different tasks.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Stent_types\">Stent types<\/span><\/h2>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Type and description\n<\/th>\n<th>Illustration\n<\/th><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_stent\" title=\"Coronary stent\" rel=\"external_link\" target=\"_blank\">Coronary stents<\/a> are placed during a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angioplasty\" title=\"Angioplasty\" rel=\"external_link\" target=\"_blank\">coronary angioplasty<\/a>. The most common use for coronary stents is in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery\" class=\"mw-redirect\" title=\"Coronary artery\" rel=\"external_link\" target=\"_blank\">coronary arteries<\/a>, into which a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bare-metal_stent\" title=\"Bare-metal stent\" rel=\"external_link\" target=\"_blank\">bare-metal stent<\/a>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug-eluting_stent\" title=\"Drug-eluting stent\" rel=\"external_link\" target=\"_blank\">drug-eluting stent<\/a>, a bioabsorbable stent, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Genous\" title=\"Genous\" rel=\"external_link\" target=\"_blank\">dual-therapy stent<\/a> (combination of both drug and bioengineered stent), or occasionally a covered stent is inserted.\n<\/td>\n<td><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Taxus_stent_FDA.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5c\/Taxus_stent_FDA.jpg\/220px-Taxus_stent_FDA.jpg\" width=\"220\" height=\"161\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Taxus_stent_FDA.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A coronary stent<\/div><\/div><\/div>\n<\/td><\/tr>\n<tr>\n<td>Vascular stents are commonly placed as part of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angioplasty#Peripheral_angioplasty\" title=\"Angioplasty\" rel=\"external_link\" target=\"_blank\">peripheral artery angioplasty<\/a>. Common sites treated with peripheral artery stents include the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carotid_artery\" title=\"Carotid artery\" rel=\"external_link\" target=\"_blank\">carotid<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Common_iliac_artery\" title=\"Common iliac artery\" rel=\"external_link\" target=\"_blank\">iliac<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femoral_artery\" title=\"Femoral artery\" rel=\"external_link\" target=\"_blank\">femoral<\/a> arteries. Because of the external compression and mechanical forces subjected to these locations, flexible stent materials such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nitinol\" class=\"mw-redirect\" title=\"Nitinol\" rel=\"external_link\" target=\"_blank\">nitinol<\/a> are used in a majority of peripheral stent placements.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/td>\n<td><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Stent4_fcm.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/48\/Stent4_fcm.jpg\/220px-Stent4_fcm.jpg\" width=\"220\" height=\"301\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Stent4_fcm.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Compressed and expanded peripheral artery stents<\/div><\/div><\/div>\n<\/td><\/tr>\n<tr>\n<td>A stent graft or covered stent is type of vascular stent with a fabric coating that creates a contained tube but is expandable like a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bare-metal_stent\" title=\"Bare-metal stent\" rel=\"external_link\" target=\"_blank\">bare metal stent<\/a>. Covered stents are used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endovascular_surgery\" class=\"mw-redirect\" title=\"Endovascular surgery\" rel=\"external_link\" target=\"_blank\">endovascular surgical<\/a> procedures such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endovascular_aneurysm_repair\" title=\"Endovascular aneurysm repair\" rel=\"external_link\" target=\"_blank\">endovascular aneurysm repair<\/a>. Stent grafts are also used to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">stenoses<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular_graft\" class=\"mw-redirect\" title=\"Vascular graft\" rel=\"external_link\" target=\"_blank\">vascular grafts<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fistula\" title=\"Fistula\" rel=\"external_link\" target=\"_blank\">fistulas<\/a> used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis#Access\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a>.\n<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ureteric_stent\" title=\"Ureteric stent\" rel=\"external_link\" target=\"_blank\">Ureteral stents<\/a> are used to ensure the patency of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ureter\" title=\"Ureter\" rel=\"external_link\" target=\"_blank\">ureter<\/a>, which may be compromised, for example, by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_stone\" class=\"mw-redirect\" title=\"Kidney stone\" rel=\"external_link\" target=\"_blank\">kidney stone<\/a>. This method is sometimes used as a temporary measure to prevent damage to a blocked kidney until a procedure to remove the stone can be performed.\n<\/td>\n<td><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Abdominal_Xray_with_uretal_stent.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9b\/Abdominal_Xray_with_uretal_stent.jpg\/220px-Abdominal_Xray_with_uretal_stent.jpg\" width=\"220\" height=\"268\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Abdominal_Xray_with_uretal_stent.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Example of a ureteral stent used to alleviate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydronephrosis\" title=\"Hydronephrosis\" rel=\"external_link\" target=\"_blank\">hydronephrosis<\/a> of the kidney<\/div><\/div><\/div>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostatic_stent\" title=\"Prostatic stent\" rel=\"external_link\" target=\"_blank\">Prostatic stents<\/a> are places from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bladder\" class=\"mw-redirect\" title=\"Bladder\" rel=\"external_link\" target=\"_blank\">bladder<\/a> through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostatic_urethra\" title=\"Prostatic urethra\" rel=\"external_link\" target=\"_blank\">prostatic<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Penile_urethra\" class=\"mw-redirect\" title=\"Penile urethra\" rel=\"external_link\" target=\"_blank\">penile urethra<\/a> to allow drainage of the bladder through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Penis\" title=\"Penis\" rel=\"external_link\" target=\"_blank\">penis<\/a>. This is sometimes required in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Benign_prostatic_hypertrophy\" class=\"mw-redirect\" title=\"Benign prostatic hypertrophy\" rel=\"external_link\" target=\"_blank\">benign prostatic hypertrophy<\/a>.\n<\/td>\n<td><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Spanner_insitu.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/97\/Spanner_insitu.jpg\/220px-Spanner_insitu.jpg\" width=\"220\" height=\"211\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Spanner_insitu.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Example of a stent\/catheter used in the prostate to treat an enlarged prostate and provide relief in cases of obstructed urination<\/div><\/div><\/div>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophageal_stent\" title=\"Esophageal stent\" rel=\"external_link\" target=\"_blank\">Esophageal stents<\/a> are a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Palliative_care\" title=\"Palliative care\" rel=\"external_link\" target=\"_blank\">palliative<\/a> treatment for advanced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophageal_cancer\" title=\"Esophageal cancer\" rel=\"external_link\" target=\"_blank\">esophageal cancer<\/a>.\n<\/td>\n<td><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:SEMS_endo.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6a\/SEMS_endo.jpg\/220px-SEMS_endo.jpg\" width=\"220\" height=\"213\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:SEMS_endo.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophagogastroduodenoscopy\" title=\"Esophagogastroduodenoscopy\" rel=\"external_link\" target=\"_blank\">Endoscopic<\/a> image of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Self-expanding_metallic_stent\" class=\"mw-redirect\" title=\"Self-expanding metallic stent\" rel=\"external_link\" target=\"_blank\">self-expanding metallic stent<\/a> in an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophagus\" title=\"Esophagus\" rel=\"external_link\" target=\"_blank\">esophagus<\/a>, used to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Palliative_care\" title=\"Palliative care\" rel=\"external_link\" target=\"_blank\">palliatively<\/a> treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophageal_cancer\" title=\"Esophageal cancer\" rel=\"external_link\" target=\"_blank\">esophageal cancer<\/a><\/div><\/div><\/div>\n<\/td><\/tr>\n<tr>\n<td>Biliary stents provide <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bile_drainage\" class=\"mw-redirect\" title=\"Bile drainage\" rel=\"external_link\" target=\"_blank\">bile drainage<\/a> from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gallbladder\" title=\"Gallbladder\" rel=\"external_link\" target=\"_blank\">gallbladder<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pancreas\" title=\"Pancreas\" rel=\"external_link\" target=\"_blank\">pancreas<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bile_duct\" title=\"Bile duct\" rel=\"external_link\" target=\"_blank\">bile ducts<\/a> to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Duodenum\" title=\"Duodenum\" rel=\"external_link\" target=\"_blank\">duodenum<\/a> in conditions such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ascending_cholangitis\" title=\"Ascending cholangitis\" rel=\"external_link\" target=\"_blank\">ascending cholangitis<\/a> due to obstructing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gallstone\" title=\"Gallstone\" rel=\"external_link\" target=\"_blank\">gallstones<\/a>.\n<\/td>\n<td><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Biliary_stent_endo.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/c\/cc\/Biliary_stent_endo.jpg\/220px-Biliary_stent_endo.jpg\" width=\"220\" height=\"198\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Biliary_stent_endo.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Endoscopic image of a biliary stent seen protruding from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ampulla_of_Vater\" title=\"Ampulla of Vater\" rel=\"external_link\" target=\"_blank\">ampulla of Vater<\/a> at the time of duodenoscopy<\/div><\/div><\/div>\n<\/td><\/tr>\n<tr>\n<td>Glaucoma drainage stents are recent developments and are awaiting approval in some countries. They are used to reduce intraocular pressure by providing a drainage channel.\n<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>Other types are duodenal stents, colonic stents, and pancreatic stents, the designations referring to the location of their placement.\n<\/td>\n<td>\n<\/td><\/tr><\/tbody><\/table>\n<h2><span class=\"mw-headline\" id=\"Etymology\">Etymology<\/span><\/h2>\n<p>As Ariel Roguin describes in his paper \"Stent: The Man and Word Behind the Coronary Metal Prosthesis\", the current acceptable origin of the word stent is that it derives from the name of a dentist, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Charles_Stent\" title=\"Charles Stent\" rel=\"external_link\" target=\"_blank\">Charles Thomas Stent<\/a>, notable for his advances in the field of denture-making. He was born in Brighton, England, on October 17, 1807, was a dentist in London, and is most famous for improving and modifying the denture base of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gutta-percha\" title=\"Gutta-percha\" rel=\"external_link\" target=\"_blank\">gutta-percha<\/a>, creating the Stent's compounding that made it practical as a material for dental impressions.\n<\/p><p>The verb form \"stenting\" was used for centuries to describe the process of stiffening garments (a usage long obsolete, per the <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxford_English_Dictionary\" title=\"Oxford English Dictionary\" rel=\"external_link\" target=\"_blank\">Oxford English Dictionary<\/a><\/i>) and some believe this to be the origin. According to the Merriam Webster Third New International Dictionary, the noun evolved from the Middle English verb <i>stenten<\/i>, shortened from <i>extenten<\/i>, meaning to stretch, which in turn came from Latin <i>extentus<\/i>, past participle of <i>extendere<\/i>, to stretch out. Others attribute the noun \"stent\" to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jan_F._Esser\" title=\"Jan F. Esser\" rel=\"external_link\" target=\"_blank\">Jan F. Esser<\/a>, a Dutch plastic surgeon who in 1916 used the word to describe a dental impression compound invented in 1856 by the English <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dentist\" title=\"Dentist\" rel=\"external_link\" target=\"_blank\">dentist<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Charles_Stent\" title=\"Charles Stent\" rel=\"external_link\" target=\"_blank\">Charles Stent<\/a> (1807–1885), whom Esser employed to craft a form for facial reconstruction. The full account is described in the <i>Journal of the History of Dentistry<\/i>.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> According to the author, from the use of Stent's compound as a support for facial tissues evolved the use of a stent to hold open various bodily structures.\n<\/p><p>The first (self-expanding) \"stents\" used in medical practice in 1986 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ulrich_Sigwart\" title=\"Ulrich Sigwart\" rel=\"external_link\" target=\"_blank\">Ulrich Sigwart<\/a> in Lausanne were initially called \"Wallstents\" after its inventor, Hans Wallst\u00e9n.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Julio_Palmaz\" title=\"Julio Palmaz\" rel=\"external_link\" target=\"_blank\">Julio Palmaz<\/a> <i>et al.<\/i> created a balloon-expandable stent that is currently used.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The first use of a coronary stent is typically attributed to Jacques Puel and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ulrich_Sigwart\" title=\"Ulrich Sigwart\" rel=\"external_link\" target=\"_blank\">Ulrich Sigwart<\/a> when they implanted a stent into a patient in Toulouse, France, in 1986.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> It was used as a scaffold to prevent the vessel from closing and to avoid <a href=\"https:\/\/en.wikipedia.org\/wiki\/Restenosis\" title=\"Restenosis\" rel=\"external_link\" target=\"_blank\">restenosis<\/a> in coronary surgery\u2014a condition where scar tissue grows within the stent and interferes with vascular flow. Shortly thereafter, in 1987, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Julio_Palmaz\" title=\"Julio Palmaz\" rel=\"external_link\" target=\"_blank\">Julio Palmaz<\/a> (known for patenting a balloon-expandable stent <sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>) and Richard Schatz implanted their similar stent into a patient in Germany. \n<\/p><p>Though several doctors have been credited with the creation of the stent, the first FDA-approved stent was invented by Cesare Gianturco and Gary S. Roubin and approved in 1993.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>To further reduce the incidence of restenosis, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug-eluting_stent\" title=\"Drug-eluting stent\" rel=\"external_link\" target=\"_blank\">drug-eluting stent<\/a> was introduced in 2003. <sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioresorbable_stent\" title=\"Bioresorbable stent\" rel=\"external_link\" target=\"_blank\">Bioresorbable stent<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bronchoscopy\" title=\"Bronchoscopy\" rel=\"external_link\" target=\"_blank\">Bronchoscopy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Colonoscopy\" title=\"Colonoscopy\" rel=\"external_link\" target=\"_blank\">Colonoscopy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophagogastroduodenoscopy\" title=\"Esophagogastroduodenoscopy\" rel=\"external_link\" target=\"_blank\">Esophagogastroduodenoscopy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Grommet\" title=\"Grommet\" rel=\"external_link\" target=\"_blank\">Grommet<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_radiology\" title=\"Interventional radiology\" rel=\"external_link\" target=\"_blank\">Interventional radiology<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Health, Center for Devices and Radiological. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/ImplantsandProsthetics\/CerebralSpinalFluidCSFShuntSystems\/default.htm\" target=\"_blank\">\"Cerebral Spinal Fluid (CSF) Shunt Systems\"<\/a>. <i>www.fda.gov<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-09-25<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.fda.gov&rft.atitle=Cerebral+Spinal+Fluid+%28CSF%29+Shunt+Systems&rft.aulast=Health&rft.aufirst=Center+for+Devices+and+Radiological&rft_id=https%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FProductsandMedicalProcedures%2FImplantsandProsthetics%2FCerebralSpinalFluidCSFShuntSystems%2Fdefault.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStent\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vogel, T; Shindelman, L.; Nackman, G.; Graham, A. (2003). \"Efficacious Use of Nitinol Stents in the Femoral and Popliteal Arteries\". <i>Journal of Vascular Surgery<\/i>. <b>38<\/b> (6): 1178\u20131183. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jvs.2003.09.011\" target=\"_blank\">10.1016\/j.jvs.2003.09.011<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Vascular+Surgery&rft.atitle=Efficacious+Use+of+Nitinol+Stents+in+the+Femoral+and+Popliteal+Arteries.&rft.volume=38&rft.issue=6&rft.pages=1178-1183&rft.date=2003&rft_id=info%3Adoi%2F10.1016%2Fj.jvs.2003.09.011&rft.aulast=Vogel&rft.aufirst=T&rft.au=Shindelman%2C+L.&rft.au=Nackman%2C+G.&rft.au=Graham%2C+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStent\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ring, Malvin (2001). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fauchard.org\/publications\/34-the-story-of-dr-charles-stent\" target=\"_blank\">\"How a Dentist's Name Became a Synonym for a Life-saving Device: The Story of Dr. Charles Stent\"<\/a>. <i>Journal of the History of Dentistry<\/i>. <b>49<\/b> (2): 77\u201380. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11484317\" target=\"_blank\">11484317<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">27 January<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+History+of+Dentistry&rft.atitle=How+a+Dentist%27s+Name+Became+a+Synonym+for+a+Life-saving+Device%3A+The+Story+of+Dr.+Charles+Stent&rft.volume=49&rft.issue=2&rft.pages=77-80&rft.date=2001&rft_id=info%3Apmid%2F11484317&rft.aulast=Ring&rft.aufirst=Malvin&rft_id=http%3A%2F%2Fwww.fauchard.org%2Fpublications%2F34-the-story-of-dr-charles-stent&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStent\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Rorsman, Birgitta. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.chalmers.se\/en\/about-chalmers\/alumni\/chalmersprofiles\/Pages\/His-invention-saves-millions-of-lives.aspx\" target=\"_blank\">\"His invention saves millions of lives | Chalmers\"<\/a>. <i>www.chalmers.se<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">25 July<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.chalmers.se&rft.atitle=His+invention+saves+millions+of+lives+++++%7C+Chalmers&rft.aulast=Rorsman&rft.aufirst=Birgitta&rft_id=http%3A%2F%2Fwww.chalmers.se%2Fen%2Fabout-chalmers%2Falumni%2Fchalmersprofiles%2FPages%2FHis-invention-saves-millions-of-lives.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStent\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">C\u00e9line Bilardo. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.invivomagazine.com\/en\/in_situ\/health_valley\/article\/75\/hans-wallsten-inventor-of-the-stent\" target=\"_blank\">\"Hans Wallsten, inventor of the stent\"<\/a>. <i>Invivo Magazine<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">28 September<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Invivo+Magazine&rft.atitle=Hans+Wallsten%2C+inventor+of+the+stent&rft.au=C%C3%A9line+Bilardo&rft_id=http%3A%2F%2Fwww.invivomagazine.com%2Fen%2Fin_situ%2Fhealth_valley%2Farticle%2F75%2Fhans-wallsten-inventor-of-the-stent&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStent\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Palmaz JC, Sibbitt RR, Reuter SR, Tio FO, Rice WJ (Jul 1985). \"Expandable intraluminal graft: a preliminary study. Work in progress\". <i>Radiology<\/i>. <b>156<\/b> (1): 73\u201377. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1148%2Fradiology.156.1.3159043\" target=\"_blank\">10.1148\/radiology.156.1.3159043<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3159043\" target=\"_blank\">3159043<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Radiology&rft.atitle=Expandable+intraluminal+graft%3A+a+preliminary+study.+Work+in+progress&rft.volume=156&rft.issue=1&rft.pages=73-77&rft.date=1985-07&rft_id=info%3Adoi%2F10.1148%2Fradiology.156.1.3159043&rft_id=info%3Apmid%2F3159043&rft.au=Palmaz+JC%2C+Sibbitt+RR%2C+Reuter+SR%2C+Tio+FO%2C+Rice+WJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStent\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Roguin, Ariel (2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/circinterventions.ahajournals.org\/content\/4\/2\/206.full\" target=\"_blank\">\"Historical Perspectives in Cardiology\"<\/a>. <i>Circulation: Cardiovascular Interventions<\/i>. <b>4<\/b>: 206\u2013209. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1161%2FCIRCINTERVENTIONS.110.960872\" target=\"_blank\">10.1161\/CIRCINTERVENTIONS.110.960872<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">6 April<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Circulation%3A+Cardiovascular+Interventions&rft.atitle=Historical+Perspectives+in+Cardiology&rft.volume=4&rft.pages=206-209&rft.date=2011&rft_id=info%3Adoi%2F10.1161%2FCIRCINTERVENTIONS.110.960872&rft.aulast=Roguin&rft.aufirst=Ariel&rft_id=http%3A%2F%2Fcircinterventions.ahajournals.org%2Fcontent%2F4%2F2%2F206.full&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStent\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/legacy.lib.utexas.edu\/taro\/uthscsa\/00022\/hscsa-00022.html\" target=\"_blank\">\"Guide to the Julio Palmaz Papers\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-08-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Guide+to+the+Julio+Palmaz+Papers&rft_id=https%3A%2F%2Flegacy.lib.utexas.edu%2Ftaro%2Futhscsa%2F00022%2Fhscsa-00022.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStent\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kesselheim AS, Xu S, Avorn, J (Feb 2014). \"EClinicians' Contributions to the Development of Coronary Artery Stents: A Qualitative Study of Transformative Device Innovation\". <i>PLoS One<\/i>. <b>9<\/b> (2). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1371%2Fjournal.pone.0088664\" target=\"_blank\">10.1371\/journal.pone.0088664<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24533133\" target=\"_blank\">24533133<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=PLoS+One&rft.atitle=EClinicians%E2%80%99+Contributions+to+the+Development+of+Coronary+Artery+Stents%3A+A+Qualitative+Study+of+Transformative+Device+Innovation&rft.volume=9&rft.issue=2&rft.date=2014-02&rft_id=info%3Adoi%2F10.1371%2Fjournal.pone.0088664&rft_id=info%3Apmid%2F24533133&rft.au=Kesselheim+AS%2C+Xu+S%2C+Avorn%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStent\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Puranek AS, Dawson ER, Peppas NA (Jan 2013). \"Recent Advances in Drug Eluting Stents\". <i>Int J Pharm<\/i>. <b>441<\/b> (1\u20132). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ijpharm.2012.10.029\" target=\"_blank\">10.1016\/j.ijpharm.2012.10.029<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23117022\" target=\"_blank\">23117022<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Int+J+Pharm&rft.atitle=Recent+Advances+in+Drug+Eluting+Stents&rft.volume=441&rft.issue=1%E2%80%932&rft.date=2013-01&rft_id=info%3Adoi%2F10.1016%2Fj.ijpharm.2012.10.029&rft_id=info%3Apmid%2F23117022&rft.au=Puranek+AS%2C+Dawson+ER%2C+Peppas+NA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStent\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090217155901\/http:\/\/landholt.com\/Heart\/Procedures\/CoronaryStent\/\" target=\"_blank\">Coronary Stent<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ptca.org\/stent.html\" target=\"_blank\">Drug-Eluting Stents \u2014 Angioplasty.Org<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cirse.org\/index.php?pid=85\" target=\"_blank\">Cardiovascular and Interventional Radiological Society of Europe<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cardiovascularCS.org\/\" target=\"_blank\">The Cardiovascular Forum<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100926060532\/http:\/\/escardio.org\/communities\/EAPCI\/Stent-For-Life\/Pages\/welcome.aspx\" target=\"_blank\">Stent for Life Initiative<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1249\nCached time: 20181212003525\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.352 seconds\nReal time usage: 0.465 seconds\nPreprocessor visited node count: 972\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 29306\/2097152 bytes\nTemplate argument size: 437\/2097152 bytes\nHighest expansion depth: 9\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 27934\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.195\/10.000 seconds\nLua memory usage: 4.33 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 379.466 1 -total\n<\/p>\n<pre>42.38% 160.812 1 Template:Reflist\n20.90% 79.317 4 Template:Cite_web\n19.60% 74.391 1 Template:Infobox_medical_intervention\n18.39% 69.784 1 Template:Infobox\n15.67% 59.451 6 Template:Cite_journal\n13.59% 51.563 1 Template:Commons_category\n11.70% 44.413 1 Template:About\n 8.98% 34.063 1 Template:Authority_control\n 3.27% 12.399 1 Template:Commons\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:414962-1!canonical and timestamp 20181212003525 and revision id 870341573\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212157\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.046 seconds\nReal time usage: 0.185 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 179.716 1 - wikipedia:Stent\n100.00% 179.716 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8075-0!*!*!*!*!*!* and timestamp 20181217212156 and revision id 24189\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Stent\">https:\/\/www.limswiki.org\/index.php\/Stent<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","58019a67491b49b0f7e7f687e222c2d6_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/ff\/Blausen_0034_Angioplasty_Stent_01.png\/560px-Blausen_0034_Angioplasty_Stent_01.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/5\/5c\/Taxus_stent_FDA.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/48\/Stent4_fcm.jpg\/440px-Stent4_fcm.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9b\/Abdominal_Xray_with_uretal_stent.jpg\/440px-Abdominal_Xray_with_uretal_stent.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/97\/Spanner_insitu.jpg\/440px-Spanner_insitu.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/6\/6a\/SEMS_endo.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/c\/cc\/Biliary_stent_endo.jpg"],"58019a67491b49b0f7e7f687e222c2d6_timestamp":1545081716,"5ca061f418e733391702327ac6d9a7d3_type":"article","5ca061f418e733391702327ac6d9a7d3_title":"Spinal cord stimulator","5ca061f418e733391702327ac6d9a7d3_url":"https:\/\/www.limswiki.org\/index.php\/Spinal_cord_stimulator","5ca061f418e733391702327ac6d9a7d3_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSpinal cord stimulator\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tSpinal cord stimulatorAnterior view X-ray of a spinal cord stimulator (SCS) implanted in the thoracic spine[edit on Wikidata]\nA Spinal Cord Stimulator (SCS) or Dorsal Column Stimulator (DCS) is a type of implantable neuromodulation device (sometimes called a \"pain pacemaker\") that is used to send electrical signals to select areas of the spinal cord (dorsal columns) for the treatment of certain pain conditions. SCS is a consideration for people who have a pain condition that has not responded to more conservative therapy.[1]\nIn the United States, Failed Back Surgery Syndrome is the most common use while in Europe the most common use is peripheral ischemia.[2]\nAs of 2014 the FDA had approved SCS as a treatment for failed back surgery syndrome (FBSS), chronic pain, Complex Regional Pain Syndrome, intractable angina, as well as visceral abdominal and perineal pain[1] and pain in the extremities from nerve damage.[3]\n\nContents \n\n1 Medical uses \n2 Contraindications \n3 Adverse effects and complications \n4 Mechanism of action \n5 History \n6 Research \n7 See also \n8 References \n\n\nMedical uses \nThe most common use of SCS is failed back surgery syndrome (FBSS) in the United States and peripheral ischemic pain in Europe.[4][5]\nOnce a person has had a psychological evaluation and deemed an appropriate candidate for SCS, a temporary implant is placed, called a trial, to determine the best stimulation pattern, and the person is sent home for three to ten days with an external pulse generator. If pain control and increased activity was achieved, a permanent system, with leads and a pulse generator, is placed.[5]\n\nContraindications \nSCS may be contraindicated in people who have coagulation related disorders, or are on anticoagulant therapy.[1] Other contraindications include local and systemic infection, pacemakers, or those people for whom pre-surgical imaging studies show have anatomy that makes placement difficult, or if concerns arise during psychological evaluation.[6][7][8]\n\nAdverse effects and complications \nComplications with SCS range from simple easily correctable problems to devastating paralysis, nerve injury and death. In a 7-year follow-up, the overall complication rate was 5-18%. The most common complications include lead migration, lead breakage, and infection. Other complications include rotation of the pulse generator, haematomas (subcutaneous or epidural), cerebrospinal fluid (CSF) leak, post dural puncture headache, discomfort at pulse generator site, seroma and transient paraplegia.[9]\nSome people find the tingling sensation caused by SPS to be unpleasant.[10]\nThe most common hardware related complication is lead migration, in which the implanted electrodes move from their original placement. With this complication, recapturing paraesthesia coverage can be attempted with reprogramming.[11] In circumstances involving major lead migration a reoperation may be required to reset the lead placement.[12] Studies differ greatly in reporting the percentage of people who have lead migration but the majority of studies report in the range of 10-25% of lead migration for spinal cord stimulation.[12]\n\nMechanism of action \nThe neurophysiological mechanisms of action of spinal cord stimulation are not completely understood but may involve masking pain sensation with tingling by altering the pain processing of the central nervous system.[10][13] The mechanism of analgesia when SCS is applied in neuropathic pain states may be very different from that involved in analgesia due to limb ischemia.[14][15] In neuropathic pain states, experimental evidence shows that SCS alters the local neurochemistry in dorsal horn, suppressing the hyperexcitability of the neurons. Specifically, there is some evidence for increased levels of GABA release, serotonin, and perhaps suppression of levels of some excitatory amino acids, including glutamate and aspartate. In the case of ischemic pain, analgesia seems to derive from restoration of the oxygen demand supply. This effect could be mediated by inhibition of the sympathetic system, although vasodilation is another possibility. It is also probable that a combination of the two above mentioned mechanisms is involved.[16]\n\nHistory \nElectrotherapy of pain by neurostimulation began shortly after Melzack and Wall proposed the gate control theory in 1965. This theory proposed that nerves carrying painful peripheral stimuli and nerves carrying touch and vibratory sensation both terminate in the dorsal horn (the gate) of spinal cord.[17] It was hypothesized that input to the latter could be manipulated to \u201cclose the gate\u201d to the former. As an application of the gate control theory, Shealy et al.[18] implanted the first spinal cord stimulator device directly on the dorsal column for the treatment of chronic pain and in 1971, Shimogi and colleagues first reported the analgesic properties of epidural spinal cord stimulation. Since then this technique has undergone numerous technical and clinical developments.\nAt this time neurostimulation for the treatment of pain is used with nerve stimulation, spinal cord stimulation, deep brain stimulation, and motor cortex stimulation.\n\nResearch \nSCS has been studied in people with Parkinson's disease[19] and angina pectoris.[20]\nResearch on improving the devices and software has included efforts to increasing the battery life, efforts to develop closed loop control, and combining stimulation with implanted drug delivery systems.[19]\nIn August 2018, The European Commission's Horizon 2020 Future and Emerging Technologies program announced a $3.5 million funding grant for the four-nation project team that is building a prototype of an implant designed to 'rewire' the spinal cord.[21][22]\nIn September 2018, the studied conducted by Mayo Clinic and UCLA reported that spinal cord stimulation supported with physical therapy can help people with paralysis to regain their ability to stand and walk with assistance.[23] \n\nSee also \nTranscutaneous electrical nerve stimulation\nReferences \n\n\n^ a b c McKenzie-Brown, Anne Marie (November 1, 2016). \"Spinal cord stimulation: Placement and management\". UptoDate. \n\n^ Eldabe, Sam; Kumar, Krishna; Buchser, Eric; Taylor, Rod S. (July 2010). \"An analysis of the components of pain, function, and health-related quality of life in patients with failed back surgery syndrome treated with spinal cord stimulation or conventional medical management\". Neuromodulation. 13 (3): 201\u2013209. doi:10.1111\/j.1525-1403.2009.00271.x. PMID 21992833. \n\n^ Song, Jason J.; Popescu, Adrian; Bell, Russell L. (May 2014). \"Present and potential use of spinal cord stimulation to control chronic pain\". Pain Physician. 17 (3): 235\u2013246. PMID 24850105. \n\n^ Turner, J. A.; Loeser, J. D.; Bell, K. G. (December 1995). \"Spinal cord stimulation for chronic low back pain: a systematic literature synthesis\". Neurosurgery. 37 (6): 1088\u20131095, discussion 1095\u20131096. doi:10.1097\/00006123-199512000-00008. PMID 8584149. \n\n^ a b Patel, Vikram B.; Wasserman, Ronald; Imani, Farnad (2015-08-22). \"Interventional Therapies for Chronic Low Back Pain: A Focused Review (Efficacy and Outcomes)\". Anesthesiology and Pain Medicine. 5 (4): e29716. doi:10.5812\/aapm.29716. PMC 4604560 . PMID 26484298. \n\n^ Narouze, Samer; Benzon, Honorio T.; Provenzano, David A.; Buvanendran, Asokumar; De Andres, Jos\u00e9; Deer, Timothy R.; Rauck, Richard; Huntoon, Marc A. (May 2015). \"Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain\". Regional Anesthesia and Pain Medicine. 40 (3): 182\u2013212. doi:10.1097\/AAP.0000000000000223. PMID 25899949. \n\n^ Deer, Timothy R.; Mekhail, Nagy; Provenzano, David; Pope, Jason; Krames, Elliot; Leong, Michael; Levy, Robert M.; Abejon, David; Buchser, Eric (August 2014). \"The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the Neuromodulation Appropriateness Consensus Committee\". Neuromodulation. 17 (6): 515\u2013550, discussion 550. doi:10.1111\/ner.12208. PMID 25112889. \n\n^ Knezevic, Nebojsa N.; Candido, Kenneth D.; Rana, Shalini; Knezevic, Ivana (July 2015). \"The Use of Spinal Cord Neuromodulation in the Management of HIV-Related Polyneuropathy\". Pain Physician. 18 (4): E643\u2013650. PMID 26218955. \n\n^ Hayek, Salim M.; Veizi, Elias; Hanes, Michael (October 2015). \"Treatment-Limiting Complications of Percutaneous Spinal Cord Stimulator Implants: A Review of Eight Years of Experience From an Academic Center Database\". Neuromodulation. 18 (7): 603\u2013608, discussion 608\u2013609. doi:10.1111\/ner.12312. PMID 26053499. \n\n^ a b Deer, Timothy R.; Krames, Elliot; Mekhail, Nagy; Pope, Jason; Leong, Michael; Stanton-Hicks, Michael; Golovac, Stan; Kapural, Leo; Alo, Ken (August 2014). \"The appropriate use of neurostimulation: new and evolving neurostimulation therapies and applicable treatment for chronic pain and selected disease states. Neuromodulation Appropriateness Consensus Committee\". Neuromodulation. 17 (6): 599\u2013615, discussion 615. doi:10.1111\/ner.12204. PMID 25112892. \n\n^ Eldabe, Sam; Buchser, Eric; Duarte, Rui V. (2016-02-01). \"Complications of Spinal Cord Stimulation and Peripheral Nerve Stimulation Techniques: A Review of the Literature\". Pain Medicine. 17 (2): 325\u2013336. doi:10.1093\/pm\/pnv025. \n\n^ a b Kumar, Krishna; Buchser, Eric; Linderoth, Bengt; Meglio, Mario; Van Buyten, Jean-Pierre (January 2007). \"Avoiding complications from spinal cord stimulation: practical recommendations from an international panel of experts\". Neuromodulation. 10 (1): 24\u201333. doi:10.1111\/j.1525-1403.2007.00084.x. PMID 22151809. \n\n^ Sinclair, Chantelle; Verrills, Paul; Barnard, Adele (2016-07-01). \"A review of spinal cord stimulation systems for chronic pain\". Journal of Pain Research. 9: 481\u2013492. doi:10.2147\/jpr.s108884. \n\n^ Linderoth, B.; Foreman, R. D. (July 1999). \"Physiology of spinal cord stimulation: review and update\". Neuromodulation. 2 (3): 150\u2013164. doi:10.1046\/j.1525-1403.1999.00150.x. PMID 22151202. \n\n^ Oakley, John C.; Prager, Joshua P. (2002-11-15). \"Spinal cord stimulation: mechanisms of action\". Spine. 27 (22): 2574\u20132583. doi:10.1097\/00007632-200211150-00034. PMID 12435996. \n\n^ Kunnumpurath, Sreekumar; Srinivasagopalan, Ravi; Vadivelu, Nalini (1 September 2009). \"Spinal cord stimulation: principles of past, present and future practice: a review\". Journal of Clinical Monitoring and Computing. 23 (5): 333\u2013339. doi:10.1007\/s10877-009-9201-0. PMID 19728120. \n\n^ Kirkpatrick, Daniel R.; McEntire, Dan M.; Hambsch, Zakary J.; Kerfeld, Mitchell J.; Smith, Tyler A.; Reisbig, Mark D.; Youngblood, Charles F.; Agrawal, Devendra K. (December 2015). \"Therapeutic Basis of Clinical Pain Modulation\". Clinical and Translational Science. 8 (6): 848\u2013856. doi:10.1111\/cts.12282. PMC 4641846 . PMID 25962969. \n\n^ Shealy, C. N.; Mortimer, J. T.; Reswick, J. B. (July 1967). \"Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report\". Anesthesia and Analgesia. 46 (4): 489\u2013491. doi:10.1213\/00000539-196707000-00025. PMID 4952225. \n\n^ a b de Andrade, Emerson Magno; Ghilardi, Maria Gabriela; Cury, Rubens Gisbert; Barbosa, Egberto Reis; Fuentes, Romulo; Teixeira, Manoel Jacobsen; Fonoff, Erich Talamoni (January 2016). \"Spinal cord stimulation for Parkinson's disease: a systematic review\". Neurosurgical Review. 39 (1): 27\u201335, discussion 35. doi:10.1007\/s10143-015-0651-1. PMID 26219854. \n\n^ Taylor, Rod S.; De Vries, Jessica; Buchser, Eric; Dejongste, Mike J. L. (2009-03-25). \"Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials\". BMC Cardiovascular Disorders. 9: 13. doi:10.1186\/1471-2261-9-13. PMC 2667170 . PMID 19320999. \n\n^ \"Radical project aims to bridge spinal cord injuries and give patients control of their limbs\". Healthcare IT Australia. 2018-08-24. Retrieved 2018-08-24 . \n\n^ \"European Commission funds $3.5 million to develop prototype implant that rewires a spinal cord\". Healthcare IT News. 2018-08-23. Retrieved 2018-08-24 . \n\n^ \"Spinal cord stimulation, physical therapy help paralyzed man stand, walk with assistance\". ScienceDaily. Retrieved 2018-09-25 . \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Spinal_cord_stimulator\">https:\/\/www.limswiki.org\/index.php\/Spinal_cord_stimulator<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 19:39.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 428 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","5ca061f418e733391702327ac6d9a7d3_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Spinal_cord_stimulator skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Spinal cord stimulator<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>A <b>Spinal Cord Stimulator<\/b> (SCS) or Dorsal Column Stimulator (DCS) is a type of implantable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromodulation\" title=\"Neuromodulation\" rel=\"external_link\" target=\"_blank\">neuromodulation<\/a> device (sometimes called a \"pain pacemaker\") that is used to send electrical signals to select areas of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord\" title=\"Spinal cord\" rel=\"external_link\" target=\"_blank\">spinal cord<\/a> (dorsal columns) for the treatment of certain pain conditions. SCS is a consideration for people who have a pain condition that has not responded to more conservative therapy.<sup id=\"rdp-ebb-cite_ref-Uptodate_1-0\" class=\"reference\"><a href=\"#cite_note-Uptodate-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>In the United States, Failed Back Surgery Syndrome is the most common use while in Europe the most common use is peripheral ischemia.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>As of 2014 the FDA had approved SCS as a treatment for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Failed_Back_Surgery_Syndrome\" class=\"mw-redirect\" title=\"Failed Back Surgery Syndrome\" rel=\"external_link\" target=\"_blank\">failed back surgery syndrome<\/a> (FBSS), chronic pain, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Complex_regional_pain_syndrome\" title=\"Complex regional pain syndrome\" rel=\"external_link\" target=\"_blank\">Complex Regional Pain Syndrome<\/a>, intractable angina, as well as visceral abdominal and perineal pain<sup id=\"rdp-ebb-cite_ref-Uptodate_1-1\" class=\"reference\"><a href=\"#cite_note-Uptodate-1\" rel=\"external_link\">[1]<\/a><\/sup> and pain in the extremities from nerve damage.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<p>The most common use of SCS is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Failed_back_syndrome\" title=\"Failed back syndrome\" rel=\"external_link\" target=\"_blank\">failed back surgery syndrome<\/a> (FBSS) in the United States and peripheral ischemic pain in Europe.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Patel2015_5-0\" class=\"reference\"><a href=\"#cite_note-Patel2015-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>Once a person has had a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Psychological_evaluation\" title=\"Psychological evaluation\" rel=\"external_link\" target=\"_blank\">psychological evaluation<\/a> and deemed an appropriate candidate for SCS, a temporary implant is placed, called a trial, to determine the best stimulation pattern, and the person is sent home for three to ten days with an external pulse generator. If pain control and increased activity was achieved, a permanent system, with leads and a pulse generator, is placed.<sup id=\"rdp-ebb-cite_ref-Patel2015_5-1\" class=\"reference\"><a href=\"#cite_note-Patel2015-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Contraindications\">Contraindications<\/span><\/h2>\n<p>SCS may be contraindicated in people who have <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coagulopathy\" title=\"Coagulopathy\" rel=\"external_link\" target=\"_blank\">coagulation<\/a> related disorders, or are on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anticoagulant\" title=\"Anticoagulant\" rel=\"external_link\" target=\"_blank\">anticoagulant therapy.<\/a><sup id=\"rdp-ebb-cite_ref-Uptodate_1-2\" class=\"reference\"><a href=\"#cite_note-Uptodate-1\" rel=\"external_link\">[1]<\/a><\/sup> Other contraindications include local and systemic infection, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pacemakers\" class=\"mw-redirect\" title=\"Pacemakers\" rel=\"external_link\" target=\"_blank\">pacemakers<\/a>, or those people for whom pre-surgical imaging studies show have anatomy that makes placement difficult, or if concerns arise during psychological evaluation.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Adverse_effects_and_complications\">Adverse effects and complications<\/span><\/h2>\n<p>Complications with SCS range from simple easily correctable problems to devastating paralysis, nerve injury and death. In a 7-year follow-up, the overall complication rate was 5-18%. The most common complications include lead migration, lead breakage, and infection. Other complications include rotation of the pulse generator, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Haematoma\" class=\"mw-redirect\" title=\"Haematoma\" rel=\"external_link\" target=\"_blank\">haematomas<\/a> (subcutaneous or epidural), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebrospinal_fluid\" title=\"Cerebrospinal fluid\" rel=\"external_link\" target=\"_blank\">cerebrospinal fluid<\/a> (CSF) leak, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Post_dural_puncture_headache\" class=\"mw-redirect\" title=\"Post dural puncture headache\" rel=\"external_link\" target=\"_blank\">post dural puncture headache<\/a>, discomfort at pulse generator site, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Seroma\" title=\"Seroma\" rel=\"external_link\" target=\"_blank\">seroma<\/a> and transient <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paraplegia\" title=\"Paraplegia\" rel=\"external_link\" target=\"_blank\">paraplegia<\/a>.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>Some people find the tingling sensation caused by SPS to be unpleasant.<sup id=\"rdp-ebb-cite_ref-Deer2014_10-0\" class=\"reference\"><a href=\"#cite_note-Deer2014-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>The most common hardware related complication is lead migration, in which the implanted electrodes move from their original placement. With this complication, recapturing paraesthesia coverage can be attempted with reprogramming.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> In circumstances involving major lead migration a reoperation may be required to reset the lead placement.<sup id=\"rdp-ebb-cite_ref-Kumar2007_12-0\" class=\"reference\"><a href=\"#cite_note-Kumar2007-12\" rel=\"external_link\">[12]<\/a><\/sup> Studies differ greatly in reporting the percentage of people who have lead migration but the majority of studies report in the range of 10-25% of lead migration for spinal cord stimulation.<sup id=\"rdp-ebb-cite_ref-Kumar2007_12-1\" class=\"reference\"><a href=\"#cite_note-Kumar2007-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Mechanism_of_action\">Mechanism of action<\/span><\/h2>\n<p>The neurophysiological mechanisms of action of spinal cord stimulation are not completely understood but may involve masking pain sensation with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paresthesia\" title=\"Paresthesia\" rel=\"external_link\" target=\"_blank\">tingling<\/a> by altering the pain processing of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Central_nervous_system\" title=\"Central nervous system\" rel=\"external_link\" target=\"_blank\">central nervous system<\/a>.<sup id=\"rdp-ebb-cite_ref-Deer2014_10-1\" class=\"reference\"><a href=\"#cite_note-Deer2014-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> The mechanism of analgesia when SCS is applied in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuropathic\" class=\"mw-redirect\" title=\"Neuropathic\" rel=\"external_link\" target=\"_blank\">neuropathic<\/a> pain states may be very different from that involved in analgesia due to limb ischemia.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> In neuropathic pain states, experimental evidence shows that SCS alters the local neurochemistry in dorsal horn, suppressing the hyperexcitability of the neurons. Specifically, there is some evidence for increased levels of <a href=\"https:\/\/en.wikipedia.org\/wiki\/GABA\" class=\"mw-redirect\" title=\"GABA\" rel=\"external_link\" target=\"_blank\">GABA<\/a> release, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Serotonin\" title=\"Serotonin\" rel=\"external_link\" target=\"_blank\">serotonin<\/a>, and perhaps suppression of levels of some excitatory amino acids, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glutamate\" class=\"mw-redirect\" title=\"Glutamate\" rel=\"external_link\" target=\"_blank\">glutamate<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aspartate\" class=\"mw-redirect\" title=\"Aspartate\" rel=\"external_link\" target=\"_blank\">aspartate<\/a>. In the case of ischemic pain, analgesia seems to derive from restoration of the oxygen demand supply. This effect could be mediated by inhibition of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sympathetic_system\" class=\"mw-redirect\" title=\"Sympathetic system\" rel=\"external_link\" target=\"_blank\">sympathetic system<\/a>, although <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vasodilation\" title=\"Vasodilation\" rel=\"external_link\" target=\"_blank\">vasodilation<\/a> is another possibility. It is also probable that a combination of the two above mentioned mechanisms is involved.<sup id=\"rdp-ebb-cite_ref-Kunnumourath_16-0\" class=\"reference\"><a href=\"#cite_note-Kunnumourath-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Electrotherapy of pain by neurostimulation began shortly after Melzack and Wall proposed the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain#Gate_control\" title=\"Pain\" rel=\"external_link\" target=\"_blank\">gate control theory<\/a> in 1965. This theory proposed that nerves carrying painful peripheral stimuli and nerves carrying touch and vibratory sensation both terminate in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Posterior_horn_of_spinal_cord\" class=\"mw-redirect\" title=\"Posterior horn of spinal cord\" rel=\"external_link\" target=\"_blank\">dorsal horn<\/a> (the gate) of spinal cord.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> It was hypothesized that input to the latter could be manipulated to \u201cclose the gate\u201d to the former. As an application of the gate control theory, Shealy et al.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> implanted the first spinal cord stimulator device directly on the dorsal column for the treatment of chronic pain and in 1971, Shimogi and colleagues first reported the analgesic properties of epidural spinal cord stimulation. Since then this technique has undergone numerous technical and clinical developments.\n<\/p><p>At this time neurostimulation for the treatment of pain is used with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nerve\" title=\"Nerve\" rel=\"external_link\" target=\"_blank\">nerve<\/a> stimulation, spinal cord stimulation, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deep_brain_stimulation\" title=\"Deep brain stimulation\" rel=\"external_link\" target=\"_blank\">deep brain stimulation<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Motor_cortex\" title=\"Motor cortex\" rel=\"external_link\" target=\"_blank\">motor cortex<\/a> stimulation.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Research\">Research<\/span><\/h2>\n<p>SCS has been studied in people with Parkinson's disease<sup id=\"rdp-ebb-cite_ref-PD_19-0\" class=\"reference\"><a href=\"#cite_note-PD-19\" rel=\"external_link\">[19]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angina_pectoris\" class=\"mw-redirect\" title=\"Angina pectoris\" rel=\"external_link\" target=\"_blank\">angina pectoris<\/a>.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><p>Research on improving the devices and software has included efforts to increasing the battery life, efforts to develop <a href=\"https:\/\/en.wikipedia.org\/wiki\/Feedback\" title=\"Feedback\" rel=\"external_link\" target=\"_blank\">closed loop<\/a> control, and combining stimulation with implanted drug delivery systems.<sup id=\"rdp-ebb-cite_ref-PD_19-1\" class=\"reference\"><a href=\"#cite_note-PD-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p><p>In August 2018, The European Commission's Horizon 2020 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Future_and_Emerging_Technologies\" title=\"Future and Emerging Technologies\" rel=\"external_link\" target=\"_blank\">Future and Emerging Technologies<\/a> program announced a $3.5 million funding grant for the four-nation project team that is building a prototype of an implant designed to 'rewire' the spinal cord.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p><p>In September 2018, the studied conducted by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mayo_Clinic\" title=\"Mayo Clinic\" rel=\"external_link\" target=\"_blank\">Mayo Clinic<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_California,_Los_Angeles\" title=\"University of California, Los Angeles\" rel=\"external_link\" target=\"_blank\">UCLA<\/a> reported that spinal cord stimulation supported with physical therapy can help people with paralysis to regain their ability to stand and walk with assistance.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> \n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Transcutaneous_electrical_nerve_stimulation\" title=\"Transcutaneous electrical nerve stimulation\" rel=\"external_link\" target=\"_blank\">Transcutaneous electrical nerve stimulation<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-Uptodate-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Uptodate_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Uptodate_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Uptodate_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">McKenzie-Brown, Anne Marie (November 1, 2016). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.uptodate.com\/contents\/spinal-cord-stimulation-placement-and-management?source=search_result&search=spinal%20cord%20stimuator&selectedTitle=1~150\" target=\"_blank\">\"Spinal cord stimulation: Placement and management\"<\/a>. UptoDate.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Spinal+cord+stimulation%3A+Placement+and+management&rft.pub=UptoDate&rft.date=2016-11-01&rft.aulast=McKenzie-Brown&rft.aufirst=Anne+Marie&rft_id=https%3A%2F%2Fwww.uptodate.com%2Fcontents%2Fspinal-cord-stimulation-placement-and-management%3Fsource%3Dsearch_result%26search%3Dspinal%2520cord%2520stimuator%26selectedTitle%3D1~150&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Eldabe, Sam; Kumar, Krishna; Buchser, Eric; Taylor, Rod S. (July 2010). \"An analysis of the components of pain, function, and health-related quality of life in patients with failed back surgery syndrome treated with spinal cord stimulation or conventional medical management\". <i>Neuromodulation<\/i>. <b>13<\/b> (3): 201\u2013209. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1525-1403.2009.00271.x\" target=\"_blank\">10.1111\/j.1525-1403.2009.00271.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21992833\" target=\"_blank\">21992833<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuromodulation&rft.atitle=An+analysis+of+the+components+of+pain%2C+function%2C+and+health-related+quality+of+life+in+patients+with+failed+back+surgery+syndrome+treated+with+spinal+cord+stimulation+or+conventional+medical+management&rft.volume=13&rft.issue=3&rft.pages=201-209&rft.date=2010-07&rft_id=info%3Adoi%2F10.1111%2Fj.1525-1403.2009.00271.x&rft_id=info%3Apmid%2F21992833&rft.aulast=Eldabe&rft.aufirst=Sam&rft.au=Kumar%2C+Krishna&rft.au=Buchser%2C+Eric&rft.au=Taylor%2C+Rod+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Song, Jason J.; Popescu, Adrian; Bell, Russell L. (May 2014). \"Present and potential use of spinal cord stimulation to control chronic pain\". <i>Pain Physician<\/i>. <b>17<\/b> (3): 235\u2013246. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24850105\" target=\"_blank\">24850105<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pain+Physician&rft.atitle=Present+and+potential+use+of+spinal+cord+stimulation+to+control+chronic+pain&rft.volume=17&rft.issue=3&rft.pages=235-246&rft.date=2014-05&rft_id=info%3Apmid%2F24850105&rft.aulast=Song&rft.aufirst=Jason+J.&rft.au=Popescu%2C+Adrian&rft.au=Bell%2C+Russell+L.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Turner, J. A.; Loeser, J. D.; Bell, K. G. (December 1995). \"Spinal cord stimulation for chronic low back pain: a systematic literature synthesis\". <i>Neurosurgery<\/i>. <b>37<\/b> (6): 1088\u20131095, discussion 1095\u20131096. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00006123-199512000-00008\" target=\"_blank\">10.1097\/00006123-199512000-00008<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8584149\" target=\"_blank\">8584149<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurosurgery&rft.atitle=Spinal+cord+stimulation+for+chronic+low+back+pain%3A+a+systematic+literature+synthesis&rft.volume=37&rft.issue=6&rft.pages=1088-1095%2C+discussion+1095-1096&rft.date=1995-12&rft_id=info%3Adoi%2F10.1097%2F00006123-199512000-00008&rft_id=info%3Apmid%2F8584149&rft.aulast=Turner&rft.aufirst=J.+A.&rft.au=Loeser%2C+J.+D.&rft.au=Bell%2C+K.+G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Patel2015-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Patel2015_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Patel2015_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Patel, Vikram B.; Wasserman, Ronald; Imani, Farnad (2015-08-22). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4604560\" target=\"_blank\">\"Interventional Therapies for Chronic Low Back Pain: A Focused Review (Efficacy and Outcomes)\"<\/a>. <i>Anesthesiology and Pain Medicine<\/i>. <b>5<\/b> (4): e29716. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.5812%2Faapm.29716\" target=\"_blank\">10.5812\/aapm.29716<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4604560\" target=\"_blank\">4604560<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26484298\" target=\"_blank\">26484298<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesiology+and+Pain+Medicine&rft.atitle=Interventional+Therapies+for+Chronic+Low+Back+Pain%3A+A+Focused+Review+%28Efficacy+and+Outcomes%29&rft.volume=5&rft.issue=4&rft.pages=e29716&rft.date=2015-08-22&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4604560&rft_id=info%3Apmid%2F26484298&rft_id=info%3Adoi%2F10.5812%2Faapm.29716&rft.aulast=Patel&rft.aufirst=Vikram+B.&rft.au=Wasserman%2C+Ronald&rft.au=Imani%2C+Farnad&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4604560&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Narouze, Samer; Benzon, Honorio T.; Provenzano, David A.; Buvanendran, Asokumar; De Andres, Jos\u00e9; Deer, Timothy R.; Rauck, Richard; Huntoon, Marc A. (May 2015). \"Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain\". <i>Regional Anesthesia and Pain Medicine<\/i>. <b>40<\/b> (3): 182\u2013212. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FAAP.0000000000000223\" target=\"_blank\">10.1097\/AAP.0000000000000223<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25899949\" target=\"_blank\">25899949<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Regional+Anesthesia+and+Pain+Medicine&rft.atitle=Interventional+spine+and+pain+procedures+in+patients+on+antiplatelet+and+anticoagulant+medications%3A+guidelines+from+the+American+Society+of+Regional+Anesthesia+and+Pain+Medicine%2C+the+European+Society+of+Regional+Anaesthesia+and+Pain+Therapy%2C+the+American+Academy+of+Pain+Medicine%2C+the+International+Neuromodulation+Society%2C+the+North+American+Neuromodulation+Society%2C+and+the+World+Institute+of+Pain&rft.volume=40&rft.issue=3&rft.pages=182-212&rft.date=2015-05&rft_id=info%3Adoi%2F10.1097%2FAAP.0000000000000223&rft_id=info%3Apmid%2F25899949&rft.aulast=Narouze&rft.aufirst=Samer&rft.au=Benzon%2C+Honorio+T.&rft.au=Provenzano%2C+David+A.&rft.au=Buvanendran%2C+Asokumar&rft.au=De+Andres%2C+Jos%C3%A9&rft.au=Deer%2C+Timothy+R.&rft.au=Rauck%2C+Richard&rft.au=Huntoon%2C+Marc+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Deer, Timothy R.; Mekhail, Nagy; Provenzano, David; Pope, Jason; Krames, Elliot; Leong, Michael; Levy, Robert M.; Abejon, David; Buchser, Eric (August 2014). \"The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the Neuromodulation Appropriateness Consensus Committee\". <i>Neuromodulation<\/i>. <b>17<\/b> (6): 515\u2013550, discussion 550. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fner.12208\" target=\"_blank\">10.1111\/ner.12208<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25112889\" target=\"_blank\">25112889<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuromodulation&rft.atitle=The+appropriate+use+of+neurostimulation+of+the+spinal+cord+and+peripheral+nervous+system+for+the+treatment+of+chronic+pain+and+ischemic+diseases%3A+the+Neuromodulation+Appropriateness+Consensus+Committee&rft.volume=17&rft.issue=6&rft.pages=515-550%2C+discussion+550&rft.date=2014-08&rft_id=info%3Adoi%2F10.1111%2Fner.12208&rft_id=info%3Apmid%2F25112889&rft.aulast=Deer&rft.aufirst=Timothy+R.&rft.au=Mekhail%2C+Nagy&rft.au=Provenzano%2C+David&rft.au=Pope%2C+Jason&rft.au=Krames%2C+Elliot&rft.au=Leong%2C+Michael&rft.au=Levy%2C+Robert+M.&rft.au=Abejon%2C+David&rft.au=Buchser%2C+Eric&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Knezevic, Nebojsa N.; Candido, Kenneth D.; Rana, Shalini; Knezevic, Ivana (July 2015). \"The Use of Spinal Cord Neuromodulation in the Management of HIV-Related Polyneuropathy\". <i>Pain Physician<\/i>. <b>18<\/b> (4): E643\u2013650. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26218955\" target=\"_blank\">26218955<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pain+Physician&rft.atitle=The+Use+of+Spinal+Cord+Neuromodulation+in+the+Management+of+HIV-Related+Polyneuropathy&rft.volume=18&rft.issue=4&rft.pages=E643-650&rft.date=2015-07&rft_id=info%3Apmid%2F26218955&rft.aulast=Knezevic&rft.aufirst=Nebojsa+N.&rft.au=Candido%2C+Kenneth+D.&rft.au=Rana%2C+Shalini&rft.au=Knezevic%2C+Ivana&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hayek, Salim M.; Veizi, Elias; Hanes, Michael (October 2015). \"Treatment-Limiting Complications of Percutaneous Spinal Cord Stimulator Implants: A Review of Eight Years of Experience From an Academic Center Database\". <i>Neuromodulation<\/i>. <b>18<\/b> (7): 603\u2013608, discussion 608\u2013609. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fner.12312\" target=\"_blank\">10.1111\/ner.12312<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26053499\" target=\"_blank\">26053499<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuromodulation&rft.atitle=Treatment-Limiting+Complications+of+Percutaneous+Spinal+Cord+Stimulator+Implants%3A+A+Review+of+Eight+Years+of+Experience+From+an+Academic+Center+Database&rft.volume=18&rft.issue=7&rft.pages=603-608%2C+discussion+608-609&rft.date=2015-10&rft_id=info%3Adoi%2F10.1111%2Fner.12312&rft_id=info%3Apmid%2F26053499&rft.aulast=Hayek&rft.aufirst=Salim+M.&rft.au=Veizi%2C+Elias&rft.au=Hanes%2C+Michael&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Deer2014-10\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Deer2014_10-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Deer2014_10-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Deer, Timothy R.; Krames, Elliot; Mekhail, Nagy; Pope, Jason; Leong, Michael; Stanton-Hicks, Michael; Golovac, Stan; Kapural, Leo; Alo, Ken (August 2014). \"The appropriate use of neurostimulation: new and evolving neurostimulation therapies and applicable treatment for chronic pain and selected disease states. Neuromodulation Appropriateness Consensus Committee\". <i>Neuromodulation<\/i>. <b>17<\/b> (6): 599\u2013615, discussion 615. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fner.12204\" target=\"_blank\">10.1111\/ner.12204<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25112892\" target=\"_blank\">25112892<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuromodulation&rft.atitle=The+appropriate+use+of+neurostimulation%3A+new+and+evolving+neurostimulation+therapies+and+applicable+treatment+for+chronic+pain+and+selected+disease+states.+Neuromodulation+Appropriateness+Consensus+Committee&rft.volume=17&rft.issue=6&rft.pages=599-615%2C+discussion+615&rft.date=2014-08&rft_id=info%3Adoi%2F10.1111%2Fner.12204&rft_id=info%3Apmid%2F25112892&rft.aulast=Deer&rft.aufirst=Timothy+R.&rft.au=Krames%2C+Elliot&rft.au=Mekhail%2C+Nagy&rft.au=Pope%2C+Jason&rft.au=Leong%2C+Michael&rft.au=Stanton-Hicks%2C+Michael&rft.au=Golovac%2C+Stan&rft.au=Kapural%2C+Leo&rft.au=Alo%2C+Ken&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Eldabe, Sam; Buchser, Eric; Duarte, Rui V. (2016-02-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/academic.oup.com\/painmedicine\/article\/17\/2\/325\/2460710\/Complications-of-Spinal-Cord-Stimulation-and\" target=\"_blank\">\"Complications of Spinal Cord Stimulation and Peripheral Nerve Stimulation Techniques: A Review of the Literature\"<\/a>. <i>Pain Medicine<\/i>. <b>17<\/b> (2): 325\u2013336. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1093%2Fpm%2Fpnv025\" target=\"_blank\">10.1093\/pm\/pnv025<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pain+Medicine&rft.atitle=Complications+of+Spinal+Cord+Stimulation+and+Peripheral+Nerve+Stimulation+Techniques%3A+A+Review+of+the+Literature&rft.volume=17&rft.issue=2&rft.pages=325-336&rft.date=2016-02-01&rft_id=info%3Adoi%2F10.1093%2Fpm%2Fpnv025&rft.aulast=Eldabe&rft.aufirst=Sam&rft.au=Buchser%2C+Eric&rft.au=Duarte%2C+Rui+V.&rft_id=https%3A%2F%2Facademic.oup.com%2Fpainmedicine%2Farticle%2F17%2F2%2F325%2F2460710%2FComplications-of-Spinal-Cord-Stimulation-and&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Kumar2007-12\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Kumar2007_12-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kumar2007_12-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kumar, Krishna; Buchser, Eric; Linderoth, Bengt; Meglio, Mario; Van Buyten, Jean-Pierre (January 2007). \"Avoiding complications from spinal cord stimulation: practical recommendations from an international panel of experts\". <i>Neuromodulation<\/i>. <b>10<\/b> (1): 24\u201333. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1525-1403.2007.00084.x\" target=\"_blank\">10.1111\/j.1525-1403.2007.00084.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22151809\" target=\"_blank\">22151809<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuromodulation&rft.atitle=Avoiding+complications+from+spinal+cord+stimulation%3A+practical+recommendations+from+an+international+panel+of+experts&rft.volume=10&rft.issue=1&rft.pages=24-33&rft.date=2007-01&rft_id=info%3Adoi%2F10.1111%2Fj.1525-1403.2007.00084.x&rft_id=info%3Apmid%2F22151809&rft.aulast=Kumar&rft.aufirst=Krishna&rft.au=Buchser%2C+Eric&rft.au=Linderoth%2C+Bengt&rft.au=Meglio%2C+Mario&rft.au=Van+Buyten%2C+Jean-Pierre&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sinclair, Chantelle; Verrills, Paul; Barnard, Adele (2016-07-01). \"A review of spinal cord stimulation systems for chronic pain\". <i>Journal of Pain Research<\/i>. <b>9<\/b>: 481\u2013492. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2147%2Fjpr.s108884\" target=\"_blank\">10.2147\/jpr.s108884<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Pain+Research&rft.atitle=A+review+of+spinal+cord+stimulation+systems+for+chronic+pain&rft.volume=9&rft.pages=481-492&rft.date=2016-07-01&rft_id=info%3Adoi%2F10.2147%2Fjpr.s108884&rft.aulast=Sinclair&rft.aufirst=Chantelle&rft.au=Verrills%2C+Paul&rft.au=Barnard%2C+Adele&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Linderoth, B.; Foreman, R. 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(July 1967). \"Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report\". <i>Anesthesia and Analgesia<\/i>. <b>46<\/b> (4): 489\u2013491. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1213%2F00000539-196707000-00025\" target=\"_blank\">10.1213\/00000539-196707000-00025<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/4952225\" target=\"_blank\">4952225<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesia+and+Analgesia&rft.atitle=Electrical+inhibition+of+pain+by+stimulation+of+the+dorsal+columns%3A+preliminary+clinical+report&rft.volume=46&rft.issue=4&rft.pages=489-491&rft.date=1967-07&rft_id=info%3Adoi%2F10.1213%2F00000539-196707000-00025&rft_id=info%3Apmid%2F4952225&rft.aulast=Shealy&rft.aufirst=C.+N.&rft.au=Mortimer%2C+J.+T.&rft.au=Reswick%2C+J.+B.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-PD-19\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-PD_19-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-PD_19-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">de Andrade, Emerson Magno; Ghilardi, Maria Gabriela; Cury, Rubens Gisbert; Barbosa, Egberto Reis; Fuentes, Romulo; Teixeira, Manoel Jacobsen; Fonoff, Erich Talamoni (January 2016). \"Spinal cord stimulation for Parkinson's disease: a systematic review\". <i>Neurosurgical Review<\/i>. <b>39<\/b> (1): 27\u201335, discussion 35. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs10143-015-0651-1\" target=\"_blank\">10.1007\/s10143-015-0651-1<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26219854\" target=\"_blank\">26219854<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurosurgical+Review&rft.atitle=Spinal+cord+stimulation+for+Parkinson%27s+disease%3A+a+systematic+review&rft.volume=39&rft.issue=1&rft.pages=27-35%2C+discussion+35&rft.date=2016-01&rft_id=info%3Adoi%2F10.1007%2Fs10143-015-0651-1&rft_id=info%3Apmid%2F26219854&rft.aulast=de+Andrade&rft.aufirst=Emerson+Magno&rft.au=Ghilardi%2C+Maria+Gabriela&rft.au=Cury%2C+Rubens+Gisbert&rft.au=Barbosa%2C+Egberto+Reis&rft.au=Fuentes%2C+Romulo&rft.au=Teixeira%2C+Manoel+Jacobsen&rft.au=Fonoff%2C+Erich+Talamoni&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Taylor, Rod S.; De Vries, Jessica; Buchser, Eric; Dejongste, Mike J. L. (2009-03-25). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2667170\" target=\"_blank\">\"Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials\"<\/a>. <i>BMC Cardiovascular Disorders<\/i>. <b>9<\/b>: 13. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2F1471-2261-9-13\" target=\"_blank\">10.1186\/1471-2261-9-13<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2667170\" target=\"_blank\">2667170<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19320999\" target=\"_blank\">19320999<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMC+Cardiovascular+Disorders&rft.atitle=Spinal+cord+stimulation+in+the+treatment+of+refractory+angina%3A+systematic+review+and+meta-analysis+of+randomised+controlled+trials&rft.volume=9&rft.pages=13&rft.date=2009-03-25&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2667170&rft_id=info%3Apmid%2F19320999&rft_id=info%3Adoi%2F10.1186%2F1471-2261-9-13&rft.aulast=Taylor&rft.aufirst=Rod+S.&rft.au=De+Vries%2C+Jessica&rft.au=Buchser%2C+Eric&rft.au=Dejongste%2C+Mike+J.+L.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2667170&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.healthcareit.com.au\/article\/radical-project-aims-bridge-spinal-cord-injuries-and-give-patients-control-their-limbs\" target=\"_blank\">\"Radical project aims to bridge spinal cord injuries and give patients control of their limbs\"<\/a>. <i>Healthcare IT Australia<\/i>. 2018-08-24<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-08-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Healthcare+IT+Australia&rft.atitle=Radical+project+aims+to+bridge+spinal+cord+injuries+and+give+patients+control+of+their+limbs&rft.date=2018-08-24&rft_id=https%3A%2F%2Fwww.healthcareit.com.au%2Farticle%2Fradical-project-aims-bridge-spinal-cord-injuries-and-give-patients-control-their-limbs&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.healthcareitnews.com\/news\/european-commission-funds-35-million-develop-prototype-implant-rewires-spinal-cord\" target=\"_blank\">\"European Commission funds $3.5 million to develop prototype implant that rewires a spinal cord\"<\/a>. <i>Healthcare IT News<\/i>. 2018-08-23<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-08-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Healthcare+IT+News&rft.atitle=European+Commission+funds+%243.5+million+to+develop+prototype+implant+that+rewires+a+spinal+cord&rft.date=2018-08-23&rft_id=https%3A%2F%2Fwww.healthcareitnews.com%2Fnews%2Feuropean-commission-funds-35-million-develop-prototype-implant-rewires-spinal-cord&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.sciencedaily.com\/releases\/2018\/09\/180924115930.htm\" target=\"_blank\">\"Spinal cord stimulation, physical therapy help paralyzed man stand, walk with assistance\"<\/a>. <i>ScienceDaily<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-09-25<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=ScienceDaily&rft.atitle=Spinal+cord+stimulation%2C+physical+therapy+help+paralyzed+man+stand%2C+walk+with+assistance&rft_id=https%3A%2F%2Fwww.sciencedaily.com%2Freleases%2F2018%2F09%2F180924115930.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpinal+cord+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1330\nCached time: 20181126013336\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.364 seconds\nReal time usage: 0.426 seconds\nPreprocessor visited node count: 1528\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 55289\/2097152 bytes\nTemplate argument size: 228\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 71653\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.229\/10.000 seconds\nLua memory usage: 4.42 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 373.203 1 -total\n<\/p>\n<pre>76.32% 284.825 1 Template:Reflist\n38.03% 141.943 19 Template:Cite_journal\n21.92% 81.797 1 Template:Cite_web\n19.66% 73.354 1 Template:Infobox_medical_intervention\n18.44% 68.833 1 Template:Infobox\n 4.92% 18.349 3 Template:Cite_news\n 1.75% 6.543 1 Template:PAGENAMEBASE\n 0.88% 3.287 1 Template:Main_other\n 0.69% 2.567 1 Template:Template_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:4793230-1!canonical and timestamp 20181126013336 and revision id 870619382\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_stimulator\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212156\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.017 seconds\nReal time usage: 0.157 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 149.262 1 - wikipedia:Spinal_cord_stimulator\n100.00% 149.262 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8261-0!*!*!*!*!*!* and timestamp 20181217212156 and revision id 24471\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Spinal_cord_stimulator\">https:\/\/www.limswiki.org\/index.php\/Spinal_cord_stimulator<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","5ca061f418e733391702327ac6d9a7d3_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b7\/Anterior_thoracic_SCS.jpg\/560px-Anterior_thoracic_SCS.jpg"],"5ca061f418e733391702327ac6d9a7d3_timestamp":1545081716,"94c3eef6e32d7e13fb15450369678b4d_type":"article","94c3eef6e32d7e13fb15450369678b4d_title":"Sling (implant)","94c3eef6e32d7e13fb15450369678b4d_url":"https:\/\/www.limswiki.org\/index.php\/Sling_(implant)","94c3eef6e32d7e13fb15450369678b4d_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSling (implant)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tIn surgery, a sling is an implant that is intended to provide additional support to a particular tissue. It usually consists of a synthetic mesh material in the shape of a narrow ribbon but sometimes a biomaterial (bovine or porcine) or the patients own tissue. The ends are usually attached to a fixed body part such as the skeleton.\n\nContents \n\n1 In stress incontinence \n2 In female genital prolapse \n3 Chin sling \n4 References \n\n\nIn stress incontinence \nFurther information: Stress incontinence \u00a7 Slings\nIn stress incontinence, a sling is a potential method of treatment, and is placed under the urethra through one vaginal incision and two small abdominal incisions. The idea is to replace the deficient pelvic floor muscles and provide a backboard of support under the urethra.\nFor this purpose, Pelvicol (a porcine dermal sling) implant sling had a comparable patient-determined success rate with TVT.[1]\n\nIn female genital prolapse \nSlings can also be used in the surgical management of female genital prolapse.\n\nChin sling \nA chin sling is a synthetic lining used in chin augmentation to lift the tissues under the chin and neck. The sling is surgically implanted under the skin of the chin and hooked behind the ears, giving a more youthful appearance, and reversing the effects of aging such as accumulated fat, lost skin elasticity and stretched muscle lining, all of which cause the neck to droop and sag.\n\nReferences \n\n\n^ Arunkalaivanan, A. S.; Barrington, J. W. (2003). \"Randomized trial of porcine dermal sling (Pelvicol ? Implant) vs. Tension-free Vaginal Tape (TVT) in the Surgical treatment of stress incontinence: A questionnaire-based study\". International Urogynecology Journal and Pelvic Floor Dysfunction. 14 (1): 17\u201323, discussion 21\u20132. doi:10.1007\/s00192-002-1000-9. PMID 12601511. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sling_(implant)\">https:\/\/www.limswiki.org\/index.php\/Sling_(implant)<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 17:43.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 322 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","94c3eef6e32d7e13fb15450369678b4d_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Sling_implant skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Sling (implant)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a>, a <b>sling<\/b> is an implant that is intended to provide additional support to a particular tissue. It usually consists of a synthetic mesh material in the shape of a narrow ribbon but sometimes a biomaterial (bovine or porcine) or the patients own tissue. The ends are usually attached to a fixed body part such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skeleton\" title=\"Skeleton\" rel=\"external_link\" target=\"_blank\">skeleton<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"In_stress_incontinence\">In stress incontinence<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stress_incontinence#Slings\" title=\"Stress incontinence\" rel=\"external_link\" target=\"_blank\">Stress incontinence \u00a7 Slings<\/a><\/div>\n<p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stress_incontinence\" title=\"Stress incontinence\" rel=\"external_link\" target=\"_blank\">stress incontinence<\/a>, a sling is a potential method of treatment, and is placed under the urethra through one vaginal incision and two small abdominal incisions. The idea is to replace the deficient pelvic floor muscles and provide a backboard of support under the urethra.\n<\/p><p>For this purpose, Pelvicol (a porcine dermal sling) implant sling had a comparable patient-determined success rate with TVT.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"In_female_genital_prolapse\">In female genital prolapse<\/span><\/h2>\n<p>Slings can also be used in the surgical management of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Female_genital_prolapse\" class=\"mw-redirect\" title=\"Female genital prolapse\" rel=\"external_link\" target=\"_blank\">female genital prolapse<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Chin_sling\">Chin sling<\/span><\/h2>\n<p>A <i>chin sling<\/i> is a <a href=\"https:\/\/en.wiktionary.org\/wiki\/synthetic\" class=\"extiw\" title=\"wikt:synthetic\" rel=\"external_link\" target=\"_blank\">synthetic<\/a> lining used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chin_augmentation\" title=\"Chin augmentation\" rel=\"external_link\" target=\"_blank\">chin augmentation<\/a> to lift the tissues under the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chin\" title=\"Chin\" rel=\"external_link\" target=\"_blank\">chin<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neck\" title=\"Neck\" rel=\"external_link\" target=\"_blank\">neck<\/a>. The sling is surgically implanted under the skin of the chin and hooked behind the ears, giving a more youthful appearance, and reversing the effects of aging such as accumulated fat, lost skin elasticity and stretched muscle lining, all of which cause the neck to droop and sag.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Arunkalaivanan, A. S.; Barrington, J. W. (2003). \"Randomized trial of porcine dermal sling (Pelvicol ? Implant) vs. Tension-free Vaginal Tape (TVT) in the Surgical treatment of stress incontinence: A questionnaire-based study\". <i>International Urogynecology Journal and Pelvic Floor Dysfunction<\/i>. <b>14<\/b> (1): 17\u201323, discussion 21\u20132. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00192-002-1000-9\" target=\"_blank\">10.1007\/s00192-002-1000-9<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12601511\" target=\"_blank\">12601511<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Urogynecology+Journal+and+Pelvic+Floor+Dysfunction&rft.atitle=Randomized+trial+of+porcine+dermal+sling+%28Pelvicol+%3F+Implant%29+vs.+Tension-free+Vaginal+Tape+%28TVT%29+in+the+Surgical+treatment+of+stress+incontinence%3A+A+questionnaire-based+study&rft.volume=14&rft.issue=1&rft.pages=17-23%2C+discussion+21-2&rft.date=2003&rft_id=info%3Adoi%2F10.1007%2Fs00192-002-1000-9&rft_id=info%3Apmid%2F12601511&rft.aulast=Arunkalaivanan&rft.aufirst=A.+S.&rft.au=Barrington%2C+J.+W.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASling+%28implant%29\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1257\nCached time: 20181204062444\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.092 seconds\nReal time usage: 0.130 seconds\nPreprocessor visited node count: 142\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 3213\/2097152 bytes\nTemplate argument size: 79\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 3254\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.063\/10.000 seconds\nLua memory usage: 1.55 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 119.445 1 -total\n<\/p>\n<pre>78.37% 93.607 1 Template:Reflist\n68.65% 81.996 1 Template:Cite_journal\n20.44% 24.417 1 Template:See\n 2.08% 2.486 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1573690-1!canonical and timestamp 20181204062444 and revision id 852107113\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sling_%28implant%29\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212155\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.138 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 132.749 1 - wikipedia:Sling_(implant)\n100.00% 132.749 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8073-0!*!*!*!*!*!* and timestamp 20181217212155 and revision id 24187\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sling_(implant)\">https:\/\/www.limswiki.org\/index.php\/Sling_(implant)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","94c3eef6e32d7e13fb15450369678b4d_images":[],"94c3eef6e32d7e13fb15450369678b4d_timestamp":1545081715,"2ba0e74622c89c9cb18d4e989dc56518_type":"article","2ba0e74622c89c9cb18d4e989dc56518_title":"Sinus implant","2ba0e74622c89c9cb18d4e989dc56518_url":"https:\/\/www.limswiki.org\/index.php\/Sinus_implant","2ba0e74622c89c9cb18d4e989dc56518_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSinus implant\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Paranasal sinus. A. Frontal sinus B. Line of basolacrimal duct C. Maxillary sinus.\nA Sinus implant is a medical device that is inserted into the sinus cavity. Implants can be in conjunction with sinus surgery to treat chronic sinusitis and also in sinus augmentation to increase bone structure for placement of dental implants.[1]\n\nContents \n\n1 Types \n\n1.1 Maxillary implant \n1.2 Rhinoplasty \n1.3 Sinus stent \n\n\n2 See also \n3 References \n\n\nTypes \nMaxillary implant \nA maxillary implant is an implant that is placed between jaw and the maxillary sinuses. It is inserted during a sinus lift or augmentation and used to increase the amount of bone to support dental implants.[1] Implants are either inserted after drilling or by using a non-drilling method known as the osteotome technique.[1] Issues such as bulging within the sinuses can occur with maxillary implants.[2][3]\nMaxillary implants can also be made using Choukroun's technique with subsinus filling material.[4] The material is used to stimulate natural bone regeneration. A clinical study of this technique detailed all patients within the study had continuous stable implants six months after placement. It also showed vertical bone gain in all subjects.[4]\n\nRhinoplasty \nNumerous different types of material have been used as sinus implants during rhinoplasty procedures. Plaster of Paris is often used during rhinoplasty and implanted into the frontal sinus.[5] Implants used in rhinoplasty have also been reported to cause enophthalmos.[6]\n\nSinus stent \nSteroid-eluting sinus stents maybe used in addition to endoscopic sinus surgery. They are, however, of unclear benefit as of 2015.[7]\n\nSee also \nBioresorbable stents\nMiddle nasal concha\nReferences \n\n\n^ a b c Summers RB (February 1994). \"A new concept in maxillary implant surgery: the osteotome technique\". Compendium. 15 (2): 152, 154\u20136, 158 passim, quiz 162. PMID 8055503. \n\n^ Sbordone L, Toti P, Menchini-Fabris G, Sbordone C, Guidetti F (2009). \"Implant success in sinus-lifted maxillae and native bone: a 3-year clinical and computerized tomographic follow-up\". The International Journal of Oral & Maxillofacial Implants. 24 (2): 316\u201324. PMID 19492648. \n\n^ Tidwell JK, Blijdorp PA, Stoelinga PJ, Brouns JB, Hinderks F (August 1992). \"Composite grafting of the maxillary sinus for placement of endosteal implants. A preliminary report of 48 patients\". International Journal of Oral and Maxillofacial Surgery. 21 (4): 204\u20139. doi:10.1016\/S0901-5027(05)80219-X. PMID 1328414. \n\n^ a b Simonpieri A, Choukroun J, Del Corso M, Sammartino G, Dohan Ehrenfest DM (February 2011). \"Simultaneous sinus-lift and implantation using microthreaded implants and leukocyte- and platelet-rich fibrin as sole grafting material: a six-year experience\". Implant Dentistry. 20 (1): 2\u201312. doi:10.1097\/ID.0b013e3181faa8af. PMID 21278521. \n\n^ Raghavan U, Jones NS, Romo T (2004). \"Immediate autogenous cartilage grafts in rhinoplasty after alloplastic implant rejection\". Archives of Facial Plastic Surgery. 6 (3): 192\u20136. doi:10.1001\/archfaci.6.3.192. PMID 15148130. \n\n^ Eloy JA, Jacobson AS, Elahi E, Shohet MR (June 2006). \"Enophthalmos as a complication of rhinoplasty\". The Laryngoscope. 116 (6): 1035\u20138. doi:10.1097\/01.mlg.0000217254.22699.09. PMID 16735922. \n\n^ Huang, Z; Hwang, P; Sun, Y; Zhou, B (10 June 2015). \"Steroid-eluting sinus stents for improving symptoms in chronic rhinosinusitis patients undergoing functional endoscopic sinus surgery\". The Cochrane database of systematic reviews (6): CD010436. doi:10.1002\/14651858.CD010436.pub2. PMID 26068957. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sinus_implant\">https:\/\/www.limswiki.org\/index.php\/Sinus_implant<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 17:42.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 388 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","2ba0e74622c89c9cb18d4e989dc56518_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Sinus_implant skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Sinus implant<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gray1199_labeled.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d9\/Gray1199_labeled.svg\/220px-Gray1199_labeled.svg.png\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gray1199_labeled.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Paranasal sinus. A. Frontal sinus B. Line of basolacrimal duct C. Maxillary sinus.<\/div><\/div><\/div>\n<p>A <b>Sinus implant<\/b> is a medical device that is inserted into the sinus cavity. Implants can be in conjunction with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Functional_endoscopic_sinus_surgery\" title=\"Functional endoscopic sinus surgery\" rel=\"external_link\" target=\"_blank\">sinus surgery<\/a> to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sinusitis\" title=\"Sinusitis\" rel=\"external_link\" target=\"_blank\">chronic sinusitis<\/a> and also in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sinus_lift\" title=\"Sinus lift\" rel=\"external_link\" target=\"_blank\">sinus augmentation<\/a> to increase bone structure for placement of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">dental implants<\/a>.<sup id=\"rdp-ebb-cite_ref-CompendimMaxxilary_1-0\" class=\"reference\"><a href=\"#cite_note-CompendimMaxxilary-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Maxillary_implant\">Maxillary implant<\/span><\/h3>\n<p>A maxillary implant is an implant that is placed between jaw and the maxillary sinuses. It is inserted during a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sinus_lift\" title=\"Sinus lift\" rel=\"external_link\" target=\"_blank\">sinus lift<\/a> or augmentation and used to increase the amount of bone to support <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">dental implants<\/a>.<sup id=\"rdp-ebb-cite_ref-CompendimMaxxilary_1-1\" class=\"reference\"><a href=\"#cite_note-CompendimMaxxilary-1\" rel=\"external_link\">[1]<\/a><\/sup> Implants are either inserted after drilling or by using a non-drilling method known as the osteotome technique.<sup id=\"rdp-ebb-cite_ref-CompendimMaxxilary_1-2\" class=\"reference\"><a href=\"#cite_note-CompendimMaxxilary-1\" rel=\"external_link\">[1]<\/a><\/sup> Issues such as bulging within the sinuses can occur with maxillary implants.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>Maxillary implants can also be made using Choukroun's technique with subsinus filling material.<sup id=\"rdp-ebb-cite_ref-Simultaneous_4-0\" class=\"reference\"><a href=\"#cite_note-Simultaneous-4\" rel=\"external_link\">[4]<\/a><\/sup> The material is used to stimulate natural bone regeneration. A clinical study of this technique detailed all patients within the study had continuous stable implants six months after placement. It also showed vertical bone gain in all subjects.<sup id=\"rdp-ebb-cite_ref-Simultaneous_4-1\" class=\"reference\"><a href=\"#cite_note-Simultaneous-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Rhinoplasty\">Rhinoplasty<\/span><\/h3>\n<p>Numerous different types of material have been used as sinus implants during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rhinoplasty\" title=\"Rhinoplasty\" rel=\"external_link\" target=\"_blank\">rhinoplasty<\/a> procedures. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plaster_of_Paris\" class=\"mw-redirect\" title=\"Plaster of Paris\" rel=\"external_link\" target=\"_blank\">Plaster of Paris<\/a> is often used during rhinoplasty and implanted into the frontal sinus.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Implants used in rhinoplasty have also been reported to cause <a href=\"https:\/\/en.wikipedia.org\/wiki\/Enophthalmos\" title=\"Enophthalmos\" rel=\"external_link\" target=\"_blank\">enophthalmos<\/a>.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Sinus_stent\">Sinus stent<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Steroid-eluting_sinus_stents\" class=\"mw-redirect\" title=\"Steroid-eluting sinus stents\" rel=\"external_link\" target=\"_blank\">Steroid-eluting sinus stents<\/a> maybe used in addition to endoscopic sinus surgery. They are, however, of unclear benefit as of 2015.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioresorbable_stents\" class=\"mw-redirect\" title=\"Bioresorbable stents\" rel=\"external_link\" target=\"_blank\">Bioresorbable stents<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Middle_nasal_concha\" title=\"Middle nasal concha\" rel=\"external_link\" target=\"_blank\">Middle nasal concha<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-CompendimMaxxilary-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-CompendimMaxxilary_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CompendimMaxxilary_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CompendimMaxxilary_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Summers RB (February 1994). \"A new concept in maxillary implant surgery: the osteotome technique\". <i>Compendium<\/i>. <b>15<\/b> (2): 152, 154\u20136, 158 passim, quiz 162. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8055503\" target=\"_blank\">8055503<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Compendium&rft.atitle=A+new+concept+in+maxillary+implant+surgery%3A+the+osteotome+technique&rft.volume=15&rft.issue=2&rft.pages=152%2C+154-6%2C+158+passim%2C+quiz+162&rft.date=1994-02&rft_id=info%3Apmid%2F8055503&rft.au=Summers+RB&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+implant\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sbordone L, Toti P, Menchini-Fabris G, Sbordone C, Guidetti F (2009). \"Implant success in sinus-lifted maxillae and native bone: a 3-year clinical and computerized tomographic follow-up\". <i>The International Journal of Oral & Maxillofacial Implants<\/i>. <b>24<\/b> (2): 316\u201324. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19492648\" target=\"_blank\">19492648<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+International+Journal+of+Oral+%26+Maxillofacial+Implants&rft.atitle=Implant+success+in+sinus-lifted+maxillae+and+native+bone%3A+a+3-year+clinical+and+computerized+tomographic+follow-up&rft.volume=24&rft.issue=2&rft.pages=316-24&rft.date=2009&rft_id=info%3Apmid%2F19492648&rft.aulast=Sbordone&rft.aufirst=L&rft.au=Toti%2C+P&rft.au=Menchini-Fabris%2C+G&rft.au=Sbordone%2C+C&rft.au=Guidetti%2C+F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tidwell JK, Blijdorp PA, Stoelinga PJ, Brouns JB, Hinderks F (August 1992). \"Composite grafting of the maxillary sinus for placement of endosteal implants. A preliminary report of 48 patients\". <i>International Journal of Oral and Maxillofacial Surgery<\/i>. <b>21<\/b> (4): 204\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0901-5027%2805%2980219-X\" target=\"_blank\">10.1016\/S0901-5027(05)80219-X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1328414\" target=\"_blank\">1328414<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Oral+and+Maxillofacial+Surgery&rft.atitle=Composite+grafting+of+the+maxillary+sinus+for+placement+of+endosteal+implants.+A+preliminary+report+of+48+patients&rft.volume=21&rft.issue=4&rft.pages=204-9&rft.date=1992-08&rft_id=info%3Adoi%2F10.1016%2FS0901-5027%2805%2980219-X&rft_id=info%3Apmid%2F1328414&rft.aulast=Tidwell&rft.aufirst=JK&rft.au=Blijdorp%2C+PA&rft.au=Stoelinga%2C+PJ&rft.au=Brouns%2C+JB&rft.au=Hinderks%2C+F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Simultaneous-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Simultaneous_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Simultaneous_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Simonpieri A, Choukroun J, Del Corso M, Sammartino G, Dohan Ehrenfest DM (February 2011). \"Simultaneous sinus-lift and implantation using microthreaded implants and leukocyte- and platelet-rich fibrin as sole grafting material: a six-year experience\". <i>Implant Dentistry<\/i>. <b>20<\/b> (1): 2\u201312. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FID.0b013e3181faa8af\" target=\"_blank\">10.1097\/ID.0b013e3181faa8af<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21278521\" target=\"_blank\">21278521<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Implant+Dentistry&rft.atitle=Simultaneous+sinus-lift+and+implantation+using+microthreaded+implants+and+leukocyte-+and+platelet-rich+fibrin+as+sole+grafting+material%3A+a+six-year+experience&rft.volume=20&rft.issue=1&rft.pages=2-12&rft.date=2011-02&rft_id=info%3Adoi%2F10.1097%2FID.0b013e3181faa8af&rft_id=info%3Apmid%2F21278521&rft.aulast=Simonpieri&rft.aufirst=A&rft.au=Choukroun%2C+J&rft.au=Del+Corso%2C+M&rft.au=Sammartino%2C+G&rft.au=Dohan+Ehrenfest%2C+DM&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Raghavan U, Jones NS, Romo T (2004). \"Immediate autogenous cartilage grafts in rhinoplasty after alloplastic implant rejection\". <i>Archives of Facial Plastic Surgery<\/i>. <b>6<\/b> (3): 192\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Farchfaci.6.3.192\" target=\"_blank\">10.1001\/archfaci.6.3.192<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15148130\" target=\"_blank\">15148130<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+of+Facial+Plastic+Surgery&rft.atitle=Immediate+autogenous+cartilage+grafts+in+rhinoplasty+after+alloplastic+implant+rejection&rft.volume=6&rft.issue=3&rft.pages=192-6&rft.date=2004&rft_id=info%3Adoi%2F10.1001%2Farchfaci.6.3.192&rft_id=info%3Apmid%2F15148130&rft.aulast=Raghavan&rft.aufirst=U&rft.au=Jones%2C+NS&rft.au=Romo%2C+T&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Eloy JA, Jacobson AS, Elahi E, Shohet MR (June 2006). \"Enophthalmos as a complication of rhinoplasty\". <i>The Laryngoscope<\/i>. <b>116<\/b> (6): 1035\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.mlg.0000217254.22699.09\" target=\"_blank\">10.1097\/01.mlg.0000217254.22699.09<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16735922\" target=\"_blank\">16735922<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Laryngoscope&rft.atitle=Enophthalmos+as+a+complication+of+rhinoplasty&rft.volume=116&rft.issue=6&rft.pages=1035-8&rft.date=2006-06&rft_id=info%3Adoi%2F10.1097%2F01.mlg.0000217254.22699.09&rft_id=info%3Apmid%2F16735922&rft.aulast=Eloy&rft.aufirst=JA&rft.au=Jacobson%2C+AS&rft.au=Elahi%2C+E&rft.au=Shohet%2C+MR&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Huang, Z; Hwang, P; Sun, Y; Zhou, B (10 June 2015). \"Steroid-eluting sinus stents for improving symptoms in chronic rhinosinusitis patients undergoing functional endoscopic sinus surgery\". <i>The Cochrane database of systematic reviews<\/i> (6): CD010436. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD010436.pub2\" target=\"_blank\">10.1002\/14651858.CD010436.pub2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26068957\" target=\"_blank\">26068957<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+database+of+systematic+reviews&rft.atitle=Steroid-eluting+sinus+stents+for+improving+symptoms+in+chronic+rhinosinusitis+patients+undergoing+functional+endoscopic+sinus+surgery.&rft.issue=6&rft.pages=CD010436&rft.date=2015-06-10&rft_id=info%3Adoi%2F10.1002%2F14651858.CD010436.pub2&rft_id=info%3Apmid%2F26068957&rft.aulast=Huang&rft.aufirst=Z&rft.au=Hwang%2C+P&rft.au=Sun%2C+Y&rft.au=Zhou%2C+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASinus+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1250\nCached time: 20181204041636\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.172 seconds\nReal time usage: 0.205 seconds\nPreprocessor visited node count: 408\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 15181\/2097152 bytes\nTemplate argument size: 94\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 21255\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.118\/10.000 seconds\nLua memory usage: 2.52 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 176.910 1 Template:Reflist\n100.00% 176.910 1 -total\n<\/p>\n<pre>87.71% 155.164 7 Template:Cite_journal\n 1.51% 2.668 1 Template:Main_other\n 1.14% 2.018 1 Template:Column-width\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:41636906-1!canonical and timestamp 20181204041636 and revision id 871898749\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sinus_implant\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212155\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.043 seconds\nReal time usage: 0.174 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 168.112 1 - wikipedia:Sinus_implant\n100.00% 168.112 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8072-0!*!*!*!*!*!* and timestamp 20181217212155 and revision id 24186\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sinus_implant\">https:\/\/www.limswiki.org\/index.php\/Sinus_implant<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","2ba0e74622c89c9cb18d4e989dc56518_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d9\/Gray1199_labeled.svg\/440px-Gray1199_labeled.svg.png"],"2ba0e74622c89c9cb18d4e989dc56518_timestamp":1545081715,"c884709401a9bec261e18c5fc4e4dff6_type":"article","c884709401a9bec261e18c5fc4e4dff6_title":"Shunt (medical)","c884709401a9bec261e18c5fc4e4dff6_url":"https:\/\/www.limswiki.org\/index.php\/Shunt_(medical)","c884709401a9bec261e18c5fc4e4dff6_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tShunt (medical)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (December 2009) (Learn how and when to remove this template message)\n Auscultogram from normal and abnormal heart sounds\nIn medicine, a shunt is a hole or a small passage which moves, or allows movement of, fluid from one part of the body to another. The term may describe either congenital or acquired shunts; and acquired shunts (sometimes referred to as iatrogenic shunts) may be either biological or mechanical.\n\nCardiac shunts may be described as right-to-left, left-to-right or bidirectional, or as systemic-to-pulmonary or pulmonary-to-systemic.\nCerebral shunt: In cases of hydrocephalus and other conditions that cause chronic increased intracranial pressure, a one-way valve is used to drain excess cerebrospinal fluid from the brain and carry it to other parts of the body. This valve usually sits outside the skull but beneath the skin, somewhere behind the ear. Cerebral shunts that drain fluid to the peritoneal cavity (located in the upper abdomen) are called ventriculoperitoneal (VP) shunts.\nLumbar-peritoneal shunt (a.k.a. lumboperitoneal, LP): In cases of chronic increased intracranial pressure such as idiopathic intracranial hypertension and hydrocephalus, a tube or shunt with or without a one-way valve is used to drain the excess [acerebrospinal fluid]] from the brain and transport it to the peritoneal cavity. Unlike the ventriculoperitoneal shunt, however, a lumbar-peritoneal shunt is usually inserted in between two of the vertebrae in the lumbar and punctures the cerebrospinal fluid sack or lumbar subarachnoid space, it then runs beneath the skin to the peritoneal cavity, where it is eventually drained away by the normal bodily fluid drainage system.[1]\nA Peritoneovenous shunt: (also called Denver shunt)[2] is a shunt which drains peritoneal fluid from the peritoneum into veins, usually the internal jugular vein or the superior vena cava. It is sometimes used in patients with refractory ascites. It is a long tube with a non-return valve running subcutaneously from the peritoneum to the internal jugular vein in the neck, which allows ascitic fluid to pass directly into the systemic circulation.\nPossible Complications\nBleeding from varices\nDIC (Disseminated intravascular coagulation)\nInfection\nSuperior vena caval thrombosis\nPulmonary edema<\/dd>\nPulmonary shunts exist when there is normal perfusion to an alveolus, but ventilation fails to supply the perfused region.\nA portosystemic shunt (PSS), also known as a liver shunt, is a bypass of the liver by the body's circulatory system. It can be either a congenital or acquired condition. Congenital PSS is an uncommon condition in dogs and cats, found mainly in small dog breeds such as Miniature Schnauzers and Yorkshire Terriers, and in cats such as Persians, Himalayans, and mix breeds. Acquired PSS is also uncommon and is found in older dogs with liver disease causing portal hypertension, especially cirrhosis.\nA portacaval shunt\/ portal caval shunt is a treatment for high blood pressure in the liver.\nA transjugular intrahepatic portosystemic shunt (TIPS) is an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein. It is used to treat portal hypertension.\nVASP (Vesicoamniotic shunting procedure): Fetal lower urinary tract outflow obstruction prevents the unborn baby from passing urine. This can result in a reduction in the volume of amniotic fluid, and problems with the development of the baby\u2019s lungs and kidneys. A vesico\u2013amniotic shunt is a tube that it is inserted into the unborn baby\u2019s bladder to drain the excess fluid into the surrounding space.[3]\nReferences \n\n\n^ For an example of a Lumbar-peritoneal\/Lumboperitoneal shunt Archived 2010-07-17 at the Wayback Machine. \n\n^ thefreedictionary.com Denver shunt Citing: McGraw-Hill Concise Dictionary of Modern Medicine. \u00a9 2002 \n\n^ IP overview: fetal vesico-amniotic shunt for bladder outflow obstruction (April 2006) Page 1 of 18, NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE, INTERVENTIONAL PROCEDURES PROGRAMME, Interventional procedure overview of fetal vesico-amniotic shunt for lower urinary tract outflow obstruction \n\n\nExternal links \nmedtronic.com\nneurology.org\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 17:40.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 313 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","c884709401a9bec261e18c5fc4e4dff6_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Shunt_medical skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Shunt (medical)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Phonocardiograms_from_normal_and_abnormal_heart_sounds.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/Phonocardiograms_from_normal_and_abnormal_heart_sounds.png\/200px-Phonocardiograms_from_normal_and_abnormal_heart_sounds.png\" width=\"200\" height=\"272\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Phonocardiograms_from_normal_and_abnormal_heart_sounds.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Auscultogram\" class=\"mw-redirect\" title=\"Auscultogram\" rel=\"external_link\" target=\"_blank\">Auscultogram<\/a> from normal and abnormal heart sounds<\/div><\/div><\/div>\n<p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medicine<\/a>, a <b>shunt<\/b> is a hole or a small passage which moves, or allows movement of, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bodily_fluid\" class=\"mw-redirect\" title=\"Bodily fluid\" rel=\"external_link\" target=\"_blank\">fluid<\/a> from one part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_anatomy\" class=\"mw-redirect\" title=\"Human anatomy\" rel=\"external_link\" target=\"_blank\">body<\/a> to another. The term may describe either <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital\" class=\"mw-redirect\" title=\"Congenital\" rel=\"external_link\" target=\"_blank\">congenital<\/a> or acquired shunts; and acquired shunts (sometimes referred to as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iatrogenic\" class=\"mw-redirect\" title=\"Iatrogenic\" rel=\"external_link\" target=\"_blank\">iatrogenic<\/a> shunts) may be either <a href=\"https:\/\/en.wiktionary.org\/wiki\/biologicial\" class=\"extiw\" title=\"wikt:biologicial\" rel=\"external_link\" target=\"_blank\">biological<\/a> or <a href=\"https:\/\/en.wiktionary.org\/wiki\/mechanical\" class=\"extiw\" title=\"wikt:mechanical\" rel=\"external_link\" target=\"_blank\">mechanical<\/a>.\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_shunt\" title=\"Cardiac shunt\" rel=\"external_link\" target=\"_blank\">Cardiac shunts<\/a> may be described as right-to-left, left-to-right or bidirectional, or as systemic-to-pulmonary or pulmonary-to-systemic.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_shunt\" title=\"Cerebral shunt\" rel=\"external_link\" target=\"_blank\">Cerebral shunt<\/a>: In cases of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrocephalus\" title=\"Hydrocephalus\" rel=\"external_link\" target=\"_blank\">hydrocephalus<\/a> and other conditions that cause chronic increased <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intracranial_pressure\" title=\"Intracranial pressure\" rel=\"external_link\" target=\"_blank\">intracranial pressure<\/a>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/One-way_valve\" class=\"mw-redirect\" title=\"One-way valve\" rel=\"external_link\" target=\"_blank\">one-way valve<\/a> is used to drain excess <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebrospinal_fluid\" title=\"Cerebrospinal fluid\" rel=\"external_link\" target=\"_blank\">cerebrospinal fluid<\/a> from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain\" title=\"Brain\" rel=\"external_link\" target=\"_blank\">brain<\/a> and carry it to other parts of the body. This valve usually sits outside the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_skull\" class=\"mw-redirect\" title=\"Human skull\" rel=\"external_link\" target=\"_blank\">skull<\/a> but beneath the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin\" title=\"Skin\" rel=\"external_link\" target=\"_blank\">skin<\/a>, somewhere behind the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ear\" title=\"Ear\" rel=\"external_link\" target=\"_blank\">ear<\/a>. Cerebral shunts that drain fluid to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_cavity\" title=\"Peritoneal cavity\" rel=\"external_link\" target=\"_blank\">peritoneal cavity<\/a> (located in the upper abdomen) are called <i>ventriculoperitoneal<\/i> (<i>VP<\/i>) shunts.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lumbar-peritoneal_shunt\" class=\"mw-redirect\" title=\"Lumbar-peritoneal shunt\" rel=\"external_link\" target=\"_blank\">Lumbar-peritoneal shunt<\/a> (a.k.a. <i>lumboperitoneal<\/i>, <i>LP<\/i>): In cases of chronic increased <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intracranial_pressure\" title=\"Intracranial pressure\" rel=\"external_link\" target=\"_blank\">intracranial pressure<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Idiopathic_intracranial_hypertension\" title=\"Idiopathic intracranial hypertension\" rel=\"external_link\" target=\"_blank\">idiopathic intracranial hypertension<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrocephalus\" title=\"Hydrocephalus\" rel=\"external_link\" target=\"_blank\">hydrocephalus<\/a>, a tube or shunt with or without a <a href=\"https:\/\/en.wikipedia.org\/wiki\/One-way_valve\" class=\"mw-redirect\" title=\"One-way valve\" rel=\"external_link\" target=\"_blank\">one-way valve<\/a> is used to drain the excess [acerebrospinal fluid]] from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain\" title=\"Brain\" rel=\"external_link\" target=\"_blank\">brain<\/a> and transport it to the peritoneal cavity. Unlike the ventriculoperitoneal shunt, however, a lumbar-peritoneal shunt is usually inserted in between two of the vertebrae in the lumbar and punctures the cerebrospinal fluid sack or lumbar subarachnoid space, it then runs beneath the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin\" title=\"Skin\" rel=\"external_link\" target=\"_blank\">skin<\/a> to the peritoneal cavity, where it is eventually drained away by the normal bodily fluid drainage system.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><\/li>\n<li>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneovenous_shunt\" title=\"Peritoneovenous shunt\" rel=\"external_link\" target=\"_blank\">Peritoneovenous shunt<\/a>: (also called <b>Denver shunt<\/b>)<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> is a shunt which drains <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_fluid\" title=\"Peritoneal fluid\" rel=\"external_link\" target=\"_blank\">peritoneal fluid<\/a> from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneum\" title=\"Peritoneum\" rel=\"external_link\" target=\"_blank\">peritoneum<\/a> into <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">veins<\/a>, usually the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Internal_jugular_vein\" title=\"Internal jugular vein\" rel=\"external_link\" target=\"_blank\">internal jugular vein<\/a> or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superior_vena_cava\" title=\"Superior vena cava\" rel=\"external_link\" target=\"_blank\">superior vena cava<\/a>. It is sometimes used in patients with refractory <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ascites\" title=\"Ascites\" rel=\"external_link\" target=\"_blank\">ascites<\/a>. It is a long tube with a non-return valve running subcutaneously from the peritoneum to the internal jugular vein in the neck, which allows ascitic fluid to pass directly into the systemic circulation.<\/li><\/ul>\n<dl><dd><dl><dd><i>Possible Complications<\/i>\n<ol><li>Bleeding from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Varices\" title=\"Varices\" rel=\"external_link\" target=\"_blank\">varices<\/a><\/li>\n<li>DIC (Disseminated intravascular coagulation)<\/li>\n<li>Infection<\/li>\n<li>Superior vena caval thrombosis<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulmonary_edema\" title=\"Pulmonary edema\" rel=\"external_link\" target=\"_blank\">Pulmonary edema<\/a><\/li><\/ol><\/dd><\/dl><\/dd><\/dl>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulmonary_shunt\" title=\"Pulmonary shunt\" rel=\"external_link\" target=\"_blank\">Pulmonary shunts<\/a> exist when there is normal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Perfusion\" title=\"Perfusion\" rel=\"external_link\" target=\"_blank\">perfusion<\/a> to an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alveolus\" class=\"mw-redirect\" title=\"Alveolus\" rel=\"external_link\" target=\"_blank\">alveolus<\/a>, but <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventilation_(physiology)\" class=\"mw-redirect\" title=\"Ventilation (physiology)\" rel=\"external_link\" target=\"_blank\">ventilation<\/a> fails to supply the perfused region.<\/li>\n<li>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Portosystemic_shunt\" title=\"Portosystemic shunt\" rel=\"external_link\" target=\"_blank\">portosystemic shunt<\/a> (PSS), also known as a liver shunt, is a bypass of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liver\" title=\"Liver\" rel=\"external_link\" target=\"_blank\">liver<\/a> by the body's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Circulatory_system\" title=\"Circulatory system\" rel=\"external_link\" target=\"_blank\">circulatory system<\/a>. It can be either a congenital or acquired condition. Congenital PSS is an uncommon condition in dogs and cats, found mainly in small dog breeds such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Miniature_Schnauzer\" title=\"Miniature Schnauzer\" rel=\"external_link\" target=\"_blank\">Miniature Schnauzers<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Yorkshire_Terrier\" title=\"Yorkshire Terrier\" rel=\"external_link\" target=\"_blank\">Yorkshire Terriers<\/a>, and in cats such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Persian_(cat)\" class=\"mw-redirect\" title=\"Persian (cat)\" rel=\"external_link\" target=\"_blank\">Persians<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Himalayan_(cat)\" class=\"mw-redirect\" title=\"Himalayan (cat)\" rel=\"external_link\" target=\"_blank\">Himalayans<\/a>, and mix breeds. Acquired PSS is also uncommon and is found in older dogs with liver disease causing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal_hypertension\" title=\"Portal hypertension\" rel=\"external_link\" target=\"_blank\">portal hypertension<\/a>, especially <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cirrhosis\" title=\"Cirrhosis\" rel=\"external_link\" target=\"_blank\">cirrhosis<\/a>.<\/li>\n<li>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Portacaval_shunt\" title=\"Portacaval shunt\" rel=\"external_link\" target=\"_blank\">portacaval shunt<\/a>\/ portal caval shunt is a treatment for high blood pressure in the liver.<\/li>\n<li>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transjugular_intrahepatic_portosystemic_shunt\" title=\"Transjugular intrahepatic portosystemic shunt\" rel=\"external_link\" target=\"_blank\">transjugular intrahepatic portosystemic shunt<\/a> (TIPS) is an artificial channel within the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liver\" title=\"Liver\" rel=\"external_link\" target=\"_blank\">liver<\/a> that establishes communication between the inflow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal_vein\" title=\"Portal vein\" rel=\"external_link\" target=\"_blank\">portal vein<\/a> and the outflow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatic_vein\" class=\"mw-redirect\" title=\"Hepatic vein\" rel=\"external_link\" target=\"_blank\">hepatic vein<\/a>. It is used to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal_hypertension\" title=\"Portal hypertension\" rel=\"external_link\" target=\"_blank\">portal hypertension<\/a>.<\/li>\n<li>VASP (Vesicoamniotic shunting procedure): Fetal lower urinary tract outflow obstruction prevents the unborn baby from passing urine. This can result in a reduction in the volume of amniotic fluid, and problems with the development of the baby\u2019s lungs and kidneys. A vesico\u2013amniotic shunt is a tube that it is inserted into the unborn baby\u2019s bladder to drain the excess fluid into the surrounding space.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"#lumbo\">For an example of a Lumbar-peritoneal\/Lumboperitoneal shunt<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100717034256\/http:\/\/www.medtronic.com\/neurosurgery\/shunts.html\" target=\"_blank\">Archived<\/a> 2010-07-17 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/medical-dictionary.thefreedictionary.com\/Denver+shunt\" target=\"_blank\">thefreedictionary.com Denver shunt Citing: McGraw-Hill Concise Dictionary of Modern Medicine. \u00a9 2002<\/a><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nice.org.uk\/guidance\/ipg202\/documents\/fetal-vesicoamniotic-shunt-for-lower-urinary-tract-outflow-obstruction-interventional-procedures-overview2\" target=\"_blank\">IP overview: fetal vesico-amniotic shunt for bladder outflow obstruction (April 2006) Page 1 of 18, NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE, INTERVENTIONAL PROCEDURES PROGRAMME, Interventional procedure overview of fetal vesico-amniotic shunt for lower urinary tract outflow obstruction <\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100717034256\/http:\/\/www.medtronic.com\/neurosurgery\/shunts.html#lumbo\" target=\"_blank\">medtronic.com<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.neurology.org\/cgi\/content\/abstract\/49\/3\/734\" target=\"_blank\">neurology.org<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1266\nCached time: 20181129192249\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.076 seconds\nReal time usage: 0.123 seconds\nPreprocessor visited node count: 226\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 4583\/2097152 bytes\nTemplate argument size: 92\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 1804\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.025\/10.000 seconds\nLua memory usage: 1.09 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 95.092 1 -total\n<\/p>\n<pre>64.96% 61.776 1 Template:Refimprove\n45.46% 43.227 1 Template:Ambox\n31.06% 29.532 1 Template:Reflist\n15.30% 14.553 1 Template:Webarchive\n 3.18% 3.020 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:208890-1!canonical and timestamp 20181129192249 and revision id 853160603\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Shunt_%28medical%29\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212154\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.138 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 132.228 1 - wikipedia:Shunt_(medical)\n100.00% 132.228 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8071-0!*!*!*!*!*!* and timestamp 20181217212154 and revision id 24185\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Shunt_(medical)\">https:\/\/www.limswiki.org\/index.php\/Shunt_(medical)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","c884709401a9bec261e18c5fc4e4dff6_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/Phonocardiograms_from_normal_and_abnormal_heart_sounds.png\/400px-Phonocardiograms_from_normal_and_abnormal_heart_sounds.png"],"c884709401a9bec261e18c5fc4e4dff6_timestamp":1545081714,"adbf5c6e0e0188c3ad5fa73289fe9e22_type":"article","adbf5c6e0e0188c3ad5fa73289fe9e22_title":"Self-expandable metallic stent","adbf5c6e0e0188c3ad5fa73289fe9e22_url":"https:\/\/www.limswiki.org\/index.php\/Self-expandable_metallic_stent","adbf5c6e0e0188c3ad5fa73289fe9e22_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSelf-expandable metallic stent\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Endoscopic view of a self-expandable metallic stent used to palliate an esophageal cancer\nA self-expandable metallic stent (or SEMS) is a metallic tube, or stent, used in order to hold open a structure in the gastrointestinal tract in order to allow the passage of food, chyme, stool, or other secretions required for digestion. SEMS are inserted by endoscopy, wherein a fibre optic camera is inserted either through the mouth or retrograde through the colon, in order to reach an area of narrowing. As such, it is termed an endoprosthesis. SEMS can also be inserted using fluoroscopy where an X-ray image is used to guide insertion, or used as an adjunct to endoscopy.\nThe vast majority of SEMS are used to alleviate symptoms caused by cancers of the gastrointestinal tract that obstruct the interior of the tube-like (or luminal) structures of the bowel \u2014 namely the esophagus, duodenum, common bile duct and colon. SEMS are designed to be permanent and, as a result, are often used when the cancer is at an advanced stage and cannot be removed by surgery.\n\nContents \n\n1 Composition and structure \n2 Applications \n3 Deployment \n4 Complications \n5 References \n\n\nComposition and structure \n Schematic of self-expandable metallic stent used to treat vascular abnormalities\nSelf-expandable metallic stents are cylindrical in shape, and are devised in a number of diameters and lengths to suit the application in question.[1] They typically consist of cross-hatched, braided or interconnecting rows of metal that are assembled into a tube-like structure. SEMS, when unexpanded, are small enough to fit through the channel of an endoscope, which is meant for delivery of devices for therapeutic endoscopy. They expand through a deployment device which is placed at the end of the SEMS, and are held in place against the wall of the luminal surface by friction.[2]\nSEMS may be coated with chemicals designed to prevent tumour ingrowth; these are termed \"covered\" stents. Nitinol[3] (a shape memory nickel-titanium alloy), polyurethane,[4] and polyethylene[5] are typically used as coatings for SEMS. Covered stents carry the advantage of preventing tumours from growing into the stent, although they run the risk of increased migration after deployment.[6]\nA plastic self-expanding stent (Polyflex, Boston Scientific) has also been developed for similar applications. It confers an additional advantage as it is designed to be removable, and may have a less traumatic insertion than metal stents. The Polyflex stent has shown benefit in palliation of esophageal malignancies.[7]\n\nApplications \nThe primary application of SEMS is in the palliation of tumours that obstruct the gastrointestinal tract. When they expand within the lumen, they are able to hold open the structure and allow passage of material, such as food, stool, or other secretions. The usual applications are for cancers of the esophagus, pancreas, bile ducts and colon that are not amenable to surgical therapy. SEMS may be used to treat additional complications of cancer, such as tracheoesophageal fistulas that may result from esophageal cancer,[8] and gastric outlet obstruction which may result from stomach, duodenal or pancreatic cancer.[9]\nSEMS and self-expanding plastic stents have also been used for non-malignant conditions that cause narrowing or leaks of the esophagus or colon. These include peptic strictures caused by esophageal reflux[10] and perforations of the esophagus.[11] SEMS may also be placed in tandem fashion to treat ingrowth or overgrowth tumours, and fractures or migration of other SEMS. For the latter, the second SEMS in usually deployed within the lumen of the first.[12]\nSEMS are also sometimes used in the vascular system, usually in the aorta and peripheral vascular system. In the past they have been used for saphenous vein graft and native coronary artery percutaneous coronary interventions.\n\nDeployment \n Fluoroscopic image of self-expandable metallic stent in the esophagus. The black solid structure is the endoscope used to place the stent.\nSelf-expandable metallic stents are typically inserted at the time of endoscopy, usually with assistance with fluoroscopy or x-ray images taken to guide placement. Prior to the development of SEMS small enough to pass through the channel of the endoscopy, SEMS were deployed using fluoroscopy alone.[13]\nEsophageal SEMS are placed after a gastroscopy is performed to identify the area of narrowing. The area may need to be dilated in order to allow the gastroscope to pass.[14] The tumour is usually better seen with the direct vision of endoscopy than on a fluoroscopic image. As a result, radio-opaque markers are usually placed on the surface of the patient in order to mark the area of narrowing on fluoroscopy. The SEMS is placed through the channel of the endoscope into the esophagus over a guidewire, marked on fluoroscopy, and mechanically deployed (using a device that sits outside of the endoscope) such that it expands when in position. Hypaque or other water-soluble dye may be placed through the passage to ensure patency of the stent on fluoroscopy.[15] Enteric and colonic SEMS are inserted in a similar fashion, but in the duodenum and colon respectively.[16]\nBiliary SEMS are used to palliatively treat tumours of the pancreas or bile duct that obstruct the common bile duct. They are inserted at the time of ERCP, a procedure that uses endoscopy and fluoroscopy to access the common bile duct. The bile duct is cannulated with the assistance of a guidewire and the sphincter of Oddi that is located at its base is typically cut. A wire is kept in the bile duct, and the SEMS is deployed over the wire in a similar fashion as esophageal stents. The location of the SEMS is confirmed by fluoroscopy.[17]\n\nComplications \n Fluoroscopic image of two metal biliary stents in the common bile duct. The large black tube across the image is the duodenoscope.\nThe complications of SEMS are related to a number of factors. The first is that the endoscopic procedure used to insert a SEMS involves the use of sedative medications, which may lead to oversedation, aspiration, or drug reaction. SEMS also expand and can lead to perforation of the bowel or compression of structures adjacent to the bowel.[18]\nLong-term complications of SEMS may be related to the underlying tumour being treated: the tumour may grow into the stent wall (tumour ingrowth) or over the end of the stent (tumour overgrowth), leading to obstruction. These complications may be limited by the use of coated stents.[6][19] Tumour ingrowth or overgrowth can be additionally palliated by the placement of a second stent through the lumen of the first,[6] through electrocautery or argon plasma coagulation of the tumour tissue in the stent,[6] or through the use of photodynamic therapy.[20]\nOver time, SEMS may also migrate to a different position that does not help with treatment of the obstructed area.[6] This may be treated with placement of a second SEMS, or endoscopic attempts to reposition or remove the first.[21] Rarely, SEMS may fracture[12] or intussescept after endoscopic intervention.[22]\n\nReferences \n\n\n^ Vitale G, Davis B, Tran T (2005). \"The advancing art and science of endoscopy\". Am J Surg. 190 (2): 228\u201333. doi:10.1016\/j.amjsurg.2005.05.017. PMID 16023436. \n\n^ Mauro M, Koehler R, Baron T (2000). \"Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents\". Radiology. 215 (3): 659\u201369. doi:10.1148\/radiology.215.3.r00jn30659. PMID 10831681. \n\n^ Schmassmann A, Meyenberger C, Knuchel J, Binek J, Lammer F, Kleiner B, H\u00fcrlimann S, Inauen W, Hammer B, Scheurer U, Halter F (1997). \"Self-expanding metal stents in malignant esophageal obstruction: a comparison between two stent types\". Am J Gastroenterol. 92 (3): 400\u20136. PMID 9068458. \n\n^ Song H, Park S, Jung H, Kim S, Kim J, Huh S, Kim T, Kim Y, Park S, Yoon H, Sung K, Min Y (1997). \"Benign and malignant esophageal strictures: treatment with a polyurethane-covered retrievable expandable metallic stent\". Radiology. 203 (3): 747\u201352. doi:10.1148\/radiology.203.3.9169699. PMID 9169699. \n\n^ Saxon R, Morrison K, Lakin P, Petersen B, Barton R, Katon R, Keller F (1997). \"Malignant esophageal obstruction and esophagorespiratory fistula: palliation with a polyethylene-covered Z-stent\". Radiology. 202 (2): 349\u201354. doi:10.1148\/radiology.202.2.9015055. PMID 9015055. \n\n^ a b c d e Ell C, Hochberger J, May A, Fleig W, Hahn E (1994). \"Coated and uncoated self-expanding metal stents for malignant stenosis in the upper GI tract: preliminary clinical experiences with Wallstents\". Am J Gastroenterol. 89 (9): 1496\u2013500. PMID 7521573. \n\n^ Decker P, Lippler J, Decker D, Hirner A (2001). \"Use of the Polyflex stent in the palliative therapy of esophageal carcinoma: results in 14 cases and review of the literature\". Surg Endosc. 15 (12): 1444\u20137. doi:10.1007\/s004640090099. PMID 11965462. \n\n^ Nelson D, Silvis S, Ansel H (1994). \"Management of a tracheoesophageal fistula with a silicone-covered self-expanding metal stent\". Gastrointest Endosc. 40 (4): 497\u20139. doi:10.1016\/S0016-5107(94)70221-7. PMID 7523233. \n\n^ Holt A, Patel M, Ahmed M (2004). \"Palliation of patients with malignant gastroduodenal obstruction with self-expanding metallic stents: the treatment of choice?\". Gastrointest Endosc. 60 (6): 1010\u20137. doi:10.1016\/S0016-5107(04)02276-X. PMID 15605026. \n\n^ Fiorini A, Fleischer D, Valero J, Israeli E, Wengrower D, Goldin E (2000). \"Self-expandable metal coil stents in the treatment of benign esophageal strictures refractory to conventional therapy: a case series\". Gastrointest Endosc. 52 (2): 259\u201362. doi:10.1067\/mge.2000.107709. PMID 10922106. \n\n^ Gelbmann C, Ratiu N, Rath H, Rogler G, Lock G, Sch\u00f6lmerich J, Kullmann F (2004). \"Use of self-expandable plastic stents for the treatment of esophageal perforations and symptomatic anastomotic leaks\". Endoscopy. 36 (8): 695\u20139. doi:10.1055\/s-2004-825656. PMID 15280974. \n\n^ a b Yoshida H, Mamada Y, Taniai N, Mizuguchi Y, Shimizu T, Aimoto T, Nakamura Y, Nomura T, Yokomuro S, Arima Y, Uchida E, Misawa H, Uchida E, Tajiri T (2006). \"Fracture of an expandable metallic stent placed for biliary obstruction due to common bile duct carcinoma\". J Nippon Med Sch. 73 (3): 164\u20138. doi:10.1272\/jnms.73.164. PMID 16790985. \n\n^ Kauffmann G, Roeren T, Friedl P, Brambs H, Richter G (1990). \"Interventional radiological treatment of malignant biliary obstruction\". Eur J Surg Oncol. 16 (4): 397\u2013403. PMID 2199224. \n\n^ Cordero J, Moores D (2000). \"Self-expanding esophageal metallic stents in the treatment of esophageal obstruction\". Am Surg. 66 (10): 956\u20138, discussion 958\u20139. PMID 11261624. \n\n^ Ramirez F, Dennert B, Zierer S, Sanowski R (1997). \"Esophageal self-expandable metallic stents--indications, practice, techniques, and complications: results of a national survey\". Gastrointest Endosc. 45 (5): 360\u20134. doi:10.1016\/S0016-5107(97)70144-5. PMID 9165315. \n\n^ Schiefke I, Zabel-Langhennig A, Wiedmann M, Huster D, Witzigmann H, M\u00f6ssner J, Berr F, Caca K (2003). \"Self-expandable metallic stents for malignant duodenal obstruction caused by biliary tract cancer\". Gastrointest Endosc. 58 (2): 213\u20139. doi:10.1067\/mge.2003.362. PMID 12872088. \n\n^ Yoon W, Lee J, Lee K, Lee W, Ryu J, Kim Y, Yoon Y (2006). \"A comparison of covered and uncovered Wallstents for the management of distal malignant biliary obstruction\". Gastrointest Endosc. 63 (7): 996\u20131000. doi:10.1016\/j.gie.2005.11.054. PMID 16733115. \n\n^ Garcia-Cano J; Gonzalez-Huix F; Juzgado D; Igea F; Perez-Miranda M; Lopez-Roses L; Rodriguez A; Gonzalez-Carro P; Yuguero L; Espinos J; Ducons J; Orive V; Rodriguez S. (2006). \"Use of self-expanding metal stents to treat malignant colorectal obstruction in general endoscopic practice (with videos)\". Gastrointest Endosc. 64 (6): 914\u2013920. doi:10.1016\/j.gie.2006.06.034. PMID 17140898. \n\n^ Vakil N, Morris A, Marcon N, Segalin A, Peracchia A, Bethge N, Zuccaro G, Bosco J, Jones W (2001). \"A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction\". Am J Gastroenterol. 96 (6): 1791\u20136. doi:10.1111\/j.1572-0241.2001.03923.x. PMID 11419831. \n\n^ Conio M, Gostout C (1998). \"Photodynamic therapy for the treatment of tumor ingrowth in expandable esophageal stents\". Gastrointest Endosc. 48 (2): 225. doi:10.1016\/S0016-5107(98)70175-0. PMID 9717799. \n\n^ Matsushita M, Takakuwa H, Nishio A, Kido M, Shimeno N (2003). \"Open-biopsy-forceps technique for endoscopic removal of distally migrated and impacted biliary metallic stents\". Gastrointest Endosc. 58 (6): 924\u20137. doi:10.1016\/S0016-5107(03)02335-6. PMID 14652567. \n\n^ Grover SC, Wang CS, Jones MB, Elyas ME, Kortan PP. \"Iatrogenic intussusception of a self-expanding metallic esophageal stent in stent after endoscopic guidewire trauma. Abstract presented at Canadian Association of Gastroenterology Meetings, February 2006\". Retrieved 2006-12-07 . \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Self-expandable_metallic_stent\">https:\/\/www.limswiki.org\/index.php\/Self-expandable_metallic_stent<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 17:35.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 535 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","adbf5c6e0e0188c3ad5fa73289fe9e22_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Self-expandable_metallic_stent skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Self-expandable metallic stent<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:SEMS_endo.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6a\/SEMS_endo.jpg\/220px-SEMS_endo.jpg\" width=\"220\" height=\"213\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:SEMS_endo.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Endoscopic view of a <b>self-expandable metallic stent<\/b> used to palliate an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophageal_cancer\" title=\"Esophageal cancer\" rel=\"external_link\" target=\"_blank\">esophageal cancer<\/a><\/div><\/div><\/div>\n<p>A <b>self-expandable metallic stent<\/b> (or <b>SEMS<\/b>) is a metallic tube, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stent<\/a>, used in order to hold open a structure in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastrointestinal_tract\" title=\"Gastrointestinal tract\" rel=\"external_link\" target=\"_blank\">gastrointestinal tract<\/a> in order to allow the passage of food, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chyme\" title=\"Chyme\" rel=\"external_link\" target=\"_blank\">chyme<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Feces\" title=\"Feces\" rel=\"external_link\" target=\"_blank\">stool<\/a>, or other secretions required for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digestion\" title=\"Digestion\" rel=\"external_link\" target=\"_blank\">digestion<\/a>. SEMS are inserted by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopy\" title=\"Endoscopy\" rel=\"external_link\" target=\"_blank\">endoscopy<\/a>, wherein a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiber_optics\" class=\"mw-redirect\" title=\"Fiber optics\" rel=\"external_link\" target=\"_blank\">fibre optic<\/a> camera is inserted either through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mouth\" title=\"Mouth\" rel=\"external_link\" target=\"_blank\">mouth<\/a> or retrograde through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colon_(anatomy)\" class=\"mw-redirect\" title=\"Colon (anatomy)\" rel=\"external_link\" target=\"_blank\">colon<\/a>, in order to reach an area of narrowing. As such, it is termed an <i>endoprosthesis<\/i>. SEMS can also be inserted using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroscopy\" title=\"Fluoroscopy\" rel=\"external_link\" target=\"_blank\">fluoroscopy<\/a> where an X-ray image is used to guide insertion, or used as an adjunct to endoscopy.\n<\/p><p>The vast majority of SEMS are used to alleviate symptoms caused by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cancer\" title=\"Cancer\" rel=\"external_link\" target=\"_blank\">cancers<\/a> of the gastrointestinal tract that obstruct the interior of the tube-like (or luminal) structures of the bowel \u2014 namely the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophagus\" title=\"Esophagus\" rel=\"external_link\" target=\"_blank\">esophagus<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Duodenum\" title=\"Duodenum\" rel=\"external_link\" target=\"_blank\">duodenum<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Common_bile_duct\" title=\"Common bile duct\" rel=\"external_link\" target=\"_blank\">common bile duct<\/a> and colon. SEMS are designed to be permanent and, as a result, are often used when the cancer is at an advanced stage and cannot be removed by surgery.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Composition_and_structure\">Composition and structure<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:USPAT6319278.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/80\/USPAT6319278.JPG\/220px-USPAT6319278.JPG\" width=\"220\" height=\"356\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:USPAT6319278.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Schematic of self-expandable metallic stent used to treat vascular abnormalities<\/div><\/div><\/div>\n<p>Self-expandable metallic stents are cylindrical in shape, and are devised in a number of diameters and lengths to suit the application in question.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> They typically consist of cross-hatched, braided or interconnecting rows of metal that are assembled into a tube-like structure. SEMS, when unexpanded, are small enough to fit through the channel of an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscope\" title=\"Endoscope\" rel=\"external_link\" target=\"_blank\">endoscope<\/a>, which is meant for delivery of devices for therapeutic endoscopy. They expand through a deployment device which is placed at the end of the SEMS, and are held in place against the wall of the luminal surface by friction.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>SEMS may be coated with chemicals designed to prevent tumour ingrowth; these are termed \"covered\" stents. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nitinol\" class=\"mw-redirect\" title=\"Nitinol\" rel=\"external_link\" target=\"_blank\">Nitinol<\/a><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> (a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shape_memory_alloy\" class=\"mw-redirect\" title=\"Shape memory alloy\" rel=\"external_link\" target=\"_blank\">shape memory<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nickel\" title=\"Nickel\" rel=\"external_link\" target=\"_blank\">nickel<\/a>-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a> alloy), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyurethane\" title=\"Polyurethane\" rel=\"external_link\" target=\"_blank\">polyurethane<\/a>,<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> are typically used as coatings for SEMS. Covered stents carry the advantage of preventing tumours from growing into the stent, although they run the risk of increased migration after deployment.<sup id=\"rdp-ebb-cite_ref-Ell_6-0\" class=\"reference\"><a href=\"#cite_note-Ell-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>A plastic self-expanding stent (Polyflex, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boston_Scientific\" title=\"Boston Scientific\" rel=\"external_link\" target=\"_blank\">Boston Scientific<\/a>) has also been developed for similar applications. It confers an additional advantage as it is designed to be removable, and may have a less traumatic insertion than metal stents. The Polyflex stent has shown benefit in palliation of esophageal malignancies.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>The primary application of SEMS is in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Palliative_care\" title=\"Palliative care\" rel=\"external_link\" target=\"_blank\">palliation<\/a> of tumours that obstruct the gastrointestinal tract. When they expand within the lumen, they are able to hold open the structure and allow passage of material, such as food, stool, or other secretions. The usual applications are for cancers of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophageal_cancer\" title=\"Esophageal cancer\" rel=\"external_link\" target=\"_blank\">esophagus<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pancreatic_cancer\" title=\"Pancreatic cancer\" rel=\"external_link\" target=\"_blank\">pancreas<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholangiocarcinoma\" title=\"Cholangiocarcinoma\" rel=\"external_link\" target=\"_blank\">bile ducts<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colon_cancer\" class=\"mw-redirect\" title=\"Colon cancer\" rel=\"external_link\" target=\"_blank\">colon<\/a> that are not amenable to surgical therapy. SEMS may be used to treat additional complications of cancer, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tracheoesophageal_fistula\" title=\"Tracheoesophageal fistula\" rel=\"external_link\" target=\"_blank\">tracheoesophageal fistulas<\/a> that may result from esophageal cancer,<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastric_outlet_obstruction\" title=\"Gastric outlet obstruction\" rel=\"external_link\" target=\"_blank\">gastric outlet obstruction<\/a> which may result from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stomach_cancer\" title=\"Stomach cancer\" rel=\"external_link\" target=\"_blank\">stomach<\/a>, duodenal or pancreatic cancer.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>SEMS and self-expanding plastic stents have also been used for non-malignant conditions that cause narrowing or leaks of the esophagus or colon. These include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastroesophageal_reflux_disease\" title=\"Gastroesophageal reflux disease\" rel=\"external_link\" target=\"_blank\">peptic strictures<\/a> caused by esophageal reflux<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> and perforations of the esophagus.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> SEMS may also be placed in tandem fashion to treat ingrowth or overgrowth tumours, and fractures or migration of other SEMS. For the latter, the second SEMS in usually deployed within the lumen of the first.<sup id=\"rdp-ebb-cite_ref-Yoshida_12-0\" class=\"reference\"><a href=\"#cite_note-Yoshida-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p>SEMS are also sometimes used in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular_system\" class=\"mw-redirect\" title=\"Vascular system\" rel=\"external_link\" target=\"_blank\">vascular system<\/a>, usually in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aorta\" title=\"Aorta\" rel=\"external_link\" target=\"_blank\">aorta<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peripheral_vascular_system\" title=\"Peripheral vascular system\" rel=\"external_link\" target=\"_blank\">peripheral vascular system<\/a>. In the past they have been used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saphenous_vein_graft\" class=\"mw-redirect\" title=\"Saphenous vein graft\" rel=\"external_link\" target=\"_blank\">saphenous vein graft<\/a> and native <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery\" class=\"mw-redirect\" title=\"Coronary artery\" rel=\"external_link\" target=\"_blank\">coronary artery<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous_coronary_intervention\" title=\"Percutaneous coronary intervention\" rel=\"external_link\" target=\"_blank\">percutaneous coronary interventions<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Deployment\">Deployment<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:SEMS_fluoro_2.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/3\/3a\/SEMS_fluoro_2.jpg\/220px-SEMS_fluoro_2.jpg\" width=\"220\" height=\"218\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:SEMS_fluoro_2.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroscopy\" title=\"Fluoroscopy\" rel=\"external_link\" target=\"_blank\">Fluoroscopic<\/a> image of self-expandable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophageal_stent\" title=\"Esophageal stent\" rel=\"external_link\" target=\"_blank\">metallic stent in the esophagus<\/a>. The black solid structure is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopy\" title=\"Endoscopy\" rel=\"external_link\" target=\"_blank\">endoscope<\/a> used to place the stent.<\/div><\/div><\/div>\n<p>Self-expandable metallic stents are typically inserted at the time of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopy\" title=\"Endoscopy\" rel=\"external_link\" target=\"_blank\">endoscopy<\/a>, usually with assistance with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroscopy\" title=\"Fluoroscopy\" rel=\"external_link\" target=\"_blank\">fluoroscopy<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray\" title=\"X-ray\" rel=\"external_link\" target=\"_blank\">x-ray<\/a> images taken to guide placement. Prior to the development of SEMS small enough to pass through the channel of the endoscopy, SEMS were deployed using fluoroscopy alone.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p><p>Esophageal SEMS are placed after a gastroscopy is performed to identify the area of narrowing. The area may need to be dilated in order to allow the gastroscope to pass.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> The tumour is usually better seen with the direct vision of endoscopy than on a fluoroscopic image. As a result, radio-opaque markers are usually placed on the surface of the patient in order to mark the area of narrowing on fluoroscopy. The SEMS is placed through the channel of the endoscope into the esophagus over a guidewire, marked on fluoroscopy, and mechanically deployed (using a device that sits outside of the endoscope) such that it expands when in position. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypaque\" class=\"mw-redirect\" title=\"Hypaque\" rel=\"external_link\" target=\"_blank\">Hypaque<\/a> or other water-soluble dye may be placed through the passage to ensure patency of the stent on fluoroscopy.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> Enteric and colonic SEMS are inserted in a similar fashion, but in the duodenum and colon respectively.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>Biliary SEMS are used to palliatively treat tumours of the pancreas or bile duct that obstruct the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Common_bile_duct\" title=\"Common bile duct\" rel=\"external_link\" target=\"_blank\">common bile duct<\/a>. They are inserted at the time of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopic_retrograde_cholangiopancreatography\" title=\"Endoscopic retrograde cholangiopancreatography\" rel=\"external_link\" target=\"_blank\">ERCP<\/a>, a procedure that uses endoscopy and fluoroscopy to access the common bile duct. The bile duct is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cannula\" title=\"Cannula\" rel=\"external_link\" target=\"_blank\">cannulated<\/a> with the assistance of a guidewire and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sphincter_of_Oddi\" title=\"Sphincter of Oddi\" rel=\"external_link\" target=\"_blank\">sphincter of Oddi<\/a> that is located at its base is typically cut. A wire is kept in the bile duct, and the SEMS is deployed over the wire in a similar fashion as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophageal_stent\" title=\"Esophageal stent\" rel=\"external_link\" target=\"_blank\">esophageal stents<\/a>. The location of the SEMS is confirmed by fluoroscopy.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Complications\">Complications<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Fluoro_biliary_SEMS.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/0\/0b\/Fluoro_biliary_SEMS.jpg\/220px-Fluoro_biliary_SEMS.jpg\" width=\"220\" height=\"195\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Fluoro_biliary_SEMS.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Fluoroscopic image of two metal biliary stents in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Common_bile_duct\" title=\"Common bile duct\" rel=\"external_link\" target=\"_blank\">common bile duct<\/a>. The large black tube across the image is the duodenoscope.<\/div><\/div><\/div>\n<p>The complications of SEMS are related to a number of factors. The first is that the endoscopic procedure used to insert a SEMS involves the use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sedative\" title=\"Sedative\" rel=\"external_link\" target=\"_blank\">sedative<\/a> medications, which may lead to oversedation, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulmonary_aspiration\" title=\"Pulmonary aspiration\" rel=\"external_link\" target=\"_blank\">aspiration<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Allergy\" title=\"Allergy\" rel=\"external_link\" target=\"_blank\">drug reaction<\/a>. SEMS also expand and can lead to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Perforation\" title=\"Perforation\" rel=\"external_link\" target=\"_blank\">perforation<\/a> of the bowel or compression of structures adjacent to the bowel.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p><p>Long-term complications of SEMS may be related to the underlying tumour being treated: the tumour may grow into the stent wall (tumour ingrowth) or over the end of the stent (tumour overgrowth), leading to obstruction. These complications may be limited by the use of coated stents.<sup id=\"rdp-ebb-cite_ref-Ell_6-1\" class=\"reference\"><a href=\"#cite_note-Ell-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> Tumour ingrowth or overgrowth can be additionally palliated by the placement of a second stent through the lumen of the first,<sup id=\"rdp-ebb-cite_ref-Ell_6-2\" class=\"reference\"><a href=\"#cite_note-Ell-6\" rel=\"external_link\">[6]<\/a><\/sup> through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrocautery\" class=\"mw-redirect\" title=\"Electrocautery\" rel=\"external_link\" target=\"_blank\">electrocautery<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Argon_plasma_coagulation\" title=\"Argon plasma coagulation\" rel=\"external_link\" target=\"_blank\">argon plasma coagulation<\/a> of the tumour tissue in the stent,<sup id=\"rdp-ebb-cite_ref-Ell_6-3\" class=\"reference\"><a href=\"#cite_note-Ell-6\" rel=\"external_link\">[6]<\/a><\/sup> or through the use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photodynamic_therapy\" title=\"Photodynamic therapy\" rel=\"external_link\" target=\"_blank\">photodynamic therapy<\/a>.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><p>Over time, SEMS may also migrate to a different position that does not help with treatment of the obstructed area.<sup id=\"rdp-ebb-cite_ref-Ell_6-4\" class=\"reference\"><a href=\"#cite_note-Ell-6\" rel=\"external_link\">[6]<\/a><\/sup> This may be treated with placement of a second SEMS, or endoscopic attempts to reposition or remove the first.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> Rarely, SEMS may fracture<sup id=\"rdp-ebb-cite_ref-Yoshida_12-1\" class=\"reference\"><a href=\"#cite_note-Yoshida-12\" rel=\"external_link\">[12]<\/a><\/sup> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intussusception_(medical_disorder)\" title=\"Intussusception (medical disorder)\" rel=\"external_link\" target=\"_blank\">intussescept<\/a> after endoscopic intervention.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vitale G, Davis B, Tran T (2005). \"The advancing art and science of endoscopy\". <i>Am J Surg<\/i>. <b>190<\/b> (2): 228\u201333. <a 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Radiology&rft.atitle=Benign+and+malignant+esophageal+strictures%3A+treatment+with+a+polyurethane-covered+retrievable+expandable+metallic+stent&rft.volume=203&rft.issue=3&rft.pages=747-52&rft.date=1997&rft_id=info%3Adoi%2F10.1148%2Fradiology.203.3.9169699&rft_id=info%3Apmid%2F9169699&rft.aulast=Song&rft.aufirst=H&rft.au=Park%2C+S&rft.au=Jung%2C+H&rft.au=Kim%2C+S&rft.au=Kim%2C+J&rft.au=Huh%2C+S&rft.au=Kim%2C+T&rft.au=Kim%2C+Y&rft.au=Park%2C+S&rft.au=Yoon%2C+H&rft.au=Sung%2C+K&rft.au=Min%2C+Y&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-expandable+metallic+stent\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Saxon 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rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ell_6-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ell_6-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ell C, Hochberger J, May A, Fleig W, Hahn E (1994). \"Coated and uncoated self-expanding metal stents for malignant stenosis in the upper GI tract: preliminary clinical experiences with Wallstents\". <i>Am J Gastroenterol<\/i>. <b>89<\/b> (9): 1496\u2013500. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7521573\" target=\"_blank\">7521573<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Am+J+Gastroenterol&rft.atitle=Coated+and+uncoated+self-expanding+metal+stents+for+malignant+stenosis+in+the+upper+GI+tract%3A+preliminary+clinical+experiences+with+Wallstents&rft.volume=89&rft.issue=9&rft.pages=1496-500&rft.date=1994&rft_id=info%3Apmid%2F7521573&rft.aulast=Ell&rft.aufirst=C&rft.au=Hochberger%2C+J&rft.au=May%2C+A&rft.au=Fleig%2C+W&rft.au=Hahn%2C+E&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-expandable+metallic+stent\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Decker P, Lippler J, Decker D, Hirner A (2001). \"Use of the Polyflex stent in the palliative therapy of esophageal carcinoma: results 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gastrointest+Endosc&rft.atitle=Management+of+a+tracheoesophageal+fistula+with+a+silicone-covered+self-expanding+metal+stent.&rft.volume=40&rft.issue=4&rft.pages=497-9&rft.date=1994&rft_id=info%3Adoi%2F10.1016%2FS0016-5107%2894%2970221-7&rft_id=info%3Apmid%2F7523233&rft.aulast=Nelson&rft.aufirst=D&rft.au=Silvis%2C+S&rft.au=Ansel%2C+H&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-expandable+metallic+stent\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Holt A, Patel M, Ahmed M (2004). \"Palliation of patients with malignant gastroduodenal obstruction with self-expanding metallic stents: the treatment of choice?\". 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rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Conio M, Gostout C (1998). \"Photodynamic therapy for the treatment of tumor ingrowth in expandable esophageal stents\". <i>Gastrointest Endosc<\/i>. <b>48<\/b> (2): 225. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0016-5107%2898%2970175-0\" target=\"_blank\">10.1016\/S0016-5107(98)70175-0<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9717799\" target=\"_blank\">9717799<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gastrointest+Endosc&rft.atitle=Photodynamic+therapy+for+the+treatment+of+tumor+ingrowth+in+expandable+esophageal+stents.&rft.volume=48&rft.issue=2&rft.pages=225&rft.date=1998&rft_id=info%3Adoi%2F10.1016%2FS0016-5107%2898%2970175-0&rft_id=info%3Apmid%2F9717799&rft.aulast=Conio&rft.aufirst=M&rft.au=Gostout%2C+C&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-expandable+metallic+stent\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Matsushita M, Takakuwa H, Nishio A, Kido M, Shimeno N (2003). \"Open-biopsy-forceps technique for endoscopic removal of distally migrated and impacted biliary metallic stents\". <i>Gastrointest Endosc<\/i>. <b>58<\/b> (6): 924\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0016-5107%2803%2902335-6\" target=\"_blank\">10.1016\/S0016-5107(03)02335-6<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14652567\" target=\"_blank\">14652567<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gastrointest+Endosc&rft.atitle=Open-biopsy-forceps+technique+for+endoscopic+removal+of+distally+migrated+and+impacted+biliary+metallic+stents&rft.volume=58&rft.issue=6&rft.pages=924-7&rft.date=2003&rft_id=info%3Adoi%2F10.1016%2FS0016-5107%2803%2902335-6&rft_id=info%3Apmid%2F14652567&rft.aulast=Matsushita&rft.aufirst=M&rft.au=Takakuwa%2C+H&rft.au=Nishio%2C+A&rft.au=Kido%2C+M&rft.au=Shimeno%2C+N&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-expandable+metallic+stent\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Grover SC, Wang CS, Jones MB, Elyas ME, Kortan PP. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.pulsus.com\/cddw2006\/abs\/120.htm\" target=\"_blank\">\"Iatrogenic intussusception of a self-expanding metallic esophageal stent in stent after endoscopic guidewire trauma. Abstract presented at Canadian Association of Gastroenterology Meetings, February 2006\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2006-12-07<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Iatrogenic+intussusception+of+a+self-expanding+metallic+esophageal+stent+in+stent+after+endoscopic+guidewire+trauma.++Abstract+presented+at+Canadian+Association+of+Gastroenterology+Meetings%2C+February+2006&rft.aulast=Grover&rft.aufirst=SC&rft.au=Wang%2C+CS&rft.au=Jones%2C+MB&rft.au=Elyas%2C+ME&rft.au=Kortan%2C+PP&rft_id=http%3A%2F%2Fwww.pulsus.com%2Fcddw2006%2Fabs%2F120.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASelf-expandable+metallic+stent\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1265\nCached time: 20181126143901\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.308 seconds\nReal time usage: 0.347 seconds\nPreprocessor visited node count: 1043\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 48782\/2097152 bytes\nTemplate argument size: 126\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 66894\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.207\/10.000 seconds\nLua memory usage: 3.29 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 284.865 1 Template:Reflist\n100.00% 284.865 1 -total\n<\/p>\n<pre>84.54% 240.837 21 Template:Cite_journal\n 2.81% 8.006 1 Template:Cite_web\n 0.95% 2.704 1 Template:Main_other\n 0.80% 2.283 1 Template:Column-width\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:8312380-1!canonical and timestamp 20181126143900 and revision id 722436914\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Self-expandable_metallic_stent\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212154\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.157 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 149.858 1 - wikipedia:Self-expandable_metallic_stent\n100.00% 149.858 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8070-0!*!*!*!*!*!* and timestamp 20181217212154 and revision id 24184\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Self-expandable_metallic_stent\">https:\/\/www.limswiki.org\/index.php\/Self-expandable_metallic_stent<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","adbf5c6e0e0188c3ad5fa73289fe9e22_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/6\/6a\/SEMS_endo.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/80\/USPAT6319278.JPG\/440px-USPAT6319278.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/en\/3\/3a\/SEMS_fluoro_2.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/0\/0b\/Fluoro_biliary_SEMS.jpg\/440px-Fluoro_biliary_SEMS.jpg"],"adbf5c6e0e0188c3ad5fa73289fe9e22_timestamp":1545081714,"4c86d91a19abe19e9a22fc501dc0f881_type":"article","4c86d91a19abe19e9a22fc501dc0f881_title":"Sacral nerve stimulator","4c86d91a19abe19e9a22fc501dc0f881_url":"https:\/\/www.limswiki.org\/index.php\/Sacral_nerve_stimulator","4c86d91a19abe19e9a22fc501dc0f881_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSacral nerve stimulator\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tA sacral nerve stimulator is a small device implanted in the buttocks of people who have problems with bladder and\/or bowel control. This device is implanted in the buttock and connected to the sacral nerve by a wire. The device stops urges to defecate and urinate by sending signals to the sacral nerve. The patient is able to control their bladder and\/or bowel via an external device similar to a remote control.[1]\nA 2007 review by the Cochrane Collaboration was cautiously optimistic about the results of sacral nerve stimulation in fecal incontinence, although it also concluded that trial periods of stimulation did not adequately identify patients that would benefit from the procedure, and that more longer-term studies were needed.[2][needs update ]\n\nReferences \n\n\n^ Urinary Incontinence Surgery - Mayo Clinic \n\n^ Mowatt G, Glazener C, Jarrett M (2007). Mowatt G, ed. \"Sacral nerve stimulation for faecal incontinence and constipation in adults\". Cochrane Database of Systematic Reviews (3): CD004464. doi:10.1002\/14651858.CD004464.pub2. PMID 17636759. \n\n\n\r\n\n\nThis article related to medical equipment is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sacral_nerve_stimulator\">https:\/\/www.limswiki.org\/index.php\/Sacral_nerve_stimulator<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 17:33.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 295 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","4c86d91a19abe19e9a22fc501dc0f881_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Sacral_nerve_stimulator skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Sacral nerve stimulator<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>A <b>sacral nerve stimulator<\/b> is a small device implanted in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Buttocks\" title=\"Buttocks\" rel=\"external_link\" target=\"_blank\">buttocks<\/a> of people who have problems with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinary_bladder\" title=\"Urinary bladder\" rel=\"external_link\" target=\"_blank\">bladder<\/a> and\/or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bowel\" class=\"mw-redirect\" title=\"Bowel\" rel=\"external_link\" target=\"_blank\">bowel<\/a> control. This device is implanted in the buttock and connected to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacral_nerve\" class=\"mw-redirect\" title=\"Sacral nerve\" rel=\"external_link\" target=\"_blank\">sacral nerve<\/a> by a wire. The device stops urges to defecate and urinate by sending signals to the sacral nerve. The patient is able to control their bladder and\/or bowel via an external device similar to a remote control.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>A 2007 review by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochrane_Collaboration\" class=\"mw-redirect\" title=\"Cochrane Collaboration\" rel=\"external_link\" target=\"_blank\">Cochrane Collaboration<\/a> was cautiously optimistic about the results of sacral nerve stimulation in fecal incontinence, although it also concluded that trial periods of stimulation did not adequately identify patients that would benefit from the procedure, and that more longer-term studies were needed.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Dates_and_numbers#Chronological_items\" title=\"Wikipedia:Manual of Style\/Dates and numbers\" rel=\"external_link\" target=\"_blank\"><span title=\"Updated version https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26299888 (November 2018)\">needs update<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mayoclinic.org\/urinary-incontinence\/surgery.html\" target=\"_blank\">Urinary Incontinence Surgery - Mayo Clinic<\/a><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mowatt G, Glazener C, Jarrett M (2007). Mowatt G, ed. \"Sacral nerve stimulation for faecal incontinence and constipation in adults\". <i>Cochrane Database of Systematic Reviews<\/i> (3): CD004464. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD004464.pub2\" target=\"_blank\">10.1002\/14651858.CD004464.pub2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17636759\" target=\"_blank\">17636759<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cochrane+Database+of+Systematic+Reviews&rft.atitle=Sacral+nerve+stimulation+for+faecal+incontinence+and+constipation+in+adults&rft.issue=3&rft.pages=CD004464&rft.date=2007&rft_id=info%3Adoi%2F10.1002%2F14651858.CD004464.pub2&rft_id=info%3Apmid%2F17636759&rft.aulast=Mowatt&rft.aufirst=G&rft.au=Glazener%2C+C&rft.au=Jarrett%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASacral+nerve+stimulator\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><br \/>\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1271\nCached time: 20181126011450\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.152 seconds\nReal time usage: 0.219 seconds\nPreprocessor visited node count: 321\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 7462\/2097152 bytes\nTemplate argument size: 673\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 3333\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.088\/10.000 seconds\nLua memory usage: 2.18 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 202.476 1 -total\n<\/p>\n<pre>47.94% 97.058 1 Template:Reflist\n42.59% 86.226 1 Template:Update_inline\n41.89% 84.823 1 Template:Cite_journal\n24.78% 50.165 1 Template:Fix\n15.89% 32.173 1 Template:Category_handler\n 9.38% 18.991 1 Template:Medical-equipment-stub\n 7.83% 15.858 1 Template:Asbox\n 7.62% 15.429 1 Template:DMCA\n 6.46% 13.083 1 Template:Delink\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:13446850-1!canonical and timestamp 20181126011450 and revision id 866857132\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sacral_nerve_stimulator\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212153\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.046 seconds\nReal time usage: 0.178 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 172.235 1 - wikipedia:Sacral_nerve_stimulator\n100.00% 172.235 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8069-0!*!*!*!*!*!* and timestamp 20181217212153 and revision id 24183\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sacral_nerve_stimulator\">https:\/\/www.limswiki.org\/index.php\/Sacral_nerve_stimulator<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","4c86d91a19abe19e9a22fc501dc0f881_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Filled_Syringe_icon.svg\/60px-Filled_Syringe_icon.svg.png"],"4c86d91a19abe19e9a22fc501dc0f881_timestamp":1545081713,"0793816bf7409e0a1934c5674bcf0309_type":"article","0793816bf7409e0a1934c5674bcf0309_title":"Sacral anterior root stimulator","0793816bf7409e0a1934c5674bcf0309_url":"https:\/\/www.limswiki.org\/index.php\/Sacral_anterior_root_stimulator","0793816bf7409e0a1934c5674bcf0309_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSacral anterior root stimulator\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tA sacral anterior root stimulator is an implantable medical device enabling patients with a spinal cord lesion to empty their bladders.\n\nHistory \nFrom 1969 onwards Giles Brindley[1] developed the sacral anterior root stimulator, with successful human trials from the early 1980s onwards. Although both sphincter and detrusor muscles are stimulated at the same time, the slower contraction kinetics of the bladder wall (smooth muscle tissue) compared to the sphincter (striated muscle tissue) mean that voiding occurs between the stimulation pulses, rather than during them.\n\nDescription \nThis device is implanted over the sacral anterior root of the spinal cord; controlled by an external transmitter, it delivers intermittent stimulation which improves the ability to empty the bladder. It may also assist in defecation and also may enable male patients to have a sustained full erection. The device is implanted in one of two regions, either through intrathecal administration or extradurally. It is often performed in conjunction with a dorsal rhizotomy, and many groups believe that the best results are only seen when this procedure is performed alongside the implantation. The rhizotomy will remove sensory reflexes, which in men may include sexual reflexes. For some patients this is a major drawback to the device. For others, the benefits outweigh the downside.\n\n\n\n\nLook up extradurally in Wiktionary, the free dictionary. \nThe related procedure of sacral nerve stimulation is to control incontinence in otherwise able-bodied patients.[2]\n\nReferences \n\n^ Brindley GS, Polkey CE, Rushton DN (1982): Sacral anterior root stimulator for bladder control in paraplegia. Paraplegia 20: 365-381. \n\n^ Schmidt RA, Jonas A, Oleson KA, Janknegt RA, Hassouna MM, Siegel SW, van Kerrebroeck PE. Sacral nerve stimulation for treatment of refractory urinary urge incontinence. Sacral nerve study group. J Urol 1999 Aug;16(2):352-357. \n\n\n\r\n\n\nThis medical treatment\u2013related article is a stub. You can help Wikipedia by expanding it.vte\nThis neuroscience article is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sacral_anterior_root_stimulator\">https:\/\/www.limswiki.org\/index.php\/Sacral_anterior_root_stimulator<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 22:27.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 320 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","0793816bf7409e0a1934c5674bcf0309_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Sacral_anterior_root_stimulator skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Sacral anterior root stimulator<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>A <b>sacral anterior root stimulator<\/b> is an implantable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> enabling patients with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_injury\" title=\"Spinal cord injury\" rel=\"external_link\" target=\"_blank\">spinal cord lesion<\/a> to empty their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bladder\" class=\"mw-redirect\" title=\"Bladder\" rel=\"external_link\" target=\"_blank\">bladders<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>From 1969 onwards <a href=\"https:\/\/en.wikipedia.org\/wiki\/Giles_Brindley\" title=\"Giles Brindley\" rel=\"external_link\" target=\"_blank\">Giles Brindley<\/a><sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> developed the sacral anterior root stimulator, with successful <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_trials\" class=\"mw-redirect\" title=\"Clinical trials\" rel=\"external_link\" target=\"_blank\">human trials<\/a> from the early 1980s onwards. Although both <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sphincter\" title=\"Sphincter\" rel=\"external_link\" target=\"_blank\">sphincter<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Detrusor_urinae_muscle\" class=\"mw-redirect\" title=\"Detrusor urinae muscle\" rel=\"external_link\" target=\"_blank\">detrusor muscles<\/a> are stimulated at the same time, the slower contraction kinetics of the bladder wall (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Smooth_muscle_tissue\" class=\"mw-redirect\" title=\"Smooth muscle tissue\" rel=\"external_link\" target=\"_blank\">smooth muscle tissue<\/a>) compared to the sphincter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Striated_muscle_tissue\" title=\"Striated muscle tissue\" rel=\"external_link\" target=\"_blank\">striated muscle tissue<\/a>) mean that <a href=\"https:\/\/en.wikipedia.org\/wiki\/Voiding\" class=\"mw-redirect\" title=\"Voiding\" rel=\"external_link\" target=\"_blank\">voiding<\/a> occurs between the stimulation pulses, rather than during them.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Description\">Description<\/span><\/h2>\n<p>This device is implanted over the sacral anterior root of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord\" title=\"Spinal cord\" rel=\"external_link\" target=\"_blank\">spinal cord<\/a>; controlled by an external transmitter, it delivers intermittent stimulation which improves the ability to empty the bladder. It may also assist in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Defecation\" title=\"Defecation\" rel=\"external_link\" target=\"_blank\">defecation<\/a> and also may enable male patients to have a sustained full <a href=\"https:\/\/en.wikipedia.org\/wiki\/Erection\" title=\"Erection\" rel=\"external_link\" target=\"_blank\">erection<\/a>. The device is implanted in one of two regions, either through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intrathecal_administration\" title=\"Intrathecal administration\" rel=\"external_link\" target=\"_blank\">intrathecal administration<\/a> or extradurally. It is often performed in conjunction with a dorsal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rhizotomy\" title=\"Rhizotomy\" rel=\"external_link\" target=\"_blank\">rhizotomy<\/a>, and many groups believe that the best results are only seen when this procedure is performed alongside the implantation. The rhizotomy will remove sensory reflexes, which in men may include sexual reflexes. For some patients this is a major drawback to the device. For others, the benefits outweigh the downside.\n<\/p>\n \n<p>The related procedure of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacral_nerve_stimulator\" title=\"Sacral nerve stimulator\" rel=\"external_link\" target=\"_blank\">sacral nerve stimulation<\/a> is to control incontinence in otherwise able-bodied patients.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Brindley GS, Polkey CE, Rushton DN (1982): Sacral anterior root stimulator for bladder control in paraplegia. Paraplegia 20: 365-381.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Schmidt RA, Jonas A, Oleson KA, Janknegt RA, Hassouna MM, Siegel SW, van Kerrebroeck PE. Sacral nerve stimulation for treatment of refractory urinary urge incontinence. Sacral nerve study group. J Urol 1999 Aug;16(2):352-357.<\/span>\n<\/li>\n<\/ol><\/div>\n<p><br \/>\n<\/p>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1326\nCached time: 20181127185749\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.052 seconds\nReal time usage: 0.087 seconds\nPreprocessor visited node count: 187\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 7052\/2097152 bytes\nTemplate argument size: 128\/2097152 bytes\nHighest expansion depth: 8\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 865\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.013\/10.000 seconds\nLua memory usage: 795 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 61.609 1 -total\n<\/p>\n<pre>51.03% 31.439 1 Template:Wikt\n43.27% 26.656 1 Template:Sister_project\n38.55% 23.751 1 Template:Treatment-stub\n37.37% 23.023 2 Template:Asbox\n36.80% 22.673 1 Template:Side_box\n 7.06% 4.349 1 Template:Neuroscience-stub\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:10688224-1!canonical and timestamp 20181127185749 and revision id 826775944\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sacral_anterior_root_stimulator\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212153\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.147 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 141.485 1 - wikipedia:Sacral_anterior_root_stimulator\n100.00% 141.485 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8281-0!*!*!*!*!*!* and timestamp 20181217212153 and revision id 24493\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sacral_anterior_root_stimulator\">https:\/\/www.limswiki.org\/index.php\/Sacral_anterior_root_stimulator<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","0793816bf7409e0a1934c5674bcf0309_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5c\/AdhesiveBandage.png\/80px-AdhesiveBandage.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e6\/Cat_brain.jpg\/80px-Cat_brain.jpg"],"0793816bf7409e0a1934c5674bcf0309_timestamp":1545081713,"509b1c17d543b634fdcca6203766c55c_type":"article","509b1c17d543b634fdcca6203766c55c_title":"Retinal implant","509b1c17d543b634fdcca6203766c55c_url":"https:\/\/www.limswiki.org\/index.php\/Retinal_implant","509b1c17d543b634fdcca6203766c55c_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tRetinal implant\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Diagram of the eye, the retina, and location of the various retinal implants. Retinal layers, from bottom to top: retinal pigment epithelium (RPE), photoreceptors (PR), horizontal cells (HC), bipolar cells (BC), amacrine cells (AC), ganglion cells (RGC), nerve fiber layer (RNFL).\nRetinal prostheses for restoration of sight to patients blinded by retinal degeneration are being developed by a number of private companies and research institutions worldwide. The system is meant to partially restore useful vision to people who have lost their photoreceptors due to retinal diseases such as retinitis pigmentosa (RP) or age-related macular degeneration (AMD). Three types of retinal implants are currently in clinical trials: epiretinal (on the retina), subretinal (behind the retina), and suprachoroidal (between the choroid and the sclera). Retinal implants introduce visual information into the retina by electrically stimulating the surviving retinal neurons. So far, elicited percepts had rather low resolution, and may be suitable for light perception and recognition of simple objects.\n\nContents \n\n1 History \n2 Candidates \n3 Types \n\n3.1 Epiretinal implants \n\n3.1.1 Design principles \n3.1.2 Advantages \n3.1.3 Disadvantages \n3.1.4 Clinical study \n\n\n3.2 Subretinal implants \n\n3.2.1 Design principles \n3.2.2 Advantages \n3.2.3 Disadvantages \n3.2.4 Clinical studies \n\n\n\n\n4 Spatial resolution \n5 Current status and future developments \n6 See also \n7 References \n8 External links \n\n\nHistory \nFoerster was the first to discover that electrical stimulation of the occipital cortex could be used to create visual percepts, phosphenes.[1] The first application of an implantable stimulator for vision restoration was developed by Drs. Brindley and Lewin in 1968.[2] This experiment demonstrated the viability of creating visual percepts using direct electrical stimulation, and it motivated the development of several other implantable devices for stimulation of the visual pathway, including retinal implants.[3] Retinal stimulation devices, in particular, have become a focus of research as approximately half of all cases of blindness are caused by retinal damage.[4] The development of retinal implants has also been motivated in part by the advancement and success of cochlear implants, which has demonstrated that humans can regain significant sensory function with limited input.[5]\nThe Argus II retinal implant, manufactured by Second Sight Medical Products received market approval in the USA in Feb 2013 and in Europe in Feb 2011, becoming the first approved implant.[6] The device may help adults with RP who have lost the ability to perceive shapes and movement to be more mobile and to perform day-to-day activities. The epiretinal device is known as the Retina Implant and was originally developed in Germany by Retina Implant AG. It completed a multi-centre clinical trial in Europe and was awarded a CE Mark in 2013, making it the first wireless epiretinal electronic device to gain approval.\n\nCandidates \nOptimal candidates for retinal implants have retinal diseases, such as retinitis pigmentosa or age-related macular degeneration. These diseases cause blindness by affecting the photoreceptor cells in the outer layer of the retina, while leaving the inner and middle retinal layers intact.[4][7][8][9][10][11] Minimally, a patient must have an intact ganglion cell layer in order to be a candidate for a retinal implant. This can be assessed non-invasively using optical coherence tomography (OCT) imaging.[12] Other factors, including the amount of residual vision, overall health, and family commitment to rehabilitation, are also considered when determining candidates for retinal implants. In subjects with age-related macular degeneration, who may have intact peripheral vision, retinal implants could result in a hybrid form of vision. In this case the implant would supplement the remaining peripheral vision with central vision information.[13]\n\nTypes \nThere are two main types of retinal implants by placement. Epiretinal implants are placed in the internal surface of the retina, while subretinal implants are placed between the outer retinal layer and the retinal pigment epithelium.\n\nEpiretinal implants \nDesign principles \nEpiretinal implants are placed on top of the retinal surface, above the nerve fiber layer, directly stimulating ganglion cells and bypassing all other retinal layers. Array of electrodes is stabilized on the retina using micro tacks which penetrate into the sclera. Typically, external video camera onto eyeglasses[3] acquires images and transmits processed video information to the stimulating electrodes via wireless telemetry.[13] An external transmitter is also required to provide power to the implant via radio-frequency induction coils or infrared lasers. The real-time image processing involves reducing the resolution, enhancing contrast, detecting the edges in the image and converting it into a spatio-temporal pattern of stimulation delivered to the electrode array on the retina.[4][13] The majority of electronics can be incorporated into the associated external components, allowing for a smaller implant and simpler upgrades without additional surgery.[14] The external electronics provides full control over the image processing for each patient.[3]\n\nAdvantages \nEpiretinal implants directly stimulate the retinal ganglion cells, thereby bypassing all other retinal layers. Therefore, in principle, epiretinal implants could provide visual perception to individuals even if all other retinal layers have been damaged.\n\nDisadvantages \nSince the nerve fiber layer has similar stimulation threshold to that of the retinal ganglion cells, axons passing under the epiretinal electrodes are stimulated, creating arcuate percepts, and thereby distorting the retinotopic map. So far, none of the epiretinal implants had light-sensitive pixels, and hence they rely on external camera for capturing the visual information. Therefore, unlike natural vision, eye movements do not shift the transmitted image on the retina, which creates a perception of the moving object when person with such an implant changes the direction of gaze. Therefore, patients with such implants are asked to not move their eyes, but rather scan the visual field with their head. Additionally, encoding visual information at the ganglion cell layer requires very sophisticated image processing techniques in order to account for various types of the retinal ganglion cells encoding different features of the image.\n\nClinical study \nThe first epiretinal implant, the ARGUS device, included a silicon platinum array with 16 electrodes.[13] The Phase I clinical trial of ARGUS began in 2002 by implanting six participants with the device. All patients reported gaining a perception of light and discrete phosphenes, with the visual function of some patients improving significantly over time. Future versions of the ARGUS device are being developed with increasingly dense electrode arrays, allowing for improved spatial resolution. The most recent ARGUS II device contains 60 electrodes, and a 200 electrode device is under development by ophthalmologists and engineers at the USC Eye Institute.[15] The ARGUS II device received marketing approval in February 2011 (CE Mark demonstrating safety and performance), and it is available in Germany, France, Italy, and UK. Interim results on 30 patients long term trials were published in Ophthalmology in 2012.[16] Argus II received approval from the US FDA on April 14, 2013 FDA Approval[dead link ] .\nAnother epiretinal device, the Learning Retinal Implant, has been developed by IIP technologies GmbH, and has begun to be evaluated in clinical trials.[13] A third epiretinal device, EPI-RET, has been developed and progressed to clinical testing in six patients. The EPI-RET device contains 25 electrodes and requires the crystalline lens to be replaced with a receiver chip. All subjects have demonstrated the ability to discriminate between different spatial and temporal patterns of stimulation.[17]\n\n\nSubretinal implants \nDesign principles \nSubretinal implants sit on the outer surface of the retina, between the photoreceptor layer and the retinal pigment epithelium, directly stimulating retinal cells and relying on the normal processing of the inner and middle retinal layers.[3] Adhering a subretinal implant in place is relatively simple, as the implant is mechanically constrained by the minimal distance between the outer retina and the retinal pigment epithelium. A subretinal implant consists of a silicon wafer containing light sensitive microphotodiodes, which generate signals directly from the incoming light. Incident light passing through the retina generates currents within the microphotodiodes, which directly inject the resultant current into the underlying retinal cells via arrays of microelectrodes. The pattern of microphotodiodes activated by incident light therefore stimulates a pattern of bipolar, horizontal, amacrine, and ganglion cells, leading to a visual perception representative of the original incident image. In principle, subretinal implants do not require any external hardware beyond the implanted microphotodiodes array. However, some subretinal implants require power from external circuitry to enhance the image signal.[4]\n\nAdvantages \nA subretinal implant is advantageous over an epiretinal implant in part because of its simpler design. The light acquisition, processing, and stimulation are all carried out by microphotodiodes mounted onto a single chip, as opposed to the external camera, processing chip, and implanted electrode array associated with an epiretinal implant.[4] The subretinal placement is also more straightforward, as it places the stimulating array directly adjacent to the damaged photoreceptors.[3][13] By relying on the function of the remaining retinal layers, subretinal implants allow for normal inner retinal processing, including amplification, thus resulting in an overall lower threshold for a visual response.[3] Additionally, subretinal implants enable subjects to use normal eye movements to shift their gaze. The retinotopic stimulation from subretinal implants is inherently more accurate, as the pattern of incident light on the microphotodiodes is a direct reflection of the desired image. Subretinal implants require minimal fixation, as the subretinal space is mechanically constrained and the retinal pigment epithelium creates negative pressure within the subretinal space.[4]\n\nDisadvantages \nThe main disadvantage of subretinal implants is the lack of sufficient incident light to enable the microphotodiodes to generate adequate current. Thus, subretinal implants often incorporate an external power source to amplify the effect of incident light.[3] The compact nature of the subretinal space imposes significant size constraints on the implant. The close proximity between the implant and the retina also increases the possibility of thermal damage to the retina from heat generated by the implant.[4] Subretinal implants require intact inner and middle retinal layers, and therefore are not beneficial for retinal diseases extending beyond the outer photoreceptor layer. Additionally, photoreceptor loss can result in the formation of a membrane at the boundary of the damaged photoreceptors, which can impede stimulation and increase the stimulation threshold.[13]\n\nClinical studies \nOptobionics was the first company to develop a subretinal implant and evaluate the design in a clinical trial. Initial reports indicated that the implantation procedure was safe, and all subjects reported some perception of light and mild improvement in visual function.[18] The current version of this device has been implanted in 10 patients, who have each reported improvements in the perception of visual details, including contrast, shape, and movement.[4] Retina Implant AG in Germany has also developed a subretinal implant, which has undergone clinical testing in nine patients. Trial was put on hold due to repeated failures.[13] The Retina Implant AG device contains 1500 microphotodiodes, allowing for increased spatial resolution, but requires an external power source. Retina implant AG reported 12 months results on the Alpha IMS study in Feb 2013 showing that six out of nine patients had a device failure in the nine months post implant Proceedings of the royal society B, and that five of the eight subjects reported various implant-mediated visual perceptions in daily life. One had optic nerve damage and did not perceive stimulation. The Boston Subretinal Implant Project has also developed several iterations of a functional subretinal implant, and focused on short term analysis of implant function.[19] Results from all clinical trials to date indicate that patients receiving subretinal implants report perception of phosphenes, with some gaining the ability to perform basic visual tasks, such as shape recognition and motion detection.[13]\n\nSpatial resolution \nThe quality of vision expected from a retinal implant is largely based on the maximum spatial resolution of the implant. Current prototypes of retinal implants are capable of providing low resolution, pixelated images.\n\"State-of-the-art\" retinal implants incorporate 60-100 channels, sufficient for basic object discrimination and recognition tasks. However, simulations of the resultant pixelated images assume that all electrodes on the implant are in contact with the desired retinal cell; in reality the expected spatial resolution is lower, as a few of the electrodes may not function optimally.[3] Tests of reading performance indicated that a 60-channel implant is sufficient to restore some reading ability, but only with significantly enlarged text.[20] Similar experiments evaluating room navigation ability with pixelated images demonstrated that 60 channels were sufficient for experienced subjects, while na\u00efve subjects required 256 channels. This experiment, therefore, not only demonstrated the functionality provided by low resolution visual feedback, but also the ability for subjects to adapt and improve over time.[21] However, these experiments are based merely on simulations of low resolution vision in normal subjects, rather than clinical testing of implanted subjects. The number of electrodes necessary for reading or room navigation may differ in implanted subjects, and further testing needs to be conducted within this clinical population to determine the required spatial resolution for specific visual tasks.\nSimulation results indicate that 600-1000 electrodes would be required to enable subjects to perform a wide variety of tasks, including reading, face recognition, and navigating around rooms.[3] Thus, the available spatial resolution of retinal implants needs to increase by a factor of 10, while remaining small enough to implant, to restore sufficient visual function for those tasks.\n\nCurrent status and future developments \nClinical reports to date have demonstrated mixed success, with all patients report at least some sensation of light from the electrodes, and a smaller proportion gaining more detailed visual function, such as identifying patterns of light and dark areas. The clinical reports indicate that, even with low resolution, retinal implants are potentially useful in providing crude vision to individuals who otherwise would not have any visual sensation.[13] However, clinical testing in implanted subjects is somewhat limited and the majority of spatial resolution simulation experiments have been conducted in normal controls. It remains unclear whether the low level vision provided by current retinal implants is sufficient to balance the risks associated with the surgical procedure, especially for subjects with intact peripheral vision. Several other aspects of retinal implants need to be addressed in future research, including the long term stability of the implants and the possibility of retinal neuron plasticity in response to prolonged stimulation.[4]\nThe Manchester Royal Infirmary and Prof Paulo E Stanga announced on July 22, 2015 the first successful implantation of Second Sight's Argus II in patients suffering from severe Age Related Macular Degeneration.[22][23] These results are very impressive as it appears that the patients integrate the residual vision and the artificial vision. It potentially opens the use of retinal implants to millions of patients suffering from AMD.\nSome new pre-clinical studies restoring vision to animal models[24] show promise of artificial photo voltaic layers transplanted on top of the retina. These layers convert light to electricity in a way similar to photoreceptors.\n\nSee also \nRetinal regeneration\nReferences \n\n\n^ O. Foerster (1929). \"Beitrage zur Pathophysiologie der Sehbahn und der Sehsphare\". Journal fur Psychologie und Neurologie. 39: 463\u201385. \n\n^ G. Brindley; W. Lewin (1968). \"The sensation produced by electrical stimulation of the visual cortex\". Journal of Physiology. 196: 479\u201393. \n\n^ a b c d e f g h i J. Weiland; T. Liu; M. Humayun (2005). \"Retinal prosthesis\". Annual Review of Biomedical Engineering. 7: 361\u2013401. doi:10.1146\/annurev.bioeng.7.060804.100435. \n\n^ a b c d e f g h i E. Zrenner (2002). \"Will retinal implants restore vision?\". Science. 295: 1022\u20135. doi:10.1126\/science.1067996. \n\n^ F. Zeng (2004). \"Trends in cochlear implants\". Trends in Amplification. 8 (1): 1\u201334. doi:10.1177\/108471380400800102. \n\n^ \"FDA approves first retinal implant for adults with rare genetic eye disease\". fda.gov. U.S. Food and Drug Administration. 14 February 2013. Retrieved 14 March 2015 . \n\n^ J. Stone; W. Barlow; M. Humayun; E. deJuan Jr.; A. Milam (1992). \"Morphometric analysis of macular photoreceptors and ganglion cells in retinas with retinitis pigmentosa\". Archives of Ophthalmology. 110: 1634\u20139. doi:10.1001\/archopht.1992.01080230134038. \n\n^ A. Santos; M. Humayun; E. deJuan Jr.; R. Greenburg; M. Marsh; I. Klock; et. al. (1997). \"Preservation of the inner retina in retinitis pigmentosa: A morphometric analysis\". Archives of Ophthalmology. 115: 511\u20135. doi:10.1001\/archopht.1997.01100150513011. \n\n^ M. Humayun (1999). \"Morphometric analysis of the extra- macular retina from post mortem eyes with retinitis pigmentosa\". Investigative Ophthalmology and Visual Science. 40: 143\u20138. \n\n^ S. Kim; S. Sadda; M. Humayun; E. deJuan Jr.; B. Melia; W. Green (2002). \"Morphometric analysis of the macula in eyes with geographic atrophy due to age-related macular degeneration\". Retina. 46: 4\u201310. doi:10.1097\/00006982-200208000-00011. \n\n^ S. Kim; S. Sadda; J. Pearlman; M. Humayun; E. deJuan Jr.; B. Melia; et. al. (2002). \"Morphometric analysis of the macula in eyes with disciform age-related macular degeneration\". Retina. 47: 1\u20137. doi:10.1097\/00006982-200208000-00012. \n\n^ T. Matsuo; N. Morimoto (2007). \"Visual acuity and perimacular retinal layers detected by optical coherence tomography in patients with retinitis pigmentosa\". Investigative Ophthalmology and Visual Science. 91: 888\u201390. doi:10.1136\/bjo.2007.114538. PMC 1955635 . \n\n^ a b c d e f g h i j G. Chader; J. Weiland; M. Humayun (2009). \"Artificial vision: needs, functioning, and testing of a retinal electronic prosthesis\". Progress in Brain Research. 175: 0079\u20136123. doi:10.1016\/s0079-6123(09)17522-2. \n\n^ W. Liu; K. Vichienchom; M. Clements; C. Demarco; C. Hughes; C. McGucken; et. al. (2000). \"A neurostimulus chip with telemetry unit for retinal prosthesis device\". IEEE Solid-State Circuits. 35 (10): 1487\u201397. doi:10.1109\/4.871327. \n\n^ M. Humayun; J. Weiland; G. Fujii; R. Greenberg; R. Williamson; J. Little; et. al. (2003). \"Visual perception in a blind subject with a chronic microelectronic retinal prosthesis\". Vision Research. 43: 2573\u201381. doi:10.1016\/s0042-6989(03)00457-7. \n\n^ Humayun MS, Dorn JD, da Cruz L, Dagnelie G, Sahel JA, Stanga PE, Cideciyan AV, Duncan JL, Eliott D, Filley E, Ho AC, Santos A, Safran AB, Arditi A, Del Priore LV, Greenberg RJ (2012). \"Interim results from the international trial of Second Sight's visual prosthesis\". Ophthalmology. 119: 779\u201388. doi:10.1016\/j.ophtha.2011.09.028. PMC 3319859 . PMID 22244176. CS1 maint: Multiple names: authors list (link) \n\n^ S. Klauke; M. Goertz; S. Rein; D. Hoehl; U. Thomas; R. Eckhorn; F. Bremmer; T. Wachtler (2011). \"Stimulation with a wireless intraocular epiretinal implant elicits visual percepts in blind humans\". Investigative Ophthalmology and Visual Science. 52 (1): 449\u201355. doi:10.1167\/iovs.09-4410. \n\n^ A. Chow; V. Chow; K. Packo; J. Pollack; G. Peyman; R. Schuchard (2004). \"The artificial silicon retina microchip for the treatment of vision loss from retinitis pigmentosa\". Archives of Ophthalmology. 122: 1156\u20137. doi:10.1001\/archopht.122.4.460. \n\n^ J. Rizzo III; J. Wyatt Jr.; J. Lowenstein; S. Kelly; D. Shire (2003). \"Perceptual efficacy of electrical stimulation of human retina with micro electrode array during short- term surgical trials\". Investigative Ophthalmology and Visual Science. 44: 5362\u20135369. doi:10.1167\/iovs.02-0817. \n\n^ A. Fornos; J. Sommerhalder; M. Pelizzone (2011). \"Reading with a simulated 60-channel implant\". Frontiers in Neuroscience. 5: 57. doi:10.3389\/fnins.2011.00057. \n\n^ G. Dagnelie; P. Keane; V. Narla; L. Yang; J. Weiland; M. Humayun (2007). \"Real and virtual mobility performance in simulated prosthetic vision\". Journal of Neural Engineering. 4 (1): S92\u2013101. doi:10.1088\/1741-2560\/4\/1\/s11. \n\n^ Article in Times \n\n^ BBC \n\n^ Nanowire arrays restore vision in blind mice, and How Tattoo Ink and Gold Could (One Day) Help Restore Vision. \n\n\nExternal links \nJapan Retinal Implant Project\n- The Retinal Implant Project - rle.mit.edu\nNational Eye Institute of the National Institutes of Heath (NIH)\nvteEmerging technologiesFieldsAgriculture\nAgricultural robot\nClosed ecological systems\nCultured meat\nGenetically modified food\nPrecision agriculture\nVertical farming\nArchitecture\nArcology\nBuilding printing\nContour crafting\nDomed city\nBiomedical\nArtificial uterus\nAmpakine\nBrain transplant\nCryonics\nCryoprotectant\nCryopreservation\nVitrification\nSuspended animation\nDe-extinction\nGenetic engineering\nGene therapy\nHead transplant\nIsolated brain\nLife extension\nStrategies for Engineered Negligible Senescence\nNanomedicine\nNanosensors\nOrgan printing\nPersonalized 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bus\nQuantum channel\nQuantum circuit\nQuantum complexity theory\nQuantum computing\nQuantum cryptography\nQuantum dynamics\nQuantum electronics\nQuantum error correction\nQuantum imaging\nQuantum information\nQuantum key distribution\nQuantum logic\nQuantum logic gates\nQuantum machine\nQuantum machine learning\nQuantum metamaterial\nQuantum metrology\nQuantum network\nQuantum neural network\nQuantum optics\nQuantum programming\nQuantum sensing\nQuantum simulator\nQuantum teleportation\nRobotics\nDomotics\nNanorobotics\nPowered exoskeleton\nSelf-reconfiguring modular robot\nSwarm robotics\nUncrewed vehicle\nSpace scienceLaunch\nFusion rocket\nNon-rocket spacelaunch\nMass driver\nOrbital ring\nSkyhook\nSpace elevator\nSpace fountain\nSpace tether\nReusable launch system\nPropulsion\nBeam-powered propulsion\nIon thruster\nLaser propulsion\nPlasma propulsion engine\nHelicon thruster\nVASIMR\nNuclear pulse propulsion\nSolar sail\nOther\nInterstellar travel\nPropellant depot\nLaser communication in space\nTransportAerial\nAdaptive compliant wing\nBackpack helicopter\nDelivery drone\nFlying car\nHigh-altitude platform\nJet pack\nPulse detonation engine\nScramjet\nSpaceplane\nSupersonic transport\nLand\nAirless tire\nAlternative fuel vehicle\nHydrogen vehicle\nDriverless car\nGround effect train\nHyperloop\nMaglev train\nPersonal rapid transit\nTransit Elevated Bus\nVactrain\nVehicular communication systems\nPipeline\nPneumatic transport\nAutomated vacuum collection\nOther\nAnti-gravity\nCloak of invisibility\nDigital scent technology\nForce field\nPlasma window\nImmersive virtual reality\nMagnetic refrigeration\nPhased-array optics\nTopics\nCollingridge dilemma\nDifferential technological development\nDisruptive Innovation\nEphemeralization\nExploratory engineering\nFictional technology\nProactionary principle\nTechnological change\nTechnological unemployment\nTechnological convergence\nTechnological evolution\nTechnological paradigm\nTechnology forecasting\nAccelerating change\nMoore's law\nTechnological singularity\nTechnology scouting\nTechnology readiness level\nTechnology roadmap\nTranshumanism\n\n Category\n List\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Retinal_implant\">https:\/\/www.limswiki.org\/index.php\/Retinal_implant<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 17:27.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 434 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","509b1c17d543b634fdcca6203766c55c_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Retinal_implant skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Retinal implant<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:312px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Diagram_of_the_eye_and_placement_of_the_retinal_implants.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e4\/Diagram_of_the_eye_and_placement_of_the_retinal_implants.jpg\/310px-Diagram_of_the_eye_and_placement_of_the_retinal_implants.jpg\" width=\"310\" height=\"224\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Diagram_of_the_eye_and_placement_of_the_retinal_implants.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Diagram of the eye, the retina, and location of the various retinal implants. Retinal layers, from bottom to top: retinal pigment epithelium (RPE), photoreceptors (PR), horizontal cells (HC), bipolar cells (BC), amacrine cells (AC), ganglion cells (RGC), nerve fiber layer (RNFL).<\/div><\/div><\/div>\n<p><b><a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_prosthesis\" title=\"Visual prosthesis\" rel=\"external_link\" target=\"_blank\">Retinal prostheses<\/a><\/b> for restoration of sight to patients blinded by retinal degeneration are being developed by a number of private companies and research institutions worldwide. The system is meant to partially restore useful vision to people who have lost their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photoreceptor_cell\" title=\"Photoreceptor cell\" rel=\"external_link\" target=\"_blank\">photoreceptors<\/a> due to retinal diseases such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinitis_pigmentosa\" title=\"Retinitis pigmentosa\" rel=\"external_link\" target=\"_blank\">retinitis pigmentosa<\/a> (RP) or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Macular_degeneration\" title=\"Macular degeneration\" rel=\"external_link\" target=\"_blank\">age-related macular degeneration<\/a> (AMD). Three types of retinal implants are currently in clinical trials: <b>epiretinal<\/b> (on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retina\" title=\"Retina\" rel=\"external_link\" target=\"_blank\">retina<\/a>), <b>subretinal<\/b> (behind the retina), and <b>suprachoroidal<\/b> (between the choroid and the sclera). Retinal implants introduce visual information into the retina by electrically stimulating the surviving retinal neurons. So far, elicited percepts had rather low resolution, and may be suitable for light perception and recognition of simple objects.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Foerster was the first to discover that electrical stimulation of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Occipital_lobe\" title=\"Occipital lobe\" rel=\"external_link\" target=\"_blank\">occipital<\/a> cortex could be used to create visual percepts, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphene\" title=\"Phosphene\" rel=\"external_link\" target=\"_blank\">phosphenes<\/a>.<sup id=\"rdp-ebb-cite_ref-Foerster1_1-0\" class=\"reference\"><a href=\"#cite_note-Foerster1-1\" rel=\"external_link\">[1]<\/a><\/sup> The first application of an implantable stimulator for vision restoration was developed by Drs. Brindley and Lewin in 1968.<sup id=\"rdp-ebb-cite_ref-Brindley2_2-0\" class=\"reference\"><a href=\"#cite_note-Brindley2-2\" rel=\"external_link\">[2]<\/a><\/sup> This experiment demonstrated the viability of creating visual percepts using direct electrical stimulation, and it motivated the development of several other implantable devices for stimulation of the visual pathway, including retinal implants.<sup id=\"rdp-ebb-cite_ref-Weiland3_3-0\" class=\"reference\"><a href=\"#cite_note-Weiland3-3\" rel=\"external_link\">[3]<\/a><\/sup> Retinal stimulation devices, in particular, have become a focus of research as approximately half of all cases of blindness are caused by retinal damage.<sup id=\"rdp-ebb-cite_ref-Zrenner4_4-0\" class=\"reference\"><a href=\"#cite_note-Zrenner4-4\" rel=\"external_link\">[4]<\/a><\/sup> The development of retinal implants has also been motivated in part by the advancement and success of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implant\" title=\"Cochlear implant\" rel=\"external_link\" target=\"_blank\">cochlear implants<\/a>, which has demonstrated that humans can regain significant sensory function with limited input.<sup id=\"rdp-ebb-cite_ref-Zeng5_5-0\" class=\"reference\"><a href=\"#cite_note-Zeng5-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Argus_Retinal_Prosthesis\" class=\"mw-redirect\" title=\"Argus Retinal Prosthesis\" rel=\"external_link\" target=\"_blank\">Argus II retinal implant<\/a>, manufactured by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Second_Sight_Medical_Products\" class=\"mw-redirect\" title=\"Second Sight Medical Products\" rel=\"external_link\" target=\"_blank\">Second Sight Medical Products<\/a> received market approval in the USA in Feb 2013 and in Europe in Feb 2011, becoming the first approved implant.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> The device may help adults with RP who have lost the ability to perceive shapes and movement to be more mobile and to perform day-to-day activities. The epiretinal device is known as the Retina Implant and was originally developed in Germany by . It completed a multi-centre clinical trial in Europe and was awarded a <a href=\"https:\/\/en.wikipedia.org\/wiki\/CE_marking\" title=\"CE marking\" rel=\"external_link\" target=\"_blank\">CE Mark<\/a> in 2013, making it the first wireless epiretinal electronic device to gain approval.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Candidates\">Candidates<\/span><\/h2>\n<p>Optimal candidates for retinal implants have retinal diseases, such as retinitis pigmentosa or age-related macular degeneration. These diseases cause blindness by affecting the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photoreceptor_cell\" title=\"Photoreceptor cell\" rel=\"external_link\" target=\"_blank\">photoreceptor cells<\/a> in the outer layer of the retina, while leaving the inner and middle retinal layers intact.<sup id=\"rdp-ebb-cite_ref-Zrenner4_4-1\" class=\"reference\"><a href=\"#cite_note-Zrenner4-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Stone6_7-0\" class=\"reference\"><a href=\"#cite_note-Stone6-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Santos7_8-0\" class=\"reference\"><a href=\"#cite_note-Santos7-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Humayun8_9-0\" class=\"reference\"><a href=\"#cite_note-Humayun8-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Kim9_10-0\" class=\"reference\"><a href=\"#cite_note-Kim9-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Kim10_11-0\" class=\"reference\"><a href=\"#cite_note-Kim10-11\" rel=\"external_link\">[11]<\/a><\/sup> Minimally, a patient must have an intact <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinal_ganglion_cell\" title=\"Retinal ganglion cell\" rel=\"external_link\" target=\"_blank\">ganglion cell<\/a> layer in order to be a candidate for a retinal implant. This can be assessed non-invasively using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_coherence_tomography\" title=\"Optical coherence tomography\" rel=\"external_link\" target=\"_blank\">optical coherence tomography (OCT) imaging<\/a>.<sup id=\"rdp-ebb-cite_ref-Matsuo11_12-0\" class=\"reference\"><a href=\"#cite_note-Matsuo11-12\" rel=\"external_link\">[12]<\/a><\/sup> Other factors, including the amount of residual vision, overall health, and family commitment to rehabilitation, are also considered when determining candidates for retinal implants. In subjects with age-related macular degeneration, who may have intact peripheral vision, retinal implants could result in a hybrid form of vision. In this case the implant would supplement the remaining peripheral vision with central vision information.<sup id=\"rdp-ebb-cite_ref-Chader12_13-0\" class=\"reference\"><a href=\"#cite_note-Chader12-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<p>There are two main types of retinal implants by placement. Epiretinal implants are placed in the internal surface of the retina, while subretinal implants are placed between the outer retinal layer and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinal_pigment_epithelium\" title=\"Retinal pigment epithelium\" rel=\"external_link\" target=\"_blank\">retinal pigment epithelium<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Epiretinal_implants\">Epiretinal implants<\/span><\/h3>\n<h4><span class=\"mw-headline\" id=\"Design_principles\">Design principles<\/span><\/h4>\n<p>Epiretinal implants are placed on top of the retinal surface, above the nerve fiber layer, directly stimulating ganglion cells and bypassing all other retinal layers. Array of electrodes is stabilized on the retina using micro tacks which penetrate into the sclera. Typically, external video camera onto eyeglasses<sup id=\"rdp-ebb-cite_ref-Weiland3_3-1\" class=\"reference\"><a href=\"#cite_note-Weiland3-3\" rel=\"external_link\">[3]<\/a><\/sup> acquires images and transmits processed video information to the stimulating electrodes via wireless <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telemetry\" title=\"Telemetry\" rel=\"external_link\" target=\"_blank\">telemetry<\/a>.<sup id=\"rdp-ebb-cite_ref-Chader12_13-1\" class=\"reference\"><a href=\"#cite_note-Chader12-13\" rel=\"external_link\">[13]<\/a><\/sup> An external transmitter is also required to provide power to the implant via <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radio-frequency_induction\" title=\"Radio-frequency induction\" rel=\"external_link\" target=\"_blank\">radio-frequency induction<\/a> coils or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infrared\" title=\"Infrared\" rel=\"external_link\" target=\"_blank\">infrared<\/a> lasers. The real-time image processing involves reducing the resolution, enhancing contrast, detecting the edges in the image and converting it into a spatio-temporal pattern of stimulation delivered to the electrode array on the retina.<sup id=\"rdp-ebb-cite_ref-Zrenner4_4-2\" class=\"reference\"><a href=\"#cite_note-Zrenner4-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Chader12_13-2\" class=\"reference\"><a href=\"#cite_note-Chader12-13\" rel=\"external_link\">[13]<\/a><\/sup> The majority of electronics can be incorporated into the associated external components, allowing for a smaller implant and simpler upgrades without additional surgery.<sup id=\"rdp-ebb-cite_ref-Liu13_14-0\" class=\"reference\"><a href=\"#cite_note-Liu13-14\" rel=\"external_link\">[14]<\/a><\/sup> The external electronics provides full control over the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Image_processing\" class=\"mw-redirect\" title=\"Image processing\" rel=\"external_link\" target=\"_blank\">image processing<\/a> for each patient.<sup id=\"rdp-ebb-cite_ref-Weiland3_3-2\" class=\"reference\"><a href=\"#cite_note-Weiland3-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Advantages\">Advantages<\/span><\/h4>\n<p>Epiretinal implants directly stimulate the retinal ganglion cells, thereby bypassing all other retinal layers. Therefore, in principle, epiretinal implants could provide visual perception to individuals even if all other retinal layers have been damaged.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Disadvantages\">Disadvantages<\/span><\/h4>\n<p>Since the nerve fiber layer has similar stimulation threshold to that of the retinal ganglion cells, axons passing under the epiretinal electrodes are stimulated, creating arcuate percepts, and thereby distorting the retinotopic map. So far, none of the epiretinal implants had light-sensitive pixels, and hence they rely on external camera for capturing the visual information. Therefore, unlike natural vision, eye movements do not shift the transmitted image on the retina, which creates a perception of the moving object when person with such an implant changes the direction of gaze. Therefore, patients with such implants are asked to not move their eyes, but rather scan the visual field with their head. Additionally, encoding visual information at the ganglion cell layer requires very sophisticated image processing techniques in order to account for various types of the retinal ganglion cells encoding different features of the image.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Clinical_study\">Clinical study<\/span><\/h4>\n<p>The first epiretinal implant, the ARGUS device, included a silicon platinum array with 16 electrodes.<sup id=\"rdp-ebb-cite_ref-Chader12_13-3\" class=\"reference\"><a href=\"#cite_note-Chader12-13\" rel=\"external_link\">[13]<\/a><\/sup> The Phase I clinical trial of ARGUS began in 2002 by implanting six participants with the device. All patients reported gaining a perception of light and discrete phosphenes, with the visual function of some patients improving significantly over time. Future versions of the ARGUS device are being developed with increasingly dense electrode arrays, allowing for improved spatial resolution. The most recent ARGUS II device contains 60 electrodes, and a 200 electrode device is under development by ophthalmologists and engineers at the USC Eye Institute.<sup id=\"rdp-ebb-cite_ref-Humayun17_15-0\" class=\"reference\"><a href=\"#cite_note-Humayun17-15\" rel=\"external_link\">[15]<\/a><\/sup> The <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/arquivo.pt\/wayback\/20141121165336\/http:\/\/www.2%2Dsight.eu\/ee\/healthcare%2Dprofessionals\" target=\"_blank\">ARGUS II device received marketing approval<\/a> in February 2011 (CE Mark demonstrating safety and performance), and it is available in Germany, France, Italy, and UK. Interim results on 30 patients long term trials were published in <i>Ophthalmology<\/i> in 2012.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> Argus II received approval from the US FDA on April 14, 2013 <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/2-sight.eu\/landing-fda-l\" target=\"_blank\">FDA Approval<\/a><sup class=\"noprint Inline-Template\"><span style=\"white-space: nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Link_rot\" title=\"Wikipedia:Link rot\" rel=\"external_link\" target=\"_blank\"><span title=\" Dead link since July 2018\">dead link<\/span><\/a><\/i>]<\/span><\/sup>.\nAnother epiretinal device, the Learning Retinal Implant, has been developed by IIP technologies GmbH, and has begun to be evaluated in clinical trials.<sup id=\"rdp-ebb-cite_ref-Chader12_13-4\" class=\"reference\"><a href=\"#cite_note-Chader12-13\" rel=\"external_link\">[13]<\/a><\/sup> A third epiretinal device, EPI-RET, has been developed and progressed to clinical testing in six patients. The EPI-RET device contains 25 electrodes and requires the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lens_(anatomy)\" title=\"Lens (anatomy)\" rel=\"external_link\" target=\"_blank\">crystalline lens<\/a> to be replaced with a receiver chip. All subjects have demonstrated the ability to discriminate between different spatial and temporal patterns of stimulation.<sup id=\"rdp-ebb-cite_ref-Klauke18_17-0\" class=\"reference\"><a href=\"#cite_note-Klauke18-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<hr \/>\n<h3><span class=\"mw-headline\" id=\"Subretinal_implants\">Subretinal implants<\/span><\/h3>\n<h4><span class=\"mw-headline\" id=\"Design_principles_2\">Design principles<\/span><\/h4>\n<p>Subretinal implants sit on the outer surface of the retina, between the photoreceptor layer and the retinal pigment epithelium, directly stimulating retinal cells and relying on the normal processing of the inner and middle retinal layers.<sup id=\"rdp-ebb-cite_ref-Weiland3_3-3\" class=\"reference\"><a href=\"#cite_note-Weiland3-3\" rel=\"external_link\">[3]<\/a><\/sup> Adhering a subretinal implant in place is relatively simple, as the implant is mechanically constrained by the minimal distance between the outer retina and the retinal pigment epithelium. A subretinal implant consists of a silicon wafer containing light sensitive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photodiode\" title=\"Photodiode\" rel=\"external_link\" target=\"_blank\">microphotodiodes<\/a>, which generate signals directly from the incoming light. Incident light passing through the retina generates currents within the microphotodiodes, which directly inject the resultant current into the underlying retinal cells via <a href=\"https:\/\/en.wikipedia.org\/wiki\/Multielectrode_array\" class=\"mw-redirect\" title=\"Multielectrode array\" rel=\"external_link\" target=\"_blank\">arrays of microelectrodes<\/a>. The pattern of microphotodiodes activated by incident light therefore stimulates a pattern of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retina_bipolar_cell\" title=\"Retina bipolar cell\" rel=\"external_link\" target=\"_blank\">bipolar<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retina_horizontal_cell\" title=\"Retina horizontal cell\" rel=\"external_link\" target=\"_blank\">horizontal<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retina_amacrine_cell\" class=\"mw-redirect\" title=\"Retina amacrine cell\" rel=\"external_link\" target=\"_blank\">amacrine<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinal_ganglion_cell\" title=\"Retinal ganglion cell\" rel=\"external_link\" target=\"_blank\">ganglion<\/a> cells, leading to a visual perception representative of the original incident image. In principle, subretinal implants do not require any external hardware beyond the implanted microphotodiodes array. However, some subretinal implants require power from external circuitry to enhance the image signal.<sup id=\"rdp-ebb-cite_ref-Zrenner4_4-3\" class=\"reference\"><a href=\"#cite_note-Zrenner4-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Advantages_2\">Advantages<\/span><\/h4>\n<p>A subretinal implant is advantageous over an epiretinal implant in part because of its simpler design. The light acquisition, processing, and stimulation are all carried out by microphotodiodes mounted onto a single chip, as opposed to the external camera, processing chip, and implanted electrode array associated with an epiretinal implant.<sup id=\"rdp-ebb-cite_ref-Zrenner4_4-4\" class=\"reference\"><a href=\"#cite_note-Zrenner4-4\" rel=\"external_link\">[4]<\/a><\/sup> The subretinal placement is also more straightforward, as it places the stimulating array directly adjacent to the damaged photoreceptors.<sup id=\"rdp-ebb-cite_ref-Weiland3_3-4\" class=\"reference\"><a href=\"#cite_note-Weiland3-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Chader12_13-5\" class=\"reference\"><a href=\"#cite_note-Chader12-13\" rel=\"external_link\">[13]<\/a><\/sup> By relying on the function of the remaining retinal layers, subretinal implants allow for normal inner retinal processing, including amplification, thus resulting in an overall lower threshold for a visual response.<sup id=\"rdp-ebb-cite_ref-Weiland3_3-5\" class=\"reference\"><a href=\"#cite_note-Weiland3-3\" rel=\"external_link\">[3]<\/a><\/sup> Additionally, subretinal implants enable subjects to use normal eye movements to shift their gaze. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinotopy\" title=\"Retinotopy\" rel=\"external_link\" target=\"_blank\">retinotopic<\/a> stimulation from subretinal implants is inherently more accurate, as the pattern of incident light on the microphotodiodes is a direct reflection of the desired image. Subretinal implants require minimal fixation, as the subretinal space is mechanically constrained and the retinal pigment epithelium creates <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pressure#Negative_pressures\" title=\"Pressure\" rel=\"external_link\" target=\"_blank\">negative pressure<\/a> within the subretinal space.<sup id=\"rdp-ebb-cite_ref-Zrenner4_4-5\" class=\"reference\"><a href=\"#cite_note-Zrenner4-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Disadvantages_2\">Disadvantages<\/span><\/h4>\n<p>The main disadvantage of subretinal implants is the lack of sufficient incident light to enable the microphotodiodes to generate adequate current. Thus, subretinal implants often incorporate an external power source to amplify the effect of incident light.<sup id=\"rdp-ebb-cite_ref-Weiland3_3-6\" class=\"reference\"><a href=\"#cite_note-Weiland3-3\" rel=\"external_link\">[3]<\/a><\/sup> The compact nature of the subretinal space imposes significant size constraints on the implant. The close proximity between the implant and the retina also increases the possibility of thermal damage to the retina from heat generated by the implant.<sup id=\"rdp-ebb-cite_ref-Zrenner4_4-6\" class=\"reference\"><a href=\"#cite_note-Zrenner4-4\" rel=\"external_link\">[4]<\/a><\/sup> Subretinal implants require intact inner and middle retinal layers, and therefore are not beneficial for retinal diseases extending beyond the outer photoreceptor layer. Additionally, photoreceptor loss can result in the formation of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glial_scar\" title=\"Glial scar\" rel=\"external_link\" target=\"_blank\">membrane<\/a> at the boundary of the damaged photoreceptors, which can impede stimulation and increase the stimulation threshold.<sup id=\"rdp-ebb-cite_ref-Chader12_13-6\" class=\"reference\"><a href=\"#cite_note-Chader12-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Clinical_studies\">Clinical studies<\/span><\/h4>\n<p>Optobionics was the first company to develop a subretinal implant and evaluate the design in a clinical trial. Initial reports indicated that the implantation procedure was safe, and all subjects reported some perception of light and mild improvement in visual function.<sup id=\"rdp-ebb-cite_ref-Chow19_18-0\" class=\"reference\"><a href=\"#cite_note-Chow19-18\" rel=\"external_link\">[18]<\/a><\/sup> The current version of this device has been implanted in 10 patients, who have each reported improvements in the perception of visual details, including contrast, shape, and movement.<sup id=\"rdp-ebb-cite_ref-Zrenner4_4-7\" class=\"reference\"><a href=\"#cite_note-Zrenner4-4\" rel=\"external_link\">[4]<\/a><\/sup> in Germany has also developed a subretinal implant, which has undergone clinical testing in nine patients. Trial was put on hold due to repeated failures.<sup id=\"rdp-ebb-cite_ref-Chader12_13-7\" class=\"reference\"><a href=\"#cite_note-Chader12-13\" rel=\"external_link\">[13]<\/a><\/sup> The Retina Implant AG device contains 1500 microphotodiodes, allowing for increased spatial resolution, but requires an external power source. Retina implant AG reported 12 months results on the Alpha IMS study in Feb 2013 showing that six out of nine patients had a device failure in the nine months post implant <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/rspb.royalsocietypublishing.org\/content\/suppl\/2013\/02\/18\/rspb.2013.0077.DC1\/rspb20130077supp1.pdf\" target=\"_blank\">Proceedings of the royal society B<\/a>, and that five of the eight subjects reported various implant-mediated visual perceptions in daily life. One had optic nerve damage and did not perceive stimulation. The Boston Subretinal Implant Project has also developed several iterations of a functional subretinal implant, and focused on short term analysis of implant function.<sup id=\"rdp-ebb-cite_ref-Rizzo20_19-0\" class=\"reference\"><a href=\"#cite_note-Rizzo20-19\" rel=\"external_link\">[19]<\/a><\/sup> Results from all clinical trials to date indicate that patients receiving subretinal implants report perception of phosphenes, with some gaining the ability to perform basic visual tasks, such as shape recognition and motion detection.<sup id=\"rdp-ebb-cite_ref-Chader12_13-8\" class=\"reference\"><a href=\"#cite_note-Chader12-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Spatial_resolution\">Spatial resolution<\/span><\/h2>\n<p>The quality of vision expected from a retinal implant is largely based on the maximum <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angular_resolution\" title=\"Angular resolution\" rel=\"external_link\" target=\"_blank\">spatial resolution<\/a> of the implant. Current prototypes of retinal implants are capable of providing low resolution, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pixelization\" title=\"Pixelization\" rel=\"external_link\" target=\"_blank\">pixelated<\/a> images.\n<\/p><p>\"State-of-the-art\" retinal implants incorporate 60-100 channels, sufficient for basic object discrimination and recognition tasks. However, simulations of the resultant pixelated images assume that all electrodes on the implant are in contact with the desired retinal cell; in reality the expected spatial resolution is lower, as a few of the electrodes may not function optimally.<sup id=\"rdp-ebb-cite_ref-Weiland3_3-7\" class=\"reference\"><a href=\"#cite_note-Weiland3-3\" rel=\"external_link\">[3]<\/a><\/sup> Tests of reading performance indicated that a 60-channel implant is sufficient to restore some reading ability, but only with significantly enlarged text.<sup id=\"rdp-ebb-cite_ref-Fornos21_20-0\" class=\"reference\"><a href=\"#cite_note-Fornos21-20\" rel=\"external_link\">[20]<\/a><\/sup> Similar experiments evaluating room navigation ability with pixelated images demonstrated that 60 channels were sufficient for experienced subjects, while na\u00efve subjects required 256 channels. This experiment, therefore, not only demonstrated the functionality provided by low resolution <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_feedback\" class=\"mw-redirect\" title=\"Optical feedback\" rel=\"external_link\" target=\"_blank\">visual feedback<\/a>, but also the ability for subjects to adapt and improve over time.<sup id=\"rdp-ebb-cite_ref-Dagnelie22_21-0\" class=\"reference\"><a href=\"#cite_note-Dagnelie22-21\" rel=\"external_link\">[21]<\/a><\/sup> However, these experiments are based merely on simulations of low resolution vision in normal subjects, rather than clinical testing of implanted subjects. The number of electrodes necessary for reading or room navigation may differ in implanted subjects, and further testing needs to be conducted within this clinical population to determine the required spatial resolution for specific visual tasks.\n<\/p><p>Simulation results indicate that 600-1000 electrodes would be required to enable subjects to perform a wide variety of tasks, including reading, face recognition, and navigating around rooms.<sup id=\"rdp-ebb-cite_ref-Weiland3_3-8\" class=\"reference\"><a href=\"#cite_note-Weiland3-3\" rel=\"external_link\">[3]<\/a><\/sup> Thus, the available spatial resolution of retinal implants needs to increase by a factor of 10, while remaining small enough to implant, to restore sufficient visual function for those tasks.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Current_status_and_future_developments\">Current status and future developments<\/span><\/h2>\n<p>Clinical reports to date have demonstrated mixed success, with all patients report at least some sensation of light from the electrodes, and a smaller proportion gaining more detailed visual function, such as identifying patterns of light and dark areas. The clinical reports indicate that, even with low resolution, retinal implants are potentially useful in providing crude vision to individuals who otherwise would not have any visual sensation.<sup id=\"rdp-ebb-cite_ref-Chader12_13-9\" class=\"reference\"><a href=\"#cite_note-Chader12-13\" rel=\"external_link\">[13]<\/a><\/sup> However, clinical testing in implanted subjects is somewhat limited and the majority of spatial resolution simulation experiments have been conducted in normal controls. It remains unclear whether the low level vision provided by current retinal implants is sufficient to balance the risks associated with the surgical procedure, especially for subjects with intact peripheral vision. Several other aspects of retinal implants need to be addressed in future research, including the long term stability of the implants and the possibility of retinal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroplasticity\" title=\"Neuroplasticity\" rel=\"external_link\" target=\"_blank\">neuron plasticity<\/a> in response to prolonged stimulation.<sup id=\"rdp-ebb-cite_ref-Zrenner4_4-8\" class=\"reference\"><a href=\"#cite_note-Zrenner4-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>The Manchester Royal Infirmary and Prof Paulo E Stanga announced on July 22, 2015 the first successful implantation of Second Sight's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Argus_II\" class=\"mw-redirect\" title=\"Argus II\" rel=\"external_link\" target=\"_blank\">Argus II<\/a> in patients suffering from severe Age Related Macular Degeneration.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> These results are very impressive as it appears that the patients integrate the residual vision and the artificial vision. It potentially opens the use of retinal implants to millions of patients suffering from AMD.\n<\/p><p>Some new pre-clinical studies restoring vision to animal models<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> show promise of artificial photo voltaic layers transplanted on top of the retina. These layers convert light to electricity in a way similar to photoreceptors.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinal_regeneration\" title=\"Retinal regeneration\" rel=\"external_link\" target=\"_blank\">Retinal regeneration<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-Foerster1-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Foerster1_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">O. 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Zrenner (2002). \"Will retinal implants restore vision?\". <i>Science<\/i>. <b>295<\/b>: 1022\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1126%2Fscience.1067996\" target=\"_blank\">10.1126\/science.1067996<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Science&rft.atitle=Will+retinal+implants+restore+vision%3F&rft.volume=295&rft.pages=1022-5&rft.date=2002&rft_id=info%3Adoi%2F10.1126%2Fscience.1067996&rft.au=E.++Zrenner&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARetinal+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Zeng5-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Zeng5_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">F. 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Wachtler (2011). \"Stimulation with a wireless intraocular epiretinal implant elicits visual percepts in blind humans\". <i>Investigative Ophthalmology and Visual Science<\/i>. <b>52<\/b> (1): 449\u201355. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1167%2Fiovs.09-4410\" target=\"_blank\">10.1167\/iovs.09-4410<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Investigative+Ophthalmology+and+Visual+Science&rft.atitle=Stimulation+with+a+wireless+intraocular+epiretinal+implant+elicits+visual+percepts+in+blind+humans&rft.volume=52&rft.issue=1&rft.pages=449-55&rft.date=2011&rft_id=info%3Adoi%2F10.1167%2Fiovs.09-4410&rft.au=S.++Klauke&rft.au=M.++Goertz&rft.au=S.++Rein&rft.au=D.++Hoehl&rft.au=U.++Thomas&rft.au=R.++Eckhorn&rft.au=F.++Bremmer&rft.au=T.++Wachtler&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARetinal+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Chow19-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Chow19_18-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">A. Chow; V. Chow; K. Packo; J. Pollack; G. Peyman; R. Schuchard (2004). \"The artificial silicon retina microchip for the treatment of vision loss from retinitis pigmentosa\". <i>Archives of Ophthalmology<\/i>. <b>122<\/b>: 1156\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Farchopht.122.4.460\" target=\"_blank\">10.1001\/archopht.122.4.460<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+of+Ophthalmology&rft.atitle=The+artificial+silicon+retina+microchip+for+the+treatment+of+vision+loss+from+retinitis+pigmentosa&rft.volume=122&rft.pages=1156-7&rft.date=2004&rft_id=info%3Adoi%2F10.1001%2Farchopht.122.4.460&rft.au=A.++Chow&rft.au=V.++Chow&rft.au=K.++Packo&rft.au=J.++Pollack&rft.au=G.++Peyman&rft.au=R.++Schuchard&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARetinal+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Rizzo20-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Rizzo20_19-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">J. Rizzo III; J. Wyatt Jr.; J. Lowenstein; S. Kelly; D. Shire (2003). \"Perceptual efficacy of electrical stimulation of human retina with micro electrode array during short- term surgical trials\". <i>Investigative Ophthalmology and Visual Science<\/i>. <b>44<\/b>: 5362\u20135369. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1167%2Fiovs.02-0817\" target=\"_blank\">10.1167\/iovs.02-0817<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Investigative+Ophthalmology+and+Visual+Science&rft.atitle=Perceptual+efficacy+of+electrical+stimulation+of+human+retina+with+micro+electrode+array+during+short-+term+surgical+trials&rft.volume=44&rft.pages=5362-5369&rft.date=2003&rft_id=info%3Adoi%2F10.1167%2Fiovs.02-0817&rft.au=J.++Rizzo+III&rft.au=J.++Wyatt+Jr.&rft.au=J.++Lowenstein&rft.au=S.++Kelly&rft.au=D.++Shire&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARetinal+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Fornos21-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Fornos21_20-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">A. Fornos; J. Sommerhalder; M. Pelizzone (2011). \"Reading with a simulated 60-channel implant\". <i>Frontiers in Neuroscience<\/i>. <b>5<\/b>: 57. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3389%2Ffnins.2011.00057\" target=\"_blank\">10.3389\/fnins.2011.00057<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Frontiers+in+Neuroscience&rft.atitle=Reading+with+a+simulated+60-channel+implant&rft.volume=5&rft.pages=57&rft.date=2011&rft_id=info%3Adoi%2F10.3389%2Ffnins.2011.00057&rft.au=A.+Fornos&rft.au=J.++Sommerhalder&rft.au=M.++Pelizzone&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARetinal+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Dagnelie22-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Dagnelie22_21-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">G. Dagnelie; P. Keane; V. Narla; L. Yang; J. Weiland; M. Humayun (2007). \"Real and virtual mobility performance in simulated prosthetic vision\". <i>Journal of Neural Engineering<\/i>. <b>4<\/b> (1): S92\u2013101. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1088%2F1741-2560%2F4%2F1%2Fs11\" target=\"_blank\">10.1088\/1741-2560\/4\/1\/s11<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Neural+Engineering&rft.atitle=Real+and+virtual+mobility+performance+in+simulated+prosthetic+vision&rft.volume=4&rft.issue=1&rft.pages=S92-101&rft.date=2007&rft_id=info%3Adoi%2F10.1088%2F1741-2560%2F4%2F1%2Fs11&rft.au=G.++Dagnelie&rft.au=P.++Keane&rft.au=V.++Narla&rft.au=L.++Yang&rft.au=J.++Weiland&rft.au=M.++Humayun&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARetinal+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.thetimes.co.uk\/tto\/health\/news\/article4504868.ece\" target=\"_blank\">Article in Times<\/a><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.bbc.com\/news\/health-33571412\" target=\"_blank\">BBC<\/a><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nature.com\/articles\/s41467-018-03212-0\" target=\"_blank\">Nanowire arrays restore vision in blind mice<\/a>, and <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.livescience.com\/62496-artificial-retina-ink-gold-restore-vision.html\" target=\"_blank\">How Tattoo Ink and Gold Could (One Day) Help Restore Vision<\/a>.<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.io.mei.titech.ac.jp\/research\/retina\/\" target=\"_blank\">Japan Retinal Implant Project<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.rle.mit.edu\/media\/pr151\/19.pdf\" target=\"_blank\">- The Retinal Implant Project - rle.mit.edu<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nei.nih.gov\/index.asp\" target=\"_blank\">National Eye Institute<\/a> of the National Institutes of Heath (NIH)<\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1324\nCached time: 20181126010813\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.488 seconds\nReal time usage: 0.567 seconds\nPreprocessor visited node count: 1706\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 141460\/2097152 bytes\nTemplate argument size: 1294\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 64366\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.218\/10.000 seconds\nLua memory usage: 4.06 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 389.874 1 -total\n<\/p>\n<pre>65.09% 253.784 1 Template:Reflist\n51.14% 199.371 20 Template:Cite_journal\n19.41% 75.667 6 Template:Navbox\n16.77% 65.382 1 Template:Dead_link\n13.24% 51.601 1 Template:Emerging_technologies\n10.80% 42.123 1 Template:Fix\n 9.69% 37.790 2 Template:Category_handler\n 3.19% 12.429 2 Template:Icon\n 1.46% 5.688 1 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:3242434-1!canonical and timestamp 20181126010813 and revision id 850539036\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Retinal_implant\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212152\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.047 seconds\nReal time usage: 0.226 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 217.131 1 - wikipedia:Retinal_implant\n100.00% 217.131 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8067-0!*!*!*!*!*!* and timestamp 20181217212152 and revision id 24181\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Retinal_implant\">https:\/\/www.limswiki.org\/index.php\/Retinal_implant<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","509b1c17d543b634fdcca6203766c55c_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e4\/Diagram_of_the_eye_and_placement_of_the_retinal_implants.jpg\/620px-Diagram_of_the_eye_and_placement_of_the_retinal_implants.jpg"],"509b1c17d543b634fdcca6203766c55c_timestamp":1545081712,"59e5353a44efaa7f277696bdb40d7a91_type":"article","59e5353a44efaa7f277696bdb40d7a91_title":"Responsive neurostimulation device","59e5353a44efaa7f277696bdb40d7a91_url":"https:\/\/www.limswiki.org\/index.php\/Responsive_neurostimulation_device","59e5353a44efaa7f277696bdb40d7a91_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tResponsive neurostimulation device\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article may have been created or edited in return for undisclosed payments, a violation of Wikipedia's terms of use. It may require cleanup to comply with Wikipedia's content policies. \nThis article has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and when to remove these template messages)\n\n This article contains content that is written like an advertisement. Please help improve it by removing promotional content and inappropriate external links, and by adding encyclopedic content written from a neutral point of view. (June 2018) (Learn how and when to remove this template message)\nThis article may require cleanup to meet Wikipedia's quality standards. The specific problem is: formatting to comply with MOS Please help improve this article if you can. (November 2018) (Learn how and when to remove this template message)\nThis article needs more links to other articles to help integrate it into the encyclopedia. Please help improve this article by adding links that are relevant to the context within the existing text. (November 2018) (Learn how and when to remove this template message)\nThis article includes a list of references, but its sources remain unclear because it has insufficient inline citations. Please help to improve this article by introducing more precise citations. (November 2018) (Learn how and when to remove this template message)\n \n (Learn how and when to remove this template message)\nResponsive neurostimulation device or RNS system is the first and only brain-responsive neurostimulation system designed to prevent epileptic seizures at their source. Similar to a pacemaker that monitors and responds to heart rhythms, the RNS System monitors and responds to brain activity. The RNS System is made by NeuroPace, Inc.\nThe RNS neurostimulator is a small, implantable device connected to leads (tiny wires) that are placed in up to two seizure onset areas. The device continuously monitors brain activity, detects abnormal patterns, and in response delivers imperceptible electrical pulses to normalize the activity before an individual experiences seizures.\nThe RNS System was FDA approved in 2013 to treat adults with partial onset seizures that are not controlled by medications. The RNS System is currently available in most Level 4 Comprehensive Epilepsy Centers throughout the United States and is broadly covered by private and government insurance. As of March, 2017 over 1,000 patients have been implanted with the RNS System.\nHow the RNS System helps prevent seizures:\nThe RNS System continuously monitors brain activity at the seizure source. It works in the background, without the patient feeling anything.\nThe device is programmed by physicians to detect early, abnormal electrical patterns that can lead to seizures. These patterns are different for every individual, and the device can be personalized to recognize each brain's unique \"fingerprint\".\nWithin milliseconds of detecting abnormal brain activity, the RNS System sends tiny electrical pulses to disrupt the abnormal activity and normalize brainwaves. This real-time response is designed to prevent seizures from occurring.\nThe RNS System is the only treatment option that monitors and responds to brain activity directly at the seizure source. It delivers treatment when needed, on average less than 6 minutes of stimulation per day.\nOnce implanted, the RNS System is unnoticeable under and individual's hair, and device setting are personalized so that the stimulation is not felt.\nA window to the brain: The RNS System is the only epilepsy therapy that also provides physicians clinically meaningful ongoing data about their patients\u2019 seizure frequency and electrocorticographic activity. The patient uses a simple remote monitor at home to wirelessly collect and upload data from their neurostimulator. The data is made available to their doctor to review and analyze, so that they can improve patient care. The RNS System is surgically implanted in the skull by a trained neurosurgeon and typically involves an overnight stay in the hospital. The therapy is reversible; the procedure does not involve removing any brain tissue. For many medically refractory partial-onset epilepsy patients who are not candidates for epilepsy surgery, the RNS System provides a clinically proven therapy option to reduce seizure frequency and improve quality of life.\nThe RNS System Clinical Summary:\nThe RNS System was evaluated in a multi-center, prospective, randomized, controlled, double-blinded clinical study\u2014one of the largest and most rigorously conducted pivotal trials for any neuromodulation technology. The study included adults who have medically refractory, partial onset seizures with up to two localized seizure foci, and who had failed at least two medications. In total, 191 patients were randomized 1:1 to either treatment with the RNS System or sham stimulation. After the four month blinded period, stimulation was turned on for all patients. Treatment with the RNS System resulted in statistically significant seizure reductions compared to the sham group. By the end of the blinded period, patients in the Treatment group had a 41.5% reduction in disabling seizures compared to 9.4% in the Sham group (p=0.008). The safety profile of the RNS System compared favorably to deep brain stimulation as well as implantation of intracranial electrodes and epilepsy surgery (Morrell, 2011).\nPatients treated with the RNS System experience substantial seizure reductions in the first year that continue to improve over time. At seven years, patients achieved a 72% median reduction in seizures (Bergey, 2015). Quality of life (QOL) and mood are often negatively affected by epilepsy, particularly in patients with poorly controlled seizures. Patients treated with the RNS System reported statistically significant improvements in mood and overall quality of life, including physical health, mental health, cognitive effects, and seizure worry (Meador, 2015).\nPatients treated with the RNS System show no evidence of cognitive decline. In fact, they have demonstrated statistically significant\nimprovements in naming and verbal memory. This is meaningful because individuals with epilepsy are at risk for cognitive disability and\ndecline which has also been associated with other epilepsy treatments. For example, many antiepileptic drugs have adverse cognitive\neffects, patients treated with deep brain stimulation have reported cognitive decline, and epilepsy surgery carries risks for decline in\ncognitive areas specifically related to those regions of the brain that are resected (Loring, 2015).\nAnother notable feature of the RNS system is the subtle, virtually imperceptible, nature of the therapy. Device settings are personalized\nso that patients do not feel or notice the stimulation. This is in contrast to other therapies, such as vagus nerve stimulation, which can\nhave chronic stimulation-related side effects such as voice alterations, coughing, throat discomfort, and shortness of breath.\n\n<\/p>\nSee also \nElectroencephalography (EEG)\nElectrocorticography (ECoG)\nSingle-unit recording a method of measuring the electro-physiological responses of single neurons using a microelectrode system\nReferences \nResponsive cortical stimulation for the treatment of medically intractable partial epilepsy. Morrell MJ; RNS System in Epilepsy Study Group. Neurology. 2011 Sep 27;77(13):1295-304\nFDA Advisory Panel Recommends Approval of the NeuroPace RNS\u00ae System for Medically Refractory Epilepsy\n(Wayback machine for http:\/\/www.seizurestudy.com\/InvestigationalTreatment.html) The RNS System Information from a patient who started in the pivotal trial and is now in the long term trials.\nMorrell MJ, et al. Neurology. 2011 Sep 27;77(13):1295-304\nBergey GK, et al. Neurology. 2015 Feb 24;84(8):810-7\nMeador KJ, et al. Epilepsy\nBehav. 2015 Apr;45:242-7, Loring, DW, et al. Epilepsia. 2015 Sep 19\nMedia Contacts:\nHillary Marder\nMSL Group for NeuroPace\nhillary.marder@mslgroup.com\n\n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Responsive_neurostimulation_device\">https:\/\/www.limswiki.org\/index.php\/Responsive_neurostimulation_device<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 22:26.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 466 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","59e5353a44efaa7f277696bdb40d7a91_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Responsive_neurostimulation_device skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Responsive neurostimulation device<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p><b>Responsive neurostimulation device<\/b> or <b>RNS system<\/b> is the first and only brain-responsive neurostimulation system designed to prevent epileptic seizures at their source. Similar to a pacemaker that monitors and responds to heart rhythms, the RNS System monitors and responds to brain activity. The RNS System is made by <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.neuropace.com\" target=\"_blank\">NeuroPace, Inc<\/a>.\n<\/p><p>The RNS neurostimulator is a small, implantable device connected to leads (tiny wires) that are placed in up to two seizure onset areas. The device continuously monitors brain activity, detects abnormal patterns, and in response delivers imperceptible electrical pulses to normalize the activity before an individual experiences seizures.\n<\/p><p>The RNS System was FDA approved in 2013 to treat adults with partial onset seizures that are not controlled by medications. The RNS System is currently available in most Level 4 Comprehensive Epilepsy Centers throughout the United States and is broadly covered by private and government insurance. As of March, 2017 over 1,000 patients have been implanted with the RNS System.\n<\/p><p><b>How the RNS System helps prevent seizures:<\/b>\n<\/p><p>The RNS System continuously monitors brain activity at the seizure source. It works in the background, without the patient feeling anything.\n<\/p><p>The device is programmed by physicians to detect early, abnormal electrical patterns that can lead to seizures. These patterns are different for every individual, and the device can be personalized to recognize each brain's unique \"fingerprint\".\n<\/p><p>Within milliseconds of detecting abnormal brain activity, the RNS System sends tiny electrical pulses to disrupt the abnormal activity and normalize brainwaves. This real-time response is designed to prevent seizures from occurring.\n<\/p><p>The RNS System is the only treatment option that monitors and responds to brain activity directly at the seizure source. It delivers treatment when needed, on average less than 6 minutes of stimulation per day.\n<\/p><p>Once implanted, the RNS System is unnoticeable under and individual's hair, and device setting are personalized so that the stimulation is not felt.\n<\/p><p>A window to the brain: The RNS System is the only epilepsy therapy that also provides physicians clinically meaningful ongoing data about their patients\u2019 seizure frequency and electrocorticographic activity. The patient uses a simple remote monitor at home to wirelessly collect and upload data from their neurostimulator. The data is made available to their doctor to review and analyze, so that they can improve patient care. The RNS System is surgically implanted in the skull by a trained neurosurgeon and typically involves an overnight stay in the hospital. The therapy is reversible; the procedure does not involve removing any brain tissue. For many medically refractory partial-onset epilepsy patients who are not candidates for epilepsy surgery, the RNS System provides a clinically proven therapy option to reduce seizure frequency and improve quality of life.\n<\/p><p><b>The RNS System Clinical Summary:<\/b>\n<\/p><p>The RNS System was evaluated in a multi-center, prospective, randomized, controlled, double-blinded clinical study\u2014one of the largest and most rigorously conducted pivotal trials for any neuromodulation technology. The study included adults who have medically refractory, partial onset seizures with up to two localized seizure foci, and who had failed at least two medications. In total, 191 patients were randomized 1:1 to either treatment with the RNS System or sham stimulation. After the four month blinded period, stimulation was turned on for all patients. Treatment with the RNS System resulted in statistically significant seizure reductions compared to the sham group. By the end of the blinded period, patients in the Treatment group had a 41.5% reduction in disabling seizures compared to 9.4% in the Sham group (p=0.008). The safety profile of the RNS System compared favorably to deep brain stimulation as well as implantation of intracranial electrodes and epilepsy surgery (Morrell, 2011).\n<\/p><p>Patients treated with the RNS System experience substantial seizure reductions in the first year that continue to improve over time. At seven years, patients achieved a 72% median reduction in seizures (Bergey, 2015). Quality of life (QOL) and mood are often negatively affected by epilepsy, particularly in patients with poorly controlled seizures. Patients treated with the RNS System reported statistically significant improvements in mood and overall quality of life, including physical health, mental health, cognitive effects, and seizure worry (Meador, 2015).\n<\/p><p>Patients treated with the RNS System show no evidence of cognitive decline. In fact, they have demonstrated statistically significant\n<p>improvements in naming and verbal memory. This is meaningful because individuals with epilepsy are at risk for cognitive disability and\ndecline which has also been associated with other epilepsy treatments. For example, many antiepileptic drugs have adverse cognitive\neffects, patients treated with deep brain stimulation have reported cognitive decline, and epilepsy surgery carries risks for decline in\ncognitive areas specifically related to those regions of the brain that are resected (Loring, 2015).\nAnother notable feature of the RNS system is the subtle, virtually imperceptible, nature of the therapy. Device settings are personalized\nso that patients do not feel or notice the stimulation. This is in contrast to other therapies, such as vagus nerve stimulation, which can\nhave chronic stimulation-related side effects such as voice alterations, coughing, throat discomfort, and shortness of breath.\n<\/p>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electroencephalography\" title=\"Electroencephalography\" rel=\"external_link\" target=\"_blank\">Electroencephalography<\/a> (EEG)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrocorticography\" title=\"Electrocorticography\" rel=\"external_link\" target=\"_blank\">Electrocorticography<\/a> (ECoG)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Single-unit_recording\" title=\"Single-unit recording\" rel=\"external_link\" target=\"_blank\">Single-unit recording<\/a> a method of measuring the electro-physiological responses of single neurons using a microelectrode system<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<ul><li>Responsive cortical stimulation for the treatment of medically intractable partial epilepsy. Morrell MJ; RNS System in Epilepsy Study Group. Neurology. 2011 Sep 27;77(13):1295-304<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.neuropace.com\/about\/news\/20130225.html\" target=\"_blank\">FDA Advisory Panel Recommends Approval of the NeuroPace RNS\u00ae System for Medically Refractory Epilepsy<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110716035100\/http:\/\/www.seizurestudy.com\/InvestigationalTreatment.html\" target=\"_blank\">(Wayback machine for http:\/\/www.seizurestudy.com\/InvestigationalTreatment.html) The RNS System<\/a> Information from a patient who started in the pivotal trial and is now in the long term trials.<\/li>\n<li>Morrell MJ, et al. Neurology. 2011 Sep 27;77(13):1295-304<\/li>\n<li>Bergey GK, et al. Neurology. 2015 Feb 24;84(8):810-7<\/li>\n<li>Meador KJ, et al. Epilepsy<\/li>\n<li>Behav. 2015 Apr;45:242-7, Loring, DW, et al. Epilepsia. 2015 Sep 19<\/li><\/ul>\n<p>Media Contacts:\nHillary Marder\nMSL Group for NeuroPace\nhillary.marder@mslgroup.com\n<\/p>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1326\nCached time: 20181205130750\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.120 seconds\nReal time usage: 0.190 seconds\nPreprocessor visited node count: 723\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 49582\/2097152 bytes\nTemplate argument size: 14849\/2097152 bytes\nHighest expansion depth: 19\/40\nExpensive parser function count: 9\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 0\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.040\/10.000 seconds\nLua memory usage: 1.55 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n101.22% 154.362 5 Template:Ambox\n100.00% 152.497 1 -total\n<\/p>\n<pre>78.50% 119.706 1 Template:MI\n25.41% 38.750 1 Template:Cleanup\n17.08% 26.043 1 Template:Advert\n16.35% 24.932 1 Template:Undisclosed_paid\n15.10% 23.021 1 Template:Category_handler\n10.96% 16.714 1 Template:More_footnotes\n 8.69% 13.254 1 Template:DMC\n 6.92% 10.559 4 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:16098606-1!canonical and timestamp 20181205130750 and revision id 869010822\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Responsive_neurostimulation_device\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212152\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.015 seconds\nReal time usage: 0.170 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 163.910 1 - wikipedia:Responsive_neurostimulation_device\n100.00% 163.910 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8280-0!*!*!*!*!*!* and timestamp 20181217212152 and revision id 24492\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Responsive_neurostimulation_device\">https:\/\/www.limswiki.org\/index.php\/Responsive_neurostimulation_device<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","59e5353a44efaa7f277696bdb40d7a91_images":[],"59e5353a44efaa7f277696bdb40d7a91_timestamp":1545081711,"8386929d828f4779c3695dc427991bce_type":"article","8386929d828f4779c3695dc427991bce_title":"Punctal plug","8386929d828f4779c3695dc427991bce_url":"https:\/\/www.limswiki.org\/index.php\/Punctal_plug","8386929d828f4779c3695dc427991bce_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPunctal plug\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tA punctal plug, also known as tear duct plug or lacrimal plug, is a small medical device that is inserted into the tear duct (puncta) of an eye to block the duct. This prevents the drainage of liquid from the eye. They are used to treat dry eye.\nArtificial tears are usually still required after punctal plug insertion.[1]\n\nContents \n\n1 Types \n2 Risks \n3 Efficacy \n4 Alternatives \n5 Other indications for use \n6 See also \n7 References \n8 External links \n\n\nTypes \nA temporary punctal occlusion can be inserted and tried first. These are made of collagen and are dissolvable.[1][2] This is to ascertain that permanent ones will not cause excessive tearing.[1]\nPermanent punctal plugs are usually made of silicone. These are available in various sizes. For maximum effectiveness, the largest size that fits should be used. These are more effective than collagen plugs. They can sometimes become loose and fall out, in which case they can be replaced.\nSome plugs are made of thermally reactive material. Some of these are inserted into the punctum as a liquid, and then harden and conform to the individual's drainage system. Others start out rigid and become soft and flexible, adapting to the individual's punctal size after they are inserted.[1]\n\nRisks \nThe risks of punctal plugs are fairly small. There is a risk of eye irritation, excessive tearing, and, in rare cases, infection.[1] Some doctors require a disclaimer to be signed prior to the insertion of a plug.\nA large silicone plug can cause slight pain upon blinking after insertion. This discomfort may stop within a week.\n\nEfficacy \nA systematic review by the Cochrane Collaboration sought to assess the safety and efficacy of punctal plugs for the management of dry eye. The review included eighteen studies, testing punctal plugs of different materials, and comparing them to other treatments for dry eye. Overall there were mixed results; punctal plugs did not show consistent improvement of dry eye symptoms compared to the comparison group at follow-up.[3] There was little evidence of differences between silicone and collagen or acrylic punctal plugs.[3] Punctal plugs may be more effective than oral pilocarpine, but may be less effective than artificial tears.[3] Some adverse outcomes from participants included spontaneous plug loss, epiphora, ocular irritation, foreign body sensation, and local inflammatory reaction.[3]\n\nAlternatives \nIf punctal plugs are at least partly effective, thermal,[4] electric[2] or radiofrequency (RF) cauterization of puncti can be performed with local sedation. RF cauterization is an electrosurgery office procedure that can be performed by an oculoplastic eye surgeon using a hyfrecator. Before the cauterization, the surgeon tests for the effectiveness of the local sedation. Depending upon the type and depth of the cauterization, it is effective for a few months to a few years, by which time the puncta are gradually likely to regrow and reopen. Cauterization can then be repeated. It initially offers complete closure of the duct. It also obviates the need for a punctal plug. It is performed for one puncta per appointment. Depending on the need, it can eventually be done for all four.\nCauterization can result in temporary redness for a few hours which is caused by a protective cover over the eye. Any lasting sensitivity can be reversed using short-term use of steroid eye drops such as those containing loteprednol.\n\nOther indications for use \nSjogren's syndrome for management\/treatment of dry eyes\nSee also \nPunctoplasty, i.e. widening of puncta\nReferences \n\n\n^ a b c d e Michelle Meadows (May\u2013June 2005). \"Dealing with Dry Eye\". FDA Consumer Magazine. U.S. Food and Drug Administration. Archived from the original on February 23, 2008. \n\n^ a b \"Keratoconjunctivitis, Sicca\". eMedicine. WebMD, Inc. January 27, 2010. Retrieved September 3, 2010 . \n\n^ a b c d Ervin AM, Law A, Pucker AD (2017). \"Punctal occlusion for dry eye syndrome\". Cochrane Database Syst Rev. 6: CD006775. doi:10.1002\/14651858.CD006775.pub3. PMC 5568656 . PMID 28649802. \n\n^ \n\"Dry eyes\". Mayo Clinic. Mayo Foundation for Medical Education and Research. 2006-06-14. Retrieved 2006-11-17 . \n\n\nExternal links \nPunctal plugs and Intracanalicular plugs\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Punctal_plug\">https:\/\/www.limswiki.org\/index.php\/Punctal_plug<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 12 March 2016, at 16:56.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 449 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","8386929d828f4779c3695dc427991bce_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Punctal_plug skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Punctal plug<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>A <b>punctal plug<\/b>, also known as <b>tear duct plug<\/b> or <b>lacrimal plug<\/b>, is a small <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> that is inserted into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nasolacrimal_duct\" title=\"Nasolacrimal duct\" rel=\"external_link\" target=\"_blank\">tear duct<\/a> (puncta) of an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_eye\" title=\"Human eye\" rel=\"external_link\" target=\"_blank\">eye<\/a> to block the duct. This prevents the drainage of liquid from the eye. They are used to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Keratoconjunctivitis_sicca\" class=\"mw-redirect\" title=\"Keratoconjunctivitis sicca\" rel=\"external_link\" target=\"_blank\">dry eye<\/a>.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_tear\" class=\"mw-redirect\" title=\"Artificial tear\" rel=\"external_link\" target=\"_blank\">Artificial tears<\/a> are usually still required after punctal plug insertion.<sup id=\"rdp-ebb-cite_ref-FDA-1_1-0\" class=\"reference\"><a href=\"#cite_note-FDA-1-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<p>A temporary punctal occlusion can be inserted and tried first. These are made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Collagen\" title=\"Collagen\" rel=\"external_link\" target=\"_blank\">collagen<\/a> and are dissolvable.<sup id=\"rdp-ebb-cite_ref-FDA-1_1-1\" class=\"reference\"><a href=\"#cite_note-FDA-1-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-eMedicine-1_2-0\" class=\"reference\"><a href=\"#cite_note-eMedicine-1-2\" rel=\"external_link\">[2]<\/a><\/sup> This is to ascertain that permanent ones will not cause excessive tearing.<sup id=\"rdp-ebb-cite_ref-FDA-1_1-2\" class=\"reference\"><a href=\"#cite_note-FDA-1-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Permanent punctal plugs are usually made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a>. These are available in various sizes. For maximum effectiveness, the largest size that fits should be used. These are more effective than collagen plugs. They can sometimes become loose and fall out, in which case they can be replaced.\n<\/p><p>Some plugs are made of thermally reactive material. Some of these are inserted into the punctum as a liquid, and then harden and conform to the individual's drainage system. Others start out rigid and become soft and flexible, adapting to the individual's punctal size after they are inserted.<sup id=\"rdp-ebb-cite_ref-FDA-1_1-3\" class=\"reference\"><a href=\"#cite_note-FDA-1-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h2>\n<p>The risks of punctal plugs are fairly small. There is a risk of eye irritation, excessive tearing, and, in rare cases, infection.<sup id=\"rdp-ebb-cite_ref-FDA-1_1-4\" class=\"reference\"><a href=\"#cite_note-FDA-1-1\" rel=\"external_link\">[1]<\/a><\/sup> Some doctors require a disclaimer to be signed prior to the insertion of a plug.\n<\/p><p>A large silicone plug can cause slight pain upon blinking after insertion. This discomfort may stop within a week.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Efficacy\">Efficacy<\/span><\/h2>\n<p>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Systematic_review\" title=\"Systematic review\" rel=\"external_link\" target=\"_blank\">systematic review<\/a> by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochrane_Collaboration\" class=\"mw-redirect\" title=\"Cochrane Collaboration\" rel=\"external_link\" target=\"_blank\">Cochrane Collaboration<\/a> sought to assess the safety and efficacy of punctal plugs for the management of dry eye. The review included eighteen studies, testing punctal plugs of different materials, and comparing them to other treatments for dry eye. Overall there were mixed results; punctal plugs did not show consistent improvement of dry eye symptoms compared to the comparison group at follow-up.<sup id=\"rdp-ebb-cite_ref-Ervin_3-0\" class=\"reference\"><a href=\"#cite_note-Ervin-3\" rel=\"external_link\">[3]<\/a><\/sup> There was little evidence of differences between silicone and collagen or acrylic punctal plugs.<sup id=\"rdp-ebb-cite_ref-Ervin_3-1\" class=\"reference\"><a href=\"#cite_note-Ervin-3\" rel=\"external_link\">[3]<\/a><\/sup> Punctal plugs may be more effective than oral <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pilocarpine\" title=\"Pilocarpine\" rel=\"external_link\" target=\"_blank\">pilocarpine<\/a>, but may be less effective than artificial tears.<sup id=\"rdp-ebb-cite_ref-Ervin_3-2\" class=\"reference\"><a href=\"#cite_note-Ervin-3\" rel=\"external_link\">[3]<\/a><\/sup> Some adverse outcomes from participants included spontaneous plug loss, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epiphora_(medicine)\" title=\"Epiphora (medicine)\" rel=\"external_link\" target=\"_blank\">epiphora<\/a>, ocular irritation, foreign body sensation, and local inflammatory reaction.<sup id=\"rdp-ebb-cite_ref-Ervin_3-3\" class=\"reference\"><a href=\"#cite_note-Ervin-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Alternatives\">Alternatives<\/span><\/h2>\n<p>If punctal plugs are at least partly effective, thermal,<sup id=\"rdp-ebb-cite_ref-MayoClinic-1_4-0\" class=\"reference\"><a href=\"#cite_note-MayoClinic-1-4\" rel=\"external_link\">[4]<\/a><\/sup> electric<sup id=\"rdp-ebb-cite_ref-eMedicine-1_2-1\" class=\"reference\"><a href=\"#cite_note-eMedicine-1-2\" rel=\"external_link\">[2]<\/a><\/sup> or radiofrequency (RF) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cauterization\" title=\"Cauterization\" rel=\"external_link\" target=\"_blank\">cauterization<\/a> of puncti can be performed with local sedation. RF cauterization is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrosurgery\" title=\"Electrosurgery\" rel=\"external_link\" target=\"_blank\">electrosurgery<\/a> office procedure that can be performed by an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oculoplastic\" class=\"mw-redirect\" title=\"Oculoplastic\" rel=\"external_link\" target=\"_blank\">oculoplastic<\/a> eye surgeon using a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyfrecator\" title=\"Hyfrecator\" rel=\"external_link\" target=\"_blank\">hyfrecator<\/a>. Before the cauterization, the surgeon tests for the effectiveness of the local sedation. Depending upon the type and depth of the cauterization, it is effective for a few months to a few years, by which time the puncta are gradually likely to regrow and reopen. Cauterization can then be repeated. It initially offers complete closure of the duct. It also obviates the need for a punctal plug. It is performed for one puncta per appointment. Depending on the need, it can eventually be done for all four.\n<\/p><p>Cauterization can result in temporary redness for a few hours which is caused by a protective cover over the eye. Any lasting sensitivity can be reversed using short-term use of steroid eye drops such as those containing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Loteprednol\" title=\"Loteprednol\" rel=\"external_link\" target=\"_blank\">loteprednol<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Other_indications_for_use\">Other indications for use<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sjogren%27s_syndrome\" class=\"mw-redirect\" title=\"Sjogren's syndrome\" rel=\"external_link\" target=\"_blank\">Sjogren's syndrome<\/a> for management\/treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dry_eyes\" class=\"mw-redirect\" title=\"Dry eyes\" rel=\"external_link\" target=\"_blank\">dry eyes<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Punctoplasty\" title=\"Punctoplasty\" rel=\"external_link\" target=\"_blank\">Punctoplasty<\/a>, i.e. widening of puncta<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-FDA-1-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-FDA-1_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDA-1_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDA-1_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDA-1_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDA-1_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Michelle Meadows (May\u2013June 2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080223190429\/http:\/\/www.fda.gov\/fdac\/features\/2005\/305_eye.html\" target=\"_blank\">\"Dealing with Dry Eye\"<\/a>. <i>FDA Consumer Magazine<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">U.S. Food and Drug Administration<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/fdac\/features\/2005\/305_eye.html\" target=\"_blank\">the original<\/a> on February 23, 2008.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=FDA+Consumer+Magazine&rft.atitle=Dealing+with+Dry+Eye&rft.date=2005-05%2F2005-06&rft.au=Michelle+Meadows&rft_id=http%3A%2F%2Fwww.fda.gov%2Ffdac%2Ffeatures%2F2005%2F305_eye.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APunctal+plug\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-eMedicine-1-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-eMedicine-1_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-eMedicine-1_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/emedicine.medscape.com\/article\/1196733-overview\" target=\"_blank\">\"Keratoconjunctivitis, Sicca\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/EMedicine\" title=\"EMedicine\" rel=\"external_link\" target=\"_blank\">eMedicine<\/a><\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/WebMD\" title=\"WebMD\" rel=\"external_link\" target=\"_blank\">WebMD, Inc.<\/a> January 27, 2010<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">September 3,<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=eMedicine&rft.atitle=Keratoconjunctivitis%2C+Sicca&rft.date=2010-01-27&rft_id=http%3A%2F%2Femedicine.medscape.com%2Farticle%2F1196733-overview&rfr_id=info%3Asid%2Fen.wikipedia.org%3APunctal+plug\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Ervin-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Ervin_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ervin_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ervin_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ervin_3-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ervin AM, Law A, Pucker AD (2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5568656\" target=\"_blank\">\"Punctal occlusion for dry eye syndrome\"<\/a>. <i>Cochrane Database Syst Rev<\/i>. <b>6<\/b>: CD006775. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD006775.pub3\" target=\"_blank\">10.1002\/14651858.CD006775.pub3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5568656\" target=\"_blank\">5568656<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28649802\" target=\"_blank\">28649802<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cochrane+Database+Syst+Rev&rft.atitle=Punctal+occlusion+for+dry+eye+syndrome&rft.volume=6&rft.pages=CD006775&rft.date=2017&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5568656&rft_id=info%3Apmid%2F28649802&rft_id=info%3Adoi%2F10.1002%2F14651858.CD006775.pub3&rft.aulast=Ervin&rft.aufirst=AM&rft.au=Law%2C+A&rft.au=Pucker%2C+AD&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5568656&rfr_id=info%3Asid%2Fen.wikipedia.org%3APunctal+plug\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-MayoClinic-1-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MayoClinic-1_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\n<cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mayoclinic.com\/health\/dry-eyes\/DS00463\/DSECTION=1\" target=\"_blank\">\"Dry eyes\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mayo_Clinic\" title=\"Mayo Clinic\" rel=\"external_link\" target=\"_blank\">Mayo Clinic<\/a><\/i>. Mayo Foundation for Medical Education and Research. 2006-06-14<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2006-11-17<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Mayo+Clinic&rft.atitle=Dry+eyes&rft.date=2006-06-14&rft_id=http%3A%2F%2Fwww.mayoclinic.com%2Fhealth%2Fdry-eyes%2FDS00463%2FDSECTION%3D1&rfr_id=info%3Asid%2Fen.wikipedia.org%3APunctal+plug\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.dryeyezone.com\/encyclopedia\/plugs.html\" target=\"_blank\">Punctal plugs and Intracanalicular plugs<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1256\nCached time: 20181125221400\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.128 seconds\nReal time usage: 0.162 seconds\nPreprocessor visited node count: 304\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 6896\/2097152 bytes\nTemplate argument size: 76\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 12409\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.075\/10.000 seconds\nLua memory usage: 2.35 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 131.613 1 Template:Reflist\n100.00% 131.613 1 -total\n<\/p>\n<pre>61.73% 81.245 3 Template:Cite_web\n23.94% 31.512 1 Template:Cite_journal\n 1.99% 2.620 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:7998279-1!canonical and timestamp 20181125221400 and revision id 829590411\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Punctal_plug\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212151\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.044 seconds\nReal time usage: 0.185 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 178.864 1 - wikipedia:Punctal_plug\n100.00% 178.864 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8452-0!*!*!*!*!*!* and timestamp 20181217212151 and revision id 24701\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Punctal_plug\">https:\/\/www.limswiki.org\/index.php\/Punctal_plug<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","8386929d828f4779c3695dc427991bce_images":[],"8386929d828f4779c3695dc427991bce_timestamp":1545081711,"074eb4c0254e4b9d0796bd278f27c097_type":"article","074eb4c0254e4b9d0796bd278f27c097_title":"PTQ implant","074eb4c0254e4b9d0796bd278f27c097_url":"https:\/\/www.limswiki.org\/index.php\/PTQ_implant","074eb4c0254e4b9d0796bd278f27c097_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPTQ implant\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tPTQ implant is a type of bio-compatible injectable bulking agent used in urinary and fecal incontinence. The material is a type of silicone, and is injected into the desired area to bulk out the tissues and reduce incontinence symptoms.\n\nReferences \n\n\n\r\n\n\nThis surgery article is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/PTQ_implant\">https:\/\/www.limswiki.org\/index.php\/PTQ_implant<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 19:36.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 369 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","074eb4c0254e4b9d0796bd278f27c097_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-PTQ_implant skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">PTQ implant<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>PTQ implant<\/b> is a type of bio-compatible injectable bulking agent used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinary_incontinence\" title=\"Urinary incontinence\" rel=\"external_link\" target=\"_blank\">urinary<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fecal_incontinence#Perianal_injectable_bulking_agents\" title=\"Fecal incontinence\" rel=\"external_link\" target=\"_blank\">fecal incontinence<\/a>. The material is a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a>, and is injected into the desired area to bulk out the tissues and reduce incontinence symptoms.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<\/div>\n<p><br \/>\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1264\nCached time: 20181129123954\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.032 seconds\nReal time usage: 0.055 seconds\nPreprocessor visited node count: 96\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 3014\/2097152 bytes\nTemplate argument size: 75\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 0\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.010\/10.000 seconds\nLua memory usage: 796 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 42.771 1 -total\n<\/p>\n<pre>50.63% 21.654 1 Template:Reflist\n49.21% 21.048 1 Template:Surgery-stub\n42.32% 18.100 1 Template:Asbox\n 5.81% 2.483 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:37862072-1!canonical and timestamp 20181129123953 and revision id 810133223\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/PTQ_implant\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212151\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.155 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 134.718 1 - wikipedia:PTQ_implant\n100.00% 134.718 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8260-0!*!*!*!*!*!* and timestamp 20181217212151 and revision id 24470\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/PTQ_implant\">https:\/\/www.limswiki.org\/index.php\/PTQ_implant<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","074eb4c0254e4b9d0796bd278f27c097_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5e\/A_nurse_and_a_surgeon%2C_both_wearing_gown_and_mask._Etching_b_Wellcome_L0028811.jpg\/50px-A_nurse_and_a_surgeon%2C_both_wearing_gown_and_mask._Etching_b_Wellcome_L0028811.jpg"],"074eb4c0254e4b9d0796bd278f27c097_timestamp":1545081711,"0f2d6a32b0b8d94e77f784371dbcb51f_type":"article","0f2d6a32b0b8d94e77f784371dbcb51f_title":"Prosthesis","0f2d6a32b0b8d94e77f784371dbcb51f_url":"https:\/\/www.limswiki.org\/index.php\/Prosthesis","0f2d6a32b0b8d94e77f784371dbcb51f_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tProsthesis\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor other uses, see Prosthesis (disambiguation).\nNot to be confused with Orthotic.\n A man with a lower-extremity prosthesis.\nDisability\nTheory and models\nDisability theory\nAbleism \/ Disablism\nMedical model\nSocial model\n\n\nEducation\nMainstreaming\nIndividualized Education Program (IEP)\n\nSpecial needs\nSpecial school\nSpecial education\nLearning disability\n\n\nTherapy\nPhysical\nOccupational\nSpeech\n\n\nSocietal implications\nDisability rights movement\nInclusion\nNormalization\nPeople-first language\nPejorative terms\n\n\nPersonal assistance\nUnlicensed assistive personnel (ADLs)\n\nOrthotics and braces\nProsthetics\nAssistive technology\nAssisted living\nMobility aid\nPhysical accessibility\nUniversal design\nWeb accessibility\n\n\nSocioeconomic assistance\nSocial Security Disability Insurance\nSupplemental Security Income\nTicket to Work\nDisability Living Allowance\nDisabled students allowance\nDisabled Persons Railcard\nFreedom Pass\nAssured Income for\r\nthe Severely Handicapped\n\nGroupsOrganizations\nNational Telecommuting Institute\nSociety for Disability Studies\nDisabled Peoples' International (DPI)\nVisitability\n\nDisabled sports\nSpecial Olympics\nParalympic Games\nDeaflympics\nInvictus Games\n\n\nCulture\nDisability in the arts\nDisability art\nDisability in the media\n\n Disability portal\n DisabilityListsvte\nIn medicine, a prosthesis (plural: prostheses; from Ancient Greek prosthesis, \"addition, application, attachment\"[1]) is an artificial device that replaces a missing body part, which may be lost through trauma, disease, or congenital conditions. Prosthetics are intended to restore the normal functions of the missing body part.[2] Prosthetic amputee rehabilitation is primarily coordinated by a prosthetist and an inter-disciplinary team of health care professionals including psychiatrists, surgeons, physical therapists, and occupational therapists. Prosthetics are commonly created with CAD (Computer-Aided Design), a software interface that helps creators visualize the creation in a 3D form,[3] and they can also be designed by hand.\n\nContents \n\n1 Types \n\n1.1 Limb prostheses \n\n1.1.1 Prosthetic raw materials \n\n\n\n\n2 History \n\n2.1 Wood and metal hands \n2.2 Technology progress before the 20th century \n2.3 Lower extremity modern history \n2.4 Upper extremity modern history \n\n\n3 Patient procedure \n4 Current technology and manufacturing \n\n4.1 Body-powered arms \n\n4.1.1 Sockets \n4.1.2 Wrists \n4.1.3 Voluntary opening and voluntary closing \n4.1.4 Feedback \n4.1.5 Terminal devices \n\n4.1.5.1 Hooks \n4.1.5.2 Hands \n\n\n4.1.6 Commercial providers and materials \n\n\n4.2 Lower-extremity prosthetics \n\n4.2.1 Socket \n4.2.2 Shank and connectors \n4.2.3 Foot \n4.2.4 Knee joint \n\n4.2.4.1 Microprocessor control \n\n\n\n\n4.3 Myoelectric \n4.4 Robotic prostheses \n\n4.4.1 Robotic arms \n4.4.2 Robotic legs \n\n4.4.2.1 Prosthesis design \n\n\n\n\n\n\n5 Attachment to the body \n\n5.1 Direct bone attachment and osseointegration \n\n\n6 Cosmesis \n7 Cognition \n8 Prosthetic enhancement \n\n8.1 Oscar Pistorius \n\n\n9 Design considerations \n\n9.1 Performance \n9.2 Other \n\n\n10 Cost and source freedom \n\n10.1 High-cost \n10.2 Low-cost \n10.3 Open-source robotic prothesis \n\n\n11 Low-cost prosthetics for children \n\n11.1 Pole and crutch \n11.2 Bamboo, PVC or plaster limbs \n11.3 Adjustable bicycle limb \n11.4 Sathi Limb \n11.5 Monolimb \n\n\n12 Cultural and social theory perspectives \n13 See also \n14 References \n15 Sources \n16 External links \n\n\nTypes \nA person's prosthesis should be designed and assembled according to the person's appearance and functional needs. For instance, a person may need a transradial prosthesis, but need to choose between an aesthetic functional device, a myoelectric device, a body-powered device, or an activity specific device. The person's future goals and economical capabilities may help them choose between one or more devices.\nCraniofacial prostheses include intra-oral and extra-oral prostheses. Extra-oral prostheses are further divided into hemifacial, auricular (ear), nasal, orbital and ocular. Intra-oral prostheses include dental prostheses such as dentures, obturators, and dental implants.\nProstheses of the neck include larynx substitutes, trachea and upper esophageal replacements,\nSomato prostheses of the torso include breast prostheses which may be either single or bilateral, full breast devices or nipple prostheses.\nPenile prostheses are used to treat erectile dysfunction.\n\nLimb prostheses \n A United States Marine with bilateral prosthetic legs leads a formation run\nLimb prostheses include both upper- and lower-extremity prostheses.\nUpper-extremity prostheses are used at varying levels of amputation: forequarter, shoulder disarticulation, transhumeral prosthesis, elbow disarticulation, transradial prosthesis, wrist disarticulation, full hand, partial hand, finger, partial finger. A transradial prosthesis is an artificial limb that replaces an arm missing below the elbow.\nUpper limb prostheses can be categorized in three main categories: Passive devices, Body Powered devices, Externally Powered (myoelectric) devices. Passive devices can either be passive hands, mainly used for cosmetic purpose, or passive tools, mainly used for specific activities (e.g. leisure or vocational). An extensive overview and classification of passive devices can be found in a literature review by Maat et.al.[4] A passive device can be static, meaning the device has no movable parts, or it can be adjustable, meaning its configuration can be adjusted (e.g. adjustable hand opening). Despite the absence of active grasping, passive devices are very useful in bimanual tasks that require fixation or support of an object, or for gesticulation in social interaction. According to scientific data a third of the upper limb amputees worldwide use a passive prosthetic hand.[4] Body Powered or cable operated limbs work by attaching a harness and cable around the opposite shoulder of the damaged arm. The third category of prosthetic devices available are myoelectric arms. These work by sensing, via electrodes, when the muscles in the upper arm move, causing an artificial hand to open or close. In the prosthetics industry, a trans-radial prosthetic arm is often referred to as a \"BE\" or below elbow prosthesis.\nLower-extremity prostheses provide replacements at varying levels of amputation. These include hip disarticulation, transfemoral prosthesis, knee disarticulation, transtibial prosthesis, Syme's amputation, foot, partial foot, and toe. The two main subcategories of lower extremity prosthetic devices are trans-tibial (any amputation transecting the tibia bone or a congenital anomaly resulting in a tibial deficiency) and trans-femoral (any amputation transecting the femur bone or a congenital anomaly resulting in a femoral deficiency).\nA transfemoral prosthesis is an artificial limb that replaces a leg missing above the knee. Transfemoral amputees can have a very difficult time regaining normal movement. In general, a transfemoral amputee must use approximately 80% more energy to walk than a person with two whole legs.[5] This is due to the complexities in movement associated with the knee. In newer and more improved designs, hydraulics, carbon fiber, mechanical linkages, motors, computer microprocessors, and innovative combinations of these technologies are employed to give more control to the user. In the prosthetics industry a trans-femoral prosthetic leg is often referred to as an \"AK\" or above the knee prosthesis.\nA transtibial prosthesis is an artificial limb that replaces a leg missing below the knee. A transtibial amputee is usually able to regain normal movement more readily than someone with a transfemoral amputation, due in large part to retaining the knee, which allows for easier movement. Lower extremity prosthetics describes artificially replaced limbs located at the hip level or lower. In the prosthetics industry a trans-tibial prosthetic leg is often referred to as a \"BK\" or below the knee prosthesis.\nPhysical therapists are trained to teach a person to walk with a leg prosthesis. To do so, the physical therapist may provide verbal instructions and may also help guide the person using touch, or tactile cues. This may be done in a clinic or home. There is some research suggesting that such training in the home may be more successful if the treatment includes the use of a treadmill.[6] Using a treadmill, along with the physical therapy treatment, helps the person to experience many of the challenges of walking with a prosthesis.\nIn the United Kingdom, 75% of lower limb amputations are performed due to inadequate circulation (dysvascularity).[7][needs update ] This condition is often associated with many other medical conditions (co-morbidities) including diabetes and heart disease that may make it a challenge to recover and use a prosthetic limb to regain mobility and independence.[7] For people who have inadequate circulation and have lost a lower limb, there is insufficient evidence due to a lack of research, to inform them regarding their choice of prosthetic rehabilitation approaches.[7]\nLower extremity prostheses are often categorized by the level of amputation or after the name of a surgeon:[8][9]\n\nTransfemoral (Above-knee)\nTranstibial (Below-knee)\nAnkle disarticulation (e.g.: Syme amputation)\nKnee disarticulation\nHemi-pelvictomy (Hip disarticulation)\nPartial foot amputations (Pirogoff, Talo-Navicular and Calcaneo-cuboid (Chopart), Tarso-metatarsal (Lisfranc), Trans-metatarsal, Metatarsal-phalangeal, Ray amputations, toe amputations).[9]\nVan Nes rotationplasty\nProsthetic raw materials \nProsthetic are made lightweight for better convenience for the amputee. Some of these materials include:\n\nPlastics:\nPolyethylene\nPolypropylene\nAcrylics\nPolyurethane\nWood (early prosthetics)\nRubber (early prosthetics)\nLightweight metals:\nTitanium\nAluminum\nComposites:\nCarbon fibre[2]\nWheeled prostheses have also been used extensively in the rehabilitation of injured domestic animals, including dogs, cats, pigs, rabbits, and turtles.[citation needed ]\n\nHistory \n Prosthetic toe from ancient Egypt\n The Capua leg (replica)\n \"Illustration of mechanical hand\", c. 1564.\n Iron prosthetic hand believed to have been owned by G\u00f6tz von Berlichingen (1480\u20131562)\n Artificial iron hand believed to date from 1560\u20131600\nProsthetics have been mentioned throughout history. The earliest recorded mention is the warrior queen Vishpala in the Rigveda.[10] The Egyptians were early pioneers of the idea, as shown by the wooden toe found on a body from the New Kingdom.[11] Roman bronze crowns have also been found, but their use could have been more aesthetic than medical.[12]\nAn early mention of a prosthetic comes from the Greek historian Herodotus, who tells the story of Hegesistratus, a Greek diviner who cut off his own foot to escape his Spartan captors and replaced it with a wooden one.[13]\n\nWood and metal hands \nPliny the Elder also recorded the tale of a Roman general, Marcus Sergius, whose right hand was cut off while campaigning and had an iron hand made to hold his shield so that he could return to battle. A famous and quite refined[14] historical prosthetic arm was that of G\u00f6tz von Berlichingen, made at the beginning of the 16th century. The first confirmed use of a prosthetic device, however, is from 950\u2013710 BC. In 2000, research pathologists discovered a mummy from this period buried in the Egyptian necropolis near ancient Thebes that possessed an artificial big toe. This toe, consisting of wood and leather, exhibited evidence of use. When reproduced by bio-mechanical engineers in 2011, researchers discovered that this ancient prosthetic enabled its wearer to walk both barefoot and in Egyptian style sandals. Previously, the earliest discovered prosthetic was an artificial leg from Capua.[15]\n\n An artificial limbs factory in 1941\nAround the same time, Fran\u00e7ois de la Noue is also reported to have had an iron hand, as is, in the 17th Century, Ren\u00e9-Robert Cavalier de la Salle.[16] Henri de Tonti had a prosthetic hook for a hand. During the Middle Ages, prosthetic remained quite basic in form. Debilitated knights would be fitted with prosthetics so they could hold up a shield, grasp a lance or a sword, or stabilize a mounted warrior.[17] Only the wealthy could afford anything that would assist in daily life.[citation needed ]\nOne notable prosthesis was that belonging to an Italian man, who scientists estimate replaced his amputated right hand with a knife.[18][19] Scientists investigating the skeleton, which was found in a Longobard cemetery in Povegliano Veronese, estimated that the man had lived sometime between the 6th and 8th centuries AD.[20][19] Materials found near the man's body suggest that the knife prosthesis was attached with a leather strap, which he repeatedly tightened with his teeth.[20]\nDuring the Renaissance, prosthetics developed with the use of iron, steel, copper, and wood. Functional prosthetics began to make an appearance in the 1500s.[21]\n\nTechnology progress before the 20th century \nAn Italian surgeon recorded the existence of an amputee who had an arm that allowed him to remove his hat, open his purse, and sign his name.[22] Improvement in amputation surgery and prosthetic design came at the hands of Ambroise Par\u00e9. Among his inventions was an above-knee device that was a kneeling peg leg and foot prosthesis with a fixed position, adjustable harness, and knee lock control. The functionality of his advancements showed how future prosthetics could develop.\nOther major improvements before the modern era:\n\nPieter Verduyn \u2013 First non-locking below-knee (BK) prosthesis.\nJames Potts \u2013 Prosthesis made of a wooden shank and socket, a steel knee joint and an articulated foot that was controlled by catgut tendons from the knee to the ankle. Came to be known as \u201cAnglesey Leg\u201d or \u201cSelpho Leg\u201d.\nSir James Syme \u2013 A new method of ankle amputation that did not involve amputating at the thigh.\nBenjamin Palmer \u2013 Improved upon the Selpho leg. Added an anterior spring and concealed tendons to simulate natural-looking movement.\nDubois Parmlee \u2013 Created prosthetic with a suction socket, polycentric knee, and multi-articulated foot.\nMarcel Desoutter & Charles Desoutter \u2013 First aluminium prosthesis[23]\nHenry Heather Bigg, and his son Henry Robert Heather Bigg, won the Queen's command to provide \"surgical appliances\" to wounded soldiers after Crimea War. They developed arms that allowed a double arm amputee to crochet, and a hand that felt natural to others based on ivory, felt, and leather.[24]\nAt the end of World War II, the NAS (National Academy of Sciences) began to advocate better research and development of prosthetics. Through government funding, a research and development program was developed within the Army, Navy, Air Force, and the Veterans Administration.\n\nLower extremity modern history \nSocket technology for lower extremity limbs saw a revolution during the 1980s when John Sabolich C.P.O., invented the Contoured Adducted Trochanteric-Controlled Alignment Method (CATCAM) socket, later to evolve into the Sabolich Socket. He followed the direction of Ivan Long and Ossur Christensen as they developed alternatives to the quadrilateral socket, which in turn followed the open ended plug socket, created from wood.[25] The advancement was due to the difference in the socket to patient contact model. Prior to this, sockets were made in the shape of a square shape with no specialized containment for muscular tissue. New designs thus help to lock in the bony anatomy, locking it into place and distributing the weight evenly over the existing limb as well as the musculature of the patient. Ischial containment is well known and used today by many prosthetist to help in patient care. Variations of the ischial containment socket thus exists and each socket is tailored to the specific needs of the patient. Others who contributed to socket development and changes over the years include Tim Staats, Chris Hoyt, and Frank Gottschalk. Gottschalk disputed the efficacy of the CAT-CAM socket- insisting the surgical procedure done by the amputation surgeon was most important to prepare the amputee for good use of a prosthesis of any type socket design.[26]\nThe first microprocessor-controlled prosthetic knees became available in the early 1990s. The Intelligent Prosthesis was the first commercially available microprocessor controlled prosthetic knee. It was released by Chas. A. Blatchford & Sons, Ltd., of Great Britain, in 1993 and made walking with the prosthesis feel and look more natural.[27] An improved version was released in 1995 by the name Intelligent Prosthesis Plus. Blatchford released another prosthesis, the Adaptive Prosthesis, in 1998. The Adaptive Prosthesis utilized hydraulic controls, pneumatic controls, and a microprocessor to provide the amputee with a gait that was more responsive to changes in walking speed. Cost analysis reveals that a sophisticated above-knee prosthesis will be about $1 million in 45 years, given only annual cost of living adjustments.[28]\n\nUpper extremity modern history \nIn 2005, DARPA started the Revolutionizing Prosthetics program.[29][30][31][32][33][34]\n\nPatient procedure \nA prosthesis is a functional replacement for an amputated or congenitally malformed or missing limb. Prosthetists are responsible for the prescription, design and management of a prosthetic device.\nIn most cases, the prosthetist begins by taking a plaster cast of the patient's affected limb. Lightweight, high-strength thermoplastics are custom-formed to this model of the patient. Cutting-edge materials such as carbon fiber, titanium and Kevlar provide strength and durability while making the new prosthesis lighter. More sophisticated prostheses are equipped with advanced electronics, providing additional stability and control.[35]\n\nCurrent technology and manufacturing \n Knee prosthesis manufactured using WorkNC Computer Aided Manufacturing software\nOver the years, there have been advancements in artificial limbs. New plastics and other materials, such as carbon fiber, have allowed artificial limbs to be stronger and lighter, limiting the amount of extra energy necessary to operate the limb. This is especially important for trans-femoral amputees. Additional materials have allowed artificial limbs to look much more realistic, which is important to trans-radial and transhumeral amputees because they are more likely to have the artificial limb exposed.[36]\n\n Manufacturing a prosthetic finger\nIn addition to new materials, the use of electronics has become very common in artificial limbs. Myoelectric limbs, which control the limbs by converting muscle movements to electrical signals, have become much more common than cable operated limbs. Myoelectric signals are picked up by electrodes, the signal gets integrated and once it exceeds a certain threshold, the prosthetic limb control signal is triggered which is why inherently, all myoelectric controls lag. Conversely, cable control is immediate and physical, and through that offers a certain degree of direct force feedback that myoelectric control does not. Computers are also used extensively in the manufacturing of limbs. Computer Aided Design and Computer Aided Manufacturing are often used to assist in the design and manufacture of artificial limbs.[36][37]\nMost modern artificial limbs are attached to the residual limb (stump) of the amputee by belts and cuffs or by suction. The residual limb either directly fits into a socket on the prosthetic, or\u2014more commonly today\u2014a liner is used that then is fixed to the socket either by vacuum (suction sockets) or a pin lock. Liners are soft and by that, they can create a far better suction fit than hard sockets. Silicone liners can be obtained in standard sizes, mostly with a circular (round) cross section, but for any other residual limb shape, custom liners can be made. The socket is custom made to fit the residual limb and to distribute the forces of the artificial limb across the area of the residual limb (rather than just one small spot), which helps reduce wear on the residual limb. The custom socket is created by taking a plaster cast of the residual limb or, more commonly today, of the liner worn over the residual limb, and then making a mold from the plaster cast. Newer methods include laser-guided measuring which can be input directly to a computer allowing for a more sophisticated design.\nOne problem with the residual limb and socket attachment is that a bad fit will reduce the area of contact between the residual limb and socket or liner, and increase pockets between residual limb skin and socket or liner. Pressure then is higher, which can be painful. Air pockets can allow sweat to accumulate that can soften the skin. Ultimately, this is a frequent cause for itchy skin rashes. Over time, this can lead to breakdown of the skin.[5]\nArtificial limbs are typically manufactured using the following steps:[36]\n\nMeasurement of the residual limb\nMeasurement of the body to determine the size required for the artificial limb\nFitting of a silicone liner\nCreation of a model of the liner worn over the residual limb\nFormation of thermoplastic sheet around the model \u2013 This is then used to test the fit of the prosthetic\nFormation of permanent socket\nFormation of plastic parts of the artificial limb \u2013 Different methods are used, including vacuum forming and injection molding\nCreation of metal parts of the artificial limb using die casting\nAssembly of entire limb\nBody-powered arms \nCurrent technology allows body powered arms to weigh around one-half to one-third of what a myoelectric arm does.\n\nSockets \nCurrent body-powered arms contain sockets that are built from hard epoxy or carbon fiber. These sockets or \"interfaces\" can be made more comfortable by lining them with a softer, compressible foam material that provides padding for the bone prominences. A self-suspending or supra-condylar socket design is useful for those with short to mid-range below elbow absence. Longer limbs may require the use of a locking roll-on type inner liner or more complex harnessing to help augment suspension.\n\nWrists \nWrist units are either screw-on connectors featuring the UNF 1\/2-20 thread (USA) or quick-release connector, of which there are different models.\n\nVoluntary opening and voluntary closing \nTwo types of body-powered systems exist, voluntary opening \"pull to open\" and voluntary closing \"pull to close\". Virtually all \"split hook\" prostheses operate with a voluntary opening type system.\nMore modern \"prehensors\" called GRIPS utilize voluntary closing systems. The differences are significant. Users of voluntary opening systems rely on elastic bands or springs for gripping force, while users of voluntary closing systems rely on their own body power and energy to create gripping force.\nVoluntary closing users can generate prehension forces equivalent to the normal hand, upwards to or exceeding one hundred pounds. Voluntary closing GRIPS require constant tension to grip, like a human hand, and in that property, they do come closer to matching human hand performance. Voluntary opening split hook users are limited to forces their rubber or springs can generate which usually is below 20 pounds.\n\nFeedback \nAn additional difference exists in the biofeedback created that allows the user to \"feel\" what is being held. Voluntary opening systems once engaged provide the holding force so that they operate like a passive vice at the end of the arm. No gripping feedback is provided once the hook has closed around the object being held. Voluntary closing systems provide directly proportional control and biofeedback so that the user can feel how much force that they are applying.\nA recent study showed that by stimulating the median and ulnar nerves, according to the information provided by the artificial sensors from a hand prosthesis, physiologically appropriate (near-natural) sensory information could be provided to an amputee. This feedback enabled the participant to effectively modulate the grasping force of the prosthesis with no visual or auditory feedback.[38]\nResearchers from \u00c9cole Polytechnique F\u00e9d\u00e9rale De Lausanne in Switzerland and the Scuola Superiore Sant'Anna in Italy, implanted the electrodes into the amputee's arm in February 2013. The study, published Wednesday[when? ] in Science Translational Medicine, details the first time sensory feedback has been restored allowing an amputee to control an artificial limb in real-time.[39] With wires linked to nerves in his upper arm, the Danish patient was able to handle objects and instantly receive a sense of touch through the special artificial hand that was created by Silvestro Micera and researchers both in Switzerland and Italy.[40]\n\nTerminal devices \nTerminal devices contain a range of hooks, prehensors, hands or other devices.\n\nHooks \nVoluntary opening split hook systems are simple, convenient, light, robust, versatile and relatively affordable.\nA hook does not match a normal human hand for appearance or overall versatility, but its material tolerances can exceed and surpass the normal human hand for mechanical stress (one can even use a hook to slice open boxes or as a hammer whereas the same is not possible with a normal hand), for thermal stability (one can use a hook to grip items from boiling water, to turn meat on a grill, to hold a match until it has burned down completely) and for chemical hazards (as a metal hook withstands acids or lye, and does not react to solvents like a prosthetic glove or human skin).\n\nHands \n Actor Owen Wilson gripping the myoelectric prosthetic arm of a United States Marine\nProsthetic hands are available in both voluntary opening and voluntary closing versions and because of their more complex mechanics and cosmetic glove covering require a relatively large activation force, which, depending on the type of harness used, may be uncomfortable.[41] A recent study by the Delft University of Technology, The Netherlands, showed that the development of mechanical prosthetic hands has been neglected during the past decades. The study showed that the pinch force level of most current mechanical hands is too low for practical use.[42] The best tested hand was a prosthetic hand developed around 1945. In 2017 however, a research has been started with bionic hands by Laura Hruby of the Medical University of Vienna.[43][44] A few open-hardware 3-d printable bionic hands have also become available.[45] Some companies are also producing robotic hands with integrated forearm, for fitting unto a patient's upper arm.[46][47]\n\nCommercial providers and materials \nHosmer and Otto Bock are major commercial hook providers. Mechanical hands are sold by Hosmer and Otto Bock as well; the Becker Hand is still manufactured by the Becker family. Prosthetic hands may be fitted with standard stock or custom-made cosmetic looking silicone gloves. But regular work gloves may be worn as well. Other terminal devices include the V2P Prehensor, a versatile robust gripper that allows customers to modify aspects of it, Texas Assist Devices (with a whole assortment of tools) and TRS that offers a range of terminal devices for sports. Cable harnesses can be built using aircraft steel cables, ball hinges, and self-lubricating cable sheaths. Some prosthetics have been designed specifically for use in salt water.[48]\n\nLower-extremity prosthetics \n A prosthetic leg worn by Ellie Cole\nLower-extremity prosthetics describes artificially replaced limbs located at the hip level or lower. Concerning all ages Ephraim et al. (2003) found a worldwide estimate of all-cause lower-extremity amputations of 2.0\u20135.9 per 10,000 inhabitants. For birth prevalence rates of congenital limb deficiency they found an estimate between 3.5\u20137.1 cases per 10,000 births.[49]\nThe two main subcategories of lower extremity prosthetic devices are trans-tibial (any amputation transecting the tibia bone or a congenital anomaly resulting in a tibial deficiency), and trans-femoral (any amputation transecting the femur bone or a congenital anomaly resulting in a femoral deficiency). In the prosthetic industry, a trans-tibial prosthetic leg is often referred to as a \"BK\" or below the knee prosthesis while the trans-femoral prosthetic leg is often referred to as an \"AK\" or above the knee prosthesis.\nOther, less prevalent lower extremity cases include the following:\n\nHip disarticulations \u2013 This usually refers to when an amputee or congenitally challenged patient has either an amputation or anomaly at or in close proximity to the hip joint.\nKnee disarticulations \u2013 This usually refers to an amputation through the knee disarticulating the femur from the tibia.\nSymes \u2013 This is an ankle disarticulation while preserving the heel pad.\nSocket \nThe socket serves as an interface between the residuum and the prosthesis, ideally allowing comfortable weight-bearing, movement control and proprioception.[50] Socket issues, such as discomfort and skin breakdown, are rated among the most important issues faced by lower-limb amputees.[51]\n\nShank and connectors \nThis part creates distance and support between the knee-joint and the foot (in case of an upper-leg prosthesis) or between the socket and the foot. The type of connectors that are used between the shank and the knee\/foot determines whether the prosthesis is modular or not. Modular means that the angle and the displacement of the foot in respect to the socket can be changed after fitting. In developing countries prosthesis mostly are non-modular, in order to reduce cost. When considering children modularity of angle and height is important because of their average growth of 1.9 cm annually.[52]\n\nFoot \nProviding contact to the ground, the foot provides shock absorption and stability during stance.[53] Additionally it influences gait biomechanics by its shape and stiffness. This is because the trajectory of the center of pressure (COP) and the angle of the ground reaction forces is determined by the shape and stiffness of the foot and needs to match the subject's build in order to produce a normal gait pattern.[54] Andrysek (2010) found 16 different types of feet, with greatly varying results concerning durability and biomechanics. The main problem found in current feet is durability, endurance ranging from 16\u201332 months [55] These results are for adults and will probably be worse for children due to higher activity levels and scale effects. Evidence comparing different types of feet and ankle prosthetic devices is not strong enough to determine if one mechanism of ankle\/foot is superior to another.[56] When deciding on a device, the cost of the device, a person's functional need, and the availability of a particular device should be considered.[56]\n\nKnee joint \nIn case of a trans-femoral amputation, there also is a need for a complex connector providing articulation, allowing flexion during swing-phase but not during stance.\n\nMicroprocessor control \nTo mimic the knee's functionality during gait, microprocessor-controlled knee joints have been developed that control the flexion of the knee. Some examples are Otto Bock\u2019s C-leg, introduced in 1997, Ossur's Rheo Knee, released in 2005, the Power Knee by Ossur, introduced in 2006, the Pli\u00e9 Knee from Freedom Innovations and DAW Industries\u2019 Self Learning Knee (SLK).[57]\nThe idea was originally developed by Kelly James, a Canadian engineer, at the University of Alberta.[58]\nA microprocessor is used to interpret and analyze signals from knee-angle sensors and moment sensors. The microprocessor receives signals from its sensors to determine the type of motion being employed by the amputee. Most microprocessor controlled knee-joints are powered by a battery housed inside the prosthesis.\nThe sensory signals computed by the microprocessor are used to control the resistance generated by hydraulic cylinders in the knee-joint. Small valves control the amount of hydraulic fluid that can pass into and out of the cylinder, thus regulating the extension and compression of a piston connected to the upper section of the knee.[28]\nThe main advantage of a microprocessor-controlled prosthesis is a closer approximation to an amputee's natural gait. Some allow amputees to walk near walking speed or run. Variations in speed are also possible and are taken into account by sensors and communicated to the microprocessor, which adjusts to these changes accordingly. It also enables the amputees to walk downstairs with a step-over-step approach, rather than the one step at a time approach used with mechanical knees.[59] There is some research suggesting that people with microprocessor-controlled prostheses report greater satisfaction and improvement in functionality, residual limb health, and safety.[60] People may be able to perform everyday activities at greater speeds, even while multitasking, and reduce their risk of falls.[60]\nHowever, some have some significant drawbacks that impair its use. They can be susceptible to water damage and thus great care must be taken to ensure that the prosthesis remains dry.[citation needed ]\n\nMyoelectric \nA myoelectric prosthesis uses the electrical tension generated every time a muscle contracts, as information. This tension can be captured from voluntarily contracted muscles by electrodes applied on the skin to control the movements of the prosthesis, such as elbow flexion\/extension, wrist supination\/pronation (rotation) or opening\/closing of the fingers. A prosthesis of this type utilizes the residual neuromuscular system of the human body to control the functions of an electric powered prosthetic hand, wrist, elbow or foot.[61] This is different from an electric switch prosthesis, which requires straps and\/or cables actuated by body movements to actuate or operate switches that control the movements of the prosthesis. There is no clear evidence concluding that myoelectric upper extremity prostheses function better than body-powered prostheses.[62] Advantages to using a myoelectric upper extremity prosthesis include the potential for improvement in cosmetic appeal (this type of prosthesis may have a more natural look), may be better for light everyday activities, and may be beneficial for people experiencing phantom limb pain.[62] When compared to a body-powered prosthesis, a myoelectric prosthesis may not be as durable, may have a longer training time, may require more adjustments, may need more maintenance, and does not provide feedback to the user.[62]\nThe USSR was the first to develop a myoelectric arm in 1958,[63] while the first myoelectric arm became commercial in 1964 by the Central Prosthetic Research Institute of the USSR, and distributed by the Hangar Limb Factory of the UK.[64][65]\nResearchers at the Rehabilitation Institute of Chicago announced in September 2013 that they have developed a robotic leg that translates neural impulses from the user's thigh muscles into movement, which is the first prosthetic leg to do so. It is currently in testing.[66]\n\nRobotic prostheses \nPlay media Brain control of 3D prosthetic arm movement (hitting targets). This movie was recorded when the participant controlled the 3D movement of a prosthetic arm to hit physical targets in a research lab.\nMain articles: Neural prosthetics and Powered exoskeleton \u00a7 Current products\nFurther information: Robotics \u00a7 Touch, 3-D printing, and Open-source hardware\nRobots can be used to generate objective measures of patient's impairment and therapy outcome, assist in diagnosis, customize therapies based on patient's motor abilities, and assure compliance with treatment regimens and maintain patient's records. It is shown in many studies that there is a significant improvement in upper limb motor function after stroke using robotics for upper limb rehabilitation.[67]\nIn order for a robotic prosthetic limb to work, it must have several components to integrate it into the body's function: Biosensors detect signals from the user's nervous or muscular systems. It then relays this information to a controller located inside the device, and processes feedback from the limb and actuator, e.g., position or force, and sends it to the controller. Examples include surface electrodes that detect electrical activity on the skin, needle electrodes implanted in muscle, or solid-state electrode arrays with nerves growing through them. One type of these biosensors are employed in myoelectric prostheses.\nA device known as the controller is connected to the user's nerve and muscular systems and the device itself. It sends intention commands from the user to the actuators of the device and interprets feedback from the mechanical and biosensors to the user. The controller is also responsible for the monitoring and control of the movements of the device.\nAn actuator mimics the actions of a muscle in producing force and movement. Examples include a motor that aids or replaces original muscle tissue.\nTargeted muscle reinnervation (TMR) is a technique in which motor nerves, which previously controlled muscles on an amputated limb, are surgically rerouted such that they reinnervate a small region of a large, intact muscle, such as the pectoralis major. As a result, when a patient thinks about moving the thumb of his missing hand, a small area of muscle on his chest will contract instead. By placing sensors over the reinnervated muscle, these contractions can be made to control the movement of an appropriate part of the robotic prosthesis.[68][69]\nA variant of this technique is called targeted sensory reinnervation (TSR). This procedure is similar to TMR, except that sensory nerves are surgically rerouted to skin on the chest, rather than motor nerves rerouted to muscle. Recently, robotic limbs have improved in their ability to take signals from the human brain and translate those signals into motion in the artificial limb. DARPA, the Pentagon's research division, is working to make even more advancements in this area. Their desire is to create an artificial limb that ties directly into the nervous system.[70]\n\nRobotic arms \nAdvancements in the processors used in myoelectric arms have allowed developers to make gains in fine-tuned control of the prosthetic. The Boston Digital Arm is a recent artificial limb that has taken advantage of these more advanced processors. The arm allows movement in five axes and allows the arm to be programmed for a more customized feel. Recently the i-Limb hand, invented in Edinburgh, Scotland, by David Gow has become the first commercially available hand prosthesis with five individually powered digits. The hand also possesses a manually rotatable thumb which is operated passively by the user and allows the hand to grip in precision, power, and key grip modes.\nAnother neural prosthetic is Johns Hopkins University Applied Physics Laboratory Proto 1. Besides the Proto 1, the university also finished the Proto 2 in 2010.[71] Early in 2013, Max Ortiz Catalan and Rickard Br\u00e5nemark of the Chalmers University of Technology, and Sahlgrenska University Hospital in Sweden, succeeded in making the first robotic arm which is mind-controlled and can be permanently attached to the body (using osseointegration).[72][73][74]\nAn approach that is very useful is called arm rotation which is common for unilateral amputees which is an amputation that affects only one side of the body; and also essential for bilateral amputees, a person who is missing or has had amputated either both arms or legs, to carry out activities of daily living. This involves inserting a small permanent magnet into the distal end of the residual bone of subjects with upper limb amputations. When a subject rotates the residual arm, the magnet will rotate with the residual bone, causing a change in magnetic field distribution.[75] EEG (electroencephalogram) signals, detected using small flat metal discs attached to the scalp, essentially decoding human brain activity used for physical movement, is used to control the robotic limbs. This allows the user to control the part directly.[76]\n\nRobotic legs \nThe research of Robotic legs has made some advancement over time, allowing exact movement and control. A company in Switzerland called Ossur, has created a robotic leg that moves through algorithms and sensors that automatically adjust the angle of the foot during different points in its wearer's stride. Also there are brain-controlled bionic legs that allow an individual to move his limbs with a wireless transmitter. [77]\n\nProsthesis design \nThe main goal of a robotic prosthesis is to provide active actuation during gait to improve the biomechanics of gait, including, among other things, stability, symmetry, or energy expenditure for amputees. There are several powered prosthetic legs currently on the market, including fully powered legs, in which actuators directly drive the joints, and semi-active legs, which use small amounts of energy and a small actuator to change the mechanical properties of the leg but do not inject net positive energy into gait. Specific examples include The emPOWER from BionX, the Proprio Foot from Ossur, and the Elan Foot from Endolite.[78][79][80] Various research groups have also experimented with robotic legs over the last decade.[81] Central issues being researched include designing the behavior of the device during stance and swing phases, recognizing the current ambulation task, and various mechanical design problems such as robustness, weight, battery-life\/efficiency, and noise-level. However, scientists from Stanford University and Seoul National University has developed artificial nerves system that will help prosthetic limbs feel.[82] This synthetic nerve system enables prosthetic limbs sense braille, feel the sense of touch and respond to the environment.[83][84]\n\nAttachment to the body \nMost prostheses can be attached to the exterior of the body, in a non-permanent way. Some others however can be attached in a permanent way. One such example are exoprostheses (see below).\n\nDirect bone attachment and osseointegration \nMain article: Osseointegration\nOsseointegration is a method of attaching the artificial limb to the body. This method is also sometimes referred to as exoprosthesis (attaching an artificial limb to the bone), or endo-exoprosthesis.\nThe stump and socket method can cause significant pain in the amputee, which is why the direct bone attachment has been explored extensively. The method works by inserting a titanium bolt into the bone at the end of the stump. After several months the bone attaches itself to the titanium bolt and an abutment is attached to the titanium bolt. The abutment extends out of the stump and the (removable) artificial limb is then attached to the abutment. Some of the benefits of this method include the following:\n\nBetter muscle control of the prosthetic.\nThe ability to wear the prosthetic for an extended period of time; with the stump and socket method this is not possible.\nThe ability for transfemoral amputees to drive a car.\nThe main disadvantage of this method is that amputees with the direct bone attachment cannot have large impacts on the limb, such as those experienced during jogging, because of the potential for the bone to break.[5]\n\nCosmesis \nCosmetic prosthesis has long been used to disguise injuries and disfigurements. With advances in modern technology, cosmesis, the creation of lifelike limbs made from silicone or PVC has been made possible. Such prosthetics, including artificial hands, can now be designed to simulate the appearance of real hands, complete with freckles, veins, hair, fingerprints and even tattoos.\nCustom-made cosmeses are generally more expensive (costing thousands of U.S. dollars, depending on the level of detail), while standard cosmeses come premade in a variety of sizes, although they are often not as realistic as their custom-made counterparts. Another option is the custom-made silicone cover, which can be made to match a person's skin tone but not details such as freckles or wrinkles. Cosmeses are attached to the body in any number of ways, using an adhesive, suction, form-fitting, stretchable skin, or a skin sleeve.\n\nCognition \nMain article: Neuroprosthetics\nUnlike neuromotor prostheses, neurocognitive prostheses would sense or modulate neural function in order to physically reconstitute or augment cognitive processes such as executive function, attention, language, and memory. No neurocognitive prostheses are currently available but the development of implantable neurocognitive brain-computer interfaces has been proposed to help treat conditions such as stroke, traumatic brain injury, cerebral palsy, autism, and Alzheimer's disease.[85]\nThe recent field of Assistive Technology for Cognition concerns the development of technologies to augment human cognition. Scheduling devices such as Neuropage remind users with memory impairments when to perform certain activities, such as visiting the doctor. Micro-prompting devices such as PEAT, AbleLink and Guide have been used to aid users with memory and executive function problems perform activities of daily living.\n\nProsthetic enhancement \nFurther information: Powered exoskeleton \u00a7 Research\n Sgt. Jerrod Fields, a U.S. Army World Class Athlete Program Paralympic sprinter hopeful, works out at the U.S. Olympic Training Center in Chula Vista, Calif. A below-the-knee amputee, Fields won a gold medal in the 100 meters with a time of 12.15 seconds at the Endeavor Games in Edmond, Okla., on June 13, 2009\nIn addition to the standard artificial limb for everyday use, many amputees or congenital patients have special limbs and devices to aid in the participation of sports and recreational activities.\nWithin science fiction, and, more recently, within the scientific community, there has been consideration given to using advanced prostheses to replace healthy body parts with artificial mechanisms and systems to improve function. The morality and desirability of such technologies are being debated by transhumanists, other ethicists, and others in general.[86][87][88][89][by whom? ] Body parts such as legs, arms, hands, feet, and others can be replaced.\nThe first experiment with a healthy individual appears to have been that by the British scientist Kevin Warwick. In 2002, an implant was interfaced directly into Warwick's nervous system. The electrode array, which contained around a hundred electrodes, was placed in the median nerve. The signals produced were detailed enough that a robot arm was able to mimic the actions of Warwick's own arm and provide a form of touch feedback again via the implant.[90]\nThe DEKA company of Dean Kamen developed the \"Luke arm\", an advanced nerve-controlled prosthetic. Clinical trials began in 2008,[91] with FDA approval in 2014 and commercial manufacturing by Universal Instruments Corporation expected in 2017. The price offered at retail by Mobius Bionics is expected to be around $100,000.[92]\n\nOscar Pistorius \nIn early 2008, Oscar Pistorius, the \"Blade Runner\" of South Africa, was briefly ruled ineligible to compete in the 2008 Summer Olympics because his transtibial prosthesis limbs were said to give him an unfair advantage over runners who had ankles. One researcher found that his limbs used twenty-five percent less energy than those of an able-bodied runner moving at the same speed. This ruling was overturned on appeal, with the appellate court stating that the overall set of advantages and disadvantages of Pistorius' limbs had not been considered.\nPistorius did not qualify for the South African team for the Olympics, but went on to sweep the 2008 Summer Paralympics, and has been ruled eligible to qualify for any future Olympics.[citation needed ] He qualified for the 2011 World Championship in South Korea and reached the semifinal where he ended last timewise, he was 14th in the first round, his personal best at 400m would have given him 5th place in the finals. At the 2012 Summer Olympics in London, Pistorius became the first amputee runner to compete at an Olympic Games.[93] He ran in the 400 metres race semifinals,[94][95][96] and the 4 \u00d7 400 metres relay race finals.[97] He also competed in 5 events in the 2012 Summer Paralympics in London.[98]\n\nDesign considerations \nThere are multiple factors to consider when designing a transtibial prosthesis. Manufacturers must make choices about their priorities regarding these factors.\n\nPerformance \nNonetheless, there are certain elements of socket and foot mechanics that are invaluable for the athlete, and these are the focus of today's high-tech prosthetics companies:\n\nFit \u2013 athletic\/active amputees, or those with bony residua, may require a carefully detailed socket fit; less-active patients may be comfortable with a 'total contact' fit and gel liner\nEnergy storage and return \u2013 storage of energy acquired through ground contact and utilization of that stored energy for propulsion\nEnergy absorption \u2013 minimizing the effect of high impact on the musculoskeletal system\nGround compliance \u2013 stability independent of terrain type and angle\nRotation \u2013 ease of changing direction\nWeight \u2013 maximizing comfort, balance and speed\nSuspension \u2013 how the socket will join and fit to the limb\nOther \nThe buyer is also concerned with numerous other factors:\n\nCosmetics\nCost\nEase of use\nSize availability\nCost and source freedom \nHigh-cost \nIn the USA a typical prosthetic limb costs anywhere between $15,000 and $90,000, depending on the type of limb desired by the patient. With medical insurance, a patient will typically pay 10%\u201350% of the total cost of a prosthetic limb, while the insurance company will cover the rest of the cost. The percent that the patient pays varies on the type of insurance plan, as well as the limb requested by the patient.[99] In the United Kingdom, much of Europe, Australia and New Zealand the entire cost of prosthetic limbs is met by state funding or statutory insurance. For example, in Australia prostheses are fully funded by state schemes in the case of amputation due to disease, and by workers compensation or traffic injury insurance in the case of most traumatic amputations.[100] The National Disability Insurance Scheme, which is being rolled out nationally between 2017 and 2020 also pays for prostheses.\nTransradial (below the elbow amputation) and transtibial prostheses (below the knee amputation) typically cost between US $6,000 and $8,000, while transfemoral (above the knee amputation) and transhumeral prosthetics (above the elbow amputation) cost approximately twice as much with a range of $10,000 to $15,000 and can sometimes reach costs of $35,000. The cost of an artificial limb often recurs, while a limb typically needs to be replaced every 3\u20134 years due to wear and tear of everyday use. In addition, if the socket has fit issues, the socket must be replaced within several months from the onset of pain. If height is an issue, components such as pylons can be changed.[101]\nNot only does the patient need to pay for their multiple prosthetic limbs, but they also need to pay for physical and occupational therapy that come along with adapting to living with an artificial limb. Unlike the reoccurring cost of the prosthetic limbs, the patient will typically only pay the $2000 to $5000 for therapy during the first year or two of living as an amputee. Once the patient is strong and comfortable with their new limb, they will not be required to go to therapy anymore. Throughout one's life, it is projected that a typical amputee will go through $1.4 million worth of treatment, including surgeries, prosthetics, as well as therapies.[99]\n\nLow-cost \nSee also: 3D printing\nLow-cost above-knee prostheses often provide only basic structural support with limited function. This function is often achieved with crude, non-articulating, unstable, or manually locking knee joints. A limited number of organizations, such as the International Committee of the Red Cross (ICRC), create devices for developing countries. Their device which is manufactured by CR Equipments is a single-axis, manually operated locking polymer prosthetic knee joint.[102]\nTable. List of knee joint technologies based on the literature review.[55]\n\n\n\n\nName of technology (country of origin)\nBrief description\nHighest level of\nevidence\n\n\n\nICRC knee (Switzerland)\nSingle-axis with manual lock\nIndependent field\n\n\nATLAS knee (UK)\nWeight-activated friction\nIndependent field\n\n\nPOF\/OTRC knee (US)\nSingle-axis with ext. assist\nField\n\n\nDAV\/Seattle knee (US)\nCompliant polycentric\nField\n\n\nLIMBS International M1 knee (US)\nFour-bar\nField\n\n\nJaipurKnee (India)\nFour-bar\nField\n\n\nLCKnee (Canada)\nSingle-axis with automatic lock\nField\n\n\nNone provided (Nepal)\nSingle-axis\nField\n\n\nNone provided (New Zealand)\nRoto-molded single-axis\nField\n\n\nNone provided (India)\nSix-bar with squatting\nTechnical development\n\n\nFriction knee (US)\nWeight-activated friction\nTechnical development\n\n\nWedgelock knee (Australia)\nWeight-activated friction\nTechnical development\n\n\nSATHI friction knee (India)\nWeight-activated friction\nLimited data available\n\n Low-cost above-knee prosthetic limbs: ICRC Knee (left) and LC Knee (right)\nA plan for a low-cost artificial leg, designed by S\u00e9bastien Dubois, was featured at the 2007 International Design Exhibition and award show in Copenhagen, Denmark, where it won the Index: Award. It would be able to create an energy-return prosthetic leg for US $8.00, composed primarily of fiberglass.[103]\nPrior to the 1980s, foot prostheses merely restored basic walking capabilities. These early devices can be characterized by a simple artificial attachment connecting one's residual limb to the ground.\nThe introduction of the Seattle Foot (Seattle Limb Systems) in 1981 revolutionized the field, bringing the concept of an Energy Storing Prosthetic Foot (ESPF) to the fore. Other companies soon followed suit, and before long, there were multiple models of energy storing prostheses on the market. Each model utilized some variation of a compressible heel. The heel is compressed during initial ground contact, storing energy which is then returned during the latter phase of ground contact to help propel the body forward.\nSince then, the foot prosthetics industry has been dominated by steady, small improvements in performance, comfort, and marketability.\nWith 3D printers, it is possible to manufacture a single product without having to have metal molds, so the costs can be drastically reduced.[104]\nJaipur Foot, an artificial limb from Jaipur, India, costs about US$40.\n\nOpen-source robotic prothesis \nSee also: Open-source hardware, Modular design, 3D printing, and Thingiverse\nThere is currently an open-design Prosthetics forum known as the \"Open Prosthetics Project\". The group employs collaborators and volunteers to advance Prosthetics technology while attempting to lower the costs of these necessary devices.[105] Open Bionics is a company that is developing open-source robotic prosthetic hands. It uses 3D printing to manufacture the devices and low-cost 3D scanners to fit them, with the aim of lowering the cost of fabricating custom prosthetics. A review study on a wide range of printed prosthetic hands, found that although 3D printing technology holds a promise for individualised prosthesis design, it is not necessarily cheaper when all costs are included. The same study also found that evidence on the functionality, durability and user acceptance of 3D printed hand prostheses is still lacking.[106]\n\nLow-cost prosthetics for children \nSee also: open-source hardware and 3D printing\nIn the USA an estimate was found of 32,500 children (<21 years) that suffer from major paediatric amputation, with 5,525 new cases each year, of which 3,315 congenital.[107] Carr et al. (1998) investigated amputations caused by landmines for Afghanistan, Bosnia and Herzegovina, Cambodia and Mozambique among children (<14 years), showing estimates of respectively 4.7, 0.19, 1.11 and 0.67 per 1000 children.[108] Mohan (1986) indicated in India a total of 424,000 amputees (23,500 annually), of which 10.3% had an onset of disability below the age of 14, amounting to a total of about 43,700 limb deficient children in India alone.[109]\nFew low-cost solutions have been created specially for children. Underneath some of them can be found.\n\n Artificial limbs for a juvenile thalidomide survivor 1961\u20131965\nPole and crutch \nThis hand-held pole with leather support band or platform for the limb is one of the simplest and cheapest solutions found. It serves well as a short-term solution, but is prone to rapid contracture formation if the limb is not stretched daily through a series of range-of motion (RoM) sets.[52]\n\n Bamboo, PVC or plaster limbs \nThis also fairly simple solution comprises a plaster socket with a bamboo or PVC pipe at the bottom, optionally attached to a prosthetic foot. This solution prevents contractures because the knee is moved through its full RoM. The David Werner Collection, an online database for the assistance of disabled village children, displays manuals of production of these solutions.[110]\n\nAdjustable bicycle limb \nThis solution is built using a bicycle seat post up side down as foot, generating flexibility and (length) adjustability. It is a very cheap solution, using locally available materials.[111]\n\nSathi Limb \nIt is an endoskeletal modular lower limb from India, which uses thermoplastic parts. Its main advantages are the small weight and adaptability.[52]\n\nMonolimb \nMonolimbs are non-modular prostheses and thus require more experienced prosthetist for correct fitting, because alignment can barely be changed after production. However, their durability on average is better than low-cost modular solutions.\n\nCultural and social theory perspectives \nA number of theorists have explored the meaning and implications of prosthetic extension of the body. Elizabeth Grosz writes, \"Creatures use tools, ornaments, and appliances to augment their bodily capacities. Are their bodies lacking something, which they need to replace with artificial or substitute organs?...Or conversely, should prostheses be understood, in terms of aesthetic reorganization and proliferation, as the consequence of an inventiveness that functions beyond and perhaps in defiance of pragmatic need?\"[112] Elaine Scarry argues that every artifact recreates and extends the body. Chairs supplement the skeleton, tools append the hands, clothing augments the skin.[113] In Scarry's thinking, \"furniture and houses are neither more nor less interior to the human body than the food it absorbs, nor are they fundamentally different from such sophisticated prosthetics as artificial lungs, eyes and kidneys. The consumption of manufactured things turns the body inside out, opening it up to and as the culture of objects.\"[114] Mark Wigley, a professor of architecture, continues this line of thinking about how architecture supplements our natural capabilities, and argues that \"a blurring of identity is produced by all prostheses.\"[115] Some of this work relies on Freud's earlier characterization of man's relation to objects as one of extension.\n\nSee also \nBionics\nCapua Leg\nHanger, Inc.\nRobotic arm\nReferences \n\n\n^ \u03c0\u03c1\u03cc\u03c3\u03b8\u03b5\u03c3\u03b9\u03c2 . 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CS1 maint: Multiple names: authors list (link) \n\n^ \"With a new prosthetic, researchers have managed to restore the sense of touch for a Denmark man who lost his left hand nine years ago.\", USA Today, February 5, 2014 \n\n^ \"Artificial hand offering immediate touch response a success\", Channelnewsasia, February 7, 2014 \n\n^ Smit G, Plettenburg DH (2010). \"Efficiency of Voluntary Closing Hand and Hook Prostheses\". Prosthetics and Orthotics International. 34 (4): 411\u2013427. doi:10.3109\/03093646.2010.486390. PMID 20849359. \n\n^ Smit, G; Bongers, RM; Van der Sluis, CK; Plettenburg, DH (2012). \"Efficiency of voluntary opening hand and hook prosthetic devices: 24 years of development?\". Journal of Rehabilitation Research and Development. 49 (4): 523\u2013534. doi:10.1682\/JRRD.2011.07.0125. 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A.; Larsen, J. A.; Smith, D. G.; Sangeorzan, B. (July 1999). \"Issues of importance reported by persons with lower limb amputations and prostheses\". Journal of Rehabilitation Research and Development. 36 (3): 155\u2013163. ISSN 0748-7711. PMID 10659798. \n\n^ a b c Strait, E. (2006) Prosthetics in Deceloping Countries. oandp.org \n\n^ Stark, Gerald (2005). \"Perspectives on How and Why Feet are Prescribed\". JPO Journal of Prosthetics and Orthotics. 17: S18. doi:10.1097\/00008526-200510001-00007. \n\n^ Jian, Yuancheng; Winter, DA; Ishac, MG; Gilchrist, L (1993). \"Trajectory of the body COG and COP during initiation and termination of gait\". Gait & Posture. 1: 9\u201322. doi:10.1016\/0966-6362(93)90038-3. \n\n^ a b Andrysek, J (2010). \"Lower-limb prosthetic technologies in the developing world: A review of literature from 1994\u20132010\". Prosthetics and Orthotics International. 34 (4): 378\u201398. doi:10.3109\/03093646.2010.520060. PMID 21083505. \n\n^ a b Hofstad, C.; Linde, H.; Limbeek, J.; Postema, K. (2004). \"Prescription of prosthetic ankle-foot mechanisms after lower limb amputation\". The Cochrane Database of Systematic Reviews (1): CD003978. doi:10.1002\/14651858.CD003978.pub2. ISSN 1469-493X. PMID 14974050. \n\n^ \"The SLK, The Self-Learning Knee\" Archived 2012-04-25 at the Wayback Machine., DAW Industries. Retrieved 16 March 2008. \n\n^ Marriott, Michel (2005-06-20). \"Titanium and Sensors Replace Ahab's Peg Leg\". The New York Times. Retrieved 2008-10-30 . \n\n^ Martin, Craig W. (November 2003) \"Otto Bock C-leg: A review of its effectiveness\". WCB Evidence Based Group \n\n^ a b Kannenberg, Andreas; Zacharias, Britta; Pr\u00f6bsting, Eva (2014). \"Benefits of microprocessor-controlled prosthetic knees to limited community ambulators: systematic review\". Journal of Rehabilitation Research and Development. 51 (10): 1469\u20131496. doi:10.1682\/JRRD.2014.05.0118. ISSN 1938-1352. PMID 25856664. \n\n^ \"Amputees control bionic legs with their thoughts\". Reuters. 20 May 2015. \n\n^ a b c Carey, Stephanie L.; Lura, Derek J.; Highsmith, M. Jason; CP; FAAOP (2015). \"Differences in myoelectric and body-powered upper-limb prostheses: Systematic literature review\". Journal of Rehabilitation Research and Development. 52 (3): 247\u2013262. doi:10.1682\/JRRD.2014.08.0192. ISSN 1938-1352. PMID 26230500. \n\n^ Wirta, R. W.; Taylor, D. R.; Finley, F. R. (1978). \"Pattern-recognition arm prosthesis: A historical perspective-a final report\" (PDF) . Bulletin of prosthetics research: 8\u201335. PMID 365281. \n\n^ Sherman, E. David (1964). \"A Russian Bioelectric-Controlled Prosthesis: Report of a Research Team from the Rehabilitation Institute of Montreal\". Canadian Medical Association Journal. 91 (24): 1268\u20131270. PMC 1927453 . PMID 14226106. \n\n^ Muzumdar, Ashok (2004). Powered Upper Limb Prostheses: Control, Implementation and Clinical Application. Springer. ISBN 978-3-540-40406-4. \n\n^ \"Rehabilitation Institute of Chicago First to Develop Thought Controlled Robotic Leg\". Medgadget.com. September 2013. Retrieved 2016-12-28 . \n\n^ Reinkensmeyer David J (2009). \"Robotic Assistance For Upper Extremity Training After Stroke\" (PDF) . Studies in Health Technology and Informatics. 145: 25\u201339. PMID 19592784. Archived from the original (PDF) on 2016-12-28. Retrieved 2016-12-28 . \n\n^ Kuiken TA, Miller LA, Lipschutz RD, Lock BA, Stubblefield K, Marasco PD, Zhou P, Dumanian GA (February 3, 2007). \"Targeted reinnervation for enhanced prosthetic arm function in a woman with a proximal amputation: a case study\". Lancet. 369 (9559): 371\u201380. doi:10.1016\/S0140-6736(07)60193-7. PMID 17276777. \n\n^ \"Blogs: TR Editors' blog: Patients Test an Advanced Prosthetic Arm\". Technology Review. 2009-02-10. Retrieved 2010-10-03 . \n\n^ \"Defense Sciences Office\". Darpa.mil. Archived from the original on 2009-04-26. Retrieved 2010-10-03 . \n\n^ \"Proto 1 and Proto 2\". Ric.org. 2007-05-01. Archived from the original on 2011-07-27. Retrieved 2010-10-03 . \n\n^ \"World premiere of muscle and nerve controlled arm prosthesis\". Sciencedaily.com. February 2013. Retrieved 2016-12-28 . \n\n^ Williams, Adam (2012-11-30). \"Mind-controlled permanently-attached prosthetic arm could revolutionize prosthetics\". Gizmag.com. Retrieved 2016-12-28 . \n\n^ Ford, Jason (2012-11-28). \"Trials imminent for implantable thought-controlled robotic arm\". Theengineer.co.uk. Retrieved 2016-12-28 . \n\n^ Li, Guanglin; Kuiken, Todd A (2008). \"Modeling of Prosthetic Limb Rotation Control by Sensing Rotation of Residual Arm Bone\". IEEE Transactions on Biomedical Engineering. 55 (9): 2134\u20132142. doi:10.1109\/tbme.2008.923914. PMC 3038244 . PMID 18713682. \n\n^ Contreras-Vidal Jos\u00e9 L.; et al. (2012). \"Restoration of Whole Body Movement: Toward a Noninvasive Brain-Machine Interface System\". IEEE Pulse. 3 (1): 34\u201337. doi:10.1109\/mpul.2011.2175635. PMC 3357625 . \n\n^ \"Brain-Controlled Bionic Legs Are Finally Here\". Popular Science. Retrieved 2018-12-01 . \n\n^ \"Home - BionX Medical Technologies\". www.bionxmed.com. Retrieved 2018-01-08 . \n\n^ \u00d6ssur. \"PROPRIO FOOT\". www.ossur.com. Retrieved 2018-01-08 . \n\n^ \"Elan - Carbon, Feet, Hydraulic - Endolite USA - Lower Limb Prosthetics\". Endolite USA - Lower Limb Prosthetics. Retrieved 2018-01-08 . \n\n^ Windrich, Michael; Grimmer, Martin; Christ, Oliver; Rinderknecht, Stephan; Beckerle, Philipp (2016-12-19). \"Active lower limb prosthetics: a systematic review of design issues and solutions\". BioMedical Engineering OnLine. 15 (3): 140. doi:10.1186\/s12938-016-0284-9. ISSN 1475-925X. PMC 5249019 . PMID 28105948. \n\n^ ENGINEERING.com. \"Researchers Create Artificial Nerve System\". www.engineering.com. Retrieved 2018-06-08 . \n\n^ \"Stanford researchers create artificial nerve system for robots - Xinhua | English.news.cn\". www.xinhuanet.com. Retrieved 2018-06-08 . \n\n^ University, Stanford (2018-05-31). \"An artificial nerve system gives prosthetic devices and robots a sense of touch | Stanford News\". Stanford News. Retrieved 2018-06-08 . \n\n^ Serruya MD, Kahana MJ (2008). \"Techniques and devices to restore cognition\". Behav Brain Res. 192 (2): 149\u201365. doi:10.1016\/j.bbr.2008.04.007. PMC 3051349 . PMID 18539345. \n\n^ \"Enhancements, Oxford Uehiro Centre for Practical Ethics\". Practicalethics.ox.ac.uk. Archived from the original on 2016-12-28. Retrieved 2016-12-28 . \n\n^ Caplan, Arthur; Elliott, Carl (2004). \"Is It Ethical to Use Enhancement Technologies to Make Us Better than Well?\". PLoS Medicine. 1 (3): e52. doi:10.1371\/journal.pmed.0010052. PMC 539045 . PMID 15630464. \n\n^ Buchanan, Allen E. (2011). Beyond Humanity?. doi:10.1093\/acprof:oso\/9780199587810.001.0001. ISBN 9780199587810. \n\n^ Anomaly, Jonny (2012). \"Beyond Humanity? The Ethics of Biomedical Enhancement \u2013 by Allen Buchanan\". Bioethics. 26 (7): 391\u2013392. doi:10.1111\/j.1467-8519.2012.01964.x. \n\n^ Warwick K, Gasson M, Hutt B, Goodhew I, Kyberd P, Andrews B, Teddy P, Shad A (2003). \"The Application of Implant Technology for Cybernetic Systems\". Archives of Neurology. 60 (10): 1369\u20131373. doi:10.1001\/archneur.60.10.1369. PMID 14568806. \n\n^ Adee, Sarah (2008-02-01). \"Dean Kamen's \"Luke Arm\" Prosthesis Readies for Clinical Trials\". IEEE Spectrum. \n\n^ https:\/\/www.meddeviceonline.com\/doc\/darpa-s-mind-controlled-arm-prosthesis-preps-for-commercial-launch-0001 \n\n^ Robert Klemko (10 August 2012), \"Oscar Pistorius makes history, leaves without medal\", USA Today, archived from the original on 11 August 2012 \n\n^ Oscar Pistorius makes Olympic history in 400m at London 2012, BBC Sport, 4 August 2012 \n\n^ Bill Chappell (4 August 2012), Oscar Pistorius makes Olympic history in 400 meters, and moves on to semifinal, NPR, archived from the original on 4 August 2012 \n\n^ \"Men's 400m \u2013 semifinals\", london2012.com, retrieved 4 August 2012 \n\n^ Greenberg, Chris (10 August 2012), Oscar Pistorius, South African 4\u00d7400m relay team finish 8th as Bahamas wins gold, Huffington Post, archived from the original on 11 August 2012 \n\n^ Hawking, Pistorius open London's Paralympics: Wheelchair-bound physicist Stephen Hawking challenged athletes to 'look to the stars' as he helped open a record-setting Paralympics Games that will run for 11 days in near sold-out venues, Yahoo! Sports, 30 August 2012, archived from the original on 30 August 2012 \n\n^ a b \"Cost of a Prosthetic Limb\". Cost Helper Health. Retrieved 13 April 2015 . \n\n^ \"Funding for your prosthesis\". Limbs4life. Limbs4life. Retrieved 28 January 2018 . \n\n^ \"Cost of Prosthetics Stirs Debate\", Boston Globe, 5 July 2005. Retrieved 11 February 2007. \n\n^ \"ICRC: Trans-Femoral Prosthesis \u2013 Manufacturing Guidelines\" (PDF) . Retrieved 2010-10-03 . \n\n^ INDEX:2007 INDEX: AWARD Archived February 2, 2009, at the Wayback Machine. \n\n^ Nagata, Kazuaki (2015-05-10). \"Robot arm startup taps 3-D printers in quest to make prosthetics affordable\". Japantimes.co.jp. Retrieved 2016-12-28 . \n\n^ \"Open Prosthetics Website\". Openprosthetics.org. Retrieved 2016-12-28 . \n\n^ Kate, Jelle ten; Smit, Gerwin; Breedveld, Paul (3 April 2017). \"3D-printed upper limb prostheses: a review\". Disability and Rehabilitation: Assistive Technology. 12 (3): 300\u2013314. doi:10.1080\/17483107.2016.1253117. ISSN 1748-3107. PMID 28152642. \n\n^ Krebs, D. E.; Edelstein, J. E.; Thornby, M. A. (1991). \"Prosthetic management of children with limb deficiencies\". Physical therapy. 71 (12): 920\u201334. doi:10.1097\/01241398-199205000-00033. PMID 1946626. \n\n^ Carr, D.B. (1998). \"Pain and Rehabilitation from Landmine Injury\" (PDF) . Update in Anaesthesia. 6 (2): 91. \n\n^ Mohan, D. (1986) A Report on Amputees in India. oandplibrary.org \n\n^ Werner, David. Disabled Village Children. dinf.ne.jp \n\n^ Cheng, V. (2004) A victim assistance solution. School of Industrial Design, Carleton University. \n\n^ Grosz, Elizabeth (2003). \"Prosthetic Objects\" in The State of Architecture at the Beginning of the 21st Century. pp. 96\u201397. The Monacelli Press. ISBN 1580931340. \n\n^ Scarry, Elaine (1985). The Body in Pain: The Making and Unmaking of the World. Oxford University Press. \n\n^ Lupton and Miller (1992). \"Streamlining: The Aesthetics of Waste\" in Taylor, M. and Preston, J. (eds.) 2006. Intimus: Interior Design Theory Reader. pp. 204\u2013212. ISBN 978-0-470-01570-4. \n\n^ Wigley, Mark (1991). \"Prosthetic Theory: The Disciplining of Architecture\". Assemblage (15): 6\u201329. doi:10.2307\/3171122. JSTOR 3171122. \n\n\nSources \nMurdoch, George; Wilson, A. Bennett, Jr. (1997). A Primer on Amputations and Artificial Limbs. United States of America: Charles C Thomas Publisher, Ltd. pp. 3\u201331. ISBN 0-398-06801-1. \n\u2018Biomechanics of running: from faulty movement patterns come injury.' Sports Injury Bulletin.\nEdelstein, J. E. Prosthetic feet. State of the Art. Physical Therapy 68(12) Dec 1988: 1874\u20131881.\nGailey, Robert. The Biomechanics of Amputee Running. October 2002.\nHafner B. J.; Sanders J. E.; Czerniecki J. M.; Ferguson J. (2002). \"Transtibial energy-storage-and-return prosthetic devices: A review of energy concepts and a proposed nomenclature\". Journal of Rehabilitation Research and Development Vol. 39 (1): 1\u201311. \nExternal links \n\n\n\nWikimedia Commons has media related to Prosthetics.\nAfghan amputees tell their stories at Texas gathering, Fayetteville Observer\nCan modern prosthetics actually help reclaim the sense of touch?, PBS Newshour\nA hand for Rick, Fayetteville Observer\nvteHuman regional anatomyHead\nEar\nFace\nCheek\nChin\nEye\nMouth\nNose\nForehead\nJaw\nOcciput\nScalp\nTemple\nNeck\nAdam's apple\nThroat\nTrunk\nAbdomen\nWaist\nMidriff\nNavel\nBack\nThorax\nBreast\nPelvis\nSex organs\nLimbsArm\nShoulder\nAxilla\nBrachium\nElbow\nForearm\nWrist\nHand\nFinger\nThumb \nIndex \nMiddle \nRing \nLittle \nLeg\nButtocks\nHip\nThigh\nKnee\nCalf\nFoot\nAnkle\nHeel\nSole\nToe\nOther\n\u00c9corch\u00e9\nGeneral anatomy: systems and organs, regional anatomy, planes and lines, superficial axial anatomy, superficial anatomy of limbs\nAuthority control \nGND: 4047540-2 \nNDL: 00562494 \n\n\n\n\n<\/pre>\n\nNotes \nThis 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 17:15.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 596 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","0f2d6a32b0b8d94e77f784371dbcb51f_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Prosthesis skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Prosthesis<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis_(disambiguation)\" class=\"mw-disambig\" title=\"Prosthesis (disambiguation)\" rel=\"external_link\" target=\"_blank\">Prosthesis (disambiguation)<\/a>.<\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Not to be confused with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthotic\" class=\"mw-redirect\" title=\"Orthotic\" rel=\"external_link\" target=\"_blank\">Orthotic<\/a>.<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:86_ACPS_Atlanta_1996_Swimming_General_Views.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a3\/86_ACPS_Atlanta_1996_Swimming_General_Views.jpg\/220px-86_ACPS_Atlanta_1996_Swimming_General_Views.jpg\" width=\"220\" height=\"340\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:86_ACPS_Atlanta_1996_Swimming_General_Views.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A man with a lower-extremity prosthesis.<\/div><\/div><\/div>\n\n<p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medicine<\/a>, a <b>prosthesis<\/b> (plural: prostheses; from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Greek\" title=\"Ancient Greek\" rel=\"external_link\" target=\"_blank\">Ancient Greek<\/a> <i>prosthesis<\/i>, \"addition, application, attachment\"<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>) is an artificial device that replaces a missing body part, which may be lost through trauma, disease, or congenital conditions. Prosthetics are intended to restore the normal functions of the missing body part.<sup id=\"rdp-ebb-cite_ref-madehow.com_2-0\" class=\"reference\"><a href=\"#cite_note-madehow.com-2\" rel=\"external_link\">[2]<\/a><\/sup> Prosthetic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amputation\" title=\"Amputation\" rel=\"external_link\" target=\"_blank\">amputee<\/a> rehabilitation is primarily coordinated by a prosthetist and an inter-disciplinary team of health care professionals including psychiatrists, surgeons, physical therapists, and occupational therapists. Prosthetics are commonly created with CAD (Computer-Aided Design), a software interface that helps creators visualize the creation in a 3D form,<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> and they can also be designed by hand.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<p>A person's prosthesis should be designed and assembled according to the person's appearance and functional needs. For instance, a person may need a transradial prosthesis, but need to choose between an aesthetic functional device, a myoelectric device, a body-powered device, or an activity specific device. The person's future goals and economical capabilities may help them choose between one or more devices.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Craniofacial_prosthesis\" title=\"Craniofacial prosthesis\" rel=\"external_link\" target=\"_blank\">Craniofacial prostheses<\/a> include intra-oral and extra-oral prostheses. Extra-oral prostheses are further divided into hemifacial, auricular (ear), nasal, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orbital_prosthesis\" class=\"mw-redirect\" title=\"Orbital prosthesis\" rel=\"external_link\" target=\"_blank\">orbital<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ocular_prosthesis\" title=\"Ocular prosthesis\" rel=\"external_link\" target=\"_blank\">ocular<\/a>. Intra-oral prostheses include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_prostheses\" class=\"mw-redirect\" title=\"Dental prostheses\" rel=\"external_link\" target=\"_blank\">dental prostheses<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dentures\" title=\"Dentures\" rel=\"external_link\" target=\"_blank\">dentures<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Palatal_obturator\" title=\"Palatal obturator\" rel=\"external_link\" target=\"_blank\">obturators<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">dental implants<\/a>.\n<\/p><p>Prostheses of the neck include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Larynx\" title=\"Larynx\" rel=\"external_link\" target=\"_blank\">larynx<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrolarynx\" title=\"Electrolarynx\" rel=\"external_link\" target=\"_blank\">substitutes<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertebrate_trachea\" class=\"mw-redirect\" title=\"Vertebrate trachea\" rel=\"external_link\" target=\"_blank\">trachea<\/a> and upper <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophagus\" title=\"Esophagus\" rel=\"external_link\" target=\"_blank\">esophageal<\/a> replacements,\n<\/p><p> of the torso include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_prostheses\" title=\"Breast prostheses\" rel=\"external_link\" target=\"_blank\">breast prostheses<\/a> which may be either single or bilateral, full breast devices or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nipple_prosthesis\" title=\"Nipple prosthesis\" rel=\"external_link\" target=\"_blank\">nipple prostheses<\/a>.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Penile_prosthesis\" title=\"Penile prosthesis\" rel=\"external_link\" target=\"_blank\">Penile prostheses<\/a> are used to treat erectile dysfunction.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Limb_prostheses\">Limb prostheses<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:A_formation_of_Marines,_firemen_and_policemen_running_across_Manhattan_in_2007.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2d\/A_formation_of_Marines%2C_firemen_and_policemen_running_across_Manhattan_in_2007.jpg\/220px-A_formation_of_Marines%2C_firemen_and_policemen_running_across_Manhattan_in_2007.jpg\" width=\"220\" height=\"340\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:A_formation_of_Marines,_firemen_and_policemen_running_across_Manhattan_in_2007.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Marine_Corps\" title=\"United States Marine Corps\" rel=\"external_link\" target=\"_blank\">United States Marine<\/a> with bilateral prosthetic legs leads a formation run<\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Limb_(anatomy)\" title=\"Limb (anatomy)\" rel=\"external_link\" target=\"_blank\">Limb<\/a> prostheses include both upper- and lower-extremity prostheses.\n<\/p><p><b>Upper-extremity prostheses<\/b> are used at varying levels of amputation: forequarter, shoulder disarticulation, transhumeral prosthesis, elbow disarticulation, transradial prosthesis, wrist disarticulation, full hand, partial hand, finger, partial finger. A transradial prosthesis is an artificial limb that replaces an arm missing below the elbow.\n<\/p><p>Upper limb prostheses can be categorized in three main categories: Passive devices, Body Powered devices, Externally Powered (myoelectric) devices. Passive devices can either be passive hands, mainly used for cosmetic purpose, or passive tools, mainly used for specific activities (e.g. leisure or vocational). An extensive overview and classification of passive devices can be found in a literature review by Maat <i>et.al.<\/i><sup id=\"rdp-ebb-cite_ref-Review_Passive_Prosthetic_Hands_4-0\" class=\"reference\"><a href=\"#cite_note-Review_Passive_Prosthetic_Hands-4\" rel=\"external_link\">[4]<\/a><\/sup> A passive device can be static, meaning the device has no movable parts, or it can be adjustable, meaning its configuration can be adjusted (e.g. adjustable hand opening). Despite the absence of active grasping, passive devices are very useful in bimanual tasks that require fixation or support of an object, or for gesticulation in social interaction. According to scientific data a third of the upper limb amputees worldwide use a passive prosthetic hand.<sup id=\"rdp-ebb-cite_ref-Review_Passive_Prosthetic_Hands_4-1\" class=\"reference\"><a href=\"#cite_note-Review_Passive_Prosthetic_Hands-4\" rel=\"external_link\">[4]<\/a><\/sup> Body Powered or cable operated limbs work by attaching a harness and cable around the opposite shoulder of the damaged arm. The third category of prosthetic devices available are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myoelectric\" class=\"mw-redirect\" title=\"Myoelectric\" rel=\"external_link\" target=\"_blank\">myoelectric<\/a> arms. These work by sensing, via <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrode\" title=\"Electrode\" rel=\"external_link\" target=\"_blank\">electrodes<\/a>, when the muscles in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arm\" title=\"Arm\" rel=\"external_link\" target=\"_blank\">upper arm<\/a> move, causing an artificial hand to open or close. In the prosthetics industry, a trans-radial prosthetic arm is often referred to as a \"BE\" or below elbow prosthesis.\n<\/p><p><b>Lower-extremity prostheses<\/b> provide replacements at varying levels of amputation. These include hip disarticulation, transfemoral prosthesis, knee disarticulation, transtibial prosthesis, Syme's amputation, foot, partial foot, and toe. The two main subcategories of lower extremity prosthetic devices are trans-tibial (any amputation transecting the tibia bone or a congenital anomaly resulting in a tibial deficiency) and trans-femoral (any amputation transecting the femur bone or a congenital anomaly resulting in a femoral deficiency).\n<\/p><p>A transfemoral prosthesis is an artificial limb that replaces a leg missing above the knee. Transfemoral amputees can have a very difficult time regaining normal movement. In general, a transfemoral amputee must use approximately 80% more energy to walk than a person with two whole legs.<sup id=\"rdp-ebb-cite_ref-four_5-0\" class=\"reference\"><a href=\"#cite_note-four-5\" rel=\"external_link\">[5]<\/a><\/sup> This is due to the complexities in movement associated with the knee. In newer and more improved designs, hydraulics, carbon fiber, mechanical linkages, motors, computer microprocessors, and innovative combinations of these technologies are employed to give more control to the user. In the prosthetics industry a trans-femoral prosthetic leg is often referred to as an \"AK\" or above the knee prosthesis.\n<\/p><p>A transtibial prosthesis is an artificial limb that replaces a leg missing below the knee. A transtibial amputee is usually able to regain normal movement more readily than someone with a transfemoral amputation, due in large part to retaining the knee, which allows for easier movement. Lower extremity prosthetics describes artificially replaced limbs located at the hip level or lower. In the prosthetics industry a trans-tibial prosthetic leg is often referred to as a \"BK\" or below the knee prosthesis.\n<\/p><p>Physical therapists are trained to teach a person to walk with a leg prosthesis. To do so, the physical therapist may provide verbal instructions and may also help guide the person using touch, or tactile cues. This may be done in a clinic or home. There is some research suggesting that such training in the home may be more successful if the treatment includes the use of a treadmill.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> Using a treadmill, along with the physical therapy treatment, helps the person to experience many of the challenges of walking with a prosthesis.\n<\/p><p>In the United Kingdom, 75% of lower limb amputations are performed due to inadequate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Circulatory_system\" title=\"Circulatory system\" rel=\"external_link\" target=\"_blank\">circulation<\/a> (dysvascularity).<sup id=\"rdp-ebb-cite_ref-:3_7-0\" class=\"reference\"><a href=\"#cite_note-:3-7\" rel=\"external_link\">[7]<\/a><\/sup><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Dates_and_numbers#Chronological_items\" title=\"Wikipedia:Manual of Style\/Dates and numbers\" rel=\"external_link\" target=\"_blank\"><span title=\"Updated version https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30350430 (December 2018)\">needs update<\/span><\/a><\/i>]<\/sup> This condition is often associated with many other medical conditions (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Comorbidity\" title=\"Comorbidity\" rel=\"external_link\" target=\"_blank\">co-morbidities<\/a>) including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetes_mellitus\" title=\"Diabetes mellitus\" rel=\"external_link\" target=\"_blank\">diabetes<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiovascular_disease\" title=\"Cardiovascular disease\" rel=\"external_link\" target=\"_blank\">heart disease<\/a> that may make it a challenge to recover and use a prosthetic limb to regain mobility and independence.<sup id=\"rdp-ebb-cite_ref-:3_7-1\" class=\"reference\"><a href=\"#cite_note-:3-7\" rel=\"external_link\">[7]<\/a><\/sup> For people who have inadequate circulation and have lost a lower limb, there is insufficient evidence due to a lack of research, to inform them regarding their choice of prosthetic rehabilitation approaches.<sup id=\"rdp-ebb-cite_ref-:3_7-2\" class=\"reference\"><a href=\"#cite_note-:3-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>Lower extremity prostheses are often categorized by the level of amputation or after the name of a surgeon:<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-:4_9-0\" class=\"reference\"><a href=\"#cite_note-:4-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<ul><li>Transfemoral (Above-knee)<\/li>\n<li>Transtibial (Below-knee)<\/li>\n<li>Ankle disarticulation (e.g.: Syme amputation)<\/li>\n<li>Knee disarticulation<\/li>\n<li>Hemi-pelvictomy (Hip disarticulation)<\/li>\n<li>Partial foot amputations (Pirogoff, Talo-Navicular and Calcaneo-cuboid (Chopart), Tarso-metatarsal (Lisfranc), Trans-metatarsal, Metatarsal-phalangeal, Ray amputations, toe amputations).<sup id=\"rdp-ebb-cite_ref-:4_9-1\" class=\"reference\"><a href=\"#cite_note-:4-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li>\n<li>Van Nes rotationplasty<\/li><\/ul>\n<h4><span class=\"mw-headline\" id=\"Prosthetic_raw_materials\">Prosthetic raw materials<\/span><\/h4>\n<p>Prosthetic are made lightweight for better convenience for the amputee. Some of these materials include:\n<\/p>\n<ul><li>Plastics:\n<ul><li>Polyethylene<\/li>\n<li>Polypropylene<\/li>\n<li>Acrylics<\/li>\n<li>Polyurethane<\/li><\/ul><\/li>\n<li>Wood (early prosthetics)<\/li>\n<li>Rubber (early prosthetics)<\/li>\n<li>Lightweight metals:\n<ul><li>Titanium<\/li>\n<li>Aluminum<\/li><\/ul><\/li>\n<li>Composites:\n<ul><li>Carbon fibre<sup id=\"rdp-ebb-cite_ref-madehow.com_2-1\" class=\"reference\"><a href=\"#cite_note-madehow.com-2\" rel=\"external_link\">[2]<\/a><\/sup><\/li><\/ul><\/li><\/ul>\n<p>Wheeled prostheses have also been used extensively in the rehabilitation of injured domestic animals, including dogs, cats, pigs, rabbits, and turtles.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Prosthetic_toe.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/67\/Prosthetic_toe.jpg\/220px-Prosthetic_toe.jpg\" width=\"220\" height=\"157\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Prosthetic_toe.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Prosthetic toe from ancient Egypt<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Roman_artificial_leg_of_bronze._Wellcome_M0012307.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/05\/Roman_artificial_leg_of_bronze._Wellcome_M0012307.jpg\/220px-Roman_artificial_leg_of_bronze._Wellcome_M0012307.jpg\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Roman_artificial_leg_of_bronze._Wellcome_M0012307.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The Capua leg (replica)<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ambroise_Pare;_prosthetics,_mechanical_hand_Wellcome_L0023364.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d5\/Ambroise_Pare%3B_prosthetics%2C_mechanical_hand_Wellcome_L0023364.jpg\/220px-Ambroise_Pare%3B_prosthetics%2C_mechanical_hand_Wellcome_L0023364.jpg\" width=\"220\" height=\"373\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ambroise_Pare;_prosthetics,_mechanical_hand_Wellcome_L0023364.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>\"Illustration of mechanical hand\", c. 1564.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Eiserne_Hand_Glasnegativ_6_cropped.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/81\/Eiserne_Hand_Glasnegativ_6_cropped.jpg\/220px-Eiserne_Hand_Glasnegativ_6_cropped.jpg\" width=\"220\" height=\"87\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Eiserne_Hand_Glasnegativ_6_cropped.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Iron prosthetic hand believed to have been owned by G\u00f6tz von Berlichingen (1480\u20131562)<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Iron_artificial_arm,_1560-1600._(9663806794).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/eb\/Iron_artificial_arm%2C_1560-1600._%289663806794%29.jpg\/220px-Iron_artificial_arm%2C_1560-1600._%289663806794%29.jpg\" width=\"220\" height=\"281\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Iron_artificial_arm,_1560-1600._(9663806794).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Artificial iron hand believed to date from 1560\u20131600<\/div><\/div><\/div>\n<p>Prosthetics have been mentioned throughout history. The earliest recorded mention is the warrior queen <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vishpala\" title=\"Vishpala\" rel=\"external_link\" target=\"_blank\">Vishpala<\/a> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rigveda\" title=\"Rigveda\" rel=\"external_link\" target=\"_blank\">Rigveda<\/a>.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> The Egyptians were early pioneers of the idea, as shown by the wooden toe found on a body from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/New_Kingdom\" class=\"mw-redirect\" title=\"New Kingdom\" rel=\"external_link\" target=\"_blank\">New Kingdom<\/a>.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> Roman bronze <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crown_(dentistry)\" title=\"Crown (dentistry)\" rel=\"external_link\" target=\"_blank\">crowns<\/a> have also been found, but their use could have been more aesthetic than medical.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p>An early mention of a prosthetic comes from the Greek historian <a href=\"https:\/\/en.wikipedia.org\/wiki\/Herodotus\" title=\"Herodotus\" rel=\"external_link\" target=\"_blank\">Herodotus<\/a>, who tells the story of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hegesistratus\" title=\"Hegesistratus\" rel=\"external_link\" target=\"_blank\">Hegesistratus<\/a>, a Greek <a href=\"https:\/\/en.wikipedia.org\/wiki\/Divination\" title=\"Divination\" rel=\"external_link\" target=\"_blank\">diviner<\/a> who cut off his own foot to escape his <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sparta\" title=\"Sparta\" rel=\"external_link\" target=\"_blank\">Spartan<\/a> captors and replaced it with a wooden one.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Wood_and_metal_hands\">Wood and metal hands<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pliny_the_Elder\" title=\"Pliny the Elder\" rel=\"external_link\" target=\"_blank\">Pliny the Elder<\/a> also recorded the tale of a Roman general, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Marcus_Sergius\" title=\"Marcus Sergius\" rel=\"external_link\" target=\"_blank\">Marcus Sergius<\/a>, whose right hand was cut off while campaigning and had an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron_hand_(prosthesis)\" title=\"Iron hand (prosthesis)\" rel=\"external_link\" target=\"_blank\">iron hand<\/a> made to hold his shield so that he could return to battle. A famous and quite refined<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> historical prosthetic arm was that of <a href=\"https:\/\/en.wikipedia.org\/wiki\/G%C3%B6tz_von_Berlichingen\" title=\"G\u00f6tz von Berlichingen\" rel=\"external_link\" target=\"_blank\">G\u00f6tz von Berlichingen<\/a>, made at the beginning of the 16th century. The first confirmed use of a prosthetic device, however, is from 950\u2013710 BC. In 2000, research pathologists discovered a mummy from this period buried in the Egyptian necropolis near ancient Thebes that possessed an artificial big toe. This toe, consisting of wood and leather, exhibited evidence of use. When reproduced by bio-mechanical engineers in 2011, researchers discovered that this ancient prosthetic enabled its wearer to walk both barefoot and in Egyptian style sandals. Previously, the earliest discovered prosthetic was an artificial <a href=\"https:\/\/en.wikipedia.org\/wiki\/Roman_Capua_Leg\" class=\"mw-redirect\" title=\"Roman Capua Leg\" rel=\"external_link\" target=\"_blank\">leg from Capua<\/a>.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:A_Visit_To_the_Artificial_Limbs_Factory,_Queen_Mary%27s_Hospital,_Roehampton,_November_1941_D5731.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/72\/A_Visit_To_the_Artificial_Limbs_Factory%2C_Queen_Mary%27s_Hospital%2C_Roehampton%2C_November_1941_D5731.jpg\/220px-A_Visit_To_the_Artificial_Limbs_Factory%2C_Queen_Mary%27s_Hospital%2C_Roehampton%2C_November_1941_D5731.jpg\" width=\"220\" height=\"157\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:A_Visit_To_the_Artificial_Limbs_Factory,_Queen_Mary%27s_Hospital,_Roehampton,_November_1941_D5731.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An artificial limbs factory in 1941<\/div><\/div><\/div>\n<p>Around the same time, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fran%C3%A7ois_de_la_Noue\" title=\"Fran\u00e7ois de la Noue\" rel=\"external_link\" target=\"_blank\">Fran\u00e7ois de la Noue<\/a> is also reported to have had an iron hand, as is, in the 17th Century, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cavalier_de_la_Salle\" class=\"mw-redirect\" title=\"Cavalier de la Salle\" rel=\"external_link\" target=\"_blank\">Ren\u00e9-Robert Cavalier de la Salle<\/a>.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Henri_de_Tonti\" title=\"Henri de Tonti\" rel=\"external_link\" target=\"_blank\">Henri de Tonti<\/a> had a prosthetic hook for a hand. During the Middle Ages, prosthetic remained quite basic in form. Debilitated knights would be fitted with prosthetics so they could hold up a shield, grasp a lance or a sword, or stabilize a mounted warrior.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> Only the wealthy could afford anything that would assist in daily life.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2014)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>One notable prosthesis was that belonging to an Italian man, who scientists estimate replaced his amputated right hand with a knife.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-:0_19-0\" class=\"reference\"><a href=\"#cite_note-:0-19\" rel=\"external_link\">[19]<\/a><\/sup> Scientists investigating the skeleton, which was found in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Longobard\" class=\"mw-redirect\" title=\"Longobard\" rel=\"external_link\" target=\"_blank\">Longobard<\/a> cemetery in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Povegliano_Veronese\" title=\"Povegliano Veronese\" rel=\"external_link\" target=\"_blank\">Povegliano Veronese<\/a>, estimated that the man had lived sometime between the 6th and 8th centuries AD.<sup id=\"rdp-ebb-cite_ref-:1_20-0\" class=\"reference\"><a href=\"#cite_note-:1-20\" rel=\"external_link\">[20]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-:0_19-1\" class=\"reference\"><a href=\"#cite_note-:0-19\" rel=\"external_link\">[19]<\/a><\/sup> Materials found near the man's body suggest that the knife prosthesis was attached with a leather strap, which he repeatedly tightened with his teeth.<sup id=\"rdp-ebb-cite_ref-:1_20-1\" class=\"reference\"><a href=\"#cite_note-:1-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><p>During the Renaissance, prosthetics developed with the use of iron, steel, copper, and wood. Functional prosthetics began to make an appearance in the 1500s.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Technology_progress_before_the_20th_century\">Technology progress before the 20th century<\/span><\/h3>\n<p>An Italian surgeon recorded the existence of an amputee who had an arm that allowed him to remove his hat, open his purse, and sign his name.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> Improvement in amputation surgery and prosthetic design came at the hands of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ambroise_Par%C3%A9\" title=\"Ambroise Par\u00e9\" rel=\"external_link\" target=\"_blank\">Ambroise Par\u00e9<\/a>. Among his inventions was an above-knee device that was a kneeling <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peg_leg\" class=\"mw-redirect\" title=\"Peg leg\" rel=\"external_link\" target=\"_blank\">peg leg<\/a> and foot prosthesis with a fixed position, adjustable harness, and knee lock control. The functionality of his advancements showed how future prosthetics could develop.\n<\/p><p>Other major improvements before the modern era:\n<\/p>\n<ul><li> \u2013 First non-locking below-knee (BK) prosthesis.<\/li>\n<li> \u2013 Prosthesis made of a wooden shank and socket, a steel knee joint and an articulated foot that was controlled by catgut tendons from the knee to the ankle. Came to be known as \u201cAnglesey Leg\u201d or \u201cSelpho Leg\u201d.<\/li>\n<li>Sir <a href=\"https:\/\/en.wikipedia.org\/wiki\/James_Syme\" title=\"James Syme\" rel=\"external_link\" target=\"_blank\">James Syme<\/a> \u2013 A new method of ankle amputation that did not involve amputating at the thigh.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Benjamin_Palmer\" class=\"mw-redirect\" title=\"Benjamin Palmer\" rel=\"external_link\" target=\"_blank\">Benjamin Palmer<\/a> \u2013 Improved upon the Selpho leg. Added an anterior spring and concealed tendons to simulate natural-looking movement.<\/li>\n<li> \u2013 Created prosthetic with a suction socket, polycentric knee, and multi-articulated foot.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Marcel_Desoutter\" title=\"Marcel Desoutter\" rel=\"external_link\" target=\"_blank\">Marcel Desoutter<\/a> &  \u2013 First aluminium prosthesis<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup><\/li>\n<li>Henry Heather Bigg, and his son Henry Robert Heather Bigg, won the Queen's command to provide \"surgical appliances\" to wounded soldiers after Crimea War. They developed arms that allowed a double arm amputee to crochet, and a hand that felt natural to others based on ivory, felt, and leather.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><\/li><\/ul>\n<p>At the end of World War II, the NAS (National Academy of Sciences) began to advocate better research and development of prosthetics. Through government funding, a research and development program was developed within the Army, Navy, Air Force, and the Veterans Administration.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Lower_extremity_modern_history\">Lower extremity modern history<\/span><\/h3>\n<p>Socket technology for lower extremity limbs saw a revolution during the 1980s when John Sabolich C.P.O., invented the Contoured Adducted Trochanteric-Controlled Alignment Method (CATCAM) socket, later to evolve into the Sabolich Socket. He followed the direction of Ivan Long and Ossur Christensen as they developed alternatives to the quadrilateral socket, which in turn followed the open ended plug socket, created from wood.<sup id=\"rdp-ebb-cite_ref-Long_25-0\" class=\"reference\"><a href=\"#cite_note-Long-25\" rel=\"external_link\">[25]<\/a><\/sup> The advancement was due to the difference in the socket to patient contact model. Prior to this, sockets were made in the shape of a square shape with no specialized containment for muscular tissue. New designs thus help to lock in the bony anatomy, locking it into place and distributing the weight evenly over the existing limb as well as the musculature of the patient. Ischial containment is well known and used today by many prosthetist to help in patient care. Variations of the ischial containment socket thus exists and each socket is tailored to the specific needs of the patient. Others who contributed to socket development and changes over the years include Tim Staats, Chris Hoyt, and Frank Gottschalk. Gottschalk disputed the efficacy of the CAT-CAM socket- insisting the surgical procedure done by the amputation surgeon was most important to prepare the amputee for good use of a prosthesis of any type socket design.<sup id=\"rdp-ebb-cite_ref-Gottschalk-Kourosh-Stills_26-0\" class=\"reference\"><a href=\"#cite_note-Gottschalk-Kourosh-Stills-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p><p>The first microprocessor-controlled prosthetic knees became available in the early 1990s. The Intelligent Prosthesis was the first commercially available microprocessor controlled prosthetic knee. It was released by Chas. A. Blatchford & Sons, Ltd., of Great Britain, in 1993 and made walking with the prosthesis feel and look more natural.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> An improved version was released in 1995 by the name Intelligent Prosthesis Plus. Blatchford released another prosthesis, the Adaptive Prosthesis, in 1998. The Adaptive Prosthesis utilized hydraulic controls, pneumatic controls, and a microprocessor to provide the amputee with a gait that was more responsive to changes in walking speed. Cost analysis reveals that a sophisticated above-knee prosthesis will be about $1 million in 45 years, given only annual cost of living adjustments.<sup id=\"rdp-ebb-cite_ref-PikeAlvin_28-0\" class=\"reference\"><a href=\"#cite_note-PikeAlvin-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Upper_extremity_modern_history\">Upper extremity modern history<\/span><\/h3>\n<p>In 2005, <a href=\"https:\/\/en.wikipedia.org\/wiki\/DARPA\" title=\"DARPA\" rel=\"external_link\" target=\"_blank\">DARPA<\/a> started the program.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Patient_procedure\">Patient procedure<\/span><\/h2>\n<p>A prosthesis is a functional replacement for an amputated or congenitally malformed or missing limb. Prosthetists are responsible for the prescription, design and management of a prosthetic device.\n<\/p><p>In most cases, the prosthetist begins by taking a plaster cast of the patient's affected limb. Lightweight, high-strength thermoplastics are custom-formed to this model of the patient. Cutting-edge materials such as carbon fiber, titanium and Kevlar provide strength and durability while making the new prosthesis lighter. More sophisticated prostheses are equipped with advanced electronics, providing additional stability and control.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Current_technology_and_manufacturing\">Current technology and manufacturing<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:WorkNC-Knee_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0b\/WorkNC-Knee_prosthesis.jpg\/250px-WorkNC-Knee_prosthesis.jpg\" width=\"250\" height=\"167\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:WorkNC-Knee_prosthesis.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Knee prosthesis manufactured using <a href=\"https:\/\/en.wikipedia.org\/wiki\/WorkNC\" title=\"WorkNC\" rel=\"external_link\" target=\"_blank\">WorkNC<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer_Aided_Manufacturing\" class=\"mw-redirect\" title=\"Computer Aided Manufacturing\" rel=\"external_link\" target=\"_blank\">Computer Aided Manufacturing<\/a> software<\/div><\/div><\/div>\n<p>Over the years, there have been advancements in artificial limbs. New plastics and other materials, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_fiber\" class=\"mw-redirect\" title=\"Carbon fiber\" rel=\"external_link\" target=\"_blank\">carbon fiber<\/a>, have allowed artificial limbs to be stronger and lighter, limiting the amount of extra energy necessary to operate the limb. This is especially important for trans-femoral amputees. Additional materials have allowed artificial limbs to look much more realistic, which is important to trans-radial and transhumeral amputees because they are more likely to have the artificial limb exposed.<sup id=\"rdp-ebb-cite_ref-three_36-0\" class=\"reference\"><a href=\"#cite_note-three-36\" rel=\"external_link\">[36]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Journal.pone.0019508.g004_prosthetic_finger.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/aa\/Journal.pone.0019508.g004_prosthetic_finger.png\/220px-Journal.pone.0019508.g004_prosthetic_finger.png\" width=\"220\" height=\"201\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Journal.pone.0019508.g004_prosthetic_finger.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Manufacturing a prosthetic finger<\/div><\/div><\/div>\n<p>In addition to new materials, the use of electronics has become very common in artificial limbs. Myoelectric limbs, which control the limbs by converting muscle movements to electrical signals, have become much more common than cable operated limbs. Myoelectric signals are picked up by electrodes, the signal gets integrated and once it exceeds a certain threshold, the prosthetic limb control signal is triggered which is why inherently, all myoelectric controls lag. Conversely, cable control is immediate and physical, and through that offers a certain degree of direct force feedback that myoelectric control does not. Computers are also used extensively in the manufacturing of limbs. <a href=\"https:\/\/en.wikipedia.org\/wiki\/CAD\/CAM\" class=\"mw-redirect\" title=\"CAD\/CAM\" rel=\"external_link\" target=\"_blank\">Computer Aided Design and Computer Aided Manufacturing<\/a> are often used to assist in the design and manufacture of artificial limbs.<sup id=\"rdp-ebb-cite_ref-three_36-1\" class=\"reference\"><a href=\"#cite_note-three-36\" rel=\"external_link\">[36]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-sapphire_37-0\" class=\"reference\"><a href=\"#cite_note-sapphire-37\" rel=\"external_link\">[37]<\/a><\/sup>\n<\/p><p>Most modern artificial limbs are attached to the residual limb (stump) of the amputee by belts and cuffs or by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Suction\" title=\"Suction\" rel=\"external_link\" target=\"_blank\">suction<\/a>. The residual limb either directly fits into a socket on the prosthetic, or\u2014more commonly today\u2014a liner is used that then is fixed to the socket either by vacuum (suction sockets) or a pin lock. Liners are soft and by that, they can create a far better suction fit than hard sockets. Silicone liners can be obtained in standard sizes, mostly with a circular (round) cross section, but for any other residual limb shape, custom liners can be made. The socket is custom made to fit the residual limb and to distribute the forces of the artificial limb across the area of the residual limb (rather than just one small spot), which helps reduce wear on the residual limb. The custom socket is created by taking a plaster cast of the residual limb or, more commonly today, of the liner worn over the residual limb, and then making a mold from the plaster cast. Newer methods include laser-guided measuring which can be input directly to a computer allowing for a more sophisticated design.\n<\/p><p>One problem with the residual limb and socket attachment is that a bad fit will reduce the area of contact between the residual limb and socket or liner, and increase pockets between residual limb skin and socket or liner. Pressure then is higher, which can be painful. Air pockets can allow sweat to accumulate that can soften the skin. Ultimately, this is a frequent cause for itchy skin rashes. Over time, this can lead to breakdown of the skin.<sup id=\"rdp-ebb-cite_ref-four_5-1\" class=\"reference\"><a href=\"#cite_note-four-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>Artificial limbs are typically manufactured using the following steps:<sup id=\"rdp-ebb-cite_ref-three_36-2\" class=\"reference\"><a href=\"#cite_note-three-36\" rel=\"external_link\">[36]<\/a><\/sup>\n<\/p>\n<ol><li>Measurement of the residual limb<\/li>\n<li>Measurement of the body to determine the size required for the artificial limb<\/li>\n<li>Fitting of a silicone liner<\/li>\n<li>Creation of a model of the liner worn over the residual limb<\/li>\n<li>Formation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermoplastic\" title=\"Thermoplastic\" rel=\"external_link\" target=\"_blank\">thermoplastic<\/a> sheet around the model \u2013 This is then used to test the fit of the prosthetic<\/li>\n<li>Formation of permanent socket<\/li>\n<li>Formation of plastic parts of the artificial limb \u2013 Different methods are used, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vacuum_forming\" title=\"Vacuum forming\" rel=\"external_link\" target=\"_blank\">vacuum forming<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Injection_molding\" class=\"mw-redirect\" title=\"Injection molding\" rel=\"external_link\" target=\"_blank\">injection molding<\/a><\/li>\n<li>Creation of metal parts of the artificial limb using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Die_casting\" title=\"Die casting\" rel=\"external_link\" target=\"_blank\">die casting<\/a><\/li>\n<li>Assembly of entire limb<\/li><\/ol>\n<h3><span class=\"mw-headline\" id=\"Body-powered_arms\">Body-powered arms<\/span><\/h3>\n<p>Current technology allows body powered arms to weigh around one-half to one-third of what a myoelectric arm does.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Sockets\">Sockets<\/span><\/h4>\n<p>Current body-powered arms contain sockets that are built from hard epoxy or carbon fiber. These sockets or \"interfaces\" can be made more comfortable by lining them with a softer, compressible foam material that provides padding for the bone prominences. A self-suspending or supra-condylar socket design is useful for those with short to mid-range below elbow absence. Longer limbs may require the use of a locking roll-on type inner liner or more complex harnessing to help augment suspension.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Wrists\">Wrists<\/span><\/h4>\n<p>Wrist units are either screw-on connectors featuring the UNF 1\/2-20 thread (USA) or quick-release connector, of which there are different models.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Voluntary_opening_and_voluntary_closing\">Voluntary opening and voluntary closing<\/span><\/h4>\n<p>Two types of body-powered systems exist, voluntary opening \"pull to open\" and voluntary closing \"pull to close\". Virtually all \"split hook\" prostheses operate with a voluntary opening type system.\n<\/p><p>More modern \"prehensors\" called GRIPS utilize voluntary closing systems. The differences are significant. Users of voluntary opening systems rely on elastic bands or springs for gripping force, while users of voluntary closing systems rely on their own body power and energy to create gripping force.\n<\/p><p>Voluntary closing users can generate prehension forces equivalent to the normal hand, upwards to or exceeding one hundred pounds. Voluntary closing GRIPS require constant tension to grip, like a human hand, and in that property, they do come closer to matching human hand performance. Voluntary opening split hook users are limited to forces their rubber or springs can generate which usually is below 20 pounds.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Feedback\">Feedback<\/span><\/h4>\n<p>An additional difference exists in the biofeedback created that allows the user to \"feel\" what is being held. Voluntary opening systems once engaged provide the holding force so that they operate like a passive vice at the end of the arm. No gripping feedback is provided once the hook has closed around the object being held. Voluntary closing systems provide directly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proportional_Myoelectric_Control\" class=\"mw-redirect\" title=\"Proportional Myoelectric Control\" rel=\"external_link\" target=\"_blank\">proportional control<\/a> and biofeedback so that the user can feel how much force that they are applying.\n<\/p><p>A recent study showed that by stimulating the median and ulnar nerves, according to the information provided by the artificial sensors from a hand prosthesis, physiologically appropriate (near-natural) sensory information could be provided to an amputee. This feedback enabled the participant to effectively modulate the grasping force of the prosthesis with no visual or auditory feedback.<sup id=\"rdp-ebb-cite_ref-pmid_=_24500407_38-0\" class=\"reference\"><a href=\"#cite_note-pmid_=_24500407-38\" rel=\"external_link\">[38]<\/a><\/sup>\n<\/p><p>Researchers from \u00c9cole Polytechnique F\u00e9d\u00e9rale De Lausanne in Switzerland and the Scuola Superiore Sant'Anna in Italy, implanted the electrodes into the amputee's arm in February 2013. The study, published Wednesday<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Dates_and_numbers#Chronological_items\" title=\"Wikipedia:Manual of Style\/Dates and numbers\" rel=\"external_link\" target=\"_blank\"><span title=\"The time period mentioned near this tag is ambiguous. (May 2015)\">when?<\/span><\/a><\/i>]<\/sup> in <i>Science Translational Medicine<\/i>, details the first time sensory feedback has been restored allowing an amputee to control an artificial limb in real-time.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup> With wires linked to nerves in his upper arm, the Danish patient was able to handle objects and instantly receive a sense of touch through the special artificial hand that was created by Silvestro Micera and researchers both in Switzerland and Italy.<sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Terminal_devices\">Terminal devices<\/span><\/h4>\n<p>Terminal devices contain a range of hooks, prehensors, hands or other devices.\n<\/p>\n<h5><span class=\"mw-headline\" id=\"Hooks\">Hooks<\/span><\/h5>\n<p>Voluntary opening split hook systems are simple, convenient, light, robust, versatile and relatively affordable.\n<\/p><p>A hook does not match a normal human hand for appearance or overall versatility, but its material tolerances can exceed and surpass the normal human hand for mechanical stress (one can even use a hook to slice open boxes or as a hammer whereas the same is not possible with a normal hand), for thermal stability (one can use a hook to grip items from boiling water, to turn meat on a grill, to hold a match until it has burned down completely) and for chemical hazards (as a metal hook withstands acids or lye, and does not react to solvents like a prosthetic glove or human skin).\n<\/p>\n<h5><span class=\"mw-headline\" id=\"Hands\">Hands<\/span><\/h5>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Myoelectric_prosthetic_arm.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6e\/Myoelectric_prosthetic_arm.jpg\/220px-Myoelectric_prosthetic_arm.jpg\" width=\"220\" height=\"252\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Myoelectric_prosthetic_arm.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Actor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Owen_Wilson\" title=\"Owen Wilson\" rel=\"external_link\" target=\"_blank\">Owen Wilson<\/a> gripping the myoelectric prosthetic arm of a United States Marine<\/div><\/div><\/div>\n<p>Prosthetic hands are available in both voluntary opening and voluntary closing versions and because of their more complex mechanics and cosmetic glove covering require a relatively large activation force, which, depending on the type of harness used, may be uncomfortable.<sup id=\"rdp-ebb-cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\" rel=\"external_link\">[41]<\/a><\/sup> A recent study by the Delft University of Technology, The Netherlands, showed that the development of mechanical prosthetic hands has been neglected during the past decades. The study showed that the pinch force level of most current mechanical hands is too low for practical use.<sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup> The best tested hand was a prosthetic hand developed around 1945. In 2017 however, a research has been started with bionic hands by of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_University_of_Vienna\" title=\"Medical University of Vienna\" rel=\"external_link\" target=\"_blank\">Medical University of Vienna<\/a>.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup> A few open-hardware 3-d printable bionic hands have also become available.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup> Some companies are also producing robotic hands with integrated forearm, for fitting unto a patient's upper arm.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Commercial_providers_and_materials\">Commercial providers and materials<\/span><\/h4>\n<p>Hosmer and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otto_Bock\" class=\"mw-redirect\" title=\"Otto Bock\" rel=\"external_link\" target=\"_blank\">Otto Bock<\/a> are major commercial hook providers. Mechanical hands are sold by Hosmer and Otto Bock as well; the Becker Hand is still manufactured by the Becker family. Prosthetic hands may be fitted with standard stock or custom-made cosmetic looking silicone gloves. But regular work gloves may be worn as well. Other terminal devices include the V2P Prehensor, a versatile robust gripper that allows customers to modify aspects of it, Texas Assist Devices (with a whole assortment of tools) and TRS that offers a range of terminal devices for sports. Cable harnesses can be built using aircraft steel cables, ball hinges, and self-lubricating cable sheaths. Some prosthetics have been designed specifically for use in salt water.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Lower-extremity_prosthetics\">Lower-extremity prosthetics<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:AustralianParalympianOfTheYear_468.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/34\/AustralianParalympianOfTheYear_468.JPG\/220px-AustralianParalympianOfTheYear_468.JPG\" width=\"220\" height=\"330\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:AustralianParalympianOfTheYear_468.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A prosthetic leg worn by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ellie_Cole\" title=\"Ellie Cole\" rel=\"external_link\" target=\"_blank\">Ellie Cole<\/a><\/div><\/div><\/div>\n<p>Lower-extremity prosthetics describes artificially replaced limbs located at the hip level or lower. Concerning all ages Ephraim et al. (2003) found a worldwide estimate of all-cause lower-extremity amputations of 2.0\u20135.9 per 10,000 inhabitants. For birth prevalence rates of congenital limb deficiency they found an estimate between 3.5\u20137.1 cases per 10,000 births.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/p><p>The two main subcategories of lower extremity prosthetic devices are trans-tibial (any amputation transecting the tibia bone or a congenital anomaly resulting in a tibial deficiency), and trans-femoral (any amputation transecting the femur bone or a congenital anomaly resulting in a femoral deficiency). In the prosthetic industry, a trans-tibial prosthetic leg is often referred to as a \"BK\" or below the knee prosthesis while the trans-femoral prosthetic leg is often referred to as an \"AK\" or above the knee prosthesis.\n<\/p><p>Other, less prevalent lower extremity cases include the following:\n<\/p>\n<ol><li>Hip disarticulations \u2013 This usually refers to when an amputee or congenitally challenged patient has either an amputation or anomaly at or in close proximity to the hip joint.<\/li>\n<li>Knee disarticulations \u2013 This usually refers to an amputation through the knee disarticulating the femur from the tibia.<\/li>\n<li>Symes \u2013 This is an ankle disarticulation while preserving the heel pad.<\/li><\/ol>\n<h4><span class=\"mw-headline\" id=\"Socket\">Socket<\/span><\/h4>\n<p>The socket serves as an interface between the residuum and the prosthesis, ideally allowing comfortable weight-bearing, movement control and proprioception.<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup> Socket issues, such as discomfort and skin breakdown, are rated among the most important issues faced by lower-limb amputees.<sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Shank_and_connectors\">Shank and connectors<\/span><\/h4>\n<p>This part creates distance and support between the knee-joint and the foot (in case of an upper-leg prosthesis) or between the socket and the foot. The type of connectors that are used between the shank and the knee\/foot determines whether the prosthesis is modular or not. Modular means that the angle and the displacement of the foot in respect to the socket can be changed after fitting. In developing countries prosthesis mostly are non-modular, in order to reduce cost. When considering children modularity of angle and height is important because of their average growth of 1.9 cm annually.<sup id=\"rdp-ebb-cite_ref-ReferenceA_52-0\" class=\"reference\"><a href=\"#cite_note-ReferenceA-52\" rel=\"external_link\">[52]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Foot\">Foot<\/span><\/h4>\n<p>Providing contact to the ground, the foot provides shock absorption and stability during stance.<sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup> Additionally it influences gait biomechanics by its shape and stiffness. This is because the trajectory of the center of pressure (COP) and the angle of the ground reaction forces is determined by the shape and stiffness of the foot and needs to match the subject's build in order to produce a normal gait pattern.<sup id=\"rdp-ebb-cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\" rel=\"external_link\">[54]<\/a><\/sup> Andrysek (2010) found 16 different types of feet, with greatly varying results concerning durability and biomechanics. The main problem found in current feet is durability, endurance ranging from 16\u201332 months <sup id=\"rdp-ebb-cite_ref-ReferenceB_55-0\" class=\"reference\"><a href=\"#cite_note-ReferenceB-55\" rel=\"external_link\">[55]<\/a><\/sup> These results are for adults and will probably be worse for children due to higher activity levels and scale effects. Evidence comparing different types of feet and ankle prosthetic devices is not strong enough to determine if one mechanism of ankle\/foot is superior to another.<sup id=\"rdp-ebb-cite_ref-:2_56-0\" class=\"reference\"><a href=\"#cite_note-:2-56\" rel=\"external_link\">[56]<\/a><\/sup> When deciding on a device, the cost of the device, a person's functional need, and the availability of a particular device should be considered.<sup id=\"rdp-ebb-cite_ref-:2_56-1\" class=\"reference\"><a href=\"#cite_note-:2-56\" rel=\"external_link\">[56]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Knee_joint\">Knee joint<\/span><\/h4>\n<p>In case of a trans-femoral amputation, there also is a need for a complex connector providing articulation, allowing flexion during swing-phase but not during stance.\n<\/p>\n<h5><span class=\"mw-headline\" id=\"Microprocessor_control\">Microprocessor control<\/span><\/h5>\n<p>To mimic the knee's functionality during gait, microprocessor-controlled knee joints have been developed that control the flexion of the knee. Some examples are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otto_Bock\" class=\"mw-redirect\" title=\"Otto Bock\" rel=\"external_link\" target=\"_blank\">Otto Bock<\/a>\u2019s C-leg, introduced in 1997, Ossur's Rheo Knee, released in 2005, the Power Knee by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ossur\" class=\"mw-redirect\" title=\"Ossur\" rel=\"external_link\" target=\"_blank\">Ossur<\/a>, introduced in 2006, the Pli\u00e9 Knee from Freedom Innovations and DAW Industries\u2019 Self Learning Knee (SLK).<sup id=\"rdp-ebb-cite_ref-57\" class=\"reference\"><a href=\"#cite_note-57\" rel=\"external_link\">[57]<\/a><\/sup>\n<\/p><p>The idea was originally developed by Kelly James, a Canadian engineer, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Alberta\" title=\"University of Alberta\" rel=\"external_link\" target=\"_blank\">University of Alberta<\/a>.<sup id=\"rdp-ebb-cite_ref-58\" class=\"reference\"><a href=\"#cite_note-58\" rel=\"external_link\">[58]<\/a><\/sup>\n<\/p><p>A microprocessor is used to interpret and analyze signals from knee-angle sensors and moment sensors. The microprocessor receives signals from its sensors to determine the type of motion being employed by the amputee. Most microprocessor controlled knee-joints are powered by a battery housed inside the prosthesis.\n<\/p><p>The sensory signals computed by the microprocessor are used to control the resistance generated by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydraulic_cylinders\" class=\"mw-redirect\" title=\"Hydraulic cylinders\" rel=\"external_link\" target=\"_blank\">hydraulic cylinders<\/a> in the knee-joint. Small valves control the amount of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydraulic_fluid\" title=\"Hydraulic fluid\" rel=\"external_link\" target=\"_blank\">hydraulic fluid<\/a> that can pass into and out of the cylinder, thus regulating the extension and compression of a piston connected to the upper section of the knee.<sup id=\"rdp-ebb-cite_ref-PikeAlvin_28-1\" class=\"reference\"><a href=\"#cite_note-PikeAlvin-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/p><p>The main advantage of a microprocessor-controlled prosthesis is a closer approximation to an amputee's natural gait. Some allow amputees to walk near walking speed or run. Variations in speed are also possible and are taken into account by sensors and communicated to the microprocessor, which adjusts to these changes accordingly. It also enables the amputees to walk downstairs with a step-over-step approach, rather than the one step at a time approach used with mechanical knees.<sup id=\"rdp-ebb-cite_ref-MartinCraigW_59-0\" class=\"reference\"><a href=\"#cite_note-MartinCraigW-59\" rel=\"external_link\">[59]<\/a><\/sup> There is some research suggesting that people with microprocessor-controlled prostheses report greater satisfaction and improvement in functionality, residual limb health, and safety.<sup id=\"rdp-ebb-cite_ref-Kannenberg_2014_1469\u20131496_60-0\" class=\"reference\"><a href=\"#cite_note-Kannenberg_2014_1469\u20131496-60\" rel=\"external_link\">[60]<\/a><\/sup> People may be able to perform everyday activities at greater speeds, even while multitasking, and reduce their risk of falls.<sup id=\"rdp-ebb-cite_ref-Kannenberg_2014_1469\u20131496_60-1\" class=\"reference\"><a href=\"#cite_note-Kannenberg_2014_1469\u20131496-60\" rel=\"external_link\">[60]<\/a><\/sup>\n<\/p><p>However, some have some significant drawbacks that impair its use. They can be susceptible to water damage and thus great care must be taken to ensure that the prosthesis remains dry.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Myoelectric\">Myoelectric<\/span><\/h3>\n<p>A <b>myoelectric prosthesis<\/b> uses the electrical tension generated every time a muscle contracts, as information. This tension can be captured from voluntarily contracted muscles by electrodes applied on the skin to control the movements of the prosthesis, such as elbow flexion\/extension, wrist supination\/pronation (rotation) or opening\/closing of the fingers. A prosthesis of this type utilizes the residual neuromuscular system of the human body to control the functions of an electric powered prosthetic hand, wrist, elbow or foot.<sup id=\"rdp-ebb-cite_ref-61\" class=\"reference\"><a href=\"#cite_note-61\" rel=\"external_link\">[61]<\/a><\/sup> This is different from an electric switch prosthesis, which requires straps and\/or cables actuated by body movements to actuate or operate switches that control the movements of the prosthesis. There is no clear evidence concluding that myoelectric upper extremity prostheses function better than body-powered prostheses.<sup id=\"rdp-ebb-cite_ref-Carey2015_62-0\" class=\"reference\"><a href=\"#cite_note-Carey2015-62\" rel=\"external_link\">[62]<\/a><\/sup> Advantages to using a myoelectric upper extremity prosthesis include the potential for improvement in cosmetic appeal (this type of prosthesis may have a more natural look), may be better for light everyday activities, and may be beneficial for people experiencing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phantom_limb\" title=\"Phantom limb\" rel=\"external_link\" target=\"_blank\">phantom limb<\/a> pain.<sup id=\"rdp-ebb-cite_ref-Carey2015_62-1\" class=\"reference\"><a href=\"#cite_note-Carey2015-62\" rel=\"external_link\">[62]<\/a><\/sup> When compared to a body-powered prosthesis, a myoelectric prosthesis may not be as durable, may have a longer training time, may require more adjustments, may need more maintenance, and does not provide feedback to the user.<sup id=\"rdp-ebb-cite_ref-Carey2015_62-2\" class=\"reference\"><a href=\"#cite_note-Carey2015-62\" rel=\"external_link\">[62]<\/a><\/sup>\n<\/p><p>The USSR was the first to develop a myoelectric arm in 1958,<sup id=\"rdp-ebb-cite_ref-63\" class=\"reference\"><a href=\"#cite_note-63\" rel=\"external_link\">[63]<\/a><\/sup> while the first myoelectric arm became commercial in 1964 by the of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soviet_Union\" title=\"Soviet Union\" rel=\"external_link\" target=\"_blank\">USSR<\/a>, and distributed by the of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_Kingdom\" title=\"United Kingdom\" rel=\"external_link\" target=\"_blank\">UK<\/a>.<sup id=\"rdp-ebb-cite_ref-64\" class=\"reference\"><a href=\"#cite_note-64\" rel=\"external_link\">[64]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-65\" class=\"reference\"><a href=\"#cite_note-65\" rel=\"external_link\">[65]<\/a><\/sup>\n<\/p><p>Researchers at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rehabilitation_Institute_of_Chicago\" class=\"mw-redirect\" title=\"Rehabilitation Institute of Chicago\" rel=\"external_link\" target=\"_blank\">Rehabilitation Institute of Chicago<\/a> announced in September 2013 that they have developed a robotic leg that translates neural impulses from the user's thigh muscles into movement, which is the first prosthetic leg to do so. It is currently in testing.<sup id=\"rdp-ebb-cite_ref-66\" class=\"reference\"><a href=\"#cite_note-66\" rel=\"external_link\">[66]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Robotic_prostheses\">Robotic prostheses<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><div id=\"rdp-ebb-mwe_player_0\" class=\"PopUpMediaTransform\" style=\"width:220px;\" videopayload=\"<div class="mediaContainer" style="width:854px"><video id="mwe_player_1" poster="\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/An-Electrocorticographic-Brain-Interface-in-an-Individual-with-Tetraplegia-pone.0055344.s009.ogv\/854px--An-Electrocorticographic-Brain-Interface-in-an-Individual-with-Tetraplegia-pone.0055344.s009.ogv.jpg" controls="" preload="none" autoplay="" style="width:854px;height:480px" class="kskin" data-durationhint="74.607866666667" data-startoffset="0" data-mwtitle="An-Electrocorticographic-Brain-Interface-in-an-Individual-with-Tetraplegia-pone.0055344.s009.ogv" data-mwprovider="wikimediacommons"><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/1f\/An-Electrocorticographic-Brain-Interface-in-an-Individual-with-Tetraplegia-pone.0055344.s009.ogv\/An-Electrocorticographic-Brain-Interface-in-an-Individual-with-Tetraplegia-pone.0055344.s009.ogv.480p.vp9.webm" type="video\/webm; 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codecs=&quot;vp8, vorbis&quot;" data-title="WebM (360P)" data-shorttitle="WebM 360P" data-transcodekey="360p.webm" data-width="640" data-height="360" data-bandwidth="576960" data-framerate="29.97002997003"\/><\/video><\/div>\"><img alt=\"File:An-Electrocorticographic-Brain-Interface-in-an-Individual-with-Tetraplegia-pone.0055344.s009.ogv\" style=\"width:220px;height:124px\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/An-Electrocorticographic-Brain-Interface-in-an-Individual-with-Tetraplegia-pone.0055344.s009.ogv\/220px--An-Electrocorticographic-Brain-Interface-in-an-Individual-with-Tetraplegia-pone.0055344.s009.ogv.jpg\" \/><a href=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/1\/1f\/An-Electrocorticographic-Brain-Interface-in-an-Individual-with-Tetraplegia-pone.0055344.s009.ogv\" title=\"Play media\" target=\"_blank\" rel=\"external_link\"><span class=\"play-btn-large\"><span class=\"mw-tmh-playtext\">Play media<\/span><\/span><\/a><\/div> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:An-Electrocorticographic-Brain-Interface-in-an-Individual-with-Tetraplegia-pone.0055344.s009.ogv\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Brain control of 3D prosthetic arm movement (hitting targets). This movie was recorded when the participant controlled the 3D movement of a prosthetic arm to hit physical targets in a research lab.<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main articles: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neural_prosthetics\" class=\"mw-redirect\" title=\"Neural prosthetics\" rel=\"external_link\" target=\"_blank\">Neural prosthetics<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Powered_exoskeleton#Current_products\" title=\"Powered exoskeleton\" rel=\"external_link\" target=\"_blank\">Powered exoskeleton \u00a7 Current products<\/a><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotics#Touch\" title=\"Robotics\" rel=\"external_link\" target=\"_blank\">Robotics \u00a7 Touch<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/3-D_printing\" class=\"mw-redirect\" title=\"3-D printing\" rel=\"external_link\" target=\"_blank\">3-D printing<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Open-source_hardware\" title=\"Open-source hardware\" rel=\"external_link\" target=\"_blank\">Open-source hardware<\/a><\/div>\n<p>Robots can be used to generate objective measures of patient's impairment and therapy outcome, assist in diagnosis, customize therapies based on patient's motor abilities, and assure compliance with treatment regimens and maintain patient's records. It is shown in many studies that there is a significant improvement in upper limb motor function after stroke using robotics for upper limb rehabilitation.<sup id=\"rdp-ebb-cite_ref-67\" class=\"reference\"><a href=\"#cite_note-67\" rel=\"external_link\">[67]<\/a><\/sup>\nIn order for a robotic prosthetic limb to work, it must have several components to integrate it into the body's function: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biosensors\" class=\"mw-redirect\" title=\"Biosensors\" rel=\"external_link\" target=\"_blank\">Biosensors<\/a> detect signals from the user's nervous or muscular systems. It then relays this information to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Controller_(computing)\" title=\"Controller (computing)\" rel=\"external_link\" target=\"_blank\">controller<\/a> located inside the device, and processes feedback from the limb and actuator, e.g., position or force, and sends it to the controller. Examples include surface electrodes that detect electrical activity on the skin, needle electrodes implanted in muscle, or solid-state electrode arrays with nerves growing through them. One type of these biosensors are employed in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myoelectric_prosthesis\" class=\"mw-redirect\" title=\"Myoelectric prosthesis\" rel=\"external_link\" target=\"_blank\">myoelectric prostheses<\/a>.\n<\/p><p>A device known as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Controller_(computing)\" title=\"Controller (computing)\" rel=\"external_link\" target=\"_blank\">controller<\/a> is connected to the user's nerve and muscular systems and the device itself. It sends intention commands from the user to the actuators of the device and interprets feedback from the mechanical and biosensors to the user. The controller is also responsible for the monitoring and control of the movements of the device.\n<\/p><p>An <a href=\"https:\/\/en.wikipedia.org\/wiki\/Actuator\" title=\"Actuator\" rel=\"external_link\" target=\"_blank\">actuator<\/a> mimics the actions of a muscle in producing force and movement. Examples include a motor that aids or replaces original muscle tissue.\n<\/p><p>Targeted muscle reinnervation (TMR) is a technique in which <a href=\"https:\/\/en.wikipedia.org\/wiki\/Motor_nerve\" title=\"Motor nerve\" rel=\"external_link\" target=\"_blank\">motor nerves<\/a>, which previously controlled <a href=\"https:\/\/en.wikipedia.org\/wiki\/Muscle\" title=\"Muscle\" rel=\"external_link\" target=\"_blank\">muscles<\/a> on an amputated limb, are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgically<\/a> rerouted such that they reinnervate a small region of a large, intact muscle, such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pectoralis_major\" title=\"Pectoralis major\" rel=\"external_link\" target=\"_blank\">pectoralis major<\/a>. As a result, when a patient thinks about moving the thumb of his missing hand, a small area of muscle on his chest will contract instead. By placing sensors over the reinnervated muscle, these contractions can be made to control the movement of an appropriate part of the robotic prosthesis.<sup id=\"rdp-ebb-cite_ref-six_68-0\" class=\"reference\"><a href=\"#cite_note-six-68\" rel=\"external_link\">[68]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-69\" class=\"reference\"><a href=\"#cite_note-69\" rel=\"external_link\">[69]<\/a><\/sup>\n<\/p><p>A variant of this technique is called targeted sensory reinnervation (TSR). This procedure is similar to TMR, except that <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sensory_nerve\" title=\"Sensory nerve\" rel=\"external_link\" target=\"_blank\">sensory nerves<\/a> are surgically rerouted to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin\" title=\"Skin\" rel=\"external_link\" target=\"_blank\">skin<\/a> on the chest, rather than motor nerves rerouted to muscle. Recently, robotic limbs have improved in their ability to take signals from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_brain\" title=\"Human brain\" rel=\"external_link\" target=\"_blank\">the human brain<\/a> and translate those signals into motion in the artificial limb. <a href=\"https:\/\/en.wikipedia.org\/wiki\/DARPA\" title=\"DARPA\" rel=\"external_link\" target=\"_blank\">DARPA<\/a>, the Pentagon's research division, is working to make even more advancements in this area. Their desire is to create an artificial limb that ties directly into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nervous_system\" title=\"Nervous system\" rel=\"external_link\" target=\"_blank\">nervous system<\/a>.<sup id=\"rdp-ebb-cite_ref-seven_70-0\" class=\"reference\"><a href=\"#cite_note-seven-70\" rel=\"external_link\">[70]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Robotic_arms\">Robotic arms<\/span><\/h4>\n<p>Advancements in the processors used in myoelectric arms have allowed developers to make gains in fine-tuned control of the prosthetic. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boston_Digital_Arm\" class=\"mw-redirect\" title=\"Boston Digital Arm\" rel=\"external_link\" target=\"_blank\">Boston Digital Arm<\/a> is a recent artificial limb that has taken advantage of these more advanced processors. The arm allows movement in five axes and allows the arm to be programmed for a more customized feel. Recently the , invented in Edinburgh, Scotland, by <a href=\"https:\/\/en.wikipedia.org\/wiki\/David_Gow\" title=\"David Gow\" rel=\"external_link\" target=\"_blank\">David Gow<\/a> has become the first commercially available hand prosthesis with five individually powered digits. The hand also possesses a manually rotatable thumb which is operated passively by the user and allows the hand to grip in precision, power, and key grip modes.\n<\/p><p>Another neural prosthetic is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Johns_Hopkins_University_Applied_Physics_Laboratory\" class=\"mw-redirect\" title=\"Johns Hopkins University Applied Physics Laboratory\" rel=\"external_link\" target=\"_blank\">Johns Hopkins University Applied Physics Laboratory<\/a> . Besides the Proto 1, the university also finished the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proto_2\" title=\"Proto 2\" rel=\"external_link\" target=\"_blank\">Proto 2<\/a> in 2010.<sup id=\"rdp-ebb-cite_ref-71\" class=\"reference\"><a href=\"#cite_note-71\" rel=\"external_link\">[71]<\/a><\/sup> Early in 2013, Max Ortiz Catalan and Rickard Br\u00e5nemark of the Chalmers University of Technology, and Sahlgrenska University Hospital in Sweden, succeeded in making the first robotic arm which is mind-controlled and can be permanently attached to the body (using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseointegration\" title=\"Osseointegration\" rel=\"external_link\" target=\"_blank\">osseointegration<\/a>).<sup id=\"rdp-ebb-cite_ref-72\" class=\"reference\"><a href=\"#cite_note-72\" rel=\"external_link\">[72]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-73\" class=\"reference\"><a href=\"#cite_note-73\" rel=\"external_link\">[73]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-74\" class=\"reference\"><a href=\"#cite_note-74\" rel=\"external_link\">[74]<\/a><\/sup>\n<\/p><p>An approach that is very useful is called arm rotation which is common for unilateral amputees which is an amputation that affects only one side of the body; and also essential for bilateral amputees, a person who is missing or has had amputated either both arms or legs, to carry out activities of daily living. This involves inserting a small permanent magnet into the distal end of the residual bone of subjects with upper limb amputations. When a subject rotates the residual arm, the magnet will rotate with the residual bone, causing a change in magnetic field distribution.<sup id=\"rdp-ebb-cite_ref-75\" class=\"reference\"><a href=\"#cite_note-75\" rel=\"external_link\">[75]<\/a><\/sup> EEG (electroencephalogram) signals, detected using small flat metal discs attached to the scalp, essentially decoding human brain activity used for physical movement, is used to control the robotic limbs. This allows the user to control the part directly.<sup id=\"rdp-ebb-cite_ref-76\" class=\"reference\"><a href=\"#cite_note-76\" rel=\"external_link\">[76]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Robotic_legs\">Robotic legs<\/span><\/h4>\n<p>The research of Robotic legs has made some advancement over time, allowing exact movement and control. A company in Switzerland called Ossur, has created a robotic leg that moves through algorithms and sensors that automatically adjust the angle of the foot during different points in its wearer's stride. Also there are brain-controlled bionic legs that allow an individual to move his limbs with a wireless transmitter. <sup id=\"rdp-ebb-cite_ref-77\" class=\"reference\"><a href=\"#cite_note-77\" rel=\"external_link\">[77]<\/a><\/sup>\n<\/p>\n<h5><span class=\"mw-headline\" id=\"Prosthesis_design\">Prosthesis design<\/span><\/h5>\n<p>The main goal of a robotic prosthesis is to provide active actuation during gait to improve the biomechanics of gait, including, among other things, stability, symmetry, or energy expenditure for amputees. There are several powered prosthetic legs currently on the market, including fully powered legs, in which actuators directly drive the joints, and semi-active legs, which use small amounts of energy and a small actuator to change the mechanical properties of the leg but do not inject net positive energy into gait. Specific examples include The emPOWER from BionX, the Proprio Foot from Ossur, and the Elan Foot from Endolite.<sup id=\"rdp-ebb-cite_ref-78\" class=\"reference\"><a href=\"#cite_note-78\" rel=\"external_link\">[78]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-79\" class=\"reference\"><a href=\"#cite_note-79\" rel=\"external_link\">[79]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-80\" class=\"reference\"><a href=\"#cite_note-80\" rel=\"external_link\">[80]<\/a><\/sup> Various research groups have also experimented with robotic legs over the last decade.<sup id=\"rdp-ebb-cite_ref-81\" class=\"reference\"><a href=\"#cite_note-81\" rel=\"external_link\">[81]<\/a><\/sup> Central issues being researched include designing the behavior of the device during stance and swing phases, recognizing the current ambulation task, and various mechanical design problems such as robustness, weight, battery-life\/efficiency, and noise-level. However, scientists from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stanford_University\" title=\"Stanford University\" rel=\"external_link\" target=\"_blank\">Stanford University<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Seoul_National_University_of_Science_and_Technology\" title=\"Seoul National University of Science and Technology\" rel=\"external_link\" target=\"_blank\">Seoul National University<\/a> has developed artificial nerves system that will help prosthetic limbs feel.<sup id=\"rdp-ebb-cite_ref-82\" class=\"reference\"><a href=\"#cite_note-82\" rel=\"external_link\">[82]<\/a><\/sup> This synthetic nerve system enables prosthetic limbs sense <a href=\"https:\/\/en.wikipedia.org\/wiki\/Braille\" title=\"Braille\" rel=\"external_link\" target=\"_blank\">braille<\/a>, feel the sense of touch and respond to the environment.<sup id=\"rdp-ebb-cite_ref-83\" class=\"reference\"><a href=\"#cite_note-83\" rel=\"external_link\">[83]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-84\" class=\"reference\"><a href=\"#cite_note-84\" rel=\"external_link\">[84]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Attachment_to_the_body\">Attachment to the body<\/span><\/h2>\n<p>Most prostheses can be attached to the exterior of the body, in a non-permanent way. Some others however can be attached in a permanent way. One such example are exoprostheses (see below).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Direct_bone_attachment_and_osseointegration\">Direct bone attachment and osseointegration<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseointegration\" title=\"Osseointegration\" rel=\"external_link\" target=\"_blank\">Osseointegration<\/a><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseointegration\" title=\"Osseointegration\" rel=\"external_link\" target=\"_blank\">Osseointegration<\/a> is a method of attaching the artificial limb to the body. This method is also sometimes referred to as (attaching an artificial limb to the bone), or endo-exoprosthesis.\n<\/p><p>The stump and socket method can cause significant pain in the amputee, which is why the direct bone attachment has been explored extensively. The method works by inserting a titanium bolt into the bone at the end of the stump. After several months the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseointegration\" title=\"Osseointegration\" rel=\"external_link\" target=\"_blank\">bone attaches itself<\/a> to the titanium bolt and an abutment is attached to the titanium bolt. The abutment extends out of the stump and the (removable) artificial limb is then attached to the abutment. Some of the benefits of this method include the following:\n<\/p>\n<ul><li>Better muscle control of the prosthetic.<\/li>\n<li>The ability to wear the prosthetic for an extended period of time; with the stump and socket method this is not possible.<\/li>\n<li>The ability for transfemoral amputees to drive a car.<\/li><\/ul>\n<p>The main disadvantage of this method is that amputees with the direct bone attachment cannot have large impacts on the limb, such as those experienced during jogging, because of the potential for the bone to break.<sup id=\"rdp-ebb-cite_ref-four_5-2\" class=\"reference\"><a href=\"#cite_note-four-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Cosmesis\">Cosmesis<\/span><\/h2>\n<p>Cosmetic prosthesis has long been used to disguise injuries and disfigurements. With advances in modern technology, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cosmesis\" title=\"Cosmesis\" rel=\"external_link\" target=\"_blank\">cosmesis<\/a>, the creation of lifelike limbs made from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/PVC\" class=\"mw-redirect\" title=\"PVC\" rel=\"external_link\" target=\"_blank\">PVC<\/a> has been made possible. Such prosthetics, including artificial hands, can now be designed to simulate the appearance of real hands, complete with freckles, veins, hair, fingerprints and even tattoos.\nCustom-made cosmeses are generally more expensive (costing thousands of U.S. dollars, depending on the level of detail), while standard cosmeses come premade in a variety of sizes, although they are often not as realistic as their custom-made counterparts. Another option is the custom-made silicone cover, which can be made to match a person's skin tone but not details such as freckles or wrinkles. Cosmeses are attached to the body in any number of ways, using an adhesive, suction, form-fitting, stretchable skin, or a skin sleeve.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Cognition\">Cognition<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroprosthetics\" title=\"Neuroprosthetics\" rel=\"external_link\" target=\"_blank\">Neuroprosthetics<\/a><\/div>\n<p>Unlike neuromotor prostheses, neurocognitive prostheses would sense or modulate neural function in order to physically reconstitute or augment cognitive processes such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Executive_function\" class=\"mw-redirect\" title=\"Executive function\" rel=\"external_link\" target=\"_blank\">executive function<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Attention\" title=\"Attention\" rel=\"external_link\" target=\"_blank\">attention<\/a>, language, and memory. No neurocognitive prostheses are currently available but the development of implantable neurocognitive brain-computer interfaces has been proposed to help treat conditions such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Traumatic_brain_injury\" title=\"Traumatic brain injury\" rel=\"external_link\" target=\"_blank\">traumatic brain injury<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_palsy\" title=\"Cerebral palsy\" rel=\"external_link\" target=\"_blank\">cerebral palsy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autism\" title=\"Autism\" rel=\"external_link\" target=\"_blank\">autism<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alzheimer%27s_disease\" title=\"Alzheimer's disease\" rel=\"external_link\" target=\"_blank\">Alzheimer's disease<\/a>.<sup id=\"rdp-ebb-cite_ref-Serruya_MD,_Kahana_MJ_2008_149_85-0\" class=\"reference\"><a href=\"#cite_note-Serruya_MD,_Kahana_MJ_2008_149-85\" rel=\"external_link\">[85]<\/a><\/sup>\nThe recent field of <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/cat.inist.fr\/?aModele=afficheN&cpsidt=15764275\" target=\"_blank\">Assistive Technology for Cognition<\/a> concerns the development of technologies to augment human cognition. Scheduling devices such as <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090413224808\/http:\/\/www.neuropage.nhs.uk\/default.asp?id=\" target=\"_blank\">Neuropage<\/a> remind users with memory impairments when to perform certain activities, such as visiting the doctor. Micro-prompting devices such as PEAT, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ablelinktech.com\/\" target=\"_blank\">AbleLink<\/a> and <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/stir.academia.edu\/AlexGillespie\/Papers\/97289\/Simulating-naturalistic-instruction--The-case-for-a-voice-mediated-interface-for-assistive-technology-for-cognition\" target=\"_blank\">Guide<\/a> have been used to aid users with memory and executive function problems perform <a href=\"https:\/\/en.wikipedia.org\/wiki\/Activities_of_daily_living\" title=\"Activities of daily living\" rel=\"external_link\" target=\"_blank\">activities of daily living<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Prosthetic_enhancement\">Prosthetic enhancement<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Powered_exoskeleton#Research\" title=\"Powered exoskeleton\" rel=\"external_link\" target=\"_blank\">Powered exoskeleton \u00a7 Research<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Flickr_-_The_U.S._Army_-_U.S._Army_World_Class_Athlete_Program_Paralympic.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8c\/Flickr_-_The_U.S._Army_-_U.S._Army_World_Class_Athlete_Program_Paralympic.jpg\/200px-Flickr_-_The_U.S._Army_-_U.S._Army_World_Class_Athlete_Program_Paralympic.jpg\" width=\"200\" height=\"301\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Flickr_-_The_U.S._Army_-_U.S._Army_World_Class_Athlete_Program_Paralympic.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Sgt. Jerrod Fields, a U.S. Army World Class Athlete Program Paralympic sprinter hopeful, works out at the U.S. Olympic Training Center in Chula Vista, Calif. A below-the-knee amputee, Fields won a gold medal in the 100 meters with a time of 12.15 seconds at the Endeavor Games in Edmond, Okla., on June 13, 2009<\/div><\/div><\/div>\n<p>In addition to the standard artificial limb for everyday use, many amputees or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital\" class=\"mw-redirect\" title=\"Congenital\" rel=\"external_link\" target=\"_blank\">congenital<\/a> patients have special limbs and devices to aid in the participation of sports and recreational activities.\n<\/p><p>Within science fiction, and, more recently, within the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scientific_community\" title=\"Scientific community\" rel=\"external_link\" target=\"_blank\">scientific community<\/a>, there has been consideration given to using advanced prostheses to replace healthy body parts with artificial mechanisms and systems to improve function. The morality and desirability of such technologies are being debated by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transhumanists\" class=\"mw-redirect\" title=\"Transhumanists\" rel=\"external_link\" target=\"_blank\">transhumanists<\/a>, other ethicists, and others in general.<sup id=\"rdp-ebb-cite_ref-86\" class=\"reference\"><a href=\"#cite_note-86\" rel=\"external_link\">[86]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-87\" class=\"reference\"><a href=\"#cite_note-87\" rel=\"external_link\">[87]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-88\" class=\"reference\"><a href=\"#cite_note-88\" rel=\"external_link\">[88]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-89\" class=\"reference\"><a href=\"#cite_note-89\" rel=\"external_link\">[89]<\/a><\/sup><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Words_to_watch#Unsupported_attributions\" title=\"Wikipedia:Manual of Style\/Words to watch\" rel=\"external_link\" target=\"_blank\"><span title=\"The material near this tag may use weasel words or too-vague attribution. (March 2014)\">by whom?<\/span><\/a><\/i>]<\/sup> Body parts such as legs, arms, hands, feet, and others can be replaced.\n<\/p><p>The first experiment with a healthy individual appears to have been that by the British scientist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kevin_Warwick\" title=\"Kevin Warwick\" rel=\"external_link\" target=\"_blank\">Kevin Warwick<\/a>. In 2002, an implant was interfaced directly into Warwick's nervous system. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrode_array\" title=\"Electrode array\" rel=\"external_link\" target=\"_blank\">electrode array<\/a>, which contained around a hundred <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrode\" title=\"Electrode\" rel=\"external_link\" target=\"_blank\">electrodes<\/a>, was placed in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Median_nerve\" title=\"Median nerve\" rel=\"external_link\" target=\"_blank\">median nerve<\/a>. The signals produced were detailed enough that a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robot_arm\" class=\"mw-redirect\" title=\"Robot arm\" rel=\"external_link\" target=\"_blank\">robot arm<\/a> was able to mimic the actions of Warwick's own arm and provide a form of touch feedback again via the implant.<sup id=\"rdp-ebb-cite_ref-Warwick,_K_1373_90-0\" class=\"reference\"><a href=\"#cite_note-Warwick,_K_1373-90\" rel=\"external_link\">[90]<\/a><\/sup>\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/DEKA_(company)\" title=\"DEKA (company)\" rel=\"external_link\" target=\"_blank\">DEKA<\/a> company of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dean_Kamen\" title=\"Dean Kamen\" rel=\"external_link\" target=\"_blank\">Dean Kamen<\/a> developed the \"Luke arm\", an advanced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroprosthetics#Motor_prosthetics_for_conscious_control_of_movement\" title=\"Neuroprosthetics\" rel=\"external_link\" target=\"_blank\">nerve-controlled prosthetic<\/a>. Clinical trials began in 2008,<sup id=\"rdp-ebb-cite_ref-spectrum.ieee.org_91-0\" class=\"reference\"><a href=\"#cite_note-spectrum.ieee.org-91\" rel=\"external_link\">[91]<\/a><\/sup> with FDA approval in 2014 and commercial manufacturing by Universal Instruments Corporation expected in 2017. The price offered at retail by Mobius Bionics is expected to be around $100,000.<sup id=\"rdp-ebb-cite_ref-92\" class=\"reference\"><a href=\"#cite_note-92\" rel=\"external_link\">[92]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Oscar_Pistorius\">Oscar Pistorius<\/span><\/h3>\n<p>In early 2008, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oscar_Pistorius\" title=\"Oscar Pistorius\" rel=\"external_link\" target=\"_blank\">Oscar Pistorius<\/a>, the \"Blade Runner\" of South Africa, was briefly ruled ineligible to compete in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/2008_Summer_Olympics\" title=\"2008 Summer Olympics\" rel=\"external_link\" target=\"_blank\">2008 Summer Olympics<\/a> because his transtibial prosthesis limbs were said to give him an unfair advantage over runners who had ankles. One researcher found that his limbs used twenty-five percent less energy than those of an able-bodied runner moving at the same speed. This ruling was overturned on appeal, with the appellate court stating that the overall set of advantages and disadvantages of Pistorius' limbs had not been considered.\n<\/p><p>Pistorius did not qualify for the South African team for the Olympics, but went on to sweep the <a href=\"https:\/\/en.wikipedia.org\/wiki\/2008_Summer_Paralympics\" title=\"2008 Summer Paralympics\" rel=\"external_link\" target=\"_blank\">2008 Summer Paralympics<\/a>, and has been ruled eligible to qualify for any future Olympics.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (May 2017)\">citation needed<\/span><\/a><\/i>]<\/sup> He qualified for the 2011 World Championship in South Korea and reached the semifinal where he ended last timewise, he was 14th in the first round, his personal best at 400m would have given him 5th place in the finals. At the <a href=\"https:\/\/en.wikipedia.org\/wiki\/2012_Summer_Olympics\" title=\"2012 Summer Olympics\" rel=\"external_link\" target=\"_blank\">2012 Summer Olympics<\/a> in London, Pistorius became the first amputee runner to compete at an Olympic Games.<sup id=\"rdp-ebb-cite_ref-93\" class=\"reference\"><a href=\"#cite_note-93\" rel=\"external_link\">[93]<\/a><\/sup> He ran in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Athletics_at_the_2012_Summer_Olympics_%E2%80%93_Men%27s_400_metres\" title=\"Athletics at the 2012 Summer Olympics \u2013 Men's 400 metres\" rel=\"external_link\" target=\"_blank\">400 metres race<\/a> semifinals,<sup id=\"rdp-ebb-cite_ref-BBC_20120804_94-0\" class=\"reference\"><a href=\"#cite_note-BBC_20120804-94\" rel=\"external_link\">[94]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-95\" class=\"reference\"><a href=\"#cite_note-95\" rel=\"external_link\">[95]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-96\" class=\"reference\"><a href=\"#cite_note-96\" rel=\"external_link\">[96]<\/a><\/sup> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Athletics_at_the_2012_Summer_Olympics_%E2%80%93_Men%27s_4_%C3%97_400_metres_relay\" title=\"Athletics at the 2012 Summer Olympics \u2013 Men's 4 \u00d7 400 metres relay\" rel=\"external_link\" target=\"_blank\">4 \u00d7 400 metres relay race<\/a> finals.<sup id=\"rdp-ebb-cite_ref-97\" class=\"reference\"><a href=\"#cite_note-97\" rel=\"external_link\">[97]<\/a><\/sup> He also competed in 5 events in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/2012_Summer_Paralympics\" title=\"2012 Summer Paralympics\" rel=\"external_link\" target=\"_blank\">2012 Summer Paralympics<\/a> in London.<sup id=\"rdp-ebb-cite_ref-98\" class=\"reference\"><a href=\"#cite_note-98\" rel=\"external_link\">[98]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Design_considerations\">Design considerations<\/span><\/h2>\n<p>There are multiple factors to consider when designing a transtibial prosthesis. Manufacturers must make choices about their priorities regarding these factors.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Performance\">Performance<\/span><\/h3>\n<p>Nonetheless, there are certain elements of socket and foot mechanics that are invaluable for the athlete, and these are the focus of today's high-tech prosthetics companies:\n<\/p>\n<ul><li>Fit \u2013 athletic\/active amputees, or those with bony residua, may require a carefully detailed socket fit; less-active patients may be comfortable with a 'total contact' fit and gel liner<\/li>\n<li>Energy storage and return \u2013 storage of energy acquired through ground contact and utilization of that stored energy for propulsion<\/li>\n<li>Energy absorption \u2013 minimizing the effect of high impact on the musculoskeletal system<\/li>\n<li>Ground compliance \u2013 stability independent of terrain type and angle<\/li>\n<li>Rotation \u2013 ease of changing direction<\/li>\n<li>Weight \u2013 maximizing comfort, balance and speed<\/li>\n<li>Suspension \u2013 how the socket will join and fit to the limb<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Other\">Other<\/span><\/h3>\n<p>The buyer is also concerned with numerous other factors:\n<\/p>\n<ul><li>Cosmetics<\/li>\n<li>Cost<\/li>\n<li>Ease of use<\/li>\n<li>Size availability<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Cost_and_source_freedom\">Cost and source freedom<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"High-cost\">High-cost<\/span><\/h3>\n<p>In the USA a typical prosthetic limb costs anywhere between $15,000 and $90,000, depending on the type of limb desired by the patient. With medical insurance, a patient will typically pay 10%\u201350% of the total cost of a prosthetic limb, while the insurance company will cover the rest of the cost. The percent that the patient pays varies on the type of insurance plan, as well as the limb requested by the patient.<sup id=\"rdp-ebb-cite_ref-Cost_of_a_Prosthetic_Limb_99-0\" class=\"reference\"><a href=\"#cite_note-Cost_of_a_Prosthetic_Limb-99\" rel=\"external_link\">[99]<\/a><\/sup> In the United Kingdom, much of Europe, Australia and New Zealand the entire cost of prosthetic limbs is met by state funding or statutory insurance. For example, in Australia prostheses are fully funded by state schemes in the case of amputation due to disease, and by workers compensation or traffic injury insurance in the case of most traumatic amputations.<sup id=\"rdp-ebb-cite_ref-100\" class=\"reference\"><a href=\"#cite_note-100\" rel=\"external_link\">[100]<\/a><\/sup> The <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Disability_Insurance_Scheme\" title=\"National Disability Insurance Scheme\" rel=\"external_link\" target=\"_blank\">National Disability Insurance Scheme<\/a>, which is being rolled out nationally between 2017 and 2020 also pays for prostheses.\n<\/p><p>Transradial (below the elbow amputation) and transtibial prostheses (below the knee amputation) typically cost between US <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_dollar\" title=\"United States dollar\" rel=\"external_link\" target=\"_blank\">$<\/a>6,000 and $8,000, while transfemoral (above the knee amputation) and transhumeral prosthetics (above the elbow amputation) cost approximately twice as much with a range of $10,000 to $15,000 and can sometimes reach costs of $35,000. The cost of an artificial limb often recurs, while a limb typically needs to be replaced every 3\u20134 years due to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wear_and_tear\" title=\"Wear and tear\" rel=\"external_link\" target=\"_blank\">wear and tear<\/a> of everyday use. In addition, if the socket has fit issues, the socket must be replaced within several months from the onset of pain. If height is an issue, components such as pylons can be changed.<sup id=\"rdp-ebb-cite_ref-eight_101-0\" class=\"reference\"><a href=\"#cite_note-eight-101\" rel=\"external_link\">[101]<\/a><\/sup>\n<\/p><p>Not only does the patient need to pay for their multiple prosthetic limbs, but they also need to pay for physical and occupational therapy that come along with adapting to living with an artificial limb. Unlike the reoccurring cost of the prosthetic limbs, the patient will typically only pay the $2000 to $5000 for therapy during the first year or two of living as an amputee. Once the patient is strong and comfortable with their new limb, they will not be required to go to therapy anymore. Throughout one's life, it is projected that a typical amputee will go through $1.4 million worth of treatment, including surgeries, prosthetics, as well as therapies.<sup id=\"rdp-ebb-cite_ref-Cost_of_a_Prosthetic_Limb_99-1\" class=\"reference\"><a href=\"#cite_note-Cost_of_a_Prosthetic_Limb-99\" rel=\"external_link\">[99]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Low-cost\">Low-cost<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/3D_printing\" title=\"3D printing\" rel=\"external_link\" target=\"_blank\">3D printing<\/a><\/div>\n<p>Low-cost above-knee prostheses often provide only basic structural support with limited function. This function is often achieved with crude, non-articulating, unstable, or manually locking knee joints. A limited number of organizations, such as the International Committee of the Red Cross (ICRC), create devices for developing countries. Their device which is manufactured by CR Equipments is a single-axis, manually operated locking polymer prosthetic knee joint.<sup id=\"rdp-ebb-cite_ref-102\" class=\"reference\"><a href=\"#cite_note-102\" rel=\"external_link\">[102]<\/a><\/sup>\n<\/p><p>Table. List of knee joint technologies based on the literature review.<sup id=\"rdp-ebb-cite_ref-ReferenceB_55-1\" class=\"reference\"><a href=\"#cite_note-ReferenceB-55\" rel=\"external_link\">[55]<\/a><\/sup>\n<\/p>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Name of technology (country of origin)<\/th>\n<th>Brief description<\/th>\n<th>Highest level of\n<p>evidence\n<\/p>\n<\/th><\/tr>\n<tr>\n<td>ICRC knee (Switzerland)<\/td>\n<td>Single-axis with manual lock<\/td>\n<td>Independent field\n<\/td><\/tr>\n<tr>\n<td>ATLAS knee (UK)<\/td>\n<td>Weight-activated friction<\/td>\n<td>Independent field\n<\/td><\/tr>\n<tr>\n<td>POF\/OTRC knee (US)<\/td>\n<td>Single-axis with ext. assist<\/td>\n<td>Field\n<\/td><\/tr>\n<tr>\n<td>DAV\/Seattle knee (US)<\/td>\n<td>Compliant polycentric<\/td>\n<td>Field\n<\/td><\/tr>\n<tr>\n<td>LIMBS International M1 knee (US)<\/td>\n<td>Four-bar<\/td>\n<td>Field\n<\/td><\/tr>\n<tr>\n<td>JaipurKnee (India)<\/td>\n<td>Four-bar<\/td>\n<td>Field\n<\/td><\/tr>\n<tr>\n<td>LCKnee (Canada)<\/td>\n<td>Single-axis with automatic lock<\/td>\n<td>Field\n<\/td><\/tr>\n<tr>\n<td>None provided (Nepal)<\/td>\n<td>Single-axis<\/td>\n<td>Field\n<\/td><\/tr>\n<tr>\n<td>None provided (New Zealand)<\/td>\n<td>Roto-molded single-axis<\/td>\n<td>Field\n<\/td><\/tr>\n<tr>\n<td>None provided (India)<\/td>\n<td>Six-bar with squatting<\/td>\n<td>Technical development\n<\/td><\/tr>\n<tr>\n<td>Friction knee (US)<\/td>\n<td>Weight-activated friction<\/td>\n<td>Technical development\n<\/td><\/tr>\n<tr>\n<td>Wedgelock knee (Australia)<\/td>\n<td>Weight-activated friction<\/td>\n<td>Technical development\n<\/td><\/tr>\n<tr>\n<td>SATHI friction knee (India)<\/td>\n<td>Weight-activated friction<\/td>\n<td>Limited data available\n<\/td><\/tr><\/tbody><\/table>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Low_cost_prosthetic_limbs.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/18\/Low_cost_prosthetic_limbs.jpg\/220px-Low_cost_prosthetic_limbs.jpg\" width=\"220\" height=\"175\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Low_cost_prosthetic_limbs.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Low-cost above-knee prosthetic limbs: ICRC Knee (left) and LC Knee (right)<\/div><\/div><\/div>\n<p>A plan for a low-cost artificial leg, designed by S\u00e9bastien Dubois, was featured at the 2007 International Design Exhibition and award show in Copenhagen, Denmark, where it won the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Index:_Award\" class=\"mw-redirect\" title=\"Index: Award\" rel=\"external_link\" target=\"_blank\">Index: Award<\/a>. It would be able to create an energy-return prosthetic leg for US <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_dollar\" title=\"United States dollar\" rel=\"external_link\" target=\"_blank\">$<\/a>8.00, composed primarily of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiberglass\" title=\"Fiberglass\" rel=\"external_link\" target=\"_blank\">fiberglass<\/a>.<sup id=\"rdp-ebb-cite_ref-103\" class=\"reference\"><a href=\"#cite_note-103\" rel=\"external_link\">[103]<\/a><\/sup>\n<\/p><p>Prior to the 1980s, foot prostheses merely restored basic walking capabilities. These early devices can be characterized by a simple artificial attachment connecting one's residual limb to the ground.\n<\/p><p>The introduction of the () in 1981 revolutionized the field, bringing the concept of an (ESPF) to the fore. Other companies soon followed suit, and before long, there were multiple models of energy storing prostheses on the market. Each model utilized some variation of a compressible heel. The heel is compressed during initial ground contact, storing energy which is then returned during the latter phase of ground contact to help propel the body forward.\n<\/p><p>Since then, the foot prosthetics industry has been dominated by steady, small improvements in performance, comfort, and marketability.\n<\/p><p>With <a href=\"https:\/\/en.wikipedia.org\/wiki\/3D_printing\" title=\"3D printing\" rel=\"external_link\" target=\"_blank\">3D printers<\/a>, it is possible to manufacture a single product without having to have metal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molding_(process)\" title=\"Molding (process)\" rel=\"external_link\" target=\"_blank\">molds<\/a>, so the costs can be drastically reduced.<sup id=\"rdp-ebb-cite_ref-104\" class=\"reference\"><a href=\"#cite_note-104\" rel=\"external_link\">[104]<\/a><\/sup>\n<\/p><p><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Jaipur_leg\" title=\"Jaipur leg\" rel=\"external_link\" target=\"_blank\">Jaipur Foot<\/a><\/i>, an artificial limb from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jaipur\" title=\"Jaipur\" rel=\"external_link\" target=\"_blank\">Jaipur<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/India\" title=\"India\" rel=\"external_link\" target=\"_blank\">India<\/a>, costs about US$40.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Open-source_robotic_prothesis\">Open-source robotic prothesis<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Open-source_hardware\" title=\"Open-source hardware\" rel=\"external_link\" target=\"_blank\">Open-source hardware<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Modular_design\" title=\"Modular design\" rel=\"external_link\" target=\"_blank\">Modular design<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/3D_printing\" title=\"3D printing\" rel=\"external_link\" target=\"_blank\">3D printing<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thingiverse\" title=\"Thingiverse\" rel=\"external_link\" target=\"_blank\">Thingiverse<\/a><\/div>\n<p>There is currently an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Open-design_movement\" title=\"Open-design movement\" rel=\"external_link\" target=\"_blank\">open-design<\/a> Prosthetics forum known as the \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Open_Prosthetics_Project\" title=\"Open Prosthetics Project\" rel=\"external_link\" target=\"_blank\">Open Prosthetics Project<\/a>\". The group employs collaborators and volunteers to advance Prosthetics technology while attempting to lower the costs of these necessary devices.<sup id=\"rdp-ebb-cite_ref-105\" class=\"reference\"><a href=\"#cite_note-105\" rel=\"external_link\">[105]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Open_Bionics\" title=\"Open Bionics\" rel=\"external_link\" target=\"_blank\">Open Bionics<\/a> is a company that is developing open-source robotic prosthetic hands. It uses 3D printing to manufacture the devices and low-cost 3D scanners to fit them, with the aim of lowering the cost of fabricating custom prosthetics. A review study on a wide range of printed prosthetic hands, found that although 3D printing technology holds a promise for individualised prosthesis design, it is not necessarily cheaper when all costs are included. The same study also found that evidence on the functionality, durability and user acceptance of 3D printed hand prostheses is still lacking.<sup id=\"rdp-ebb-cite_ref-Review_3D-printed_hand_prostheses_106-0\" class=\"reference\"><a href=\"#cite_note-Review_3D-printed_hand_prostheses-106\" rel=\"external_link\">[106]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Low-cost_prosthetics_for_children\">Low-cost prosthetics for children<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Open-source_hardware\" title=\"Open-source hardware\" rel=\"external_link\" target=\"_blank\">open-source hardware<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/3D_printing\" title=\"3D printing\" rel=\"external_link\" target=\"_blank\">3D printing<\/a><\/div>\n<p>In the USA an estimate was found of 32,500 children (<21 years) that suffer from major paediatric amputation, with 5,525 new cases each year, of which 3,315 congenital.<sup id=\"rdp-ebb-cite_ref-107\" class=\"reference\"><a href=\"#cite_note-107\" rel=\"external_link\">[107]<\/a><\/sup> Carr et al. (1998) investigated amputations caused by landmines for Afghanistan, Bosnia and Herzegovina, Cambodia and Mozambique among children (<14 years), showing estimates of respectively 4.7, 0.19, 1.11 and 0.67 per 1000 children.<sup id=\"rdp-ebb-cite_ref-108\" class=\"reference\"><a href=\"#cite_note-108\" rel=\"external_link\">[108]<\/a><\/sup> Mohan (1986) indicated in India a total of 424,000 amputees (23,500 annually), of which 10.3% had an onset of disability below the age of 14, amounting to a total of about 43,700 limb deficient children in India alone.<sup id=\"rdp-ebb-cite_ref-109\" class=\"reference\"><a href=\"#cite_note-109\" rel=\"external_link\">[109]<\/a><\/sup>\n<\/p><p>Few low-cost solutions have been created specially for children. Underneath some of them can be found.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Artificial_limbs_for_a_thalidomide_child,_1961-1965._(9660575567).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/Artificial_limbs_for_a_thalidomide_child%2C_1961-1965._%289660575567%29.jpg\/220px-Artificial_limbs_for_a_thalidomide_child%2C_1961-1965._%289660575567%29.jpg\" width=\"220\" height=\"303\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Artificial_limbs_for_a_thalidomide_child,_1961-1965._(9660575567).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Artificial limbs for a juvenile <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thalidomide\" title=\"Thalidomide\" rel=\"external_link\" target=\"_blank\">thalidomide<\/a> survivor 1961\u20131965<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Pole_and_crutch\">Pole and crutch<\/span><\/h3>\n<p>This hand-held pole with leather support band or platform for the limb is one of the simplest and cheapest solutions found. It serves well as a short-term solution, but is prone to rapid contracture formation if the limb is not stretched daily through a series of range-of motion (RoM) sets.<sup id=\"rdp-ebb-cite_ref-ReferenceA_52-1\" class=\"reference\"><a href=\"#cite_note-ReferenceA-52\" rel=\"external_link\">[52]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Bamboo.2C_PVC_or_plaster_limbs\"><\/span><span class=\"mw-headline\" id=\"Bamboo,_PVC_or_plaster_limbs\">Bamboo, PVC or plaster limbs<\/span><\/h3>\n<p>This also fairly simple solution comprises a plaster socket with a bamboo or PVC pipe at the bottom, optionally attached to a prosthetic foot. This solution prevents contractures because the knee is moved through its full RoM. The David Werner Collection, an online database for the assistance of disabled village children, displays manuals of production of these solutions.<sup id=\"rdp-ebb-cite_ref-110\" class=\"reference\"><a href=\"#cite_note-110\" rel=\"external_link\">[110]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Adjustable_bicycle_limb\">Adjustable bicycle limb<\/span><\/h3>\n<p>This solution is built using a bicycle seat post up side down as foot, generating flexibility and (length) adjustability. It is a very cheap solution, using locally available materials.<sup id=\"rdp-ebb-cite_ref-111\" class=\"reference\"><a href=\"#cite_note-111\" rel=\"external_link\">[111]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Sathi_Limb\">Sathi Limb<\/span><\/h3>\n<p>It is an endoskeletal modular lower limb from India, which uses thermoplastic parts. Its main advantages are the small weight and adaptability.<sup id=\"rdp-ebb-cite_ref-ReferenceA_52-2\" class=\"reference\"><a href=\"#cite_note-ReferenceA-52\" rel=\"external_link\">[52]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Monolimb\">Monolimb<\/span><\/h3>\n<p>Monolimbs are non-modular prostheses and thus require more experienced prosthetist for correct fitting, because alignment can barely be changed after production. However, their durability on average is better than low-cost modular solutions.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Cultural_and_social_theory_perspectives\">Cultural and social theory perspectives<\/span><\/h2>\n<p>A number of theorists have explored the meaning and implications of prosthetic extension of the body. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elizabeth_Grosz\" title=\"Elizabeth Grosz\" rel=\"external_link\" target=\"_blank\">Elizabeth Grosz<\/a> writes, \"Creatures use tools, ornaments, and appliances to augment their bodily capacities. Are their bodies lacking something, which they need to replace with artificial or substitute organs?...Or conversely, should prostheses be understood, in terms of aesthetic reorganization and proliferation, as the consequence of an inventiveness that functions beyond and perhaps in defiance of pragmatic need?\"<sup id=\"rdp-ebb-cite_ref-112\" class=\"reference\"><a href=\"#cite_note-112\" rel=\"external_link\">[112]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elaine_Scarry\" title=\"Elaine Scarry\" rel=\"external_link\" target=\"_blank\">Elaine Scarry<\/a> argues that every artifact recreates and extends the body. Chairs supplement the skeleton, tools append the hands, clothing augments the skin.<sup id=\"rdp-ebb-cite_ref-113\" class=\"reference\"><a href=\"#cite_note-113\" rel=\"external_link\">[113]<\/a><\/sup> In Scarry's thinking, \"furniture and houses are neither more nor less interior to the human body than the food it absorbs, nor are they fundamentally different from such sophisticated prosthetics as artificial lungs, eyes and kidneys. The consumption of manufactured things turns the body inside out, opening it up <i>to<\/i> and <i>as<\/i> the culture of objects.\"<sup id=\"rdp-ebb-cite_ref-114\" class=\"reference\"><a href=\"#cite_note-114\" rel=\"external_link\">[114]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mark_Wigley\" title=\"Mark Wigley\" rel=\"external_link\" target=\"_blank\">Mark Wigley<\/a>, a professor of architecture, continues this line of thinking about how architecture supplements our natural capabilities, and argues that \"a blurring of identity is produced by all prostheses.\"<sup id=\"rdp-ebb-cite_ref-115\" class=\"reference\"><a href=\"#cite_note-115\" rel=\"external_link\">[115]<\/a><\/sup> Some of this work relies on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sigmund_Freud\" title=\"Sigmund Freud\" rel=\"external_link\" target=\"_blank\">Freud<\/a>'s earlier characterization of man's relation to objects as one of extension.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bionics\" title=\"Bionics\" rel=\"external_link\" target=\"_blank\">Bionics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Capua_Leg\" title=\"Capua Leg\" rel=\"external_link\" target=\"_blank\">Capua Leg<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hanger,_Inc.\" title=\"Hanger, Inc.\" rel=\"external_link\" target=\"_blank\">Hanger, Inc.<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_arm\" title=\"Robotic arm\" rel=\"external_link\" target=\"_blank\">Robotic arm<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.perseus.tufts.edu\/hopper\/text?doc=Perseus:text:1999.04.0057:entry=pro\/sqesis\" target=\"_blank\"><span lang=\"grc\" title=\"Ancient Greek language text\">\u03c0\u03c1\u03cc\u03c3\u03b8\u03b5\u03c3\u03b9\u03c2<\/span><\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Henry_Liddell\" title=\"Henry Liddell\" rel=\"external_link\" target=\"_blank\">Liddell, Henry George<\/a>; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_Scott_(philologist)\" title=\"Robert Scott (philologist)\" rel=\"external_link\" target=\"_blank\">Scott, Robert<\/a>; <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/A_Greek%E2%80%93English_Lexicon\" title=\"A Greek\u2013English Lexicon\" rel=\"external_link\" target=\"_blank\">A Greek\u2013English Lexicon<\/a><\/i> at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Perseus_Project\" title=\"Perseus Project\" rel=\"external_link\" target=\"_blank\">Perseus Project<\/a><\/span>\n<\/li>\n<li id=\"cite_note-madehow.com-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-madehow.com_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-madehow.com_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.madehow.com\/Volume-1\/Artificial-Limb.html\" target=\"_blank\">\"How artificial limb is made - material, manufacture, making, used, parts, components, structure, procedure\"<\/a>. <i>www.madehow.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.madehow.com&rft.atitle=How+artificial+limb+is+made+-+material%2C+manufacture%2C+making%2C+used%2C+parts%2C+components%2C+structure%2C+procedure&rft_id=http%3A%2F%2Fwww.madehow.com%2FVolume-1%2FArtificial-Limb.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.oandplibrary.org\/alp\/chap04-01.asp\" target=\"_blank\">\"4: Prosthetic Management: Overview, Methods, and Materials | O&P Virtual Library\"<\/a>. <i>www.oandplibrary.org<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.oandplibrary.org&rft.atitle=4%3A+Prosthetic+Management%3A+Overview%2C+Methods%2C+and+Materials+%7C+O%26P+Virtual+Library&rft_id=http%3A%2F%2Fwww.oandplibrary.org%2Falp%2Fchap04-01.asp&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Review_Passive_Prosthetic_Hands-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Review_Passive_Prosthetic_Hands_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Review_Passive_Prosthetic_Hands_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Maat, Bartjan; Smit, Gerwin; Plettenburg, Dick; Breedveld, Paul (1 March 2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5810914\" target=\"_blank\">\"Passive prosthetic hands and tools: A literature review\"<\/a>. <i>Prosthetics and Orthotics International<\/i>. <b>42<\/b> (1): 66\u201374. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F0309364617691622\" target=\"_blank\">10.1177\/0309364617691622<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5810914\" target=\"_blank\">5810914<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28190380\" target=\"_blank\">28190380<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Prosthetics+and+Orthotics+International&rft.atitle=Passive+prosthetic+hands+and+tools%3A+A+literature+review&rft.volume=42&rft.issue=1&rft.pages=66-74&rft.date=2017-03-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5810914&rft_id=info%3Apmid%2F28190380&rft_id=info%3Adoi%2F10.1177%2F0309364617691622&rft.aulast=Maat&rft.aufirst=Bartjan&rft.au=Smit%2C+Gerwin&rft.au=Plettenburg%2C+Dick&rft.au=Breedveld%2C+Paul&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5810914&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-four-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-four_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-four_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-four_5-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.abc.net.au\/science\/slab\/leg\/default.htm\" target=\"_blank\">\"Getting an artificial leg up \u2013 Cathy Johnson\"<\/a>. Australian Broadcasting Corporation<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2010-10-03<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Getting+an+artificial+leg+up+%E2%80%93+Cathy+Johnson&rft.pub=Australian+Broadcasting+Corporation&rft_id=http%3A%2F%2Fwww.abc.net.au%2Fscience%2Fslab%2Fleg%2Fdefault.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Highsmith, M. Jason; Andrews, Casey R.; Millman, Claire; Fuller, Ashley; Kahle, Jason T.; Klenow, Tyler D.; Lewis, Katherine L.; Bradley, Rachel C.; Orriola, John J. (2016-09-16). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5218520\" target=\"_blank\">\"Gait Training Interventions for Lower Extremity Amputees: A Systematic Literature Review\"<\/a>. <i>Technology & Innovation<\/i>. <b>18<\/b> (2\u20133): 99\u2013113. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.21300%2F18.2-3.2016.99\" target=\"_blank\">10.21300\/18.2-3.2016.99<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5218520\" target=\"_blank\">5218520<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28066520\" target=\"_blank\">28066520<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Technology+%26+Innovation&rft.atitle=Gait+Training+Interventions+for+Lower+Extremity+Amputees%3A+A+Systematic+Literature+Review&rft.volume=18&rft.issue=2%E2%80%933&rft.pages=99-113&rft.date=2016-09-16&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5218520&rft_id=info%3Apmid%2F28066520&rft_id=info%3Adoi%2F10.21300%2F18.2-3.2016.99&rft.aulast=Highsmith&rft.aufirst=M.+Jason&rft.au=Andrews%2C+Casey+R.&rft.au=Millman%2C+Claire&rft.au=Fuller%2C+Ashley&rft.au=Kahle%2C+Jason+T.&rft.au=Klenow%2C+Tyler+D.&rft.au=Lewis%2C+Katherine+L.&rft.au=Bradley%2C+Rachel+C.&rft.au=Orriola%2C+John+J.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5218520&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:3-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:3_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_7-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cumming, Jane; Barr, Steve; Howe, Tracey E. (2015-01-25). \"Prosthetic rehabilitation for older dysvascular people following a unilateral transfemoral amputation\". <i>The Cochrane Database of Systematic Reviews<\/i>. <b>1<\/b>: CD005260. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD005260.pub3\" target=\"_blank\">10.1002\/14651858.CD005260.pub3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1469-493X\" target=\"_blank\">1469-493X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25618482\" target=\"_blank\">25618482<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Prosthetic+rehabilitation+for+older+dysvascular+people+following+a+unilateral+transfemoral+amputation&rft.volume=1&rft.pages=CD005260&rft.date=2015-01-25&rft.issn=1469-493X&rft_id=info%3Apmid%2F25618482&rft_id=info%3Adoi%2F10.1002%2F14651858.CD005260.pub3&rft.aulast=Cumming&rft.aufirst=Jane&rft.au=Barr%2C+Steve&rft.au=Howe%2C+Tracey+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><i>Atlas of limb prosthetics : surgical, prosthetic, and rehabilitation principles<\/i>. Bowker, John H., Michael, John W., American Academy of Orthopaedic Surgeons. (2nd ed.). St. Louis: Mosby Year Book. 2002. pp. 389, 413, 429, 479, 501, 535, 885. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0892032754. <a href=\"https:\/\/en.wikipedia.org\/wiki\/OCLC\" title=\"OCLC\" rel=\"external_link\" target=\"_blank\">OCLC<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/oclc\/54693136\" target=\"_blank\">54693136<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Atlas+of+limb+prosthetics+%3A+surgical%2C+prosthetic%2C+and+rehabilitation+principles&rft.place=St.+Louis&rft.pages=389%2C+413%2C+429%2C+479%2C+501%2C+535%2C+885&rft.edition=2nd&rft.pub=Mosby+Year+Book&rft.date=2002&rft_id=info%3Aoclcnum%2F54693136&rft.isbn=978-0892032754&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:4-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:4_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:4_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Bengt., S\u00f6derberg (2001). <i>Partial foot amputations<\/i> (2nd ed.). Sweden: Centre for Partial Foot Amputees. p. 21. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-9163107566. <a href=\"https:\/\/en.wikipedia.org\/wiki\/OCLC\" title=\"OCLC\" rel=\"external_link\" target=\"_blank\">OCLC<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/oclc\/152577368\" target=\"_blank\">152577368<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Partial+foot+amputations&rft.place=Sweden&rft.pages=21&rft.edition=2nd&rft.pub=Centre+for+Partial+Foot+Amputees&rft.date=2001&rft_id=info%3Aoclcnum%2F152577368&rft.isbn=978-9163107566&rft.aulast=Bengt.&rft.aufirst=S%C3%B6derberg&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vanderwerker, Earl E., Jr. (1976). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.acpoc.org\/library\/1976_05_015.asp\" target=\"_blank\">\"A Brief Review of the History of Amputations and Prostheses\"<\/a>. <i>ICIB<\/i>. <b>15<\/b> (5): 15\u201316.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=ICIB&rft.atitle=A+Brief+Review+of+the+History+of+Amputations+and+Prostheses&rft.volume=15&rft.issue=5&rft.pages=15-16&rft.date=1976&rft.au=Vanderwerker%2C+Earl+E.%2C+Jr.&rft_id=http%3A%2F%2Fwww.acpoc.org%2Flibrary%2F1976_05_015.asp&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.uh.edu\/engines\/epi1705.htm\" target=\"_blank\">\"No. 1705: A 3000-Year-Old Toe\"<\/a>. Uh.edu. 2004-08-01<span class=\"reference-accessdate\">. 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Retrieved <span class=\"nowrap\">2018-01-08<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Endolite+USA+-+Lower+Limb+Prosthetics&rft.atitle=Elan+-+Carbon%2C+Feet%2C+Hydraulic+-+Endolite+USA+-+Lower+Limb+Prosthetics&rft_id=http%3A%2F%2Fwww.endolite.com%2Fproducts%2Felan&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-81\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-81\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Windrich, Michael; Grimmer, Martin; Christ, Oliver; Rinderknecht, Stephan; Beckerle, Philipp (2016-12-19). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5249019\" target=\"_blank\">\"Active lower limb prosthetics: a systematic review of design issues and solutions\"<\/a>. <i>BioMedical Engineering OnLine<\/i>. <b>15<\/b> (3): 140. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2Fs12938-016-0284-9\" target=\"_blank\">10.1186\/s12938-016-0284-9<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1475-925X\" target=\"_blank\">1475-925X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5249019\" target=\"_blank\">5249019<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28105948\" target=\"_blank\">28105948<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BioMedical+Engineering+OnLine&rft.atitle=Active+lower+limb+prosthetics%3A+a+systematic+review+of+design+issues+and+solutions&rft.volume=15&rft.issue=3&rft.pages=140&rft.date=2016-12-19&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5249019&rft.issn=1475-925X&rft_id=info%3Apmid%2F28105948&rft_id=info%3Adoi%2F10.1186%2Fs12938-016-0284-9&rft.aulast=Windrich&rft.aufirst=Michael&rft.au=Grimmer%2C+Martin&rft.au=Christ%2C+Oliver&rft.au=Rinderknecht%2C+Stephan&rft.au=Beckerle%2C+Philipp&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5249019&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-82\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-82\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">ENGINEERING.com. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.engineering.com\/DesignerEdge\/DesignerEdgeArticles\/ArticleID\/17049\/Researchers-Create-Artificial-Nerve-System.aspx\" target=\"_blank\">\"Researchers Create Artificial Nerve System\"<\/a>. <i>www.engineering.com<\/i><span class=\"reference-accessdate\">. 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(2011). <i>Beyond Humanity?<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1093%2Facprof%3Aoso%2F9780199587810.001.0001\" target=\"_blank\">10.1093\/acprof:oso\/9780199587810.001.0001<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780199587810.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Beyond+Humanity%3F&rft.date=2011&rft_id=info%3Adoi%2F10.1093%2Facprof%3Aoso%2F9780199587810.001.0001&rft.isbn=9780199587810&rft.aulast=Buchanan&rft.aufirst=Allen+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-89\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-89\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Anomaly, Jonny (2012). \"Beyond Humanity? 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rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14568806\" target=\"_blank\">14568806<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+of+Neurology&rft.atitle=The+Application+of+Implant+Technology+for+Cybernetic+Systems&rft.volume=60&rft.issue=10&rft.pages=1369-1373&rft.date=2003&rft_id=info%3Adoi%2F10.1001%2Farchneur.60.10.1369&rft_id=info%3Apmid%2F14568806&rft.aulast=Warwick&rft.aufirst=K&rft.au=Gasson%2C+M&rft.au=Hutt%2C+B&rft.au=Goodhew%2C+I&rft.au=Kyberd%2C+P&rft.au=Andrews%2C+B&rft.au=Teddy%2C+P&rft.au=Shad%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-spectrum.ieee.org-91\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-spectrum.ieee.org_91-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Adee, Sarah (2008-02-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/spectrum.ieee.org\/biomedical\/bionics\/dean-kamens-luke-arm-prosthesis-readies-for-clinical-trials\" target=\"_blank\">\"Dean Kamen's \"Luke Arm\" Prosthesis Readies for Clinical Trials\"<\/a>. <i>IEEE Spectrum<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=IEEE+Spectrum&rft.atitle=Dean+Kamen%27s+%22Luke+Arm%22+Prosthesis+Readies+for+Clinical+Trials&rft.date=2008-02-01&rft.au=Adee%2C+Sarah&rft_id=http%3A%2F%2Fspectrum.ieee.org%2Fbiomedical%2Fbionics%2Fdean-kamens-luke-arm-prosthesis-readies-for-clinical-trials&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-92\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-92\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.meddeviceonline.com\/doc\/darpa-s-mind-controlled-arm-prosthesis-preps-for-commercial-launch-0001\" target=\"_blank\">https:\/\/www.meddeviceonline.com\/doc\/darpa-s-mind-controlled-arm-prosthesis-preps-for-commercial-launch-0001<\/a><\/span>\n<\/li>\n<li id=\"cite_note-93\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-93\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFRobert_Klemko2012\" class=\"citation\">Robert Klemko (10 August 2012), <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.webcitation.org\/69qCZG7ST?url=http:\/\/www.usatoday.com\/sports\/olympics\/london\/track\/story\/2012-08-10\/4x400-relay-oscar-pistorius-south-afric\/56946372\/1\" target=\"_blank\">\"Oscar Pistorius makes history, leaves without medal\"<\/a>, <i>USA Today<\/i>, archived from <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.usatoday.com\/sports\/olympics\/london\/track\/story\/2012-08-10\/4x400-relay-oscar-pistorius-south-afric\/56946372\/1\" target=\"_blank\">the original<\/a> on 11 August 2012<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=USA+Today&rft.atitle=Oscar+Pistorius+makes+history%2C+leaves+without+medal&rft.date=2012-08-10&rft.au=Robert+Klemko&rft_id=https%3A%2F%2Fwww.usatoday.com%2Fsports%2Folympics%2Flondon%2Ftrack%2Fstory%2F2012-08-10%2F4x400-relay-oscar-pistorius-south-afric%2F56946372%2F1&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-BBC_20120804-94\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-BBC_20120804_94-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.bbc.co.uk\/sport\/0\/olympics\/18911479\" target=\"_blank\"><i>Oscar Pistorius makes Olympic history in 400m at London 2012<\/i><\/a>, BBC Sport, 4 August 2012<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Oscar+Pistorius+makes+Olympic+history+in+400m+at+London+2012&rft.pub=BBC+Sport&rft.date=2012-08-04&rft_id=https%3A%2F%2Fwww.bbc.co.uk%2Fsport%2F0%2Folympics%2F18911479&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-95\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-95\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFBill_Chappell2012\" class=\"citation\">Bill Chappell (4 August 2012), <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.webcitation.org\/69fiw3sEg?url=https:\/\/www.npr.org\/blogs\/thetorch\/2012\/08\/04\/158126486\/oscar-pistorius-makes-olympic-history-in-400-meters-and-moves-on-to-semifinal\" target=\"_blank\"><i>Oscar Pistorius makes Olympic history in 400 meters, and moves on to semifinal<\/i><\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/NPR\" title=\"NPR\" rel=\"external_link\" target=\"_blank\">NPR<\/a>, archived from <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.npr.org\/blogs\/thetorch\/2012\/08\/04\/158126486\/oscar-pistorius-makes-olympic-history-in-400-meters-and-moves-on-to-semifinal\" target=\"_blank\">the original<\/a> on 4 August 2012<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Oscar+Pistorius+makes+Olympic+history+in+400+meters%2C+and+moves+on+to+semifinal&rft.pub=NPR&rft.date=2012-08-04&rft.au=Bill+Chappell&rft_id=https%3A%2F%2Fwww.npr.org%2Fblogs%2Fthetorch%2F2012%2F08%2F04%2F158126486%2Foscar-pistorius-makes-olympic-history-in-400-meters-and-moves-on-to-semifinal&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-96\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-96\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.london2012.com\/athletics\/event\/men-400m\/phase=atm004200\/index.html\" target=\"_blank\">\"Men's 400m \u2013 semifinals\"<\/a>, <i>london2012.com<\/i><span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">4 August<\/span> 2012<\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=london2012.com&rft.atitle=Men%27s+400m+%E2%80%93+semifinals&rft_id=http%3A%2F%2Fwww.london2012.com%2Fathletics%2Fevent%2Fmen-400m%2Fphase%3Datm004200%2Findex.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-97\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-97\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFGreenberg2012\" class=\"citation\">Greenberg, Chris (10 August 2012), <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.webcitation.org\/69qCxjdgj?url=http:\/\/www.huffingtonpost.com\/2012\/08\/10\/oscar-pistorius-south-africa-relay-4x400-olympics_n_1765596.html\" target=\"_blank\"><i>Oscar Pistorius, South African 4\u00d7400m relay team finish 8th as Bahamas wins gold<\/i><\/a>, Huffington Post, archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.huffingtonpost.com\/2012\/08\/10\/oscar-pistorius-south-africa-relay-4x400-olympics_n_1765596.html\" target=\"_blank\">the original<\/a> on 11 August 2012<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Oscar+Pistorius%2C+South+African+4%C3%97400m+relay+team+finish+8th+as+Bahamas+wins+gold&rft.pub=Huffington+Post&rft.date=2012-08-10&rft.aulast=Greenberg&rft.aufirst=Chris&rft_id=http%3A%2F%2Fwww.huffingtonpost.com%2F2012%2F08%2F10%2Foscar-pistorius-south-africa-relay-4x400-olympics_n_1765596.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-98\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-98\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.webcitation.org\/6AJGcTrlp?url=http:\/\/uk.eurosport.yahoo.com\/news\/hawking-pistorius-open-londons-paralympics-194425194.html\" target=\"_blank\"><i>Hawking, Pistorius open London's Paralympics: Wheelchair-bound physicist Stephen Hawking challenged athletes to 'look to the stars' as he helped open a record-setting Paralympics Games that will run for 11 days in near sold-out venues<\/i><\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Yahoo!_Sports\" class=\"mw-redirect\" title=\"Yahoo! Sports\" rel=\"external_link\" target=\"_blank\">Yahoo! Sports<\/a>, 30 August 2012, archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/uk.eurosport.yahoo.com\/news\/hawking-pistorius-open-londons-paralympics-194425194.html\" target=\"_blank\">the original<\/a> on 30 August 2012<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Hawking%2C+Pistorius+open+London%27s+Paralympics%3A+Wheelchair-bound+physicist+Stephen+Hawking+challenged+athletes+to+%27look+to+the+stars%27+as+he+helped+open+a+record-setting+Paralympics+Games+that+will+run+for+11+days+in+near+sold-out+venues&rft.pub=Yahoo%21+Sports&rft.date=2012-08-30&rft_id=http%3A%2F%2Fuk.eurosport.yahoo.com%2Fnews%2Fhawking-pistorius-open-londons-paralympics-194425194.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Cost_of_a_Prosthetic_Limb-99\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Cost_of_a_Prosthetic_Limb_99-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Cost_of_a_Prosthetic_Limb_99-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/health.costhelper.com\/prosthetic-legs.html\" target=\"_blank\">\"Cost of a Prosthetic Limb\"<\/a>. <i>Cost Helper Health<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">13 April<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Cost+Helper+Health&rft.atitle=Cost+of+a+Prosthetic+Limb&rft_id=http%3A%2F%2Fhealth.costhelper.com%2Fprosthetic-legs.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-100\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-100\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.limbs4life.org.au\/funding\/funding-for-your-prosthesis\" target=\"_blank\">\"Funding for your prosthesis\"<\/a>. <i>Limbs4life<\/i>. Limbs4life<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">28 January<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Limbs4life&rft.atitle=Funding+for+your+prosthesis.&rft_id=http%3A%2F%2Fwww.limbs4life.org.au%2Ffunding%2Ffunding-for-your-prosthesis&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-eight-101\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-eight_101-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.boston.com\/business\/globe\/articles\/2005\/07\/05\/cost_of_prosthetics_stirs_debate\/\" target=\"_blank\">\"Cost of Prosthetics Stirs Debate\"<\/a>, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Boston_Globe\" class=\"mw-redirect\" title=\"Boston Globe\" rel=\"external_link\" target=\"_blank\">Boston Globe<\/a><\/i>, 5 July 2005. Retrieved 11 February 2007.<\/span>\n<\/li>\n<li id=\"cite_note-102\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-102\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.icrc.org\/Web\/eng\/siteeng0.nsf\/htmlall\/p0868\/$File\/Eng-Transfemoral.pdf\" target=\"_blank\">\"ICRC: Trans-Femoral Prosthesis \u2013 Manufacturing Guidelines\"<\/a> <span class=\"cs1-format\">(PDF)<\/span><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2010-10-03<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=ICRC%3A+Trans-Femoral+Prosthesis+%E2%80%93+Manufacturing+Guidelines&rft_id=http%3A%2F%2Fwww.icrc.org%2FWeb%2Feng%2Fsiteeng0.nsf%2Fhtmlall%2Fp0868%2F%24File%2FEng-Transfemoral.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-103\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-103\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.indexaward.dk\/2007\/default.asp?id=706&show=nomination&nominationid=163&playmovie=wmv\" target=\"_blank\">INDEX:2007 INDEX: AWARD<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090202173652\/http:\/\/www.indexaward.dk\/2007\/default.asp?id=706&show=nomination&nominationid=163&playmovie=wmv\" target=\"_blank\">Archived<\/a> February 2, 2009, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-104\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-104\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Nagata, Kazuaki (2015-05-10). <a rel=\"external_link\" class=\"external text\" href=\"#.VeCJ9_btlBd\">\"Robot arm startup taps 3-D printers in quest to make prosthetics affordable\"<\/a>. Japantimes.co.jp<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-12-28<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Robot+arm+startup+taps+3-D+printers+in+quest+to+make+prosthetics+affordable&rft.pub=Japantimes.co.jp&rft.date=2015-05-10&rft.aulast=Nagata&rft.aufirst=Kazuaki&rft_id=http%3A%2F%2Fwww.japantimes.co.jp%2Fnews%2F2015%2F05%2F10%2Fnational%2Fscience-health%2Frobot-arm-startup-taps-3-d-printers-in-quest-to-make-prosthetics-affordable%2F%23.VeCJ9_btlBd&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-105\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-105\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/OpenProsthetics.org\" target=\"_blank\">\"Open Prosthetics Website\"<\/a>. Openprosthetics.org<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-12-28<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Open+Prosthetics+Website&rft.pub=Openprosthetics.org&rft_id=http%3A%2F%2FOpenProsthetics.org&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Review_3D-printed_hand_prostheses-106\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Review_3D-printed_hand_prostheses_106-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kate, Jelle ten; Smit, Gerwin; Breedveld, Paul (3 April 2017). \"3D-printed upper limb prostheses: a review\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Disability_and_Rehabilitation:_Assistive_Technology\" title=\"Disability and Rehabilitation: Assistive Technology\" rel=\"external_link\" target=\"_blank\">Disability and Rehabilitation: Assistive Technology<\/a><\/i>. <b>12<\/b> (3): 300\u2013314. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1080%2F17483107.2016.1253117\" target=\"_blank\">10.1080\/17483107.2016.1253117<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1748-3107\" target=\"_blank\">1748-3107<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28152642\" target=\"_blank\">28152642<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Disability+and+Rehabilitation%3A+Assistive+Technology&rft.atitle=3D-printed+upper+limb+prostheses%3A+a+review&rft.volume=12&rft.issue=3&rft.pages=300-314&rft.date=2017-04-03&rft.issn=1748-3107&rft_id=info%3Apmid%2F28152642&rft_id=info%3Adoi%2F10.1080%2F17483107.2016.1253117&rft.aulast=Kate&rft.aufirst=Jelle+ten&rft.au=Smit%2C+Gerwin&rft.au=Breedveld%2C+Paul&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-107\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-107\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Krebs, D. E.; Edelstein, J. E.; Thornby, M. A. (1991). \"Prosthetic management of children with limb deficiencies\". <i>Physical therapy<\/i>. <b>71<\/b> (12): 920\u201334. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01241398-199205000-00033\" target=\"_blank\">10.1097\/01241398-199205000-00033<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1946626\" target=\"_blank\">1946626<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Physical+therapy&rft.atitle=Prosthetic+management+of+children+with+limb+deficiencies&rft.volume=71&rft.issue=12&rft.pages=920-34&rft.date=1991&rft_id=info%3Adoi%2F10.1097%2F01241398-199205000-00033&rft_id=info%3Apmid%2F1946626&rft.aulast=Krebs&rft.aufirst=D.+E.&rft.au=Edelstein%2C+J.+E.&rft.au=Thornby%2C+M.+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-108\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-108\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Carr, D.B. (1998). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/e-safe-anaesthesia.org\/e_library\/10\/Pain_and_rehabilitation_from_landmine_injuries_Update_2000.pdf\" target=\"_blank\">\"Pain and Rehabilitation from Landmine Injury\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Update in Anaesthesia<\/i>. <b>6<\/b> (2): 91.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Update+in+Anaesthesia&rft.atitle=Pain+and+Rehabilitation+from+Landmine+Injury&rft.volume=6&rft.issue=2&rft.pages=91&rft.date=1998&rft.au=Carr%2C+D.B.&rft_id=http%3A%2F%2Fe-safe-anaesthesia.org%2Fe_library%2F10%2FPain_and_rehabilitation_from_landmine_injuries_Update_2000.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-109\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-109\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Mohan, D. (1986) <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.oandplibrary.org\/op\/1986_01_016.asp\" target=\"_blank\">A Report on Amputees in India<\/a>. oandplibrary.org<\/span>\n<\/li>\n<li id=\"cite_note-110\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-110\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Werner, David. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.dinf.ne.jp\/doc\/english\/global\/david\/dwe002\/dwe00201.html\" target=\"_blank\">Disabled Village Children<\/a>. dinf.ne.jp<\/span>\n<\/li>\n<li id=\"cite_note-111\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-111\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Cheng, V. (2004) <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ispo.ca\/files\/bicycle-prosthesis.pdf\" target=\"_blank\">A victim assistance solution<\/a>. School of Industrial Design, Carleton University.<\/span>\n<\/li>\n<li id=\"cite_note-112\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-112\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Grosz, Elizabeth (2003). \"Prosthetic Objects\" in <i>The State of Architecture at the Beginning of the 21st Century<\/i>. pp. 96\u201397. The Monacelli Press. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1580931340.<\/span>\n<\/li>\n<li id=\"cite_note-113\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-113\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Scarry, Elaine (1985). <i>The Body in Pain: The Making and Unmaking of the World<\/i>. Oxford University Press.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Body+in+Pain%3A+The+Making+and+Unmaking+of+the+World&rft.pub=Oxford+University+Press&rft.date=1985&rft.aulast=Scarry&rft.aufirst=Elaine&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-114\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-114\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Lupton and Miller (1992). \"Streamlining: The Aesthetics of Waste\" in Taylor, M. and Preston, J. (eds.) 2006. <i>Intimus: Interior Design Theory Reader<\/i>. pp. 204\u2013212. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-470-01570-4.<\/span>\n<\/li>\n<li id=\"cite_note-115\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-115\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wigley, Mark (1991). \"Prosthetic Theory: The Disciplining of Architecture\". <i>Assemblage<\/i> (15): 6\u201329. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2307%2F3171122\" target=\"_blank\">10.2307\/3171122<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/JSTOR\" title=\"JSTOR\" rel=\"external_link\" target=\"_blank\">JSTOR<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.jstor.org\/stable\/3171122\" target=\"_blank\">3171122<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Assemblage&rft.atitle=Prosthetic+Theory%3A+The+Disciplining+of+Architecture&rft.issue=15&rft.pages=6-29&rft.date=1991&rft_id=info%3Adoi%2F10.2307%2F3171122&rft_id=%2F%2Fwww.jstor.org%2Fstable%2F3171122&rft.au=Wigley%2C+Mark&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Sources\">Sources<\/span><\/h2>\n<ul><li><cite class=\"citation book\">Murdoch, George; Wilson, A. Bennett, Jr. (1997). <i>A Primer on Amputations and Artificial Limbs<\/i>. United States of America: Charles C Thomas Publisher, Ltd. pp. 3\u201331. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-398-06801-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=A+Primer+on+Amputations+and+Artificial+Limbs&rft.place=United+States+of+America&rft.pages=3-31&rft.pub=Charles+C+Thomas+Publisher%2C+Ltd.&rft.date=1997&rft.isbn=0-398-06801-1&rft.aulast=Murdoch&rft.aufirst=George&rft.au=Wilson%2C+A.+Bennett%2C+Jr.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sportsinjurybulletin.com\/archive\/biomechanics-running.html\" target=\"_blank\">\u2018Biomechanics of running: from faulty movement patterns come injury.' Sports Injury Bulletin.<\/a><\/li>\n<li>Edelstein, J. E. Prosthetic feet. State of the Art. Physical Therapy 68(12) Dec 1988: 1874\u20131881.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.oandp.com\/edge\/issues\/articles\/2002-10_02.asp\" target=\"_blank\">Gailey, Robert. The Biomechanics of Amputee Running. October 2002.<\/a><\/li>\n<li><cite class=\"citation journal\">Hafner B. J.; Sanders J. E.; Czerniecki J. M.; Ferguson J. (2002). \"Transtibial energy-storage-and-return prosthetic devices: A review of energy concepts and a proposed nomenclature\". <i>Journal of Rehabilitation Research and Development Vol<\/i>. <b>39<\/b> (1): 1\u201311.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Rehabilitation+Research+and+Development+Vol&rft.atitle=Transtibial+energy-storage-and-return+prosthetic+devices%3A+A+review+of+energy+concepts+and+a+proposed+nomenclature&rft.volume=39&rft.issue=1&rft.pages=1-11&rft.date=2002&rft.au=Hafner+B.+J.&rft.au=Sanders+J.+E.&rft.au=Czerniecki+J.+M.&rft.au=Ferguson+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProsthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fayobserver.com\/military\/afghan-amputees-tell-their-stories-at-texas-gathering\/article_45beb9dd-9c3d-5291-ba43-0aa0664a39be.html\" target=\"_blank\">Afghan amputees tell their stories at Texas gathering<\/a>, Fayetteville Observer<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.pbs.org\/newshour\/bb\/can-modern-prosthetics-actually-help-reclaim-sense-touch\/\" target=\"_blank\">Can modern prosthetics actually help reclaim the sense of touch?<\/a>, PBS Newshour<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fayobserver.com\/news\/local\/a-hand-for-rick-underwater-videographer-rick-allen-almost-killed\/article_56c56af0-ab7a-5d5c-9c71-ccbea5ac7421.html\" target=\"_blank\">A hand for Rick<\/a>, Fayetteville Observer<\/li><\/ul>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1319\nCached time: 20181217092122\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 1.528 seconds\nReal time usage: 1.816 seconds\nPreprocessor visited node count: 6476\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 227554\/2097152 bytes\nTemplate argument size: 5253\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 14\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 265872\/5000000 bytes\nNumber of Wikibase entities loaded: 6\/400\nLua time usage: 0.907\/10.000 seconds\nLua memory usage: 21.13 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1520.632 1 -total\n<\/p>\n<pre>69.69% 1059.756 1 Template:Reflist\n22.60% 343.628 39 Template:Cite_journal\n12.27% 186.583 1 Template:LSJ\n11.98% 182.123 1 Template:Lang\n11.87% 180.431 27 Template:Cite_web\n 6.06% 92.170 7 Template:Fix\n 4.83% 73.440 1 Template:Disability\n 4.55% 69.249 1 Template:Commons_category\n 4.33% 65.877 1 Template:Sidebar_with_collapsible_lists\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:72750-1!canonical and timestamp 20181217092121 and revision id 872308076\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212150\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.026 seconds\nReal time usage: 0.200 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 187.036 1 - wikipedia:Prosthesis\n100.00% 187.036 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8058-0!*!*!*!*!*!* and timestamp 20181217212150 and revision id 24177\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Prosthesis\">https:\/\/www.limswiki.org\/index.php\/Prosthesis<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","0f2d6a32b0b8d94e77f784371dbcb51f_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a3\/86_ACPS_Atlanta_1996_Swimming_General_Views.jpg\/440px-86_ACPS_Atlanta_1996_Swimming_General_Views.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/eb\/Handicapped_Accessible_sign.svg\/32px-Handicapped_Accessible_sign.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2d\/A_formation_of_Marines%2C_firemen_and_policemen_running_across_Manhattan_in_2007.jpg\/440px-A_formation_of_Marines%2C_firemen_and_policemen_running_across_Manhattan_in_2007.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/67\/Prosthetic_toe.jpg\/440px-Prosthetic_toe.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/05\/Roman_artificial_leg_of_bronze._Wellcome_M0012307.jpg\/440px-Roman_artificial_leg_of_bronze._Wellcome_M0012307.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d5\/Ambroise_Pare%3B_prosthetics%2C_mechanical_hand_Wellcome_L0023364.jpg\/440px-Ambroise_Pare%3B_prosthetics%2C_mechanical_hand_Wellcome_L0023364.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/81\/Eiserne_Hand_Glasnegativ_6_cropped.jpg\/440px-Eiserne_Hand_Glasnegativ_6_cropped.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/eb\/Iron_artificial_arm%2C_1560-1600._%289663806794%29.jpg\/440px-Iron_artificial_arm%2C_1560-1600._%289663806794%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/72\/A_Visit_To_the_Artificial_Limbs_Factory%2C_Queen_Mary%27s_Hospital%2C_Roehampton%2C_November_1941_D5731.jpg\/440px-A_Visit_To_the_Artificial_Limbs_Factory%2C_Queen_Mary%27s_Hospital%2C_Roehampton%2C_November_1941_D5731.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0b\/WorkNC-Knee_prosthesis.jpg\/500px-WorkNC-Knee_prosthesis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/aa\/Journal.pone.0019508.g004_prosthetic_finger.png\/440px-Journal.pone.0019508.g004_prosthetic_finger.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/6e\/Myoelectric_prosthetic_arm.jpg\/440px-Myoelectric_prosthetic_arm.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/34\/AustralianParalympianOfTheYear_468.JPG\/440px-AustralianParalympianOfTheYear_468.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8c\/Flickr_-_The_U.S._Army_-_U.S._Army_World_Class_Athlete_Program_Paralympic.jpg\/400px-Flickr_-_The_U.S._Army_-_U.S._Army_World_Class_Athlete_Program_Paralympic.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/18\/Low_cost_prosthetic_limbs.jpg\/440px-Low_cost_prosthetic_limbs.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/Artificial_limbs_for_a_thalidomide_child%2C_1961-1965._%289660575567%29.jpg\/440px-Artificial_limbs_for_a_thalidomide_child%2C_1961-1965._%289660575567%29.jpg"],"0f2d6a32b0b8d94e77f784371dbcb51f_timestamp":1545081710,"12120de9cd351556539cdca543d60d87_type":"article","12120de9cd351556539cdca543d60d87_title":"Propel mometasone furoate implant","12120de9cd351556539cdca543d60d87_url":"https:\/\/www.limswiki.org\/index.php\/Propel_mometasone_furoate_implant","12120de9cd351556539cdca543d60d87_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPropel mometasone furoate implant\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tSteroid-eluting sinus stents maybe used in addition to endoscopic sinus surgery. They are, however, of unclear benefit as of 2015.[1]\nOne version releases mometasone furoate. It is a bioabsorbable steroid-eluting stent. It delivers steroids over a 30-day period prior to dissolving.[2]\n\nSociety and culture \nA number of brands exist including Relieva Stratus Spacer and Propel sinus implant.[3][4]\n\nApproval \nOne brand received pre-market approval from the FDA in 2011.\n\nReferences \n\n\n^ Huang, Z; Hwang, P; Sun, Y; Zhou, B (10 June 2015). \"Steroid-eluting sinus stents for improving symptoms in chronic rhinosinusitis patients undergoing functional endoscopic sinus surgery\". The Cochrane database of systematic reviews (6): CD010436. doi:10.1002\/14651858.CD010436.pub2. PMID 26068957. \n\n^ Lee, Jivianne T; Han, Joseph K (2013). \"Sinus implants for chronic rhinosinusitis: Technology evaluation\". Expert Opinion on Drug Delivery. 10 (12): 1735\u201348. doi:10.1517\/17425247.2013.839654. PMID 24088141. \n\n^ Liang, Jonathan; Lane, Andrew P. (2012). \"Topical Drug Delivery for Chronic Rhinosinusitis\". Current Otorhinolaryngology Reports. 1 (1): 51\u201360. doi:10.1007\/s40136-012-0003-4. PMC 3603706 . PMID 23525506. \n\n^ Kennedy, David W (2012). \"The PROPEL\u2122 steroid-releasing bioabsorbable implant to improve outcomes of sinus surgery\". Expert Review of Respiratory Medicine. 6 (5): 493\u20138. doi:10.1586\/ers.12.53. PMID 23134241. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Propel_mometasone_furoate_implant\">https:\/\/www.limswiki.org\/index.php\/Propel_mometasone_furoate_implant<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:34.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 345 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","12120de9cd351556539cdca543d60d87_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Propel_mometasone_furoate_implant skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Propel mometasone furoate implant<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Steroid-eluting sinus stents<\/b> maybe used in addition to endoscopic sinus surgery. They are, however, of unclear benefit as of 2015.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>One version releases <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mometasone_furoate\" title=\"Mometasone furoate\" rel=\"external_link\" target=\"_blank\">mometasone furoate<\/a>. It is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioresorbable_stents\" class=\"mw-redirect\" title=\"Bioresorbable stents\" rel=\"external_link\" target=\"_blank\">bioabsorbable steroid-eluting stent<\/a>. It delivers steroids over a 30-day period prior to dissolving.<sup id=\"rdp-ebb-cite_ref-SIfochronic_2-0\" class=\"reference\"><a href=\"#cite_note-SIfochronic-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Society_and_culture\">Society and culture<\/span><\/h2>\n<p>A number of brands exist including Relieva Stratus Spacer and Propel sinus implant.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-KennedyDW_4-0\" class=\"reference\"><a href=\"#cite_note-KennedyDW-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Approval\">Approval<\/span><\/h3>\n<p>One brand received pre-market approval from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">FDA<\/a> in 2011.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Huang, Z; Hwang, P; Sun, Y; Zhou, B (10 June 2015). \"Steroid-eluting sinus stents for improving symptoms in chronic rhinosinusitis patients undergoing functional endoscopic sinus surgery\". <i>The Cochrane database of systematic reviews<\/i> (6): CD010436. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD010436.pub2\" target=\"_blank\">10.1002\/14651858.CD010436.pub2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26068957\" target=\"_blank\">26068957<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+database+of+systematic+reviews&rft.atitle=Steroid-eluting+sinus+stents+for+improving+symptoms+in+chronic+rhinosinusitis+patients+undergoing+functional+endoscopic+sinus+surgery.&rft.issue=6&rft.pages=CD010436&rft.date=2015-06-10&rft_id=info%3Adoi%2F10.1002%2F14651858.CD010436.pub2&rft_id=info%3Apmid%2F26068957&rft.aulast=Huang&rft.aufirst=Z&rft.au=Hwang%2C+P&rft.au=Sun%2C+Y&rft.au=Zhou%2C+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASteroid+eluting+sinus+stent\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-SIfochronic-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SIfochronic_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lee, Jivianne T; Han, Joseph K (2013). \"Sinus implants for chronic rhinosinusitis: Technology evaluation\". <i>Expert Opinion on Drug Delivery<\/i>. <b>10<\/b> (12): 1735\u201348. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1517%2F17425247.2013.839654\" target=\"_blank\">10.1517\/17425247.2013.839654<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24088141\" target=\"_blank\">24088141<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Expert+Opinion+on+Drug+Delivery&rft.atitle=Sinus+implants+for+chronic+rhinosinusitis%3A+Technology+evaluation&rft.volume=10&rft.issue=12&rft.pages=1735-48&rft.date=2013&rft_id=info%3Adoi%2F10.1517%2F17425247.2013.839654&rft_id=info%3Apmid%2F24088141&rft.aulast=Lee&rft.aufirst=Jivianne+T&rft.au=Han%2C+Joseph+K&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASteroid+eluting+sinus+stent\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Liang, Jonathan; Lane, Andrew P. (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3603706\" target=\"_blank\">\"Topical Drug Delivery for Chronic Rhinosinusitis\"<\/a>. <i>Current Otorhinolaryngology Reports<\/i>. <b>1<\/b> (1): 51\u201360. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs40136-012-0003-4\" target=\"_blank\">10.1007\/s40136-012-0003-4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3603706\" target=\"_blank\">3603706<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23525506\" target=\"_blank\">23525506<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Current+Otorhinolaryngology+Reports&rft.atitle=Topical+Drug+Delivery+for+Chronic+Rhinosinusitis&rft.volume=1&rft.issue=1&rft.pages=51-60&rft.date=2012&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3603706&rft_id=info%3Apmid%2F23525506&rft_id=info%3Adoi%2F10.1007%2Fs40136-012-0003-4&rft.aulast=Liang&rft.aufirst=Jonathan&rft.au=Lane%2C+Andrew+P.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3603706&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASteroid+eluting+sinus+stent\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-KennedyDW-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-KennedyDW_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kennedy, David W (2012). \"The PROPEL\u2122 steroid-releasing bioabsorbable implant to improve outcomes of sinus surgery\". <i>Expert Review of Respiratory Medicine<\/i>. <b>6<\/b> (5): 493\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1586%2Fers.12.53\" target=\"_blank\">10.1586\/ers.12.53<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23134241\" target=\"_blank\">23134241<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Expert+Review+of+Respiratory+Medicine&rft.atitle=The+PROPEL%E2%84%A2+steroid-releasing+bioabsorbable+implant+to+improve+outcomes+of+sinus+surgery&rft.volume=6&rft.issue=5&rft.pages=493-8&rft.date=2012&rft_id=info%3Adoi%2F10.1586%2Fers.12.53&rft_id=info%3Apmid%2F23134241&rft.aulast=Kennedy&rft.aufirst=David+W&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASteroid+eluting+sinus+stent\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1269\nCached time: 20181206074146\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.128 seconds\nReal time usage: 0.157 seconds\nPreprocessor visited node count: 260\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 8941\/2097152 bytes\nTemplate argument size: 91\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 12136\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.080\/10.000 seconds\nLua memory usage: 2.43 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 139.703 1 Template:Reflist\n100.00% 139.703 1 -total\n<\/p>\n<pre>86.34% 120.624 4 Template:Cite_journal\n 1.71% 2.390 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:41303407-1!canonical and timestamp 20181206074146 and revision id 871898696\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Propel_mometasone_furoate_implant\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212150\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.147 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 141.339 1 - wikipedia:Propel_mometasone_furoate_implant\n100.00% 141.339 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8057-0!*!*!*!*!*!* and timestamp 20181217212149 and revision id 24168\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Propel_mometasone_furoate_implant\">https:\/\/www.limswiki.org\/index.php\/Propel_mometasone_furoate_implant<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","12120de9cd351556539cdca543d60d87_images":[],"12120de9cd351556539cdca543d60d87_timestamp":1545081709,"66f306a9b1671f4ccef0b68b1ee54d12_type":"article","66f306a9b1671f4ccef0b68b1ee54d12_title":"Port (medical)","66f306a9b1671f4ccef0b68b1ee54d12_url":"https:\/\/www.limswiki.org\/index.php\/Port_(medical)","66f306a9b1671f4ccef0b68b1ee54d12_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPort (medical)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (December 2015) (Learn how and when to remove this template message)\n Port-a-Cath with needle assembly inserted.\nIn medicine, a port is a small medical appliance that is installed beneath the skin. A catheter connects the port to a vein. Under the skin, the port has a septum through which drugs can be injected and blood samples can be drawn many times, usually with less discomfort for the patient than a more typical \"needle stick\".\nPorts are used mostly to treat hematology and oncology patients. Ports were previously adapted for use in hemodialysis patients, but were found to be associated with increased rate of infections and are no longer available in the US.[1]\nThe port is usually inserted in the upper chest (known as a \"chest port\"), just below the clavicle or collar bone, leaving the patient's hands free.\n\nContents \n\n1 Terminology \n2 How it works \n3 Uses \n4 Insertion \n5 Models \n6 Risks \n7 Manufacturers \n8 Use \n9 Alternatives \n10 In popular culture \n11 See also \n12 References \n13 Further reading \n14 External links \n\n\nTerminology \n Chest X-ray showing an implanted port.\nA port is more correctly known as a \"totally implantable venous access device\". Brand Names include Eco Port, Clip-a-Port, SmartPort, Microport, Bardport, PowerPort, Passport, Port-a-Cath, Infuse-a-Port, Medi-Port, and Bioflo.\n\nHow it works \n The catheter runs from the portal and is surgically inserted into a vein (usually the jugular vein, subclavian vein, or superior vena cava). Ideally, the catheter terminates in the superior vena cava, just upstream of the right atrium. This position allows infused agents to be spread throughout the body quickly and efficiently.\nA port consists of a reservoir compartment (the portal) that has a silicone bubble for needle insertion (the septum), with an attached plastic tube (the catheter). The device is surgically inserted under the skin in the upper chest or in the arm and appears as a bump under the skin. It requires no special maintenance and is completely internal so swimming and bathing are not a problem. The catheter runs from the portal and is surgically inserted into a vein (usually the jugular vein or less optimally the subclavian vein). Ideally, the catheter terminates in the superior vena cava or the right atrium. This position allows infused agents to be spread throughout the body quickly and efficiently.\nThe septum is made of a special self-sealing silicone; it can be punctured hundreds of times before it weakens significantly. To administer treatment or to withdraw blood, a health care professional will first locate the port and disinfect the area, then access the port by puncturing the overlying skin with a Huber point needle. Due to its design, there is a very low infection risk, as the breach of skin integrity is never larger than the caliber of the needle. This gives it an advantage over indwelling lines such as the Hickman line. Negative pressure is created to withdraw blood into the vacuumized needle, to check for blood return and see if the port is functioning normally. Next, the port is flushed with a saline solution. Then, treatment will begin.\nThe implantation procedure itself is considered minor, and is typically performed with both local anaesthesia and moderate sedation. Patients often have post-procedure discomfort at the insertion site which is most often managed by administration of acetaminophen or a non-steroidal anti-inflammatory drug such as ibuprofen.\nA port is most commonly inserted as an outpatient surgery procedure in a hospital or clinic by an interventional radiologist or surgeon, under moderate sedation. Implantation is increasingly performed by interventional radiologists due to advancements in techniques and their facile use of imaging technologies. When no longer needed, the port can be removed in the interventional radiology suite or an operating room.\n\nUses \nPorts have many uses:\n\nTo deliver chemotherapy to cancer patients who must undergo treatment frequently. Chemotherapy is often toxic, and can damage skin and muscle tissue, and therefore should not be delivered through these tissues. Ports provide a solution, delivering drugs quickly and efficiently through the entire body via the circulatory system.\nTo deliver coagulation factors in patients with severe hemophilia.\nTo withdraw (and\/or return) blood to the body in patients who require frequent blood tests, and in hemodialysis patients.\nTo deliver antibiotics to patients requiring them for a long time or frequently, such as those with cystic fibrosis and bronchiectasis.\nDelivering medications to patients with immune disorders.\nFor treating alpha 1-antitrypsin deficiency with replacement therapy\nFor delivering radiopaque contrast agents, which enhance contrast in CT imaging.\nTo fill or withdraw fluid from the Lap-Band or Realize gastric bands used in Bariatric surgeries.\nTo administer analgesics to patients with chronic pain, such as cancer patients and those with sickle-cell disease\nInsertion \n Follow-up chest X-ray after insertion of a port, with a malpositioned tip in the azygos vein.\n CT scan confirming a tip in the azygos vein.\nFluoroscopy is useful in guiding the insertion of ports.[2]\nA follow-up chest radiograph can immediately detect complications associated with the procedure in the form of pneumothorax, hemothorax and malpositions of the catheter (see Risks below for further details). However, it is suggested that chest radiography is not mandatory as a routine method after fluoroscopy-guided port insertion that is mainly performed by venous cutdown.[2]\nThe side of the patients' chest the port is implanted in will usually be chosen to avoid damage to the port and the veins by the seat belt in case of accident when seated as the driver. Thus, there is a potential conflict by left- and right-hand traffic as the rule of the road.[3][4]\n\nModels \nThere are many different models of ports. The particular model selected is based on the patient's specific medical conditions.\nPortals: \n\ncan be made of plastic, stainless steel, or titanium\ncan be single chamber or dual chamber\nvary in height, width and shape.\nCatheters:\n\ncan be made of biocompatible, medical-grade polyurethane or silicone\ncan vary in length and diameter\nPorts can be put in the upper chest or arm. The exact positioning itself is variable as it can be inserted to avoid visibility when wearing low cut shirts, and to avoid excess contact due to a backpack or bra strap. The most common placement is on the upper right portion of the chest, with the catheter itself looping through the right jugular vein, and down towards the patient's heart.\nFor applications as CT scan, high pressure infusion allowing ports are needed.[5][6]\n\nRisks \nAge: If the device is put into a child, the child's growth means that the catheter becomes relatively shorter and will move towards the head. It may become necessary to remove or replace it.\nArterial injury: The subclavian artery can be inadvertently punctured while attempting a subclavian vein access, leading to a subcutaneous hematoma and occasionally a pseudoaneurysm. An alternative site may need to be used for port placement. Puncture of the carotid artery is significantly more rare, since attempts to access the nearby jugular vein are increasingly done with ultrasound guidance.\nInfection: An infection may develop in the line or around the port. This may require antibiotic treatment or removal of the device.\nMechanical failure is uncommon. Ports placed through the subclavian vein may suffer from \"pinch-off syndrome\" where the catheter fractures as it passes into the vein. Ports placed via the jugular vein do not suffer from this problem. The catheter fragment then travels through the venous system and typically lodges in the right heart or the lungs. Many patients are asymptomatic but the mechanical failure is discovered because of an inability to flush or withdraw fluids from the port. In those instances, an interventional radiologist can usually retrieve the fragment and place a new port.\nPneumothorax: Attempts to gain access to the subclavian vein or jugular vein can injure the lung, potentially causing a pneumothorax. If the pneumothorax is large enough, a chest tube might need to be placed. In experienced hands, the incidence of this complication is about 1% when accessing the subclavian vein. When accessing the jugular vein the pneumothorax rate is virtually nonexistent.\nThrombosis: formation of a blood clot in the catheter may block the device irrevocably. To prevent clotting the port is flushed with saline and heparin, usually by a nurse or other medical professional, or someone properly trained that is a family member or the patient, at least once every four weeks, or more often in conjunction with administering medication.\nManufacturers \nThe major manufacturers of ports are AngioDynamics, B. Braun Medical,[7] Bard Access Systems,[6] Cook Medical, MedComp, Navilyst Medical, Norfolk Medical Products, and Smiths Medical.\n\nUse \nTo reduce damage or coring of the septum during use, low or non coring needles are to be used.[8]\nAfter each use, a heparin lock is made by injecting a small amount of heparinized saline (an anticoagulant) into the device, preventing development of clots within the port or catheter. In some catheter designs where there is a self-sealing valve at the far end, the system is locked with just saline. The port can be left accessed for as long as required. The port is covered in a dressing to protect the site from infection and to secure the needle in position.\nIf a port is used infrequently, it may be necessary to access the port, flush it with saline, and inject a new heparin lock to prevent clotting between uses.\n\nAlternatives \nSometimes, the physical condition of the patient, especially the structure of his veins, does not allow for the insertion of a port. An alternative is the PICC line, despite drawbacks such as external entry point and limited lifespan of the device.[9]\n\nIn popular culture \nIn the 1984 cyberpunk novel Neuromancer, a minor character, Peter Riviera, has a kind of medical port placed in his arm to facilitate his recreational drug use.[10]\n\nSee also \nHickman line\nPeripherally inserted central catheter or \"PICC\"\nGroshong line\nReferences \n\n\n^ \"Gastroenterology-Urology Devices; Reclassification of Implanted Blood Access Devices\". Food and Drug Administration. 25 July 2014. \n\n^ a b Thomopoulos, Theodoros; Meyer, Jeremy; Staszewicz, Wojciech; Bagetakos, Ilias; Scheffler, Max; Lomessy, Antoine; Toso, Christian; Becker, Christoph D.; Morel, Philippe (2014). \"Routine Chest X-ray is not Mandatory after Fluoroscopy-Guided Totally Implantable Venous Access Device Insertion\". Annals of Vascular Surgery. 28 (2): 345\u2013350. doi:10.1016\/j.avsg.2013.08.003. ISSN 0890-5096. \n\n^ Julia Lederbogen-H\u00fclsen (2009). Erleichterung der Chemotherapie durch implantierbare Portkatheter-Systeme bei Patientinnen mit gyn\u00e4kologischen Tumoren (in German). M\u00fcnster: Universit\u00e4tsklinikum M\u00fcnster. p. 91. Verlauf des Autosicherheitsgurts in die \u00dcberlegungen mit einzubeziehen (to include the place of the safety belt into the planning) \n\n^ \"Celsite\u00ae Portkatheter-Systeme\" (PDF) (in German). B. Braun Melsungen. 2012. Auf welcher Seite wird der Sicherheitsgurt angebracht? (which side is the safety belt) \n\n^ \"C-Port\u00aeCT\". Retrieved 25 November 2017 . \n\n^ a b \"IMPLANTABLE PORT DEVICES\". Retrieved 23 November 2017 . \n\n^ \"Celsite\u00ae Access Ports\" (PDF) . Retrieved 23 November 2017 . \n\n^ \"Choice of the Needles\" (PDF) . p. 7. Retrieved 25 November 2017 . \n\n^ Michaela Hans. \"Pflegeleitfaden\" (PDF) (in German). CHARIT\u00c9. p. 22. Retrieved 2017-12-03 . Liegedauer von 4 Monaten \n\n^ Gibson, William (July 2000) [July 1983]. \"Chapter Eight\". Neuromancer (Ace trade paperback ed.). p. 105. Riviera loosened and removed the elastic length of surgical tubing from his arm. 'Yes. It's more fun.' He smiled, his eyes distant now, cheeks flushed. 'I've a membrane set in, just over the vein, so I never have to worry about the condition of the needle.' 'Doesn't hurt?' [said Case] The bright eyes met his. 'Of course it does. That's part of it, isn't it?' \n\n\nFurther reading \nMallon, William (March 2001). \"Is It Acceptable to Discharge a Heroin User with an Intravenous Line to Complete His Antibiotic Therapy for Cellulitis at Home under a Nurse's Supervision?\". Point-Counterpoint (column). The Western Journal of Medicine. 174 (3): 157. doi:10.1136\/ewjm.174.3.157. PMC 1071292 . PMID 11238332. \nExternal links \nwww.breastcancer.org: Ports for Chemo\nA photo-essay on what it's like to have a port\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Port_(medical)\">https:\/\/www.limswiki.org\/index.php\/Port_(medical)<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:29.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 582 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","66f306a9b1671f4ccef0b68b1ee54d12_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Port_medical skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Port (medical)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PAC_met_Gripper_erin.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/95\/PAC_met_Gripper_erin.JPG\/220px-PAC_met_Gripper_erin.JPG\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PAC_met_Gripper_erin.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Port-a-Cath with needle assembly inserted.<\/div><\/div><\/div>\n<p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medicine<\/a>, a <b>port<\/b> is a small medical appliance that is installed beneath the skin. A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheter<\/a> connects the port to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">vein<\/a>. Under the skin, the port has a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Septum\" title=\"Septum\" rel=\"external_link\" target=\"_blank\">septum<\/a> through which drugs can be injected and blood samples can be drawn many times, usually with less discomfort for the patient than a more typical \"needle stick\".\n<\/p><p>Ports are used mostly to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hematology\" title=\"Hematology\" rel=\"external_link\" target=\"_blank\">hematology<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oncology\" title=\"Oncology\" rel=\"external_link\" target=\"_blank\">oncology<\/a> patients. Ports were previously adapted for use in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a> patients, but were found to be associated with increased rate of infections and are no longer available in the US.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>The port is usually inserted in the upper chest (known as a \"chest port\"), just below the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clavicle\" title=\"Clavicle\" rel=\"external_link\" target=\"_blank\">clavicle<\/a> or collar bone, leaving the patient's hands free.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Terminology\">Terminology<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Portkatheter_R%C3%B6ntgen.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9f\/Portkatheter_R%C3%B6ntgen.JPG\/220px-Portkatheter_R%C3%B6ntgen.JPG\" width=\"220\" height=\"249\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Portkatheter_R%C3%B6ntgen.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Chest X-ray showing an implanted port.<\/div><\/div><\/div>\n<p>A port is more correctly known as a \"totally implantable venous access device\". Brand Names include Eco Port, Clip-a-Port, SmartPort, Microport, Bardport, PowerPort, Passport, Port-a-Cath, Infuse-a-Port, Medi-Port, and Bioflo.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"How_it_works\">How it works<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gray576.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e9\/Gray576.png\/220px-Gray576.png\" width=\"220\" height=\"177\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gray576.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheter<\/a> runs from the portal and is surgically inserted into a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">vein<\/a> (usually the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jugular_vein\" title=\"Jugular vein\" rel=\"external_link\" target=\"_blank\">jugular vein<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subclavian_vein\" title=\"Subclavian vein\" rel=\"external_link\" target=\"_blank\">subclavian vein<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superior_vena_cava\" title=\"Superior vena cava\" rel=\"external_link\" target=\"_blank\">superior vena cava<\/a>). Ideally, the catheter terminates in the superior vena cava, just upstream of the right atrium. This position allows infused agents to be spread throughout the body quickly and efficiently.<\/div><\/div><\/div>\n<p>A port consists of a reservoir compartment (the portal) that has a silicone bubble for needle insertion (the septum), with an attached plastic tube (the catheter). The device is surgically inserted under the skin in the upper chest or in the arm and appears as a bump under the skin. It requires no special maintenance and is completely internal so swimming and bathing are not a problem. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheter<\/a> runs from the portal and is surgically inserted into a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">vein<\/a> (usually the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jugular_vein\" title=\"Jugular vein\" rel=\"external_link\" target=\"_blank\">jugular vein<\/a> or less optimally the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subclavian_vein\" title=\"Subclavian vein\" rel=\"external_link\" target=\"_blank\">subclavian vein<\/a>). Ideally, the catheter terminates in the superior vena cava or the right atrium. This position allows infused agents to be spread throughout the body quickly and efficiently.\n<\/p><p>The septum is made of a special self-sealing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a>; it can be punctured hundreds of times before it weakens significantly. To administer treatment or to withdraw blood, a health care professional will first locate the port and disinfect the area, then access the port by puncturing the overlying skin with a Huber point needle. Due to its design, there is a very low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a> risk, as the breach of skin integrity is never larger than the caliber of the needle. This gives it an advantage over indwelling lines such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hickman_line\" title=\"Hickman line\" rel=\"external_link\" target=\"_blank\">Hickman line<\/a>. Negative pressure is created to withdraw blood into the vacuumized needle, to check for blood return and see if the port is functioning normally. Next, the port is flushed with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saline_solution\" class=\"mw-redirect\" title=\"Saline solution\" rel=\"external_link\" target=\"_blank\">saline solution<\/a>. Then, treatment will begin.\n<\/p><p>The implantation procedure itself is considered minor, and is typically performed with both local anaesthesia and moderate sedation. Patients often have post-procedure discomfort at the insertion site which is most often managed by administration of acetaminophen or a non-steroidal anti-inflammatory drug such as ibuprofen.\n<\/p><p>A port is most commonly inserted as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Outpatient_surgery\" title=\"Outpatient surgery\" rel=\"external_link\" target=\"_blank\">outpatient surgery<\/a> procedure in a hospital or clinic by an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_radiologist\" class=\"mw-redirect\" title=\"Interventional radiologist\" rel=\"external_link\" target=\"_blank\">interventional radiologist<\/a> or surgeon, under moderate sedation. Implantation is increasingly performed by interventional radiologists due to advancements in techniques and their facile use of imaging technologies. When no longer needed, the port can be removed in the interventional radiology suite or an operating room.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Uses\">Uses<\/span><\/h2>\n<p>Ports have many uses:\n<\/p>\n<ul><li>To deliver <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemotherapy\" title=\"Chemotherapy\" rel=\"external_link\" target=\"_blank\">chemotherapy<\/a> to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cancer\" title=\"Cancer\" rel=\"external_link\" target=\"_blank\">cancer<\/a> patients who must undergo treatment frequently. Chemotherapy is often toxic, and can damage skin and muscle tissue, and therefore should not be delivered through these tissues. Ports provide a solution, delivering drugs quickly and efficiently through the entire body via the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Circulatory_system\" title=\"Circulatory system\" rel=\"external_link\" target=\"_blank\">circulatory system<\/a>.<\/li>\n<li>To deliver <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coagulation\" title=\"Coagulation\" rel=\"external_link\" target=\"_blank\">coagulation factors<\/a> in patients with severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemophilia\" class=\"mw-redirect\" title=\"Hemophilia\" rel=\"external_link\" target=\"_blank\">hemophilia<\/a>.<\/li>\n<li>To withdraw (and\/or return) blood to the body in patients who require frequent blood tests, and in hemodialysis patients.<\/li>\n<li>To deliver <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antibiotic\" title=\"Antibiotic\" rel=\"external_link\" target=\"_blank\">antibiotics<\/a> to patients requiring them for a long time or frequently, such as those with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cystic_fibrosis\" title=\"Cystic fibrosis\" rel=\"external_link\" target=\"_blank\">cystic fibrosis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bronchiectasis\" title=\"Bronchiectasis\" rel=\"external_link\" target=\"_blank\">bronchiectasis<\/a>.<\/li>\n<li>Delivering medications to patients with immune disorders.<\/li>\n<li>For treating <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alpha_1-antitrypsin_deficiency\" title=\"Alpha 1-antitrypsin deficiency\" rel=\"external_link\" target=\"_blank\">alpha 1-antitrypsin deficiency<\/a> with replacement therapy<\/li>\n<li>For delivering radiopaque contrast agents, which enhance contrast in CT imaging.<\/li>\n<li>To fill or withdraw fluid from the Lap-Band or Realize gastric bands used in Bariatric surgeries.<\/li>\n<li>To administer analgesics to patients with chronic pain, such as cancer patients and those with sickle-cell disease<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Insertion\">Insertion<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:X-ray_of_port-a-cath_in_azygos_vein_-_anteroposterior.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0e\/X-ray_of_port-a-cath_in_azygos_vein_-_anteroposterior.jpg\/220px-X-ray_of_port-a-cath_in_azygos_vein_-_anteroposterior.jpg\" width=\"220\" height=\"204\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:X-ray_of_port-a-cath_in_azygos_vein_-_anteroposterior.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Follow-up <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest_radiograph\" title=\"Chest radiograph\" rel=\"external_link\" target=\"_blank\">chest X-ray<\/a> after insertion of a port, with a malpositioned tip in the azygos vein.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CT_of_port-a-cath_in_azygos_vein.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f6\/CT_of_port-a-cath_in_azygos_vein.jpg\/220px-CT_of_port-a-cath_in_azygos_vein.jpg\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CT_of_port-a-cath_in_azygos_vein.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/CT_scan\" title=\"CT scan\" rel=\"external_link\" target=\"_blank\">CT scan<\/a> confirming a tip in the azygos vein.<\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroscopy\" title=\"Fluoroscopy\" rel=\"external_link\" target=\"_blank\">Fluoroscopy<\/a> is useful in guiding the insertion of ports.<sup id=\"rdp-ebb-cite_ref-ThomopoulosMeyer2014_2-0\" class=\"reference\"><a href=\"#cite_note-ThomopoulosMeyer2014-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>A follow-up <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest_radiograph\" title=\"Chest radiograph\" rel=\"external_link\" target=\"_blank\">chest radiograph<\/a> can immediately detect complications associated with the procedure in the form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pneumothorax\" title=\"Pneumothorax\" rel=\"external_link\" target=\"_blank\">pneumothorax<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemothorax\" title=\"Hemothorax\" rel=\"external_link\" target=\"_blank\">hemothorax<\/a> and malpositions of the catheter (see Risks below for further details). However, it is suggested that chest radiography is not mandatory as a routine method after fluoroscopy-guided port insertion that is mainly performed by venous cutdown.<sup id=\"rdp-ebb-cite_ref-ThomopoulosMeyer2014_2-1\" class=\"reference\"><a href=\"#cite_note-ThomopoulosMeyer2014-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>The side of the patients' chest the port is implanted in will usually be chosen to avoid damage to the port and the veins by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Seat_belt\" title=\"Seat belt\" rel=\"external_link\" target=\"_blank\">seat belt<\/a> in case of accident when seated as the driver. Thus, there is a potential conflict by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Left-_and_right-hand_traffic\" title=\"Left- and right-hand traffic\" rel=\"external_link\" target=\"_blank\">left- and right-hand traffic<\/a> as the rule of the road.<sup id=\"rdp-ebb-cite_ref-SIGU1_3-0\" class=\"reference\"><a href=\"#cite_note-SIGU1-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-SIGU2_4-0\" class=\"reference\"><a href=\"#cite_note-SIGU2-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Models\">Models<\/span><\/h2>\n<p>There are many different models of ports. The particular model selected is based on the patient's specific medical conditions.\n<\/p><p>Portals: \n<\/p>\n<ul><li>can be made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic\" title=\"Plastic\" rel=\"external_link\" target=\"_blank\">plastic<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a><\/li>\n<li>can be single chamber or dual chamber<\/li>\n<li>vary in height, width and shape.<\/li><\/ul>\n<p>Catheters:\n<\/p>\n<ul><li>can be made of biocompatible, medical-grade <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyurethane\" title=\"Polyurethane\" rel=\"external_link\" target=\"_blank\">polyurethane<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a><\/li>\n<li>can vary in length and diameter<\/li><\/ul>\n<p>Ports can be put in the upper chest or arm. The exact positioning itself is variable as it can be inserted to avoid visibility when wearing low cut shirts, and to avoid excess contact due to a backpack or bra strap. The most common placement is on the upper right portion of the chest, with the catheter itself looping through the right jugular vein, and down towards the patient's heart.\n<\/p><p>For applications as <a href=\"https:\/\/en.wikipedia.org\/wiki\/CT_scan\" title=\"CT scan\" rel=\"external_link\" target=\"_blank\">CT scan<\/a>, high pressure infusion allowing ports are needed.<sup id=\"rdp-ebb-cite_ref-HPPM1_5-0\" class=\"reference\"><a href=\"#cite_note-HPPM1-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-MMS5_6-0\" class=\"reference\"><a href=\"#cite_note-MMS5-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h2>\n<ul><li>Age: If the device is put into a child, the child's growth means that the catheter becomes relatively shorter and will move towards the head. It may become necessary to remove or replace it.<\/li>\n<li>Arterial injury: The subclavian artery can be inadvertently punctured while attempting a subclavian vein access, leading to a subcutaneous hematoma and occasionally a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pseudoaneurysm\" title=\"Pseudoaneurysm\" rel=\"external_link\" target=\"_blank\">pseudoaneurysm<\/a>. An alternative site may need to be used for port placement. Puncture of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carotid_artery\" title=\"Carotid artery\" rel=\"external_link\" target=\"_blank\">carotid artery<\/a> is significantly more rare, since attempts to access the nearby <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jugular_vein\" title=\"Jugular vein\" rel=\"external_link\" target=\"_blank\">jugular vein<\/a> are increasingly done with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasound\" title=\"Ultrasound\" rel=\"external_link\" target=\"_blank\">ultrasound<\/a> guidance.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">Infection<\/a>: An infection may develop in the line or around the port. This may require antibiotic treatment or removal of the device.<\/li>\n<li>Mechanical failure is uncommon. Ports placed through the subclavian vein may suffer from \"pinch-off syndrome\" where the catheter fractures as it passes into the vein. Ports placed via the jugular vein do not suffer from this problem. The catheter fragment then travels through the venous system and typically lodges in the right heart or the lungs. Many patients are asymptomatic but the mechanical failure is discovered because of an inability to flush or withdraw fluids from the port. In those instances, an interventional radiologist can usually retrieve the fragment and place a new port.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pneumothorax\" title=\"Pneumothorax\" rel=\"external_link\" target=\"_blank\">Pneumothorax<\/a>: Attempts to gain access to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subclavian_vein\" title=\"Subclavian vein\" rel=\"external_link\" target=\"_blank\">subclavian vein<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jugular_vein\" title=\"Jugular vein\" rel=\"external_link\" target=\"_blank\">jugular vein<\/a> can injure the lung, potentially causing a pneumothorax. If the pneumothorax is large enough, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest_tube\" title=\"Chest tube\" rel=\"external_link\" target=\"_blank\">chest tube<\/a> might need to be placed. In experienced hands, the incidence of this complication is about 1% when accessing the subclavian vein. When accessing the jugular vein the pneumothorax rate is virtually nonexistent.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Thrombosis\" title=\"Thrombosis\" rel=\"external_link\" target=\"_blank\">Thrombosis<\/a>: formation of a blood clot in the catheter may block the device irrevocably. To prevent clotting the port is flushed with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saline_(medicine)\" title=\"Saline (medicine)\" rel=\"external_link\" target=\"_blank\">saline<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heparin\" title=\"Heparin\" rel=\"external_link\" target=\"_blank\">heparin<\/a>, usually by a nurse or other medical professional, or someone properly trained that is a family member or the patient, at least once every four weeks, or more often in conjunction with administering medication.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Manufacturers\">Manufacturers<\/span><\/h2>\n<p>The major manufacturers of ports are , <a href=\"https:\/\/en.wikipedia.org\/wiki\/B._Braun_Melsungen\" title=\"B. Braun Melsungen\" rel=\"external_link\" target=\"_blank\">B. Braun Medical<\/a>,<sup id=\"rdp-ebb-cite_ref-MMS4_7-0\" class=\"reference\"><a href=\"#cite_note-MMS4-7\" rel=\"external_link\">[7]<\/a><\/sup> ,<sup id=\"rdp-ebb-cite_ref-MMS5_6-1\" class=\"reference\"><a href=\"#cite_note-MMS5-6\" rel=\"external_link\">[6]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cook_Medical\" class=\"mw-redirect\" title=\"Cook Medical\" rel=\"external_link\" target=\"_blank\">Cook Medical<\/a>, , <a href=\"https:\/\/en.wikipedia.org\/wiki\/Navilyst_Medical\" title=\"Navilyst Medical\" rel=\"external_link\" target=\"_blank\">Navilyst Medical<\/a>, , and .\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Use\">Use<\/span><\/h2>\n<p>To reduce damage or coring of the septum during use, low or non coring needles are to be used.<sup id=\"rdp-ebb-cite_ref-NEED1_8-0\" class=\"reference\"><a href=\"#cite_note-NEED1-8\" rel=\"external_link\">[8]<\/a><\/sup>\nAfter each use, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heparin\" title=\"Heparin\" rel=\"external_link\" target=\"_blank\">heparin<\/a> lock is made by injecting a small amount of heparinized saline (an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anticoagulant\" title=\"Anticoagulant\" rel=\"external_link\" target=\"_blank\">anticoagulant<\/a>) into the device, preventing development of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thrombus\" title=\"Thrombus\" rel=\"external_link\" target=\"_blank\">clots<\/a> within the port or catheter. In some catheter designs where there is a self-sealing valve at the far end, the system is locked with just saline. The port can be left accessed for as long as required. The port is covered in a dressing to protect the site from infection and to secure the needle in position.\n<\/p><p>If a port is used infrequently, it may be necessary to access the port, flush it with saline, and inject a new heparin lock to prevent clotting between uses.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Alternatives\">Alternatives<\/span><\/h2>\n<p>Sometimes, the physical condition of the patient, especially the structure of his veins, does not allow for the insertion of a port. An alternative is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peripherally_inserted_central_catheter\" title=\"Peripherally inserted central catheter\" rel=\"external_link\" target=\"_blank\">PICC line<\/a>, despite drawbacks such as external entry point and limited lifespan of the device.<sup id=\"rdp-ebb-cite_ref-PICC1_9-0\" class=\"reference\"><a href=\"#cite_note-PICC1-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"In_popular_culture\">In popular culture<\/span><\/h2>\n<p>In the 1984 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyberpunk\" title=\"Cyberpunk\" rel=\"external_link\" target=\"_blank\">cyberpunk<\/a> novel <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromancer\" title=\"Neuromancer\" rel=\"external_link\" target=\"_blank\">Neuromancer<\/a><\/i>, a minor character, Peter Riviera, has a kind of medical port placed in his arm to facilitate his <a href=\"https:\/\/en.wikipedia.org\/wiki\/Recreational_drug_use\" title=\"Recreational drug use\" rel=\"external_link\" target=\"_blank\">recreational drug use<\/a>.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hickman_line\" title=\"Hickman line\" rel=\"external_link\" target=\"_blank\">Hickman line<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Peripherally_inserted_central_catheter\" title=\"Peripherally inserted central catheter\" rel=\"external_link\" target=\"_blank\">Peripherally inserted central catheter<\/a> or \"PICC\"<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Groshong_line\" title=\"Groshong line\" rel=\"external_link\" target=\"_blank\">Groshong line<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.federalregister.gov\/documents\/2014\/07\/25\/2014-17477\/gastroenterology-urology-devices-reclassification-of-implanted-blood-access-devices\" target=\"_blank\">\"Gastroenterology-Urology Devices; Reclassification of Implanted Blood Access Devices\"<\/a>. Food and Drug Administration. 25 July 2014.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Gastroenterology-Urology+Devices%3B+Reclassification+of+Implanted+Blood+Access+Devices&rft.pub=Food+and+Drug+Administration&rft.date=2014-07-25&rft_id=https%3A%2F%2Fwww.federalregister.gov%2Fdocuments%2F2014%2F07%2F25%2F2014-17477%2Fgastroenterology-urology-devices-reclassification-of-implanted-blood-access-devices&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-ThomopoulosMeyer2014-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ThomopoulosMeyer2014_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ThomopoulosMeyer2014_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Thomopoulos, Theodoros; Meyer, Jeremy; Staszewicz, Wojciech; Bagetakos, Ilias; Scheffler, Max; Lomessy, Antoine; Toso, Christian; Becker, Christoph D.; Morel, Philippe (2014). \"Routine Chest X-ray is not Mandatory after Fluoroscopy-Guided Totally Implantable Venous Access Device Insertion\". <i>Annals of Vascular Surgery<\/i>. <b>28<\/b> (2): 345\u2013350. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.avsg.2013.08.003\" target=\"_blank\">10.1016\/j.avsg.2013.08.003<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0890-5096\" target=\"_blank\">0890-5096<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+Vascular+Surgery&rft.atitle=Routine+Chest+X-ray+is+not+Mandatory+after+Fluoroscopy-Guided+Totally+Implantable+Venous+Access+Device+Insertion&rft.volume=28&rft.issue=2&rft.pages=345-350&rft.date=2014&rft_id=info%3Adoi%2F10.1016%2Fj.avsg.2013.08.003&rft.issn=0890-5096&rft.aulast=Thomopoulos&rft.aufirst=Theodoros&rft.au=Meyer%2C+Jeremy&rft.au=Staszewicz%2C+Wojciech&rft.au=Bagetakos%2C+Ilias&rft.au=Scheffler%2C+Max&rft.au=Lomessy%2C+Antoine&rft.au=Toso%2C+Christian&rft.au=Becker%2C+Christoph+D.&rft.au=Morel%2C+Philippe&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-SIGU1-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SIGU1_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Julia Lederbogen-H\u00fclsen (2009). <i>Erleichterung der Chemotherapie durch implantierbare Portkatheter-Systeme bei Patientinnen mit gyn\u00e4kologischen Tumoren<\/i> (in German). M\u00fcnster: Universit\u00e4tsklinikum M\u00fcnster. p. 91. <q>Verlauf des Autosicherheitsgurts in die \u00dcberlegungen mit einzubeziehen (to include the place of the safety belt into the planning)<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Erleichterung+der+Chemotherapie+durch+implantierbare+Portkatheter-Systeme+bei+Patientinnen+mit+gyn%C3%A4kologischen+Tumoren&rft.place=M%C3%BCnster&rft.pages=91&rft.pub=Universit%C3%A4tsklinikum+M%C3%BCnster&rft.date=2009&rft.au=Julia+Lederbogen-H%C3%BClsen&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-SIGU2-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SIGU2_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sichereinfusionstherapie.de\/documents\/french\/OPM_9994688_Celsite_Portkath_Syst_Pflegebroschuere_Version_07-2012.pdf\" target=\"_blank\">\"Celsite\u00ae Portkatheter-Systeme\"<\/a> <span class=\"cs1-format\">(PDF)<\/span> (in German). B. Braun Melsungen. 2012. <q>Auf welcher Seite wird der Sicherheitsgurt angebracht? (which side is the safety belt)<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Celsite%C2%AE++Portkatheter-Systeme&rft.pub=B.+Braun+Melsungen&rft.date=2012&rft_id=http%3A%2F%2Fwww.sichereinfusionstherapie.de%2Fdocuments%2Ffrench%2FOPM_9994688_Celsite_Portkath_Syst_Pflegebroschuere_Version_07-2012.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-HPPM1-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-HPPM1_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.phs-medical.de\/en\/ports\/c-port-ct\/product-information\/\" target=\"_blank\">\"C-Port\u00aeCT\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">25 November<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=C-Port%C2%AECT&rft_id=http%3A%2F%2Fwww.phs-medical.de%2Fen%2Fports%2Fc-port-ct%2Fproduct-information%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-MMS5-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-MMS5_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-MMS5_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.bardaccess.com\/products\/ports\" target=\"_blank\">\"IMPLANTABLE PORT DEVICES\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">23 November<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=IMPLANTABLE+PORT+DEVICES&rft_id=https%3A%2F%2Fwww.bardaccess.com%2Fproducts%2Fports&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-MMS4-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MMS4_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.safeinfusiontherapy.com\/documents\/6050198_0613_Nursing_Guideline_low.pdf\" target=\"_blank\">\"Celsite\u00ae Access Ports\"<\/a> <span class=\"cs1-format\">(PDF)<\/span><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">23 November<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Celsite%C2%AE+Access+Ports&rft_id=http%3A%2F%2Fwww.safeinfusiontherapy.com%2Fdocuments%2F6050198_0613_Nursing_Guideline_low.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-NEED1-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-NEED1_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.safeinfusiontherapy.com\/documents\/6050198_0613_Nursing_Guideline_low.pdf\" target=\"_blank\">\"Choice of the Needles\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. p. 7<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">25 November<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Choice+of+the+Needles&rft.pages=7&rft_id=http%3A%2F%2Fwww.safeinfusiontherapy.com%2Fdocuments%2F6050198_0613_Nursing_Guideline_low.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-PICC1-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-PICC1_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Michaela Hans. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/radiologie.charite.de\/pflegeleitfaden\/leitfaden_picc_pflege.pdf\" target=\"_blank\">\"Pflegeleitfaden\"<\/a> <span class=\"cs1-format\">(PDF)<\/span> (in German). CHARIT\u00c9. p. 22<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-12-03<\/span><\/span>. <q>Liegedauer von 4 Monaten<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Pflegeleitfaden&rft.pages=22&rft.pub=CHARIT%C3%89&rft.au=Michaela+Hans&rft_id=http%3A%2F%2Fradiologie.charite.de%2Fpflegeleitfaden%2Fleitfaden_picc_pflege.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/William_Gibson\" title=\"William Gibson\" rel=\"external_link\" target=\"_blank\">Gibson, William<\/a> (July 2000) [July 1983]. <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=false\">\"Chapter Eight\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuromancer\" title=\"Neuromancer\" rel=\"external_link\" target=\"_blank\">Neuromancer<\/a><\/i> (Ace trade paperback ed.). p. 105. <q>Riviera loosened and removed the elastic length of surgical tubing from his arm. 'Yes. It's more fun.' He smiled, his eyes distant now, cheeks flushed. 'I've a membrane set in, just over the vein, so I never have to worry about the condition of the needle.' 'Doesn't hurt?' [said Case] The bright eyes met his. 'Of course it does. That's part of it, isn't it?'<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+Eight&rft.btitle=Neuromancer&rft.pages=105&rft.edition=Ace+trade+paperback&rft.date=2000-07&rft.aulast=Gibson&rft.aufirst=William&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DIDFfMPW32hQC%26pg%3DPA105%23v%3Donepage%26q%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation journal\">Mallon, William (March 2001). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1071292\" target=\"_blank\">\"Is It Acceptable to Discharge a Heroin User with an Intravenous Line to Complete His Antibiotic Therapy for Cellulitis at Home under a Nurse's Supervision?\"<\/a>. Point-Counterpoint (column). <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wjm_(journal)\" class=\"mw-redirect\" title=\"Wjm (journal)\" rel=\"external_link\" target=\"_blank\">The Western Journal of Medicine<\/a><\/i>. <b>174<\/b> (3): 157. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fewjm.174.3.157\" target=\"_blank\">10.1136\/ewjm.174.3.157<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1071292\" target=\"_blank\">1071292<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11238332\" target=\"_blank\">11238332<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Western+Journal+of+Medicine&rft.atitle=Is+It+Acceptable+to+Discharge+a+Heroin+User+with+an+Intravenous+Line+to+Complete+His+Antibiotic+Therapy+for+Cellulitis+at+Home+under+a+Nurse%27s+Supervision%3F&rft.volume=174&rft.issue=3&rft.pages=157&rft.date=2001-03&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1071292&rft_id=info%3Apmid%2F11238332&rft_id=info%3Adoi%2F10.1136%2Fewjm.174.3.157&rft.aulast=Mallon&rft.aufirst=William&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1071292&rfr_id=info%3Asid%2Fen.wikipedia.org%3APort+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.breastcancer.org\/treatment\/chemotherapy\/process\/how.jsp\" target=\"_blank\">www.breastcancer.org: Ports for Chemo<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/diehlmartin.com\/infusion\/\" target=\"_blank\">A photo-essay on what it's like to have a port<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1253\nCached time: 20181206084945\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.288 seconds\nReal time usage: 0.360 seconds\nPreprocessor visited node count: 668\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 23612\/2097152 bytes\nTemplate argument size: 91\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 28887\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.158\/10.000 seconds\nLua memory usage: 4.08 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 271.958 1 -total\n<\/p>\n<pre>69.22% 188.258 1 Template:Reflist\n36.05% 98.053 7 Template:Cite_web\n23.07% 62.751 2 Template:Cite_journal\n20.40% 55.482 1 Template:More_citations_needed\n14.71% 40.006 1 Template:Ambox\n 6.37% 17.320 2 Template:Cite_book\n 1.29% 3.508 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:14047065-1!canonical and timestamp 20181206084944 and revision id 872246448\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Port_%28medical%29\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212149\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.153 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 146.623 1 - wikipedia:Port_(medical)\n100.00% 146.623 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8055-0!*!*!*!*!*!* and timestamp 20181217212149 and revision id 24166\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Port_(medical)\">https:\/\/www.limswiki.org\/index.php\/Port_(medical)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","66f306a9b1671f4ccef0b68b1ee54d12_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/95\/PAC_met_Gripper_erin.JPG\/440px-PAC_met_Gripper_erin.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9f\/Portkatheter_R%C3%B6ntgen.JPG\/440px-Portkatheter_R%C3%B6ntgen.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e9\/Gray576.png\/440px-Gray576.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0e\/X-ray_of_port-a-cath_in_azygos_vein_-_anteroposterior.jpg\/440px-X-ray_of_port-a-cath_in_azygos_vein_-_anteroposterior.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f6\/CT_of_port-a-cath_in_azygos_vein.jpg\/440px-CT_of_port-a-cath_in_azygos_vein.jpg"],"66f306a9b1671f4ccef0b68b1ee54d12_timestamp":1545081709,"4367904b65b544bf935878c5523ffdcc_type":"article","4367904b65b544bf935878c5523ffdcc_title":"Polyaxial screw","4367904b65b544bf935878c5523ffdcc_url":"https:\/\/www.limswiki.org\/index.php\/Polyaxial_screw","4367904b65b544bf935878c5523ffdcc_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPolyaxial screw\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tA polyaxial screw is used for connecting vertebrae to rods in spinal surgery. It is essentially a screw whose spherical head is enclosed on a housing, which allows the screw a range of motion along several different axes relative to the housing. The ball joint allows the surgeon some flexibility in placing the screws.\nIt has also been hypothesized that polyaxial screws add a safety benefit by failing in the housing\/screw interface before breaking in the shaft of the bone screw or in the orthopaedic rod. \nUnlike standard lateral mass plate and screw systems, the new cervical polyaxial screw and rod system easily accommodates severe degenerative cervical spondylosis and curvatures. This instrumentation system allows for polyaxial screw placement with subsequent multiplanar rod contouring and offset attachment.[1]\n\n<\/p>\nExternal links \nU.S. Patent 5,520,690 \"Anterior spinal polyaxial locking screw plate assembly\", 1996\nReferences \n\n^ Subach, Brian R.; Haid, RW; Traynelis, VC; Sasso, RC; Subach, BR; Fiore, AJ; Rodts, GE (15 Jan 2002). \"Posterior Cervical Fixation Using a New Polyaxial Screw and Rod System: Technique and Surgical Results\". Neurosurg Focus. 12 (1): E8. PMID 16212335. \n\n\nThis surgery article is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polyaxial_screw\">https:\/\/www.limswiki.org\/index.php\/Polyaxial_screw<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:29.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 589 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","4367904b65b544bf935878c5523ffdcc_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Polyaxial_screw skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Polyaxial screw<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>A <b>polyaxial screw<\/b> is used for connecting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertebrae\" class=\"mw-redirect\" title=\"Vertebrae\" rel=\"external_link\" target=\"_blank\">vertebrae<\/a> to rods in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_surgery\" class=\"mw-redirect\" title=\"Spinal surgery\" rel=\"external_link\" target=\"_blank\">spinal surgery<\/a>. It is essentially a screw whose spherical head is enclosed on a housing, which allows the screw a range of motion along several different axes relative to the housing. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ball_joint\" title=\"Ball joint\" rel=\"external_link\" target=\"_blank\">ball joint<\/a> allows the surgeon some flexibility in placing the screws.\n<\/p><p>It has also been hypothesized that polyaxial screws add a safety benefit by failing in the housing\/screw interface before breaking in the shaft of the bone screw or in the . \n<p>Unlike standard and screw systems, the new cervical polyaxial screw and rod system easily accommodates severe degenerative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cervical_spondylosis\" class=\"mw-redirect\" title=\"Cervical spondylosis\" rel=\"external_link\" target=\"_blank\">cervical spondylosis<\/a> and curvatures. This instrumentation system allows for polyaxial screw placement with subsequent contouring and offset attachment.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><span><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.google.com\/patents\/US5520690\" target=\"_blank\">U.S. Patent 5,520,690<\/a><\/span> \"Anterior spinal polyaxial locking screw plate assembly\", 1996<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Subach, Brian R.; Haid, RW; Traynelis, VC; Sasso, RC; Subach, BR; Fiore, AJ; Rodts, GE (15 Jan 2002). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.spinemd.com\/publications\/articles\/posterior-cervical-fixation-using-a-new-polyaxial-screw-and-rod-system-technique-and-surgical-results\" target=\"_blank\">\"Posterior Cervical Fixation Using a New Polyaxial Screw and Rod System: Technique and Surgical Results\"<\/a>. <i>Neurosurg Focus<\/i>. <b>12<\/b> (1): E8. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16212335\" target=\"_blank\">16212335<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurosurg+Focus&rft.atitle=Posterior+Cervical+Fixation+Using+a+New+Polyaxial+Screw+and+Rod+System%3A+Technique+and+Surgical+Results&rft.volume=12&rft.issue=1&rft.pages=E8&rft.date=2002-01-15&rft_id=info%3Apmid%2F16212335&rft.aulast=Subach&rft.aufirst=Brian+R.&rft.au=Haid%2C+RW&rft.au=Traynelis%2C+VC&rft.au=Sasso%2C+RC&rft.au=Subach%2C+BR&rft.au=Fiore%2C+AJ&rft.au=Rodts%2C+GE&rft_id=http%3A%2F%2Fwww.spinemd.com%2Fpublications%2Farticles%2Fposterior-cervical-fixation-using-a-new-polyaxial-screw-and-rod-system-technique-and-surgical-results&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolyaxial+screw\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1266\nCached time: 20181217081109\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.116 seconds\nReal time usage: 0.147 seconds\nPreprocessor visited node count: 130\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 5494\/2097152 bytes\nTemplate argument size: 21\/2097152 bytes\nHighest expansion depth: 6\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 3297\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.070\/10.000 seconds\nLua memory usage: 1.5 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 128.491 1 -total\n<\/p>\n<pre>78.58% 100.962 1 Template:Cite_journal\n16.76% 21.536 1 Template:Surgery-stub\n14.74% 18.937 1 Template:Asbox\n 2.80% 3.595 1 Template:US_patent\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:3644357-1!canonical and timestamp 20181217081108 and revision id 709022259\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Polyaxial_screw\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212149\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.043 seconds\nReal time usage: 0.165 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 158.819 1 - wikipedia:Polyaxial_screw\n100.00% 158.819 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8054-0!*!*!*!*!*!* and timestamp 20181217212149 and revision id 24165\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Polyaxial_screw\">https:\/\/www.limswiki.org\/index.php\/Polyaxial_screw<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","4367904b65b544bf935878c5523ffdcc_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5e\/A_nurse_and_a_surgeon%2C_both_wearing_gown_and_mask._Etching_b_Wellcome_L0028811.jpg\/50px-A_nurse_and_a_surgeon%2C_both_wearing_gown_and_mask._Etching_b_Wellcome_L0028811.jpg"],"4367904b65b544bf935878c5523ffdcc_timestamp":1545081709,"a0584b5a142d7615c0f09aa793d28525_type":"article","a0584b5a142d7615c0f09aa793d28525_title":"Pessary","a0584b5a142d7615c0f09aa793d28525_url":"https:\/\/www.limswiki.org\/index.php\/Pessary","a0584b5a142d7615c0f09aa793d28525_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPessary\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (May 2008) (Learn how and when to remove this template message)\nA pessary is a prosthetic device inserted into the vagina to reduce the protrusion of pelvic structures into the vagina. It can be a route of administration of medication and provides a slow and consistent release of the medication. Pessaries are of varying shapes and sizes. They may cause vaginal ulceration if they are not correctly sized and routinely cleansed. Depending on locale, pessaries can be fitted by health care practitioners; in some countries, pessaries may be available over the counter.[1] \n\nThe term is derived from Ancient Greek: \u03c0\u03b5\u03c3\u03c3\u03ac\u03c1\u03b9\u03bf\u03bd , translit. pess\u00e1rion, \"a piece of medication-soaked wool\/lint, inserted into the vagina.\"[2] An assortment of pessaries Pessaries are mentioned in the oldest surviving copy of the Hippocratic Oath as something that physicians should never administer for the purposes of an abortion: \"Similarly I will not give to a woman a pessary to cause abortion.\"[3]\nContents \n\n1 Types of pessaries \n\n1.1 Therapeutic pessaries \n1.2 Pharmaceutical pessaries \n1.3 Occlusive pessaries \n\n1.3.1 Stem pessary \n\n\n\n\n2 General side effects \n3 See also \n4 References \n\n\nTypes of pessaries \n Different types of pessaries\nTherapeutic pessaries \nA therapeutic pessary is a medical device similar to the outer ring of a diaphragm. Therapeutic pessaries are used to support the uterus, vagina, bladder, or rectum. Pessaries are a treatment option for pelvic organ prolapse.[4] A pessary is most commonly used to treat prolapse of the uterus. It is also used to treat stress urinary incontinence, a retroverted uterus, cystocele and rectocele. Historically, pessaries may have also been used to perform abortions.\nThe Cerclage Pessary is used to treat pregnant women with cervical incompetence in order to support the cervix and turn it backward towards the sacrum. It may be indicated in pregnancies with a history of premature labor, multiple pregnancies or mothers who are exposed to physical strain (e.g. standing for a long time). It may also be indicated in pregnant women suffering from prolapse of the genital organs.[5]\nThe pessary can be placed temporarily or permanently, and must be fitted by a physician, physician assistant, midwife, or advanced practice nurse. Some pessaries can be worn during intercourse.\n\nPharmaceutical pessaries \nA pharmaceutical pessary is used as a very effective means of delivery of pharmaceutical substances easily absorbed through the skin of the vagina, or intended to have action in the locality, for example against inflammation or yeast infection, or on the uterus. Pessaries were used as birth control in ancient times[vague ].[citation needed ]\n\nOcclusive pessaries \nMain article: Cervical cap\nSee also: womb veil\nAn occlusive pessary is generally used in combination with spermicide as a contraceptive.\n\nStem pessary \nThe stem pessary, a type of occlusive pessary, was an early form of the cervical cap. Shaped like a dome, it covered the cervix, and a central rod or \"stem\" entered the uterus through the os, to hold it in place.[6]\n\nGeneral side effects \nSide effects that are shared among most different types of pessaries include: risks of increased vaginal discharge, vaginal irritation, ulceration, bleeding, and dyspareunia (painful intercourse for the male or female).\n\nSee also \nUnited States v. One Package of Japanese Pessaries\nDiaphragm (birth control)\nSuppository\nReferences \n\n\n^ \"Cystoceles, Urethroceles, Enteroceles, and Rectoceles - Gynecology and Obstetrics - Merck Manuals Professional Edition\". Merck Manuals Professional Edition. Retrieved 2017-12-29 . \n\n^ \"Pessary - Define Pessary at Dictionary.com\". dictionary.com. Retrieved 9 April 2018 . \n\n^ Hippocrates of Cos (1923). \"The Oath\". Loeb Classical Library. 147: 298\u2013299. doi:10.4159\/DLCL.hippocrates_cos-oath.1923. retrieved 18 September 2018 \n\n^ American Urogynecologic Society (May 5, 2015), \"Five Things Physicians and Patients Should Question\", Choosing Wisely: an initiative of the ABIM Foundation, American Urogynecologic Society, retrieved June 1, 2015 , which cites: * Culligan, PJ (April 2012). \"Nonsurgical management of pelvic organ prolapse\". Obstetrics and gynecology. 119 (4): 852\u201360. doi:10.1097\/aog.0b013e31824c0806. PMID 22433350. \nACOG Committee on Practice, Bulletins--Gynecology (September 2007). \"ACOG Practice Bulletin No. 85: Pelvic organ prolapse\". Obstetrics and gynecology. 110 (3): 717\u201329. doi:10.1097\/01.aog.0000263925.97887.72. PMID 17766624. .\n \n^ \"Archived copy\". Archived from the original on 2016-03-24. Retrieved 2016-03-11 . CS1 maint: Archived copy as title (link) \n\n^ \"Contraceptive Stem Pessary in Aluminium - Phisick - Medical Antiques\". www.phisick.com. Retrieved 9 April 2018 . \n\n\nvteRoutes of administration, dosage formsOralDigestive\r\ntract (enteral)Solids\nPill\nTablet\nCapsule\nPastille\nTime release technology\nOsmotic delivery system (OROS)\n\r\nLiquids\nDecoction\nElixir\nElectuary\nEmulsion\nExtended-release syrup\nEffervescent powder or tablet\nHerbal tea\nHydrogel\nMolecular encapsulation\nPowder\nSoftgel\nSolution\nSuspension\nSyrup\nSyrup Concentrate for dilution and\/or addition of carbonated water\nTincture\nBuccal (sublabial), sublingualSolids\nOrally disintegrating tablet (ODT)\nFilm\nLollipop\nSublingual drops\nLozenges\nEffervescent buccal tablet\nChewing gum\nLiquids\nMouthwash\nToothpaste\nOintment\nOral spray\nRespiratory\r\ntractSolids\nSmoking device\nDry-powder inhaler (DPI)\n\r\n0 \r\n0 Liquids\nAnaesthetic vaporizer\nVaporizer\nNebulizer\nMetered-dose inhaler (MDI)\nGas\nOxygen mask and Nasal cannula\nOxygen concentrator\nAnaesthetic machine\nRelative analgesia machine\nOphthalmic,\r\notologic, nasal\nNasal spray\nEar drops\nEye drops\nOintment\nHydrogel\nNanosphere suspension\nInsufflation\nMucoadhesive microdisc (microsphere tablet)Urogenital\nOintment\nPessary (vaginal suppository)\nVaginal ring\nVaginal douche\nIntrauterine device (IUD)\nExtra-amniotic infusion\nIntravesical infusion\nRectal (enteral)\nOintment\nSuppository\nEnema\nSolution\nHydrogel\nMurphy drip\nNutrient enemaDermal\nOintment\nTopical cream\nTopical gel\nLiniment\nPaste\nFilm\nDMSO drug solution\nElectrophoretic dermal delivery system\nHydrogel\nLiposomes\nTransfersome vesicles\nCream\nLotion\nLip balm\nMedicated shampoo\nDermal patch\nTransdermal patch\nContact (rubbed into break in the skin)\nTransdermal spray\nJet injectorInjection,\r\ninfusion\r\n(into tissue\/blood)Skin\nIntradermal\nSubcutaneous\nTransdermal implant\nOrgans\nIntracavernous\nIntravitreal\nIntra-articular injection\nTransscleral\nCentral nervous system\nIntracerebral\nIntrathecal\nEpidural\nCirculatory, musculoskeletal\nIntravenous\nIntracardiac\nIntramuscular\nIntraosseous\nIntraperitoneal\nNanocell injection\nPatient-Controlled Analgesia pump\nPIC line\n\n Category\n WikiProject\n Pharmacy portal\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Pessary\">https:\/\/www.limswiki.org\/index.php\/Pessary<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog 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version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 12 March 2016, at 17:16.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 591 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","a0584b5a142d7615c0f09aa793d28525_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Pessary skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Pessary<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>A <b>pessary<\/b> is a prosthetic device inserted into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vagina\" title=\"Vagina\" rel=\"external_link\" target=\"_blank\">vagina<\/a> to reduce the protrusion of pelvic structures into the vagina. It can be a route of administration of medication and provides a slow and consistent release of the medication. Pessaries are of varying shapes and sizes. They may cause vaginal ulceration if they are not correctly sized and routinely cleansed. Depending on locale, pessaries can be fitted by health care practitioners; in some countries, pessaries may be available over the counter.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> \n<\/p><p>\nThe term is derived from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Greek_language\" class=\"mw-redirect\" title=\"Ancient Greek language\" rel=\"external_link\" target=\"_blank\">Ancient Greek<\/a>: <span lang=\"grc\">\u03c0\u03b5\u03c3\u03c3\u03ac\u03c1\u03b9\u03bf\u03bd<\/span>, <small><a href=\"https:\/\/en.wikipedia.org\/wiki\/Romanization_of_Ancient_Greek\" class=\"mw-redirect\" title=\"Romanization of Ancient Greek\" rel=\"external_link\" target=\"_blank\">translit.<\/a> <\/small><i lang=\"grc-Latn\" title=\"Ancient Greek-language transliteration\">pess\u00e1rion<\/i>, \"a piece of medication-soaked wool\/lint, inserted into the vagina.\"<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> <\/p><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pessaries.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f5\/Pessaries.JPG\/250px-Pessaries.JPG\" width=\"250\" height=\"188\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pessaries.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An assortment of pessaries<\/div><\/div><\/div><p> Pessaries are mentioned in the oldest surviving copy of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hippocratic_Oath#Earliest_surviving_copy\" title=\"Hippocratic Oath\" rel=\"external_link\" target=\"_blank\">Hippocratic Oath<\/a> as something that physicians should never administer for the purposes of an abortion: \"Similarly I will not give to a woman a pessary to cause abortion.\"<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types_of_pessaries\">Types of pessaries<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pessary.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bf\/Pessary.png\/220px-Pessary.png\" width=\"220\" height=\"255\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pessary.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Different types of pessaries<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Therapeutic_pessaries\">Therapeutic pessaries<\/span><\/h3>\n<p>A <b>therapeutic pessary<\/b> is a medical device similar to the outer ring of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diaphragm_(contraceptive)\" class=\"mw-redirect\" title=\"Diaphragm (contraceptive)\" rel=\"external_link\" target=\"_blank\">diaphragm<\/a>. Therapeutic pessaries are used to support the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Uterus\" title=\"Uterus\" rel=\"external_link\" target=\"_blank\">uterus<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vagina\" title=\"Vagina\" rel=\"external_link\" target=\"_blank\">vagina<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinary_bladder\" title=\"Urinary bladder\" rel=\"external_link\" target=\"_blank\">bladder<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rectum\" title=\"Rectum\" rel=\"external_link\" target=\"_blank\">rectum<\/a>. Pessaries are a treatment option for pelvic organ prolapse.<sup id=\"rdp-ebb-cite_ref-AUSFive_4-0\" class=\"reference\"><a href=\"#cite_note-AUSFive-4\" rel=\"external_link\">[4]<\/a><\/sup> A pessary is most commonly used to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prolapse\" title=\"Prolapse\" rel=\"external_link\" target=\"_blank\">prolapse<\/a> of the uterus. It is also used to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinary_incontinence\" title=\"Urinary incontinence\" rel=\"external_link\" target=\"_blank\">stress urinary incontinence<\/a>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retroverted_uterus\" title=\"Retroverted uterus\" rel=\"external_link\" target=\"_blank\">retroverted uterus<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cystocele\" title=\"Cystocele\" rel=\"external_link\" target=\"_blank\">cystocele<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rectocele\" title=\"Rectocele\" rel=\"external_link\" target=\"_blank\">rectocele<\/a>. Historically, pessaries may have also been used to perform <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abortions\" class=\"mw-redirect\" title=\"Abortions\" rel=\"external_link\" target=\"_blank\">abortions<\/a>.\n<\/p><p>The <i>Cerclage Pessary<\/i> is used to treat pregnant women with cervical incompetence in order to support the cervix and turn it backward towards the sacrum. It may be indicated in pregnancies with a history of premature labor, multiple pregnancies or mothers who are exposed to physical strain (e.g. standing for a long time). It may also be indicated in pregnant women suffering from prolapse of the genital organs.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>The pessary can be placed temporarily or permanently, and must be fitted by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physician\" title=\"Physician\" rel=\"external_link\" target=\"_blank\">physician<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physician_assistant\" title=\"Physician assistant\" rel=\"external_link\" target=\"_blank\">physician assistant<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Midwife\" title=\"Midwife\" rel=\"external_link\" target=\"_blank\">midwife<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Advanced_practice_nurse\" class=\"mw-redirect\" title=\"Advanced practice nurse\" rel=\"external_link\" target=\"_blank\">advanced practice nurse<\/a>. Some pessaries can be worn during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sexual_intercourse\" title=\"Sexual intercourse\" rel=\"external_link\" target=\"_blank\">intercourse<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Pharmaceutical_pessaries\">Pharmaceutical pessaries<\/span><\/h3>\n<p>A <b>pharmaceutical pessary<\/b> is used as a very effective means of delivery of pharmaceutical substances easily absorbed through the skin of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vagina\" title=\"Vagina\" rel=\"external_link\" target=\"_blank\">vagina<\/a>, or intended to have action in the locality, for example against inflammation or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Yeast_infection\" class=\"mw-redirect\" title=\"Yeast infection\" rel=\"external_link\" target=\"_blank\">yeast infection<\/a>, or on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Uterus\" title=\"Uterus\" rel=\"external_link\" target=\"_blank\">uterus<\/a>. Pessaries were used as birth control in ancient times<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Vagueness\" title=\"Wikipedia:Vagueness\" rel=\"external_link\" target=\"_blank\"><span title=\"This information is too vague. (February 2016)\">vague<\/span><\/a><\/i>]<\/sup>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2016)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Occlusive_pessaries\">Occlusive pessaries<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cervical_cap\" title=\"Cervical cap\" rel=\"external_link\" target=\"_blank\">Cervical cap<\/a><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Womb_veil\" title=\"Womb veil\" rel=\"external_link\" target=\"_blank\">womb veil<\/a><\/div>\n<p>An <b>occlusive pessary<\/b> is generally used in combination with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spermicide\" title=\"Spermicide\" rel=\"external_link\" target=\"_blank\">spermicide<\/a> as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Contraceptive\" class=\"mw-redirect\" title=\"Contraceptive\" rel=\"external_link\" target=\"_blank\">contraceptive<\/a>.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Stem_pessary\">Stem pessary<\/span><\/h4>\n<p>The stem pessary, a type of occlusive pessary, was an early form of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cervical_cap\" title=\"Cervical cap\" rel=\"external_link\" target=\"_blank\">cervical cap<\/a>. Shaped like a dome, it covered the cervix, and a central rod or \"stem\" entered the uterus through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/External_orifice_of_the_uterus\" class=\"mw-redirect\" title=\"External orifice of the uterus\" rel=\"external_link\" target=\"_blank\">os<\/a>, to hold it in place.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"General_side_effects\">General side effects<\/span><\/h2>\n<p>Side effects that are shared among most different types of pessaries include: risks of increased <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vaginal_discharge\" title=\"Vaginal discharge\" rel=\"external_link\" target=\"_blank\">vaginal discharge<\/a>, vaginal irritation, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ulceration\" class=\"mw-redirect\" title=\"Ulceration\" rel=\"external_link\" target=\"_blank\">ulceration<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bleeding\" title=\"Bleeding\" rel=\"external_link\" target=\"_blank\">bleeding<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dyspareunia\" title=\"Dyspareunia\" rel=\"external_link\" target=\"_blank\">dyspareunia<\/a> (painful intercourse for the male or female).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_v._One_Package_of_Japanese_Pessaries\" title=\"United States v. One Package of Japanese Pessaries\" rel=\"external_link\" target=\"_blank\">United States v. One Package of Japanese Pessaries<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Diaphragm_(birth_control)\" title=\"Diaphragm (birth control)\" rel=\"external_link\" target=\"_blank\">Diaphragm (birth control)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Suppository\" title=\"Suppository\" rel=\"external_link\" target=\"_blank\">Suppository<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.merckmanuals.com\/professional\/gynecology-and-obstetrics\/pelvic-relaxation-syndromes\/cystoceles,-urethroceles,-enteroceles,-and-rectoceles\" target=\"_blank\">\"Cystoceles, Urethroceles, Enteroceles, and Rectoceles - Gynecology and Obstetrics - Merck Manuals Professional Edition\"<\/a>. <i>Merck Manuals Professional Edition<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-12-29<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Merck+Manuals+Professional+Edition&rft.atitle=Cystoceles%2C+Urethroceles%2C+Enteroceles%2C+and+Rectoceles+-+Gynecology+and+Obstetrics+-+Merck+Manuals+Professional+Edition&rft_id=https%3A%2F%2Fwww.merckmanuals.com%2Fprofessional%2Fgynecology-and-obstetrics%2Fpelvic-relaxation-syndromes%2Fcystoceles%2C-urethroceles%2C-enteroceles%2C-and-rectoceles&rfr_id=info%3Asid%2Fen.wikipedia.org%3APessary\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.dictionary.com\/browse\/pessary\" target=\"_blank\">\"Pessary - Define Pessary at Dictionary.com\"<\/a>. <i>dictionary.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">9 April<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=dictionary.com&rft.atitle=Pessary+-+Define+Pessary+at+Dictionary.com&rft_id=http%3A%2F%2Fwww.dictionary.com%2Fbrowse%2Fpessary&rfr_id=info%3Asid%2Fen.wikipedia.org%3APessary\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Hippocrates of Cos (1923). \"The Oath\". Loeb Classical Library. 147: 298\u2013299. doi:10.4159\/DLCL.hippocrates_cos-oath.1923. retrieved 18 September 2018<\/span>\n<\/li>\n<li id=\"cite_note-AUSFive-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-AUSFive_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFAmerican_Urogynecologic_Society2015\" class=\"citation\"> (May 5, 2015), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.choosingwisely.org\/societies\/american-urogynecologic-society\/\" target=\"_blank\">\"Five Things Physicians and Patients Should Question\"<\/a>, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Choosing_Wisely\" title=\"Choosing Wisely\" rel=\"external_link\" target=\"_blank\">Choosing Wisely<\/a>: an initiative of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ABIM_Foundation\" class=\"mw-redirect\" title=\"ABIM Foundation\" rel=\"external_link\" target=\"_blank\">ABIM Foundation<\/a><\/i>, American Urogynecologic Society<span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">June 1,<\/span> 2015<\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Choosing+Wisely%3A+an+initiative+of+the+ABIM+Foundation&rft.atitle=Five+Things+Physicians+and+Patients+Should+Question&rft.date=2015-05-05&rft.au=American+Urogynecologic+Society&rft_id=http%3A%2F%2Fwww.choosingwisely.org%2Fsocieties%2Famerican-urogynecologic-society%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APessary\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>, which cites: * <cite class=\"citation journal\">Culligan, PJ (April 2012). \"Nonsurgical management of pelvic organ prolapse\". <i>Obstetrics and gynecology<\/i>. <b>119<\/b> (4): 852\u201360. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2Faog.0b013e31824c0806\" target=\"_blank\">10.1097\/aog.0b013e31824c0806<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22433350\" target=\"_blank\">22433350<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Obstetrics+and+gynecology&rft.atitle=Nonsurgical+management+of+pelvic+organ+prolapse.&rft.volume=119&rft.issue=4&rft.pages=852-60&rft.date=2012-04&rft_id=info%3Adoi%2F10.1097%2Faog.0b013e31824c0806&rft_id=info%3Apmid%2F22433350&rft.aulast=Culligan&rft.aufirst=PJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3APessary\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>\n<ol><li><ul><li><cite class=\"citation journal\">ACOG Committee on Practice, Bulletins--Gynecology (September 2007). \"ACOG Practice Bulletin No. 85: Pelvic organ prolapse\". <i>Obstetrics and gynecology<\/i>. <b>110<\/b> (3): 717\u201329. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.aog.0000263925.97887.72\" target=\"_blank\">10.1097\/01.aog.0000263925.97887.72<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17766624\" target=\"_blank\">17766624<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Obstetrics+and+gynecology&rft.atitle=ACOG+Practice+Bulletin+No.+85%3A+Pelvic+organ+prolapse.&rft.volume=110&rft.issue=3&rft.pages=717-29&rft.date=2007-09&rft_id=info%3Adoi%2F10.1097%2F01.aog.0000263925.97887.72&rft_id=info%3Apmid%2F17766624&rft.aulast=ACOG+Committee+on+Practice&rft.aufirst=Bulletins--Gynecology&rfr_id=info%3Asid%2Fen.wikipedia.org%3APessary\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>.<\/li><\/ul><\/li><\/ol>\n<\/span><\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160324025247\/http:\/\/www.dr-arabin.de\/e\/cerclage.html\" target=\"_blank\">\"Archived copy\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.dr-arabin.de\/e\/cerclage.html\" target=\"_blank\">the original<\/a> on 2016-03-24<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-03-11<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Archived+copy&rft_id=http%3A%2F%2Fwww.dr-arabin.de%2Fe%2Fcerclage.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APessary\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Archived copy as title (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Archived_copy_as_title\" title=\"Category:CS1 maint: Archived copy as title\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.phisick.com\/a4pessaluminium.htm\" target=\"_blank\">\"Contraceptive Stem Pessary in Aluminium - Phisick - Medical Antiques\"<\/a>. <i>www.phisick.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">9 April<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.phisick.com&rft.atitle=Contraceptive+Stem+Pessary+in+Aluminium+-+Phisick+-+Medical+Antiques&rft_id=http%3A%2F%2Fwww.phisick.com%2Fa4pessaluminium.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3APessary\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1333\nCached time: 20181215191052\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.440 seconds\nReal time usage: 0.594 seconds\nPreprocessor visited node count: 1002\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 79069\/2097152 bytes\nTemplate argument size: 1221\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 18845\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.266\/10.000 seconds\nLua memory usage: 13.87 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 477.649 1 -total\n<\/p>\n<pre>31.78% 151.783 1 Template:Lang-grc\n28.00% 133.760 1 Template:Reflist\n16.36% 78.156 6 Template:Navbox\n15.18% 72.526 1 Template:Refimprove\n13.79% 65.867 1 Template:Dosage_forms\n12.66% 60.476 1 Template:Cite_news\n 9.30% 44.439 1 Template:Ambox\n 7.07% 33.775 2 Template:Cite_journal\n 5.23% 24.982 2 Template:Fix\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:574491-1!canonical and timestamp 20181215191052 and revision id 860058423\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Pessary\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212148\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.145 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 138.522 1 - wikipedia:Pessary\n100.00% 138.522 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8457-0!*!*!*!*!*!* and timestamp 20181217212148 and revision id 24707\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Pessary\">https:\/\/www.limswiki.org\/index.php\/Pessary<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","a0584b5a142d7615c0f09aa793d28525_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f5\/Pessaries.JPG\/500px-Pessaries.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bf\/Pessary.png\/440px-Pessary.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/00\/FlattenedRoundPills.jpg\/120px-FlattenedRoundPills.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bf\/Hexaaquatitanium%28III%29-solution.jpg\/120px-Hexaaquatitanium%28III%29-solution.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b6\/Inhaler.jpg\/120px-Inhaler.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a7\/Action_photo_of_nasal_spray_on_a_black_background.jpg\/60px-Action_photo_of_nasal_spray_on_a_black_background.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/98\/Glycerin_suppositories.jpg\/60px-Glycerin_suppositories.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/SPF15SunBlock.JPG\/80px-SPF15SunBlock.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a5\/Injection_Syringe_01.jpg\/120px-Injection_Syringe_01.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5f\/Tabletten.JPG\/32px-Tabletten.JPG"],"a0584b5a142d7615c0f09aa793d28525_timestamp":1545081708,"8edfceee6521398392d9fa246ecb1108_type":"article","8edfceee6521398392d9fa246ecb1108_title":"Peritoneovenous shunt","8edfceee6521398392d9fa246ecb1108_url":"https:\/\/www.limswiki.org\/index.php\/Peritoneovenous_shunt","8edfceee6521398392d9fa246ecb1108_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPeritoneovenous shunt\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (December 2009) (Learn how and when to remove this template message)\nPeritoneovenous shuntMeSHD010536 [edit on Wikidata]\nA peritoneovenous shunt (also called LeVeen Shunt) is a shunt which drains peritoneal fluid from the peritoneum into veins, usually the internal jugular vein or the superior vena cava. It is sometimes used in patients with refractory ascites.\nIt is a long tube with a non-return valve running subcutaneously from the peritoneum to the internal jugular vein in the neck, which allows ascitic fluid to pass directly into the systemic circulation.\nPossible complications include:\n\nInfection\nSuperior vena caval thrombosis\nPulmonary edema\nBleeding from varices\nDisseminated intravascular coagulation\nReferences \n\n\n\r\n\n\nThis medical treatment\u2013related article is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Peritoneovenous_shunt\">https:\/\/www.limswiki.org\/index.php\/Peritoneovenous_shunt<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:23.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 356 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","8edfceee6521398392d9fa246ecb1108_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Peritoneovenous_shunt skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Peritoneovenous shunt<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p>A <b>peritoneovenous shunt<\/b> (also called <b>LeVeen Shunt<\/b>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shunt_(medical)\" title=\"Shunt (medical)\" rel=\"external_link\" target=\"_blank\">shunt<\/a> which drains <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_fluid\" title=\"Peritoneal fluid\" rel=\"external_link\" target=\"_blank\">peritoneal fluid<\/a> from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneum\" title=\"Peritoneum\" rel=\"external_link\" target=\"_blank\">peritoneum<\/a> into <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">veins<\/a>, usually the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Internal_jugular_vein\" title=\"Internal jugular vein\" rel=\"external_link\" target=\"_blank\">internal jugular vein<\/a> or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superior_vena_cava\" title=\"Superior vena cava\" rel=\"external_link\" target=\"_blank\">superior vena cava<\/a>. It is sometimes used in patients with refractory <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ascites\" title=\"Ascites\" rel=\"external_link\" target=\"_blank\">ascites<\/a>.\n<\/p><p>It is a long tube with a non-return valve running subcutaneously from the peritoneum to the internal jugular vein in the neck, which allows ascitic fluid to pass directly into the systemic circulation.\n<\/p><p>Possible complications include:\n<\/p>\n<ol><li>Infection<\/li>\n<li>Superior vena caval thrombosis<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulmonary_edema\" title=\"Pulmonary edema\" rel=\"external_link\" target=\"_blank\">Pulmonary edema<\/a><\/li>\n<li>Bleeding from varices<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Disseminated_intravascular_coagulation\" title=\"Disseminated intravascular coagulation\" rel=\"external_link\" target=\"_blank\">Disseminated intravascular coagulation<\/a><\/li><\/ol>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<\/div>\n<p><br \/>\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1331\nCached time: 20181129215626\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.120 seconds\nReal time usage: 0.174 seconds\nPreprocessor visited node count: 319\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 8762\/2097152 bytes\nTemplate argument size: 140\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 0\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.058\/10.000 seconds\nLua memory usage: 1.58 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 151.205 1 -total\n<\/p>\n<pre>42.09% 63.648 1 Template:Infobox_interventions\n38.73% 58.556 1 Template:Refimprove\n37.80% 57.159 1 Template:Infobox\n28.13% 42.527 1 Template:Ambox\n11.55% 17.471 1 Template:Treatment-stub\n 9.87% 14.930 1 Template:Asbox\n 7.37% 11.137 1 Template:Reflist\n 2.17% 3.282 1 Template:Template_other\n 2.17% 3.275 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:5591664-1!canonical and timestamp 20181129215625 and revision id 679961810\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneovenous_shunt\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212148\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.157 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 151.784 1 - wikipedia:Peritoneovenous_shunt\n100.00% 151.784 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8051-0!*!*!*!*!*!* and timestamp 20181217212148 and revision id 24161\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Peritoneovenous_shunt\">https:\/\/www.limswiki.org\/index.php\/Peritoneovenous_shunt<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","8edfceee6521398392d9fa246ecb1108_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5c\/AdhesiveBandage.png\/80px-AdhesiveBandage.png"],"8edfceee6521398392d9fa246ecb1108_timestamp":1545081708,"197dc606042bfa39a6f9b4cf1b198ec3_type":"article","197dc606042bfa39a6f9b4cf1b198ec3_title":"Peripheral nerve interface","197dc606042bfa39a6f9b4cf1b198ec3_url":"https:\/\/www.limswiki.org\/index.php\/Peripheral_nerve_interface","197dc606042bfa39a6f9b4cf1b198ec3_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPeripheral nerve interface\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is an orphan, as no other articles link to it. Please introduce links to this page from related articles ; try the Find link tool for suggestions. (November 2013)\nA peripheral nerve interface is the bridge between the peripheral nervous system and a computer interface which serves as a bi\u2010directional information transducer recording and sending signals between the human body and a machine processor. Interfaces to the nervous system usually take the form of electrodes for stimulation and recording, though chemical stimulation and sensing are possible.[1] Research in this area is focused on developing peripheral nerve interfaces for the restoration of function following disease or injury to minimize associated losses. Peripheral nerve interfaces also enable electrical stimulation and recording of the peripheral nervous system to study the form and function of the peripheral nervous system. Many researchers also focus in the area of neuroprosthesis, linking the human nervous system to bionics in order to mimic natural sensorimotor control and function.[2] Successful implantation of peripheral nerve interfaces depend on a number of factors which include appropriate indication, perioperative testing, differentiated planning, and functional training.[3] Typically microelectrode devices are implanted adjacent to, around or within the nerve trunk to establish contact with the peripheral nervous system. Different approaches may be used depending on the type of signal desired and attainable.\n\nContents \n\n1 Function \n2 Problems and limitations \n3 Application \n4 Types \n\n4.1 Epineurial electrode interface \n4.2 Helicoidal electrode interface \n4.3 Book electrode interface \n\n\n5 References \n\n\nFunction \nThe primary purpose of a neural interface is to enable two-way exchange of information with the nervous system for a sustained period of time to enable effective and high density stimulation and recording. The peripheral nervous system (PNS) is responsible for relaying information from the brain and spinal cord to the extremities of the body and back. The function of a peripheral nerve interface is to assist the nervous system when peripheral nerve function is compromised. To supplement the roles of the nervous system, interfaces need to augment motor function as well as discern sensory information. The feasibility of peripheral nerve stimulation to achieve a desired motor output has been demonstrated and is one of the major driving forces for this area of research.[4] Information throughout the nervous system is exchanged primarily through action potentials. These signals occur at varying numbers and intervals dependent on both the neuroanatomical and neurochemical make up of the individual and localized region. Information may be either introduced or read out by inducing or recovering action potentials from the body. Successful development and implementation of a peripheral nerve interface would allow for both the introduction of information to the nervous system, and extraction of information from the nervous system.\n\nProblems and limitations \nProblems and limitations in peripheral nerve interfacing are both biophysical and biological in nature. These challenges[1] include:\n\nFidelity of the interface in terms of functional resolution\nRelatively weak, noise-ridden electrical signals causing a challenging interface design constraint\nInterface implantation-associated injury to nerve fibers of interest\nStability of the interface over time due to inflammation\nManaging inadvertent consequences such as pain or false sensory\/motor stimulation due to physical movement or inflammation-associated triggering of neural activity\nApplication \nPeripheral nerve interfaces are used for pain modulation,[5] restoration of motor function following spinal cord injury or stroke,[6] treatment of epilepsy by electrical stimulation of the vagus nerve,[7] nerve stimulation to control micturition, occipital nerve stimulation for chronic migraines and to interface with neuroprosthetics. \n\nTypes \nA wide variety of electrode designs have been researched, tested, and manufactured.[8][9] These electrodes lie on a spectrum varying in degrees of invasiveness. Research in this area seeks to address issues centered around peripheral nerve\/tissue damage, access to efferent and afferent signals, and selective recording\/stimulation of nerve tissue. Ideally peripheral nerve interfaces are optimally designed to interface with biological constraints of peripheral nerve fibers, match the mechanical and electrical properties of the surrounding tissue, biocompatible with minimal immune response, high sensor resolution, are minimally invasive, and chronically stable with low signal-to-noise ratios. Strongest signals are recorded from nodes of ranvier. Peripheral nerve interfaces may be divided into extraneural and intrafascular categories.\n\nEpineurial electrode interface \nEpineurial electrodes are fabricated as longitudinal strips holding two or more contact sites to interface with peripheral nerves. These electrodes are placed on the nerve and secured by suturing to the epineurium. The suturing process requires delicate surgery and can be torn from the nerve if excessive motion creates tension. Since the electrode is sutured to the epineurium it is unlikely to damage the nerve trunk.\n\nHelicoidal electrode interface \nHelicoidal electrodes are placed cirumjacent to the nerve and are made of flexible platinum ribbon in a helical design. This design allows the electrode to conform to the size and shape of the nerve in attempts to minimize mechanical trauma. The structural design causes low selectivity. Helicoidal electrodes are currently used for FES stimulation of the vagus nerve to control intractable epilepsy, sleep apnea, and to treat depressive syndromes.\n\nBook electrode interface \nThe book electrode consists of a silicone rubber block with slots. Each slot contains three platinum foils which function as electrodes, anode electrodes and one cathode. The spinal roots of the nerve are placed into these slots and the slots are then covered with a flap made of silicone and fixed with silicone glue. This electrode is mostly used to interrupt reflex circuits of the dorsal sacral roots and to control bladder function. Book electrodes are still considered very bulky.\n\nReferences \n\n^ a b Grill, W. M., Norman, S. E., & Bellamkonda, R. V. (2009). Implanted neural interfaces: biochallenges and engineered solutions. Annual review of biomedical engineering, 11, 1\u201324. doi:10.1146\/annurev-bioeng-061008-124927 \n\n^ Donaldson PEK (1983). The Cooper cable: An Implantable Multiconductor cable for neurological prostheses. Med Biol Eng Comput 21:371-374 \n\n^ Navarro, X., Krueger, T. B., Lago, N., Micera, S., Stieglitz, T., & Dario, P. (2005). A critical review of interfaces with the peripheral nervous system for the control of neuroprostheses and hybrid bionic systems. Journal of the peripheral nervous system : JPNS, 10(3), 229\u201358. doi:10.1111\/j.1085-9489.2005.10303.x \n\n^ Bhadra N, Peckham PH. 1997. Peripheral nerve stimulation for restoration of motor function. J. Clin. Neurophysiol. 14:378\u201393 \n\n^ Weiner RL. 2000. The future of peripheral nerve neurostimulation. Neurol. Res. 22:299\u2013304 3. \n\n^ Stein RB, Peckham PH, Popovic DB, eds. 1992. Neural Prostheses Replacing Motor Function After Disease or Disability.New York: Oxford Univ. Press \n\n^ George R, Sonnen A, Upton A, Salinsky M, Ristanovic R, et al. 1995. A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. Neurology 45:224\u201330 \n\n^ \"M. Varga, M. Luniak and K. J. Wolter, \"Novel self-folding electrode for neural stimulation and recording,\" Electronics and Nanotechnology (ELNANO), 2013 IEEE XXXIII International Scientific Conference, Kiev, 2013, pp. 237-240\". \n\n^ \"M. Varga, M. Luniak and K. J. Wolter, \"Technology for bipolar polycarbonate electrodes applied for intraoperative neuromonitoring,\" Electronics Packaging Technology Conference (EPTC 2013), 2013 IEEE 15th, Singapore, 2013, pp. 103-107\". \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Peripheral_nerve_interface\">https:\/\/www.limswiki.org\/index.php\/Peripheral_nerve_interface<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 22:25.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 427 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","197dc606042bfa39a6f9b4cf1b198ec3_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Peripheral_nerve_interface skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Peripheral nerve interface<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>A <b>peripheral nerve interface<\/b> is the bridge between the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peripheral_nervous_system\" title=\"Peripheral nervous system\" rel=\"external_link\" target=\"_blank\">peripheral nervous system<\/a> and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer_interface\" class=\"mw-redirect\" title=\"Computer interface\" rel=\"external_link\" target=\"_blank\">computer interface<\/a> which serves as a bi\u2010directional information <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transducer\" title=\"Transducer\" rel=\"external_link\" target=\"_blank\">transducer<\/a> recording and sending signals between the human body and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Machine_processing\" class=\"mw-redirect\" title=\"Machine processing\" rel=\"external_link\" target=\"_blank\">machine processor<\/a>. Interfaces to the nervous system usually take the form of electrodes for stimulation and recording, though chemical stimulation and sensing are possible.<sup id=\"rdp-ebb-cite_ref-Warren_1-0\" class=\"reference\"><a href=\"#cite_note-Warren-1\" rel=\"external_link\">[1]<\/a><\/sup> Research in this area is focused on developing peripheral nerve interfaces for the restoration of function following disease or injury to minimize associated losses. Peripheral nerve interfaces also enable electrical stimulation and recording of the peripheral nervous system to study the form and function of the peripheral nervous system. Many researchers also focus in the area of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroprosthesis\" class=\"mw-redirect\" title=\"Neuroprosthesis\" rel=\"external_link\" target=\"_blank\">neuroprosthesis<\/a>, linking the human nervous system to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bionic_hand#In_medicine\" class=\"mw-redirect\" title=\"Bionic hand\" rel=\"external_link\" target=\"_blank\">bionics<\/a> in order to mimic natural <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sensorimotor_coupling\" class=\"mw-redirect\" title=\"Sensorimotor coupling\" rel=\"external_link\" target=\"_blank\">sensorimotor control<\/a> and function.<sup id=\"rdp-ebb-cite_ref-Donaldson_2-0\" class=\"reference\"><a href=\"#cite_note-Donaldson-2\" rel=\"external_link\">[2]<\/a><\/sup> Successful implantation of peripheral nerve interfaces depend on a number of factors which include appropriate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Indication_(medicine)\" title=\"Indication (medicine)\" rel=\"external_link\" target=\"_blank\">indication<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Perioperative\" title=\"Perioperative\" rel=\"external_link\" target=\"_blank\"> perioperative testing<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Differentiated_instruction\" title=\"Differentiated instruction\" rel=\"external_link\" target=\"_blank\">differentiated planning<\/a>, and functional training.<sup id=\"rdp-ebb-cite_ref-NavarroReview_3-0\" class=\"reference\"><a href=\"#cite_note-NavarroReview-3\" rel=\"external_link\">[3]<\/a><\/sup> Typically <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microelectrode\" title=\"Microelectrode\" rel=\"external_link\" target=\"_blank\">microelectrode<\/a> devices are implanted adjacent to, around or within the nerve trunk to establish contact with the peripheral nervous system. Different approaches may be used depending on the type of signal desired and attainable.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Function\">Function<\/span><\/h2>\n<p>The primary purpose of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neural_interface\" class=\"mw-redirect\" title=\"Neural interface\" rel=\"external_link\" target=\"_blank\">neural interface<\/a> is to enable two-way exchange of information with the nervous system for a sustained period of time to enable effective and high density stimulation and recording. The peripheral nervous system (PNS) is responsible for relaying information from the brain and spinal cord to the extremities of the body and back. The function of a peripheral nerve interface is to assist the nervous system when peripheral nerve function is compromised. To supplement the roles of the nervous system, interfaces need to augment motor function as well as discern sensory information. The feasibility of peripheral nerve stimulation to achieve a desired motor output has been demonstrated and is one of the major driving forces for this area of research.<sup id=\"rdp-ebb-cite_ref-Bhadra_4-0\" class=\"reference\"><a href=\"#cite_note-Bhadra-4\" rel=\"external_link\">[4]<\/a><\/sup> Information throughout the nervous system is exchanged primarily through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Action_potential\" title=\"Action potential\" rel=\"external_link\" target=\"_blank\">action potentials<\/a>. These signals occur at varying numbers and intervals dependent on both the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroanatomy\" title=\"Neuroanatomy\" rel=\"external_link\" target=\"_blank\">neuroanatomical<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurochemical\" title=\"Neurochemical\" rel=\"external_link\" target=\"_blank\">neurochemical<\/a> make up of the individual and localized region. Information may be either introduced or read out by inducing or recovering action potentials from the body. Successful development and implementation of a peripheral nerve interface would allow for both the introduction of information to the nervous system, and extraction of information from the nervous system.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Problems_and_limitations\">Problems and limitations<\/span><\/h2>\n<p>Problems and limitations in peripheral nerve interfacing are both biophysical and biological in nature. These challenges<sup id=\"rdp-ebb-cite_ref-Warren_1-1\" class=\"reference\"><a href=\"#cite_note-Warren-1\" rel=\"external_link\">[1]<\/a><\/sup> include:\n<\/p>\n<ul><li>Fidelity of the interface in terms of functional resolution<\/li>\n<li>Relatively weak, noise-ridden electrical signals causing a challenging interface design constraint<\/li>\n<li>Interface implantation-associated injury to nerve fibers of interest<\/li>\n<li>Stability of the interface over time due to inflammation<\/li>\n<li>Managing inadvertent consequences such as pain or false sensory\/motor stimulation due to physical movement or inflammation-associated triggering of neural activity<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Application\">Application<\/span><\/h2>\n<p>Peripheral nerve interfaces are used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_modulation\" class=\"mw-redirect\" title=\"Pain modulation\" rel=\"external_link\" target=\"_blank\">pain modulation<\/a>,<sup id=\"rdp-ebb-cite_ref-Weiner_5-0\" class=\"reference\"><a href=\"#cite_note-Weiner-5\" rel=\"external_link\">[5]<\/a><\/sup> restoration of motor function following <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_injury\" title=\"Spinal cord injury\" rel=\"external_link\" target=\"_blank\">spinal cord injury<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a>,<sup id=\"rdp-ebb-cite_ref-Stein_6-0\" class=\"reference\"><a href=\"#cite_note-Stein-6\" rel=\"external_link\">[6]<\/a><\/sup> treatment of epilepsy by electrical stimulation of the vagus nerve,<sup id=\"rdp-ebb-cite_ref-George_7-0\" class=\"reference\"><a href=\"#cite_note-George-7\" rel=\"external_link\">[7]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacral_nerve_stimulation\" title=\"Sacral nerve stimulation\" rel=\"external_link\" target=\"_blank\">nerve stimulation<\/a> to control micturition, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peripheral_nerve_stimulation_of_the_occipital_nerves\" class=\"mw-redirect\" title=\"Peripheral nerve stimulation of the occipital nerves\" rel=\"external_link\" target=\"_blank\">occipital nerve stimulation<\/a> for chronic migraines and to interface with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroprosthetics\" title=\"Neuroprosthetics\" rel=\"external_link\" target=\"_blank\">neuroprosthetics<\/a>. \n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<p>A wide variety of electrode designs have been researched, tested, and manufactured.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> These electrodes lie on a spectrum varying in degrees of invasiveness. Research in this area seeks to address issues centered around peripheral nerve\/tissue damage, access to efferent and afferent signals, and selective recording\/stimulation of nerve tissue. Ideally peripheral nerve interfaces are optimally designed to interface with biological constraints of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nerve_fiber\" class=\"mw-redirect\" title=\"Nerve fiber\" rel=\"external_link\" target=\"_blank\">peripheral nerve fibers<\/a>, match the <a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_materials_properties#Mechanical_properties\" title=\"List of materials properties\" rel=\"external_link\" target=\"_blank\">mechanical<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_materials_properties#Electrical_properties\" title=\"List of materials properties\" rel=\"external_link\" target=\"_blank\">electrical properties<\/a> of the surrounding tissue, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatible<\/a> with minimal immune response, high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sensor_resolution#Resolution\" class=\"mw-redirect\" title=\"Sensor resolution\" rel=\"external_link\" target=\"_blank\">sensor resolution<\/a>, are minimally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Invasiveness\" class=\"mw-redirect\" title=\"Invasiveness\" rel=\"external_link\" target=\"_blank\">invasive<\/a>, and chronically stable with low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Signal-to-noise_ratio\" title=\"Signal-to-noise ratio\" rel=\"external_link\" target=\"_blank\">signal-to-noise ratios<\/a>. Strongest signals are recorded from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Node_of_Ranvier\" title=\"Node of Ranvier\" rel=\"external_link\" target=\"_blank\">nodes of ranvier<\/a>. Peripheral nerve interfaces may be divided into extraneural and intrafascular categories.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Epineurial_electrode_interface\">Epineurial electrode interface<\/span><\/h3>\n<p>Epineurial electrodes are fabricated as longitudinal strips holding two or more contact sites to interface with peripheral nerves. These electrodes are placed on the nerve and secured by suturing to the epineurium. The suturing process requires delicate surgery and can be torn from the nerve if excessive motion creates tension. Since the electrode is sutured to the epineurium it is unlikely to damage the nerve trunk.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Helicoidal_electrode_interface\">Helicoidal electrode interface<\/span><\/h3>\n<p>Helicoidal electrodes are placed cirumjacent to the nerve and are made of flexible platinum ribbon in a helical design. This design allows the electrode to conform to the size and shape of the nerve in attempts to minimize mechanical trauma. The structural design causes low selectivity. Helicoidal electrodes are currently used for FES stimulation of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vagus_nerve\" title=\"Vagus nerve\" rel=\"external_link\" target=\"_blank\">vagus nerve<\/a> to control intractable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epilepsy\" title=\"Epilepsy\" rel=\"external_link\" target=\"_blank\">epilepsy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sleep_apnea\" title=\"Sleep apnea\" rel=\"external_link\" target=\"_blank\">sleep apnea<\/a>, and to treat depressive syndromes.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Book_electrode_interface\">Book electrode interface<\/span><\/h3>\n<p>The book electrode consists of a silicone rubber block with slots. Each slot contains three platinum foils which function as electrodes, anode electrodes and one cathode. The spinal roots of the nerve are placed into these slots and the slots are then covered with a flap made of silicone and fixed with silicone glue. This electrode is mostly used to interrupt reflex circuits of the dorsal sacral roots and to control bladder function. Book electrodes are still considered very bulky.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-Warren-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Warren_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Warren_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Grill, W. M., Norman, S. E., & Bellamkonda, R. V. (2009). Implanted neural interfaces: biochallenges and engineered solutions. Annual review of biomedical engineering, 11, 1\u201324. doi:10.1146\/annurev-bioeng-061008-124927<\/span>\n<\/li>\n<li id=\"cite_note-Donaldson-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Donaldson_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Donaldson PEK (1983). The Cooper cable: An Implantable Multiconductor cable for neurological prostheses. Med Biol Eng Comput 21:371-374<\/span>\n<\/li>\n<li id=\"cite_note-NavarroReview-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-NavarroReview_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Navarro, X., Krueger, T. B., Lago, N., Micera, S., Stieglitz, T., & Dario, P. (2005). A critical review of interfaces with the peripheral nervous system for the control of neuroprostheses and hybrid bionic systems. Journal of the peripheral nervous system : JPNS, 10(3), 229\u201358. doi:10.1111\/j.1085-9489.2005.10303.x<\/span>\n<\/li>\n<li id=\"cite_note-Bhadra-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Bhadra_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Bhadra N, Peckham PH. 1997. Peripheral nerve stimulation for restoration of motor function. J. Clin. Neurophysiol. 14:378\u201393<\/span>\n<\/li>\n<li id=\"cite_note-Weiner-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Weiner_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Weiner RL. 2000. The future of peripheral nerve neurostimulation. Neurol. Res. 22:299\u2013304 3.<\/span>\n<\/li>\n<li id=\"cite_note-Stein-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Stein_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Stein RB, Peckham PH, Popovic DB, eds. 1992. Neural Prostheses Replacing Motor Function After Disease or Disability.New York: Oxford Univ. Press<\/span>\n<\/li>\n<li id=\"cite_note-George-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-George_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">George R, Sonnen A, Upton A, Salinsky M, Ristanovic R, et al. 1995. A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. Neurology 45:224\u201330<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ieeexplore.ieee.org\/stamp\/stamp.jsp?tp=&arnumber=6552092&isnumber=6551989\" target=\"_blank\">\"M. Varga, M. Luniak and K. J. Wolter, \"Novel self-folding electrode for neural stimulation and recording,\" Electronics and Nanotechnology (ELNANO), 2013 IEEE XXXIII International Scientific Conference, Kiev, 2013, pp. 237-240\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=M.+Varga%2C+M.+Luniak+and+K.+J.+Wolter%2C+%22Novel+self-folding+electrode+for+neural+stimulation+and+recording%2C%22+Electronics+and+Nanotechnology+%28ELNANO%29%2C+2013+IEEE+XXXIII+International+Scientific+Conference%2C+Kiev%2C+2013%2C+pp.+237-240.&rft_id=http%3A%2F%2Fieeexplore.ieee.org%2Fstamp%2Fstamp.jsp%3Ftp%3D%26arnumber%3D6552092%26isnumber%3D6551989&rfr_id=info%3Asid%2Fen.wikipedia.org%3APeripheral+nerve+interface\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ieeexplore.ieee.org\/stamp\/stamp.jsp?tp=&arnumber=6745693&isnumber=6745670\" target=\"_blank\">\"M. Varga, M. Luniak and K. J. Wolter, \"Technology for bipolar polycarbonate electrodes applied for intraoperative neuromonitoring,\" Electronics Packaging Technology Conference (EPTC 2013), 2013 IEEE 15th, Singapore, 2013, pp. 103-107\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=M.+Varga%2C+M.+Luniak+and+K.+J.+Wolter%2C+%22Technology+for+bipolar+polycarbonate+electrodes+applied+for+intraoperative+neuromonitoring%2C%22+Electronics+Packaging+Technology+Conference+%28EPTC+2013%29%2C+2013+IEEE+15th%2C+Singapore%2C+2013%2C+pp.+103-107.&rft_id=http%3A%2F%2Fieeexplore.ieee.org%2Fstamp%2Fstamp.jsp%3Ftp%3D%26arnumber%3D6745693%26isnumber%3D6745670&rfr_id=info%3Asid%2Fen.wikipedia.org%3APeripheral+nerve+interface\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1325\nCached time: 20181217071432\nCache expiry: 86400\nDynamic content: true\nCPU time usage: 0.156 seconds\nReal time usage: 0.215 seconds\nPreprocessor visited node count: 301\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 10110\/2097152 bytes\nTemplate argument size: 1012\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 8883\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.081\/10.000 seconds\nLua memory usage: 1.75 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 179.606 1 -total\n<\/p>\n<pre>48.49% 87.085 2 Template:Cite_web\n45.14% 81.073 1 Template:Orphan\n33.44% 60.059 1 Template:Draft_other\n31.73% 56.994 1 Template:Ambox\n 1.74% 3.129 1 Template:Monthyear-1\n 1.64% 2.952 1 Template:Monthyear\n 1.55% 2.791 2 Template:PAGENAMEU\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:41121740-1!canonical and timestamp 20181217071431 and revision id 813856719\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Peripheral_nerve_interface\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212147\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.051 seconds\nReal time usage: 0.177 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 171.798 1 - wikipedia:Peripheral_nerve_interface\n100.00% 171.798 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8279-0!*!*!*!*!*!* and timestamp 20181217212147 and revision id 24491\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Peripheral_nerve_interface\">https:\/\/www.limswiki.org\/index.php\/Peripheral_nerve_interface<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","197dc606042bfa39a6f9b4cf1b198ec3_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/6c\/Wiki_letter_w.svg\/80px-Wiki_letter_w.svg.png"],"197dc606042bfa39a6f9b4cf1b198ec3_timestamp":1545081707,"8c8d0da61c507a33c2f7c3f5fe6c7de7_type":"article","8c8d0da61c507a33c2f7c3f5fe6c7de7_title":"Penile prosthesis","8c8d0da61c507a33c2f7c3f5fe6c7de7_url":"https:\/\/www.limswiki.org\/index.php\/Penile_prosthesis","8c8d0da61c507a33c2f7c3f5fe6c7de7_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPenile prosthesis\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article includes a list of references, but its sources remain unclear because it has insufficient inline citations. Please help to improve this article by introducing more precise citations. (July 2011) (Learn how and when to remove this template message)\nA penile prosthesis, or penile implant, is a medical device which is surgically implanted within the corpora cavernosa of the penis during a surgical procedure. The device is indicated for use in men with organic or treatment-resistant impotence or erectile dysfunction that is the result of various physical conditions such as cardiovascular disease, diabetes, pelvic trauma, Peyronie's disease, or as the result of prostate cancer treatments.[1] Less commonly, a penile prosthesis may also be used in the final stage of plastic surgery phalloplasty to complete female to male gender reassignment surgery as well as during total phalloplasty for adult and child patients that need male genital modification.\n\nContents \n\n1 Reasons for use \n2 Types of devices \n3 Advantages \n4 Disadvantages \n5 References \n6 External links \n\n\nReasons for use \nA penile implant is one treatment option available to individuals who are unable to achieve or maintain an erection adequate for successful sexual intercourse or penetration. Its primary use is for men with erectile dysfunction from vascular conditions (cardiovascular disease, high blood pressure, diabetes), congenital anomalies, iatrogenic, accidental penile or pelvic trauma, Peyronie's disease, or as a result of prostate cancer treatments. This implant is normally considered when less invasive medical treatments such as oral medications (PDE5 inhibitors: Viagra, Levitra, Cialis), penile injections, or vacuum erection devices are unsuccessful, provide an unsatisfactory result, or are contraindicated.[2] For example, many drugs used to treat erectile dysfunction are unsuitable for patients with heart problems and may interfere with other medications.\nSometimes a penile prosthesis is implanted during surgery to alter, construct or reconstruct the penis in phalloplasty. The British Journal of Urology International reports[3] that unlike metoidioplasty for female to male sexual reassignment patients, which may result in a penis that is long but narrow, current total phalloplasty neophallus creation using a musculocutaneous latissimus dorsi flap could result in a long, large volume penis which enables safe insertion of any type of penile prosthesis.\nThis same technique enables male victims of minor to serious iatrogenic, accidental or intentional penile trauma injuries (or even total emasculation) caused by accidents, child abuse or self-mutilation to have penises suitable for penile prosthesis implantation enabling successful sexual intercourse.\nIn some cases of genital reconstructive surgery, implantation of a semirigid prosthesis is recommended for three months after total phalloplasty to prevent phallic retraction. It can be replaced later with an inflatable one.\n\nTypes of devices \nThere are two primary types of penile prosthesis: noninflatable semirigid devices, and inflatable devices.[4] Noninflatable, semirigid devices consist of rods implanted into the erection chambers of the penis and can be bent into position as needed for sexual penetration. With this type of implant the penis is always semi-rigid and therefore may be difficult to conceal.[5]\nHydraulic, inflatable prosthesis also exist and were first described in 1973 by Brantley Scott et al.[6] These saline-filled devices consist of inflatable cylinders placed in the erection chambers of the penis, a pump placed in the scrotum for patient-activated inflation\/deflation, and a reservoir placed in the abdomen which stores the fluid. The device is inflated by squeezing the pump several times to transfer fluid from the reservoir to the chambers in the penis. After intercourse, a valve next to the pump is manually operated, allowing fluid to be released from the penis (not instantaneously; squeezing the penis may be necessary), causing the penis to return to a flaccid or semi-flaccid condition. Almost all implanted penile prosthesis devices perform satisfactorily for a decade or more before needing replacement.[7] Some surgeons recommend these due to the opinion that they are more easily concealed and provide the highest levels of patient\/partner satisfaction.\n\n Three piece inflatable penile prosthesis\nAdvantages \nMechanical failure rates are low: most often inability to deflate the penis because of pump failure; less often inability to inflate the prosthesis; and sometimes disconnection or failure of the reservoir.\nIPP (Inflatable Penile Prostheses) are easily concealable under clothing including swimsuits or jeans.\nThe erection can be maintained as long as necessary, or as long as desired without any of the potentially serious complications of organic priapism.\nPsychological and emotional well-being is enhanced in a proportion of men who undergo implant surgery. Some studies indicate a high level of patient satisfaction, attributable in part to improved technology in the prosthesis itself, improved surgical techniques making the procedure less painful, and more reasonable patient expectations.\nInflation of the device can be accomplished discreetly.\nDisadvantages \nThe glans does not enlarge and sexual penetration may be awkward. The penis also may not be as firm as a natural erection.\nSome models do not deflate easily; some degree of manual dexterity is required to operate any of the inflatable models, making them inappropriate for men with other neurological disorders such as stroke or Parkinson's disease.\nThe penis may not be completely flaccid, depending upon the model of prosthesis (most usually seen in semi-rigid or malleable implants).\nMany men lose between 1\u20132 cm (.25 to .75 in) in length.\nFollowing surgery, patients experience one to two weeks of moderate or occasionally severe pain, usually controlled with analgesics. This is most often due to scrotal swelling, which can be quite profound at times. Normal sexual intercourse can be resumed six to eight weeks post-operatively, pending clearance from the surgeon.\nNot all men report complete satisfaction with the prosthesis.\nSome studies indicate a partner satisfaction rate of 70% or less, due, some studies suggest, to heightened or unreasonable expectations. Many surgeons are now recommending that both partners be counseled pre-operatively regarding outcome and expectations.\nThe inflation of the devices is not instantaneous.\nIt can be difficult to conceal a prosthesis because the scrotal components are hard and irregularly shaped. A partner feeling the scrotum will notice this.\nManual stimulation can be painful.\nThere is a 2-10% complication rate, mainly as a result of infection or device failure. Complications include: uncontrolled bleeding after the surgery possibly leading to re-operation, scar tissue formation, erosion (tissue around the implant may break down) requiring removal or mechanical failure leading to re-operation and removal.\nReferences \n\n\n^ Sadeghi-Nejad H. Penile prosthesis surgery: a review of prosthetic devices and associated complications. J Sex Med 2007; 4: 296-309. \n\n^ Garber B. Inflatable penile prostheses for the treatment of erectile dysfunction: an update. Expert Rev Med Devices 2008; 5(2): 133-144. \n\n^ British Journal of Urology International, Volume 100, Number 4, pp 899-905, Reconstructive Urology: Total phalloplasty using a musculocutaneous latissimus dorsi flap, Sava V. Perovic, Rados Djinovic et al., School of Medicine, Belgrade University \n\n^ Simmons M, Montague D. \"Penile prosthesis implantation: past, present, and future\". Int J Imp Res 2008; 20: 37-444. \n\n^ \"penile imaplnt types\". International society of sexual medicine. 2015-12-16. Retrieved 2018-08-14 . \n\n^ Scott B, Bradley W, Timm G. \"Management of erectile impotence: use of inflatable prosthesis\". Urol 1973; 2: 80-82. \n\n^ Wilson S, Delk J, Salem E. \"Long-term survival of inflatable penile prostheses: single surgical group experience with 2,384 first-time implants spanning two decades\". J Sex Med 2007; 4: 1074-1079. \n\n\nExternal links \nMedscape\nhttps:\/\/web.archive.org\/web\/20090314071253\/http:\/\/cat.inist.fr\/?aModele=afficheN&cpsidt=862126\nvteMale genital surgical and other procedures: reproductive system (ICD-9-CM V3 60\u201364, ICD-10-PCS 0V)InternalProstate\nTransurethral incision of the prostate\nProstate biopsy\nTransrectal biopsy\nTransurethral biopsy\nProstatectomy\nTransurethral resection of the prostate\nRadical retropubic prostatectomy\nTransurethral microwave thermotherapy\nTransurethral needle ablation of the prostate\nBrachytherapy\nProstate brachytherapy\nProstate massage\nseminal vesicles:\nSpermatocelectomy\nVas deferens\nVasectomy\nVasectomy reversal\nVasovasostomy\nVasoepididymostomy\nTestes\nOrchiectomy\nCastration\nOrchiopexy\nExternalPenis\nCircumcision\nPenectomy\nPenile prosthesis\nPreputioplasty\n\nPenile plethysmograph\nPostage stamp test\nFrenuloplasty of prepuce of penis\nTests\nSemen analysis\nMedical imaging\nTransscrotal ultrasound\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Penile_prosthesis\">https:\/\/www.limswiki.org\/index.php\/Penile_prosthesis<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:21.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 990 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","8c8d0da61c507a33c2f7c3f5fe6c7de7_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Penile_prosthesis skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Penile prosthesis<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>A <b>penile prosthesis<\/b>, or penile implant, is a medical device which is surgically implanted within the corpora cavernosa of the penis during a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgical procedure<\/a>. The device is indicated for use in men with organic or treatment-resistant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Impotence\" class=\"mw-redirect\" title=\"Impotence\" rel=\"external_link\" target=\"_blank\">impotence<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Erectile_dysfunction\" title=\"Erectile dysfunction\" rel=\"external_link\" target=\"_blank\">erectile dysfunction<\/a> that is the result of various physical conditions such as cardiovascular disease, diabetes, pelvic trauma, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peyronie%27s_disease\" title=\"Peyronie's disease\" rel=\"external_link\" target=\"_blank\">Peyronie's disease<\/a>, or as the result of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostate_cancer\" title=\"Prostate cancer\" rel=\"external_link\" target=\"_blank\">prostate cancer<\/a> treatments.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> Less commonly, a penile prosthesis may also be used in the final stage of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">plastic surgery<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phalloplasty\" title=\"Phalloplasty\" rel=\"external_link\" target=\"_blank\">phalloplasty<\/a> to complete female to male <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gender_reassignment_surgery\" class=\"mw-redirect\" title=\"Gender reassignment surgery\" rel=\"external_link\" target=\"_blank\">gender reassignment surgery<\/a> as well as during total <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phalloplasty\" title=\"Phalloplasty\" rel=\"external_link\" target=\"_blank\">phalloplasty<\/a> for adult and child patients that need male <a href=\"https:\/\/en.wikipedia.org\/wiki\/Genital_modification\" class=\"mw-redirect\" title=\"Genital modification\" rel=\"external_link\" target=\"_blank\">genital modification<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Reasons_for_use\">Reasons for use<\/span><\/h2>\n<p>A penile implant is one treatment option available to individuals who are unable to achieve or maintain an erection adequate for successful sexual intercourse or penetration. Its primary use is for men with erectile dysfunction from vascular conditions (cardiovascular disease, high blood pressure, diabetes), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital_anomalies\" class=\"mw-redirect\" title=\"Congenital anomalies\" rel=\"external_link\" target=\"_blank\">congenital anomalies<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iatrogenic\" class=\"mw-redirect\" title=\"Iatrogenic\" rel=\"external_link\" target=\"_blank\">iatrogenic<\/a>, accidental penile or pelvic trauma, Peyronie's disease, or as a result of prostate cancer treatments. This implant is normally considered when less invasive medical treatments such as oral medications (PDE5 inhibitors: Viagra, Levitra, Cialis), penile injections, or vacuum erection devices are unsuccessful, provide an unsatisfactory result, or are contraindicated.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> For example, many drugs used to treat erectile dysfunction are unsuitable for patients with heart problems and may interfere with other medications.\n<\/p><p>Sometimes a penile prosthesis is implanted during surgery to alter, construct or reconstruct the penis in phalloplasty. The British Journal of Urology International reports<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> that unlike <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metoidioplasty\" title=\"Metoidioplasty\" rel=\"external_link\" target=\"_blank\">metoidioplasty<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sex_reassignment_surgery_(female-to-male)\" title=\"Sex reassignment surgery (female-to-male)\" rel=\"external_link\" target=\"_blank\">female to male sexual reassignment<\/a> patients, which may result in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Penis\" title=\"Penis\" rel=\"external_link\" target=\"_blank\">penis<\/a> that is long but narrow, current total phalloplasty <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neophallus\" class=\"mw-redirect\" title=\"Neophallus\" rel=\"external_link\" target=\"_blank\">neophallus<\/a> creation using a musculocutaneous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Latissimus_dorsi\" class=\"mw-redirect\" title=\"Latissimus dorsi\" rel=\"external_link\" target=\"_blank\">latissimus dorsi<\/a> flap could result in a long, large volume <a href=\"https:\/\/en.wikipedia.org\/wiki\/Penis\" title=\"Penis\" rel=\"external_link\" target=\"_blank\">penis<\/a> which enables safe insertion of any type of penile prosthesis.\n<\/p><p>This same technique enables male victims of minor to serious iatrogenic, accidental or intentional penile trauma injuries (or even total <a href=\"https:\/\/en.wikipedia.org\/wiki\/Emasculation\" title=\"Emasculation\" rel=\"external_link\" target=\"_blank\">emasculation<\/a>) caused by accidents, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Child_abuse\" title=\"Child abuse\" rel=\"external_link\" target=\"_blank\">child abuse<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Self-mutilation\" class=\"mw-redirect\" title=\"Self-mutilation\" rel=\"external_link\" target=\"_blank\">self-mutilation<\/a> to have penises suitable for penile prosthesis implantation enabling successful <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sexual_intercourse\" title=\"Sexual intercourse\" rel=\"external_link\" target=\"_blank\">sexual intercourse<\/a>.\n<\/p><p>In some cases of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sex_reassignment_surgery_(female-to-male)\" title=\"Sex reassignment surgery (female-to-male)\" rel=\"external_link\" target=\"_blank\">genital reconstructive surgery<\/a>, implantation of a semirigid prosthesis is recommended for three months after total <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phalloplasty\" title=\"Phalloplasty\" rel=\"external_link\" target=\"_blank\">phalloplasty<\/a> to prevent phallic retraction. It can be replaced later with an inflatable one.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types_of_devices\">Types of devices<\/span><\/h2>\n<p>There are two primary types of penile prosthesis: noninflatable semirigid devices, and inflatable devices.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Noninflatable, semirigid devices consist of rods implanted into the erection chambers of the penis and can be bent into position as needed for sexual penetration. With this type of implant the penis is always semi-rigid and therefore may be difficult to conceal.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>Hydraulic, inflatable prosthesis also exist and were first described in 1973 by Brantley Scott et al.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> These <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saline_(medicine)\" title=\"Saline (medicine)\" rel=\"external_link\" target=\"_blank\">saline<\/a>-filled devices consist of inflatable cylinders placed in the erection chambers of the penis, a pump placed in the scrotum for patient-activated inflation\/deflation, and a reservoir placed in the abdomen which stores the fluid. The device is inflated by squeezing the pump several times to transfer fluid from the reservoir to the chambers in the penis. After intercourse, a valve next to the pump is manually operated, allowing fluid to be released from the penis (not instantaneously; squeezing the penis may be necessary), causing the penis to return to a flaccid or semi-flaccid condition. Almost all implanted penile prosthesis devices perform satisfactorily for a decade or more before needing replacement.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> Some surgeons recommend these due to the opinion that they are more easily concealed and provide the highest levels of patient\/partner satisfaction.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Penile_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ee\/Penile_prosthesis.jpg\/220px-Penile_prosthesis.jpg\" width=\"220\" height=\"329\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Penile_prosthesis.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Three piece inflatable penile prosthesis<\/div><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Advantages\">Advantages<\/span><\/h2>\n<ul><li>Mechanical failure rates are low: most often inability to deflate the penis because of pump failure; less often inability to inflate the prosthesis; and sometimes disconnection or failure of the reservoir.<\/li>\n<li>IPP (Inflatable Penile Prostheses) are easily concealable under clothing including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Swimsuit\" title=\"Swimsuit\" rel=\"external_link\" target=\"_blank\">swimsuits<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jeans\" title=\"Jeans\" rel=\"external_link\" target=\"_blank\">jeans<\/a>.<\/li>\n<li>The erection can be maintained as long as necessary, or as long as desired without any of the potentially serious complications of organic priapism.<\/li>\n<li>Psychological and emotional well-being is enhanced in a proportion of men who undergo implant surgery. Some studies indicate a high level of patient satisfaction, attributable in part to improved technology in the prosthesis itself, improved surgical techniques making the procedure less painful, and more reasonable patient expectations.<\/li>\n<li>Inflation of the device can be accomplished discreetly.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Disadvantages\">Disadvantages<\/span><\/h2>\n<ul><li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glans_penis\" title=\"Glans penis\" rel=\"external_link\" target=\"_blank\">glans<\/a> does not enlarge and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sexual_penetration\" title=\"Sexual penetration\" rel=\"external_link\" target=\"_blank\">sexual penetration<\/a> may be awkward. The penis also may not be as firm as a natural erection.<\/li>\n<li>Some models do not deflate easily; some degree of manual dexterity is required to operate any of the inflatable models, making them inappropriate for men with other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurological_disorder\" title=\"Neurological disorder\" rel=\"external_link\" target=\"_blank\">neurological disorders<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parkinson%27s_disease\" title=\"Parkinson's disease\" rel=\"external_link\" target=\"_blank\">Parkinson's disease<\/a>.<\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Penis\" title=\"Penis\" rel=\"external_link\" target=\"_blank\">penis<\/a> may not be completely flaccid, depending upon the model of prosthesis (most usually seen in semi-rigid or malleable implants).<\/li>\n<li>Many men lose between 1\u20132 cm (.25 to .75 in) in length.<\/li>\n<li>Following surgery, patients experience one to two weeks of moderate or occasionally severe pain, usually controlled with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Analgesic\" title=\"Analgesic\" rel=\"external_link\" target=\"_blank\">analgesics<\/a>. This is most often due to scrotal swelling, which can be quite profound at times. Normal sexual intercourse can be resumed six to eight weeks post-operatively, pending clearance from the surgeon.<\/li>\n<li>Not all men report complete satisfaction with the prosthesis.<\/li>\n<li>Some studies indicate a partner satisfaction rate of 70% or less, due, some studies suggest, to heightened or unreasonable expectations. Many surgeons are now recommending that both partners be counseled pre-operatively regarding outcome and expectations.<\/li>\n<li>The inflation of the devices is not instantaneous.<\/li>\n<li>It can be difficult to conceal a prosthesis because the scrotal components are hard and irregularly shaped. A partner feeling the scrotum will notice this.<\/li>\n<li>Manual stimulation can be painful.<\/li>\n<li>There is a 2-10% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Complication_(medicine)\" title=\"Complication (medicine)\" rel=\"external_link\" target=\"_blank\">complication<\/a> rate, mainly as a result of infection or device failure. Complications include: uncontrolled bleeding after the surgery possibly leading to re-operation, scar tissue formation, erosion (tissue around the implant may break down) requiring removal or mechanical failure leading to re-operation and removal.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Sadeghi-Nejad H. Penile prosthesis surgery: a review of prosthetic devices and associated complications. J Sex Med 2007; 4: 296-309.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Garber B. Inflatable penile prostheses for the treatment of erectile dysfunction: an update. Expert Rev Med Devices 2008; 5(2): 133-144.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">British Journal of Urology International, Volume 100, Number 4, pp 899-905, Reconstructive Urology: Total phalloplasty using a musculocutaneous latissimus dorsi flap, Sava V. Perovic, Rados Djinovic et al., School of Medicine, Belgrade University<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Simmons M, Montague D. \"Penile prosthesis implantation: past, present, and future\". Int J Imp Res 2008; 20: 37-444.<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.issm.info\/sexual-health-qa\/when-should-a-man-consider-a-prosthesis\/\" target=\"_blank\">\"penile imaplnt types\"<\/a>. <i>International society of sexual medicine<\/i>. 2015-12-16<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-08-14<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International++society+of+sexual+medicine&rft.atitle=penile+imaplnt+types&rft.date=2015-12-16&rft_id=http%3A%2F%2Fwww.issm.info%2Fsexual-health-qa%2Fwhen-should-a-man-consider-a-prosthesis%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APenile+prosthesis\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Scott B, Bradley W, Timm G. \"Management of erectile impotence: use of inflatable prosthesis\". Urol 1973; 2: 80-82.<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Wilson S, Delk J, Salem E. \"Long-term survival of inflatable penile prostheses: single surgical group experience with 2,384 first-time implants spanning two decades\". J Sex Med 2007; 4: 1074-1079.<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.emedicine.com\/med\/topic3047.htm\" target=\"_blank\">Medscape<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external free\" href=\"https:\/\/web.archive.org\/web\/20090314071253\/http:\/\/cat.inist.fr\/?aModele=afficheN&cpsidt=862126\" target=\"_blank\">https:\/\/web.archive.org\/web\/20090314071253\/http:\/\/cat.inist.fr\/?aModele=afficheN&cpsidt=862126<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1327\nCached time: 20181206140953\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.188 seconds\nReal time usage: 0.261 seconds\nPreprocessor visited node count: 493\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 32945\/2097152 bytes\nTemplate argument size: 182\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 4891\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.096\/10.000 seconds\nLua memory usage: 2.44 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 197.663 1 -total\n<\/p>\n<pre>46.93% 92.762 1 Template:Reflist\n41.31% 81.652 1 Template:Cite_news\n37.22% 73.571 1 Template:More_footnotes\n24.71% 48.835 1 Template:Ambox\n17.39% 34.380 6 Template:Navbox\n13.00% 25.693 1 Template:Male_genital_procedures\n 2.89% 5.722 2 Template:Yesno-no\n 1.51% 2.976 2 Template:Main_other\n 1.40% 2.771 2 Template:Yesno\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:10525403-1!canonical and timestamp 20181206140952 and revision id 872286432\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Penile_prosthesis\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212147\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.169 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 163.207 1 - wikipedia:Penile_prosthesis\n100.00% 163.207 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8049-0!*!*!*!*!*!* and timestamp 20181217212147 and revision id 24159\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Penile_prosthesis\">https:\/\/www.limswiki.org\/index.php\/Penile_prosthesis<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","8c8d0da61c507a33c2f7c3f5fe6c7de7_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ee\/Penile_prosthesis.jpg\/440px-Penile_prosthesis.jpg"],"8c8d0da61c507a33c2f7c3f5fe6c7de7_timestamp":1545081707,"bd1517d651a8032aae6b2c50fead33bb_type":"article","bd1517d651a8032aae6b2c50fead33bb_title":"Palatal obturator","bd1517d651a8032aae6b2c50fead33bb_url":"https:\/\/www.limswiki.org\/index.php\/Palatal_obturator","bd1517d651a8032aae6b2c50fead33bb_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPalatal obturator\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article includes a list of references, related reading or external links, but its sources remain unclear because it lacks inline citations. Please help to improve this article by introducing more precise citations. (February 2017) (Learn how and when to remove this template message)\n The Latham Device\n Post Latham\n Nasal Alveolar Molding Device\n Post Insertion\nA palatal obturator is a prosthesis that totally occludes an opening such as an oronasal fistula (in the roof of the mouth). They are similar to dental retainers, but without the front wire. Palatal obturators are typically short-term prosthetics used to close defects of the hard\/soft palate that may affect speech production or cause nasal regurgitation during feeding. Following surgery, there may remain a residual orinasal opening on the palate, alveolar ridge, or vestibule of the larynx. A palatal obturator may be used to compensate for hypernasality and to aid in speech therapy targeting correction of compensatory articulation caused by the cleft palate. In simpler terms, a palatal obturator covers any fistulas (or \"holes\") in the roof of the mouth that lead to the nasal cavity, providing the wearer with a plastic\/acrylic, removable roof of the mouth, which aids in speech, eating, and proper air flow.\nPalatal obturators are not to be confused with palatal lifts or other prosthetic devices. A palatal obturator may be used in cases of a deficiency in tissue, when a remaining opening in the palate occurs. In some cases it may be downsized gradually so that tissue can strengthen over time and compensate for the decreasing size of the obturator. The palatal lift however, is used when there is not enough palatal movement. It raises the palate and reduces the range of movement necessary to provide adequate closure to separate the nasal cavity from the oral cavity. Speech bulbs and palatal lifts aid in velopharyngeal closure and do not obturate a fistula. A speech bulb, yet another type of prosthetic device often confused with a palatal obturator, contains a pharyngeal section, which goes behind the soft palate.\nPalatal obturators are needed by individuals with cleft palate, those who have had tumors removed or have had traumatic injuries to their palate.\n\nContents \n\n1 Types of palatal obturators \n2 The Nance Obturator \n3 Speech \n4 See also \n5 References \n\n\nTypes of palatal obturators \nA palatal plate is a prosthetic device, generally consisting of an acrylic plate and retention clasps of orthodontic wire, which covers a fistula of the palate. It may be used to aid in improving articulation and feeding. The blockage of the opening helps improve hypernasality and suckling ability for babies. In the case of a labial-oral-nasal fistula, the plate may include an anterior upward extension to fully occlude the passageway running between the labial surface of the alveolus, alveolus, and nasal cavity. The plate may be constructed to include any congenitally missing teeth to improve articulation and appearance. Individuals who use palatal plates must be monitored periodically by their dental professionals due to possible tissue irritation by the plate. Materials such as food particles, oral mucosa and secretions may cause buildup on the upper surface of the plate; therefore, it is essential to clean a palatal obturator at least twice a day to avoid tissue irritation. There are also more specific terms used for obturators depending on their time and purpose of use: Photo Examples of the Latham Device or the Nasal Alveolar are prime examples for use in Cleft Palate Deformities.\n\nA modification obturator may be used in the short term to block a palatal fistula, for augmentation of the seal and to separate the oral and nasal cavities.\nAn interim palatal obturator is used post-palatal surgery. This obturator aids in closing the remaining fistula and is used when no further surgical procedures are planned. It must be frequently revised.\nA definitive obturator is used when further rehabilitation is not possible for the patient and is intended for long-term use.\nPalatal adhesives are oral adhesives or skin barrier materials used to occlude a fistula of the hard palate. Obturators of this type must be removed before eating and drinking. Users must cut the new piece of adhesive and hold it over the fistula until it adheres. Adhesives are not to be used for soft palate fistulae if the soft palate has some mobility due to possible unintentional dislodging and digestion of the material.\n\nThe Nance Obturator \nThis fixed obturator is based on the Nance appliance, which was originally used as a space maintainer in dentistry and orthodontics, but has been redesigned for closing anterior palatal fistulas in patients with cleft lip and palate. The Nance obturator may be used when the surgical closure of the fistula is not feasible and a removable device is not successful.\n\nSpeech \nOften a palatal obturator is used because a palatal fistula can affect development and proper articulation. As fistula sizes vary, small fistulae tend to result in little to no speech alterations whereas large fistulae tend to result in audible nasal emissions and weak pressure with and\/or without hypernasality. Misarticulations, abnormal nasal resonance and nasal escape or air often results from the problem. Fistulae may decrease intraoral air pressure during production of oral pressure consonants causing distortion of sounds as well as increase in nasal airflow. It is common for an individual with a fistula to compensate for a loss of pressure during speech sound production by attempting to regulate intraoral air pressure with increasing respiration effort and using compensatory articulation. Middorsum palatal stops (atypical place of articulation) often results from palatal fistulae causing sound distortions during speech. Occlusion for the fistula is attempted by speakers with deviant tongue placements during these palatal stops.\nThe palatal obturation may be managed temporarily or may be sustained for longer periods of time. Location-specific palatal obturation has been documented to significantly improve articulation errors, hypernasality (based on listener judgments), and nasal emissions (immediately post-obturation only). Usage of more anterior tongue placements is considered a primary target for speech therapy. The relationship between palatal openings and articulation is important to note prior to surgical plans to ascertain timing of speech therapy and most appropriate therapy goals and approach. Speech therapy may be most beneficial prior to sustained palatal obturation rather than short-term obturation.\n\nSee also \nCleft Palate\nProstheses\nDentures\nProsthodontics\nReferences \nBorzabadi-Farahani, A., Groper, J.N., Tanner, A.M., Urata, M.M., Panossian, A., & Yen, S.L. (2012). The Nance Obturator, a New Fixed Obturator for Patients with Cleft Palate and Fistula. Journal of Prosthodontics,21(5):400-403.\nKuehn, D.P., & Moller, K.T. (2000).Speech and Language Issues in the Cleft PalatePopulation: The State of the Art. The Cleft Palate-Craniofacial Journal\t,37,\t348-348.\nMarino, V.C.C., Williams, W.N., Wharton, P.W., Paulk, M.F., Dutka-Souza, J.C.R.,& Schulz, G.M. (2005). Immediate and Sustained Changes in Tongue Movement With an Experimental *Palatal \u201cFistula\u201d: A Case Study. The Cleft Palate-Craniofacial Journal, 42, 286\u2013296.\n\"Maxillofacial Prosthetics.\" Rhode Island Department of Human Services. Rhode Island Department of Human Services. 10 July 2006<https:\/\/web.archive.org\/web\/20110719215543\/http:\/\/www.dhs.ri.gov\/dhs\/heacre\/\t\t provsvcs\/manuals\/dental\/maxpros.htm>.\nPeterson-Falzone, S., Hardin-Jones, M., & Karnell, M. (2001). Cleft Palate Speech (3rd ed.). St. Louis: Mosby.\nPinborough-Zimmerman, J., Canady C., Yamashiro, D.K., & Morales Jr., L. (1998). Articulation and Nasality Changes Resulting from Sustained Palatal Fistula Obturation. The Cleft Palate-Craniofacial Journal, 35, 81\u201387.\nReisberg, D.J. (2000). Dental and Prosthodontic Care for Patients With Cleft or Craniofacial Conditions. The Cleft Palate-Craniofacial Journal, 37, 534\u2013537.\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Palatal_obturator\">https:\/\/www.limswiki.org\/index.php\/Palatal_obturator<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:20.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 716 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","bd1517d651a8032aae6b2c50fead33bb_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Palatal_obturator skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Palatal obturator<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pre_Latham_Device.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/de\/Pre_Latham_Device.jpg\/220px-Pre_Latham_Device.jpg\" width=\"220\" height=\"341\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Pre_Latham_Device.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The Latham Device<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Post_Latham_Device.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/42\/Post_Latham_Device.jpg\/220px-Post_Latham_Device.jpg\" width=\"220\" height=\"184\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Post_Latham_Device.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Post Latham<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Nasoalveolar.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/84\/Nasoalveolar.jpg\/220px-Nasoalveolar.jpg\" width=\"220\" height=\"90\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Nasoalveolar.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Nasal Alveolar Molding Device<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Post_Nasal_Alveolar_Molding.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c9\/Post_Nasal_Alveolar_Molding.jpg\/220px-Post_Nasal_Alveolar_Molding.jpg\" width=\"220\" height=\"209\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Post_Nasal_Alveolar_Molding.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Post Insertion<\/div><\/div><\/div>\n<p>A <b>palatal obturator<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthesis<\/a> that totally occludes an opening such as an oronasal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fistula\" title=\"Fistula\" rel=\"external_link\" target=\"_blank\">fistula<\/a> (in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Palate\" title=\"Palate\" rel=\"external_link\" target=\"_blank\">roof of the mouth<\/a>). They are similar to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_retainer\" class=\"mw-redirect\" title=\"Dental retainer\" rel=\"external_link\" target=\"_blank\">dental retainers<\/a>, but without the front wire. Palatal obturators are typically short-term prosthetics used to close defects of the hard\/soft palate that may affect speech production or cause during feeding. Following surgery, there may remain a residual orinasal opening on the palate, alveolar ridge, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vestibule_of_the_larynx\" class=\"mw-redirect\" title=\"Vestibule of the larynx\" rel=\"external_link\" target=\"_blank\">vestibule of the larynx<\/a>. A palatal obturator may be used to compensate for hypernasality and to aid in speech therapy targeting correction of compensatory articulation caused by the cleft palate. In simpler terms, a palatal obturator covers any fistulas (or \"holes\") in the roof of the mouth that lead to the nasal cavity, providing the wearer with a plastic\/acrylic, removable roof of the mouth, which aids in speech, eating, and proper air flow.\n<\/p><p>Palatal obturators are not to be confused with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Palatal_lifts\" class=\"mw-redirect\" title=\"Palatal lifts\" rel=\"external_link\" target=\"_blank\">palatal lifts<\/a> or other prosthetic devices. A palatal obturator may be used in cases of a deficiency in tissue, when a remaining opening in the palate occurs. In some cases it may be downsized gradually so that tissue can strengthen over time and compensate for the decreasing size of the obturator. The palatal lift however, is used when there is not enough palatal movement. It raises the palate and reduces the range of movement necessary to provide adequate closure to separate the nasal cavity from the oral cavity. and palatal lifts aid in and do not obturate a fistula. A speech bulb, yet another type of prosthetic device often confused with a palatal obturator, contains a pharyngeal section, which goes behind the soft palate.\n<\/p><p>Palatal obturators are needed by individuals with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cleft_palate\" class=\"mw-redirect\" title=\"Cleft palate\" rel=\"external_link\" target=\"_blank\">cleft palate<\/a>, those who have had tumors removed or have had traumatic injuries to their palate.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types_of_palatal_obturators\">Types of palatal obturators<\/span><\/h2>\n<p>A <i>palatal plate<\/i> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthetic device<\/a>, generally consisting of an acrylic plate and retention clasps of orthodontic wire, which covers a fistula of the palate. It may be used to aid in improving <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manner_of_articulation\" title=\"Manner of articulation\" rel=\"external_link\" target=\"_blank\">articulation<\/a> and feeding. The blockage of the opening helps improve <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypernasality\" class=\"mw-redirect\" title=\"Hypernasality\" rel=\"external_link\" target=\"_blank\">hypernasality<\/a> and suckling ability for babies. In the case of a labial-oral-nasal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fistula\" title=\"Fistula\" rel=\"external_link\" target=\"_blank\">fistula<\/a>, the plate may include an anterior upward extension to fully occlude the passageway running between the labial surface of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alveolus\" class=\"mw-redirect\" title=\"Alveolus\" rel=\"external_link\" target=\"_blank\">alveolus<\/a>, alveolus, and nasal cavity. The plate may be constructed to include any <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital\" class=\"mw-redirect\" title=\"Congenital\" rel=\"external_link\" target=\"_blank\">congenitally<\/a> missing teeth to improve articulation and appearance. Individuals who use palatal plates must be monitored periodically by their dental professionals due to possible tissue irritation by the plate. Materials such as food particles, oral mucosa and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Secretions\" class=\"mw-redirect\" title=\"Secretions\" rel=\"external_link\" target=\"_blank\">secretions<\/a> may cause buildup on the upper surface of the plate; therefore, it is essential to clean a palatal obturator at least twice a day to avoid tissue irritation. There are also more specific terms used for obturators depending on their time and purpose of use: Photo Examples of the Latham Device or the Nasal Alveolar are prime examples for use in Cleft Palate Deformities.\n<\/p>\n<ul><li>A modification obturator may be used in the short term to block a palatal fistula, for augmentation of the seal and to separate the oral and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nasal_cavities\" class=\"mw-redirect\" title=\"Nasal cavities\" rel=\"external_link\" target=\"_blank\">nasal cavities<\/a>.<\/li>\n<li>An interim palatal obturator is used post-palatal surgery. This obturator aids in closing the remaining fistula and is used when no further surgical procedures are planned. It must be frequently revised.<\/li>\n<li>A definitive obturator is used when further rehabilitation is not possible for the patient and is intended for long-term use.<\/li><\/ul>\n<p> are oral adhesives or skin barrier materials used to occlude a fistula of the hard palate. Obturators of this type must be removed before eating and drinking. Users must cut the new piece of adhesive and hold it over the fistula until it adheres. Adhesives are not to be used for soft palate fistulae if the soft palate has some mobility due to possible unintentional dislodging and digestion of the material.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"The_Nance_Obturator\">The Nance Obturator<\/span><\/h2>\n<p>This fixed obturator is based on the Nance appliance, which was originally used as a space maintainer in dentistry and orthodontics, but has been redesigned for closing anterior palatal fistulas in patients with cleft lip and palate. The Nance obturator may be used when the surgical closure of the fistula is not feasible and a removable device is not successful.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Speech\">Speech<\/span><\/h2>\n<p>Often a palatal obturator is used because a palatal fistula can affect development and proper articulation. As fistula sizes vary, small fistulae tend to result in little to no speech alterations whereas large fistulae tend to result in audible nasal emissions and weak pressure with and\/or without . , abnormal nasal resonance and nasal escape or air often results from the problem. Fistulae may decrease intraoral air pressure during production of oral pressure consonants causing distortion of sounds as well as increase in nasal airflow. It is common for an individual with a fistula to compensate for a loss of pressure during speech sound production by attempting to regulate intraoral air pressure with increasing respiration effort and using compensatory articulation. Middorsum palatal stops (atypical place of articulation) often results from palatal fistulae causing sound distortions during speech. Occlusion for the fistula is attempted by speakers with deviant tongue placements during these palatal stops.\n<\/p><p>The palatal obturation may be managed temporarily or may be sustained for longer periods of time. Location-specific palatal obturation has been documented to significantly improve articulation errors, hypernasality (based on listener judgments), and nasal emissions (immediately post-obturation only). Usage of more anterior tongue placements is considered a primary target for speech therapy. The relationship between palatal openings and articulation is important to note prior to surgical plans to ascertain timing of speech therapy and most appropriate therapy goals and approach. Speech therapy may be most beneficial prior to sustained palatal obturation rather than short-term obturation.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cleft_Palate\" class=\"mw-redirect\" title=\"Cleft Palate\" rel=\"external_link\" target=\"_blank\">Cleft Palate<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostheses\" class=\"mw-redirect\" title=\"Prostheses\" rel=\"external_link\" target=\"_blank\">Prostheses<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dentures\" title=\"Dentures\" rel=\"external_link\" target=\"_blank\">Dentures<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthodontics\" title=\"Prosthodontics\" rel=\"external_link\" target=\"_blank\">Prosthodontics<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<ul><li>Borzabadi-Farahani, A., Groper, J.N., Tanner, A.M., Urata, M.M., Panossian, A., & Yen, S.L. (2012). The Nance Obturator, a New Fixed Obturator for Patients with Cleft Palate and Fistula. Journal of Prosthodontics,21(5):400-403.<\/li>\n<li>Kuehn, D.P., & Moller, K.T. (2000).Speech and Language Issues in the Cleft PalatePopulation: The State of the Art. The Cleft Palate-Craniofacial Journal\t,37,\t348-348.<\/li>\n<li>Marino, V.C.C., Williams, W.N., Wharton, P.W., Paulk, M.F., Dutka-Souza, J.C.R.,& Schulz, G.M. (2005). Immediate and Sustained Changes in Tongue Movement With an Experimental *Palatal \u201cFistula\u201d: A Case Study. The Cleft Palate-Craniofacial Journal, 42, 286\u2013296.<\/li>\n<li>\"Maxillofacial Prosthetics.\" Rhode Island Department of Human Services. Rhode Island Department of Human Services. 10 July 2006<<a rel=\"external_link\" class=\"external free\" href=\"https:\/\/web.archive.org\/web\/20110719215543\/http:\/\/www.dhs.ri.gov\/dhs\/heacre\/\" target=\"_blank\">https:\/\/web.archive.org\/web\/20110719215543\/http:\/\/www.dhs.ri.gov\/dhs\/heacre\/<\/a>\t\t provsvcs\/manuals\/dental\/maxpros.htm>.<\/li>\n<li>Peterson-Falzone, S., Hardin-Jones, M., & Karnell, M. (2001). Cleft Palate Speech (3rd ed.). St. Louis: Mosby.<\/li>\n<li>Pinborough-Zimmerman, J., Canady C., Yamashiro, D.K., & Morales Jr., L. (1998). Articulation and Nasality Changes Resulting from Sustained Palatal Fistula Obturation. The Cleft Palate-Craniofacial Journal, 35, 81\u201387.<\/li>\n<li>Reisberg, D.J. (2000). Dental and Prosthodontic Care for Patients With Cleft or Craniofacial Conditions. The Cleft Palate-Craniofacial Journal, 37, 534\u2013537.<\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1270\nCached time: 20181129124037\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.076 seconds\nReal time usage: 0.124 seconds\nPreprocessor visited node count: 184\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 4361\/2097152 bytes\nTemplate argument size: 103\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 0\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.025\/10.000 seconds\nLua memory usage: 831 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 84.473 1 Template:No_footnotes\n100.00% 84.473 1 -total\n<\/p>\n<pre>66.73% 56.367 1 Template:Ambox\n 8.79% 7.424 2 Template:Yesno-no\n 5.30% 4.481 2 Template:Yesno\n 3.75% 3.172 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:6195759-1!canonical and timestamp 20181129124037 and revision id 829738923\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Palatal_obturator\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212146\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.166 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 160.208 1 - wikipedia:Palatal_obturator\n100.00% 160.208 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8048-0!*!*!*!*!*!* and timestamp 20181217212146 and revision id 24158\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Palatal_obturator\">https:\/\/www.limswiki.org\/index.php\/Palatal_obturator<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","bd1517d651a8032aae6b2c50fead33bb_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/de\/Pre_Latham_Device.jpg\/440px-Pre_Latham_Device.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/42\/Post_Latham_Device.jpg\/440px-Post_Latham_Device.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/84\/Nasoalveolar.jpg\/440px-Nasoalveolar.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c9\/Post_Nasal_Alveolar_Molding.jpg\/440px-Post_Nasal_Alveolar_Molding.jpg"],"bd1517d651a8032aae6b2c50fead33bb_timestamp":1545081706,"c304ad727307690fa2fa9aa2fe28935c_type":"article","c304ad727307690fa2fa9aa2fe28935c_title":"Ossicular replacement prosthesis","c304ad727307690fa2fa9aa2fe28935c_url":"https:\/\/www.limswiki.org\/index.php\/Ossicular_replacement_prosthesis","c304ad727307690fa2fa9aa2fe28935c_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tOssicular replacement prosthesis\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is an orphan, as no other articles link to it. Please introduce links to this page from related articles ; try the Find link tool for suggestions. (April 2013)\nIn medicine, an ossicular replacement prosthesis is a device intended to be implanted for the functional reconstruction of segments of the ossicles and facilitates the conduction of sound waves from the tympanic membrane to the inner ear.[1] There are two common types of ossicular replacement prostheses, the total ossicular replacement prosthesis (TORP) and partial ossicular replacement prosthesis (PORP). A TORP replaces the entire ossicular chain while a PORP replaces only the incus and malleus but not the stapes. Indications for use of an ossicular replacement prosthesis include:[1]\n\nChronic middle ear disease\nOtosclerosis\nCongenital fixation of the stapes\nSecondary surgical intervention to correct for a significant and persistent conductive hearing loss from prior otologic surgery\nSurgically correctable injury to the middle ear from trauma\nReferences \n\n^ a b Food and Drug Administration. \"510k Notification - Grace Dynamic Ossicular Replacement Prosthesis, 2009\". \n\n\nThis article related to medical equipment is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Ossicular_replacement_prosthesis\">https:\/\/www.limswiki.org\/index.php\/Ossicular_replacement_prosthesis<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 19:34.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 416 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","c304ad727307690fa2fa9aa2fe28935c_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Ossicular_replacement_prosthesis skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Ossicular replacement prosthesis<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medicine<\/a>, an <b>ossicular replacement prosthesis<\/b> is a device intended to be implanted for the functional reconstruction of segments of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ossicles\" title=\"Ossicles\" rel=\"external_link\" target=\"_blank\">ossicles<\/a> and facilitates the conduction of sound waves from the tympanic membrane to the inner ear.<sup id=\"rdp-ebb-cite_ref-FDA_1-0\" class=\"reference\"><a href=\"#cite_note-FDA-1\" rel=\"external_link\">[1]<\/a><\/sup> There are two common types of ossicular replacement prostheses, the total ossicular replacement prosthesis (TORP) and partial ossicular replacement prosthesis (PORP). A TORP replaces the entire ossicular chain while a PORP replaces only the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Incus\" title=\"Incus\" rel=\"external_link\" target=\"_blank\">incus<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Malleus\" title=\"Malleus\" rel=\"external_link\" target=\"_blank\">malleus<\/a> but not the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stapes\" title=\"Stapes\" rel=\"external_link\" target=\"_blank\">stapes<\/a>. Indications for use of an ossicular replacement prosthesis include:<sup id=\"rdp-ebb-cite_ref-FDA_1-1\" class=\"reference\"><a href=\"#cite_note-FDA-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<ul><li>Chronic middle ear disease<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Otosclerosis\" title=\"Otosclerosis\" rel=\"external_link\" target=\"_blank\">Otosclerosis<\/a><\/li>\n<li>Congenital fixation of the stapes<\/li>\n<li>Secondary surgical intervention to correct for a significant and persistent conductive hearing loss from prior otologic surgery<\/li>\n<li>Surgically correctable injury to the middle ear from trauma<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-FDA-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-FDA_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-FDA_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Food and Drug Administration. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/510k.directory\/clearances\/K091187\" target=\"_blank\">\"510k Notification - Grace Dynamic Ossicular Replacement Prosthesis, 2009\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=510k+Notification+-+Grace+Dynamic+Ossicular+Replacement+Prosthesis%2C+2009&rft.au=Food+and+Drug+Administration&rft_id=https%3A%2F%2F510k.directory%2Fclearances%2FK091187&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOssicular+replacement+prosthesis\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1273\nCached time: 20181217110836\nCache expiry: 86400\nDynamic content: true\nCPU time usage: 0.124 seconds\nReal time usage: 0.184 seconds\nPreprocessor visited node count: 160\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 10422\/2097152 bytes\nTemplate argument size: 1024\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 2700\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.076\/10.000 seconds\nLua memory usage: 1.86 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 169.273 1 -total\n<\/p>\n<pre>44.08% 74.613 1 Template:Cite_web\n43.21% 73.146 1 Template:Orphan\n32.60% 55.179 1 Template:Draft_other\n30.98% 52.441 1 Template:Ambox\n10.58% 17.906 1 Template:Medical-equipment-stub\n 9.31% 15.757 1 Template:Asbox\n 1.88% 3.186 1 Template:Monthyear-1\n 1.83% 3.094 2 Template:PAGENAMEU\n 1.10% 1.868 1 Template:Monthyear\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:39205709-1!canonical and timestamp 20181217110836 and revision id 820850895\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ossicular_replacement_prosthesis\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212146\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.042 seconds\nReal time usage: 0.184 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 178.959 1 - wikipedia:Ossicular_replacement_prosthesis\n100.00% 178.959 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8259-0!*!*!*!*!*!* and timestamp 20181217212146 and revision id 24469\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Ossicular_replacement_prosthesis\">https:\/\/www.limswiki.org\/index.php\/Ossicular_replacement_prosthesis<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","c304ad727307690fa2fa9aa2fe28935c_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/6c\/Wiki_letter_w.svg\/80px-Wiki_letter_w.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Filled_Syringe_icon.svg\/60px-Filled_Syringe_icon.svg.png"],"c304ad727307690fa2fa9aa2fe28935c_timestamp":1545081706,"43b1ab5bfb275ebbf5e33e4a189d28fb_type":"article","43b1ab5bfb275ebbf5e33e4a189d28fb_title":"Orthopedic plate","43b1ab5bfb275ebbf5e33e4a189d28fb_url":"https:\/\/www.limswiki.org\/index.php\/Orthopedic_plate","43b1ab5bfb275ebbf5e33e4a189d28fb_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tOrthopedic plate\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tAn orthopedic plate is a form of internal fixation used in orthopaedic surgery to hold fractures in place to allow bone healing.\n\nHistory \n\n\n\nYear\n\nType\n\nInventor\n\nDescription\n\n\n1969\n\nDynamic compression plate (DCP)\n\n\n\n\n\n\n1990\n\nLimited-contact dynamic compression plate (LC-DCP)\n\n\n\n\n\n\n1994\n\nLess-invasive stabilization system (LISS)\n\n\n\n\n\n\n2001\n\nLocking Compression Plate (LCP)\n\n\n\n\n\nModes of use \nButtress\nNeutralisation\nBridging\nTension\nCompression\nSee also \nList of orthopedic implants\nThis article about Orthopedic surgery is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Orthopedic_plate\">https:\/\/www.limswiki.org\/index.php\/Orthopedic_plate<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 10 March 2016, at 00:42.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 337 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","43b1ab5bfb275ebbf5e33e4a189d28fb_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Orthopedic_plate skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Orthopedic plate<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>An <b>orthopedic plate<\/b> is a form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Internal_fixation\" title=\"Internal fixation\" rel=\"external_link\" target=\"_blank\">internal fixation<\/a> used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopaedic_surgery\" class=\"mw-redirect\" title=\"Orthopaedic surgery\" rel=\"external_link\" target=\"_blank\">orthopaedic surgery<\/a> to hold <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_fracture\" title=\"Bone fracture\" rel=\"external_link\" target=\"_blank\">fractures<\/a> in place to allow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_healing\" title=\"Bone healing\" rel=\"external_link\" target=\"_blank\">bone healing<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Year\n<\/th>\n<th>Type\n<\/th>\n<th>Inventor\n<\/th>\n<th>Description\n<\/th><\/tr>\n<tr>\n<td>1969\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dynamic_compression_plate\" title=\"Dynamic compression plate\" rel=\"external_link\" target=\"_blank\">Dynamic compression plate<\/a> (DCP)\n<\/td>\n<td>\n<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>1990\n<\/td>\n<td>Limited-contact dynamic compression plate (LC-DCP)\n<\/td>\n<td>\n<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>1994\n<\/td>\n<td>Less-invasive stabilization system (LISS)\n<\/td>\n<td>\n<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>2001\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Locking_Compression_Plate\" class=\"mw-redirect\" title=\"Locking Compression Plate\" rel=\"external_link\" target=\"_blank\">Locking Compression Plate<\/a> (LCP)\n<\/td>\n<td>\n<\/td>\n<td>\n<\/td><\/tr><\/tbody><\/table>\n<h2><span class=\"mw-headline\" id=\"Modes_of_use\">Modes of use<\/span><\/h2>\n<ul><li>Buttress<\/li>\n<li>Neutralisation<\/li>\n<li>Bridging<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tension_band_wiring\" title=\"Tension band wiring\" rel=\"external_link\" target=\"_blank\">Tension<\/a><\/li>\n<li>Compression<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_orthopedic_implants\" title=\"List of orthopedic implants\" rel=\"external_link\" target=\"_blank\">List of orthopedic implants<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1252\nCached time: 20181129050446\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.036 seconds\nReal time usage: 0.048 seconds\nPreprocessor visited node count: 44\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 2607\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 3\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 0\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.010\/10.000 seconds\nLua memory usage: 780 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 30.901 1 Template:Orthopedics-stub\n100.00% 30.901 1 -total\n<\/p>\n<pre>92.49% 28.580 1 Template:Asbox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:49706954-1!canonical and timestamp 20181129050446 and revision id 813198721\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedic_plate\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212146\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.136 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 130.639 1 - wikipedia:Orthopedic_plate\n100.00% 130.639 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8375-0!*!*!*!*!*!* and timestamp 20181217212145 and revision id 24604\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Orthopedic_plate\">https:\/\/www.limswiki.org\/index.php\/Orthopedic_plate<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","43b1ab5bfb275ebbf5e33e4a189d28fb_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Andry_tree.png\/30px-Andry_tree.png"],"43b1ab5bfb275ebbf5e33e4a189d28fb_timestamp":1545081705,"4968f8ef9f337a859c6e437cda8a94d4_type":"article","4968f8ef9f337a859c6e437cda8a94d4_title":"Ocular prosthesis","4968f8ef9f337a859c6e437cda8a94d4_url":"https:\/\/www.limswiki.org\/index.php\/Ocular_prosthesis","4968f8ef9f337a859c6e437cda8a94d4_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tOcular prosthesis\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor a functional replacement, or \"bionic eye\", see Visual prosthesis.\n\"Glass eye\" redirects here. For the fish, see Heteropriacanthus cruentatus. For the American rock band, see Glass Eye (band).\n\"Glass eyes\" redirects here. For the Radiohead song, see A Moon Shaped Pool.\n Human ocular prosthesis of brown color\n Cat with an ocular prosthesis.An ocular prosthesis, artificial eye or glass eye is a type of craniofacial prosthesis that replaces an absent natural eye following an enucleation, evisceration, or orbital exenteration. The prosthesis fits over an orbital implant and under the eyelids. Though often referred to as a glass eye, the ocular prosthesis roughly takes the shape of a convex shell and is made of medical grade plastic acrylic. A few ocular prostheses today are made of cryolite glass. A variant of the ocular prosthesis is a very thin hard shell known as a scleral shell which can be worn over a damaged or eviscerated eye. Makers of ocular prosthetics are known as ocularists. An ocular prosthesis does not provide vision; this would be a visual prosthesis. Someone with an ocular prosthesis is totally blind on the affected side and has monocular (one sided) vision.\nContents \n\n1 History \n\n1.1 Limits of realism \n\n\n2 Implant types and chemical construction \n\n2.1 Nonintegrated implants \n2.2 Integrated implants (porous) \n\n\n3 Implant movement \n4 Surgical procedure \n5 Aftermath of surgical procedures \n6 Notable people with prosthetic eyes \n7 References \n8 External links \n\n\nHistory \n Prosthetic eye and glasses made for an injured World War I soldier by pioneering plastic surgeon Johannes Esser\n \"Making glass eye\", c. 1915\u20131920 .\nThe earliest known evidence of the use of ocular prosthesis is that of a woman found in Shahr-I Sokhta, Iran [1] dating back to 2900\u20132800 BCE.[2] It has a hemispherical form and a diameter of just over 2.5 cm (1 inch). It consists of very light material, probably bitumen paste. The surface of the artificial eye is covered with a thin layer of gold, engraved with a central circle (representing the iris) and gold lines patterned like sun rays. On both sides of the eye are drilled tiny holes, through which a golden thread could hold the eyeball in place. Since microscopic research has shown that the eye socket showed clear imprints of the golden thread, the eyeball must have been worn during her lifetime. In addition to this, an early Hebrew text references a woman who wore an artificial eye made of gold (Yer. Ned. 41c; comp. Yer. Sanh. 13c). Roman and Egyptian priests are known to have produced artificial eyes as early as the fifth century BCE constructed from painted clay attached to cloth and worn outside the socket.[3]\nThe first in-socket artificial eyes were made of gold with colored enamel, later evolving into the use of glass (thus the name \"glass eye\") by the Venetians in the later part of the sixteenth century. These were crude, uncomfortable, and fragile and the production methodology remained known only to Venetians until the end of the 18th century, when Parisians took over as the center for artificial eye-making. But the center shifted again, this time to Germany because of their superior glass blowing techniques. Shortly following the introduction of the art of glass eye-making to the United States, German goods became unavailable because of World War II. As a result, the US instead made artificial eyes from acrylic plastic.[3]\nProduction of modern ocular prosthetics has expanded from simply using glass into many different types of materials. In the United States, most custom ocular prostheses are fabricated using PMMA (polymethyl methacrylate), or acrylic. In some countries, Germany especially, prostheses are still most commonly made from glass.[3]\n\nLimits of realism \nOcularist surgeons have always worked together to make artificial eyes look more realistic. For decades, all efforts and investments to improve the appearance of artificial eyes have been dampened by the immobility of the pupil. One solution to this problem has been demonstrated recently in a device based on an LCD which simulates the pupil size as a function of the ambient light.[4]\n\nImplant types and chemical construction \nThere are many different types of implants, classification ranging from shape (Spherical vs egg (oval) shaped), stock vs custom,[3] porous vs nonporous, specific chemical make-up, and the presence of a peg or motility post. The most basic simplification can be to divide implant types into two main groups: non-integrated (non-porous) and integrated (porous).[5]\n\nNonintegrated implants \nThough there is evidence that ocular implants have been around for thousands of years[2] modern nonintegrated spherical intraconal implants came into existence around 1976 (not just glass eyes[3]).[6] Nonintegrated implants contain no unique apparatus for attachments to the extraocular muscles and do not allow in-growth of organic tissue into their inorganic substance. Such implants have no direct attachment to the ocular prosthesis.[5] Usually, these implants are covered with a material that permits fixation of the extraocular recti muscles, such as donor sclera or polyester gauze which improves implant motility, but does not allow for direct mechanical coupling between the implant and the artificial eye.[6]\nNon-integrated implants include the acrylic (PMMA[5]), glass, and silicone spheres.[7]\nPolymethyl methacrylate (PMMA) (acrylic)\n\n Eyes Prosthetics, Polymethyl methacrylate\nPolymethyl methacrylate (PMMA)[5] is a transparent thermoplastic available for use as ocular prosthesis, replacement intraocular lenses when the original lens has been removed in the treatment of cataracts and has historically been used as hard contact lenses.\nPMMA has a good degree of compatibility with human tissue, much more so than glass. Although various materials have been used to make nonintegrated implants in the past, polymethyl methacrylate is one of the implants of choice.[5]\n\n Integrated implants (porous) \nThe porous nature of integrated implants allows fibrovascular ingrowth throughout the implant and thus also insertion of pegs or posts.[8]\nBecause direct mechanical coupling is thought to improve artificial eye motility, attempts have been made to develop so-called \u2018integrated implants\u2019 that are directly connected to the artificial eye.[6]\nHistorically, implants that directly attached to the prosthesis were unsuccessful because of chronic inflammation or infection arising from the exposed nonporous implant material.[8]\nThis led to the development of quasi-integrated implants with a specially designed anterior surface that allegedly better transferred implant motility to the artificial eye through the closed conjunctiva and Tenon\u2019s capsule.[6]\nIn 1985, the problems associated with integrated implants were thought to be largely solved with the introduction of spherical implants made of porous calcium hydroxyapatite. This material allows for fibrovascular ingrowth within several months.[6]\nPorous enucleation implants currently are fabricated from a variety of materials including natural and synthetic hydroxyapatite, aluminium oxide, and polyethylene.\nThe surgeon can alter the contour of porous implants before insertion, and it is also possible to modify the contour in situ, although this is sometimes difficult.[8]\nHydroxyapatite (HA)\nHydroxyapatite implants are spherical and made in a variety of sizes and different materials (Coralline\/ Synthetic\/ Chinese).[7][8]\nSince their introduction in 1989 when an implant made from hydroxyapatite received Food and Drug Administration approval, spherical hydroxyapatite implants have gained widespread popularity as an enucleation implant[6][8] and was at one point was the most commonly used orbital implant in the United States.[9][10] The porous nature of this material allows fibrovascular ingrowth throughout the implant and permits insertion of a coupling device (PEG) with reduced risk of inflammation or infection associated with earlier types of exposed integrated implants.[8]\nhydroxyapatite is limited to preformed (stock[3]) spheres (for enucleation) or granules (for building up defects).[11]\nOne main disadvantage of HA is that it needs to be covered with exogenous material, such as sclera, polyethylene terephthalate, or vicryl mesh (which has the disadvantage of creating a rough implant tissue interface that can lead to technical difficulties in implantation and subsequent erosion of overlying tissue with the end stage being extrusion), as direct suturing is not possible for muscle attachment. Scleral covering carries with it the risk of transmission of infection, inflammation, and rejection.[9]\nA recent study has shown that HA has a more rapid rate of fibrovascularization than\nMedpor.[9]\n\n<\/p>Porous polyethylene (PP)\nMEDPOR is a high-density porous polyethylene (Medpor) [8]\nImplant manufactured from linear high-density polyethylene.[12][13]\nDevelopment in polymer chemistry has allowed introduction of newer biocompatible material such as porous polyethylene (PP) to be introduced into the field of orbital implant surgery.[9] Porous polyethylene enucleation implants have been used since at least 1989.[8] It is available in dozens of prefabricated spherical and non-spherical shapes and in different sizes or plain blocks for individualized intraoperative customizing.[8]\nThe material is firm but malleable and allows direct suturing of muscles to implant without wrapping or extra steps. Additionally, the smooth surface is less abrasive and irritating than other materials used for similar purposes.[11] Polyethylene also becomes vascularized, allowing placement of a titanium motility post that joins the implant to the prosthesis in the same way that the peg is used for hydroxyapatite implants.[8]\n\n<\/p>PP has been shown to have a good outcome, and in 2004, it was the most commonly used orbital implant in the United States.[9][14] Porous polyethylene fulfills several criteria for a successful implant, including little propensity to migrate and restoration of defect in an anatomic fashion; it is readily available, cost-effective, and can be easily modified or custom-fit for each defect.[11] The PP implant does not require to be covered and therefore avoids some of the problems associated with hydroxyapatite implants.[9]\nBioceramic\nBioceramic prosthetics are made of aluminium oxide (Al2O3). Aluminium oxide is a ceramic biomaterial that has been used for more than 35 years in the orthopedic and dental fields for a variety of prosthetic applications because of its low friction, durability, stability, and inertness.[15]\nAluminium oxide ocular implants can be obtained in spherical and non-spherical (egg-shaped) shapes and in different sizes [8] for use in the anophthalmic socket. It received US Food and Drug Administration approval in April 2000 and was approved by Health and Welfare, Canada, in February 2001.[15]\n\n<\/p>Aluminium oxide has previously been shown to be more biocompatible than HA in cell culture studies and has been suggested as the standard reference material when biocompatibility studies are required to investigate new products. The rate of exposure previously associated with the bioceramic implant (2%) was less than most reports on the HA or porous polyethylene implant (0% to 50%).[15]\nConical orbital implant (COI) and multipurpose conical orbital implant (MCOI) \nThe safe and effective sphere (still popular and easy to use) was supplemented with the pyramid or COI implant.[11] The COI has unique design elements that have been incorporated into an overall conical shape, including a flat anterior surface, superior projection and preformed channels for the rectus muscles.[16] 5-0 Vicryl suture needles can be passed with slight difficulty straight through the implant to be tied on the anterior surface. In addition, this implant features a slightly recessed slot for the superior rectus and a protrusion to fill the superior fornix.[11]\nThe newest model is the multipurpose conical orbital implant, which was designed to address the issues of the postoperative anophthalmic orbit being at risk for the development of socket abnormalities including enophthalmos, retraction of the upper eyelid, deepening of the superior sulcus, backward tilt of the prothesis, and stretching of the lower eyelid.1 after evisceration or enucleation, These problems are generally thought to be secondary to orbital volume deficiencies which is also addressed by MCOIs.\nThe conical shape of the multipurpose conical porous polyethylene orbital implant (MCOI) (Porex Medical) more closely matches the anatomic shape of the orbit than a spherical implant. The wider anterior portion, combined with the narrower and longer posterior portion, allows for a more complete and natural replacement of the lost orbital volume. This shape reduces the risk of superior sulcus deformity and puts more volume within the muscle cone.[17][18]\nMuscles can be placed at any location the surgeon desires with these implants. This is advantageous for cases of damaged or lost muscles after trauma, and the remaining muscles are transposed to improve postoperative motility. And in anticipation of future peg placement there is a 6 mm diameter flattened surface, which eliminates the need to shave a flat anterior surface prior to peg placement.[11]\n\n<\/p>Both implants (COI and MCOI) are composed of interconnecting channels that allow ingrowth of host connective tissue. Complete implant vascularization reduces the risk of infection, extrusion, and other complications associated with nonintegrated implants. And both implants produce superior motility and postoperative cosmesis.[11]\nPegged (motility post) implants\nIn hydroxyapatite implants a secondary procedure can insert an externalized, round-headed peg or screw into the implant. The prosthesis is modified to accommodate the peg, creating a ball-and-socket joint:[8] after fibrovascular ingrowth is completed, a small hole can be drilled into the anterior surface of the implant. After conjunctivalization of this hole, it can be fitted with a peg with a rounded top that fits into a corresponding dimple at the posterior surface of the artificial eye. This peg thus directly transfers implant motility to the artificial eye.[6]\nHowever, the motility peg is mounted in only a minority of patients. This may partially be the result of problems associated with peg placement, whereas hydroxyapatite implants are assumed to yield superior artificial eye motility even without the peg.[6]\n\n<\/p>Polyethylene also becomes vascularized, allowing placement of a titanium motility post that joins the implant to the prosthesis in the same way that the peg is used for hydroxyapatite implants.[8]\n\nImplant movement \nImplant and prosthesis movement are important aspects of the overall cosmetic appearance after enucleation and are essential to the ideal objective of crafting a lifelike eye similar in all aspects to the normal fellow eye.[5][19]\nThere are several theories of improved eye movement, such as using integrating prosthetic material, pegging the implant, covering the implant (e.g. with scleral tissue), or suturing the eye muscles directly to the prosthetic implant.\nThe efficiency of transmitting movement from the implant to the prosthesis determines the degree of prosthetic motility. Movement is transmitted from traditional nonporous spherical implants through the surface tension at the conjunctival\u2013prosthetic interface and movement of the fornices. Quasi-integrated implants have irregularly shaped surfaces that create an indirect coupling mechanism between the implant and prosthesis that imparts greater movement to the prosthesis. Directly integrating the implant to the prosthesis through an externalized coupling mechanism would be expected to improve motility further.[8]\nDespite the reasoning stating that hydroxyapatite orbital implants without a motility peg would yield a superior artificial eye motility,[20] when similar surgical techniques are used unpegged porous (hydroxyapatite) enucleation implants and donor sclera-covered nonporous (acrylic) spherical enucleation implants yield comparable artificial eye motility.[6][8] In two studies[6][21] there were no differences in maximum amplitude between hydroxyapatite and acrylic or silicone spherical enucleation implants,[6] thus indicating that the implant material itself may not have a bearing on implant movement as long as the muscles are attached directly or indirectly to the implant and the implant is not pegged.[5]\nThe motility of a nonintegrated artificial eye may be caused by at least two forces. (1) The rubbing force between the posterior surface of the artificial eye and the conjunctiva that covers the implant may cause the artificial eye to move. Because this force is likely to be approximately equal in all directions, it would cause comparable horizontal and vertical artificial eye amplitudes. (2) An artificial eye usually fits snugly in the conjunctival space (possibly not in the superior fornix). Therefore, any movement of the conjunctival fornices will cause a similar movement of the artificial eye, whereas lack of movement of the fornices will restrict its motility.[6]\nImbrication of the rectus muscles over a nonintegrated implant traditionally was thought to impart movement to the implant and prosthesis. Like a ball-and-socket joint, when the implant moves, the prosthesis moves. However, because the so-called ball and socket are separated by layers of Tenon\u2019s capsule, imbricated muscles, and conjunctiva, the mechanical efficiency of transmission of movement from the implant to the prosthesis is suboptimal. Moreover, the concern is that imbrication of the recti over nonintegrated implants actually can result in implant migration.[22] The recent myoconjuctival technique of enucleation is an alternative to muscle imbrication.[5][21][23]\n\n<\/p>Although it is generally accepted that integrating the prosthesis to a porous implant with peg insertion enhances prosthetic movement, there is little available evidence in the literature that documents the degree of improvement.[8]\nAnd although the porous implants have been reported to offer improved implant movement,[24] these clearly are more expensive and intrusive, requiring wrapping, and subsequent imaging to determine vascularization and pegging to provide for better transmission of implant movement to the prosthesis, and also are prone to implant exposure.[5]\n\n<\/p>Age and size of the implant may also affect the motility, since in a study comparing patients with hydroxyapatite implants and patients with nonporous implants, the implant movement appeared to decrease with age in both groups. This study also demonstrated improved movement of larger implants irrespective of material.[8]\n\nSurgical procedure \nEssentially the surgery follows these steps:[8]\n\nAnesthesia\nConjunctival peritomy\nSeparation of the anterior Tenon\u2019s fascia from the sclera\nPass sutures through rectus muscles\nRectus muscles disinserted from the globe\nRotate and elevate the globe\nOpen Tenon\u2019s capsule to visualize optic nerve\nCauterize necessary blood vessels\nDivide the nerve\nRemove the eye\nHemostasis is achieved with either cautery or digital pressure.\nInsert orbital implant.\nIf necessary (hydroxyapatite) cover the implant with wrapping material before\nAttach the muscle (if possible) either directly (PP) or indirectly (HA) to implant.\nCreate fenestrations in wrapping material if necessary\nFor HA implants drill 1 mm holes as muscle insertion site\nDraw Tenon\u2019s fascia over implant\nClose Tenon\u2019s facia in one or two layers\nSuture conjunctiva\nInsert temporary ocular conformer until prosthesis is received (4\u20138 weeks later)\nAfter implant vascularization an optional secondary procedure can be done to place a couple peg or post.\nAlso under anesthesia\n\nCreate conjunctival incision at the peg insertion site\nCreate hole into implant to insert peg or post\nModify prosthesis to receive peg\/post.\nThe surgery is done under general anesthesia with the addition of extra subconjunctival and\/or retrobulbar anesthetics injected locally in some cases.\nThe following is a description of the surgical procedure performed by Custer et al.:[8]\nThe conjunctival peritomy is performed at the corneal limbus, preserving as much healthy tissue as possible. Anterior Tenon\u2019s fascia is separated from the sclera. Blunt dissection in the four quadrants between the rectus muscles separates deep Tenon\u2019s fascia.\nSutures may be passed through the rectus muscles before their disinsertion from the globe. Some surgeons also suture one or both oblique muscles. Traction sutures or clamps may be applied to the horizontal rectus muscle insertions to assist in rotating and elevating the globe during the ensuing dissection. Tenon\u2019s capsule may be opened posteriorly to allow visualization of the optic nerve. The vortex veins and posterior ciliary vessels may be cauterized before dividing the nerve and removing the eye. Alternatively, the optic nerve may be localized with a clamp before transection. Hemostasis is achieved with either cautery or digital pressure.\nThe orbital implant is inserted at the time of enucleation. An appropriately sized implant should replace the volume of the globe and leave sufficient room for the ocular prosthesis. Enucleation implants are available in a variety of sizes that may be determined by using sizing implants or calculated by measuring globe volume or axial length of the contralateral eye.\nIn the past, spherical nonporous implants were placed in the intraconal space and the extraocular muscles were either left unattached or were tied over the implant. Wrapping these implants allows attachment of the muscles to the covering material, a technique that seems to improve implant movement and reduce the incidence of implant migration. Porous implants may be saturated with antibiotic solution before insertion. Because the brittle nature of hydroxyapatite prevents direct suturing of the muscles to the implant, these implants are usually covered with some form of wrapping material. The muscles are attached to the implant in a technique similar to that used for spherical non-porous implants. The muscles may be directly sutured to porous polyethylene implants either by passing the suture through the implant material or by using an implant with fabricated suture tunnels. Some surgeons also wrap porous polyethylene implants either to facilitate muscle attachment or to reduce the risk of implant exposure. A variety of wrapping materials have been used to cover porous implants, including polyglactin or polyglycolic acid mesh, heterologous tissue (bovine pericardium), homologous donor tissue (sclera, dermis), and autogenous tissue (fascia lata, temporalis fascia, posterior auricular muscle, rectus abdominis sheath).\nFenestrations in the wrapping material are created at the insertion sites of the extraocular muscles, allowing the attached muscles to be in contact with the implant and improving implant vascularization. Drilling 1 mm holes into the implant at the muscle insertion sites is performed to facilitate vascularization of hydroxyapatite implants. Tenon\u2019s fascia is drawn over the implant and closed in one or two layers. The conjunctiva is then sutured. A temporary ocular conformer is inserted at the completion of the pro- cedure and is worn until the patient receives a prosthesis 4 to 8 weeks after surgery.\nAn elective secondary procedure is required to place the coupling peg or post in those patients who desire improved prosthetic motility. That procedure is usually delayed for at least 6 months after enucleation to allow time for implant vascularization. Technetium bone or gadolinium-enhanced magnetic resonance imaging scans are not now universally used, but they have been used to confirm vascularization before peg insertion. Under local anesthesia, a conjunctival incision is created at the peg insertion site. A hole is created into the porous implant to allow insertion of the peg or post.\nThe prosthesis is then modified to receive the peg or post. Some surgeons have preplaced coupling posts in porous polyethylene implants at the time of enucleation. The post may spontaneously expose or is externalized in a later procedure via a conjunctival incision.\n\n<\/p>\nAftermath of surgical procedures \nRegardless of the procedure, a type of ocular prosthesis is always needed afterwards. The surgeon will insert a temporary prosthesis at the end of the surgery, known as a stock eye,[25] and refer the patient to an ocularist, who is not a medical doctor, but board certified ocularist by the American Society of Ocularists.[26] The process of making an ocular prosthesis, or a custom eye, will begin, usually six weeks after the surgical procedure, and it typically will take up to three visits before the final fitting of the prosthesis. In most cases, the patient will be fitted during the first visit, return for the hand-painting of the prosthesis, and finally come back for the final fitting. The methods used to fit, shape, and paint the prosthesis often vary between ocularist and patient needs.\nLiving with an ocular prosthesis requires care, but oftentimes patients who have suffered from incurable eye disorders, such as micropthalmia, anophtalmia or retinoblastoma, achieve a better quality of life with their prostheses. The care required for an ocular prosthesis, outside of regular polishes and check-ups with ocularists, typically revolves around maintaining moisture of the prosthesis and cleanliness.[27]\n\nNotable people with prosthetic eyes \nBaz Bastien \u2013 Canadian ice hockey player, coach (right eye)[28]\nMokhtar Belmokhtar \u2013 Algerian smuggler, kidnapper, weapons dealer, and terrorist; lost his eye mishandling explosives (left eye)[29]\nHelen Keller \u2013 American deafblind social reformer (both eyes)\nSammy Davis Jr. \u2013 American singer (left eye)[30]\nPeter Falk \u2013 American actor (right eye)[31]\nTex Avery \u2013 Influential American animation director (left eye)[32]\nLeo Fender \u2013 Musical instrument architect; founded what is now known as the Fender Musical Instruments Corporation, and is well known for inventing, among other instruments, the Fender Stratocaster and the Fender Precision Bass (left eye).\nRy Cooder \u2013 Famous musician best known for his slide guitar work. (left eye) [33]\nNick Griffin \u2013 BNP leader (left eye)[34]\nBen Dreyfuss \u2013 writer (left eye)\nJeff Healey \u2013 Canadian blues guitarist (both eyes)\nLeo McKern \u2013 actor (left eye)[35]\nCarl Ouellet \u2013 Canadian professional wrestler (right eye)[36]\nPark Jie-won \u2013 South Korean politician (left eye)\nClaus Schenk Graf von Stauffenberg \u2013 German career army officer and resistance leader (left eye)[37]\nDean Shiels \u2013 Northern Irish professional footballer who lost his eye during a childhood accident (right eye).\nRobert Thurman \u2013 writer (left eye)[38]\nMo Udall \u2013 politician (right eye)[39]\nBen Underwood \u2013 California student (both eyes)\nHenry Lee Lucas \u2013 serial killer (left eye)\nFetty Wap \u2013 American rap-star (left eye) (no longer wears the prosthesis)\nAlice Walker \u2013 author (right eye)\nJim Leavelle \u2013 Dallas police detective (left eye)\nDan Crenshaw - U.S. Congressman elect of Texas\u2019s 2nd Congressional District and former Navy SEAL (right eye)\nReferences \n\n\n^ 3rd Millennium BC Artificial Eyeball Discovered in Burnt City Archived 2012-04-11 at the Wayback Machine., December 10, 2006 \n\n^ a b \nLondon Times (February 20, 2007). \"5,000-Year-Old Artificial Eye Found on Iran-Afghan Border\". foxnews. Retrieved December 14, 2012 . \n\n^ a b c d e f Frequently asked questions, American Society of Ocularists \n\n^ Lapointe, J; Durette, J-F; Harhira, A; Shaat, A; Boulos, PR; Kashyap, R (Sep 2010). \"A 'living' prosthetic iris\". Nature Eye. 24: 1716\u201323. doi:10.1038\/eye.2010.128. PMID 20847748. \n\n^ a b c d e f g h i Shome, D; Honavar, SG; Raizada, K; Raizada, D (2010). \"Implant and prosthesis movement after enucleation: a randomized controlled trial\". Ophthalmology. 117 (8): 1638\u201344. doi:10.1016\/j.ophtha.2009.12.035. PMID 20417565. \n\n^ a b c d e f g h i j k l Colen, TP; Paridaens, DA; Lemij, HG; Mourits, MP; Van Den Bosch, WA (2000). \"Comparison of artificial eye amplitudes with acrylic and hydroxyapatite spherical enucleation implants\". Ophthalmology. 107 (10): 1889\u201394. doi:10.1016\/S0161-6420(00)00348-1. PMID 11013194. \n\n^ a b Chuah, CT; Chee, SP; Fong, KS; Por, YM; Choo, CT; Luu, C; Seah, LL (2004). \"Integrated hydroxyapatite implant and non-integrated implants in enucleated Asian patients\". Annals of the Academy of Medicine, Singapore. 33 (4): 477\u201383. PMID 15329760. \n\n^ a b c d e f g h i j k l m n o p q r s Custer, PL; Kennedy, RH; Woog, JJ; Kaltreider, SA; Meyer, DR (2003). \"Orbital implants in enucleation surgery: a report by the American Academy of Ophthalmology\". Ophthalmology. 110 (10): 2054\u201361. doi:10.1016\/S0161-6420(03)00857-1. PMID 14522788. \n\n^ a b c d e f Sadiq, SA; Mengher, LS; Lowry, J; Downes, R (2008). \"Integrated orbital implants \u2013 a comparison of hydroxyapatite and porous polyethylene implants\". Orbit (Amsterdam, Netherlands). 27 (1): 37\u201340. doi:10.1080\/01676830701512585. PMID 18307145. \n\n^ Hornblass, A; Biesman, BS; Eviatar, JA; Nunery, William R. (1995). \"Current techniques of enucleation: a survey of 5,439 intraorbital implants and a review of the literature\". Ophthalmic plastic and reconstructive surgery. 11 (2): 77\u201386, discussion 87\u201388. doi:10.1097\/00002341-199506000-00001. PMID 7654621. \n\n^ a b c d e f g Duffy, M., Biesman, B. (2000). \"Porous polyethylene expands orbitofacial options\". Ophthalmology Times. 25 (7): 18. CS1 maint: Multiple names: authors list (link) \n\n^ OPTIONS: MEDPOR Biomaterial and Surgical Implants \n\n^ Chen, YH; Cui, HG (2006). \"High density porous polyethylene material (Medpor) as an unwrapped orbital implant\". Journal of Zhejiang University. Science. B. 7 (8): 679\u201382. doi:10.1631\/jzus.2006.B0679. PMC 1533749 . PMID 16845724. \n\n^ Su, GW; Yen, MT (2004). \"Current trends in managing the anophthalmic socket after primary enucleation and evisceration\". Ophthalmic plastic and reconstructive surgery. 20 (4): 274\u201380. doi:10.1097\/01.IOP.0000129528.16938.1E. PMID 15266140. \n\n^ a b c Jordan, DR; Klapper, SR; Gilberg, SM; Dutton, JJ; Wong, A; Mawn, L (2010). \"The bioceramic implant: evaluation of implant exposures in 419 implants\". Ophthalmic plastic and reconstructive surgery. 26 (2): 80\u201382. doi:10.1097\/IOP.0b013e3181b80c30. PMID 20305504. \n\n^ Conical Orbital Implant (COI) \n\n^ Marshak, H; Dresner, SC (2005). \"Multipurpose conical orbital implant in evisceration\". Ophthalmic plastic and reconstructive surgery. 21 (5): 376\u201378. doi:10.1097\/01.iop.0000173191.24824.40. PMID 16234704. \n\n^ Kostick, DA; Linberg, JV (1995). \"Evisceration with hydroxyapatite implant. Surgical technique and review of 31 case reports\". Ophthalmology. 102 (10): 1542\u201348, discussion 1548\u201349. doi:10.1016\/s0161-6420(95)30833-0. PMID 9097804. \n\n^ Byron C. Smith; Frank A. Nesi; Mark R. Levine; Richard D. Lisman (1998). Smith's Ophthalmic Plastic and Reconstructive Surgery. Mosby Incorporated. ISBN 978-0-8151-6356-5. \n\n^ Shields, CL; Shields, JA; De Potter, P (1992). \"Hydroxyapatite orbital implant after enucleation. Experience with initial 100 consecutive cases\". Archives of Ophthalmology. 110 (3): 333\u201338. doi:10.1001\/archopht.1992.01080150031022. PMID 1311918. \n\n^ a b Custer, PL; Trinkaus, KM; Fornoff, J (1999). \"Comparative motility of hydroxyapatite and alloplastic enucleation implants\". Ophthalmology. 106 (3): 513\u201316. doi:10.1016\/S0161-6420(99)90109-4. PMID 10080207. \n\n^ Beard, C (1995). \"Remarks on historical and newer approaches to orbital implants\". Ophthalmic plastic and reconstructive surgery. 11 (2): 89\u201390. doi:10.1097\/00002341-199506000-00002. PMID 7654622. \n\n^ Yadava U, Sachdeva P, Arora A (2004). \"Myoconjunctival enucleation for enhanced implant movement: result of a randomised prospective study\". Indian J Ophthalmol. 52 (3): 221\u201326. PMID 15510462. \n\n^ Jordan, DR; Chan, S; Mawn, L; Gilberg, S; Dean, T; Brownstein, S; Hill, VE (1999). \"Complications associated with pegging hydroxyapatite orbital implants\". Ophthalmology. 106 (3): 505\u201312. doi:10.1016\/S0161-6420(99)90108-2. PMID 10080206. \n\n^ \"American Society of Ocularists - Frequently Asked Questions\". www.ocularist.org. Retrieved 2016-11-09 . \n\n^ \"American Society of Ocularists - Frequently Asked Questions\". www.ocularist.org. Retrieved 2016-11-09 . \n\n^ \"Prosthetic Eye Care\". ocularpro.com. Ocular Prosthetics, Inc. Retrieved 2016-11-09 . \n\n^ Starkey, Joe (2006). Tales from the Pittsburgh Penguins. Sports Publishing LLC. Sports Publishing LLC. p. 45. ISBN 978-1-58261-199-0. Retrieved September 18, 2011 . \n\n^ \"Profile: Mokhtar Belmokhtar\". BBC News. June 4, 2013. \n\n^ \"Nice Fellow\". Time. Time Warner. April 18, 1955. Retrieved September 18, 2009 . \n\n^ \"Peter Falk\". Bio. (UK). Archived from the original on June 10, 2009. Retrieved January 30, 2009 . \n\n^ \"Tex Avery Loses an Eye, 1933\". Walter Lantz Archive. Cartoon Research. Retrieved March 16, 2018 . \n\n^ Entry for \"Ry Cooder\", in The Rolling Stone Encyclopedia of Rock & Roll, Touchstone (revised, updated edition); November 8, 2001; ISBN 978-0743201209 \n\n^ Ross, Deborah (April 30, 2010). \"Deborah Ross: How exciting! I've never met proper racists before\". London: independent.co.uk. Retrieved May 12, 2010 . \n\n^ Australian letters. Sun Books. 1. 1957. p. 1963. Retrieved September 18, 2011 . \n\n^ \"Pierre Carl Ouellet Profile\". Slam! Sports. Canadian Online Explorer. Retrieved August 6, 2008 . \n\n^ Commire, Anne (1994). Historic World Leaders: Europe (L\u2013Z). Gale Research Inc. Gale Research International, Limited. p. 769. ISBN 978-0-8103-8411-8. Retrieved September 18, 2011 . \n\n^ Roberts, John B.; Roberts, Elizabeth A. (2009). Freeing Tibet: 50 years of struggle, resilience, and hope. AMACOM Div American Mgmt Assn. AMACOM Div American Mgmt Assn. p. 160. ISBN 978-0-8144-0983-1. Retrieved September 19, 2011 . \n\n^ Kaufman, Burton Ira (2006). The Carter years. Infobase Publishing. Facts on File. p. 485. ISBN 978-0-8160-5369-8. Retrieved September 19, 2011 . \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Ocular prosthesis.\nMind Map: Adjusting and Adapting to Eye Loss\nPersonal stories about having an artificial eye\nFabricating Ocular Prostheses\nHistory of Artificial Eyes\nOcular Prosthetics\nEyeform Opticians Ocular Prosthesis information\nA FourDoc (short on-line documentary) about last glass eye maker in England.\nHow Prosthetic Eyes are made\nAmerican Academy of Maxillofacial Prosthetics\nIntroduction to the Self-Lubricating Prosthesis\nAuthority control \nBNF: cb16680198h (data) \nGND: 4296585-8 \nNDL: 00562440 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Ocular_prosthesis\">https:\/\/www.limswiki.org\/index.php\/Ocular_prosthesis<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 19:32.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 486 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","4968f8ef9f337a859c6e437cda8a94d4_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Ocular_prosthesis skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Ocular prosthesis<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For a functional replacement, or \"bionic eye\", see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_prosthesis\" title=\"Visual prosthesis\" rel=\"external_link\" target=\"_blank\">Visual prosthesis<\/a>.<\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">\"Glass eye\" redirects here. For the fish, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heteropriacanthus_cruentatus\" class=\"mw-redirect\" title=\"Heteropriacanthus cruentatus\" rel=\"external_link\" target=\"_blank\">Heteropriacanthus cruentatus<\/a>. For the American rock band, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass_Eye_(band)\" title=\"Glass Eye (band)\" rel=\"external_link\" target=\"_blank\">Glass Eye (band)<\/a>.<\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">\"Glass eyes\" redirects here. For the Radiohead song, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/A_Moon_Shaped_Pool\" title=\"A Moon Shaped Pool\" rel=\"external_link\" target=\"_blank\">A Moon Shaped Pool<\/a>.<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Eye-prosthesis-brown.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7c\/Eye-prosthesis-brown.jpg\/220px-Eye-prosthesis-brown.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Eye-prosthesis-brown.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Human ocular prosthesis of brown color<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CatWithOcularProsthetic.jpeg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/15\/CatWithOcularProsthetic.jpeg\/220px-CatWithOcularProsthetic.jpeg\" width=\"220\" height=\"146\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CatWithOcularProsthetic.jpeg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Cat with an ocular prosthesis.<\/div><\/div><\/div><p>An <b>ocular prosthesis<\/b>, <b>artificial eye<\/b> or <b>glass eye<\/b> is a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Craniofacial_prosthesis\" title=\"Craniofacial prosthesis\" rel=\"external_link\" target=\"_blank\">craniofacial prosthesis<\/a> that replaces an absent natural <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_eye\" title=\"Human eye\" rel=\"external_link\" target=\"_blank\">eye<\/a> following an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Enucleation_of_the_eye\" title=\"Enucleation of the eye\" rel=\"external_link\" target=\"_blank\">enucleation<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Evisceration_(ophthalmology)\" title=\"Evisceration (ophthalmology)\" rel=\"external_link\" target=\"_blank\">evisceration<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orbital_exenteration\" class=\"mw-redirect\" title=\"Orbital exenteration\" rel=\"external_link\" target=\"_blank\">orbital exenteration<\/a>. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthesis<\/a> fits over an orbital implant and under the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eyelid\" title=\"Eyelid\" rel=\"external_link\" target=\"_blank\">eyelids<\/a>. Though often referred to as a glass eye, the ocular prosthesis roughly takes the shape of a convex shell and is made of medical grade plastic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymethyl_methacrylate\" class=\"mw-redirect\" title=\"Polymethyl methacrylate\" rel=\"external_link\" target=\"_blank\">acrylic<\/a>. A few ocular prostheses today are made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cryolite\" title=\"Cryolite\" rel=\"external_link\" target=\"_blank\">cryolite<\/a> glass. A variant of the ocular prosthesis is a very thin hard shell known as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sclera\" title=\"Sclera\" rel=\"external_link\" target=\"_blank\">scleral<\/a> shell which can be worn over a damaged or eviscerated eye. Makers of ocular prosthetics are known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ocularist\" title=\"Ocularist\" rel=\"external_link\" target=\"_blank\">ocularists<\/a>. An ocular prosthesis does <i>not<\/i> provide vision; this would be a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_prosthesis\" title=\"Visual prosthesis\" rel=\"external_link\" target=\"_blank\">visual prosthesis<\/a>. Someone with an ocular prosthesis is totally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blindness\" class=\"mw-redirect\" title=\"Blindness\" rel=\"external_link\" target=\"_blank\">blind<\/a> on the affected side and has monocular (one sided) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_perception\" title=\"Visual perception\" rel=\"external_link\" target=\"_blank\">vision<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Prothese_met_klein_oog_en_bril,_item_1.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/66\/Prothese_met_klein_oog_en_bril%2C_item_1.jpg\/220px-Prothese_met_klein_oog_en_bril%2C_item_1.jpg\" width=\"220\" height=\"146\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Prothese_met_klein_oog_en_bril,_item_1.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Prosthetic eye and glasses made for an injured <a href=\"https:\/\/en.wikipedia.org\/wiki\/World_War_I\" title=\"World War I\" rel=\"external_link\" target=\"_blank\">World War I<\/a> soldier by pioneering plastic surgeon <a href=\"https:\/\/en.wikipedia.org\/wiki\/Johannes_Esser\" class=\"mw-redirect\" title=\"Johannes Esser\" rel=\"external_link\" target=\"_blank\">Johannes Esser<\/a><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Making_glass_eye_LOC_15601805189.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/43\/Making_glass_eye_LOC_15601805189.jpg\/220px-Making_glass_eye_LOC_15601805189.jpg\" width=\"220\" height=\"160\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Making_glass_eye_LOC_15601805189.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>\"Making glass eye\", <abbr title=\"circa\">c.<\/abbr><span style=\"white-space:nowrap;\"> 1915\u20131920<\/span>.<\/div><\/div><\/div>\n<p>The earliest known evidence of the use of ocular prosthesis is that of a woman found in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shahr-e_Sukhteh\" title=\"Shahr-e Sukhteh\" rel=\"external_link\" target=\"_blank\">Shahr-I Sokhta<\/a>, Iran <sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> dating back to 2900\u20132800 BCE.<sup id=\"rdp-ebb-cite_ref-london_2-0\" class=\"reference\"><a href=\"#cite_note-london-2\" rel=\"external_link\">[2]<\/a><\/sup> It has a hemispherical form and a diameter of just over 2.5 cm (1 inch). It consists of very light material, probably bitumen paste. The surface of the artificial eye is covered with a thin layer of gold, engraved with a central circle (representing the iris) and gold lines patterned like sun rays. On both sides of the eye are drilled tiny holes, through which a golden thread could hold the eyeball in place. Since microscopic research has shown that the eye socket showed clear imprints of the golden thread, the eyeball must have been worn during her lifetime. In addition to this, an early Hebrew text references a woman who wore an artificial eye made of gold (Yer. Ned. 41c; comp. Yer. Sanh. 13c). Roman and Egyptian priests are known to have produced artificial eyes as early as the fifth century BCE constructed from painted clay attached to cloth and worn outside the socket.<sup id=\"rdp-ebb-cite_ref-ocularist.org_3-0\" class=\"reference\"><a href=\"#cite_note-ocularist.org-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>The first in-socket artificial eyes were made of gold with colored enamel, later evolving into the use of glass (thus the name \"glass eye\") by the Venetians in the later part of the sixteenth century. These were crude, uncomfortable, and fragile and the production methodology remained known only to Venetians until the end of the 18th century, when Parisians took over as the center for artificial eye-making. But the center shifted again, this time to Germany because of their superior glass blowing techniques. Shortly following the introduction of the art of glass eye-making to the United States, German goods became unavailable because of World War II. As a result, the US instead made artificial eyes from acrylic plastic.<sup id=\"rdp-ebb-cite_ref-ocularist.org_3-1\" class=\"reference\"><a href=\"#cite_note-ocularist.org-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>Production of modern ocular prosthetics has expanded from simply using glass into many different types of materials. In the United States, most custom ocular prostheses are fabricated using PMMA (polymethyl methacrylate), or acrylic. In some countries, Germany especially, prostheses are still most commonly made from glass.<sup id=\"rdp-ebb-cite_ref-ocularist.org_3-2\" class=\"reference\"><a href=\"#cite_note-ocularist.org-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Limits_of_realism\">Limits of realism<\/span><\/h3>\n<p>Ocularist surgeons have always worked together to make artificial eyes look more realistic. For decades, all efforts and investments to improve the appearance of artificial eyes have been dampened by the immobility of the pupil. One solution to this problem has been demonstrated recently in a device based on an LCD which simulates the pupil size as a function of the ambient light.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Implant_types_and_chemical_construction\">Implant types and chemical construction<\/span><\/h2>\n<p>There are many different types of implants, classification ranging from shape (Spherical vs egg (oval) shaped), stock vs custom,<sup id=\"rdp-ebb-cite_ref-ocularist.org_3-3\" class=\"reference\"><a href=\"#cite_note-ocularist.org-3\" rel=\"external_link\">[3]<\/a><\/sup> porous vs nonporous, specific chemical make-up, and the presence of a peg or motility post. The most basic simplification can be to divide implant types into two main groups: non-integrated (non-porous) and integrated (porous).<sup id=\"rdp-ebb-cite_ref-ReferenceA_5-0\" class=\"reference\"><a href=\"#cite_note-ReferenceA-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Nonintegrated_implants\">Nonintegrated implants<\/span><\/h3>\n<p>Though there is evidence that ocular implants have been around for thousands of years<sup id=\"rdp-ebb-cite_ref-london_2-1\" class=\"reference\"><a href=\"#cite_note-london-2\" rel=\"external_link\">[2]<\/a><\/sup> modern nonintegrated spherical intraconal implants came into existence around 1976 (not just glass eyes<sup id=\"rdp-ebb-cite_ref-ocularist.org_3-4\" class=\"reference\"><a href=\"#cite_note-ocularist.org-3\" rel=\"external_link\">[3]<\/a><\/sup>).<sup id=\"rdp-ebb-cite_ref-ReferenceB_6-0\" class=\"reference\"><a href=\"#cite_note-ReferenceB-6\" rel=\"external_link\">[6]<\/a><\/sup> Nonintegrated implants contain no unique apparatus for attachments to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Extraocular_muscles\" title=\"Extraocular muscles\" rel=\"external_link\" target=\"_blank\">extraocular muscles<\/a> and do not allow in-growth of organic tissue into their inorganic substance. Such implants have no direct attachment to the ocular prosthesis.<sup id=\"rdp-ebb-cite_ref-ReferenceA_5-1\" class=\"reference\"><a href=\"#cite_note-ReferenceA-5\" rel=\"external_link\">[5]<\/a><\/sup> Usually, these implants are covered with a material that permits fixation of the extraocular recti muscles, such as donor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sclera\" title=\"Sclera\" rel=\"external_link\" target=\"_blank\">sclera<\/a> or polyester gauze which improves implant motility, but does not allow for direct mechanical coupling between the implant and the artificial eye.<sup id=\"rdp-ebb-cite_ref-ReferenceB_6-1\" class=\"reference\"><a href=\"#cite_note-ReferenceB-6\" rel=\"external_link\">[6]<\/a><\/sup>\nNon-integrated implants include the acrylic (PMMA<sup id=\"rdp-ebb-cite_ref-ReferenceA_5-2\" class=\"reference\"><a href=\"#cite_note-ReferenceA-5\" rel=\"external_link\">[5]<\/a><\/sup>), glass, and silicone spheres.<sup id=\"rdp-ebb-cite_ref-ReferenceC_7-0\" class=\"reference\"><a href=\"#cite_note-ReferenceC-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p><b>Polymethyl methacrylate (PMMA) (acrylic)<\/b>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Eyes_Prosthetics.tif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4b\/Eyes_Prosthetics.tif\/lossy-page1-220px-Eyes_Prosthetics.tif.jpg\" width=\"220\" height=\"320\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Eyes_Prosthetics.tif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Eyes Prosthetics, Polymethyl methacrylate<\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Poly(methyl_methacrylate)\" title=\"Poly(methyl methacrylate)\" rel=\"external_link\" target=\"_blank\">Polymethyl methacrylate<\/a> (PMMA)<sup id=\"rdp-ebb-cite_ref-ReferenceA_5-3\" class=\"reference\"><a href=\"#cite_note-ReferenceA-5\" rel=\"external_link\">[5]<\/a><\/sup> is a transparent thermoplastic available for use as ocular prosthesis, replacement intraocular lenses when the original lens has been removed in the treatment of cataracts and has historically been used as hard contact lenses.\n<\/p><p>PMMA has a good degree of compatibility with human tissue, much more so than glass. Although various materials have been used to make nonintegrated implants in the past, polymethyl methacrylate is one of the implants of choice.<sup id=\"rdp-ebb-cite_ref-ReferenceA_5-4\" class=\"reference\"><a href=\"#cite_note-ReferenceA-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Integrated_implants_.28porous.29\"><\/span><span class=\"mw-headline\" id=\"Integrated_implants_(porous)\">Integrated implants (porous)<\/span><\/h3>\n<p>The porous nature of integrated implants allows fibrovascular ingrowth throughout the implant and thus also insertion of pegs or posts.<sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-0\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup>\nBecause direct mechanical coupling is thought to improve artificial eye motility, attempts have been made to develop so-called \u2018integrated implants\u2019 that are directly connected to the artificial eye.<sup id=\"rdp-ebb-cite_ref-ReferenceB_6-2\" class=\"reference\"><a href=\"#cite_note-ReferenceB-6\" rel=\"external_link\">[6]<\/a><\/sup>\nHistorically, implants that directly attached to the prosthesis were unsuccessful because of chronic inflammation or infection arising from the exposed nonporous implant material.<sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-1\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup>\nThis led to the development of quasi-integrated implants with a specially designed anterior surface that allegedly better transferred implant motility to the artificial eye through the closed conjunctiva and Tenon\u2019s capsule.<sup id=\"rdp-ebb-cite_ref-ReferenceB_6-3\" class=\"reference\"><a href=\"#cite_note-ReferenceB-6\" rel=\"external_link\">[6]<\/a><\/sup>\nIn 1985, the problems associated with integrated implants were thought to be largely solved with the introduction of spherical implants made of porous calcium hydroxyapatite. This material allows for fibrovascular ingrowth within several months.<sup id=\"rdp-ebb-cite_ref-ReferenceB_6-4\" class=\"reference\"><a href=\"#cite_note-ReferenceB-6\" rel=\"external_link\">[6]<\/a><\/sup>\nPorous enucleation implants currently are fabricated from a variety of materials including natural and synthetic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydroxyapatite\" title=\"Hydroxyapatite\" rel=\"external_link\" target=\"_blank\">hydroxyapatite<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium_oxide\" title=\"Aluminium oxide\" rel=\"external_link\" target=\"_blank\">aluminium oxide<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a>.\n<\/p><p>The surgeon can alter the contour of porous implants before insertion, and it is also possible to modify the contour in situ, although this is sometimes difficult.<sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-2\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p><b>Hydroxyapatite (HA)<\/b>\n<\/p><p>Hydroxyapatite implants are spherical and made in a variety of sizes and different materials (Coralline\/ Synthetic\/ Chinese).<sup id=\"rdp-ebb-cite_ref-ReferenceC_7-1\" class=\"reference\"><a href=\"#cite_note-ReferenceC-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-3\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>Since their introduction in 1989 when an implant made from hydroxyapatite received Food and Drug Administration approval, spherical hydroxyapatite implants have gained widespread popularity as an enucleation implant<sup id=\"rdp-ebb-cite_ref-ReferenceB_6-5\" class=\"reference\"><a href=\"#cite_note-ReferenceB-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-4\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup> and was at one point was the most commonly used orbital implant in the United States.<sup id=\"rdp-ebb-cite_ref-r1_9-0\" class=\"reference\"><a href=\"#cite_note-r1-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> The porous nature of this material allows fibrovascular ingrowth throughout the implant and permits insertion of a coupling device (PEG) with reduced risk of inflammation or infection associated with earlier types of exposed integrated implants.<sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-5\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>hydroxyapatite is limited to preformed (stock<sup id=\"rdp-ebb-cite_ref-ocularist.org_3-5\" class=\"reference\"><a href=\"#cite_note-ocularist.org-3\" rel=\"external_link\">[3]<\/a><\/sup>) spheres (for enucleation) or granules (for building up defects).<sup id=\"rdp-ebb-cite_ref-r2_11-0\" class=\"reference\"><a href=\"#cite_note-r2-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>One main disadvantage of HA is that it needs to be covered with exogenous material, such as sclera, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene_terephthalate\" title=\"Polyethylene terephthalate\" rel=\"external_link\" target=\"_blank\">polyethylene terephthalate<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vicryl\" title=\"Vicryl\" rel=\"external_link\" target=\"_blank\">vicryl<\/a> mesh (which has the disadvantage of creating a rough implant tissue interface that can lead to technical difficulties in implantation and subsequent erosion of overlying tissue with the end stage being extrusion), as direct suturing is not possible for muscle attachment. Scleral covering carries with it the risk of transmission of infection, inflammation, and rejection.<sup id=\"rdp-ebb-cite_ref-r1_9-1\" class=\"reference\"><a href=\"#cite_note-r1-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>A recent study has shown that HA has a more rapid rate of fibrovascularization than\n<p>Medpor.<sup id=\"rdp-ebb-cite_ref-r1_9-2\" class=\"reference\"><a href=\"#cite_note-r1-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<\/p><p><b>Porous polyethylene (PP)<\/b>\n<\/p><p>MEDPOR is a high-density porous polyethylene (Medpor) <sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-6\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<p>Implant manufactured from linear high-density polyethylene.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\nDevelopment in polymer chemistry has allowed introduction of newer biocompatible material such as porous polyethylene (PP) to be introduced into the field of orbital implant surgery.<sup id=\"rdp-ebb-cite_ref-r1_9-3\" class=\"reference\"><a href=\"#cite_note-r1-9\" rel=\"external_link\">[9]<\/a><\/sup> Porous polyethylene enucleation implants have been used since at least 1989.<sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-7\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup> It is available in dozens of prefabricated spherical and non-spherical shapes and in different sizes or plain blocks for individualized intraoperative customizing.<sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-8\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup>\nThe material is firm but malleable and allows direct suturing of muscles to implant without wrapping or extra steps. Additionally, the smooth surface is less abrasive and irritating than other materials used for similar purposes.<sup id=\"rdp-ebb-cite_ref-r2_11-1\" class=\"reference\"><a href=\"#cite_note-r2-11\" rel=\"external_link\">[11]<\/a><\/sup> Polyethylene also becomes vascularized, allowing placement of a titanium motility post that joins the implant to the prosthesis in the same way that the peg is used for hydroxyapatite implants.<sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-9\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<\/p><p>PP has been shown to have a good outcome, and in 2004, it was the most commonly used orbital implant in the United States.<sup id=\"rdp-ebb-cite_ref-r1_9-4\" class=\"reference\"><a href=\"#cite_note-r1-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> Porous polyethylene fulfills several criteria for a successful implant, including little propensity to migrate and restoration of defect in an anatomic fashion; it is readily available, cost-effective, and can be easily modified or custom-fit for each defect.<sup id=\"rdp-ebb-cite_ref-r2_11-2\" class=\"reference\"><a href=\"#cite_note-r2-11\" rel=\"external_link\">[11]<\/a><\/sup> The PP implant does not require to be covered and therefore avoids some of the problems associated with hydroxyapatite implants.<sup id=\"rdp-ebb-cite_ref-r1_9-5\" class=\"reference\"><a href=\"#cite_note-r1-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p><b>Bioceramic<\/b>\n<\/p><p>Bioceramic prosthetics are made of aluminium oxide (Al<sub>2<\/sub>O<sub>3<\/sub>). Aluminium oxide is a ceramic biomaterial that has been used for more than 35 years in the orthopedic and dental fields for a variety of prosthetic applications because of its low friction, durability, stability, and inertness.<sup id=\"rdp-ebb-cite_ref-r3_15-0\" class=\"reference\"><a href=\"#cite_note-r3-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<p>Aluminium oxide ocular implants can be obtained in spherical and non-spherical (egg-shaped) shapes and in different sizes <sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-10\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup> for use in the anophthalmic socket. It received US Food and Drug Administration approval in April 2000 and was approved by Health and Welfare, Canada, in February 2001.<sup id=\"rdp-ebb-cite_ref-r3_15-1\" class=\"reference\"><a href=\"#cite_note-r3-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<\/p><p>Aluminium oxide has previously been shown to be more biocompatible than HA in cell culture studies and has been suggested as the standard reference material when biocompatibility studies are required to investigate new products. The rate of exposure previously associated with the bioceramic implant (2%) was less than most reports on the HA or porous polyethylene implant (0% to 50%).<sup id=\"rdp-ebb-cite_ref-r3_15-2\" class=\"reference\"><a href=\"#cite_note-r3-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p><b>Conical orbital implant (COI) and multipurpose conical orbital implant (MCOI) <\/b>\n<\/p><p>The safe and effective sphere (still popular and easy to use) was supplemented with the pyramid or COI implant.<sup id=\"rdp-ebb-cite_ref-r2_11-3\" class=\"reference\"><a href=\"#cite_note-r2-11\" rel=\"external_link\">[11]<\/a><\/sup> The COI has unique design elements that have been incorporated into an overall conical shape, including a flat anterior surface, superior projection and preformed channels for the rectus muscles.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> 5-0 Vicryl suture needles can be passed with slight difficulty straight through the implant to be tied on the anterior surface. In addition, this implant features a slightly recessed slot for the superior rectus and a protrusion to fill the superior fornix.<sup id=\"rdp-ebb-cite_ref-r2_11-4\" class=\"reference\"><a href=\"#cite_note-r2-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>The newest model is the multipurpose conical orbital implant, which was designed to address the issues of the postoperative anophthalmic orbit being at risk for the development of socket abnormalities including enophthalmos, retraction of the upper eyelid, deepening of the superior sulcus, backward tilt of the prothesis, and stretching of the lower eyelid.1 after evisceration or enucleation, These problems are generally thought to be secondary to orbital volume deficiencies which is also addressed by MCOIs.\n<p>The conical shape of the multipurpose conical porous polyethylene orbital implant (MCOI) (Porex Medical) more closely matches the anatomic shape of the orbit than a spherical implant. The wider anterior portion, combined with the narrower and longer posterior portion, allows for a more complete and natural replacement of the lost orbital volume. This shape reduces the risk of superior sulcus deformity and puts more volume within the muscle cone.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\nMuscles can be placed at any location the surgeon desires with these implants. This is advantageous for cases of damaged or lost muscles after trauma, and the remaining muscles are transposed to improve postoperative motility. And in anticipation of future peg placement there is a 6 mm diameter flattened surface, which eliminates the need to shave a flat anterior surface prior to peg placement.<sup id=\"rdp-ebb-cite_ref-r2_11-5\" class=\"reference\"><a href=\"#cite_note-r2-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<\/p><p>Both implants (COI and MCOI) are composed of interconnecting channels that allow ingrowth of host connective tissue. Complete implant vascularization reduces the risk of infection, extrusion, and other complications associated with nonintegrated implants. And both implants produce superior motility and postoperative cosmesis.<sup id=\"rdp-ebb-cite_ref-r2_11-6\" class=\"reference\"><a href=\"#cite_note-r2-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p><b>Pegged (motility post) implants<\/b>\n<\/p><p>In hydroxyapatite implants a secondary procedure can insert an externalized, round-headed peg or screw into the implant. The prosthesis is modified to accommodate the peg, creating a ball-and-socket joint:<sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-11\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup> after fibrovascular ingrowth is completed, a small hole can be drilled into the anterior surface of the implant. After conjunctivalization of this hole, it can be fitted with a peg with a rounded top that fits into a corresponding dimple at the posterior surface of the artificial eye. This peg thus directly transfers implant motility to the artificial eye.<sup id=\"rdp-ebb-cite_ref-ReferenceB_6-6\" class=\"reference\"><a href=\"#cite_note-ReferenceB-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<p>However, the motility peg is mounted in only a minority of patients. This may partially be the result of problems associated with peg placement, whereas hydroxyapatite implants are assumed to yield superior artificial eye motility even without the peg.<sup id=\"rdp-ebb-cite_ref-ReferenceB_6-7\" class=\"reference\"><a href=\"#cite_note-ReferenceB-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<\/p><p>Polyethylene also becomes vascularized, allowing placement of a titanium motility post that joins the implant to the prosthesis in the same way that the peg is used for hydroxyapatite implants.<sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-12\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Implant_movement\">Implant movement<\/span><\/h2>\n<p>Implant and prosthesis movement are important aspects of the overall cosmetic appearance after enucleation and are essential to the ideal objective of crafting a lifelike eye similar in all aspects to the normal fellow eye.<sup id=\"rdp-ebb-cite_ref-ReferenceA_5-5\" class=\"reference\"><a href=\"#cite_note-ReferenceA-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\nThere are several theories of improved eye movement, such as using integrating prosthetic material, pegging the implant, covering the implant (e.g. with scleral tissue), or suturing the eye muscles directly to the prosthetic implant.\nThe efficiency of transmitting movement from the implant to the prosthesis determines the degree of prosthetic motility. Movement is transmitted from traditional nonporous spherical implants through the surface tension at the conjunctival\u2013prosthetic interface and movement of the fornices. Quasi-integrated implants have irregularly shaped surfaces that create an indirect coupling mechanism between the implant and prosthesis that imparts greater movement to the prosthesis. Directly integrating the implant to the prosthesis through an externalized coupling mechanism would be expected to improve motility further.<sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-13\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>Despite the reasoning stating that hydroxyapatite orbital implants without a motility peg would yield a superior artificial eye motility,<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> when similar surgical techniques are used unpegged porous (hydroxyapatite) enucleation implants and donor sclera-covered nonporous (acrylic) spherical enucleation implants yield comparable artificial eye motility.<sup id=\"rdp-ebb-cite_ref-ReferenceB_6-8\" class=\"reference\"><a href=\"#cite_note-ReferenceB-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-14\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup> In two studies<sup id=\"rdp-ebb-cite_ref-ReferenceB_6-9\" class=\"reference\"><a href=\"#cite_note-ReferenceB-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-r4_21-0\" class=\"reference\"><a href=\"#cite_note-r4-21\" rel=\"external_link\">[21]<\/a><\/sup> there were no differences in maximum amplitude between hydroxyapatite and acrylic or silicone spherical enucleation implants,<sup id=\"rdp-ebb-cite_ref-ReferenceB_6-10\" class=\"reference\"><a href=\"#cite_note-ReferenceB-6\" rel=\"external_link\">[6]<\/a><\/sup> thus indicating that the implant material itself may not have a bearing on implant movement as long as the muscles are attached directly or indirectly to the implant and the implant is not pegged.<sup id=\"rdp-ebb-cite_ref-ReferenceA_5-6\" class=\"reference\"><a href=\"#cite_note-ReferenceA-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<p>The motility of a nonintegrated artificial eye may be caused by at least two forces. (1) The rubbing force between the posterior surface of the artificial eye and the conjunctiva that covers the implant may cause the artificial eye to move. Because this force is likely to be approximately equal in all directions, it would cause comparable horizontal and vertical artificial eye amplitudes. (2) An artificial eye usually fits snugly in the conjunctival space (possibly not in the superior fornix). Therefore, any movement of the conjunctival fornices will cause a similar movement of the artificial eye, whereas lack of movement of the fornices will restrict its motility.<sup id=\"rdp-ebb-cite_ref-ReferenceB_6-11\" class=\"reference\"><a href=\"#cite_note-ReferenceB-6\" rel=\"external_link\">[6]<\/a><\/sup>\nImbrication of the rectus muscles over a nonintegrated implant traditionally was thought to impart movement to the implant and prosthesis. Like a ball-and-socket joint, when the implant moves, the prosthesis moves. However, because the so-called ball and socket are separated by layers of Tenon\u2019s capsule, imbricated muscles, and conjunctiva, the mechanical efficiency of transmission of movement from the implant to the prosthesis is suboptimal. Moreover, the concern is that imbrication of the recti over nonintegrated implants actually can result in implant migration.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> The recent myoconjuctival technique of enucleation is an alternative to muscle imbrication.<sup id=\"rdp-ebb-cite_ref-ReferenceA_5-7\" class=\"reference\"><a href=\"#cite_note-ReferenceA-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-r4_21-1\" class=\"reference\"><a href=\"#cite_note-r4-21\" rel=\"external_link\">[21]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p>\n<\/p><p>Although it is generally accepted that integrating the prosthesis to a porous implant with peg insertion enhances prosthetic movement, there is little available evidence in the literature that documents the degree of improvement.<sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-15\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<p>And although the porous implants have been reported to offer improved implant movement,<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> these clearly are more expensive and intrusive, requiring wrapping, and subsequent imaging to determine vascularization and pegging to provide for better transmission of implant movement to the prosthesis, and also are prone to implant exposure.<sup id=\"rdp-ebb-cite_ref-ReferenceA_5-8\" class=\"reference\"><a href=\"#cite_note-ReferenceA-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<\/p><p>Age and size of the implant may also affect the motility, since in a study comparing patients with hydroxyapatite implants and patients with nonporous implants, the implant movement appeared to decrease with age in both groups. This study also demonstrated improved movement of larger implants irrespective of material.<sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-16\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Surgical_procedure\">Surgical procedure<\/span><\/h2>\n<p>Essentially the surgery follows these steps:<sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-17\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<ul><li>Anesthesia<\/li>\n<li>Conjunctival peritomy<\/li>\n<li>Separation of the anterior <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tenon%27s_capsule\" title=\"Tenon's capsule\" rel=\"external_link\" target=\"_blank\">Tenon\u2019s fascia<\/a> from the sclera<\/li>\n<li>Pass sutures through rectus muscles<\/li>\n<li>Rectus muscles disinserted from the globe<\/li>\n<li>Rotate and elevate the globe<\/li>\n<li>Open Tenon\u2019s capsule to visualize optic nerve<\/li>\n<li>Cauterize necessary blood vessels<\/li>\n<li>Divide the nerve<\/li>\n<li>Remove the eye<\/li>\n<li>Hemostasis is achieved with either cautery or digital pressure.<\/li>\n<li>Insert orbital implant.<\/li>\n<li>If necessary (hydroxyapatite) cover the implant with wrapping material before<\/li>\n<li>Attach the muscle (if possible) either directly (PP) or indirectly (HA) to implant.<\/li>\n<li>Create fenestrations in wrapping material if necessary<\/li>\n<li>For HA implants drill 1 mm holes as muscle insertion site<\/li>\n<li>Draw Tenon\u2019s fascia over implant<\/li>\n<li>Close Tenon\u2019s facia in one or two layers<\/li>\n<li>Suture conjunctiva<\/li>\n<li>Insert temporary ocular conformer until prosthesis is received (4\u20138 weeks later)<\/li>\n<li>After implant vascularization an optional secondary procedure can be done to place a couple peg or post.<\/li><\/ul>\n<p>Also under anesthesia\n<\/p>\n<ul><li>Create conjunctival incision at the peg insertion site<\/li>\n<li>Create hole into implant to insert peg or post<\/li>\n<li>Modify prosthesis to receive peg\/post.<\/li><\/ul>\n<p>The surgery is done under general anesthesia with the addition of extra subconjunctival and\/or retrobulbar anesthetics injected locally in some cases.\nThe following is a description of the surgical procedure performed by Custer <i>et al.<\/i>:<sup id=\"rdp-ebb-cite_ref-Custer,_P._L._2003_8-18\" class=\"reference\"><a href=\"#cite_note-Custer,_P._L._2003-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>The conjunctival peritomy is performed at the corneal limbus, preserving as much healthy tissue as possible. Anterior Tenon\u2019s fascia is separated from the sclera. Blunt dissection in the four quadrants between the rectus muscles separates deep Tenon\u2019s fascia.\n<\/p><p>Sutures may be passed through the rectus muscles before their disinsertion from the globe. Some surgeons also suture one or both oblique muscles. Traction sutures or clamps may be applied to the horizontal rectus muscle insertions to assist in rotating and elevating the globe during the ensuing dissection. Tenon\u2019s capsule may be opened posteriorly to allow visualization of the optic nerve. The vortex veins and posterior ciliary vessels may be cauterized before dividing the nerve and removing the eye. Alternatively, the optic nerve may be localized with a clamp before transection. Hemostasis is achieved with either cautery or digital pressure.\n<\/p><p>The orbital implant is inserted at the time of enucleation. An appropriately sized implant should replace the volume of the globe and leave sufficient room for the ocular prosthesis. Enucleation implants are available in a variety of sizes that may be determined by using sizing implants or calculated by measuring globe volume or axial length of the contralateral eye.\n<\/p><p>In the past, spherical nonporous implants were placed in the intraconal space and the extraocular muscles were either left unattached or were tied over the implant. Wrapping these implants allows attachment of the muscles to the covering material, a technique that seems to improve implant movement and reduce the incidence of implant migration. Porous implants may be saturated with antibiotic solution before insertion. Because the brittle nature of hydroxyapatite prevents direct suturing of the muscles to the implant, these implants are usually covered with some form of wrapping material. The muscles are attached to the implant in a technique similar to that used for spherical non-porous implants. The muscles may be directly sutured to porous polyethylene implants either by passing the suture through the implant material or by using an implant with fabricated suture tunnels. Some surgeons also wrap porous polyethylene implants either to facilitate muscle attachment or to reduce the risk of implant exposure. A variety of wrapping materials have been used to cover porous implants, including polyglactin or polyglycolic acid mesh, heterologous tissue (bovine pericardium), homologous donor tissue (sclera, dermis), and autogenous tissue (fascia lata, temporalis fascia, posterior auricular muscle, rectus abdominis sheath).\n<p>Fenestrations in the wrapping material are created at the insertion sites of the extraocular muscles, allowing the attached muscles to be in contact with the implant and improving implant vascularization. Drilling 1 mm holes into the implant at the muscle insertion sites is performed to facilitate vascularization of hydroxyapatite implants. Tenon\u2019s fascia is drawn over the implant and closed in one or two layers. The conjunctiva is then sutured. A temporary ocular conformer is inserted at the completion of the pro- cedure and is worn until the patient receives a prosthesis 4 to 8 weeks after surgery.\nAn elective secondary procedure is required to place the coupling peg or post in those patients who desire improved prosthetic motility. That procedure is usually delayed for at least 6 months after enucleation to allow time for implant vascularization. Technetium bone or gadolinium-enhanced magnetic resonance imaging scans are not now universally used, but they have been used to confirm vascularization before peg insertion. Under local anesthesia, a conjunctival incision is created at the peg insertion site. A hole is created into the porous implant to allow insertion of the peg or post.\nThe prosthesis is then modified to receive the peg or post. Some surgeons have preplaced coupling posts in porous polyethylene implants at the time of enucleation. The post may spontaneously expose or is externalized in a later procedure via a conjunctival incision.\n<\/p>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Aftermath_of_surgical_procedures\">Aftermath of surgical procedures<\/span><\/h2>\n<p>Regardless of the procedure, a type of ocular prosthesis is always needed afterwards. The surgeon will insert a temporary prosthesis at the end of the surgery, known as a stock eye,<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> and refer the patient to an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ocularist\" title=\"Ocularist\" rel=\"external_link\" target=\"_blank\">ocularist<\/a>, who is not a medical doctor, but board certified ocularist by the American Society of Ocularists.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> The process of making an ocular prosthesis, or a custom eye, will begin, usually six weeks after the surgical procedure, and it typically will take up to three visits before the final fitting of the prosthesis. In most cases, the patient will be fitted during the first visit, return for the hand-painting of the prosthesis, and finally come back for the final fitting. The methods used to fit, shape, and paint the prosthesis often vary between ocularist and patient needs.\n<\/p><p>Living with an ocular prosthesis requires care, but oftentimes patients who have suffered from incurable eye disorders, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microphthalmia\" title=\"Microphthalmia\" rel=\"external_link\" target=\"_blank\">micropthalmia<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anophthalmia\" title=\"Anophthalmia\" rel=\"external_link\" target=\"_blank\">anophtalmia<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinoblastoma\" title=\"Retinoblastoma\" rel=\"external_link\" target=\"_blank\">retinoblastoma<\/a>, achieve a better quality of life with their prostheses. The care required for an ocular prosthesis, outside of regular polishes and check-ups with ocularists, typically revolves around maintaining moisture of the prosthesis and cleanliness.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Notable_people_with_prosthetic_eyes\">Notable people with prosthetic eyes<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Baz_Bastien\" title=\"Baz Bastien\" rel=\"external_link\" target=\"_blank\">Baz Bastien<\/a> \u2013 Canadian ice hockey player, coach <i>(right eye)<\/i><sup id=\"rdp-ebb-cite_ref-Starkey2006_28-0\" class=\"reference\"><a href=\"#cite_note-Starkey2006-28\" rel=\"external_link\">[28]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mokhtar_Belmokhtar\" title=\"Mokhtar Belmokhtar\" rel=\"external_link\" target=\"_blank\">Mokhtar Belmokhtar<\/a> \u2013 Algerian smuggler, kidnapper, weapons dealer, and terrorist; lost his eye mishandling explosives <i>(left eye)<\/i><sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Helen_Keller\" title=\"Helen Keller\" rel=\"external_link\" target=\"_blank\">Helen Keller<\/a> \u2013 American deafblind social reformer <i>(both eyes)<\/i><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sammy_Davis_Jr.\" title=\"Sammy Davis Jr.\" rel=\"external_link\" target=\"_blank\">Sammy Davis Jr.<\/a> \u2013 American singer <i>(left eye)<\/i><sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Peter_Falk\" title=\"Peter Falk\" rel=\"external_link\" target=\"_blank\">Peter Falk<\/a> \u2013 American actor <i>(right eye)<\/i><sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tex_Avery\" title=\"Tex Avery\" rel=\"external_link\" target=\"_blank\">Tex Avery<\/a> \u2013 Influential American animation director <i>(left eye)<\/i><sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Leo_Fender\" title=\"Leo Fender\" rel=\"external_link\" target=\"_blank\">Leo Fender<\/a> \u2013 Musical instrument architect; founded what is now known as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fender_Musical_Instruments_Corporation\" title=\"Fender Musical Instruments Corporation\" rel=\"external_link\" target=\"_blank\">Fender Musical Instruments Corporation<\/a>, and is well known for inventing, among other instruments, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fender_Stratocaster\" title=\"Fender Stratocaster\" rel=\"external_link\" target=\"_blank\">Fender Stratocaster<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fender_Precision_Bass\" title=\"Fender Precision Bass\" rel=\"external_link\" target=\"_blank\">Fender Precision Bass<\/a> <i>(left eye)<\/i>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ry_Cooder\" title=\"Ry Cooder\" rel=\"external_link\" target=\"_blank\">Ry Cooder<\/a> \u2013 Famous musician best known for his slide guitar work. <i> (left eye) <\/i><sup id=\"rdp-ebb-cite_ref-rs_33-0\" class=\"reference\"><a href=\"#cite_note-rs-33\" rel=\"external_link\">[33]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nick_Griffin\" title=\"Nick Griffin\" rel=\"external_link\" target=\"_blank\">Nick Griffin<\/a> \u2013 BNP leader <i>(left eye)<\/i><sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ben_Dreyfuss\" title=\"Ben Dreyfuss\" rel=\"external_link\" target=\"_blank\">Ben Dreyfuss<\/a> \u2013 writer (<i>left eye<\/i>)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Jeff_Healey\" title=\"Jeff Healey\" rel=\"external_link\" target=\"_blank\">Jeff Healey<\/a> \u2013 Canadian blues guitarist <i>(both eyes)<\/i><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Leo_McKern\" title=\"Leo McKern\" rel=\"external_link\" target=\"_blank\">Leo McKern<\/a> \u2013 actor <i>(left eye)<\/i><sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Carl_Ouellet\" title=\"Carl Ouellet\" rel=\"external_link\" target=\"_blank\">Carl Ouellet<\/a> \u2013 Canadian professional wrestler <i>(right eye)<\/i><sup id=\"rdp-ebb-cite_ref-SLAM!_Profile_36-0\" class=\"reference\"><a href=\"#cite_note-SLAM!_Profile-36\" rel=\"external_link\">[36]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Park_Jie-won\" title=\"Park Jie-won\" rel=\"external_link\" target=\"_blank\">Park Jie-won<\/a> \u2013 South Korean politician <i>(left eye)<\/i><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Claus_Schenk_Graf_von_Stauffenberg\" class=\"mw-redirect\" title=\"Claus Schenk Graf von Stauffenberg\" rel=\"external_link\" target=\"_blank\">Claus Schenk Graf von Stauffenberg<\/a> \u2013 German career army officer and resistance leader <i>(left eye)<\/i><sup id=\"rdp-ebb-cite_ref-Commire1994_37-0\" class=\"reference\"><a href=\"#cite_note-Commire1994-37\" rel=\"external_link\">[37]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dean_Shiels\" title=\"Dean Shiels\" rel=\"external_link\" target=\"_blank\">Dean Shiels<\/a> \u2013 Northern Irish professional footballer who lost his eye during a childhood accident (<i>right eye<\/i>).<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_Thurman\" title=\"Robert Thurman\" rel=\"external_link\" target=\"_blank\">Robert Thurman<\/a> \u2013 writer <i>(left eye)<\/i><sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mo_Udall\" title=\"Mo Udall\" rel=\"external_link\" target=\"_blank\">Mo Udall<\/a> \u2013 politician <i>(right eye)<\/i><sup id=\"rdp-ebb-cite_ref-Kaufman2006_39-0\" class=\"reference\"><a href=\"#cite_note-Kaufman2006-39\" rel=\"external_link\">[39]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_echolocation#Ben_Underwood\" title=\"Human echolocation\" rel=\"external_link\" target=\"_blank\">Ben Underwood<\/a> \u2013 California student <i>(both eyes)<\/i><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Henry_Lee_Lucas\" title=\"Henry Lee Lucas\" rel=\"external_link\" target=\"_blank\">Henry Lee Lucas<\/a> \u2013 serial killer <i>(left eye)<\/i><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fetty_Wap\" title=\"Fetty Wap\" rel=\"external_link\" target=\"_blank\">Fetty Wap<\/a> \u2013 American rap-star <i>(left eye) (no longer wears the prosthesis)<\/i><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Alice_Walker\" title=\"Alice Walker\" rel=\"external_link\" target=\"_blank\">Alice Walker<\/a> \u2013 author <i>(right eye)<\/i><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Jim_Leavelle\" title=\"Jim Leavelle\" rel=\"external_link\" target=\"_blank\">Jim Leavelle<\/a> \u2013 Dallas police detective <i>(left eye)<\/i><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dan_Crenshaw\" title=\"Dan Crenshaw\" rel=\"external_link\" target=\"_blank\">Dan Crenshaw<\/a> - U.S. Congressman elect of Texas\u2019s 2nd Congressional District and former Navy SEAL <i>(right eye)<\/i><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.chnpress.com\/news\/?Section=2&id=6857\" target=\"_blank\">3rd Millennium BC Artificial Eyeball Discovered in Burnt City<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120411144011\/http:\/\/www.chnpress.com\/news\/?Section=2&id=6857\" target=\"_blank\">Archived<\/a> 2012-04-11 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>., December 10, 2006<\/span>\n<\/li>\n<li id=\"cite_note-london-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-london_2-0\" 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(2000). \"Porous polyethylene expands orbitofacial options\". <i>Ophthalmology Times<\/i>. <b>25<\/b> (7): 18.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ophthalmology+Times&rft.atitle=Porous+polyethylene+expands+orbitofacial+options&rft.volume=25&rft.issue=7&rft.pages=18&rft.date=2000&rft.au=Duffy%2C+M.%2C+Biesman%2C+B.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOcular+prosthesis\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.porexsurgical.com\/english\/surgical\/smedpor.asp\" target=\"_blank\">OPTIONS: MEDPOR Biomaterial and Surgical Implants<\/a><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chen, YH; Cui, HG (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1533749\" target=\"_blank\">\"High density porous polyethylene material (Medpor) as an unwrapped orbital implant\"<\/a>. <i>Journal of Zhejiang University. 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Retrieved <span class=\"nowrap\">May 12,<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Deborah+Ross%3A+How+exciting%21+I%27ve+never+met+proper+racists+before&rft.date=2010-04-30&rft.aulast=Ross&rft.aufirst=Deborah&rft_id=https%3A%2F%2Fwww.independent.co.uk%2Fnews%2Fuk%2Fpolitics%2Fdeborah-ross-how-exciting-ive-never-met-proper-racists-before-1958673.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOcular+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=8mMYAQAAIAAJ\" target=\"_blank\"><i>Australian letters<\/i><\/a>. <i>Sun Books<\/i>. <b>1<\/b>. 1957. p. 1963<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">September 18,<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Australian+letters&rft.pages=1963&rft.date=1957&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D8mMYAQAAIAAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOcular+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-SLAM!_Profile-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SLAM!_Profile_36-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/slam.canoe.ca\/Slam\/Wrestling\/Bios\/ouellet.html\" target=\"_blank\">\"Pierre Carl Ouellet Profile\"<\/a>. <i>Slam! Sports<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Canadian_Online_Explorer\" class=\"mw-redirect\" title=\"Canadian Online Explorer\" rel=\"external_link\" target=\"_blank\">Canadian Online Explorer<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">August 6,<\/span> 2008<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Slam%21+Sports&rft.atitle=Pierre+Carl+Ouellet+Profile&rft_id=http%3A%2F%2Fslam.canoe.ca%2FSlam%2FWrestling%2FBios%2Fouellet.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOcular+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Commire1994-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Commire1994_37-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Anne_Commire\" title=\"Anne Commire\" rel=\"external_link\" target=\"_blank\">Commire, Anne<\/a> (1994). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=-joOAQAAMAAJ\" target=\"_blank\"><i>Historic World Leaders: Europe (L\u2013Z)<\/i><\/a>. <i>Gale Research Inc<\/i>. Gale Research International, Limited. p. 769. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-8103-8411-8<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">September 18,<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Historic+World+Leaders%3A+Europe+%28L%E2%80%93Z%29&rft.pages=769&rft.pub=Gale+Research+International%2C+Limited&rft.date=1994&rft.isbn=978-0-8103-8411-8&rft.au=Commire%2C+Anne&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D-joOAQAAMAAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOcular+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-38\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-38\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Roberts, John B.; Roberts, Elizabeth A. (2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=BSb-a72RyQMC\" target=\"_blank\"><i>Freeing Tibet: 50 years of struggle, resilience, and hope<\/i><\/a>. <i>AMACOM Div American Mgmt Assn<\/i>. AMACOM Div American Mgmt Assn. p. 160. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-8144-0983-1<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">September 19,<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Freeing+Tibet%3A+50+years+of+struggle%2C+resilience%2C+and+hope&rft.pages=160&rft.pub=AMACOM+Div+American+Mgmt+Assn&rft.date=2009&rft.isbn=978-0-8144-0983-1&rft.aulast=Roberts&rft.aufirst=John+B.&rft.au=Roberts%2C+Elizabeth+A.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DBSb-a72RyQMC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOcular+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Kaufman2006-39\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Kaufman2006_39-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Kaufman, Burton Ira (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=WtEluAAACAAJ\" target=\"_blank\"><i>The Carter years<\/i><\/a>. <i>Infobase Publishing<\/i>. Facts on File. p. 485. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-8160-5369-8<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">September 19,<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Carter+years&rft.pages=485&rft.pub=Facts+on+File&rft.date=2006&rft.isbn=978-0-8160-5369-8&rft.au=Kaufman%2C+Burton+Ira&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DWtEluAAACAAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOcular+prosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/artificialeyes.net\/adjusting-to-eye-loss-mind-map\/\" target=\"_blank\">Mind Map: Adjusting and Adapting to Eye Loss<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/geelen.com.au\/stories-of-eye-loss\/\" target=\"_blank\">Personal stories about having an artificial eye<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080509132153\/http:\/\/www.artificialeyeclinic.com\/fabricating_prostheses.html\" target=\"_blank\">Fabricating Ocular Prostheses<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20020605012207\/http:\/\/www.artificialeyeclinic.com\/history.html\" target=\"_blank\">History of Artificial Eyes<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080614025515\/http:\/\/www.eyemdlink.com\/EyeProcedure.asp?EyeProcedureID=35\" target=\"_blank\">Ocular Prosthetics<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/eyeform.co.uk\/prosthesis\" target=\"_blank\">Eyeform Opticians Ocular Prosthesis information<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.channel4.com\/fourdocs\/film\/film-detail.jsp?id=1343\" target=\"_blank\">A FourDoc (short on-line documentary) about last glass eye maker in England.<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ericksonlabs.com\/v\/Artificial_Eyes\/our_process.asp\" target=\"_blank\">How Prosthetic Eyes are made<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.maxillofacialprosth.org\/ReferringPhysicians\/WhatisMP.html\" target=\"_blank\">American Academy of Maxillofacial Prosthetics<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.slpeye.com\/the-slp\" target=\"_blank\">Introduction to the Self-Lubricating Prosthesis<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1268\nCached time: 20181217104654\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.612 seconds\nReal time usage: 0.754 seconds\nPreprocessor visited node count: 2478\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 69475\/2097152 bytes\nTemplate argument size: 609\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 7\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 109258\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.305\/10.000 seconds\nLua memory usage: 4.54 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 621.560 1 -total\n<\/p>\n<pre>63.90% 397.199 1 Template:Reflist\n23.98% 149.028 18 Template:Cite_journal\n12.66% 78.715 4 Template:Cite_news\n 9.18% 57.066 1 Template:Commons_category\n 6.47% 40.200 1 Template:For\n 6.30% 39.187 1 Template:ISBN\n 5.49% 34.147 1 Template:Authority_control\n 4.93% 30.637 6 Template:Cite_book\n 4.27% 26.528 6 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:8302636-1!canonical and timestamp 20181217104653 and revision id 873370396\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Ocular_prosthesis\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212145\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.016 seconds\nReal time usage: 0.156 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 148.270 1 - wikipedia:Ocular_prosthesis\n100.00% 148.270 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8257-0!*!*!*!*!*!* and timestamp 20181217212145 and revision id 24467\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Ocular_prosthesis\">https:\/\/www.limswiki.org\/index.php\/Ocular_prosthesis<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","4968f8ef9f337a859c6e437cda8a94d4_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7c\/Eye-prosthesis-brown.jpg\/440px-Eye-prosthesis-brown.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/15\/CatWithOcularProsthetic.jpeg\/440px-CatWithOcularProsthetic.jpe","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/66\/Prothese_met_klein_oog_en_bril%2C_item_1.jpg\/440px-Prothese_met_klein_oog_en_bril%2C_item_1.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/43\/Making_glass_eye_LOC_15601805189.jpg\/440px-Making_glass_eye_LOC_15601805189.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4b\/Eyes_Prosthetics.tif\/lossy-page1-440px-Eyes_Prosthetics.tif.jpg"],"4968f8ef9f337a859c6e437cda8a94d4_timestamp":1545081705,"75ce87ee0133b541e6aa301709ab7639_type":"article","75ce87ee0133b541e6aa301709ab7639_title":"Nose prosthesis","75ce87ee0133b541e6aa301709ab7639_url":"https:\/\/www.limswiki.org\/index.php\/Nose_prosthesis","75ce87ee0133b541e6aa301709ab7639_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tNose prosthesis\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Nose prosthesis ca. 1918A nose (nasal) prosthesis is a type of craniofacial prosthesis used to replace an absent nose. Modern prosthetic noses are typically made of polydimethylsiloxane, a flexible material made to move with the skin. It is retained to the patient daily by using an adhesive or osseointegrated implants.\nReferences \n\n\n\r\n\n\nThis biotechnology article is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Nose_prosthesis\">https:\/\/www.limswiki.org\/index.php\/Nose_prosthesis<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 22:24.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 284 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","75ce87ee0133b541e6aa301709ab7639_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Nose_prosthesis skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Nose prosthesis<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Reclaiming_the_maimed;_a_handbook_of_physical_therapy_(1918)_(14594834080).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0a\/Reclaiming_the_maimed%3B_a_handbook_of_physical_therapy_%281918%29_%2814594834080%29.jpg\/220px-Reclaiming_the_maimed%3B_a_handbook_of_physical_therapy_%281918%29_%2814594834080%29.jpg\" width=\"220\" height=\"148\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Reclaiming_the_maimed;_a_handbook_of_physical_therapy_(1918)_(14594834080).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Nose prosthesis ca. 1918<\/div><\/div><\/div><p>A <b>nose (nasal) prosthesis<\/b> is a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Craniofacial_prosthesis\" title=\"Craniofacial prosthesis\" rel=\"external_link\" target=\"_blank\">craniofacial prosthesis<\/a> used to replace an absent nose. Modern prosthetic noses are typically made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polydimethylsiloxane\" title=\"Polydimethylsiloxane\" rel=\"external_link\" target=\"_blank\">polydimethylsiloxane<\/a>, a flexible material made to move with the skin. It is retained to the patient daily by using an adhesive or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseointegrated_implants\" class=\"mw-redirect\" title=\"Osseointegrated implants\" rel=\"external_link\" target=\"_blank\">osseointegrated implants<\/a>.\n<\/p><h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<\/div>\n<p><br \/>\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1258\nCached time: 20181205184052\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.032 seconds\nReal time usage: 0.049 seconds\nPreprocessor visited node count: 96\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 2867\/2097152 bytes\nTemplate argument size: 79\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 0\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.009\/10.000 seconds\nLua memory usage: 796 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 35.968 1 -total\n<\/p>\n<pre>52.54% 18.899 1 Template:Reflist\n47.26% 16.998 1 Template:Biotech-stub\n41.52% 14.934 1 Template:Asbox\n 7.53% 2.710 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:15240606-1!canonical and timestamp 20181205184052 and revision id 825730613\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Nose_prosthesis\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212145\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.147 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 142.502 1 - wikipedia:Nose_prosthesis\n100.00% 142.502 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8278-0!*!*!*!*!*!* and timestamp 20181217212145 and revision id 24490\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Nose_prosthesis\">https:\/\/www.limswiki.org\/index.php\/Nose_prosthesis<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","75ce87ee0133b541e6aa301709ab7639_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0a\/Reclaiming_the_maimed%3B_a_handbook_of_physical_therapy_%281918%29_%2814594834080%29.jpg\/440px-Reclaiming_the_maimed%3B_a_handbook_of_physical_therapy_%281918%29_%2814594834080%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/39\/Lq-dna.png\/60px-Lq-dna.png"],"75ce87ee0133b541e6aa301709ab7639_timestamp":1545081705,"7a44e92187d82ca27673d29b6feb12eb_type":"article","7a44e92187d82ca27673d29b6feb12eb_title":"Neurotrophic electrode","7a44e92187d82ca27673d29b6feb12eb_url":"https:\/\/www.limswiki.org\/index.php\/Neurotrophic_electrode","7a44e92187d82ca27673d29b6feb12eb_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tNeurotrophic electrode\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t The neurotrophic electrode: teflon-coated gold wires extend from the back of the glass cone, while neurites (shown in blue) grow through it.\nThe neurotrophic electrode is an intracortical device designed to read the electrical signals that the brain uses to process information. It consists of a small, hollow glass cone attached to several electrically conductive gold wires. The term neurotrophic means \"relating to the nutrition and maintenance of nerve tissue\" and the device gets its name from the fact that it is coated with Matrigel and nerve growth factor to encourage the expansion of neurites through its tip.[1] It was invented by neurologist Dr. Philip Kennedy and was successfully implanted for the first time in a human patient in 1996 by neurosurgeon Roy Bakay.[2]\n\nContents \n\n1 Background \n\n1.1 Motivation for development \n1.2 Design development \n\n\n2 Components \n\n2.1 Glass cone \n2.2 Gold wires \n2.3 Wireless transmitter \n2.4 Data acquisition system \n2.5 Assembly \n\n\n3 Implementation \n\n3.1 Computer cursor control \n3.2 Speech synthesis \n\n\n4 Comparison to other recording methods \n5 Drawbacks \n\n5.1 Activation delay \n5.2 Surgery risks \n5.3 Device failure \n\n\n6 Future applications \n\n6.1 Neuroprosthetics \n6.2 Silent speech \n\n\n7 References \n\n\nBackground \nMotivation for development \nVictims of locked-in syndrome are cognitively intact and aware of their surroundings, but cannot move or communicate due to near complete paralysis of voluntary muscles. In early attempts to return some degree of control to these patients, researchers used cortical signals obtained with electroencephalography (EEG) to drive a mouse cursor. However, EEG lacks the speed and precision that can be obtained by using a direct cortical interface.[3]\nPatients with other motor diseases, such as amyotrophic lateral sclerosis and cerebral palsy, as well as those who have suffered a severe stroke or spinal cord injury, also can benefit from implanted electrodes. Cortical signals can be used to control robotic limbs, so as the technology improves and the risks of the procedure are reduced, direct interfacing may even provide assistance for amputees.[4]\n\nDesign development \nWhen Dr. Kennedy was designing the electrode, he knew he needed a device that would be wireless, biologically compatible, and capable of chronic implantation. Initial studies with Rhesus monkeys and rats demonstrated that the neurotrophic electrode was capable of chronic implantation for as long as 14 months (human trials would later establish even greater robustness).[5] This longevity was invaluable for the studies because while the monkeys were being trained at a task, neurons that were initially silent began firing as the task was learned, a phenomenon that would not have been observable if the electrode was not capable of long term implantation.[1]\n\nComponents \nGlass cone \nThe glass cone is only 1\u20132 mm long, and is filled with trophic factors in order to encourage axons and dendrites to grow through its tip and hollow body. When the neurites reach the back end of the cone, they rejoin with the neuropil on that side, which anchors the glass cone in place. As a result, stable and robust long-term recording is attainable.[6] The cone sits with its tip near layer five of the cortex, among corticospinal tract cell bodies, and is inserted at an angle of 45\u00b0 from the surface, about 5 or 6 mm deep.[7]\n\nGold wires \nThree or four gold wires are glued to the inside of the glass cone and protrude out the back. They record the electrical activity of the axons that have grown through the cone, and are insulated with Teflon. The wires are coiled so as to relieve strain because they are embedded in the cortex on one end and attached to the amplifiers, which are fixed to the inside of the skull, on the other. Two wires are plugged into each amplifier to provide differential signalling.[7]\n\nWireless transmitter \nOne of the greatest strengths of the neurotrophic electrode is its wireless capability, because without transdermal wiring, the risk of infection is significantly reduced. As neural signals are collected by the electrodes, they travel up the gold wires and through the cranium, where they are passed on to the bioamplifiers (usually implemented by differential amplifiers). The amplified signals are sent through a switch to a transmitter, where they are converted to FM signals and broadcast with an antenna. The amplifiers and the transmitters are powered by a 1 MHz induction signal that is rectified and filtered. The antenna, amplifiers, analog switches, and FM transmitters are all contained in a standard surface mount printed circuit board that sits just under the scalp. The whole ensemble is coated in protective gels, Parylene, Elvax, and Silastic, to make it biocompatible and to protect the electronics from fluids.[7]\n\nData acquisition system \nOn the outside of the patient's scalp rests the corresponding induction coil and an antenna that sends the FM signal to the receiver. These devices are temporarily held in place with a water-soluble paste. The receiver demodulates the signal and sends it to the computer for spike sorting and data recording.[7]\n\nAssembly \nMost of the neurotrophic electrode is made by hand. The gold wires are cut to the correct length, coiled, and then bent to an angle of 45\u00b0 just above the point of contact with the cone in order to limit the implantation depth. One more bend in the opposite direction is added where the wires pass through the skull. The tips are stripped of their Teflon coating, and the ones farthest from the cone are soldered and then sealed with dental acrylic to a component connector. The glass cone is made by heating and pulling a glass rod to a point and then cutting the tip at the desired length. The other end is not a straight cut, but rather is carved at an angle to provide a shelf onto which the gold wires can be attached. The wires are then placed on the shelf and a methyl methacrylate gel glue is applied in several coats, with care taken to avoid covering the conductive tips. Lastly, the device is sterilized using glutaraldehyde gas at a low temperature, and aerated.[7]\n\nImplementation \nComputer cursor control \nOne of Dr. Kennedy's patients, Johnny Ray, was able to learn how to control a computer cursor with the neurotrophic electrode. Three distinct neural signals from the device were correlated with cursor movement along the x-axis, along the y-axis, and a \"select\" function, respectively. Movement in a given direction was triggered by an increase in neuron firing rate on the associated channel.[3]\n\nSpeech synthesis \nNeural signals elicited from another of Dr. Kennedy's patients have been used to formulate vowel sounds using a speech synthesizer in real time. The electronics setup was very similar to that used for the cursor, with the addition of a post-receiver neural decoder and the synthesizer itself. Researchers implanted the electrode in the area of the motor cortex associated with the movement of speech articulators because a pre-surgery fMRI scan indicated high activity there during a picture naming task. The average delay from neural firing to synthesizer output was 50 ms, which is approximately the same as the delay for an intact biological pathway.[8]\n\nComparison to other recording methods \nThe neurotrophic electrode, as described above, is a wireless device, and transmits its signals transcutaneously. In addition, it has demonstrated longevity of over four years in a human patient, because every component is completely biocompatible. It is limited in the amount of information it can provide, however, because the electronics it uses to transmit its signal require so much space on the scalp that only four can fit on a human skull.[2]\nAlternatively, the Utah array is currently a wired device, but transmits more information. It has been implanted in a human for over two years and consists of 100 conductive silicon needle-like electrodes, so it has high resolution and can record from many individual neurons.[9]\nIn one experiment, Dr. Kennedy adapted the neurotrophic electrode to read local field potentials (LFPs). He demonstrated that they are capable of controlling assistive technology devices, suggesting that less invasive techniques can be used to restore functionality to locked-in patients. However, the study did not address the degree of control possible with LFPs or make a formal comparison between LFPs and single unit activity.[10]\nElectroencephalography (EEG) involves the placement of many surface electrodes on the patient's scalp, in an attempt to record the summed activity of tens of thousands to millions of neurons. EEG has the potential for long term use as a brain-computer interface, because the electrodes can be kept on the scalp indefinitely. The temporal and spatial resolutions and signal to noise ratios of EEG have always lagged behind those of comparable intracortical devices, but it has the advantage of not requiring surgery.[9]\nElectrocorticography (ECoG) records the cumulative activity of hundreds to thousands of neurons with a sheet of electrodes placed directly on the surface of the brain. In addition to requiring surgery and having low resolution, the ECoG device is wired, meaning the scalp cannot be completely closed, increasing the risk of infection. However, researchers investigating ECoG claim that the grid \"possesses characteristics suitable for long term implantation\".[9]\n\nDrawbacks \nActivation delay \nThe neurotrophic electrode is not active immediately after implantation because the axons must grow into the cone before the device can pick up electrical signals. Studies have shown that tissue growth is largely complete as early as one month after the procedure, but takes as many as four months to stabilize.[1]\n\nSurgery risks \nThe risks involved with the implantation are those that are usually associated with brain surgery, namely, the possibility of bleeding, infection, seizures, stroke, and brain damage. Until the technology advances to the point that these risks are considerably reduced, the procedure will be reserved for extreme or experimental cases.[2]\n\nDevice failure \nWhen Johnny Ray was implanted in 1998, one of the neurotrophic electrodes started providing an intermittent signal after it had become anchored in the neuropil, and as a result, Dr. Kennedy was forced to rely on the remaining devices.[3] Therefore, even if there is no complication from surgery, there is still a possibility that the electronics will fail. In addition, while the implants themselves are encased in the skull and are therefore relatively safe from physical damage, the electronics on the outside of the skull are vulnerable. Two of Dr. Kennedy's patients accidentally caused damage during spasms, but in both cases only the external devices needed to be replaced.[7]\n\nFuture applications \nNeuroprosthetics \nAs of November 2010, Dr. Kennedy is working on the speech synthesis application of the electrode, but has plans to expand its uses to many different areas, one of which is restoring movement with neuroprosthetics.[2]\n\nSilent speech \nSilent speech is \"speech processing in the absence of an intelligible acoustic signal\" to be used either as an aid for the speech-handicapped or to communicate in areas with required silence or high background noise. One of the proposed future uses of the neurotrophic electrode, and brain computer interfaces in general, is to enable silent speech by decoding the \"speaker's\" neural signals and transmitting the audio output to headphones worn by the intended listener. The standard advantages and disadvantages of invasive versus non-invasive interfaces still apply.[11] However, for this particular application, the neurotrophic electrode has an advantage in that it has already been shown to be effective for restoring communication to disabled patients.[8]\n\nReferences \n\n\n^ a b c Kennedy, P. R., & Bakay, R. A. E. (1997). Activity of single action potentials in monkey motor cortex during long-term task learning. Brain Research, 760(1-2), 251-254. \n\n^ a b c d Interview with Dr. Kennedy, Senior Research Scientist, Neural Signals, Inc., 9\/30\/2010 \n\n^ a b c Kennedy, P. R., Bakay, R. A. E., Moore, M. M., Adams, K., & Goldwaithe, J. (2000). Direct control of a computer from the human central nervous system. [Article]. IEEE Transactions on Rehabilitation Engineering, 8(2), 198-202. \n\n^ Lebedev, M. A., & Nicolelis, M. A. L. (2006). Brain-machine interfaces: past, present and future. [Review]. Trends in Neurosciences, 29(9), 536-546. \n\n^ Kennedy, P. R., Mirra, S. S., & Bakay, R. A. E. (1992). THE CONE ELECTRODE - ULTRASTRUCTURAL STUDIES FOLLOWING LONG-TERM RECORDING IN RAT AND MONKEY CORTEX. [Article]. Neuroscience Letters, 142(1), 89-94. \n\n^ Kennedy, P. R. (1989). THE CONE ELECTRODE - A LONG-TERM ELECTRODE THAT RECORDS FROM NEURITES GROWN ONTO ITS RECORDING SURFACE. [Article]. Journal of Neuroscience Methods, 29(3), 181-193. \n\n^ a b c d e f Bartels, J., Andreasen, D., Ehirim, P., Mao, H., Seibert, S., Wright, E. J., et al. (2008). Neurotrophic electrode: Method of assembly and implantation into human motor speech cortex. [Article]. Journal of Neuroscience Methods, 174(2), 168-176. \n\n^ a b Guenther, F. H., Brumberg, J. S., Wright, E. J., Nieto-Castanon, A., Tourville, J. A., Panko, M., et al. (2009). A Wireless Brain-Machine Interface for Real-Time Speech Synthesis. PLoS ONE, 4(12). \n\n^ a b c Brumberg, J. S., Nieto-Castanon, A., Kennedy, P. R., & Guenther, F. H. (2010). Brain-computer interfaces for speech communication. Speech Communication, 52(4), 367-379. \n\n^ Kennedy, P. R., Kirby, M. T., Moore, M. M., King, B., & Mallory, A. (2004). Computer control using human intracortical local field potentials. [Article]. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 12(3), 339-344. \n\n^ Denby, B., Schultz, T., Honda, K., Hueber, T., Gilbert, J. M., & Brumberg, J. S. (2010). Silent speech interfaces. [Article]. Speech Communication, 52(4), 270-287. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Neurotrophic_electrode\">https:\/\/www.limswiki.org\/index.php\/Neurotrophic_electrode<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesMedical monitoring and signal processingHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 16 August 2016, at 17:17.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 298 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","7a44e92187d82ca27673d29b6feb12eb_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Neurotrophic_electrode skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Neurotrophic electrode<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Neurotrophic_Electrode2.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"A\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/Neurotrophic_Electrode2.JPG\/220px-Neurotrophic_Electrode2.JPG\" width=\"220\" height=\"136\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Neurotrophic_Electrode2.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The neurotrophic electrode: teflon-coated gold wires extend from the back of the glass cone, while neurites (shown in blue) grow through it.<\/div><\/div><\/div>\n<p>The <b>neurotrophic electrode<\/b> is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_electrode_implants\" class=\"mw-redirect\" title=\"Chronic electrode implants\" rel=\"external_link\" target=\"_blank\">intracortical device<\/a> designed to read the electrical signals that the brain uses to process information. It consists of a small, hollow glass cone attached to several electrically conductive gold wires. The term <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurotrophic\" class=\"mw-redirect\" title=\"Neurotrophic\" rel=\"external_link\" target=\"_blank\">neurotrophic<\/a><\/i> means \"relating to the nutrition and maintenance of nerve tissue\" and the device gets its name from the fact that it is coated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Matrigel\" title=\"Matrigel\" rel=\"external_link\" target=\"_blank\">Matrigel<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nerve_growth_factor\" title=\"Nerve growth factor\" rel=\"external_link\" target=\"_blank\">nerve growth factor<\/a> to encourage the expansion of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurites\" class=\"mw-redirect\" title=\"Neurites\" rel=\"external_link\" target=\"_blank\">neurites<\/a> through its tip.<sup id=\"rdp-ebb-cite_ref-activity_1-0\" class=\"reference\"><a href=\"#cite_note-activity-1\" rel=\"external_link\">[1]<\/a><\/sup> It was invented by neurologist Dr. Philip Kennedy and was successfully implanted for the first time in a human patient in 1996 by neurosurgeon Roy Bakay.<sup id=\"rdp-ebb-cite_ref-interview_2-0\" class=\"reference\"><a href=\"#cite_note-interview-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Background\">Background<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Motivation_for_development\">Motivation for development<\/span><\/h3>\n<p>Victims of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Locked-in_syndrome\" title=\"Locked-in syndrome\" rel=\"external_link\" target=\"_blank\">locked-in syndrome<\/a> are cognitively intact and aware of their surroundings, but cannot move or communicate due to near complete paralysis of voluntary muscles. In early attempts to return some degree of control to these patients, researchers used <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neural_coding\" title=\"Neural coding\" rel=\"external_link\" target=\"_blank\">cortical signals<\/a> obtained with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electroencephalography\" title=\"Electroencephalography\" rel=\"external_link\" target=\"_blank\">electroencephalography<\/a> (EEG) to drive a mouse cursor. However, EEG lacks the speed and precision that can be obtained by using a direct cortical interface.<sup id=\"rdp-ebb-cite_ref-cursor_3-0\" class=\"reference\"><a href=\"#cite_note-cursor-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>Patients with other motor diseases, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amyotrophic_lateral_sclerosis\" title=\"Amyotrophic lateral sclerosis\" rel=\"external_link\" target=\"_blank\">amyotrophic lateral sclerosis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_palsy\" title=\"Cerebral palsy\" rel=\"external_link\" target=\"_blank\">cerebral palsy<\/a>, as well as those who have suffered a severe stroke or spinal cord injury, also can benefit from implanted electrodes. Cortical signals can be used to control robotic limbs, so as the technology improves and the risks of the procedure are reduced, direct interfacing may even provide assistance for amputees.<sup id=\"rdp-ebb-cite_ref-BMIs_4-0\" class=\"reference\"><a href=\"#cite_note-BMIs-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Design_development\">Design development<\/span><\/h3>\n<p>When Dr. Kennedy was designing the electrode, he knew he needed a device that would be wireless, biologically compatible, and capable of chronic implantation. Initial studies with Rhesus monkeys and rats demonstrated that the neurotrophic electrode was capable of chronic implantation for as long as 14 months (human trials would later establish even greater robustness).<sup id=\"rdp-ebb-cite_ref-ultrastructural_5-0\" class=\"reference\"><a href=\"#cite_note-ultrastructural-5\" rel=\"external_link\">[5]<\/a><\/sup> This longevity was invaluable for the studies because while the monkeys were being trained at a task, neurons that were initially silent began firing as the task was learned, a phenomenon that would not have been observable if the electrode was not capable of long term implantation.<sup id=\"rdp-ebb-cite_ref-activity_1-1\" class=\"reference\"><a href=\"#cite_note-activity-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Components\">Components<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Glass_cone\">Glass cone<\/span><\/h3>\n<p>The glass cone is only 1\u20132 mm long, and is filled with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Growth_factor\" title=\"Growth factor\" rel=\"external_link\" target=\"_blank\">trophic factors<\/a> in order to encourage axons and dendrites to grow through its tip and hollow body. When the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurites\" class=\"mw-redirect\" title=\"Neurites\" rel=\"external_link\" target=\"_blank\">neurites<\/a> reach the back end of the cone, they rejoin with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuropil\" title=\"Neuropil\" rel=\"external_link\" target=\"_blank\">neuropil<\/a> on that side, which anchors the glass cone in place. As a result, stable and robust long-term recording is attainable.<sup id=\"rdp-ebb-cite_ref-cone_6-0\" class=\"reference\"><a href=\"#cite_note-cone-6\" rel=\"external_link\">[6]<\/a><\/sup> The cone sits with its tip near layer five of the cortex, among <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corticospinal_tract\" title=\"Corticospinal tract\" rel=\"external_link\" target=\"_blank\">corticospinal tract<\/a> cell bodies, and is inserted at an angle of 45\u00b0 from the surface, about 5 or 6 mm deep.<sup id=\"rdp-ebb-cite_ref-assembly_7-0\" class=\"reference\"><a href=\"#cite_note-assembly-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Gold_wires\">Gold wires<\/span><\/h3>\n<p>Three or four gold wires are glued to the inside of the glass cone and protrude out the back. They record the electrical activity of the axons that have grown through the cone, and are insulated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Teflon\" class=\"mw-redirect\" title=\"Teflon\" rel=\"external_link\" target=\"_blank\">Teflon<\/a>. The wires are coiled so as to relieve strain because they are embedded in the cortex on one end and attached to the amplifiers, which are fixed to the inside of the skull, on the other. Two wires are plugged into each amplifier to provide <a href=\"https:\/\/en.wikipedia.org\/wiki\/Differential_signaling\" title=\"Differential signaling\" rel=\"external_link\" target=\"_blank\">differential signalling<\/a>.<sup id=\"rdp-ebb-cite_ref-assembly_7-1\" class=\"reference\"><a href=\"#cite_note-assembly-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Wireless_transmitter\">Wireless transmitter<\/span><\/h3>\n<p>One of the greatest strengths of the neurotrophic electrode is its wireless capability, because without transdermal wiring, the risk of infection is significantly reduced. As neural signals are collected by the electrodes, they travel up the gold wires and through the cranium, where they are passed on to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioamplifier\" title=\"Bioamplifier\" rel=\"external_link\" target=\"_blank\">bioamplifiers<\/a> (usually implemented by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Differential_amplifier\" title=\"Differential amplifier\" rel=\"external_link\" target=\"_blank\">differential amplifiers<\/a>). The amplified signals are sent through a switch to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transmitter\" title=\"Transmitter\" rel=\"external_link\" target=\"_blank\">transmitter<\/a>, where they are converted to FM signals and broadcast with an antenna. The amplifiers and the transmitters are powered by a 1 MHz <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electromagnetic_induction\" title=\"Electromagnetic induction\" rel=\"external_link\" target=\"_blank\">induction<\/a> signal that is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rectifier\" title=\"Rectifier\" rel=\"external_link\" target=\"_blank\">rectified<\/a> and filtered. The antenna, amplifiers, analog switches, and FM transmitters are all contained in a standard <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surface-mount_technology\" title=\"Surface-mount technology\" rel=\"external_link\" target=\"_blank\">surface mount printed circuit board<\/a> that sits just under the scalp. The whole ensemble is coated in protective gels, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parylene\" title=\"Parylene\" rel=\"external_link\" target=\"_blank\">Parylene<\/a>, Elvax, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silastic\" title=\"Silastic\" rel=\"external_link\" target=\"_blank\">Silastic<\/a>, to make it biocompatible and to protect the electronics from fluids.<sup id=\"rdp-ebb-cite_ref-assembly_7-2\" class=\"reference\"><a href=\"#cite_note-assembly-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Data_acquisition_system\">Data acquisition system<\/span><\/h3>\n<p>On the outside of the patient's scalp rests the corresponding induction coil and an antenna that sends the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Frequency_modulation\" title=\"Frequency modulation\" rel=\"external_link\" target=\"_blank\">FM signal<\/a> to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Receiver_(radio)\" class=\"mw-redirect\" title=\"Receiver (radio)\" rel=\"external_link\" target=\"_blank\">receiver<\/a>. These devices are temporarily held in place with a water-soluble paste. The receiver demodulates the signal and sends it to the computer for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spike_sorting\" title=\"Spike sorting\" rel=\"external_link\" target=\"_blank\">spike sorting<\/a> and data recording.<sup id=\"rdp-ebb-cite_ref-assembly_7-3\" class=\"reference\"><a href=\"#cite_note-assembly-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Assembly\">Assembly<\/span><\/h3>\n<p>Most of the neurotrophic electrode is made by hand. The gold wires are cut to the correct length, coiled, and then bent to an angle of 45\u00b0 just above the point of contact with the cone in order to limit the implantation depth. One more bend in the opposite direction is added where the wires pass through the skull. The tips are stripped of their Teflon coating, and the ones farthest from the cone are soldered and then sealed with dental acrylic to a component connector. The glass cone is made by heating and pulling a glass rod to a point and then cutting the tip at the desired length. The other end is not a straight cut, but rather is carved at an angle to provide a shelf onto which the gold wires can be attached. The wires are then placed on the shelf and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methyl_methacrylate\" title=\"Methyl methacrylate\" rel=\"external_link\" target=\"_blank\">methyl methacrylate<\/a> gel glue is applied in several coats, with care taken to avoid covering the conductive tips. Lastly, the device is sterilized using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glutaraldehyde\" title=\"Glutaraldehyde\" rel=\"external_link\" target=\"_blank\">glutaraldehyde<\/a> gas at a low temperature, and aerated.<sup id=\"rdp-ebb-cite_ref-assembly_7-4\" class=\"reference\"><a href=\"#cite_note-assembly-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Implementation\">Implementation<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Computer_cursor_control\">Computer cursor control<\/span><\/h3>\n<p>One of Dr. Kennedy's patients, Johnny Ray, was able to learn how to control a computer cursor with the neurotrophic electrode. Three distinct neural signals from the device were correlated with cursor movement along the x-axis, along the y-axis, and a \"select\" function, respectively. Movement in a given direction was triggered by an increase in neuron firing rate on the associated channel.<sup id=\"rdp-ebb-cite_ref-cursor_3-1\" class=\"reference\"><a href=\"#cite_note-cursor-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Speech_synthesis\">Speech synthesis<\/span><\/h3>\n<p>Neural signals elicited from another of Dr. Kennedy's patients have been used to formulate vowel sounds using a speech synthesizer in real time. The electronics setup was very similar to that used for the cursor, with the addition of a post-receiver neural decoder and the synthesizer itself. Researchers implanted the electrode in the area of the motor cortex associated with the movement of speech articulators because a pre-surgery <a href=\"https:\/\/en.wikipedia.org\/wiki\/FMRI\" class=\"mw-redirect\" title=\"FMRI\" rel=\"external_link\" target=\"_blank\">fMRI<\/a> scan indicated high activity there during a picture naming task. The average delay from neural firing to synthesizer output was 50 ms, which is approximately the same as the delay for an intact biological pathway.<sup id=\"rdp-ebb-cite_ref-speech_8-0\" class=\"reference\"><a href=\"#cite_note-speech-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Comparison_to_other_recording_methods\">Comparison to other recording methods<\/span><\/h2>\n<p>The neurotrophic electrode, as described above, is a wireless device, and transmits its signals transcutaneously. In addition, it has demonstrated longevity of over four years in a human patient, because every component is completely <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatible<\/a>. It is limited in the amount of information it can provide, however, because the electronics it uses to transmit its signal require so much space on the scalp that only four can fit on a human skull.<sup id=\"rdp-ebb-cite_ref-interview_2-1\" class=\"reference\"><a href=\"#cite_note-interview-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Alternatively, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Utah_array\" class=\"mw-redirect\" title=\"Utah array\" rel=\"external_link\" target=\"_blank\">Utah array<\/a> is currently a wired device, but transmits more information. It has been implanted in a human for over two years and consists of 100 conductive silicon needle-like electrodes, so it has high resolution and can record from many individual neurons.<sup id=\"rdp-ebb-cite_ref-review_9-0\" class=\"reference\"><a href=\"#cite_note-review-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>In one experiment, Dr. Kennedy adapted the neurotrophic electrode to read <a href=\"https:\/\/en.wikipedia.org\/wiki\/Local_field_potentials\" class=\"mw-redirect\" title=\"Local field potentials\" rel=\"external_link\" target=\"_blank\">local field potentials<\/a> (LFPs). He demonstrated that they are capable of controlling assistive technology devices, suggesting that less invasive techniques can be used to restore functionality to locked-in patients. However, the study did not address the degree of control possible with LFPs or make a formal comparison between LFPs and single unit activity.<sup id=\"rdp-ebb-cite_ref-LFP_10-0\" class=\"reference\"><a href=\"#cite_note-LFP-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electroencephalography\" title=\"Electroencephalography\" rel=\"external_link\" target=\"_blank\">Electroencephalography<\/a> (EEG) involves the placement of many surface electrodes on the patient's scalp, in an attempt to record the summed activity of tens of thousands to millions of neurons. EEG has the potential for long term use as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain-computer_interface\" class=\"mw-redirect\" title=\"Brain-computer interface\" rel=\"external_link\" target=\"_blank\">brain-computer interface<\/a>, because the electrodes can be kept on the scalp indefinitely. The temporal and spatial resolutions and signal to noise ratios of EEG have always lagged behind those of comparable intracortical devices, but it has the advantage of not requiring surgery.<sup id=\"rdp-ebb-cite_ref-review_9-1\" class=\"reference\"><a href=\"#cite_note-review-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrocorticography\" title=\"Electrocorticography\" rel=\"external_link\" target=\"_blank\">Electrocorticography<\/a> (ECoG) records the cumulative activity of hundreds to thousands of neurons with a sheet of electrodes placed directly on the surface of the brain. In addition to requiring surgery and having low resolution, the ECoG device is wired, meaning the scalp cannot be completely closed, increasing the risk of infection. However, researchers investigating ECoG claim that the grid \"possesses characteristics suitable for long term implantation\".<sup id=\"rdp-ebb-cite_ref-review_9-2\" class=\"reference\"><a href=\"#cite_note-review-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Drawbacks\">Drawbacks<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Activation_delay\">Activation delay<\/span><\/h3>\n<p>The neurotrophic electrode is not active immediately after implantation because the axons must grow into the cone before the device can pick up electrical signals. Studies have shown that tissue growth is largely complete as early as one month after the procedure, but takes as many as four months to stabilize.<sup id=\"rdp-ebb-cite_ref-activity_1-2\" class=\"reference\"><a href=\"#cite_note-activity-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Surgery_risks\">Surgery risks<\/span><\/h3>\n<p>The risks involved with the implantation are those that are usually associated with brain surgery, namely, the possibility of bleeding, infection, seizures, stroke, and brain damage. Until the technology advances to the point that these risks are considerably reduced, the procedure will be reserved for extreme or experimental cases.<sup id=\"rdp-ebb-cite_ref-interview_2-2\" class=\"reference\"><a href=\"#cite_note-interview-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Device_failure\">Device failure<\/span><\/h3>\n<p>When Johnny Ray was implanted in 1998, one of the neurotrophic electrodes started providing an intermittent signal after it had become anchored in the neuropil, and as a result, Dr. Kennedy was forced to rely on the remaining devices.<sup id=\"rdp-ebb-cite_ref-cursor_3-2\" class=\"reference\"><a href=\"#cite_note-cursor-3\" rel=\"external_link\">[3]<\/a><\/sup> Therefore, even if there is no complication from surgery, there is still a possibility that the electronics will fail. In addition, while the implants themselves are encased in the skull and are therefore relatively safe from physical damage, the electronics on the outside of the skull are vulnerable. Two of Dr. Kennedy's patients accidentally caused damage during spasms, but in both cases only the external devices needed to be replaced.<sup id=\"rdp-ebb-cite_ref-assembly_7-5\" class=\"reference\"><a href=\"#cite_note-assembly-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Future_applications\">Future applications<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Neuroprosthetics\">Neuroprosthetics<\/span><\/h3>\n<p>As of November 2010, Dr. Kennedy is working on the speech synthesis application of the electrode, but has plans to expand its uses to many different areas, one of which is restoring movement with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroprosthetics\" title=\"Neuroprosthetics\" rel=\"external_link\" target=\"_blank\">neuroprosthetics<\/a>.<sup id=\"rdp-ebb-cite_ref-interview_2-3\" class=\"reference\"><a href=\"#cite_note-interview-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Silent_speech\">Silent speech<\/span><\/h3>\n<p>Silent speech is \"speech processing in the absence of an intelligible acoustic signal\" to be used either as an aid for the speech-handicapped or to communicate in areas with required silence or high background noise. One of the proposed future uses of the neurotrophic electrode, and brain computer interfaces in general, is to enable silent speech by decoding the \"speaker's\" neural signals and transmitting the audio output to headphones worn by the intended listener. The standard advantages and disadvantages of invasive versus non-invasive interfaces still apply.<sup id=\"rdp-ebb-cite_ref-silent_11-0\" class=\"reference\"><a href=\"#cite_note-silent-11\" rel=\"external_link\">[11]<\/a><\/sup> However, for this particular application, the neurotrophic electrode has an advantage in that it has already been shown to be effective for restoring communication to disabled patients.<sup id=\"rdp-ebb-cite_ref-speech_8-1\" class=\"reference\"><a href=\"#cite_note-speech-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-activity-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-activity_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-activity_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-activity_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Kennedy, P. R., & Bakay, R. A. E. (1997). Activity of single action potentials in monkey motor cortex during long-term task learning. Brain Research, 760(1-2), 251-254.<\/span>\n<\/li>\n<li id=\"cite_note-interview-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-interview_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-interview_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-interview_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-interview_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Interview with Dr. Kennedy, Senior Research Scientist, Neural Signals, Inc., 9\/30\/2010<\/span>\n<\/li>\n<li id=\"cite_note-cursor-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-cursor_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-cursor_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-cursor_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Kennedy, P. R., Bakay, R. A. E., Moore, M. M., Adams, K., & Goldwaithe, J. (2000). Direct control of a computer from the human central nervous system. [Article]. IEEE Transactions on Rehabilitation Engineering, 8(2), 198-202.<\/span>\n<\/li>\n<li id=\"cite_note-BMIs-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-BMIs_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Lebedev, M. A., & Nicolelis, M. A. L. (2006). Brain-machine interfaces: past, present and future. [Review]. Trends in Neurosciences, 29(9), 536-546.<\/span>\n<\/li>\n<li id=\"cite_note-ultrastructural-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ultrastructural_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Kennedy, P. R., Mirra, S. S., & Bakay, R. A. E. (1992). THE CONE ELECTRODE - ULTRASTRUCTURAL STUDIES FOLLOWING LONG-TERM RECORDING IN RAT AND MONKEY CORTEX. [Article]. Neuroscience Letters, 142(1), 89-94.<\/span>\n<\/li>\n<li id=\"cite_note-cone-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-cone_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Kennedy, P. R. (1989). THE CONE ELECTRODE - A LONG-TERM ELECTRODE THAT RECORDS FROM NEURITES GROWN ONTO ITS RECORDING SURFACE. [Article]. Journal of Neuroscience Methods, 29(3), 181-193.<\/span>\n<\/li>\n<li id=\"cite_note-assembly-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-assembly_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-assembly_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-assembly_7-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-assembly_7-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-assembly_7-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-assembly_7-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Bartels, J., Andreasen, D., Ehirim, P., Mao, H., Seibert, S., Wright, E. J., et al. (2008). Neurotrophic electrode: Method of assembly and implantation into human motor speech cortex. [Article]. Journal of Neuroscience Methods, 174(2), 168-176.<\/span>\n<\/li>\n<li id=\"cite_note-speech-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-speech_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-speech_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Guenther, F. H., Brumberg, J. S., Wright, E. J., Nieto-Castanon, A., Tourville, J. A., Panko, M., et al. (2009). A Wireless Brain-Machine Interface for Real-Time Speech Synthesis. PLoS ONE, 4(12).<\/span>\n<\/li>\n<li id=\"cite_note-review-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-review_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-review_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-review_9-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Brumberg, J. S., Nieto-Castanon, A., Kennedy, P. R., & Guenther, F. H. (2010). Brain-computer interfaces for speech communication. Speech Communication, 52(4), 367-379.<\/span>\n<\/li>\n<li id=\"cite_note-LFP-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-LFP_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Kennedy, P. R., Kirby, M. T., Moore, M. M., King, B., & Mallory, A. (2004). Computer control using human intracortical local field potentials. [Article]. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 12(3), 339-344.<\/span>\n<\/li>\n<li id=\"cite_note-silent-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-silent_11-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Denby, B., Schultz, T., Honda, K., Hueber, T., Gilbert, J. M., & Brumberg, J. S. (2010). Silent speech interfaces. [Article]. Speech Communication, 52(4), 270-287.<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1329\nCached time: 20181130213521\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.100 seconds\nReal time usage: 0.115 seconds\nPreprocessor visited node count: 364\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 350\/2097152 bytes\nTemplate argument size: 86\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 7536\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.004\/10.000 seconds\nLua memory usage: 521 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 36.364 1 Template:Reflist\n100.00% 36.364 1 -total\n<\/p>\n<pre> 8.87% 3.224 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:29806228-1!canonical and timestamp 20181130213521 and revision id 863887908\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Neurotrophic_electrode\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212144\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.061 seconds\nReal time usage: 0.203 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 196.362 1 - wikipedia:Neurotrophic_electrode\n100.00% 196.362 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8277-0!*!*!*!*!*!* and timestamp 20181217212144 and revision id 27018\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Neurotrophic_electrode\">https:\/\/www.limswiki.org\/index.php\/Neurotrophic_electrode<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","7a44e92187d82ca27673d29b6feb12eb_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/c\/cd\/Neurotrophic_Electrode2.JPG"],"7a44e92187d82ca27673d29b6feb12eb_timestamp":1545081704,"81df8edecfd22b24f9c53b96aa30b9b6_type":"article","81df8edecfd22b24f9c53b96aa30b9b6_title":"Neuroprosthetics","81df8edecfd22b24f9c53b96aa30b9b6_url":"https:\/\/www.limswiki.org\/index.php\/Neuroprosthetics","81df8edecfd22b24f9c53b96aa30b9b6_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tNeuroprosthetics\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and when to remove these template messages)\n\n This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2016) (Learn how and when to remove this template message)\nThis article's tone or style may not reflect the encyclopedic tone used on Wikipedia. See Wikipedia's guide to writing better articles for suggestions. (August 2011) (Learn how and when to remove this template message)\n \n (Learn how and when to remove this template message)\nNeuroprosthetics (also called neural prosthetics) is a discipline related to neuroscience and biomedical engineering concerned with developing neural prostheses. They are sometimes contrasted with a brain\u2013computer interface, which connects the brain to a computer rather than a device meant to replace missing biological functionality.[1]\nNeural prostheses are a series of devices that can substitute a motor, sensory or cognitive modality that might have been damaged as a result of an injury or a disease. Cochlear implants provide an example of such devices. These devices substitute the functions performed by the ear drum and stapes while simulating the frequency analysis performed in the cochlea. A microphone on an external unit gathers the sound and processes it; the processed signal is then transferred to an implanted unit that stimulates the auditory nerve through a microelectrode array. Through the replacement or augmentation of damaged senses, these devices intend to improve the quality of life for those with disabilities.\nThese implantable devices are also commonly used in animal experimentation as a tool to aid neuroscientists in developing a greater understanding of the brain and its functioning. By wirelessly monitoring the brain's electrical signals sent out by electrodes implanted in the subject's brain, the subject can be studied without the device affecting the results.\nAccurately probing and recording the electrical signals in the brain would help better understand the relationship among a local population of neurons that are responsible for a specific function.\nNeural implants are designed to be as small as possible in order to be minimally invasive, particularly in areas surrounding the brain, eyes or cochlea. These implants typically communicate with their prosthetic counterparts wirelessly. Additionally, power is currently received through wireless power transmission through the skin. The tissue surrounding the implant is usually highly sensitive to temperature rise, meaning that power consumption must be minimal in order to prevent tissue damage.[2]\nThe neuroprosthetic currently undergoing the most widespread use is the cochlear implant, with over 300,000 in use worldwide as of 2012[update].[3]\n\nContents \n\n1 History \n\n1.1 Visual prosthetics \n1.2 Auditory prosthetics \n1.3 Prosthetics for pain relief \n\n\n2 Motor prosthetics \n\n2.1 Bladder control implants \n2.2 Motor prosthetics for conscious control of movement \n2.3 Sensory\/motor prosthetics \n2.4 Surgical Innovations for Neural Interfacing \n\n\n3 Obstacles \n\n3.1 Mathematical modelling \n3.2 Size \n3.3 Power consumption \n3.4 Biocompatibility \n3.5 Data transmission \n3.6 Correct implantation \n\n\n4 Technologies involved \n\n4.1 Local field potentials \n4.2 Automated movable electrical probes \n4.3 Imaged guided surgical techniques \n\n\n5 See also \n6 References \n7 Further reading \n8 External links \n\n\nHistory \nThe first known cochlear implant was created in 1957. Other milestones include the first motor prosthesis for foot drop in hemiplegia in 1961, the first auditory brainstem implant in 1977 and a peripheral nerve bridge implanted into the spinal cord of an adult rat in 1981. In 1988, the lumbar anterior root implant and functional electrical stimulation (FES) facilitated standing and walking, respectively, for a group of paraplegics.[4]\nRegarding the development of electrodes implanted in the brain, an early difficulty was reliably locating the electrodes, originally done by inserting the electrodes with needles and breaking off the needles at the desired depth. Recent systems utilize more advanced probes, such as those used in deep brain stimulation to alleviate the symptoms of Parkinson's disease. The problem with either approach is that the brain floats free in the skull while the probe does not, and relatively minor impacts, such as a low speed car accident, are potentially damaging. Some researchers, such as Kensall Wise at the University of Michigan, have proposed tethering 'electrodes to be mounted on the exterior surface of the brain' to the inner surface of the skull. However, even if successful, tethering would not resolve the problem in devices meant to be inserted deep into the brain, such as in the case of deep brain stimulation (DBS).\n\nVisual prosthetics \nMain article: Visual prosthetic\nA visual prosthesis can create a sense of image by electrically stimulating neurons in the visual system. A camera would wirelessly transmit to an implant, the implant would map the image across an array of electrodes. The array of electrodes has to effectively stimulate 600-1000 locations, stimulating these optic neurons in the retina thus will create an image. The stimulation can also be done anywhere along the optic signal's path way. The optical nerve can be stimulated in order to create an image, or the visual cortex can be stimulated, although clinical tests have proven most successful for retinal implants.\nA visual prosthesis system consists of an external (or implantable) imaging system which acquires and processes the video. Power and data will be transmitted to the implant wirelessly by the external unit. The implant uses the received power\/data to convert the digital data to an analog output which will be delivered to the nerve via micro electrodes.\nPhotoreceptors are the specialized neurons that convert photons into electrical signals. They are part of the retina, a multilayer neural structure about 200 um thick that lines the back of the eye. The processed signal is sent to the brain through the optical nerve. If any part of this pathway is damaged blindness can occur.\nBlindness can result from damage to the optical pathway (cornea, aqueous humor, crystalline lens, and vitreous). This can happen as a result of accident or disease. The two most common retinal degenerative diseases that result in blindness secondary to photoreceptor loss is age related macular degeneration (AMD) and retinitis pigmentosa (RP).\nThe first clinical trial of a permanently implanted retinal prosthesis was a device with a passive microphotodiode array with 3500 elements.[5] This trial was implemented at Optobionics, Inc., in 2000. In 2002, Second Sight Medical Products, Inc. (Sylmar, CA) began a trial with a prototype epiretinal implant with 16 electrodes. The subjects were six individuals with bare light perception secondary to RP. The subjects demonstrated their ability to distinguish between three common objects (plate, cup, and knife) at levels statistically above chance. An active sub retinal device developed by Retina Implant GMbH (Reutlingen, Germany) began clinical trials in 2006. An IC with 1500 microphotodiodes was implanted under the retina. The microphotodiodes serve to modulate current pulses based on the amount of light incident on the photo diode.[6]\nThe seminal experimental work towards the development of visual prostheses was done by cortical stimulation using a grid of large surface electrodes. In 1968 Giles Brindley implanted an 80 electrode device on the visual cortical surface of a 52-year-old blind woman. As a result of the stimulation the patient was able to see phosphenes in 40 different positions of the visual field.[7] This experiment showed that an implanted electrical stimulator device could restore some degree of vision. Recent efforts in visual cortex prosthesis have evaluated efficacy of visual cortex stimulation in a non-human primate. In this experiment after a training and mapping process the monkey is able to perform the same visual saccade task with both light and electrical stimulation.\nThe requirements for a high resolution retinal prosthesis should follow from the needs and desires of blind individuals who will benefit from the device. Interactions with these patients indicate that mobility without a cane, face recognition and reading are the main necessary enabling capabilities.[8]\nThe results and implications of fully functional visual prostheses are exciting. However, the challenges are grave. In order for a good quality image to be mapped in the retina a high number of micro-scale electrode arrays are needed. Also, the image quality is dependent on how much information can be sent over the wireless link. Also this high amount of information must be received and processed by the implant without much power dissipation which can damage the tissue. The size of the implant is also of great concern. Any implant would be preferred to be minimally invasive.[8]\nWith this new technology, several scientists, including Karen Moxon at Drexel, John Chapin at SUNY, and Miguel Nicolelis at Duke University, started research on the design of a sophisticated visual prosthesis. Other scientists[who? ] have disagreed with the focus of their research, arguing that the basic research and design of the densely populated microscopic wire was not sophisticated enough to proceed.\n\nAuditory prosthetics \nMain articles: cochlear implant and auditory brainstem implant\n(For receiving sound)\nCochlear implants (CIs), auditory brain stem implants (ABIs), and auditory midbrain implants (AMIs) are the three main categories for auditory prostheses. CI electrode arrays are implanted in the cochlea, ABI electrode arrays stimulate the cochlear nucleus complex in the lower brain stem, and AMIs stimulates auditory neurons in the inferior colliculus. Cochlear implants have been very successful among these three categories. Today the Advanced Bionics Corporation, the Cochlear Corporation and the Med-El Corporation are the major commercial providers of cochlea implants.\nIn contrast to traditional hearing aids that amplify sound and send it through the external ear, cochlear implants acquire and process the sound and convert it into electrical energy for subsequent delivery to the auditory nerve. The microphone of the CI system receives sound from the external environment and sends it to processor. The processor digitizes the sound and filters it into separate frequency bands that are sent to the appropriate tonotonic region in the cochlea that approximately corresponds to those frequencies.\nIn 1957, French researchers A. Djourno and C. Eyries, with the help of D. Kayser, provided the first detailed description of directly stimulation the auditory nerve in a human subject.[9] The individuals described hearing chirping sounds during simulation. In 1972, the first portable cochlear implant system in an adult was implanted at the House Ear Clinic. The U.S. Food and Drug Administration (FDA) formally approved the marketing of the House-3M cochlear implant in November 1984.[10]\nImproved performance on cochlear implant not only depends on understanding the physical and biophysical limitations of implant stimulation but also on an understanding of the brain's pattern processing requirements. Modern signal processing represents the most important speech information while also providing the brain the pattern recognition information that it needs. Pattern recognition in the brain is more effective than algorithmic preprocessing at identifying important features in speech. A combination of engineering, signal processing, biophysics, and cognitive neuroscience was necessary to produce the right balance of technology to maximize the performance of auditory prosthesis.[11]\nCochlear implants have been also used to allow acquiring of spoken language development in congenitally deaf children, with remarkable success in early implantations (before 2\u20134 years of life have been reached).[12] There have been about 80,000 children implanted worldwide.\nThe concept of combining simultaneous electric-acoustic stimulation (EAS) for the purposes of better hearing was first described by C. von Ilberg and J. Kiefer, from the Universit\u00e4tsklinik Frankfurt, Germany, in 1999.[13] That same year the first EAS patient was implanted. Since the early 2000s FDA has been involved in a clinical trial of device termed the \"Hybrid\" by Cochlear Corporation. This trial is aimed at examining the usefulness of cochlea implantation in patients with residual low-frequency hearing. The \"Hybrid\" utilizes a shorter electrode than the standard cochlea implant, since the electrode is shorter it stimulates the basil region of the cochlea and hence the high-frequency tonotopic region. In theory these devices would benefit patients with significant low-frequency residual hearing who have lost perception in the speech frequency range and hence have decreased discrimination scores.[14]\nFor producing sound see Speech synthesis.\n\nProsthetics for pain relief \nMain article: Spinal Cord Stimulator\nThe SCS (Spinal Cord Stimulator) device has two main components: an electrode and a generator. The technical goal of SCS for neuropathic pain is to mask the area of a patient's pain with a stimulation induced tingling, known as \"paresthesia\", because this overlap is necessary (but not sufficient) to achieve pain relief.[15] Paresthesia coverage depends upon which afferent nerves are stimulated. The most easily recruited by a dorsal midline electrode, close to the pial surface of spinal cord, are the large dorsal column afferents, which produce broad paresthesia covering segments caudally.\nIn ancient times the electrogenic fish was used as a shocker to subside pain. Healers had developed specific and detailed techniques to exploit the generative qualities of the fish to treat various types of pain, including headache. Because of the awkwardness of using a living shock generator, a fair level of skill was required to deliver the therapy to the target for the proper amount of time. (Including keeping the fish alive as long as possible)\nElectro analgesia was the first deliberate application of electricity. By the nineteenth century, most western physicians were offering their patients electrotherapy delivered by portable generator.[16] In the mid-1960s, however, three things converged to ensure the future of electro stimulation.\n\n<\/p>\nPacemaker technology, which had it start in 1950, became available.\nMelzack and Wall published their gate control theory of pain, which proposed that the transmission of pain could be blocked by stimulation of large afferent fibers.[17]\nPioneering physicians became interested in stimulating the nervous system to relieve patients from pain.\nThe design options for electrodes include their size, shape, arrangement, number, and assignment of contacts and how the electrode is implanted.\nThe design option for the pulse generator include the power source, target anatomic placement location, current or voltage source, pulse rate, pulse width, and number of independent channels.\nProgramming options are very numerous (a four-contact electrode offers 50 functional bipolar combinations). The current devices use computerized equipment to find the best options for use. This reprogramming option compensates for postural changes, electrode migration, changes in pain location, and suboptimal electrode placement.[18]\n\nMotor prosthetics \nDevices which support the function of autonomous nervous system include the implant for bladder control. In the somatic nervous system attempts to aid conscious control of movement include Functional electrical stimulation and the lumbar anterior root stimulator.\n\nBladder control implants \nMain article: Sacral anterior root stimulator\nWhere a spinal cord lesion leads to paraplegia, patients have difficulty emptying their bladders and this can cause infection. From 1969 onwards Brindley developed the sacral anterior root stimulator, with successful human trials from the early 1980s onwards.[19] This device is implanted over the sacral anterior root ganglia of the spinal cord; controlled by an external transmitter, it delivers intermittent stimulation which improves bladder emptying. It also assists in defecation and enables male patients to have a sustained full erection.\nThe related procedure of sacral nerve stimulation is for the control of incontinence in able-bodied patients.[20]\n\nMotor prosthetics for conscious control of movement \nMain article: Brain\u2013computer interface\nResearchers are currently investigating and building motor neuroprosthetics that will help restore movement and the ability to communicate with the outside world to persons with motor disabilities such as tetraplegia or amyotrophic lateral sclerosis. Research has found that the striatum plays a crucial role in motor sensory learning. This was demonstrated by an experiment in which lab rats' firing rates of the striatum was recorded at higher rates after performing a task consecutively.\nTo capture electrical signals from the brain, scientists have developed microelectrode arrays smaller than a square centimeter that can be implanted in the skull to record electrical activity, transducing recorded information through a thin cable. After decades of research in monkeys, neuroscientists have been able to decode neuronal signals into movements. Completing the translation, researchers have built interfaces that allow patients to move computer cursors, and they are beginning to build robotic limbs and exoskeletons that patients can control by thinking about movement.\nThe technology behind motor neuroprostheses is still in its infancy. Investigators and study participants continue to experiment with different ways of using the prostheses. Having a patient think about clenching a fist, for example, produces a different result than having him or her think about tapping a finger. The filters used in the prostheses are also being fine-tuned, and in the future, doctors hope to create an implant capable of transmitting signals from inside the skull wirelessly, as opposed to through a cable.\nPreliminary clinical trials suggest that the devices are safe and that they have the potential to be effective.[citation needed ] Some patients have worn the devices for over two years with few, if any, ill effects.[citation needed ]\nPrior to these advancements, Philip Kennedy (Emory and Georgia Tech) had an operable if somewhat primitive system which allowed an individual with paralysis to spell words by modulating their brain activity. Kennedy's device used two neurotrophic electrodes: the first was implanted in an intact motor cortical region (e.g. finger representation area) and was used to move a cursor among a group of letters. The second was implanted in a different motor region and was used to indicate the selection.[21]\nDevelopments continue in replacing lost arms with cybernetic replacements by using nerves normally connected to the pectoralis muscles. These arms allow a slightly limited range of motion, and reportedly are slated to feature sensors for detecting pressure and temperature.[22]\nDr. Todd Kuiken at Northwestern University and Rehabilitation Institute of Chicago has developed a method called targeted reinnervation for an amputee to control motorized prosthetic devices and to regain sensory feedback.\n\n Sensory\/motor prosthetics \nIn 2002 an Multielectrode array of 100 electrodes, which now forms the sensor part of a Braingate, was implanted directly into the median nerve fibers of scientist Kevin Warwick. The recorded signals were used to control a robot arm developed by Warwick's colleague, Peter Kyberd and was able to mimic the actions of Warwick's own arm.[23] Additionally, a form of sensory feedback was provided via the implant by passing small electrical currents into the nerve. This caused a contraction of the first lumbrical muscle of the hand and it was this movement that was perceived.[23]\n\nSurgical Innovations for Neural Interfacing \nThe MIT Biomechatronics Group has designed a novel amputation paradigm that enables biological muscles and myoelectric prostheses to interface neurally with high reliability. This surgical paradigm, termed the agonist-antagonist myoneural interface (AMI), provides the user with the ability to sense and control their prosthetic limb as an extension of their own body, rather than using a prosthetic that merely resembles an appendage. In a normal agonist-antagonist muscle pair relationship (e.g. bicep-tricep), when the agonist muscle contracts, the antagonist muscle is stretched, and vice versa, providing one with the knowledge of the position of one\u2019s limb without even having to look at it. During a standard amputation, agonist-antagonist muscles (e.g. bicep-tricep) are isolated from each other, preventing the ability to have the dynamic contract-extend mechanism that generates sensory feedback. Therefore, current amputees have no way of feeling the physical environment their prosthetic limb encounters. Moreover, with the current amputation surgery which has been in place for over 200 years, 1\/3 patients undergo revision surgeries due to pain in their stumps. \nAn AMI is composed of two muscles that originally shared an agonist-antagonist relationship. During the amputation surgery, these two muscles are mechanically linked together within the amputated stump.[24] One AMI muscle pair can be created for each joint degree of freedom in a patient in order to establish control and sensation of multiple prosthetic joints. In preliminary testing of this new neural interface, patients with an AMI have demonstrated and reported greater control over the prosthesis. Additionally, more naturally reflexive behavior during stair walking was observed compared to subjects with a traditional amputation.[25] An AMI can also be constructed through the combination of two devascularized muscle grafts. These muscle grafts (or flaps) are spare muscle that is denervated (detached from original nerves) and removed from one part of the body to be re-innervated by severed nerves found in the limb to be amputated.[26] Through the use of regenerated muscle flaps, AMIs can be created for patients with muscle tissue that has experienced extreme atrophy or damage or for patients who are undergoing revision of an amputated limb for reasons such as neuroma pain, bone spurs, etc.\n\nObstacles \nMathematical modelling \nAccurate characterization of the nonlinear input\/output (I\/O) parameters of the normally functioning tissue to be replaced is paramount to designing a prosthetic that mimics normal biologic synaptic signals.[27][28] Mathematical modeling of these signals is a complex task \"because of the nonlinear dynamics inherent in the cellular\/molecular mechanisms comprising neurons and their synaptic connections\".[29][30][31] The output of nearly all brain neurons are dependent on which post-synaptic inputs are active and in what order the inputs are received. (spatial and temporal properties, respectively).[32]\nOnce the I\/O parameters are modeled mathematically, integrated circuits are designed to mimic the normal biologic signals. For the prosthetic to perform like normal tissue, it must process the input signals, a process known as transformation, in the same way as normal tissue.\n\nSize \nImplantable devices must be very small to be implanted directly in the brain, roughly the size of a quarter. One of the example of microimplantable electrode array is the Utah array.[33]\nWireless controlling devices can be mounted outside of the skull and should be smaller than a pager.\n\nPower consumption \nPower consumption drives battery size. Optimization of the implanted circuits reduces power needs. Implanted devices currently need on-board power sources. Once the battery runs out, surgery is needed to replace the unit. Longer battery life correlates to fewer surgeries needed to replace batteries. One option that could be used to recharge implant batteries without surgery or wires is being used in powered toothbrushes.[citation needed ] These devices make use of inductive coupling to recharge batteries. Another strategy is to convert electromagnetic energy into electrical energy, as in radio-frequency identification tags.\n\nBiocompatibility \nCognitive prostheses are implanted directly in the brain, so biocompatibility is a very important obstacle to overcome.\nMaterials used in the housing of the device, the electrode material (such as iridium oxide[34]), and electrode insulation must be chosen for long term implantation. Subject to Standards: ISO 14708-3 2008-11-15, Implants for Surgery - Active implantable medical devices Part 3: Implantable neurostimulators.\nCrossing the blood\u2013brain barrier can introduce pathogens or other materials that may cause an immune response. The brain has its own immune system that acts differently from the immune system of the rest of the body.\nQuestions to answer: How does this affect material choice? Does the brain have unique phages that act differently and may affect materials thought to be biocompatible in other areas of the body?\n\nData transmission \nWireless Transmission is being developed to allow continuous recording of neuronal signals of individuals in their daily life. This allows physicians and clinicians to capture more data, ensuring that short term events like epileptic seizures can be recorded, allowing better treatment and characterization of neural disease.\nA small, light weight device has been developed that allows constant recording of primate brain neurons at Stanford University.[35] This technology also enables neuroscientists to study the brain outside of the controlled environment of a lab.\nMethods of data transmission must be robust and secure. Neurosecurity is a new issue. Makers of cognitive implants must prevent unwanted downloading of information or thoughts[citation needed ] from and uploading of detrimental data to the device that may interrupt function.\n\nCorrect implantation \nImplantation of the device presents many problems. First, the correct presynaptic inputs must be wired to the correct postsynaptic inputs on the device. Secondly, the outputs from the device must be targeted correctly on the desired tissue. Thirdly, the brain must learn how to use the implant. Various studies in brain plasticity suggest that this may be possible through exercises designed with proper motivation.\n\nTechnologies involved \nLocal field potentials \nLocal field potentials (LFPs) are electrophysiological signals that are related to the sum of all dendritic synaptic activity within a volume of tissue. Recent studies suggest goals and expected value are high-level cognitive functions that can be used for neural cognitive prostheses.[36]\nAlso, Rice University scientists have discovered a new method to tune the light-induced vibrations of nanoparticles through slight alterations to the surface to which the particles are attached. According to the university, the discovery could lead to new applications of photonics from molecular sensing to wireless communications. They used ultrafast laser pulses to induce the atoms in gold nanodisks to vibrate.[37]\n\nAutomated movable electrical probes \nOne hurdle to overcome is the long term implantation of electrodes. If the electrodes are moved by physical shock or the brain moves in relation to electrode position, the electrodes could be recording different nerves. Adjustment to electrodes is necessary to maintain an optimal signal. Individually adjusting multi electrode arrays is a very tedious and time consuming process. Development of automatically adjusting electrodes would mitigate this problem. Anderson's group is currently collaborating with Yu-Chong Tai's lab and the Burdick lab (all at Caltech) to make such a system that uses electrolysis-based actuators to independently adjust electrodes in a chronically implanted array of electrodes.[38]\n\nImaged guided surgical techniques \nImage-guided surgery is used to precisely position brain implants.[36]\n\nSee also \n\nBiomedical engineering\nBrain-reading\nCyborg\nNeural engineering\nNeurosecurity\nProsthetics\nSimulated reality\nProsthetic Neuronal Memory Silicon Chips\n\nReferences \n\n^ Krucoff, Max O.; Rahimpour, Shervin; Slutzky, Marc W.; Edgerton, V. Reggie; Turner, Dennis A. (2016-01-01). \"Enhancing Nervous System Recovery through Neurobiologics, Neural Interface Training, and Neurorehabilitation\". Neuroprosthetics: 584. doi:10.3389\/fnins.2016.00584. PMC 5186786 . PMID 28082858. \n\n^ Daniel Garrison. \"Minimizing Thermal Effects of In Vivo Body Sensors\". Retrieved May 5, 2010 . \n\n^ https:\/\/www.nidcd.nih.gov\/health\/cochlear-implants \n\n^ Handa G (2006) \"Neural Prosthesis \u2013 Past, Present and Future\" Indian Journal of Physical Medicine & Rehabilitation 17(1) \n\n^ A. Y. Chow, V. Y. Chow, K. Packo, J. Pollack, G. Peyman, and R. Schuchard, \"The artificial silicon retina microchip for the treatment of vision loss from retinitis pigmentosa,\" Arch.Ophthalmol., vol. 122, p. 460, 2004 \n\n^ M. J. McMahon, A. Caspi, J. D.Dorn,\nK. H. McClure, M. Humayun, and R. Greenberg, \"Spatial vision in blind subjects implanted with the second sight retinal\nprosthesis,\" presented at the ARVO Annu. Meeting, Ft. Lauderdale, FL, 2007. \n\n^ G. S. Brindley and W. S. Lewin, \"The sensations produced by electrical stimulation of the visual cortex,\" J. Physiol., vol. 196, p. 479, 1968 \n\n^ a b Weiland JD, Humayun MS. 2008. Visual prosthesis. Proceedings of the IEEE 96:1076-84 \n\n^ J. K. Niparko and B. W. Wilson, \"History of cochlear implants,\" in Cochlear Implants:Principles and Practices. Philadelphia, PA: Lippincott Williams and Wilkins, 2000, pp. 103\u2013108 \n\n^ W. F. House, Cochlear implants: My perspective \n\n^ Fayad JN, Otto SR, Shannon RV, Brackmann DE. 2008. Cochlear and brainstern auditory prostheses \"neural interface for hearing restoration: Cochlear and brain stem implants\". Proceedings of the IEEE 96:1085-95 \n\n^ Kral A, O'Donoghue GM. Profound Deafness in Childhood. New England J Medicine 2010: 363; 1438-50 \n\n^ V. Ilberg C., Kiefer J., Tillein J., Pfennigdorff T., Hartmann R., St\u00fcrzebecher E., Klinke R. (1999). Electric-acoustic stimulation of the auditory system. ORL 61:334-340. \n\n^ B. J. Gantz, C. Turner, and K. E. Gfeller, \"Acoustic plus electric speech processing:\nPreliminary results of a multicenter clinical trial of the Iowa\/Nucleus hybrid implant,\" Audiol. Neurotol., vol. 11 (suppl.), pp. 63\u201368, 2006, Vol 1 \n\n^ R. B. North, M. E. Ewend, M. A. Lawton, and S. Piantadosi, \"Spinal cord stimulation for chronic, intractable pain: Superiority of 'multi-channel' devices,\" Pain, vol. 4, no. 2, pp. 119\u2013130, 1991 \n\n^ D. Fishlock, \"Doctor volts [electrotherapy],\" Inst. Elect. Eng. Rev., vol. 47, pp. 23\u201328, May 2001 \n\n^ P. Melzack and P. D. Wall, \"Pain mechanisms: A new theory,\" Science, vol. 150, no. 3699, pp. 971\u2013978, Nov. 1965 \n\n^ North RB. 2008. Neural interface devices: Spinal cord stimulation technology. Proceedings of the IEEE 96:1108\u201319 \n\n^ Brindley GS, Polkey CE, Rushton DN (1982): Sacral anterior root stimulator for bladder control in paraplegia. Paraplegia 20: 365-381. \n\n^ Schmidt RA, Jonas A, Oleson KA, Janknegt RA, Hassouna MM, Siegel SW, van Kerrebroeck PE. Sacral nerve stimulation for treatment of refractory urinary urge incontinence. Sacral nerve study group. J Urol 1999 Aug;16(2):352-357. \n\n^ Gary Goettling. \"Harnessing the Power of Thought\". Archived from the original on April 14, 2006. Retrieved April 22, 2006 . \n\n^ David Brown (September 14, 2006). \"Washington Post\". The Washington Post. Retrieved September 14, 2006 . \n\n^ a b Warwick, K, Gasson, M, Hutt, B, Goodhew, I, Kyberd, P, Andrews, B, Teddy, P and Shad, A:\"The Application of Implant Technology for Cybernetic Systems\", Archives of Neurology, 60(10), pp1369-1373, 2003 \n\n^ \"On prosthetic control: A regenerative agonist-antagonist myoneural interface\",' 'Science Robotics' ', 31 May 2017 \n\n^ \"Proprioception from a neurally controlled lower-extremity prosthesis\",' ' Science Translational Medicine' ', 30 May 2018 \n\n^ \"On prosthetic control: A regenerative agonist-antagonist myoneural interface\",' 'Science Robotics' ', 31 May 2017 \n\n^ Bertaccini, D., & Fanelli, S. (2009). Computational and conditioning issues of a discrete model for cochlear sensorineural hypoacusia. [Article]. Applied Numerical Mathematics, 59(8), 1989-2001. \n\n^ Marmarelis, V. Z. (1993). IDENTIFICATION OF NONLINEAR BIOLOGICAL-SYSTEMS USING LAGUERRE EXPANSIONS OF KERNELS. [Article]. Annals of Biomedical Engineering, 21(6), 573-589. \n\n^ T.W. Berger, T.P. Harty, X. Xie, G. Barrionuevo, and R.J. Sclabassi, \"Modeling\nof neuronal networks through experimental decomposition,\" in Proc. IEEE 34th Mid\nSymp. Cir. Sys., Monterey, CA, 1991, vol. 1, pp. 91\u201397. \n\n^ T.W. Berger, G. Chauvet, and R.J. Sclabassi, \"A biologically based model of\nfunctional properties of the hippocampus,\" Neural Netw., vol. 7,\nno. 6\u20137, pp. 1031\u20131064, 1994. \n\n^ S.S. Dalal, V.Z. Marmarelis, and T.W. Berger, \"A nonlinear positive feedback\nmodel of glutamatergic synaptic transmission in dentate gyrus,\" in Proc. 4th Joint Symp.\nNeural Computation, California, 1997, vol. 7, pp. 68\u201375. \n\n^ Berger, T. W., Ahuja, A., Courellis, S. H., Deadwyler, S. A., Erinjippurath, G., Gerhardt, G. A., et al. (2005). Restoring lost cognitive function. IEEE Engineering in Medicine and Biology Magazine, 24(5), 30-44. \n\n^ R. Bhandari, S. Negi, F. Solzbacher (2010). \"Wafer Scale Fabrication of Penetrating Neural Electrode Arrays\". Biomedical Microdevices. 12 (5): 797\u2013807. CS1 maint: Uses authors parameter (link) \n\n^ S Negi, R. Bhandari, L Rieth, R V Wagenen, and F Solzbacher, \u201cNeural Electrode Degradation from Continuous Electrical Stimulation: Comparison of Sputtered and Activated Iridium Oxide\u201d, Journal of Neuroscience Methods, vol. 186, pp. 8-17, 2010. \n\n^ HermesC: Low-Power Wireless Neural Recording System for Freely Moving Primates Chestek, C.A.; Gilja, V.; Nuyujukian, P.; Kier, R.J.; Solzbacher, F.; Ryu, S.I.; Harrison, R.R.; Shenoy, K.V.; Neural Systems and Rehabilitation Engineering, IEEE Transactions on Volume 17, Issue 4, Aug. 2009 Page(s):330 - 338. \n\n^ a b Andersen, R. A., Burdick, J. W., Musallam, S., Pesaran, B., & Cham, J. G. (2004). Cognitive neural prosthetics. Trends in Cognitive Sciences, 8(11), 486-493. \n\n^ The Engineer.London United Kingdom.Centaur Communications Ltd. 2015, May 8 \n\n^ Anderson, R.A. et al (2004) Cognitive Neural Prosthetics. Trends in Cognitive Sciences. 8(11):486-493. \n\n\nFurther reading \nSanthanam G, Ryu SI, Yu BM, Afshar A, Shenoy KV. 2006. A high-performance brain-computer interface. Nature 442:195\u20138\nPatil PG, Turner DA. 2008. The development of brain-machine interface neuroprosthetic devices. Neurotherapeutics 5:137\u201346\nLiu WT, Humayun MS, Liker MA. 2008. Implantable biomimetic microelectronics systems. Proceedings of the IEEE 96:1073\u20134\nHarrison RR. 2008. The design of integrated circuits to observe brain activity. Proceedings of the IEEE 96:1203\u201316\nAbbott A. 2006. Neuroprosthetics: In search of the sixth sense. Nature 442:125\u20137\nVelliste M, Perel S, Spalding MC, Whitford AS, Schwartz AB (2008) \"Cortical control of a prosthetic arm for self-feeding.\"Nature. 19;453(7198):1098\u2013101.\nSchwartz AB, Cui XT, Weber DJ, Moran DW \"Brain-controlled interfaces: movement restoration with neural prosthetics.\" (2006) Neuron 5;52(1):205\u201320\nSantucci DM, Kralik JD, Lebedev MA, Nicolelis MA (2005) \"Frontal and parietal cortical ensembles predict single-trial muscle activity during reaching movements in primates.\"Eur J Neurosci. 22(6): 1529\u20131540.\nLebedev MA, Carmena JM, O'Doherty JE, Zacksenhouse M, Henriquez CS, Principe JC, Nicolelis MA (2005) \"Cortical ensemble adaptation to represent velocity of an artificial actuator controlled by a brain-machine interface.\"J Neurosci. 25: 4681\u20134893.\nNicolelis MA (2003) \"Brain-machine interfaces to restore motor function and probe neural circuits.\" Nat Rev Neurosci. 4: 417\u2013422.\nWessberg J, Stambaugh CR, Kralik JD, Beck PD, Laubach M, Chapin JK, Kim J, Biggs SJ, Srinivasan MA, Nicolelis MA. (2000) \"Real-time prediction of hand trajectory by ensembles of cortical neurons in primates.\"Nature 16: 361\u2013365.\nLaryionava K, Gross D. 2011. Public Understanding of Neural Prosthetics in Germany: Ethical, Social and Cultural Challenges. Cambridge Quarterly of Healthcare Ethics International issue 20\/3: 434\u2013439\nExternal links \n\n\n\nWikimedia Commons has media related to Neuroprosthetics.\nThe open-source Electroencephalography project and Programmable chip version, Sourceforge open source EEG projects\nDr. Theodore W. 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 19:28.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 364 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","81df8edecfd22b24f9c53b96aa30b9b6_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Neuroprosthetics skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Neuroprosthetics<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Neuroprosthetics<\/b> (also called <b>neural prosthetics<\/b>) is a discipline related to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroscience\" title=\"Neuroscience\" rel=\"external_link\" target=\"_blank\">neuroscience<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical_engineering\" title=\"Biomedical engineering\" rel=\"external_link\" target=\"_blank\">biomedical engineering<\/a> concerned with developing neural <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthetics\" class=\"mw-redirect\" title=\"Prosthetics\" rel=\"external_link\" target=\"_blank\">prostheses<\/a>. They are sometimes contrasted with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain%E2%80%93computer_interface\" title=\"Brain\u2013computer interface\" rel=\"external_link\" target=\"_blank\">brain\u2013computer interface<\/a>, which connects the brain to a computer rather than a device meant to replace missing biological functionality.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Neural prostheses are a series of devices that can substitute a motor, sensory or cognitive modality that might have been damaged as a result of an injury or a disease. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implant\" title=\"Cochlear implant\" rel=\"external_link\" target=\"_blank\">Cochlear implants<\/a> provide an example of such devices. These devices substitute the functions performed by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ear_drum\" class=\"mw-redirect\" title=\"Ear drum\" rel=\"external_link\" target=\"_blank\">ear drum<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stapes\" title=\"Stapes\" rel=\"external_link\" target=\"_blank\">stapes<\/a> while simulating the frequency analysis performed in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlea\" title=\"Cochlea\" rel=\"external_link\" target=\"_blank\">cochlea<\/a>. A microphone on an external unit gathers the sound and processes it; the processed signal is then transferred to an implanted unit that stimulates the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Auditory_nerve\" class=\"mw-redirect\" title=\"Auditory nerve\" rel=\"external_link\" target=\"_blank\">auditory nerve<\/a> through a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microelectrode_array\" title=\"Microelectrode array\" rel=\"external_link\" target=\"_blank\">microelectrode array<\/a>. Through the replacement or augmentation of damaged senses, these devices intend to improve the quality of life for those with disabilities.\n<\/p><p>These implantable devices are also commonly used in animal experimentation as a tool to aid neuroscientists in developing a greater understanding of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_brain\" title=\"Human brain\" rel=\"external_link\" target=\"_blank\">brain<\/a> and its functioning. By wirelessly monitoring the brain's electrical signals sent out by electrodes implanted in the subject's brain, the subject can be studied without the device affecting the results.\n<\/p><p>Accurately probing and recording the electrical signals in the brain would help better understand the relationship among a local population of neurons that are responsible for a specific function.\n<\/p><p>Neural implants are designed to be as small as possible in order to be minimally invasive, particularly in areas surrounding the brain, eyes or cochlea. These implants typically communicate with their prosthetic counterparts wirelessly. Additionally, power is currently received through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wireless_power_transmission\" class=\"mw-redirect\" title=\"Wireless power transmission\" rel=\"external_link\" target=\"_blank\">wireless power transmission<\/a> through the skin. The tissue surrounding the implant is usually highly sensitive to temperature rise, meaning that power consumption must be minimal in order to prevent tissue damage.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>The neuroprosthetic currently undergoing the most widespread use is the cochlear implant, with over 300,000 in use worldwide as of 2012<sup class=\"plainlinks noexcerpt noprint asof-tag update\" style=\"display:none;\"><\/sup>.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The first known cochlear implant was created in 1957. Other milestones include the first motor prosthesis for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foot_drop\" title=\"Foot drop\" rel=\"external_link\" target=\"_blank\">foot drop<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemiplegia\" class=\"mw-redirect\" title=\"Hemiplegia\" rel=\"external_link\" target=\"_blank\">hemiplegia<\/a> in 1961, the first <a href=\"https:\/\/en.wikipedia.org\/wiki\/Auditory_brainstem_implant\" title=\"Auditory brainstem implant\" rel=\"external_link\" target=\"_blank\">auditory brainstem implant<\/a> in 1977 and a implanted into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord\" title=\"Spinal cord\" rel=\"external_link\" target=\"_blank\">spinal cord<\/a> of an adult rat in 1981. In 1988, the and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Functional_electrical_stimulation\" title=\"Functional electrical stimulation\" rel=\"external_link\" target=\"_blank\">functional electrical stimulation<\/a> (FES) facilitated standing and walking, respectively, for a group of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paraplegics\" class=\"mw-redirect\" title=\"Paraplegics\" rel=\"external_link\" target=\"_blank\">paraplegics<\/a>.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>Regarding the development of electrodes implanted in the brain, an early difficulty was reliably locating the electrodes, originally done by inserting the electrodes with needles and breaking off the needles at the desired depth. Recent systems utilize more advanced probes, such as those used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deep_brain_stimulation\" title=\"Deep brain stimulation\" rel=\"external_link\" target=\"_blank\">deep brain stimulation<\/a> to alleviate the symptoms of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parkinson%27s_disease\" title=\"Parkinson's disease\" rel=\"external_link\" target=\"_blank\">Parkinson's disease<\/a>. The problem with either approach is that the brain floats free in the skull while the probe does not, and relatively minor impacts, such as a low speed car accident, are potentially damaging. Some researchers, such as Kensall Wise at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Michigan\" title=\"University of Michigan\" rel=\"external_link\" target=\"_blank\">University of Michigan<\/a>, have proposed tethering 'electrodes to be mounted on the exterior surface of the brain' to the inner surface of the skull. However, even if successful, tethering would not resolve the problem in devices meant to be inserted deep into the brain, such as in the case of deep brain stimulation (DBS).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Visual_prosthetics\">Visual prosthetics<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_prosthetic\" class=\"mw-redirect\" title=\"Visual prosthetic\" rel=\"external_link\" target=\"_blank\">Visual prosthetic<\/a><\/div>\n<p>A visual prosthesis can create a sense of image by electrically stimulating neurons in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_system\" title=\"Visual system\" rel=\"external_link\" target=\"_blank\">visual system<\/a>. A camera would wirelessly transmit to an implant, the implant would map the image across an array of electrodes. The array of electrodes has to effectively stimulate 600-1000 locations, stimulating these optic neurons in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retina\" title=\"Retina\" rel=\"external_link\" target=\"_blank\">retina<\/a> thus will create an image. The stimulation can also be done anywhere along the optic signal's path way. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_nerve\" class=\"mw-redirect\" title=\"Optical nerve\" rel=\"external_link\" target=\"_blank\">optical nerve<\/a> can be stimulated in order to create an image, or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_cortex\" title=\"Visual cortex\" rel=\"external_link\" target=\"_blank\">visual cortex<\/a> can be stimulated, although clinical tests have proven most successful for retinal implants.\n<\/p><p>A visual prosthesis system consists of an external (or implantable) imaging system which acquires and processes the video. Power and data will be transmitted to the implant wirelessly by the external unit. The implant uses the received power\/data to convert the digital data to an analog output which will be delivered to the nerve via micro electrodes.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Photoreceptor_cell\" title=\"Photoreceptor cell\" rel=\"external_link\" target=\"_blank\">Photoreceptors<\/a> are the specialized neurons that convert <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photons\" class=\"mw-redirect\" title=\"Photons\" rel=\"external_link\" target=\"_blank\">photons<\/a> into electrical signals. They are part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retina\" title=\"Retina\" rel=\"external_link\" target=\"_blank\">retina<\/a>, a multilayer neural structure about 200 um thick that lines the back of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_eye\" title=\"Human eye\" rel=\"external_link\" target=\"_blank\">eye<\/a>. The processed signal is sent to the brain through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_nerve\" class=\"mw-redirect\" title=\"Optical nerve\" rel=\"external_link\" target=\"_blank\">optical nerve<\/a>. If any part of this pathway is damaged <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blindness\" class=\"mw-redirect\" title=\"Blindness\" rel=\"external_link\" target=\"_blank\">blindness<\/a> can occur.\n<\/p><p>Blindness can result from damage to the optical pathway (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornea\" title=\"Cornea\" rel=\"external_link\" target=\"_blank\">cornea<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aqueous_humor\" class=\"mw-redirect\" title=\"Aqueous humor\" rel=\"external_link\" target=\"_blank\">aqueous humor<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystalline_lens\" class=\"mw-redirect\" title=\"Crystalline lens\" rel=\"external_link\" target=\"_blank\">crystalline lens<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vitreous_humour\" class=\"mw-redirect\" title=\"Vitreous humour\" rel=\"external_link\" target=\"_blank\">vitreous<\/a>). This can happen as a result of accident or disease. The two most common retinal degenerative diseases that result in blindness secondary to photoreceptor loss is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Age_related_macular_degeneration\" class=\"mw-redirect\" title=\"Age related macular degeneration\" rel=\"external_link\" target=\"_blank\">age related macular degeneration<\/a> (AMD) and retinitis pigmentosa (RP).\n<\/p><p>The first clinical trial of a permanently implanted retinal prosthesis was a device with a passive microphotodiode array with 3500 elements.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> This trial was implemented at Optobionics, Inc., in 2000. In 2002, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Second_Sight_Medical_Products\" class=\"mw-redirect\" title=\"Second Sight Medical Products\" rel=\"external_link\" target=\"_blank\">Second Sight Medical Products<\/a>, Inc. (Sylmar, CA) began a trial with a prototype epiretinal implant with 16 electrodes. The subjects were six individuals with bare light perception secondary to RP. The subjects demonstrated their ability to distinguish between three common objects (plate, cup, and knife) at levels statistically above chance. An active sub retinal device developed by Retina Implant GMbH (Reutlingen, Germany) began clinical trials in 2006. An IC with 1500 microphotodiodes was implanted under the retina. The microphotodiodes serve to modulate current pulses based on the amount of light incident on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photo_diode\" class=\"mw-redirect\" title=\"Photo diode\" rel=\"external_link\" target=\"_blank\">photo diode<\/a>.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>The seminal experimental work towards the development of visual prostheses was done by cortical stimulation using a grid of large surface electrodes. In 1968 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Giles_Brindley\" title=\"Giles Brindley\" rel=\"external_link\" target=\"_blank\">Giles Brindley<\/a> implanted an 80 electrode device on the visual cortical surface of a 52-year-old blind woman. As a result of the stimulation the patient was able to see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphenes\" class=\"mw-redirect\" title=\"Phosphenes\" rel=\"external_link\" target=\"_blank\">phosphenes<\/a> in 40 different positions of the visual field.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> This experiment showed that an implanted electrical stimulator device could restore some degree of vision. Recent efforts in visual cortex prosthesis have evaluated efficacy of visual cortex stimulation in a non-human primate. In this experiment after a training and mapping process the monkey is able to perform the same visual saccade task with both light and electrical stimulation.\n<\/p><p>The requirements for a high resolution retinal prosthesis should follow from the needs and desires of blind individuals who will benefit from the device. Interactions with these patients indicate that mobility without a cane, face recognition and reading are the main necessary enabling capabilities.<sup id=\"rdp-ebb-cite_ref-Weiland_JD_2008_8-0\" class=\"reference\"><a href=\"#cite_note-Weiland_JD_2008-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>The results and implications of fully functional visual prostheses are exciting. However, the challenges are grave. In order for a good quality image to be mapped in the retina a high number of micro-scale electrode arrays are needed. Also, the image quality is dependent on how much information can be sent over the wireless link. Also this high amount of information must be received and processed by the implant without much power dissipation which can damage the tissue. The size of the implant is also of great concern. Any implant would be preferred to be minimally invasive.<sup id=\"rdp-ebb-cite_ref-Weiland_JD_2008_8-1\" class=\"reference\"><a href=\"#cite_note-Weiland_JD_2008-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>With this new technology, several scientists, including Karen Moxon at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drexel_University\" title=\"Drexel University\" rel=\"external_link\" target=\"_blank\">Drexel<\/a>, John Chapin at <a href=\"https:\/\/en.wikipedia.org\/wiki\/SUNY\" class=\"mw-redirect\" title=\"SUNY\" rel=\"external_link\" target=\"_blank\">SUNY<\/a>, and Miguel Nicolelis at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Duke_University\" title=\"Duke University\" rel=\"external_link\" target=\"_blank\">Duke University<\/a>, started research on the design of a sophisticated visual prosthesis. Other scientists<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Words_to_watch#Unsupported_attributions\" title=\"Wikipedia:Manual of Style\/Words to watch\" rel=\"external_link\" target=\"_blank\"><span title=\"The material near this tag possibly uses too-vague attribution or weasel words. (October 2011)\">who?<\/span><\/a><\/i>]<\/sup> have disagreed with the focus of their research, arguing that the basic research and design of the densely populated microscopic wire was not sophisticated enough to proceed.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Auditory_prosthetics\">Auditory prosthetics<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main articles: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implant\" title=\"Cochlear implant\" rel=\"external_link\" target=\"_blank\">cochlear implant<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Auditory_brainstem_implant\" title=\"Auditory brainstem implant\" rel=\"external_link\" target=\"_blank\">auditory brainstem implant<\/a><\/div>\n<p>(For receiving sound)\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implants\" class=\"mw-redirect\" title=\"Cochlear implants\" rel=\"external_link\" target=\"_blank\">Cochlear implants<\/a> (CIs), auditory <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain_stem\" class=\"mw-redirect\" title=\"Brain stem\" rel=\"external_link\" target=\"_blank\">brain stem<\/a> implants (ABIs), and auditory <a href=\"https:\/\/en.wikipedia.org\/wiki\/Midbrain\" title=\"Midbrain\" rel=\"external_link\" target=\"_blank\">midbrain<\/a> implants (AMIs) are the three main categories for auditory prostheses. CI electrode arrays are implanted in the cochlea, ABI electrode arrays stimulate the cochlear nucleus complex in the lower <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain_stem\" class=\"mw-redirect\" title=\"Brain stem\" rel=\"external_link\" target=\"_blank\">brain stem<\/a>, and AMIs stimulates auditory neurons in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inferior_colliculus\" title=\"Inferior colliculus\" rel=\"external_link\" target=\"_blank\">inferior colliculus<\/a>. Cochlear implants have been very successful among these three categories. Today the Advanced Bionics Corporation, the Cochlear Corporation and the Med-El Corporation are the major commercial providers of cochlea implants.\n<\/p><p>In contrast to traditional hearing aids that amplify sound and send it through the external ear, cochlear implants acquire and process the sound and convert it into electrical energy for subsequent delivery to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Auditory_nerve\" class=\"mw-redirect\" title=\"Auditory nerve\" rel=\"external_link\" target=\"_blank\">auditory nerve<\/a>. The microphone of the CI system receives sound from the external environment and sends it to processor. The processor digitizes the sound and filters it into separate frequency bands that are sent to the appropriate tonotonic region in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlea\" title=\"Cochlea\" rel=\"external_link\" target=\"_blank\">cochlea<\/a> that approximately corresponds to those frequencies.\n<\/p><p>In 1957, French researchers A. Djourno and C. Eyries, with the help of D. Kayser, provided the first detailed description of directly stimulation the auditory nerve in a human subject.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> The individuals described hearing chirping sounds during simulation. In 1972, the first portable cochlear implant system in an adult was implanted at the House Ear Clinic. The U.S. Food and Drug Administration (FDA) formally approved the marketing of the House-3M cochlear implant in November 1984.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>Improved performance on cochlear implant not only depends on understanding the physical and biophysical limitations of implant stimulation but also on an understanding of the brain's pattern processing requirements. Modern <a href=\"https:\/\/en.wikipedia.org\/wiki\/Signal_processing\" title=\"Signal processing\" rel=\"external_link\" target=\"_blank\">signal processing<\/a> represents the most important speech information while also providing the brain the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pattern_recognition\" title=\"Pattern recognition\" rel=\"external_link\" target=\"_blank\">pattern recognition<\/a> information that it needs. Pattern recognition in the brain is more effective than algorithmic preprocessing at identifying important features in speech. A combination of engineering, signal processing, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biophysics\" title=\"Biophysics\" rel=\"external_link\" target=\"_blank\">biophysics<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cognitive_neuroscience\" title=\"Cognitive neuroscience\" rel=\"external_link\" target=\"_blank\">cognitive neuroscience<\/a> was necessary to produce the right balance of technology to maximize the performance of auditory prosthesis.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>Cochlear implants have been also used to allow acquiring of spoken language development in congenitally deaf children, with remarkable success in early implantations (before 2\u20134 years of life have been reached).<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> There have been about 80,000 children implanted worldwide.\n<\/p><p>The concept of combining simultaneous electric-acoustic stimulation (EAS) for the purposes of better hearing was first described by C. von Ilberg and J. Kiefer, from the Universit\u00e4tsklinik Frankfurt, Germany, in 1999.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> That same year the first EAS patient was implanted. Since the early 2000s FDA has been involved in a clinical trial of device termed the \"Hybrid\" by Cochlear Corporation. This trial is aimed at examining the usefulness of cochlea implantation in patients with residual low-frequency hearing. The \"Hybrid\" utilizes a shorter electrode than the standard cochlea implant, since the electrode is shorter it stimulates the basil region of the cochlea and hence the high-frequency tonotopic region. In theory these devices would benefit patients with significant low-frequency residual hearing who have lost perception in the speech frequency range and hence have decreased discrimination scores.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>For producing sound see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Speech_synthesis\" title=\"Speech synthesis\" rel=\"external_link\" target=\"_blank\">Speech synthesis<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Prosthetics_for_pain_relief\">Prosthetics for pain relief<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_Cord_Stimulator\" class=\"mw-redirect\" title=\"Spinal Cord Stimulator\" rel=\"external_link\" target=\"_blank\">Spinal Cord Stimulator<\/a><\/div>\n<p>The SCS (Spinal Cord Stimulator) device has two main components: an electrode and a generator. The technical goal of SCS for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuropathic_pain\" title=\"Neuropathic pain\" rel=\"external_link\" target=\"_blank\">neuropathic pain<\/a> is to mask the area of a patient's pain with a stimulation induced tingling, known as \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Paresthesia\" title=\"Paresthesia\" rel=\"external_link\" target=\"_blank\">paresthesia<\/a>\", because this overlap is necessary (but not sufficient) to achieve pain relief.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> Paresthesia coverage depends upon which <a href=\"https:\/\/en.wikipedia.org\/wiki\/Afferent_nerves\" class=\"mw-redirect\" title=\"Afferent nerves\" rel=\"external_link\" target=\"_blank\">afferent nerves<\/a> are stimulated. The most easily recruited by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dorsum_(biology)\" class=\"mw-redirect\" title=\"Dorsum (biology)\" rel=\"external_link\" target=\"_blank\">dorsal<\/a> midline electrode, close to the pial surface of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord\" title=\"Spinal cord\" rel=\"external_link\" target=\"_blank\">spinal cord<\/a>, are the large <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dorsal_column\" class=\"mw-redirect\" title=\"Dorsal column\" rel=\"external_link\" target=\"_blank\">dorsal column<\/a> afferents, which produce broad paresthesia covering segments caudally.\n<\/p><p>In ancient times the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrogenic\" class=\"mw-redirect\" title=\"Electrogenic\" rel=\"external_link\" target=\"_blank\">electrogenic<\/a> fish was used as a shocker to subside pain. Healers had developed specific and detailed techniques to exploit the generative qualities of the fish to treat various types of pain, including headache. Because of the awkwardness of using a living shock generator, a fair level of skill was required to deliver the therapy to the target for the proper amount of time. (Including keeping the fish alive as long as possible)\n<p>Electro analgesia was the first deliberate application of electricity. By the nineteenth century, most western physicians were offering their patients <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrotherapy\" title=\"Electrotherapy\" rel=\"external_link\" target=\"_blank\">electrotherapy<\/a> delivered by portable generator.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> In the mid-1960s, however, three things converged to ensure the future of electro stimulation.\n<\/p>\n<\/p>\n<ol><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pacemaker\" class=\"mw-redirect\" title=\"Pacemaker\" rel=\"external_link\" target=\"_blank\">Pacemaker<\/a> technology, which had it start in 1950, became available.<\/li>\n<li>Melzack and Wall published their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain#Gate_control\" title=\"Pain\" rel=\"external_link\" target=\"_blank\">gate control theory of pain<\/a>, which proposed that the transmission of pain could be blocked by stimulation of large afferent fibers.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup><\/li>\n<li>Pioneering physicians became interested in stimulating the nervous system to relieve patients from pain.<\/li><\/ol>\n<p>The design options for electrodes include their size, shape, arrangement, number, and assignment of contacts and how the electrode is implanted.\nThe design option for the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse_generator\" title=\"Pulse generator\" rel=\"external_link\" target=\"_blank\">pulse generator<\/a> include the power source, target anatomic placement location, current or voltage source, pulse rate, pulse width, and number of independent channels.\nProgramming options are very numerous (a four-contact electrode offers 50 functional bipolar combinations). The current devices use computerized equipment to find the best options for use. This reprogramming option compensates for postural changes, electrode migration, changes in pain location, and suboptimal electrode placement.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Motor_prosthetics\">Motor prosthetics<\/span><\/h2>\n<p>Devices which support the function of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autonomous_nervous_system\" class=\"mw-redirect\" title=\"Autonomous nervous system\" rel=\"external_link\" target=\"_blank\">autonomous nervous system<\/a> include the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacral_anterior_root_stimulator\" title=\"Sacral anterior root stimulator\" rel=\"external_link\" target=\"_blank\">implant for bladder control<\/a>. In the somatic nervous system attempts to aid conscious control of movement include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Functional_electrical_stimulation\" title=\"Functional electrical stimulation\" rel=\"external_link\" target=\"_blank\">Functional electrical stimulation<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lumbar_anterior_root_stimulator\" title=\"Lumbar anterior root stimulator\" rel=\"external_link\" target=\"_blank\">lumbar anterior root stimulator<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Bladder_control_implants\">Bladder control implants<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacral_anterior_root_stimulator\" title=\"Sacral anterior root stimulator\" rel=\"external_link\" target=\"_blank\">Sacral anterior root stimulator<\/a><\/div>\n<p>Where a spinal cord lesion leads to paraplegia, patients have difficulty emptying their bladders and this can cause infection. From 1969 onwards Brindley developed the sacral anterior root stimulator, with successful human trials from the early 1980s onwards.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> This device is implanted over the sacral anterior root ganglia of the spinal cord; controlled by an external transmitter, it delivers intermittent stimulation which improves bladder emptying. It also assists in defecation and enables male patients to have a sustained full erection.\n<\/p><p>The related procedure of sacral nerve stimulation is for the control of incontinence in able-bodied patients.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Motor_prosthetics_for_conscious_control_of_movement\">Motor prosthetics for conscious control of movement<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain%E2%80%93computer_interface\" title=\"Brain\u2013computer interface\" rel=\"external_link\" target=\"_blank\">Brain\u2013computer interface<\/a><\/div>\n<p>Researchers are currently investigating and building motor neuroprosthetics that will help restore movement and the ability to communicate with the outside world to persons with motor disabilities such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tetraplegia\" title=\"Tetraplegia\" rel=\"external_link\" target=\"_blank\">tetraplegia<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amyotrophic_lateral_sclerosis\" title=\"Amyotrophic lateral sclerosis\" rel=\"external_link\" target=\"_blank\">amyotrophic lateral sclerosis<\/a>. Research has found that the striatum plays a crucial role in motor sensory learning. This was demonstrated by an experiment in which lab rats' firing rates of the striatum was recorded at higher rates after performing a task consecutively.\n<\/p><p>To capture electrical signals from the brain, scientists have developed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microelectrode\" title=\"Microelectrode\" rel=\"external_link\" target=\"_blank\">microelectrode<\/a> arrays smaller than a square centimeter that can be implanted in the skull to record electrical activity, transducing recorded information through a thin cable. After decades of research in monkeys, neuroscientists have been able to decode <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuronal\" class=\"mw-redirect\" title=\"Neuronal\" rel=\"external_link\" target=\"_blank\">neuronal<\/a> signals into movements. Completing the translation, researchers have built interfaces that allow patients to move computer cursors, and they are beginning to build robotic limbs and exoskeletons that patients can control by thinking about movement.\n<\/p><p>The technology behind motor neuroprostheses is still in its infancy. Investigators and study participants continue to experiment with different ways of using the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostheses\" class=\"mw-redirect\" title=\"Prostheses\" rel=\"external_link\" target=\"_blank\">prostheses<\/a>. Having a patient think about clenching a fist, for example, produces a different result than having him or her think about tapping a finger. The filters used in the prostheses are also being fine-tuned, and in the future, doctors hope to create an implant capable of transmitting signals from inside the skull <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wireless\" title=\"Wireless\" rel=\"external_link\" target=\"_blank\">wirelessly<\/a>, as opposed to through a cable.\n<\/p><p>Preliminary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_trials\" class=\"mw-redirect\" title=\"Clinical trials\" rel=\"external_link\" target=\"_blank\">clinical trials<\/a> suggest that the devices are safe and that they have the potential to be effective.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2007)\">citation needed<\/span><\/a><\/i>]<\/sup> Some patients have worn the devices for over two years with few, if any, ill effects.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2007)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Prior to these advancements, Philip Kennedy (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Emory_University\" title=\"Emory University\" rel=\"external_link\" target=\"_blank\">Emory<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Georgia_Institute_of_Technology\" title=\"Georgia Institute of Technology\" rel=\"external_link\" target=\"_blank\">Georgia Tech<\/a>) had an operable if somewhat primitive system which allowed an individual with paralysis to spell words by modulating their brain activity. Kennedy's device used two <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurotrophic_electrodes\" class=\"mw-redirect\" title=\"Neurotrophic electrodes\" rel=\"external_link\" target=\"_blank\">neurotrophic electrodes<\/a>: the first was implanted in an intact motor cortical region (e.g. finger representation area) and was used to move a cursor among a group of letters. The second was implanted in a different motor region and was used to indicate the selection.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p><p>Developments continue in replacing lost arms with cybernetic replacements by using nerves normally connected to the pectoralis muscles. These arms allow a slightly limited range of motion, and reportedly are slated to feature sensors for detecting pressure and temperature.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p><p>Dr. Todd Kuiken at Northwestern University and Rehabilitation Institute of Chicago has developed a method called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Targeted_reinnervation\" title=\"Targeted reinnervation\" rel=\"external_link\" target=\"_blank\">targeted reinnervation<\/a> for an amputee to control motorized prosthetic devices and to regain sensory feedback.\n<\/p>\n<h3><span id=\"rdp-ebb-Sensory.2Fmotor_prosthetics\"><\/span><span class=\"mw-headline\" id=\"Sensory\/motor_prosthetics\">Sensory\/motor prosthetics<\/span><\/h3>\n<p>In 2002 an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Multielectrode_array\" class=\"mw-redirect\" title=\"Multielectrode array\" rel=\"external_link\" target=\"_blank\">Multielectrode array<\/a> of 100 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrode\" title=\"Electrode\" rel=\"external_link\" target=\"_blank\">electrodes<\/a>, which now forms the sensor part of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Braingate\" class=\"mw-redirect\" title=\"Braingate\" rel=\"external_link\" target=\"_blank\">Braingate<\/a>, was implanted directly into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Median_nerve\" title=\"Median nerve\" rel=\"external_link\" target=\"_blank\">median nerve<\/a> fibers of scientist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kevin_Warwick\" title=\"Kevin Warwick\" rel=\"external_link\" target=\"_blank\">Kevin Warwick<\/a>. The recorded signals were used to control a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robot_arm\" class=\"mw-redirect\" title=\"Robot arm\" rel=\"external_link\" target=\"_blank\">robot arm<\/a> developed by Warwick's colleague, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peter_Kyberd\" title=\"Peter Kyberd\" rel=\"external_link\" target=\"_blank\">Peter Kyberd<\/a> and was able to mimic the actions of Warwick's own arm.<sup id=\"rdp-ebb-cite_ref-warwick_23-0\" class=\"reference\"><a href=\"#cite_note-warwick-23\" rel=\"external_link\">[23]<\/a><\/sup> Additionally, a form of sensory feedback was provided via the implant by passing small electrical currents into the nerve. This caused a contraction of the first <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lumbrical_muscle_(hand)\" class=\"mw-redirect\" title=\"Lumbrical muscle (hand)\" rel=\"external_link\" target=\"_blank\">lumbrical muscle<\/a> of the hand and it was this movement that was perceived.<sup id=\"rdp-ebb-cite_ref-warwick_23-1\" class=\"reference\"><a href=\"#cite_note-warwick-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Surgical_Innovations_for_Neural_Interfacing\">Surgical Innovations for Neural Interfacing<\/span><\/h3>\n<p>The MIT Biomechatronics Group has designed a novel amputation paradigm that enables biological muscles and myoelectric prostheses to interface neurally with high reliability. This surgical paradigm, termed the agonist-antagonist myoneural interface (AMI), provides the user with the ability to sense and control their prosthetic limb as an extension of their own body, rather than using a prosthetic that merely resembles an appendage. In a normal agonist-antagonist muscle pair relationship (e.g. bicep-tricep), when the agonist muscle contracts, the antagonist muscle is stretched, and vice versa, providing one with the knowledge of the position of one\u2019s limb without even having to look at it. During a standard amputation, agonist-antagonist muscles (e.g. bicep-tricep) are isolated from each other, preventing the ability to have the dynamic contract-extend mechanism that generates sensory feedback. Therefore, current amputees have no way of feeling the physical environment their prosthetic limb encounters. Moreover, with the current amputation surgery which has been in place for over 200 years, 1\/3 patients undergo revision surgeries due to pain in their stumps. \n<\/p><p>An AMI is composed of two muscles that originally shared an agonist-antagonist relationship. During the amputation surgery, these two muscles are mechanically linked together within the amputated stump.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> One AMI muscle pair can be created for each joint degree of freedom in a patient in order to establish control and sensation of multiple prosthetic joints. In preliminary testing of this new neural interface, patients with an AMI have demonstrated and reported greater control over the prosthesis. Additionally, more naturally reflexive behavior during stair walking was observed compared to subjects with a traditional amputation.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> An AMI can also be constructed through the combination of two devascularized muscle grafts. These muscle grafts (or flaps) are spare muscle that is denervated (detached from original nerves) and removed from one part of the body to be re-innervated by severed nerves found in the limb to be amputated.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> Through the use of regenerated muscle flaps, AMIs can be created for patients with muscle tissue that has experienced extreme atrophy or damage or for patients who are undergoing revision of an amputated limb for reasons such as neuroma pain, bone spurs, etc.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Obstacles\">Obstacles<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Mathematical_modelling\">Mathematical modelling<\/span><\/h3>\n<p>Accurate characterization of the nonlinear input\/output (I\/O) parameters of the normally functioning tissue to be replaced is paramount to designing a prosthetic that mimics normal biologic synaptic signals.<sup id=\"rdp-ebb-cite_ref-Bertaccini_2009_27-0\" class=\"reference\"><a href=\"#cite_note-Bertaccini_2009-27\" rel=\"external_link\">[27]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Marmarelis_1993_28-0\" class=\"reference\"><a href=\"#cite_note-Marmarelis_1993-28\" rel=\"external_link\">[28]<\/a><\/sup> Mathematical modeling of these signals is a complex task \"because of the nonlinear dynamics inherent in the cellular\/molecular mechanisms comprising neurons and their synaptic connections\".<sup id=\"rdp-ebb-cite_ref-Berger_1991_29-0\" class=\"reference\"><a href=\"#cite_note-Berger_1991-29\" rel=\"external_link\">[29]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Berger_1994_30-0\" class=\"reference\"><a href=\"#cite_note-Berger_1994-30\" rel=\"external_link\">[30]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Dalal_31-0\" class=\"reference\"><a href=\"#cite_note-Dalal-31\" rel=\"external_link\">[31]<\/a><\/sup> The output of nearly all brain neurons are dependent on which post-synaptic inputs are active and in what order the inputs are received. (spatial and temporal properties, respectively).<sup id=\"rdp-ebb-cite_ref-Berger_Restoring_32-0\" class=\"reference\"><a href=\"#cite_note-Berger_Restoring-32\" rel=\"external_link\">[32]<\/a><\/sup>\n<\/p><p>Once the I\/O parameters are modeled mathematically, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Integrated_circuit\" title=\"Integrated circuit\" rel=\"external_link\" target=\"_blank\">integrated circuits<\/a> are designed to mimic the normal biologic signals. For the prosthetic to perform like normal tissue, it must process the input signals, a process known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Integral_transform\" title=\"Integral transform\" rel=\"external_link\" target=\"_blank\">transformation<\/a>, in the same way as normal tissue.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Size\">Size<\/span><\/h3>\n<p>Implantable devices must be very small to be implanted directly in the brain, roughly the size of a quarter. One of the example of microimplantable electrode array is the Utah array.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p><p>Wireless controlling devices can be mounted outside of the skull and should be smaller than a pager.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Power_consumption\">Power consumption<\/span><\/h3>\n<p>Power consumption drives battery size. Optimization of the implanted circuits reduces power needs. Implanted devices currently need on-board power sources. Once the battery runs out, surgery is needed to replace the unit. Longer battery life correlates to fewer surgeries needed to replace batteries. One option that could be used to recharge implant batteries without surgery or wires is being used in powered toothbrushes.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2015)\">citation needed<\/span><\/a><\/i>]<\/sup> These devices make use of inductive coupling to recharge batteries. Another strategy is to convert electromagnetic energy into electrical energy, as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radio-frequency_identification\" title=\"Radio-frequency identification\" rel=\"external_link\" target=\"_blank\">radio-frequency identification<\/a> tags.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Biocompatibility\">Biocompatibility<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroprosthetics#Cognitive_prosthetics\" title=\"Neuroprosthetics\" rel=\"external_link\" target=\"_blank\">Cognitive prostheses<\/a> are implanted directly in the brain, so <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatibility<\/a> is a very important obstacle to overcome.\nMaterials used in the housing of the device, the electrode material (such as iridium oxide<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup>), and electrode insulation must be chosen for long term implantation. Subject to Standards: ISO 14708-3 2008-11-15, Implants for Surgery - Active implantable medical devices Part 3: Implantable neurostimulators.\n<\/p><p>Crossing the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood%E2%80%93brain_barrier\" title=\"Blood\u2013brain barrier\" rel=\"external_link\" target=\"_blank\">blood\u2013brain barrier<\/a> can introduce pathogens or other materials that may cause an immune response. The brain has its own immune system that acts differently from the immune system of the rest of the body.\n<\/p><p>Questions to answer: How does this affect material choice? Does the brain have unique phages that act differently and may affect materials thought to be biocompatible in other areas of the body?\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Data_transmission\">Data transmission<\/span><\/h3>\n<p>Wireless Transmission is being developed to allow continuous recording of neuronal signals of individuals in their daily life. This allows physicians and clinicians to capture more data, ensuring that short term events like epileptic seizures can be recorded, allowing better treatment and characterization of neural disease.\n<\/p><p>A small, light weight device has been developed that allows constant recording of primate brain neurons at Stanford University.<sup id=\"rdp-ebb-cite_ref-Chestak_35-0\" class=\"reference\"><a href=\"#cite_note-Chestak-35\" rel=\"external_link\">[35]<\/a><\/sup> This technology also enables neuroscientists to study the brain outside of the controlled environment of a lab.\n<\/p><p>Methods of data transmission must be robust and secure. Neurosecurity is a new issue. Makers of cognitive implants must prevent unwanted downloading of information or thoughts<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (September 2010)\">citation needed<\/span><\/a><\/i>]<\/sup> from and uploading of detrimental data to the device that may interrupt function.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Correct_implantation\">Correct implantation<\/span><\/h3>\n<p>Implantation of the device presents many problems. First, the correct presynaptic inputs must be wired to the correct postsynaptic inputs on the device. Secondly, the outputs from the device must be targeted correctly on the desired tissue. Thirdly, the brain must learn how to use the implant. Various studies in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroplasticity\" title=\"Neuroplasticity\" rel=\"external_link\" target=\"_blank\">brain plasticity<\/a> suggest that this may be possible through exercises designed with proper motivation.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technologies_involved\">Technologies involved<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Local_field_potentials\">Local field potentials<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Local_field_potential\" title=\"Local field potential\" rel=\"external_link\" target=\"_blank\">Local field potentials (LFPs)<\/a> are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrophysiology\" title=\"Electrophysiology\" rel=\"external_link\" target=\"_blank\">electrophysiological<\/a> signals that are related to the sum of all <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dendrite\" title=\"Dendrite\" rel=\"external_link\" target=\"_blank\">dendritic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_synapse\" title=\"Chemical synapse\" rel=\"external_link\" target=\"_blank\">synaptic activity<\/a> within a volume of tissue. Recent studies suggest goals and expected value are high-level cognitive functions that can be used for neural cognitive prostheses.<sup id=\"rdp-ebb-cite_ref-Andersen_36-0\" class=\"reference\"><a href=\"#cite_note-Andersen-36\" rel=\"external_link\">[36]<\/a><\/sup>\nAlso, Rice University scientists have discovered a new method to tune the light-induced vibrations of nanoparticles through slight alterations to the surface to which the particles are attached. According to the university, the discovery could lead to new applications of photonics from molecular sensing to wireless communications. They used ultrafast laser pulses to induce the atoms in gold nanodisks to vibrate.<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Automated_movable_electrical_probes\">Automated movable electrical probes<\/span><\/h3>\n<p>One hurdle to overcome is the long term implantation of electrodes. If the electrodes are moved by physical shock or the brain moves in relation to electrode position, the electrodes could be recording different nerves. Adjustment to electrodes is necessary to maintain an optimal signal. Individually adjusting multi electrode arrays is a very tedious and time consuming process. Development of automatically adjusting electrodes would mitigate this problem. Anderson's group is currently collaborating with Yu-Chong Tai's lab and the Burdick lab (all at Caltech) to make such a system that uses electrolysis-based actuators to independently adjust electrodes in a chronically implanted array of electrodes.<sup id=\"rdp-ebb-cite_ref-Andersen_Trends_38-0\" class=\"reference\"><a href=\"#cite_note-Andersen_Trends-38\" rel=\"external_link\">[38]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Imaged_guided_surgical_techniques\">Imaged guided surgical techniques<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Image-guided_surgery\" title=\"Image-guided surgery\" rel=\"external_link\" target=\"_blank\">Image-guided surgery<\/a> is used to precisely position brain implants.<sup id=\"rdp-ebb-cite_ref-Andersen_36-1\" class=\"reference\"><a href=\"#cite_note-Andersen-36\" rel=\"external_link\">[36]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical_engineering\" title=\"Biomedical engineering\" rel=\"external_link\" target=\"_blank\">Biomedical engineering<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain-reading\" title=\"Brain-reading\" rel=\"external_link\" target=\"_blank\">Brain-reading<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyborg\" title=\"Cyborg\" rel=\"external_link\" target=\"_blank\">Cyborg<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neural_engineering\" title=\"Neural engineering\" rel=\"external_link\" target=\"_blank\">Neural engineering<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurosecurity\" title=\"Neurosecurity\" rel=\"external_link\" target=\"_blank\">Neurosecurity<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthetics\" class=\"mw-redirect\" title=\"Prosthetics\" rel=\"external_link\" target=\"_blank\">Prosthetics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Simulated_reality\" title=\"Simulated reality\" rel=\"external_link\" target=\"_blank\">Simulated reality<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthetic_Neuronal_Memory_Silicon_Chips\" class=\"mw-redirect\" title=\"Prosthetic Neuronal Memory Silicon Chips\" rel=\"external_link\" target=\"_blank\">Prosthetic Neuronal Memory Silicon Chips<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Krucoff, Max O.; Rahimpour, Shervin; Slutzky, Marc W.; Edgerton, V. Reggie; Turner, Dennis A. (2016-01-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/journal.frontiersin.org\/article\/10.3389\/fnins.2016.00584\/full\" target=\"_blank\">\"Enhancing Nervous System Recovery through Neurobiologics, Neural Interface Training, and Neurorehabilitation\"<\/a>. <i>Neuroprosthetics<\/i>: 584. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3389%2Ffnins.2016.00584\" target=\"_blank\">10.3389\/fnins.2016.00584<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5186786\" target=\"_blank\">5186786<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28082858\" target=\"_blank\">28082858<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuroprosthetics&rft.atitle=Enhancing+Nervous+System+Recovery+through+Neurobiologics%2C+Neural+Interface+Training%2C+and+Neurorehabilitation&rft.pages=584&rft.date=2016-01-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5186786&rft_id=info%3Apmid%2F28082858&rft_id=info%3Adoi%2F10.3389%2Ffnins.2016.00584&rft.aulast=Krucoff&rft.aufirst=Max+O.&rft.au=Rahimpour%2C+Shervin&rft.au=Slutzky%2C+Marc+W.&rft.au=Edgerton%2C+V.+Reggie&rft.au=Turner%2C+Dennis+A.&rft_id=http%3A%2F%2Fjournal.frontiersin.org%2Farticle%2F10.3389%2Ffnins.2016.00584%2Ffull&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuroprosthetics\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Daniel Garrison. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.springerlink.com\/content\/qjjwu2l4n363j278\/\" target=\"_blank\">\"Minimizing Thermal Effects of In Vivo Body Sensors\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">May 5,<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Minimizing+Thermal+Effects+of+In+Vivo+Body+Sensors&rft.au=Daniel+Garrison&rft_id=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fqjjwu2l4n363j278%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuroprosthetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.nidcd.nih.gov\/health\/cochlear-implants\" target=\"_blank\">https:\/\/www.nidcd.nih.gov\/health\/cochlear-implants<\/a><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Handa G (2006) \"Neural Prosthesis \u2013 Past, Present and Future\" <i>Indian Journal of Physical Medicine & Rehabilitation<\/i> 17(1)<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">A. Y. Chow, V. Y. Chow, K. Packo, J. Pollack, G. Peyman, and R. Schuchard, \"The artificial silicon retina microchip for the treatment of vision loss from retinitis pigmentosa,\" Arch.Ophthalmol., vol. 122, p. 460, 2004<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">M. J. McMahon, A. Caspi, J. D.Dorn,\nK. H. McClure, M. Humayun, and R. Greenberg, \"Spatial vision in blind subjects implanted with the second sight retinal\nprosthesis,\" presented at the ARVO Annu. Meeting, Ft. Lauderdale, FL, 2007.<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">G. S. Brindley and W. S. Lewin, \"The sensations produced by electrical stimulation of the visual cortex,\" J. 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J Urol 1999 Aug;16(2):352-357.<\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Gary Goettling. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060414085019\/http:\/\/gtalumni.org\/news\/magazine\/sum99\/harnessing.html\" target=\"_blank\">\"Harnessing the Power of Thought\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/gtalumni.org\/news\/magazine\/sum99\/harnessing.html\" target=\"_blank\">the original<\/a> on April 14, 2006<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">April 22,<\/span> 2006<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Harnessing+the+Power+of+Thought&rft.au=Gary+Goettling&rft_id=http%3A%2F%2Fgtalumni.org%2Fnews%2Fmagazine%2Fsum99%2Fharnessing.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuroprosthetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">David Brown (September 14, 2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.washingtonpost.com\/wp-dyn\/content\/article\/2006\/09\/13\/AR2006091302271.html\" target=\"_blank\">\"Washington Post\"<\/a>. <i>The Washington Post<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">September 14,<\/span> 2006<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Washington+Post&rft.atitle=Washington+Post&rft.date=2006-09-14&rft.au=David+Brown&rft_id=https%3A%2F%2Fwww.washingtonpost.com%2Fwp-dyn%2Fcontent%2Farticle%2F2006%2F09%2F13%2FAR2006091302271.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuroprosthetics\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-warwick-23\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-warwick_23-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-warwick_23-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Warwick, K, Gasson, M, Hutt, B, Goodhew, I, Kyberd, P, Andrews, B, Teddy, P and Shad, A:\"The Application of Implant Technology for Cybernetic Systems\", <i>Archives of Neurology<\/i>, 60(10), pp1369-1373, 2003<\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/robotics.sciencemag.org\/content\/2\/6\/eaan2971\" target=\"_blank\">\"On prosthetic control: A regenerative agonist-antagonist myoneural interface\"<\/a>,' 'Science Robotics' ', 31 May 2017<\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/stm.sciencemag.org\/content\/10\/443\/eaap8373\" target=\"_blank\">\"Proprioception from a neurally controlled lower-extremity prosthesis\"<\/a>,' ' Science Translational Medicine' ', 30 May 2018<\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/robotics.sciencemag.org\/content\/2\/6\/eaan2971\" target=\"_blank\">\"On prosthetic control: A regenerative agonist-antagonist myoneural interface\"<\/a>,' 'Science Robotics' ', 31 May 2017<\/span>\n<\/li>\n<li id=\"cite_note-Bertaccini_2009-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Bertaccini_2009_27-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Bertaccini, D., & Fanelli, S. (2009). Computational and conditioning issues of a discrete model for cochlear sensorineural hypoacusia. [Article]. Applied Numerical Mathematics, 59(8), 1989-2001.<\/span>\n<\/li>\n<li id=\"cite_note-Marmarelis_1993-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Marmarelis_1993_28-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Marmarelis, V. Z. (1993). IDENTIFICATION OF NONLINEAR BIOLOGICAL-SYSTEMS USING LAGUERRE EXPANSIONS OF KERNELS. [Article]. Annals of Biomedical Engineering, 21(6), 573-589.<\/span>\n<\/li>\n<li id=\"cite_note-Berger_1991-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Berger_1991_29-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">T.W. Berger, T.P. Harty, X. Xie, G. Barrionuevo, and R.J. Sclabassi, \"Modeling\nof neuronal networks through experimental decomposition,\" in Proc. IEEE 34th Mid\nSymp. Cir. Sys., Monterey, CA, 1991, vol. 1, pp. 91\u201397.<\/span>\n<\/li>\n<li id=\"cite_note-Berger_1994-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Berger_1994_30-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">T.W. Berger, G. Chauvet, and R.J. Sclabassi, \"A biologically based model of\nfunctional properties of the hippocampus,\" Neural Netw., vol. 7,\nno. 6\u20137, pp. 1031\u20131064, 1994.<\/span>\n<\/li>\n<li id=\"cite_note-Dalal-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Dalal_31-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">S.S. Dalal, V.Z. Marmarelis, and T.W. Berger, \"A nonlinear positive feedback\nmodel of glutamatergic synaptic transmission in dentate gyrus,\" in Proc. 4th Joint Symp.\nNeural Computation, California, 1997, vol. 7, pp. 68\u201375.<\/span>\n<\/li>\n<li id=\"cite_note-Berger_Restoring-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Berger_Restoring_32-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Berger, T. W., Ahuja, A., Courellis, S. H., Deadwyler, S. A., Erinjippurath, G., Gerhardt, G. A., et al. (2005). Restoring lost cognitive function. IEEE Engineering in Medicine and Biology Magazine, 24(5), 30-44.<\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">R. Bhandari, S. Negi, F. Solzbacher (2010). \"Wafer Scale Fabrication of Penetrating Neural Electrode Arrays\". <i>Biomedical Microdevices<\/i>. <b>12<\/b> (5): 797\u2013807.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biomedical+Microdevices&rft.atitle=Wafer+Scale+Fabrication+of+Penetrating+Neural+Electrode+Arrays&rft.volume=12&rft.issue=5&rft.pages=797-807&rft.date=2010&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANeuroprosthetics\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Uses authors parameter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Uses_authors_parameter\" title=\"Category:CS1 maint: Uses authors parameter\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">S Negi, R. Bhandari, L Rieth, R V Wagenen, and F Solzbacher, \u201cNeural Electrode Degradation from Continuous Electrical Stimulation: Comparison of Sputtered and Activated Iridium Oxide\u201d, Journal of Neuroscience Methods, vol. 186, pp. 8-17, 2010.<\/span>\n<\/li>\n<li id=\"cite_note-Chestak-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Chestak_35-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">HermesC: Low-Power Wireless Neural Recording System for Freely Moving Primates Chestek, C.A.; Gilja, V.; Nuyujukian, P.; Kier, R.J.; Solzbacher, F.; Ryu, S.I.; Harrison, R.R.; Shenoy, K.V.; Neural Systems and Rehabilitation Engineering, IEEE Transactions on Volume 17, Issue 4, Aug. 2009 Page(s):330 - 338.<\/span>\n<\/li>\n<li id=\"cite_note-Andersen-36\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Andersen_36-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Andersen_36-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Andersen, R. A., Burdick, J. W., Musallam, S., Pesaran, B., & Cham, J. G. (2004). Cognitive neural prosthetics. Trends in Cognitive Sciences, 8(11), 486-493.<\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">The Engineer.London United Kingdom.Centaur Communications Ltd. 2015, May 8<\/span>\n<\/li>\n<li id=\"cite_note-Andersen_Trends-38\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Andersen_Trends_38-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Anderson, R.A. et al (2004) Cognitive Neural Prosthetics. Trends in Cognitive Sciences. 8(11):486-493.<\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li>Santhanam G, Ryu SI, Yu BM, Afshar A, Shenoy KV. 2006. A high-performance brain-computer interface. Nature 442:195\u20138<\/li>\n<li>Patil PG, Turner DA. 2008. The development of brain-machine interface neuroprosthetic devices. Neurotherapeutics 5:137\u201346<\/li>\n<li>Liu WT, Humayun MS, Liker MA. 2008. Implantable biomimetic microelectronics systems. Proceedings of the IEEE 96:1073\u20134<\/li>\n<li>Harrison RR. 2008. The design of integrated circuits to observe brain activity. Proceedings of the IEEE 96:1203\u201316<\/li>\n<li>Abbott A. 2006. Neuroprosthetics: In search of the sixth sense. Nature 442:125\u20137<\/li>\n<li>Velliste M, Perel S, Spalding MC, Whitford AS, Schwartz AB (2008) \"Cortical control of a prosthetic arm for self-feeding.\"<i>Nature<\/i>. 19;453(7198):1098\u2013101.<\/li>\n<li>Schwartz AB, Cui XT, Weber DJ, Moran DW \"Brain-controlled interfaces: movement restoration with neural prosthetics.\" (2006) <i>Neuron<\/i> 5;52(1):205\u201320<\/li>\n<li>Santucci DM, Kralik JD, Lebedev MA, Nicolelis MA (2005) \"Frontal and parietal cortical ensembles predict single-trial muscle activity during reaching movements in primates.\"<i>Eur J Neurosci.<\/i> 22(6): 1529\u20131540.<\/li>\n<li>Lebedev MA, Carmena JM, O'Doherty JE, Zacksenhouse M, Henriquez CS, Principe JC, Nicolelis MA (2005) \"Cortical ensemble adaptation to represent velocity of an artificial actuator controlled by a brain-machine interface.\"<i>J Neurosci.<\/i> 25: 4681\u20134893.<\/li>\n<li>Nicolelis MA (2003) \"Brain-machine interfaces to restore motor function and probe neural circuits.\" <i>Nat Rev Neurosci.<\/i> 4: 417\u2013422.<\/li>\n<li>Wessberg J, Stambaugh CR, Kralik JD, Beck PD, Laubach M, Chapin JK, Kim J, Biggs SJ, Srinivasan MA, Nicolelis MA. (2000) \"Real-time prediction of hand trajectory by ensembles of cortical neurons in primates.\"<i>Nature<\/i> 16: 361\u2013365.<\/li>\n<li>Laryionava K, Gross D. 2011. Public Understanding of Neural Prosthetics in Germany: Ethical, Social and Cultural Challenges. Cambridge Quarterly of Healthcare Ethics International issue 20\/3: 434\u2013439<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/openeeg.sourceforge.net\/doc\/\" target=\"_blank\">The open-source Electroencephalography project<\/a> and <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pceeg.sourceforge.net\/\" target=\"_blank\">Programmable chip version<\/a>, <i>Sourceforge<\/i> open source EEG projects<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.neural-prosthesis.com\/\" target=\"_blank\">Dr. Theodore W. Berger's website<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.neuroprosthetic.org\/\" target=\"_blank\">Neuroprosthetics Research Society (NRS) - Neuroprosthetic.org<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cimit.org\/\" target=\"_blank\">CIMIT - Center For Integration Of Medicine And Innovative Technology - Advances & Research in Neuroprosthetics<\/a><\/li><\/ul>\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1268\nCached time: 20181215082723\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.548 seconds\nReal time usage: 0.732 seconds\nPreprocessor visited node count: 2397\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 174049\/2097152 bytes\nTemplate argument size: 8783\/2097152 bytes\nHighest expansion depth: 14\/40\nExpensive parser function count: 9\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 28105\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.226\/10.000 seconds\nLua memory usage: 5.3 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 529.743 1 -total\n<\/p>\n<pre>22.05% 116.819 3 Template:Ambox\n18.12% 96.011 1 Template:Multiple_issues\n17.94% 95.034 2 Template:Cite_journal\n14.32% 75.840 1 Template:Commonscat\n13.56% 71.808 8 Template:Navbox\n11.54% 61.129 1 Template:Commons\n11.50% 60.926 5 Template:Fix\n11.00% 58.272 1 Template:Sister_project\n10.18% 53.906 1 Template:Side_box\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2072616-1!canonical and timestamp 20181215082722 and revision id 869025976\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroprosthetics\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212144\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.019 seconds\nReal time usage: 0.181 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 170.880 1 - wikipedia:Neuroprosthetics\n100.00% 170.880 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8256-0!*!*!*!*!*!* and timestamp 20181217212144 and revision id 24466\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Neuroprosthetics\">https:\/\/www.limswiki.org\/index.php\/Neuroprosthetics<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","81df8edecfd22b24f9c53b96aa30b9b6_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fd\/BrainGate.jpg\/200px-BrainGate.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/96\/Gray739.png\/260px-Gray739.png"],"81df8edecfd22b24f9c53b96aa30b9b6_timestamp":1545081703,"8e9a6c138632577aeb2d3c9ff94fee7f_type":"article","8e9a6c138632577aeb2d3c9ff94fee7f_title":"Mynx vascular closure device","8e9a6c138632577aeb2d3c9ff94fee7f_url":"https:\/\/www.limswiki.org\/index.php\/Mynx_vascular_closure_device","8e9a6c138632577aeb2d3c9ff94fee7f_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMynx vascular closure device\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThe Mynx Vascular Closure Device is an extravascular vascular closure device (VCD) whose deployment system is designed to minimize the discomfort commonly associated with closing the small hole in the artery following catheterization procedure. The device is manufactured by AccessClosure, Inc., a medical device company located in Mountain View, California.\n\nContents \n\n1 History \n2 Device description \n3 Procedure \n4 Sealant \n5 References \n\n\nHistory \nThe Mynx received FDA Premarket Approval (PMA) in May, 2007.[1]\n\nDevice description \nThe device uses a soft, sponge-like sealant material to close the small hole in the femoral artery. The sealant works by rapidly absorbing blood and fluids around the puncture site, swelling in size and covering the hole. This seals the hole and stops the bleeding.\nThe sealant material consists of polyethylene glycol (PEG), a water-soluble, non-thrombogenic, conformable, bio-inert polymer. PEG has an established safety profile[2] and various forms of PEG are commonly used in a range of consumer and medical products including toothpaste, skin cream and lubricant eye drops.\n\nProcedure \nThe device utilizes a gentle, extravascular deployment method, which avoids cinching or tugging of the artery by placing the sealant on the outside of the artery.\nThe procedure has been described in medical literature as causing little to no pain for the vast majority of patients.,[3][4]\nThe device utilizes the existing 5, 6 or 7 French procedural sheath, eliminating the need for a sheath exchange. This avoids potential tissue tract expansion, which can cause tissue trauma and oozing, a post-procedure hassle to the patient and nursing staff, often resulting in longer bed rest for the patient and potentially delaying ambulation and discharge.,[5][6]\nAs the sealant is placed on the outside of the artery, it is exposed to blood and subcutaneous fluids. The sealant rapidly expands, covering the hole in the artery and conforming to the tissue tract, producing a durable hemostasis.,[7][8]\nThis extravascular placement of the sealant avoids leaving behind an intravascular component, which can compromise blood flow and, in rare circumstances, embolize, requiring surgical repair.\nThe sealant fully dissolves within 30 days through hydrolysis.[9]\n\nSealant \nThe sealant avoids initiating platelet activation or an abnormal inflammatory response, and does not generate fibrous scar tissue. In addition, the porous characteristics of the sealant create a platform for natural clot formation and facilitate tissue healing.[10]\n\nReferences \n\n\n^ US FDA\/CDRH: New Device Approval \u2013 Mynx Vascular Closure System. http:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/DeviceApprovalsandClearances\/PMAApprovals\/default.htm Retrieved April 2, 2010 \n\n^ D. Scheinert MD, et al. The Safety and Efficacy of an Extravascular, Water-Soluble Sealant for Vascular Closure: Initial Clinical Results for Mynx. Catheterization and Cardiovascular Interventions. 70:627-633 (2007) \n\n^ Gary M. Ansel MD, and Joseph M. Garasic MD. The Mynx Vascular Closure Device: Initial clinical experience using a novel approach to vascular closure. Endovascular Today. January 2008 \n\n^ Charles L. Brown, III, MD, FACC, FACP. The Mynx Vascular Closure Device: The Piedmont Heart Institute Experience. Cath Lab Digest. February 2009 \n\n^ Charles L. Brown, III, MD, FACC, FACP. The Mynx Vascular Closure Device: The Piedmont Heart Institute Experience. Cath Lab Digest. February 2009 \n\n^ John B. Patterson, MD. Patient Comfort and Patient Satisfaction with the Mynx Vascular Closure Device: A Single-Center Evaluation. Cath Lab Digest. October 2009 \n\n^ D. Scheinert MD, et al. The Safety and Efficacy of an Extravascular, Water-Soluble Sealant for Vascular Closure: Initial Clinical Results for Mynx. Catheterization and Cardiovascular Interventions. 70:627-633 (2007) \n\n^ Gary M. Ansel MD, and Joseph M. Garasic MD. The Mynx Vascular Closure Device: Initial clinical experience using a novel approach to vascular closure. Endovascular Today. January 2008 \n\n^ D. Scheinert MD, et al. The Safety and Efficacy of an Extravascular, Water-Soluble Sealant for Vascular Closure: Initial Clinical Results for Mynx. Catheterization and Cardiovascular Interventions. 70:627-633 (2007) \n\n^ D. Scheinert MD, et al. The Safety and Efficacy of an Extravascular, Water-Soluble Sealant for Vascular Closure: Initial Clinical Results for Mynx. Catheterization and Cardiovascular Interventions. 70:627-633 (2007) \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Mynx_vascular_closure_device\">https:\/\/www.limswiki.org\/index.php\/Mynx_vascular_closure_device<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 12 March 2016, at 17:00.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 896 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","8e9a6c138632577aeb2d3c9ff94fee7f_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Mynx_vascular_closure_device skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Mynx vascular closure device<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>The <b>Mynx Vascular Closure Device<\/b> is an <a href=\"https:\/\/en.wiktionary.org\/wiki\/extravascular\" class=\"extiw\" title=\"wikt:extravascular\" rel=\"external_link\" target=\"_blank\">extravascular<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular_closure_device\" title=\"Vascular closure device\" rel=\"external_link\" target=\"_blank\">vascular closure device<\/a> (VCD) whose deployment system is designed to minimize the discomfort commonly associated with closing the small hole in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">artery<\/a> following <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheterization\" class=\"mw-redirect\" title=\"Catheterization\" rel=\"external_link\" target=\"_blank\">catheterization<\/a> procedure. The device is manufactured by AccessClosure, Inc., a medical device company located in Mountain View, California.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The Mynx received FDA Premarket Approval (PMA) in May, 2007.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Device_description\">Device description<\/span><\/h2>\n<p>The device uses a soft, sponge-like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sealant\" title=\"Sealant\" rel=\"external_link\" target=\"_blank\">sealant<\/a> material to close the small hole in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femoral_artery\" title=\"Femoral artery\" rel=\"external_link\" target=\"_blank\">femoral artery<\/a>. The sealant works by rapidly absorbing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood\" title=\"Blood\" rel=\"external_link\" target=\"_blank\">blood<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_fluid\" title=\"Body fluid\" rel=\"external_link\" target=\"_blank\">fluids<\/a> around the puncture site, swelling in size and covering the hole. This seals the hole and stops the bleeding.\n<\/p><p>The sealant material consists of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene_glycol\" title=\"Polyethylene glycol\" rel=\"external_link\" target=\"_blank\">polyethylene glycol<\/a> (PEG), a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Water-soluble\" class=\"mw-redirect\" title=\"Water-soluble\" rel=\"external_link\" target=\"_blank\">water-soluble<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thrombogenicity\" title=\"Thrombogenicity\" rel=\"external_link\" target=\"_blank\">non-thrombogenic<\/a>, conformable, bio-inert <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a>. PEG has an established safety profile<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> and various forms of PEG are commonly used in a range of consumer and medical products including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toothpaste\" title=\"Toothpaste\" rel=\"external_link\" target=\"_blank\">toothpaste<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cream_(pharmaceutical)\" title=\"Cream (pharmaceutical)\" rel=\"external_link\" target=\"_blank\">skin cream<\/a> and lubricant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eye_drop\" title=\"Eye drop\" rel=\"external_link\" target=\"_blank\">eye drops<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Procedure\">Procedure<\/span><\/h2>\n<p>The device utilizes a gentle, extravascular deployment method, which avoids cinching or tugging of the artery by placing the sealant on the outside of the artery.\n<\/p><p>The procedure has been described in medical literature as causing little to no pain for the vast majority of patients.,<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>The device utilizes the existing 5, 6 or 7 <a href=\"https:\/\/en.wikipedia.org\/wiki\/French_catheter_scale\" title=\"French catheter scale\" rel=\"external_link\" target=\"_blank\">French<\/a> procedural sheath, eliminating the need for a sheath exchange. This avoids potential tissue tract expansion, which can cause tissue trauma and oozing, a post-procedure hassle to the patient and nursing staff, often resulting in longer bed rest for the patient and potentially delaying <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ambulation\" class=\"mw-redirect\" title=\"Ambulation\" rel=\"external_link\" target=\"_blank\">ambulation<\/a> and discharge.,<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>As the sealant is placed on the outside of the artery, it is exposed to blood and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subcutaneous_tissue\" title=\"Subcutaneous tissue\" rel=\"external_link\" target=\"_blank\">subcutaneous<\/a> fluids. The sealant rapidly expands, covering the hole in the artery and conforming to the tissue tract, producing a durable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemostasis\" title=\"Hemostasis\" rel=\"external_link\" target=\"_blank\">hemostasis<\/a>.,<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>This extravascular placement of the sealant avoids leaving behind an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intravascular\" class=\"mw-redirect\" title=\"Intravascular\" rel=\"external_link\" target=\"_blank\">intravascular<\/a> component, which can compromise blood flow and, in rare circumstances, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Embolism\" title=\"Embolism\" rel=\"external_link\" target=\"_blank\">embolize<\/a>, requiring surgical repair.\n<\/p><p>The sealant fully dissolves within 30 days through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrolysis\" title=\"Hydrolysis\" rel=\"external_link\" target=\"_blank\">hydrolysis<\/a>.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Sealant\">Sealant<\/span><\/h2>\n<p>The sealant avoids initiating <a href=\"https:\/\/en.wikipedia.org\/wiki\/Platelet\" title=\"Platelet\" rel=\"external_link\" target=\"_blank\">platelet<\/a> activation or an abnormal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammatory_response\" class=\"mw-redirect\" title=\"Inflammatory response\" rel=\"external_link\" target=\"_blank\">inflammatory response<\/a>, and does not generate fibrous scar tissue. In addition, the porous characteristics of the sealant create a platform for natural <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clot_formation\" class=\"mw-redirect\" title=\"Clot formation\" rel=\"external_link\" target=\"_blank\">clot formation<\/a> and facilitate tissue healing.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">US FDA\/CDRH: New Device Approval \u2013 Mynx Vascular Closure System. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/DeviceApprovalsandClearances\/PMAApprovals\/default.htm\" target=\"_blank\">http:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/DeviceApprovalsandClearances\/PMAApprovals\/default.htm<\/a> Retrieved April 2, 2010<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">D. Scheinert MD, et al. The Safety and Efficacy of an Extravascular, Water-Soluble Sealant for Vascular Closure: Initial Clinical Results for Mynx. Catheterization and Cardiovascular Interventions. 70:627-633 (2007)<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Gary M. Ansel MD, and Joseph M. Garasic MD. The Mynx Vascular Closure Device: Initial clinical experience using a novel approach to vascular closure. Endovascular Today. January 2008<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Charles L. Brown, III, MD, FACC, FACP. The Mynx Vascular Closure Device: The Piedmont Heart Institute Experience. Cath Lab Digest. February 2009<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Charles L. Brown, III, MD, FACC, FACP. The Mynx Vascular Closure Device: The Piedmont Heart Institute Experience. Cath Lab Digest. February 2009<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">John B. Patterson, MD. Patient Comfort and Patient Satisfaction with the Mynx Vascular Closure Device: A Single-Center Evaluation. Cath Lab Digest. October 2009<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">D. Scheinert MD, et al. The Safety and Efficacy of an Extravascular, Water-Soluble Sealant for Vascular Closure: Initial Clinical Results for Mynx. Catheterization and Cardiovascular Interventions. 70:627-633 (2007)<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Gary M. Ansel MD, and Joseph M. Garasic MD. The Mynx Vascular Closure Device: Initial clinical experience using a novel approach to vascular closure. Endovascular Today. January 2008<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">D. Scheinert MD, et al. The Safety and Efficacy of an Extravascular, Water-Soluble Sealant for Vascular Closure: Initial Clinical Results for Mynx. Catheterization and Cardiovascular Interventions. 70:627-633 (2007)<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">D. Scheinert MD, et al. The Safety and Efficacy of an Extravascular, Water-Soluble Sealant for Vascular Closure: Initial Clinical Results for Mynx. Catheterization and Cardiovascular Interventions. 70:627-633 (2007)<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1240\nCached time: 20181217105706\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.052 seconds\nReal time usage: 0.062 seconds\nPreprocessor visited node count: 201\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 368\/2097152 bytes\nTemplate argument size: 92\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 4319\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.004\/10.000 seconds\nLua memory usage: 521 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 33.467 1 Template:Reflist\n100.00% 33.467 1 -total\n<\/p>\n<pre> 9.24% 3.094 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:26955350-1!canonical and timestamp 20181217105706 and revision id 745679689\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Mynx_vascular_closure_device\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212143\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.041 seconds\nReal time usage: 0.165 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 159.979 1 - wikipedia:Mynx_vascular_closure_device\n100.00% 159.979 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8454-0!*!*!*!*!*!* and timestamp 20181217212143 and revision id 24704\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Mynx_vascular_closure_device\">https:\/\/www.limswiki.org\/index.php\/Mynx_vascular_closure_device<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","8e9a6c138632577aeb2d3c9ff94fee7f_images":[],"8e9a6c138632577aeb2d3c9ff94fee7f_timestamp":1545081703,"26d053f75c5d17b40493e0f0665df75b_type":"article","26d053f75c5d17b40493e0f0665df75b_title":"Mitral valve annuloplasty ring","26d053f75c5d17b40493e0f0665df75b_url":"https:\/\/www.limswiki.org\/index.php\/Mitral_valve_annuloplasty","26d053f75c5d17b40493e0f0665df75b_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMitral valve annuloplasty\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tMitral valve annuloplastyExamples of commercially available annuloplasty rings. From top: St. Judes Rigid Saddle Shaped Ring, Edwards Geoform, Edwards Physio, Edwards ETlogix, Edwards Cosgrove.Specialtycardiology[edit on Wikidata]\nMitral valve annuloplasty is a surgical technique for the repair of leaking mitral valves. Due to various factors, the two leaflets normally involved in sealing the mitral valve to retrograde flow may not coapt properly. Surgical repair typically involves the implantation of a device surrounding the mitral valve, called an annuloplasty device, which pulls the leaflets together to facilitate coaptation and aids to re-establish mitral valve function.\n\nContents \n\n1 Need \n2 Relevance \n3 Rationale \n4 Sizing \n5 Device classification and regulatory considerations \n6 References \n7 Further reading \n\n\nNeed \nMitral regurgitation is the most common form of mitral valve dysfunction. Today more than 2.5 million Americans are estimated to be affected by mitral regurgitation. This number is expected to double by the year 2030. Every year, 300,000 people worldwide undergo open heart surgery for mitral valve repair, 44,000 people in the US alone.[1]\n\nRelevance \nSince it was initially established 40 years ago by Professor Alain Carpentier, mitral valve annuloplasty has been continuously improved and is considered the gold standard for the treatment of most etiologies of mitral valve dysfunction today.[2]\n\nRationale \nThe goal of mitral valve annuloplasty is to regain mitral valve competence by restoring the physiological form and function of the normal mitral valve apparatus.[3] Under normal conditions the mitral valve undergoes significant dynamic changes in shape and size throughout the cardiac cycle. These changes are primarily due to the dynamic motion of the surrounding mitral valve annulus, a collageneous structure which attaches the mitral leaflets and the left atrium to the ostium of the left ventricle and the aortic root.\nThroughout the cardiac cycle, the annulus undergoes a sphincter motion, narrowing down the orifice area during systole to facilitate coaptation of the two leaflets and widens during diastole to allow for easy diastolic filling of the left ventricle. This motion is further enhanced by a pronounced three-dimensional configuration during systole, the characteristic saddle shape. These changes throughout the cycle are believed to be key to optimize leaflet coaptation and to minimize tissue stresses. The challenge of mitral valve annuloplasty is to improve the diseased and distorted shape of the mitral valve and to reestablish the physiological configuration, while preserving normal annular dynamics. Today, cardiac surgeons can select from a variety of annuloplasty devices, flexible, semi-rigid, or rigid, incomplete or complete, planar or saddle-shaped, adjustable and non-adjustable. While the general goal of all devices is the same, namely to increase leaflet coaptation and to support the posterior annulus against dilation, flexible bands are designed to maintain the three-dimensional contour of the native annulus and some of its natural dynamics. The goal of semi-rigid rings is to maintain coaptation and valve integrity during systole, while allowing for good hemodynamics during diastole. Rigid rings are designed to provide rigid support in large dilation and under high-pressure.\n\nSizing \nAnnuloplasty devices usually come in different sizes. The surgeon can estimate the dimensions of the patient\u2019s mitral valve and decide on an appropriate ring size. Depending on the disease etiology, different approaches are taken. Surgeons can decide to \"undersize\" the device, \"truesize\" the device, or \"oversize\" it.\n\nDevice classification and regulatory considerations \nAnnuloplasty devices are classified by the U.S. Food and Drug Administration (FDA) as class II medical devices.[4]\n\nReferences \n\n\n^ Bonow, R.O.; et al. (2006). \"ACC\/AHA 2006 guidelines for the management of patients with valvular heart disease\". Circulation. 114 (5): e84\u2013e231. doi:10.1161\/CIRCULATIONAHA.106.176857. PMID 16880336. \n\n^ de Oliveira, J.M.F; Antunes, M.J (2006). \"Mitral valve repair: better than replacement\". Heart. 92 (2): 275\u2013281. doi:10.1136\/hrt.2005.076208. PMC 1860778 . PMID 16415204. \n\n^ Carpentier, A.F. (2010). Carpentier\u2019s Reconstructive Valve Surgery. Elsevier Saunders. \n\n^ \"Guidance for Annuloplasty Rings 510(k) Submissions; Final Guidance for Industry and FDA Staff\" (PDF) . FDA. Retrieved 15 November 2011 . \n\n\nFurther reading \nRausch, M.K.; Bothe W.; Kvitting J.P.; Swanson J.C.; Miller D.C.; Kuhl E. (2011). \"Mitral valve annuloplasty - A quantitative clinical and mechanical comparison of different annuloplasty devices\". Annals of Biomedical Engineering. 40 (3): 750\u201361. doi:10.1007\/s10439-011-0442-y. PMC 3288426 . PMID 22037916. \n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Mitral_valve_annuloplasty\">https:\/\/www.limswiki.org\/index.php\/Mitral_valve_annuloplasty<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 19:27.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 514 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","26d053f75c5d17b40493e0f0665df75b_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Mitral_valve_annuloplasty skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Mitral valve annuloplasty<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Mitral valve annuloplasty<\/b> is a surgical technique for the repair of leaking <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mitral_valves\" class=\"mw-redirect\" title=\"Mitral valves\" rel=\"external_link\" target=\"_blank\">mitral valves<\/a>. Due to various factors, the two leaflets normally involved in sealing the mitral valve to retrograde flow may not <a href=\"https:\/\/en.wiktionary.org\/wiki\/coapt\" class=\"extiw\" title=\"wikt:coapt\" rel=\"external_link\" target=\"_blank\">coapt<\/a> properly. Surgical repair typically involves the implantation of a device surrounding the mitral valve, called an annuloplasty device, which pulls the leaflets together to facilitate coaptation and aids to re-establish mitral valve function.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Need\">Need<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mitral_regurgitation\" class=\"mw-redirect\" title=\"Mitral regurgitation\" rel=\"external_link\" target=\"_blank\">Mitral regurgitation<\/a> is the most common form of mitral valve dysfunction. Today more than 2.5 million Americans are estimated to be affected by mitral regurgitation. This number is expected to double by the year 2030. Every year, 300,000 people worldwide undergo open heart surgery for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mitral_valve_repair\" title=\"Mitral valve repair\" rel=\"external_link\" target=\"_blank\">mitral valve repair<\/a>, 44,000 people in the US alone.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Relevance\">Relevance<\/span><\/h2>\n<p>Since it was initially established 40 years ago by Professor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alain_Carpentier\" title=\"Alain Carpentier\" rel=\"external_link\" target=\"_blank\">Alain Carpentier<\/a>, mitral valve annuloplasty has been continuously improved and is considered the gold standard for the treatment of most etiologies of mitral valve dysfunction today.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Rationale\">Rationale<\/span><\/h2>\n<p>The goal of mitral valve annuloplasty is to regain mitral valve competence by restoring the physiological form and function of the normal mitral valve apparatus.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> Under normal conditions the mitral valve undergoes significant dynamic changes in shape and size throughout the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_cycle\" title=\"Cardiac cycle\" rel=\"external_link\" target=\"_blank\">cardiac cycle<\/a>. These changes are primarily due to the dynamic motion of the surrounding mitral valve annulus, a collageneous structure which attaches the mitral leaflets and the left <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrium_(heart)\" title=\"Atrium (heart)\" rel=\"external_link\" target=\"_blank\">atrium<\/a> to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ostium_primum\" class=\"mw-redirect\" title=\"Ostium primum\" rel=\"external_link\" target=\"_blank\">ostium<\/a> of the left ventricle and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aortic_root\" class=\"mw-redirect\" title=\"Aortic root\" rel=\"external_link\" target=\"_blank\">aortic root<\/a>.\n<\/p><p>Throughout the cardiac cycle, the annulus undergoes a sphincter motion, narrowing down the orifice area during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Systole_(medicine)\" class=\"mw-redirect\" title=\"Systole (medicine)\" rel=\"external_link\" target=\"_blank\">systole<\/a> to facilitate coaptation of the two leaflets and widens during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diastole\" title=\"Diastole\" rel=\"external_link\" target=\"_blank\">diastole<\/a> to allow for easy diastolic filling of the left ventricle. This motion is further enhanced by a pronounced three-dimensional configuration during systole, the characteristic saddle shape. These changes throughout the cycle are believed to be key to optimize leaflet coaptation and to minimize tissue stresses. The challenge of mitral valve annuloplasty is to improve the diseased and distorted shape of the mitral valve and to reestablish the physiological configuration, while preserving normal annular dynamics. Today, cardiac surgeons can select from a variety of annuloplasty devices, flexible, semi-rigid, or rigid, incomplete or complete, planar or saddle-shaped, adjustable and non-adjustable. While the general goal of all devices is the same, namely to increase leaflet coaptation and to support the posterior annulus against dilation, flexible bands are designed to maintain the three-dimensional contour of the native annulus and some of its natural dynamics. The goal of semi-rigid rings is to maintain coaptation and valve integrity during systole, while allowing for good hemodynamics during diastole. Rigid rings are designed to provide rigid support in large dilation and under high-pressure.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Sizing\">Sizing<\/span><\/h2>\n<p>Annuloplasty devices usually come in different sizes. The surgeon can estimate the dimensions of the patient\u2019s mitral valve and decide on an appropriate ring size. Depending on the disease etiology, different approaches are taken. Surgeons can decide to \"undersize\" the device, \"truesize\" the device, or \"oversize\" it.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Device_classification_and_regulatory_considerations\">Device classification and regulatory considerations<\/span><\/h2>\n<p>Annuloplasty devices are classified by the U.S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> (FDA) as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device#Class_II:_General_controls_with_special_controls\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">class II<\/a> medical devices.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bonow, R.O.; et al. (2006). \"ACC\/AHA 2006 guidelines for the management of patients with valvular heart disease\". <i>Circulation<\/i>. <b>114<\/b> (5): e84\u2013e231. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1161%2FCIRCULATIONAHA.106.176857\" target=\"_blank\">10.1161\/CIRCULATIONAHA.106.176857<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16880336\" target=\"_blank\">16880336<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Circulation&rft.atitle=ACC%2FAHA+2006+guidelines+for+the+management+of+patients+with+valvular+heart+disease&rft.volume=114&rft.issue=5&rft.pages=e84-e231&rft.date=2006&rft_id=info%3Adoi%2F10.1161%2FCIRCULATIONAHA.106.176857&rft_id=info%3Apmid%2F16880336&rft.aulast=Bonow&rft.aufirst=R.O.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+annuloplasty\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">de Oliveira, J.M.F; Antunes, M.J (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1860778\" target=\"_blank\">\"Mitral valve repair: better than replacement\"<\/a>. <i>Heart<\/i>. <b>92<\/b> (2): 275\u2013281. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fhrt.2005.076208\" target=\"_blank\">10.1136\/hrt.2005.076208<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1860778\" target=\"_blank\">1860778<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16415204\" target=\"_blank\">16415204<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Heart&rft.atitle=Mitral+valve+repair%3A+better+than+replacement&rft.volume=92&rft.issue=2&rft.pages=275-281&rft.date=2006&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1860778&rft_id=info%3Apmid%2F16415204&rft_id=info%3Adoi%2F10.1136%2Fhrt.2005.076208&rft.aulast=de+Oliveira&rft.aufirst=J.M.F&rft.au=Antunes%2C+M.J&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1860778&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+annuloplasty\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Carpentier, A.F. (2010). <i>Carpentier\u2019s Reconstructive Valve Surgery<\/i>. Elsevier Saunders.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Carpentier%E2%80%99s+Reconstructive+Valve+Surgery&rft.pub=Elsevier+Saunders&rft.date=2010&rft.aulast=Carpentier&rft.aufirst=A.F.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+annuloplasty\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/downloads\/MedicalDevices\/DeviceRegulationandGuidance\/GuidanceDocuments\/ucm073648.pdf\" target=\"_blank\">\"Guidance for Annuloplasty Rings 510(k) Submissions; Final Guidance for Industry and FDA Staff\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. FDA<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">15 November<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Guidance+for+Annuloplasty+Rings+510%28k%29+Submissions%3B+Final+Guidance+for+Industry+and+FDA+Staff&rft.pub=FDA&rft_id=http%3A%2F%2Fwww.fda.gov%2Fdownloads%2FMedicalDevices%2FDeviceRegulationandGuidance%2FGuidanceDocuments%2Fucm073648.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+annuloplasty\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation journal\">Rausch, M.K.; Bothe W.; Kvitting J.P.; Swanson J.C.; Miller D.C.; Kuhl E. (2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3288426\" target=\"_blank\">\"Mitral valve annuloplasty - A quantitative clinical and mechanical comparison of different annuloplasty devices\"<\/a>. <i>Annals of Biomedical Engineering<\/i>. <b>40<\/b> (3): 750\u201361. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs10439-011-0442-y\" target=\"_blank\">10.1007\/s10439-011-0442-y<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3288426\" target=\"_blank\">3288426<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22037916\" target=\"_blank\">22037916<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+Biomedical+Engineering&rft.atitle=Mitral+valve+annuloplasty+-+A+quantitative+clinical+and+mechanical+comparison+of+different+annuloplasty+devices&rft.volume=40&rft.issue=3&rft.pages=750-61&rft.date=2011&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3288426&rft_id=info%3Apmid%2F22037916&rft_id=info%3Adoi%2F10.1007%2Fs10439-011-0442-y&rft.aulast=Rausch&rft.aufirst=M.K.&rft.au=Bothe+W.&rft.au=Kvitting+J.P.&rft.au=Swanson+J.C.&rft.au=Miller+D.C.&rft.au=Kuhl+E.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3288426&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMitral+valve+annuloplasty\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1328\nCached time: 20181129045359\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.240 seconds\nReal time usage: 0.301 seconds\nPreprocessor visited node count: 486\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 12510\/2097152 bytes\nTemplate argument size: 304\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 12605\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.149\/10.000 seconds\nLua memory usage: 2.72 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 266.733 1 -total\n<\/p>\n<pre>56.67% 151.167 1 Template:Reflist\n46.61% 124.319 3 Template:Cite_journal\n37.83% 100.896 1 Template:Infobox_medical_intervention\n35.89% 95.733 1 Template:Infobox\n 3.27% 8.717 1 Template:Cite_book\n 3.17% 8.456 1 Template:Cite_web\n 3.09% 8.251 1 Template:PAGENAMEBASE\n 1.67% 4.451 1 Template:Template_other\n 1.52% 4.053 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:33566284-1!canonical and timestamp 20181129045359 and revision id 861634790\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Mitral_valve_annuloplasty\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212143\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.009 seconds\nReal time usage: 0.143 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 136.972 1 - wikipedia:Mitral_valve_annuloplasty\n100.00% 136.972 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8255-0!*!*!*!*!*!* and timestamp 20181217212143 and revision id 24465\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Mitral_valve_annuloplasty\">https:\/\/www.limswiki.org\/index.php\/Mitral_valve_annuloplasty<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","26d053f75c5d17b40493e0f0665df75b_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/21\/Annuloplasty_Rings.jpg\/560px-Annuloplasty_Rings.jpg"],"26d053f75c5d17b40493e0f0665df75b_timestamp":1545081703,"6f82a58abdc5f62be708c1c05caa09c3_type":"article","6f82a58abdc5f62be708c1c05caa09c3_title":"Microchip implant (human)","6f82a58abdc5f62be708c1c05caa09c3_url":"https:\/\/www.limswiki.org\/index.php\/Microchip_implant_(human)","6f82a58abdc5f62be708c1c05caa09c3_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMicrochip implant (human)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor use in animals, see Microchip implant (animal).\n A surgeon implants British scientist Dr Mark Gasson in his left hand with an RFID microchip (March 16, 2009)A human microchip implant is typically an identifying integrated circuit device or RFID transponder encased in silicate glass and implanted in the body of a human being. This type of subdermal implant usually contains a unique ID number that can be linked to information contained in an external database, such as personal identification, law enforcement, medical history, medications, allergies, and contact information.\nContents \n\n1 History \n2 Hobbyists \n3 Commercial implants \n\n3.1 Medical records \n3.2 Building access and security \n3.3 Possible future applications \n\n\n4 Potential problems \n\n4.1 Cancer \n4.2 Security risks \n\n\n5 Legislation \n\n5.1 United States \n\n\n6 In popular culture \n7 See also \n8 References \n9 Further reading \n\n\nHistory \nThe first experiments with an RFID implant were carried out in 1998 by the British scientist Kevin Warwick.[1][2][3][4][5] His implant was used to open doors, switch on lights, and cause verbal output within a building. After nine days the implant was removed and has since been held in the Science Museum (London).[citation needed ]\nOn 16 March 2009 British scientist Mark Gasson had an advanced glass capsule RFID device surgically implanted into his left hand. In April 2010 Gasson's team demonstrated how a computer virus could wirelessly infect his implant and then be transmitted on to other systems.[6] Gasson reasoned that with implanted technology the separation between man and machine can become theoretical because the technology can be perceived by the human as being a part of their body. Because of this development in our understanding of what constitutes our body and its boundaries he became credited as being the first human infected by a computer virus. He has no plans to remove his implant.[7]\n\nHobbyists \n An RFID tag visible under the skin soon after being implanted.\nSeveral hobbyists have placed RFID microchip implants into their hands or had them inserted by others.\nAmal Graafstra,[8] author of the book RFID Toys,[9] asked doctors to place implants in his hands in March 2005. A cosmetic surgeon used a scalpel to place a microchip in his left hand, and his family doctor injected a chip into his right hand using a veterinary Avid injector kit. Graafstra uses the implants to access his home, open car doors, and to log on to his computer. With public interest growing, in 2013 he launched biohacking company Dangerous Things[10] and crowdfunded the world's first implantable NFC transponder in 2014.[11] He has also spoken at various events and promotional gigs[12] including TEDx,[13] and built a smartgun that only fires after reading his implant.[14]\nAlejandro Hernandez CEO of Futura is known to be the first in Central America to have Dangerous Things' transponder installed in his left hand by Federico Cortes in November 2017.\nMikey Sklar had a chip implanted into his left hand and filmed the procedure.[15]\nJonathan Oxer self-implanted an RFID chip in his arm using a veterinary implantation tool.[16]\nMartijn Wismeijer, Dutch marketing manager for Bitcoin ATM manufacturer General Bytes, placed RFID chips in both of his hands to store his Bitcoin private keys and business card.[17]\nPatric Lanhed sent a \u201cbio-payment\u201d of one euro worth of Bitcoin using a chip embedded in his hand.\n[18]\n\n<\/p>Marcel Varallo had an NXP chip coated in Bioglass 8625 inserted into his hand between his forefinger and thumb allowing him to open secure elevators and doors at work, print from secure printers, unlock his mobile phone and home, and store his digital business card for transfer to mobile phones enabled for NFC.\n[19]\n\n<\/p>Biohacker Hannes Sj\u00f6blad has been experimenting with NFC (Near Field Communication) chip implants since 2015. During his talk at Echapp\u00e9e Vol\u00e9\u00e9 2016 in Paris, Sj\u00f6blad disclosed that he has also implanted himself between his forefinger and thumb and uses it to unlock doors, make payments, and unlock his phone (essentially replacing anything you can put in your pockets).[20] Additionally, Sj\u00f6blad has hosted several \"implant parties,\" where interested individuals can also be implanted with the chip.[21]\n\nCommercial implants \nMedical records \nResearchers have examined microchip implants in humans in the medical field and they indicate that there are potential benefits and risks to incorporating the device in the medical field. For example, it could be beneficial for noncompliant patients but still poses great risks for potential misuse of the device.[22]\nDestron Fearing, a subsidiary of Digital Angel, initially developed the technology for the VeriChip.[23]\nIn 2004, the VeriChip implanted device and reader were classified as Class II: General controls with special controls by the FDA;[24] that year the FDA also published a draft guidance describing the special controls required to market such devices.[25]\nAbout the size of a grain of rice, the device was typically implanted between the shoulder and elbow area of an individual\u2019s right arm. Once scanned at the proper frequency, the chip responded with a unique 16-digit number which could be then linked with information about the user held on a database for identity verification, medical records access and other uses. The insertion procedure was performed under local anesthetic in a physician's office.[26][27]\nPrivacy advocates raised concerns regarding potential abuse of the chip, with some warning that adoption by governments as a compulsory identification program could lead to erosion of civil liberties, as well as identity theft if the device should be hacked.[27][28][29] Another ethical dilemma posed by the technology, is that people with dementia could possibly benefit the most from an implanted device that contained their medical records, but issues of informed consent are the most difficult in precisely such people.[30]\nIn June 2007, the American Medical Association declared that \"implantable radio frequency identification (RFID) devices may help to identify patients, thereby improving the safety and efficiency of patient care, and may be used to enable secure access to patient clinical information\",[31] but in the same year, news reports linking similar devices to cancer caused in laboratory animals had a devastating impact on the company's stock price and sales.[32]\nIn 2010, the company, by then called \"PositiveID\", withdrew the product from the market due to poor sales.[33]\nIn January 2012, PositiveID sold the chip assets to a company called VeriTeQ that was owned by Scott Silverman, the former CEO of Positive ID.[34]\nIn 2016, JAMM Technologies acquired the chip assets from VeriTeQ; JAMM's business plan was to partner with companies selling implanted medical devices and use the RfID tags to monitor and identify the devices.[35] JAMM Technologies is co-located in the same Plymouth, Minnesota building as Geissler Corporation with Randolph K. Geissler and Donald R. Brattain[36][37] listed as its principals. \nThe website also claims that Geissler was CEO of PositiveID Corporation, Destron Fearing Corporation, and Digital Angel Corporation.[38]\n\n<\/p>In 2018, A Danish firm called BiChip released a new generation of microchip implant that is intended to be readable from distance and connected to Internet. The company released an update for its microchip implant to associate it with the Ripple cryptocurrency to allow payments to be made using the implanted microchip.[39]\n\nBuilding access and security \nIn February 2006, CityWatcher, Inc. of Cincinnati, OH became the first company in the world to implant microchips into their employees as part of their building access control and security system. The workers needed the implants to access the company's secure video tape room, as documented in USA Today.[40] The project was initiated and implemented by Six Sigma Security, Inc. The VeriChip Corporation had originally marketed the implant as a way to restrict access to secure facilities such as power plants.\nA major drawback for such systems is the relative ease with which the 16-digit ID number contained in a chip implant can be obtained and cloned using a hand-held device, a problem that has been demonstrated publicly by security researcher Jonathan Westhues[41] and documented in the May 2006 issue of Wired magazine,[42] among other places.\n\nThe Baja Beach Club, a nightclub in Rotterdam, the Netherlands, once used VeriChip implants for identifying VIP guests.[43]\nThe Epicenter in Stockholm, Sweden is using RFID implants for employees to operate security doors, copiers, and pay for lunch.[44]\nPossible future applications \nIn 2017 Mike Miller, chief executive of the World Olympians Association, was widely reported as suggesting the use of such implants in athletes in an attempt to reduce problems in sport due to drug taking.[45]\nTheoretically, a GPS-enabled chip could one day make it possible for individuals to be physically located by latitude, longitude, altitude, speed, and direction of movement. Such implantable GPS devices are not technically feasible at this time. However, if widely deployed at some future point, implantable GPS devices could conceivably allow authorities to locate missing persons and\/or fugitives and those who fled from a crime scene. Critics contend, however, that the technology could lead to political repression as governments could use implants to track and persecute human rights activists, labor activists, civil dissidents, and political opponents; criminals and domestic abusers could use them to stalk and harass their victims; and child abusers could use them to locate and abduct children.\nAnother suggested application for a tracking implant, discussed in 2008 by the legislature of Indonesia's Irian Jaya would be to monitor the activities of persons infected with HIV, aimed at reducing their chances of infecting other people.[46][47] The microchipping section was not, however, included into the final version of the provincial HIV\/AIDS Handling bylaw passed by the legislature in December 2008.[48] With current technology, this would not be workable anyway, since there is no implantable device on the market with GPS tracking capability.\nSince modern payment methods rely upon RFID\/NFC, it is thought that implantable microchips, if they were to ever become popular in use, would form a part of the cashless society.[49] Verichip implants have already been used in nightclubs such as the Baja club for such a purpose, allowing patrons to purchase drinks with their implantable microchip.\n\nPotential problems \nCancer \nIn a self-published report[50] anti-RFID advocate Katherine Albrecht, who refers to RFID devices as \"spy chips\", cites veterinary and toxicological studies carried out from 1996 to 2006 which found lab rodents injected with microchips as an incidental part of unrelated experiments and dogs implanted with identification microchips sometimes developed cancerous tumors at the injection site (subcutaneous sarcomas) as evidence of a human implantation risk.[51] However, the link between foreign-body tumorigenesis in lab animals and implantation in humans has been publicly refuted as erroneous and misleading[52] and the report's author has been criticized over the use of \"provocative\" language \"not based in scientific fact\".[53] Notably, none of the studies cited specifically set out to investigate the cancer risk of implanted microchips and so none of the studies had a control group of animals that did not get implanted. While the issue is considered worthy of further investigation, one of the studies cited cautioned \"Blind leaps from the detection of tumors to the prediction of human health risk should be avoided\".[54][55][56]\n\nSecurity risks \nThe Council on Ethical and Judicial Affairs (CEJA) of the American Medical Association published a report in 2007 alleging that RFID implanted chips may compromise privacy because there is no assurance that the information contained in the chip can be properly protected.[57]\n\nLegislation \nThe examples and perspective in this article may not represent a worldwide view of the subject. You may improve this article, discuss the issue on the talk page, or create a new article, as appropriate. (August 2017) (Learn how and when to remove this template message)\nUnited States \nFollowing Wisconsin and North Dakota,[58] California issued Senate Bill 362 in 2007, which makes it illegal to force a person to have a microchip implanted, and provide for an assessment of civil penalties against violators of the bill.[58]\nIn 2008, Oklahoma passed 63 OK Stat \u00a7 63-1-1430 (2008 S.B. 47), that bans involuntary microchip implants in humans.[59][60]\nOn April 5, 2010, the Georgia Senate passed Senate Bill 235 that prohibits forced microchip implants in humans and that would make it a misdemeanor for anyone to require them, including employers.[61] The bill would allow voluntary microchip implants, as long as they are performed by a physician and regulated by the Georgia Composite Medical Board. The state's House of Representatives did not take up the measure.[citation needed ]\nOn February 10, 2010, Virginia's House of Delegates also passed a bill that forbids companies from forcing their employees to be implanted with tracking devices.[62]\nWashington State House Bill 1142-2009-10 orders a study using implanted radio frequency identification or other similar technology to electronically monitor sex offenders and other felons.[63]\n\nIn popular culture \nThe general public are most familiar with microchips in the context of tracking their pets. In the U.S., some Christian activists, including conspiracy theorist Mark Dice, the author of a book titled The Resistance Manifesto[64], make a link between the PositiveID and the Biblical Mark of the Beast,[65][66] prophesied to be a future requirement for buying and selling,[67] and a key element of the Book of Revelation.[68][69] Gary Wohlscheid, president of These Last Days Ministries, has argued that \"Out of all the technologies with potential to be the mark of the beast, VeriChip has got the best possibility right now\".[70]\n\nSee also \nRFID\nAmbient intelligence\nReferences \n\n\n^ \"Is human chip implant wave of the future?\". CNN. January 13, 1999. Retrieved May 12, 2010 . \n\n^ \"Professor has world's first silicon chip implant\". independent.co.uk. 26 August 1998. \n\n^ \"Professor Cyborg\". wired.com. \n\n^ \"BBC News - Sci\/Tech - Technology gets under the skin\". news.bbc.co.uk. \n\n^ Sanchez-Klein, Jana. \"CNN - Cyberfuturist plants chip in arm to test human-computer interaction - August 28, 1998\". edition.cnn.com. \n\n^ Gasson, M. N. (2010). \"Human Enhancement: Could you become infected with a computer virus?\". 2010 IEEE International Symposium on Technology and Society. p. 61. doi:10.1109\/ISTAS.2010.5514651. ISBN 978-1-4244-7777-7. \n\n^ http:\/\/www.personal.reading.ac.uk\/~sis04mng\/research\/ FAQ: Could you become infected with a computer virus? \n\n^ \"Amal Graafstra - Technologist, Author & Double RFID Implantee\". amal.net. Retrieved 2017-05-26 . \n\n^ \"RFID Toys Forum\". Dangerous Things Forum. Retrieved 2017-05-26 . \n\n^ \"Dangerous Things\". Dangerous Things. Retrieved 2017-05-26 . \n\n^ \"The xNT implantable NFC chip\". Indiegogo. Retrieved 2017-05-26 . \n\n^ bpg (2017-03-09), PRMT | Ghost In the Shell | Live Stream, retrieved 2017-05-26 \n\n^ TEDx Talks (2013-10-17), Biohacking - the forefront of a new kind of human evolution: Amal Graafstra at TEDxSFU, retrieved 2017-05-26 \n\n^ Motherboard (2017-03-23), Who Killed the Smart Gun?, retrieved 2017-05-26 \n\n^ https:\/\/www.youtube.com\/watch?v=w2gKJeM6Ihw link Fox News Interviews Mikey Sklar \n\n^ \"Jondo the Mandroid is RFID enabled\". \n\n^ Clark, Liat (November 11, 2014). \"Hand-implanted NFC chips open this man's bitcoin wallet\". Retrieved February 15, 2015 . \n\n^ Pearson, Jordan (October 30, 2015). \"This Guy Implanted His Bitcoin Wallet and Made a Payment With His Hand\". Retrieved November 2, 2015 . \n\n^ \"Heraldsun.com.au - Subscribe to the Herald Sun for exclusive stories\". www.heraldsun.com.au. \n\n^ \"Au pays des esp\u00e8ces en voie de disparition\". lesechos.fr. 2016-02-19. Retrieved 2016-07-07 . \n\n^ \"The rise of the Swedish cyborgs - BBC News\". Retrieved 2016-07-07 . \n\n^ Eltorai, Adam E. M.; Fox, Henry; McGurrin, Emily; Guang, Stephanie (2016). \"Microchips in Medicine: Current and Future Applications\". BioMed Research International. 2016: 1\u20137. doi:10.1155\/2016\/1743472. ISSN 2314-6133. \n\n^ Smith, Richard M. \u201cTough Sell Ahead for the VeriChip Implant ID System.\u201dArchived October 25, 2007, at the Wayback Machine., Computer Bytes Man. 27 Dec. 2001. 16 Oct. 2007 \n\n^ \"KO33440: Designation of VeriChip as Class II with special controls\" (PDF) . FDA. October 12, 2004. \n\n^ \"Class II Special Controls Guidance Document: Implantable Radiofrequency Transponder System for Patient Identification and Health Information\" (PDF) . FDA. December 10, 2004. \n\n^ \"Verichip Consumer FAQ\". Archived from the original on August 2, 2009. Retrieved 2009-08-16 . \n\n^ a b Halamka, J; Juels, A; Stubblefield, A; Westhues, J (2006). \"The security implications of VeriChip cloning\". Journal of the American Medical Informatics Association : JAMIA. 13 (6): 601\u20137. doi:10.1197\/jamia.M2143. PMC 1656959 . PMID 16929037. \n\n^ \"Human-implantable RFID chips: Some ethical and privacy concerns\". Healthcare IT News. 30 July 2007. \n\n^ Westra, BL (March 2009). \"Radio frequency identification\". The American journal of nursing. 109 (3): 34\u20136. doi:10.1097\/01.NAJ.0000346925.67498.a4. PMID 19240491. \n\n^ Mordini, E; Ottolini, C (2007). \"Body identification, biometrics and medicine: ethical and social considerations\" (PDF) . Annali dell'Istituto Superiore di Sanit\u00e0. 43 (1): 51\u201360. PMID 17536154. \n\n^ \"American Medical Association CEJA Report 5-A-07\". \n\n^ Lewan, Todd (September 8, 2007). \"Chip Implants Linked to Animal Tumours\". The Washington Post. Retrieved 2010-06-08 . \n\n^ Edwards, Jim. \"Down With the Chip: PositiveID Axes Its Scary Medical Records\". bNET. July 15, 2010. Retrieved March 2, 2017 \n\n^ \"VeriTeQ Acquisition Corporation Acquires Implantable, FDA-Cleared VeriChip Technology and Health Link Personal Health Record from PositiveID Corporation\". VeriTeQ via BusinessWire. January 17, 2012. \n\n^ Geissler, Randy (April 4, 2016). \"JAMM Technologies Acquires the Veriteq RFID Technology Platform and Enters into Supply Agreement with Establishment Labs\". JAMM via PRWeb. \n\n^ \"Don Brattain, OSU SPEARS SCHOOL TRIBUTES: 100 FOR 100\". Oklahoma State University. Retrieved April 21, 2018 . \n\n^ \"Tyler Technologies, Inc., Tyler Investor Community, Directors, Donald R. Brattain, Independent Director\". Tyler Technologies, Inc. Retrieved April 21, 2018 . \n\n^ \"Geissler Corporation - Management\". Geissler Corporation. Retrieved April 21, 2018 . \n\n^ Hamill, Jasper (January 2018). \"Would you store Ripple and Bitcoin in microchip?\". Metro. \n\n^ Lewan, Todd. USA Today. July 2007. \"Microchips in humans spark privacy debate.\". \n\n^ Westhues, Jonathan. \"Demo: Cloning a VeriChip.\" Demo: Cloning a VeriChip. \n\n^ Newitz, Annalee (May 2006). \"The RFID Hacking Underground\". Wired. Retrieved July 13, 2011 . \n\n^ http:\/\/www.baja.nl\/vipform.aspx \n\n^ Mearian, Lucas (February 6, 2015). \"Office complex implants RFID chips in employees' hands\". Computerworld. Retrieved February 15, 2015 . \n\n^ http:\/\/home.bt.com\/tech-gadgets\/future-tech\/microchips-in-humans-to-prevent-doping-11364220161232 \n\n^ \"Indonesia's Papua plans to tag AIDS sufferers\", Mon Nov 24, 2008. \n\n^ Jason Tedjasukmana (Nov 26, 2008), \"Papua Proposal: A Microchip to Track the HIV-Positive\", Time \n\n^ Government Of Indonesian Province Rejects Plan To Implant Microchips In Some HIV-Positive People Archived 2013-12-25 at the Wayback Machine., 2008-12-08 \n\n^ \"Cashless Society\" This is a dead link. \n\n^ http:\/\/www.antichips.com\/cancer\/ Microchip-Induced Tumors in Laboratory Rodents and Dogs: A Review of the Literature 1990\u20132006 \n\n^ Lewan, Todd (September 8, 2007), \"Chip Implants Linked to Animal Tumours\", The Washington Post, retrieved 2010-06-08 \n\n^ RFID Journal. \"VeriChip Defends the Safety of Implanted RFID Tags\". rfidjournal.com. Retrieved 13 April 2016 . \n\n^ https:\/\/www.youtube.com\/watch?v=CS13kFWQIYM#t=60m53s Tumours, Tracking, and Tyranny: The Downside to Implantable Microchip \n\n^ Blanchard, K. T.; Barthel, C.; French, J. E.; Holden, H. E.; Moretz, R.; Pack, F. D.; Tennant, R. W.; Stoll, R. E. (1999). \"Transponder-Induced Sarcoma in the Heterozygous p53+\/- Mouse\". Toxicologic Pathology. 27 (5): 519. doi:10.1177\/019262339902700505. \n\n^ \"Lewan, Todd. The Associated Press, September 8, 2007. \"Chip Implants Linked to Animal Tumors\" \". washingtonpost.com. \n\n^ Studies Linking Microchips and Cancer \n\n^ CEJA of the American Medical Association, CEJA Report 5-A-07, Radio Frequency ID Devices in Humans, presented by Robert M. Sade, MD, Chair. 2007 \n\n^ a b California Bans Forced RFID Tagging of Humans, Government Technology website, October 17, 2007 \n\n^ \nTim Talley.\n\"Bill bans involuntary microchip implants\".\n2008. \n\n^ \n\"Radio Frequency Identification (RFID) Privacy Laws\".\n2015. \n\n^ \"Georgia SB 235 - Ban on Required Human Microchip Implantation - Key Vote - The Voter's Self Defense System - Vote Smart\". Project Vote Smart. Retrieved 13 April 2016 . \n\n^ Virginia delegates pass bill banning chip implants as \u2018mark of the beast\u2019, The Raw Story, By Daniel Tencer, Wednesday, February 10, 2010 retrieved April 23, 2010 \n\n^ HB 1142-2009-10 to study requiring the use of implanted RFID in certain felons. \n\n^ Dice, Mark (July 26, 2006). The Resistance Manifesto. The Resistance. ISBN 0967346649. \n\n^ Streitfield, David (9 May 2002). \"First Humans to Receive ID Chips; Technology: Device injected under the skin will provide identification and medical information\". Los Angeles Times. Retrieved 13 September 2010 . \n\n^ Gilbert, Alorie (16 February 2005). \"Is RFID the mark of the beast?\". CNET News. Retrieved 13 September 2010 . \n\n^ \"Revelation 14:9-11\". Bible Gateway. Retrieved 2010-07-03 . \n\n^ Albrecht, Katherine; McIntyre, Liz (2006-01-31). The Spychips Threat: Why Christians Should Resist RFID and Electronic Surveillance. Nelson Current. ISBN 1-59555-021-6. \n\n^ Baard, Mark (2006-06-06). \"RFID: Sign of the (End) Times?\". Wired.com. Retrieved 2009-10-13 . \n\n^ Scheeres, Julia (6 February 2002). \"They Want Their ID Chips Now\". Wired News. Retrieved 13 September 2010 . \n\n\nFurther reading \nHaag, Stephen; Cummings, Maeve,; McCubbrey, Donald (2004). Management Information Systems for the Information Age (4th ed.). New York City, New York: McGraw-Hill. ISBN 0-07-281947-2. CS1 maint: Multiple names: authors list (link) \nGraafstra, Amal (2004). RFID Toys: 11 Cool Projects for Home, Office and Entertainment (4th ed.). New York City, New York: (ExtremeTech) Ziff Davis Publishing Holdings Inc. ISBN 0-471-77196-1. \n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Microchip_implant_(human)\">https:\/\/www.limswiki.org\/index.php\/Microchip_implant_(human)<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:14.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,230 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","6f82a58abdc5f62be708c1c05caa09c3_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Microchip_implant_human skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Microchip implant (human)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For use in animals, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microchip_implant_(animal)\" title=\"Microchip implant (animal)\" rel=\"external_link\" target=\"_blank\">Microchip implant (animal)<\/a>.<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dr_Mark_Gasson_has_an_RFID_microchip_implanted_in_his_left_hand_by_a_surgeon_(March_16_2009).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/81\/Dr_Mark_Gasson_has_an_RFID_microchip_implanted_in_his_left_hand_by_a_surgeon_%28March_16_2009%29.jpg\/220px-Dr_Mark_Gasson_has_an_RFID_microchip_implanted_in_his_left_hand_by_a_surgeon_%28March_16_2009%29.jpg\" width=\"220\" height=\"330\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dr_Mark_Gasson_has_an_RFID_microchip_implanted_in_his_left_hand_by_a_surgeon_(March_16_2009).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A surgeon implants British scientist Dr <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mark_Gasson\" title=\"Mark Gasson\" rel=\"external_link\" target=\"_blank\">Mark Gasson<\/a> in his left hand with an RFID microchip (March 16, 2009)<\/div><\/div><\/div><p>A human <b>microchip implant<\/b> is typically an identifying <a href=\"https:\/\/en.wikipedia.org\/wiki\/Integrated_circuit\" title=\"Integrated circuit\" rel=\"external_link\" target=\"_blank\">integrated circuit<\/a> device or <a href=\"https:\/\/en.wikipedia.org\/wiki\/RFID\" class=\"mw-redirect\" title=\"RFID\" rel=\"external_link\" target=\"_blank\">RFID<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transponder\" title=\"Transponder\" rel=\"external_link\" target=\"_blank\">transponder<\/a> encased in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicate_glass\" class=\"mw-redirect\" title=\"Silicate glass\" rel=\"external_link\" target=\"_blank\">silicate glass<\/a> and implanted in the body of a human being. This type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subdermal_implant\" title=\"Subdermal implant\" rel=\"external_link\" target=\"_blank\">subdermal implant<\/a> usually contains a unique <a href=\"https:\/\/en.wikipedia.org\/wiki\/Identification_(information)\" title=\"Identification (information)\" rel=\"external_link\" target=\"_blank\">ID number<\/a> that can be linked to information contained in an external database, such as personal identification, law enforcement, medical history, medications, allergies, and contact information.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The first experiments with an <a href=\"https:\/\/en.wikipedia.org\/wiki\/RFID\" class=\"mw-redirect\" title=\"RFID\" rel=\"external_link\" target=\"_blank\">RFID<\/a> implant were carried out in 1998 by the British scientist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kevin_Warwick\" title=\"Kevin Warwick\" rel=\"external_link\" target=\"_blank\">Kevin Warwick<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> His implant was used to open doors, switch on lights, and cause verbal output within a building. After nine days the implant was removed and has since been held in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Science_Museum_(London)\" class=\"mw-redirect\" title=\"Science Museum (London)\" rel=\"external_link\" target=\"_blank\">Science Museum (London)<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2009)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>On 16 March 2009 British scientist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mark_Gasson\" title=\"Mark Gasson\" rel=\"external_link\" target=\"_blank\">Mark Gasson<\/a> had an advanced glass capsule RFID device surgically implanted into his left hand. In April 2010 Gasson's team demonstrated how a computer virus could wirelessly infect his implant and then be transmitted on to other systems.<sup id=\"rdp-ebb-cite_ref-istas_6-0\" class=\"reference\"><a href=\"#cite_note-istas-6\" rel=\"external_link\">[6]<\/a><\/sup> Gasson reasoned that with implanted technology the separation between man and machine can become theoretical because the technology can be perceived by the human as being a part of their body. Because of this development in our understanding of what constitutes our body and its boundaries he became credited as being the first human infected by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer_virus\" title=\"Computer virus\" rel=\"external_link\" target=\"_blank\">computer virus<\/a>. He has no plans to remove his implant.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Hobbyists\">Hobbyists<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:RFID_hand.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/96\/RFID_hand.jpg\/220px-RFID_hand.jpg\" width=\"220\" height=\"293\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:RFID_hand.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An RFID tag visible under the skin soon after being implanted.<\/div><\/div><\/div>\n<p>Several hobbyists have placed RFID microchip implants into their hands or had them inserted by others.\n<\/p><p>Amal Graafstra,<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> author of the book RFID Toys,<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> asked doctors to place implants in his hands in March 2005. A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cosmetic_surgeon\" class=\"mw-redirect\" title=\"Cosmetic surgeon\" rel=\"external_link\" target=\"_blank\">cosmetic surgeon<\/a> used a scalpel to place a microchip in his left hand, and his family doctor injected a chip into his right hand using a veterinary Avid injector kit. Graafstra uses the implants to access his home, open car doors, and to log on to his computer. With public interest growing, in 2013 he launched biohacking company Dangerous Things<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> and crowdfunded the world's first implantable NFC transponder in 2014.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> He has also spoken at various events and promotional gigs<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> including TEDx,<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> and built a smartgun that only fires after reading his implant.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>Alejandro Hernandez CEO of Futura is known to be the first in Central America to have Dangerous Things' transponder installed in his left hand by Federico Cortes in November 2017.\n<\/p><p>Mikey Sklar had a chip implanted into his left hand and filmed the procedure.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Jonathan_Oxer\" title=\"Jonathan Oxer\" rel=\"external_link\" target=\"_blank\">Jonathan Oxer<\/a> self-implanted an RFID chip in his arm using a veterinary implantation tool.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>Martijn Wismeijer, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dutch_people\" title=\"Dutch people\" rel=\"external_link\" target=\"_blank\">Dutch<\/a> marketing manager for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bitcoin_ATM\" title=\"Bitcoin ATM\" rel=\"external_link\" target=\"_blank\">Bitcoin ATM<\/a> manufacturer <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_Bytes\" title=\"General Bytes\" rel=\"external_link\" target=\"_blank\">General Bytes<\/a>, placed RFID chips in both of his hands to store his <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bitcoin\" title=\"Bitcoin\" rel=\"external_link\" target=\"_blank\">Bitcoin<\/a> private keys and business card.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p><p>Patric Lanhed sent a \u201cbio-payment\u201d of one euro worth of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bitcoin\" title=\"Bitcoin\" rel=\"external_link\" target=\"_blank\">Bitcoin<\/a> using a chip embedded in his hand.\n<p><sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<\/p><p>Marcel Varallo had an NXP chip coated in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioglass\" title=\"Bioglass\" rel=\"external_link\" target=\"_blank\">Bioglass<\/a> 8625 inserted into his hand between his forefinger and thumb allowing him to open secure elevators and doors at work, print from secure printers, unlock his mobile phone and home, and store his digital business card for transfer to mobile phones enabled for NFC.\n<p><sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Do-it-yourself_biology\" title=\"Do-it-yourself biology\" rel=\"external_link\" target=\"_blank\">Biohacker<\/a> Hannes Sj\u00f6blad has been experimenting with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Near_field_communication\" class=\"mw-redirect\" title=\"Near field communication\" rel=\"external_link\" target=\"_blank\">NFC<\/a> (Near Field Communication) chip implants since 2015. During his talk at Echapp\u00e9e Vol\u00e9\u00e9 2016 in Paris, Sj\u00f6blad disclosed that he has also implanted himself between his forefinger and thumb and uses it to unlock doors, make payments, and unlock his phone (essentially replacing anything you can put in your pockets).<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> Additionally, Sj\u00f6blad has hosted several \"implant parties,\" where interested individuals can also be implanted with the chip.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Commercial_implants\">Commercial implants<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Medical_records\">Medical records<\/span><\/h3>\n<p>Researchers have examined microchip implants in humans in the medical field and they indicate that there are potential benefits and risks to incorporating the device in the medical field. For example, it could be beneficial for noncompliant patients but still poses great risks for potential misuse of the device.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p><p>Destron Fearing, a subsidiary of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_Angel\" title=\"Digital Angel\" rel=\"external_link\" target=\"_blank\">Digital Angel<\/a>, initially developed the technology for the VeriChip.<sup id=\"rdp-ebb-cite_ref-ComputerBytesMan_23-0\" class=\"reference\"><a href=\"#cite_note-ComputerBytesMan-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p><p>In 2004, the VeriChip implanted device and reader were classified as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device#Class_II:_General_controls_with_special_controls\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">Class II: General controls with special controls<\/a> by the FDA;<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> that year the FDA also published a draft guidance describing the special controls required to market such devices.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p><p>About the size of a grain of rice, the device was typically implanted between the shoulder and elbow area of an individual\u2019s right arm. Once scanned at the proper frequency, the chip responded with a unique 16-digit number which could be then linked with information about the user held on a database for identity verification, medical records access and other uses. The insertion procedure was performed under local anesthetic in a physician's office.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Halamka_27-0\" class=\"reference\"><a href=\"#cite_note-Halamka-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p><p>Privacy advocates raised concerns regarding potential abuse of the chip, with some warning that adoption by governments as a compulsory identification program could lead to erosion of civil liberties, as well as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Identity_theft\" title=\"Identity theft\" rel=\"external_link\" target=\"_blank\">identity theft<\/a> if the device should be hacked.<sup id=\"rdp-ebb-cite_ref-Halamka_27-1\" class=\"reference\"><a href=\"#cite_note-Halamka-27\" rel=\"external_link\">[27]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> Another ethical dilemma posed by the technology, is that people with dementia could possibly benefit the most from an implanted device that contained their medical records, but issues of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Informed_consent\" title=\"Informed consent\" rel=\"external_link\" target=\"_blank\">informed consent<\/a> are the most difficult in precisely such people.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p><p>In June 2007, the American Medical Association declared that \"implantable radio frequency identification (RFID) devices may help to identify patients, thereby improving the safety and efficiency of patient care, and may be used to enable secure access to patient clinical information\",<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> but in the same year, news reports linking similar devices to cancer caused in laboratory animals had a devastating impact on the company's stock price and sales.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup>\n<\/p><p>In 2010, the company, by then called \"PositiveID\", withdrew the product from the market due to poor sales.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p><p>In January 2012, PositiveID sold the chip assets to a company called VeriTeQ that was owned by Scott Silverman, the former CEO of Positive ID.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p><p>In 2016, JAMM Technologies acquired the chip assets from VeriTeQ; JAMM's business plan was to partner with companies selling <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_augmentation\" title=\"Breast augmentation\" rel=\"external_link\" target=\"_blank\">implanted medical devices<\/a> and use the RfID tags to monitor and identify the devices.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup> JAMM Technologies is co-located in the same <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plymouth,_Minnesota\" title=\"Plymouth, Minnesota\" rel=\"external_link\" target=\"_blank\">Plymouth, Minnesota<\/a> building as Geissler Corporation with Randolph K. Geissler and Donald R. Brattain<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup> listed as its principals. \n<p>The website also claims that Geissler was CEO of PositiveID Corporation, Destron Fearing Corporation, and Digital Angel Corporation.<sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup>\n<\/p>\n<\/p><p>In 2018, A Danish firm called BiChip released a new generation of microchip implant that is intended to be readable from distance and connected to Internet. The company released an update for its microchip implant to associate it with the Ripple <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cryptocurrency\" title=\"Cryptocurrency\" rel=\"external_link\" target=\"_blank\">cryptocurrency<\/a> to allow payments to be made using the implanted microchip.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Building_access_and_security\">Building access and security<\/span><\/h3>\n<p>In February 2006, CityWatcher, Inc. of Cincinnati, OH became the first company in the world to implant microchips into their employees as part of their building access control and security system. The workers needed the implants to access the company's secure video tape room, as documented in <a href=\"https:\/\/en.wikipedia.org\/wiki\/USA_Today\" title=\"USA Today\" rel=\"external_link\" target=\"_blank\">USA Today<\/a>.<sup id=\"rdp-ebb-cite_ref-USAToday2_40-0\" class=\"reference\"><a href=\"#cite_note-USAToday2-40\" rel=\"external_link\">[40]<\/a><\/sup> The project was initiated and implemented by Six Sigma Security, Inc. The VeriChip Corporation had originally marketed the implant as a way to restrict access to secure facilities such as power plants.\n<\/p><p>A major drawback for such systems is the relative ease with which the 16-digit ID number contained in a chip implant can be obtained and cloned using a hand-held device, a problem that has been demonstrated publicly by security researcher <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jonathan_Westhues\" title=\"Jonathan Westhues\" rel=\"external_link\" target=\"_blank\">Jonathan Westhues<\/a><sup id=\"rdp-ebb-cite_ref-clone_41-0\" class=\"reference\"><a href=\"#cite_note-clone-41\" rel=\"external_link\">[41]<\/a><\/sup> and documented in the May 2006 issue of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wired_magazine\" class=\"mw-redirect\" title=\"Wired magazine\" rel=\"external_link\" target=\"_blank\"><i>Wired<\/i> magazine<\/a>,<sup id=\"rdp-ebb-cite_ref-wired_42-0\" class=\"reference\"><a href=\"#cite_note-wired-42\" rel=\"external_link\">[42]<\/a><\/sup> among other places.\n<\/p>\n<ul><li>The Baja Beach Club, a nightclub in Rotterdam, the Netherlands, once used VeriChip implants for identifying VIP guests.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup><\/li>\n<li>The Epicenter in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stockholm,_Sweden\" class=\"mw-redirect\" title=\"Stockholm, Sweden\" rel=\"external_link\" target=\"_blank\">Stockholm, Sweden<\/a> is using RFID implants for employees to operate security doors, copiers, and pay for lunch.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Possible_future_applications\">Possible future applications<\/span><\/h3>\n<p>In 2017 Mike Miller, chief executive of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/World_Olympians_Association\" title=\"World Olympians Association\" rel=\"external_link\" target=\"_blank\">World Olympians Association<\/a>, was widely reported as suggesting the use of such implants in athletes in an attempt to reduce problems in sport due to drug taking.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup>\n<\/p><p>Theoretically, a GPS-enabled chip could one day make it possible for individuals to be physically located by latitude, longitude, altitude, speed, and direction of movement. Such implantable GPS devices are not technically feasible at this time. However, if widely deployed at some future point, implantable GPS devices could conceivably allow authorities to locate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Missing_person\" title=\"Missing person\" rel=\"external_link\" target=\"_blank\">missing persons<\/a> and\/or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fugitive\" title=\"Fugitive\" rel=\"external_link\" target=\"_blank\">fugitives<\/a> and those who fled from a crime scene. Critics contend, however, that the technology could lead to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Political_repression\" title=\"Political repression\" rel=\"external_link\" target=\"_blank\">political repression<\/a> as governments could use implants to track and persecute human rights activists, labor activists, civil dissidents, and political opponents; criminals and domestic abusers could use them to stalk and harass their victims; and child abusers could use them to locate and abduct children.\n<\/p><p>Another suggested application for a tracking implant, discussed in 2008 by the legislature of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Indonesia\" title=\"Indonesia\" rel=\"external_link\" target=\"_blank\">Indonesia<\/a>'s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Irian_Jaya\" class=\"mw-redirect\" title=\"Irian Jaya\" rel=\"external_link\" target=\"_blank\">Irian Jaya<\/a> would be to monitor the activities of persons infected with <a href=\"https:\/\/en.wikipedia.org\/wiki\/HIV\" title=\"HIV\" rel=\"external_link\" target=\"_blank\">HIV<\/a>, aimed at reducing their chances of infecting other people.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup> The microchipping section was not, however, included into the final version of the provincial <i>HIV\/AIDS Handling bylaw<\/i> passed by the legislature in December 2008.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup> With current technology, this would not be workable anyway, since there is no implantable device on the market with <a href=\"https:\/\/en.wikipedia.org\/wiki\/GPS_tracking_unit\" title=\"GPS tracking unit\" rel=\"external_link\" target=\"_blank\">GPS tracking<\/a> capability.\n<\/p><p>Since modern payment methods rely upon RFID\/NFC, it is thought that implantable microchips, if they were to ever become popular in use, would form a part of the cashless society.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup> Verichip implants have already been used in nightclubs such as the Baja club for such a purpose, allowing patrons to purchase drinks with their implantable microchip.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Potential_problems\">Potential problems<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Cancer\">Cancer<\/span><\/h3>\n<p>In a self-published report<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup> anti-RFID advocate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Katherine_Albrecht\" title=\"Katherine Albrecht\" rel=\"external_link\" target=\"_blank\">Katherine Albrecht<\/a>, who refers to RFID devices as \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Spy_chips\" class=\"mw-redirect\" title=\"Spy chips\" rel=\"external_link\" target=\"_blank\">spy chips<\/a>\", cites <a href=\"https:\/\/en.wikipedia.org\/wiki\/Veterinary\" class=\"mw-redirect\" title=\"Veterinary\" rel=\"external_link\" target=\"_blank\">veterinary<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxicology\" title=\"Toxicology\" rel=\"external_link\" target=\"_blank\">toxicological<\/a> studies carried out from 1996 to 2006 which found lab rodents injected with microchips as an incidental part of unrelated experiments and dogs implanted with identification microchips sometimes developed cancerous tumors at the injection site (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Subcutaneous_tissue\" title=\"Subcutaneous tissue\" rel=\"external_link\" target=\"_blank\">subcutaneous<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sarcoma\" title=\"Sarcoma\" rel=\"external_link\" target=\"_blank\">sarcomas<\/a>) as evidence of a human implantation risk.<sup id=\"rdp-ebb-cite_ref-WashingPost_51-0\" class=\"reference\"><a href=\"#cite_note-WashingPost-51\" rel=\"external_link\">[51]<\/a><\/sup> However, the link between foreign-body tumorigenesis in lab animals and implantation in humans has been publicly refuted as erroneous and misleading<sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup> and the report's author has been criticized over the use of \"provocative\" language \"not based in scientific fact\".<sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup> Notably, none of the studies cited specifically set out to investigate the cancer risk of implanted microchips and so none of the studies had a control group of animals that did not get implanted. While the issue is considered worthy of further investigation, one of the studies cited cautioned \"Blind leaps from the detection of tumors to the prediction of human health risk should be avoided\".<sup id=\"rdp-ebb-cite_ref-blanchard_54-0\" class=\"reference\"><a href=\"#cite_note-blanchard-54\" rel=\"external_link\">[54]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-55\" class=\"reference\"><a href=\"#cite_note-55\" rel=\"external_link\">[55]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-56\" class=\"reference\"><a href=\"#cite_note-56\" rel=\"external_link\">[56]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Security_risks\">Security risks<\/span><\/h3>\n<p>The Council on Ethical and Judicial Affairs (CEJA) of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Medical_Association\" title=\"American Medical Association\" rel=\"external_link\" target=\"_blank\">American Medical Association<\/a> published a report in 2007 alleging that RFID implanted chips may compromise <a href=\"https:\/\/en.wikipedia.org\/wiki\/Privacy\" title=\"Privacy\" rel=\"external_link\" target=\"_blank\">privacy<\/a> because there is no assurance that the information contained in the chip can be properly protected.<sup id=\"rdp-ebb-cite_ref-57\" class=\"reference\"><a href=\"#cite_note-57\" rel=\"external_link\">[57]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Legislation\">Legislation<\/span><\/h2>\n\n<h3><span class=\"mw-headline\" id=\"United_States\">United States<\/span><\/h3>\n<p>Following <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wisconsin\" title=\"Wisconsin\" rel=\"external_link\" target=\"_blank\">Wisconsin<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/North_Dakota\" title=\"North Dakota\" rel=\"external_link\" target=\"_blank\">North Dakota<\/a>,<sup id=\"rdp-ebb-cite_ref-Cal_58-0\" class=\"reference\"><a href=\"#cite_note-Cal-58\" rel=\"external_link\">[58]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/California\" title=\"California\" rel=\"external_link\" target=\"_blank\">California<\/a> issued <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.leginfo.ca.gov\/pub\/07-08\/bill\/sen\/sb_0351-0400\/sb_362_bill_20071012_chaptered.html\" target=\"_blank\">Senate Bill 362<\/a> in 2007, which makes it illegal to force a person to have a microchip implanted, and provide for an assessment of civil penalties against violators of the bill.<sup id=\"rdp-ebb-cite_ref-Cal_58-1\" class=\"reference\"><a href=\"#cite_note-Cal-58\" rel=\"external_link\">[58]<\/a><\/sup>\n<\/p><p>In 2008, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oklahoma\" title=\"Oklahoma\" rel=\"external_link\" target=\"_blank\">Oklahoma<\/a> passed 63 OK Stat \u00a7 63-1-1430 (2008 S.B. 47), that bans involuntary microchip implants in humans.<sup id=\"rdp-ebb-cite_ref-59\" class=\"reference\"><a href=\"#cite_note-59\" rel=\"external_link\">[59]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-60\" class=\"reference\"><a href=\"#cite_note-60\" rel=\"external_link\">[60]<\/a><\/sup>\n<\/p><p>On April 5, 2010, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Georgia_(U.S._state)\" title=\"Georgia (U.S. state)\" rel=\"external_link\" target=\"_blank\">Georgia<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Georgia_Senate\" class=\"mw-redirect\" title=\"Georgia Senate\" rel=\"external_link\" target=\"_blank\">Senate<\/a> passed Senate Bill 235 that prohibits forced microchip implants in humans and that would make it a misdemeanor for anyone to require them, including employers.<sup id=\"rdp-ebb-cite_ref-61\" class=\"reference\"><a href=\"#cite_note-61\" rel=\"external_link\">[61]<\/a><\/sup> The bill would allow voluntary microchip implants, as long as they are performed by a physician and regulated by the Georgia Composite Medical Board. The state's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Georgia_House_of_Representatives\" title=\"Georgia House of Representatives\" rel=\"external_link\" target=\"_blank\">House of Representatives<\/a> did not take up the measure.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (July 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>On February 10, 2010, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Virginia\" title=\"Virginia\" rel=\"external_link\" target=\"_blank\">Virginia<\/a>'s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Virginia_House_of_Delegates\" title=\"Virginia House of Delegates\" rel=\"external_link\" target=\"_blank\">House of Delegates<\/a> also passed a bill that forbids companies from forcing their employees to be implanted with tracking devices.<sup id=\"rdp-ebb-cite_ref-62\" class=\"reference\"><a href=\"#cite_note-62\" rel=\"external_link\">[62]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Washington_(state)\" title=\"Washington (state)\" rel=\"external_link\" target=\"_blank\">Washington State<\/a> House Bill 1142-2009-10 orders a study using implanted radio frequency identification or other similar technology to electronically monitor sex offenders and other felons.<sup id=\"rdp-ebb-cite_ref-63\" class=\"reference\"><a href=\"#cite_note-63\" rel=\"external_link\">[63]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"In_popular_culture\">In popular culture<\/span><\/h2>\n<p>The general public are most familiar with microchips in the context of tracking their pets. In the U.S., some Christian activists, including conspiracy theorist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mark_Dice\" title=\"Mark Dice\" rel=\"external_link\" target=\"_blank\">Mark Dice<\/a>, the author of a book titled <i>The Resistance Manifesto<\/i><sup id=\"rdp-ebb-cite_ref-64\" class=\"reference\"><a href=\"#cite_note-64\" rel=\"external_link\">[64]<\/a><\/sup>, make a link between the PositiveID and the Biblical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Number_of_the_Beast#Mark_of_the_Beast\" title=\"Number of the Beast\" rel=\"external_link\" target=\"_blank\">Mark of the Beast<\/a>,<sup id=\"rdp-ebb-cite_ref-65\" class=\"reference\"><a href=\"#cite_note-65\" rel=\"external_link\">[65]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-66\" class=\"reference\"><a href=\"#cite_note-66\" rel=\"external_link\">[66]<\/a><\/sup> prophesied to be a future requirement for buying and selling,<sup id=\"rdp-ebb-cite_ref-67\" class=\"reference\"><a href=\"#cite_note-67\" rel=\"external_link\">[67]<\/a><\/sup> and a key element of the <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Book_of_Revelation\" title=\"Book of Revelation\" rel=\"external_link\" target=\"_blank\">Book of Revelation<\/a><\/i>.<sup id=\"rdp-ebb-cite_ref-68\" class=\"reference\"><a href=\"#cite_note-68\" rel=\"external_link\">[68]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-69\" class=\"reference\"><a href=\"#cite_note-69\" rel=\"external_link\">[69]<\/a><\/sup> Gary Wohlscheid, president of These Last Days Ministries, has argued that \"Out of all the technologies with potential to be the mark of the beast, VeriChip has got the best possibility right now\".<sup id=\"rdp-ebb-cite_ref-70\" class=\"reference\"><a href=\"#cite_note-70\" rel=\"external_link\">[70]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/RFID\" class=\"mw-redirect\" title=\"RFID\" rel=\"external_link\" target=\"_blank\">RFID<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ambient_intelligence\" title=\"Ambient intelligence\" rel=\"external_link\" target=\"_blank\">Ambient intelligence<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cnn.com\/TECH\/computing\/9901\/14\/chipman.idg\/\" target=\"_blank\">\"Is human chip implant wave of the future?\"<\/a>. <i>CNN<\/i>. January 13, 1999<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">May 12,<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=CNN&rft.atitle=Is+human+chip+implant+wave+of+the+future%3F&rft.date=1999-01-13&rft_id=http%3A%2F%2Fwww.cnn.com%2FTECH%2Fcomputing%2F9901%2F14%2Fchipman.idg%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.independent.co.uk\/news\/professor-has-worlds-first-silicon-chip-implant-1174101.html\" target=\"_blank\">\"Professor has world's first silicon chip implant\"<\/a>. <i>independent.co.uk<\/i>. 26 August 1998.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=independent.co.uk&rft.atitle=Professor+has+world%27s+first+silicon+chip+implant&rft.date=1998-08-26&rft_id=https%3A%2F%2Fwww.independent.co.uk%2Fnews%2Fprofessor-has-worlds-first-silicon-chip-implant-1174101.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.wired.com\/1998\/08\/professor-cyborg\/\" target=\"_blank\">\"Professor Cyborg\"<\/a>. <i>wired.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=wired.com&rft.atitle=Professor+Cyborg&rft_id=https%3A%2F%2Fwww.wired.com%2F1998%2F08%2Fprofessor-cyborg%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/news.bbc.co.uk\/1\/hi\/sci\/tech\/158007.stm\" target=\"_blank\">\"BBC News - Sci\/Tech - Technology gets under the skin\"<\/a>. <i>news.bbc.co.uk<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=news.bbc.co.uk&rft.atitle=BBC+News+-+Sci%2FTech+-+Technology+gets+under+the+skin&rft_id=http%3A%2F%2Fnews.bbc.co.uk%2F1%2Fhi%2Fsci%2Ftech%2F158007.stm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Sanchez-Klein, Jana. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/edition.cnn.com\/TECH\/computing\/9808\/28\/armchip.idg\/index.html?eref=sitesearch\" target=\"_blank\">\"CNN - Cyberfuturist plants chip in arm to test human-computer interaction - August 28, 1998\"<\/a>. <i>edition.cnn.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=edition.cnn.com&rft.atitle=CNN+-+Cyberfuturist+plants+chip+in+arm+to+test+human-computer+interaction+-+August+28%2C+1998&rft.aulast=Sanchez-Klein&rft.aufirst=Jana&rft_id=http%3A%2F%2Fedition.cnn.com%2FTECH%2Fcomputing%2F9808%2F28%2Farmchip.idg%2Findex.html%3Feref%3Dsitesearch&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-istas-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-istas_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Gasson, M. N. (2010). \"Human Enhancement: Could you become infected with a computer virus?\". <i>2010 IEEE International Symposium on Technology and Society<\/i>. p. 61. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2FISTAS.2010.5514651\" target=\"_blank\">10.1109\/ISTAS.2010.5514651<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-4244-7777-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Human+Enhancement%3A+Could+you+become+infected+with+a+computer+virus%3F&rft.btitle=2010+IEEE+International+Symposium+on+Technology+and+Society&rft.pages=61&rft.date=2010&rft_id=info%3Adoi%2F10.1109%2FISTAS.2010.5514651&rft.isbn=978-1-4244-7777-7&rft.aulast=Gasson&rft.aufirst=M.+N.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.personal.reading.ac.uk\/~sis04mng\/research\/\" target=\"_blank\">http:\/\/www.personal.reading.ac.uk\/~sis04mng\/research\/<\/a> FAQ: Could you become infected with a computer virus?<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/amal.net\/\" target=\"_blank\">\"Amal Graafstra - Technologist, Author & Double RFID Implantee\"<\/a>. <i>amal.net<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-05-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=amal.net&rft.atitle=Amal+Graafstra+-+Technologist%2C+Author+%26+Double+RFID+Implantee&rft_id=http%3A%2F%2Famal.net%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/rfidtoys.com\/\" target=\"_blank\">\"RFID Toys Forum\"<\/a>. <i>Dangerous Things Forum<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-05-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Dangerous+Things+Forum&rft.atitle=RFID+Toys+Forum&rft_id=http%3A%2F%2Frfidtoys.com%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/dangerousthings.com\/\" target=\"_blank\">\"Dangerous Things\"<\/a>. <i>Dangerous Things<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-05-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Dangerous+Things&rft.atitle=Dangerous+Things&rft_id=http%3A%2F%2Fdangerousthings.com%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.indiegogo.com\/projects\/the-xnt-implantable-nfc-chip\" target=\"_blank\">\"The xNT implantable NFC chip\"<\/a>. <i>Indiegogo<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-05-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Indiegogo&rft.atitle=The+xNT+implantable+NFC+chip&rft_id=https%3A%2F%2Fwww.indiegogo.com%2Fprojects%2Fthe-xnt-implantable-nfc-chip&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFbpg2017\" class=\"citation\">bpg (2017-03-09), <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/vimeo.com\/207688901\" target=\"_blank\"><i>PRMT | Ghost In the Shell | Live Stream<\/i><\/a><span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">2017-05-26<\/span><\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=PRMT+%7C+Ghost+In+the+Shell+%7C+Live+Stream&rft.date=2017-03-09&rft.au=bpg&rft_id=https%3A%2F%2Fvimeo.com%2F207688901&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFTEDx_Talks2013\" class=\"citation\">TEDx Talks (2013-10-17), <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=7DxVWhFLI6E\" target=\"_blank\"><i>Biohacking - the forefront of a new kind of human evolution: Amal Graafstra at TEDxSFU<\/i><\/a><span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">2017-05-26<\/span><\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Biohacking+-+the+forefront+of+a+new+kind+of+human+evolution%3A+Amal+Graafstra+at+TEDxSFU&rft.date=2013-10-17&rft.au=TEDx+Talks&rft_id=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3D7DxVWhFLI6E&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFMotherboard2017\" class=\"citation\">Motherboard (2017-03-23), <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=sXtqBVbxmto&t=33m39s\" target=\"_blank\"><i>Who Killed the Smart Gun?<\/i><\/a><span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">2017-05-26<\/span><\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Who+Killed+the+Smart+Gun%3F&rft.date=2017-03-23&rft.au=Motherboard&rft_id=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DsXtqBVbxmto%26t%3D33m39s&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.youtube.com\/watch?v=w2gKJeM6Ihw\" target=\"_blank\">https:\/\/www.youtube.com\/watch?v=w2gKJeM6Ihw<\/a> link Fox News Interviews Mikey Sklar<\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/jon.oxer.com.au\/blog\/id\/86\" target=\"_blank\">\"Jondo the Mandroid is RFID enabled\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Jondo+the+Mandroid+is+RFID+enabled&rft_id=http%3A%2F%2Fjon.oxer.com.au%2Fblog%2Fid%2F86&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Clark, Liat (November 11, 2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.wired.co.uk\/news\/archive\/2014-11\/11\/mr-bitcoin-nfc-implant\" target=\"_blank\">\"Hand-implanted NFC chips open this man's bitcoin wallet\"<\/a><span class=\"reference-accessdate\">. 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target=\"_blank\">http:\/\/www.antichips.com\/cancer\/<\/a> Microchip-Induced Tumors in Laboratory Rodents and Dogs: A Review of the Literature 1990\u20132006<\/span>\n<\/li>\n<li id=\"cite_note-WashingPost-51\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-WashingPost_51-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFLewan2007\" class=\"citation\">Lewan, Todd (September 8, 2007), <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.washingtonpost.com\/wp-dyn\/content\/article\/2007\/09\/08\/AR2007090800997_pf.html\" target=\"_blank\">\"Chip Implants Linked to Animal Tumours\"<\/a>, <i>The Washington Post<\/i><span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">2010-06-08<\/span><\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Washington+Post&rft.atitle=Chip+Implants+Linked+to+Animal+Tumours&rft.date=2007-09-08&rft.aulast=Lewan&rft.aufirst=Todd&rft_id=https%3A%2F%2Fwww.washingtonpost.com%2Fwp-dyn%2Fcontent%2Farticle%2F2007%2F09%2F08%2FAR2007090800997_pf.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-52\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-52\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">RFID Journal. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.rfidjournal.com\/articles\/view?3609\" target=\"_blank\">\"VeriChip Defends the Safety of Implanted RFID Tags\"<\/a>. <i>rfidjournal.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">13 April<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=rfidjournal.com&rft.atitle=VeriChip+Defends+the+Safety+of+Implanted+RFID+Tags&rft.au=RFID+Journal&rft_id=http%3A%2F%2Fwww.rfidjournal.com%2Farticles%2Fview%3F3609&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-53\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-53\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"#t=60m53s\">https:\/\/www.youtube.com\/watch?v=CS13kFWQIYM#t=60m53s<\/a> Tumours, Tracking, and Tyranny: The Downside to Implantable Microchip<\/span>\n<\/li>\n<li id=\"cite_note-blanchard-54\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-blanchard_54-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Blanchard, K. T.; Barthel, C.; French, J. E.; Holden, H. E.; Moretz, R.; Pack, F. D.; Tennant, R. W.; Stoll, R. E. (1999). \"Transponder-Induced Sarcoma in the Heterozygous p53+\/- Mouse\". <i>Toxicologic Pathology<\/i>. <b>27<\/b> (5): 519. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F019262339902700505\" target=\"_blank\">10.1177\/019262339902700505<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Toxicologic+Pathology&rft.atitle=Transponder-Induced+Sarcoma+in+the+Heterozygous+p53%2B%2F-+Mouse&rft.volume=27&rft.issue=5&rft.pages=519&rft.date=1999&rft_id=info%3Adoi%2F10.1177%2F019262339902700505&rft.aulast=Blanchard&rft.aufirst=K.+T.&rft.au=Barthel%2C+C.&rft.au=French%2C+J.+E.&rft.au=Holden%2C+H.+E.&rft.au=Moretz%2C+R.&rft.au=Pack%2C+F.+D.&rft.au=Tennant%2C+R.+W.&rft.au=Stoll%2C+R.+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-55\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-55\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.washingtonpost.com\/wp-dyn\/content\/article\/2007\/09\/08\/AR2007090800997_pf.html\/\" target=\"_blank\">\"Lewan, Todd. The Associated Press, September 8, 2007. \"Chip Implants Linked to Animal Tumors<span class=\"cs1-kern-right\">\"<\/span>\"<\/a>. <i>washingtonpost.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=washingtonpost.com&rft.atitle=Lewan%2C+Todd.+The+Associated+Press%2C+September+8%2C+2007.+%22Chip+Implants+Linked+to+Animal+Tumors%22&rft_id=https%3A%2F%2Fwww.washingtonpost.com%2Fwp-dyn%2Fcontent%2Farticle%2F2007%2F09%2F08%2FAR2007090800997_pf.html%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-56\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-56\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.antichips.com\/cancer\/index.html\" target=\"_blank\">Studies Linking Microchips and Cancer<\/a><\/span>\n<\/li>\n<li id=\"cite_note-57\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-57\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">CEJA of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Medical_Association\" title=\"American Medical Association\" rel=\"external_link\" target=\"_blank\">American Medical Association<\/a>, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ama-assn.org\/ama1\/pub\/upload\/mm\/467\/ceja5a07.doc\" target=\"_blank\">CEJA Report 5-A-07<\/a>, Radio Frequency ID Devices in Humans, presented by Robert M. Sade, MD, Chair. 2007<\/span>\n<\/li>\n<li id=\"cite_note-Cal-58\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Cal_58-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Cal_58-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.govtech.com\/gt\/156351?topic=117688\" target=\"_blank\">California Bans Forced RFID Tagging of Humans<\/a>, <i>Government Technology<\/i> website, October 17, 2007<\/span>\n<\/li>\n<li id=\"cite_note-59\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-59\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\nTim Talley.\n<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/newsok.com\/article\/3247279\" target=\"_blank\">\"Bill bans involuntary microchip implants\"<\/a>.\n2008.<\/span>\n<\/li>\n<li id=\"cite_note-60\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-60\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\n<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ncsl.org\/research\/telecommunications-and-information-technology\/radio-frequency-identification-rfid-privacy-laws.aspx\" target=\"_blank\">\"Radio Frequency Identification (RFID) Privacy Laws\"<\/a>.\n2015.<\/span>\n<\/li>\n<li id=\"cite_note-61\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-61\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"#.U49ngS_O63U\">\"Georgia SB 235 - Ban on Required Human Microchip Implantation - Key Vote - The Voter's Self Defense System - Vote Smart\"<\/a>. <i>Project Vote Smart<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">13 April<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Project+Vote+Smart&rft.atitle=Georgia+SB+235+-+Ban+on+Required+Human+Microchip+Implantation+-+Key+Vote+-+The+Voter%27s+Self+Defense+System+-+Vote+Smart&rft_id=http%3A%2F%2Fvotesmart.org%2Fbill%2F10786%2F28834%2Fban-on-required-human-microchip-implantation%23.U49ngS_O63U&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-62\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-62\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.rawstory.com\/rs\/2010\/02\/10\/virginia-passes-law-banning-chip-implants-mark-beast\/\" target=\"_blank\">Virginia delegates pass bill banning chip implants as \u2018mark of the beast\u2019<\/a>, <i>The Raw Story<\/i>, By Daniel Tencer, Wednesday, February 10, 2010 retrieved April 23, 2010<\/span>\n<\/li>\n<li id=\"cite_note-63\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-63\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/apps.leg.wa.gov\/billinfo\/summary.aspx?year=2009&bill=1142\" target=\"_blank\">HB 1142-2009-10<\/a> to study requiring the use of implanted RFID in certain felons.<\/span>\n<\/li>\n<li id=\"cite_note-64\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-64\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mark_Dice\" title=\"Mark Dice\" rel=\"external_link\" target=\"_blank\">Dice, Mark<\/a> (July 26, 2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/MarkDice\" target=\"_blank\"><i>The Resistance Manifesto<\/i><\/a>. The Resistance. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0967346649.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Resistance+Manifesto&rft.pub=The+Resistance&rft.date=2006-07-26&rft.isbn=0967346649&rft.aulast=Dice&rft.aufirst=Mark&rft_id=https%3A%2F%2Fwww.youtube.com%2FMarkDice&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-65\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-65\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Streitfield, David (9 May 2002). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/pqasb.pqarchiver.com\/latimes\/access\/118857652.html?dids=118857652:118857652&FMT=ABS&FMTS=ABS:FT&type=current&date=May+09%2C+2002&author=DAVID+STREITFELD&pub=Los+Angeles+Times&desc=First+Humans+to+Receive+ID+Chips%3B+Technology%3A+Device+injected+under+the+skin+will+provide+identification+and+medical+information.&pqatl=google\" target=\"_blank\">\"First Humans to Receive ID Chips; Technology: Device injected under the skin will provide identification and medical information\"<\/a>. <i>Los Angeles Times<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">13 September<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Los+Angeles+Times&rft.atitle=First+Humans+to+Receive+ID+Chips%3B+Technology%3A+Device+injected+under+the+skin+will+provide+identification+and+medical+information.&rft.date=2002-05-09&rft.aulast=Streitfield&rft.aufirst=David&rft_id=https%3A%2F%2Fpqasb.pqarchiver.com%2Flatimes%2Faccess%2F118857652.html%3Fdids%3D118857652%3A118857652%26FMT%3DABS%26FMTS%3DABS%3AFT%26type%3Dcurrent%26date%3DMay%2B09%252C%2B2002%26author%3DDAVID%2BSTREITFELD%26pub%3DLos%2BAngeles%2BTimes%26desc%3DFirst%2BHumans%2Bto%2BReceive%2BID%2BChips%253B%2BTechnology%253A%2BDevice%2Binjected%2Bunder%2Bthe%2Bskin%2Bwill%2Bprovide%2Bidentification%2Band%2Bmedical%2Binformation.%26pqatl%3Dgoogle&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-66\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-66\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Gilbert, Alorie (16 February 2005). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/news.cnet.com\/8301-10784_3-5579795-7.html\" target=\"_blank\">\"Is RFID the mark of the beast?\"<\/a>. <i>CNET News<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">13 September<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=CNET+News&rft.atitle=Is+RFID+the+mark+of+the+beast%3F&rft.date=2005-02-16&rft.aulast=Gilbert&rft.aufirst=Alorie&rft_id=http%3A%2F%2Fnews.cnet.com%2F8301-10784_3-5579795-7.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-67\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-67\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.biblegateway.com\/passage\/?search=revelation%2013:16-18&version=NIV\" target=\"_blank\">\"Revelation 14:9-11\"<\/a>. Bible Gateway<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2010-07-03<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Revelation+14%3A9-11&rft.pub=Bible+Gateway&rft_id=http%3A%2F%2Fwww.biblegateway.com%2Fpassage%2F%3Fsearch%3Drevelation%252013%3A16-18%26version%3DNIV&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-68\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-68\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Katherine_Albrecht\" title=\"Katherine Albrecht\" rel=\"external_link\" target=\"_blank\">Albrecht, Katherine<\/a>; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liz_McIntyre_(writer)\" title=\"Liz McIntyre (writer)\" rel=\"external_link\" target=\"_blank\">McIntyre, Liz<\/a> (2006-01-31). <i>The Spychips Threat: Why Christians Should Resist RFID and Electronic Surveillance<\/i>. Nelson Current. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-59555-021-6.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Spychips+Threat%3A+Why+Christians+Should+Resist+RFID+and+Electronic+Surveillance&rft.pub=Nelson+Current&rft.date=2006-01-31&rft.isbn=1-59555-021-6&rft.aulast=Albrecht&rft.aufirst=Katherine&rft.au=McIntyre%2C+Liz&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-69\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-69\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Baard, Mark (2006-06-06). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.wired.com\/science\/discoveries\/news\/2006\/06\/70308\" target=\"_blank\">\"RFID: Sign of the (End) Times?\"<\/a>. Wired.com<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2009-10-13<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=RFID%3A+Sign+of+the+%28End%29+Times%3F&rft.pub=Wired.com&rft.date=2006-06-06&rft.aulast=Baard&rft.aufirst=Mark&rft_id=https%3A%2F%2Fwww.wired.com%2Fscience%2Fdiscoveries%2Fnews%2F2006%2F06%2F70308&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-70\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-70\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Scheeres, Julia (6 February 2002). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/archive.wired.com\/politics\/security\/news\/2002\/02\/50187?currentPage=2\" target=\"_blank\">\"They Want Their ID Chips Now\"<\/a>. <i>Wired News<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">13 September<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Wired+News&rft.atitle=They+Want+Their+ID+Chips+Now&rft.date=2002-02-06&rft.aulast=Scheeres&rft.aufirst=Julia&rft_id=http%3A%2F%2Farchive.wired.com%2Fpolitics%2Fsecurity%2Fnews%2F2002%2F02%2F50187%3FcurrentPage%3D2&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation book\">Haag, Stephen; Cummings, Maeve,; McCubbrey, Donald (2004). <i>Management Information Systems for the Information Age<\/i> (4th ed.). New York City, New York: McGraw-Hill. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-07-281947-2.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Management+Information+Systems+for+the+Information+Age&rft.place=New+York+City%2C+New+York&rft.edition=4th&rft.pub=McGraw-Hill&rft.date=2004&rft.isbn=0-07-281947-2&rft.aulast=Haag&rft.aufirst=Stephen&rft.au=Cummings%2C+Maeve%2C&rft.au=McCubbrey%2C+Donald&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Graafstra, Amal (2004). <i>RFID Toys: 11 Cool Projects for Home, Office and Entertainment<\/i> (4th ed.). New York City, New York: (ExtremeTech) Ziff Davis Publishing Holdings Inc. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-471-77196-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=RFID+Toys%3A+11+Cool+Projects+for+Home%2C+Office+and+Entertainment&rft.place=New+York+City%2C+New+York&rft.edition=4th&rft.pub=%28ExtremeTech%29+Ziff+Davis+Publishing+Holdings+Inc.&rft.date=2004&rft.isbn=0-471-77196-1&rft.aulast=Graafstra&rft.aufirst=Amal&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMicrochip+implant+%28human%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1324\nCached time: 20181129160604\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.548 seconds\nReal time usage: 0.643 seconds\nPreprocessor visited node count: 2616\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 92950\/2097152 bytes\nTemplate argument size: 1088\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 6\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 143992\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.324\/10.000 seconds\nLua memory usage: 5.73 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 559.663 1 -total\n<\/p>\n<pre>71.43% 399.742 1 Template:Reflist\n21.21% 118.698 30 Template:Cite_web\n16.48% 92.220 7 Template:Cite_news\n11.11% 62.199 2 Template:Citation_needed\n 9.71% 54.336 2 Template:Fix\n 8.71% 48.749 5 Template:Cite_book\n 8.00% 44.771 5 Template:Cite_journal\n 5.83% 32.652 4 Template:Category_handler\n 5.25% 29.374 5 Template:Citation\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:25004968-1!canonical and timestamp 20181129160603 and revision id 871146215\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Microchip_implant_%28human%29\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212142\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.046 seconds\nReal time usage: 0.197 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 189.113 1 - wikipedia:Microchip_implant_(human)\n100.00% 189.113 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8042-0!*!*!*!*!*!* and timestamp 20181217212142 and revision id 24152\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Microchip_implant_(human)\">https:\/\/www.limswiki.org\/index.php\/Microchip_implant_(human)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","6f82a58abdc5f62be708c1c05caa09c3_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/81\/Dr_Mark_Gasson_has_an_RFID_microchip_implanted_in_his_left_hand_by_a_surgeon_%28March_16_2009%29.jpg\/440px-Dr_Mark_Gasson_has_an_RFID_microchip_implanted_in_his_left_hand_by_a_surgeon_%28March_16_2009%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/96\/RFID_hand.jpg\/440px-RFID_hand.jpg"],"6f82a58abdc5f62be708c1c05caa09c3_timestamp":1545081702,"279e17db72db9e8fec2802cf9fe6a997_type":"article","279e17db72db9e8fec2802cf9fe6a997_title":"Medical-grade silicone","279e17db72db9e8fec2802cf9fe6a997_url":"https:\/\/www.limswiki.org\/index.php\/Medical-grade_silicone","279e17db72db9e8fec2802cf9fe6a997_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMedical-grade silicone\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tMedical grade silicones are silicones tested for biocompatibility and are appropriate to be used for medical applications. In the United States, the Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH) regulates devices implanted into the body. It does not regulate materials other than certain dental materials. The FDA regulate silicones used in food contact under the auspices of the Center for Food Safety and Nutrition (CFSAN) and for use in pharmaceuticals under the auspices of the Center for Drug Evaluation and Research (CDER).\nMedical grade silicones are generally grouped into three categories: non implantable, short term implantable, and long-term implantable. Materials approved as Class V and VI can be considered medical grade. Most medical grade silicones are at least Class VI certified. Silicone suppliers and some silicone prototyping companies provide guidelines for material use.[1]\n[2]\n\n<\/p>\r\n\n\nContents \n\n1 Uses \n2 Limitations \n3 See also \n4 References \n\n\nUses \nTubing\nDrains\nFeeding tubes\nCatheters\nImplants for long and short term use\nSeals and gaskets\nSyringe pistons\nScar Treatment Silicone Sheets (FDA Class 1 Medical Device) and gels.\nCondoms\nMenstrual cups\nSex toys\nNon-Stick Containers\nRespiratory masks[3]\nLimitations \nSilicone rubber applications such as catheters are widespread in medicine, but have several limitations. For example, they exhibit poor tear strength and poor resistance to fatigue. Brittle fracture can occur from defects within sections owing to poor control of vulcanization. It resulted in high failure rates for breast implants, and much subsequent litigation in the USA, as well as elsewhere in the world. It led to a crisis of confidence in the US, with many manufacturers being forced out of the business entirely, and others to manufacture under FDA control.\n\nSee also \nSilicone\nUnited States Pharmacopeia\nU.S. Food and Drug Administration\nSilicone rubber\nPolymers\nPlastics engineering\nReferences \n\n^ - Silicone Molding Design Manual \n\n^ \"Silicone Straw\". Wednesday, 10 October 2018 \n\n^ http:\/\/www.cva-silicone.com\/en\/silicone-life-sciences \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical-grade_silicone\">https:\/\/www.limswiki.org\/index.php\/Medical-grade_silicone<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:13.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 560 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","279e17db72db9e8fec2802cf9fe6a997_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Medical-grade_silicone skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Medical-grade silicone<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Medical grade silicones<\/b> are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicones<\/a> tested for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatibility<\/a> and are appropriate to be used for medical applications. In the United States, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> (FDA) Center for Devices and Radiological Health (CDRH) regulates devices <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implanted<\/a> into the body. It does not regulate materials other than certain dental materials. The FDA regulate silicones used in food contact under the auspices of the Center for Food Safety and Nutrition (CFSAN) and for use in pharmaceuticals under the auspices of the Center for Drug Evaluation and Research (CDER).\n<\/p><p>Medical grade silicones are generally grouped into three categories: non implantable, short term implantable, and long-term implantable. Materials approved as Class V and VI can be considered medical grade. Most medical grade silicones are at least Class VI certified. Silicone suppliers and some silicone prototyping companies provide guidelines for material use.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<p><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<\/p><p><br \/>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Uses\">Uses<\/span><\/h2>\n<ul><li>Tubing<\/li>\n<li>Drains<\/li>\n<li>Feeding tubes<\/li>\n<li>Catheters<\/li>\n<li>Implants for long and short term use<\/li>\n<li>Seals and gaskets<\/li>\n<li>Syringe pistons<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone_scar_sheet\" class=\"mw-redirect\" title=\"Silicone scar sheet\" rel=\"external_link\" target=\"_blank\">Scar Treatment Silicone Sheets<\/a> (FDA Class 1 Medical Device) and gels.<\/li>\n<li>Condoms<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Menstrual_cup\" title=\"Menstrual cup\" rel=\"external_link\" target=\"_blank\">Menstrual cups<\/a><\/li>\n<li>Sex toys<\/li>\n<li>Non-Stick Containers<\/li>\n<li>Respiratory masks<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Limitations\">Limitations<\/span><\/h2>\n<p>Silicone rubber applications such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheters<\/a> are widespread in medicine, but have several limitations. For example, they exhibit poor tear <a href=\"https:\/\/en.wikipedia.org\/wiki\/Strength_of_materials\" title=\"Strength of materials\" rel=\"external_link\" target=\"_blank\">strength<\/a> and poor resistance to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fatigue_(material)\" title=\"Fatigue (material)\" rel=\"external_link\" target=\"_blank\">fatigue<\/a>. Brittle fracture can occur from defects within sections owing to poor control of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vulcanization\" title=\"Vulcanization\" rel=\"external_link\" target=\"_blank\">vulcanization<\/a>. It resulted in high failure rates for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_implant\" title=\"Breast implant\" rel=\"external_link\" target=\"_blank\">breast implants<\/a>, and much subsequent litigation in the USA, as well as elsewhere in the world. It led to a crisis of confidence in the US, with many manufacturers being forced out of the business entirely, and others to manufacture under FDA control.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">Silicone<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Pharmacopeia\" title=\"United States Pharmacopeia\" rel=\"external_link\" target=\"_blank\">United States Pharmacopeia<\/a><\/li>\n<li>U.S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone_rubber\" title=\"Silicone rubber\" rel=\"external_link\" target=\"_blank\">Silicone rubber<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymers\" class=\"mw-redirect\" title=\"Polymers\" rel=\"external_link\" target=\"_blank\">Polymers<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastics_engineering\" title=\"Plastics engineering\" rel=\"external_link\" target=\"_blank\">Plastics engineering<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.albright1.com\/manual\" target=\"_blank\">- Silicone Molding Design Manual<\/a><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/siliconestraws.com.au\" target=\"_blank\">\"Silicone Straw\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Silicone+Straw&rft_id=https%3A%2F%2Fsiliconestraws.com.au&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+grade+silicone\" class=\"Z3988\"><\/span> Wednesday, 10 October 2018 <\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.cva-silicone.com\/en\/silicone-life-sciences\" target=\"_blank\">http:\/\/www.cva-silicone.com\/en\/silicone-life-sciences<\/a><\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1243\nCached time: 20181217110833\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.092 seconds\nReal time usage: 0.114 seconds\nPreprocessor visited node count: 78\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 754\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 3\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 3023\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.052\/10.000 seconds\nLua memory usage: 1.31 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 87.740 1 Template:Cite_web\n100.00% 87.740 1 -total\n-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:25944940-1!canonical and timestamp 20181217110833 and revision id 863275332\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_grade_silicone\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212142\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.009 seconds\nReal time usage: 0.160 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 153.955 1 - wikipedia:Medical_grade_silicone\n100.00% 153.955 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8041-0!*!*!*!*!*!* and timestamp 20181217212142 and revision id 24151\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical-grade_silicone\">https:\/\/www.limswiki.org\/index.php\/Medical-grade_silicone<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","279e17db72db9e8fec2802cf9fe6a997_images":[],"279e17db72db9e8fec2802cf9fe6a997_timestamp":1545081702,"6866114d4b93b0334e5b71a4d91ae088_type":"article","6866114d4b93b0334e5b71a4d91ae088_title":"Lumbar anterior root stimulator","6866114d4b93b0334e5b71a4d91ae088_url":"https:\/\/www.limswiki.org\/index.php\/Lumbar_anterior_root_stimulator","6866114d4b93b0334e5b71a4d91ae088_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tLumbar anterior root stimulator\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article relies too much on references to primary sources. Please improve this by adding secondary or tertiary sources. (November 2013) (Learn how and when to remove this template message)\n Spinal lumbar pain\nA lumbar anterior root stimulator is a type of neuroprosthesis used in patients suffering from a spinal cord injury or to treat some forms of chronic spinal pain.[1][2] More specifically, the root stimulator can be used in patients who have lost proper bowel function due to damaged neurons related to gastrointestinal control and potentially allow paraplegics to exercise otherwise paralyzed leg muscles.[3][4]\n\nContents \n\n1 Usage \n\n1.1 Bowel control \n1.2 Treatment of chronic pain \n1.3 Muscle stimulation \n\n\n2 Related issues \n\n2.1 Spinal cord injury \n2.2 Gastrointestinal issues \n2.3 Paraplegia \n\n\n3 Complications \n4 References \n\n\nUsage \nThe lumbar anterior root stimulator is similar in nature to Brindley's sacral anterior root stimulator. The difference in nomenclature is derived from which nerve roots on the spinal cord are being electrically stimulated. However the two types may be used in conjunction and may be referred to as sacro-lumbar root stimulators or lumbo-sacral root stimulators which seem to be the most researched in literature. The stimulators are implanted from the anterior side due to easier access of the spine below the cervical vertebrae.\n\nBowel control \nLoss of bowel control due to severed nerves in the spinal cord is one of the more common reasons for lumbar root stimulator usage. Patients in such a condition often suffer from gastrointestinal issues such as incontinence, diarrhea, or an inability to completely evacuate the urinary tract. This is in turn puts the patient at further risk for more complications such as a urinary tract infection. Giles Brindley initially developed for paraplegic patients with diminished or no bladder control as severed neurons affected both the gastrointestinal system and the mobility of the lower limbs.[3] Root stimulators are mounted onto the anterior roots of the spinal cord and electrically stimulate the neurons allowing them to propagate signals in their respective pathways and thus restore overall gastrointestinal function. Additional studies showed that a rhizotomy may also be performed on patients with the implant to reduce sensory reflexes which may otherwise inhibit the device's function. The procedure has been shown to both improve the device's function and reduce overall patient discomfort since the device is less likely to be rejected by the patient's body.[5]\n\nTreatment of chronic pain \nThe spine is an important part of pain sensation as many pathways pass from the extremities through the spine into the brain. As such, dysfunctional nerves in the spine can unnecessarily signal pain even when there is no reason for the pain. Some research has been conducted in potentially using the prosthesis to help treat chronic pain related to failed back syndrome or discogenic low back pain as an alternative to stimulating the entire dorsal column. Stimulation of the nerve roots has been shown as a potential alternative for those who suffer chronic pain and either have not had success with conventional spinal cord stimulation or do not qualify for that treatment option. The stimulators are able to focus stimulation on the nerve roots of the spine and hypothetically improve the relief of neuropathic pain signals sent through the spinal cord. The study showed some promise as all subjects indicated some degree of pain relief.\n[2] While this method may be more effective, it carries with it important risks that must be considered. Direct stimulation of the root risks greater neurological damage due to intra-operative spinal cord injury which in turn would yield further complications.[6]\n\nMuscle stimulation \nDonaldson and Perkins theorized the ability to use lumbar root stimulation in conjunction with a multi-moment chair in order to restore control of leg function in paraplegic patients. A multi-moment chair is a device used to record movement data of the leg in different directions. The researchers were able to generate muscle action through the devices and were later able to display leg control in a cycling paraplegic patient. Lumbar root stimulation poses unique advantage over peripheral motor nerves stimulation in terms of accessibility to target effectors. Activation of peripheral motor nerves is limited to small group of muscles and thus stimulation will only result in a considerably more localized response. On the other hand, root stimulation operates at a higher level of muscle control and therefore has wider targeting. The inherent tradeoff is the difficulty of controlling and predicting the response of the targets. The multi-moment chair was used to measure the responsiveness of the muscle across multiple axes to predict how stimulation of the root would affect the quadriceps and create more predictive model to better understand the relationship between lumbar root stimulation and the leg response.[7] An ongoing problem with patients suffering from paralysis was the inability to exercise the muscles causing them to atrophy. Using the previous study, researchers focused on using the sacro-lumbar anterior root stimulator to give patients the ability to cycle. Cycling is non-weight bearing has a simpler motion compared to other forms of low impact exercises such as walking. The stimulators allowed one patient cycle up to 1.2 km in one try and were able to create a \"fluid cycling gait.\"\n[4]\n\nRelated issues \nSpinal cord injury \nSpinal cord injuries have many causes, and result in a high comorbidity. In other words, victims of spinal cord injuries tend to develop many other health problems due to the importance of the spine in the central nervous system. SCI has a prevalence of up to 55 per million people in the United States alone while approximately 10,000 new cases occur annually. Car crashes are the highest contributor while violence and recreational activities are causes as well.[8] While spinal cord injury is a broad and widely-encompassing term, root stimulators may be used for many instances of SCIs.[3] \nFor example, certain cases of spinal cord injuries may sever key nerves necessary to maintain bladder and bowel control. The severance is often the cause of Neurogenic Bowel Dysfunction.[9] \nSimilarly, spinal cord injuries can potentially cause a loss of motor control in lower limbs, such as with paraplegic and tetraplegic patients. Stimulators, in turn, may be used to stimulate the muscle and treat motor control loss in order to regain function in the limbs.[4][7]\n\nGastrointestinal issues \nAs mentioned previously, neurogenic bowel dysfunction tends to occur after some form of spinal cord injury in which nerves important to control of sphincter contraction, bowel movements, and bladder control are severed or damaged.[9] Lumbar root stimulators have been used in order to treat bowel dysfunction by allowing the patient to regain control of both excretory muscles and organs. Regaining such motor control prevents further complications associated with NBD such as constipation, incontinence, and irritable bowel syndrome.[10] However, lumbar anterior root stimulators are not effective for all gastorintestinal issues. In the case of bladder control, contractions are controlled by the parasympathetic efferent pathways of the sacral section of the spine which renders lumbar stimulation ineffective. On the other hand, bladder control is closely associated with parasympathetic pathways on both the sacral and lumbar sections of the spine thus making sacro-lumbar anterior root stimulators a more viable option as it can deal with both sets of issues.[11]\n\nParaplegia \nParaplegia is a condition in which a person loses the ability to control or perceive his or her lower limbs. Patients that have lost functional limb control due to spinal cord injuries often have further complications past the point of injury. Due to paralysis, paraplegics remain unable to exercise the leg muscles and leads to muscle atrophy. In such cases, lumbar anterior root stimulators may offer a minimal and temporary solution by allowing paraplegics some capacity to exercise the legs. Some research has shown that root stimulators may allow cycling to be feasible to those who suffer from paraplegia as a proof of concept. The devices may show promise in applications of more complex leg movement processes such as walking. At the very least, they offer a potential solution to delaying the issue of atrophy in paraplegics so that they might have an easier recovery in the case that better treatments come along.[4]\n\nComplications \nRoot stimulators are far from being perfect as there are many potential complications. Approximately 18% of patients with root stimulators have reported issues with the device. Approximately 8% of stimulator reports are due to cerebrospinal fluid collecting around the stimulator which inhibits stimulator function and causes significant discomfort to the patient. Another 8% of cases are caused by receiver failure in which the patient is unable to use the stimulator effectively or is in some way \"incompatible\" with the implant. The final 2% is associated with some type of disease that requires removal of the device and puts the patient at great risk. \nTwo major studies have been associated with issues in root stimulators. One twenty-nine-year-old male cervical spinal cord injury patient had severe complications with a sacral anterior root stimulator. The patient received the implant due to a traffic collision in 1978. The patient experienced increased spasms which inhibited daily functions such as sleeping or trying to get into his car. Later on, he suffered delayed lumbar spinal fracture at the site of the implant which required its subsequent retraction. The spasms reduced in intensity when the patient decided to discontinue the use of the sacral anterior root stimulator and instead chose to use an indwelling urethral catheter. The case was cited as \"compelling evidence for disuse\" of the device. \n[12]\nA more recent study focused on a tetraplegic SCI patient whose stimulator was infected by Pseuomana aeruginosa which was found after blood-stained fluid started leaking out of a post-operative wound several days after the device was implanted. As in the aforementioned case, the patient had the device removed and lost considerable function of bowel and urinary bladder control. He had recurring instances of fecal incontinence which left him almost completely immobile and reported significant distress due to the incident. Other issues due to the failed implantation included constipation, an inability to empty the bladder, and a loss of reflexive penile erection. The case identified the high risk associated with the usage of root stimulators.\n[13]\n\n<\/p>\nReferences \n\n\n^ Domurath, B; Kutzenberger (2012). \"Modern neurological treatment strategies for patients with spinal cord injury\". Urologe. 51 (2): 184\u2013188. doi:10.1007\/s00120-011-2780-7. \n\n^ a b Alo, KM; Yland MJ; Redko V; Feler C; Naumann C. (January 1999). \"Lumbar and Sacral Nerve Root Stimulation (NRS) in the Treatment of Chronic Pain: A Novel Anatomic Approach and Neuro Stimulation Technique\". Neuromodulation. 2 (1): 23\u201331. doi:10.1046\/j.1525-1403.1999.00023.x. \n\n^ a b c Ebert, E (2012). \"Gastrointestinal Involvement in Spinal Cord Injury: a Clinical Perspective\". Journal of Gastrointestinal and Liver Diseases. 21 (1): 75\u201382. \n\n^ a b c d Perkins TA, de N Donaldson N, Hatcher NA, Swain ID, Wood DE (September 2002). \"Control of leg-powered paraplegic cycling using stimulation of the lumbo-sacral anterior spinal nerve roots\". Artif Organs. 21 (3): 158\u201364. \n\n^ Castano-Botero, JC; Ospina-Galeona I; Illanes RG; Lopera-Tora AR (2013). \"Results of Implantation of Sacral Anterior Root Stimulator Combined with Posterior Rhizotomy in Patients with Spinal Cord Injury in Latin America\". Neurourology and Urodynamics. 32: 676\u20137. \n\n^ Barolat, Giancarlo (May 2000). \"Spinal Cord Stimulation for Chronic Pain Management\". Archives of Medical Research. 31 (3): 258\u201362. doi:10.1016\/s0188-4409(00)00075-8. \n\n^ a b Donaldson, N. de N.; Perkins TA; Worley ACM (February 1996). \"Lumbar Root Stimulation for Restoring Leg Function: Stimulator and Measurement of Muscle Action\". Artificial. 21 (3): 247\u20139. doi:10.1111\/j.1525-1594.1997.tb04660.x. \n\n^ McDonald, John W.; Sandowsky, Cristina (February 2002). \"Spinal-cord injury\". Lancet. 359 (9304): 417\u201325. doi:10.1016\/s0140-6736(02)07603-1. \n\n^ a b Stiens, Steven; Susan Biener Bergman; Lance Goetz (1997). \"Neurogenic bowel dysfunction after spinal cord injury: clinical evaluation and rehabilitative management\". Archives of Physical Medicine and Rehabilitation. 78 (3): 86\u2013102. doi:10.1016\/s0003-9993(97)90416-0. \n\n^ Paris, G; Gourcerol G; Leroi AM (December 2011). \"Management of Neurogenic Bowel Dysfunction\". European Journal of Physical and Rehabilitation Medicine. 47 (4): 661\u201376. \n\n^ Benevento, Barbara; Sipski, Marca (June 2002). \"Neurogenic Bladder, Neurogenic Bowel, and Sexual Dysfunction in People With Spinal Cord Injury\". Physical Therapy. 82 (6): 601\u201312. \n\n^ Soni, BM; Oo T; Vaidyanathan S; Hughes PL; Singh G. (February 2004). \"Complications of sacral anterior root stimulator implantation in a cervical spinal cord injury patient: increased spasms requiring intrathecal baclofen therapy followed by delayed fracture of lumbar spine leading to intractable spasms compelling disuse of the sacral anterior root stimulator\". Spinal Cord. 42 (2): 136\u20138. doi:10.1038\/sj.sc.3101546. \n\n^ Vaidyanathan, Subramanium; Bakul M Soni; Tun Oo; Peter L Hughes; Paul Mansour; Gurpreet Singh (December 2009). \"Infection of Brindley sacral anterior root stimulator by Pseudomonas aeruginosa requiring removal of the implant: long-term deleterious effects on bowel and urinary bladder function in a spinal cord injury patient with tetraplegia: a case report\". Cases Journal. 2 (9364): 1\u20138. doi:10.1186\/1757-1626-2-9364. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Lumbar_anterior_root_stimulator\">https:\/\/www.limswiki.org\/index.php\/Lumbar_anterior_root_stimulator<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 22:20.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 573 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","6866114d4b93b0334e5b71a4d91ae088_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Lumbar_anterior_root_stimulator skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Lumbar anterior root stimulator<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Spondylolysis-_back_pain.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3e\/Spondylolysis-_back_pain.jpg\/220px-Spondylolysis-_back_pain.jpg\" width=\"220\" height=\"295\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Spondylolysis-_back_pain.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Spinal lumbar pain<\/div><\/div><\/div>\n<p>A <b>lumbar anterior root stimulator<\/b> is a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroprosthetic\" class=\"mw-redirect\" title=\"Neuroprosthetic\" rel=\"external_link\" target=\"_blank\">neuroprosthesis<\/a> used in patients suffering from a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord_injury\" title=\"Spinal cord injury\" rel=\"external_link\" target=\"_blank\">spinal cord injury<\/a> or to treat some forms of chronic spinal pain.<sup id=\"rdp-ebb-cite_ref-Domurath_1-0\" class=\"reference\"><a href=\"#cite_note-Domurath-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-KM_2-0\" class=\"reference\"><a href=\"#cite_note-KM-2\" rel=\"external_link\">[2]<\/a><\/sup> More specifically, the root stimulator can be used in patients who have lost proper <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bowel\" class=\"mw-redirect\" title=\"Bowel\" rel=\"external_link\" target=\"_blank\">bowel<\/a> function due to damaged <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurons\" class=\"mw-redirect\" title=\"Neurons\" rel=\"external_link\" target=\"_blank\">neurons<\/a> related to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastrointestinal\" class=\"mw-redirect\" title=\"Gastrointestinal\" rel=\"external_link\" target=\"_blank\">gastrointestinal<\/a> control and potentially allow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paraplegics\" class=\"mw-redirect\" title=\"Paraplegics\" rel=\"external_link\" target=\"_blank\">paraplegics<\/a> to exercise otherwise paralyzed leg <a href=\"https:\/\/en.wikipedia.org\/wiki\/Muscles\" class=\"mw-redirect\" title=\"Muscles\" rel=\"external_link\" target=\"_blank\">muscles<\/a>.<sup id=\"rdp-ebb-cite_ref-Ebert_3-0\" class=\"reference\"><a href=\"#cite_note-Ebert-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Perkins_4-0\" class=\"reference\"><a href=\"#cite_note-Perkins-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Usage\">Usage<\/span><\/h2>\n<p>The lumbar anterior root stimulator is similar in nature to Brindley's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sacral_anterior_root_stimulator\" title=\"Sacral anterior root stimulator\" rel=\"external_link\" target=\"_blank\">sacral anterior root stimulator<\/a>. The difference in nomenclature is derived from which nerve roots on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord\" title=\"Spinal cord\" rel=\"external_link\" target=\"_blank\">spinal cord<\/a> are being electrically stimulated. However the two types may be used in conjunction and may be referred to as sacro-lumbar root stimulators or lumbo-sacral root stimulators which seem to be the most researched in literature. The stimulators are implanted from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anterior\" class=\"mw-redirect\" title=\"Anterior\" rel=\"external_link\" target=\"_blank\">anterior<\/a> side due to easier access of the spine below the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cervical_vertebrae\" title=\"Cervical vertebrae\" rel=\"external_link\" target=\"_blank\">cervical vertebrae<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Bowel_control\">Bowel control<\/span><\/h3>\n<p>Loss of bowel control due to severed nerves in the spinal cord is one of the more common reasons for lumbar root stimulator usage. Patients in such a condition often suffer from gastrointestinal issues such as incontinence, diarrhea, or an inability to completely evacuate the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinary_tract\" class=\"mw-redirect\" title=\"Urinary tract\" rel=\"external_link\" target=\"_blank\">urinary tract<\/a>. This is in turn puts the patient at further risk for more complications such as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinary_tract_infection\" title=\"Urinary tract infection\" rel=\"external_link\" target=\"_blank\">urinary tract infection<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Giles_Brindley\" title=\"Giles Brindley\" rel=\"external_link\" target=\"_blank\">Giles Brindley<\/a> initially developed for paraplegic patients with diminished or no bladder control as severed neurons affected both the gastrointestinal system and the mobility of the lower limbs.<sup id=\"rdp-ebb-cite_ref-Ebert_3-1\" class=\"reference\"><a href=\"#cite_note-Ebert-3\" rel=\"external_link\">[3]<\/a><\/sup> Root stimulators are mounted onto the anterior roots of the spinal cord and electrically stimulate the neurons allowing them to propagate signals in their respective pathways and thus restore overall gastrointestinal function. Additional studies showed that a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rhizotomy\" title=\"Rhizotomy\" rel=\"external_link\" target=\"_blank\">rhizotomy<\/a> may also be performed on patients with the implant to reduce sensory <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reflexes\" class=\"mw-redirect\" title=\"Reflexes\" rel=\"external_link\" target=\"_blank\">reflexes<\/a> which may otherwise inhibit the device's function. The procedure has been shown to both improve the device's function and reduce overall patient discomfort since the device is less likely to be rejected by the patient's body.<sup id=\"rdp-ebb-cite_ref-Latin_America_5-0\" class=\"reference\"><a href=\"#cite_note-Latin_America-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Treatment_of_chronic_pain\">Treatment of chronic pain<\/span><\/h3>\n<p>The spine is an important part of pain sensation as many pathways pass from the extremities through the spine into the brain. As such, dysfunctional nerves in the spine can unnecessarily signal pain even when there is no reason for the pain. Some research has been conducted in potentially using the prosthesis to help treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_pain\" title=\"Chronic pain\" rel=\"external_link\" target=\"_blank\">chronic pain<\/a> related to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Failed_back_syndrome\" title=\"Failed back syndrome\" rel=\"external_link\" target=\"_blank\">failed back syndrome<\/a> or discogenic low back pain as an alternative to stimulating the entire <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dorsal_column\" class=\"mw-redirect\" title=\"Dorsal column\" rel=\"external_link\" target=\"_blank\">dorsal column<\/a>. Stimulation of the nerve roots has been shown as a potential alternative for those who suffer chronic pain and either have not had success with conventional spinal cord stimulation or do not qualify for that treatment option. The stimulators are able to focus stimulation on the nerve roots of the spine and hypothetically improve the relief of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuropathic_pain\" title=\"Neuropathic pain\" rel=\"external_link\" target=\"_blank\">neuropathic pain<\/a> signals sent through the spinal cord. The study showed some promise as all subjects indicated some degree of pain relief.\n<sup id=\"rdp-ebb-cite_ref-KM_2-1\" class=\"reference\"><a href=\"#cite_note-KM-2\" rel=\"external_link\">[2]<\/a><\/sup> While this method may be more effective, it carries with it important risks that must be considered. Direct stimulation of the root risks greater neurological damage due to intra-operative spinal cord injury which in turn would yield further complications.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Muscle_stimulation\">Muscle stimulation<\/span><\/h3>\n<p>Donaldson and Perkins theorized the ability to use lumbar root stimulation in conjunction with a multi-moment chair in order to restore control of leg function in paraplegic patients. A multi-moment chair is a device used to record movement data of the leg in different directions. The researchers were able to generate muscle action through the devices and were later able to display leg control in a cycling paraplegic patient. Lumbar root stimulation poses unique advantage over peripheral motor nerves stimulation in terms of accessibility to target effectors. Activation of peripheral motor nerves is limited to small group of muscles and thus stimulation will only result in a considerably more localized response. On the other hand, root stimulation operates at a higher level of muscle control and therefore has wider targeting. The inherent tradeoff is the difficulty of controlling and predicting the response of the targets. The multi-moment chair was used to measure the responsiveness of the muscle across multiple axes to predict how stimulation of the root would affect the quadriceps and create more predictive model to better understand the relationship between lumbar root stimulation and the leg response.<sup id=\"rdp-ebb-cite_ref-Donaldson_7-0\" class=\"reference\"><a href=\"#cite_note-Donaldson-7\" rel=\"external_link\">[7]<\/a><\/sup> An ongoing problem with patients suffering from paralysis was the inability to exercise the muscles causing them to atrophy. Using the previous study, researchers focused on using the sacro-lumbar anterior root stimulator to give patients the ability to cycle. Cycling is non-weight bearing has a simpler motion compared to other forms of low impact exercises such as walking. The stimulators allowed one patient cycle up to 1.2 km in one try and were able to create a \"fluid cycling gait.\"\n<sup id=\"rdp-ebb-cite_ref-Perkins_4-1\" class=\"reference\"><a href=\"#cite_note-Perkins-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Related_issues\">Related issues<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Spinal_cord_injury\">Spinal cord injury<\/span><\/h3>\n<p>Spinal cord injuries have many causes, and result in a high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Comorbidity\" title=\"Comorbidity\" rel=\"external_link\" target=\"_blank\">comorbidity<\/a>. In other words, victims of spinal cord injuries tend to develop many other health problems due to the importance of the spine in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Central_nervous_system\" title=\"Central nervous system\" rel=\"external_link\" target=\"_blank\">central nervous system<\/a>. SCI has a prevalence of up to 55 per million people in the United States alone while approximately 10,000 new cases occur annually. Car crashes are the highest contributor while violence and recreational activities are causes as well.<sup id=\"rdp-ebb-cite_ref-SCI_stats_8-0\" class=\"reference\"><a href=\"#cite_note-SCI_stats-8\" rel=\"external_link\">[8]<\/a><\/sup> While spinal cord injury is a broad and widely-encompassing term, root stimulators may be used for many instances of SCIs.<sup id=\"rdp-ebb-cite_ref-Ebert_3-2\" class=\"reference\"><a href=\"#cite_note-Ebert-3\" rel=\"external_link\">[3]<\/a><\/sup> \nFor example, certain cases of spinal cord injuries may sever key nerves necessary to maintain bladder and bowel control. The severance is often the cause of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurogenic_Bowel_Dysfunction\" class=\"mw-redirect\" title=\"Neurogenic Bowel Dysfunction\" rel=\"external_link\" target=\"_blank\">Neurogenic Bowel Dysfunction<\/a>.<sup id=\"rdp-ebb-cite_ref-Stiens_NBS_9-0\" class=\"reference\"><a href=\"#cite_note-Stiens_NBS-9\" rel=\"external_link\">[9]<\/a><\/sup> \nSimilarly, spinal cord injuries can potentially cause a loss of motor control in lower limbs, such as with paraplegic and tetraplegic patients. Stimulators, in turn, may be used to stimulate the muscle and treat motor control loss in order to regain function in the limbs.<sup id=\"rdp-ebb-cite_ref-Perkins_4-2\" class=\"reference\"><a href=\"#cite_note-Perkins-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Donaldson_7-1\" class=\"reference\"><a href=\"#cite_note-Donaldson-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Gastrointestinal_issues\">Gastrointestinal issues<\/span><\/h3>\n<p>As mentioned previously, neurogenic bowel dysfunction tends to occur after some form of spinal cord injury in which nerves important to control of sphincter contraction, bowel movements, and bladder control are severed or damaged.<sup id=\"rdp-ebb-cite_ref-Stiens_NBS_9-1\" class=\"reference\"><a href=\"#cite_note-Stiens_NBS-9\" rel=\"external_link\">[9]<\/a><\/sup> Lumbar root stimulators have been used in order to treat bowel dysfunction by allowing the patient to regain control of both excretory muscles and organs. Regaining such motor control prevents further complications associated with NBD such as constipation, incontinence, and irritable bowel syndrome.<sup id=\"rdp-ebb-cite_ref-Paris_NBS_10-0\" class=\"reference\"><a href=\"#cite_note-Paris_NBS-10\" rel=\"external_link\">[10]<\/a><\/sup> However, lumbar anterior root stimulators are not effective for all gastorintestinal issues. In the case of bladder control, contractions are controlled by the parasympathetic efferent pathways of the sacral section of the spine which renders lumbar stimulation ineffective. On the other hand, bladder control is closely associated with parasympathetic pathways on both the sacral and lumbar sections of the spine thus making sacro-lumbar anterior root stimulators a more viable option as it can deal with both sets of issues.<sup id=\"rdp-ebb-cite_ref-gastro_11-0\" class=\"reference\"><a href=\"#cite_note-gastro-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Paraplegia\">Paraplegia<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Paraplegia\" title=\"Paraplegia\" rel=\"external_link\" target=\"_blank\">Paraplegia<\/a> is a condition in which a person loses the ability to control or perceive his or her lower limbs. Patients that have lost functional limb control due to spinal cord injuries often have further complications past the point of injury. Due to paralysis, paraplegics remain unable to exercise the leg muscles and leads to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Muscle_atrophy\" title=\"Muscle atrophy\" rel=\"external_link\" target=\"_blank\">muscle atrophy<\/a>. In such cases, lumbar anterior root stimulators may offer a minimal and temporary solution by allowing paraplegics some capacity to exercise the legs. Some research has shown that root stimulators may allow cycling to be feasible to those who suffer from paraplegia as a proof of concept. The devices may show promise in applications of more complex leg movement processes such as walking. At the very least, they offer a potential solution to delaying the issue of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrophy\" title=\"Atrophy\" rel=\"external_link\" target=\"_blank\">atrophy<\/a> in paraplegics so that they might have an easier recovery in the case that better treatments come along.<sup id=\"rdp-ebb-cite_ref-Perkins_4-3\" class=\"reference\"><a href=\"#cite_note-Perkins-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Complications\">Complications<\/span><\/h2>\n<p>Root stimulators are far from being perfect as there are many potential complications. Approximately 18% of patients with root stimulators have reported issues with the device. Approximately 8% of stimulator reports are due to cerebrospinal fluid collecting around the stimulator which inhibits stimulator function and causes significant discomfort to the patient. Another 8% of cases are caused by receiver failure in which the patient is unable to use the stimulator effectively or is in some way \"incompatible\" with the implant. The final 2% is associated with some type of disease that requires removal of the device and puts the patient at great risk. \nTwo major studies have been associated with issues in root stimulators. One twenty-nine-year-old male cervical spinal cord injury patient had severe complications with a sacral anterior root stimulator. The patient received the implant due to a traffic collision in 1978. The patient experienced increased spasms which inhibited daily functions such as sleeping or trying to get into his car. Later on, he suffered delayed lumbar spinal fracture at the site of the implant which required its subsequent retraction. The spasms reduced in intensity when the patient decided to discontinue the use of the sacral anterior root stimulator and instead chose to use an indwelling urethral catheter. The case was cited as \"compelling evidence for disuse\" of the device. \n<sup id=\"rdp-ebb-cite_ref-Soni_12-0\" class=\"reference\"><a href=\"#cite_note-Soni-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p>A more recent study focused on a tetraplegic SCI patient whose stimulator was infected by Pseuomana aeruginosa which was found after blood-stained fluid started leaking out of a post-operative wound several days after the device was implanted. As in the aforementioned case, the patient had the device removed and lost considerable function of bowel and urinary bladder control. He had recurring instances of fecal incontinence which left him almost completely immobile and reported significant distress due to the incident. Other issues due to the failed implantation included constipation, an inability to empty the bladder, and a loss of reflexive penile erection. The case identified the high risk associated with the usage of root stimulators.\n<p><sup id=\"rdp-ebb-cite_ref-Vdawg_13-0\" class=\"reference\"><a href=\"#cite_note-Vdawg-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-Domurath-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Domurath_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Domurath, B; Kutzenberger (2012). \"Modern neurological treatment strategies for patients with spinal cord injury\". <i>Urologe<\/i>. <b>51<\/b> (2): 184\u2013188. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00120-011-2780-7\" target=\"_blank\">10.1007\/s00120-011-2780-7<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Urologe&rft.atitle=Modern+neurological+treatment+strategies+for+patients+with+spinal+cord+injury&rft.volume=51&rft.issue=2&rft.pages=184-188&rft.date=2012&rft_id=info%3Adoi%2F10.1007%2Fs00120-011-2780-7&rft.aulast=Domurath&rft.aufirst=B&rft.au=Kutzenberger&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALumbar+anterior+root+stimulator\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-KM-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-KM_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-KM_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Alo, KM; Yland MJ; Redko V; Feler C; Naumann C. (January 1999). \"Lumbar and Sacral Nerve Root Stimulation (NRS) in the Treatment of Chronic Pain: A Novel Anatomic Approach and Neuro Stimulation Technique\". <i>Neuromodulation<\/i>. <b>2<\/b> (1): 23\u201331. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1046%2Fj.1525-1403.1999.00023.x\" target=\"_blank\">10.1046\/j.1525-1403.1999.00023.x<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuromodulation&rft.atitle=Lumbar+and+Sacral+Nerve+Root+Stimulation+%28NRS%29+in+the+Treatment+of+Chronic+Pain%3A+A+Novel+Anatomic+Approach+and+Neuro+Stimulation+Technique&rft.volume=2&rft.issue=1&rft.pages=23-31&rft.date=1999-01&rft_id=info%3Adoi%2F10.1046%2Fj.1525-1403.1999.00023.x&rft.aulast=Alo&rft.aufirst=KM&rft.au=Yland+MJ&rft.au=Redko+V&rft.au=Feler+C&rft.au=Naumann+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALumbar+anterior+root+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Ebert-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Ebert_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ebert_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Ebert_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ebert, E (2012). \"Gastrointestinal Involvement in Spinal Cord Injury: a Clinical Perspective\". <i>Journal of Gastrointestinal and Liver Diseases<\/i>. <b>21<\/b> (1): 75\u201382.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Gastrointestinal+and+Liver+Diseases&rft.atitle=Gastrointestinal+Involvement+in+Spinal+Cord+Injury%3A+a+Clinical+Perspective&rft.volume=21&rft.issue=1&rft.pages=75-82&rft.date=2012&rft.aulast=Ebert&rft.aufirst=E&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALumbar+anterior+root+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Perkins-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Perkins_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Perkins_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Perkins_4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Perkins_4-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Perkins TA, de N Donaldson N, Hatcher NA, Swain ID, Wood DE (September 2002). \"Control of leg-powered paraplegic cycling using stimulation of the lumbo-sacral anterior spinal nerve roots\". <i>Artif Organs<\/i>. <b>21<\/b> (3): 158\u201364.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Artif+Organs&rft.atitle=Control+of+leg-powered+paraplegic+cycling+using+stimulation+of+the+lumbo-sacral+anterior+spinal+nerve+roots&rft.volume=21&rft.issue=3&rft.pages=158-64&rft.date=2002-09&rft.aulast=Perkins&rft.aufirst=TA&rft.au=de+N+Donaldson+N&rft.au=Hatcher%2C+NA&rft.au=Swain%2C+ID&rft.au=Wood%2C+DE&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALumbar+anterior+root+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Latin_America-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Latin_America_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Castano-Botero, JC; Ospina-Galeona I; Illanes RG; Lopera-Tora AR (2013). \"Results of Implantation of Sacral Anterior Root Stimulator Combined with Posterior Rhizotomy in Patients with Spinal Cord Injury in Latin America\". <i>Neurourology and Urodynamics<\/i>. <b>32<\/b>: 676\u20137.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurourology+and+Urodynamics&rft.atitle=Results+of+Implantation+of+Sacral+Anterior+Root+Stimulator+Combined+with+Posterior+Rhizotomy+in+Patients+with+Spinal+Cord+Injury+in+Latin+America&rft.volume=32&rft.pages=676-7&rft.date=2013&rft.aulast=Castano-Botero&rft.aufirst=JC&rft.au=Ospina-Galeona+I&rft.au=Illanes+RG&rft.au=Lopera-Tora+AR&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALumbar+anterior+root+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Barolat, Giancarlo (May 2000). \"Spinal Cord Stimulation for Chronic Pain Management\". <i>Archives of Medical Research<\/i>. <b>31<\/b> (3): 258\u201362. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fs0188-4409%2800%2900075-8\" target=\"_blank\">10.1016\/s0188-4409(00)00075-8<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+of+Medical+Research&rft.atitle=Spinal+Cord+Stimulation+for+Chronic+Pain+Management&rft.volume=31&rft.issue=3&rft.pages=258-62&rft.date=2000-05&rft_id=info%3Adoi%2F10.1016%2Fs0188-4409%2800%2900075-8&rft.aulast=Barolat&rft.aufirst=Giancarlo&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALumbar+anterior+root+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Donaldson-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Donaldson_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Donaldson_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Donaldson, N. de N.; 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Sandowsky, Cristina (February 2002). \"Spinal-cord injury\". <i>Lancet<\/i>. <b>359<\/b> (9304): 417\u201325. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fs0140-6736%2802%2907603-1\" target=\"_blank\">10.1016\/s0140-6736(02)07603-1<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Lancet&rft.atitle=Spinal-cord+injury&rft.volume=359&rft.issue=9304&rft.pages=417-25&rft.date=2002-02&rft_id=info%3Adoi%2F10.1016%2Fs0140-6736%2802%2907603-1&rft.aulast=McDonald&rft.aufirst=John+W.&rft.au=Sandowsky%2C+Cristina&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALumbar+anterior+root+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Stiens_NBS-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Stiens_NBS_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Stiens_NBS_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stiens, Steven; Susan Biener Bergman; Lance Goetz (1997). \"Neurogenic bowel dysfunction after spinal cord injury: clinical evaluation and rehabilitative management\". <i>Archives of Physical Medicine and Rehabilitation<\/i>. <b>78<\/b> (3): 86\u2013102. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fs0003-9993%2897%2990416-0\" target=\"_blank\">10.1016\/s0003-9993(97)90416-0<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+of+Physical+Medicine+and+Rehabilitation&rft.atitle=Neurogenic+bowel+dysfunction+after+spinal+cord+injury%3A+clinical+evaluation+and+rehabilitative+management&rft.volume=78&rft.issue=3&rft.pages=86-102&rft.date=1997&rft_id=info%3Adoi%2F10.1016%2Fs0003-9993%2897%2990416-0&rft.aulast=Stiens&rft.aufirst=Steven&rft.au=Susan+Biener+Bergman&rft.au=Lance+Goetz&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALumbar+anterior+root+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Paris_NBS-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Paris_NBS_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Paris, G; Gourcerol G; Leroi AM (December 2011). \"Management of Neurogenic Bowel Dysfunction\". <i>European Journal of Physical and Rehabilitation Medicine<\/i>. <b>47<\/b> (4): 661\u201376.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Journal+of+Physical+and+Rehabilitation+Medicine&rft.atitle=Management+of+Neurogenic+Bowel+Dysfunction&rft.volume=47&rft.issue=4&rft.pages=661-76&rft.date=2011-12&rft.aulast=Paris&rft.aufirst=G&rft.au=Gourcerol+G&rft.au=Leroi+AM&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALumbar+anterior+root+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-gastro-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-gastro_11-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Benevento, Barbara; Sipski, Marca (June 2002). \"Neurogenic Bladder, Neurogenic Bowel, and Sexual Dysfunction in People With Spinal Cord Injury\". <i>Physical Therapy<\/i>. <b>82<\/b> (6): 601\u201312.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Physical+Therapy&rft.atitle=Neurogenic+Bladder%2C+Neurogenic+Bowel%2C+and+Sexual+Dysfunction+in+People+With+Spinal+Cord+Injury&rft.volume=82&rft.issue=6&rft.pages=601-12&rft.date=2002-06&rft.aulast=Benevento&rft.aufirst=Barbara&rft.au=Sipski%2C+Marca&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALumbar+anterior+root+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Soni-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Soni_12-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Soni, BM; Oo T; Vaidyanathan S; Hughes PL; Singh G. (February 2004). \"Complications of sacral anterior root stimulator implantation in a cervical spinal cord injury patient: increased spasms requiring intrathecal baclofen therapy followed by delayed fracture of lumbar spine leading to intractable spasms compelling disuse of the sacral anterior root stimulator\". <i>Spinal Cord<\/i>. <b>42<\/b> (2): 136\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fsj.sc.3101546\" target=\"_blank\">10.1038\/sj.sc.3101546<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Spinal+Cord&rft.atitle=Complications+of+sacral+anterior+root+stimulator+implantation+in+a+cervical+spinal+cord+injury+patient%3A+increased+spasms+requiring+intrathecal+baclofen+therapy+followed+by+delayed+fracture+of+lumbar+spine+leading+to+intractable+spasms+compelling+disuse+of+the+sacral+anterior+root+stimulator&rft.volume=42&rft.issue=2&rft.pages=136-8&rft.date=2004-02&rft_id=info%3Adoi%2F10.1038%2Fsj.sc.3101546&rft.aulast=Soni&rft.aufirst=BM&rft.au=Oo+T&rft.au=Vaidyanathan+S&rft.au=Hughes+PL&rft.au=Singh+G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALumbar+anterior+root+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Vdawg-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Vdawg_13-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vaidyanathan, Subramanium; Bakul M Soni; Tun Oo; Peter L Hughes; Paul Mansour; Gurpreet Singh (December 2009). \"Infection of Brindley sacral anterior root stimulator by Pseudomonas aeruginosa requiring removal of the implant: long-term deleterious effects on bowel and urinary bladder function in a spinal cord injury patient with tetraplegia: a case report\". <i>Cases Journal<\/i>. <b>2<\/b> (9364): 1\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2F1757-1626-2-9364\" target=\"_blank\">10.1186\/1757-1626-2-9364<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cases+Journal&rft.atitle=Infection+of+Brindley+sacral+anterior+root+stimulator+by+Pseudomonas+aeruginosa+requiring+removal+of+the+implant%3A+long-term+deleterious+effects+on+bowel+and+urinary+bladder+function+in+a+spinal+cord+injury+patient+with+tetraplegia%3A+a+case+report&rft.volume=2&rft.issue=9364&rft.pages=1-8&rft.date=2009-12&rft_id=info%3Adoi%2F10.1186%2F1757-1626-2-9364&rft.aulast=Vaidyanathan&rft.aufirst=Subramanium&rft.au=Bakul+M+Soni&rft.au=Tun+Oo&rft.au=Peter+L+Hughes&rft.au=Paul+Mansour&rft.au=Gurpreet+Singh&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALumbar+anterior+root+stimulator\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1275\nCached time: 20181129232356\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 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863489121\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Lumbar_anterior_root_stimulator\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212142\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.046 seconds\nReal time usage: 0.187 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 181.470 1 - wikipedia:Lumbar_anterior_root_stimulator\n100.00% 181.470 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8276-0!*!*!*!*!*!* and timestamp 20181217212141 and revision id 24488\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Lumbar_anterior_root_stimulator\">https:\/\/www.limswiki.org\/index.php\/Lumbar_anterior_root_stimulator<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","6866114d4b93b0334e5b71a4d91ae088_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3e\/Spondylolysis-_back_pain.jpg\/440px-Spondylolysis-_back_pain.jpg"],"6866114d4b93b0334e5b71a4d91ae088_timestamp":1545081701,"dc9d017bfcf11e68e5fe57f7b1da477b_type":"article","dc9d017bfcf11e68e5fe57f7b1da477b_title":"Levonorgestrel implant","dc9d017bfcf11e68e5fe57f7b1da477b_url":"https:\/\/www.limswiki.org\/index.php\/Levonorgestrel_implant","dc9d017bfcf11e68e5fe57f7b1da477b_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tLevonorgestrel implant\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tLevonorgestrel-releasing implantBackgroundTypeHormonal\r\nProgestogen implantFirst use1983 (Finland)[1]Trade namesNorplant, Jadelle, Sino-implant (II), others[1]Failure rates (first year)Perfect use0.05%[2]Typical use0.05%[2]UsageDuration effectup to 5 years[3]ReversibilityProvided correctly insertedUser remindersAlternative method required after 5 yearsAdvantages and disadvantagesSTI protectionNoWeightNo proven effectPeriod disadvantagesirregular light spottingBenefitsNo further user action neededMedical notesPossible scarring and difficulty in removal\nLevonorgestrel-releasing implant, sold under the brand name Jadelle among others, is a device made up of a two rods of levonorgestrel used for birth control.[1] It is one of the most effective forms of birth control with a one-year failure rate around 0.05%.[1][2] The device is placed under the skin and lasts for up to five years.[3] It may be used by women who have a history of pelvic inflammatory disease and therefore cannot use an intrauterine device.[3] Following removal fertility quickly returns.[3]\nIt is generally well tolerated with few significant side effects.[1] Side effects may include irregular menstrual periods, no periods, headaches, and breast pain.[3][4] Use is not recommended in people with significant liver disease.[3] The levonorgestrel implant is a type of long-acting reversible birth control.[5] It primarily works by stopping ovulation and by thickening the mucus around the cervix.[4]\nA levonorgestrel-releasing implant was approved for medical use in 1983 in Finland and in the United States in 1990.[1] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[6] The wholesale cost in the developing world is about US$8.93\u201313.29 per set.[7] Levonorgestrel implants are approved in more than 60 countries and used by more than seven million women.[8][9] As of 2015 it is approved but not available in the United States.[1]\n\nContents \n\n1 Medical uses \n2 Contraindications \n3 Side effects \n4 Technique \n\n4.1 Insertion \n4.2 Removal \n\n\n5 History \n6 Society and culture \n\n6.1 United States \n6.2 New Zealand \n6.3 Controversy \n\n\n7 See also \n8 References \n9 External links \n\n\nMedical uses \nLevonorgestrel-releasing implant is 99% – 99.95% effective at preventing pregnancy, and is one of the most reliable, though not the most available, forms of birth control. Levonorgestrel-releasing implant prevents pregnancy through multiple methods: by preventing ovulation, which means that no eggs are released for fertilization; by thickening the mucus of the cervix, which prevents sperm from entering; and by thinning the lining of the uterus, which makes implantation of an embryo less likely.[citation needed ]\nThe way in which levonorgestrel-releasing implant causes these effects is by use of hormones. A small amount of the hormone progestin is released through the capsules continuously, more during the first year and a half, but then at a level similar to most contraceptive pills afterward. Like all hormonal contraception, levonorgestrel-releasing implant does not protect against sexually transmitted infections.[citation needed ]\nImplantable contraceptives are especially effective in the developing world, as they do not require daily administration or access to a hospital to be effective. In addition, no continual contraceptive supplies (pills, condoms, etc.) are necessary, and it is a highly effective, low cost contraceptive over the long term.\n\nContraindications \nLevonorgestrel-releasing implant should not be used in women with liver disease, breast cancer, or blood clots. Women who believe they may already be pregnant or those with vaginal bleeding should first see a physician. However, since it does not contain estrogen like some birth control pills, older women, women who smoke, and women with high blood pressure are not restricted from using the system.\n\nSide effects \nThis section does not cite any sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (March 2014) (Learn how and when to remove this template message)\nAfter three months of using, women will need to schedule a follow-up appointment to monitor blood pressure and discuss any concerns. Side effects may include irregular menstrual periods for the first approximately three months, including periods lasting longer than normal, bleeding or spotting between periods, heavy bleeding, or going with no period for the mentioned period of time. Common side effects include weight gain, \nnervousness, anxiety, nausea, vomiting, mastalgia, dizziness, dermatitis\/rash, hirsutism, scalp-hair loss, headache, depression, and acne. [citation needed ] Sometimes, pain, itching or infection at the site of the implant will occur. Ovarian cysts may also occur, but usually do not require treatment, although they can cause pain even if benign.\n\nTechnique \nInsertion \nLevonorgestrel-releasing implant is implanted under the skin in the upper arm of a woman, by creating a small incision and inserting the capsules in a fanlike shape. Insertion usually takes 15 minutes and the capsules can sometimes be seen under the skin, although usually they look like small veins. They can also be felt under the skin. Once inserted, the contraceptive works within 24 hours and lasts up to five years.[citation needed ]\n\nRemoval \nLevonorgestrel-releasing implant can be removed by creating a second incision and withdrawing the capsules. It is normally removed when the five-year period is over, or if:\n\nPregnancy is desired\nDifferent birth control is preferred\nComplications arise\nNormally removal is not complicated; removal difficulties have been reported with a frequency of 6.2%, based on 849 removals. Removal difficulties include: multiple incisions, capsule fragments remaining, pain, multiple visits, deep placement, lengthy removal procedure, or other.[10]\nIf desired, a new implant can be inserted at the time of removal.\n\nHistory \nIt was developed by Sheldon J. Segal and Horacio Croxatto at the Population Council beginning in 1966, with the first clinical trial in Chile in 1974.[11][12][13] It was first approved in Finland on November 23, 1983, where it was manufactured by Leiras Oy Pharmaceuticals.[14] The original Norplant consisted of a set of six small (2.4 mm \u00d7 34 mm) silicone capsules, each filled with 36 mg of levonorgestrel implanted under the skin in the upper arm and effective for five years.[15] The original (six capsule) Norplant's production has been phased out; USAID's contract ran until December 2006.[16]\nThe original (six capsule) Norplant was approved by the U.S. Food and Drug Administration (FDA) on December 10, 1990, and marketed in the United States in 1991 by Wyeth Pharmaceuticals.[17] Norplant distribution in the United States ended in 2002; limited supplies still remained in the U.S. until 2004. Norplant was withdrawn from the UK market in 1999.[18] Production of Norplant was discontinued globally in 2008.[19]\nNorplant II (Norplant-2, Jadelle), also developed by the Population Council and manufactured by Schering Oy, consists of two small (2.5 mm \u00d7 43 mm) silicone rods each containing 75 mg of levonorgestrel in a polymer matrix, instead of six capsules. It was approved May 31, 1996 by the FDA as being effective for three years; it was subsequently approved November 22, 2002 by the FDA as being effective for five years. Jadelle has not been marketed in the United States;[20] Jadelle is the successor to the original Norplant in USAID's contract beginning January 2007.[21]\n\nSociety and culture \nUnited States \nBy 1996, more than 50,000 women had filed lawsuits, including 70 class actions, against Wyeth and\/or its subsidiaries, or doctors who prescribed Norplant.[22] Wyeth never lost a Norplant lawsuit, even in cases which came before a jury.[23]\nOn August 26, 1999, after winning 3 jury verdicts, 20 pretrial summary judgments and the dismissal of 14,000 claims, Wyeth offered out-of-court cash settlements of $1,500 each to about 36,000 women who contended that they had not been adequately warned about possible side effects of Norplant such as irregular menstrual bleeding, headaches, nausea and depression. Wyeth said that most of the plaintiffs experienced routine side effects described in Norplant's labeling information. Wyeth did not admit to any wrongdoing, saying the settlement offer \"was purely a business decision,\" noting \"our legal success has come at a steep price because lawsuits are time-consuming, expensive, and have a chilling effect on research,\" and that it would continue to offer Norplant and would contest \"any and all new lawsuits aggressively.\"[24][25]\nAbout 32,000 women accepted the out-of-court $1,500 settlements. On August 14, 2002, Wyeth won partial summary judgment and dismissal of the claims of the 2,960 remaining plaintiffs who had not accepted Wyeth's out-of-court settlement offer.[26]\nIn August 2000, Wyeth suspended shipments of Norplant in the United States because during regular quality assurance monitoring, representative samples of seven lots distributed beginning October 20, 1999 tested within product specifications, but at the lower end of the release rate specification for shelf life stability, raising concerns about those lots' contraceptive effectiveness. Wyeth recommended that women who had Norplant capsules from those lots implanted use backup contraception until they determined the clinical relevance of the atypically low levels of levonorgestrel release.[27]\nOn July 26, 2002, Wyeth announced that data from investigations conducted in women with Norplant capsules from the suspect lots did not suggest less contraceptive effectiveness than that reported in clinical trials, and that therefore backup contraception could be safely discontinued. Wyeth also announced that due to limitations in product component supplies, they did not plan to resume marketing the six-capsule Norplant system in the United States.[28]\n\nNew Zealand \nJadelle was added to the Pharmaceutical Management Agency's (Pharmac) schedule and subsequently subsidized in August 2010. Medical professionals raised concerns during a consultation process indicating preference for a product which is easier to insert. The agreement between Bayer New Zealand and Pharmac was conditional on Bayer New Zealand providing adequate training to ensure doctors are comfortable in the insertion and removal technique.[29]\n\nControversy \nSome American legislators have unsuccessfully attempted to provide financial incentives to women on welfare who agree to use Norplant. For example, in Kansas, Republican Kerry Patrick introduced legislation that would grant welfare recipients a one-time payment of $500 to use Norplant, followed by a $50 bonus each year the implants remained in place.\"[30] Some judges have offered Norplant implants as a voluntary alternative to jail time for certain women convicted of child abuse or drug abuse during pregnancy. Two days after the 1990 FDA approval of Norplant, an editorial in The Philadelphia Inquirer suggested reducing the size of the black underclass by offering welfare mothers increased benefits if they agreed to use Norplant.[30][31] Eleven days later the Inquirer apologized for their \"misguided and wrongheaded\" editorial and for their suggestion of offering incentives for Norplant use.[30][32] Critics such as the ACLU argued that such uses are coercive and discriminatory, and compared such uses to early 20th-century American eugenics.[33] In Killing the Black Body, black feminist Dorothy Roberts links such uses of Norplant to a \"white mainstream\" that is allegedly determined to \"demonize, even criminalize\" poor black women's lives and reproductive choices.[30]\nWithin two years of Norplant's FDA approval, legislators in thirteen U.S. states had proposed nearly two dozen bills offering incentives for, or requiring use of Norplant by welfare mothers; none of these proposals passed.[30][34]\nThe first big city to aggressively promote the use of Norplant was Baltimore.[30] Baltimore targeted teenagers because the birthrate was three times higher than other states. In Baltimore, about ten percent of girls between ages 15 and 17 gave birth during 1990. Young mothers would often drop out of school and struggle to raise the child in poverty.[35] The mayor at the time, Kurt Schmoke, pushed for laws that would give teen girls more access to Norplant. Norplant was eventually given to teen girls at schools without parental consent. Programs were designed for, and performed in, predominantly black schools. Laurence G. Paquin Middle School became the first school to provide Norplant to their students.[30] Paquin Middle School had 355 female students but only 5 of them were not black. Their program started off as a pilot program and soon other urban high schools like San Fernando High School in Los Angeles and Crane High School in Chicago's West Side adopted the program of providing Norplant to their students. Because of a focus on predominantly black schools, questions of racism arose amongst black community leaders.[citation needed ]\n\nSee also \nNexplanon, another subdermal contraceptive implant\nReferences \n\n\n^ a b c d e f g Shoupe, Donna; Jr, Daniel R. Mishell (2015). The Handbook of Contraception: A Guide for Practical Management (2 ed.). Humana Press. p. 141. ISBN 9783319201856. Archived from the original on 2017-09-23. \n\n^ a b c \"Effectiveness of Family Planning Methods\" (PDF) . CDC. Archived (PDF) from the original on 29 December 2016. Retrieved 1 January 2017 . \n\n^ a b c d e f WHO Model Formulary 2008 (PDF) . World Health Organization. 2009. p. 373. ISBN 9789241547659. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016 . \n\n^ a b Corson, S. L.; Derman, R. J. (1995). Fertility Control. CRC Press. p. 195. ISBN 9780969797807. Archived from the original on 2017-09-23. \n\n^ Medicine, Institute of; Policy, Division of Health Sciences; Development, Committee on Contraceptive Research and (1998). Contraceptive Research, Introduction, and Use: Lessons From Norplant. National Academies Press. p. 107. ISBN 9780309059855. Archived from the original on 2017-09-23. \n\n^ \"WHO Model List of Essential Medicines (19th List)\" (PDF) . World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016 . \n\n^ \"Levonorgestrel\". International Drug Price Indicator Guide. Archived from the original on 22 January 2018. Retrieved 8 December 2016 . \n\n^ Kulczycki, Andrzej (2013). Critical Issues in Reproductive Health. Springer Science & Business Media. p. 16. ISBN 9789400767225. Archived from the original on 2017-09-23. \n\n^ Siving, Irving; Nash, Harold (2002). Jadelle Levonorgestrel Rod Implants: A Summary of Scientific Data and Lessons Learned from Programmatic Experience. Population Council. p. 4. ISBN 9780878341054. Archived from the original on 2017-09-23. \n\n^ . (2006). \"Norplant side effects\". RxList.com. New York: WebMD. Archived from the original on February 9, 2002. Retrieved August 16, 2006 . \n\n^ Subcommittee for Workshop on Implant Contraceptives, Committee on Contraceptive Research and Development, Division of Health Policy, Institute of Medicine (March 9, 1998). \"Appendix B: Norplant: historical background\". In Harrison, Polly F.; Rosenfield, Allan. Contraceptive research, introduction, and use: lessons from Norplant. Washington, D.C.: National Academy Press. pp. 107\u2013114. ISBN 978-0-309-05985-5. CS1 maint: Multiple names: authors list (link) \n\n^ Sivin, Irving; Nash, Harold; Waldman, Sandra (February 28, 2002). \"Development and introduction of contraceptive implants\". Jadelle\u00ae levonorgestrel rod implants: a summary of scientific data and lessons learned from programmatic experience (PDF) . New York, N.Y.: Population Council. pp. 1\u20136. ISBN 0-87834-105-6. Archived from the original (PDF) on September 5, 2012. \n\n^ Gunardi, Eka Rusdianto; Affandi, Biran; Muchtar, Armen (January 2011). \"Monoplant\u00ae the Indonesian implant: the overview of implant and its development\". Indoesian Journal of Obstetrics and Gynecology. 35 (1): 40\u201346. ISSN 0303-7924. Archived from the original on 2014-07-25. \n\n^ Roy, Subir (1985). \"Current status of Norplant subdermal implants for contraception\". In Runnebaum, Benno; Rabe, Thomas; Kiesel, Ludwig. Future aspects in contraception: proceedings of an international symposium held in Heidelberg, 5\u20138 September 1984; Part 2, Female contraception. Boston, Mass.: MTP Press. pp. 95\u2013106. ISBN 0-85200-906-2. The Finnish National Board of Health approved the NORPLANT sub-dermal implant system as a contraceptive method in Finland on 23 November 1983. \n\n^ Chin, Mona (1997). \"Norplant: levonorgestrel implants\". Berkeley: UC Berkeley Computer Science Undergraduate Association (Mona Chin's personal web page). Archived from the original on August 29, 2006. Retrieved August 17, 2006 . \n\n^ Shelton, James D. (Office of Population, USAID) (March 24, 2006). \"Future for implants\". Baltimore: The Johns Hopkins University, Bloomberg School of Public Health, Center for Communication Programs. Archived from the original on September 28, 2007. Retrieved August 17, 2006 . CS1 maint: Multiple names: authors list (link) \n\n^ Grimes, William (October 20, 2009). \"Sheldon J. Segal, who developed contraceptives, dies at 83\". The New York Times. Archived from the original on April 1, 2014. Retrieved October 22, 2009 . \n\n^ BBC News (April 30, 1999). \"Contraceptive implant withdrawn\". London: BBC News. Retrieved August 16, 2006 . \n\n^ Ahmed, Kabir; Deperthes, Bidia; Frederick, Beth; Ehlers, Suzanne; Kapp, Natalie; Paladines, Cindy; Siemerink, Marie Christine; Skibiak, John; Skorochod, Beth; Steiner, Markus; Townsend, John; Westley, Elizabeth (March 2012). \"Contraceptive Commodities for Women's Health: Key Data and Findings\" (PDF) . New York: UNFPA (United Nations Population Fund). p. 4. Archived from the original (PDF) on June 11, 2014. Retrieved December 16, 2013 . Norplant (six rods each containing 36 mg of levonorgestrel, effective for five to seven years) was discontinued in 2008. \r\nCaucus on New and Underused Reproductive Health Technologies (July 2013). \"Contraceptive implants\" (PDF) . Brussels: Reproductive Health Supplies Coalition. Archived from the original (PDF) on December 17, 2013. Retrieved December 16, 2013 . Production of Norplant was discontinued in 2008 because the new generation of products\u2014the two-rod implants, Jadelle and Sino-implant (II), and 1-rod implants, Implanon and Nexplanon\/Implanon NXT\u2014are easier to insert and remove. \r\nRademacher, Kate H.; Vahdat, Heather L.; Dorflinger, Laneta; Owen, Derek H.; Steiner, Markus J. (2014). \"Global Introduction of a Low-Cost Contraceptive Implant\". In Kulczycki, Adnrzej. Critical Issues in Reproductive Health. Dordrecht: Springer. p. 288 . ISBN 978-94-007-6721-8. Studies and field experience demonstrated that compared to Norplant, one- and two-rod implants are easier and quicker to remove. This advantage led to the replacement of Norplant by Jadelle and Implanon in health programs around the world; in 2008, global production of Norplant was discontinued (Ramchandran and Upadhyay 2007). \n\n^ Population Council (December 19, 2003). \"Jadelle implants - general information\". New York: Population Council. Archived from the original on January 4, 2004. Retrieved August 16, 2005 . \n\n^ Shelton, James D. (Office of Population, USAID) (September 6, 2006). \"New USAID award for contraceptive implants (Jadelle)\". INFO (Information and Knowledge for Optimal Health) Project. Baltimore: The Johns Hopkins University, Bloomberg School of Public Health, Center for Communication Programs. Archived from the original on July 5, 2008. Retrieved January 6, 2007 . CS1 maint: Multiple names: authors list (link) \n\n^ Johnson, Erica; Smyth, Carmel; Jones, Colman (April 1, 2003). \"Medical device lawsuits\". Marketplace. Toronto: CBC News. Archived from the original on April 18, 2003. Retrieved July 28, 2006 . \n\n^ ARHP (2006). \"New developments in contraception: the single-rod implant\" (PDF) . Washington, D.C.: Association of Reproductive Health Professionals. Archived from the original (PDF) on April 22, 2006. Retrieved January 6, 2007 . \n\n^ . (September 5, 1998). \"Contraceptive maker wins woman's suit over side effects\". The New York Times. p. A7. Archived from the original on November 7, 2012. Retrieved January 15, 2007 . \n\n^ Morrow, David J. (August 27, 1999). \"Maker of Norplant offers a settlement in suit over effects\". The New York Times. p. A1. Archived from the original on March 7, 2016. Retrieved January 15, 2007 . \n\n^ Manson, Pamela (August 27, 2002). \"Federal judge dismisses Norplant damage claims\". Texas Lawyer. New York: Law.com. Archived from the original on October 1, 2002. Retrieved January 15, 2007 . \n\n^ FDA (September 13, 2000). \"MedWatch - New safety information summaries 2000 - Norplant\". Silver Spring, Md.: U.S. Food and Drug Administration. Archived from the original on November 19, 2000. Retrieved January 6, 2007 . \n\n^ FDA (July 26, 2002). \"Update on advisory for Norplant contraceptive kits\". Silver Spring, Md.: U.S. Food and Drug Administration. Archived from the original on October 2, 2002. Retrieved January 6, 2007 . \n\n^ Pharmaceutical Management Agency (July 1, 2010). \"Notification: Jadelle (levonorgestrel 2 x 75 mg rods) funding proposal approved\" (PDF) . Wellington, New Zealand: Pharmaceutical Management Agency. Archived (PDF) from the original on July 24, 2011. Retrieved July 26, 2010 . \n\n^ a b c d e f g Roberts, Dorothy (1997). \"Chapter 3. From Norplant to the Contraceptive Vaccine. The New Frontier of Population Control\". Killing the Black Body: Race, Reproduction, and the Meaning of Liberty. New York: Pantheon. ISBN 0-679-44226-X. \n\n^ editorial (December 12, 1990). \"Poverty and Norplant; can contraception reduce the underclass?\". The Philadelphia Inquirer. p. A18. Archived from the original on November 27, 2015. Retrieved December 16, 2013 . \n\n^ editorial (December 23, 1990). \"An apology: the editorial on 'Norplant and poverty' was misguided and wrongheaded\". The Philadelphia Inquirer. p. C04. Archived from the original on August 6, 2015. Retrieved December 16, 2013 . \n\n^ ACLU (January 31, 1994). \"Norplant: A New Contraceptive with the Potential for Abuse\". New York: American Civil Liberties Union. Archived from the original on December 2, 2013. Retrieved November 24, 2013 . \n\n^ Harrison, Polly F.; Rosenfield, Allan, eds. (1998). \"Workshop Report\". Contraceptive Research, Introduction, and Use: Lessons from Norplant. Washington, D.C.: National Academy Press. pp. 30 , 55 . ISBN 978-0-309-05985-5. \r\nDavidson, Andrew R.; Kalmuss, Debra (April 1997). \"Topics for our times: Norplant coercion\u2014an overstated threat\". American Journal of Public Health. 87 (4): 550\u2013551. doi:10.2105\/ajph.87.4.550. PMC 1380830 . PMID 9146429. Retrieved December 16, 2013 . \n\n^ Banisky, Sandy (December 3, 1992). \"City officials planning to promote Norplant; teen-agers will be targeted for the 5-year contraceptive\". The Baltimore Sun. p. 1A. Archived from the original on December 12, 2013. Retrieved December 9, 2013 . \n\n\nExternal links \nvteBirth control methods (G02B, G03A)Comparison\nComparison of birth control methods\nLong-acting reversible contraception (LARC)\nBehavioral\nAvoiding vaginal intercourse: Abstinence\nAnal sex\nMasturbation\nNon-penetrative sex\nOral sex\r\nIncluding vaginal intercourse: Breastfeeding infertility (LAM)\nCalendar-based methods (rhythm, etc.)\nFertility awareness (Billings ovulation method\nCreighton Model, etc.)\nWithdrawal\nBarrier and \/ or\r\n spermicidal\nCervical cap\nCondom\nContraceptive sponge\nDiaphragm\nFemale condom\nSpermicide\nHormonal\r\n(formulations)Combined estrogen-progestogen\nContraceptive patch\nExtended cycle\nInjectable\nCombined vaginal ring\nPill\nProgestogen-only\nDepo-Provera\nEtonogestrel implant (Nexplanon)\nLevonorgestrel implant (Norplant)\nProgestogen-only pill\nProgesterone vaginal ring\nAnti-estrogen\nOrmeloxifene (Centchroman)\nPost-intercourse\nEmergency contraception (Ulipristal acetate\nYuzpe regimen\nLevonorgestrel)\nIntrauterine device\nCopper IUDs\nHormonal IUDs (progestogens)\nSterilization\nFemale: Essure\nTubal ligation\r\nMale: Vasectomy\nExperimental\nReversible inhibition of sperm under guidance (Vasalgel)\nLong-acting reversible contraception (LARC)\nIntrauterine device (Hormonal IUD\nCopper IUD)\nContraceptive implant (Etonogestrel implant, Levonorgestrel implant)\n\nvteHormonal contraception (G02B, G03A)Androgens\nMale-only: Dimethandrolone\nTestosterone buciclate\nTestosterone undecanoate\nTrestolone\nEstrogens\nDiethylstilbestrol\nEstradiol\nEstradiol benzoate\nEstradiol cypionate\nEstradiol enanthate\nEstradiol valerate\nEthinylestradiol\nMestranol\nOrmeloxifene\nProgestogensFirst generation (estranes)\nEthisterone\nEtynodiol diacetate\nLynestrenol\nNorethisterone (norethindrone)\nNorethisterone acetate\nNorethisterone enanthate\nNoretynodrel\nQuingestanol\nSecond generation\nEstranes: Norethisterone enanthate\nNorgestrienone\nGonanes: Levonorgestrel\nNorelgestromin\nNorgestrel\nThird generation (gonanes)\nDesogestrel\nEtonogestrel\nGestodene\nNorgestimate\nFourth generation\nEstranes: Dienogest\nNorpregnanes: Demegestone\nNomegestrol acetate\nPromegestone\nTrimegestone\nSpironolactone derivatives: Drospirenone\nPregnanes\nChlormadinone acetate\nMedrogestone\nMedroxyprogesterone acetate\nMegestrol acetate\nMiscellaneous\nMifepristone\nUlipristal acetate\nAlgestone acetophenide\nDydrogesterone\nGestrinone\nProgesterone\nProligestone\n\nvteEstrogen receptor modulatorsERAgonists\nSteroidal: 2-Hydroxyestradiol\n2-Hydroxyestrone\n3-Methyl-19-methyleneandrosta-3,5-dien-17\u03b2-ol\n3\u03b1-Androstanediol\n3\u03b1,5\u03b1-Dihydrolevonorgestrel\n3\u03b2,5\u03b1-Dihydrolevonorgestrel\n3\u03b1-Hydroxytibolone\n3\u03b2-Hydroxytibolone\n3\u03b2-Androstanediol\n4-Androstenediol\n4-Androstenedione\n4-Hydroxyestradiol\n4-Hydroxyestrone\n4-Methoxyestradiol\n4-Methoxyestrone\n5-Androstenediol\n7-Oxo-DHEA\n7\u03b1-Hydroxy-DHEA\n7\u03b1-Methylestradiol\n7\u03b2-Hydroxyepiandrosterone\n8,9-Dehydroestradiol\n8,9-Dehydroestrone\n8\u03b2-VE2\n10\u03b2,17\u03b2-Dihydroxyestra-1,4-dien-3-one (DHED)\n16\u03b1-Fluoroestradiol\n16\u03b1-Hydroxy-DHEA\n16\u03b1-Hydroxyestrone\n16\u03b1-Iodoestradiol\n16\u03b1-LE2\n16\u03b2,17\u03b1-Epiestriol (16\u03b2-hydroxy-17\u03b1-estradiol)\n17\u03b1-Estradiol (alfatradiol)\n17\u03b1-Dihydroequilenin\n17\u03b1-Dihydroequilin\n17\u03b1-Epiestriol (16\u03b1-hydroxy-17\u03b1-estradiol)\n17\u03b2-Dihydroequilenin\n17\u03b2-Dihydroequilin\nAbiraterone\nAbiraterone acetate\nAlestramustine\nAlmestrone\nAnabolic steroids (e.g., testosterone and esters, methyltestosterone, metandienone (methandrostenolone), nandrolone and esters, many others; via estrogenic metabolites)\nAtrimustine\nBolandiol\nBolandiol dipropionate\nButolame\nClomestrone\nCloxestradiol\nCloxestradiol acetate\nConjugated estrogens\nCyclodiol\nCyclotriol\nDHEA\nDHEA-S\nEpiestriol (16\u03b2-epiestriol, 16\u03b2-hydroxy-17\u03b2-estradiol)\nEpimestrol\nEquilenin\nEquilin\nERA-63 (ORG-37663)\nEsterified estrogens\nEstetrol\nEstradiol\nEstradiol esters\nLipoidal estradiol\nPolyestradiol phosphate\nEstramustine\nEstramustine phosphate\nEstrapronicate\nEstrazinol\nEstriol\nEstriol esters\nPolyestriol phosphate\nEstrofurate\nEstromustine\nEstrone\nEstrone esters\nEstrone methyl ether\nEstropipate\nEtamestrol (eptamestrol)\nEthinylestradiol\nEthinylestradiol 3-benzoate\nEthinylestradiol sulfonate\nEthinylestriol\nEthylestradiol\nEtynodiol\nEtynodiol diacetate\nHexolame\nHippulin\nHydroxyestrone diacetate\nLynestrenol\nLynestrenol phenylpropionate\nMestranol\nMethylestradiol\nMoxestrol\nMytatrienediol\nNilestriol\nNorethisterone\nNoretynodrel\nOrestrate\nPentolame\nProdiame\nProlame\nPromestriene\nRU-16117\nQuinestradol\nQuinestrol\nTibolone\nNonsteroidal: (R,R)-THC\n(S,S)-THC\n2,8-DHHHC\n\u03b2-LGND1\n\u03b2-LGND2 (GTx-878)\nAC-186\nAllenestrol\nAllenolic acid\nBenzestrol\nBifluranol\nBisdehydrodoisynolic acid\nCarbestrol\nD-15414\nDCW234\nDiarylpropionitrile\nDienestrol\nDienestrol diacetate\nDiethylstilbestrol\nDiethylstilbestrol esters\nDimestrol (dianisylhexene)\nDoisynoestrol (fenocycline)\nDoisynolic acid\nEfavirenz\nERB-196 (WAY-202196)\nErteberel (SERBA-1, LY-500307)\nEstrobin (DBE)\nFenestrel\nFERb 033\nFosfestrol (diethylstilbestrol diphosphate)\nFurostilbestrol (diethylstilbestrol difuroate)\nGTx-758\nHexestrol\nHexestrol esters\nICI-85966 (Stilbostat)\nMestilbol\nMethallenestril\nMethestrol\nMethestrol dipropionate\nParoxypropione\nPentafluranol\nPhenestrol\nPrinaberel (ERB-041, WAY-202041)\nPropylpyrazoletriol\nQuadrosilan\nSC-4289\nSERBA-2\nSKF-82,958\nTerfluranol\nTriphenylbromoethylene\nTriphenylchloroethylene\nTriphenyliodoethylene\nTriphenylmethylethylene (triphenylpropene)\nWAY-166818\nWAY-169916\nWAY-200070\nWAY-204688 (SIM-688)\nWAY-214156\nUnknown\/unsorted: ERB-26\nERA-45\nERB-79\nZK-283197\nXenoestrogens: Anise-related (e.g., anethole, anol, dianethole, dianol, photoanethole)\nChalconoids (e.g., isoliquiritigenin, phloretin, phlorizin (phloridzin), wedelolactone)\nCoumestans (e.g., coumestrol, psoralidin)\nFlavonoids (incl. 7,8-DHF, 8-prenylnaringenin, apigenin, baicalein, baicalin, biochanin A, calycosin, catechin, daidzein, daidzin, ECG, EGCG, epicatechin, equol, formononetin, glabrene, glabridin, genistein, genistin, glycitein, kaempferol, liquiritigenin, mirificin, myricetin, naringenin, penduletin, pinocembrin, prunetin, puerarin, quercetin, tectoridin, tectorigenin)\nLavender oil\nLignans (e.g., enterodiol, enterolactone, nyasol (cis-hinokiresinol))\nMetalloestrogens (e.g., cadmium)\nPesticides (e.g., alternariol, dieldrin, endosulfan, fenarimol, methiocarb, methoxychlor, triclocarban, triclosan)\nPhytosteroids (e.g., digitoxin (digitalis), diosgenin, guggulsterone)\nPhytosterols (e.g., \u03b2-sitosterol, campesterol, stigmasterol)\nResorcylic acid lactones (e.g., zearalanone, \u03b1-zearalenol, \u03b2-zearalenol, zearalenone, zeranol (\u03b1-zearalanol), taleranol (teranol, \u03b2-zearalanol))\nSteroid-like (e.g., deoxymiroestrol, miroestrol)\nStilbenoids (e.g., resveratrol, rhaponticin)\nSynthetic xenoestrogens (e.g., alkylphenols, bisphenols (e.g., BPA, BPF, BPS), DDT, parabens, PBBs, PHBA, phthalates, PCBs)\nOthers (e.g., agnuside, rotundifuran)\nMixed\r\n(SERMs)\n2-Phenylbenzofuran\n2-Phenylbenzothiophene\n4'-Hydroxynorendoxifen\n27-Hydroxycholesterol\nAcefluranol\nAcolbifene\nAfimoxifene\nAnordiol\nAnordrin\nArzoxifene\nBazedoxifene\nBrilanestrant\nBroparestrol\nChlorotrianisene\nClomifene\nClomifenoxide\nCyclofenil\nD-15413\nDroloxifene\nElacestrant\nEnclomifene\nEndoxifen\nEtacstil (GW-5638, DPC-974)\nEthamoxytriphetol (MER-25)\nFemarelle\nFispemifene\nGW-7604\nICI-55548\nIdoxifene\nLasofoxifene\nLevormeloxifene\nLN-1643\nLN-2299\nLY-117018\nMenerba\nMiproxifene\nMiproxifene phosphate\nNafoxidine\nNitromifene\nNNC 45-0095\nNNC 45-0320\nNNC 45-0781\nNNC 45-1506\nOrmeloxifene\nOspemifene\nPanomifene\nPipendoxifene\nPromensil\nRaloxifene\nRimostil (P-081)\nSpironolactone\nSS1010\nTamoxifen\nTAS-108 (SR-16234)\nToremifene\nTrioxifene\nTZE-5323\nY-134\nZindoxifene\nZuclomifene\nAntagonists\n(R,R)-THC\n7\u03b2-Hydroxy-DHEA\nChloroindazole\nCytestrol acetate\nEM-800\nEpitiostanol\nERA-90\nERB-88\nFulvestrant (ICI-182780)\nGlyceollins (I, II, III, IV)\nICI-164384\nMepitiostane\nMethylepitiostanol\nMethylpiperidinopyrazole\nMIBE\nOxabicycloheptene sulfonate\nPhenytoin\nPHTPP\nProchloraz\nRU-58668\nSS1020\nTAS-108 (SR-16234)\nZB716\nZK-164015\nZK-191703\nCoregulator-binding modulators: ERX-11\nGPERAgonists\n2-Methoxyestradiol\n7\u03b2-Hydroxyepiandrosterone\nAfimoxifene (4-hydroxytamoxifen)\nAtrazine\nBisphenol A\nDaidzein\nDDT (p,p'-DDT, o',p'-DDE)\nEquol\nEstradiol\nEthinylestradiol\nFulvestrant (ICI-182780)\nG-1\nGenistein\nGPER-L1\nGPER-L2\nHydroxytyrosol\nKepone\nNiacin\nNicotinamide\nNonylphenol\nOleuropein\nPCBs (2,2',5'-PCB-4-OH)\nPropylpyrazoletriol\nQuercetin\nRaloxifene\nResveratrol\nTamoxifen\nTectoridin\nZearalanone\nZearalenol\nZearalenone\nZeranol (zearalanol))\nAntagonists\nCCL18\nEstriol\nG-15\nG-36\nMIBE\n\nSee also\nReceptor\/signaling modulators\nEstrogens and antiestrogens\nAndrogen receptor modulators\nProgesterone receptor modulators\nList of estrogens\n\nvteProgesterone receptor modulatorsPRAgonists\nProgesterone derivatives: 3\u03b2-Dihydroprogesterone\n5\u03b1-Dihydroprogesterone\n9\u03b1-Bromo-11-ketoprogesterone\n11-Dehydroprogesterone\n11-Deoxycorticosterone\n16\u03b1-Hydroxyprogesterone\n20\u03b1-Dihydroprogesterone\n20\u03b2-Dihydroprogesterone\nDimepregnen\nDiosgenin\nP1-185\nProgesterone\nProgesterone 3-acetyl enol ether\nQuingestrone\nRetroprogesterone derivatives: 20\u03b1-Dihydrodydrogesterone\n20\u03b1-Dihydrotrengestone\nDU-41164\nDU-41165\nDydrogesterone\nRetroprogesterone\nRo 6-3129\nTrengestone\n17\u03b1-Substituted progesterone derivatives: 6\u03b1-Methyl-17\u03b1-bromoprogesterone\n15\u03b2-Hydroxycyproterone acetate\n16-Methylene-17\u03b1-hydroxyprogesterone acetate\n17\u03b1-Bromoprogesterone\n17\u03b1-Hydroxyprogesterone (hydroxyprogesterone)\n17\u03b1-Methylprogesterone\nAcetomepregenol (mepregenol diacetate)\nAlgestone\nAlgestone acetonide\nAlgestone acetophenide\nAnagestone\nAnagestone acetate\nBromethenmadinone\nBromethenmadinone acetate\nButagest (buterol)\nChlormadinone\nChlormadinone acetate\nChlormadinone caproate\nChlormethenmadinone\nChlormethenmadinone acetate\nCismadinone\nCismadinone acetate\nClogestone\nClogestone acetate\nClomegestone\nClomegestone acetate\nCymegesolate\nCyproterone acetate\nDelmadinone\nDelmadinone acetate\nEdogestrone\nFlugestone\nFlugestone acetate\nFlumedroxone\nFlumedroxone acetate\nFluoromedroxyprogesterone acetate\nGestaclone\nHaloprogesterone\nHydromadinone\nHydromadinone acetate\nHydroxyprogesterone acetate\nHydroxyprogesterone caproate (hydroxyprogesterone hexanoate)\nHydroxyprogesterone heptanoate (hydroxyprogesterone enanthate)\nMecigestone (pentarane B)\nMedrogestone\nMedroxyprogesterone\nMedroxyprogesterone acetate\nMedroxyprogesterone caproate\nMegestrol\nMegestrol acetate\nMegestrol caproate\nMelengestrol\nMelengestrol acetate\nMethenmadinone\nMethenmadinone acetate\nMethenmadinone caproate\nMometasone\nMometasone furoate\nOsaterone\nOsaterone acetate\nPentagestrone\nPentagestrone acetate\nPentarane A\nProligestone\n19-Norprogesterone derivatives: 17\u03b1-Methyl-19-norprogesterone\n18-Methylsegesterone acetate\n19-Norprogesterone\nAmadinone\nAmadinone acetate\nDemegestone\nFluoro ethyl norprogesterone\nFluoro furanyl norprogesterone\nGestadienol\nGestadienol acetate\nGestonorone caproate (gestronol hexanoate)\nGestronol (gestonorone)\nNomegestrol\nNomegestrol acetate\nNorgestomet\nORG-2058\nOxogestone\nOxogestone phenpropionate (xinogestone)\nPromegestone\nSegesterone\nSegesterone acetate (nestorone)\nTrimegestone\nTestosterone derivatives: Progestins: 6,6-Difluoronorethisterone\n6,6-Difluoronorethisterone acetate\n17\u03b1-Allyl-19-nortestosterone\nAllylestrenol\nAltrenogest\nChloroethynylnorgestrel\nCingestol\nDanazol\nDesogestrel\nDienogest\nEthisterone\nEthynerone\nEtonogestrel\nEtynodiol\nEtynodiol diacetate\nGestodene\nGestrinone\nLevonorgestrel\nLevonorgestrel esters (e.g., levonorgestrel butanoate)\nLynestrenol\nLynestrenol phenylpropionate\nMetynodiol\nMetynodiol diacetate\nNorelgestromin\nNorethisterone (norethindrone)\nNorethisterone esters (e.g., norethisterone acetate, norethisterone enanthate)\nNoretynodrel\nNorgesterone\nNorgestimate\nNorgestrel\nNorgestrienone\nNorvinisterone\nOxendolone\nQuingestanol\nQuingestanol acetate\nTibolone\nTigestol\nTosagestin; Anabolic\u2013androgenic steroids: 11\u03b2-Methyl-19-nortestosterone\n11\u03b2-Methyl-19-nortestosterone dodecylcarbonate\n19-Nor-5-androstenediol\n19-Nor-5-androstenedione\n19-Nordehydroepiandrosterone\nBolandiol\nBolandiol dipropionate\nBolandione\nDimethisterone\nDienedione\nDienolone\nDimethandrolone\nDimethandrolone buciclate\nDimethandrolone dodecylcarbonate\nDimethandrolone undecanoate\nDimethyldienolone\nDimethyltrienolone\nEthyldienolone\nEthylestrenol (ethylnandrol)\nMethyldienolone\nMetribolone (R-1881)\nMethoxydienone (methoxygonadiene)\nMibolerone\nNandrolone\nNandrolone esters (e.g., nandrolone decanoate, nandrolone phenylpropionate)\nNorethandrolone\nNormethandrone (methylestrenolone, normethandrolone, normethisterone)\nRU-2309\nTetrahydrogestrinone\nTrenbolone (trienolone)\nTrenbolone esters (e.g., trenbolone acetate, trenbolone enanthate)\nTrendione\nTrestolone\nTrestolone acetate\nSpirolactone derivatives: Canrenoic acid\nCanrenone\nDrospirenone\nMespirenone\nPotassium canrenoate\nProrenone\nSC-5233 (spirolactone)\nSC-8109\nSpironolactone\nSpirorenone\nNonsteroidal: 3,8-Dihydrodiligustilide\nLG-2527\nLG-100128\nRiligustilide\nRWJ-26819\nRWJ-49853\nRWJ-60130\nTanaproget\nZM-182345\nUnknown: ORG-47241\nORG-201745\nMixed\r\n(SPRMs)\nSteroidal: Dihydroethisterone\n5\u03b1-Dihydrolevonorgestrel\n5\u03b1-Dihydronorethisterone\nAsoprisnil\nAsoprisnil ecamate\nGuggulsterone\nJ1042\nLG-120838\nMetapristone (RU-42633)\nMifepristone (RU-486)\nORF-9371\nORF-9326\nORG-31710\nORG-33628\nRMI-12936\nTelapristone\nUlipristal acetate\nVilaprisan\nZK-137316\nNonsteroidal: Apigenin\nKaempferol\nLG-120920\nNaringenin\nPRA-910\nSyringic acid\nAntagonists\nSteroidal: Aglepristone\nLilopristone\nLonaprisan\nOnapristone\nORG-31710\nORG-31806\nORG-33628\nRTI 3021\u2013022\nToripristone\nZanoterone\nNonsteroidal: LG-001447\nLG-100127\nLG-100128\nLG-120830\nLG-121046\nValproic acid\nZM-150271\nZM-172406\nmPR\r\n(PAQR)Agonists\n5\u03b1-Dihydroprogesterone\n5\u03b2-Dihydroprogesterone\n11-Deoxycortisone (21-hydroxyprogesterone)\n11-Deoxycortisol (17\u03b1,21-dihydroxyprogesterone)\n17\u03b1-Hydroxyprogesterone\nAllopregnanolone\nMifepristone\nPregnenolone\nProgesterone\nAntagonists\nMifepristone\n\nSee also\nReceptor\/signaling modulators\nProgestogens and antiprogestogens\nAndrogen receptor modulators\nEstrogen receptor modulators\nList of progestogens\n\n Pharmacy and pharmacology portal Medicine portal \n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Levonorgestrel_implant\">https:\/\/www.limswiki.org\/index.php\/Levonorgestrel_implant<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:11.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,130 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","dc9d017bfcf11e68e5fe57f7b1da477b_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Levonorgestrel_implant skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Levonorgestrel implant<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Levonorgestrel-releasing implant<\/b>, sold under the brand name <b>Jadelle<\/b> among others, is a device made up of a two rods of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Levonorgestrel\" title=\"Levonorgestrel\" rel=\"external_link\" target=\"_blank\">levonorgestrel<\/a> used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Birth_control\" title=\"Birth control\" rel=\"external_link\" target=\"_blank\">birth control<\/a>.<sup id=\"rdp-ebb-cite_ref-Sh2015_1-2\" class=\"reference\"><a href=\"#cite_note-Sh2015-1\" rel=\"external_link\">[1]<\/a><\/sup> It is one of the most effective forms of birth control with a one-year failure rate around 0.05%.<sup id=\"rdp-ebb-cite_ref-Sh2015_1-3\" class=\"reference\"><a href=\"#cite_note-Sh2015-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-CDC2011_2-2\" class=\"reference\"><a href=\"#cite_note-CDC2011-2\" rel=\"external_link\">[2]<\/a><\/sup> The device is placed under the skin and lasts for up to five years.<sup id=\"rdp-ebb-cite_ref-WHO2008_3-1\" class=\"reference\"><a href=\"#cite_note-WHO2008-3\" rel=\"external_link\">[3]<\/a><\/sup> It may be used by women who have a history of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pelvic_inflammatory_disease\" title=\"Pelvic inflammatory disease\" rel=\"external_link\" target=\"_blank\">pelvic inflammatory disease<\/a> and therefore cannot use an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intrauterine_device\" title=\"Intrauterine device\" rel=\"external_link\" target=\"_blank\">intrauterine device<\/a>.<sup id=\"rdp-ebb-cite_ref-WHO2008_3-2\" class=\"reference\"><a href=\"#cite_note-WHO2008-3\" rel=\"external_link\">[3]<\/a><\/sup> Following removal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fertility\" title=\"Fertility\" rel=\"external_link\" target=\"_blank\">fertility<\/a> quickly returns.<sup id=\"rdp-ebb-cite_ref-WHO2008_3-3\" class=\"reference\"><a href=\"#cite_note-WHO2008-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>It is generally well tolerated with few significant side effects.<sup id=\"rdp-ebb-cite_ref-Sh2015_1-4\" class=\"reference\"><a href=\"#cite_note-Sh2015-1\" rel=\"external_link\">[1]<\/a><\/sup> Side effects may include irregular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Menstrual_periods\" class=\"mw-redirect\" title=\"Menstrual periods\" rel=\"external_link\" target=\"_blank\">menstrual periods<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amenorrhea\" title=\"Amenorrhea\" rel=\"external_link\" target=\"_blank\">no periods<\/a>, headaches, and breast pain.<sup id=\"rdp-ebb-cite_ref-WHO2008_3-4\" class=\"reference\"><a href=\"#cite_note-WHO2008-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Cor1995_4-0\" class=\"reference\"><a href=\"#cite_note-Cor1995-4\" rel=\"external_link\">[4]<\/a><\/sup> Use is not recommended in people with significant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liver_disease\" title=\"Liver disease\" rel=\"external_link\" target=\"_blank\">liver disease<\/a>.<sup id=\"rdp-ebb-cite_ref-WHO2008_3-5\" class=\"reference\"><a href=\"#cite_note-WHO2008-3\" rel=\"external_link\">[3]<\/a><\/sup> The levonorgestrel implant is a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Long-acting_reversible_birth_control\" class=\"mw-redirect\" title=\"Long-acting reversible birth control\" rel=\"external_link\" target=\"_blank\">long-acting reversible birth control<\/a>.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> It primarily works by stopping <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ovulation\" title=\"Ovulation\" rel=\"external_link\" target=\"_blank\">ovulation<\/a> and by thickening the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mucus\" title=\"Mucus\" rel=\"external_link\" target=\"_blank\">mucus<\/a> around the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cervix\" title=\"Cervix\" rel=\"external_link\" target=\"_blank\">cervix<\/a>.<sup id=\"rdp-ebb-cite_ref-Cor1995_4-1\" class=\"reference\"><a href=\"#cite_note-Cor1995-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>A levonorgestrel-releasing implant was approved for medical use in 1983 in Finland and in the United States in 1990.<sup id=\"rdp-ebb-cite_ref-Sh2015_1-5\" class=\"reference\"><a href=\"#cite_note-Sh2015-1\" rel=\"external_link\">[1]<\/a><\/sup> It is on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/World_Health_Organization%27s_List_of_Essential_Medicines\" class=\"mw-redirect\" title=\"World Health Organization's List of Essential Medicines\" rel=\"external_link\" target=\"_blank\">World Health Organization's List of Essential Medicines<\/a>, the most effective and safe medicines needed in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_system\" title=\"Health system\" rel=\"external_link\" target=\"_blank\">health system<\/a>.<sup id=\"rdp-ebb-cite_ref-WHO19th_6-0\" class=\"reference\"><a href=\"#cite_note-WHO19th-6\" rel=\"external_link\">[6]<\/a><\/sup> The wholesale cost in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Developing_world\" class=\"mw-redirect\" title=\"Developing world\" rel=\"external_link\" target=\"_blank\">developing world<\/a> is about US$8.93\u201313.29 per set.<sup id=\"rdp-ebb-cite_ref-ERC2014_7-0\" class=\"reference\"><a href=\"#cite_note-ERC2014-7\" rel=\"external_link\">[7]<\/a><\/sup> Levonorgestrel implants are approved in more than 60 countries and used by more than seven million women.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> As of 2015 it is approved but not available in the United States.<sup id=\"rdp-ebb-cite_ref-Sh2015_1-6\" class=\"reference\"><a href=\"#cite_note-Sh2015-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<p>Levonorgestrel-releasing implant is 99% – 99.95% effective at preventing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pregnancy\" title=\"Pregnancy\" rel=\"external_link\" target=\"_blank\">pregnancy<\/a>, and is one of the most reliable, though not the most available, forms of birth control. Levonorgestrel-releasing implant prevents pregnancy through multiple methods: by preventing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ovulation\" title=\"Ovulation\" rel=\"external_link\" target=\"_blank\">ovulation<\/a>, which means that no <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ovum\" class=\"mw-redirect\" title=\"Ovum\" rel=\"external_link\" target=\"_blank\">eggs<\/a> are released for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fertilization\" class=\"mw-redirect\" title=\"Fertilization\" rel=\"external_link\" target=\"_blank\">fertilization<\/a>; by thickening the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mucus\" title=\"Mucus\" rel=\"external_link\" target=\"_blank\">mucus<\/a> of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cervix\" title=\"Cervix\" rel=\"external_link\" target=\"_blank\">cervix<\/a>, which prevents <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spermatozoon\" title=\"Spermatozoon\" rel=\"external_link\" target=\"_blank\">sperm<\/a> from entering; and by thinning the lining of the uterus, which makes implantation of an embryo less likely.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2016)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>The way in which levonorgestrel-releasing implant causes these effects is by use of hormones. A small amount of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hormone\" title=\"Hormone\" rel=\"external_link\" target=\"_blank\">hormone<\/a> progestin is released through the capsules continuously, more during the first year and a half, but then at a level similar to most contraceptive pills afterward. Like all hormonal contraception, levonorgestrel-releasing implant does not protect against <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sexually_transmitted_infection\" title=\"Sexually transmitted infection\" rel=\"external_link\" target=\"_blank\">sexually transmitted infections<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2016)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Implantable contraceptives are especially effective in the developing world, as they do not require daily administration or access to a hospital to be effective. In addition, no continual contraceptive supplies (pills, condoms, etc.) are necessary, and it is a highly effective, low cost contraceptive over the long term.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Contraindications\">Contraindications<\/span><\/h2>\n<p>Levonorgestrel-releasing implant should not be used in women with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liver\" title=\"Liver\" rel=\"external_link\" target=\"_blank\">liver disease<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_cancer\" title=\"Breast cancer\" rel=\"external_link\" target=\"_blank\">breast cancer<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_clot\" class=\"mw-redirect\" title=\"Blood clot\" rel=\"external_link\" target=\"_blank\">blood clots<\/a>. Women who believe they may already be pregnant or those with vaginal bleeding should first see a physician. However, since it does not contain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Estrogen\" title=\"Estrogen\" rel=\"external_link\" target=\"_blank\">estrogen<\/a> like some birth control pills, older women, women who smoke, and women with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arterial_hypertension\" class=\"mw-redirect\" title=\"Arterial hypertension\" rel=\"external_link\" target=\"_blank\">high blood pressure<\/a> are not restricted from using the system.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Side_effects\">Side effects<\/span><\/h2>\n\n<p>After three months of using, women will need to schedule a follow-up appointment to monitor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure\" title=\"Blood pressure\" rel=\"external_link\" target=\"_blank\">blood pressure<\/a> and discuss any concerns. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adverse_effect_(medicine)\" class=\"mw-redirect\" title=\"Adverse effect (medicine)\" rel=\"external_link\" target=\"_blank\">Side effects<\/a> may include irregular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Menstrual_cycle\" title=\"Menstrual cycle\" rel=\"external_link\" target=\"_blank\">menstrual periods<\/a> for the first approximately three months, including periods lasting longer than normal, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bleeding\" title=\"Bleeding\" rel=\"external_link\" target=\"_blank\">bleeding<\/a> or spotting between periods, heavy bleeding, or going with no period for the mentioned period of time. <span class=\"citation-needed-content\" style=\"padding-left:0.1em; padding-right:0.1em; color:#595959; border:1px solid #DDD;\">Common side effects include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Weight_gain\" title=\"Weight gain\" rel=\"external_link\" target=\"_blank\">weight gain<\/a>, \n<a href=\"https:\/\/en.wikipedia.org\/wiki\/Anxiety\" title=\"Anxiety\" rel=\"external_link\" target=\"_blank\">nervousness<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anxiety\" title=\"Anxiety\" rel=\"external_link\" target=\"_blank\">anxiety<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nausea\" title=\"Nausea\" rel=\"external_link\" target=\"_blank\">nausea<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vomiting\" title=\"Vomiting\" rel=\"external_link\" target=\"_blank\">vomiting<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mastalgia\" class=\"mw-redirect\" title=\"Mastalgia\" rel=\"external_link\" target=\"_blank\">mastalgia<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dizziness\" title=\"Dizziness\" rel=\"external_link\" target=\"_blank\">dizziness<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dermatitis\" title=\"Dermatitis\" rel=\"external_link\" target=\"_blank\">dermatitis<\/a>\/<a href=\"https:\/\/en.wikipedia.org\/wiki\/Rash\" title=\"Rash\" rel=\"external_link\" target=\"_blank\">rash<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hirsutism\" title=\"Hirsutism\" rel=\"external_link\" target=\"_blank\">hirsutism<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Baldness\" class=\"mw-redirect\" title=\"Baldness\" rel=\"external_link\" target=\"_blank\">scalp-hair loss<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Headache\" title=\"Headache\" rel=\"external_link\" target=\"_blank\">headache<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Depression_(mood)\" title=\"Depression (mood)\" rel=\"external_link\" target=\"_blank\">depression<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acne_vulgaris\" class=\"mw-redirect\" title=\"Acne vulgaris\" rel=\"external_link\" target=\"_blank\">acne<\/a>.<\/span><sup class=\"noprint Inline-Template Template-Fact\" style=\"margin-left:0.1em; white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2014)\">citation needed<\/span><\/a><\/i>]<\/sup> Sometimes, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\" title=\"Pain\" rel=\"external_link\" target=\"_blank\">pain<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Itching\" class=\"mw-redirect\" title=\"Itching\" rel=\"external_link\" target=\"_blank\">itching<\/a> or infection at the site of the implant will occur. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ovarian_cyst\" title=\"Ovarian cyst\" rel=\"external_link\" target=\"_blank\">Ovarian cysts<\/a> may also occur, but usually do not require treatment, although they can cause pain even if <a href=\"https:\/\/en.wikipedia.org\/wiki\/Benign\" class=\"mw-redirect\" title=\"Benign\" rel=\"external_link\" target=\"_blank\">benign<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technique\">Technique<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Insertion\">Insertion<\/span><\/h3>\n<p>Levonorgestrel-releasing implant is implanted under the skin in the upper arm of a woman, by creating a small incision and inserting the capsules in a fanlike shape. Insertion usually takes 15 minutes and the capsules can sometimes be seen under the skin, although usually they look like small <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">veins<\/a>. They can also be felt under the skin. Once inserted, the contraceptive works within 24 hours and lasts up to five years.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2016)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Removal\">Removal<\/span><\/h3>\n<p>Levonorgestrel-releasing implant can be removed by creating a second incision and withdrawing the capsules. It is normally removed when the five-year period is over, or if:\n<\/p>\n<ul><li>Pregnancy is desired<\/li>\n<li>Different birth control is preferred<\/li>\n<li>Complications arise<\/li><\/ul>\n<p>Normally removal is not complicated; removal difficulties have been reported with a frequency of 6.2%, based on 849 removals. Removal difficulties include: multiple incisions, capsule fragments remaining, pain, multiple visits, deep placement, lengthy removal procedure, or other.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>If desired, a new implant can be inserted at the time of removal.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>It was developed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sheldon_Segal\" title=\"Sheldon Segal\" rel=\"external_link\" target=\"_blank\">Sheldon J. Segal<\/a> and at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Population_Council\" title=\"Population Council\" rel=\"external_link\" target=\"_blank\">Population Council<\/a> beginning in 1966, with the first clinical trial in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chile\" title=\"Chile\" rel=\"external_link\" target=\"_blank\">Chile<\/a> in 1974.<sup id=\"rdp-ebb-cite_ref-IOM_1993_11-0\" class=\"reference\"><a href=\"#cite_note-IOM_1993-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Sivin_2002_12-0\" class=\"reference\"><a href=\"#cite_note-Sivin_2002-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Gunardi_2011_13-0\" class=\"reference\"><a href=\"#cite_note-Gunardi_2011-13\" rel=\"external_link\">[13]<\/a><\/sup> It was first approved in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Finland\" title=\"Finland\" rel=\"external_link\" target=\"_blank\">Finland<\/a> on November 23, 1983, where it was manufactured by Leiras Oy Pharmaceuticals.<sup id=\"rdp-ebb-cite_ref-Roy_1985_14-0\" class=\"reference\"><a href=\"#cite_note-Roy_1985-14\" rel=\"external_link\">[14]<\/a><\/sup> The original Norplant consisted of a set of six small (2.4 mm \u00d7 34 mm) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a> capsules, each filled with 36 mg of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Levonorgestrel\" title=\"Levonorgestrel\" rel=\"external_link\" target=\"_blank\">levonorgestrel<\/a> implanted under the skin in the upper arm and effective for five years.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> The original (six capsule) Norplant's production has been phased out; <a href=\"https:\/\/en.wikipedia.org\/wiki\/USAID\" class=\"mw-redirect\" title=\"USAID\" rel=\"external_link\" target=\"_blank\">USAID<\/a>'s contract ran until December 2006.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\nThe original (six capsule) Norplant was approved by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration_(United_States)\" class=\"mw-redirect\" title=\"Food and Drug Administration (United States)\" rel=\"external_link\" target=\"_blank\">U.S. Food and Drug Administration<\/a> (FDA) on December 10, 1990, and marketed in the United States in 1991 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wyeth_Pharmaceuticals\" class=\"mw-redirect\" title=\"Wyeth Pharmaceuticals\" rel=\"external_link\" target=\"_blank\">Wyeth Pharmaceuticals<\/a>.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> Norplant distribution in the United States ended in 2002; limited supplies still remained in the U.S. until 2004. Norplant was withdrawn from the UK market in 1999.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> Production of Norplant was discontinued globally in 2008.<sup id=\"rdp-ebb-cite_ref-Norplant_2008_19-0\" class=\"reference\"><a href=\"#cite_note-Norplant_2008-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p><p>Norplant II (Norplant-2, Jadelle), also developed by the Population Council and manufactured by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Schering_AG\" title=\"Schering AG\" rel=\"external_link\" target=\"_blank\">Schering Oy<\/a>, consists of two small (2.5 mm \u00d7 43 mm) silicone rods each containing 75 mg of levonorgestrel in a polymer matrix, instead of six capsules. It was approved May 31, 1996 by the FDA as being effective for three years; it was subsequently approved November 22, 2002 by the FDA as being effective for five years. Jadelle has not been marketed in the United States;<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> Jadelle is the successor to the original Norplant in USAID's contract beginning January 2007.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Society_and_culture\">Society and culture<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"United_States\">United States<\/span><\/h3>\n<p>By 1996, more than 50,000 women had filed lawsuits, including 70 class actions, against Wyeth and\/or its subsidiaries, or doctors who prescribed Norplant.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> Wyeth never lost a Norplant lawsuit, even in cases which came before a jury.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p><p>On August 26, 1999, after winning 3 jury verdicts, 20 pretrial <a href=\"https:\/\/en.wikipedia.org\/wiki\/Summary_judgment\" title=\"Summary judgment\" rel=\"external_link\" target=\"_blank\">summary judgments<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Involuntary_dismissal\" title=\"Involuntary dismissal\" rel=\"external_link\" target=\"_blank\">dismissal<\/a> of 14,000 claims, Wyeth offered out-of-court cash <a href=\"https:\/\/en.wikipedia.org\/wiki\/Settlement_(law)\" class=\"mw-redirect\" title=\"Settlement (law)\" rel=\"external_link\" target=\"_blank\">settlements<\/a> of $1,500 each to about 36,000 women who contended that they had not been adequately warned about possible side effects of Norplant such as irregular menstrual bleeding, headaches, nausea and depression. Wyeth said that most of the plaintiffs experienced routine side effects described in Norplant's labeling information. Wyeth did not admit to any wrongdoing, saying the settlement offer \"was purely a business decision,\" noting \"our legal success has come at a steep price because lawsuits are time-consuming, expensive, and have a chilling effect on research,\" and that it would continue to offer Norplant and would contest \"any and all new lawsuits aggressively.\"<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p><p>About 32,000 women accepted the out-of-court $1,500 settlements. On August 14, 2002, Wyeth won <a href=\"https:\/\/en.wikipedia.org\/wiki\/Partial_summary_judgment\" class=\"mw-redirect\" title=\"Partial summary judgment\" rel=\"external_link\" target=\"_blank\">partial summary judgment<\/a> and dismissal of the claims of the 2,960 remaining plaintiffs who had not accepted Wyeth's out-of-court settlement offer.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p><p>In August 2000, Wyeth suspended shipments of Norplant in the United States because during regular quality assurance monitoring, representative samples of seven lots distributed beginning October 20, 1999 tested within product specifications, but at the lower end of the release rate specification for shelf life stability, raising concerns about those lots' contraceptive effectiveness. Wyeth recommended that women who had Norplant capsules from those lots implanted use backup contraception until they determined the clinical relevance of the atypically low levels of levonorgestrel release.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p><p>On July 26, 2002, Wyeth announced that data from investigations conducted in women with Norplant capsules from the suspect lots did not suggest less contraceptive effectiveness than that reported in clinical trials, and that therefore backup contraception could be safely discontinued. Wyeth also announced that due to limitations in product component supplies, they did not plan to resume marketing the six-capsule Norplant system in the United States.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"New_Zealand\">New Zealand<\/span><\/h3>\n<p>Jadelle was added to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmaceutical_Management_Agency\" class=\"mw-redirect\" title=\"Pharmaceutical Management Agency\" rel=\"external_link\" target=\"_blank\">Pharmaceutical Management Agency<\/a>'s (Pharmac) schedule and subsequently subsidized in August 2010. Medical professionals raised concerns during a consultation process indicating preference for a product which is easier to insert. The agreement between Bayer New Zealand and Pharmac was conditional on Bayer New Zealand providing adequate training to ensure doctors are comfortable in the insertion and removal technique.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Controversy\">Controversy<\/span><\/h3>\n<p>Some American legislators have unsuccessfully attempted to provide financial incentives to women on welfare who agree to use Norplant. For example, in Kansas, Republican Kerry Patrick introduced legislation that would grant welfare recipients a one-time payment of $500 to use Norplant, followed by a $50 bonus each year the implants remained in place.\"<sup id=\"rdp-ebb-cite_ref-Roberts_1997_30-0\" class=\"reference\"><a href=\"#cite_note-Roberts_1997-30\" rel=\"external_link\">[30]<\/a><\/sup> Some judges have offered Norplant implants as a voluntary alternative to jail time for certain women convicted of child abuse or drug abuse during pregnancy. Two days after the 1990 FDA approval of Norplant, an editorial in <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Philadelphia_Inquirer\" title=\"The Philadelphia Inquirer\" rel=\"external_link\" target=\"_blank\">The Philadelphia Inquirer<\/a><\/i> suggested reducing the size of the black underclass by offering welfare mothers increased benefits if they agreed to use Norplant.<sup id=\"rdp-ebb-cite_ref-Roberts_1997_30-1\" class=\"reference\"><a href=\"#cite_note-Roberts_1997-30\" rel=\"external_link\">[30]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> Eleven days later the <i>Inquirer<\/i> apologized for their \"misguided and wrongheaded\" editorial and for their suggestion of offering incentives for Norplant use.<sup id=\"rdp-ebb-cite_ref-Roberts_1997_30-2\" class=\"reference\"><a href=\"#cite_note-Roberts_1997-30\" rel=\"external_link\">[30]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> Critics such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ACLU\" class=\"mw-redirect\" title=\"ACLU\" rel=\"external_link\" target=\"_blank\">ACLU<\/a> argued that such uses are coercive and discriminatory, and compared such uses to early 20th-century American eugenics.<sup id=\"rdp-ebb-cite_ref-ACLU_1994_33-0\" class=\"reference\"><a href=\"#cite_note-ACLU_1994-33\" rel=\"external_link\">[33]<\/a><\/sup> In <i>Killing the Black Body<\/i>, black feminist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dorothy_Roberts\" title=\"Dorothy Roberts\" rel=\"external_link\" target=\"_blank\">Dorothy Roberts<\/a> links such uses of Norplant to a \"white mainstream\" that is allegedly determined to \"demonize, even criminalize\" poor black women's lives and reproductive choices.<sup id=\"rdp-ebb-cite_ref-Roberts_1997_30-3\" class=\"reference\"><a href=\"#cite_note-Roberts_1997-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p><p>Within two years of Norplant's FDA approval, legislators in thirteen U.S. states had proposed nearly two dozen bills offering incentives for, or requiring use of Norplant by welfare mothers; none of these proposals passed.<sup id=\"rdp-ebb-cite_ref-Roberts_1997_30-4\" class=\"reference\"><a href=\"#cite_note-Roberts_1997-30\" rel=\"external_link\">[30]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Harrison_1998_34-0\" class=\"reference\"><a href=\"#cite_note-Harrison_1998-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p><p>The first big city to aggressively promote the use of Norplant was Baltimore.<sup id=\"rdp-ebb-cite_ref-Roberts_1997_30-5\" class=\"reference\"><a href=\"#cite_note-Roberts_1997-30\" rel=\"external_link\">[30]<\/a><\/sup> Baltimore targeted teenagers because the birthrate was three times higher than other states. In Baltimore, about ten percent of girls between ages 15 and 17 gave birth during 1990. Young mothers would often drop out of school and struggle to raise the child in poverty.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup> The mayor at the time, Kurt Schmoke, pushed for laws that would give teen girls more access to Norplant. Norplant was eventually given to teen girls at schools without parental consent. Programs were designed for, and performed in, predominantly black schools. Laurence G. Paquin Middle School became the first school to provide Norplant to their students.<sup id=\"rdp-ebb-cite_ref-Roberts_1997_30-6\" class=\"reference\"><a href=\"#cite_note-Roberts_1997-30\" rel=\"external_link\">[30]<\/a><\/sup> Paquin Middle School had 355 female students but only 5 of them were not black. Their program started off as a pilot program and soon other urban high schools like San Fernando High School in Los Angeles and Crane High School in Chicago's West Side adopted the program of providing Norplant to their students. Because of a focus on predominantly black schools, questions of racism arose amongst black community leaders.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nexplanon\" class=\"mw-redirect\" title=\"Nexplanon\" rel=\"external_link\" target=\"_blank\">Nexplanon<\/a>, another subdermal contraceptive implant<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-Sh2015-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Sh2015_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Sh2015_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Sh2015_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Sh2015_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Sh2015_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Sh2015_1-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Sh2015_1-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Shoupe, Donna; Jr, Daniel R. Mishell (2015). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=ZQehCgAAQBAJ&pg=PA141\" target=\"_blank\"><i>The Handbook of Contraception: A Guide for Practical Management<\/i><\/a> (2 ed.). Humana Press. p. 141. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9783319201856. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170923235733\/https:\/\/books.google.com\/books?id=ZQehCgAAQBAJ&pg=PA141\" target=\"_blank\">Archived<\/a> from the original on 2017-09-23.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Handbook+of+Contraception%3A+A+Guide+for+Practical+Management&rft.pages=141&rft.edition=2&rft.pub=Humana+Press&rft.date=2015&rft.isbn=9783319201856&rft.aulast=Shoupe&rft.aufirst=Donna&rft.au=Jr%2C+Daniel+R.+Mishell&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DZQehCgAAQBAJ%26pg%3DPA141&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-CDC2011-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-CDC2011_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CDC2011_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CDC2011_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cdc.gov\/reproductivehealth\/unintendedpregnancy\/pdf\/contraceptive_methods_508.pdf\" target=\"_blank\">\"Effectiveness of Family Planning Methods\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>CDC<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20161229095001\/https:\/\/www.cdc.gov\/reproductivehealth\/unintendedpregnancy\/pdf\/contraceptive_methods_508.pdf\" target=\"_blank\">Archived<\/a> <span class=\"cs1-format\">(PDF)<\/span> from the original on 29 December 2016<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">1 January<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=CDC&rft.atitle=Effectiveness+of+Family+Planning+Methods&rft_id=https%3A%2F%2Fwww.cdc.gov%2Freproductivehealth%2Funintendedpregnancy%2Fpdf%2Fcontraceptive_methods_508.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-WHO2008-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-WHO2008_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-WHO2008_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-WHO2008_3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-WHO2008_3-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-WHO2008_3-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-WHO2008_3-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/apps.who.int\/medicinedocs\/documents\/s16879e\/s16879e.pdf\" target=\"_blank\"><i>WHO Model Formulary 2008<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. World Health Organization. 2009. p. 373. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9789241547659. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20161213060118\/http:\/\/apps.who.int\/medicinedocs\/documents\/s16879e\/s16879e.pdf\" target=\"_blank\">Archived<\/a> <span class=\"cs1-format\">(PDF)<\/span> from the original on 13 December 2016<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">8 December<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=WHO+Model+Formulary+2008&rft.pages=373&rft.pub=World+Health+Organization&rft.date=2009&rft.isbn=9789241547659&rft_id=http%3A%2F%2Fapps.who.int%2Fmedicinedocs%2Fdocuments%2Fs16879e%2Fs16879e.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Cor1995-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Cor1995_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Cor1995_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Corson, S. L.; Derman, R. J. (1995). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=30EzZPp1ypYC&pg=PA195\" target=\"_blank\"><i>Fertility Control<\/i><\/a>. CRC Press. p. 195. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780969797807. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170923235733\/https:\/\/books.google.com\/books?id=30EzZPp1ypYC&pg=PA195\" target=\"_blank\">Archived<\/a> from the original on 2017-09-23.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Fertility+Control&rft.pages=195&rft.pub=CRC+Press&rft.date=1995&rft.isbn=9780969797807&rft.aulast=Corson&rft.aufirst=S.+L.&rft.au=Derman%2C+R.+J.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D30EzZPp1ypYC%26pg%3DPA195&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Medicine, Institute of; Policy, Division of Health Sciences; Development, Committee on Contraceptive Research and (1998). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=DPGbAgAAQBAJ&pg=PT115\" target=\"_blank\"><i>Contraceptive Research, Introduction, and Use: Lessons From Norplant<\/i><\/a>. National Academies Press. p. 107. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780309059855. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170923235733\/https:\/\/books.google.com\/books?id=DPGbAgAAQBAJ&pg=PT115\" target=\"_blank\">Archived<\/a> from the original on 2017-09-23.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Contraceptive+Research%2C+Introduction%2C+and+Use%3A+Lessons+From+Norplant&rft.pages=107&rft.pub=National+Academies+Press&rft.date=1998&rft.isbn=9780309059855&rft.aulast=Medicine&rft.aufirst=Institute+of&rft.au=Policy%2C+Division+of+Health+Sciences&rft.au=Development%2C+Committee+on+Contraceptive+Research+and&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DDPGbAgAAQBAJ%26pg%3DPT115&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-WHO19th-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-WHO19th_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.who.int\/medicines\/publications\/essentialmedicines\/EML_2015_FINAL_amended_NOV2015.pdf?ua=1\" target=\"_blank\">\"WHO Model List of Essential Medicines (19th List)\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>World Health Organization<\/i>. April 2015. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20161213052708\/http:\/\/www.who.int\/medicines\/publications\/essentialmedicines\/EML_2015_FINAL_amended_NOV2015.pdf?ua=1\" target=\"_blank\">Archived<\/a> <span class=\"cs1-format\">(PDF)<\/span> from the original on 13 December 2016<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">8 December<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=World+Health+Organization&rft.atitle=WHO+Model+List+of+Essential+Medicines+%2819th+List%29&rft.date=2015-04&rft_id=http%3A%2F%2Fwww.who.int%2Fmedicines%2Fpublications%2Fessentialmedicines%2FEML_2015_FINAL_amended_NOV2015.pdf%3Fua%3D1&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ERC2014-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ERC2014_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20180122072753\/http:\/\/mshpriceguide.org\/en\/single-drug-information\/?DMFId=1234&searchYear=2014\" target=\"_blank\">\"Levonorgestrel\"<\/a>. <i>International Drug Price Indicator Guide<\/i>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/mshpriceguide.org\/en\/single-drug-information\/?DMFId=1234&searchYear=2014\" target=\"_blank\">the original<\/a> on 22 January 2018<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">8 December<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=International+Drug+Price+Indicator+Guide&rft.atitle=Levonorgestrel&rft_id=http%3A%2F%2Fmshpriceguide.org%2Fen%2Fsingle-drug-information%2F%3FDMFId%3D1234%26searchYear%3D2014&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Kulczycki, Andrzej (2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=LXJ_AAAAQBAJ&pg=PA16\" target=\"_blank\"><i>Critical Issues in Reproductive Health<\/i><\/a>. Springer Science & Business Media. p. 16. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9789400767225. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170923235733\/https:\/\/books.google.com\/books?id=LXJ_AAAAQBAJ&pg=PA16\" target=\"_blank\">Archived<\/a> from the original on 2017-09-23.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Critical+Issues+in+Reproductive+Health&rft.pages=16&rft.pub=Springer+Science+%26+Business+Media&rft.date=2013&rft.isbn=9789400767225&rft.aulast=Kulczycki&rft.aufirst=Andrzej&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DLXJ_AAAAQBAJ%26pg%3DPA16&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Siving, Irving; Nash, Harold (2002). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=YYoeAQAAIAAJ&q\" target=\"_blank\"><i>Jadelle Levonorgestrel Rod Implants: A Summary of Scientific Data and Lessons Learned from Programmatic Experience<\/i><\/a>. Population Council. p. 4. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780878341054. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170923235733\/https:\/\/books.google.com\/books?id=YYoeAQAAIAAJ&q\" target=\"_blank\">Archived<\/a> from the original on 2017-09-23.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Jadelle+Levonorgestrel+Rod+Implants%3A+A+Summary+of+Scientific+Data+and+Lessons+Learned+from+Programmatic+Experience&rft.pages=4&rft.pub=Population+Council&rft.date=2002&rft.isbn=9780878341054&rft.aulast=Siving&rft.aufirst=Irving&rft.au=Nash%2C+Harold&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DYYoeAQAAIAAJ%26q&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">. (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20020209132924\/http:\/\/www.rxlist.com\/cgi\/generic2\/norplant_ad.htm\" target=\"_blank\">\"Norplant side effects\"<\/a>. <i>RxList.com<\/i>. New York: WebMD. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.rxlist.com\/cgi\/generic2\/norplant_ad.htm\" target=\"_blank\">the original<\/a> on February 9, 2002<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">August 16,<\/span> 2006<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=RxList.com&rft.atitle=Norplant+side+effects&rft.date=2006&rft.au=.&rft_id=http%3A%2F%2Fwww.rxlist.com%2Fcgi%2Fgeneric2%2Fnorplant_ad.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-IOM_1993-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-IOM_1993_11-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Subcommittee for Workshop on Implant Contraceptives, Committee on Contraceptive Research and Development, Division of Health Policy, Institute of Medicine (March 9, 1998). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nap.edu\/openbook.php?record_id=5946&page=107\" target=\"_blank\">\"Appendix B: Norplant: historical background\"<\/a>. In Harrison, Polly F.; Rosenfield, Allan. <i>Contraceptive research, introduction, and use: lessons from Norplant<\/i>. Washington, D.C.: National Academy Press. pp. 107\u2013114. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-309-05985-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Appendix+B%3A+Norplant%3A+historical+background&rft.btitle=Contraceptive+research%2C+introduction%2C+and+use%3A+lessons+from+Norplant&rft.place=Washington%2C+D.C.&rft.pages=107-114&rft.pub=National+Academy+Press&rft.date=1998-03-09&rft.isbn=978-0-309-05985-5&rft.au=Subcommittee+for+Workshop+on+Implant+Contraceptives%2C+Committee+on+Contraceptive+Research+and+Development%2C+Division+of+Health+Policy%2C+Institute+of+Medicine&rft_id=http%3A%2F%2Fwww.nap.edu%2Fopenbook.php%3Frecord_id%3D5946%26page%3D107&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Sivin_2002-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Sivin_2002_12-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Sivin, Irving; Nash, Harold; Waldman, Sandra (February 28, 2002). \"Development and introduction of contraceptive implants\". <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120905222505\/http:\/\/www.popcouncil.org\/pdfs\/jadelle_monograph.pdf\" target=\"_blank\"><i>Jadelle\u00ae levonorgestrel rod implants: a summary of scientific data and lessons learned from programmatic experience<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. New York, N.Y.: Population Council. pp. 1\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-87834-105-6. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.popcouncil.org\/pdfs\/jadelle_monograph.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on September 5, 2012.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Development+and+introduction+of+contraceptive+implants&rft.btitle=Jadelle%C2%AE+levonorgestrel+rod+implants%3A+a+summary+of+scientific+data+and+lessons+learned+from+programmatic+experience&rft.place=New+York%2C+N.Y.&rft.pages=1-6&rft.pub=Population+Council&rft.date=2002-02-28&rft.isbn=0-87834-105-6&rft.aulast=Sivin&rft.aufirst=Irving&rft.au=Nash%2C+Harold&rft.au=Waldman%2C+Sandra&rft_id=http%3A%2F%2Fwww.popcouncil.org%2Fpdfs%2Fjadelle_monograph.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Gunardi_2011-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Gunardi_2011_13-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gunardi, Eka Rusdianto; Affandi, Biran; Muchtar, Armen (January 2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/indonesia.digitaljournals.org\/index.php\/IJOG\/article\/view\/1002\" target=\"_blank\">\"Monoplant\u00ae the Indonesian implant: the overview of implant and its development\"<\/a>. <i>Indoesian Journal of Obstetrics and Gynecology<\/i>. <b>35<\/b> (1): 40\u201346. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0303-7924\" target=\"_blank\">0303-7924<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140725234436\/http:\/\/indonesia.digitaljournals.org\/index.php\/IJOG\/article\/view\/1002\" target=\"_blank\">Archived<\/a> from the original on 2014-07-25.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Indoesian+Journal+of+Obstetrics+and+Gynecology&rft.atitle=Monoplant%C2%AE+the+Indonesian+implant%3A+the+overview+of+implant+and+its+development&rft.volume=35&rft.issue=1&rft.pages=40-46&rft.date=2011-01&rft.issn=0303-7924&rft.aulast=Gunardi&rft.aufirst=Eka+Rusdianto&rft.au=Affandi%2C+Biran&rft.au=Muchtar%2C+Armen&rft_id=http%3A%2F%2Findonesia.digitaljournals.org%2Findex.php%2FIJOG%2Farticle%2Fview%2F1002&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Roy_1985-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Roy_1985_14-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Roy, Subir (1985). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.popline.org\/node\/419015\" target=\"_blank\">\"Current status of Norplant subdermal implants for contraception\"<\/a>. In Runnebaum, Benno; Rabe, Thomas; Kiesel, Ludwig. <i>Future aspects in contraception: proceedings of an international symposium held in Heidelberg, 5\u20138 September 1984; Part 2, Female contraception<\/i>. Boston, Mass.: MTP Press. pp. 95\u2013106. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-85200-906-2. <q>The Finnish National Board of Health approved the NORPLANT sub-dermal implant system as a contraceptive method in Finland on 23 November 1983.<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Current+status+of+Norplant+subdermal+implants+for+contraception&rft.btitle=Future+aspects+in+contraception%3A+proceedings+of+an+international+symposium+held+in+Heidelberg%2C+5%E2%80%938+September+1984%3B+Part+2%2C+Female+contraception&rft.place=Boston%2C+Mass.&rft.pages=95-106&rft.pub=MTP+Press&rft.date=1985&rft.isbn=0-85200-906-2&rft.aulast=Roy&rft.aufirst=Subir&rft_id=http%3A%2F%2Fwww.popline.org%2Fnode%2F419015&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Chin, Mona (1997). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/csua.berkeley.edu\/~monac\/norplant.html\" target=\"_blank\">\"Norplant: levonorgestrel implants\"<\/a>. Berkeley: UC Berkeley Computer Science Undergraduate Association (Mona Chin's personal web page). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060829075211\/http:\/\/www.csua.berkeley.edu\/~monac\/norplant.html\" target=\"_blank\">Archived<\/a> from the original on August 29, 2006<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">August 17,<\/span> 2006<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Norplant%3A+levonorgestrel+implants&rft.place=Berkeley&rft.pub=UC+Berkeley+Computer+Science+Undergraduate+Association+%28Mona+Chin%27s+personal+web+page%29&rft.date=1997&rft.aulast=Chin&rft.aufirst=Mona&rft_id=http%3A%2F%2Fcsua.berkeley.edu%2F~monac%2Fnorplant.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Shelton, James D. (Office of Population, USAID) (March 24, 2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070928002524\/http:\/\/www.jhuccp.org\/pearls\/pearl.php?id=325\" target=\"_blank\">\"Future for implants\"<\/a>. Baltimore: The Johns Hopkins University, Bloomberg School of Public Health, Center for Communication Programs. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jhuccp.org\/pearls\/pearl.php?id=325\" target=\"_blank\">the original<\/a> on September 28, 2007<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">August 17,<\/span> 2006<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Future+for+implants&rft.place=Baltimore&rft.pub=The+Johns+Hopkins+University%2C+Bloomberg+School+of+Public+Health%2C+Center+for+Communication+Programs&rft.date=2006-03-24&rft.au=Shelton%2C+James+D.+%28Office+of+Population%2C+USAID%29&rft_id=http%3A%2F%2Fwww.jhuccp.org%2Fpearls%2Fpearl.php%3Fid%3D325&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Grimes, William (October 20, 2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2009\/10\/21\/health\/21segal.html\" target=\"_blank\">\"Sheldon J. Segal, who developed contraceptives, dies at 83\"<\/a>. <i>The New York Times<\/i>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140401085239\/http:\/\/www.nytimes.com\/2009\/10\/21\/health\/21segal.html\" target=\"_blank\">Archived<\/a> from the original on April 1, 2014<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">October 22,<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=Sheldon+J.+Segal%2C+who+developed+contraceptives%2C+dies+at+83&rft.date=2009-10-20&rft.aulast=Grimes&rft.aufirst=William&rft_id=https%3A%2F%2Fwww.nytimes.com%2F2009%2F10%2F21%2Fhealth%2F21segal.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">BBC News (April 30, 1999). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/news.bbc.co.uk\/1\/hi\/health\/331618.stm\" target=\"_blank\">\"Contraceptive implant withdrawn\"<\/a>. London: BBC News<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">August 16,<\/span> 2006<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Contraceptive+implant+withdrawn&rft.date=1999-04-30&rft.au=BBC+News&rft_id=http%3A%2F%2Fnews.bbc.co.uk%2F1%2Fhi%2Fhealth%2F331618.stm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Norplant_2008-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Norplant_2008_19-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Ahmed, Kabir; Deperthes, Bidia; Frederick, Beth; Ehlers, Suzanne; Kapp, Natalie; Paladines, Cindy; Siemerink, Marie Christine; Skibiak, John; Skorochod, Beth; Steiner, Markus; Townsend, John; Westley, Elizabeth (March 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140611091045\/https:\/\/www.unfpa.org\/webdav\/site\/global\/shared\/images\/publications\/2012\/UN%20Commission_%20FP%20Synthesis_%20Final%2019%20March%202012.pdf\" target=\"_blank\">\"Contraceptive Commodities for Women's Health: Key Data and Findings\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. New York: UNFPA (United Nations Population Fund). p. 4. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.unfpa.org\/webdav\/site\/global\/shared\/images\/publications\/2012\/UN%20Commission_%20FP%20Synthesis_%20Final%2019%20March%202012.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on June 11, 2014<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">December 16,<\/span> 2013<\/span>. <q>Norplant (six rods each containing 36 mg of levonorgestrel, effective for five to seven years) was discontinued in 2008.<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Contraceptive+Commodities+for+Women%27s+Health%3A+Key+Data+and+Findings&rft.place=New+York&rft.pages=4&rft.pub=UNFPA+%28United+Nations+Population+Fund%29&rft.date=2012-03&rft.aulast=Ahmed&rft.aufirst=Kabir&rft.au=Deperthes%2C+Bidia&rft.au=Frederick%2C+Beth&rft.au=Ehlers%2C+Suzanne&rft.au=Kapp%2C+Natalie&rft.au=Paladines%2C+Cindy&rft.au=Siemerink%2C+Marie+Christine&rft.au=Skibiak%2C+John&rft.au=Skorochod%2C+Beth&rft.au=Steiner%2C+Markus&rft.au=Townsend%2C+John&rft.au=Westley%2C+Elizabeth&rft_id=http%3A%2F%2Fwww.unfpa.org%2Fwebdav%2Fsite%2Fglobal%2Fshared%2Fimages%2Fpublications%2F2012%2FUN%2520Commission_%2520FP%2520Synthesis_%2520Final%252019%2520March%25202012.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><br \/><cite class=\"citation web\">Caucus on New and Underused Reproductive Health Technologies (July 2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131217001941\/http:\/\/www.rhsupplies.org\/fileadmin\/user_upload\/Caucus_on_New_RH_technologies\/rhsc-brief-contraceptive-implants_A4.pdf\" target=\"_blank\">\"Contraceptive implants\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Brussels: Reproductive Health Supplies Coalition. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.rhsupplies.org\/fileadmin\/user_upload\/Caucus_on_New_RH_technologies\/rhsc-brief-contraceptive-implants_A4.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on December 17, 2013<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">December 16,<\/span> 2013<\/span>. <q>Production of Norplant was discontinued in 2008 because the new generation of products\u2014the two-rod implants, Jadelle and Sino-implant (II), and 1-rod implants, Implanon and Nexplanon\/Implanon NXT\u2014are easier to insert and remove.<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Contraceptive+implants&rft.place=Brussels&rft.pub=Reproductive+Health+Supplies+Coalition&rft.date=2013-07&rft.au=Caucus+on+New+and+Underused+Reproductive+Health+Technologies&rft_id=http%3A%2F%2Fwww.rhsupplies.org%2Ffileadmin%2Fuser_upload%2FCaucus_on_New_RH_technologies%2Frhsc-brief-contraceptive-implants_A4.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><br \/><cite class=\"citation book\">Rademacher, Kate H.; Vahdat, Heather L.; Dorflinger, Laneta; Owen, Derek H.; Steiner, Markus J. (2014). \"Global Introduction of a Low-Cost Contraceptive Implant\". In Kulczycki, Adnrzej. <i>Critical Issues in Reproductive Health<\/i>. Dordrecht: Springer. p. <span class=\"plainlinks\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=LXJ_AAAAQBAJ&pg=PA288\" target=\"_blank\">288<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-94-007-6721-8. <q>Studies and field experience demonstrated that compared to Norplant, one- and two-rod implants are easier and quicker to remove. This advantage led to the replacement of Norplant by Jadelle and Implanon in health programs around the world; in 2008, global production of Norplant was discontinued (Ramchandran and Upadhyay 2007).<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Global+Introduction+of+a+Low-Cost+Contraceptive+Implant&rft.btitle=Critical+Issues+in+Reproductive+Health&rft.place=Dordrecht&rft.pages=%3Cspan+class%3D%22plainlinks%22%3E288%3C%2Fspan%3E&rft.pub=Springer&rft.date=2014&rft.isbn=978-94-007-6721-8&rft.aulast=Rademacher&rft.aufirst=Kate+H.&rft.au=Vahdat%2C+Heather+L.&rft.au=Dorflinger%2C+Laneta&rft.au=Owen%2C+Derek+H.&rft.au=Steiner%2C+Markus+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Population Council (December 19, 2003). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20040104141640\/http:\/\/www.popcouncil.org\/biomed\/jadellefaqgeninfo.html\" target=\"_blank\">\"Jadelle implants - general information\"<\/a>. New York: Population Council. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.popcouncil.org\/biomed\/jadellefaqgeninfo.html\" target=\"_blank\">the original<\/a> on January 4, 2004<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">August 16,<\/span> 2005<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Jadelle+implants+-+general+information&rft.place=New+York&rft.pub=Population+Council&rft.date=2003-12-19&rft.au=Population+Council&rft_id=http%3A%2F%2Fwww.popcouncil.org%2Fbiomed%2Fjadellefaqgeninfo.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Shelton, James D. (Office of Population, USAID) (September 6, 2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080705232236\/http:\/\/www.infoforhealth.org\/pearls\/2006\/09-06.shtml\" target=\"_blank\">\"New USAID award for contraceptive implants (Jadelle)\"<\/a>. <i>INFO (Information and Knowledge for Optimal Health) Project<\/i>. Baltimore: The Johns Hopkins University, Bloomberg School of Public Health, Center for Communication Programs. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.infoforhealth.org\/pearls\/2006\/09-06.shtml\" target=\"_blank\">the original<\/a> on July 5, 2008<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">January 6,<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=INFO+%28Information+and+Knowledge+for+Optimal+Health%29+Project&rft.atitle=New+USAID+award+for+contraceptive+implants+%28Jadelle%29&rft.date=2006-09-06&rft.au=Shelton%2C+James+D.+%28Office+of+Population%2C+USAID%29&rft_id=http%3A%2F%2Fwww.infoforhealth.org%2Fpearls%2F2006%2F09-06.shtml&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Johnson, Erica; Smyth, Carmel; Jones, Colman (April 1, 2003). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20030418181912\/http:\/\/www.cbc.ca\/consumers\/market\/files\/health\/medical_devices\/lawsuits.html\" target=\"_blank\">\"Medical device lawsuits\"<\/a>. <i>Marketplace<\/i>. Toronto: CBC News. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cbc.ca\/consumers\/market\/files\/health\/medical_devices\/lawsuits.html\" target=\"_blank\">the original<\/a> on April 18, 2003<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">July 28,<\/span> 2006<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Marketplace&rft.atitle=Medical+device+lawsuits&rft.date=2003-04-01&rft.aulast=Johnson&rft.aufirst=Erica&rft.au=Smyth%2C+Carmel&rft.au=Jones%2C+Colman&rft_id=http%3A%2F%2Fwww.cbc.ca%2Fconsumers%2Fmarket%2Ffiles%2Fhealth%2Fmedical_devices%2Flawsuits.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">ARHP (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060422135700\/http:\/\/www.arhp.org\/files\/ndicimplants.pdf\" target=\"_blank\">\"New developments in contraception: the single-rod implant\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Washington, D.C.: Association of Reproductive Health Professionals. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.arhp.org\/files\/ndicimplants.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on April 22, 2006<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">January 6,<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=New+developments+in+contraception%3A+the+single-rod+implant&rft.place=Washington%2C+D.C.&rft.pub=Association+of+Reproductive+Health+Professionals&rft.date=2006&rft.au=ARHP&rft_id=http%3A%2F%2Fwww.arhp.org%2Ffiles%2Fndicimplants.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">. (September 5, 1998). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/1998\/09\/05\/us\/contraceptive-maker-wins-woman-s-suit-over-side-effects.html\" target=\"_blank\">\"Contraceptive maker wins woman's suit over side effects\"<\/a>. <i>The New York Times<\/i>. p. A7. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20121107065836\/http:\/\/www.nytimes.com\/1998\/09\/05\/us\/contraceptive-maker-wins-woman-s-suit-over-side-effects.html\" target=\"_blank\">Archived<\/a> from the original on November 7, 2012<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">January 15,<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=Contraceptive+maker+wins+woman%27s+suit+over+side+effects&rft.pages=A7&rft.date=1998-09-05&rft.au=.&rft_id=https%3A%2F%2Fwww.nytimes.com%2F1998%2F09%2F05%2Fus%2Fcontraceptive-maker-wins-woman-s-suit-over-side-effects.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Morrow, David J. (August 27, 1999). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/1999\/08\/27\/us\/maker-of-norplant-offers-a-settlement-in-suit-over-effects.html?pagewanted=all\" target=\"_blank\">\"Maker of Norplant offers a settlement in suit over effects\"<\/a>. <i>The New York Times<\/i>. p. A1. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160307012216\/http:\/\/www.nytimes.com\/1999\/08\/27\/us\/maker-of-norplant-offers-a-settlement-in-suit-over-effects.html?pagewanted=all\" target=\"_blank\">Archived<\/a> from the original on March 7, 2016<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">January 15,<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=Maker+of+Norplant+offers+a+settlement+in+suit+over+effects&rft.pages=A1&rft.date=1999-08-27&rft.aulast=Morrow&rft.aufirst=David+J.&rft_id=https%3A%2F%2Fwww.nytimes.com%2F1999%2F08%2F27%2Fus%2Fmaker-of-norplant-offers-a-settlement-in-suit-over-effects.html%3Fpagewanted%3Dall&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Manson, Pamela (August 27, 2002). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20021001142646\/http:\/\/www.law.com\/jsp\/article.jsp?id=1029689061746\" target=\"_blank\">\"Federal judge dismisses Norplant damage claims\"<\/a>. <i>Texas Lawyer<\/i>. New York: Law.com. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.law.com\/jsp\/article.jsp?id=1029689061746\" target=\"_blank\">the original<\/a> on October 1, 2002<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">January 15,<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Texas+Lawyer&rft.atitle=Federal+judge+dismisses+Norplant+damage+claims&rft.date=2002-08-27&rft.aulast=Manson&rft.aufirst=Pamela&rft_id=http%3A%2F%2Fwww.law.com%2Fjsp%2Farticle.jsp%3Fid%3D1029689061746&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">FDA (September 13, 2000). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20001119165300\/http:\/\/www.fda.gov\/medwatch\/safety\/2000\/safety00.htm\" target=\"_blank\">\"MedWatch - New safety information summaries 2000 - Norplant\"<\/a>. Silver Spring, Md.: U.S. Food and Drug Administration. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/medwatch\/safety\/2000\/safety00.htm\" target=\"_blank\">the original<\/a> on November 19, 2000<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">January 6,<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=MedWatch+-+New+safety+information+summaries+2000+-+Norplant&rft.place=Silver+Spring%2C+Md.&rft.pub=U.S.+Food+and+Drug+Administration&rft.date=2000-09-13&rft.au=FDA&rft_id=http%3A%2F%2Fwww.fda.gov%2Fmedwatch%2Fsafety%2F2000%2Fsafety00.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">FDA (July 26, 2002). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20021002220753\/http:\/\/www.fda.gov\/bbs\/topics\/ANSWERS\/2002\/ANS01161.html\" target=\"_blank\">\"Update on advisory for Norplant contraceptive kits\"<\/a>. Silver Spring, Md.: U.S. Food and Drug Administration. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/bbs\/topics\/ANSWERS\/2002\/ANS01161.html\" target=\"_blank\">the original<\/a> on October 2, 2002<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">January 6,<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Update+on+advisory+for+Norplant+contraceptive+kits&rft.place=Silver+Spring%2C+Md.&rft.pub=U.S.+Food+and+Drug+Administration&rft.date=2002-07-26&rft.au=FDA&rft_id=http%3A%2F%2Fwww.fda.gov%2Fbbs%2Ftopics%2FANSWERS%2F2002%2FANS01161.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Pharmaceutical Management Agency (July 1, 2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.pharmac.govt.nz\/2010\/07\/01\/Notification%20of%20approved%20Jadelle%20funding%20proposal.pdf\" target=\"_blank\">\"Notification: Jadelle (levonorgestrel 2 x 75 mg rods) funding proposal approved\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Wellington, New Zealand: Pharmaceutical Management Agency. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110724200104\/http:\/\/www.pharmac.govt.nz\/2010\/07\/01\/Notification%20of%20approved%20Jadelle%20funding%20proposal.pdf\" target=\"_blank\">Archived<\/a> <span class=\"cs1-format\">(PDF)<\/span> from the original on July 24, 2011<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">July 26,<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Notification%3A+Jadelle+%28levonorgestrel+2+x+75+mg+rods%29+funding+proposal+approved&rft.place=Wellington%2C+New+Zealand&rft.pub=Pharmaceutical+Management+Agency&rft.date=2010-07-01&rft.au=Pharmaceutical+Management+Agency&rft_id=http%3A%2F%2Fwww.pharmac.govt.nz%2F2010%2F07%2F01%2FNotification%2520of%2520approved%2520Jadelle%2520funding%2520proposal.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Roberts_1997-30\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Roberts_1997_30-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Roberts_1997_30-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Roberts_1997_30-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Roberts_1997_30-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Roberts_1997_30-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Roberts_1997_30-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Roberts_1997_30-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dorothy_Roberts\" title=\"Dorothy Roberts\" rel=\"external_link\" target=\"_blank\">Roberts, Dorothy<\/a> (1997). \"Chapter 3. From Norplant to the Contraceptive Vaccine. The New Frontier of Population Control\". <i>Killing the Black Body: Race, Reproduction, and the Meaning of Liberty<\/i>. New York: Pantheon. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-679-44226-X.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+3.+From+Norplant+to+the+Contraceptive+Vaccine.+The+New+Frontier+of+Population+Control&rft.btitle=Killing+the+Black+Body%3A+Race%2C+Reproduction%2C+and+the+Meaning+of+Liberty&rft.place=New+York&rft.pub=Pantheon&rft.date=1997&rft.isbn=0-679-44226-X&rft.aulast=Roberts&rft.aufirst=Dorothy&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">editorial (December 12, 1990). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/articles.philly.com\/1990-12-12\/news\/25920681_1_black-children-norplant-black-middle-class\" target=\"_blank\">\"Poverty and Norplant; can contraception reduce the underclass?\"<\/a>. <i>The Philadelphia Inquirer<\/i>. p. A18. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20151127012044\/http:\/\/articles.philly.com\/1990-12-12\/news\/25920681_1_black-children-norplant-black-middle-class\" target=\"_blank\">Archived<\/a> from the original on November 27, 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">December 16,<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Philadelphia+Inquirer&rft.atitle=Poverty+and+Norplant%3B+can+contraception+reduce+the+underclass%3F&rft.pages=A18&rft.date=1990-12-12&rft.au=editorial&rft_id=http%3A%2F%2Farticles.philly.com%2F1990-12-12%2Fnews%2F25920681_1_black-children-norplant-black-middle-class&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">editorial (December 23, 1990). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/articles.philly.com\/1990-12-23\/news\/25922202_1_norplant-poor-women-poverty\" target=\"_blank\">\"An apology: the editorial on 'Norplant and poverty' was misguided and wrongheaded\"<\/a>. <i>The Philadelphia Inquirer<\/i>. p. C04. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150806154740\/http:\/\/articles.philly.com\/1990-12-23\/news\/25922202_1_norplant-poor-women-poverty\" target=\"_blank\">Archived<\/a> from the original on August 6, 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">December 16,<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Philadelphia+Inquirer&rft.atitle=An+apology%3A+the+editorial+on+%27Norplant+and+poverty%27+was+misguided+and+wrongheaded&rft.pages=C04&rft.date=1990-12-23&rft.au=editorial&rft_id=http%3A%2F%2Farticles.philly.com%2F1990-12-23%2Fnews%2F25922202_1_norplant-poor-women-poverty&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ACLU_1994-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ACLU_1994_33-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">ACLU (January 31, 1994). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.aclu.org\/reproductive-freedom\/norplant-new-contraceptive-potential-abuse\" target=\"_blank\">\"Norplant: A New Contraceptive with the Potential for Abuse\"<\/a>. New York: American Civil Liberties Union. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131202230936\/https:\/\/www.aclu.org\/reproductive-freedom\/norplant-new-contraceptive-potential-abuse\" target=\"_blank\">Archived<\/a> from the original on December 2, 2013<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">November 24,<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Norplant%3A+A+New+Contraceptive+with+the+Potential+for+Abuse&rft.place=New+York&rft.pub=American+Civil+Liberties+Union&rft.date=1994-01-31&rft.au=ACLU&rft_id=https%3A%2F%2Fwww.aclu.org%2Freproductive-freedom%2Fnorplant-new-contraceptive-potential-abuse&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Harrison_1998-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Harrison_1998_34-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Harrison, Polly F.; Rosenfield, Allan, eds. (1998). \"Workshop Report\". <i>Contraceptive Research, Introduction, and Use: Lessons from Norplant<\/i>. Washington, D.C.: National Academy Press. pp. <span class=\"plainlinks\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nap.edu\/openbook.php?record_id=5946&page=30\" target=\"_blank\">30<\/a><\/span>, <span class=\"plainlinks\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nap.edu\/openbook.php?record_id=5946&page=55\" target=\"_blank\">55<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-309-05985-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Workshop+Report&rft.btitle=Contraceptive+Research%2C+Introduction%2C+and+Use%3A+Lessons+from+Norplant&rft.place=Washington%2C+D.C.&rft.pages=%3Cspan+class%3D%22plainlinks%22%3E30%3C%2Fspan%3E%2C+%3Cspan+class%3D%22plainlinks%22%3E55%3C%2Fspan%3E&rft.pub=National+Academy+Press&rft.date=1998&rft.isbn=978-0-309-05985-5&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><br \/><cite class=\"citation journal\">Davidson, Andrew R.; Kalmuss, Debra (April 1997). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ajph.aphapublications.org\/doi\/pdf\/10.2105\/AJPH.87.4.550\" target=\"_blank\">\"Topics for our times: Norplant coercion\u2014an overstated threat\"<\/a>. <i>American Journal of Public Health<\/i>. <b>87<\/b> (4): 550\u2013551. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2105%2Fajph.87.4.550\" target=\"_blank\">10.2105\/ajph.87.4.550<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1380830\" target=\"_blank\">1380830<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9146429\" target=\"_blank\">9146429<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">December 16,<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Public+Health&rft.atitle=Topics+for+our+times%3A+Norplant+coercion%E2%80%94an+overstated+threat&rft.volume=87&rft.issue=4&rft.pages=550-551&rft.date=1997-04&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1380830&rft_id=info%3Apmid%2F9146429&rft_id=info%3Adoi%2F10.2105%2Fajph.87.4.550&rft.aulast=Davidson&rft.aufirst=Andrew+R.&rft.au=Kalmuss%2C+Debra&rft_id=http%3A%2F%2Fajph.aphapublications.org%2Fdoi%2Fpdf%2F10.2105%2FAJPH.87.4.550&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Banisky, Sandy (December 3, 1992). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/articles.baltimoresun.com\/1992-12-03\/news\/1992338097_1_norplant-abell-foundation-beilenson\" target=\"_blank\">\"City officials planning to promote Norplant; teen-agers will be targeted for the 5-year contraceptive\"<\/a>. <i>The Baltimore Sun<\/i>. p. 1A. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131212015414\/http:\/\/articles.baltimoresun.com\/1992-12-03\/news\/1992338097_1_norplant-abell-foundation-beilenson\" target=\"_blank\">Archived<\/a> from the original on December 12, 2013<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">December 9,<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Baltimore+Sun&rft.atitle=City+officials+planning+to+promote+Norplant%3B+teen-agers+will+be+targeted+for+the+5-year+contraceptive&rft.pages=1A&rft.date=1992-12-03&rft.aulast=Banisky&rft.aufirst=Sandy&rft_id=http%3A%2F%2Farticles.baltimoresun.com%2F1992-12-03%2Fnews%2F1992338097_1_norplant-abell-foundation-beilenson&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALevonorgestrel-releasing+implant\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1254\nCached time: 20181217105115\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.784 seconds\nReal time usage: 0.948 seconds\nPreprocessor visited node count: 3803\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 267129\/2097152 bytes\nTemplate argument size: 4965\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 7\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 119365\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.368\/10.000 seconds\nLua memory usage: 5.48 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 663.125 1 -total\n<\/p>\n<pre>56.35% 373.670 1 Template:Reflist\n19.48% 129.189 12 Template:Cite_book\n12.83% 85.079 4 Template:Citation_needed\n11.88% 78.752 15 Template:Cite_web\n11.49% 76.209 4 Template:Fix\n10.86% 71.991 10 Template:Navbox\n 8.31% 55.115 9 Template:Cite_news\n 7.42% 49.229 2 Template:Cite_journal\n 6.95% 46.088 1 Template:Infobox_birth_control\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:770854-1!canonical and timestamp 20181217105114 and revision id 869966681\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Levonorgestrel_implant\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212141\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.022 seconds\nReal time usage: 0.184 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 172.361 1 - wikipedia:Levonorgestrel_implant\n100.00% 172.361 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8037-0!*!*!*!*!*!* and timestamp 20181217212141 and revision id 24148\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Levonorgestrel_implant\">https:\/\/www.limswiki.org\/index.php\/Levonorgestrel_implant<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","dc9d017bfcf11e68e5fe57f7b1da477b_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5f\/Tabletten.JPG\/48px-Tabletten.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/WHO_Rod.svg\/18px-WHO_Rod.svg.png"],"dc9d017bfcf11e68e5fe57f7b1da477b_timestamp":1545081701,"b3e77d18a2bdfedc1268178e524fcbcb_type":"article","b3e77d18a2bdfedc1268178e524fcbcb_title":"Kirschner wire","b3e77d18a2bdfedc1268178e524fcbcb_url":"https:\/\/www.limswiki.org\/index.php\/Kirschner_wire","b3e77d18a2bdfedc1268178e524fcbcb_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tKirschner wire\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Intraoperative X-Ray of a Humerus fixated by Kirschner wires\nKirschner wires or K-wires or pins are sterilized, sharpened, smooth stainless steel pins. Introduced in 1909 by Martin Kirschner, the wires are now widely used in orthopedics and other types of medical and veterinary surgery. They come in different sizes and are used to hold bone fragments together (pin fixation) or to provide an anchor for skeletal traction. The pins are often driven into the bone through the skin (percutaneous pin fixation) using a power or hand drill. They also form part of the Ilizarov apparatus.\n\n Kirschner Wires used for fixation of a Colles' fracture\nContents \n\n1 Variations \n2 Indications \n3 Complications \n4 See also \n5 References \n6 External links \n\n\nVariations \nThreaded K-wires are manufactured. They are used in situations where backing out of the pin is undesirable but they are weaker.\r\n\n\"Denham Pins\" are strong stout wires with a threaded portion in the middle. They are used for skeletal traction with the threads engaging the bone. It was invented in 1956 by the English Orthopedic Surgeon, Robert Arthur Denham (b. 1922).\n\nIndications \nK-wires are used for temporary fixation during some operations. After definitive fixation they are then removed. The pins are usually removed four weeks post operation.[1]\nThey can be used for definitive fixation if the fracture fragments are small (e.g. wrist fractures and hand injuries). In some settings they can be used for intramedullary fixation of bones such as the ulna.\nTension band wiring is a technique in which the bone fragments are transfixed by K-wires which are then also used as an anchor for a loop of flexible wire. As the loop is tightened the bone fragments are compressed together. Fractures of the kneecap and the olecranon process of the elbow are commonly treated by this method.\nA wire is passed through the skin then transversely through the bone and out the other side of the limb. The wire is then attached to some form of traction so that the pull is applied directly to bone. In traction of the femur for example, the protruding ends of the wire are fixed to the legs of a horsehoe shaped frame which maintains tension in the wire while the crook of the horseshoe is attached via line and pulleys to weights which maintain the traction.\nThey can be used for temporary joint immobilization.\nK-wires can be used to guide cannulated screws to a precise location.\nComplications \nPin tract infection: Because K-wires often pass through the skin into bone they form a potential passage for bacteria from the skin to migrate into the bone and cause an infection. In such cases, the area around the pin becomes red and swollen and may start to drain pus. Usually this infection clears up after removal of the pin.\nBreakage: K-wires may bend or break, especially if the fracture does not heal.[2]\nLoss of fixation: Smooth K-wires may back out of the bone losing the fixation. This is especially likely if they pass between two mobile bones.\nMigration of K-wires can occur; instead of backing out the wire can move deeper. K-wires passed across the acromioclavicular (AC) joint in the shoulder have been found to migrate into the chest with the potential to penetrate the major blood vessels, the trachea,[3] lung,[4] or the heart.[5]\nSee also \nSuzuki frame\nReferences \n\n\n^ http:\/\/sussexhandsurgery.co.uk\/downloads\/surgery\/hand\/K%20wire%20fixation%20of%20hand%20fractures.pdf \n\n^ Cebesoy O, Subasi M, Arpacioglu O (August 2007). \"Finsen V, Hofstad M, Haugan H. A rare complication in scaphoid pseudoarthrosis: intraarticlar migration and breaking of Kirschner wire\". Injury. 38 (8): 988\u20139. doi:10.1016\/j.injury.2007.04.011. PMID 17631883. \n\n^ Mitsuo Nakayama, MD; Masatoshi Gika, MD; Hiroki Fukuda, MD; Takeshi Yamahata, MD; Kohei Aoki, MD; Syugo Shiba, MD; Keisuke Eguchi, MD (2009). \"Migration of a Kirschner Wire From the Clavicle Into the Intrathoracic Trachea\". Ann Thorac Surg. 88 (2): 653\u2013654. doi:10.1016\/j.athoracsur.2008.12.093. PMID 19632433. \n\n^ Robert Mazet Jr. (1943). \"Migration of a Kirschner Wire From the Shoulder Region Into the Lung:Report of Two Cases\". Journal of Bone and Joint Surgery. 25 (2): 477\u2013483. Archived from the original on 2008-07-24. Retrieved 2009-12-15 . \n\n^ Lenard L, Aradi D, Donauer E (April 2009). \"Migrating Kirschner wire in the heart mimics acute coronary syndrome\". Eur Heart J. 30 (7): 754. doi:10.1093\/eurheartj\/ehn548. PMID 19066210. \n\n\nExternal links \nKirschner Wires vs. Steinmann Pins\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Kirschner_wire\">https:\/\/www.limswiki.org\/index.php\/Kirschner_wire<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:09.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 876 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","b3e77d18a2bdfedc1268178e524fcbcb_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Kirschner_wire skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Kirschner wire<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kirschner_wires_ulna.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a8\/Kirschner_wires_ulna.jpg\/220px-Kirschner_wires_ulna.jpg\" width=\"220\" height=\"330\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kirschner_wires_ulna.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Intraoperative X-Ray of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Humerus\" title=\"Humerus\" rel=\"external_link\" target=\"_blank\">Humerus<\/a> fixated by Kirschner wires<\/div><\/div><\/div>\n<p><b>Kirschner wires<\/b> or <b>K-wires<\/b> or <b>pins<\/b> are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">sterilized<\/a>, sharpened, smooth <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a> pins. Introduced in 1909 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Martin_Kirschner\" title=\"Martin Kirschner\" rel=\"external_link\" target=\"_blank\">Martin Kirschner<\/a>, the wires are now widely used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedic_surgery\" title=\"Orthopedic surgery\" rel=\"external_link\" target=\"_blank\">orthopedics<\/a> and other types of medical and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Veterinarian\" class=\"mw-redirect\" title=\"Veterinarian\" rel=\"external_link\" target=\"_blank\">veterinary surgery<\/a>. They come in different sizes and are used to hold bone fragments together (pin fixation) or to provide an anchor for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skeletal_traction\" class=\"mw-redirect\" title=\"Skeletal traction\" rel=\"external_link\" target=\"_blank\">skeletal traction<\/a>. The pins are often driven into the bone through the skin (percutaneous pin fixation) using a power or hand drill. They also form part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ilizarov_apparatus\" title=\"Ilizarov apparatus\" rel=\"external_link\" target=\"_blank\">Ilizarov apparatus<\/a>.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Wrist_Kirschner_Wires.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4d\/Wrist_Kirschner_Wires.jpg\/220px-Wrist_Kirschner_Wires.jpg\" width=\"220\" height=\"89\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Wrist_Kirschner_Wires.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Kirschner Wires used for fixation of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colles%27_fracture\" title=\"Colles' fracture\" rel=\"external_link\" target=\"_blank\">Colles' fracture<\/a><\/div><\/div><\/div>\n\n<h2><span class=\"mw-headline\" id=\"Variations\">Variations<\/span><\/h2>\n<p>Threaded K-wires are manufactured. They are used in situations where backing out of the pin is undesirable but they are weaker.<br \/>\n\"Denham Pins\" are strong stout wires with a threaded portion in the middle. They are used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skeletal_traction\" class=\"mw-redirect\" title=\"Skeletal traction\" rel=\"external_link\" target=\"_blank\">skeletal traction<\/a> with the threads engaging the bone. It was invented in 1956 by the English Orthopedic Surgeon, Robert Arthur Denham (b. 1922).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h2>\n<ul><li>K-wires are used for temporary fixation during some operations. After definitive fixation they are then removed. The pins are usually removed four weeks post operation.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><\/li>\n<li>They can be used for definitive fixation if the fracture fragments are small (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Distal_radius_fracture\" title=\"Distal radius fracture\" rel=\"external_link\" target=\"_blank\">wrist fractures<\/a> and hand injuries). In some settings they can be used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intramedullary\" class=\"mw-redirect\" title=\"Intramedullary\" rel=\"external_link\" target=\"_blank\">intramedullary<\/a> fixation of bones such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ulna\" title=\"Ulna\" rel=\"external_link\" target=\"_blank\">ulna<\/a>.<\/li>\n<li>Tension band wiring is a technique in which the bone fragments are transfixed by K-wires which are then also used as an anchor for a loop of flexible wire. As the loop is tightened the bone fragments are compressed together. Fractures of the kneecap and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Olecranon_process\" class=\"mw-redirect\" title=\"Olecranon process\" rel=\"external_link\" target=\"_blank\">olecranon process<\/a> of the elbow are commonly treated by this method.<\/li>\n<li>A wire is passed through the skin then transversely through the bone and out the other side of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Limb_(anatomy)\" title=\"Limb (anatomy)\" rel=\"external_link\" target=\"_blank\">limb<\/a>. The wire is then attached to some form of traction so that the pull is applied directly to bone. In traction of the femur for example, the protruding ends of the wire are fixed to the legs of a horsehoe shaped frame which maintains tension in the wire while the crook of the horseshoe is attached via line and pulleys to weights which maintain the traction.<\/li>\n<li>They can be used for temporary joint immobilization.<\/li>\n<li>K-wires can be used to guide <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cannula\" title=\"Cannula\" rel=\"external_link\" target=\"_blank\">cannulated<\/a> screws to a precise location.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Complications\">Complications<\/span><\/h2>\n<ul><li>Pin tract infection: Because K-wires often pass through the skin into bone they form a potential passage for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bacteria\" title=\"Bacteria\" rel=\"external_link\" target=\"_blank\">bacteria<\/a> from the skin to migrate into the bone and cause an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteomyelitis\" title=\"Osteomyelitis\" rel=\"external_link\" target=\"_blank\">infection<\/a>. In such cases, the area around the pin becomes red and swollen and may start to drain pus. Usually this infection clears up after removal of the pin.<\/li>\n<li>Breakage: K-wires may bend or break, especially if the fracture does not heal.<sup id=\"rdp-ebb-cite_ref-usgs_2-0\" class=\"reference\"><a href=\"#cite_note-usgs-2\" rel=\"external_link\">[2]<\/a><\/sup><\/li>\n<li>Loss of fixation: Smooth K-wires may back out of the bone losing the fixation. This is especially likely if they pass between two mobile bones.<\/li>\n<li>Migration of K-wires can occur; instead of backing out the wire can move deeper. K-wires passed across the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acromioclavicular\" class=\"mw-redirect\" title=\"Acromioclavicular\" rel=\"external_link\" target=\"_blank\">acromioclavicular<\/a> (AC) joint in the shoulder have been found to migrate into the chest with the potential to penetrate the major blood vessels, the trachea,<sup id=\"rdp-ebb-cite_ref-Nakayama_3-0\" class=\"reference\"><a href=\"#cite_note-Nakayama-3\" rel=\"external_link\">[3]<\/a><\/sup> lung,<sup id=\"rdp-ebb-cite_ref-Mazet_4-0\" class=\"reference\"><a href=\"#cite_note-Mazet-4\" rel=\"external_link\">[4]<\/a><\/sup> or the heart.<sup id=\"rdp-ebb-cite_ref-Lenard_5-0\" class=\"reference\"><a href=\"#cite_note-Lenard-5\" rel=\"external_link\">[5]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Suzuki_frame\" title=\"Suzuki frame\" rel=\"external_link\" target=\"_blank\">Suzuki frame<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/sussexhandsurgery.co.uk\/downloads\/surgery\/hand\/K%20wire%20fixation%20of%20hand%20fractures.pdf\" target=\"_blank\">http:\/\/sussexhandsurgery.co.uk\/downloads\/surgery\/hand\/K%20wire%20fixation%20of%20hand%20fractures.pdf<\/a><\/span>\n<\/li>\n<li id=\"cite_note-usgs-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-usgs_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cebesoy O, Subasi M, Arpacioglu O (August 2007). \"Finsen V, Hofstad M, Haugan H. A rare complication in scaphoid pseudoarthrosis: intraarticlar migration and breaking of Kirschner wire\". <i>Injury<\/i>. <b>38<\/b> (8): 988\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.injury.2007.04.011\" target=\"_blank\">10.1016\/j.injury.2007.04.011<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17631883\" target=\"_blank\">17631883<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Injury&rft.atitle=Finsen+V%2C+Hofstad+M%2C+Haugan+H.+A+rare+complication+in+scaphoid+pseudoarthrosis%3A+intraarticlar+migration+and+breaking+of+Kirschner+wire&rft.volume=38&rft.issue=8&rft.pages=988-9&rft.date=2007-08&rft_id=info%3Adoi%2F10.1016%2Fj.injury.2007.04.011&rft_id=info%3Apmid%2F17631883&rft.aulast=Cebesoy&rft.aufirst=O&rft.au=Subasi%2C+M&rft.au=Arpacioglu%2C+O&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKirschner+wire\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Nakayama-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Nakayama_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mitsuo Nakayama, MD; Masatoshi Gika, MD; Hiroki Fukuda, MD; Takeshi Yamahata, MD; Kohei Aoki, MD; Syugo Shiba, MD; Keisuke Eguchi, MD (2009). \"Migration of a Kirschner Wire From the Clavicle Into the Intrathoracic Trachea\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ann_Thorac_Surg\" class=\"mw-redirect\" title=\"Ann Thorac Surg\" rel=\"external_link\" target=\"_blank\">Ann Thorac Surg<\/a><\/i>. <b>88<\/b> (2): 653\u2013654. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.athoracsur.2008.12.093\" target=\"_blank\">10.1016\/j.athoracsur.2008.12.093<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19632433\" target=\"_blank\">19632433<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ann+Thorac+Surg&rft.atitle=Migration+of+a+Kirschner+Wire+From+the+Clavicle+Into+the+Intrathoracic+Trachea&rft.volume=88&rft.issue=2&rft.pages=653-654&rft.date=2009&rft_id=info%3Adoi%2F10.1016%2Fj.athoracsur.2008.12.093&rft_id=info%3Apmid%2F19632433&rft.au=Mitsuo+Nakayama%2C+MD&rft.au=Masatoshi+Gika%2C+MD&rft.au=Hiroki+Fukuda%2C+MD&rft.au=Takeshi+Yamahata%2C+MD&rft.au=Kohei+Aoki%2C+MD&rft.au=Syugo+Shiba%2C+MD&rft.au=Keisuke+Eguchi%2C+MD&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKirschner+wire\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Mazet-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Mazet_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Robert Mazet Jr. (1943). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20080724151540\/http:\/\/www.ejbjs.org\/cgi\/content\/abstract\/25\/2\/477\" target=\"_blank\">\"Migration of a Kirschner Wire From the Shoulder Region Into the Lung:Report of Two Cases\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Journal_of_Bone_and_Joint_Surgery\" class=\"mw-redirect\" title=\"Journal of Bone and Joint Surgery\" rel=\"external_link\" target=\"_blank\">Journal of Bone and Joint Surgery<\/a><\/i>. <b>25<\/b> (2): 477\u2013483. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ejbjs.org\/cgi\/content\/abstract\/25\/2\/477\" target=\"_blank\">the original<\/a> on 2008-07-24<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2009-12-15<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Bone+and+Joint+Surgery&rft.atitle=Migration+of+a+Kirschner+Wire+From+the+Shoulder+Region+Into+the+Lung%3AReport+of+Two+Cases&rft.volume=25&rft.issue=2&rft.pages=477-483&rft.date=1943&rft.au=Robert+Mazet+Jr.&rft_id=http%3A%2F%2Fwww.ejbjs.org%2Fcgi%2Fcontent%2Fabstract%2F25%2F2%2F477&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKirschner+wire\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Lenard-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Lenard_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lenard L, Aradi D, Donauer E (April 2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/eurheartj.oxfordjournals.org\/cgi\/content\/extract\/30\/7\/754\" target=\"_blank\">\"Migrating Kirschner wire in the heart mimics acute coronary syndrome\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Eur_Heart_J\" class=\"mw-redirect\" title=\"Eur Heart J\" rel=\"external_link\" target=\"_blank\">Eur Heart J<\/a><\/i>. <b>30<\/b> (7): 754. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1093%2Feurheartj%2Fehn548\" target=\"_blank\">10.1093\/eurheartj\/ehn548<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19066210\" target=\"_blank\">19066210<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Eur+Heart+J&rft.atitle=Migrating+Kirschner+wire+in+the+heart+mimics+acute+coronary+syndrome&rft.volume=30&rft.issue=7&rft.pages=754&rft.date=2009-04&rft_id=info%3Adoi%2F10.1093%2Feurheartj%2Fehn548&rft_id=info%3Apmid%2F19066210&rft.aulast=Lenard&rft.aufirst=L&rft.au=Aradi%2C+D&rft.au=Donauer%2C+E&rft_id=http%3A%2F%2Feurheartj.oxfordjournals.org%2Fcgi%2Fcontent%2Fextract%2F30%2F7%2F754&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKirschner+wire\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.moderngrinding.com\/thewire\/k-wire-kirschner-wire-vs-steinmann-pin\/\" target=\"_blank\">Kirschner Wires vs. Steinmann Pins<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1267\nCached time: 20181209203739\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.156 seconds\nReal time usage: 0.194 seconds\nPreprocessor visited node count: 300\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 9010\/2097152 bytes\nTemplate argument size: 78\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 12669\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.092\/10.000 seconds\nLua memory usage: 2.44 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 162.262 1 Template:Reflist\n100.00% 162.262 1 -total\n<\/p>\n<pre>87.77% 142.411 4 Template:Cite_journal\n 1.86% 3.015 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2966807-1!canonical and timestamp 20181209203739 and revision id 865814628\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Kirschner_wire\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212141\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.009 seconds\nReal time usage: 0.144 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 138.476 1 - wikipedia:Kirschner_wire\n100.00% 138.476 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8034-0!*!*!*!*!*!* and timestamp 20181217212140 and revision id 24145\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Kirschner_wire\">https:\/\/www.limswiki.org\/index.php\/Kirschner_wire<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","b3e77d18a2bdfedc1268178e524fcbcb_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a8\/Kirschner_wires_ulna.jpg\/440px-Kirschner_wires_ulna.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4d\/Wrist_Kirschner_Wires.jpg\/440px-Wrist_Kirschner_Wires.jpg"],"b3e77d18a2bdfedc1268178e524fcbcb_timestamp":1545081700,"7baf739c1946653ca7ecf15fdcbb049a_type":"article","7baf739c1946653ca7ecf15fdcbb049a_title":"Keratoprosthesis","7baf739c1946653ca7ecf15fdcbb049a_url":"https:\/\/www.limswiki.org\/index.php\/Keratoprosthesis","7baf739c1946653ca7ecf15fdcbb049a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tKeratoprosthesis\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2011) (Learn how and when to remove this template message)\n Boston Kpro type 1 titanium posterior plate\nKeratoprosthesis is a surgical procedure where a diseased cornea is replaced with an artificial cornea. Traditionally, keratoprosthesis is recommended after a person has had a failure of one or more donor corneal transplants.[1] More recently, a less invasive, non-penetrating artificial cornea has been developed which can be used in more routine cases of corneal blindness. While conventional cornea transplant uses donor tissue for transplant, an artificial cornea is used in the Keratoprosthesis procedure. The surgery is performed to restore vision in patients suffering from severely damaged cornea due to congenital birth defects, infections, injuries and burns.\nKeratoprotheses are made of clear plastic with excellent tissue tolerance and optical properties. They vary in design, size and even the implantation techniques may differ across different treatment centers. The procedure is done by ophthalmologists, often on an outpatient basis.\nThe idea of artificial cornea was first proposed in 1789 by French ophthalmologist Guillaume Pellier de Quengsy.[2][3][4]\n\nContents \n\n1 Types \n2 Indications \n3 Pre-operative examination \n4 Patient selection \n5 Procedure \n6 Risks \n7 Prognosis \n8 Economics \n9 See also \n10 References \n11 External links \n\n\nTypes \nAlthough many keratoprostheses have been developed, only four models are currently in commercial use: the Boston keratoprosthesis, Osteo-Odonto-Keratoprosthesis (OOKP), AlphaCor and the KeraKlear Artificial Cornea.\n\nIndications \nIndications for penetrating keratoprotheses include the following:\n\nTreatment of patients whose vision is less than 20\/200 in the affected eye.\nPatients with failed corneal transplant using donor cornea and have little or no vision left.\nPatients with non-autoimmune diseases, congenital birth defects and other ocular problems.\nPatients who do not have access to corneal transplant tissue\nIndications for non-penetrating keratoprostheses include the following:\n\nKeratoconus\nCorneal Dystrophies\nCorneal scars not related to active inflammation in the eye\nCorneal edema\nLimbal stem cell deficiency (e.g. Aniridia)\nFailed corneal transplants with a non-inflammatory original diagnosis (e.g. keratoconus)\nPre-operative examination \nIn most cases, the patient meets the ophthalmologist for eye examination and other tests weeks or months preceding surgery. During the meeting, the ophthalmologist will examine the eye and diagnose its condition. The doctor will also record the history of the patient\u2019s health and other previous eye treatments, if any. The doctor will discuss the risks and benefits of the surgery. If the patient elects for the surgery, the doctor will have the patient sign an informed consent form. The doctor may also perform physical and lab examinations, such as an X-ray, an EKG, a slit lamp test, an ultrasound B-scan, or an A-scan.\nThe surgery date and time is also set, and the patient will also be told where the surgery will take place. The patient can also make any other queries regarding the procedure.\n\nPatient selection \nVision should not be better than 20\/200.\nBlink and tear mechanisms should be reasonably intact.\nRetina should be in place and there should not be extreme optic nerve cupping.\nConsider shunt if patient is suffering from advanced stage of glaucoma.\nProcedure \nSee also: Corneal transplantation \u00a7 Procedure\nOn the day of the procedure, the patient will arrive to the hospital or laser center where the surgery is to be performed. After a brief physical examination, he\/she will be taken to the operating room. General anesthesia or local anesthesia is given before the surgery begins.\nAn eyelid speculum is used to keep the eye open throughout the surgery. Some lubrication may be used to prevent the eye from drying. Depending on the type of keratoprosthesis used, the surgery may involve a full thickness replacement of the cornea or the placement of an intralamellar implant. For the Alphacor a manual incision is used to create a corneal pocket and a punch is used to create an opening through the posterior cornea into the anterior chamber. The Alphacor is then inserted into the corneal pocket to allow for bio-integration after several months, a second procedure is used to remove part of the anterior cornea to allow light to reach the retina. In the case of the KeraKlear, the intrallamellar pocket is created with a femtosecond laser or a corneal pocket making microkeratome. The posterior cornea is left intact.\nTypically, there is a follow up session few days after surgery, when patients\u2019 complaints are addressed and modifications are made, if needed.\nSince Keratoprosthesis surgeries are evolving, constant attempts are being made to improve the outcome of the surgery. Also, the material and design used in the artificial cornea may vary and as a result of this, there can be minor variations in surgical procedure as well.\nThe surgery is done on an outpatient basis with the patient returning home the same day.\n\nRisks \nThough the rate of success with Keratoprosthesis is high, in rare cases, certain serious complications could occur.\n\nGlaucoma and extrusion of the implant are serious complications that could occur.\nSudden vitritis can cause a drastic reduction in vision. However, it is possible to treat this condition through antibiotics or by a minor laser surgery.\nInflammation of the eye tissue could occur. This condition is also treatable.\nUsage of keratoprosthesis is typically considered when multiple donor corneal transplants have failed for a patient. A Cochrane Review found no controlled trials comparing the effectiveness of artificial corneas with donor corneas for repeat corneas transplantations.[1]\n\nPrognosis \nThe primary purpose of Keratoprosthesis is to improve vision in patients with complex ocular diseases who are at high risk for donor graft failure. After an impressive success record with Keratoprosthesis in adults, the procedure is used to treat young patients with severe ocular deformities.\n\nEconomics \nKeratoprosthesis is continuously evolving with newer generation materials that seek to improve treatment outcomes. However, the cost of surgery is on the expensive side and can typically run up to $35,000 in the US. In order to obtain surgical treatment at a lower cost, many patients choose to get the treatment done from popular medical tourism destinations like India and Singapore where the cost of treatment may be as little as one fourth the cost as in the US or UK.\n\nSee also \nOsteo-Odonto-Keratoprosthesis\nBoston keratoprosthesis\nAlphaCor\nReferences \n\n^ a b Akpek, Esen K; Alkharashi, Majed; Hwang, Frank S; Ng, Sueko M; Lindsley, Kristina (2014). \"Artificial corneas versus donor corneas for repeat corneal transplants\". Cochrane Database of Systematic Reviews (11): CD009561. doi:10.1002\/14651858.CD009561.pub2. PMC 4270365 . PMID 25372407. \n\n^ de Quengsy, Guillaume Pellier (1789). Pr\u00e9cis au cours d'operations sur la chirurgie des yeux [Accuracy during eye surgery operations] (in French). Paris: Didot. OCLC 14829290. [page needed ] \n\n^ Alio, Jorge L; Abdelghany, Ahmed A; Abu-Mustafa, Sabat K; Zein, G (2015). \"A new epidescemetic keratoprosthesis: Pilot investigation and proof of concept of a new alternative solution for corneal blindness\". British Journal of Ophthalmology. 99 (11): 1483\u20137. doi:10.1136\/bjophthalmol-2014-306264. PMID 25868791. \n\n^ Alio, Jorge L; Abbouda, Alessandro; Vega-Estrada, Alfredo (2018). \"An Innovative Intrastromal Keratoprosthesis Surgery Assisted by Femtosecond Laser\". European Journal of Ophthalmology. 24 (4): 490\u20133. doi:10.5301\/ejo.5000435. PMID 24519504. \n\n\nExternal links \nhttp:\/\/www.stronghealth.com\/services\/ophthalmology\/aboutus\/keratoprosthesis.cfm\nhttp:\/\/webeye.ophth.uiowa.edu\/eyeforum\/cases\/60-AlphaCor-Surgical-Approaches-Artificial-Cornea-Implant.htm\nhttp:\/\/www.masseyeandear.org\/for-professionals\/physician-resources\/keratoprosthesis\/care\/\nhttp:\/\/www.nice.org.uk\/guidance\/index.jsp?action=article&o=31194\nhttp:\/\/www.uic.edu\/com\/eye\/Department\/News\/KeratoprosthesisInformation%20.pdf\nhttp:\/\/www.masseyeandear.org\/specialties\/ophthalmology\/cornea-and-refractive-surgery\/keratoprosthesis\/\nhttp:\/\/www.dukeeye.org\/specialties\/cornea\/artificial_cornea-faq.html\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Keratoprosthesis\">https:\/\/www.limswiki.org\/index.php\/Keratoprosthesis<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 18:35.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 380 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","7baf739c1946653ca7ecf15fdcbb049a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Keratoprosthesis skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Keratoprosthesis<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Boston_Kpro_type_1_Titanium_posterior_plate.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Boston_Kpro_type_1_Titanium_posterior_plate.JPG\/220px-Boston_Kpro_type_1_Titanium_posterior_plate.JPG\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Boston_Kpro_type_1_Titanium_posterior_plate.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Boston Kpro type 1 titanium posterior plate<\/div><\/div><\/div>\n<p><b>Keratoprosthesis<\/b> is a surgical procedure where a diseased <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornea\" title=\"Cornea\" rel=\"external_link\" target=\"_blank\">cornea<\/a> is replaced with an artificial cornea. Traditionally, keratoprosthesis is recommended after a person has had a failure of one or more donor corneal transplants.<sup id=\"rdp-ebb-cite_ref-Akpek_1-0\" class=\"reference\"><a href=\"#cite_note-Akpek-1\" rel=\"external_link\">[1]<\/a><\/sup> More recently, a less invasive, non-penetrating artificial cornea has been developed which can be used in more routine cases of corneal blindness. While conventional cornea transplant uses donor tissue for transplant, an artificial cornea is used in the Keratoprosthesis procedure. The surgery is performed to restore vision in patients suffering from severely damaged cornea due to congenital <a href=\"https:\/\/en.wikipedia.org\/wiki\/Birth_defects\" class=\"mw-redirect\" title=\"Birth defects\" rel=\"external_link\" target=\"_blank\">birth defects<\/a>, infections, injuries and burns.\n<\/p><p>Keratoprotheses are made of clear plastic with excellent tissue tolerance and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical\" class=\"mw-redirect\" title=\"Optical\" rel=\"external_link\" target=\"_blank\">optical<\/a> properties. They vary in design, size and even the implantation techniques may differ across different treatment centers. The procedure is done by ophthalmologists, often on an outpatient basis.\n<\/p><p>The idea of artificial cornea was first proposed in 1789 by French ophthalmologist Guillaume Pellier de Quengsy.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<p>Although many keratoprostheses have been developed, only four models are currently in commercial use: the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boston_keratoprosthesis\" title=\"Boston keratoprosthesis\" rel=\"external_link\" target=\"_blank\">Boston keratoprosthesis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteo-Odonto-Keratoprosthesis\" class=\"mw-redirect\" title=\"Osteo-Odonto-Keratoprosthesis\" rel=\"external_link\" target=\"_blank\">Osteo-Odonto-Keratoprosthesis<\/a> (OOKP), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corneal_transplantation#AlphaCor\" title=\"Corneal transplantation\" rel=\"external_link\" target=\"_blank\">AlphaCor<\/a> and the .\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h2>\n<p>Indications for penetrating keratoprotheses include the following:\n<\/p>\n<ul><li>Treatment of patients whose vision is less than 20\/200 in the affected eye.<\/li>\n<li>Patients with failed corneal transplant using donor cornea and have little or no vision left.<\/li>\n<li>Patients with non-autoimmune diseases, congenital birth defects and other ocular problems.<\/li>\n<li>Patients who do not have access to corneal transplant tissue<\/li><\/ul>\n<p>Indications for non-penetrating keratoprostheses include the following:\n<\/p>\n<ul><li>Keratoconus<\/li>\n<li>Corneal Dystrophies<\/li>\n<li>Corneal scars not related to active inflammation in the eye<\/li>\n<li>Corneal edema<\/li>\n<li>Limbal stem cell deficiency (e.g. Aniridia)<\/li>\n<li>Failed corneal transplants with a non-inflammatory original diagnosis (e.g. keratoconus)<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Pre-operative_examination\">Pre-operative examination<\/span><\/h2>\n<p>In most cases, the patient meets the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ophthalmologist\" class=\"mw-redirect\" title=\"Ophthalmologist\" rel=\"external_link\" target=\"_blank\">ophthalmologist<\/a> for eye examination and other tests weeks or months preceding surgery. During the meeting, the ophthalmologist will examine the eye and diagnose its condition. The doctor will also record the history of the patient\u2019s health and other previous eye treatments, if any. The doctor will discuss the risks and benefits of the surgery. If the patient elects for the surgery, the doctor will have the patient sign an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Informed_consent\" title=\"Informed consent\" rel=\"external_link\" target=\"_blank\">informed consent<\/a> form. The doctor may also perform physical and lab examinations, such as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray\" title=\"X-ray\" rel=\"external_link\" target=\"_blank\">X-ray<\/a>, an <a href=\"https:\/\/en.wikipedia.org\/wiki\/EKG\" class=\"mw-redirect\" title=\"EKG\" rel=\"external_link\" target=\"_blank\">EKG<\/a>, a slit lamp test, an ultrasound <a href=\"https:\/\/en.wikipedia.org\/wiki\/B-scan\" class=\"mw-redirect\" title=\"B-scan\" rel=\"external_link\" target=\"_blank\">B-scan<\/a>, or an <a href=\"https:\/\/en.wikipedia.org\/wiki\/A-scan\" class=\"mw-redirect\" title=\"A-scan\" rel=\"external_link\" target=\"_blank\">A-scan<\/a>.\n<\/p><p>The surgery date and time is also set, and the patient will also be told where the surgery will take place. The patient can also make any other queries regarding the procedure.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Patient_selection\">Patient selection<\/span><\/h2>\n<ul><li>Vision should not be better than 20\/200.<\/li>\n<li>Blink and tear mechanisms should be reasonably intact.<\/li>\n<li>Retina should be in place and there should not be extreme <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optic_nerve\" title=\"Optic nerve\" rel=\"external_link\" target=\"_blank\">optic nerve<\/a> cupping.<\/li>\n<li>Consider <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shunt_(medical)\" title=\"Shunt (medical)\" rel=\"external_link\" target=\"_blank\">shunt<\/a> if patient is suffering from advanced stage of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glaucoma\" title=\"Glaucoma\" rel=\"external_link\" target=\"_blank\">glaucoma<\/a>.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Procedure\">Procedure<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corneal_transplantation#Procedure\" title=\"Corneal transplantation\" rel=\"external_link\" target=\"_blank\">Corneal transplantation \u00a7 Procedure<\/a><\/div>\n<p>On the day of the procedure, the patient will arrive to the hospital or laser center where the surgery is to be performed. After a brief physical examination, he\/she will be taken to the operating room. <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_anesthesia\" class=\"mw-redirect\" title=\"General anesthesia\" rel=\"external_link\" target=\"_blank\">General anesthesia<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Local_anesthesia\" title=\"Local anesthesia\" rel=\"external_link\" target=\"_blank\">local anesthesia<\/a> is given before the surgery begins.\n<\/p><p>An eyelid <a href=\"https:\/\/en.wikipedia.org\/wiki\/Speculum_(medical)\" title=\"Speculum (medical)\" rel=\"external_link\" target=\"_blank\">speculum<\/a> is used to keep the eye open throughout the surgery. Some lubrication may be used to prevent the eye from drying. Depending on the type of keratoprosthesis used, the surgery may involve a full thickness replacement of the cornea or the placement of an intralamellar implant. For the Alphacor a manual incision is used to create a corneal pocket and a punch is used to create an opening through the posterior cornea into the anterior chamber. The Alphacor is then inserted into the corneal pocket to allow for bio-integration after several months, a second procedure is used to remove part of the anterior cornea to allow light to reach the retina. In the case of the KeraKlear, the intrallamellar pocket is created with a femtosecond laser or a corneal pocket making microkeratome. The posterior cornea is left intact.\n<\/p><p>Typically, there is a follow up session few days after surgery, when patients\u2019 complaints are addressed and modifications are made, if needed.\n<\/p><p>Since Keratoprosthesis surgeries are evolving, constant attempts are being made to improve the outcome of the surgery. Also, the material and design used in the artificial cornea may vary and as a result of this, there can be minor variations in surgical procedure as well.\n<\/p><p>The surgery is done on an outpatient basis with the patient returning home the same day.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h2>\n<p>Though the rate of success with Keratoprosthesis is high, in rare cases, certain serious complications could occur.\n<\/p>\n<ul><li>Glaucoma and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Extrusion\" title=\"Extrusion\" rel=\"external_link\" target=\"_blank\">extrusion<\/a> of the implant are serious complications that could occur.<\/li>\n<li>Sudden can cause a drastic reduction in vision. However, it is possible to treat this condition through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antibiotics\" class=\"mw-redirect\" title=\"Antibiotics\" rel=\"external_link\" target=\"_blank\">antibiotics<\/a> or by a minor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laser_surgery\" title=\"Laser surgery\" rel=\"external_link\" target=\"_blank\">laser surgery<\/a>.<\/li>\n<li>Inflammation of the eye tissue could occur. This condition is also treatable.<\/li><\/ul>\n<p>Usage of keratoprosthesis is typically considered when multiple donor corneal transplants have failed for a patient. A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochrane_(organisation)\" title=\"Cochrane (organisation)\" rel=\"external_link\" target=\"_blank\">Cochrane Review<\/a> found no controlled trials comparing the effectiveness of artificial corneas with donor corneas for repeat corneas transplantations.<sup id=\"rdp-ebb-cite_ref-Akpek_1-1\" class=\"reference\"><a href=\"#cite_note-Akpek-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Prognosis\">Prognosis<\/span><\/h2>\n<p>The primary purpose of Keratoprosthesis is to improve vision in patients with complex ocular diseases who are at high risk for donor graft failure. After an impressive success record with Keratoprosthesis in adults, the procedure is used to treat young patients with severe ocular deformities.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Economics\">Economics<\/span><\/h2>\n<p>Keratoprosthesis is continuously evolving with newer generation materials that seek to improve treatment outcomes. However, the cost of surgery is on the expensive side and can typically run up to $35,000 in the US. In order to obtain surgical treatment at a lower cost, many patients choose to get the treatment done from popular medical tourism destinations like <a href=\"https:\/\/en.wikipedia.org\/wiki\/India\" title=\"India\" rel=\"external_link\" target=\"_blank\">India<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Singapore\" title=\"Singapore\" rel=\"external_link\" target=\"_blank\">Singapore<\/a> where the cost of treatment may be as little as one fourth the cost as in the US or UK.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteo-Odonto-Keratoprosthesis\" class=\"mw-redirect\" title=\"Osteo-Odonto-Keratoprosthesis\" rel=\"external_link\" target=\"_blank\">Osteo-Odonto-Keratoprosthesis<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Boston_keratoprosthesis\" title=\"Boston keratoprosthesis\" rel=\"external_link\" target=\"_blank\">Boston keratoprosthesis<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Corneal_transplantation#AlphaCor\" title=\"Corneal transplantation\" rel=\"external_link\" target=\"_blank\">AlphaCor<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-Akpek-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Akpek_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Akpek_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Akpek, Esen K; Alkharashi, Majed; Hwang, Frank S; Ng, Sueko M; Lindsley, Kristina (2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4270365\" target=\"_blank\">\"Artificial corneas versus donor corneas for repeat corneal transplants\"<\/a>. <i>Cochrane Database of Systematic Reviews<\/i> (11): CD009561. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD009561.pub2\" target=\"_blank\">10.1002\/14651858.CD009561.pub2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4270365\" target=\"_blank\">4270365<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25372407\" target=\"_blank\">25372407<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cochrane+Database+of+Systematic+Reviews&rft.atitle=Artificial+corneas+versus+donor+corneas+for+repeat+corneal+transplants&rft.issue=11&rft.pages=CD009561&rft.date=2014&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4270365&rft_id=info%3Apmid%2F25372407&rft_id=info%3Adoi%2F10.1002%2F14651858.CD009561.pub2&rft.aulast=Akpek&rft.aufirst=Esen+K&rft.au=Alkharashi%2C+Majed&rft.au=Hwang%2C+Frank+S&rft.au=Ng%2C+Sueko+M&rft.au=Lindsley%2C+Kristina&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4270365&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKeratoprosthesis\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">de Quengsy, Guillaume Pellier (1789). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/archive.org\/details\/BIUSante_56107x01\" target=\"_blank\"><i>Pr\u00e9cis au cours d'operations sur la chirurgie des yeux<\/i><\/a> [<i>Accuracy during eye surgery operations<\/i>] (in French). Paris: Didot. <a href=\"https:\/\/en.wikipedia.org\/wiki\/OCLC\" title=\"OCLC\" rel=\"external_link\" target=\"_blank\">OCLC<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/oclc\/14829290\" target=\"_blank\">14829290<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Pr%C3%A9cis+au+cours+d%27operations+sur+la+chirurgie+des+yeux&rft.place=Paris&rft.pub=Didot&rft.date=1789&rft_id=info%3Aoclcnum%2F14829290&rft.aulast=de+Quengsy&rft.aufirst=Guillaume+Pellier&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2FBIUSante_56107x01&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKeratoprosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citing_sources\" title=\"Wikipedia:Citing sources\" rel=\"external_link\" target=\"_blank\"><span title=\"This citation requires a reference to the specific page or range of pages in which the material appears. (July 2018)\">page needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Alio, Jorge L; Abdelghany, Ahmed A; Abu-Mustafa, Sabat K; Zein, G (2015). \"A new epidescemetic keratoprosthesis: Pilot investigation and proof of concept of a new alternative solution for corneal blindness\". <i>British Journal of Ophthalmology<\/i>. <b>99<\/b> (11): 1483\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbjophthalmol-2014-306264\" target=\"_blank\">10.1136\/bjophthalmol-2014-306264<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25868791\" target=\"_blank\">25868791<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=British+Journal+of+Ophthalmology&rft.atitle=A+new+epidescemetic+keratoprosthesis%3A+Pilot+investigation+and+proof+of+concept+of+a+new+alternative+solution+for+corneal+blindness&rft.volume=99&rft.issue=11&rft.pages=1483-7&rft.date=2015&rft_id=info%3Adoi%2F10.1136%2Fbjophthalmol-2014-306264&rft_id=info%3Apmid%2F25868791&rft.aulast=Alio&rft.aufirst=Jorge+L&rft.au=Abdelghany%2C+Ahmed+A&rft.au=Abu-Mustafa%2C+Sabat+K&rft.au=Zein%2C+G&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKeratoprosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Alio, Jorge L; Abbouda, Alessandro; Vega-Estrada, Alfredo (2018). \"An Innovative Intrastromal Keratoprosthesis Surgery Assisted by Femtosecond Laser\". <i>European Journal of Ophthalmology<\/i>. <b>24<\/b> (4): 490\u20133. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.5301%2Fejo.5000435\" target=\"_blank\">10.5301\/ejo.5000435<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24519504\" target=\"_blank\">24519504<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Journal+of+Ophthalmology&rft.atitle=An+Innovative+Intrastromal+Keratoprosthesis+Surgery+Assisted+by+Femtosecond+Laser&rft.volume=24&rft.issue=4&rft.pages=490-3&rft.date=2018&rft_id=info%3Adoi%2F10.5301%2Fejo.5000435&rft_id=info%3Apmid%2F24519504&rft.aulast=Alio&rft.aufirst=Jorge+L&rft.au=Abbouda%2C+Alessandro&rft.au=Vega-Estrada%2C+Alfredo&rfr_id=info%3Asid%2Fen.wikipedia.org%3AKeratoprosthesis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.stronghealth.com\/services\/ophthalmology\/aboutus\/keratoprosthesis.cfm\" target=\"_blank\">http:\/\/www.stronghealth.com\/services\/ophthalmology\/aboutus\/keratoprosthesis.cfm<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/webeye.ophth.uiowa.edu\/eyeforum\/cases\/60-AlphaCor-Surgical-Approaches-Artificial-Cornea-Implant.htm\" target=\"_blank\">http:\/\/webeye.ophth.uiowa.edu\/eyeforum\/cases\/60-AlphaCor-Surgical-Approaches-Artificial-Cornea-Implant.htm<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.masseyeandear.org\/for-professionals\/physician-resources\/keratoprosthesis\/care\/\" target=\"_blank\">http:\/\/www.masseyeandear.org\/for-professionals\/physician-resources\/keratoprosthesis\/care\/<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.nice.org.uk\/guidance\/index.jsp?action=article&o=31194\" target=\"_blank\">http:\/\/www.nice.org.uk\/guidance\/index.jsp?action=article&o=31194<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.uic.edu\/com\/eye\/Department\/News\/KeratoprosthesisInformation%20.pdf\" target=\"_blank\">http:\/\/www.uic.edu\/com\/eye\/Department\/News\/KeratoprosthesisInformation%20.pdf<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.masseyeandear.org\/specialties\/ophthalmology\/cornea-and-refractive-surgery\/keratoprosthesis\/\" target=\"_blank\">http:\/\/www.masseyeandear.org\/specialties\/ophthalmology\/cornea-and-refractive-surgery\/keratoprosthesis\/<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.dukeeye.org\/specialties\/cornea\/artificial_cornea-faq.html\" target=\"_blank\">http:\/\/www.dukeeye.org\/specialties\/cornea\/artificial_cornea-faq.html<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1271\nCached time: 20181129210545\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.252 seconds\nReal time usage: 0.320 seconds\nPreprocessor visited node count: 457\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 14972\/2097152 bytes\nTemplate argument size: 470\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 12506\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.147\/10.000 seconds\nLua memory usage: 2.98 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 271.353 1 -total\n<\/p>\n<pre>45.36% 123.094 3 Template:Cite_journal\n24.95% 67.708 1 Template:Refimprove\n15.30% 41.513 1 Template:Ambox\n11.45% 31.081 1 Template:Pn\n 9.38% 25.453 1 Template:Fix\n 8.31% 22.542 1 Template:Cite_book\n 5.72% 15.527 1 Template:See_also\n 4.41% 11.961 1 Template:Delink\n 3.62% 9.829 2 Template:Category_handler\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:21967441-1!canonical and timestamp 20181129210545 and revision id 851092825\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Keratoprosthesis\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212140\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.141 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 134.638 1 - wikipedia:Keratoprosthesis\n100.00% 134.638 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8247-0!*!*!*!*!*!* and timestamp 20181217212140 and revision id 24457\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Keratoprosthesis\">https:\/\/www.limswiki.org\/index.php\/Keratoprosthesis<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","7baf739c1946653ca7ecf15fdcbb049a_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Boston_Kpro_type_1_Titanium_posterior_plate.JPG\/440px-Boston_Kpro_type_1_Titanium_posterior_plate.JPG"],"7baf739c1946653ca7ecf15fdcbb049a_timestamp":1545081700,"c458ab38030c48c73655fcfd88ad86b2_type":"article","c458ab38030c48c73655fcfd88ad86b2_title":"Intrathecal pump","c458ab38030c48c73655fcfd88ad86b2_url":"https:\/\/www.limswiki.org\/index.php\/Intrathecal_pump","c458ab38030c48c73655fcfd88ad86b2_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tIntrathecal pump\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (February 2016) (Learn how and when to remove this template message)\nAn intrathecal pump is a medical device used to via an intrathecal catheter deliver medications directly into the (intrathecal) space between the spinal cord and the protective sheath surrounding the spinal cord. Medications such as baclofen, bupivacaine, clonidine, morphine, or ziconotide may be delivered in this manner to minimize the side effects often associated with the higher doses used in oral or intravenous delivery of these drugs.\n\nContents \n\n1 Indications \n2 Application \n3 Construction \n4 Maintenance \n\n4.1 Refills \n4.2 Replacement \n\n\n5 See also \n6 References \n7 External links \n\n\nIndications \nSome cancer patients with opioid resistant pain or serious side effects may benefit from intrathecal pain management.\nProbably, only some benign patients with opioid resistant pain or serious side effects are suitable for intrathecal treatment.\nApplication \nPeople with spastic diplegia or other forms of spasticity, or people in intolerable pain, who cannot tolerate side effects of the higher-dose oral medications of the same medication type, are potential candidates for that medication being administered via an intrathecal pump.\n\nConstruction \nThe implantable intrathecal pump consists of a metal pump which stores and delivers the medication, and an intrathecal catheter which delivers the medication from the pump to the intrathecal space in the spine where the medication takes effect. Two types of pumps are available: a constant rate pump delivers the medication at a constant rate, and a programmable pump delivers the medication according to a rate determined by a computer program.\nAlso external pumps, with or without at a subcutaneous port are used for intrathecal delivery.\nThe implantable medical device requires a surgical procedure; sometimes a surgeon performs a trial intrathecal injection or implants a temporary intrathecal catheter and pump to determine if the medication works to begin with, and thus if a pump is appropriate. A permanent intrathecal pump is then implanted if the patient derives at least 50% improvement in his or her symptoms.\n\nMaintenance \nRefills \nIntrathecal pumps require maintenance. Individuals who use these pumps will need to come into their physician's office to have the pump refilled. How frequently this occurs is dependent on several factors, including drug concentration and dosage, and pump size. The refill frequency can range between one and six months for baclofen pumps.[1]\n\nReplacement \nIntrathecal pumps periodically need to be replaced. For baclofen pumps, this may be once every 5\u20137 years.[2]\n\nSee also \nInfusion pump\nIntrathecal administration\nIntrathecal pump\nReferences \n\n\n^ \"Intrathecal Baclofen Pumps Fact Sheet\" (PDF) . Women's and Children's Hospital. Government of South Australia. Retrieved 2016-03-28 . \n\n^ \"Intrathecal Baclofen Therapy for Spasticity\". sci.washington.edu. Retrieved 2016-03-28 . \n\n\nExternal links \nInternational Neuromodulation Society\nNorth American Neuromodulation Society\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Intrathecal_pump\">https:\/\/www.limswiki.org\/index.php\/Intrathecal_pump<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:06.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 466 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","c458ab38030c48c73655fcfd88ad86b2_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Intrathecal_pump skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Intrathecal pump<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>An <b>intrathecal pump<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> used to via an intrathecal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheter<\/a> deliver medications directly into the (intrathecal) space between the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord\" title=\"Spinal cord\" rel=\"external_link\" target=\"_blank\">spinal cord<\/a> and the protective sheath surrounding the spinal cord. Medications such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Baclofen\" title=\"Baclofen\" rel=\"external_link\" target=\"_blank\">baclofen<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bupivacaine\" title=\"Bupivacaine\" rel=\"external_link\" target=\"_blank\">bupivacaine<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clonidine\" title=\"Clonidine\" rel=\"external_link\" target=\"_blank\">clonidine<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Morphine\" title=\"Morphine\" rel=\"external_link\" target=\"_blank\">morphine<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ziconotide\" title=\"Ziconotide\" rel=\"external_link\" target=\"_blank\">ziconotide<\/a> may be delivered in this manner to minimize the side effects often associated with the higher doses used in oral or intravenous delivery of these drugs.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h2>\n<ul><li>Some cancer patients with opioid resistant pain or serious side effects may benefit from intrathecal pain management.<\/li>\n<li>Probably, only some benign patients with opioid resistant pain or serious side effects are suitable for intrathecal treatment.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Application\">Application<\/span><\/h2>\n<p>People with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spastic_diplegia\" title=\"Spastic diplegia\" rel=\"external_link\" target=\"_blank\">spastic diplegia<\/a> or other forms of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spasticity\" title=\"Spasticity\" rel=\"external_link\" target=\"_blank\">spasticity<\/a>, or people in intolerable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\" title=\"Pain\" rel=\"external_link\" target=\"_blank\">pain<\/a>, who cannot tolerate side effects of the higher-dose oral medications of the same medication type, are potential candidates for that medication being administered via an intrathecal pump.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Construction\">Construction<\/span><\/h2>\n<p>The implantable intrathecal pump consists of a metal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pump\" title=\"Pump\" rel=\"external_link\" target=\"_blank\">pump<\/a> which stores and delivers the medication, and an intrathecal catheter which delivers the medication from the pump to the intrathecal space in the spine where the medication takes effect. Two types of pumps are available: a constant rate pump delivers the medication at a constant rate, and a programmable pump delivers the medication according to a rate determined by a computer program.\n<\/p><p>Also external pumps, with or without at a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subcutaneous_injection\" title=\"Subcutaneous injection\" rel=\"external_link\" target=\"_blank\">subcutaneous<\/a> port are used for intrathecal delivery.\n<\/p><p>The implantable medical device requires a surgical procedure; sometimes a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgeon\" title=\"Surgeon\" rel=\"external_link\" target=\"_blank\">surgeon<\/a> performs a trial intrathecal injection or implants a temporary intrathecal catheter and pump to determine if the medication works to begin with, and thus if a pump is appropriate. A permanent intrathecal pump is then implanted if the patient derives at least 50% improvement in his or her symptoms.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Maintenance\">Maintenance<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Refills\">Refills<\/span><\/h3>\n<p>Intrathecal pumps require maintenance. Individuals who use these pumps will need to come into their physician's office to have the pump refilled. How frequently this occurs is dependent on several factors, including drug concentration and dosage, and pump size. The refill frequency can range between one and six months for baclofen pumps.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Replacement\">Replacement<\/span><\/h3>\n<p>Intrathecal pumps periodically need to be replaced. For baclofen pumps, this may be once every 5\u20137 years.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Infusion_pump\" title=\"Infusion pump\" rel=\"external_link\" target=\"_blank\">Infusion pump<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Intrathecal_administration\" title=\"Intrathecal administration\" rel=\"external_link\" target=\"_blank\">Intrathecal administration<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cancer_pain#Interventional\" title=\"Cancer pain\" rel=\"external_link\" target=\"_blank\">Intrathecal pump<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.wch.sa.gov.au\/services\/az\/divisions\/pphealth\/paedrehab\/documents\/IntrathecalBaclofenPumpsfactsheet.pdf\" target=\"_blank\">\"Intrathecal Baclofen Pumps Fact Sheet\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Women's and Children's Hospital<\/i>. Government of South Australia<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-03-28<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Women%27s+and+Children%27s+Hospital&rft.atitle=Intrathecal+Baclofen+Pumps+Fact+Sheet&rft_id=http%3A%2F%2Fwww.wch.sa.gov.au%2Fservices%2Faz%2Fdivisions%2Fpphealth%2Fpaedrehab%2Fdocuments%2FIntrathecalBaclofenPumpsfactsheet.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntrathecal+pump\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"#maintain\">\"Intrathecal Baclofen Therapy for Spasticity\"<\/a>. <i>sci.washington.edu<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-03-28<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=sci.washington.edu&rft.atitle=Intrathecal+Baclofen+Therapy+for+Spasticity&rft_id=http%3A%2F%2Fsci.washington.edu%2Finfo%2Fforums%2Freports%2Fintrathecal_baclofen.asp%23maintain&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntrathecal+pump\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.neuromodulation.com\" target=\"_blank\">International Neuromodulation Society<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.neuromodulation.org\" target=\"_blank\">North American Neuromodulation Society<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1247\nCached time: 20181129192733\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.116 seconds\nReal time usage: 0.163 seconds\nPreprocessor visited node count: 240\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 7286\/2097152 bytes\nTemplate argument size: 93\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 5292\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.068\/10.000 seconds\nLua memory usage: 1.86 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 141.501 1 -total\n<\/p>\n<pre>58.61% 82.939 1 Template:Reflist\n49.78% 70.442 2 Template:Cite_web\n39.77% 56.273 1 Template:Refimprove\n25.95% 36.722 1 Template:Ambox\n 1.92% 2.721 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:4882000-1!canonical and timestamp 20181129192733 and revision id 864617543\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Intrathecal_pump\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212140\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.009 seconds\nReal time usage: 0.140 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 134.514 1 - wikipedia:Intrathecal_pump\n100.00% 134.514 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8032-0!*!*!*!*!*!* and timestamp 20181217212140 and revision id 24143\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Intrathecal_pump\">https:\/\/www.limswiki.org\/index.php\/Intrathecal_pump<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","c458ab38030c48c73655fcfd88ad86b2_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png"],"c458ab38030c48c73655fcfd88ad86b2_timestamp":1545081700,"d2ff904756a19ced7675f0663c6447ba_type":"article","d2ff904756a19ced7675f0663c6447ba_title":"Intrastromal corneal ring segment","d2ff904756a19ced7675f0663c6447ba_url":"https:\/\/www.limswiki.org\/index.php\/Intrastromal_corneal_ring_segment","d2ff904756a19ced7675f0663c6447ba_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tIntrastromal corneal ring segment\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tIntrastromal corneal ring segmentA pair of corneal rings after insertion into the corneaSpecialtyophthalmology[edit on Wikidata]\nAn intrastromal corneal ring segment (ICRS) (also known as intrastromal corneal ring, corneal implant or corneal insert) is a small device implanted in the eye to correct vision. The procedure involves an ophthalmologist who makes a small incision in the cornea of the eye and inserts two crescent or semi-circular shaped ring segments between the layers of the corneal stroma, one on each side of the pupil.[1] The embedding of the two rings in the cornea is intended to flatten the cornea and change the refraction of light passing through the cornea on its way into the eye.\n\nDesign \nIntrastromal corneal ring segments have many different types and designs, including Intacs (US), Keraring (Brazil), Ferrara ring (Brazil),[2] and Intraseg (UK).\n\nMedical uses \nIntrastromal corneal rings were originally used to treat mild myopia.[1] For this purpose, they have largely been superseded by excimer lasers, which have better accuracy.[1] They are now mostly used to treat mild to moderate keratoconus.[1] Intrastromal corneal rings were approved in 2004 by the Food and Drug Administration for people with keratoconus who cannot adequately correct their vision with glasses or contact lenses, and for whom corneal transplant is the only other option.[3] They were approved under the Humanitarian Device Exemption,[2][4] which means the manufacturer did not have to demonstrate effectiveness. According to the FDA, these products should not be used by people who \"can achieve functional vision on a daily basis using contact lenses.\"[3]\n\nReferences \n\n\n^ a b c d Rabinowitz YS (2013). \"INTACS for keratoconus and ectasia after LASIK\". Int Ophthalmol Clin. 53 (1): 27\u201339. doi:10.1097\/IIO.0b013e3182774453. PMC 3653443 . PMID 23221883. \n\n^ a b Zadnik K, Lindsley K (2014). \"Intrastromal corneal ring segments for treating keratoconus (Protocol)\". Cochrane Database of Systematic Reviews. doi:10.1002\/14651858.CD011150. \n\n^ a b Food and Drug Administration (26 July 2004). \"INTACS Prescription Inserts for Keratoconus - H040002\". \n\n^ Food and Drug Administration (9 June 2006). \"Humanitarian Device Exemption (HDE)\". \n\n\n\r\n\n\nvteEye surgery and other procedures (ICD-9-CM V3 08\u201316+95.0\u201395.2, ICD-10-PCS 08)AdnexaEyelids\nBlepharoplasty\nEast Asian blepharoplasty\nEpicanthoplasty\nTarsorrhaphy\nLacrimal system\nDacryocystorhinostomy\nPunctoplasty\nGlobeCornea\nRadial keratotomy\nLASIK\nKeratomileusis\nEpikeratophakia\nCorneal transplantation\nPhotorefractive keratectomy\nIntrastromal corneal ring segment\nCorneal collagen cross-linking\nIris, ciliary body,\r\nsclera, and anterior chamber\nGlaucoma surgery: Trabeculectomy\nIridectomy\nLens\nPhacoemulsification\nCataract surgery\nCapsulorhexis\nRetina, choroid,\r\nvitreous, and posterior chamber\nVitrectomy\nOrbit and eyeball\nEnucleation of the eye\nExtraocular muscles\nHarada\u2013Ito procedure\nStrabismus surgery\nBotulinum toxin therapy of strabismus\nMedical imaging\nFluorescein angiography\nFundus photography\nCorneal topography\nOptical coherence tomography\nElectrodiagnosis: Electrooculography\nElectroretinography\nElectronystagmography\nEye examination\nGonioscopy\nDilated fundus examination\nOcular tonometry\nOphthalmoscopy\nRetinoscopy\nColor perception test\nVisual field test\/Perimetry\nRadiotherapy\nPlaque radiotherapy\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Intrastromal_corneal_ring_segment\">https:\/\/www.limswiki.org\/index.php\/Intrastromal_corneal_ring_segment<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","d2ff904756a19ced7675f0663c6447ba_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Intrastromal_corneal_ring_segment skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Intrastromal corneal ring segment<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>An <b>intrastromal corneal ring segment (ICRS)<\/b> (also known as <b>intrastromal corneal ring<\/b>, <b>corneal implant<\/b> or <b>corneal insert<\/b>) is a small device implanted in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_eye\" title=\"Human eye\" rel=\"external_link\" target=\"_blank\">eye<\/a> to correct <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_perception\" title=\"Visual perception\" rel=\"external_link\" target=\"_blank\">vision<\/a>. The procedure involves an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ophthalmologist\" class=\"mw-redirect\" title=\"Ophthalmologist\" rel=\"external_link\" target=\"_blank\">ophthalmologist<\/a> who makes a small incision in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornea\" title=\"Cornea\" rel=\"external_link\" target=\"_blank\">cornea<\/a> of the eye and inserts two crescent or semi-circular shaped ring segments between the layers of the corneal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroma_of_cornea\" title=\"Stroma of cornea\" rel=\"external_link\" target=\"_blank\">stroma<\/a>, one on each side of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pupil\" title=\"Pupil\" rel=\"external_link\" target=\"_blank\">pupil<\/a>.<sup id=\"rdp-ebb-cite_ref-rabinowitz2013_1-0\" class=\"reference\"><a href=\"#cite_note-rabinowitz2013-1\" rel=\"external_link\">[1]<\/a><\/sup> The embedding of the two rings in the cornea is intended to flatten the cornea and change the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refraction\" title=\"Refraction\" rel=\"external_link\" target=\"_blank\">refraction<\/a> of light passing through the cornea on its way into the eye.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Design\">Design<\/span><\/h2>\n<p>Intrastromal corneal ring segments have many different types and designs, including Intacs (US), Keraring (Brazil), Ferrara ring (Brazil),<sup id=\"rdp-ebb-cite_ref-zadnik2014_2-0\" class=\"reference\"><a href=\"#cite_note-zadnik2014-2\" rel=\"external_link\">[2]<\/a><\/sup> and Intraseg (UK).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<p>Intrastromal corneal rings were originally used to treat mild <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myopia\" class=\"mw-redirect\" title=\"Myopia\" rel=\"external_link\" target=\"_blank\">myopia<\/a>.<sup id=\"rdp-ebb-cite_ref-rabinowitz2013_1-1\" class=\"reference\"><a href=\"#cite_note-rabinowitz2013-1\" rel=\"external_link\">[1]<\/a><\/sup> For this purpose, they have largely been superseded by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Excimer_laser\" title=\"Excimer laser\" rel=\"external_link\" target=\"_blank\">excimer lasers<\/a>, which have better accuracy.<sup id=\"rdp-ebb-cite_ref-rabinowitz2013_1-2\" class=\"reference\"><a href=\"#cite_note-rabinowitz2013-1\" rel=\"external_link\">[1]<\/a><\/sup> They are now mostly used to treat mild to moderate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Keratoconus\" title=\"Keratoconus\" rel=\"external_link\" target=\"_blank\">keratoconus<\/a>.<sup id=\"rdp-ebb-cite_ref-rabinowitz2013_1-3\" class=\"reference\"><a href=\"#cite_note-rabinowitz2013-1\" rel=\"external_link\">[1]<\/a><\/sup> Intrastromal corneal rings were approved in 2004 by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> for people with keratoconus who cannot adequately correct their vision with glasses or contact lenses, and for whom <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corneal_transplant\" class=\"mw-redirect\" title=\"Corneal transplant\" rel=\"external_link\" target=\"_blank\">corneal transplant<\/a> is the only other option.<sup id=\"rdp-ebb-cite_ref-fda_3-0\" class=\"reference\"><a href=\"#cite_note-fda-3\" rel=\"external_link\">[3]<\/a><\/sup> They were approved under the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Humanitarian_Device_Exemption\" title=\"Humanitarian Device Exemption\" rel=\"external_link\" target=\"_blank\">Humanitarian Device Exemption<\/a>,<sup id=\"rdp-ebb-cite_ref-zadnik2014_2-1\" class=\"reference\"><a href=\"#cite_note-zadnik2014-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-fda2_4-0\" class=\"reference\"><a href=\"#cite_note-fda2-4\" rel=\"external_link\">[4]<\/a><\/sup> which means the manufacturer did not have to demonstrate effectiveness. According to the FDA, these products should not be used by people who \"can achieve functional vision on a daily basis using contact lenses.\"<sup id=\"rdp-ebb-cite_ref-fda_3-1\" class=\"reference\"><a href=\"#cite_note-fda-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-rabinowitz2013-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-rabinowitz2013_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-rabinowitz2013_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-rabinowitz2013_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-rabinowitz2013_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rabinowitz YS (2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3653443\" target=\"_blank\">\"INTACS for keratoconus and ectasia after LASIK\"<\/a>. <i>Int Ophthalmol Clin<\/i>. <b>53<\/b> (1): 27\u201339. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FIIO.0b013e3182774453\" target=\"_blank\">10.1097\/IIO.0b013e3182774453<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3653443\" target=\"_blank\">3653443<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23221883\" target=\"_blank\">23221883<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Int+Ophthalmol+Clin&rft.atitle=INTACS+for+keratoconus+and+ectasia+after+LASIK&rft.volume=53&rft.issue=1&rft.pages=27-39&rft.date=2013&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3653443&rft_id=info%3Apmid%2F23221883&rft_id=info%3Adoi%2F10.1097%2FIIO.0b013e3182774453&rft.aulast=Rabinowitz&rft.aufirst=YS&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3653443&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntrastromal+corneal+ring+segment\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-zadnik2014-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-zadnik2014_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-zadnik2014_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zadnik K, Lindsley K (2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/14651858.CD011150\/full\" target=\"_blank\">\"Intrastromal corneal ring segments for treating keratoconus (Protocol)\"<\/a>. <i>Cochrane Database of Systematic Reviews<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD011150\" target=\"_blank\">10.1002\/14651858.CD011150<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cochrane+Database+of+Systematic+Reviews&rft.atitle=Intrastromal+corneal+ring+segments+for+treating+keratoconus+%28Protocol%29&rft.date=2014&rft_id=info%3Adoi%2F10.1002%2F14651858.CD011150&rft.aulast=Zadnik&rft.aufirst=K&rft.au=Lindsley%2C+K&rft_id=http%3A%2F%2Fonlinelibrary.wiley.com%2Fdoi%2F10.1002%2F14651858.CD011150%2Ffull&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntrastromal+corneal+ring+segment\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-fda-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-fda_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fda_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Food and Drug Administration (26 July 2004). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/DeviceApprovalsandClearances\/Recently-ApprovedDevices\/ucm080953.htm\" target=\"_blank\">\"INTACS Prescription Inserts for Keratoconus - H040002\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=INTACS+Prescription+Inserts+for+Keratoconus+-+H040002&rft.date=2004-07-26&rft.au=Food+and+Drug+Administration&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FProductsandMedicalProcedures%2FDeviceApprovalsandClearances%2FRecently-ApprovedDevices%2Fucm080953.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntrastromal+corneal+ring+segment\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-fda2-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-fda2_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Food and Drug Administration (9 June 2006). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.accessdata.fda.gov\/scripts\/cdrh\/cfdocs\/cfhde\/hde.cfm?id=375523\" target=\"_blank\">\"Humanitarian Device Exemption (HDE)\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Humanitarian+Device+Exemption+%28HDE%29&rft.date=2006-06-09&rft.au=Food+and+Drug+Administration&rft_id=http%3A%2F%2Fwww.accessdata.fda.gov%2Fscripts%2Fcdrh%2Fcfdocs%2Fcfhde%2Fhde.cfm%3Fid%3D375523&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntrastromal+corneal+ring+segment\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<p><br \/>\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1258\nCached time: 20181129021502\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.212 seconds\nReal time usage: 0.284 seconds\nPreprocessor visited node count: 582\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 34269\/2097152 bytes\nTemplate argument size: 240\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 12234\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.106\/10.000 seconds\nLua memory usage: 2.76 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 223.702 1 -total\n<\/p>\n<pre>56.28% 125.896 1 Template:Reflist\n41.31% 92.413 2 Template:Cite_journal\n31.49% 70.445 1 Template:Infobox_medical_intervention\n29.75% 66.542 1 Template:Infobox\n 9.70% 21.692 1 Template:Eye_surgery\n 8.36% 18.699 3 Template:Navbox\n 5.08% 11.360 2 Template:Cite_web\n 2.85% 6.381 1 Template:PAGENAMEBASE\n 1.30% 2.918 1 Template:Template_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:3850208-1!canonical and timestamp 20181129021501 and revision id 864945424\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Intrastromal_corneal_ring_segment\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217212139\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.150 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 144.333 1 - wikipedia:Intrastromal_corneal_ring_segment\n100.00% 144.333 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8374-0!*!*!*!*!*!* and timestamp 20181217212139 and revision id 24603\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Intrastromal_corneal_ring_segment\">https:\/\/www.limswiki.org\/index.php\/Intrastromal_corneal_ring_segment<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","d2ff904756a19ced7675f0663c6447ba_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2a\/IntacsAfterInsertion.jpg\/560px-IntacsAfterInsertion.jpg"],"d2ff904756a19ced7675f0663c6447ba_timestamp":1545081699,"53d85fcc8c7faa18e68ea091df63abd2_type":"article","53d85fcc8c7faa18e68ea091df63abd2_title":"Intraocular lens","53d85fcc8c7faa18e68ea091df63abd2_url":"https:\/\/www.limswiki.org\/index.php\/Intraocular_lens","53d85fcc8c7faa18e68ea091df63abd2_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tIntraocular lens\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\n\nIntraocular lensICD-9-CM13.72MeSHD054120 OPS-301 code5-984[edit on Wikidata]\nIntraocular lens (IOL) is a lens implanted in the eye as part of a treatment for cataracts or myopia. Sanduk Ruit of Nepal is said to be the modern founder and designer.[citation needed ] Its modernification was done in mid 2000s. The most common type of IOL is the pseudophakic IOL. These are implanted during cataract surgery, after the cloudy eye's natural lens (colloquially called a cataract) has been removed. The pseudophakic IOL provides the same light focusing function as the natural crystalline lens. The second type of IOL, more commonly known as a phakic intraocular lens (PIOL), is a lens which is placed over the existing natural lens and is used in refractive surgery to change the eye's optical power as a treatment for myopia (nearsightedness).[1]\nIOLs usually consist of a small plastic lens with plastic side struts, called haptics, to hold the lens in place in the capsular bag inside the eye.[2] IOLs were conventionally made of an inflexible material (PMMA), although this has largely been superseded by the use of flexible materials.[citation needed ] Most IOLs fitted today are fixed monofocal lenses matched to distance vision. However, other types are available, such as multifocal IOLs that provide the patient with multiple-focused vision at far and reading distance, and adaptive IOLs that provide the patient with limited visual accommodation.\nSurgeons annually implant more than 6 million lenses.[3] The procedure can be done under local anesthesia with the patient awake throughout the operation. The use of a flexible IOL enables the lens to be rolled for insertion into the capsule through a very small incision, thus avoiding the need for stitches. This procedure usually takes less than 30 minutes in the hands of an experienced ophthalmologist. The recovery period is about 2\u20133 weeks. After surgery, patients should avoid strenuous exercise or anything else that significantly increases blood pressure. They should visit their ophthalmologists regularly for several months to monitor the implants.\nIOL implantation carries several risks associated with eye surgeries, such as infection, loosening of the lens, lens rotation, inflammation and nighttime halos, but a systematic review of studies has determined that the procedure is safer than conventional laser eye treatment.[4] Though IOLs enable many patients to have reduced dependence on glasses, most patients still rely on glasses for certain activities, such as reading.\n\nContents \n\n1 History \n2 Medical uses \n3 Accommodating IOLs \n4 Materials \n5 Types \n\n5.1 PIOLs \n5.2 Toric IOLs \n\n\n6 Pseudophakic IOLs that address presbyopia \n7 See also \n8 References \n\n\nHistory \n First permanent insertion of intraocular lens 8 February 1950\nSir Harold Ridley was the first to successfully implant an intraocular lens on 29 November 1949, at St Thomas' Hospital at London.[5] That lens was manufactured by the Rayner company of Brighton, East Sussex, England from Perspex CQ polymethylmethacrylate (PMMA) made by ICI (Imperial Chemical Industries). It is said the idea of implanting an intraocular lens came to him after an intern asked him why he was not replacing the lens he had removed during cataract surgery. The acrylic plastic material was chosen because Ridley noticed it was inert after seeing RAF (Royal Air Force) pilots of World War II with pieces of shattered canopies in their eyes (this acrylic resin is known by several trade names including Lucite and Plexiglas).\nThe intraocular lens did not find widespread acceptance in cataract surgery until the 1970s, when further developments in lens design and surgical techniques had come about.\nAs of the early 2000s, more than a million IOLs were implanted annually in the United States.[citation needed ] That number was estimated by the World Health Organization to have increased to 20 million annually worldwide by 2010 (for cataract surgery), and has projected increased IOL surgeries to reach 32 million worldwide by 2020.[6]\n\nMedical uses \nThis section does not cite any sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (March 2010) (Learn how and when to remove this template message)\nIntraocular lenses have been used since 1999 for correcting larger errors in near-sighted, far-sighted, and astigmatic eyes. This type of IOL is also called phakic intraocular lens (PIOL), and the crystalline lens is not removed.\nPhakic IOL appear to be less dangerous than excimer laser surgery in those with significant nearsightedness.[4]\nMore commonly, aphakic IOLs (that is, not PIOLs) are implanted via clear lens extraction and replacement (CLEAR) surgery. During CLEAR, the crystalline lens is extracted and an IOL replaces it in a process that is very similar to cataract surgery: both involve lens replacement, local anesthesia, last approximately 30 minutes, and require making a small incision in the eye for lens insertion. People recover from CLEAR surgery 1\u20137 days after the operation. During this time, they should avoid strenuous exercise or anything else that significantly raises blood pressure. They should visit their ophthalmologists regularly for several months to monitor the IOL implants.\nCLEAR has a 90% success rate (risks include wound leakage, infection, inflammation, and astigmatism). CLEAR can be performed only on patients ages 40 and older. This is to ensure that eye growth, which disrupts IOL lenses, will not occur post-surgery.\nOnce implanted, IOL lenses have three major benefits. First, they are an alternative to LASIK, a form of eye surgery that does not work for people with serious vision problems. Effective IOL implants also entirely eliminate the need for glasses or contact lenses post-surgery for most patients.[7] The cataract will not return, as the lens has been removed. The disadvantage is that the eye's ability to change focus (accommodate) has generally been reduced or eliminated, depending on the kind of lens implanted.\nSome of the risks that FDA have been found so far during a three-year study of the Artisan are:\n\na yearly loss of 1.8% of the endothelial cells,\n0.6% risk of retinal detachment,\n0.6% risk of cataract (other studies have shown a risk of 0.5 \u2013 1.0%), and\n0.4% risk of corneal swelling.\nOther risks include:\n\n0.03\u20130.05% eye infection risk, which in worst case can lead to blindness. This risk exists in all eye surgery procedures and is not unique for IOLs.\nglaucoma,\nastigmatism,\nremaining near or far sightedness,\nrotation of the lens inside the eye one or two days after surgery.\nOne of the causes of the risks above is that the lens can rotate inside the eye if the PIOL is too short, if the eye was incorrectly measured, or because the sulcus has a slightly oval shape (the height is slightly smaller than the width). Toric IOLs must be powered and aligned inside the eye on a meridian that corrects the patient's preexisting astigmatism. Again, these lenses can rotate inside the eye postoperatively or be placed incorrectly by the operating surgeon. Either way, the patient's preexisting astigmatism may not be corrected completely or may even increase.\nWhen IOLs are implanted in the aphakic patient\u2014either after clear lensectomy for the correction of refractive error or after cataract extraction to restore eyesight\u2014astigmatism in these patients is mainly attributable to the cornea. The surgeon can ascertain the astigmatic, or steepest, meridian in a number of ways, including manifest refraction or corneal topography. Manifest refraction is the familiar test where the eye doctor rotates lenses in front of the eye, asking the patient, \"Which is better (or clearer), this one or this one?\" Corneal topography is considered a more quantitative test, and for purposes of aligning a toric IOL, most surgeons use a measurement called simulated keratometry (SimK), which is calculated by the internal programming of the corneal topography machine, to determine the astigmatic meridian on the surface of the cornea. The astigmatic meridian can also be identified using corneal wavefront technology or paraxial curvature matching.\n\r\n\n\nAccommodating IOLs \nOne of the major disadvantages of conventional IOLs is that they are primarily focused for distance vision. Though patients who undergo a standard IOL implantation no longer experience clouding from cataracts, they are unable to accommodate, or change focus from near to far, far to near, and to distances in between. Accommodating IOLs interact with ciliary muscles and zonules, using hinges at both ends to \u201clatch on\u201d and move forward and backward inside the eye using the same mechanism as normal accommodation. These IOLs have a 4.5-mm square-edged optic and a long hinged plate design with polyimide loops at the end of the haptics. The hinges are made of an advanced silicone called BioSil that was thoroughly tested to make sure it was capable of unlimited flexing in the eye.[8]\n\nMaterials \n Acrylic MICS-IOL in holder\nThis section does not cite any sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (March 2010) (Learn how and when to remove this template message)\nThis section needs expansion with: reorganization, clarifications, better differentiation between the practices of different countries, and specific differences between PMMA, silicone, and silicone acrylate. You can help by adding to it. (January 2008)\nThe materials that have been used to manufacture intraocular lens implants include polymethylmethacrylate (PMMA), silicone, hydrophobic acrylate, hydrophilic acrylate and collamer.[9] Polymethylmethacrylate (PMMA) was the first material to be used successfully in intraocular lenses. British ophthalmologist Sir Harold Ridley observed that Royal Air Force pilots who sustained eye injuries during World War II involving PMMA windshield material did not show any rejection or foreign body reaction. Deducing that the transparent material was inert and useful for implantation in the eye, Ridley designed and implanted the first intraocular lens in a human eye.\nAdvances in technology have brought about the use of silicone and acrylic, both of which are soft foldable inert materials. This allows the lens to be folded and inserted into the eye through a smaller incision. Specifically, acrylic lenses are a better choice in people who have a history of uveitis or are likely to have to undergo retinal surgery requiring vitrectomy with replacement by silicone oil, such as persons with proliferative diabetic retinopathy or who are at high risk of retinal detachment, such as persons with high myopia. A study found that in participants with a history of uveitis, eyes treated with hydrophobic acrylic IOLs were over 2 times more likely to have a best corrected visual acuity of 20\/40 or more, compared to eyes treated with silicone IOLs.[10][11]\nThe trademarked \"Natural Yellow\" material is available in three hydrophilic IOLs. Dr. Patrick H. Benz of Benz Research and Development created the first IOL material to incorporate the same UV-A blocking and violet light filtering chromophore that's present in the human crystalline lens. This breakthrough material provides the exact chromophore the human retina naturally has for light protection.\nOther IOLs include:\n\nBlue light filtering IOLs filter the UV and high-energy blue light present in natural and artificial light, both of which can cause vision problems[citation needed ]; however too much filtering of blue light can increase depression, especially in the winter months (SAD).\nToric IOLs (1998) correct astigmatic vision.\nTypes \n Slit lamp photo of Pseudophakia: Posterior chamber Intraocular lens \u2013 note that Posterior capsular opacification is visible a few months after implantation of Intraocular lens in eye, as seen on retroillumination\nPhakia is the presence of the natural crystalline lenses.\nAphakia is the absence of the natural crystalline lens. The aphakic state is usually due to surgery to remove a cataractous lens, but post-surgical aphakia is rare nowadays because of the ubiquity of intraocular lenses. Rarely, aphakia can be post-traumatic or congenital in nature.\nPseudophakia is the substitution of the natural crystalline lens with an IOL, as is often done after cataract extraction or to correct refractive error.\nThe root of these words comes from the Greek word phakos 'lens'.[12]\nPhakic IOLs are implanted without removal of the patient's original crystalline lens, and this is performed solely to correct refractive error in the presence of a clear crystalline lens.\nAphakic IOLs generally refer to lenses implanted secondarily in an eye already aphakic from previous surgery or trauma some time ago.\nPseudophakic IOLs refer to lenses implanted during cataract surgery, as a sequential step after removal of the cataractous lens of the person.\nMany aphakic and pseudophakic IOLs such as anterior chamber IOLs or 3 piece posterior chamber IOLs can be used interchangeably. The exception are one piece IOLs, which must be placed within the capsular bag at the time of cataract surgery and hence cannot be used as secondary implants.\n\nPIOLs \nAs with IOLs inserted after cataract extraction, phakic IOLs (PIOLs) can be spheric or toric. The difference is that they are placed in an eye that retains the natural human crystalline lens. As with aphakic eyes, toric PIOLs have to be aligned with the meridian of astigmatism; toric IOL misalignment or rotation can lead to residual or even greater astigmatism postoperatively.\nDepending on their placement site in the eye, PIOLs can be divided into:[12]\n\nAngle-supported PIOLs: those IOLs are placed in the anterior chamber. They are notorious for their negative impact on the corneal endothelial lining, which is vital for maintaining a healthy clear cornea.\nIris-supported PIOLs: The IOL is attached by claws to the mid-peripheral iris by a technique called enclavation. It is believed to have a lesser effect on corneal endothelium. The main complication with this type is their tendency to cause endothelial cell reduction.\nSulcus-supported PIOLs: this type is gaining more and more popularity. These IOLs are placed in the posterior chamber in front of the natural crystalline lens. They have special vaulting so as not to be in contact with the normal lens. The main complication with older versions was a small possibility of cataract formation.\nToric IOLs \nA toric IOL is a type of toric lens used to correct preexisting corneal astigmatism at the time of cataract surgery. This astigmatism can also be treated with limbal relaxing incisions or an excimer laser procedure.[13][14] About 40% of Americans have significant astigmatism and thus may be candidates for a toric IOL.[14]\nCataract surgery with implantation of a toric IOL is essentially the same as cataract surgery with a conventional IOL. Like toric contact lenses, toric IOLs have different powers in different meridians of the lens, and they must be positioned on the correct meridian to reverse the preexisting astigmatism. If the toric IOL is not on the correct meridian, it may need to be repositioned in a second procedure.[14]\n\nPseudophakic IOLs that address presbyopia \nIn the United States, a new category of intraocular lenses was opened with the approval by the Food and Drug Administration in 2003 of multifocal and accommodating lenses. These come at an additional cost to the recipient beyond what Medicare will pay and each has advantages and disadvantages.[citation needed ]\nMultifocal IOLs provide for simultaneous viewing of distance vision and near vision. Trifocal IOLs can provide intermediate vision.[7] The most common adverse visual effects from multifocal IOLs include glare, halos, and a loss of contrast sensitivity, in low light conditions.[15]\nMonofocal lenses are standard lenses used in cataract surgery.[16] People who have a multifocal intraocular lens after their cataract is removed may be less likely to need additional glasses compared with people who have standard monofocal lenses.[16] However, people receiving multifocal lenses may experience more visual problems, such as glare or haloes (rings around lights), than with monofocal lenses.[16]\nPeople receiving accommodative intraocular lenses had improvements in near vision but these improvements were small and reduced over time.[17] People who received accommodative intraocular lenses may have a higher risk of thickening and clouding of the tissue behind the intraocular lenses (posterior capsule opacification) but there is some uncertainty around this finding.[17]\n\r\n\n\nSee also \nAphakia\nCapsulorhexis\nContact lens\nAdjustable-focus eyeglasses\nPhacoemulsification\nReferences \n\n\n^ G\u00fcell, Jose Luis; Morral, Merce; Kook, Daniel; Kohnen, Thomas (2010). \"Phakic intraocular lenses\". Journal of Cataract & Refractive Surgery. 36 (11): 1976\u20131993. doi:10.1016\/j.jcrs.2010.08.014. \n\n^ Sanders, Donald; Vukich, John A (2006). \"Comparison of Implantable Collamer Lens (ICL) and Laser-assisted in Situ Keratomileusis (LASIK) for Low Myopia\". Cornea. 25 (10): 1139\u201346. doi:10.1097\/ICO.0b013e31802cbf3c. PMID 17172886. \n\n^ Gaudet, Jodie ed. 1001 Inventions That Changed the World, page 697, ISBN 978-0-7333-2536-6 \n\n^ a b Barsam, A; Allan, BD (17 June 2014). \"Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia\". The Cochrane Database of Systematic Reviews. 6: CD007679. doi:10.1002\/14651858.CD007679.pub4. PMID 24937100. \n\n^ Ophthalmol, J. (2001). \"Sir Harold Ridley's vision\" (PDF) . Br J Ophthalmol. 85: 1022\u20133. doi:10.1136\/bjo.85.9.1022. PMC 1724118 . PMID 11520745. \n\n^ \"The Global Intraocular Lens Market is Forecast to Reach $3.1 Billion b | ASDReports\". www.asdreports.com. Retrieved 2015-09-14 . \n\n^ a b Zamora-De la Cruz D, Garz\u00f3n M, Pulido-London D, Jimenez-Corona A, Z\u00fa\u00f1iga-Posselt M, Bartlett J, Gutierrez M, Chavez-Mondrag\u00f3n E (2017). \"Trifocal intraocular lenses versus bifocal intraocular lenses after cataract extraction\". Cochrane Database Syst Rev. 5: CD012648. doi:10.1002\/14651858.CD012648. CS1 maint: Uses authors parameter (link) \n\n^ Slade, Stephen. \"Accommodating IOLs: Design, Technique, Results.\" Review of Ophthalmology. 2005. 20 Mar 2009. <\"Archived copy\". Archived from the original on 17 October 2006. Retrieved 17 October 2006 . CS1 maint: Archived copy as title (link) > \n\n^ Belluci R. An Introduction to Intraocular Lenses: Material, Optics, Haptics, Design and Aberration. In: G\u00fcell JL (ed): Cataract. ESASO Course Series. Basel, Karger, 2013, vol 3, pp 38\u201355 \n\n^ Alio JL, Chipont E, BenEzra D, Fakhry MA, International ocular Inflammation Society, Study Group of Uveitic Cataract Surgery (2002). \"Comparative performance of intraocular lenses in eyes with cataract and uveitis\". Journal of Cataract and Refractive Surgery. 28 (12): 2096\u20132108. doi:10.1016\/s0886-3350(02)01452-9. PMID 12498843. CS1 maint: Multiple names: authors list (link) \n\n^ Leung TG, Lindsley K, Kuo IC (2014). \"Types of intraocular lenses for cataract surgery in eyes with uveitis\". Cochrane Database Syst Rev (2): CD007284. doi:10.1002\/14651858.CD007284.pub2. PMC 4261623 . PMID 24590672. CS1 maint: Multiple names: authors list (link) \n\n^ a b Myron Yanoff; Jay S. Duker (2009). Ophthalmology (3rd ed.). Mosby Elsevier. ISBN 978-0-323-04332-8. \n\n^ Boyd, K.\"IOL Implants: Lens Replacement and Cataract Surgery\". American Academy of Ophthalmology. 16 Nov 2016. Retrieved 2 Jun 2017 . \n\n^ a b c Heiting, G.\"Astigmatism and Cataract? A Toric IOL Can Fix Both\". AllAboutVision.com. Sep 2016. Retrieved 2 Jun 2017 . \n\n^ Carson D, Hill WE, Hong X, Karakelle M (2014). \"Optical bench performance of AcrySof(\u00ae) IQ ReSTOR(\u00ae), AT LISA(\u00ae) tri, and FineVision(\u00ae) intraocular lenses\". Clin Ophthalmol. 8: 2105\u20132113. doi:10.2147\/OPTH.S66760. PMC 4206402 . PMID 25342881. CS1 maint: Uses authors parameter (link) \n\n^ a b c de Silva, Samantha R.; Evans, Jennifer R.; Kirthi, Varo; Ziaei, Mohammed; Leyland, Martin (12 December 2016). \"Multifocal versus monofocal intraocular lenses after cataract extraction\". The Cochrane Database of Systematic Reviews. 12: CD003169. doi:10.1002\/14651858.CD003169.pub4. ISSN 1469-493X. PMID 27943250. \n\n^ a b Ong, Hon Shing; Evans, Jennifer R.; Allan, Bruce D. S. (2014-05-01). \"Accommodative intraocular lens versus standard monofocal intraocular lens implantation in cataract surgery\". The Cochrane Database of Systematic Reviews (5): CD009667. doi:10.1002\/14651858.CD009667.pub2. ISSN 1469-493X. PMID 24788900. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Intraocular_lens\">https:\/\/www.limswiki.org\/index.php\/Intraocular_lens<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:29.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 697 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","53d85fcc8c7faa18e68ea091df63abd2_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Intraocular_lens skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Intraocular lens<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p class=\"mw-empty-elt\">\n<\/p>\n\n<p><b>Intraocular lens<\/b> (<b>IOL<\/b>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lens_(optics)\" title=\"Lens (optics)\" rel=\"external_link\" target=\"_blank\">lens<\/a> implanted in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_eye\" title=\"Human eye\" rel=\"external_link\" target=\"_blank\">eye<\/a> as part of a treatment for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cataracts\" class=\"mw-redirect\" title=\"Cataracts\" rel=\"external_link\" target=\"_blank\">cataracts<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myopia\" class=\"mw-redirect\" title=\"Myopia\" rel=\"external_link\" target=\"_blank\">myopia<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sanduk_Ruit\" title=\"Sanduk Ruit\" rel=\"external_link\" target=\"_blank\">Sanduk Ruit<\/a> of Nepal is said to be the modern founder and designer.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2018)\">citation needed<\/span><\/a><\/i>]<\/sup> Its modernification was done in mid 2000s. The most common type of IOL is the pseudophakic IOL. These are implanted during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cataract_surgery\" title=\"Cataract surgery\" rel=\"external_link\" target=\"_blank\">cataract surgery<\/a>, after the cloudy <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lens_(anatomy)\" title=\"Lens (anatomy)\" rel=\"external_link\" target=\"_blank\">eye's natural lens<\/a> (colloquially called a cataract) has been removed. The pseudophakic IOL provides the same light focusing function as the natural <a href=\"https:\/\/en.wikipedia.org\/wiki\/Crystalline\" class=\"mw-redirect\" title=\"Crystalline\" rel=\"external_link\" target=\"_blank\">crystalline<\/a> lens. The second type of IOL, more commonly known as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phakic_intraocular_lens\" title=\"Phakic intraocular lens\" rel=\"external_link\" target=\"_blank\">phakic intraocular lens (PIOL)<\/a>, is a lens which is placed over the existing natural lens and is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refractive_surgery\" title=\"Refractive surgery\" rel=\"external_link\" target=\"_blank\">refractive surgery<\/a> to change the eye's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_power\" title=\"Optical power\" rel=\"external_link\" target=\"_blank\">optical power<\/a> as a treatment for myopia (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Nearsightedness\" class=\"mw-redirect\" title=\"Nearsightedness\" rel=\"external_link\" target=\"_blank\">nearsightedness<\/a>).<sup id=\"rdp-ebb-cite_ref-pmid21029908_1-0\" class=\"reference\"><a href=\"#cite_note-pmid21029908-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>IOLs usually consist of a small plastic lens with plastic side struts, called haptics, to hold the lens in place in the capsular bag inside the eye.<sup id=\"rdp-ebb-cite_ref-pmid17172886_2-0\" class=\"reference\"><a href=\"#cite_note-pmid17172886-2\" rel=\"external_link\">[2]<\/a><\/sup> IOLs were conventionally made of an inflexible material (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymethyl_methacrylate\" class=\"mw-redirect\" title=\"Polymethyl methacrylate\" rel=\"external_link\" target=\"_blank\">PMMA<\/a>), although this has largely been superseded by the use of flexible materials.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2015)\">citation needed<\/span><\/a><\/i>]<\/sup> Most IOLs fitted today are fixed monofocal lenses matched to distance vision. However, other types are available, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Multifocal_intraocular_lens\" title=\"Multifocal intraocular lens\" rel=\"external_link\" target=\"_blank\">multifocal IOLs<\/a> that provide the patient with multiple-focused vision at far and reading distance, and adaptive IOLs that provide the patient with limited visual accommodation.\n<\/p><p>Surgeons annually implant more than 6 million lenses.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> The procedure can be done under local anesthesia with the patient awake throughout the operation. The use of a flexible IOL enables the lens to be rolled for insertion into the capsule through a very small incision, thus avoiding the need for stitches. This procedure usually takes less than 30 minutes in the hands of an experienced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ophthalmologist\" class=\"mw-redirect\" title=\"Ophthalmologist\" rel=\"external_link\" target=\"_blank\">ophthalmologist<\/a>. The recovery period is about 2\u20133 weeks. After surgery, patients should avoid strenuous exercise or anything else that significantly increases blood pressure. They should visit their ophthalmologists regularly for several months to monitor the implants.\n<\/p><p>IOL implantation carries several risks associated with eye surgeries, such as infection, loosening of the lens, lens rotation, inflammation and nighttime halos, but a systematic review of studies has determined that the procedure is safer than conventional laser eye treatment.<sup id=\"rdp-ebb-cite_ref-Barsam2014_4-0\" class=\"reference\"><a href=\"#cite_note-Barsam2014-4\" rel=\"external_link\">[4]<\/a><\/sup> Though IOLs enable many patients to have reduced dependence on glasses, most patients still rely on glasses for certain activities, such as reading.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:152px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Plaque_for_Harold_Ridley%27s_first_intraocular_lens_at_St_Thomas%27_Hospital.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fd\/Plaque_for_Harold_Ridley%27s_first_intraocular_lens_at_St_Thomas%27_Hospital.jpg\/150px-Plaque_for_Harold_Ridley%27s_first_intraocular_lens_at_St_Thomas%27_Hospital.jpg\" width=\"150\" height=\"151\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Plaque_for_Harold_Ridley%27s_first_intraocular_lens_at_St_Thomas%27_Hospital.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>First permanent insertion of intraocular lens 8 February 1950<\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Harold_Ridley_(ophthalmologist)\" title=\"Harold Ridley (ophthalmologist)\" rel=\"external_link\" target=\"_blank\">Sir Harold Ridley<\/a> was the first to successfully implant an intraocular lens on 29 November 1949, at <a href=\"https:\/\/en.wikipedia.org\/wiki\/St_Thomas%27_Hospital\" title=\"St Thomas' Hospital\" rel=\"external_link\" target=\"_blank\">St Thomas' Hospital<\/a> at London.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> That lens was manufactured by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rayner_(company)\" title=\"Rayner (company)\" rel=\"external_link\" target=\"_blank\">Rayner<\/a> company of Brighton, East Sussex, England from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymethylmethacrylate\" class=\"mw-redirect\" title=\"Polymethylmethacrylate\" rel=\"external_link\" target=\"_blank\">polymethylmethacrylate<\/a> (PMMA) made by ICI (Imperial Chemical Industries). It is said the idea of implanting an intraocular lens came to him after an intern asked him why he was not replacing the lens he had removed during cataract surgery. The acrylic plastic material was chosen because Ridley noticed it was inert after seeing RAF (Royal Air Force) pilots of World War II with pieces of shattered canopies in their eyes (this acrylic resin is known by several trade names including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lucite\" class=\"mw-redirect\" title=\"Lucite\" rel=\"external_link\" target=\"_blank\">Lucite<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plexiglas\" class=\"mw-redirect\" title=\"Plexiglas\" rel=\"external_link\" target=\"_blank\">Plexiglas<\/a>).\n<\/p><p>The intraocular lens did not find widespread acceptance in cataract surgery until the 1970s, when further developments in lens design and surgical techniques had come about.\n<\/p><p>As of the early 2000s, more than a million IOLs were implanted annually in the United States.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (September 2015)\">citation needed<\/span><\/a><\/i>]<\/sup> That number was estimated by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/World_Health_Organization\" title=\"World Health Organization\" rel=\"external_link\" target=\"_blank\">World Health Organization<\/a> to have increased to 20 million annually worldwide by 2010 (for cataract surgery), and has projected increased IOL surgeries to reach 32 million worldwide by 2020.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n\n<p>Intraocular lenses have been used since 1999 for correcting larger errors in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myopic\" class=\"mw-redirect\" title=\"Myopic\" rel=\"external_link\" target=\"_blank\">near-sighted<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperopic\" class=\"mw-redirect\" title=\"Hyperopic\" rel=\"external_link\" target=\"_blank\">far-sighted<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Astigmatism_(eye)\" class=\"mw-redirect\" title=\"Astigmatism (eye)\" rel=\"external_link\" target=\"_blank\">astigmatic<\/a> eyes. This type of IOL is also called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phakic_intraocular_lens\" title=\"Phakic intraocular lens\" rel=\"external_link\" target=\"_blank\">phakic intraocular lens<\/a> (PIOL), and the crystalline lens is not removed.\n<\/p><p>Phakic IOL appear to be less dangerous than excimer laser surgery in those with significant nearsightedness.<sup id=\"rdp-ebb-cite_ref-Barsam2014_4-1\" class=\"reference\"><a href=\"#cite_note-Barsam2014-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>More commonly, aphakic IOLs (that is, not PIOLs) are implanted via clear lens extraction and replacement (CLEAR) surgery. During CLEAR, the crystalline lens is extracted and an IOL replaces it in a process that is very similar to cataract surgery: both involve lens replacement, local anesthesia, last approximately 30 minutes, and require making a small incision in the eye for lens insertion. People recover from CLEAR surgery 1\u20137 days after the operation. During this time, they should avoid strenuous exercise or anything else that significantly raises blood pressure. They should visit their ophthalmologists regularly for several months to monitor the IOL implants.\n<\/p><p>CLEAR has a 90% success rate (risks include wound leakage, infection, inflammation, and astigmatism). CLEAR can be performed only on patients ages 40 and older. This is to ensure that eye growth, which disrupts IOL lenses, will not occur post-surgery.\n<\/p><p>Once implanted, IOL lenses have three major benefits. First, they are an alternative to <a href=\"https:\/\/en.wikipedia.org\/wiki\/LASIK\" title=\"LASIK\" rel=\"external_link\" target=\"_blank\">LASIK<\/a>, a form of eye surgery that does not work for people with serious vision problems. Effective IOL implants also entirely eliminate the need for glasses or contact lenses post-surgery for most patients.<sup id=\"rdp-ebb-cite_ref-Zamora_7-0\" class=\"reference\"><a href=\"#cite_note-Zamora-7\" rel=\"external_link\">[7]<\/a><\/sup> The cataract will not return, as the lens has been removed. The disadvantage is that the eye's ability to change focus (accommodate) has generally been reduced or eliminated, depending on the kind of lens implanted.\n<\/p><p>Some of the risks that FDA have been found so far during a three-year study of the Artisan are:\n<\/p>\n<ul><li>a yearly loss of 1.8% of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endothelial_cell\" class=\"mw-redirect\" title=\"Endothelial cell\" rel=\"external_link\" target=\"_blank\">endothelial cells<\/a>,<\/li>\n<li>0.6% risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinal_detachment\" title=\"Retinal detachment\" rel=\"external_link\" target=\"_blank\">retinal detachment<\/a>,<\/li>\n<li>0.6% risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cataract\" title=\"Cataract\" rel=\"external_link\" target=\"_blank\">cataract<\/a> (other studies have shown a risk of 0.5 \u2013 1.0%), and<\/li>\n<li>0.4% risk of corneal swelling.<\/li><\/ul>\n<p>Other risks include:\n<\/p>\n<ul><li>0.03\u20130.05% eye infection risk, which in worst case can lead to blindness. This risk exists in all eye surgery procedures and is not unique for IOLs.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Glaucoma\" title=\"Glaucoma\" rel=\"external_link\" target=\"_blank\">glaucoma<\/a>,<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Astigmatism_(eye)\" class=\"mw-redirect\" title=\"Astigmatism (eye)\" rel=\"external_link\" target=\"_blank\">astigmatism<\/a>,<\/li>\n<li>remaining near or far sightedness,<\/li>\n<li>rotation of the lens inside the eye one or two days after surgery.<\/li><\/ul>\n<p>One of the causes of the risks above is that the lens can rotate inside the eye if the PIOL is too short, if the eye was incorrectly measured, or because the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sulcus_(anatomy)\" class=\"mw-redirect\" title=\"Sulcus (anatomy)\" rel=\"external_link\" target=\"_blank\">sulcus<\/a> has a slightly oval shape (the height is slightly smaller than the width). Toric IOLs must be powered and aligned inside the eye on a meridian that corrects the patient's preexisting astigmatism. Again, these lenses can rotate inside the eye postoperatively or be placed incorrectly by the operating surgeon. Either way, the patient's preexisting astigmatism may not be corrected completely or may even increase.\n<\/p><p>When IOLs are implanted in the aphakic patient\u2014either after clear lensectomy for the correction of refractive error or after cataract extraction to restore eyesight\u2014astigmatism in these patients is mainly attributable to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornea\" title=\"Cornea\" rel=\"external_link\" target=\"_blank\">cornea<\/a>. The surgeon can ascertain the astigmatic, or steepest, meridian in a number of ways, including manifest refraction or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corneal_topography\" title=\"Corneal topography\" rel=\"external_link\" target=\"_blank\">corneal topography<\/a>. Manifest refraction is the familiar test where the eye doctor rotates lenses in front of the eye, asking the patient, \"Which is better (or clearer), this one or this one?\" Corneal topography is considered a more quantitative test, and for purposes of aligning a toric IOL, most surgeons use a measurement called simulated keratometry (SimK), which is calculated by the internal programming of the corneal topography machine, to determine the astigmatic meridian on the surface of the cornea. The astigmatic meridian can also be identified using corneal wavefront technology or paraxial curvature matching.\n<\/p><p><br \/>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Accommodating_IOLs\">Accommodating IOLs<\/span><\/h2>\n<p>One of the major disadvantages of conventional IOLs is that they are primarily focused for distance vision. Though patients who undergo a standard IOL implantation no longer experience clouding from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cataracts\" class=\"mw-redirect\" title=\"Cataracts\" rel=\"external_link\" target=\"_blank\">cataracts<\/a>, they are unable to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Accommodation_(eye)\" title=\"Accommodation (eye)\" rel=\"external_link\" target=\"_blank\">accommodate<\/a>, or change focus from near to far, far to near, and to distances in between. Accommodating IOLs interact with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ciliary_muscle\" title=\"Ciliary muscle\" rel=\"external_link\" target=\"_blank\">ciliary muscles<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zonules\" class=\"mw-redirect\" title=\"Zonules\" rel=\"external_link\" target=\"_blank\">zonules<\/a>, using hinges at both ends to \u201clatch on\u201d and move forward and backward inside the eye using the same mechanism as normal accommodation. These IOLs have a 4.5-mm square-edged optic and a long hinged plate design with polyimide loops at the end of the haptics. The hinges are made of an advanced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a> called BioSil that was thoroughly tested to make sure it was capable of unlimited flexing in the eye.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Materials\">Materials<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Intraocular-lens-in-holder.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f2\/Intraocular-lens-in-holder.jpg\/220px-Intraocular-lens-in-holder.jpg\" width=\"220\" height=\"143\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Intraocular-lens-in-holder.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Acrylic MICS-IOL in holder<\/div><\/div><\/div>\n\n\n<p>The materials that have been used to manufacture intraocular lens implants include polymethylmethacrylate (PMMA), silicone, hydrophobic acrylate, hydrophilic acrylate and collamer.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymethylmethacrylate\" class=\"mw-redirect\" title=\"Polymethylmethacrylate\" rel=\"external_link\" target=\"_blank\">Polymethylmethacrylate<\/a> (PMMA) was the first material to be used successfully in intraocular lenses. British ophthalmologist <a href=\"https:\/\/en.wikipedia.org\/wiki\/Harold_Ridley_(ophthalmologist)\" title=\"Harold Ridley (ophthalmologist)\" rel=\"external_link\" target=\"_blank\">Sir Harold Ridley<\/a> observed that <a href=\"https:\/\/en.wikipedia.org\/wiki\/Royal_Air_Force\" title=\"Royal Air Force\" rel=\"external_link\" target=\"_blank\">Royal Air Force<\/a> pilots who sustained <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eye_injury\" title=\"Eye injury\" rel=\"external_link\" target=\"_blank\">eye injuries<\/a> during <a href=\"https:\/\/en.wikipedia.org\/wiki\/World_War_II\" title=\"World War II\" rel=\"external_link\" target=\"_blank\">World War II<\/a> involving PMMA windshield material did not show any rejection or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foreign_body\" title=\"Foreign body\" rel=\"external_link\" target=\"_blank\">foreign body<\/a> reaction. Deducing that the transparent material was inert and useful for implantation in the eye, Ridley designed and implanted the first intraocular lens in a human eye.\n<\/p><p>Advances in technology have brought about the use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silicone\" title=\"Silicone\" rel=\"external_link\" target=\"_blank\">silicone<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acrylic_glass\" class=\"mw-redirect\" title=\"Acrylic glass\" rel=\"external_link\" target=\"_blank\">acrylic<\/a>, both of which are soft foldable inert materials. This allows the lens to be folded and inserted into the eye through a smaller incision. Specifically, acrylic lenses are a better choice in people who have a history of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Uveitis\" title=\"Uveitis\" rel=\"external_link\" target=\"_blank\">uveitis<\/a> or are likely to have to undergo retinal surgery requiring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vitrectomy\" title=\"Vitrectomy\" rel=\"external_link\" target=\"_blank\">vitrectomy<\/a> with replacement by silicone oil, such as persons with proliferative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetic_retinopathy\" title=\"Diabetic retinopathy\" rel=\"external_link\" target=\"_blank\">diabetic retinopathy<\/a> or who are at high risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Retinal_detachment\" title=\"Retinal detachment\" rel=\"external_link\" target=\"_blank\">retinal detachment<\/a>, such as persons with high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myopia\" class=\"mw-redirect\" title=\"Myopia\" rel=\"external_link\" target=\"_blank\">myopia<\/a>. A study found that in participants with a history of uveitis, eyes treated with hydrophobic acrylic IOLs were over 2 times more likely to have a best corrected visual acuity of 20\/40 or more, compared to eyes treated with silicone IOLs.<sup id=\"rdp-ebb-cite_ref-Alio_10-0\" class=\"reference\"><a href=\"#cite_note-Alio-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Leung_11-0\" class=\"reference\"><a href=\"#cite_note-Leung-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>The trademarked \"Natural Yellow\" material is available in three hydrophilic IOLs. Dr. Patrick H. Benz of Benz Research and Development created the first IOL material to incorporate the same UV-A blocking and violet light filtering <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromophore\" title=\"Chromophore\" rel=\"external_link\" target=\"_blank\">chromophore<\/a> that's present in the human crystalline lens. This breakthrough material provides the exact <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromophore\" title=\"Chromophore\" rel=\"external_link\" target=\"_blank\">chromophore<\/a> the human retina naturally has for light protection.\n<\/p><p>Other IOLs include:\n<\/p>\n<ul><li>Blue light filtering IOLs filter the UV and high-energy blue light present in natural and artificial light, both of which can cause vision problems<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (September 2010)\">citation needed<\/span><\/a><\/i>]<\/sup>; however too much filtering of blue light can increase depression, especially in the winter months (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Seasonal_affective_disorder\" title=\"Seasonal affective disorder\" rel=\"external_link\" target=\"_blank\">SAD<\/a>).<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Toric_lens\" title=\"Toric lens\" rel=\"external_link\" target=\"_blank\">Toric<\/a> IOLs (1998) correct astigmatic vision.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Posterior_capsular_opacification_on_retroillumination.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2c\/Posterior_capsular_opacification_on_retroillumination.jpg\/250px-Posterior_capsular_opacification_on_retroillumination.jpg\" width=\"250\" height=\"151\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Posterior_capsular_opacification_on_retroillumination.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Slit_lamp\" title=\"Slit lamp\" rel=\"external_link\" target=\"_blank\">Slit lamp<\/a> photo of Pseudophakia: Posterior chamber Intraocular lens \u2013 note that Posterior capsular opacification is visible a few months after implantation of Intraocular lens in eye, as seen on retroillumination<\/div><\/div><\/div>\n<ul><li><i>Phakia<\/i> is the presence of the natural crystalline lenses.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Aphakia\" title=\"Aphakia\" rel=\"external_link\" target=\"_blank\">Aphakia<\/a> is the absence of the natural crystalline lens. The aphakic state is usually due to surgery to remove a cataractous lens, but post-surgical aphakia is rare nowadays because of the ubiquity of intraocular lenses. Rarely, aphakia can be post-traumatic or congenital in nature.<\/li>\n<li><i>Pseudophakia<\/i> is the substitution of the natural crystalline lens with an IOL, as is often done after cataract extraction or to correct refractive error.<\/li><\/ul>\n<p>The root of these words comes from the Greek word <i>phakos<\/i> 'lens'.<sup id=\"rdp-ebb-cite_ref-yanoff_12-0\" class=\"reference\"><a href=\"#cite_note-yanoff-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p>Phakic IOLs are implanted without removal of the patient's original crystalline lens, and this is performed solely to correct refractive error in the presence of a clear crystalline lens.\n<\/p><p>Aphakic IOLs generally refer to lenses implanted secondarily in an eye already aphakic from previous surgery or trauma some time ago.\n<\/p><p>Pseudophakic IOLs refer to lenses implanted during cataract surgery, as a sequential step after removal of the cataractous lens of the person.\n<\/p><p>Many aphakic and pseudophakic IOLs such as anterior chamber IOLs or 3 piece posterior chamber IOLs can be used interchangeably. The exception are one piece IOLs, which must be placed within the capsular bag at the time of cataract surgery and hence cannot be used as secondary implants.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"PIOLs\">PIOLs<\/span><\/h3>\n<p>As with IOLs inserted after <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cataract_surgery\" title=\"Cataract surgery\" rel=\"external_link\" target=\"_blank\">cataract extraction<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phakic_intraocular_lens\" title=\"Phakic intraocular lens\" rel=\"external_link\" target=\"_blank\">phakic IOLs<\/a> (PIOLs) can be spheric or toric. The difference is that they are placed in an eye that retains the natural human crystalline lens. As with aphakic eyes, toric PIOLs have to be aligned with the meridian of astigmatism; toric IOL misalignment or rotation can lead to residual or even greater astigmatism postoperatively.\n<\/p><p>Depending on their placement site in the eye, PIOLs can be divided into:<sup id=\"rdp-ebb-cite_ref-yanoff_12-1\" class=\"reference\"><a href=\"#cite_note-yanoff-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<ul><li>Angle-supported PIOLs: those IOLs are placed in the anterior chamber. They are notorious for their negative impact on the corneal endothelial lining, which is vital for maintaining a healthy clear cornea.<\/li>\n<li>Iris-supported PIOLs: The IOL is attached by claws to the mid-peripheral iris by a technique called enclavation. It is believed to have a lesser effect on corneal endothelium. The main complication with this type is their tendency to cause endothelial cell reduction.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Implantable_Collamer_Lens\" class=\"mw-redirect\" title=\"Implantable Collamer Lens\" rel=\"external_link\" target=\"_blank\">Sulcus-supported PIOLs<\/a>: this type is gaining more and more popularity. These IOLs are placed in the posterior chamber in front of the natural crystalline lens. They have special vaulting so as not to be in contact with the normal lens. The main complication with older versions was a small possibility of cataract formation.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Toric_IOLs\">Toric IOLs<\/span><\/h3>\n<p>A toric IOL is a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toric_lens\" title=\"Toric lens\" rel=\"external_link\" target=\"_blank\">toric lens<\/a> used to correct preexisting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornea\" title=\"Cornea\" rel=\"external_link\" target=\"_blank\">corneal<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Astigmatism\" title=\"Astigmatism\" rel=\"external_link\" target=\"_blank\">astigmatism<\/a> at the time of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cataract_surgery\" title=\"Cataract surgery\" rel=\"external_link\" target=\"_blank\">cataract surgery<\/a>. This astigmatism can also be treated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Limbal_relaxing_incisions\" title=\"Limbal relaxing incisions\" rel=\"external_link\" target=\"_blank\">limbal relaxing incisions<\/a> or an <a href=\"https:\/\/en.wikipedia.org\/wiki\/LASIK\" title=\"LASIK\" rel=\"external_link\" target=\"_blank\">excimer laser<\/a> procedure.<sup id=\"rdp-ebb-cite_ref-Boyd_13-0\" class=\"reference\"><a href=\"#cite_note-Boyd-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Heiting_14-0\" class=\"reference\"><a href=\"#cite_note-Heiting-14\" rel=\"external_link\">[14]<\/a><\/sup> About 40% of Americans have significant astigmatism and thus may be candidates for a toric IOL.<sup id=\"rdp-ebb-cite_ref-Heiting_14-1\" class=\"reference\"><a href=\"#cite_note-Heiting-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cataract_surgery\" title=\"Cataract surgery\" rel=\"external_link\" target=\"_blank\">Cataract surgery<\/a> with implantation of a toric IOL is essentially the same as cataract surgery with a conventional IOL. Like toric <a href=\"https:\/\/en.wikipedia.org\/wiki\/Contact_lens\" title=\"Contact lens\" rel=\"external_link\" target=\"_blank\">contact lenses<\/a>, toric IOLs have different powers in different meridians of the lens, and they must be positioned on the correct meridian to reverse the preexisting astigmatism. If the toric IOL is not on the correct meridian, it may need to be repositioned in a second procedure.<sup id=\"rdp-ebb-cite_ref-Heiting_14-2\" class=\"reference\"><a href=\"#cite_note-Heiting-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Pseudophakic_IOLs_that_address_presbyopia\">Pseudophakic IOLs that address presbyopia<\/span><\/h2>\n<p>In the United States, a new category of intraocular lenses was opened with the approval by the Food and Drug Administration in 2003 of multifocal and accommodating lenses. These come at an additional cost to the recipient beyond what Medicare will pay and each has advantages and disadvantages.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Multifocal IOLs provide for simultaneous viewing of distance vision and near vision. Trifocal IOLs can provide intermediate vision.<sup id=\"rdp-ebb-cite_ref-Zamora_7-1\" class=\"reference\"><a href=\"#cite_note-Zamora-7\" rel=\"external_link\">[7]<\/a><\/sup> The most common adverse visual effects from multifocal IOLs include glare, halos, and a loss of contrast sensitivity, in low light conditions.<sup id=\"rdp-ebb-cite_ref-Carson_15-0\" class=\"reference\"><a href=\"#cite_note-Carson-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p>Monofocal lenses are standard lenses used in cataract surgery.<sup id=\"rdp-ebb-cite_ref-:0_16-0\" class=\"reference\"><a href=\"#cite_note-:0-16\" rel=\"external_link\">[16]<\/a><\/sup> People who have a multifocal intraocular lens after their cataract is removed may be less likely to need additional glasses compared with people who have standard monofocal lenses.<sup id=\"rdp-ebb-cite_ref-:0_16-1\" class=\"reference\"><a href=\"#cite_note-:0-16\" rel=\"external_link\">[16]<\/a><\/sup> However, people receiving multifocal lenses may experience more visual problems, such as glare or haloes (rings around lights), than with monofocal lenses.<sup id=\"rdp-ebb-cite_ref-:0_16-2\" class=\"reference\"><a href=\"#cite_note-:0-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>People receiving accommodative intraocular lenses had improvements in near vision but these improvements were small and reduced over time.<sup id=\"rdp-ebb-cite_ref-:1_17-0\" class=\"reference\"><a href=\"#cite_note-:1-17\" rel=\"external_link\">[17]<\/a><\/sup> People who received accommodative intraocular lenses may have a higher risk of thickening and clouding of the tissue behind the intraocular lenses (posterior capsule opacification) but there is some uncertainty around this finding.<sup id=\"rdp-ebb-cite_ref-:1_17-1\" class=\"reference\"><a href=\"#cite_note-:1-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p><p><br \/>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Aphakia\" title=\"Aphakia\" rel=\"external_link\" target=\"_blank\">Aphakia<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Capsulorhexis\" title=\"Capsulorhexis\" rel=\"external_link\" target=\"_blank\">Capsulorhexis<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Contact_lens\" title=\"Contact lens\" rel=\"external_link\" target=\"_blank\">Contact lens<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Adjustable-focus_eyeglasses\" title=\"Adjustable-focus eyeglasses\" rel=\"external_link\" target=\"_blank\">Adjustable-focus eyeglasses<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Phacoemulsification\" title=\"Phacoemulsification\" rel=\"external_link\" target=\"_blank\">Phacoemulsification<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-pmid21029908-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid21029908_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">G\u00fcell, Jose Luis; Morral, Merce; Kook, Daniel; Kohnen, Thomas (2010). \"Phakic intraocular lenses\". <i>Journal of Cataract & Refractive Surgery<\/i>. <b>36<\/b> (11): 1976\u20131993. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jcrs.2010.08.014\" target=\"_blank\">10.1016\/j.jcrs.2010.08.014<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Cataract+%26+Refractive+Surgery&rft.atitle=Phakic+intraocular+lenses&rft.volume=36&rft.issue=11&rft.pages=1976-1993&rft.date=2010&rft_id=info%3Adoi%2F10.1016%2Fj.jcrs.2010.08.014&rft.aulast=G%C3%BCell&rft.aufirst=Jose+Luis&rft.au=Morral%2C+Merce&rft.au=Kook%2C+Daniel&rft.au=Kohnen%2C+Thomas&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntraocular+lens\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-pmid17172886-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid17172886_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sanders, Donald; Vukich, John A (2006). \"Comparison of Implantable Collamer Lens (ICL) and Laser-assisted in Situ Keratomileusis (LASIK) for Low Myopia\". <i>Cornea<\/i>. <b>25<\/b> (10): 1139\u201346. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FICO.0b013e31802cbf3c\" target=\"_blank\">10.1097\/ICO.0b013e31802cbf3c<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17172886\" target=\"_blank\">17172886<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cornea&rft.atitle=Comparison+of+Implantable+Collamer+Lens+%28ICL%29+and+Laser-assisted+in+Situ+Keratomileusis+%28LASIK%29+for+Low+Myopia&rft.volume=25&rft.issue=10&rft.pages=1139-46&rft.date=2006&rft_id=info%3Adoi%2F10.1097%2FICO.0b013e31802cbf3c&rft_id=info%3Apmid%2F17172886&rft.aulast=Sanders&rft.aufirst=Donald&rft.au=Vukich%2C+John+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntraocular+lens\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Gaudet, Jodie ed. 1001 Inventions That Changed the World, page 697, <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-7333-2536-6<\/span>\n<\/li>\n<li id=\"cite_note-Barsam2014-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Barsam2014_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Barsam2014_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Barsam, A; Allan, BD (17 June 2014). \"Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia\". <i>The Cochrane Database of Systematic Reviews<\/i>. <b>6<\/b>: CD007679. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD007679.pub4\" target=\"_blank\">10.1002\/14651858.CD007679.pub4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24937100\" target=\"_blank\">24937100<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Excimer+laser+refractive+surgery+versus+phakic+intraocular+lenses+for+the+correction+of+moderate+to+high+myopia.&rft.volume=6&rft.pages=CD007679&rft.date=2014-06-17&rft_id=info%3Adoi%2F10.1002%2F14651858.CD007679.pub4&rft_id=info%3Apmid%2F24937100&rft.aulast=Barsam&rft.aufirst=A&rft.au=Allan%2C+BD&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIntraocular+lens\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ophthalmol, J. 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